Oncology, Etc. – In Conversation with Dr. David Steensma (Part 2)

ASCO Education

In Part Two of this Oncology, Etc. episode, hosts Patrick Loehrer and David Johnson continue their chat with hematologist-oncologist Dr. David Steensma. They explore his views of key opinion leaders and a lifelong passion – collecting rare stamps, including medical stamps. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at [e-mail].

TRANSCRIPT

Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a Medical Oncologist from The University of Texas, Southwestern in Dallas, Texas.

Welcome to the second half of our Oncology, Etc. conversation with Dr. David Steensma. He's a highly accomplished physician and scientist in the field of Hematology/Oncology.

In the first part of this episode, Dr. Steensma told us about his Dutch immigrant roots, and how a single college biology course changed his career interests from astronomy into medicine. Today, we'll explore his views on Key Opinion Leaders and another passion of his, and an interest of ours - collecting rare stamps, including medical stamps.

Dave Johnson: So, David, in addition to your scientific writing, you've been a prolific writer in many other sort of viewpoints and opinion pieces. There's a lot to choose from, but I know you've been interviewed in the past about your column called ‘The Raven’, which I won't ask you about, as an Edgar Allen Poe fan. You also wrote a wonderful piece called, ‘Key Opinion Leaders’, which I thought might be quite interesting to ask you about, now that you might be calling upon KOLs. Do you want to tell us a little about that?

Dr. David Steensma: Yeah, that's not my favorite term. Thought Leaders is another kind of silly term, but we know what we mean when people are talking about it. Yeah, I've had a chance to write on a lot of different things over the years, and that's been great fun. And when I first heard that term, I couldn't figure out what it meant, KOL. And then, a pharmaceutical representative actually accidentally left a list of KOLs in my office and I realized that not only are KOLs cultivated very carefully, those relationships, but there's a hierarchy of KOLs. They were people who influenced the local formulary and local practice at the institution, there were those who had a regional impact, and then there were those who were on the NCCN guideline committees, and had, you know, much broader impact that they really wanted to make sure to influence the heart and minds of-- in my interactions now, this opinion piece was a sort of tongue-in-cheek about Key Opinion Leaders and Thought Leaders.

And with Thought Leaders, I was reminded of Sherlock Holmes’s brother Mycroft Holmes, who, by Conan Doyle's fiction, was a brilliant man, but unwilling to stir his ample backside from his Chair in the Diogenes Club to actually get out there, and do some real work, and solve mysteries. And so, it fell to his slightly less brilliant brother, Sherlock, to become the consulting detective. So, that was fun. Now, we're sort of on the receiving end of wisdom from people who are experts in the area. And it's very important what doctors think, and in different geographies about how they think their patients will be potentially treated in a year or two, five years down the road, what the issues they have with current approaches are, where they see opportunity for some of our new compounds, for some of those of other companies, and it's different in Europe versus the US versus Australia.

And so, there's a lot that we gain from advisory boards. There's an arc to an advisory board. You don't want to convene an advisory board when there's no data, because then, everybody is just speculating. You don't want to do it too late after something is already on the doorstep of FDA approval because then not anything can be changed at that point. So, you know, doing it at an in-between point where there's some initial data, but where we can really be guided by academic, clinical, and other experts, is really helpful.

Pat Loehrer: I'd encourage people to pull this article out. It is really, really good. 2015, I think it came out there. The end of it, I also love it. You're talking about Kanti Rai who came up with the Rai classification and he was at this Meet the Expert session at the ASH meeting, and he said at the meeting, and this is your quote from it, and I love it, he said, “I don't like the name of this session because no one's an expert in chronic lymphocytic leukemia. I've been studying this disease for decades, and still too many of my patients die. If I was truly an expert, the disease would've been cured by now." I just love it, but it's a great read.

Dave Johnson: Let me ask you, very seriously, if a younger colleague were to come to you, David, what advice would you give him or her about being invited to be on an advisory board? We'll skip the term KOL or Thought Leader. What advice would you give him or her, and what should they look for, and how should they prepare for that activity should you think they should do it?

Dr. David Steensma: Well, I think getting back to imposter syndrome, people should feel, if they're invited to be in such a meeting, that they're there for a reason because their opinion does matter. And sometimes, younger physicians are reluctant to speak up in this setting, especially when there maybe leaders in the field there that have been doing it for decades, and may have very strong opinions. So, not being afraid to share their perspective and realizing that they're invited for a reason.

On the other hand, I found it very helpful when I was a young faculty member and, on these panels, to listen to how colleagues were assessing data, and the recommendations they were making, and their perspective. And I learned a lot from some of those advisory boards earlier on. Many of the people who are the senior leaders in leukemia and MDS, you know, Rich Stone, Peter Greenberg, you know, John Bennett, in MDS, Marty Tallman, Hagop Kantarjian, Clara Bloomfield, just people who had decades of experience. And in part, I think it's some of my comments at advisory boards that helped get me my job at Dana-Farber, because I'd been in a number of meetings with Rich Stone, and he apparently liked some of the things I'd said about approaching patients. And so, you know, when a faculty position came open, he invited me out to come visit. And so, they can have benefits that you don’t anticipate.

Dave Johnson: Yeah, I would definitely agree with that. And there's pros and cons to being involved in those activities, but there are an awful lot of good that comes from it. And I think you've just touched on some of those.

I'm going to shift gears a little bit because Pat has been waiting anxiously to hear all about your stamps. So, out of the many, many things that you've done and written about, I would say you've got close to 100 publications on medical stamps. It's an extraordinary productivity, David. So, tell us a little about your interest in medical stamps. How did you get involved in this, and where do you find time to write about them, and how do you decide which ones you're going to write about?

Dr. David Steensma: Yeah. Bob Kyle, is really the driver on that, and we continue to do these together. Bob turned 94 this year, and he continues to be intellectually engaged. He's fun to talk to, if it weren't for COVID, he'd still be traveling and coming into the office, you know, which he was doing until just a few years ago. So, I met Bob as an intern when I was at Mayo. Somebody said, "Oh, you should meet this guy, he's really fun to talk to." And we just hit it off. And when I was a boy, my grandfather and my great-grandfather had collected stamps. And my grandfather really got me interested in it, partly given our family history, those of The Netherlands and former colonies, but also just more generally. And then as often happens, I got to be a teenager and other things took over in terms of interest, and there was less time, so, I had fallen away from it a bit.

But somehow in this conversation, Bob had mentioned this, and that they were looking for someone younger who had this kind of background, to help with this series that has been running. Initially, it was running in JAMA with a guy named John Mirt, beginning around 1960, and then about a decade later, moved to the Mayo Clinic proceedings when they published six stamp vignettes on medical science per year, and Bob has done over 500 of these going back decades. And so, I got involved in that, and writing about-- thus far, it's mostly focused on individuals, but I have done a few also about more general trends in Philately. I will say that there are fewer of us, certainly those under 50, who are involved in the hobby. There's so much other distractions, but I still find it interesting and fun. And I've learned a lot, putting those vignettes together.

Pat Loehrer: I started collecting stamps when I was young, I still have my Scott’s album down. And now it's not stored, in properly, but I remember US Number One, I could have bought for $35, but I was only like 10 years old, and that was, you know, like $500 to me. So, I still regret that. Are you collecting stamps yourself now, still that you've resumed the collection part of it?

Dr. David Steensma: Yeah. I would say, only a little bit. So, my Netherlands and Colonies collection is now actually complete, except there's one elusive. There's always one, right? Can't find this thing, even at auctions and such. And I also collected coins as a kid, and you know, still have some involvement in that. It's hard to find the time because I do do so many other things, and my wife and I have children, they're now college and PhD age, so I do woodworking, I have a telescope, so I never lost the love of astronomy. It seems like there's always other things to do. But I still have my collection over there on the shelf.

Pat Loehrer: Did you inherit it from your grandfather too?

Dr. David Steensma: Some of it I did. Yep. The core of it, I inherited from my grandfather and my great-grandfather. And then once I paid off my substantial medical school debt to the University of Chicago with the help of, in part, from advisory boards, but also mostly from moonlighting in emergency rooms around rural Minnesota-- during fellowship, I was like a full-time ER doc who happened to be doing a Hem/Onc Fellowship on the side, and finally got it paid off and then I could start on filling in some of the gaps.

Pat Loehrer: Before we change this thing, what is your most cherished stamp that you own?

Dr. David Steensma: Oh, my most cherished stamp is not a Dutch one. It is a set of national park stamps from 1934, authorized by James Farley, who was the Postmaster General at that point. 10 stamps, different colors about, you know, Zion and Acadia-- and it was my grandfather's favorite, and he was a big fan of the national parks, took two big trips there back in the '50s out West. And so, at his funeral, I put together a little display of those hanging with the photographs of other things from his life. I have that display, it's very meaningful to me - it's a connection with him. He was certainly very influential in my life. I never imagined I'd be working for a Basel-based pharmaceutical company, like he did for his whole career. Never thought that that would happen, but life has some unexpected twists.

He worked for Roche in Nutley, New Jersey for much of his career as a research chemist. And ironically, when my grandmother was diagnosed in the 1990s, pancreatic cancer, and she saw the oncologist and was offered a 5-FU infusion after surgical, he said, "5-FU. I worked on that in 1959, 1960, that's still the best that we have to offer?" He was shocked by that. I was a fellow at the time. I said, "We need better drugs."

Dave Johnson: For sure. So, do you have a favorite medical stamp, David?

Dr. David Steensma: A favorite medical stamp? Gosh, that one's I think a little bit harder. I certainly have medical stamps that have piqued my interest. One of the sort of most moving is one of the US stamps that came out in the 1950s that has the Sir Luke Fildes’ ‘The Doctor’, on it. You know, with this concerned physician at the bedside of a young boy, and I actually wrote a vignette about the history and background there, and I think that connection with patients at the end of the day when we don't have good drugs, that connection with patients is still so meaningful, isn't it? As you guys really know. So, and as many of our listeners know, and so much of what medicine remains despite the molecular glue degraders and CAR T and gene therapy, is still that human connection, and being there for our patients. And so, I would say that that is probably one of the most meaningful.

There's some real quirky ones, too. Austria's come out with some stamps in the last few years; one made of toilet paper, when the toilet paper shortage was happening, another, made of the mask material and the shape of the mask to remind people to mask up. You know, there's been a lot of creativity. And the Dutch are very good about design. They come up with just some brilliant innovations in postage stamps.

Dave Johnson: I mean, stamps are really quite artful, by the way, the Fildes painting hangs on the wall of my office. You can't see it, but it's on the wall. And then behind me, you can perhaps see a couple of framed stamps that are some of my favorites. One was a gift to me from a former Group of Chief Residents, of an Osler stamp that Canada put out, and the other is one I received actually as a gift, as part of an award. It's the first cancer stamp that was produced in the United States. So, I love them both. They're quite nice. The Fildes stamp is actually my favorite of all, so I think that's a great stamp.

Pat Loehrer: I have actually looked behind me. I've got a stamp collection on the frame that was given to me too that I love. It's stamps of medicine. There was one, a Dag Hammarskjöld stamp, that was famous because they printed it upside down when they put the color in, and I think it created a huge controversy from-- you know this better than I do because they decided then just to overprint them. Instead of making a few sheets that were incredibly valuable, they ended up printing out thousands of these things, which I have one now. It's only worth 7 cents, but at the time, it seemed really cool to have a misprinted stamp in your collection.

Dr. David Steensma: Dag Hammarskjöld, there's an interesting connection with what I was talking about a little bit earlier with St. Elizabeth's Hospital. So, this relatively small teaching hospital had, at one point, a very strong hematology research program led by a guy named Fred Stallman. And in 1974, Fred Stallman, who was coming back from ISH, International Society Hematology, which was in Tel Aviv that year, and his plane exploded somewhere over the Aegean Sea, ultimately thought to be related to the PLO, and so he died. There was a big painting on the wall, in the hospital of him. And Dag Hammarskjöld also, at the peak of his career, you know, as the UN Secretary-General, was killed in a plane crash. But the interesting thing about Fred Stallman is, here, you have somebody who was so important in hematology. None of the fellows had any idea who he was or their connection to hematology. You know, it shows how fleeting fame is, unless you're an Einstein or Babe Ruth level. So, that was a good thing to keep in mind as well.

Pat Loehrer: We could talk for another hour or two on this. Dave, we really appreciate it. But unfortunately, this is all the time we have for today. And I really want to thank you for joining us, Dave. This has been a wonderful conversation.

I also want to thank all our listeners for tuning in to Oncology, Etc. This is an ASCO Education broadcast where we will talk about anything and everything, as you can imagine. If you have an idea for a topic or a guest you'd like to see on the show, just email us at: [e-mail].

Thanks, again. And, Dave, I've got a quiz for you here. Do you know why pirates don't take a shower before they walk off the plank?

Dr. David Steensma: I do not.

Dave Johnson: I have no idea.

Pat Loehrer: It's because they wash up on shore.

Dave Johnson: Oh boy.

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