Conversations with the Pioneers of Oncology: Dr Hyman Muss

Dr. Hayes interviews Dr. Muss on geriatric oncology.

Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes' research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018.

TRANSCRIPT

PRESENTER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

DAN: Welcome to JCO's Cancer Stories, The Art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insights into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Today, my guest on this podcast is Dr. Hyman Muss. Dr. Muss has been instrumental in several facets of the history of oncology, the generation and conduct of cooperative groups, the establishment of medical oncology as our board of the subspecialty, and perhaps he's most well known as one of the founders of the field of geriatric oncology.

Throughout his career, he's devoted much of his efforts to research in breast cancer mentoring many young investigators, and, frankly, I'm very proud to consider myself one of those. Dr. Muss's personal journey is fascinating. He was raised in Brooklyn, which even though he spent the last 50 years in other locations, including Boston, North Carolina, and Vermont, our listeners will appreciate from his dialect within the first 10 words from his mouth that he is, indeed, from Brooklyn.

He received his undergraduate degree at Lafayette College in Eastern Pennsylvania, where he was elected to Phi Beta Kappa. He got his medical degree at the State University of New York downstate in Brooklyn, where he was elected to the AOA. He did his internship and his residency at the then Peter Bent Brigham Hospital, now the Brigham and Women's Hospital in Boston. That shows how old you are, Dr. Muss.

HYMAN MUSS: [LAUGHS]

DAN: Then he took a tour to Vietnam for a military tour of duty. He won a bronze star during that experience. He returned stateside, and he obtained his medical oncology fellowship at the then Sidney Farber Cancer Institute, which is now, of course, designated the Dana-Farber Cancer Institute. Following his fellowship in 1974, Hy joined the faculty at Bowman Gray School of Medicine at Wake Forrest, and there he served many roles over the next 22 years before he then moved to the University of Vermont to head the division of hematology oncology.

After 10 cold years in Vermont, he got tired of the snow, and he returned to North Carolina and this time at the University of North Carolina, where he is now the Mary Jones-Hudson distinguished professor of geriatric oncology and the director of the geriatric oncology program in the University of North Carolina Lineberger Cancer Center. Dr. Muss has authored over 500 peer reviewed papers, and like most of the guests on this program, he's just simply won too many awards for me to list them all. However, in addition to his bronze star from the US military, I know he is particularly proud of being an eagle scout. And if you ever meet Hy and he's got his tie on, you have to ask him about his tie tack because it is an eagle scout tie tack, one of the few people I know who has one of those.

Dr. Muss has served ASCO faithfully in many roles. He served on the board of directors from 2004 to 2007, and perhaps importantly, he was the recipient of the Allen S. Lichter Visionary Leader Award in 2020, which was well deserved. I knew of very few people with the vision that Hy Muss has shown for our field. Dr. Muss, welcome to our program.

HYMAN MUSS: Thank you so much. My mother would have loved that introduction.

DAN: [LAUGHS] Let's start with your origin story. I know you weren't bit by a radioactive spider in Brooklyn and became Spider-man, but seriously, I've heard you speak about your father, who was a dentist, and your uncle, a family practitioner, who, I think, shared an office or something. And this sounds a little bit different than the typical medical establishment that we work in these days. How did that influence you?

HYMAN MUSS: Oh my god. How different it is. I grew up in Brooklyn. And I went to PS-167, and we lived in a little brownstone. And my father was the neighborhood dentist, and my uncle was the neighborhood GP, a term not used anymore.

And I grew up with them, and I didn't always know I wanted to be a doctor. But I used to do house calls, especially with my uncle. And patients loved him. An interesting digression is he went to Howard University. He got a minority scholarship. He was picked out of Brooklyn.

He had a lot of African-American patients too, and he would take me in his Buick. And I'd go, and I'd get candy and ice cream and love what he did. And I loved the patient interaction that he had. And I think that was instrumental eventually in college of me after working in a chemistry lab for a semester doing research on cyclic ketones to say I don't think I can do this for a living and consider medical school, which I think was probably one of my best choices. So I had a great upbringing and saw medicine. If my parents saw a credit card or an Epic EMR, they wouldn't know what it was. They'd think it was science fiction.

DAN: And I'm sure you were HIPAA compliant when you were making the rounds with your uncle, right?

HYMAN MUSS: Oh, yeah. So when he got very sick and he couldn't really do his practice anymore, my father said go to your uncle's office and take his records down to the basement. And I went in, and my uncle's records were 3 by 5 index cards with the name of the patient, Mary Jones, diabetes, and her phone number. That was it. That was it. And I could move them down in a cardboard box. And today when we see one patient and start one Epic note, we got 85,000 documents in there, so it was great.

DAN: How did you get to Lafayette College?

HYMAN MUSS: My father had a patient, and I inherited from both my parents loquaciousness. And my dad would talk with all his patients, and bring them up occasionally, have a scotch with them. And he had a patient-- I was probably a junior or a senior in high school. I was really-- didn't know what I wanted to do. I wasn't the greatest student academically in high school.

Although, I went to Brooklyn Tech, a terrific high school. Rich Schilsky went to Stuyvesant, and the patient told my dad that he knew of a small college in Pennsylvania, a boys college, that was really good academically about 100 miles from home. Told me about it. I went and saw it, and liked it, and went there, and it really changed my life going to Lafayette. I got one on-- I went from 6,000 boys in my high school, no women, to a small college with maybe 1,200 boys, but I got to know my professors. It was a lot of one to one. It was terrific, and it still is.

DAN: It's amazing how many people I've interviewed where what they do is serendipity. This sort of thing. Didn't know what I wanted to do, and I was-- you may have heard Dr. Freireich when I interviewed him. Told me that when he grew up in Chicago, his mother was a single parent, and so he started stealing hubcaps to pay for his tuition. [LAUGHS] The founder of our field was a juvenile delinquent.

HYMAN MUSS: Oh, god. Yeah, no, I wasn't that bad. But Lafayette really changed my life, and I had people who actually knew me, knew my name, knew what I was interested in. I had some-- I was a chemistry major, not a really premed. And I had some wonderful professors, and I think they were disappointed when I didn't go for PhD graduate school in chemistry.

DAN: Again, it's just amazing, and I remember this every time I run into a med student, where I think I don't have time to do this. And just one little comment or pat on the back and suddenly they're off in a different way, so I think all of us keep that mind. I've interviewed several of the pioneers, who many of them were so-called yellow berets at the NIH in the 1960s to avoid going to Vietnam and, frankly, changed the picture of medicine in America I think, especially oncology. But so far, only you and one other interviewee, Larry Baker, who I know you know and good friends, actually joined the military and was sent overseas.

He did it sort of unwillingly. It looks, to me, like you did it more willingly. It's not that he was unwilling, but it wasn't in his career plans. That must have really been a very frightening but enlightening experience. Are you willing to give us any back stories on this and talk about it?

HYMAN MUSS: Of course. So I was in medical school. Vietnam was going, and the draft was hot. And we were all worried that if we got drafted out of medical school or out of residency, we'd have to repeat a whole year. So there was something called the Barry plan. And what it was is you joined the military, you could join any service, and they would let you finish medical school and actually credit me for time in the military during medical school.

And then they promised in residency not to draft me in the middle of the year. So I joined the Barry plan, and so I knew I had to go into the military. And so when my time came because I had good training, I was at the Brigham then, the military said, well, if you want to do three years instead of two years, we'll send you to this place or that to do research. And I didn't want to spend another year, so I know the minute I told them that I was heading to Vietnam. I did go to the NIH to look at a cardiology training.

And I got there, and I was the only guy sitting in that interview area who hadn't written 10 papers. So I knew I was going to Vietnam after that day too. And I didn't about the NCI. I didn't know about cancer. Some of my close friends and your friends went to the NCI.

Had I known, it would have been a terrific thing, and I would have applied. I would have worked with the greats there at the time. But I didn't know, so I went to Vietnam. And I was with an artillery battalion. I wasn't anything elegant. I never saw any units with MASH with women or anything.

I was married three months. It was extremely hard on my wife, Loretta, who you know well, but I learned a lot about myself then. I was 27 years old. I didn't have 25 smart people behind me to ask questions to, residents, and terrific faculty, and colleagues, and I got to know myself. I was terrified when I went, terrified, but I got to know the system.

And you learn how well-run the military is. Unlike some of our clinics, they really know how to do it. I got a very valuable experience there, and I set up a drug amnesty program, which is why I won the bronze star. It wasn't anything like I was in front of a machine gun. We had a major drug problem in Vietnam.

Young people, nothing to do, time on their hands, frequently poor kids who got drafted and went in. It was the poor kids. World history, so I set up a program to try to help a lot of them not really get deep into bad drugs. And I think we had some success. Hard to measure.

DAN: So when you say you were an artillery unit, were you like the doctor for the artillery unit?

HYMAN MUSS: I was it.

DAN: Were you patching up injuries and stuff, or taking care of sore throats, or what?

HYMAN MUSS: I did. I did a lot of sore throats. I did a lot of venereal disease. I did back pain. I set one or two fractures. The first fracture I set, I had a big book in another part of our little aid station called the Palma.

It was like a-- we didn't have YouTube. I needed YouTube videos. I put this cast on this guy. It probably weighed 300 pounds, and he said, doc, have you done this before? And I said, oh, yeah, I've done this a lot.

So I did that, and I took care of a heart attack or two on the base in the base hospital. Although, I was in a unit that had little field units out with artillery, and I used to go a few times a week in a helicopter and check on the medics and troops. So it was an extremely valuable experience.

DAN: That's incredible. Well, let's go on. You already sort of alluded to this, but I've asked almost everybody. What made you go into oncology, especially in the 1960s when there wasn't oncology? You came back to the Brigham. What got you interested in doing cancer?

HYMAN MUSS: When I was an intern and resident at the Brigham, our chief of hematology was a guy named William Moloney, and I know you know him.

DAN: I sure do.

HYMAN MUSS: And he was an incredible guy. He was a professor at Harvard, but if you think my Brooklyn accent is heavy, you should have heard his Boston-Irish accent. It was off the wall. And he was the most terrific guy. He kind of served as my dad for part of the time because my dad had passed.

He would round every day, and we'd see all the hem patients. And we had all the AMLs, so I'm talking about, oh, 68 to 70. I never saw a remission. Never.

And they all passed away, but he loved the patient care. And I got interested, and so when I was in Vietnam and when I got out of the Vietnam and was back, I thought, what do I want to do? And I said, I really like that hematology.

DAN: I'll just say that Dr. Moloney was almost exclusively hematology.

HYMAN MUSS: He was almost all exclusive. He used to grow little AML cells in little chambers in mice and treat them with drugs, and so I decided to do hematology. And I came back, and I think in my first weeks there he said, Hy, you're not going to believe this, but you can actually put these people into complete remission and take their leukemic bone marrow and make it look normal. And I'm saying, oh, yeah, right, because I had used all these regimens like VAMP, methotrexate, all the things that never worked.

And we had two new drugs, ara-C and daunomycin. And so I used to go up and treat these patients' IV pushes, ara-C and daunomycin, big doses, and I started seeing remissions. And I said, this is amazing. And then during that year, we had our first child, and I started to run out of money.

DAN: So this is when you're still a resident?

HYMAN MUSS: This is when I'm now a fellow. That year, we were very short of cash. I had a new baby, and I went to Dr. Moloney and talked with him. And he said, I'll try to help you, and he talked with a guy named Dr. Francis Moore, who was chief of surgery, one of the icons of surgery. And Dr. Moore talked with some of his donors in the Brooklyn area, and I became the first Sidney Farber Cancer Research fellow.

I knew nothing about cancer, solid tumors. So as the requirement was, I had to go over to the Jimmy fund, the Sydney Farber Cancer Center and see cancer patients. And all my hardcore hem friends said, oh, you're not going to like it, but it's worth doing for the stipend I got. The first day I was there I knew medical oncology was for me. I loved-- it was open.

We were treating everyone with CAF-- CMFVP, the old regimen, every single cancer. There was so much to be learned. There was so much opportunity for clinical trials. And then in the middle of that year, Tom Frei came, and he was so inspiring. And I knew that I was going to do an onc career.

There were no hem-oncs then. There were hardly any oncology fellowships, so I got to love that. I did two years, not three.

DAN: So let me interrupt you for just a moment just for our speakers-- our listeners. So Tom Frei was one of the three who were the first to put combination therapy together.

HYMAN MUSS: Right.

DAN: Jay Freireich, Jim Holland-- actually, it was Jim Holland's idea frankly. I figured that one out, and Tom Frei. So, again, in terms of pioneers, you were right there with the first pioneer.

HYMAN MUSS: And I did little combinations of things I'm not going to tell you about. They're embarrassing. They didn't work, but I learned so much. And actually, Ezra Greenspan was in that early group in breast cancer treating patients with hormonal agents and chemotherapy. But I learned from them, and I just love the clinical environment.

And those days, there was nothing. I've witnessed other miracles like Larry Einhorn developing platinum and curing testis patients. I'm old enough, every male I saw with testis cancer and mets died. Everyone. Drugs like that were virtually miraculous, and we're doing so many great things today. So I was at a really great crossroads.

DAN: Who else was at your level at the time, especially before Dr. Frei? You must have been pretty much alone.

HYMAN MUSS: There was a fellow named Jacob [INAUDIBLE] you may remember, who was there and was really interested in chemotherapy timed by your biologic clock, and a few other people, people like Craig Henderson and others who came in after. I preceded them, so I was virtually one of the few oncology trainees at that time.

DAN: And who mixed up your chemotherapy?

HYMAN MUSS: I did.

DAN: And who started the IVs?

HYMAN MUSS: I did.

DAN: And who--

HYMAN MUSS: You don't want to know. I was very careful with daunomycin, and so Dr. Moloney had a little office in the Brigham. And it had a little bathroom, and a very popular regimen-- and we had a lot of lymphoma patients-- was COP, cyclophosphamide, vincristine, and prednisone, COP. So I would go into that little bathroom. It's very hard to dissolve this stuff.

I put it all in a little sink. I'd have to tell the patients I'm going to be in here a minute. Don't come in. And I would put it all in syringes. I'd put them in a little chair, like kids sit in in school.

Put your arm on the side. I'd start the IV and give it to them. When I got to the Farber in the second year, now they were training because they had so many kids. They had nurses that could do some of that, but I think I recall giving it there. But in the Brigham, I gave the chemo.

DAN: Did you do any pediatric work with Dr. Nathan?

HYMAN MUSS: I did a few months in peds with Dave Nathan, another amazing, amazing guy, and that's where I met people like Larry boxer.

DAN: Larry was a colleague of mine here at Michigan.

HYMAN MUSS: I know.

DAN: Passed away about two years ago. Just a wonderful guy. He also, by the way, was my attending physician when I was a med student at Indiana on pediatrics--

HYMAN MUSS: Oh my gosh.

DAN: --just by coincidence.

HYMAN MUSS: His wife, Grace, was one of my colleagues.

DAN: Let's move on a little bit. From there, I know you went to Wake Forrest. And I have to say, how does a kid from Brooklyn, who has been at Harvard in the middle of, really, no oncology probably outside of the coast, end up in North Carolina?

HYMAN MUSS: At the Brigham, I knew I wanted to do a career in-- I wanted to try academics, but I didn't want to go in the lab. And I was actually offered a job by Gene Brown Wald and others at that time to work to stay in the Harvard system and do work on methotrexate in the lab. High dose methotrexate was hot then, and I couldn't see myself in a lab. I worked with Frank Bunn, one of the world's great hematologist at the Brigham, who is-- really became a great friend and knew me. And he said, Hy, I know you don't-- laboratory work isn't for you, so he knew someone at Wake Forrest doing work on sickle cell anemia.

They were infusing urea to try to prevent sickling. And he called this fellow, and they said they were looking for oncologists, clinicians. And I went down there and another open place. I met my future boss at that time, a guy named Charlie Spurr, who is also one of the pioneers in oncology. Gave nitrogen mustard after the war.

Just a terrific guy and probably my most-- among my most impressive mentors, and they offered me the job. And I told Loretta about it. I was thinking of Rochester and some other places, but I decided on this job. And one of the reasons was the other places I went it had snowed, and I was delayed and couldn't get out. True story.

You talk about serendipity. And I came out here. There was some azaleas blooming, and I said, I'm going. And it was a difficult adjustment for a kid from Brooklyn to go down here. My mother, who was alive at that time, never heard of North Carolina.

She was one of these women born in a candy store in Greenwich Village over a candy store by a midwife, and she said, they're going to kill you down there. And I said, I think it'll be fine, and Loretta got out of the car when we drove down here and cried. But it turned out that Wake Forrest and my mentorship and ability to work in their cancer center was incredible in my career, so I was able at Wake Forrest to really set up lots of research studies in breast cancer, prostate cancer, brain tumors. It was an open field there. They didn't have, really, many people like me, and it just was absolutely terrific.

DAN: Let me segue that. There's a lot more I want to talk to you about, but I got to know you because of our experience in CLGB and the cooperative groups. And it was clear to me right away you were a major player, but I also-- and you still are as far as I can see at CLGB Alliance. But you're one of the few people I know who then went off and started his own group, the Piedmont Group. What was the background? What made you think you could compete with the big boys, and how did you get those folks to play? And how did you also straddle two different groups at once?

HYMAN MUSS: Well, we had a very-- Dr. Spurr was an amazing man, and he realized that most oncology was going to be practiced in the community. Even at that time when I started my career, I would drive out to these small towns occasionally once a week, once a month, and actually give some of the chemo still or train nurses in practices. There were no medical oncologists around there. I took the second set of boards, so I think I'm talking about 1975 or something.

And so he knew that, and we cultivated some very strong community relationships. And we didn't have CCOPs and NCORP there. Although, Dr. Spurr and his colleagues were instrumental in getting CCOPs and things going in this country, so community people didn't have a lot they could do. It wasn't a formal mechanism. And so we formed a little small group called the Piedmont Oncology Association.

It was kind of fluffy. We didn't have 5,000 bylaws or anything. It was just a conglomerate group, and ironically, I published a New England Journal study out of that group reviewing all the things, and how long to give chemo, things that people like yourself have really expanded on and made much better. But we work with them, and then there was an announcement to form regional cooperative groups from the NCI. And I was involved in CLGB but not heavily at that time.

We didn't have all the traveling and things that we had, and now we've replaced it with Zoom meetings and things. And so I knew a lot of these people. I'd seen a lot of their patients. So we applied, and we got funding for the POA. And we did OK for a few years, and it actually is still in existence as an educational group.

But we couldn't compete with the large cooperative groups. We did well with accrual, but the brainpower to develop and keep up all the diseases-- disease sites were emerging. I was writing prostate cancer stuff. I couldn't keep up with the expertise nor could my colleagues. So it was a good experiment, and a lot of them ended-- my colleagues ended up in CCOP and now NCORP and have made major contributions. And I suspect we got people used to trials and protocols, but it was a short lived experiment.

DAN: Well, short lived but changed practice. And by the way, some of your colleagues still talk about it and what a great experience it was, so you're the-- all right the next thing I want to talk to you about is your real love, which is geriatric oncology. And you got involved in geriatric oncology before the word existed as far as I can see.

Two things, one is you weren't geriatric at the time. Although you are now, as am I. And, two, is-- just talk about the people you got involved. I know Dr. Hazzard had a big influence on you, but also Ludovico Balducci and Harvey Cohen. And tell us about how that all got started.

HYMAN MUSS: Yeah, so when I was in my career at Wake Forrest, Bill Hazzard, who's one of the grand old men of geriatrics, wrote one of the first textbooks, and is still hanging around as professor emeritus, came to all the faculty and said, I'd like you to work with one of our residents in a project related to your specialty and geriatrics. So he came to me specifically and said you would like to do this. He's my chair.

He's got to promote me someday, so I said, oh, of course. So what we did is Dr. Spurr was ahead of his time, and actually, we had codified all people in local protocols, our POA, into a database system with the punch cards from IBM, those little cards. I can remember that great movie about those African-American women where there's one woman who's the only one who knows how to use those cards.

DAN: In NASA, yeah.

HYMAN MUSS: I could go and actually ask our statisticians to run things, so what we did was we compared. We had metastatic breast cancer. We had no upper limits of age on protocols, which was very common then. We were patronizing to older people, and we compared women above 70 with 50 to 70 and less for metastatic breast cancer. And when I looked at the data, I had about 60, 70 patients, and I work with a wonderful woman who's now a medical oncologist named Kathy Christman.

She was the resident, and we put this together in a paper. And we submitted it to JAMA, and I thought, oh, they're going to-- this will be gone. And they accepted it actually without any revision. Then I had to get my friends to read it because if you read the-- if you hear the way I talk and see the way I write, we need a lot of editing here. So in any event, it got there, and I really enjoyed the project.

And I started learning about other people. Then what happens-- and you know this, Dan, your biomarker and all your expertise-- your friends start calling you. Hey, Dan, should we be doing this or that? And so they'd start to call me about older women with breast cancer and say, you think she could tolerate chemo? And so I got more and more interested. And then in the CALGB at that time, there were some other people interested, Peggy Kemeny, et cetera.

DAN: Harvey Cohen, I think.

HYMAN MUSS: Harvey Cohen. And we formed the-- and Rich Schilsky.

DAN: And Stuart Lichtman was also a big player, as I recall.

HYMAN MUSS: Stu Lichtman, yeah. I'm going to mention-- so we thought we'd form something on cancer in the elderly, and Rich Schilsky backed this up. And we made a working group, and one thing led to another. And then we became a committee. We were very successful.

We wrote clinical trial protocols not just in breast cancer. We had terrific people like Stu Lichtman. Harvey and I chaired that committee for 22 years. We didn't even know it was that long, and we saw such evolution in our field. At that time, there was expertise evolving nationally with people like Ludovico Balducci.

And I should add that early in my career at ASCO, BJ Kennedy, who's really considered one of the fathers of oncology, used to get up at meetings and when he heard a presentation and there were no older people, he said, where are all the older people there? And if you know BJ, he was not a man who was afraid to get up and speak his mind. And so he was really-- pushed this too, and Ludovico, and our cooperative group. And we slowly built up a wonderful committee. It really evolved, and then we pulled in people like the late Arti Hurria, one of the world's most incredible people, who really taught us how to get geriatric assessment into clinical trials and do it in the community. And it just evolved, and it's never--

DAN: You just stole my question, which is that you just told us about the first generation, and the second generation has taken this and run with it. This is why you're being interviewed. You were a pioneer. Arti was a settler.

HYMAN MUSS: Oh, yeah.

DAN: In terms off-- and we miss her so much. For our listeners, I think many of you know, she was tragically-- lost her life. She tragically lost her life in a car accident a few years ago, and she was on the board of directors. I remember standing with her during cocktail hour before one of the board of directors meetings, and I said, you know, Arti, you're going to be president of ASCO someday.

And, well-- and she kind of looked at me like, are you kidding? And I said, no, I'm not kidding at all. You're on your way. It's such a tragedy.

Actually, the final thing I want to do is I was going to ask about BJ Kennedy and his role in geriatrics, which you covered, but that allows me to segue into BJ's role in our field becoming a field. And you sort of stepped into his shoes, in my opinion, with the American Board of Internal Medicine, but BJ, I think, was responsible for our becoming a boarded subspecialty. Can you talk more about that?

HYMAN MUSS: Oncology, we were relatively new, and to become an ABIM subspecialty, you have to show a need, that there's a need and enough patients and that you're doing something uniquely different and beneficial. And for a long time, the hematologists were a little-- think what do those oncologists do? They have one drug. They have 5FU.

DAN: 5FU for colon cancer.

HYMAN MUSS: Yeah. And maybe nitrogen mustard or something. But so they felt there's certainly a need. There's no question cancer was a need, but they really can't do much for their patients. And it was people like BJ, Jim Holland, and other visionary guys that really worked with ABIM and pushed to make it a specialty.

And I think we began in 1973. I think hematology was 30, 50 years before because there was so much more knowledge in that field. And so it took people like BJ and Jim Holland, strong, outspoken people, to convince the board and not back off. Well, come back when you guys really have something to do for patients. No, we're doing things for patients now.

This was well before pall care and all the other things we do non-treatment related that are so wonderful for patients. And they pushed it, so this was crucial in BJ building this, and being on the front line, and doing this, and building the whole field. And then what can I say? I think we're all in the greatest field in medicine, most exciting, best biology, can do tremendous things for many sick patients. But they were the people that really got us going or it would have taken 10, 20 years more.

DAN: Yeah, it's a remarkable story. And actually to cap it off, I think you probably saw two days ago, the ACS, Siegel et al, put out their annual cancer statistics. And the last year, which was to 2018 to '19, was the greatest reduction in age specific mortality in the history of the statistical thing. And overall, since the '80s, there's been about a one third reduction in the odds of dying of cancer in this country. And it all started back with you and the generation ahead of you. I mean, there are very few specialties that can look at that kind of success, and look backwards, and talk to the people who were there. The cardiologists can't talk to Harvey and--

HYMAN MUSS: Yeah, I owe so much to my friends supporting us through the years, like you, like Larry Norton, one of my also great mentors and friends, Rick Schilsky, for just supporting the field, and the studies, and things or it never would have happened as well, and so many wonderful people involved. And so many nice things that ASCO has done, like education, and developing YIAs, and things. As you say, it's got to be the new generation. It's going to be the [INAUDIBLE], and William Dales, and all these absolutely terrific people that are going to have to push this field, Heidi Klepin. And I just was in the right place at the right time in all of this and had tremendous friendships and mentoring.

DAN: Well, and I can't remember who said it, but those who don't remember history are destined to make the mistakes of others. So one reason I'm doing this is so all those people know what it took to get us there and the history behind it. So I want to finish this by thanking you for all you've done for me as a mentor, and all you've done for our field in terms of pioneering geriatrics, and the Board of Internal Medicine, which you've been on now for, what, 15 years I think.

HYMAN MUSS: Yeah. Well, I'm off now, but I--

DAN: Oh, you're off now. OK. And mostly for our patients. So many of our patients are alive and doing well because of what you've done, so thank you very much. Appreciate your time today, and looking forward to being on the river with you someday soon.

HYMAN MUSS: Oh, yeah.

DAN: For our listeners, we both like to fly fish, so--

HYMAN MUSS: Thank you so much, Dan. I appreciate you allowing me to do this. I'm very grateful to ASCO. Thank you.

DAN: Until next time, thank you for listening to this JCO's Cancer Story, The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org.