If we keep the [big data] process going—creating, accepting, and disproving theories—we will discover clinical solutions and use them until the process comes up with something better. I’m confident it’s going to take us into new dimensions of care.
—Peter P. Yu, MD
The road leading to a career in medicine is often a stepwise journey of multiple decision points and influences. However, sometimes the decision to become a doctor is hardwired from birth. Such was the case with 2014-2015 ASCO President Peter P. Yu, MD. Since his days in nursery school, Dr. Yu always wanted to be a doctor and care for sick people. “I never considered any other profession but medicine,” he said.
Dr. Yu grew up in the Riverdale section of New York City. “Both sides of my family were engineers, so becoming a doctor was breaking the mold,” said Dr. Yu. He went to the Bronx High School of Science and during his senior year applied to Brown University. “The application had a check box that asked if you wanted to be considered for Brown’s new 7-year medical program. I checked the box and when I received my acceptance letter I was enrolled in medical school. So looking back, I had a very clear path to a career in medicine,” noted Dr. Yu.
A Fork in the Road
“The first time I wrestled with a career decision was when I was an intern at St. Luke’s Hospital in New York City. I wanted a discipline that combined diagnostic skills with therapeutic decisions. But I also wanted a field that would continually expand and challenge me over a 30-year career. It took a little while to sort out, but when I added those factors, oncology became the natural choice,” said Dr. Yu.
Following his internship, Dr. Yu crossed from the West to the East side of Manhattan for an oncology fellowship at Mount Sinai Hospital, where his interest in oncology was firmly planted. “I was fortunate to work with Dr. James Holland, one of the giants in the field. He looks at clinical issues without any preexisting rules, so it was a great learning experience for me,” said Dr. Yu. “While at Mount Sinai, I also began friendships with Drs. Larry Norton and Edward Ambinder, which, in large part, began my relationship with ASCO,” he added.
After completing his clinical fellowship at Mount Sinai, Dr. Yu plunged into the exciting challenges of the newly emerging field of translational medicine. “I went downtown to Memorial Sloan Kettering and did bench research with Dr. John Mendelson. We worked on epidermal growth factor receptor and tyrosine signal transduction, which was a little known pathway at the time. The work in that lab eventually led to the clinical trials that brought cetuximab [Erbitux] to the market,” said Dr. Yu, remarking that it was exciting to be part of one of the first success stories in translational research, bringing an agent from the bench to the bedside.
Clinical Practice Calls
“I realized if I stayed at Memorial I could continue this kind of research, but it would take a full-time commitment to the lab. But I also enjoyed patient care and I was only doing one clinic a week. I realized that to be successful I would have to choose between the lab or the clinic,” said Dr. Yu.
Dr. Yu took time to examine this important fork in his career path, but in the end, he decided to concentrate on clinical practice. “In 1989, I went to California and joined a six-doctor community oncology practice. It was very rewarding to focus on clinical practice; however, after a while, an overriding desire to provide service to society on a larger scale kicked in, and I become involved in the state’s Association of Northern California Oncologists,” explained Dr. Yu.
“When I was Chair of the Clinical Practice Committee, I caught the attention of ASCO. I was recruited for the Clinical Practice Committee, of which I became President. ASCO nurtured my interest about issues that affect the delivery of cancer care on a societal level,” said Dr. Yu.
A Changing Landscape
Dr. Yu came onto the national stage during a time of change in health care. “Change usually happens first in California, then spreads across the nation. All of a sudden we had huge enrollments into HMOs and rapid consolidation of the health-care delivery market, which put enormous stress on practices. My six-doctor practice, the El Camino Internal Medical Group, has become part of the 1,300-physician Camino Medical, which is a member of the Sutter Health System,” said Dr. Yu.
The tectonic shift in size, scope, and complexity of his once small practice sparked yet another new direction in Dr. Yu’s career. “I wanted to understand how a massive and complex delivery care system functions without losing its precision and at the same time how you can use its vast size and resources to spur innovation. One way, of course, is by advancing the use of information technology. Paper charts simply cannot function efficiently when you reach that kind of patient volume,” said Dr. Yu.
“We’ve been using electronic medical records for about 14 years, so our Foundation has been way ahead of the information technology curve. That’s given me a leg up in policy meetings on the Hill when the discussion turns to the implementation of health information technology and meaningful use,” said Dr. Yu.
Work in Health-Care Policy
Dr. Yu noted that his combined knowledge of national public policy, health information technology, and coordination of care across large delivery systems, has given him keen insight into large-scale challenges faced by the oncology community. Besides his clinical practice, Dr. Yu maintains a whirlwind schedule of conference calls, workshops, and strategy meetings, from Capitol Hill to the National Institutes of Health and the Centers for Disease Control and Prevention.
How does Dr. Yu balance clinical practice with his demanding policy work? He credits a close working relationship with his practice partners and electronic access to patient records. “With our electronic medical records, we can access patient records and read chart notes from the same day. So we have a built in backup system that allows us to care for each others patients when needed,” said Dr. Yu.
He continued, “Being part of this national dialogue has been an enriching experience. Moreover, being a representative of ASCO, I try to advance the Society’s role as the ‘big tent’ under which the serious policy discussions about cancer care take place. It makes sense, since ASCO has evolved into the preeminent professional society in the cancer world.”
When asked how he was planning to approach his ASCO presidency, Dr. Yu responded, “ASCO typically runs its leadership through cycles for any work group or committee chair. For instance, there is a president-elect year, a presidential year, and a past-president year. So I look at this as a 3-year cycle. In the immediate past year as president-elect, I looked at the meetings and committees I attended from a high point of view so I could truly get an overview of all the sectors of the Society that I had not thus far been part of.”
Dr. Yu said that along with helping him develop his own vision for the future direction of the Society, his year as president-elect provided him insight into how ASCO’s Board of Directors works. “Part of a President’s job is to serve as Chairman of the Board. I see my role as not so much telling people what they should do, but more as an observer who helps the members distill the salient points of discussion into a working consensus so we can effectively move important agendas forward,” said Dr. Yu.
Dr. Yu allowed that one of the challenges moving forward for ASCO is the collection of clinically relevant data that can be used at point-of-care to enhance our delivery system. Asked if we are making progress to that end, he said a book he was reading offered a clue. “I’m reading The Quantum Universe [by Brian Cox and Jeff Forshaw], and what I’m struck by is the authors’ point of view. You make a clinical observation and create a theory to explain it, which may or may not be true. If it’s true you hold onto it until disproven. That’s sort of what CancerLinQ is doing except in a big-data process. And if we keep the process going—creating, accepting, and disproving theories—we will discover clinical solutions and use them until the process comes up with something better. I’m confident it’s going to take us into new dimensions of care.”
ASCO’s new president brings an impressive resume to the Society. Dr. Yu understands the oncology world from the research bench to the clinic to intense health-care policy meetings on Capitol Hill, and the Society will certainly benefit from that rich experiential knowledge and energy.
However, it will also benefit from a president who, from the age of 6, sought no other career than doctor. Dr. Yu recalled a day in medical school when a physician said to him and a few other classmates, “At, the end of the day when you leave the room with a patient, that patient should feel better because you were there.” ■