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Jean B. DeKernion—A Gentleman Chairman
Commentary Jean B. DeKernion—A Gentleman Chairman A master surgeon and an astute clinician, an innovative thinker and dedicated teacher, our gentleman leader, Dr. Jean B. deKernion stepped down as Chairman of the UCLA Department of Urology on August 1, 2011. During his tenure of more than one quarter of a century, Dr. deKernion grasped the helm of a renowned Division of Urology, led by giants of urology William Goodwin and then Joseph Kaufman, and raised it to an even higher level. An accomplished physician-scientist in his own right, Dr. deKernion focused much of his efforts on supporting his faculty and raising more than $32 million dollars through donors, many of whom became lifelong friends. Accomplishments during his tenure include founding of the Department in 1996, expanding the faculty from 5 to 29, and creating leaders in all subspecialties of Urology. In this tribute to Dr. deKernion, we will highlight salient moments in his career; salute him for his years of dedication to his patients, colleagues, and to the UCLA Institution; and spend a few paragraphs conversing with Dr. deKernion on his reflections on the past 40 years in Urology and predictions of the challenges facing Urology in the decades to come.
THE EARLY YEARS Dr. deKernion’s family immigrated to the Louisiana territory from France in the early 1700s, where most of the descendants of his family reside to this day. He was 1 of 7 children and enjoyed a childhood in the outskirts of New Orleans with his close-knit family. Even now, family remains important to Dr. deKernion and his siblings. His parents were loving, yet strict, and, as 1 of 5 boys all within one and a half years of each other, he was instilled with a measure of diplomacy, determination, and survival instincts. These influences marked the culture of the Department during his leadership. Dr. deKernion graduated from Loyola University in 1961 and has always felt fortunate that very early on he knew that he wanted to become a physician and a surgeon. During medical school at Louisiana State University, he worked part time in the operating rooms and participated in research projects with faculty. This experience sparked an interest to pursue an academic career, which carried over to his residency at Case Western Reserve University. From 1967 to 1969, as a Clinical Associate at the National Cancer Institute, he became intrigued with tumor immunology, marking the founda244
© 2012 Elsevier Inc. All Rights Reserved
tion of his basic research. At that time, the surgical societies were experimenting with combined programs and he returned to Cleveland to complete a combined General Surgery/Urology training program, receiving board certification in 1973.
CAREER AT UCLA An offer from Dr. Kaufman brought Dr. deKernion to UCLA for the first time from 1973 to 1978, a period when he was most active in his own research. After a brief hiatus at Tulane University, Dr. deKernion’s recruitment back to UCLA resulted in his being named Director for Clinical Programs at the Jonsson Comprehensive Cancer Center and Head of Urologic Oncology. Dr. deKernion’s pioneering research quite remarkably spans the breadth of urologic oncology, showing innovation and foresight, while tackling critical questions. In bladder cancer, he described the first intravesical use of Bacille Calmette-Guerin for malignant melanoma in 1974.1,2 In kidney cancer, he championed the use of immune RNA and subsequently interferon alpha for advanced disease.3,4 In prostate cancer, Dr. deKernion investigated the use of magnetic resonance imaging in prostate cancer in 1986 and described the use of prostatespecific antigen doubling time to define surgical failure in 1997.5,6 In addition, he was the Principal Investigator of UROLOGY 80: 244 –246, 2012 • 0090-4295/12/$36.00 http://dx.doi.org/10.1016/j.urology.2012.05.022
the initial Prostate Cancer SPORE at UCLA in 2002.3 To this day, the study and development of immune-based therapies remains in the forefront of cancer research and reinforces the importance of his contributions. With the stepping down of Dr. Kaufman, Dr. deKernion became acting Chief and then, after a nationwide search, Chief of the Division of Urology in 1984. He subsequently converted the Division of Urology to a Department in 1996. A natural leader, Dr. deKernion led by example, with a clear vision and unparalleled honesty. He chooses his words carefully, and provides timely and keen advice. Dr. deKernion selflessly worked for the success of his Department and supported the faculty by securing resources, while giving them the independence to mature and the credit for their accomplishments. His success in part is measured by the successes of his faculty, fellows, and residents alike. This leadership style contributed to a cohesive Department excited to advance the field of Urology. Dr. deKernion’s ability to accomplish so much on so many fronts is quite remarkable. Although today it seems that subspecializing within urologic oncology is rapidly becoming the norm, Dr. deKernion always maintained a busy urologic oncological practice, treating patients with prostate, bladder, kidney, penile, and testicular cancer using an armament of approaches. He practiced with empathy, professionalism, and a keen clinical judgment, and his surgical mastery was truly art in motion. Dr. deKernion also served on the First Exam Committee of the American Board of Urology, and subsequently on the Board itself. He has held positions that include the Dean of Clinical Operations of the UCLA Medical Enterprise, served on the National Cancer Advisory Board and Committees at the National Cancer Institute, was associate editor of the Journal of Urology and contributing editor to numerous journals, and is a founding member of the Society of Urologic Oncology. This involvement has kept the UCLA Department of Urology at the forefront of our field both nationally and worldwide.
and to attribute to each person their total due without taking personal claim on their accomplishments. Finally, leadership is the single indispensable quality of a Chair. Over my career, I have read a number of classic leadership books, but it is still my opinion that the basic leadership characteristics cannot be learned, but are owned and refined. Leadership will trump intelligence, hard work, and even determination.”
A BRIEF INTERVIEW
Always humble, Dr. deKernion often reflects more on his mistakes rather than his achievements, and he acknowledges that his mistakes are many.
What is Your Key to Success? Dr. deKernion has a rather simple philosophy. “First, it isn’t necessary to be the smartest person to achieve success. I have always observed that, although I did well academically throughout my career, I was surrounded by many people with much more innate intelligence, but without the other necessary components for success. Secondly, a requisite for success in any field is hard work. To a large extent I thank my family for instilling this work ethic in me. I always had a summer job, even at a young age, up to Medical School. No matter how smart a person of authority or leadership is, they must surround themselves with people who are even smarter and more innovative. Along with this commitment comes an obligation to allow everyone to flourish UROLOGY 80 (2), 2012
As with most aspiring young leaders, Dr. deKernion’s career was influenced by a number of mentors. “My legendary Chief of Urology in Cleveland, Dr. Lester Persky, had a great influence on me and guided me first to the NIH and then to the position at UCLA. Joe Kaufman and Willard Goodwin subsequently strongly influenced my understanding of Academic Urology and Clinical Medicine.” What Do You Rate as Your Most Notable Achievements? Dr. deKernion made several clinical contributions in the treatment of prostate cancer patients. “Up until the early 1980s, the standard approach to radical prostatectomy involved extensive routine frozen sections. Frozen sections were performed and if a single focus of cancer was found, the procedure was abandoned. We recognized it might be possible to cure patients with microscopic positive margins. Furthermore, the ability of a pathologist to do adequate frozen sections on such a large specimen was very limited. We published a paper showing the survival of patients with microscopic positive nodes was quite acceptable and argued for elimination of routine frozen section.” “PSA doubling time has been used to assess outcomes in radiotherapy patients in one paper. We had observed for some time that the change in PSA in all our failures seem[s] to correlate with outcomes. We published the first paper in the importance of PSA doubling time, and this has since become a standard diagnostic indicator for that group of patients.”
“After injecting a melanoma in the bladder with BCG, I was initially unable to get permission to treat transitional carcinomas of the bladder. Mistakenly, I did not press the issue hard enough and it was left to others to evolve the use of BCG for this purpose.” Despite all of his clinical and scientific achievements, Dr. deKernion prides himself on his contributions to his home institution, UCLA: “Without a doubt, however, my greatest satisfaction comes from my work in our Department. I often turned down opportunities to participate in regional and national urology affairs, instead devoting the greatest part of 245
my efforts to building our department, recruiting and nurturing our excellent faculty, and educating students of all levels. I am proud of our residents who have served our community with great expertise and dedication, and especially proud of those who have pursued academic careers. We have trained urologists on almost every continent, many of who[m] are now international figures in our specialty. The list is too long to single out any one of them without giving appropriate due to all.” What Changes Do You Foresee in Urology? “Urology and the entire medical field have changed dramatically during my career. Education of students, residents, and fellows are in many ways more efficient, although restriction of resident work hours will definitely have an impact on the amount of training a resident will receive. As long as 30 years ago, some Urology leaders, envisioning the continued and necessary subspecialization in our field, suggested a radical alteration of Urology training. All such proposals have in common the concept that a Urologist can achieve a certain level of expertise in an abbreviated program. Those wishing to become skilled in one of the subspecialties can then complete a further specific training program. While legitimate concerns have been expressed and accepted, it is becoming more and more clear that a single urologist will be unable to achieve the sufficient skills to perform the full range of urologic management and interventions.” Over Dr. DeKernion’s career, he notes that Urology has made great advancement in its inclusion of minority populations and diversification of programs. “Nonetheless, few women and minorities have ascended to leadership positions in the United States. The Urology academic and training programs must continue to focus on this issue and assure that advancement in leadership opportunities are equally open to all.” Do You Have Words of Advice to Those Beginning Their Careers? “In spite of the major changes in medicine, I encourage young people to strongly consider a career in research and teaching. A physician, in any field, has the privilege of doing something for someone every day and, no matter what the economic environment, can always find a job and make a living to support his family. The evolution of medicine, and of Urology specifically, has been dramatic
246
and will continue to evolve. No matter, I am optimistic of our careers and confident that physicians entering our field will have great opportunities to advance research and treatment, more so than they have had in prior generations.”
CLOSING REMARKS Despite all his achievements, Dr. deKernion has always emphasized to us the importance and privilege of taking care of patients. This he has done with unwavering dedication and skill in the operating room. Although he continues to practice Urology and participates in projects with the UCLA Business of Science Program, he is spending more time now with his devoted and loving wife Mary, his children, and his grandchildren. Dr. deKernion always referred to his predecessors Willard Goodwin and Joseph Kaufman as giants of urology. We stake Dr. Jean B. deKernion’s position in history as a giant of urology and one that holds the respect and admiration of all whom have the privilege to know him. Acknowledgments. I would like to thank Drs. Robert B. Smith and Carol Bennett for a careful reading of the manuscript. Arnold I. Chin, M.D., Ph.D. UCLA Department of Urology, Broad Stem Cell Research Center, Los Angeles, California References 1. deKernion JB, Golub SH, Gupta RK, et al. Successful transurethral intralesional BCG therapy of a bladder melanoma. Cancer. 1975;36: 1662-1667. 2. Silverstein MJ, DeKernion J, Morton DL. Malignant melanoma metastatic to the bladder. Regression following intratumor injection of BCG vaccine. JAMA. 1974;229:688. 3. deKernion JB, Ramming KP, Brower P, et al. Immunotherapy for malignant lesions in man using immunogenic ribonucleic acid. Am J Surg. 1975;130:575-857. 4. deKernion JB, Sarna G, Figlin R, et al. The treatment of renal cell carcinoma with human leukocyte alpha-interferon. J Urol. 1983;130: 1063-1066. 5. Mukamel E, Hannah J, Barbaric Z, et al. The value of computerized tomography scan and magnetic resonance imaging in staging prostatic carcinoma: comparison with the clinical and histological staging. J Urol. 1986;136:1231-1233. 6. Patel A, Dorey F, Franklin J, et al. Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol. 1997;158:1441-1445.
UROLOGY 80 (2), 2012
THE EARLY YEARS Dr. deKernion’s family immigrated to the Louisiana territory from France in the early 1700s, where most of the descendants of his family reside to this day. He was 1 of 7 children and enjoyed a childhood in the outskirts of New Orleans with his close-knit family. Even now, family remains important to Dr. deKernion and his siblings. His parents were loving, yet strict, and, as 1 of 5 boys all within one and a half years of each other, he was instilled with a measure of diplomacy, determination, and survival instincts. These influences marked the culture of the Department during his leadership. Dr. deKernion graduated from Loyola University in 1961 and has always felt fortunate that very early on he knew that he wanted to become a physician and a surgeon. During medical school at Louisiana State University, he worked part time in the operating rooms and participated in research projects with faculty. This experience sparked an interest to pursue an academic career, which carried over to his residency at Case Western Reserve University. From 1967 to 1969, as a Clinical Associate at the National Cancer Institute, he became intrigued with tumor immunology, marking the founda244
© 2012 Elsevier Inc. All Rights Reserved
tion of his basic research. At that time, the surgical societies were experimenting with combined programs and he returned to Cleveland to complete a combined General Surgery/Urology training program, receiving board certification in 1973.
CAREER AT UCLA An offer from Dr. Kaufman brought Dr. deKernion to UCLA for the first time from 1973 to 1978, a period when he was most active in his own research. After a brief hiatus at Tulane University, Dr. deKernion’s recruitment back to UCLA resulted in his being named Director for Clinical Programs at the Jonsson Comprehensive Cancer Center and Head of Urologic Oncology. Dr. deKernion’s pioneering research quite remarkably spans the breadth of urologic oncology, showing innovation and foresight, while tackling critical questions. In bladder cancer, he described the first intravesical use of Bacille Calmette-Guerin for malignant melanoma in 1974.1,2 In kidney cancer, he championed the use of immune RNA and subsequently interferon alpha for advanced disease.3,4 In prostate cancer, Dr. deKernion investigated the use of magnetic resonance imaging in prostate cancer in 1986 and described the use of prostatespecific antigen doubling time to define surgical failure in 1997.5,6 In addition, he was the Principal Investigator of UROLOGY 80: 244 –246, 2012 • 0090-4295/12/$36.00 http://dx.doi.org/10.1016/j.urology.2012.05.022
the initial Prostate Cancer SPORE at UCLA in 2002.3 To this day, the study and development of immune-based therapies remains in the forefront of cancer research and reinforces the importance of his contributions. With the stepping down of Dr. Kaufman, Dr. deKernion became acting Chief and then, after a nationwide search, Chief of the Division of Urology in 1984. He subsequently converted the Division of Urology to a Department in 1996. A natural leader, Dr. deKernion led by example, with a clear vision and unparalleled honesty. He chooses his words carefully, and provides timely and keen advice. Dr. deKernion selflessly worked for the success of his Department and supported the faculty by securing resources, while giving them the independence to mature and the credit for their accomplishments. His success in part is measured by the successes of his faculty, fellows, and residents alike. This leadership style contributed to a cohesive Department excited to advance the field of Urology. Dr. deKernion’s ability to accomplish so much on so many fronts is quite remarkable. Although today it seems that subspecializing within urologic oncology is rapidly becoming the norm, Dr. deKernion always maintained a busy urologic oncological practice, treating patients with prostate, bladder, kidney, penile, and testicular cancer using an armament of approaches. He practiced with empathy, professionalism, and a keen clinical judgment, and his surgical mastery was truly art in motion. Dr. deKernion also served on the First Exam Committee of the American Board of Urology, and subsequently on the Board itself. He has held positions that include the Dean of Clinical Operations of the UCLA Medical Enterprise, served on the National Cancer Advisory Board and Committees at the National Cancer Institute, was associate editor of the Journal of Urology and contributing editor to numerous journals, and is a founding member of the Society of Urologic Oncology. This involvement has kept the UCLA Department of Urology at the forefront of our field both nationally and worldwide.
and to attribute to each person their total due without taking personal claim on their accomplishments. Finally, leadership is the single indispensable quality of a Chair. Over my career, I have read a number of classic leadership books, but it is still my opinion that the basic leadership characteristics cannot be learned, but are owned and refined. Leadership will trump intelligence, hard work, and even determination.”
A BRIEF INTERVIEW
Always humble, Dr. deKernion often reflects more on his mistakes rather than his achievements, and he acknowledges that his mistakes are many.
What is Your Key to Success? Dr. deKernion has a rather simple philosophy. “First, it isn’t necessary to be the smartest person to achieve success. I have always observed that, although I did well academically throughout my career, I was surrounded by many people with much more innate intelligence, but without the other necessary components for success. Secondly, a requisite for success in any field is hard work. To a large extent I thank my family for instilling this work ethic in me. I always had a summer job, even at a young age, up to Medical School. No matter how smart a person of authority or leadership is, they must surround themselves with people who are even smarter and more innovative. Along with this commitment comes an obligation to allow everyone to flourish UROLOGY 80 (2), 2012
As with most aspiring young leaders, Dr. deKernion’s career was influenced by a number of mentors. “My legendary Chief of Urology in Cleveland, Dr. Lester Persky, had a great influence on me and guided me first to the NIH and then to the position at UCLA. Joe Kaufman and Willard Goodwin subsequently strongly influenced my understanding of Academic Urology and Clinical Medicine.” What Do You Rate as Your Most Notable Achievements? Dr. deKernion made several clinical contributions in the treatment of prostate cancer patients. “Up until the early 1980s, the standard approach to radical prostatectomy involved extensive routine frozen sections. Frozen sections were performed and if a single focus of cancer was found, the procedure was abandoned. We recognized it might be possible to cure patients with microscopic positive margins. Furthermore, the ability of a pathologist to do adequate frozen sections on such a large specimen was very limited. We published a paper showing the survival of patients with microscopic positive nodes was quite acceptable and argued for elimination of routine frozen section.” “PSA doubling time has been used to assess outcomes in radiotherapy patients in one paper. We had observed for some time that the change in PSA in all our failures seem[s] to correlate with outcomes. We published the first paper in the importance of PSA doubling time, and this has since become a standard diagnostic indicator for that group of patients.”
“After injecting a melanoma in the bladder with BCG, I was initially unable to get permission to treat transitional carcinomas of the bladder. Mistakenly, I did not press the issue hard enough and it was left to others to evolve the use of BCG for this purpose.” Despite all of his clinical and scientific achievements, Dr. deKernion prides himself on his contributions to his home institution, UCLA: “Without a doubt, however, my greatest satisfaction comes from my work in our Department. I often turned down opportunities to participate in regional and national urology affairs, instead devoting the greatest part of 245
my efforts to building our department, recruiting and nurturing our excellent faculty, and educating students of all levels. I am proud of our residents who have served our community with great expertise and dedication, and especially proud of those who have pursued academic careers. We have trained urologists on almost every continent, many of who[m] are now international figures in our specialty. The list is too long to single out any one of them without giving appropriate due to all.” What Changes Do You Foresee in Urology? “Urology and the entire medical field have changed dramatically during my career. Education of students, residents, and fellows are in many ways more efficient, although restriction of resident work hours will definitely have an impact on the amount of training a resident will receive. As long as 30 years ago, some Urology leaders, envisioning the continued and necessary subspecialization in our field, suggested a radical alteration of Urology training. All such proposals have in common the concept that a Urologist can achieve a certain level of expertise in an abbreviated program. Those wishing to become skilled in one of the subspecialties can then complete a further specific training program. While legitimate concerns have been expressed and accepted, it is becoming more and more clear that a single urologist will be unable to achieve the sufficient skills to perform the full range of urologic management and interventions.” Over Dr. DeKernion’s career, he notes that Urology has made great advancement in its inclusion of minority populations and diversification of programs. “Nonetheless, few women and minorities have ascended to leadership positions in the United States. The Urology academic and training programs must continue to focus on this issue and assure that advancement in leadership opportunities are equally open to all.” Do You Have Words of Advice to Those Beginning Their Careers? “In spite of the major changes in medicine, I encourage young people to strongly consider a career in research and teaching. A physician, in any field, has the privilege of doing something for someone every day and, no matter what the economic environment, can always find a job and make a living to support his family. The evolution of medicine, and of Urology specifically, has been dramatic
246
and will continue to evolve. No matter, I am optimistic of our careers and confident that physicians entering our field will have great opportunities to advance research and treatment, more so than they have had in prior generations.”
CLOSING REMARKS Despite all his achievements, Dr. deKernion has always emphasized to us the importance and privilege of taking care of patients. This he has done with unwavering dedication and skill in the operating room. Although he continues to practice Urology and participates in projects with the UCLA Business of Science Program, he is spending more time now with his devoted and loving wife Mary, his children, and his grandchildren. Dr. deKernion always referred to his predecessors Willard Goodwin and Joseph Kaufman as giants of urology. We stake Dr. Jean B. deKernion’s position in history as a giant of urology and one that holds the respect and admiration of all whom have the privilege to know him. Acknowledgments. I would like to thank Drs. Robert B. Smith and Carol Bennett for a careful reading of the manuscript. Arnold I. Chin, M.D., Ph.D. UCLA Department of Urology, Broad Stem Cell Research Center, Los Angeles, California References 1. deKernion JB, Golub SH, Gupta RK, et al. Successful transurethral intralesional BCG therapy of a bladder melanoma. Cancer. 1975;36: 1662-1667. 2. Silverstein MJ, DeKernion J, Morton DL. Malignant melanoma metastatic to the bladder. Regression following intratumor injection of BCG vaccine. JAMA. 1974;229:688. 3. deKernion JB, Ramming KP, Brower P, et al. Immunotherapy for malignant lesions in man using immunogenic ribonucleic acid. Am J Surg. 1975;130:575-857. 4. deKernion JB, Sarna G, Figlin R, et al. The treatment of renal cell carcinoma with human leukocyte alpha-interferon. J Urol. 1983;130: 1063-1066. 5. Mukamel E, Hannah J, Barbaric Z, et al. The value of computerized tomography scan and magnetic resonance imaging in staging prostatic carcinoma: comparison with the clinical and histological staging. J Urol. 1986;136:1231-1233. 6. Patel A, Dorey F, Franklin J, et al. Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol. 1997;158:1441-1445.
UROLOGY 80 (2), 2012