A Personal Stake in Beating Cancer

DATE June 6, 2005 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Sandra Horning and David Johnson discuss being cancer
patients as well as cancer doctors
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guests, Dr. Sandra Horning and Dr. David Johnson, are cancer specialists
who have also had cancer. They're the first cancer survivors to serve as
president of the American Society of Clinical Oncology. Dr. Horning just
started her term last month, succeeding Dr. Johnson. We invited them to talk
about their experiences with cancer and cancer treatments and how that's
affected them as doctors.

Dr. Sandra Horning is a professor of medicine at Stanford University in the
divisions of medical oncology and blood and bone marrow transplantation.
She's leading a research project on Hodgkin's disease, funded by the National
Cancer Institute. Dr. David Johnson is a professor in medical and surgical
oncology at Vanderbilt University and deputy director of the Vanderbilt-Ingram
Cancer Center. His area of specialization is lung and breast cancer.

You're both surrounded by patients with cancer. Watching them over the years,
did you worry about getting cancer yourself? Before you actually got cancer,
did you allow yourself to think about and to worry about that possibility?
Dr. Johnson, start with you.

Dr. DAVID JOHNSON (Vanderbilt University; Deputy Director, Vanderbilt-Ingram
Cancer Center): No, I don't think being involved in the care of patients with
cancer ever necessarily made me worry about getting cancer. My mother died of
cancer at a young age when I was a medical student, so cancer had been
something that I was aware of on a personal level as well as a professional
level. So I wouldn't say I worried about it, but certainly it was something
that I was always are of and certainly, you know, watched our patients
struggle with their illness.

GROSS: Well, what kind of cancer did your mother have?

Dr. JOHNSON: She had a rare form of cancer known as cholangio carcinoma,
which is cancer of the bowel ducts, the tubes leading from the liver to the
intestines.

GROSS: Dr. Horning, what about you? Did you worry about getting cancer after
having seen so many patients with it?

Dr. SANDRA HORNING (Stanford University): No, I wasn't worried about getting
cancer myself, although, like Dr. Johnson, I had personal experience in that
my father died shortly after I started medical school of esophageal cancer.
In my practice, I take care of very young patients, and I remember in training
taking care of a patient in particular who was 16 years old and dying. And I
thought to myself at that point that I would be grateful for every year of
life that I had, and I maintained that attitude to the point where I had a
personal diagnosis of cancer and continually afterward.

GROSS: Can you each tell us a little bit about the kind of practice that you
have and the kind of cancer that you had?

Dr. JOHNSON: Well, I'm practicing at Vanderbilt University. My practice is
largely geared towards patients that have lung cancer and breast cancer, but I
see other forms of cancer as well. But those are the two predominant types of
cancer that I see. My own diagnosis was of non-Hodgkin's lymphoma, which
happens to be an area of expertise of Dr. Horning's. And, in fact, she was
one of the people we consulted back when my diagnosis was made to get some
recommendations about what might be the best option for treatment during that
time.

GROSS: Dr. Horning?

Dr. HORNING: My area of specialty is, as Dr. Johnson mentioned, in the
non-Hodgkin's lymphoma and also Hodgkin's disease. These are disorders that
occur among the very young up to the elderly. And many of the patients in my
practice are treated with curative intent, so that there's a focus not only on
the cure but the least-complicated cure and survivorship issues for our
patients. My own diagnosis was of breast cancer nine years ago.

GROSS: Did you diagnose the cancer yourselves, or did you not know you had it
until seeing a doctor?

Dr. HORNING: I could start with that because I think I have one of those
stories that is not all that atypical, which is that I myself detected
something that was different and was concerned. I first asked my husband
about it, as he is also an oncologist, and he reassured me. I then went to
see an internist, who performed an exam, reassured me; had a mammogram, was
told that that was normal. I also saw a gynecologist, who felt that there was
nothing to be concerned about. But I continued to be concerned and, on that
basis, actually asked a colleague of mine, who's a surgical oncologist, to
perform an examination, which she did. And we agreed together that further
diagnostic testing was in order. Afterward the diagnosis of breast cancer was
made.

GROSS: I find stories like that so frightening 'cause every step of the way
you were basically told not to worry, until you pushed it further.

Dr. HORNING: Well, I think it's an example of a story that I've heard
certainly on several occasions, and it's an important message, particularly
among women who are premenopausal and may have a difficult breast to examine.
Mammography is notoriously difficult in younger women or women with dense
breasts, and it's an important lesson, if you know your body and you determine
a change, that you really need to carry your concern to resolution.

GROSS: Dr. Johnson, did you kind of surmise yourself that you had cancer, or
was that diagnosed for you?

Dr. JOHNSON: Well, my situation's a little bit different, but I first noticed
an enlarged lymph gland, oh, a week or two after Christmas. We had purchased
a kitten for my daughter, and while playing with the kitten with her one
evening, the cat scratched me on my leg, and a few weeks later a lymph node
developed in the groin area. There is a well-known entity known as cat
scratch fever, and, frankly, that's what I thought I had. So I watched this
lymph node for a bit and, more or less, self-medicated myself for the presumed
diagnosed. But after a few weeks, when things did not really improve and I
began to lose some weight, I thought it warranted more careful evaluation and
a biopsy.

So like Sandra, I went to a surgical colleague of mine, who generously offered
to do the biopsy the day before we left for a little family vacation, which
actually was closer to the time of my daughter's school spring break. And so
he did the biopsy on a Friday afternoon, and we had left to go on a vacation.
And on the following Monday he called me to tell me that the diagnosis was
lymphoma.

GROSS: Did you both go through the `Why me?' kind of response after you were
diagnosed, especially--I mean, both of you, you've decided your lives to
helping people with cancer, and then you were hit with it yourself.

Dr. JOHNSON: No, that's never a question I ask myself. The first thought I
had was, `I'm glad it's me and not my wife or my daughter.' And the second
thought I had--and it may seem a bit odd--is that I was in some ways not glad
but thankful that I didn't have to talk to either of my parents about it. My
mother, as I mentioned, had already passed away when I was a medical student.
My father died when I was in my cancer training. And I'm not sure I could
have mustered up the courage to discuss with my parents, you know, a
potentially terminal illness. And I also--I'm fortunate that I have several
brothers and sisters, so I was concerned about informing them. So, really, my
thoughts were entirely focused on my family. I don't recall ever having
thought, `Why me?'

GROSS: Dr. Horning, what about you?

Dr. HORNING: Well, likewise, I never addressed the question `Why me?' As
with Dr. Johnson, I think my greatest concerns were dealing with my immediate
family and particularly my children.

GROSS: My guests are Dr. Sandra Horning and Dr. David Johnson, respectively
the current and former presidents of the American Society of Clinical
Oncology. We'll talk more about their experiences as cancer patients after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guests are Dr. Sandra Horning, the
president of the American Society of Clinical Oncology, and Dr. David Johnson,
her predecessor as president of the group. They both treat patients with
cancer, but they also have both had cancer.

There are so many difficult medical choices you have to make after diagnosed
with cancer. And I've met so many people who felt like they had to research
their own disease: going on the Internet, going to the library, going to
different doctors, assembling as much research as you can, so you can make
complicated decisions about what kind of treatment you want to get and come to
some kind of understanding of what to expect. And, still, those decisions are
sometimes incredibly difficult to make. Being as informed about cancer as you
both are, as oncologists, did you still have to arm yourself before
confronting the decisions you had to make about your own cancers? Dr.
Horning, let's start with you.

Dr. HORNING: Well, as you indicate, I have more background knowledge than the
typical patient with breast cancer. But I feel very strongly that one needs
to take advantage of the expertise of those who really focus on a single
disease. So I was completely prepared to put my faith and trust in
individuals who were true experts in breast cancer. However, I did solicit
the opinions of several experts and did some of my own background reading and
brush-ups since, as I indicated, I am relatively focused on the diseases that I
treat.

I found it difficult to pour over survival curves and wonder where I might
fall on a survival curve over time. I remember also, shortly after the
diagnosis and as I was actually entering my treatment, being at a meeting
where someone mentioned to me in the context of this meeting, which was based
upon long-term complications of treatment--saying to me, `Well, at least with
Hodgkin's disease,' the disorder that I treat, `one knows if he or she is
cured in a short time. But if you have breast cancer, you know it can recur
at anytime.' And those kinds of zingers still come in to haunt you.

GROSS: Dr. Horning, were there any particularly difficult decisions you had
to make about what treatment you were going to have? Were there any decisions
to where it just wasn't clear-cut and you had to struggle to make up your
mind?

Dr. HORNING: Well, things happened rather fast and furious at the beginning,
and it was clear to me that the decision that was the most difficult for me
personally, which was a major surgical procedure, had to be done. So it was
clear-cut, but it was difficult, after which I needed to make a decision,
together with my physicians, regarding the systemic therapy: chemotherapy,
hormonal therapy or a combination that would come thereafter. And I think the
only difficult decision, as it were, related to the duration of treatment and
whether or not I would also receive hormonal therapy in addition to the six
months of chemotherapy.

GROSS: Dr. Johnson, I believe you opted to take an experimental form of
therapy for your cancer. Can you tell us why you chose that and what the
therapy was?

Dr. JOHNSON: The therapy I received was one that was thought to be more
advantageous than the so-called standard therapy at the time. And this
decision was made after consulting with various individuals. One of the
advantages I saw in the therapy we selected for my treatment was that it was
very short. In other words, rather than the customary six months or so that
it might ordinarily take, this particular program was completed in a period of
about three months. I did not wish to interfere, if you will, in my practice
or my career any more than I had to, so that was very attractive to me.

It turns out that a study that was ongoing at that time, for which I was not
eligible--but had I been, I would have joined--later demonstrated that the
more standard therapy, the one we still use today, was as good, if you will,
as the therapy I received, which was perceived to be a better therapy but
turned out to be no better in terms of its outcome but somewhat worse in terms
of the side effects, at least the acute side effects. There are also...

GROSS: What were they?

Dr. JOHNSON: Well, for me, the most severe sign effect was the extreme
fatigue that was associated with treatment; extreme mucositis, which is
soreness of the throat and mouth, much like what one would experience after
drinking a hot cup of coffee, but just magnify that by about a hundredfold, so
difficult that it was at times hard to even swallow saliva, much less food.
And I also experienced something that doctors in our field refer to as
Palmar-Planter syndrome or hand-foot syndrome or--there are other terms that
are used, but basically the palms of your hands and the soles of your feet
become extremely tender ...(unintelligible) this red. And the skin can peel
off, so that you have--it's like you've burned your hands and feet. So it's a
very unpleasant and rather painful situation.

The nausea and vomiting part of it was not pleasant, but I was fully prepared
for that and expected that. The other side effects, of course, I knew would
happen. But I think the one that was most surprising to me was the level of
fatigue that I experienced. I'm a fairly energetic person, and, you know, I'm
not out playing basketball or doing things of that nature, but I'm a hard
worker. And that really was psychologically demoralizing to not even be able
to concentrate on reading, for example, very effectively. So that was the
part that was most surprising and difficult for me.

GROSS: Dr. Horning, Dr. Johnson said one of the things that surprised him
most when he had cancer was the extreme fatigue. What are some of the things
that surprised you most about the symptoms that you experienced from either
the cancer or the treatment?

Dr. HORNING: One of the things that I wasn't prepared for, which I relate
more to the diagnosis and the psychosocial aspects of having cancer rather
than the specifics of treatment, was the difficulty in sleeping. I'd been
told by various patients over the years about their problems with sleeping,
but for me, for several months' period of time, I could not sleep at night.
And what was on my mind constantly was mortality. I think contributing to
that difficulty in sleeping was that I was on a fast track to menopause, so
that is a well-known side effect of entering menopause in combination with hot
flashes. But that lack of sleeping paired with the effects of the
chemotherapy also left me very fatigued. I definitely recall days when I
simply had to put my head down on my desk because I was just too tired to
continue.

Other side effects that I was a bit surprised about, with the specific therapy
that I was taking, was the fact that I lost weight rather than gained weight,
which is a more common effect of that particular treatment. And I also had a
fair amount of gastrointestinal difficulties, including diarrhea. So I had to
work my life around basically being prepared to deal with side effects when
and if they occurred.

GROSS: Let me ask you the mortality question. You--one of the things keeping
you from sleeping when you had cancer was thinking about your mortality,
certainly a really obvious thing to think about if you have cancer. There's
no simple way of dealing with that. I mean, this is a reality that, you know,
your life is in danger. So how'd you deal with it? Sleeping pills? Therapy?
Just kind of lying awake at night and accepting the fact that you were going
to be worried?

Dr. HORNING: In general, I did not take sleeping aids, and I felt, you know,
that this was something that was going to pass. I did a fair amount of
research as to, you know, why this might be happening. And I came to grips
with what I think I was really dealing with--was a grieving process. I think
I was grieving for the loss of health. It is a loss, and when losses occur in
various aspects of life, we're asked to deal with it. And I think when this
occurs at a time in your life when you are a responsible individual, as a
mother, as a wife, as a physician or whatever, you know, you're used to being
strong and maintaining in the face of adversity. And perhaps this sleeping
problem that I was having was a way that this was coming out when it could
come out, which was at night.

GROSS: Dr. Sandra Horning is the current president of ASCO, the American
Society of Clinical Oncologist. She's a professor of medicine at Stanford
University. Dr. David Johnson, the former president of ASCO, is a professor
at Vanderbilt University and deputy director of the Vanderbilt-Ingram Cancer
Center. They'll be back in the second half of the show. I'm Terry Gross, and
this is FRESH AIR.

(Soundbite of music)

(Announcements)

(Soundbite of music)

GROSS: Coming up, more with oncologists Sandra Horning and David Johnson
about what being cancer patients taught them about being cancer doctors.
Also, rock critic Ken Tucker reviews the new documentary "Rock School" about a
place in Philadelphia where kids and teen-agers learn to play power chords and
drum solos.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross back with Drs. Sandra Horning and
David Johnson. They're the respective current and former presidents of the
American Society of Clinical Oncology. They're the first cancer survivors to
head this organization of cancer doctors. Dr. Horning is a specialist in
Hodgkin's disease and non-Hodgkin's lymphoma. She had breast cancer. Dr.
Johnson is a specialist in lung and breast cancer. He had non-Hodgkin's
lymphoma.

What was it like for you to be doctors who had also become patients? Were
there things you feel like you learned about what it's like to be a patient
from having cancer yourself? Dr. Johnson?

Dr. JOHNSON: Well, that's the main question I get asked all the time--is:
Did I alter how I administer to others? And the short answer is I don't think
so outwardly. I'd like to think that I was always a good physician and one
who cared about my patients and sympathized and empathized with them.
However, there is simply no way one can go through a diagnosis and treatment
of cancer without having been changed.

And so as much as I would like to tell you that I'm no different now than I
was before, there's no question that I'm different. I'm sure I'm pained just
a little more when I talk to patients and I know how this diagnosis will
impact them and not just the individual but their entire family, their nuclear
family and then their friends and colleagues. I mean, it really is like
throwing a pebble in a pond; there's a ripple effect that takes place. And
having experienced that, I'm sure that, you know, inside I feel that. I know
I do.

So I do think it's altered, to some degree, my approach to patients. I also
think that I'm better able to describe the side effects of treatment. I've
been glib at times and said, `One doesn't have to be shot with a bullet to
know that it's a bad thing.' On the other hand, if you've ever been shot with
a bullet, you know it's a bad thing, and you know exactly how to describe
that. So I do think I have the ability to describe, on a personal level, what
the side effects might be for an individual. But, again, I would emphasize
that we're much better today at controlling those side effects, and so,
thankfully, fewer patients have to experience these types of side effects.

GROSS: Dr. Horning, do you feel like being a patient changed you as a
doctor?

Dr. HORNING: I think my lifetime experience with cancer has enabled me to be
a better physician for my patients and also for their families. Dealing with
my father's cancer diagnosis and the impact of his death on my mother, my
brother and myself, going through a cancer diagnosis with my mother, not once,
but twice, as well as myself, I think, has given me a perspective that allows
me to deal with the group that cancer affects, not just the patient, but the
family and sometimes the friends as well.

I feel that it has influence me in the speed and the manner with which I would
deliver test results, knowing how one is really on needles and pins waiting
for that information. Like Dr. Johnson, I've always prided myself on being a
sensitive physician who really cares for her patients. But I do think that
it's given me additional ability to empathize and particularly given me
insight into the emotional and physcosocial aspects of cancer diagnosis.

GROSS: I'm glad you mentioned the speed of delivering test results 'cause
that's--it's not a big deal to get test results back to people in a timely
fashion. Vut it means so much to the person getting the results, to know, you
know, whether you're healthy or whether you have cancer or whatever the test
is for.

Dr. HORNING: It was such an important issue for me, as I waited to hear the
results of my axillary dissection and lymph nodes, whether they were or were
not involved with breast cancer. And I remember being out for a walk, a short
one, as I was recovering from surgery with my husband. And we were waiting
for that call and being hailed in the driveway by someone in the house that
the surgeon was on the phone with the results almost immediately as soon as
they were available. And I was very appreciative of that.

GROSS: And the results were that it had not spread to the lymph nodes?

Dr. HORNING: That's correct.

GROSS: You know, a lot of people complain that when they're a patient, that
they're seen as their disease and that they're not seen as a full-dimensional
person. You were mostly dealing with doctors who knew that you were doctors,
and you might have already known them professionally. But did you get a taste
of that, of that feeling of being reduced to whatever the disease is that is
afflicting you at that moment?

Dr. HORNING: Well, I never had that feeling, but I have to say that what you
are referring to, I think, is a really important part of the training of young
doctors. When I was training in internal medicine, in my residency program,
one of the questions that the attending physician would ask us is, `What is on
the bedside table of the patient?' once we were outside of the room. And we
always were required to know more about that patient's personality and their
persona before illness as a part of caring for them. I love it when I'm
attending in the hospital and my patients have pictures from home, especially
pictures when they were well and together with other family members. It's a
very important part of understanding the individual that you're taking care
of.

GROSS: I know of one doctor who was a specialist in breast cancer, and she
had breast cancer. And after returning to her practice afterwards, she
retired early and felt that she just couldn't surround herself with cancer all
the time anymore, that she had to just leave the field. Both of you have
stayed in oncology, and you both became presidents of the American Society of
Clinical Oncology after having had cancer yourselves. Have there ever been
moments in your career where you felt, `I can't surround myself with this much
cancer anymore. I have to get out'?

Dr. JOHNSON: Well, my response to that is that with my diagnosis and
treatment--and I was confident that I was going to survive--it just
intensified my desire to be involved in trying to improve the situation for
patients like myself as well as all of my patients. So if anything, it sort
of intensified my ardor for what I do, and I can't imagine doing anything
else, quite frankly.

GROSS: Dr. Horning?

Dr. HORNING: I think my feelings are very similar to Dr. Johnson's. At the
time of diagnosis and particularly entering into treatment, most people do go
through an assessment of where they are in life and are they happy with what
they're doing and how do they want to continue. And as I evaluated, I
realized that I really loved being a physician, an oncologist, and that I'm
totally passionate about taking care of the individuals that I see with cancer
diagnoses but, you know, in particular, working toward improving outcomes of
better therapies, safer therapies.

Initially, when I had the diagnosis and went through treatment, I found it
more difficult to deal with very desperate situations. But with time, that
eased, and I think that that was directly what I was discusing earlier about
the, you know, kind of constant daily thinking about your own mortality. And
it is something that, at least for me, was eased with time, so that I no
longer think about that on a daily basis.

GROSS: My guests are Dr. Sandra Horning and Dr. David Johnson, respectively
the current and former presidents of the American Society of Clinical
Oncology. We'll talk more about their experiences as cancer patients after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guests are the first two cancer survivors to head the American
Society of Clinical Oncology. Dr. Sandra Horning, the new president, had
breast cancer. Dr. David Johnson, the former president, had non-Hodgkin's
lymphoma.

What are some of the ways that you think cancer treatment has changed in the
past few years, and what are some of the more promising things you can tell
your cancer patients now about, not only the outcome of their cancer, but how
difficult the treatment is going to be?

Dr. JOHNSON: Well, something that the public sees or reads a lot about are
the so-called targeted therapies, drugs that are designed to principally
attack the cancer and not impact indiscriminately on the normal tissues of the
body. We're not quite there yet, but we certainly have drugs that are much
more focused on the cancer, the way the cancer gains a survival advantage, if
you will, that are less damaging to normal tissues. Those drugs sometimes can
be used in isolation. But, frankly, more often than not, they're used in
combination with existing therapies, like chemotherapy. So some of the
perceived or theoretical advantages of the drugs with regard to side effects
are not being fully realized as of yet.

But the good news is we have drugs that be used in combination that will
prevent or minimize nausea, for example. We have drugs that actually can
improve fatigue, not in every case but in some cases. We have medications
that can minimize the drop in the blood counts that occur commonly with
chemotherapy. This is important because if one's white blood cell count falls
to a lower level, you become much more susceptible to developing an infection,
and the infection can be quite serious, even life-threatening. But we have
mediations that can minimize that risk.

So over the past two decades the improvement in supportive care medications
has been really dramatic. I think if I were treated today, many of the side
effects that I described to you earlier would be far less or, in some cases,
maybe nonexistent. So I think we're seeing real progress, not only on the
therapeutic side, but in the supportive care side of treatment of cancer.

GROSS: I know when I see a doctor, I like the doctor to tell me with
certainty that I'm going to be OK, whether it's a major or minor thing. I
want to hear a confident and certain doctor that everything's going to be
fine. And, of course, that's not an answer you can always provide. When
you're dealing with cancer patients, you're dealing with a level of
uncertainty, both in terms of the outcome of the cancer and the outcome of the
treatment for the cancer--you know, what kind of symptoms you're going to get
from the chemo itself. Uncertainty, for most of us, is really hard to deal
with. So I'm wondering how you both dealt with uncertainty in your own bouts
with cancer and how you deal with it as the doctor giving information to
patients, knowing that there's a degree of uncertainty in whatever you can
tell them.

Dr. JOHNSON: That's probably the single most difficult thing we do on a
regular basis. The reality is most physicians never have to spend, you know,
a regular amount of time, if you will, discussing terminal diagnoses with
their patients. I mean, even your primary care physician, in his or her
lifetime, probably deals with only a small number of patients who actually
succumb to a serious illness. That may be surprising, but that, in fact, is
the reality. In our practice, this is a daily occurrence. And practice
doesn't make perfect, I would add. Each case is individual. It's always
difficult to convey a difficult diagnosis like cancer and the fact that
someone may not survive that diagnosis. Hopefully, we all learn with time how
to do that in an empathetic fashion.

The fact is all of us are born to die. That's a fact that is inescapable.
We're very good at denying that fact. Most of us don't spend our day thinking
about our mortality. But as Sandra pointed out, once you've had the diagnosis
of cancer, that equals death in the minds of almost all of us. So all I can
say is that it's a very difficult conversation that we have with each
individual patient. And I can't give you a script because we don't have--or
at least I don't have a script. I have to look at each patient's case
individually and discuss with him or her what I perceive to be the best course
of action.

Of course we give hope. Hope is a very important aspect of what we provide
our patients. When there is no hope left in terms of the option of curing
that patient, our job is not to provide false hope, but to smooth that
passage, if you will, to one's death. That's another aspect of what we do on
a regular basis.

GROSS: So you see that as a part of your work as an oncologist?

Dr. JOHNSON: I think it's an absolute critical and essential part of what we
do as oncologists.

GROSS: Do you discuss the fact that you've had cancer with any of your cancer
patients?

Dr. JOHNSON: The answer to that is I do. But I didn't when I first recovered
from my treatments.

GROSS: Why did you not do it then but you do it now?

Dr. JOHNSON: I felt it was kind of selfish, to be blunt. But, frankly, what
happened is most of the nurses that I work with would tell patients, `You
know, Dr. Johnson has had cancer, too.' And that--and I realized very quickly
thereafter when patients learned that, that they wanted to know more. And so
now I don't make it a point to say, `You know, I've had cancer, too,' but if
the issue comes up, I'm more than willing to discuss it in as much detail as
the patient would like.

GROSS: Dr. Horning, do you mention it to your patients?

Dr. HORNING: I'm very selective about mentioning it for the simple reason
that I do want to, you know, focus on the patient. But there are certain
circumstances that arise where I think it's going to be really helpful for
that individual patient to let them know that I've been through this; they
can do it. And if there are, you know, particular issues that they're dealing
with that I think to share my experiences would be helpful, I freely do so.

GROSS: Dr. Horning, you're the present president of ASCO, the American
Society of Clinical Oncology. And, Dr. Johnson, you preceded Dr. Horning as
president. Have either of you spoken to the members of the group about things
that you've learned about the field based on being a patient and things you
think other doctors need to consider based on your experience as being a
patient?

Dr. JOHNSON: Well, I'll address that this way. During my presidency, I made
it a point to focus on survivorship. I'm sure that in part came from my own
experience as a survivor. Actually, I asked Sandra is she would lead a task
force on survivorship, which she gladly did and has done admirably and
wonderfully in my view. And I'm hopeful that many of the initiatives that
have been started in my term and with Sandra's help, quite frankly, will
continue and will help draw even greater attention to these issues within our
society.

GROSS: I want to thank you so much, both of you, for talking with us. Thank
you.

Dr. JOHNSON: You're more than welcome.

Dr. HORNING: Thank you.

GROSS: Dr. Sandra Horning is the current president of ASCO, the American
Society of Clinical Oncologists. She's a professor of medicine at Stanford
University. Dr. David Johnson, the former president of ASCO, is a professor
at Vanderbilt University and deputy director of the Vanderbilt-Ingram Cancer
Center.

(Soundbite of music)

GROSS: Coming up, Ken Tucker reviews the new documentary "Rock School" about
a place where kids learn power chords. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: New documentary "Rock School"
TERRY GROSS, host:

A new documentary called "Rock School" profiles the Paul Green School of Rock
Music in Philadelphia, an after-school program that teaches young people the
rudiments of hard rock in a novel, aggressive way. Our rock critic Ken Tucker
has a review. But, first, here's one of Green's students playing Santana's
"Black Magic Woman."

(Soundbite of music; cheering)

Unidentified Man: Ladies and gentlemen, our tribute to the guitar gods.

(Soundbite of "Black Magic Woman")

KEN TUCKER reporting:

If you saw Jack Black lead schoolkids in the ABC's of AC/DC in "School of
Rock," you ain't seen nothing yet. In "Rock School," a new plugged-in,
turned-on documentary, real-life Philadelphia after-school teacher Paul Green
yells, cajoles, jokes and kicks at walls to inspire a bunch of nine- to
17-year-olds to thrash authoritatively through Black Sabbath and Frank Zappa.

Green is a stubby scrapper who looks to be in his 30s. He's given up his
dream to be the best rock star guitarist and replaced it, he says, with
another one, to be the best rock music teacher. We live in a society where
aspiring to be a teacher of troubled and troublesome kids gets you a slim
paycheck, pitying looks and empty praise about what a noble calling you've
chosen. But Paul Green is the sort of devoted teacher that would give Laura
Bush pause. He doesn't want your stinking pity or your admiration. He wants
to kick out the jams with a band he builds from the ground up, filled with
malcontents who can perform wizardly guitar solos on Santana's "Black Magic
Woman" or strain their tender vocal cords screaming the lyrics to Black
Sabbath's "Iron Man."

Paul Green shocks disaffected kids out of their complacency by asking his
class, `Do you love Satan? I want to give you the gift of rock. That's what
Satan gives you.' In other words, Green wants to startle these kids into
questioning what teaching and learning is all about, to argue with them and
then buckle down and get to doing Satan's work because, in this context, the
devil takes the form of intricate chord progressions and maintaining the beat
through the abrupt time signature changes in a Frank Zappa rock opera.

"Rock School," directed by Don Argott, would seem like the exact opposite of
another school music documentary, the beautifully entrancing "Mad Hot
Ballroom." Paul Green gets mad and hot, all right. He bellows at his 120
students, pushing them hard. He's not politically correct. `Don't look at
your fingers,' he yells at a boy struggling to master a guitar rift. `You
want to be a girl guitar player?' he taunts. `You want to be in the Bangles?'
One of the pleasures of "Rock School" is that the kids give as good as they
get. This young boy, for example, clearly has no idea who the Bangles even
are and gives his phrenetic teacher a stare that stops the sarcasm.

But Green gets results. A teen named Will tells the filmmakers that in his
public school, he was diagnosed as, quote, "retarded," and that he's tried to
commit suicide, quote, "many times." `If it wasn't for Rock School,' he says,
peering at the camera through thick glasses with a muttering voice, `I'd
probably be dead.' As for Green himself, here's what he says are his goals.

(Soundbite of "Rock School")

Mr. PAUL GREEN: So, basically, I have two goals with the kids: get the kids
to realize their potential musically, to get them as good as possible, and
then to get them out on stage in front of as many people as possible. So, you
know, my only real interest in any of these kids is to really see what they
can do once you sort of strip away the fear and the laziness.

TUCKER: To strip away the fear and laziness in his students--I've never heard
my own kids' teachers declare this as a goal on parents' night, and believe
me, I wish I did.

Watching "Rock School" is an exercise in exhilarating ambivalence. I think
Green's taste in musical material, for example, is lousy. I don't have much
use for Zappa or Sabbath, but I get why he uses that stuff. It's loud and
aggressive, just like young people are. And it often seems chaotic and tossed
off, the way so many of their lives can seem. By teaching them that there's a
lot of rigor and complexity behind even the most vulger Frank Zappa
compositions, Paul Green is letting his students in on a secret of life beyond
school: Even stuff that looks easy is hard to do well.

The movie peaks with a trip to Germany, where he takes the band he's molded to
an annual Zappa festival. He's told them that he never wants their adult
audiences to, quote, "come look at kids playing music, but to come look at
kids playing music well." He's prepared them to be judged just as severely by
hard-core Zappaphiles as any of the middle-age geezers who precede them on
stage trying to recapture their mothers-of-invention-spent youth.

Director Argott has done a very tricky thing. He's made a film that's easy to
love with a protagonist who's hard to like. You're going to come out of this
movie debating whether Paul Green deserves the MacArthur genius grant or to be
brought up on charges of child emotional abuse. Me? I'd hand out DVD's of
"Rock School" to everyone in the country with a teaching degree and dare them
to match this level of commitment.

GROSS: Ken Tucker is FRESH AIR's rock critic and film critic for New York
magazine.

(Credits)

GROSS: I'm Terry Gross.
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