Samuel M. Silver, MD: No regrets about leaving infectious disease for hematology/oncology

Samuel M. Silver, MD, PhD, is professor in the department of internal medicine and director of the Cancer Center Network at University of Michigan Cancer Center, as well as chair of the National Comprehensive Cancer Network’s board of directors.

Silver is HemOnc Today’s section editor for health policy and value of care.

Samuel M. Silver, MD, PhD

He specializes in malignant and benign hematology, with a specific research focus in quality of oncology care. He also is well known for his work and involvement in clinical reimbursement and coding.

Question: What inspired you to go into hematology/oncology?

Answer: I really did not think of it until I was a medical resident at University of California, San Francisco. I have a PhD in virology, so I thought I was going to go into infectious disease. Quite honestly, when I was a first-year resident, HIV had just shown its head in San Francisco and I was overwhelmed by that. I steered myself away from infectious disease, and I had a number of attendings in both hematology and oncology who I really liked working with. I saw hematology/oncology as a specialty where one has to become deeply involved with their patients and families and have lots of discussion, and I liked that. I also saw it as a discipline that was going to have tremendous advances during my career, and both of these things have turned out to be true.

Q: What has been your greatest professional reward?

A: I think there are two. For one, taking care of patients has been a tremendous reward. Also, the fact that I can be in the same room with such incredibly smart and thoughtful colleagues. So, both the care of my patients and the opportunity to work with my colleagues have been the two greatest rewards.

Q: What has been your biggest professional challenge?

A: When I was director of bone marrow transplantation here at University of Michigan, my biggest challenge was severe graft-versus-host disease. This was often a pyrrhic victory; these patients achieved remission, but then they had to deal with the effects of the transplant itself with all of the complications of GVHD. This is something we still struggle with today, and I have great admiration for my colleagues who are involved in the care of these patients and are involved in the basic, translational and clinical research in this difficult problem. This is no longer my day-to-day field, but even though we are making major advances, this remains a major issue in patients who undergo transplantation.

Q: Whom do you consider to be your mentor?

A: I have had many mentors over the years. One was my PhD advisor, Purnell W. Choppin, MD, a virologist at Rockefeller University who later became director of the Howard Hughes Medical Institute. He was of tremendous help to me at a time when I was unsure that I was going to get through my PhD. Another mentor is Laurence A. “Larry” Boxer, MD, former chief of pediatric hematology-oncology at Michigan. He really helped me throughout my career, especially during difficult times, and he has been someone who I hold conversations with regularly. A third is Allen S. Lichter, MD, FASCO. He was the chair of radiation oncology at Michigan, and then became the dean of the medical school before going on to become CEO at ASCO. He made many opportunities available to me, as well as being my personal physician. Even though Allen and Larry were not in my department, they have given me entrée into many things that I am tremendously grateful for.

Q: What is the best advice that you have received in your career?

A: I’m not sure that anyone has ever given me best advice, quite honestly.

Q: What is the biggest breakthrough that you have witnessed in your specialty?

A: The introduction of imatinib (Gleevec, Novartis) for chronic myeloid leukemia. In just a short period of time, patients who were going to be going for bone marrow transplant can now take a pill a day. The patients that I have taken care of for over a decade now have lived a normal life with only taking oral medication ― who would have thought?

Q: What do you think will be the biggest breakthrough in your specialty within the next 10 years?

A: The targeted therapies that we are discovering now that are being released as new FDA drugs day-by-day have unfortunately not been imatinib all over again. Things are very difficult in other diseases. So, I think quick answers are still unusual. Even targeted therapy and trying to see what the targets are, doing personalized medicine, is not as easy as people thought it would be. There is still a lot of work to do.

Q: What advice would you offer someone entering into your field?

A: It is a wonderful field, and the things that got me interested in it are still the same ― working with patients and discoveries that are going to change patients’ lives. The difficult part is the economic uncertainties and how people will be paid for the difficult work that we do. The costs of therapies for our patients are unsustainable, so we have a lot of difficult issues aside from discovering cures. Still, I have not regretted doing what I do ― ever.

Q: If you had not gone into medicine, which career path would you have chosen?

A: As an undergraduate, I almost went into organic chemistry. I was always interested in early pharmaceutical discoveries, so I probably would have been a PhD in phase 1 discovery at a pharmaceutical company.

Q: Can you talk a little about the impact of the Affordable Care Act and what you expect the long-term impact to be?

A: I do not think anyone knows what the long-term effect will be, only because of Congress and all the blocks that have been put in front of it. It certainly is far from a perfect whole, which makes it a difficult set of principles to follow. There is no question that more patients have insurance and are able to get care, and there is no question that people with catastrophic conditions like cancer now do not have to look at lifetime maximums that their insurance company will pay for. This is all very different from before the act. But I am very concerned about various states not taking the Medicaid matching funds that are available to them and the disparities between the states. People are going to have even more difficulty getting care in those areas. It is a very difficult time to be able to see what is going to happen in the future.

Q: What do you do in your free time?

A: When the weather is nice, I like to play golf and I like to spend time with my wife and children, when they let me. I enjoy going to Chicago, where my daughter lives, and spend time with her. My son just moved back to Ann Arbor ― he is a hospitalist here at University of Michigan, so hopefully I’ll get to see him more.

Q: What is the last good book that you have read?

A: I cannot even remember.

Q: What is your favorite travel destination?

We love going to Hawaii, it does not matter the island. The weather is beautiful, the golf is beautiful. It is a great destination for us.

Q: Which musical artist(s) or type of music are at the top of your playlist right now?

A: I actually do not have a play list. I have never even heard music on my iPhone, nor do I know how to do this. But I enjoy classical music ― string quartets and chamber music. My wife and I enjoy going to classical concerts. When I am in the car and I have time, I listen to music from the 1960s. I do not think I make it beyond the 1960s.