This is the interview of Helmuth Goepfert for the American Head and Neck Society History Committee. Date of interview, February 13, 2004.
Helmuth Goepfert had a very early exposure to medicine and surgery growing up in Chile. His father was a surgeon in Santiago, Chile and exposed Helmuth to patient care rounds when he was a youngster. This piqued an interest in biology, chemistry, physics, and mathematics. The Chilean system of education is quite different than that in the US. In high school, an equivalency examination to the standard SAT was taken as a written examination about two years prior to the end of his academic year in 1955. Helmuth performed exemplarily on the SAT-equivalency exam, which allowed him to pursue medicine. If medicine was not feasible, he would have to pursue engineering, farming or a similar diversion of his interests.
Helmuth graduated with the highest grades in his medical school class in 1961. After graduation, a six-month internship was performed in surgery, neurology, and pediatrics.
In surgery, he actually performed his first appendectomy in 1958 working as an assistant to his father. He had other opportunities to work basically as a surgical assistant to his father and his surgical colleagues.
In medical school, he worked on research projects including determining the effect of radioactive iodine-131 on mice thyroid. He was also involved in an epidemiological study of pinworm infestations in a suburban shanty town in Santiago, Chile in 1957.
In 1962, Helmuth began his surgery residency in Valdivia. This area had been seriously hit in an earthquake in 1960, and had not still recovered to that time. There were significant challenges in that hospital environment, but Helmuth continued to thrive.
In 1964, Helmuth first arrived in the United States at the University of California, Los Angeles and began a fellowship in medical oncology looking at primarily solid tumor chemotherapy under the direction of Dr. W. Longmire. This exposure to systemic therapy for solid malignancy at UCLA opened the door for Helmuth at the University of Texas M.D. Anderson Cancer Center. He first arrived here in 1966 to be a project research investigator in the department of radiation therapy looking at the role of regional chemotherapy at this institution mentored by Dr. John Stehlin. As the Department of Head and Neck Surgery was evolving at that time, Helmuth was transferred to the Head and Neck Surgery Section under Dr. Richard Jesse who became chairman of the section of head and neck surgery in 1968 following the retirement of William S. MacComb.
Many individuals had profound influences upon Helmuth’s development as a head and neck surgical oncologist. Dr. Dick Jesse really ushered in the interdisciplinary management of head and neck cancer and implanted this philosophy in Helmuth who distributed it internationally. Dr. Orlando J. Ballantine, already a seasoned surgeon at M.D. Anderson really taught Helmuth the art of blood-less surgery. Dr. Gilbert Fletcher, the chairman of radiation therapy at the University of Texas helped impart an understanding of the history of cancer and the importance of sound radiotherapeutic approaches in the management of solid malignancies. The pediatric interdisciplinary management and treatment approaches especially rabdomyosarcoma led Helmuth to further develop the interdisciplinary team concept with the surgeon as the team leader and the burgeoning specialty of medical oncology at that time.
Helmuth actually planned on returning to Chile and not staying in the United States. Nevertheless, in 1967, Helmuth’s anticipated return to Chile was thwarted by basically the termination of his promised appointment in Santiago. Dr. Edgar White offered him a fellowship in surgical oncology at M.D. Anderson, including eight months of general surgical oncology and four months of head and neck surgery.
In 1968, Helmuth returned to Chile to practice surgical oncology. The environment was precarious at the National Institute of Radiation Therapy. Nevertheless, with a meager salary, and a headstrong approach, Helmuth developed the interdisciplinary pediatric tumor board. Helmuth sought to influence the Chilean medical environment through teaching other surgeons and attempting to get cancer drugs on the national formulary. As a function of the medical system in Chile, he also had to assist other surgeons and develop a limited private practice in order to just make ends meet.
The political scene in Chile in 1969 and the early 1970s led Helmuth to a decision to return to the USA. Unfortunately, visa problems led to his inability to return to the United States, and he actually went to Stuttgart, Germany and became exposed to the “silo” system of medicine in Germany and the limitations that such as system created. In 1971, Helmuth returned to Houston to pursue a career in academic surgery. He had never seriously considered private practice, but his desire to do head and neck surgery at that time was during an evolving period of transition of head and neck surgery between general surgery and otolaryngology. Ultimately, his decision to pursue otolaryngology was most significantly influenced by Dr. Bobby Alford. Dr. Alford basically called Helmuth at M.D. Anderson and offered him a residency which he rapidly accepted.
Helmuth somewhat in a backward fashion, did his residency from 1971 to 1974 following his fellowship experiences. Helmuth certainly learned the antagonistic relationship sometimes experienced between surgery and radiation therapy. Helmuth also had to deal with the unique situation of the uncomfortable nature of staff physicians working with a resident who clearly had a broad understanding of oncologic principals, and extensive surgical exposure and experience and an inquisitive intellect. The sometimes competitive nature between educator and resident continues to be of what residency stories are made. During residency, Helmuth continued to diversify his understanding of head and neck tumor sites and management approaches. He developed a staging system for paranasal sinus cancers. He thoughtfully looked at the results of radiation therapy in the management of cancers of the larynx and considered the issues of local failure, surgical salvage of radiation therapy failure, and the expanding role of partial laryngeal surgery and post-operative radiation therapy.
Helmuth became board-certified in otolaryngology head and neck surgery in 1974 and began his academic career immediately following his residency as the section head of otolaryngology head and neck surgery at the University of Texas at Houston. He was 38 years of age at that time and the only full-time faculty with all other faculty being part-time. Although a section chief at the University of Texas at Houston at Herman Hospital, Helmuth always maintained a “part-time” appointment at the University of Texas M.D. Anderson Cancer Center. For four years, this dual role was maintained, but Helmuth’s desire to be a full-time cancer care provider in an environment solely dedicated to this always emerged. Helmuth saw the gradual move of internal medicine to take over the “medical treatment” of cancer and the evolution of the field of medical oncology.
Helmuth exposed himself on the statewide and national scene via attendance at meetings and presentations in otolaryngology societies. His skillful art of presentations and conflict generation are of historical importance. Additionally, the significant friction between the two head and neck societies was at its peak during Helmuth’s academic evolution. He first joined the American Society for Head and Neck Surgery and then the Society for Head and Neck Surgeons. Both societies exquisitely respected him as a surgeon and academic leader and his influence was paramount in the tearing down of the walls and eventual amalgamation of these societies.
Many people have significantly influenced Helmuth’s academic life. Bobby Alford served as a constant counselor and sounding board for Helmuth over the years. Helmuth also had the support of Dr. Richard Jesse. Dr. Jesse’s clear decision that otolaryngology would provide the leadership for head and neck surgery for the future and that Helmuth would marshal this effort at the University of Texas M.D. Anderson Cancer Center and through the world helped create the field as we know it today.
All of these influences were also affected by illnesses, A.J. Ballantine’s illness from 1974 to 1976 as well as the rapid progressive cirrhosis of Dr. Richard Jesse from 1978 until his eventual demise in August of 1981. This amalgamation of events led to Helmuth’s resignation from the University of Texas at Houston in 1979. Personal stress in his marriage led to his separation from his wife in 1976 and he subsequently met and married Joann Goepfert in 1978.
Helmuth was appointed professor and chairman of the Department of Head and Neck Surgery at the University of Texas M.D. Anderson Cancer Center in January of 1982. One of his first missions was the creation of the interdisciplinary tumor conference which he created based upon the model of the radiotherapy planning sessions. The Department of Head and Neck Surgery began its own fellowship separated from the Department of General Surgery in 1973 and Dr. James Suen was the first fellow. The Department’s clear emphasis to train the next leaders of head and neck surgical oncology was noted in this separation.
There are many memorable experiences enumerated below.
1. Five and six hour monthly staff meetings at the University of Texas Medical School, which always appeared to be endless.
2. Helmuth having to assume “a very low-key” position during his residency in order to not threaten the junior faculty who had originally opposed his appointment. Their opposition to his appointment was usually a sense of insecurity which is not hard to understand knowing Helmuth Goepfert.
3. Helmuth Goepfert was invited by the leadership of the American Head and Neck Society to be the program chairman for the Puerto Rico meeting in the mid-1980s.
4. Helmuth was also invited by the international conference committees of both societies to help develop the programs especially in 1988 and 1992. This put Helmuth in the middle of leadership on an international basis.
5. Helmuth was requested to be the editor for the Head and Neck Surgery Journal leading this journal to become visible as a peer review journal for clinical head and neck oncology. Helmuth never had the opportunity to be trained as a physician scientist, but always advocated on the value of these individuals and served as a champion for making opportunities in this cause.
6. Helmuth helped Dr. Jesse during the latter years of his illness move towards the amalgamation of the two head and neck societies. Helmuth carried the banner for several years following Dr. Jesse’s demise including defending the cause during a meeting panel. Fortunately this eventually occurred and the American Head and Neck Society was born.
7. Helmuth recalls in the mid-1980s at the winter meeting in Utah that it was snowing and Wong Kee Hong and Gregory Wolf were both sitting at a bar with him. His words were, “Chemotherapy should be used with radiotherapy to treat laryngeal cancer. Let’s go beyond the palliative use of drugs and search for a curative use.” He believes that both probably have forgotten this incidental conversation which he suggested that the VA system would also be the best place to do the study. Not too long thereafter the first classical study was launched.
What is the current state of head and neck surgical oncology and how has it evolved over the years? Modern reconstructive surgery has made considerable contributions to head and neck surgical oncology, however the proof in the pudding requires outcome studies which have been slow to come forth. Fortunately, interdisciplinary care has become the paradigm shift with improved diagnostic imaging of pathology as well.
Few general surgeons and even fewer plastic surgeons now practice head and neck surgery. The majority of work is actually performed by otolaryngologists nationally. Unfortunately, many of these are inadequately trained and therefore improper therapy and patient selection is more commonly seen than acceptable. Helmuth has been a constant advocate against the “dabbler in head and neck surgical oncology”. Nevertheless, his beating the fist on the table has not changed this observation.