Understanding the Relationship Between the Lab and the Clinic is Key to 2014 Karnofsky Memorial Award Honoree’s Success

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H.M. (Bob) Pinedo, MD, PhD

One of the secrets to my research success was that basic scientists understood how we explained things to patients as they entered phase I trials. Understanding is the basis of trust and collaboration.

— H.M. (Bob) Pinedo, MD, PhD

The island nation of Curaçao is nestled in the southern Caribbean Sea off the Venezuelan coast. Curaçao was first settled by the Arawaks, an Amerindian people that inhabited the island for hundreds of years before the arrival of Europeans. Amid one wave of settlers from Portugal and Spain that landed on the island in 1715 were the descendants of this year’s David A. Karnofsky Memorial Award honoree, H.M. (Bob) Pinedo, MD, PhD.

Dr. Pinedo remembered a wonderful childhood on Curaçao, surrounded by breathtaking natural beauty. “I grew up in a Jewish neighborhood in Curaçao. The synagogue is the oldest in the Western hemisphere. We later moved out of town to a plantation house when I was in high school,” said Dr. Pinedo.

“At that time in Curaçao we had very good Dutch teachers. I attended the Pieter Stuyvesant High School, named for the Director-General of New Netherland—which was later renamed New York—in the 1600s,” he continued. “Our schools emphasized language; English, Spanish, French, and German were mandatory. Curaçao is multilingual, but it has its own language called Papiamentu, which is a mixture of Spanish, Portuguese, Dutch, and Africian. At school it was all Dutch, but at home we spoke Papiamentu.”

The Road to Medicine

However, there were no universities in Curaçao at that time, so after graduating high school Dr. Pinedo had to make a decision. He had two choices before him: attend university in the United States or Holland. “My cousins decided on the States, but our family went to Holland where I initially attended Delft University of Technology. I had a terrific chemistry teacher in high school who really got me excited about the field. When I entered Delft, I majored in chemistry, but I found it too dry and I switched to medicine at Leiden University, which is the oldest univerity in the Netherlands. My interest in chemistry would resurface later in my career when I worked in drug development,” said Dr. Pinedo.

He continued, “I think my decision to study medicine was influenced, in part, by family illness. My grandmother had breast cancer. She spent her last year of life in our home and being confronted with cancer care daily certainly affected my thoughts about becoming a doctor.”

Dr. Pinedo explained that when he was attending university, an undergraduate medical program was 7 years, after which you chose a specialty. “I went into an internal medicine program. During that time I also did my doctoral work. Actually, my PhD was not in cancer, but in nephrology. After 12 years at Leiden, I graduated at 29 years old with my MD and PhD,” said Dr. Pinedo.

Confronting Unmet Needs in Cancer Care

After graduating, Dr. Pinedo was offered a position as Chief of Residents at the University Medical Center Utrecht. “When I arrived at Utrecht in 1972, it was clear that the cancer patients on my ward were neglected. Not purposely, but oncology was not a specialty at the time, so many doctors didn’t know how to treat these very sick patients, especially those with metastatic disease. The new drugs, like [doxorubicin], were coming along, but they weren’t widely used. Nephrology was well taken care of at the university, and I didn’t see a real challenge in that specialty, so I decided to go into oncology where there were many unmet needs,” said Dr. Pinedo.

He went right to work, creating a division of oncology within the internal medicine department. Four years later, seeking to gather more information and knowledge about the nascent field of oncology, Dr. Pinedo journeyed to the United States, determined to work at the National Cancer Institute (NCI). “I got a position as a visiting scientist in the Division of Pharmacology. Dr. Bruce Chabner headed the division; he was a terrific mentor who clearly influenced my career in research. We remain close friends to this day. I had 2 excellent years of scientific research at the NCI, doing pharmacology of methotrexate. I also published five papers in leading journals. I worked very long hours, a habit I kept during my whole career,” said Dr. Pinedo.

Dr. Pinedo was quick to point out that his workaholic regimen in the lab and clinic would have been impossible without the full support of his wife whom he met while working at the NCI. “My wife is originally from Washington, DC. She was an intensive care nurse so she understood the kind of dedication it took for me to conduct research and see patients.”

The Importance of Understanding

In 1976, Dr. Pinedo returned to the University of Utrecht and, with the help of his friend Dr. Chabner, set up a research laboratory to continue his pharmacologic work with methotrexate. Three years later he was offered a position by the administration of VU University Amsterdam.

“I moved to Amsterdam and set up another laboratory in my oncology department. The lab was actually in my clinic. One of my rules was that any clinician on my staff had to have worked 2 years in a lab. Also, the biologists and chemists in my lab were required to work at least 1 week in the clinic so they could truly understand the intimate relationship between patient and research. I think one of the secrets to my research success was that basic scientists understood how we explained things to patients as they entered a phase I trials. Understanding is the basis of trust and collaboration, which is why I titled my Karnofsky Lecture “Understanding,” said Dr. Pinedo.”

An Obligation to Give Back

The subject of the doctor-humanitarian is part of the philosophical framework of Dr. Pinedo’s approach to medicine. “One reason I am honored to be this year’s recipient of the David A. Karnofsky Memorial Award is because more than just a great doctor, David Karnofsky was a humanitarian who stimulated those around him to be better researchers and doctors. Throughout my career in the lab and the clinic, I’ve always maintained a relationship with the patients that goes beyond treating cancer,” said Dr. Pinedo.

He continued, “I retired a few years ago because in Holland, retirement is required at age 65. But I’m as busy as I was prior to official retirement. Now I divide my time between Holland and Curaçao, and after serving Holland for 50 years I wanted to do certain things that were neglected on the island. There was no cancer screening so I set up breast and cervical cancer screening programs, which are running very well,” said Dr. Pinedo.

Continued Interests

“I’ve been involved in translational research throughout my career. In fact, about 7 years ago I co-founded the Center for Translational Molecular Medicine in the Netherlands. It’s a publicly-privately funded center that has €400 million available for grants,” said Dr. Pinedo.

Asked about his late-career research pursuits, Dr. Pinedo responded, “My current interests are in epigenetics and immunology. In fact, I was a pioneer in the field of immunology. In 1999, I published a paper in The Lancet that described using an autologous tumor cell-BCG vaccine on patients with Dukes’ B colon cancer. We used it as adjuvant treatment, and it worked.”

During the time he spends in Holland, Dr. Pinedo chairs an international advisory board at VU University Medical Center Amsterdam to build an imaging center. “The imaging center takes up a lot of time, but I still see patients. I see patients outside of the university, partly second-opinion patients and also those that I’ve been following for more than 10 years. It’s a busy schedule,” Dr. Pinedo said.

Even after such a long and illustrious career, Dr. Pinedo’s schedule allows little free time for hobbies. But while in Curaçao he takes advantage of the therapeutic waters surrounding the island. “I have scoliosis, and swimming in the tropical sea is very soothing. There’s also a naturalist there we call Dutch who has a submersible that dives to 1,000 feet. He collects samples of the algae along the undersea cliff. I go down in the ocean with "Dutch" once in a while. Other than that, my life centers on my work. My wife helps me keep track of my schedule,” said Dr. Pinedo. ■