00:00:00HATHAWAY: Since I probably won't call you by name, I will say your name in the
beginning. I'm interviewing Yusuf [A.] Hannun. [Pronounced] Hannun is right?
HANNUN: Yes. That's correct.
HATHAWAY: At Duke [University Medical Center]. I don't alter the beginning. I
always simply ask where and when you were born. Do you want to start there and
just talk about your family?
HANNUN: I was born in Dhahran, Saudi Arabia. My father [Awni Hannun] was a
physician at the Arabian-American Oil Company, ARAMCO. We were living in sort of
the town [Ras Tannoura] built by ARAMCO to house families who came to Saudi
00:01:00Arabia to work there. That's where I spent the first four to five years of my
life mostly, as the first child. I'm four years older than my brother [Imad
Hannun]. My sister [Rana Hannun Bibi] is two years younger than my brother.
HATHAWAY: So, you were the only one born in--
HANNUN: I was the only one born in Dhahran. My brother was born in Beirut,
[Lebanon], but he came back to Dhahran for a little while before we finally
moved to Beirut. So he was born in that transition period.
HATHAWAY: And what's your birth date, just for the record?
HANNUN: My birth date is September 18, 1955. We moved to Beirut--I'm not a
hundred percent sure now--in '60 or '61.
00:02:00HATHAWAY: Why had your father taken the job with ARAMCO?
HANNUN: Well, my father is a physician. He was originally Palestinian, but he
had left Palestine in I would think the thirties, went to Glasgow, Scotland, got
his M.D. degree there and training, and joined the British army for World War
II, because he couldn't go back to his country during World War II.
HATHAWAY: Because nobody would--
HANNUN: There was no transportation, basically. He joined the British army as a
medical officer and spent the balance of the war-- I don't know what year he
joined, but he spent several years until the end of the war with the British
00:03:00army, mostly in Europe. After that, I think he returned back to Palestine. That
was the interphase between World War II in '45 and the partition in '48. He had
to leave then as part of the evacuation, deportation, what have you, that
happened, the massive exodus that happened in '48. I think at that time he went
to Jordan, worked as a physician there, but then went to Saudi Arabia. So most
of the fifties I think he was in Saudi Arabia.
HATHAWAY: Perhaps it was a better opportunity, perhaps even more lucrative than
practicing medicine in Jordan. Was he practicing medicine in the Palestinian
HANNUN: In Jordan?
HANNUN: I really don't know the details of that. I know for one thing he was
00:04:00somewhat politically involved in Jordan. We still have the same king in Jordan
from the fifties.
HATHAWAY: Hussein [I], right.
HANNUN: Hussein. My father, after being in the British army, went back to the
Jordanian army as a physician, and with some political discontent or something
he quit that job. I think from there he went to Saudi Arabia for a job
opportunity. Maybe there was some sort of political conflict--nothing
serious--but something that he probably wasn't comfortable staying in Jordan for.
HATHAWAY: I realize this is more about your father, and so it really is just
background. But if I understand correctly, there is a very large Palestinian
population, and I believe that Hussein has been allied with them. I mean, there
00:05:00has always been some tension between Jordanian nationals and Palestinians, but
there has always been a political connection between Hussein and his maybe
staying in power or support.
HANNUN: That's a good assessment. I think it's an important question because a
lot of those concepts I think are formative for me in terms of my political
awareness. The funny thing about it was Jordan was carved out by the British and
French after World War I. After '48 there was a massive exodus of Palestinians,
so there's a big segment of Palestinians. I think now it's estimated at 60
percent or something. And then there is a 30 to 40 percent sort of the
00:06:00indigenous population of Jordanians, who were either tribal people or the sort
of people who lived in a couple of cities there.
HATHAWAY: I guess I wasn't aware that the Palestinian population was then a
HANNUN: It is.
HATHAWAY: I knew it was a large segment, but I didn't realize it was actually--
HANNUN: Yeah. It is a majority. The funny thing about it, though, is the king is
not one of those indigenous Jordanians. The king comes sort of from the Arabian
peninsula lineage that he traces all the way back to the prophet Muhammad.
Again, between World War I until World War II, that family has-- I forget the
lineage. His uncle was prince of Iraq [Faisal], and his grandfather or his
00:07:00great-grandfather [Hussein] tried to establish sort of an Arabian kingdom
between Syria and Jordan and Iraq. And then his son [Abdullah] became king of
Jordan and the other son [Faisal] king of Iraq. Hussein inherited his kingdom
from his grandfather as a very young person. And he's survived since then, which
is pretty remarkable for the Middle East. The king has sort of always balanced
all kinds of opposing forces. There's a lot of intermarriage between the
Jordanians and Palestinians. So now it's very difficult to distinguish, I think,
subpopulations there, except that there are the different kinds of Palestinians,
as we talked about the other day briefly, in Jordan as well as in Syria and in
00:08:00Lebanon and probably in Egypt. These are the countries where most of the
Palestinians sort of immigrated to after '48. I think from my understanding, the
Palestinians who were not endowed with either special skills or education ended
up in the refugee camps, where they still are. That defines sort of one
population of Palestinians. And then another population, of either the educated
or people who had skills to promote, defined a very active work force, usually a
highly skilled work force, because the Palestinians apparently were and remain
the most educated population in the Arab Middle East. A lot of the business
00:09:00people, the finance people, the physicians, the engineers in Lebanon, Syria,
Jordan were Palestinians. So there is that population. That population, I think,
mixed much with the Jordanian population in Jordan, mixed somewhat with the
Syrian population, probably to a lesser degree with the different Lebanese
populations because Lebanon tends to be more strictly defined along ethnic or
So that's sort of my father's background. I think the main reason he went back
to Saudi Arabia is I think he was politically unhappy with Jordan at that time
aligning with Iraq and what was the Baghdad Pact. And his being in the military,
sort of, I think he resigned and just left the country.
HATHAWAY: That perhaps his own political views were known and he would no longer
00:10:00make it any further or would be in a very uncomfortable position, anyway.
HANNUN: Probably something like that. I don't think he was in danger of being
imprisoned or hurt, but I think he was just not comfortable with being part of
it, I guess.
HATHAWAY: Do you know how he became involved in this? Do you know whether it was
through his involvement in the war, let's say, in Europe and through British
connections? Or do you think it was from family connections and his growing up
HANNUN: I think the latter, much more the latter. think his sort of experience
in the Second World War enabled him to assume a top position in the medical
branch of the army in Jordan because he was sort of uniquely qualified for that
position. But I think his sort of political activism, in retrospect, like many
00:11:00of his generation, was very naive and very impulsive and was shaped a lot by the
events that were happening in Palestine over the thirties and forties and
whatnot. People just didn't comprehend what was going on in terms of the
creation of Israel, the support of the West for that, and sort of the major
friction that arose between the West and the Arab Middle East. I think a lot of
that resentment and sort of denial led to very naive political activism that
pretty much led nowhere. That's obviously in retrospect. I think those were the
greater motives for that.
HATHAWAY: And as you say, your family moved back to Beirut when you were--
00:12:00HANNUN: Approximately five years of age.
HATHAWAY: So that really to talk about Dhahran beyond perhaps one or two very
vague memories is really not--
HANNUN: Yeah. I have some happy recollections of Dhahran. I don't know whether
it was the atmosphere there, being the only child at that time. I think jobwise
my father was in a very good position. I think he was the director of the
hospital there, too, for ARAMCO.
HATHAWAY: And so this would have been a hospital for any type of foreigner, in
other words, American, British, and other Middle Eastern.
HANNUN: Most of the foreigners who lived in-- Actually, it's not Dhahran. It's
called Ras Tannoura. It's where the refinery is. From my recollection, it's like
00:13:00regular suburban USA, you know, individual homes with a little garden and then a
supermarket and all that transplanted there. I do have some recollections of our
neighbors. One family was a physician from India. Another family was-- God, I
forgot. Definitely a couple of American families there and one with kids my age.
I remember those somewhat vaguely too. So these are my recollections of that.
They were happy years, I think, but I have a feeling that my parents didn't want
to bring us up in that environment.
HATHAWAY: For what reasons?
HANNUN: Maybe for sort of-- I don't want to say political, but maybe social
00:14:00reasons. They didn't want us to grow uprooted, basically. I mean, it was
predominantly an American cultural impact there. That I think became quite an
obvious concern for them--that I was growing up with English as a first language
and not being part of an Arab culture.
HATHAWAY: You say English was your first language, obviously was spoken
everywhere outside of your family. But I take it you were speaking Arabic at
home. Although your father, of course, was, I'm sure, more than fluent in English.
HANNUN: I would say at home it was mostly Arabic, but then because it was such a
close neighborhood, the common language was English.
HATHAWAY: And your mom [Aida Ashour Hannun], where did your father meet her or
00:15:00what was her--? I mean, she spoke English, too, then, I take it.
HANNUN: Yeah. My mom was also of Palestinian origin. Her family immigrated to
Lebanon in '48, and that's where she went to high school and college or maybe
just college. I forget if she had finished high school before '48. They got
married in the early fifties. I think it was more or less a prearranged-- Not
prearranged but sort of through mutual friends that my father was introduced to
my mother and they got engaged and then they got married. And then my mom went
00:16:00back to Saudi Arabia with my dad. I think the choice of Lebanon over Jordan was
dictated by, one, I don't think my father still wanted to go back to Jordan at
that time, and [two] my mother's family was all in Lebanon. So they decided to
go to Beirut at that time.
HATHAWAY: And your father's family, had they--?
HANNUN: If you want to get back into that kind of history, it's--
HATHAWAY: Not perhaps in great detail but just a sense of how-- Because of
course everybody was uprooted.
HANNUN: It's funny, because the roots of my father's family are in a town called
Tulkahrm, which is in the West Bank, with my grandfather [Yusuf Hannun]. They
were sort of landlords and things like that, and my grandfather was their, I
00:17:00guess, export-import connection. He was located in Jaffa, sort of the port of
Jaffa. So that's where he established his own land and property and residence.
That's where my father and all my uncles and aunts grew up. And very
analogously, my maternal grandfather [Yusuf Ashour] was originally from a West
Bank town called Nablus. Again, he was located in Jaffa for similar reasons,
because both families apparently were landlords with a lot of orange groves and
what have you. The immediate families were translocated, but the rest of the
extended families are still in Tulkahrm and Nablus. My mother's family went to
Lebanon rather than go to Nablus. I think the only way they could leave Jaffa
was by sea at that time, so that's why they went that way. But my father's
00:18:00family went initially to Lebanon but went back to Tulkahrm, so they stayed more
in the West Bank.
HATHAWAY: Again, I think this is important. You mentioned actually a few things.
I'm just kind of guessing at this or suggesting that maybe this is some way of
understanding it, even for just myself so that this conversation can flow more
easily. I don't want to--Well, it's not so much a class distinction, but you
mentioned the fact that, for instance, quite a large portion of the Palestinian
population became refugees. They really were not wealthy enough or were not
recompensed because they didn't have property. I don't know exactly what
happened. There seem to be two cultures, let's say, or something like that,
00:19:00within the Palestinian culture. For instance, this arranged situation between
your parents would come from a pretty close-knit and maybe small--
HANNUN: I think it came about because both families grew up in Jaffa, so they
had a lot of mutual friends.
HATHAWAY: This isn't such a planned or traditional way of doing things in
HANNUN: No. I guess my dad wanted to get married, and he was asking around. I
would think he wanted to marry a Palestinian lady. And because of his friends
and both families growing up in the same town, that's how it ended up being.
HATHAWAY: And you mentioned you father-- When they left Saudi [Arabia], there
was no place to go back to. Going to Lebanon and Beirut, there was a choice over
00:20:00perhaps Jordan or maybe even other places. Was there a job there? You mentioned
there was some family there, your mother's family. It was just time to get out
of Saudi Arabia, perhaps, and this kind of artificial American culture.
HANNUN: I think, yeah. I must tell you that a lot of the decision making there
has not been-- You know, I wasn't part of--
HATHAWAY: And you didn't ask.
HANNUN: Yeah. Maybe also part of leaving ARAMCO was the fact the job wasn't
going anywhere or something. I really don't know the economic or financial
aspects of those decisions. The first few years in Beirut my father started out
on his own as a private practitioner. He chose a clinic very close to
00:21:00Palestinian refugee camps so he could sort of cater to that group of patients,
and he stuck to that throughout the remainder of his career. He did take an
additional job with the UNRWA [United Nations Relief Work Agency], which is the
relief agency for the UN that caters to Palestinians. So he had sort of dual--
HATHAWAY: A private sort of practice and also-
HANNUN: A private practice and that, but both were heavily catered towards
serving Palestinian refugees.
HATHAWAY: That may indeed be the answer to the question about why Beirut or why
Lebanon, because certainly as far as I can tell the problems for refugees and
the situation for Palestinians was more acute in southern Lebanon than
elsewhere, perhaps, or than even the West Bank, at least economically.
HANNUN: Oh, yeah. At that time the West Bank was a very integral part of Jordan,
00:22:00so there was no discrimination at all. The Palestinians who could make inroads
into the productive strata of society in Jordan were automatically admitted on
equal footing, the same in Syria, with a little more difficulty in Lebanon. But,
again, my father could easily set up practice there. The obstacles couldn't have
been very formidable.
But there has been a political [force], I think, also, a political and not just
an economic force creating those refugee camps. The delicate balance in Lebanon
would not have taken admission of a refugee community into it, which would have
tilted the balance, the religious and ethnic balance. I think also, in a more
global political sense, there was a feeling that this refugee problem was very
00:23:00temporary, because even when I left Lebanon in '83 they still lived in tin
shacks, you know, temporary, even though they've been in it for more than--
HATHAWAY: Temporary, but where were they going?
HANNUN: I think there was strong feeling that they were sooner or later going
back to Palestine. And obviously the political leaders were reinforcing that day
and night, although without the ability to deliver on those promises. Maybe
there was also a deliberate, initially subconscious, but maybe more articulated
decision on the part of Arab governments to keep the refugee problem rather than
assimilate Palestinian refugees. I mean, not just sort of not to create
imbalances. That was one factor, but another factor was to maintain that as a
00:24:00status quo. Irrespective of the perception of Palestinians and many others that
this was temporary, I think the governments wanted as more a political
expediency to keep it as an ongoing problem.
HATHAWAY: Sure. And indeed it is, right.
HANNUN: And it is, yeah.
HATHAWAY: I guess maybe this is inappropriate to ask you with retrospect and
hindsight. I mean, you experienced it, and now you've had some distance from it.
I'm not asking you to kind of recreate how you thought about it then but I guess
how you think about it now. Given that in many ways the situation is still,
quote, "the same," although things do change slowly and there always seems to be
a chance in the foreseeable future some settlements and agreements will be made
such that there will either be two nations or there will be some-- What was your
00:25:00sense, when you were growing up, of what was going on around you? Was it a sense
of, yes, someday your family or maybe you yourself would be able to go back to
where your family's roots were?
HANNUN: That's a very loaded question.
HATHAWAY: I know, so take your time. That's probably five or six questions, and
I really don't want to narrow it or define it so that you have to answer one of them.
HANNUN: I think all that background has been very formative for me.
HATHAWAY: Yeah. You mentioned that. That's what I'm trying to get a sense of.
HANNUN: In one way, I think the '48 exodus has reinforced in a lot of
Palestinians' minds, and especially my family's, that education was their
salvaging, redeeming point. Education was always the highest priority in our
00:26:00family, no question about that whatsoever. So much so that in retrospect my
parents initially prevented us from engaging in any activity that could remotely
take us away from education.
HATHAWAY: So no playing in the afternoon. You came home and--
HANNUN: Not really. That was temporary because I think my brother, sister, and
myself did sufficiently well--very well--at school that we bought our freedom,
so to speak. But earlier on, especially with me, I was the one most restricted
to sort of give up other things, whether it was piano lessons or whatever. But
as we proved ourselves, so to speak, and showed that we could deal with school
and education, we bought our freedom. So in high school and whatnot--
00:27:00HATHAWAY: As long as you brought home good grades.
HANNUN: There was no problem whatsoever. Actually, the funny part is education
was so much emphasized that almost nothing else mattered. I could do whatever I
wanted to do as long as my grades were top-notch.
HATHAWAY: So it wasn't that you needed to learn how to play the piano, if that's
what you wanted to do, or play tennis-- You know, I'm just picking things out of
HANNUN: There was no attempt at religious education. There was no attempt at
even modifying my behavior as a teenager, which at times, in retrospect, was
probably quite nasty.
HATHAWAY: We'll get to that.
HANNUN: Education was an overriding concern. The other thing, the political
awareness, growing up in Lebanon, unfortunately-- I don't want to say
00:28:00"unfortunately," but definitely a distinctive feature of it is, because of the
sort of strict ethnic and religious identification of people in Lebanon, you
could almost recognize by a person's name where they come from and what religion
they belong to. I don't know if you can sort of imagine how such a society would
interact with a foreigner, which I was basically. I was not Maronite; I was not
a Druze; was not Lebanese. So I was never totally molded by or taken by the
00:29:00Lebanese social structure. I want to bring that up because it's extremely
different from the U.S. culture. Because in the U.S., it's such a melting pot
that it doesn't matter where you come from. It depends on who you are. In the
Middle East, it's almost the reverse of that. It doesn't matter who you are but
where you come from. The closest thing sort of to that in the U.S. would be,
what was it, East of Eden.
HATHAWAY: The movie, right, yeah.
HANNUN: The novel by Steinbeck. In terms of how a foreign family or family from
the outside comes in and integrates and how that shapes the development of the family.
00:30:00HATHAWAY: Our history is almost wave after wave of different kinds of immigrants
finally assimilating, you know, the third generation or second, from Europeans,
western Europeans, over a century ago, to Asians.
HANNUN: Yeah. It's very mixed. You really care here much more about who the
person is. So in Lebanon, going back to your political question, I could always
sense that I was different, because I was considered a little different. I'll
grant you that there were many ameliorating factors to that, so I never felt
rejected. It's not a feeling of rejection because there were-- I am Sunni
Muslim, so I could be considered part of that.
HATHAWAY: Even among Muslims in Lebanon, right, the Shiite--
HANNUN: The Shiites now are the majority. Back then, who knows. I mean,
00:31:00definitely the Sunnis had more political clout. There were many other
Palestinians, mostly maybe Christian but also some Muslim, who were in sort of a
similar situation. So there were other kids in my school with similar
backgrounds. I wasn't really an outcast or rejected. I was just different. I
And there was always this question of what's going to happen to Palestinians
over time, this uncertainty. That was obvious at home. I grew up with that. As I
mentioned before, [there was] the expectation that pretty soon we'll be going
back. The turning point came, at least to me, in '67, when there was such a hype
built up by [Egyptian President Gamal Abdel] Nasser that "Hey, that's going to
00:32:00be solved." We were going to confront the Israelis and the French and whatever
and just solve this problem. In retrospect, it looks like he was totally
suckered into it, and overnight reality hit home. I was only, what, eleven, at
that time. Reality hit that that kind of political demagoguery wasn't going to
solve the problem, that the problem was much more fundamental than that.
HATHAWAY: Was this also a point of realization for many Palestinians, that
Israel was perhaps more--?
HANNUN: Stronger in the long term. Yeah. It wasn't a temporary wrinkle in the
00:33:00history of the region, you know, like no Israel for two thousand years and then
there is going to be no Israel for the next two thousand years. It wasn't a
wrinkle. That was a reality to be confronted. Although I would say at the
population level that did not go much further than that in terms of-- "Okay,
that's a more severe case than we thought," but it didn't translate into "Okay,
well, let's see how we can solve it and deal with it." Obviously, the Israelis
at that point, at that time, didn't want to make it any easier,
-1325880000either, by coming out victorious. At first [Israeli Prime Minister]
Golda Meir said, "Who are the Palestinians?" I mean, they were not in the mood
of accommodating at that time. Therefore the reaction was the growth of the
Palestinian radical movements and the armed resistance movement. That was a
00:34:00direct outcome of the 1967 war. But to me it was an eye-opener that the
infrastructure to deal with the aspirations of Palestinians or Arabs was just
not there. It wasn't a mere change in leadership or the political program. The
education wasn't there, the understanding wasn't there, of how to deal with the
situation. I mean, until '67, people were in the mind-set of, "We're going to
ignore this problem until it goes away." Basically refusing to acknowledge that
Israel exists. I mean, other than what you hear about in terms of Arab states
not recognizing Israel. That's a political maneuver. But even at the level of
people refusing to hear Israeli news or acknowledge that Israel existed-- It was
00:35:00a nightmare that was going to go away. After '67, this nightmare was not going
to go away. But the reaction was still very immature in terms of how do we deal
with that. And as I said, the Israeli political system at that time wasn't in
any compromising mood either, so it just resulted in armed conflict.
HATHAWAY: One other area in kind of asking a rather, I guess, undefined or
series of questions in one question--Certainly on this political level and your
awareness of it, it must have been quite striking for an eleven-year old-- I
mean, really, although, again, you've got the hindsight of being an adult and
other events happening to be able to filter those feelings and emotions through.
00:36:00I also was hoping to get some sense of the community you were in, and for
yourself those kinds of experiences, like somebody at school and things like
that. You mentioned when we met last Friday, just kind of got acquainted, that
although it was a small part of Beirut, there was a part of Beirut where
everything was mixed, where it didn't matter what your religious background and
your family background or ethnic background was. I assume that this also was
true maybe in school and on the streets and in the cafe. I mean that this was--
HANNUN: Yeah. That's definitely true. I mean, I grew up in what's called Ras
Beirut. This is sort of like a peninsula to the west of Beirut surrounded by the
Mediterranean on pretty much three sides of it. It's really centered around the
00:37:00American University of Beirut and the hospital of the university. The school I
went to [International College] was an offshoot of the American University and
was structured very much the same way, run -1301750000by an American board of
trustees out of New York. The president was American. Invariably, most of the
senior administration was American. It was a very, again, by relative
terminology, liberal education and totally nondenominational. The whole area of
Ras Beirut was very unique, very cosmopolitan, when I was growing up. Beirut was
the financial capital and the intellectual capital and the political capital for
00:38:00the Middle East, basically, and a very good interface between Europe and the
rest of the Middle East, especially at that time when the oil-rich countries
were starting to want access to the West. Really, Lebanon was at the interface
of that. Usually when you say Lebanon, it's Beirut, and when you say Beirut, it
was really that segment of Beirut. So that was sort of the central nervous
system of the whole operation there.
It was very cosmopolitan, very mixed. I think in terms of Lebanese it was
equally mixed, you know, Christians and Muslims. As I told you the other day,
the Christians in Ras Beirut didn't leave during the civil war. So it was a very
tolerant, mixed population. There were a lot of the Palestinian class of
educated Palestinian people. When I went to school I had all kinds of friends
00:39:00from all sources, all facets of middle-class Lebanon, or middle- to
upper-middle-class Lebanon. It resulted in a very interwoven social fabric,
because when you grow up with one group, one cohort of classmates, and their
brothers, ancestors, families, and other acquaintances, you get to know directly
or indirectly almost everyone there, which is a very sizable number.
HATHAWAY: Would you care to give a rough estimate? I mean, we know this is not exact.
HANNUN: I would say it's in the several thousands.
HATHAWAY: And they would know who you were, again, just simply by some sort of,
"Oh, that's so-and-so's son," right, even if they hadn't ever--
00:40:00HANNUN: Exactly, exactly.
HATHAWAY: And this is, again, you say Christian and Muslim and Palestinian and Lebanese.
HANNUN: Yeah. I mean, you could easily make all those associations. Like if
someone didn't know my parents, they may know who my aunt was married to or
their family. You could almost immediately, when you were introduced to someone,
find common acquaintances or even relations. And this very extended social
fabric is very different than what you have in this country, very different.
bring it up because I can see how Americans cannot see that. It's extremely
different. I mean, Ras Beirut was bigger than Durham, [North Carolina], yet I
probably know -1311910000one-hundredth, relatively, the number of people in
00:41:00Durham. The social interactions were different. I mean, if you went to the gas
station, in a year--because things don't change, things don't move--you get to
know those people and you know the people they know and the same about the
people who run a restaurant and the people who run a store. You get to know
those people at a personal level too. So the social fabric was very different.
HATHAWAY: Is this something that you still have? I mean, even given all that's
happened in Beirut since-- I mean, now we're talking about your going to school
at perhaps even kind of what we would call in this country junior high or high
school. We're talking up into the end of the sixties and well into the
seventies, I assume. Things changed quite a bit even at that time but then
certainly since, even before you left in '83, but there is still this kind of--
What's the word I'm looking for?
HANNUN: Do you mean does it still exist or is it in my consciousness? Which are
HATHAWAY: I guess maybe I'm asking about both. But let's pick one, let's say
your consciousness, something you miss and wish that your children would have here.
HANNUN: Yes, absolutely. It's something I miss. It's something my wife [Una
Obeid Hannun] misses, because, although she's American-born, she grew up pretty
much in the same environment. I don't know if I wish it on my children [Awni,
Marya, and Reem Hannun] or not. I would have liked for them to be sort of part
of that. It's a very difficult question what to wish for your children. I think
it's a trade-off. I think from my philosophical sort of analysis of it, I think
it's a trade-off between trying to foster excellence and matching the best
person for the best job and having mobility and therefore negating roots, or
00:43:00having roots and trying to find the best job any one person can do rather than
match the best person. So you sacrifice one for the other. If you want to
maintain roots, you don't foster excellence and achievement. I sort of believe
HATHAWAY: That's something that you've come to realize, let's say, for instance,
from your own career or your own experiences now as a biologist and somebody who
is actually running quite a-- We'll call it an operation. And I don't mean to be
glib about it or flip, but it's quite an operation that's going on here [Duke
University Medical Center], and you are in charge. And so obviously you're
looking for people who perhaps think the same way, too, who are for instance
willing to move to Durham and would never have any connection to their own--
HANNUN: Exactly. They move because they think this is the best thing for them.
-1298575000HATHAWAY: And I take it's that's why indeed you're here in Durham
still and not back in Beirut.
HANNUN: Yeah. Exactly.
HATHAWAY: Or maybe even why you left originally to come here.
00:44:00HANNUN: Yeah. That's a pretty much accurate assessment.
HATHAWAY: I guess the other question just for historical purposes or for the
record, because we have somebody whose experience is so tied up with it-- What
is left of this, again, I guess, the part of Beirut? I don't want to try to
HANNUN: As Graham Greene once said, "A city without its people is a collection
of concrete and steel." I think that's what's left of it. Most of the people who
could have left have left, basically. They're all over the world.
HATHAWAY: Especially from the Palestinian point of view, again, maybe, one more exodus.
HANNUN: For the Palestinian, it was one more exodus; for the Lebanese, it was a
new one, yeah. Many of them are all over. Because that's what happened in a more
00:45:00global sense in the Middle East. The people who want to concentrate on their own
abilities and to achieve and move on with it, I mean, they're always constrained
by all this political, not just the fighting but all the -1344295000constraints
that developed from that. I see it happening in Lebanon among the Palestinians,
also among the Israelis. It's sort of a sad twist to the thing, because you're
sort of depleting the area of the people who would be much more open-minded and
tolerant and leaving in place the people who are less tolerant.
[END OF TAPE 1, SIDE 1]
00:46:00HATHAWAY: You kind of maybe got to an endpoint on a topic. I would like to still
pursue a little bit more, I guess, your education, a sense of the milieu in
which the education happened, but perhaps more along the lines of curriculum,
especially perhaps as things loosened up and you were able to do more things,
your parents weren't sitting on you saying, "Study, study, study." If that's
something you want to pursue, perhaps with the aim of why it ended up in med
school or ended up at American University in Beirut or something like that.
HANNUN: The school I went to, incidentally, is the International College. Again,
by American standards it had a very rigid curriculum, not much flexibility. I
00:47:00mean hardly any electives. It was forced to comply with the curriculum of the
Lebanese baccalaureate for high school. This was a standardized test. But the
attitude was very pro education rather than pro instruction, which I cherish a
lot, basically. I had many, many outstanding teachers who made education fun
rather than a chore.
HATHAWAY: So you mean the emphasis was more put on investigating things as
opposed to "These are the seventeen parts of grammar you need to know."
HANNUN: No, not quite that. No. That was a shortcoming of the system. Not just
at the International College but definitely throughout the Middle East, there is
00:48:00no emphasis on inquisitive sort of scientific experimental approaches. Maybe
it's very entrenched in Arab history. It's much more analytical than
experimental. They did a tremendous job a thousand years ago in translating the
Greek and Latin. Actually, they preserved it for the West, and they analyzed it
ad infinitum, basically.
HATHAWAY: And it was their analysis, really, more than anybody else's. It was
translated into Hebrew and then of course into Latin. Then it wasn't even so
much Aristotle's texts that were important but of course the commentaries that
went with them.
HANNUN: Yeah. So that's through Spain, through that connection. But definitely
00:49:00growing up, there wasn't any emphasis-- Actually, there was some downgrading of
the experimental attitude. The teachers were a very respected class of people,
and they definitely enjoyed what they were doing. I think the International
College probably recruited by far the best teachers available. Those people were
stimulated by what they were doing, and they definitely transmitted that. But
I'm trying to dissociate that from the experimental attitude or lack of-
HATHAWAY: It's almost more of an attitude of the way they taught that was
infectious or that got you-
HANNUN: Yes. Yeah, exactly. My problem with the educational system is, as we got
closer to the Lebanese curriculum, which is sort of the equivalent of the high
school program in this country, it became very mundane, very boring, and that
00:50:00became almost anti-intellectual. I mean, now that I think about it, there were
options whether to take mathematics or literature or some other aspects towards
the end of high school. I took sort of the mathematics route, but I had occasion
to look at what they taught in biology and other things that I did not take.
They were literal translations from like 1940 French texts. That was mandated
pretty much by the government. So it was horrible, pretty much. But what I did
was sort of use that to study a lot on my own. I relied heavily on American high
school textbooks in the sciences.
HATHAWAY: And these you went to a library and got?
00:51:00HANNUN: Yeah. The high school library would have them.
HATHAWAY: So they would have the other texts.
HANNUN: Yeah. I definitely vividly remember the biology texts, physics texts,
mostly biology and physics and chemistry.
HATHAWAY: And we're talking about textbooks. I mean, I could pull out my
[Lubert] Stryer's Biochemistry, or are we talking more also like essays on
evolution? Were there also that sort of--?
HANNUN: Both. Definitely the textbooks, plus additional material. I got to be
very much enamored by mathematics and physics, sort of theoretical physics at
that time. That for me was going to be a definite career option, to go more into mathematics.
HATHAWAY: Who did you talk with about this? Were there other students, colleagues?
HATHAWAY: Your father wasn't sitting there saying, "You're reading biology.
HATHAWAY: Your father wasn't doing this himself also, maybe keeping abreast of medical--?
HANNUN: My father kept up with more clinical [literature], because he was really
into practice, but not with sort of the basic sciences of it.
HATHAWAY: Where do you think the math and theoretical physics and all that--?
HANNUN: Came from?
HANNUN: Oh, I never thought of that. There was definitely an emphasis growing
up, I think, that the sciences were to be coveted over-- But, again, not the
attitude of the experimental aspect of science as much, think, as a selection
process, that people who make it in the sciences are the smarter people and
therefore they can succeed. That's why every mother wanted her children to be,
00:53:00at least in Ras Beirut, very good in sciences and mathematics. So there was this
HATHAWAY: And just the general, as you said, pressure, which lightened up as you
got older and you did better in school.
HANNUN: Oh, I mean, that pressure let up since I was ten or eleven.
HATHAWAY: But still in the back of all, perhaps, the influence one's parents
have or the attitudes that they display toward their children and in
communicating to their children what they want from them, perhaps it was the science.
HANNUN: That may have been part of it too. I think a lot of it, come to think of
it, came from the literature, which showed me-- When I was even ten years old, I
had a teacher who encouraged me to join the British [consul]--God, what do you
call it now? Sort of the cultural attaché part to the British embassy. They had
00:54:00like an open library that you could subscribe to. Even when I was ten years old,
I would spend the summer going there almost daily, picking up books and reading
them. That was at the sort of very elementary level. I was in elementary school.
And then in high school I had a couple of American teachers who-- They used to
have a program where the American teachers, you know, fresh graduates basically
from college, would go spend a year in Beirut and then at the International
College, teach a couple of advanced courses in usually English literature or
something. That was a very small group of students, like we were three from my class.
HATHAWAY: And this was also this age, this ten, eleven, twelve?
HANNUN: No. This is past that, more like fifteen, sixteen. We went real deep
into English literature.
HATHAWAY: I was going to say, you were citing Graham Greene earlier.
00:55:00HANNUN: Yeah. We read that way back then probably.
HATHAWAY: Were you reading novels from the British?
HANNUN: We were reading novels from Kafka, Mann, Hermann Hesse. We read
Shakespeare, a lot of Shakespeare. It was an eye-opener for me in terms of how
you can access education on your own, because there was the regular curriculum
that the other students were having, which was very dull and boring, and then
there was this curriculum that we pretty much designed on our own. You know, "Go
find a novel you want to read and discuss it tomorrow."
HATHAWAY: Kind of like an honors class or more formal?
HANNUN: It's something like that, very informal. Actually, we used to meet in
the lobby of the dorms there or somewhere else. There were just two or three
from my class.
HATHAWAY: Was this organized, though, by the school or by these teachers, or was
00:56:00this something that maybe even some of the students had way back when or sort of
HANNUN: I don't know who had set it up, but it was an ongoing program where-
HATHAWAY: You knew about it before you got to the age or something-
HANNUN: Yeah. At that time, it was a really healthy program. I know the teachers
who went from here just loved it because they had very flexible time and they
were doing something usually they enjoyed a lot, taking those advanced or
HATHAWAY: Sure, and had students who were perhaps eager and the motivational
aspect didn't need to be practiced or taught. It was just the stuff itself.
HANNUN: Yeah, exactly. But it did show me that you can access knowledge and
education on your own, and you can pretty much do it, because that was a
definite deviation from the norm that existed there. I must have picked up on
that, now that you ask the question, because after that year, that's when I
started reading the sciences and mathematics on my own. I got a lot into the
00:57:00history of mathematics and physics. I was really taken by mathematics and
HATHAWAY: And, again, no explanation or no sense of why there was the math--? I
mean, we are talking about really a specific kind of knowledge, which is highly
abstract, and, if you will, actually very much divorced from the kind of
experimental work that you do now.
HANNUN: Absolutely. It's something I've never figured out. It used to excite me
HATHAWAY: It's not a trick question. It's actually a very common-- Not that I
look for these things. You know, you [Pew scholars] all have the same background
or the same thing. But it's a very common occurrence that the initial interest
and the area that people do very well in--biologists, sometimes the people I've
interviewed and the Beckman [Institute] interviews-- It's very strange. It's
always mathematics. And there is some point at which it's rejected for being
highly abstract and having nothing to do with the world. But it seems to be the
00:58:00math, not physics, not chemistry, but mathematics.
HANNUN: Yeah. Mathematics was like my love in high school, and I got to be real
good at it. I mean, I didn't drop it until I went into medical school. Because
even as an undergrad I had to take again a fixed curriculum to enter medical
school, which I had decided on, but I also majored in mathematics, side by side.
I was pretty much carrying double the load of everyone else. Mathematics to me
was like just go to class and that's it. I didn't even have to do homework or
anything. But I had to drop that once I entered medical school. That's one
reason I was very miserable the first year in medical school.
HATHAWAY: Why the choice of medical--?
00:59:00HANNUN: Yeah. Why the choice of medical school? I think--
HATHAWAY: In other words, at the sacrifice of what you loved the most. I mean,
you really gave it up, and it made you--
HANNUN: Yeah. Many reasons. It was many, many reasons. I guess it's one of those
career choices one makes. By that time, by the time I was finishing high school,
I was sensing trouble in Lebanon and friction was building up.
HATHAWAY: And we are talking--
HANNUN: In '73, '74, and you could sense trouble. There was even now starting to
have polarization at my high school. [It was] very funny, because that group was
like very homogeneous until the last year I was in high school, and then they
started polarizing real bad.
HATHAWAY: Over what issues?
01:00:00HANNUN: Over the same political issues that resulted in the civil war. I think
you'll find more than one person say that what happened in my high school and in
the university contributed quite a bit to the escalation towards the civil war.
I don't think it ignited it or anything, but it was definitely a telling sign.
HATHAWAY: An intellectual underpinning or something of it.
HANNUN: Something like that. But even the highly educated people exposed most to
other kinds of people basically got polarized. So I could tell that politically
Lebanon was becoming very unstable and I couldn't plan on a career in Lebanon.
That was becoming quite obvious.
HATHAWAY: Was this something you talked about with friends or your father or
your mother? I mean, was it just something you kept to yourself?
HANNUN: Something I probably never articulated that way.
HATHAWAY: Something that you saw later that you were getting ready for.
01:01:00HANNUN: Yeah. Something I sensed but I may have never articulated. I definitely
didn't discuss it with my parents. They let me make all those choices on my own,
basically. So that was one reason to avoid more questionable careers. I mean, I
HATHAWAY: Like an artist or a mathematician.
HANNUN: Yeah. You know, I told you I was very interested in the history of
mathematics. Two things I learned from that influenced my career choice: one was
that to achieve in mathematics or theoretical physics you have to be very fully
supported by society, basically. I mean, you have to have a very stable society,
a healthy society, a wealthy society, too.
HATHAWAY: What were you studying the history--? What were you equating? What
01:02:00were the situations or the cultures that you were looking at in the past that
were giving you--?
HANNUN: Mostly looking at European physics.
HATHAWAY: I think of theoretical, right, and I think of the twentieth century.
HANNUN: Yeah, nineteenth and twentieth century.
HATHAWAY: Of prewar Germany. But I also think of the development of it in the
United States as under duress, almost, and with biology, actually, people
uprooted and in places where they must have felt-- You know, when I think of
someone like [Salvador Edward] Luria at Vanderbilt [University] or--
HANNUN: At Vanderbilt. [Max] Delbruck and Luria.
-1356360000HATHAWAY: Right. But Luria was the one who was in Nashville.
HATHAWAY: But again, so I think of it maybe perhaps as both very stable-- It's
HANNUN: I don't think anything in the U.S.-- I mean, instability in the U.S.
itself? Or in Europe?
HATHAWAY: No. I mean more these people and their sense of themselves and what
they were doing in the States all of a sudden.
HANNUN: No matter where you come from, once you hit the U.S. you feel stability.
HATHAWAY: Especially the more brilliant, already established--
HANNUN: I mean the kind of instability there, which I think was validated by the
events. So that was one reason. The other thing I learned from [the history of
mathematics]-- I'm not sure if that's a true assessment or not, but I sort of
came to the conclusion that mathematics was really a career or maybe more like a
hobby for the very young. I really believed that all those people who made
brilliant discoveries in mathematics or theoretical physics were pretty much
done by the age of twenty-five.
01:04:00HATHAWAY: It's a common belief.
HANNUN: And all those sort of misleading pictures of Einstein as an older man,
discovering the secrets of the universe, are so misleading, because he was less
than twenty-five when he came up with the general theory of relativity, not to
mention the specific theory. So I was very disillusioned with that because I saw
myself having wasted so many years in high school not developing those skills to
the level I wanted and then I didn't have much opportunity in the university to
develop them sort of creatively. Didactically, you could learn all what there is to--
HATHAWAY: You just weren't in the right place, perhaps.
HANNUN: Yeah. And I did learn that. I took all those courses, and I got to learn
all the matrix algebra and calculus I needed to formally, but there wasn't any
01:05:00room for creativity. So I think I was in the wrong place at the wrong time. And
at that point, I did consider coming to the States to study mathematics. I
actually sat for the SATs [Scholastic Aptitude Test] in high school. scored very
high on those. I guess a couple of places offered me--
HATHAWAY: It's within a mathematics department, as well? You hadn't started
looking at medical school here or--?
HANNUN: No, no. It was mathematics or economics. For some reason I also looked
HATHAWAY: They use a lot of mathematics, depending on the economics department.
HANNUN: Yeah. Theoretical economics.
HATHAWAY: Do you remember where?
HANNUN: One was the University of Chicago. And the other for the life of me I
can't remember, but definitely Chicago, because I considered that very
seriously. I agonized over it. I think I was young, and it wasn't the norm then
for people to leave home at seventeen or eighteen, so I didn't do it.
01:06:00HATHAWAY: Were a lot of your friends and colleagues also going to the American
University in Beirut? I mean, was this also a community kind of--?
HANNUN: It was pretty much. It was sort of the best you could do if you stayed
in the Middle East. It probably still is. With all the trouble, it's probably
still a true statement. So mathematics became less and less of an option as the
years went by, primarily maybe because I was in the wrong place at the wrong time.
HATHAWAY: You had only like three years left before you had to do it, right?
HANNUN: Yeah. Right. Exactly. In retrospect, I sometimes wish in high school I
could have taken off two years and just studied mathematics, you know, abstract,
theoretical mathematics. It's something I don't regret, but if I had to do
something, I would have wanted it to be that way.
HATHAWAY: I guess you talked about reading a lot, not just mathematics but maybe
we should use that as an example, again, of getting a sense-- You also
01:07:00noted--now at least, and looking back on it perhaps you did as well at the
time--that not a whole lot of your friends and colleagues were doing this. I'm
sure there were probably other people who would spend a lot of time in the
library, but this is kind of a systematic, it seems, approach to the thing--"Go
find every textbook on mathematics." You said you were interested in the history
of it as well, perhaps not just to find out more about the content of
mathematics but how it develops. And you came to some pretty actually-- What
word do I want to use? Not advanced but shrewd conclusions about the development
and history of mathematics from reading these things. It takes a little bit of
work and quite a bit of energy to come to these kinds of conclusions. You
already had this kind of mentality of looking at it from this historical
perspective. What were you reading? Was there something, two or three texts or
01:08:00whatever, that really grabbed you? Or was this just a general kind of ongoing
process that now it would be hard to dissect like that?
HANNUN: I had sort of broad-based interest in mathematics and its history. I was
most captivated by Georg Friedrich Bernhard Riemann, Gauss, Leibniz, Poincare.
You know, late nineteenth, early twentieth century mostly, but even earlier nineteenth.
HATHAWAY: I guess you were reading Leibniz in English?
HANNUN: Yeah, in English. Evariste Galois.
HATHAWAY: Just about everybody. You've just gone through the list. I mean,
01:09:00you've left out maybe--now I can't come up with his name--Fourier, but that's
HANNUN: Fourier. A couple that were very impressive were Evariste Galois and the
HATHAWAY: I can't even pronounce his name, but I know who you mean.
HANNUN: You know who I mean, the guy who trained with Harvey.
HATHAWAY: I have trouble even pronouncing the name. When I see it I recognize it.
HANNUN: You know who I'm talking about. Galois died when he was nineteen or
something, and this guy died when he was twenty-something. [Ramanchandran] I was
impressed by their achievement basically a lot and by their thought process.
HATHAWAY: Maybe age identification.
HANNUN: Age identification at that time probably.
HATHAWAY: And what about the other areas, let's say theoretical physics? I'm
thinking, you know, Delbruck read Schrodinger and that was his-- He was another
01:10:00physicist, but that was his raison d'être to go into biology. It was an
obsession. His whole life was just making something from what Schrodinger-- Just
theoretical and not based on any kind of-- You know, make it true with a kind of
experiment. So that's what I'm sort of fishing for, I guess, is some sense that
you see--Well, something I mentioned, a genealogy, if you will, of your
experience, how you approach things. But perhaps, as you say, it was more
general or generic. It was all these things together.
HANNUN: Yeah. It was all these things together, and I enjoyed it. I mean, the
bottom line was I really enjoyed it. It was not very systematic. I would just--
There was a systematic component. Now that you remind me, there was. I did start
with like the high school textbooks for physics and biology. I'm not sure about
01:11:00mathematics. Probably not. Physics and biology. And then I started going into
HATHAWAY: That's where I'm at. [laughter]
HANNUN: In physics and biology, when I was still in high school. Mathematics I
kept more as a pure hobby. With physics, I know I tried to understand better
quantum mechanics and relativity, but it got to be very frustrating towards the
end because for that I needed sort of guidance. I needed to discuss things, and
that wasn't available pretty much. With mathematics, it was much easier to just
pick up anything and see how someone solved the problem, either from the history
side or sort of a book side of things. Either way it was always gratifying. So
the desire to go into mathematics, to go back to your question, waned with time,
01:12:00as the reality sort of took over and medicine became-- Medicine was always
like--what's the right word to describe it--the fallback option. I mean, I knew
my father was a good physician. He enjoyed it. I thought that was always a
HATHAWAY: And there was still all this stuff you were interested in, science and--
HANNUN: Yeah. I would explore science. As the interest-- My conviction that I
could not make a rewarding-- I mean, I didn't want to become a college professor
in mathematics. That wasn't my goal at all. I just didn't have that aspiration.
HATHAWAY: And that's really-- I mean, if you want to become a mathematician,
there's not much else. Either that or an actuary.
HANNUN: Yeah. I was interested in how creative I could be in mathematics. I know
I was good in solving problems, but that's not the same thing. And I didn't have
01:13:00the opportunity to do that. So I think with time I went back to the sort of
fallback, the concrete option of becoming a physician. But I think from that I
started building the intellectual sort of direction to that, which is to get
more into the biological science within that context, if you will.
HATHAWAY: This is, in a sense, even before any real definite choice has been
made on your part that med school will be it or that "I will become a practicing
physician," right? I mean, this was high school.
HANNUN: Yeah. Correct, high-school-level-decision sort of analysis. You know,
the fallback position actually still is clinical practice, being a physician.
It's funny. It's always been in my mind like the fallback position. When I was
thinking whether I would go into mathematics or medicine, I would say, "Hey, I'm
01:14:00going to do the undergrad mathematics but at the same time fulfill the course
requirements for medical school." So it was always the fallback position. It
still is in terms of how I'm a researcher but also a physician. So that still is
a fallback position. I must confess that I enjoy clinical medicine tremendously.
I know many physicianscientists--
HATHAWAY: They want to back off from that. That's why they're the scientists.
HANNUN: Yeah. They're the scientists because they don't want to--
HATHAWAY: Have you much--? Maybe we're jumping ahead, but just at least so I
know to approach it later in more detail. Are you doing much clinical practice here?
HANNUN: Not much. I do rounds on clinical services two months a year.
HATHAWAY: So do you just really drop everything here and go do that?
HANNUN: I can keep sort of the status quo in the lab, but I can't do much more
01:15:00than that during those two months. My function is more of a supervisor-consultant.
HATHAWAY: You mean here in the lab?
HANNUN: No, in the clinic. Teacher rather than primary caregiver. You know, I
round with the house staff. I round with the fellows, but I don't see patients
in my clinic, because otherwise that kind of commitment becomes too open-ended
and I wouldn't be able to do my lab work.
HATHAWAY: And you can just sort of do it for two months and then walk away from
HANNUN: Yeah. Exactly. Especially with my specialty, you know. Where most of the
patients have cancer, you just can't do it. If you want to treat those patients,
at least our model here is you're very accessible. And if you want to keep that,
you can't do lab work.
HATHAWAY: I think rather than go through any more kind of systematic
year-by-year approach to your college education and things like that, we could
perhaps--Actually, I want to go back and cover a few things but just kind of
take up medical school as an experience and then the transition over into also
01:16:00some interest in basic research. But first, one, you said that as your parents
loosened the reins on you guys because you did pretty well in school, you said
that at some times perhaps as a teenager you weren't-- I'm not even sure I
recall the word. But I get the impression that you thought perhaps your behavior
was not that of the most upright young man but perhaps you got into trouble.
HANNUN: I didn't get much into trouble.
HATHAWAY: I'm thinking more of your social [life] and what a kid's life is like.
Without asking directly for all the bad things you did, but more just your group
of friends, or if you were perhaps much more of a loner, that sort of thing,
just what it was like outside of the classroom and the library.
01:17:00HANNUN: Let me put you in some sort of context there. First of all, there was a
lot of free time growing up in terms of activities after school. I mean, society
did not offer children anything compared to what any normal kid would have in
this country. There's a lot of free time after school, almost nothing structured
HATHAWAY: No sports teams or high school bands or debate.
HANNUN: No. Very little of that. Even television would start later in the
evening. It wasn't all-day television. Boring television, too. Summer was long
and idle, very idle. Summer was probably a good three and a half months'
01:18:00vacation time. So there was plenty of time to do many things. It wasn't like I
was either at school or in the library or reading at home. I mean, there was
really plenty of time. And the other thing is mobility. From that part of Ras
Beirut you could get from anywhere to anywhere else within ten to fifteen
minutes walking. So it gives you a lot of mobility that way. You don't even have
to borrow your parent's car or anything. I was a very outgoing person. I had a
big group of friends, I would say. To the contrary, growing up as an adolescent,
as a teenager, my behavior wasn't really bad, except I had very long, ugly hair.
01:19:00I looked very uncouth, just a rebel-type teenager. I look at my pictures now. I
say now, "How the hell did my parents accept that?" I think I wouldn't accept
that from my children. How did they accept that? That's why I put it in that
context, that they were pro education to the extent of that's even okay. You
know, "He's doing so well at school, that's okay. He can look whatever he wants
to look like." I actually had a lot of extracurricular activities. I was very
heavily into swimming, so very rigorous swimming training.
HATHAWAY: And that was organized, I mean, either in the community or in the school?
HANNUN: Both. Again, the school functions were very rudimentary, mostly in the
HATHAWAY: So it's competitive-type swimming.
01:20:00HANNUN: Competitive swimming. What else? Then hanging out with other kids.
HATHAWAY: Maybe smoking cigarettes or whatever it is. I'm thinking about again
my own [youth] or American culture.
HANNUN: Yeah. I wasn't much of a smoker. I never liked it, but hanging out with
people who smoked or whatever. And I really hung out. And again, something I
wouldn't now understand, during school days I would maybe not come back home
HATHAWAY: And this, again, is high school and not quite twelve or thirteen, more
like fifteen, sixteen.
HANNUN: Maybe more like fifteen, sixteen.
HATHAWAY: And your parents weren't concerned.
HANNUN: They weren't concerned. I think the barometer was "How well is he doing
at school?" And in retrospect I think I must have-- I mean the trust must have
01:21:00influenced me indirectly. I didn't need prodding to act responsibly, maybe
because they were so trusting.
HATHAWAY: And they treated your brother and sister in sort of the same way.
HANNUN: Yeah. Same way. In many aspects, I was sort of the one to initiate
things, and then my brother and sister would have that option. I like even
competitive swimming. I started that at maybe ten or eleven, and my parents were
hesitant about that. But once I got into that, my brother and sister would--
HATHAWAY: Because it would again cut into academics.
HANNUN: Yeah. Again, sort of hanging out with friends. I know my brother never
had problems with that. Initially, I may have had some. I distinctly remember
01:22:00the summers being long and boring, even with having two hours of swim practice
every day, reading a book maybe every couple of days, and hanging out with
friends for another few hours. It was still long and--
HATHAWAY: Your family didn't travel outside.
HANNUN: No. My family didn't do much traveling. My father was a hardworking
physician. I mean, he would work twelve hours. Or at least he'd leave at seven,
come back at seven daily, and he wouldn't take off. I don't recall him taking a
HATHAWAY: And as things got more tense in Beirut and Lebanon in general, was
the--? I mean, you talk about this area, you know, almost this oasis among all
the different struggles and conflicts. Was it really pretty much an area that
you knew you were restricted to? In other words, you didn't walk into the Druze
neighborhoods or the Maronite?
01:23:00HANNUN: Yeah. As things became uglier, we were pretty much confined to that
area. And it got uglier with time. Now and then it would improve a little bit
but then get back even uglier. But at that time I was in medical school.
HATHAWAY: You weren't about to go anywhere.
HANNUN: I spent medical school hours in hospitals, basically.
HATHAWAY: Twenty-four hours.
HANNUN: Yeah. Pretty much that. Actually, one aside here is sort of my name
didn't help matters either. For some reason my name, Yusuf Hannun, by Lebanese
standards, would sound like a Maronite's name.
HATHAWAY: The last? We're talking about the family name?
HANNUN: The first name Yusuf in Lebanon is much more frequently used by Christians.
HATHAWAY: Because of the perhaps--
01:24:00HANNUN: For some reason. It's a very common name. It's a very archaic name, a
very old name. It's Jewish, European. All cultures have a Yusuf or a Joseph or
something. But in Lebanon for some reason, unlike in Jordan, let's say, or other
countries, it was much more associated with Christian names. And the last name
was very ambiguous. There were Christian and Muslim families in Lebanon with
that name, so that made it particularly hazardous. I mean, I could be nailed by
any group basically. I wouldn't be comfortable.
HATHAWAY: I guess that's where maybe we should end up today. You mentioned
earlier on tape that the realization-- Again, there was really more of a
subconscious thing or something that you were always prepared for. That staying
in Beirut wasn't really going to be an option at some point or that things were
01:25:00going to get worse and worse. And you're also at an age--Admittedly, your
concentration was on your studies as an undergrad, I'm sure, but in med school,
and then in residency or whatever, much more intensely that way. But as you
said, you could get nailed by-- Politics and all these issues were constantly
surrounding you. I'm wondering about your political involvement or about how--
Were you almost forced to and you refused? I'm trying to get a sense of how one
dealt with what must have been daily kind of encounters with movements and sects
of movements and just sort of your commitment.
HANNUN: Politics is a very strong element, or was, in Lebanese society. It
01:26:00absorbs a lot of people's energy. I attribute it, in my simplistic analysis, to
the fact that people don't work as hard. They're not as much trying to achieve,
and therefore they don't spend much time doing their work. I mentioned that's
the trade-off, whether you want to keep the roots and then say, "Okay, what job
can we find you so that you stay here?" And then you get a job, and you're not
particularly excited about the job, and the job doesn't really depend on you
either. I mean, government functionaries in Lebanon would probably work three
hours a day at best and then spend the rest of the day bullshitting around or
01:27:00going to another more real job. So there's a lot of this idle time.
And people don't engage in a lot of either hobbies or productive activities.
They engage a lot in just cafe-type discussions, and that's on a daily basis.
People would also engage in all kinds of social activities the whole week round.
It's not like, "Oh, we'll go out Saturday." People go visit each other during
the days, during weekends. So it's that kind of atmosphere.
HATHAWAY: And you're ascribing that to the situation and the tension in Beirut,
to the cultures that are there? Or just all for every human culture?
HANNUN: Not every-- That was Lebanese, maybe Middle Eastern. I mean, I have my
own unsubstantiated analysis.
01:28:00HATHAWAY: Well, that's part of what we do when we interview is to try to get
these opinions, which are as important as facts.
HANNUN: I think the economic basis of wealth in the Middle East has made it very
easy for people. With the oil, in the oil-rich countries-- Definitely the people
in the oil-rich countries never sweated it out. And they're given handouts,
hundreds of thousands of dollars' worth of handouts, and that's why everybody's
happy and there's no discontent there. But it's also filtered down a lot to the
Syrian, Lebanese, Jordanian, and Palestinian communities because a lot of those
people went and worked in the [Persian] Gulf, including my father. But most of
the people who stayed in the sixties, unlike my father, made a lot of money,
01:29:00because the sixties were the boom days of the gulf. And those were the days when
that part of the Middle East--Syria, Lebanon, Jordan--were the interface with
the rest of the world for the gulf region. A lot of people made megabucks there
at that time and were supporting their family. It was easy basically. I mean,
you could be a millionaire without having sweated it much. And that permeated
society to a great extent. It didn't get all the way to the lower socioeconomic
strata. It didn't filter that much there. That stratum was, I think, the root of
all the strife in Lebanon because it was totally underprivileged and uncared
for. But a lot of the sort of more professionals that you would equate with the
hardworking class, let's say, in the States, were not hardworking people. Many
01:30:00were. I would say a few were, but most were not. I know my father was a very
hard worker; other people that were acquaintances worked hard. But many were
not. Many would have just all kinds of idle time. By and large, a lot of the
people-- A government employee or even bank employees-- You know, the banks
would close at one o'clock.
So this idle time I think fermented a lot of this or allowed the fermentation of
a lot of this political discussion, not that it was any more intelligent than
what conversation you could have with someone else about U.S. politics where you
only discuss it once every two weeks, but they were engaging in it day in, day
out. And with the civil war, there was a lot of pressure, first, to understand
what was going on, because your life could depend on it if you go in the wrong
01:31:00neighborhood. You don't want to do that. And it took a few years before things
really got defined, demarcated, at the geographical level, because when the
civil war first started I didn't know that this area was mostly Druze and this
was mostly Maronite. But obviously within two or three years that became very evident.
And the other thing is, as things polarize what happens is-- That's a general
statement too. I always like to make sure those are clear. As a scientist, I
hate to make general statements. As things become polarized and friction arises,
what happens is those different sectors of society relinquish decision making to
the wrong people, just like what's happening now in Bosnia. It's not the
01:32:00moderates who are running the decision making. The Serbs have relinquished their
decision making to the militia leaders. And the Bosnian Muslims the same and the
Croats. The same thing happened in Lebanon.
HATHAWAY: They had more than just this nationalist interest at heart--their
careers and whatnot.
HANNUN: You give decision making to these people who are either criminals or
with very strong criminal tendencies who are willing to go and murder for you.
You first accept that "Hey, they're going to protect me."
[END OF TAPE 1, SIDE 2]
HATHAWAY: I'm going to try to remember where we were. I think you were
discussing a situation where the tensions were growing and the pressure was on.
01:33:00But you'd also gone by way of talking about how the people were giving the
opportunities to the wrong people to answer these questions or solve the problem.
HANNUN: And suddenly, or not very suddenly, the society in Lebanon was run
pretty much by those warlords. So that set the forces backwards. And then the
pressure was on everybody to basically, willingly or not, belong to one group or
the other. Definitely for Lebanese it was so much so. If you were a Maronite and
you didn't support your Maronite warlord, you'd be in trouble, and definitely
for the Druze and whatever the same thing. I think people in Ras Beirut were
still much more protected from those, just because of, again, daily interactions
with other people of different backgrounds.
01:34:00My personal involvement is-- I mean, I was always interested in Palestinian
nationalism and sort of always felt the injustice to the Palestinian people,
especially the people in the refugee camps. I always considered myself lucky in
having a lot of options. But obviously the people in the camps were victims of
almost everybody. That obviously panned out in time in terms of how they got
beaten by the Israelis, by the Lebanese Christians, by the Lebanese Muslims, by
the Syrians. I mean, everybody who said they were their enemy beat up on them.
Everybody who said they were their friend beat up on them.
HATHAWAY: And the massacre--
HANNUN: And the massacre, yeah.
HATHAWAY: That absolutely nobody had their interest at heart.
01:35:00HANNUN: Yeah. So I always felt those were sort of helpless victims. That was
sort of my sense of civic responsibility. I think I'll put it more as civic
responsibility rather than political responsibility.
HATHAWAY: Do you find the same criticisms you have for, let's say, the different
Lebanese groups, which obviously have outside, clearly outside influences, as
well, and actually rely on them--the Syrian, the Iranians, in the case of the
Maronite--? God knows it's a different group of the Israelis at one point,
right? Everyone's using this as-- Again, the people who are supposedly
representing certain Lebanese groups are using it for the furtherance of their
own power, but also the foreign or outside are using it for their influence
within a situation. Do you see that there's something like the PLO [Palestine
Liberation Organization] as also kind of outside-inside or do you see that as
01:36:00having some sort of more civic, let's say, and less political approach to--?
HANNUN: Both. Definitely the PLO was as much shattered by outside influence as
anything else. The way I look at the Lebanese conflict, again, just to sort of
put things in context, is that there are many tiers to this conflict. There's
the age-old conflict between Lebanese Druze and Lebanese Maronites who lived in
the mountains. Then there's the more general Lebanese conflict between the
different sects and the Shiites trying to aspire mostly for a bigger share of
government, since they were mostly cut out of that. And then the Maronites and
to a lesser extent the Sunnis trying to prevent that. But then the regional
conflict, you know, Syria and Israel playing their own war games and tug of war,
basically, through the Lebanese factions, definitely feeding that conflict a
01:37:00lot. And then, obviously, the more global conflict was between the Soviet Union
and the U.S., sort of polarizing that even further.
I think that global context was a necessity for the regional context, which was
a necessity for the Lebanese conflict. I mean, it wouldn't have been possible
for Syria and Israel to play those games if they were not selling themselves as
subserving the interests of the U.S. and U.S.S.R. respectively. And definitely
the Lebanese people wouldn't have been as well armed and financed if they didn't
get money from Saudi Arabia and Syria and Israel and Egypt. I think everybody
around there gave arms and supplies. And Iraq and Iran. The whole region was engaged.
01:38:00It was a pitiful game because the language of that political game was naked
violence. That was the language, literally, meaning that you could send a
message by blowing up a car. That was the level of communication. I mean, it's
not hyperbole. It was blowing up a car in the middle of the market just to tell
the leader of whoever controls that region, "Hey, we got to you today because
you weren't toeing the line yesterday."
HATHAWAY: The same that's in perhaps Northern Ireland between the British and
the IRA [Irish Republican Army].
HANNUN: Yeah. Although there the messages are much more clear-cut, that, you
know, "Hey, we hate your guts, you hate our guts, and we're going to blow you up
until you do--" There, I mean, it was even, what, instead of sort of France
sending a message to Germany, "We don't like your interest rates," [Syrian
President] Hafiz [al-]Assad could send a message to the Maronites one day or the
01:39:00other people the other day, "We didn't like what you said yesterday," and blow
up a car. It was that level. The worst part about it is the people. We could
never interpret those messages. We would see it as random violence, but we knew
it wasn't random. Someone had planted that car bomb for a reason. You knew that
whoever received that message knew exactly what the message was. It was a very
sick game being played with human lives. Just to jump back to later years, when
I was a resident in the hospital, you'd get a bomb--either an Israeli attack or
a Syrian bomb or whoever planted a bomb somewhere--and you'd get two hundred
casualties in half an hour. I mean, it was horrible. It was really horrible. So
the pressure was there to--
01:40:00So the PLO was both-- The other side, going back to your question, the PLO was
obviously rampant with all these levels of conflict, one faction going for the
U.S.S.R., the other aligning with the Saudis, so that they can align with the
West and all kinds of things. But it did represent, and I think it still does,
although I'm not much now in the situation, in the middle of it--Definitely,
when I was in Beirut, the PLO did represent the sort of national aspiration of
the Palestinian people. It did command their civic duties, meaning that if you
were a Palestinian engineer and you wanted to do something about Palestinian
refugee camps, you would go through that [the PLO] and do it. So it did command
not only the political and nationalistic but also the civic--
01:41:00HATHAWAY: And that's again where we started going, came from on this, was your
talking about your direct sort of--
HANNUN: Yeah. So I mean, obviously, at the personal level, I would engage in
whatever political discussions are going on, trying to probe why we think one
way or the other. Almost invariably those were fruitless discussions. Towards
the end, I got very disenchanted with the whole system. The whole social
structure basically became very disappointing that would allow this kind of
nonsense going on and on. Beyond that, in terms of political activism, I was on
and off involved in-- I don't know how to describe it. Nothing significant
basically. But I would always-- You know, if there are ways to help-- Let me
01:42:00give you examples. During '79, when Israel attacked southern Lebanon and there
was a major displacement of Shiites and some Palestinians, I was very engaged in
collecting blankets and food and whatnot.
HATHAWAY: You were either just graduating from your undergrad or you were just
going into medical school, right, if you finished in '83.
HANNUN: I was early in medical--
HATHAWAY: Right, because '83 was actually when you finished your residency.
HANNUN: Right. So I was in medical school. It must have been '78, I forget the
year, '78 or '79, when the invasion of southern Lebanon occurred. That was one
time I remember vividly because we stayed engaged for many weeks on end. We set
01:43:00up a clinic to cater to those people. That would be the most sort of vigorous
memory of that.
HATHAWAY: And again, we really are talking about--again, I think your
distinction is much better than anything I could have come up with--the civic
versus really the political, whereas that doesn't mean it [doesn't have]
political ramifications. But it was, again, Shiites as well as Palestinians, and
that wasn't an issue for you. It wasn't simply "Okay, which of you are
Palestinian? I'll help you."
HANNUN: Yeah. I was very disenchanted with the political structure even of the
PLO. I mean, even if I wanted to express my political nationalistic activism,
which I did-- I would have liked to see the Palestinians improve their human
condition. But the PLO was not the structure for me to express that, because I
01:44:00could just see it like another mess of things where you couldn't develop a
healthy infrastructure. And I did have some encounters with people from the PLO
or other militias. You know, immediately the first thing that comes across is
that you don't want to be dealing with those people. You could get tricked into
doing that, I think, if you develop sufficient hatred, let's say, against
another sect, say, "Hey, I want to do to them what they did to us." I guess once
you start playing the game of us and them you could get easily involved in that
kind of-- But if you're thinking more long-term--how can you make the whole
01:45:00Middle East more peaceful and healthier and a productive area of the world--the
minute you'd see those people, whether they're nominally on your side or not,
you'd say, "Those are not the people I really want to interact with." They were
not selected because they were popularly elected. They were not selected because
they were doers in terms of doing good to the population, or achievers. They
were selected because they could do the dirty work. That's not the way to solve
the problem. I guess that was pretty much the extent of my political activity.
[END OF TAPE 2, SIDE 1]
[END OF INTERVIEW]
01:46:00HATHAWAY: We talked a little bit before we turned this on. I think we pretty
much decided we'll just kind of pick up where we left off and worry about maybe
talking about some more general things toward the end where maybe there's a
relationship there. Really where we left off was your going to medical school. I
think we covered why and the impetus for going. I guess the only question or the
way I'd start it off is to ask, was the American University [of Beirut] your
only choice, or your first choice? What were the reasons for going there, as
01:47:00opposed to like your dad [Awni Hannun], I guess? I think he went to Europe.
HANNUN: Well, going to undergraduate at the American University was sort of a
very logical progression at the time. And again, I guess from the cultural point
of view, which is quite different from the U.S. culture, the family stays
closely knit much longer than the U.S. family. The age of separation is usually
not at eighteen. It usually actually comes after college rather than before
college, and it's never as clear-cut a separation. The fabric is much tighter
and extends into the extended family, not just the nuclear family. So going to
01:48:00the American University was a very logical choice. It was the usual norm there.
At that time--and I have to remember here a few things--I did toy with the idea
of coming to the States for undergrad. We talked about that a little bit. I
really didn't feel like it was important. Maybe in retrospect I would have done
it, I don't know. Again, I think the frame of mind of myself and most other
people my age is you didn't have to leave home or your town when you hit
eighteen and just go on your own. So staying there was a very logical solution.
01:49:00The other thing is I think the civil war was starting to brew. That must have
been a little later on.
HATHAWAY: Yeah. I wanted to get it down for the record that you started medical
[school] in '70--
HANNUN: In '76.
HATHAWAY: Okay. I wanted to say '78, but okay.
HANNUN: In '76. And the civil war in Lebanon started in '75. At that time, I
sort of got trapped in staying in medical school at Beirut. The way the civil
war started, it wasn't clear whether it was going to escalate and become what it
turned out to be or it was going to be a wrinkle that was going to go away. I
01:50:00guess people tended to stay together in sort of a more cautious approach to things.
HATHAWAY: I think in talking about the same period of time in our first session,
maybe it was-- I think I'm thinking high school, college. Maybe I'm going back
too far. You mentioned a sense of it just getting worse and worse, though. I
guess I get the impression what you were talking about was-- And it wasn't just
you sitting there thinking about this all by yourself. Just a sense of all of
you having to get out at some point. I mean, that there was just nothing
definite, that there was certainly always in just the back of your mind--
HANNUN: In terms of--?
HATHAWAY: I don't want to say impending doom.
HANNUN: More anxiety, maybe, at the social, societal level, anxiety. You could
01:51:00see the process fermenting, brewing, in terms of people becoming more polarized
in their thoughts, more anxious, more exclusive of other groups. And that was
prior to the onset of the civil war. With the civil war, sort of it started
forcing people to take sides, even if they didn't want to.
HATHAWAY: I guess I'm trying to get a sense of how much that might have affected
your decisions about staying with your family, being near. Perhaps you even had
conversations with your father or siblings about what the family was going to
do. Maybe there were preparations starting to be made, because certainly
01:52:00everybody had had the experience prior to that of having to just up and--
HANNUN: I haven't thought much about that, but I think there was a sense of
maybe I wanted to be more practical at that point and really follow more a
clinical career and stick with medical school and try to be more down-to-earth,
more relevant that way.
HATHAWAY: And close to home.
HANNUN: And close to home. I don't know. Remember, for us growing up in Beirut,
the American University was really a highlight of education.
HATHAWAY: Obviously, it wasn't just a perception that was shared by people in
Beirut of certain backgrounds, but also that's the perception of many people in
the Middle East and the world. I'm talking about pictures in your yearbook of
01:53:00lecturers or visitors like LBJ [Lyndon B. Johnson] in '62 and [Jawaharlal]
Nehru. Obviously it was an intellectual center.
HANNUN: It was. It was a highlight in the Middle East. A lot of the leaders in
the Arab countries graduated from the American University of Beirut. It's
probably like having Harvard [University] in the U.S. but not having anything
else either. It's that kind of situation.
HATHAWAY: Cambridge [University] and Oxford [University] rolled up into one.
HANNUN: Yeah, and with very little in terms of other choices. I think after the
civil war other options opened to people in the Middle East in general in terms
of sending their kids to Europe or the U.S. But before that if you lived in
01:54:00Saudi Arabia, people would send their kids if they had the ability to. They
would send them to the American University because it was an Arabic-speaking
country and closer to home and offered really top education. The medical school
in particular had an astounding reputation. [tape recorder off] The medical
school was maybe in a way elitist, but it was the highlight of education in the
Middle East by far, undisputed.
HATHAWAY: Was it really tough--?
HANNUN: It was extremely tough to get into. So again, in the good old days,
probably even before my days, you were talking about selecting a class of fifty
01:55:00students from mostly the whole Arab population, not just Lebanon. I mean, you
really were selecting the top young graduates from the American University as
well as other places for admission to the American University.
HATHAWAY: I hope I also haven't been giving the implication that I was saying,
"Oh, why didn't you leave and go to a better school in Europe?"
HANNUN: Yeah. I understand that. I have to explain sort of my perception at that
time. It's very different from a kid going to high school in Durham, [North
Carolina] saying, "Well, do I go to UNC [University of North Carolina] or do I
go to the West Coast?" I mean, those were really not the options available at
01:56:00that time. For one thing, the American University was it in the Middle East for
a medical education. And the reputation was great because the medical school was
primarily set up by solid academicians who came mostly from American medical
schools and set up the different departments.
HATHAWAY: And they were American-born?
HANNUN: Yeah, mostly American-born.
HATHAWAY: So a mix perhaps, then, of Arabs and-
HANNUN: The faculty was-- You know, an Arab-Lebanese faculty was groomed, but it
was really initiated mostly by American heads of departments. I think in the
01:57:00forties perhaps, 1940s and 1950s. I recall people saying [Allen 0.] Whipple of
the Whipple procedure would spend a few months at the American University and
so-and-so did. I mean, many of the big names we encountered in textbooks. Ray
[Raymond D.] Adams, the top neurologist in this country--he's an older man
now--was still visiting Beirut even during the civil war. The interactions were
mostly, actually, with Harvard and with Johns Hopkins [University], a lot with
Johns Hopkins. Probably the American University was the only sort of medical
school outside the U.S. built on the Osler tradition.
HATHAWAY: I have some familiarity with that.
01:58:00HANNUN: In terms of the apprenticeship system of William Osler, in having
medical students have hands-on experience from the very beginning, in terms of
the house staff training being not only hands-on but more like a boot camp,
which it was until very recently in most medical schools around the U.S. As an
intern, you just lived in the hospital. You just had no other life. Your life
was the hospital, which was very important because, from my experience going
through it and as an educator, it's the year where people undergo a
transformation. So it was very unlike most European systems. Even in France and
01:59:00Western [Europe], it's more the professor and everyone flocking around the
professor and watching what the professor [does]. It was a real hands-on experience.
The reputation of the medical school was great, so it was a very viable
alternative to stay and go to medical school there. It was so well connected
with mostly Hopkins and Harvard that most people who went through easily usually
went on to have more specialty training at either Boston or Baltimore or go back
or stay. So it wasn't like a dead-end situation. It was a very viable choice
and, again, probably financially a much cheaper choice than going to the U.S. to
a private medical school or something like that.
HATHAWAY: Do you mind my asking, is there any way you can equate what you were
02:00:00paying in tuition or something with anything that--? If you could remember how
much it costs, say how much it costs.
HANNUN: It must have been around $3,000 for tuition. But remember, I was staying
with my folks, so that was it for expenses.
HATHAWAY: Do you also know perhaps what the tradition or the attraction was for
places like Hopkins and Harvard? You mentioned just offhand there was some
administration being done by this board of trustees that was actually back in
New York and not in Beirut, from World War II. I'm just wondering if you can--
02:01:00HANNUN: I don't know the history of it.
HATHAWAY: Americans founded the place certainly.
HANNUN: I think it may have had to do as much with people at Hopkins or Harvard
very interested in exploring international possibilities, and the American
University stood out as sort of--
HATHAWAY: There was also a chance to get to a really nice beach in the
Mediterranean! Who knows?
HANNUN: So I really don't know the historical background to it. I vividly
recall, going myself through the medical school, that most of the faculty were
Lebanese or Arab, had trained at usually either Hopkins or Harvard, mostly
specialty training. There was definitely this kind of connection.
02:02:00HATHAWAY: And is that where your opportunity to come to Duke [University Medical
Center]--? I mean, we're just jumping ahead. We won't get into it. It was a
tradition. It was a thing that many people did.
HANNUN: Yeah. The tradition was-- I think as the place was growing, up until the
civil war, the American University had set up first-rate residency programs,
which are sort of the initial specialty training, whether it's in surgery or
internal medicine or what have you. Those were very powerful programs, again,
extremely competitive. But they had not set up any significant subspecialty
programs. So that was the end of the road with the American University. Most
people who wanted any further training, subspecialty training, had to get it
somewhere else, usually in the States, sometimes in Europe.
HATHAWAY: And so actually your father going to a place like Glasgow is actually
02:03:00more kind of against the grain or something. Or maybe there was no tradition, he
just simply went because he wanted to go to med school.
HANNUN: When he started out, that was in the late twenties.
HATHAWAY: Of course the British presence was so-
HANNUN: The British presence in Palestine was it . . . . I mean, they were it
there. He did try to go to the American University. It wasn't yet sort of a
premier medical school at that time. He did try to go there, but I don't recall
the details. There were some funny incidents. He said, "I don't want to go
there." And he decided to--
HATHAWAY: It still could have well been tough to get in just because there were
many families or connections or something.
HANNUN: I think it was even more trivial than that. I think he wanted to play
soccer and they wouldn't let him. It was something like that. It was real
trivial at the time.
02:04:00HATHAWAY: You were a mathematics major, right, as a undergrad, but of course, as
you said, did double time doing all the requirements for the math major but also
making sure you got all the requirements in for premed and being able to apply
to med school. I don't know that you talked much about what that was like. You
were obviously more interested in the mathematics, I think.
HANNUN: Actually, for a while I was more than a mathematics major. Let me recall
that. Because when I went-- How did it happen? My first semester, my faculty
adviser would not let me register for more mathematics courses, for as many as I
wanted. I actually-- And this is another university. That was the Lebanese
University. I went as a math major there. But after the first semester, my
02:05:00adviser let me take as many courses as I wanted. So that's when I sort of
majored primarily in mathematics.
HATHAWAY: So the other courses-- I mean, you were taking just kind of the gamut
of chemistry, organic chem, biochem.
HANNUN: Well, it was a rigorous curriculum. And for people who went into
straight premed, which I did, it was a full curriculum.
HATHAWAY: Much like it is here, I take it.
HANNUN: No. Not even-- I mean even more so. I mean less flexible than the premed
curriculum here. People had to take a fixed number of biology, chemistry,
physics, English, and literature. I think all the course requirements amounted
to very few electives, very few electives.
HATHAWAY: Right. Or as long as you took the three English classes from each
02:06:00century, you got to pick which class you took or which professor you ended up
with, that sort of thing.
HANNUN: Yeah. Pretty much.
HATHAWAY: I'm trying to get a sense of what the quality--Again, you're mainly
looking at biology classes.
HANNUN: As an undergraduate.
HATHAWAY: Or just as prep[aration] for med school, and then we can talk more
about the med school classes. I don't want to make this a major--
HANNUN: Remember, I started at the university in '74, undergrad[uate]. There's a
quirk there to the system, because we graduate from high school and the freshman
year is incorporated in high school.
HATHAWAY: So it's three years you did-
HANNUN: Yeah. It's a whole combination of one being incorporated into the other.
There was an option for non-Lebanese like myself to enter the university at the
02:07:00freshman level, but most people entered at the sophomore. So I entered at the
sophomore level. I did the equivalent of a [college] freshman in high school.
The same thing with medical school. There was an option for most people who
would qualify to enter medical school in the senior year, and the first year of
medical school would double up as the senior year. So that's why the premed
curriculum was pretty tight, because you could take it over two years.
HATHAWAY: And actually kind of one year was in high school. I mean, you're
really talking about--
HANNUN: In addition to the high school year, you could take it over the
sophomore and junior and then go into medical school.
HATHAWAY: Med school with a year under your belt.
HANNUN: Quite a number of people condensed it, went through the two-year
program, but the same requirements.
HATHAWAY: That's what you did.
HANNUN: That's what I did.
HATHAWAY: I was going to say, you entered in '74 and you've talked about med
school beginning in '76.
HANNUN: So it's a little confusing because sort of the freshman year you do in
02:08:00high school and the senior year you do in medical school. It was really only two
years of your usual undergrad. The quality of education was excellent from the
didactic point of view, excellent. We talked about that the other day a little
bit also. In terms of the creative aspect of it, I think as compared to my high
school experience, if anything, the didactic part was not as superb as the high
school experience, but the creative aspect became more available.
HATHAWAY: What examples might, you know--?
HANNUN: It's very haphazard, very much dependent on the teacher and the course,
rather than on a program or a department. Let me think. My theoretical physics
was wonderful. I had a very brilliant teacher who just engaged us in all kinds
02:09:00of ad-libbing theoretical physics rather than follow a textbook. Our botany
teacher, the second or third week into the course, turned against us pretty
much. I guess the class started becoming rowdy or something, and he just became
the most horrible, didactic teacher. There were some literature courses that
were wonderful, English courses horrible.
HATHAWAY: When you say literature, then, you're not talking about just
literature taught in English or-
HANNUN: There were required courses in English as a language.
HATHAWAY: Like composition and grammar.
HANNUN: Yes. Yes. That kind of stuff. Those were horrible. Arabic classes, the
ones I took, were very uninspiring, I think.
HATHAWAY: And those were literature, more literature study, reading.
HANNUN: Yes. Reading and some writing too. Mathematics, again, some were
02:10:00wonderful and brilliant, and others were not. Organic chemistry was good, but I
didn't like it at that time. Actually, while I was doing my mathematics, I
somewhat resented the premedical curriculum.
HATHAWAY: And you were really more geared-- I guess I'm also trying to get a
sense of what your perceptions were. As you said, you'd become more practical,
given the situation you found yourself and your family in. But you also had this
lifetime's experience of what it was like to be a doctor, I assume, with your
father, I mean, whether he took you on rounds every day or not. You still had to
have some sense of what a doctor does, how a doctor does it, and that sort of
thing. And then here you are having to take these prep classes.
I'm also, on top of all that, trying to get a sense of your own feeling-- Are
02:11:00you just going into something to do? You know, in 1974, '75, '76, biology, like
it had in the early 1950s, had just come full circle. It was taking off. And I
was wondering-- I've noticed there's a wide variety of responses, because you
[Pew scholars] all basically were undergraduates or just thinking about
continuing a career in biology or health or something when this happened. People
have a wide variety of experience with it. For instance, no such thing as
molecular biology was being taught to undergrads at all until '82 or something
like that. So I'm also trying to get just a sense beyond your reaction to it of
what was being-- Did you have an idea of what biology and medicine were, in a
larger sense, beyond your father's practice?
HANNUN: No, not really, actually. Not really. And even my father was very remote
02:12:00from my decision making. If anything, at the intellectual level, I did not like
my father's model of clinical practice.
HATHAWAY: Because it seemed boring?
HANNUN: His was really down-to-earth taking care of patients, day in, day out, a
very hardworking person.
HATHAWAY: Not a specialty and not sitting in an office. He was out--
HANNUN: He was an internist. He was working very hard, and he was motivated to
take care of that group of patients. But you could see the price he was paying
for taking this kind of career.
HATHAWAY: You mean emotionally.
HANNUN: Emotionally it was draining. Tough patients to deal with, mostly
uneducated, poorly educated.
HATHAWAY: Maybe few results in the preventive area, right. You treat them, but
they'd come back with the same--
02:13:00HANNUN: All those kinds of frustrations. I always respect his dedication to that
work. But in terms of a model for clinical medicine, if anything, I probably, in
retrospect now, since you ask, didn't like that. I never thought of it that way
before. I didn't want-- It was something that I was ambivalent about, I guess.
HATHAWAY: I was going to say, what other models maybe did you have? Maybe the
HANNUN: At that time, probably, honestly, I didn't have too many role models.
HATHAWAY: This was a real practical--
HANNUN: Yeah. And going through undergrad, that was part of the resentment in
going through the premedical curriculum. On the other hand, I had decided that
math was not going to be my long-term career. I wanted to enjoy it in undergrad,
and I did that. But I also resented a lot of the premed. The premed
02:14:00mentality--Again, to put you in that perspective, there was a major selection
among premed students for medical school. I don't recall the numbers any longer,
but it could have been as many as three to four hundred students, entering
premedical students, with only fifty being accepted at the end.
HATHAWAY: Fifty from American University plus others--
HANNUN: Plus a few others from other places. Mostly from their undergrad. It was
HATHAWAY: It was happening right there in front of you, as well. You know, if
you were all applying to Harvard, you live in a thousand different places. You
live in the same town--
HANNUN: It transformed many people, and you could see it transform them. I
didn't like that. I didn't have any difficulty in getting high grades, so I
02:15:00wasn't worried about myself. But I resented the fact that I had to be in this
kind of rat race.
HATHAWAY: If I can interject for a second and, again, not to really go after
something-- You talked about "resenting." That feeling-- I'm wondering, did you
have a sense of what it was or who it was you were resenting? I mean, was it
life in general, all of mankind, your parents? I'm just curious to get just a general--
HANNUN: No. It was a very focused resentment. I was happy being at home. I was
totally free. It was like renting out basically. Very good terms with my
parents, my siblings. Many friends. I always did things with friends, always had
02:16:00the time to do that. But intellectually the premedical program was uninspiring.
And I sort of at that time-- To be very honest here, at that time it was like a
gamble to me that there was something good about medical school, but I
definitely did not see it in premed. That was a source of that kind of
resentment. I think that, again in retrospect, was justified, because once I hit
the clinical years in medical school I loved that, I loved that. But the
premedical program, I didn't like it. It was a rat race. A lot of my friends
just got sucked into it. I could see them struggling and many dropped out. It
02:17:00was a lot of pressure, sort of family pressure. "You either become an engineer
or you become a doctor." In the Middle East, lawyer is not an option.
HATHAWAY: It's no longer being considered much of an option here either. Well,
that's maybe not completely true yet. I was going to say, what were the other
options? I mean, I guess there weren't any. This isn't just an issue of peer
HANNUN: Yes. Exactly. I mean, for me, if you ruled out theoretical physics or
mathematics, engineering was the other option of sort of acquiring a
professional career. Many people went into business if they had the family
support. You know, if they were born into a wealthy family, they knew they had a
02:18:00business to grow into after they graduated. But other than that there were very
few opportunities for professional education and professional careers. I think
that's a true statement.
HATHAWAY: You also brought up--and maybe not directly, I mean not in this
context--the sense of how you looked around you in Beirut and saw a lot of
people who were idle. And I assume perhaps that was another option, right,
especially if your family could support you or you could just hold some sort of
a job that was even semiprofessional or not a job at all, especially in times
when there was real doubt about what tomorrow would bring or this
holding-pattern situation. You didn't talk with negative things to say about
this, but you mentioned that you saw around you a lot of people who--
HANNUN: Were idle.
02:19:00HATHAWAY: And then became almost kind of like, as you saw, perhaps a detriment
to any solution to the problems that were facing both the Lebanese and
HANNUN: Let me see if I got your question. I think, for me, being idle was never
an option. I mean, to put it that way. I think in retrospect I could explain
many things by saying I was always looking for a career that would
intellectually grab me full-time, twenty-four hours a day. In retrospect, it's
easy now to understand those forces because at that time it was maybe more
resentment or anxiety. But now I can easily see how I could never be a
02:20:00nine-to-five-job person. The vacuum that kind of job would leave in me would be
just horrible. I could not be someone in a career basically that did not grow
intellectually with time. So that eliminated a lot of options for me. I think in
retrospect, again, I was always steering away from all those kinds of options.
HATHAWAY: And I guess I was kind of just mulling around or just kind of bouncing
around this whole area, because, again, I get a sense that the situation you
found yourself in, the compromise with the premed-- And, of course, you later
came to realize it was not so much of a bad compromise-- But now, the time we're
talking about, you haven't figured that out yet. It must have been stifling.
There was this uncertainty. There were limited options. And here's somebody who
said that it wasn't even an option to think about not-- I mean, just kind of
02:21:00hanging out for five years. I guess maybe I expect more anger. Not that you have
to fit my view of things, but just you seem to be--
HANNUN: Yeah. It was stifling. I think that may be a very good description of my
emotion, why my reaction was that way. But again, I don't think my reaction
was-- I don't want to say it was anger. If I was growing up now in that
environment I would be angry, because I know different now, I know what other
options are. I know what good education is. I know what creativity is and how
that can be fostered. But back then I really didn't know that. I felt like I was
missing something. I was maybe being stifled, but I really didn't know what I
02:22:00was missing. So I don't think anger was a major-- There was some resentment, but
not anger necessarily.
I would resent going to biology. I mean, biology class was at eight o'clock. I
would never go to biology class. Small things like that. Organic chemistry,
always made a point of going fifteen minutes late to the lecture, almost
adolescent resentment of being part of that game. Again, in retrospect, I think
it was that stifling component. I was in search of something that would fulfill
me and have a long-term prospect. That's why I dropped math. I knew math would
at that point provide a lot of fulfillment, and it did. It definitely did for
those couple of years provide me with a lot of fulfillment.
02:23:00Along those same forces, the first year of medical school was the pits because
the first year of medical school was actually much more a continuation of premed
than an entry into medicine. The courses were lousy basically. With the
exception of neuroanatomy that we had and gross anatomy and some biochemistry,
all the other courses could almost have been premed courses. And at that time I
couldn't do my math. I couldn't do any other thing--
HATHAWAY: But med school, right, of course.
HANNUN: And that I resented. In the second year, things started turning around.
HATHAWAY: And this method you mentioned before, this mentorship or
apprenticeship method kicked in the second year then.
02:24:00HANNUN: It started a little bit in the second year, but then we started studying
real medicine. We studied pharmacology, the body systems, physiology,
microbiology, and interacting a lot with clinicians. So we were starting to
interface with the clinical. I thought, "Hey, there's so much to learn there." I
was really excited about the dimensions of this new knowledge.
One thing I have to bring in about all this, because parallel to what I was just
describing about my own personal reaction to the educational system was the
civil war. The civil war was brewing in '74, kicked in in '75 in ups and downs,
and towards the end of my junior year all hell broke loose in Lebanon. I was
02:25:00actually on a vacation in London, England. It was probably the only vacation I
took without my family outside Lebanon. I'm trying to double-check on that. I
got stuck in London because I couldn't get back. Now, come to think of it,
that's when I also was about to register at Imperial College [of Science and
Technology] for engineering.
HATHAWAY: Okay. This is a story I haven't got a sense--Because you were stuck
you looked into it.
HANNUN: Because I was stuck. That was definitely because I was stuck.
HATHAWAY: Never stopped for a minute, right. You would just pick up and-- I
mean, if you were going to be in London for, oh, a year or six months--
HANNUN: Yeah. I better do something about it. I corresponded with my father, and
he said he could support me partly. I went to Imperial College, and they offered
me admission and some support. For some reason, I had--Or maybe my father sent
02:26:00me my transcripts or something. So it was real easy, based on my transcripts, to
convince them that I was a good candidate.
HATHAWAY: Prospect, right.
HANNUN: Yeah. Prospect.
HATHAWAY: Had you friends there? I mean, were you really kind of like stuck in
the middle of London without family or friends?
HANNUN: We sort of were a group of three, I think, who traveled there, and we
met with another group of a couple of other people. So we ended up being six,
seven people who got stuck there. The airport was closed in Beirut. I thought,
"If I'm stuck here, I'm going to make something useful out of my stay." I
thought engineering would be a good option. Three or four years and you're done
with it and you have a career and just get it going. Obviously, I couldn't see
myself idle in London. Or with the prospect of not having any way of yourself,
being, I guess we use the phrase, "down and out."
02:27:00HANNUN: I did have a friend there in London who had already sort of bailed out
from Lebanon and went to London for education. That year, '75, many people
started bailing out. Many of my friends started bailing out, and that continued
throughout the years. Because now if you ask me who of my couple of hundred
friends that I had growing up remains in Beirut, probably there are only two or three.
HATHAWAY: And why didn't you go? Had you considered--? I mean, it didn't take
you long to think about doing it for practical reasons as well when you were
unable to get back to Beirut. But had you thought, "Oh, I'll just kind of pick
up medical school somewhere else, and I'll get the hell out of here."
HANNUN: I think I tried to look into medical school, but it was pretty difficult
in England to get into medical school on that short a notice. You know,
basically it was I think late September or something, walking in, saying, "Hey,
I'm stuck here. What's available?" Medical school was not available.
HATHAWAY: But you hadn't thought about this while you were still in Beirut. As
you say, your friends started leaving in droves.
02:28:00HANNUN: In terms of bailing out, I'm sure it's something that had come up dozens
of times with my friends.
HATHAWAY: I meant more seriously, like you'd sent off that application and got
that plane ticket.
HANNUN: It never became serious.
HATHAWAY: Sat down with your father to figure out the logistics of doing
something like this.
HANNUN: No. It never became serious except when I got stuck. But then things
quieted down, the airport opened, the medical school opened. I went back. So
there is this sort of parallel going on with the civil war there that I'm sure
affected a lot--maybe not a lot--but did affect my decision making.
HATHAWAY: It would have had to if the whole community that you expressed as
being very close and something you actually kind of miss in American culture and
here in Durham-- Although I guess we're not in Durham right now, Chapel Hill,
but, you know, in this area and in this part of the world. It must have had some
02:29:00effect, again, not anything direct that we can calculate.
HANNUN: I don't think it's something very direct to articulate.
HATHAWAY: It must have been frustrating. I mean, you had a goal in
mind--finishing med school. But did you have beyond that? Some people really,
really plan their lives.
HANNUN: I didn't really plan my life. One of the ironic things is-- Again, in
medical school there were many excellent role models, people who were either
good basic scientists, very few-- There were very few basic scientists, but they
were very good role models. And there were many very good role models for
clinical medicine, very thoughtful, well-read, perceptive people, analytical.
The system there-- I mean, its excellence was derived primarily from those kinds
of people, because clinical research or basic research was not the forte. It was
02:30:00HATHAWAY: I guess that's what I wanted to go to. You know, it was the hands-on
stuff and the experience with--I'm sure we can even name names if there are two
or three particular mentors you have in mind or people you came in contact with
as a med student. I wanted to know what that spark was that kicked in and made
you decide this wasn't-- And I think actually, yeah, why don't we do that? I
asked the question on this side, but you can answer it on the other.
[END OF TAPE 3, SIDE 1]
HANNUN: So you're done with your question, I guess.
HATHAWAY: Unless you had more to add about the experience of being kind of stuck outside.
HANNUN: No. That was really transient, and it's never something I hesitated to
02:31:00drop once I had the option to go back and finish medical school. So it wasn't really--
HATHAWAY: And this is far enough along in the process that you already had that spark.
HANNUN: What spark?
HATHAWAY: You said something about how in the second year it finally-- I think
you used the phrase "kicked in."
HANNUN: There were a couple of things that happened in medical school that I did
not anticipate when I was a premed or even before. One is the enjoyment of
clinical medicine and the satisfaction that that gave me. I knew that that would
be a good career, but until I had sort of the second year and definitely the
third year of medical [school]--which is where the clinical stuff really kicked
02:32:00in--I really did not have a good anticipation of that. Had I had that
anticipation, probably things would have been more palatable to me in terms of
premed and what have you. So that was--I don't want to call it a spark, not even
a revelation--a very positive thing that happened. It was intellectually very
stimulating. There was so much to learn about the human body in health and
disease. The hands-on experience in clinical medicine was very gratifying
because you could easily be called a doctor even as a third-year medical student
and would deal with patients as their primary caregiver under very close
supervision and whatnot. And again, the role models there were very good, were
02:33:00excellent clinicians that mostly were very stimulating people.
Now, the other thing that was starting to develop at that time was sort of the
interest in biomedical research. That's sort of a very funny story there.
There's a twist to it, because when I was even in high school I considered sort
of shortcutting all that and going into-- As one option, you know, considering
many options, considering going into biomedical research, either some
biochemistry or microbiology or something like that, one of the biomedical
research areas. In high school, there were many people who were invited as role
02:34:00models to discuss career possibilities and whatnot. The person [Ibrahim purr]
who came to discuss with us biochemistry and microbiology sort of made me think,
"Hey, I don't want to do that." It's very ironic because that person turned out
to be my biochemistry teacher who I came to like very much and respect a lot. I
don't think I ever told him that.
HATHAWAY: A biochemistry teacher in college.
HANNUN: In medical school.
HATHAWAY: Okay. So he came down from the university.
HANNUN: When I was still in high school. I said, "I don't want to consider
that." It was sort of a generic conclusion on my part that I still think was
significant, that I didn't want to pursue academics or a career in research at
that time and sort of left it at that. And then the research option started
02:35:00growing again in medical school. I don't know if there was a spark there that
sort of got me into biomedical research or if it was more a gradual process. I
think it was more a gradual process. I enjoyed biochemistry a lot in the first
year. That was pretty much the only course I enjoyed. I enjoyed understanding,
or the goal of trying to understand, how the body works at the level of the
molecules and reactions, biochemical reactions. I thought that was fascinating.
Again, one is influenced by role models perhaps.
A couple of biochemists there were very smart people, a very positive influence
02:36:00on me. We also had a person [Naji Sahyoun] come in. He was several years our
senior. He had finished his M.D. That's a long story that also intersects my
career choices a couple of times at least, or actually more than that. He had
come to the States to-- Actually, he did not follow the normal track by Beirut
standards of going through residency and whatnot. But once he finished medical
school, he came to Hopkins to do biochemistry research.
HATHAWAY: So in a real sense he was kind of a model. I mean, even though you
didn't do it his way, you knew that was--
HANNUN: Yeah. What happened is my first year of medical school was his first
year of coming back to Beirut. After doing a lot of training--several years of
training, or maybe two or three years of training--he went back to Beirut and
02:37:00taught part of biochemistry. He sparked a lot of interest in many of us in sort
HATHAWAY: Was he doing some there?
HANNUN: He did some in Beirut. He did some research in Beirut.
HATHAWAY: Kind of continuing what he was doing.
HANNUN: I think so. Some of us started poking our nose in and just finding out
what was going on. And again, in the setting of the American University, by that
time it had become unusual. Apparently there was a strong tradition of research
in the medical center in even the thirties and forties and fifties.
HATHAWAY: Clinical, I mean, kind of applied-
HANNUN: That and very basic research.
HATHAWAY: Oh, so basic, not really related at all to treatment.
02:38:00HANNUN: I think with the civil war that was the first thing to go. I mean, from
day one of the civil war that was eliminated.
HATHAWAY: Was the government funding some of that? This was all
private-endowment type? I mean, I'm just curious. Obviously, it seems above the
fray of politics for almost forever. And it was only the outside forces that
kind of brought it directly into political-
HANNUN: I don't know what were the major sources of funding. I would say most of
it was university funds and maybe some government funds. But that was really the
first to go, because by the time we hit medical school, which was really the
first year of the civil war, it had gone. It had come almost to a screeching
halt. So that was really something different at that time, finding someone
setting up some experiments and things like that. That was a very strong
influence at that point.
02:39:00HATHAWAY: You were taking biochem classes even as an undergrad. Obviously
microbiology and all the curriculum was there. But there was, in a sense, then,
no-- I mean, a common-- Not by any means the majority, but a common avenue into
discovery about research and, "Oh, wow, this is fun," is undergrads who all of a
sudden are summer interns in what turns out to be similarly interesting.
HANNUN: No. The opportunities were not there, and that's a recurrent theme.
Biochemistry was a first-year medicine course. It wasn't undergrad. Undergrad,
the kind of labs we took were so anticreative that--
HATHAWAY: And they were just to repeat the same thing. "All of you do twenty of--"
HANNUN: You wouldn't believe it, but biology probably still involved dissecting
02:40:00starfish and whatnot. It was very primitive biology lab work. Chemistry,
inorganic chemistry, was also very primitive. I don't think even organic
chemistry had the lab. They probably didn't offer a lab for the premeds. There
was this sort of herd mentality that premeds are there for the grades, they're
not there for-- It was sort of a mutually reinforcing situation, where the
premed students wanted just to do the things that got them the higher grade, and
as a result or as also an additional impetus to that is that many of the faculty
dropped even any attempt at introducing creativity in the curriculum.
HATHAWAY: Just kind of bowled over by the students, you think, or just kind of
almost throw up their hands.
02:41:00HANNUN: Well, probably in the attitude of "Well, if they're coming here for the
grade and they're not interested in very creative lab work or spending a summer
in research, why bother with it? Just give them the didactic lecture."
HATHAWAY: And the problems at the end of the chapter.
HANNUN: Yeah. Something like that. So throughout, there were very few
opportunities for basic research.
HATHAWAY: Or just even to see it happen. You say you entertained the thought in
high school-- If I can just back up a little bit and get a sense of this, I
think it's interesting. And this guy, who turns out to be somebody you have
respect for and who really had an influence on you, didn't do anything for you
then. What was your sense of your exposure to this idea of academic research and
02:42:00an academic career? I mean, was it really just that opportunities were limited
for these people in Beirut? I'm trying to get a sense of-- You knew the
possibility was out there, but there was almost no way to grab onto it and
experience it for yourself.
HANNUN: Yeah. Absolutely not. I know now we recruit undergrads and high school
students to spend a summer rotation.
HATHAWAY: They're more of a nuisance than a help, right?
HANNUN: Well, they get to see what the lab is about and how science works. I
think the ones who have come to my lab, the way I could see how they reacted,
they had a positive experience. That to me is significant because leaving an
impression on high school students that science can be a very gratifying
02:43:00experience-- We didn't have any of those opportunities, primarily because they
didn't really exist as role models either. So research was as much of an
abstraction as anything else.
HATHAWAY: As you say, as the medical school kind of rolled along, the clinical
stuff became the real-- I mean, that was no longer abstract at all.
HANNUN: Yeah. Exactly.
HATHAWAY: I wanted to go back to that, unless you feel I'm kind of pushing you
to answer my questions, as opposed to treating this area as a whole. I was also
interested in getting a sense of how you compared the kind of clinical practice
02:44:00you got in medical school and your father's. You know, your father didn't serve
for you, at first at least, as-- Well, I mean, I think a lot of the reason some
people are doctors when their fathers are physicians, something about it excited
them or they liked the big car in the driveway, if it's an American situation. I
was just wondering if now, seeing this clinical stuff and patients and dealing
with patients and finding that exciting, whether you were able to make some sort
of connection with your father's work that you hadn't before or whether still he
was doing such basic kind of triage out in the--?
HANNUN: No. I think I did. I definitely connected with what he did. We could
discuss things, talk about things. Maybe I failed to express that. Medicine was
02:45:00probably to me much more viable than engineering because he was a good role
model for that. And dealing with people, maybe I thought, maybe subconsciously,
was a better career than dealing with concrete, for example. So there was this
positive influence there.
HATHAWAY: But as you said, it wasn't the drawing card to go into medicine, which
maybe you could see later on.
HANNUN: Yeah. It wasn't as such. I don't really recall ever sitting down and
discussing with him those options specifically.
HATHAWAY: You said once they realized you were doing the school work, it was
hands off. And who knows, maybe in some ways that's a really good way to deal
with it. Your father never forced you to talk about what you wanted to do and
said, "See, isn't this great, I'm a doctor. You can be a doctor." It was almost
like, "Okay. You're going to be a doctor. Fine."
HANNUN: Yeah. Pretty much that way.
HATHAWAY: Maybe in the long run it paid off and you found medicine to be-- Who
02:46:00knows, he could have turned you off from it by pushing it. I'm just curious
about this. For all he seems to have been hands-off, there seems to perhaps be a
lot in the way of influence that, as you said, maybe you hadn't-
HANNUN: Yeah. I believe in sort of a more philosophical point of view. Children
are more influenced by the reality of the situation rather than by how their
parents try to fake it out to them. If your father tells you, "Go ahead and
become a physician," and nags you to death about it, but you could tell that he
didn't care a bit about being a physician himself, that's-
HATHAWAY: That's the key.
HANNUN: Yeah. And on the other hand, I've seen my father being not necessarily a
02:47:00workaholic but a very hardworking person. It must have influenced me in
respecting that quality. I would consider myself a hardworking person. I mean, I
take my work seriously. may be very cynical at many times, but I take my work
seriously. I think he has the same attribute. But he never-
HATHAWAY: Said you had to have those-
HANNUN: Yeah. At all. But that's where I think children learn from their
parents. If you see your parents acting as good citizens, you grow up to be a
good citizen. If you see them not acting as good citizens, no matter how much
they tell you to act as a good citizen, it's not going to stick. That applies to
02:48:00maybe the hidden positive reinforcement of working with people and being a
doctor, not only as having a professional and secure job but also as having a
rewarding kind of job. I think that maybe, in talking a lot about the
educational part of getting there, that may have been missing. I could see that
if I was to be a physician I would have something I would like to do, dealing
with people and trying to help them out. But even at that time, I didn't have a
good concept of what it was. Actually, when I found what it was, it was even
better than what I expected.
HATHAWAY: And perhaps it's something that, even if your father had dragged you
out there once a month or something, you still wouldn't have got it the same way
as you did by--
HANNUN: Yeah. Again, my perception from looking at my father very indirectly was
02:49:00a physician is someone who just prescribes medicine.
HATHAWAY: And reassures people.
HANNUN: Yeah. From the outside you just see that kind of interaction, the final
action. You don't see any of the activity that's gone into providing this
action. So that per se was not a very positive influence. I guess that's when I
was on the wards and finding that "Hey, you go in and take a history and do an
exam and read about things and think about what studies you want to get, what X
rays. You have a differential diagnosis to think about and a line of management
to institute." I found that this was extremely gratifying.
02:50:00HATHAWAY: Can you say why--? This is as good a time as any. I mean, you've
described almost a kind of-- This one's abstract. We don't have a particular
case--maybe you do in your mind--but we're talking about a case. And the whole
process you've just described, I think, from the beginning to solving a problem,
or maybe not solving it well enough, but trying to solve it, and then to making
sure that the problem stays solved or reaches some resolution, which is really
what a doctor does in providing health care, right? Nurses take care of the
day-to-day things and then actually kind of act as the foreshock. They get the
message first, but it's the doctor that's expected to see the whole picture. Do
you know why that's what grabs you? Because it's complex? Because it's got
gratifying results, and it gets better usually?
02:51:00HANNUN: Well, it's sort of a whole, on the one hand, social microcosm. On the
other hand, it's a whole scientific microcosm. I think I may have to come back
to that second analogy, the analogy between science and clinical practice. But
it was a very intensive experience at the human, social, scientific, personal
level. It was way much more than--
Remember, back then what I would see-- When I was very young, my father might
take me to his clinic sort of as a baby-sitting arrangement for an afternoon or
something and put me in the side room to read something or whatnot while he was
seeing patients. That's when I described that I'd only see that he was
dispensing a medicine but not seeing what was going behind it. Even that to me
02:52:00was still positive. But when I saw that what was behind it was much more than
that, that was very gratifying. And again, back then, to put you in context,
there were hardly any sophisticated television programs on physician role models
and all the processes of things that could go on in a hospital or in a clinic.
So I liked it. Basically, the bottom line is once I hit clinical medicine I
liked that a lot. However, I think I liked it a little less and less as I
progressed in it.
HATHAWAY: Less challenging or same old thing maybe?
HANNUN: It became less challenging. There was sort of an exponential growth
phase in one's knowledge in understanding clinical medicine. But then with time
that really plateaus and--
02:53:00HATHAWAY: Even in the kind of changes that take place so rapidly, I guess.
HANNUN: Yeah. I mean, in terms of there's a major buffer that slows down things
in terms of when they come to clinical practice. So clinical practice doesn't
move as fast as I like it basically. But at least hitting the clinical years, I
was very happy, and I was very involved. I knew that that's what I wanted to
pursue at that time. So if you want to move on with the career choices, science
at that time was intriguing. It wasn't a career option for me at that time.
HATHAWAY: From this practical side of things, about something to fall back on,
02:54:00always being able to pick yourself up no matter where you landed, that sort of
thing? Or just also from the intellectual--?
HANNUN: Well, that sort of thing-- The problem is even at the intellectual level
I did not have the opportunity to explore what that was at an intellectual
level. And the only--
HATHAWAY: So this young M.D. who came back [Sahyoun], there wasn't any progress
made or there wasn't something he finally was doing in the lab that really was
going to go anywhere.
HANNUN: Yeah. When I was in the first year of medical school, he stayed a few
months in Lebanon and then went back to Hopkins. And then--because that's going
to come back to the story--he came back to North Carolina. You know, he didn't
set up like the hottest scientific lab in Beirut. That wasn't physically
02:55:00possible. I did not have a visual model of what that could be about.
HATHAWAY: And it wasn't long-term enough to kind of follow something through--
HANNUN: Yeah. It did raise my interest. I became aware that "Hey, there is this
dimension to medicine." started reading beyond the clinical literature, and the
more the clinical literature became boring, the more the basic science
literature became exciting.
HATHAWAY: Can you give us--I always say "us" because I always assume there's
certainly not just an audience of one--what some of that was? I mean, do you
recall? Was this just textbooks you came by? Was this the latest journals coming to--?
HANNUN: Let's say even starting the third year of medical school I was reading
the New England Journal of Medicine and Lancet and a couple, of other medical
02:56:00journals. I was totally intrigued for maybe a couple of years but then much,
much less with time. Now when I pick up the New England or Lancet, I dispense
with them in fifteen minutes. I clearly remember the first time or even for the
first few months I could spend the whole afternoon with the New England Journal,
just being fascinated by--
HATHAWAY: It's like learning a culture from reading-
HANNUN: Yeah. Like learning a new language basically.
HATHAWAY: Sure. And how things get written about and who's who even.
HANNUN: Yeah. Where were we now?
HATHAWAY: I was trying to get a sense of-- I don't think I was actually
engineering to see how you got away from the clinical to the stronger--
HANNUN: Initially, it was just sort of minor excursions into the basic research
02:57:00area. Maybe start with a review that the New England Journal throws in every now
and then about something more at the basic level or maybe pick up Science
magazine and look at it more than anything-- I mean, not anything deeper than that.
HATHAWAY: Not PNAS [Proceedings of the National Academy of Sciences]?
HANNUN: No. Nothing more specialized or less general. But clinical medicine
stayed as a very strong influence with me throughout my internship and my
residency. The other thing that was starting to come up as a career choice is
02:58:00subspecialty training. Throughout medical school you decide on what specialty
training you want to go into. I went into internal medicine as the most direct,
sort of, where you communicate with a patient, you know, where you try to probe
the patient. That was the most gratifying part of medicine for me. As compared
to surgery or ob-gyn [obstetrics-gynecology] or something like that, internal
medicine obviously was a clear-cut choice for me, where if you got a good
history from a patient, you could almost solve 80 percent of the problem. But
02:59:00you only could get a good history if you could probe the patient real well and
get to the heart of basically their soul, you know, to really understand how
HATHAWAY: Like this.
HATHAWAY: I get a little more time. It's not quite so vital to get--
HANNUN: To get the info real quick. So internal medicine was a very obvious
choice to me. In fact, I hated surgery. I think surgery selects the morning
people who are the doers, you know, the people who have to be on the go all the
time and don't really want to stop and-
HATHAWAY: Technical prowess and-
HATHAWAY: And the person that they're dealing with is unconscious.
HANNUN: Yeah. Exactly. I was turned off from all those and stuck with internal
medicine. When it came to internal medicine, obviously the norm was-- There was
a possibility to stick with that and then go out and practice, but by that time
03:00:00the civil war became rampant and Lebanon was not a viable option at all. And to
me Jordan was never really an option. I didn't like Jordan as a country to live in.
HATHAWAY: Your parents weren't going to budge. I mean, they still weren't
talking about leaving.
HANNUN: No. They became too entrenched in Lebanon.
HATHAWAY: And your sister [Rasa Hannun Bibi] and your brother [Imad Hannun] were
already away at school somewhere else? Or your brother is at Caltech [California
Institute of Technology], but I don't know if that's after.
HANNUN: My brother had come to Caltech by that time. He did engineering at the
American University of Beirut but then went to Caltech for his Ph.D. Then my
sister, she was the youngest, so she was still starting. She was in economics at
the American University of Beirut.
03:01:00Going back to the previous question, that's been an ongoing evaluation ever
since for me--what are viable options in the Middle East? And really nothing has
stood out in terms of a viable option.
HATHAWAY: For doing what you're doing here at Duke [University Medical Center]?
HANNUN: No. Even before that.
HATHAWAY: I guess I thought you were still talking like in the present tense,
though, as well.
HANNUN: It's still ongoing because I still have both hats, I mean, clinically
HATHAWAY: And both citizenships.
HANNUN: Yeah. Exactly. Both citizenships, Jordanian and American. Nothing really
stood out. I couldn't go to the West Bank, because I did go to the West Bank
under the Israeli occupation once or twice, and it's too demeaning to-- I mean,
I respect the people who live there under occupation. This is their home. They
03:02:00were born there; they grew up there. It's their home. They have to take it. I
respect them for that. But I just can't see myself taking that as a way of life.
HATHAWAY: Looking forward or picking that as the-
HANNUN: Yeah. And Jordan wasn't really a viable option for me. The whole Middle
East-- I did once in my residency go to one of the [Persian] Gulf states, Qatar.
I think it would be spelled Qatar.
HATHAWAY: That's I think how we spell it here in the United States.
HANNUN: It was sort of like a locum tenens, spending two months as an internist
there, and I hated it.
HATHAWAY: Just no culture in the sense of something you were familiar with?
HANNUN: I just didn't like the whole gulf area basically. Very wealthy people,
03:03:00born into wealth, without having had anything to do to earn it, and importing
all expert and technical support from outside the country to run their
hospitals, their schools, their police, their army, I mean their whole life
basically. It was evidently clear to me that that wasn't a society that I could
at all thrive in or be happy in. Although that was an option for many other
people to go--Definitely many of the engineers ended up in the gulf area, my
classmates or whatnot. Even some very few of the clinicians ended up there. So
the Middle East was not an option to practice in or that was an attractive
option to practice in.
03:04:00The only options there would have been at significant hardship that maybe I just
didn't want to-- I didn't feel like-- I mean, the hardship in terms of
uncertainty about the future, you know, whether you want to stay in Lebanon,
Jordan. Look at Iraq now or probably Syria a few years from now. I mean, the
uncertainly is just too great. And definitely professionally the careers were--
It would have been downhill from that point on, definitely downhill. So
careerwise it wasn't attractive. And societywise it wasn't very attractive. As
we talked the other day, I just didn't feel comfortable in a culture that
doesn't respect you for what you are. That may respect you a lot for where you
come from, may respect you for your title--"Oh, doctor," you know, that's
03:05:00tremendous--but not really what you do yourself. It's the title. It's your
social status that becomes more important.
HATHAWAY: That's a very kind of American-- I mean, ideally. I'm not saying
Americans are wonderfully democratic, with a small d, all the time. I think we
hold that ideal up to ourself that it doesn't matter what your last name is.
HANNUN: Oh, that's like night and day coming to this country. That's again the
HATHAWAY: I'll let you say that we're great! I don't want to appear to be some
yahoo on tape. But I mean it's an ideal of our society.
HANNUN: Well, it's a definite point of contrast. That's what made it very
difficult-- Again, I'm anticipating myself here. It makes it very difficult once
you come here to go back. That's not only my case but many, many other of my
classmates and people who preceded me. And people who came after me find it very
difficult too, because again you're selecting for people like myself.
03:06:00Now, going back to my story, after internal medicine I wanted a subspecialty. I
was very impressed with oncology, medical oncology and hematology. Those were
mostly presented as a combined specialty training.
HATHAWAY: All over--? I mean, wherever you were looking, not just the United States?
HANNUN: I looked only in the United States.
HATHAWAY: Right after your brief experience in the gulf and you weren't even entertaining-
HANNUN: I wasn't interested.
HATHAWAY: And Europe was just not a-
HANNUN: Europe wasn't an option. We had many graduates come to the American
University from European schools, and we were never impressed. They sort of
follow the professor mode of medical education. That's how they operate in
03:07:00Europe, even in biomedical research. Very recently the Germans have broken out
from that mold, but It's really the big professor who runs everything. Until
that professor retires, you can't be very creative on your own. It's a very
different-- And it's the same thing in clinical practice. So for subspecialty it
became very obvious that the U.S. was the place to go. That's where most people
had gone before. It was definitely important to explore that, and that's what I
did. So I came here on a trip during my residency. I came here to Duke.
HATHAWAY: This was not your first trip to the United States.
HANNUN: No. That was my first trip. That was in '81, and that's when I spent
three months in the States.
HATHAWAY: All down here in-
HANNUN: Mostly down here. The first two months all down here.
HATHAWAY: You can tell I'm from the North--"down here."
03:08:00HANNUN: Yeah, down here.
HATHAWAY: Here in North Carolina.
HANNUN: Let me remember the details here. I did an elective in hematology here.
The reason I came here is that friend I talked about.
HATHAWAY: We should maybe get his name.
HANNUN: His name is Naji Sahyoun. He had moved with his mentor, Pedro
Quatrecasas, from Hopkins to Burroughs-Wellcome [Company]. Because Naji was
here, he had made it easy for another person [George Atweh] to come to
hematology at Duke. So that person became my connection later.
HATHAWAY: And this was a faculty person at American University.
HANNUN: No. He was training in hematology.
HATHAWAY: Just doing it before you did.
03:09:00HANNUN: Yeah. Before I did. And when I wanted to explore places to look into, he
said, "Hey, come try an elective, come look at this program." It works both
ways. I get to see what hematology/oncology is all about, and they get to see me
and see if-- You know, because, remember, especially for Duke at that time, a
foreign medical graduate was almost an unheard-of entity.
HATHAWAY: This is '81.
HANNUN: That's '81. I mean, there were a couple of--
HATHAWAY: That wouldn't be the case, would you say, like out West or up in New
England or down in Florida. I mean, I'm just thinking, is that--? Or Vanderbilt
HANNUN: Oh, it would definitely be the case in Vanderbilt. I don't know the
answer to that. Things have changed in the last couple of years, but in the
03:10:00eighties and seventies you would be very hard-pressed to find many foreign
HATHAWAY: I'm thinking of just-- And there is nothing statistical or scientific
about this. But I'm thinking of Georgetown [University]. Again, this is all
personal experience and graduating from there in '81 but actually doing
work-study in the medical center. And then having contact with the UCLA medical
center [Center for Health Sciences] again, '82, '83. I got a sense that there
actually was a pretty typical situation for residents and beyond who hadn't done
medical school necessarily in this country but were here doing-- And not just in
HANNUN: So you think there were a few foreign medical graduates.
HATHAWAY: That it was accepted and nothing radically new about it, but maybe
03:11:00HANNUN: It very much goes by the institution and maybe even much more so by
different programs in the institution. Because now, for example, the program in
internal medicine at Duke has a significant number of foreign medical graduates,
many of them from my alma mater, from the American University.
HATHAWAY: I take it this person [Atweh], this friend of yours, kind of opened up
not a floodgate but certainly a gate.
HANNUN: Not a floodgate. It started out like a trickle. I came to an elective
here. My wife [Ling Obeid] came for internal medicine. We weren't married at
that time, so I was here by myself in '81. I liked the program here a lot. I got
to know the people; they got to know me. They offered me a fellowship position.
03:12:00But also the chief of hematology at that time [Wendell Rosse] offered to support
me in looking at other programs. I looked at a few other programs in the States,
other programs in hematology. The only other one at that time I looked at
seriously was Stanford [University]. But I guess-- No, wait a minute. I came
back to that the following year. So I came on another visit.
HATHAWAY: Like a three-month-
HANNUN: No. Shorter even, probably three weeks, in '82.
HATHAWAY: And when you say to support you, what you mean is that-
HANNUN: You know, help me go and talk to people, things like that.
HATHAWAY: He was extending his judgment of you not only to himself in getting
you in his department but to anybody else.
HANNUN: Exactly. Yeah. I obviously liked the Duke program a lot, and that's what
03:13:00I decided to come to. At that time I had gotten engaged, and my wife came to Duke.
HATHAWAY: You met her here.
HANNUN: No. We met in Beirut. She had gone to undergraduate school at Rutgers
[University], but she came back to American University in Beirut for her medical
school. She was two years behind me. So when I came for a fellowship, she came
for a residency. Again, in my fellowship here, the way it was organized, the
first year was clinical hematology and medical oncology. I liked that a lot, but
03:14:00during that year it became obvious that beyond that first year of clinical
subspecialty training, really there wasn't much more in terms of education and
HATHAWAY: What about teaching and the academic or the medical balance?
HANNUN: There were some possibilities for teaching, and it's something that
probably I could have considered as an option, but teaching's never been a very
valid option in the States in academia.
HATHAWAY: But I meant taking an academic appointment. You've got one, I realize,
but I guess I'm looking at the difference between being a clinical professor and
03:15:00actually being somebody who is a PI [principal investigator] and running the
lab. Maybe that distinction is in my own head and not something you're thinking
about. But I was saying a more straightforward clinical kind of-- To go on and
just stay at Duke and be a clinical professor.
HANNUN: Yeah. What I was trying to say is that the modes of-- I mean, obviously,
again, let me put it that way. First of all, my career was going to be in
academics. I mean, I had settled that issue. I wasn't going to go out and
practice. Now, in academics, what I was trying to say is not only there aren't
many role models for teaching but it's not something that's much valued either.
03:16:00HANNUN: I was trying to say, when I first joined the program here, I could have
considered a teaching academic position as an okay model because that was the
predominant model back in Beirut. But it wasn't a model that was much viable
around here. And the other model would be a clinical researcher or a very active
clinician in an academic setting versus a basic researcher. And that's when I
started-- Again, intellectually, I think I really could see how clinical
medicine had hit the plateau for me. There wasn't much more to learn from
clinical medicine. And from there on the choices were either stay in clinical
03:17:00medicine totally--and, again, it's the same downhill analogy--and just execute,
you know, having learned your vocation, then execute that. Yes. There are some
advances every now and then.
[END OF TAPE 3, SIDE 2]
HATHAWAY: You were talking about seeing kind of the plateau or the end of the plateau.
HANNUN: Yeah. At that time, I started thinking more seriously about trying my
hand out at basic research. Obviously, the opportunity was there in terms of the
way the fellowship program was structured in that the first year was clinical
but the second and third years were very flexible in terms of either pursue more
03:18:00clinical work or clinical research or basic research. I spent quite some time
during my first year in the States thinking about these possibilities. From that
point onwards, I think basic research started growing on me quite fast. I
started reading more-
HATHAWAY: You started reading PNAS [Proceedings of the National Academy of Sciences].
HANNUN: I'm trying to remember if PNAS specifically. The thing is something like
our specialty journal Blood or Cancer Research. They are also more heavily
involved in not just clinical research but also basic research.
HATHAWAY: And the bridge sort of--
HANNUN: So that was a bridge. Couple that to Science, maybe an occasional look
03:19:00probably not even at PNAS but definitely Nature and Science. And then sort of
finding the excitement that was going on in the early eighties in basic
HATHAWAY: And in particular in oncogenesis? Or was there--?
HANNUN: Particularly in oncogenesis. Over the years that became more sort of
cell regulation in general and how cells work.
HATHAWAY: That's kind of that other area of-- I guess a lot of the in vitro
stuff was really being done as kind of developmental biology. They kind of met.
HANNUN: Well, many things were coming together in that period, and I started
becoming more excited about that. That's when I thought, "Well, maybe I should
03:20:00take my research options seriously and try my hand at that." That's what I did.
I don't know if you want to go into that today.
HATHAWAY: It's really more up to you if you want to begin with it. I would think
that this actually is not a bad place to stop since it's midnight, and I'm sure
you have a long day ahead of you. Why don't we turn it off now?
[END OF TAPE 4, SIDE 1]
[END OF INTERVIEW]
HATHAWAY: We kind of left off really with your first couple of months here in
Durham [Duke University Medical Center]. We talked a little bit about also just
meeting your wife [Lina Obeid Hannun] and situations like that. I guess we've
decided off tape to just kind of jump right into the basic research that you
started doing. One thing you had mentioned on tape toward the end of our last
03:21:00conversation was your sense that you were kind of losing a sense of being
challenged with medicine. And actually, one of the things that you mentioned to
illustrate that was reading the journals. Whereas in the beginning of your
medical studies you'd take hours to read JAMA [Journal of the American Medical
Association] or Lancet or something like that, you're now able to open it, get
the four things you needed to know out of it in ten minutes, and set it aside. I
was interested in the fact that you really became acquainted with a lot of basic
research and with what was going on in biochemistry or molecular biology through
the literature. It seems that a lot of maybe your, quote, "exposure" was that
way, and I was wondering if you had a-- Certainly you've talked about the young
man [Naji Sahyoun] who returned from I think it was Duke but who went back to--
HANNUN: Yeah. He was at [Johns] Hopkins [University] at the time.
03:22:00HATHAWAY: Excuse me. I also have kind of an idea of where else you got kind of--
"Exposure" is not the right word, because it wasn't in a lab, but I guess I
would like to kind of make that have some connection with the last conversation,
last time's conversation, but also just to get a--
HANNUN: My exposure was primarily the courses I took in first-year medical
school. Biochemistry really stuck in my mind. I still to this day remember
almost everything I read in biochemistry that year. It was probably the only
course during first-year medical school where I did a lot of outside reading
too. I enjoyed that a lot and talked a little bit about that. My other exposure
in Beirut was two things. One was in clinical research. I told you the other
day, too, I mean, I sort of always felt inclined that I was going to end up in
03:23:00an academic situation rather than in a clinical practice. Obviously, the two
outlets were either clinical research or basic research. I tried to work a lot
on clinical research, and in Beirut that was possible. For example, for one year
on the side I collected material on maybe four hundred patients with rheumatic
heart disease and analyzed that and collected a lot of data and analyzed that a
lot. It didn't make me feel very happy. I didn't find that I liked that a lot.
HATHAWAY: It was boring work or--
HANNUN: It was tedious work, a lot of data collection. It's what you mentioned a
bit ago, a retrospective analysis. And that kind of clinical research just
didn't click with me. I did try a little with Naji Sahyoun when he set up his
03:24:00lab, try a couple of research projects with a very cursory type approach to a
biochemical project. Again, I didn't like that a lot, specifically at that time.
It didn't convert me, but it did open my eyes in terms of how difficult it was
to obtain new knowledge in biomedical sciences. That to be able to contribute
even the smallest item you had to read a lot, find out what's known, how things
got to be known, how to set up an experiment to start adding to that, and how
difficult it was to do that.
In Beirut it was almost impossible. I mean, by the time you order, let's say,
ATP [radiolabeled adenosine triphosphate]-- By the time it got there, it's been
03:25:00through at least one half-life. So it did teach me a lot about improvisation in
research, having to set up your own tools and maybe deviate from
well-established methodology because of the lack of the appropriate or the most
convenient reagent. But it didn't convert me in terms of saying, "Hey, I want to
become a basic scientist."
HATHAWAY: What was it that you were working on, or trying to work on maybe?
HANNUN: One was to try and-- God, I have to remember that. The one thing I tried
my hand on was to look for adenosine and ADP [adenosine diphosphate] receptors
on blood cells. At that time that was pretty novel. But we didn't get far along
HATHAWAY: And that was more a materials kind of-
HANNUN: A lot had to do with materials. In retrospect, a lot had to do with that
I didn't just prepare well for those studies. I mean, I was basically taken off
03:26:00of the street and thrown into this situation. As I mentioned before, there was
no preparation in terms of practical experimentation, period, in my education.
HATHAWAY: And so, in a sense, you and-- I guess from what you're saying there
were two or three other people involved. It was just a matter of giving it a try
really. And with this one guy back from Hopkins, Naji. That's his first name. I
don't mean to be so informal with somebody I haven't met.
HANNUN: Well, he has passed away, actually, a young man who passed away
recently. He died of cancer, a very bad malignancy. He was a very bright person.
He was very excited about science. That definitely got transmitted, not just to
me but a whole chunk of us in medical school.
HATHAWAY: But there was some frustration with the conditions in--
HANNUN: In the lab. Yeah.
HATHAWAY: I mean, you say you didn't get far, so I assume that means--
03:27:00HANNUN: Yeah. I wasn't much frustrated because I didn't have much expectation
from it either. I mean, I wasn't going there and saying, "Hey, I'm going to
accomplish so much in those two months." I just wanted to see what this was all
about. I mean, I had to learn how to handle pipettes and radioactivity and
scintillation counting and whatnot.
The other thing is we toyed around-- He [Sahyoun] was very interested in
neurological diseases and neuropharmacology, neurobiochemistry. We sort of
started on a more hypothetical project at that time in terms of trying to
understand multiple sclerosis. I say "hypothetical" because we did a lot of
reading, we discussed many ideas, but it never came to the point where we said,
"Hey, we're going to devise this experiment or that." So it was a couple of
03:28:00months that I enjoyed quite a bit, but it did not convert me at that time.
HATHAWAY: Just two kind of quick questions, not expecting that they'll
necessarily lead to anything of real great import. Where did the money come from
to buy or at least try to order them, even if they showed up kind of, how shall
we say, half dead? That's not necessarily a good pun.
HANNUN: I think the money came mostly from departmental sources. I think at that
time the department and university were trying to get Naji back to a more
permanent position. So it was like a pre-startup, something for him to have a
lab and see if he could work. And I think he approached it, too, in terms of a
trial, whether research would pick up and flourish or it was going to be working
03:29:00against the odds. I think he settled down towards the latter conclusion. But I
think the money came from-- The space definitely came from that, and the money
probably came from that.
HATHAWAY: And your interest in the MS [multiple sclerosis] was just-
HANNUN: It was mostly Naji's interest. He maintained that working in sort of
neurobiology mostly, at the biochemical, molecular level.
HATHAWAY: I just thought it was important to get some sense of-- Again, not that
these are all directly connected or anything like that, but just I guess kind of
your experience. And then I would, I guess, kind of jump ahead and ask, how did
it come about here that--?
HANNUN: My next encounter with research-- Actually, when I came to Duke in '81,
I did I think one or one and a half months of clinical work. I liked that a lot,
03:30:00by the way. I liked the academics a lot at Duke. People were extremely
knowledgeable, very nice people. I liked that a lot, so much so that when I went
back to Beirut I tried to--because I was to become chief resident in medicine
there--install some of those things I learned. But I also spent two to three
weeks with Russ [Russel] Kaufman, who now is actually the chief of hematology
here. He had just come back within a year or two from the NIH [National
Institutes of Health], where he had trained with Art [Arthur] Nienhuis in
molecular biology. So to me that was a whole new area of doing DNA work and
whatnot. Again, the expectations on my part were not high at all. We just wanted
to look at genomic DNA from patients with thalassemia. So it was, again,
learning the very ABC's of DNA extraction, running gels and enzyme digests and
03:31:00whatnot. So my expectations were not high. I didn't give it-- Actually, no, I
did spend a lot of time reading. That's always been my approach: before I get
into something or as I get into something to try and get as solid a background
as I could. So I did spend a lot of effort in trying to understand molecular biology.
HATHAWAY: In a sense, then, you hadn't really had any kind of formalized
classwork that was really strictly geared toward molecular biology versus--
HANNUN: Exactly. That was very novel at that time. I think Russ Kaufman was
considered the only molecular biologist probably at Duke at that time. Maybe I'm
not correct on this, but definitely in the Department of Medicine he was the
only person who could do molecular biology. It was very novel. It hadn't yet
filtered through to the curriculum, even in the States.
03:32:00So that was another encounter with research. Maybe it more opened my eyes again
to another kind of research, more in terms of the pace of research, also what it
takes to get research done. I would consider both experiences up to that point
to have been negative experiences in terms of achieving any meaningful results.
But again, that was valuable experience in terms of expectations, to have
realistic expectations, in terms of how to judge a project, whether it was going
to be useful or not long-term, you know, worth the investment or not. It's very
different from seeing patients, where you go through the process many times a
day. Anytime you pick up a project, it's a long-term commitment. You better
choose a good project.
03:33:00HATHAWAY: You said three weeks of clinical, four weeks, or am I missing and
thinking of the three months that you were here?
HANNUN: I was here at that time for three months. It was partly in clinical
work, which I think was like a month and a half, maybe actually closer to two
months or eight weeks in clinical medicine, more like two to three weeks in the
lab. And then a couple of weeks, one or two weeks, I just vacationed basically.
HATHAWAY: In a sense, in two weeks, just from walking into a lab or an operating
lab, you kind of were able to, again, see these things, like see how much work
went into a project or how many people were working on it, to understand some of
the-- I mean, obviously you've been doing reading, but that actually seems to me
a pretty quick study. To get that kind of information out of something in two
weeks, that's actually kind of a high payoff. I mean, you're not going to walk
away with a disappointed or--
03:34:00HANNUN: Yeah. But I didn't even learn significant skills from that. I mean,
these are really primitive, elementary skills. You have to look at me in terms
of someone who had very little research experience. And I can see it now in high
school kids who come to my lab or undergrads, who I can structure for them a
more productive experience in the lab than I did.
HATHAWAY: In these two weeks, you mean, not when you finally came back and
worked with Dr. [Robert M.] Bell.
HANNUN: Yeah. The other benefit from both encounters was in both cases I had
invested a lot into reading in new areas at the basic level.
HATHAWAY: What were the areas, and why--?
HANNUN: One was receptors, the other was multiple sclerosis. But that turned out
to be very confusing. I think the literature on multiple sclerosis is still very
03:35:00confusing. You can't make head nor tails out of multiple sclerosis in terms of
the basics. Is it an immune disorder? Is it a whatnot? The other in terms of
reading in molecular biology. So it became easier to pick up like Science and
start to appreciate what the authors were trying to do and to say in their
studies and to be really impressed by the work.
HATHAWAY: Or perhaps critical of something you thought might be-
HANNUN: I wasn't that advanced, I think. I couldn't critique something real
significantly. I probably couldn't even read a Science article like from A to Z
and figure out exactly what they were doing. I wasn't that sophisticated, but I
could get a sense of where science was at. Those were very exciting days, which
03:36:00we talked about a little bit the other day too. During my clinical year--if you
want to spend just a couple of minutes on that--that was a very tough year. I
don't know if we talked about that or not.
HATHAWAY: I think what we talked about was your reception here. You were talking
about your year here and those sorts of things, as opposed to any clinical work
you did or what it was like.
HANNUN: Well, it was a tough year, a very rough clinical load. That's how
hematology/oncology is. It's a very wide specialty, and you have to master it.
And we had to master it in one year. Fellows still have to do that. So it's a
very intensive year. The patient material is very intensive too, emotionally and
03:37:00physically, especially on the oncology side. We were more or less in a new
country. We were newlyweds, and both were-- You know, my wife was an intern back
then, and that's even worse than being a fellow in hematology.
HATHAWAY: And she was an intern--
HANNUN: At Duke, an intern at Duke, in the Department of Medicine. Yet with that
I still tried to keep some contact with what was going on in basic research. My
research contact person at, Duke at that time was Jim [James E.] Neidel, who
went on to become I think senior vice president at Glaxo [Laboratories]. He was
sort of the model of a successful basic researcher in hematology, a young,
active researcher. I had talked to him before actually, when I was here in '81.
03:38:00That was the main reason I had come to Duke, because I thought that was exciting
research or part of the exciting research. I had discussed with him options that
year to either join his lab or structure something related to that. And my
interest, coming from the clinical side-- Oh, I must add one more thing here for
background. You came across that too. I did also some clinical research that
first year. I looked at testicular cancer patients. Again, I found that to be
tedious, ultimately boring, and it doesn't contribute much.
HATHAWAY: I was going to say, what was there--? In reading it, I was kind of not
clear in getting a sense of how the retrospective study allowed one to then make
decisions about treatments.
HANNUN: Not much. I thought the rewards were very few from those kinds of
03:39:00efforts. Now, to engage in prospective studies, that was a possibility. I must
confess there weren't too many role models around Duke to sort of look into
that. Again, with my clinical reading, I had come to the conclusion that
clinical research was not going to satisfy me. The way it was conducted was we
took one agent that's used in cancer and now tried to give it in three days
rather than two or five. It was more splitting hairs rather than acquiring
fundamentally new information. So I definitely wanted to find out what basic
research, you know, more sort of longer commitment, what that meant.
Approaching it from that point of view, I was mostly interested in the
hematologic malignancies. I wanted to study leukemia, biology of
03:40:00differentiation, what makes leukemia cells grow, what makes them differentiate.
Jim Neidel at that time was studying leukemia cells, and he had made an
important discovery concerning phorbol esters, which are tumor promoters, and
possibly how they work. Earlier on, a group in Japan led by [Yasutomi] Nishizuka
and [Yoshimi] Takai had discovered a new enzyme, a new protein kinase, called
protein kinase C. They had shown that it really belonged in the signal
transduction pathway. It was activated by lipids, by diacylglycerol. They had
also shown that this tumor promoter activated this kinase. What Jim Neidel
showed is that this kinase is actually the receptor for those phorbol esters.
Now, to put it in some perspective, the finding that this kinase was activated
03:41:00by diacylglycerol was nice. It had placed this enzyme in what has been called
the PI [phosphatidylinositol] cycle of cell regulation. People had discovered
that cycle in the fifties. [L.] Hokin and [M.] Hokin had discovered that cycle
in the early fifties. In the early eighties, the two products of this cycle--
Diacylglycerol was found to activate a kinase, and the other, inositol
triphosphate, released calcium from inside the cell and really initiated a lot
of activity in the cell, biochemical activity. So that was good.
But the more dramatic, actually, biologic significance came from phorbol esters.
Why? Because phorbol esters are tumor promoters. They were discovered as tumor
promoters in an animal model of tumor promotion and cancer formation. But over
03:42:00the ensuing twenty or thirty years every cell biologist who tried phorbol esters
in their cell system found that phorbol esters did something important in cell
biology. There was no cell system that did not respond to phorbol esters by some
important biology. So when Nishizuka found that phorbol esters activated protein
kinase C and Jim [Neidel] found that protein kinase C is the receptor for
phorbol esters, it was not like just something being hit by phorbol ester
accidentally. It was it, pretty much. Then suddenly every cell biologist became
interested in protein kinase C, and they still are. It's very true. It's the
only kinase that's I think individually entered in the Index Medicus. The number
of publications on the biology of phorbol esters or protein kinase C is too
03:43:00numerous to keep track of. So that really put protein kinase C in the center of
cell biology research.
That's when I approached Jim Neidel in terms of the possibilities of working in
that area. We had a couple of discussions. I think he sensed my determination to
get into basic research. He was an M.D./Ph.D. He had a couple of recommendations
for me. One was, if I wanted to become a basic [science] researcher and sort of
be in that bridging region between the very basic and something maybe with
ultimately more clinical relevance, to actually train in a more rigorous
fashion, to seek more fundamental training, either biochemistry or molecular
03:44:00biology. And so that was the first sort of outcome of those discussions. The
second was, he was starting a collaboration with Bob Bell, who still is in the
Department of Biochemistry at Duke, to look at diacylglycerol regulation with
protein kinase C. Ironically, Bob Bell-- The collaboration started because Bob
Bell was a lipid biochemist. And ironically, Bob started being a big skeptic
that his favorite molecule, diacylglycerol, which he worked on metabolically,
would do something in terms of activating a kinase. It just didn't fit sort of
the way people understood lipids. It was this skepticism that actually led to a
very healthy collaboration and understanding of how diacyiglycerol activates the enzyme.
HATHAWAY: Was Bell maybe even convinced--I mean without being completely
convinced until he saw it happening in an experiment--that the connection
03:45:00between the protein kinase C and diacylglycerol would be more accidental or
would have intermediates or this would be some minor--?
HANNUN: Yeah. He couldn't see how a molecule that's in the cell, as a metabolic
precursor to all the phospholipids-- [indicating] This is diacyiglycerol there
on the chart in the center and surrounded by all the phospholipids in the cell,
and there are dozens of phospholipids. Diacylglycerol is really at the heart of
all those metabolic pathways. That's what Bob Bell was working on. Suddenly to
tell him, "Hey, we're going to pull that out of here and put it in the center of
something very different--" I'll give you an example of how skeptical he was.
Basically, he [Neidel] suggested that I explore working with Bob Bell, and I did
that. think we hit it off real well initially. The arrangement was-- Bob Bell
03:46:00wasn't working with protein kinase C then. I went and spent a couple of months
in the summer of '84 with Jim Neidel, learned how to work with protein kinase C,
how to purify it and start doing some assays on it. The assays were real crude
and obviously designed by biochemists with no expertise in lipids. The first
thing Bob Bell wanted me to do was design an assay that's amenable to study
lipid protein interactions. In fact, we designed a mixed micelle assay. But to
give you a sense of Bob's skepticism-- Once I got the initial technical know-how
from Jim's lab, I went to Bob's lab. The first experiment he wanted me to do was
to make sure that I was activating a kinase and that there wasn't a
lipid-metabolizing enzyme in the prep that was resulting in phosphatidic acid.
03:47:00He actually thought that the 32p we were measuring was not in histone, the
protein substrate, but in phosphatidic acid. So he wanted me to really make sure
we were not wasting our time on that.
HATHAWAY: They weren't screwing up over in the other lab.
HANNUN: And we did that. Obviously, when you look at the data, it was
phosphorylation of the protein. So we knew that diacylglycerol was activating
this kinase. We designed this approach to evaluating mixed micelles. The success
was phenomenal, because the very first experiment I tried worked. It's a nice
thing, because that's the kind of approach where, in the two months I was with
Jim Neidel, I had again delved very deeply into the literature there. I came to
know all this history I'm telling you about and more of the technical aspects of
03:48:00it. I could start to refine the assay and understand it more. When I went to
Bob's lab, I spent a couple of weeks maybe or a week just studying methods of
solubilizing lipids and developing these kinds of approaches. So it worked real
well from day one.
HATHAWAY: I get a sense in talking with people that there is still some sort of,
let's say-- That the actual doing of experiments is a skill, like I think
anything that one does. You know, one builds houses or one develops these kinds
of manual skills. I get the impression in talking to you that they're just
already kind of there from whatever, just innate, or-
HANNUN: No. Technically, I've always been very careful but never brilliant. I
03:49:00wouldn't rank myself technically as a whiz, definitely not. But I've always been
very careful, probably recognizing, actually, deficiencies in even my ability to
hold tubes and pipettes. I'm not terribly great at that. But my experiments
would work pretty well.
HATHAWAY: Because you're cautious. Step by step.
HANNUN: I'm careful, not to the point of being obstructive. I'm pretty efficient
too. I've always probably been more on the side of being efficient, but I treat
things with caution until I figure them out. When I'm comfortable with them, I
would allow myself some more laxity if you will.
HATHAWAY: I guess I'm asking this not just because I wanted you to say, "Oh, I'm
03:50:00a klutz" or "I'm not" or "I was just born with it." I'm wondering if the way you
approach the manual and day-to-day aspects of your work guides or has some
influence on the kinds of work you choose to do. In other words, if you're not a
whiz, do you tend to like the low-tech, basic end of biochemistry, where there
are things that are always techniques that can be applied to a whole other set
of experiments that you've already got a grasp on? Or are you pretty daring? Or
do you encourage that--to try something completely new and go send somebody up
to another lab to learn that whole new thing and just--?
HANNUN: The way I describe these things to my students is to tell them that as a
scientist they're like artists, and they have to paint a picture or write a
03:51:00story. And it has to be a new story, a contribution that people can say, "You
didn't just copy someone else's painting." Now, to do that and to come up with
something beautiful, you have to be able to get your hands to do what your brain
wants them to do. You can have people who can paint very beautifully, but if
they don't have the right connections they can't paint what they want to express
in painting. That's really what you want in science is the expression of your
ideas in research through experiments. And those connections-- I mean, that's
03:52:00where you have to develop those connections, understand what goes into
developing and making those connections, because that's how you make a
nonscientist a scientist is to give them those connections. Those connections
come from reading, understanding, and thinking at all kinds of levels. You have
to think about the technical level. I mean, you need to know that if you use
different-sized brushes you get different results. And if you mix different
paints differently you get different results. It comes from reading and
developing more general strategic goals. So you can say, "Hey, I want to paint a
picture of the sunset." You don't start painting and whatever comes out comes out.
Then you also have the intermediate level of tactical approaches towards
03:53:00science. Those probably are also very difficult to accomplish. Where you can
say, "My approach towards painting the sunset is going to be to position the sun
here, the clouds over there, the ocean from this perspective, and I want to
include people in it." And the same thing with science. You have to say, "I want
In one case, we want to study if sphingolipids are precursors to second
messengers. This is a big unknown. This is the big picture we want to paint.
Tactically, what are we going to do first and next? We're going to look at
metabolism of sphingolipids and see if there are any products generated under
physiologic conditions. At the technical level, we need to be able to look at
these sphingolipid metabolites and whatnot. So that's what I try to get my
03:54:00students to appreciate, that if you lack at any one of these levels, you can't
translate the final image you have or the big question you're trying to answer
into concrete data that will direct you one way or the other.
HATHAWAY: So I'm really kind of asking the question backwards. It's not about
limitation or innovation on one thing leading to-- It's not unidirectional or
something like that, I guess is what I'm-- I mean, you're describing something
that's almost-- I don't know if I can even come up with a word or an idea that
describes the approach, because it's obviously not theoretical either. It's not
like, "I've got these great ideas and I want to find out the answers to them, so
03:55:00I will be driven by those four ideas and I will do them." There is some sort of
reality check always--
HANNUN: Yes. You have to be able to execute at the very realistic level step by
step. Yet you have to make sure that these experiments you're designing are
answering the questions you're asking. And going now to the strategic level, you
have to make sure that these are really the questions that you want to ask and
that they fit some general logic or at least a logical approach. I think I've
followed that. I've followed that very carefully with my students at all times.
And that's where most students-- They all come defective in one area or the
other, otherwise they wouldn't be students--
HATHAWAY: They'd be in charge.
HANNUN: Exactly. I always tell my students the time to leave or the time to
graduate is the time that you feel comfortable that you can do science in this
03:56:00fashion. Some students come with very developed ideas about the areas they want
to study and how that fits the universe, but then they can't translate that into
experiments. So you have to make them take the strategy and devise tactics out
of that. On the other hand, you get some students who are very good in designing
experiments but then they can't analyze the data very carefully. They also need
to troubleshoot. I mean, troubleshooting is part of this connection between the
brains and the hands at the bench side. Troubleshooting also has to fit the
general scheme of things.
HATHAWAY: Was this something you think you were aware of before you walked into
these two labs here at Duke? Or was it maybe related also to clinical practice?
03:57:00Or is this something you've kind of learned from these two guys?
HANNUN: In retrospect, I can analyze this pretty well, I think. Developing my
understanding of science obviously came as I stayed with science. But in
retrospect it's obvious to me--and I try to make it obvious to all the medical
students and the M.D.'s who come to work in the lab--that these are identical
skills to those they use in the clinic. They go by different names, but they're
identical skills. It's experimental problem solving. What we call in the clinic
history and physical, here we call data collection. We do studies of the
literature; you do studies of the literature here. You do a differential
diagnosis in the clinic; here you call it hypothesis generation. They're the
03:58:00same mental functions. You order lab data and X rays in the clinic; in the lab
you run your experiment to collect the data, refine your hypothesis, narrow down
your differential diagnosis. The parallelism is tight, very tight. It's obvious,
when M.D.'s come to the lab, they're able to hit the lab running much faster
HATHAWAY: You mean than a Ph.D.? Or you mean like an undergrad?
HANNUN: Like a graduate student starting out.
HATHAWAY: Okay. Who hasn't got lab experience.
HANNUN: A Ph.D. is someone who has gone through that phase. Yes. But that helps
in allowing me to formulate what it takes to be able to succeed in solving
03:59:00Going back to science--my experiences--I stayed in science because I prepared
well for my important experiments. They worked easy, or readily, I should say. I
was concerned back then whether this was what I wanted to do or not, even with
the initial success. It's funny, because at that time I had a much more global
aspiration of what I wanted to accomplish out of science. Suddenly I found
myself becoming the world's specialist on mixed micelles, and I thought, "I
don't want to do that for the rest of my life. I don't want to be that kind of person."
HATHAWAY: You mean too narrowly focused?
HANNUN: Too narrowly focused. It's very funny, because in retrospect those
04:00:00skills have really defined my specialty for me. But at that time I just thought,
"That's not going to satisfy me."
HATHAWAY: And I would suggest--not criticizing people who pick a narrower focus
or, let's say, work or run a smaller lab--your focus really doesn't seem that
narrow anymore. You can certainly talk about an area it covers and how it's--for
me, at least--very clear why that has developed out of this. Just even from an
armchair view, it's all pretty clear. But it seems to have expanded, not going
in a straight line but also maybe poking around as well. And maybe I'm jumping
the gun and talking about this before we've talked about the specifics.
HANNUN: Well, let me give you sort of the background to that, because at that
04:01:00time I didn't want to be a mixed micelle specialist. Now I wouldn't mind having
spent three years just becoming that. It's funny sort of the perspective there.
But at that time I wanted more out of science. And the first grant I submitted--
I was able to collect enough data and submit a grant proposal within three
months after being in the lab for a Physician Scientist Award and actually got
funded. Although, again, the material was pretty dry for anyone other than a
lipid biochemist. So I was-
HATHAWAY: You mean straightforward-- I mean, I'm trying to get a sense of what
you mean. You're kind of using it in a pejorative sense.
HATHAWAY: Yeah. Just dull, you mean? Kind of that you didn't know what the
answers were yet, but you knew--
04:02:00HANNUN: I was proposing to do studies on mixed micelles and regulation of
protein kinase C that at that time I didn't really appreciate their
significance. And obviously I couldn't communicate that therefore in the grant
process. It's all a question of timing. If I had submitted that grant three
years later, it would have been considered the best grant in the world, and I
probably would have been much more convinced about it. At that time, I thought--
You know, I was uncertain, thinking, "I'm not going to make a career out of
mixed micelles. I'm going to use them, though, to get my Physician Scientist."
Because I wanted to give the lab more time than my fellowship permitted, which
was two years in the lab, and the Physician Scientist would have given me five
years. So I wasn't convinced about it. I definitely didn't communicate any
excitement in my grant. It was a dry grant. It got funded, and it really
04:03:00relieved me from a lot of pressures in terms of "Hey, I'm funded five years. Now
I can do whatever science I want to do."
And what I did was a couple of tacks there, take two different tacks. One is I
wondered whether protein kinase C was a target to develop cancer chemotherapy.
It was a very simplistic, almost naive notion at that time, but I spent quite
some time looking at inhibitors of protein kinase C and using those
sophisticated, more exact ways of analysis. I think that got actually Bob Bell
very excited about protein kinase C. I mean, for a basic scientist, he found
that this was a real opportunity to have relevance for what he was doing,
especially coming all the way from lipid biochemistry, which was not exciting
04:04:00even to other biochemists. He got very excited about that, so much so that he
set up a company to study inhibitors of protein kinase C, and actually he did that.
The other thing is Carson Loomis, who was in the lab at that time, was doing
structure-function studies on protein kinase using some of the methods that I
developed actually with his help. He found that one molecule did not work the
way he thought. He was testing it. It was sphingosine. It was maybe inhibiting
rather than activating. Somehow these immediately started a whole process going
in my mind that here is this molecule sphingosine that's naturally found in
cells that's interacting with this enzyme.
I didn't just ask what was going on here. I almost developed a full scenario
04:05:00from day one with that. The first thing I did was study it as an inhibitor, and
lo and behold it was an inhibitor. But I developed a whole scenario that hasn't
panned out yet. It probably will never pan out as such. But that's something I
think I've always-- I bring that as an example. I've always been good at taking
one piece of information and putting it in the best possible light as how that
could possibly unfold as a long-term project. For example, with sphingosine I
thought, "Hey, maybe there are signals on the outside of the cell that activate
enzymes that break down sphingolipids. That generates sphingosine, that goes on
to inhibit protein kinase C." I would say that entered my mind almost from the
04:06:00HATHAWAY: Why something like that? Was the relationship between the other lipid
and the protein kinase C still novel? In other words, there wasn't yet a sense
that all these lipids were now going to have all these other functions?
HANNUN: Oh, absolutely not. It was still an anomaly that diacylglycerol was a
HATHAWAY: Here, as you point out-- For the record, we're pointing to a rather
complex and confusing-looking chart that you can find in one of the biochem
books, too, I believe. It's got a real central role in that. It's old-fashioned,
if you will.
HANNUN: Yes. Old-fashioned central role.
HATHAWAY: The jump you're making seems-- Let me ask it the other way, since it
didn't happen that way. Why would people still want to treat it--after maybe a
04:07:00good two years' worth of work--as an anomaly?
[END OF TAPE 5, SIDE 1]
HANNUN: It was an anomaly. I mean, even people who studied protein kinase C and
were very excited about it, I'm absolutely convinced they were excited about it
because of phorbol esters not because of diacylglycerol. And actually very few
people have studied diacylglycerol as the molecule on its own, in its own right.
HATHAWAY: Because it's so-
HANNUN: It's a lipid. It's difficult to work with. People haven't made the
realization that "Hey, maybe these lipids are there not just as building blocks
for the membrane of the cell but that a lot of information is being passed
04:08:00through lipids." That has become now, currently, our sort of central thesis,
that lipids carry just tons of information. That primarily their raison d'être
is to transmit information, as relays of information. But back then
diacylglycerol was considered as an exception or an n of one. So with
sphingosine, actually, when I first told Bob Bell that "Hey, what about
sphingosine doing that?" he was just as skeptical as he was with diacylglycerol
and protein kinase C. Only after a few months, when I had a lot of data showing
that sphingosine really inhibited, how it inhibited, and it inhibited in cells--
Actually, one of his students who was a sphingolipid biochemist had picked up on
that, Al Merrill, Alfred Merrill. I discussed that with him, and he picked up on
that and actually came up with his own study at that time. [Only then] Bob
04:09:00started becoming very interested about it. At that time, I think it became clear
that these lipids are more active molecules than just metabolically.
You asked me a question about why is it not intuitive. I think now we can say
it's very intuitive. Actually, you want to take a molecule like diacylglycerol--
If you were designing cell function and cell communication and signaling events,
you want to take a molecule like diacylglycerol that's at the heart of so many
metabolic pathways and use it also as a signal, because this way you make a very
solid interface between a metabolic function and a signaling function.
HATHAWAY: As a matter of fact, as it's functioning in its metabolic way, it
changes, and the way it changes other things is going to be the signals, right?
I mean, in a sense, it's not doing two things. It's doing one thing, but of
04:10:00course it has a dual function.
HANNUN: It has a dual function. Well, maybe I should explain that. In the
metabolic sense, the old metabolic sense, diacylglycerol was the building block
to make other phospholipids. In the signaling function, totally dissociated from
the metabolic function, it's a signal. If cells generate diacylglycerol, that's
a signal to activate protein kinase C.
HATHAWAY: But it's also going to be making diacylglycerol do its lipid or its
typical, old, metabolic function.
HANNUN: Now, I would still think currently, if you want to say "dogma"-- That's
a funny thing about science which I never understand, is after being around for
two years things become dogma, you know--
HATHAWAY: No. I do, yeah. I actually find it really very interesting.
HANNUN: It is very amazing. I mean, it's probably a tendency on scientists' part
04:11:00to simplify the processing of knowledge and the communication of knowledge
because there's so much of it going on. I think dogma now would have it that
these are more distinct, separated events, that diacylglycerol is a precursor to
lipids. That's one function. And it's a signaling molecule. That's another function.
HATHAWAY: So maybe, let's say, in an evolutionary sense or in a gross cell
biological sense, what's the order perhaps of it having--?
HANNUN: That's a good question. I would think in an evolutionary sense perhaps
the metabolic function came first, and then evolution would say, "Hey, this is a
neat molecule to carry a signal through."
HATHAWAY: Because it's so central or so busy changing and conforming.
HANNUN: It's central. And if you look at it in terms of signal, it's something
04:12:00that you want to reprogram cells with. That's what a signal ultimately does. You
can obviously give it a kinase as a target, but also by changing all other
phospholipids you're reprogramming cells too. So you may want to take a molecule
that's already at the heart of one metabolic function and give it another
signaling function. That's almost philosophy of science at this point.
But in terms of my working, I could always--not always--but I find myself that
I'm very good at painting a big picture. Maybe 80 percent of the time it turns
out to be wrong. That's the way science works. That's sort of what I took with
me when I left Bob. Well, before I left Bob, since I got my Physician Scientist,
I took more formal training in science. I attended course work, and I started
04:13:00doing some molecular biology projects on my own, cloning techniques, because
obviously it became apparent that you can't do serious cell biology and
molecular biology if one didn't have the techniques and tools of DNA work and
RNA work. So I sort of taught myself on my own those techniques while with Bob.
I was very comfortable in my productivity because I had a technician [Linda
Karolak] working with me at that time and I could generate a lot of data on my
enzymology and mixed micelles and whatnot, while at the same time freeing myself
up to do other things.
HATHAWAY: And that was, in a sense, your own money. This is by the time you had
gotten that grant. So even though you were in Bob's lab and using the space, I
HANNUN: Well, I'm sure he supported the research with his money. I mean, my
money didn't go far in terms of supporting research beyond my salary and a
04:14:00HATHAWAY: Could we maybe just for the record-- Probably it's very easy to find
what the grant was worth over five years.
HANNUN: I think the grant was somewhere around $60,000 per year, close to
$300,000 over the five years, which covered mostly my salary, some of the
technician's salary, and some supply money. Actually, it was structured in sort
of two phases: the first phase, two years, would pay mostly my salary, and the
third through fifth would pay for additional technician support and some
supplies. So it got a little better.
HATHAWAY: But perhaps, although geared specifically toward M.D.'s with, again,
this kind of developmental sort of thing-- This idea that "Okay, you'll be in
04:15:00someone's lab. There will be support there. But here is this, I guess we'll call
it, hump money or whatever." You know, it's to get you over the-- And to build
you up so that you can-- It's very programmed, but I guess it--
HANNUN: It's a brilliant program, this Physician Scientist.
HATHAWAY: This is NIH?
HANNUN: NIH. It was-
HATHAWAY: I believe some of your colleagues, M.D. colleagues, did it, too, and
that's how they are--
HANNUN: It was designed I think by [James B.] Wyngaarden, who was chairman of
medicine at Duke and went on to become head of NIH. I think he designed that.
think that's one of the more successful programs at NIH. It has a very well
designated target group, and it really accomplishes its goals with that target
group because it allows physicians to commit to a career in research without
04:16:00having to worry about funding. It's a five-year grant, and it allows them to
become junior faculty once they get it. It allows them to train, keep on
training, and it really covers that transition period, because most physicians
would get it after having spent some time, anywhere from a few months to a
couple of years, in the lab. Instead of trying to set up something on their own
and then fall on their face, it gives them this transition. To me, that was
obviously a blessing because if I didn't get it back then, one, I would have
been probably very disappointed. You know, I didn't have that sort of patience
with a career in science back then. I wasn't very sure.
HATHAWAY: You'd have walked away maybe.
HANNUN: I may have walked away. And it definitely made my next phase very
04:17:00secure. I just worried about science, that was it. So during that tenure of the
Physician Scientist, that's when I was offered to stay here at Duke as junior
faculty and set up my own lab right here. What I wanted to do back then, my sort
of strategic plan, was to say, "Let's take these studies to a cellular level and
define sort of pathways of cell regulation at the level of the cell," using my
background in enzymology, protein chemistry, lipid biochemistry, and more
recently founded expertise--I wouldn't say expertise--but familiarity with
That pretty much defines my program in science, my aspirations in science. I
04:18:00want to discover and understand ways by which cells are regulated, focusing
mostly now on cell growth and differentiation and more recently cell death. The
way I designed the approach--Now, the tactical approach is to have each
predoctoral or postdoctoral student tackle an independent project that belonged
to the big scheme. I think that's where the payoff has come in the last year or
so, that these things have started to make sense, that they are really
components of one story. Most of the projects in the lab came with the general
lipid question of signal transduction, asking the very basic, very naive
04:19:00question of the role of sphingolipids in signal transduction. By that time, it
was becoming more obvious that phospholipids are involved in signal transduction
beyond diacyiglycerol, beyond the PI cycle. People had started to make
discoveries of other enzymes involved in signal transduction. Putting that with
what had been known for a long time about arachidonic acid, another lipid coming
from phospholipids, the paradigm became well established, dogma now--to elevate
it to the status of dogma--that phospholipids participate in signal transduction.
So what we wanted to do is ask the question about sphingolipids. Do
sphingolipids participate in signal transduction processes? That has been one of
the overriding concerns in the lab, the major program in the lab. There is
04:20:00another program on protein kinase C in the lab. I'll never let go of protein
kinase C at this point. However, the questions became, again, more at the
cellular level, at the biochemical level in the cell. It's sort of a funny
niche. But what we've been after with protein kinase C is to try and ask
questions and answer them in terms of how is this enzyme working in the cell at
the molecular level in order to understand what function it serves.
Now, let me put that in some perspective, because I could almost make a
statement now that so far we don't know what any one protein kinase does in the
cell. We have a lot of correlative evidence. We have a lot of ideas. But if you
come down to sort of very solid proof, you can almost not make any statements
04:21:00saying, "This protein kinase or this signaling molecule is really intimately
responsible for that function." You almost cannot make that statement. It's sort
of horrifying, knowing how much signal transduction studies have mushroomed over
the last ten years.
So our approach has been, "Well, let's move the in vitro studies because that's
not going to tell you about function. Let's move them to the cell, stick at the
molecular level, and try to find out how one component really interacts with the
other in the cell, and figuring out how this can result in changes in function."
Now, I would say it's only now, in the sort of, what, fifth year of my work as
an independent person, on the protein kinase C side, that we are getting some
rewards from this approach, that we are starting-
HATHAWAY: You mean rewards along the lines of maybe getting some answers.
HANNUN: Of the big picture. Well, not even the big picture itself at this point.
04:22:00Of establishing some important and new connections with protein kinase C at the
molecular level that we hope will direct us to function. It's going to be
tedious, it's going to be long, but I think it's going to be building it step by
step at the molecular level in the context of the cell.
HATHAWAY: I guess maybe what I would like to do is play devil's advocate a
little bit, if I can, and actually maybe they will be a little more naive than
devil's advocate kind of questions. They will just be "Duh?" kinds of questions.
HANNUN: Go ahead.
HATHAWAY: I get the sense that the biochemical approach that you use isn't just
a matter of "Okay, that's what I learned and I'm good at that and so I'll stick
04:23:00with it," but that you think it's the best way to answer some of these
functional questions, again, of cell biology and cells, not at a narrow level of
genes and molecules and proteins and individual things like that, but the whole
thing. I was wondering what your opinion was of perhaps more structural
approaches or more straight genetic approaches. Are they just something that you
see as obstructive or taking you down into narrower areas? Or is the competition
doing it? I'm trying to get a sense of the wider context in which you're doing
this, because you've been pretty steady with the biochemical--
04:24:00HANNUN: Well, if that's the devil's advocate, we put ourselves through much more
stringent questioning. Let me describe where I stand on things. I come from the
clinical side on things. That always gives me a clinical perspective on things.
It's very easy for me to see how something we do now, if it works out in a
certain direction, can have clinical significance. I'm not saying it will. I'm
just saying how I can evaluate every item very easily along those lines. On the
other hand, I think my training with Bob Bell on almost, I would say, an
04:25:00esoteric subject of lipid biochemistry, and having I think succeeded in that,
has given me a lot of self-confidence that I can learn new things at a very
basic and molecular level. That's what I always tell my students they have to
adopt as a policy: that tools are only tools. We're not a protein chemistry lab.
We're not a biochemistry lab. We're after solving problems. think you
articulated that yourself pretty well. We are after solving problems,
irrespective of the tools. In the course of the last few years, we have come
across all kinds of techniques.
HATHAWAY: I'm actually kind of being-- I'm still kind of thinking back in like
'89 and '90, as opposed to-- You look through this [curriculum vitae] and
there's a heck of a lot more, for instance, molecular genetics in the past,
what, two, three years.
HANNUN: So we look at all these things as tools. If they help us to get to
answering those questions, fine. Now, what are the questions? I think that's
04:26:00where they get imprinted with my philosophy and my bias. If I was a structural
biochemist who was not only trained in X-ray crystallography but really loved
the subject, I would pose questions related to X-ray crystallography.
HATHAWAY: What about collaboration? You obviously have enough familiarity with
what goes on and why people ask structural questions and go at it from a
structural point of view to perhaps at some point-- I mean, you must sit there
occasionally and it crosses your mind, "Now, what if we thought about its
spatial relationship to all that stuff?" I mean, what you can do, I mean, you
can do functional studies that are-
HANNUN: But I mean that's where I think our lab may be a little unique. Maybe
04:27:00"unique" is not the right word, but in a special group of labs, because we're
not the very structural people like the people who do X-ray crystallography. On
the sphingolipid side, I think before we started with the sphingosine story,
believe me, it was 90 percent structural work with sphingolipids, all describing
new structures and analyzing them.
HATHAWAY: And not going anywhere maybe or not going as far as you did with the--
HANNUN: Yeah. So I think the way I would like to think that we are special is
that we do think of what we're doing at sort of the three-dimensional molecular
level. That's always something I encourage in my students: Never work with a
compound you don't have some visualization of what it looks like. Even your
protein. Just try to have an arbitrary image of that, definitely your lipids.
04:28:00Have a good understanding of that structurally, and physical properties too.
That's what obviously gives us an edge in studying lipids. But I think it's this
ability to think about things on a molecular level and at the same time trying
to push the whole system towards understanding very general biology questions of
maybe more clinical relevance. Because if we did not have this--
And when I say "clinical relevance," it's not like I expect to have a drug in
the next five years. I mean, it may be the next generation or may be never. But
in terms of providing these kinds of novel connections that alert people, "Hey,
these may be targets for drugs" or "These may allow us an understanding of
diseases, pathology, physiology." This very global, generic clinical sense. A
good sphingolipid chemist may just characterize the structure of the
04:29:00sphingolipid. A sphingolipid biochemist may want to understand how the enzyme
works. You know, how does it take a sphingolipid and modify it and spit out a
different sphingolipid and really become very sophisticated in that? I love that
kind of science, but that's not what we're doing.
HATHAWAY: I would say that was part of what you were doing in preparation. For
instance, the one article I really concentrated on, the '89 Science one [Y.A.
Hannun and R.M. Bell, 1989. Functions of sphingolipids and sphingolipid
breakdown products in cellular regulation. Science, 243:500-507], is almost
partially a review article, right?
HANNUN: It is a review.
HATHAWAY: So clearly a lot of that work came out of your own experimental work,
as well as your ability and your like-- You know, one of the things you like to
do, which is to read widely. It's a piece of work about, I think, kind of all
those incredibly subtle little "How does that enzyme work?" without maybe
looking at-- And then putting it together.
04:30:00HANNUN: So let me give you an example. I think we have discovered a couple of
new enzymes in the lab. One is a sphingomyelinase. Now I will definitely go
after-- We have already purified it. We're going to study it more, analyze it,
understand the biochemistry of this enzyme. But I guess my overriding goal is
we're not trying to understand the enzyme just to understand it, like maybe a
sphingolipid biochemist would do, which is legitimate, which will provide new
information and insight. We will still do that stuff--because we can do
molecular and enzymologic studies--but always looking for hints about, if we
understand how it works, how does that allow us to understand how the enzyme is
regulated in the cell, and vice versa, so that we can place it in its
And the same thing we have developed much more--Because we have much better
04:31:00tools to study protein kinase C. Again, we now have-- For example, you mentioned
structural. We are at a structural level with one of the isoenzymes. We have a
domain of the enzyme that interacts with the actin cytoskeleton of the cell,
with the matrix of the cell. So we've defined that interaction, because we were
after a physiologic substrate for this enzyme at the molecular level. Now we've
narrowed it down to like fifteen amino acids. But it's not because our idea was
to take the enzyme and chop it up into domains and understand how each domain
works in the test tube and stay there. We want to understand how it works in
terms of can we pull out a physiologic real substrate for this enzyme so we can
place it in its physiologic niche. So if you're putting together the jigsaw
puzzle of the cell, you can take the piece of the puzzle and understand exactly
04:32:00how this piece is made up. We only do that in so far as we can know how to fit it.
So that's always been an overriding concern about what we do in the lab. I
believe strongly that by understanding the structure of each jigsaw puzzle you
will be able to fit it best. That's the duality I'm trying to explain in the
lab, that while we are very molecular and structural, we do that so that we can
place things where they fit. That may be too ambitious and presumptuous. So we
understand or have a much better feel of how they could possibly fit. I mean,
obviously, eucaryotic biology is so complicated. But to gain more insight into
how these things fit in a global scheme. So it's this duality that I personally
enjoy tremendously, going back and forth, saying, "Oh, did you do this
04:33:00structural study with ceramide?" which is a second messenger we think we discovered.
And ceramide, incidentally-- You take diacylglycerol from this picture [on the
wall], put ceramide in, take phospholipids out, put sphingolipids in, you have
almost an analogous situation. You take ceramide-- I mean, one of the questions
we asked very early on was "What about the structure? What's unique to the
structure?" And those kinds of studies led us to find that a very closely
related molecule called dihydroceramide doesn't work. In fact, it almost does
the opposite. So that gives us a much better sense of what ceramide does in the
cell, because its cousin doesn't work.
HATHAWAY: It also maybe says something about the relationship of certain, you know--
HANNUN: Lipids to each other?
HATHAWAY: Yeah, And that they're doing opposite things, but they may have
similar structures or parts.
HANNUN: Oh, absolutely. By doing sort of the mundane, which is taking ceramide
and doing many compounds that look like ceramide and trying to understand how
04:34:00they work-- I shouldn't say mundane. It's sort of the rigorous biochemistry. You
could have that for its own sake. A biochemist in a biochemistry department may
be very happy just doing that for its own sake, and that would be considered a
good contribution even by me.
HATHAWAY: So you'd fund that. Actually, you brought this up three or four times,
so I'll jump in. And we'll get back to this ceramide. Your reasons why you've
gone after it the way you have-- You would sit on a study section, fund
something that was just going to-
HANNUN: Oh, yeah, I would. I mean, I think different people have different
contributions to science. We wouldn't be sitting here discussing sphingolipids
had people not spent a hundred years figuring out sphingolipid structure and
biochemistry or, for that matter, all other cell-- I mean, the usual cliché, we
04:35:00all stand on the shoulders of people who stand on other giants' shoulders,
that's very true. But I think I'm just-
HATHAWAY: Also the phrase has a wonderful history.
HANNUN: Maybe you'll tell me about that later.
HATHAWAY: Yeah. Off the tape.
HANNUN: I'm just trying to give you a perspective of what kind of science we
pursue and for what reason. We are a very molecularly oriented lab, but we try
to figure things in terms of biology. And we can work both ways. We can work the
biochemistry or the molecular biology and move to the cell using that
information, like finding out that dihydroceramide doesn't work, or, vice versa,
try to understand something about the biology and then move back. See if that
allows us to understand the molecule better or the molecular interactions better
in vitro. Elaborate on that, move back to the cell, and see how things work at
04:36:00that level. It's a very dynamic interaction, but that's really what excites me
about science. I think we've been quite lucky in both sides of the lab, the
protein kinase C and the sphingolipid side. Definitely on the sphingolipid side
we're sort of painting a very beautiful picture. On the protein kinase C, I
think we have developed sophisticated insight that we can now paint a more
detailed-- Hopefully, I can start seeing a more detailed picture being painted
because of that.
HATHAWAY: You prefaced a lot of this by saying you'd like to think your lab--its
approach--is special and that there are not a lot of them doing it this way. Or
maybe this, again, you used the word "dual," and I guess I used it too. So we're
04:37:00both using the word a lot and that's fine. I guess, one, I'd ask you who else is
doing it. And it doesn't have to be-- Maybe you're aware of other people not
even in related fields in the sense of they're not your competitors. They could
be doing, I don't know, transcription, but they're doing it some way that's got
this--I don't know what phrase I'd use--extra thing added onto it or something.
That the goals aren't just what's produced from the lab and its papers but
perhaps a more general understanding of biology beyond the areas you're working
on. That's kind of a two-part question. Who else do you see--? Would you pattern
yourself after somebody else? Do you see somebody patterning themselves after
you? Is this something you talk about or verbalize with people?
04:38:00HANNUN: I think I'm still too young and too junior to be patterned after. Who do
I pattern myself after?
HATHAWAY: Or who do you talk to about these sorts of things, or has it all been
saved up for me?
HANNUN: Yeah. Well, I talk to my wife about things. We collaborate. She's a
physician-scientist too. I talk to myself quite a bit about these things. That's
sort of, I guess-- I hope I have my creative moments. But beyond just
creativity, I talk to myself quite a bit. I analyze strategy, tactics,
individual days' results. At all levels I'm involved in that. I don't think I
04:39:00consciously have a role model that I pattern [myself] after.
HATHAWAY: I guess you started saying "unique," and then you kind of backed down
from that and said "a few."
HANNUN: Yeah. I don't want to be presumptuous.
HATHAWAY: Well, but you're not naming any others.
HANNUN: Yeah, but it's primarily either because of ignorance or because of not
wanting to spend ten minutes now going systematically over different areas or
regions, saying, "These people do the same thing, these people don't." I mean,
if you take a rundown of people doing things around Duke, basic research, I
think the more successful labs I can name have been mostly on the basic side of
things, not really concentrating too much on the physiologic significance of
04:40:00HATHAWAY: But on the kind of, like, as you said, the cellular or something--
HANNUN: I should take that back. If you now incorporate all the people who
incorporate molecular genetics, I think these people are using the tools of
molecular genetics to approach questions of physiology and biology. That's
obvious. That opens up a whole group of people for you right there. I think we
are a little different because we're not much into molecular genetics. We use it
as an occasional tool, but maybe we're a little special because we're now using
lipids in the same context and maybe enzymes. Was there another component to
HATHAWAY: I thought the second part was really more, again, if you could find
somebody to compare with and how the comparison worked, not just were there
04:41:00others and who were they. Again, I think, as you've just said, you talk to
yourself a lot, so I think this is something maybe you've really given some
thought to. It's not just coming off the top of your head as we talk. I mean,
I'm asking you to drop names, because somebody can maybe read this and go and
check out what you have to say even 150 years from now and say, "Oh, there is
this kind of sense of doing things a certain way that may be communicated even
here at Duke." You may have students, postdocs, who have gone on and they are
struggling new PIs [principal investigators] and they've taken a lot of your
methods as well as your--
HANNUN: Well, I think I'm still too junior. My students have hardly graduated,
or a couple of them have only. We do discuss these issues, sort of the
04:42:00philosophy of the lab and the approaches to experimental design at all levels,
the general, strategic-- In the lab, we actually once a year take off a whole
day and go for sort of a retreat and discuss these issues. On a one-to-one
basis, I usually meet with my students at home over dinner and discuss the
general strategies and goals, rather than when I meet with them in the lab,
which is on a day-to-day basis, and go over the daily results. Or even every
couple of months they present their achievements and problems over that
perspective. I still meet with them for more general levels of discussion. But I
think we haven't advanced to a point where some of the students have gone on
04:43:00with those ideas. I don't know even how seriously they will take them after they
go with them.
In terms of the other part of your question, we can drop a few names. Bob
[Robert J.] Lefkowitz is considered the premier scientist, you know, the most
known scientist at Duke now. He's a person who has been studying adrenergic
receptors from day one until now, and he's done the whole thing with the
biochemistry and the molecular biology, more biochemistry, more molecular
biology. His work is superb. He has a large operation funded by the [Howard]
Hughes [Medical Institute], internationally renowned as the premier scientist
working with adrenergic receptors and probably as one of very few premier
scientists working in receptors in general. He's really in that group. You
cannot mention signal transduction or receptors without talking about Bob Lefkowitz.
04:44:00But I can definitely say that Bob Lefkowitz has never had in his lab--maybe in
his subconscious or even long-term goals he has, but definitely not in his
lab--a program to study the physiologic significance of these studies at the
physiologic level. You can always say that if you understand how a drug binds to
a receptor you understand how it works. That's plenty of justification for that
great science for me. But he represents a group where he doesn't even want to
invest in saying, "Well, do you make a transgene, let's say, with an adrenergic
receptor and look at what happens to biology or knock out the receptor and see
what happens? Or are the receptors important in cardiac failure, heart failure,
04:45:00or are they important directly in hypertension?" He's not looking at total-body
or total-cell-system physiology. And the justification of his work-- I mean, he
doesn't need justification. But he represents that class of science. I may
represent more, now, come to think of it in that way, maybe of what the
molecular geneticists-- In terms of using molecular biology techniques to answer
questions of physiology and biology. Except we're not a molecular genetics lab.
HATHAWAY: You're talking about an outlook sort of.
HANNUN: Yes. The outlook may be much more similar. Now, unlike most molecular
geneticists, who may be more involved with yeast or E. coil, we're involved with
04:46:00higher eucaryotic systems. This may be splitting hairs, too, because I'm sure
many people who study enzymes or lipids want to know what they do to their cell
system. I think our duality comes maybe more from in a way preimposing the
physiology we're interested in, which is sort of leukemia growth and
differentiation, on the biochemistry we're doing, rather than saying, "Well, we
have this lipid. What does it do?" Do you know what I'm saying?
HATHAWAY: Right. You happen to come across this great sphingosine stuff. Nobody
else did it. What does it do?
HANNUN: What does it do? Yeah. I mean, we have done some of those studies, not
that we haven't, but it's never been the overriding concern of "Oh, if we find
it does that, that's what we're going to be doing for the rest of our career." I
HATHAWAY: I think it's all very clear. You seem to be all of a sudden hesitating
as you get-
04:47:00HANNUN: I've never thought of it, I guess, in terms of how does it compare to
other labs. I've always thought about what I want to do and how do the things we
do stand up to what I want to do. That's my yardstick. It's not like "Am I
closer to the Lefkowitz model or am I closer to the [Michael] Brown and [Joseph]
Goldstein or this and that?" I'm not thinking of it in that-
HATHAWAY: I guess I'm thinking more along the lines--actually, maybe I haven't
approached the question right--that nobody is doing biology in a vacuum. And you
read widely. Indeed, maybe I could have asked the same question about the four
or five articles or the book you read, or, who knows, maybe it's a
04:48:00mathematician. Maybe before you pass on to other worlds you want to see some
real serious inroads made with cancers and leukemia, where the basic science
really pays off in a much more direct fashion and people aren't still doing
retrospective studies about "Do we dose them at this level and this many times a
day?" I don't know, that's I guess--
HANNUN: I think my perspective is to go after discovery of physiology at the
molecular level. I think a lot of physiology has been discovered at the
physiology level, at the whole-animal level, the whole-body level, at an organ
level. But I believe a whole lot of physiology is still hidden in terms of the
cellular level and subcellular level.
HATHAWAY: One would think of cancer being kind of the exemplar of how it has got
to be hidden somewhere.
HANNUN: Cancer in a way is an opportunity to look at derangements in that
physiology. On the other hand, it may be one of the very last things we can
04:49:00crack open as a scientific community because it's really a normal cell in
disguise. We need to understand the normal cell function in great detail, I
think, before we can understand individual cancers and how they go awry. I
believe that there's a lot of discovery to be made in terms of even identifying
new players, new lipids, or new functions for old lipids, new enzymes, new
pathways. I think there are many pathways, the way elements in the cell connect
to each other and communicate to each other. I think we know a few now: the map
kinases and protein kinase C and calcium signaling and calmodulin kinases and
04:50:00transcription factors. We know a lot, but I think that's much less than half the
story. I think that's a small fraction of what we're going to learn in the
future. As I said, there's still many proteins and enzymes to discover, many DNA
sequences, many lipids. But what's more important, we're going to become much
more sophisticated in understanding how one component talks to the other. Only
after we start building that element can we start dissecting out whole pathways
in terms of taking something from A to Z. How does A talk to B to C to D to E?
And it's going to be even more complicated because B can talk to C and C'
(prime] and C' can receive a signal from B and B'.
HATHAWAY: And if it's got the day off, then F takes over.
HANNUN: Oh, yeah, absolutely. So it's going to be very complicated, but each one
04:51:00has to make their own contribution and slowly inch forward with that.
[END OF TAPE 5, SIDE 2]
[END OF INTERVIEW]
HATHAWAY: I guess we decided that we'll pick up with a point you wanted to clarify.
HANNUN: Well, I think it's something we talked about yesterday in terms of how I
view sort of the gestalt of the lab in terms of its soul. I had to think about
it in terms of comparisons with others, because, as we talked about yesterday, I
never really sit back and compare it to other models as much as how it matches
04:52:00up with what I want to do. But when I did think about it, the name that came up
was that of Jim [James E.] Rothman, who studies vesicle transport at the very
biochemical level. I find that fascinating because it's nothing very intimately
related to what we do at all. But I think the approach [is similar] in that
there's a fundamental problem of biology--trying to understand how proteins and
lipids get moved along in the cell and sorted to different places in the
cell--and the approach has been molecular and biochemical, not genetic. I find
that a very gratifying approach because it identifies the components of the
system but through functional studies. It identifies simultaneously, I guess,
04:53:00the function and the component because that's the approach.
HATHAWAY: Instead of this kind of perhaps a two-step or a process where you
identify, clone it, and say, "Okay, here it is," and then move on to the next
thing and let somebody else mess around with it.
HANNUN: Exactly. The classical biochemistry or genetic approach is you have
something and you try to figure out how it works or what it does. You have an
enzyme and all you're interested in is how this enzyme is regulated. Or you have
a clone, and you want to know what is the function of that clone. That's a
major, I would say, problem in the reverse genetic approach, where you really
take a problem of fundamental biology and you pick up components of that problem
but often you don't know what those components do. You don't have the functional significance.
HATHAWAY: And you may not even care, right?
HANNUN: For a while you may not care, as long as you're cataloging and
04:54:00assembling the pieces, but sooner or later you need to see how they fit
together. You have to move to that next level of functional studies.
HATHAWAY: Do you think that's harder work?
HANNUN: What, the biochemical approach?
HATHAWAY: Or the fact that once you get past the catalog you might as well do
something with the things now that you've identified. Is it harder to then do
HANNUN: It is harder. It's probably getting easier with time as people
understand structural motifs in terms of functional consequences. From
sequencing genes one could always glean some idea about how things work, and
with more insight and cleverness and whatnot you could-- I would think that an
important goal for most molecular geneticists once they've identified something
on a pathway is to find out how it fits in that pathway and how it works at the
biochemical level, although many molecular geneticists are not trained in
04:55:00biochemistry, so it may be very difficult to move on to that level. Just as
many, I guess, biochemists are not trained in molecular genetics, so they can't
bridge that gap from the other direction, either. I think that's where the
functional approach is best--again, I hate to use that terminology--best
exemplified by this example with Jim Rothman. That's appealing to me.
HATHAWAY: And as you say, it's not anything to do with-- It's not a matter of
comparing content, it's a matter of comparing approach. And even perhaps on an
ideological level, [it shows] why one would be interested in biology and what
one wants to get out of investigating. Where is he [Rothman]?
HANNUN: He has moved a few times. He is now at Sloan Kettering [Cancer Research
Center]. He is head of a department or something at Sloan Kettering.
04:56:00HATHAWAY: I know I've talked about him with somebody before-- Isn't that awful?
I believe it was Greg [Gregory S.] Payne.
HANNUN: There are other people who follow a similar approach. Gunther Blobel
does related things in terms of nuclear structure and function import. There are
major labs that follow that paradigm. That's the kind of approach that I find appealing.
HATHAWAY: Actually, there's somebody else I've talked to about Blobel. And
again, to talk about his approach, if you wanted to say a little bit-- Maybe
it's again just something you're aware of. You see his name or his lab's work in
a journal and you read it just-
HANNUN: I mean, Blobel may have started with things more from the biology part
04:57:00and been more recently moving into the molecular aspect of it. But I just needed
the whole thing just as a clarification.
HATHAWAY: Sure. I was listening to the tape last night. I didn't want you to
think that-- Actually, that's something I should have made a note of to make
sure I definitely got on tape. I was not talking about like some sort of role
model hero or "Who is this person, and I'm imitating him," but more along--
HANNUN: Yeah, because I think that does identify one approach to science. There
are a few scientists that probably conduct science with this approach, although
the majority have probably a more basic approach.
HATHAWAY: I think it's also kind of an important question to ask from my point
of view because I think there are issues about whether it doesn't matter who is
04:58:00doing the science and when. "There's this truth to be found and we'll find it,"
versus a much more, I don't want to use the word "relativistic," but a much more
subjective understanding of how science gets done. Which is that the style and
the personalities and the people actually affect content, not just as some sort
of side effect, but that people's values and approaches and mores affect the
kinds of questions they ask and how they go about finding the answers. To have
people talk about that on tape, these sorts of things, is, I think, worth
spending some time on, not that I have a position that I hold on who's right and
wrong, but those are the kind of extreme ends of the issue. So that's what I was
04:59:00HANNUN: Yeah. Well, that again sort of also is a more philosophical question.
And I want to borrow again from William Harvey, the mathematician. It's sort of
a mathematician's apology--why engage in the game of mathematics and still
consider yourself a functional member of society. I have to justify my work,
too, from that point of view.
HATHAWAY: To yourself.
HANNUN: To myself, yes, not to NIH [National Institutes of Health] or anyone
05:00:00else. Why engage in the abstractions of basic research and spend my life doing
that rather than either work in the clinic, in academia, or for that matter go
and immunize children in Bangladesh or some Third World country. It's a serious
HATHAWAY: You think one especially that confronts or is a part of being a
doctor, I mean, of being in--?
HANNUN: Yes. Because I do have that other hat and that capacity to do that.
These are real life possibilities and options. Almost instantaneously-- I mean,
I could switch--I do switch--a couple of months a year from one to the other. I
05:01:00could switch permanently. So I have to justify my role to myself very carefully.
But the philosophy of it beyond that-- I mean, that's a very complex issue in
terms of, yes, we can say I can work with one patient at a time and maybe
provide a little increment in the well-being of that patient or work in science
and try to enhance knowledge and that may touch on human health later on. I
don't think that argument stacks up real well in favor of research.
HANNUN: I don't think so.
HATHAWAY: I think it's a common one that's, again, without any kind of serious
studying on my part-
HANNUN: A common denial.
05:02:00HATHAWAY: Or a common-
HATHAWAY: Yeah. Or "Yes. I'm doing basic research. I'm an M.D. But I think that
I actually am contributing something more basic and in the long term helpful to
more people." And, again, I'm not thinking of anybody in particular. I haven't
read any studies. I just-
HANNUN: Yeah. I don't have data on that at all. I'm sure many other
physician-scientists believe that they may be more useful as scientists,
although I'm pretty sure that many other physician-scientists are more stuck in
science because they got to be disillusioned with clinical medicine. See, I
don't have that problem. That's why I really have a true option here. I don't
have a problem with clinical medicine. I enjoy it tremendously, and I'm very
effective there. I establish good rapport with patients, and that is half the
05:03:00problem right there in helping patients out. So I do have that dilemma. I think
my role may be more in-- In a way, I have a deep-rooted belief that excellence
and driving knowledge per se, in a very abstract form, is extremely important. I
think people who can provide role models, who can train younger people along the
same lines, almost like Aristotle or Plato-- If you can touch a few people and
carry a tradition of striving to be as analytical and as innovative and as a
05:04:00contributor to new knowledge or new ways to understand existing knowledge--which
is, again, new knowledge--it is very important. I really look at it in almost a
political sense rather than a philosophical sense, that if we can move human
society one notch further across the board in the striving to excellence and to
more intellectual aspirations, I think that's a tremendous benefit to mankind. I
look at it from that point of view.
I really don't believe that what we're doing with leukemia cells is really going
05:05:00to contribute to leukemia therapy in a very real sense. It may. I hope that
someday it will offer a lot of knowledge about that, but I can't sort of stick
my neck out for that, because if it doesn't pan out--and most examples in
science don't pan out in terms of resulting in concrete health benefits--I would
be a very frustrated and vulnerable person. No, I think of it more in terms of
I'm contributing to how people understand things. I'm contributing to how
younger students develop their intellectual skills in research. That probably
will touch them beyond that, you know, beyond the immediate results of
experimental biomedical research. And if that is part of a bigger tradition that
05:06:00maintains that, I think the impact can be tremendous.
HATHAWAY: And you mean in a sense of them passing it on or having x number of
people with a sense of what education and investigation and abstraction and
analysis and human kind of endeavor is?
HANNUN: Yeah. In terms of myself being part of a much bigger group of people
doing the same thing or at least achieving similar results and myself grooming
younger people directly to do that. Some of the most rewarding feedback I've
had-- People who teach lipid biochemistry come and tell me, "Hey, we teach your
papers in our courses on lipid biochemistry."
HATHAWAY: Maybe there's a textbook in the future if you're getting this kind of
feedback. No. I'm being serious.
HANNUN: It's that kind of reward that I appreciate a lot, and also having
05:07:00younger people think about science in a different way. My bias is that it's a
more enlightened way, a more productive way. If you can carry that across the
board and improve everyone's ability to analytically look at things and
synthesize information--and they do it across the board in all their social
functions--I think society will be much healthier. I'm not only talking about
the U.S. society but the world society at large.
HATHAWAY: Do you see this as something that you learned from--? Well, you wanted
to say something. Let me let you finish your thought.
HANNUN: Well, coming back to the original question, I didn't go on a tangent
here not to come back to the original point, which is that [that] is my dilemma.
And since it is my dilemma, I'm always trying to make sure that what I'm doing
05:08:00in science is unique, that if I'm not in science there would be a gap, maybe a
very, very tiny, small gap, but there would be a gap because other people won't
be doing what I'm doing. And it's something I also transmit to my students,
because there is always this "scooped" idea running around in science, "We got
scooped" or "We're going to get scooped" or "Someone's going to beat us to the
punch." I always tell my students, "That's not what you're going to get in my
lab." I try to make sure that they understand that because, one, we're trying to
solve a problem. If anyone else contributes to solving that problem, that's only
going to help us. Again, it has practical benefits, too, because if other people
start working on our problems, our problems become more important. That's a
05:09:00definition of being important. And it helps us really look at things with
other-- I mean, no one's going to do the same thing we're doing exactly
verbatim. They're going to either use a different cell line or a different agent
or a different thing. So we're going to learn more. In the long run, that's
going to make our story even more solid. I always try to transmit that to
students. To me, that's important, that almost avoiding trying to solve problems
that would put you in a position of being scooped, because that automatically
implies there are other people working on that problem. If they're capable,
competent people, I feel redundant. That's been a major steering force for me in
HATHAWAY: Is it also maybe a reaction to your sense that there's a lot of that
going on or too much of it?
HANNUN: There's a lot of science going on, absolutely.
HATHAWAY: That's just strictly-- I mean, "Oh, they're doing that. That looks
good. Let's try it ourselves"? Or is it just that you think, "Well, okay, all of
a sudden--"? I'm trying to think of a-- Let's talk about gene knockouts, just
because I keep running into it, you know, where literally in some cases there's
a race who is going to get--
HANNUN: The knockout first.
HATHAWAY: First. And let's say that there are, I guess, fifty so far, there have
HANNUN: I don't know how many genes have been knocked out.
HATHAWAY: The first two that were done were the same. And that was apparently
like--this is hearsay from my point of view because I have not read it or seen
it, you know, that kind of direct way--but that these two labs were-- I mean, it
wasn't a matter of "Oh, they're doing it. We're going to do this one too." They
05:11:00both came to the conclusion "This is a good gene to do it on for these different
reasons," and boom--
HANNUN: Well, I mean, again, we always find ourselves in that kind of situation,
but it wouldn't bother me.
HATHAWAY: You'd still go on with the work or--
HANNUN: If that gene knockout is part of a general question about understanding
how something works in a system, that's fine. You do it even if you get scooped
on that. That only helps you move faster and further and makes you think how you
can contribute more to that and deeper. But with me it goes even at the level of
choosing the projects in the lab. Definitely every student in my lab gets what I
think is a new project, you know, something that hasn't been done somewhere else
and that is unlikely that it is being done by someone else. But equally
05:12:00important is to make sure that it fits in a scheme where the whole scheme is a
novel angle of things or a novel contribution.
Maybe now is a good time to discuss how the lab is structured. I don't know if
you-- But to sum that part up, therefore, in terms of the philosophy, I want to
make sure that what I'm doing in the lab is not redundant. That's important
justifying my existence in the lab. Because if I was in a race in a knockout
experiment--that means there's someone else knocking out that gene--it means
that if I went back to the clinic I'm going to be contributing something
important, while if I'm in the lab I'm going to be contributing something
redundant. You could carry the same argument to the clinic and say, "How do you
contribute something unique in the clinic?" My gut feeling is there is always
05:13:00opportunity to contribute something unique and different in the clinic. Maybe if
you're in a tertiary referral center like Duke [University Medical Center] or
Harvard [University] or something, there are many other competent people, but
then there is really a lack of superspecialized people definitely in the world
at large but also in many areas of this country. And even in that context I
could contribute new things because I've been through that, I know. I mean, I
can't kid myself and say, "I cannot contribute."
So that's an overriding force here. How has that helped structure my lab? I
think that's a major steering force or guiding force in structuring the lab.
Maybe my own excitement about some biology problems has dictated the themes we
05:14:00want to address. But trying to do something that establishes a unique, I would
say, niche for us, at the approach level, as well as at the knowledge level, has
dictated the structure of the lab.
The two things that we do in the lab, if I can spend just a couple of minutes on
that-- We have two programs, one on protein kinase C and one on sphingolipids.
This is a major burden to me because these are two different disciplines now.
It's at the point where I'm exhausted, basically, in trying to keep up with
those two areas, run two programs independently, almost independently. Yet I'm
still not willing to give up one or the other. Both have turned out to be very
rewarding. My initial bias that they're good for the health of each other has
panned out. Let me explain that.
05:15:00The sphingolipid story is the easier to explain. It started--I think we also
talked about that--when we found that sphingosine inhibited protein kinase C. We
asked-- we talked about that--"Do sphingolipids offer signaling molecules?" And
that's the story we have built. The answer seems to be yes in at least one,
probably two, situations. In the first situation, which is really the better
developed story at this point, which we have been working on for four years or
so, we have found that a number of extracellular hormones and agents turn on
what we call the sphingomyelin cycle of cell regulation, as we've termed it, in
analogy with the PI cycle. This has resulted for us in identifying either new
entities or new functions for old entities. We have a new enzyme, a
05:16:00sphingomyelinase. We have a new function for sphingomyelin now as a relay or a
switch, and we have ceramide as the messenger from that relay switch, generated
as a second messenger. We believe, at this point, ceramide functions at least in
part by activating a protein phosphatase.
What's been tantalizing for us over the last few months is that we're now
getting an appreciation that this pathway of cell regulation seems to be much
more involved in negative regulation of cell growth. It's an antiproliferative
pathway. From our very recent studies, we believe it's important in inducing
programmed cell death. Why is that important? One, it's important for all the
05:17:00biology and all the implications of the biology. That now we may have new tools
and handles on mechanisms that counter proliferative signals, that make cells
slow down, that may even instruct cells to die if they should die. This is of
fundamental importance in biology. It's of great importance in cancer. The way
we think of it is those instructions served by the sphingolipids are important
to allow cells to adjust to hazardous situations. If a cell gets beaten up
because it has suffered hypoxia, ischemia, lack of oxygen, or some other stress
or some other injury, you don't want that cell to go on and divide with all the
injury because you get a mutated cell, and that's sort of inviting abnormal
function, even cancer. So these are the molecules that instruct the cells to
05:18:00"Slow down. There is injury in the environment or injury in the cell. Maybe it's
time to start repairing that injury."
HATHAWAY: And this you think is just an intracellular kind of thing or do you
think is some sort of whole biological--?
HANNUN: Well, I think at both levels. It operates definitely in response in
cell-to-cell communication, or environment-to-cell instruction, but it probably
is going to emerge that it also operates as a sensor inside the cell.
HATHAWAY: Kind of a federalist system, if you will, with the federal government
and the local government kind of working it out together.
HANNUN: Pretty much, I think. The instructions can come either from within or
from without to slow the cell so that it can size up the damage, or maybe even
some of the sphingolipids are the molecules that size up the damage. And if the
damage is irreparable, the cell is instructed to die. If the damage is
05:19:00repairable, then the cell is instructed to start repair. Once it's healthy
again, those signals may fade away, or those sensors, and the cell--
HATHAWAY: And you think it's the sphingomyelin cycle that's doing all those
levels. In other words, it's the monitor and the messenger.
HANNUN: The sphingomyelinase part and the sphingomyelin are sort of the sensing
part of it, and ceramide is the second messenger, the signal that goes on to
instruct the cell exactly.
HATHAWAY: One of the, I guess, more recent articles--and I wish I could just
pull it right out: maybe it's the one that is just two weeks old--[seemed to say
that] though it seems to be competing with the phorbol ester protein kinase C-
05:20:00HATHAWAY: Right, that it's not the only thing out there but-- Am I making the
picture too complex too quickly?
HANNUN: No. That was my other point where I think this is significant. One was
the biology. The other is "Where does this pathway fit in terms of other
pathways?" The way now I'm trying to explain it and think about it is a major
drive in cancer biology over the last twenty years has been understanding what
makes cells grow, and the knowledge base there is phenomenal. We have
discovered--scientists have discovered--dozens of players in those mitogenic
pathways: the signals that drive cells to grow, all kinds of mitogenic hormones,
stimuli, receptors, second messengers, protein kinases, transcription factors.
The list is really extensive. And the oncogenes that have come in to fit with
05:21:00that have really solidified that structural conceptualization of mitogenesis.
And that's something I tell students. If I tell you that hormone x works on the
cell to induce it to turn from red to blue and I ask you, "How does it do that?"
in terms of all the signaling and all that it turns on in the cell, the way to
answer that is actually very simple. My next question would be "Does hormone x
in any cell system instruct the cells to divide or not?" Now, it may be that
hormone x, like thrombin in human platelets, makes platelets aggregate. Yet in
endothelial cells it may make them divide. Once you make that connection, you
can bring in all that we know about the mitogenic pathways and understand how
thrombin works. You can relate it to tyrosine kinases, diacylglycerol, calcium,
05:22:00protein kinase C, the whole concept. Now, platelets don't have a nucleus, but in
other cells thrombin will do a lot of those things. Your yield from
investigating those pathways with thrombin is going to be phenomenonally high,
and the understanding you're going to develop is going to be incredible. Now, if
I tell you hormone y turns the cell from red to green, and you answer my other
question that "Well, no, hormone, y doesn't make cells grow. In fact, in some
cells, if it does anything, it makes those cells stop growing," I can't give you
anything as a structural framework to understand how hormone y works.
HATHAWAY: I think just yesterday, going through the [James D.] Watson-[Nancy H.)
Hopkins book [Microbiology of the Gene]-- It's way out of date of course, but it
gives credit to someone. I think it's actually in transcription, but in the
regulation of that there's something that actually turns things off. In other
05:23:00words, it tends to work as a negative-- This is like the only example, and this
is, what, '86, '87? "Oh, isn't that novel?"
HANNUN: So basically there is a paucity in understanding how a signal that turns
off a cell works. That to me means there's a whole missing black box of what's
happening inside the cell. Again, for the record, I must state that hormones x
and y do not necessarily [have] to be primarily a promitogenic or an
HATHAWAY: You even mentioned that maybe hormone x could be the negative
regulator and another-
HANNUN: Another cell type, that's possible. But as long as you're trying to
05:24:00match up-- So even many of the elements in the mitogenic pathway, what I'm
trying to say is they were discovered because they are involved in mitogenic
pathways primarily, or a lot of the excitement about them has come because they
are either oncogenes or regulators of oncogenes or substrates for oncogenes, all
related to the mitogenic pathway, although they may carry out other functions.
For example, thrombin can stimulate mitogenesis but turns on platelets. Protein
kinase C can activate platelets but can induce cell proliferation. So there are
a lot of different functions for even the same molecules. But the thing is, if
you want to understand how a molecule y that turns off a cell works, there is
really, a tabula rasa, a very blank page there.
HATHAWAY: Can I interrupt?
HATHAWAY: Why? Do you know why people would have just missed the point?
HANNUN: A couple of good reasons. I think one is that even at the biology
level-- Because a lot of this work has really been driven initially by biology.
05:25:00Although now we're at a stage of molecular biology and biochemistry, a lot of
the discovery was initiated at the biology level. You culture cells, take what's
in the soup, find a growth factor there, and then purify-- So the biologists
always turned away from things that inhibited growth.
HATHAWAY: Just because of what they had at their disposal, which are these
things that they need to plate and get them and get them to grow.
HANNUN: There has always been great skepticism about things that inhibit growth.
Why, I don't know.
HATHAWAY: A kind of mental block or mental construct is there maybe about
HANNUN: I've heard it from many biologists who work with growth factors.
HATHAWAY: Just the name, I mean just the language and the semantics or whatever.
HANNUN: Whenever they came across an activity that inhibits growth, they would
pursue the activity that promoted growth. There was skepticism, and skepticism
generates more skepticism. Basically, things that inhibit growth were looked
05:26:00down upon in terms of--
HATHAWAY: And must be tougher to investigate. Something that's going to turn off
your system is going to be a real pain in the neck, isn't it?
HANNUN: It is. I think that's part of the skepticism. It's very difficult to
investigate. I really haven't explored the roots of that. Definitely those
things were there before I even started in science. So I definitely was aware of
skepticism about all those things back in the early eighties, even the concept
that some of those hormones were called chalones, almost in a pejorative sense
that if you talk about a chalone it means you don't know what you're talking
about. So I think part of it, yes, is the complexity of understanding the
system, because it turns out that many of these things that inhibit growth
actually sometimes induce cell death. Now, that has been a no-no for cell
biologists. Things that induce cell death are not real.
05:27:00HATHAWAY: It's like suicide.
HANNUN: Well, now we understand it as cell suicide, but back then I think cell
death meant you're not growing the cells right or you're doing something wrong,
you can't get information. Now two breakthroughs have come that have really sort
of started rectifying the imbalance there. One is a conceptualization of
necrosis as a form of the cell death that really happens when you put a flame to
a cell and burn it. And apoptosis, which actually was formulated in the early
seventies but it's only picked up very recently, again, because an oncogene was
found to work by inhibiting apoptosis. Again, you needed sort of that kind of
connection, the oncogene first, to understand, "Oh, this is inhibiting cell
05:28:00death, so cell death is for real now." And now, whenever I explain cell death,
you know, this apoptosis to someone, even an undergraduate, it's so intuitive
that cells and the body need that kind of machinery to make sure that when cells
need to die they go ahead and die and don't injure the body in the process of
dying. So that was a brilliant formulation, I think, that there is programmed
cell death, one, two more pathways, I don't know. There's at least one
biochemical molecular pathway that instructs the cell to go ahead and die. So
that's a brilliant breakthrough.
HATHAWAY: There are actually quite a few Pew scholars now--
HATHAWAY: Oh, yeah. They're coming into their own. There were quite a few talks--
HANNUN: I didn't know that. But it's picking up.
HATHAWAY: It's a hot area.
HANNUN: It's a hot area, absolutely.
05:29:00HATHAWAY: Could you attribute the change--? I mean, to whom could you--? Isn't
it a situation where you need to be so-and-so, the PI [principal investigator]
in the lab, but just maybe to--?
HANNUN: [A. H.] Wyllie and [J. F. R.] Kerr in 1970, I think, published the first
paper at the pathologic level distinguishing two kinds of pathology, cell death
by necrosis and cell death by apoptosis. But I really think there's been a lot
of work on-- I should actually say two things. One is this connection to bcl-2,
which is an oncogene that works by inhibiting cell death. The other is showing
that this mechanism of cell death is 7498080-101727000associated with DNA
fragmentation in a very orderly fashion. That I think sold the people to "Hey,
we can reduce the cell death to a biochemical measure." I think that has been a
very important-- And I really don't know who is the first group to show that.
HATHAWAY: You've certainly given the future readers of this plenty to go on.
That's their job, not ours.
05:30:00HANNUN: The other major breakthrough in legitimizing mechanisms of growth
inhibition came with the study of, again, cancer. One was the p53 oncogene,
which initially was thought to be an oncogene, and I think the consensus now is
it's an anti-oncogene. You can mutate it to become an oncogene, but its function
in the cell is to stop growth. And the other is definitely the retinoblastoma
gene [RB] product. RB now also causes cancer by not being there, by being
eliminated functionally. And, again, the formulation for that started in 1970
with an epidemiologist-pediatrician [Alfred Knudson] going through the disease
and how it's expressed, saying, "Hey, this looks like two alleles have been
05:31:00knocked out." It looks like a recessive disease at the molecular level, although
you look at the pedigrees and you say this is an autosomal dominant [condition].
With the cloning it was verified immediately that this is a gene that's missing
in those diseases. It's missing, and it results in cancer because it in a very
sort of general way inhibits growth. So I think those two formulations came in
to show that "Hey, there are real molecules working to suppress growth, and the
mechanisms of cell growth inhibition and death are real biochemical molecular mechanisms."
Now, why is that important for us? Because I think that's where sphingolipids
currently look like they fit in. They may provide us with some of those tools
that we had in the seventies and eighties about understanding mitogenic
pathways. These may be equivalent tools in understanding all the antimitogenic
05:32:00pathways. This may also be the reason they were not discovered until now: that
they operate primarily when cells are instructed to slow down or to die, and
people have been avoiding all that area of biology.
HATHAWAY: I'm also trying now in my mind to recall what the situation was then.
You're working between the two labs. In other words, what are almost the
accidents that allow and even--? You weren't even sure in 1987, '88, '89,
about-- Oh, this is all, you know-- Down regulation is not the right word, but--
HANNUN: Oh, the biology.
HATHAWAY: Right. That would have allowed you to see this come out as well as--
HANNUN: In retrospect everything seemed like it was laid out magically.
HATHAWAY: Just to be found.
HANNUN: Just to be found. But obviously it's more our limitations in thinking
that have actually delayed us.
HATHAWAY: Oh, I would agree with you.
05:33:00HANNUN: It's funny. In this context, maybe we should mention the Pew [Scholars
Program in the Biomedical Sciences], because when I wrote the Pew [application]
it was actually the first month I was setting up my lab. That's when I wrote the
Pew proposal, incidentally the month my triplets were born. I remember that
distinctly. The proposal was aimed at that global thing in terms of "Hey, let's
look at sphingolipid products that can be second messengers." In retrospect, I
think it took quite some trust in my abilities to fund me. But I think that's
also maybe the tradition of the Pew, that they weren't really looking like NIH
does in terms of "Oh, is this well and proven and not necessarily wise but a
safe investment?" And the Pew I don't think considered that at all, because if
05:34:00they wanted a safe investment mine would have been the first out the window.
There was definitely a lipid person on the committee there. I think it took some
insight and trust that lipids are important and this guy may be qualified to
look at the sphingolipids.
[END OF TAPE 6, SIDE 1]
HATHAWAY: Since you were bringing up the Pew and the situation there, as well as
since the copy of the NIH grant application you gave me is dated from around
this same time-- I'm not going to play devil's advocate because in a sense the
reviewers already have. There seems to be a question about, "Oh, God, here comes
another thing about protein kinase C" and "Isn't this stuff everywhere?" and "It
05:35:00reacts with everything" and "Is this going to work?" There seems to be this
issue--and I think you kind of brought it up--that even with you there was-- You
know, you saw that this could really pay off, not "make you a famous person" pay
off, but answering some basic questions about biology.
HANNUN: Well, actually, you touched at it in a very sort of specific way in
terms of PKC [protein kinase C] because that was our initial connection to
sphingolipids, but in my mind I never thought of sphingolipids as peculiarly
associated with PKC. I thought of that as a lead into starting to examine
sphingolipids. And again, to size up the Pew evaluation, I think that came as a
05:36:00wonderful boost of morale that you could still do innovative research and carve
a new area and attack a new area.
HATHAWAY: And I think where the NIH is saying, "Okay, slow down," there's some
mention of "You don't have this incredibly detailed thing of what you're going
to be doing every minute for the next five years, because this is already
risky." And somebody said, "This is somebody who is just starting out, and don't
they--" It's almost like they're suggesting you're arrogant. Whereas I think the
reaction among people of the Pew is "Boy, this is what we're after some of the
time, and this is where we're going to see what-- This is where we throw some
money at it and don't worry about it."
HANNUN: That, again, maybe we can come back to that, but I think this is how
science should be funded, to encourage excellence and innovation and not the
immediate results. But that maybe we can come back to--the qualities of science.
HATHAWAY: It's certainly a major issue, even if Bernadine [Healy] is no longer
there [as head of the National Institutes of Health].
05:37:00HANNUN: Oh, yeah. It's still a major issue. And the Pew money had practical
effects that went beyond the money. One was the meetings. The annual meetings
were always mind-boggling because it showed me that I wasn't alone. There were
nineteen people in my year and sixty other people. Each was embarking on a new
story, with new approaches, new ideas, and a lot of it was way out in left field
for me in terms of a lot of biology, even some botany. But it showed me that if
you sit back and think, "Hey, how can we be innovative here?" you can be. And
there's a lot to be innovative about. That has been very helpful to me because,
if I wanted to be innovative on my own and went through just the regular NIH
05:38:00channels and whatnot, with the years it's becoming more and more coercing in
terms of not being innovative. The Pew is like a breath of fresh air. My idioms
are terrible, so you must correct me. Actually, they've gotten me in trouble
many times, just misplacing an "off" into an "of," and people can get irritated.
HATHAWAY: I've found that very articulate people, when English isn't their--
They actually are doing wonderful things with the language, and I actually enjoy them.
HANNUN: I do commit a lot of errors in either idioms or whatever. So the Pew was
really fascinating from those aspects. It was also important practically because
I think my chairman, Joe [Joseph C.] Greenfield [Jr.], head of [the Department
of] Medicine at Duke, who was very supportive from day one-- He trusted me more
05:39:00at the sort of a gut-level feeling from knowing about what I did and how people
who were very close to me like Bob [Robert M.] Bell and Jim [James E.] Neidel
viewed my work and abilities, rather than from the point of view of saying,
"Hey, he solved this problem this way, so he is good" or from the point of
"Well, we really need someone doing this kind of work in our department." So
with that kind of trust, getting-
HATHAWAY: It was a personal thing. I mean, even if he wasn't personally close to
you, what it was you could have been doing, you know, God knows what.
HANNUN: He wasn't close to my science either. So it was very good to have this
kind of outside consolidation of his trust, his belief that-
HATHAWAY: When you've got somebody on your side kind of taking the plunge with
you or whatever-
HANNUN: Well, it's a vote of confidence from the Pew that "This guy was chosen
among a very competitive group by a very prestigious group, so what I thought
05:40:00about him must have been good." That was helpful. These kinds of attitudes and
support are very essential to survive. So that's where the Pew came in. A year
later--or a couple of years later--I got an American Heart [Association]
Established Investigator [Award]. That was another vote-- I mean, that
definitely wasn't important for the dollars, again, as much as the vote of
confidence to get from the outside peers-
HATHAWAY: And this one now, I'm almost afraid to pronounce it.
HANNUN: Mallinckrodt [scholar].
HATHAWAY: Mallinckrodt. Yeah. That was really something. That's one person. Is
that bucks too?
HANNUN: Oh, yeah.
HATHAWAY: Yeah. That's money, too, that's great.
HANNUN: Yeah. And that's one person a year chosen.
HATHAWAY: Oh, really. Do you mind--? We can spend a couple of minutes-- I mean,
since we're talking about funding or how these day-to-day and practical aspects
of survival affect doing science, did they just call you up and say, "You win" or--?
05:41:00HANNUN: No. They invite a nominee from several institutions, one nominee per
institution from several institutions. They ask them to submit-
HATHAWAY: Is it the same institutions every year? Or they just pick--?
HANNUN: I think different institutions, different years. There may be a few that
sort of-- Like the Pew does. It's not as extensive. The pool is not anywhere as extensive.
HATHAWAY: The Pew's criterion is $17,000,000 in NIH funding at an institution.
If there's twice that or there's the medical center plus the-- Then they're
allowed two people to apply.
HANNUN: I really don't know the mechanics of the Mallinckrodt. But they invite
several, and then they have five who go to Saint Louis for personal interviews
with a group of lay people--a lawyer, a businessman, a radiologist, I think, but
really no basic scientists.
HATHAWAY: And who is funding this?
05:42:00HANNUN: The Mallinckrodt Foundation, which is a foundation based on, I think,
the Mallinckrodt Chemical Works.
HATHAWAY: And that's anything to do with biomedicals.
HANNUN: Yeah. Chemical reagents and biomedical supplies. It was fascinating
because I had to describe my research and interact with these people--four or
five different people--over an hour, describing my work in very simple-- Not
necessarily simple, but be able to articulate it--
HATHAWAY: Like you're doing here.
HANNUN: Well, no. You've read some of my work. You've met other scientists.
Those are people who haven't done science, haven't read science either. So it
was really an experience. I prepared for that a little bit, a few hours, mostly
with my wife [Lina Obeid Hannun], in terms of how can I come across to those
[people]. And I think I did. We had a very lively discussion.
HATHAWAY: I don't know if your wife would have been the best-- I mean, as a
05:43:00confidant she would have been, but as somebody--
HANNUN: Because I was starting out from a very technical-- You know, where you
could easily lose the people, lose the forest because of the trees. But I think
starting at sort of a common ground, finding the common ground, we ended up with
a very lively discussion about the science. It was really intriguing. So one can
be effective in communicating excitement about science to the lay audience if
you can discover the common ground. Again, that was another vote of confidence.
My experience with NIH has been much less of-- The review process at NIH is very
rigorous, but it's becoming more exacting and playing it very, very safe, and
05:44:00that's at the sacrifice of any leeway in innovativeness. You can't go in with a
grant, say, "Hey, I'm interested in that. I want to look at how--" You have to
lay it out in almost excruciating detail in terms of-- I don't know if we're
going to come back to that later or now is the time for this.
HATHAWAY: There's a few more things about your research--
HANNUN: Because we took off from how we built our research.
HATHAWAY: It's actually amazingly coherent, and will be, I think. Don't worry.
Let's continue with the NIH since it's--
HANNUN: Well, biomedical research is in a big mess now, and it's in jeopardy,
Because the way I see it, the scaffold, backbone, to biomedical research in this
nation is the R01 given out by NIH, the individual research proposal. That's the
05:45:00one that's been taking a beating year after year, for a number of reasons.
First, the research budget has grown--the government, the NIH, has grown--but at
a slow pace. And number two, the government is mandating more and more how a lot
of that research money is being spent. That is being subject to a lot of
lobbying groups. I think the AIDS lobby has been very effective in pouring in a
lot of money into AIDS research, which is fine. If you want to make progress on
a specific disease, you need to fund until saturation, so that you fund a lot of
garbage, but you never know when the real insight comes from what lab doing what
at what time. So that's fine. But it has also opened up the eyes of many other
05:46:00groups that say, "Hey, breast cancer. We want to fund breast cancer [research]."
HATHAWAY: There's a very interesting article or series of pieces in Science
recently, too, about that, and the woman talks quite openly about tactics.
HANNUN: Yeah. People are starting to talk about tactics and lobbying efforts,
which is fine, but the way I would like to see it is that if those moneys come
in on top of what's in the potty-
HATHAWAY: The pot!
HANNUN: The pot. Too many children! Geez, what a goof! But it's not happening
that way. So what's giving is the R01. My prediction is there's going to be more
and more of people with prostrate cancer. The older men are going to lobby for
prostrate cancer research.
HATHAWAY: They may not have to lobby. The Senate might be full of them,
05:47:00themselves, right, and they just-
HANNUN: Any group that can get an audience with the Senate is going to make an
HATHAWAY: What about the--?
HANNUN: Let me sort of finish that train of thought. So that's one problem. A
lot of money is now being mandated. You know, cancer centers. We have a cancer
center here that gets a budget of $2.5 million a year, and there are dozens of
those. You know, $2.5 million a year, that's fifteen to twenty-five R01's.
That's a lot. And that money doesn't filter much into research. That does not
filter into basic research. It filters into other health issues but not directly
into basic research. So there is that problem.
Another major problem is, unlike medical schools that have regulated entry into
05:48:00medical education, graduate schools in biomedical research have not regulated
entry, either at the level of graduate admissions or at the level of junior
faculty, so there is a tremendous surplus now that does not match the demand.
HATHAWAY: And that's relatively new, isn't it? I mean, it's really like there
was such expansion in the field until what, God, even the end of the seventies,
HANNUN: There is expansion going on right now.
HATHAWAY: I also meant just the positions available and people going into the
graduate school. Before, like five years ago, it wasn't a problem. There wasn't
a flood of now unemployable-
HANNUN: Five years ago, there was no acute problem, but I bet you if someone had
sat down and run through the calculations, they should have predicted a problem,
because at that time that's when a lot of hiring was going on, new faculty, and
05:49:00new funds. The system was set up for plenty, when there was a lot of demand
created by the research dollars poured in by the government and very little
supply. Government was supplying construction, fully funding research, and that
was the mode. So departments started being created, and new faculty were being
hired. That's still going on now, even at Duke.
As you look outside my window now, there's a new building coming up. What does
that mean? New recruits creating more supply? And more graduate students?
Because with every new recruit you need to expand your graduate training
program, because, again, like the R01 is the backbone of biomedical research,
graduate students are the backbone of individual labs. So this is more and more
expansion. That was good in the sixties and seventies. It's not good now, I
05:50:00think. So the system is starting to crack real fast.
Other errors in projections-- I think the NSF [National Science Foundation] made
serious errors in projections that there's going to be a shortage of faculty by
the year 2000. They retracted that miserably last year. Those were very
primitive, erroneous calculations. So a number of reasons, I think, have worked
almost in concert at the same time to really put major force on the R01 system.
And again, study sections which appropriate or approve grants and rank them were
designed where peers can go in, review grants, and decide, "This one-third is
great, this one-third is lousy, and the middle third, well, we can fund some
now, give the remaining a chance. They'll come back. If they're on the right
track, they'll prove themselves." So ultimately they were funding a big
05:51:00percentage of [proposals].
HATHAWAY: Wasn't it even like 50 percent at some point?
HANNUN: I think 50 percent from first round and maybe up to 70, 80 percent being
funded. You know, if you consider-
HATHAWAY: Of the approved.
HANNUN: Of the approved, and going back, you know, second cycle or something. So
the system was very generous, and the results were phenomenal. I mean, the
expansion in basic research has just been phenomenal. I should actually
distribute the blame where the blame should be distributed. The scientific
community-- I mean, I've blamed now the university administration for not
realizing the new times and what the new forces are and Congress for
micromanaging and missing the point. But also the scientific community for
playing the game and not making sure that even early on when things were plenty
05:52:00that they make the case for what their case should be.
Let me explain that. If I was a researcher in the seventies-- I could be a
biochemist studying E. coli. I would send a grant to NIH and preface it by
saying, "If we understand how E. coli do function x, we'll help understand
cancer," and they would get funded through the National Cancer Institute. They
knew they had no interest in cancer. Their work was not going to lead in sort of
any legitimate connection to cancer, so that any independent outsider, if you
really look at it, could say, "That's not going to tell me anything about
cancer." So they played the game. They played it as people who did the research
and applied for the grants and as people sitting on study sections funding those
grants. They ignored that. They were instructed not to look at the relationship
05:53:00of research to really the health issues directly but just evaluate the merit,
which is fine. But by playing that game, I think they forfeited-
HATHAWAY: We out there whose supposed tax money, to put it in the kind of
context you're doing, think that "Yeah, those guys who say they're going to help
cure cancer are going to do that."
HANNUN: And where are the results? That's the question now raised by congressmen
and people. Where are the results from that E. coli work? That's where the
scientific community, us, the scientific community, have forfeited a lot of our
input into the system.
HATHAWAY: Why do you think that--? Why is there just "Okay, the NCI [National
Cancer Institute] has got the big pot of cash now, so you make this up." Instead
of going down the straight and narrow path and saying, "Look, we want you to set
05:54:00up the National Science Foundation's subdivision of basic pure research and fund
that. This is why. We'll show you why."
HANNUN: Exactly. I mean, everybody was playing the game--the congressmen, NIH,
the scientists, the universities. I mean, still up to this day my operation
costs Duke probably nothing. My salary, the salary of everyone in my lab, all
our research supplies, expenses are paid by my grant.
HATHAWAY: As a matter of fact, you probably bring in money.
HANNUN: Oh, I bring in indirect cost rate that goes into administration and overhead.
HATHAWAY: Which are actually pretty low here, or they were in '89.
HANNUN: They're like 50 percent. That's not trivial.
HATHAWAY: It's 78 percent some places.
HANNUN: Everybody was playing the game. And instead of the scientists saying,
"Hey, science, by providing the infrastructure, cancer researchers will benefit
a lot, the economy will benefit a lot. We will be the leaders in biomedical
research, and the economy is going to get a boost. The nation is going to get a
05:55:00boost because we're going to train the best minds in this country." That should
have been the argument.
HATHAWAY: And it occurs-- Something like the National Endowment for the
Humanities. I mean, people are editing Latin texts written in the fourteenth
century, and they're justifying-- I mean, somehow they are.
HANNUN: Oh, people would have justified that. I think they should have said
exactly like you said. That would have been a very viable model, to say, "Well,
let's restructure part of NIH like NSF and fund basic research, knowing that if
we understand how DNA gets clipped in E. coli we'll have restriction enzymes."
You can't foresee what's going to happen, but you could make the general case.
And then you prove it by example, in retrospect, saying, "By understanding
restriction enzymes, we have the molecular biology revolution. Cancer research
will definitely benefit and has benefited from that." But, you see, scientists
didn't make that argument.
05:56:00HATHAWAY: They just were too busy with other things.
HANNUN: They played the game.
HATHAWAY: I mean but why? Here's somebody-- I think of you and actually
everybody I've interviewed. They'll always say, "Well, I don't want to make that
generalization because I can't back it or I don't like to go--" You know,
they're very, very careful people about making statements of fact and moving
from point to point. That's the currency in which you trade. Why would they just
give it up and--? And I've seen-- I mean, it's not in the seventies. I've seen
grants where I know it's phony. I know it's this thing--
HANNUN: Yeah. And if you know-- You're the taxpayer. If you're a representative
of the taxpayer, I think that's where the trust has broken down. Why did they do
05:57:00it? I think that was the game in town. It was sanctioned by everybody. NCI was
happy to have the best minds in biomedical research being funded by NCI, so they
didn't mind that. The system, as I told you, was not set up to say, "Hey, this
is not NCI material. This is pure science. Let's create a pot for basic
research." Those were the available funds. I think researchers went after the dollars.
Now, in the big picture, you can say by pouring in the money into NCI you did
recruit the greatest minds into cancer. You know, basic research made them
survive, provided the infrastructure. So to me it's justified. The thing is that
not making the case has discredited us. I don't think playing the game is really
05:58:00the evil. In fact, those people that you mentioned, where it looks like it's
really phony, those people probably don't play the game well. [laughter] No. I'm
serious. Because the game-- To explain the situation, I think the game does not
ask you to make a phony statement that "Hey, my work is related to cancer
research through this and this and this way." Because who are the reviewers? The
reviewers are scientists who actually, if they smell any phony part, they're
going to discredit you a little bit.
HATHAWAY: I also on tape have situations or discussions about the fact-- Well,
"I write my NIH grant. And really my NIH grant has three parts. There's one
part, the first third, which is 'I've already done this. See what I've done?
This is really good.' The second part is 'This is what I'm doing. See, it's
05:59:00going to pan out. It's starting to pan out.' And then there's this other little
part, the third part, that's kind of really totally buried: 'Here's the stuff
that I don't really know about. I'm really not even going to talk about it. But,
indeed, I'm really going to use part of my funding on that.'" But I'm talking
about, you know--
HANNUN: For cancer research? To relate to cancer research? Is that what you're
saying? Or to relate to arthritis?
HATHAWAY: And then they'll say, "When I sit in on a study section, I read that
grant, and it's written the same way. I know exactly what's going on, and I fund it."
HANNUN: But, see, those people are really not playing the game well, because,
you know, I sit on study sections, too, and if anything, when you start pulling
in those weak aims of your research, it starts sinking your proposal. The other
parts must be really good to maintain it at the funding level. But if you didn't
put that in-
HATHAWAY: I think the work is brilliant work, but what I'm saying is that they
think they're playing a game about, for instance, not taking risks and making it
06:00:00look like its going to save someone's life.
HANNUN: There are two components here in what you're saying: One is about not
taking risks. That's unfortunately a reality now. If you get a reviewer--and
there's a lot of mediocrity now among reviewers--they cannot take risks because
they can't even imagine what's going on. We are facing mediocrity in science. I
want to come back to that. But the other component of your statement is to say,
"I'm going to save human lives with that study." I sit on American Heart
[Association study sections]. American Heart tells people, "You can discuss the
relationship of your proposal to heart disease in a paragraph outside the
proposal." But you see some people coming in with a specific aim, saying, "Well,
I'm going to do these things in cardiac cells and heart cells and whatnot." It's
such a phony and weak part that it only sinks down the grant. So you don't have
06:01:00to. What I'm saying is NIH does not ask you to make that phony claim for an R01.
The reviewers are asked not to look for a connection. You will still be funded
by NCI for whatever you present to NCI without making the phony claim. So
scientists shouldn't have been in part of the deception game. That's not a
question of deception. The people who were incorporating some of that, let's
call it deception, in their grants didn't have to. It was a misunderstanding on
their part of how the process works, I think. But the problem comes--
HATHAWAY: Yeah. I guess I don't want to imply on tape that I think that there's
really kind of like out-and-out deception going on and now it's coming home to
roost--the payoff. I was agreeing, however, with your getting into this
situation where once things get really tight it's like people have just kind of
06:02:00waited and now the thing has fallen.
HANNUN: Maybe it's fallen, but I think where scientists failed is to make their
case directly to the people, in Congress, and in funding agencies that "Protect
the investment in basic research because it's for the benefit of the health and
the economy of the nation." That is an undisputed argument, and it should have
been made that way. I think universities should have said-- It's still not too
late, because I think the scientific community has to go back and make those
arguments. Because I read in Science someone claiming that no one died of
general medical sciences, so we shouldn't fund the Institute of General Medical
Sciences! To have a bureaucrat at NIH utter that sentence even half jokingly is
06:03:00kind of very descriptive of the problem, very symptomatic of the problem. I
think the scientific community should come back and make the case for really
describing the significance of what they do, that what they do is going to
maintain a class, an echelon, of brilliant young scientists. That is helpful for
the economy, helpful for future health discoveries, and for health-related research.
HATHAWAY: And of course these issues go beyond just biomedical-- I mean, look at
the issues surrounding like the funding of the space station and the [super
conduction] super collider and just the almost kind of-- It's become violent,
almost, and everybody's involved, and the American public is engaged in it.
HANNUN: The problem is you get something like with the [William J.] Clinton
administration, which says we want to invest in the future of the country in the
areas of the strength of the country. That administration sees clearly
06:04:00microchips as an area where we are ahead, and we are ahead, and we should invest
in that and keep training people who are brilliant in that area. But that
administration doesn't see as clearly that biomedical research is equally
important, probably more important as an economic investment. If you look at the
pharmaceutical industry in this country, the biotechnology industry, the
university industry, I mean, we are clearly in an undisputed leadership
position. I mean, with microchips, we're in a race with Japan. In biomedical
research, were in a race with no one. We're clear leaders. We export to the rest
of the world our abilities and accomplishments. I think the university should
readjust and say-- The universities that want to make a commitment to biomedical
research should invest now in that and say, "Okay, we want to keep active
biomedical research programs. We're going to invest in building buildings"--if
06:05:00that's what they need to do--"and supporting programs," instead of saying--
HATHAWAY: Instead of just expecting it to be a cash cow.
HANNUN: Yeah, exactly. And the government has to, I think, dissociate the
funding of health-related issues, where you as a taxpayer can read the proposal
HATHAWAY: This is an epidemiological study about preventing--
HANNUN: Yeah. This is health. Or this person is looking at how molecules
interact with the HIV [human immunodeficiency virus] so that they get imported
or I can see the relationship. But then you say, "Oh, this is a pure science
project. That's beyond my expertise in terms of knowing whether it's of merit or
not. I'm going to let the experts decide on that. I don't need to decide on
that. I don't need to give my stamp of approval for this particular proposal,
but I understand that we should preserve and maintain this kind of science."
06:06:00Also programs should come in-- I think that's the last item of the equation.
Programs in universities should come in and say, "Hey, a useful steady state for
us, considering the budget limitations, is to have x number of young faculty
coming into the system a year. That steady state. And really try to control
entry into the system so that they maintain that supply of young investigators.
That's where, again, excellence becomes the issue here. This is where we'll
regain excellence, because if things keep on deteriorating we're going to lose
the best young minds, because they're going to say, "Hey, there's a very great
uncertainty in this career. I'm going to go into law school." The only way to
overcome that is to say, "If you're excellent and you give it your all"--you
know, all that you've got--"and work in that area, we're going to take care of
06:07:00you. You're going to be funded to do the best thing you can do, and you're going
to have a decent life-style." Which, again-- I mean, scientists could be
physicians. The best scientists could be. They don't go ahead-
HATHAWAY: They're not in it for the money.
HANNUN: Yeah. Although, again, the social climate has tempted many to switch to
HATHAWAY: I think we're entering an era also, clearly, where the lines that seem
to have been drawn, let's say, between academia and industry and an
investigator's self-interest in a project--his or her reputation, the reputation
of postdocs and grad students in the lab, the peer review acceptance of the
work, and now the starting of a biotech firm--have become fuzzier.
06:08:00HANNUN: They're fuzzier, and there are a lot of contradictory directives and
forces there, like government wanting to foster NIH relationships with industry.
And yet NIH researchers, if they go to a company, they can't even get a bagel
offered to them. You know, they can't accept a bagel. It's kind of-
HATHAWAY: Schizophrenic right now.
HANNUN: It is right now.
HATHAWAY: That's more, I think, a symptom of change, not so much a symptom of
some disease that needs to be routed out.
HANNUN: No. That's a symptom of change. The same with funding. It is very
symptomatic of change now However, those symptoms are sort of malignant symptoms.
HATHAWAY: But then you look at what-- And whether it can be correlated-- As I
said to you off tape, the Pew program itself, in and of itself, and the people
behind it and the board and Tom [Thomas W.] Langfitt and Rebecca [W.] Rimel are
06:09:00perhaps--and, actually, they've done oral history--are, from my point of view,
equally or potentially interesting people to talk to about this. Because all of
a sudden in 1985 the kind of funding that you've just said on tape and I think
almost everybody has, without exception-- You know, it is something sort of new
and different. It's aimed at people at this one--I mean, it's very narrowly
focused. It hits every big institution. I mean, somebody planned this, and it
would be interesting to know exactly why. The way the selections are made is
very different than most selections. It's fluid and flexible, I think.
And then the HHMI [Howard Hughes Medical Institute], which seems to be switching
from "Okay, we're going to go to this place, build this building, fund these
fifty guys and gals, and put them all together," and now they seem to be going
around and just picking out individuals. I mean, how HHMI perceives its role.
06:10:00And it's also just spending more money. I mean, it's in Russia now. So there may
be responses to the malignancies or something like that.
HANNUN: These are very important, but they're only going to make a dent. They're
maybe more like the equivalent of pain relievers in treating a cancer patient.
You need more of those. It's very good that these are a couple of things that
recognize and reward excellence, but you need it at other levels too. I mean,
you may need it for more senior people, to tell senior scientists-- There isn't
anything in the system at this point to reward a senior scientist at any level
that makes a dent in the system. You reward them with a Nobel Prize or a couple
of other major awards, but that doesn't make a dent in the system because all
06:11:00these awards go to the top .05 percent. That really doesn't make a dent in the
system. But you almost need to award excellence at an advanced level, where you
can say, "Hey, you've trained a wonderful cadre of young investigators. We're
going to reward you." To the point where you know that if you do that, you're
going to be rewarded. You know, with a Nobel Prize, now it's like touch and go.
You could be the most wonderful, fascinating scientist, and you'll never make
it, just because of the volume. So the Nobel Prize I don't think should be a
goal because, again, it's--
HATHAWAY: Yeah. I don't know that it-- Well, I guess I get the sense that like
any kind of daydreaming goal, it's a goal-
HANNUN: But therefore it loses its effectiveness in rewarding excellence. So you
need other rewards that can touch more people and reward them for different
aspects. You can award the megalabs for their productivity, but you need to
06:12:00reward maybe the smaller labs. Phillip Majerus has trained maybe half of the
academic hematologists in this country.
HATHAWAY: Who? I didn't hear the name.
HANNUN: Phillip Majerus.
HATHAWAY: Thank you. Now I recognize the name.
HANNUN: He's either trained directly or indirectly, you know. People who he
trained went on to train others. Reward someone like that. Maybe his body of
work has been excellent but never super-outstanding, but his pedigree, his
contribution in terms of future scientists, I think is unmatched. Reward that,
and reward the top 10, 20 percent who do that. Reward the top 10, 20 percent who
contribute new creative thoughts to science. Those are still very much needed at
06:13:00entry level, like the Pew does. Maybe at intermediate levels, at later levels,
but I still think we need to tackle things at the root. I think obviously now
the country as a nation is not ready to keep expanding the biomedical research
base the same way it's been expanded in the last twenty years.
HATHAWAY: It obviously isn't. I mean, perhaps that's kind of all of a sudden why
HANNUN: But rather than have sort of a scientific massacre five years from now,
try to anticipate--
HATHAWAY: And have these new buildings be empty or something.
HANNUN: It's funny. Like my chairman already mentions the fact that the
Department of Medicine, which is going to get a lot of space in this huge
building right outside this window here-- He doesn't plan major recruiting into
it because he realizes now that he's not going to have the dollars for startups
for new investigators and at the same time give funding for scientists who miss
06:14:00one round of funding or were going to miss more than one round of funding. So I
think reality is going to sink in. That's why I think building is kind of stupid now.
HATHAWAY: Yeah. But this was probably planned, what, seven years ago?
HANNUN: No. It was planned three years ago, two, three, no, two years ago. It
was thought of maybe three, four years ago, but really planned two years ago. So
I think the reality is going to catch up with us. But what I'm afraid of is, in
the process, we're going to sacrifice the excellence in science. That's my
concern. I'm pretty sure ten years from now, if things continue the same way
that they are--let's say maintaining the same kind of funding--things are going
to come back to a different steady state. We're going to see many schools bail
out of the research game. They're just not going to get funded, and they're not
going to have the ability to support research.
HATHAWAY: And maybe they got into it for the wrong reasons--they were getting
money for it.
HANNUN: Yeah. From indirect cost and the prestige and whatnot. We're going to
06:15:00see bigger schools scale back on what they have. But what I'm afraid is in the
meantime we're going to sacrifice excellence. We're already doing that. The
message we're sending to our high school students, I've seen it. Mike [J.
Michael] Bishop, the Nobel laureate, who came here a couple of weeks ago, spent
quite a bit of his lecture to describe that.
HATHAWAY: I was going to bring up that lecture, because I heard it in Hawaii, I believe.
HANNUN: You did? Oh, okay.
HATHAWAY: Actually, I was disappointed in it in some aspects, but maybe we'll
find that it is this-- We're getting toward the end [of the tape]. There was one
question I wanted to follow up on and kind of ask you.
HANNUN: Do you want to stop now or continue with that--?
HATHAWAY: I think we can go two minutes. I mean, I'll just make sure I catch it
HANNUN: In his discussions with high school students, the word has filtered down
already that this is not the sort of career that people want if they want to be
06:16:00creative and productive. So we're sacrificing that at that level--entry into the
system. We're sacrificing excellence at the level of people already in the
system who are outstanding and excellent, in terms of really preventing them
from being creative. I consider myself a successful scientist. The amount of
time I spend in grant writing, in management, in doing things I don't care
about, is overwhelming. What is the time that's given to allow for that? It's
the creative time. It's the time when I can sit and read something really
different from what I'm doing and get new ideas or times when I can go down the
hallway and talk to someone, spend an hour. I don't have that time anymore, not
HATHAWAY: And you think that's increased? In other words, that maybe like the
generation before you was doing less paperwork and more--?
HANNUN: Oh, much less paperwork. And they would send one grant in, be funded
06:17:00four, five years, minor modifications, be funded for five years. I mean, now I
probably have to write one grant, make sure I write a couple of others to send
to other places, just to make sure I get the funding. So it's cutting back on
the creative time. It's cutting back on what I propose in my grants in terms of
creativity, which is a point you brought up. The peer review system is really
suffering from mediocrity at this point in time. That's scary.
HATHAWAY: That's what I'm going to come back to. You kind of suggested, in a
way, that that's still the one thing you want to see kept in place. In other
words, that there has to be a reworking of it to convince the public, the
taxpayer, that "Yes, okay, that's an epidemiological study. It's clear-cut about
its health benefits or payoff, but you've got to trust us on the--We'll come
06:18:00forward and admit there's no direct correlation." But still it's too-- You know,
it's difficult for the nonprofessional or the untrained person to do that.
HANNUN: I would still admit that the untrained professional should not evaluate
even the epidemiological grant, but I think the untrained professional will see
the relevance of the epidemiological grant. What I'm saying is the
nonprofessional should also accept the benefits, although they're going to be
much more long-term towards the health of the nation and its economy, of the
purely basic research proposal. In both cases, I think it should be peers who
review the merits of the proposal.
HATHAWAY: I don't think that people who collect garbage should be reviewing R01
grants, and I don't know that people who get R01 grants should be telling people
06:19:00who collect garbage how to do that either.
[END OF TAPE 6, SIDE 2]
HATHAWAY: You had something you kind of wanted to maybe follow up that we'd been
talking about. I guess you were talking about [J. Michael] Bishop's lecture.
HANNUN: The image or the conclusion there was how we're losing excellence in
science. I enumerated a few things, like, in terms of what image science is
getting now among high school students, how creativity at the level of us
scientists is being jeopardized very seriously, how our creative time is being
06:20:00eroded, how our creative thoughts are not being accepted in the peer review
system, how mediocrity has crept all over the review system because of a number
of reasons. One is many of the senior scientists--where the Pew [Scholars
Program in the Biomedical Sciences] committee would be quite a good
representation--have bailed out of the NIH [National Institutes of Health]
review system. I think as a product of the eighties a lot of them have gone into
spending their time forging ties with biotechnology and industry, and they've
really bailed out of the NIH review system. They are the ones who could look at
a proposal that I submit and evaluate it the way the Pew does in terms of "What
is it this person does? Is he trained adequately? What is he proposing? Can he
do it? And is it exciting, is it unique, is it something that's going to help science?"
06:21:00HATHAWAY: With this NIH grant, though, I mean, that's clearly something they've
given-- You just don't think the people who sat on the committee are qualified.
I mean, they do talk about how you're new and whether you look like you're capable.
HANNUN: You're bringing up my particular grant proposal to NIH and that
particular study section. This is physical chemistry or physiological chemistry.
This is one of the most rigorous study sections. I think if you read the
critique you would have found that it is a very rigorous critique.
HATHAWAY: Compared to some of the other ones I've seen, I actually can follow it
from sentence to sentence.
HANNUN: It's a very rigorous critique. I have no problems at all with this kind
of review. And if you look at the study section members, it was pretty much
senior people in biochemistry.
HATHAWAY: Actually, somebody went through them at some point and actually marked
a check--I don't think it's a rating thing--marked check marks and then "new."
And so I guess it was just a question of knowing who was on it?
06:22:00HANNUN: Yeah. Something like that. But I had another R01 sent to a hematology
study section, which is much more representative of other NIH study sections. I
didn't give you a copy of that. I got funded through that, but the quality of
the review was mediocre. They still funded me because I think I had a very
strong proposal and I had done a lot of the work. Sort of anticipating that, I
had written it that way. But that's not a study section I want to entrust my
future in science to.
HATHAWAY: This one started in '93, if we can just use your situation as a
particular and then back out to some more general discussions, because I think
there's more that we'd both like to cover, although I think I let off a lot of
steam off tape--a good thing. This is your interview, not mine. It started in, I
guess, June of right? No, no. They met-- Okay, so the funding didn't start until '91.
06:23:00HANNUN: Yeah. I think either December '90 or January I forget the-
HATHAWAY: Okay, and then you submitted it in '89, I mean, a good year and a half
before. And I guess it was reviewed, and you were asked to--
HANNUN: Yeah. It was reviewed, and it was right at the borderline. I think I got
16 or 17 percentile, and I had to move up to 15 to get funded.
HATHAWAY: Okay, and this is what this-- Yeah. It says 15.7, I guess.
HANNUN: Yeah, that's the percentile ranking.
HATHAWAY: They've just divided by ten the score, right.
HANNUN: Oh, no. This is actual ranking. You know, per hundred grants, where does
it rank in the hundred grants, all grants.
HATHAWAY: And this 157 or 15.7 was the one that-- That's the original score it
was given, or is this the result of the resubmission?
HANNUN: This is the result of this-
HATHAWAY: Again, not to bring up anything bad, but with the news about or the
gossip about that this year or next year, the first fiscal year of the Clinton
06:24:00administration, there will be 10 percent funding-- This wouldn't-- I mean,
you're not going to apply again until '95, I guess, right? But this would be--
There would be a chance-- I mean, I know some study sections get fewer
applications and they can fund down to the hundred percentile.
HANNUN: It's all going to be funded by percentile, so it doesn't matter how many
applications a study section gets. So that's why they rank them.
HATHAWAY: So if there's none in the physiological chemistry that got above it--
Yeah, okay, I see. Is that something you're aware of or think about? Or do you
think that your percentile ranking will be much better because you've
established this grant and the Pew established your work? And now some of the
reservations they had on this one, that you're starting out and you seem to be
doing too much or trying to--?
HANNUN: It is a major concern to me. It's a concern. I don't know how major. I
think with what we've accomplished on this, we've really accomplished a lot. In
06:25:00normal times, I think I would rank real high with that and be funded. However,
again, these are not normal times, and the system, as I mentioned before, has
not really been set up to discriminate the best 10 percent from all the others.
It's been really set up primarily to discriminate what should not be funded.
With 10 percentile you're talking about grants in the outstanding category not
HATHAWAY: Oh, yeah. I guess people feel that in even 20 percent that they are-
HANNUN: Remember, there's a category of excellent, and then there's a category
of outstanding. So excellent are definitely not getting funded, and even many
outstanding are not getting funded. My concern, again, with the mediocrity of
study sections, is the attitude has shifted in funding. The way they would look
at it is not whether this is fundable or not or how exciting or not, but the
06:26:00attitude is "What can we nail this grant on?" In a way, it's trying not to fund
anyone if you possibly could.
And to be able to do that you need any justification. So if you can find
something to shoot down the whole grant with, that's what they're doing. They're
shooting down whole grants based on anything they can.
HATHAWAY: Have you done any ad hoc reviewing, any study section for the NIH, for physiological--?
HANNUN: No. I haven't done-
HATHAWAY: Not for NIH.
HANNUN: No. Not for NIH. I've done program projects for NIH, but I haven't done-
HATHAWAY: These are like site visits or-
HANNUN: These are like site visits and reverse site visits, both ways.
HATHAWAY: I'm sure you'll get asked soon.
HANNUN: Well, I'm trying to avoid that.
HATHAWAY: Now, but you just also pointed out-
06:27:00HANNUN: Well, I'm not senior. Maybe in a few years.
HATHAWAY: I'm sure you'd take the responsibility seriously.
HANNUN: When I say "senior" people, people who have been through it for some
time, so they have the perspective and they can know that someone like me coming
through the system-- They have some, I would say, gut feeling from experience.
"Is this someone who is going to make it? Is this someone who is going to
contribute original research? Or is that someone who is going to be stuck with
different obstacles and really not be a productive member of the scientific
community?" The problem with this kind of discrimination is you need to have the
flexibility to fund 40 percent of grants or 50 percent.
HATHAWAY: And expect that you're going to fund the person who's going to have
the obstacles and it's going to turn out to be kind of a dud, at least that one time.
One thing I just wanted to kind of follow through--I actually brought this up
06:28:00off tape, but I'll bring it up again. We don't need to spend a lot of time on
it. You were talking about kind of your ideas about the reform of the system and
the need of the scientific community to kind of push and be a part of this kind
of reform. So that the public's perception, perhaps, and the way that they get
funded actually reflects the reality of the work they're doing in its
relationship to society. And that they had kind of gone along and played the
game. Not that they were guilty of deception, but they played this game just for
whatever [reason]. It seemed to be easier. Who knows? Everybody else was playing
it. And I think you were emphasizing it as specifically for the more esoteric
areas of basic and pure research, let's say, like theoretical particle physics,
as well as biology, or lots of different areas within biology. And that really
06:29:00there is a gap between-- I mean, there really shouldn't be this kind of, let's
say, lobby-- I don't really want to call them a lobby, but this breast cancer group.
Where really through political pressure and really direct action--civil
disobedience, coming up with their own budget, writing their own proposals, and
really taking over the agenda--they were able to get this huge, I mean, hundreds
of millions of dollars set aside for specific kinds of funding.
I guess I wanted to ask you about that. You seem to find that that's not a
good-- You know, again, not that breast cancer research doesn't need to be
funded to the tune that they say, but just that that kind of situation is how
it's coming about and that it's now because basic research is seen as being a
part of this, right. People write grants and say, "We're going to help find a
06:30:00cure for breast cancer" or a way to detect it even or something like that. That
these people who are not biologists shouldn't be in on it at that level. Of
course, we're all in on it in some way. We pay taxes; we elect representatives.
I also asked off tape if you were familiar with Representative George Brown's
recent piece on "the myth." I actually think maybe it was to get scientists all
upset and to start thinking about it, as opposed to being real, given his past
record. But he just comes right out and says, "This is all baloney. Basic
research doesn't have any direct benefits for society. We need to start thinking
about funding applied research." He even says, you know, "And in the social
sciences we need to start, instead of this little NEH [National Endowment for
the Humanities] thing that we give just a trickle of money to and this big NIH
06:31:00thing and this lots of money we give to--" He's talking about restructuring it
so that economics is going to become the money-maker for universities or
something like that. I'm wondering how you feel or what you-- George Brown is
really taking kind of a radical position and coming right out and saying, "Not
only should that stuff be allowed to happen, but I'm in a position to
institutionalize it and to make it like the law of the land." How would you
combat that or respond to--? I know that's a whole bunch of questions.
HANNUN: I haven't read the article, but I know sort of the gist of it. So I know
what you're talking about. I think that's, again, part of the scientific
community and university's not articulating their goals and the strategic goals
06:32:00of what they're doing and why they're doing it beyond the phase of scientific
discovery. Because as I mentioned-- Or as a consequence of not articulating--
The dynamics is sort of more complex than that, but the infrastructure of basic
research is really based on thin ice. On one side, you have the whole biomedical
establishment--universities and labs and research and investigators. And on the
other side, you have Congress and the public. And the support-- The thin ice has
really been built primarily by V. Bush, who was the adviser to [Harry S] Truman
or-- Vannevar Bush--
06:33:00HATHAWAY: Who is of course everybody's hero.
HANNUN: Truman and [Franklin D.] Roosevelt.
HATHAWAY: Yeah. Well, he, I think, had an important position by the end--
HANNUN: End of World War II.
HATHAWAY: Certainly by the end. So [adviser to] Roosevelt, perhaps.
HANNUN: Roosevelt and Truman. Then a few more enlightened members of Congress.
That's not thick, deep support. It's been great that they had the power and
influence to set up this gigantic biomedical research infrastructure. But
everybody followed the line without articulating the long-term strategies.
Universities went for it because it was a good source of dollars and prestige.
They rank medical schools now by how much NIH dollars they bring in. So they're
playing that game. Scientists play the game. And remember, these things dictate
06:34:00the shape of science, maybe not directly, but obviously indirectly they dictate
the shape of science. If you're a cell biologist and you come to a point where
you have an option of working with hormone x or y or cell type a or b, if you
know that there's going to be more money in breast cancer research and one of
your cell lines is a breast cancer cell line, you go for that cell line. So
you're going to become a breast cancer researcher, even tangentially. But with
time you will be part of creating the infrastructure for basic research in
So society does indirectly dictate the shape and outcome of science. However, by
not stepping back and having universities articulate-- "Do we want to be a
formidable center for biomedical research?" And if the answer is yes, "Well,
what are we going to put into it?" Not just "What are we going to get out of the
government for it?" "What are we going to put into it? What are our goals going
06:35:00to be? How do we modify those goals? And how do we modify our tactics if our
strategy changes?" Well, they haven't done anything of that.
They just know that it's good to be prestigious, and it's prestigious if you
have NIH dollars. "Let's get as many as we can. Let's get as many researchers so
that they can get as many dollars as they can."
HATHAWAY: And you see that just across the board. There's not a medical school
or a medical center like Duke [University Medical Center] or Harvard
[University] or whatever that's done this for any other reason?
HANNUN: No. Then the same with the research community at the level of senior
scientists and department heads and what have you who come and say, "Well, how
much research--? Let's figure out, let's think through, how much research does
our nation want to support for basic research?"
HATHAWAY: And have a say--
HANNUN: Yeah, and articulate that. They should have been articulating that for
twenty years so that everybody is in sync on that. So that exactly what
06:36:00Representative Brown is saying wouldn't come up because-- Actually, it's funny,
because even two years ago I was trying to discuss these issues with someone.
Everyone thinks I'm a pessimist, but I try to tell them-- You know, when I was
telling my fellow Lebanese that their country was going to fall apart, they
thought I was a pessimist. And when I say, "Well, let's be careful here. Maybe
the whole biomedical research community is going to fall apart. Our support is thin--"
HATHAWAY: If George Brown's piece was more than just "Hey, wake up scientists,"
then maybe it's really thin, because he's-
HANNUN: Yeah. I hope it's just a wake-up sign, but--
HATHAWAY: I'll send you a copy.
HANNUN: Yeah. Please do. But I mean, I'm still worried about that, about a time
when the breast cancer lobby starts clashing with the prostrate cancer, with the
AIDS and whatnot, and when they finally say, "Hey, let's ax out all the
Drosophila studies," you know, or all the E. coli or all the yeast genetics.
06:37:00"Let's pour all that money into--"
HATHAWAY: Applied research.
HANNUN: Applied research. We have to create deep support for what we do, but
also beyond that deep support we have to define the volume of science we're
going to support. We are at a steady state, I would think, in terms of the
physical sciences--chemistry, physics, even biology. Universities have adjusted
to that. They get some research from NSF [National Science Foundation], some
from in house. They pay salaries. You know, they pay nine-month salaries for
faculty. It's at a small scale mostly, except for very particular labs. It's at
a small scale, but they're steady state. No one's going to dispute the
department of biology in terms of, well, "We need the department of biology. We
need research in biology." That volume the nation is happy with. But then we
06:38:00have biomedical research. No one has articulated how much we need of that.
You know, you look at Duke. I look at Duke and I think, "You know, the sky is
the limit in terms of how much biomedical research they're going to go for." If
there was no crunch in funding, I really would not see them even thinking twice
about how much they want to grow. The more the better: the more the scientists,
the more the money, the higher the ranking of Duke. We don't have a problem with
land here. We don't have a problem with construction. So there was no problem in
the social aspect and the civic aspect of "How much do we need to be part of
biomedical research?" We haven't articulated that. That's why it's coming back
to haunt us now.
HATHAWAY: It's kind of occurred to me, at least a couple of times, that also-- I
even wonder about-- It's certainly been institutionalized, but why, for
instance, so much of the molecular biology, molecular genetics, even cell
06:39:00biology that's being done is being done in medical schools and not in
traditional [university departments]. I mean, of the really great places and
HANNUN: I think the bottom-line answer is money was available from NIH. That has
to go primarily to medical schools. Medical schools knew they could access that
money. They put up the buildings and brought in the researchers.
HATHAWAY: You can trace some of the-- I actually believe that I have no
[knowledge] beyond anecdotal-type things, for instance, that this thing that is
DUMC [Duke University Medical Center] and its semiautonomy from the rest of the
campus and the university is due to its incredible-- It throws its weight around
here. I know the case, for instance, of UCLA, that development of a medical
06:40:00school right at 1948, '49, '50. It's always been an issue of "Is the medical
school going to take over the administration of the entire campus because of its clout?"
HANNUN: Yeah. I mean, I think it's obviously--
HATHAWAY: It's institutionalized by now.
HANNUN: And since now the winds are blowing in the reverse direction, or in
another direction, I think rather than to allow this hurricane to realign things
at a very great cost--I really believe it's going to be at very great
cost--let's be more intelligent and everybody who is involved in it help
redefine it. We should bring in the pharmaceutical industry, the biotechnology
industry, because it's the same infrastructure for all of them. We have to be
careful about that. One thing I'm disappointed with really is the ability of
06:41:00scientists to come together and discuss these things and articulate them.
HATHAWAY: They're so busy.
HANNUN: Well, I don't think it's that.
HATHAWAY: You think it's something more about being a-- I mean, I'll just ask, I
guess, instead of trying to put words in your mouth.
HANNUN: As we talked off tape, in last year's Pew meeting I was almost horrified
to see how scientists reacted to a Ph.D. [S. Wesley Jackson] from the Land Institute.
HATHAWAY: And this is an environmentalist-type--
HANNUN: Yeah. Environmentalist. He's a land researcher. That's what he calls
himself. Many scientists were outright antagonistic to this guy. I thought it
was a combination of arrogance, ignorance, and not feeling comfortable in
dealing with these issues. Because I had very good discussions with this person,
and I think we came to a common ground. And believe me, once you hit a common
ground with the public, it's a point to take off. But scientists, for some
06:42:00reason-- I think you mentioned maybe they're all wrapped up in a cocoon now, and
they've been protected, overpampered. They don't want--
HATHAWAY: I don't know if so much pampered but just this idea that "You're
right, you needed eighty hours a week," and you've got to admit-- You know what
I mean? By "coddled," I don't mean pampered but allowed to do it the way that--
HANNUN: To do it right in the current environment may take eighty hours, but I
question the validity of that. I question whether this is the appropriate model
too. I mean, the British do it with probably thirty hours a week.
HATHAWAY: You would be an exception. Most people bring up the British scientist
as an example of the blithering kind of thinking person who doesn't do any work.
But I think it's an American-British kind of--
HANNUN: I don't agree with that assessment. There are formidable British
scientists. Their support is dwindling; that's a different story. That doesn't
06:43:00say they're any lesser scientists. But I think they're actually forced to think
more carefully about what they do because of the constraints on doing research.
HATHAWAY: I've talked to somebody who said the exact opposite, that there it's a
situation where they don't ever want to be seen as kind of like being wrong, so
they overdesign everything instead of just going out and doing it and maybe
finding out the accidental discovery that would come from just doing a million--
HANNUN: That's clearly the American way of doing it, the Clint Eastwood way of
HATHAWAY: [laughter] Which has its other downside.
HANNUN: It has its merits; it has its downside. That's fine. But it definitely
tells you that it doesn't have to be totally that way. My philosophical
interpretation is that scientists have poor social skills. It's something I
06:44:00consider at the personal, family level, because I grew up in the Middle East and
my children are growing up in the States, and there's a black-and-white
difference in social skills and interactions that occur, I would say, not only
in the Middle East but almost the rest of the world versus the U.S.
HATHAWAY: And the U.S. is--?
HANNUN: The U.S. is very nuclear-family-type, not much in terms of social fabric
HATHAWAY: I'd except Germany but-- I'm just being mean.
HANNUN: There isn't much beyond that. Definitely the extended family has all but
disappeared pretty much. Beyond that, the structure-- I mean, I think the
mobility question-- With mobility, that means uprooting. That's equivalent,
synonymous. You can't have one without the other. So while mobility is essential
06:45:00for economic success and individual success, it has uprooted the social
structure, uprooted families and therefore the social structure. Now, the
downside to that-- I don't think that per se is a downside. You know, I
definitely want the mobility aspect because I favor excellence and having people
matched with the best they can do.
HATHAWAY: Something I think is the theme throughout the interview.
HANNUN: But the downside, the obvious downside, is by having the nuclear family,
things have turned around. So that with my children growing up, everything
revolves around them. When I was growing up, I was almost on the periphery, and
we had to find our way into-
HATHAWAY: It's not a children's culture.
HANNUN: It's not a children's-- We had to find our way into the social
structure. I think that polishes social skills a lot in terms of being able to
06:46:00develop solid, long-lasting friendships, understanding of how society works. It
seems to me that the superspecialization-- Well, first, the upbringing does not
necessitate, doesn't even require, the development of social skills. Most smart
people will do fine because they're smart and they can learn real quick; many
other people, though, don't. When it comes to scientists, I think they learn how
to deal with their environment real well. But I guess because of two pressures,
not just the pressure of needing to work very hard but also the pressure of not
having-- You know, if you have to learn social skills beyond that, that's a
whole new set of pressures and limitations to your ability to go and sit with
06:47:00other scientists and discuss the policy of science and the civics of science and
how to organize scientists productively into going beyond their prescribed
roles, going beyond what's dictated by Congress and universities and department
heads in terms of "Well, this is the space you're going to work in. These are
the funds you can apply to. This is what you can do." And I think a lot of it
is, one, we don't have the time, but, two, we don't have the necessary social
skills to look at it from a social perspective and say, "Well, this is a
question of national importance."
That's my other hat, the clinical hat, and we're now facing an even worse
situation on the clinical side. We're going to redefine how 10 percent of the
06:48:00GDP [gross domestic product] is going to be allocated, with clinicians and
physicians playing a very marginal role in that, actually physicians and
patients playing a very minor role in that.
HATHAWAY: And who's playing-- Insurance companies and pharmaceutical companies?
HANNUN: Well, who knows who Hillary [Rodham] Clinton--
HATHAWAY: Right. It's a big secret.
HANNUN: Yeah. Who's providing information, analysis, and whatnot. I don't know.
But obviously the lobbyists are representing not the clinicians who are treating
patients, as such, not that aspect of physicians. You have the AMA [American
Medical Association], which is presenting the more sort of business-type
physicians. You have the health insurance industry. You have the lawyers. You
have the whatnot. And yet this is talking about 10 percent of the national economy.
HATHAWAY: You mean the total spent on health care.
HATHAWAY: No. It's actually like 17 percent now.
HANNUN: It's 17 now. Geez. Last year it was like 10 or 11.
HATHAWAY: I think I just saw 17 percent in the paper on Sunday.
06:49:00HANNUN: Maybe that's a projection or something.
HATHAWAY: Actually, maybe it is, but 14 percent for sure this year or last year.
HANNUN: That's amazing. But then this is dispensed at the level of the physician
and patient, and they're almost out of the picture. And, again, it's poor social
skills. The physicians haven't come-- You know, they're busy too, but it's also
poor social skills. They haven't seen the social implications of what's going on
and come and said, "If you want to maintain excellence in clinical care, this is
our say in it."
HATHAWAY: It's funny. There's a report in the New York Times asking people what
they thought doctors made and what they thought they should make. And they
underestimated by half what they think doctors make, and then they say that they
should be making about half what they underestimated they're making by half!
It's almost automatic, if you mention the AMA, that anybody who has paid
06:50:00attention or has had an experience now where insurance is hard to get and
they're not having regular medical care anymore--and that's a lot of people--the
response is "AMA, they're evil." I mean, it's gotten to a point where what
you're saying has clearly gotten to a level of-
HANNUN: Well, instead of the physicians who work with patients directly, which,
you know, the bulk of-- You know, this is the primary hat of a physician.
Instead of organizing around the patient-physician relationship and
administration of health through that, the only organization is that created to
protect the business hat of physicians. That's given us a very bad press.
HATHAWAY: Very bad.
HANNUN: Appropriately so. When the AMA starts supporting one congressman over
the other and pouring in money as just any other lousy lobby-
HATHAWAY: It's a special interest group in the eyes of-
06:51:00HANNUN: It's a special interest group. And what physicians should have done is
say, "Yes, be a special interest, but in the interest of the patient-physician
relationship." That's the interest that should have gone in. I think if society
comes to grips with it, it will approve a decent--not just decent, a
lucrative--salary for physicians. But you don't have to make most physicians
into millionaires. Most students who come through that I work with, that's not
their ambition. That's something that builds later in their careers because they
see it as an opportunity.
HATHAWAY: To become a private corporation.
HANNUN: Yeah. So I think it has as much to do with being busy and
superspecialized as with the lack of social skills.
HATHAWAY: It's interesting how although we were just a little bit before talking
about the rather almost opportunistic attachment of basic biomedical research--
06:52:00and we call it biomedical research, interestingly enough--to something like
where the money was, I see the other effect as well, the superspecial-- I mean,
in some ways it's not unnatural or strange, and it's not just a bunch of people
with their financial hats on thinking.
HANNUN: This is how the free market works in this country. It's not totally
free. Society dictates some priorities and pours in money there and then free market.
HATHAWAY: And as I think I said to you on tape very early on, or maybe off
tape--maybe it was to Dennis [B.] Lubahn--I really think that we're kind of
documenting a lot of this by the people who participate. There are a lot of
M.D.'s, in your year especially, who are doing basic-- Really, talk about
wearing hats. That's an image you've used, I mean, a phrase you've used, without
my prompting, and actually every other M.D. I've interviewed so far. I'm sure
it's something that I think you're all aware of. Who knows, maybe you talk about
06:53:00it with each other. I'm not saying you Pew scholars but M.D.'s. This is a vital
concern to them because they're involved in it. But perhaps once they're
involved in basic research, we see their medical hat off every once in a while
and they have the other one on. Very interesting. I don't know. I mean,
actually, I could go on for days.
HANNUN: I hope not.
HATHAWAY: No, no. And that's what I'm going to say. I don't have anything
absolutely vital [to ask] about funding your work anymore. I mean, I think we've
come to the point where we need to-- Unless you feel you need to add a few more things.
HANNUN: On my work, we talked a lot about the sphingolipids and how I thought
that fit the whole thing. I didn't talk about the protein kinase C work.
HATHAWAY: And I promised we'd get back to it, and, of course, I lied.
HANNUN: Well, I just need a minute to describe it, just to contrast it with the
sphingolipid side because the sphingolipid side has been purely biology and
06:54:00discovery. The protein kinase C side has been what we talked about the other day
in terms of taking things at the molecular level but still within the cell to
look at function. I don't want to spend too much time on that, but we're
starting with a much more advanced background, information, and database with
protein kinase C. As you mentioned a little bit, there was so much going on with
protein kinase C. Yet we think we've sort of attacked aspects that have been
more or less not looked at with protein kinase C and not examined in terms of--
HATHAWAY: And that they're fundamental. That it's not just "Oh, protein kinase C
is involved." I mean, it gets reacted--
HANNUN: Yes. Not this-and-that biology but more in terms of how the enzyme works
in the cell. We have evidence now that it binds proteins, that it gets
phosphorylated by other kinases. These are things that regulate individual
isoenzymes of protein kinase C. Rather than look at the whole family as one
06:55:00entity involved in a biologic process, we're coming down now to the molecular
interactions that define the function of each isoenzyme, because each one is an
entity on its own. So that's where we're heading with that. I mentioned that
because this aspect of the lab has provided very complementary conceptual and
practical skills to the sphingolipid side of the lab. We have some very advanced
methodologies and techniques in molecular biology, in protein biochemistry with
protein kinase C. While with sphingolipids we've started with a very
physiologic-biologic point, and the work on protein kinase C has helped us move
with the sphingolipids very fast whenever we come to a molecular level. I think
that's the extent of how I want to describe our research. I think I described
06:56:00how I work with my students, too, in terms of working-
HATHAWAY: Right. No, you did. I think it's been very thorough on the level of
theoretical, philosophical, as well as the guts, you know, what happened. I
think you have a leaning toward talking about it in more general terms, and I
think that's actually the gems that I'm looking for. I don't want to ask you to
go through this step by step. People can read the publications. That's what
they're there for as well. I did have one quick question. Are you really the
only bridge between the two--? I mean, are you the one who has all this
perspective about how the two sides of the lab or the two labs work? Or have you
got people who are--? I mean, are you inculcating this view and perspective into students?
HANNUN: Not much. The only person is my wife [Lina Obeid Hannun], who is my
collaborator, who partly trained with me-
HATHAWAY: And that's where we're going to move next, to your family, so this is-
06:57:00HANNUN: Yeah. My wife is my collaborator. She's now an assistant professor, and
so she's in faculty. She has just set up her own independent research. We sort
of still collaborate on a lot of things, but she has a few things on her own, I
have a few things on my own. She's the other person who has now that additional
perspective, but that's about it. I think it's too much to ask students at this
point to have the perspective of--
HATHAWAY: But nobody's seen it. I mean, has anybody come up to you and said or
you've gotten a letter from somebody saying, "Hey, you know, it's kind of
HATHAWAY: I mean, I noticed you've published-- Well, I think even in the same
issue of like the JBC [Journal of Biological Chemistry]-- But, you know, kind of
the two sides, two articles. I mean, not next to it, but anybody who is astute
enough to figure this out might say, "Wait, there's these--" I certainly looked
confused when I first started calling up your name on MEDLINE [medical database].
HANNUN: I haven't had that yet. I mean, I'm invited many times to talk about
06:58:00sphingolipids, a few times about protein kinase C, but it's either one or the
other usually. It's either one or the other.
HATHAWAY: We were just talking about hyperspecialization or something like that.
That may be, actually, it occurs to me, another reason for your not letting go,
even if it's starting to be tense or too much work or you understand that you're
hitting a limit of saturation, that to let go of that is to admit that you have
to superspecialize. Keep up the fight, right?
HANNUN: The other thing is the biology. I think as we've pursued sphingolipids,
the biology is just totally fascinating. As we have pursued protein kinase C,
the biology is not less important. We use platelets as a model a lot, and the
implications for atherosclerosis, for ischemia, for heart attacks, for strokes
06:59:00are just very important. That's another reason not to let go of that. In a way,
again, there's a bridge that's still missing that we would like to somehow get
into in the future by, again, building those molecular blocks basically.
HATHAWAY: In a sense, we have a time limitation, but we can come back after your
appointment, and we shouldn't hesitate to do that. One thing I know you wanted
to talk about, and I would like to as well-- And we don't have to do it from the
point of view "Oh, Dr. Obeid is your collaborator, so we have to talk about
her." We can just talk about your family, and so we'll talk about her as your
wife and your three children. I'm not going to come up with a question to ask
you. It's something you said you definitely wanted to talk about.
HANNUN: Well, I want to talk about it because, again, as you mentioned, we talk
07:00:00about the background and then the science, but, again, to put it in perspective-
HATHAWAY: And then I lose sight of the other parts of your life.
HANNUN: I think my family is an important part of my life. I don't want to rank
order them. As long as my kids [Awni, Marya, and Reem Hannun] are healthy, I
want both. If my kids are not healthy, I'm ready to give up science without a
blink. But my family is a very important part of my life, and I've structured a
lot my activity to fulfill my family obligations.
HATHAWAY: We met on a Friday, and of course we didn't meet over the weekend. I
mean, as an example of-- I'm not bringing that up to kind of-- Just to indicate it-
HANNUN: No, that's true.
HATHAWAY: I remember the first time I talked to you on the phone, you told me
you "don't do weekends," not for this sort of thing.
HANNUN: Yeah, well, I don't do weekends for almost anything unless it's my month
of rounding on the clinical service. I also go home early two days a week and
07:01:00take care of my children.
HATHAWAY: There's an explicit sort of agreement between you and your wife?
HANNUN: There is. It's something that we've worked out.
HATHAWAY: There are no rules written down.
HANNUN: There are no rules written down, but that's something-- I mean, I wanted
to be involved, and she was getting too much pressure just handling the family
all by herself and a clinical career and a research career.
HATHAWAY: And triplets. I know you already mentioned it, but we should emphasize
that, I think.
HANNUN: A lot of my civic concerns, my concerns about excellence, the future,
derive a lot from making sure that my children have even better chances and
07:02:00options than I had. I don't think I need to belabor on my family beyond that.
HATHAWAY: If you want to kind of just say, "That's it," I actually have a few
HANNUN: Yeah. Go ahead if you have specific questions, but I just wanted to put
things in the right perspective. Well, the other perspective is that my wife and
I collaborate. We haven't come up with any formal arrangement, but we can talk
about work at home or we don't. I know some couples have an arrangement where
they don't talk science at all at home or other arrangements. We're sort of
feeling our way around that. At times it does tend to be exhausting, you know,
when you're doing science around the clock.
HATHAWAY: It's a very common phenomenon, however, that scientists marry-- And I
don't mean a physicist marries a geologist but-
HANNUN: Within a similar discipline.
HATHAWAY: Right. You meet them-- I mean, your life is--You didn't meet your
07:03:00wife-- You met her in high school. Well, maybe there wasn't a romantic attachment.
HANNUN: No. We just met in high school.
HATHAWAY: So it was med school where the romantic-- I don't want to get into the
nitty-gritty of dating and hand-holding or anything like that, but I would be
curious--if you do want to talk about it--to get some sense of both your
consciousness about being in the same field-- Obviously, this was back in
Beirut, so before definitely either of you had any idea of research and basic
research as the path you were taking and whether this-- Not that there were
struggles and working it out, but just how you-- Was it just something you
decided you would not deal with that way and that kind of it advanced just as
things came up?
HANNUN: I think we pretty much independently developed our careers, if that's
07:04:00your question. I'm very sure there are subtle influences and maybe very strong
subtle influences from one of us on the other, but it was never sort of "Oh, I'm
going to go into science. How about you also going into science?" Or "I'm going
to stay in academics. How about you staying in academics?"
HATHAWAY: "I won't leave here for twenty years because you've got to stay here."
I take it, when you came back to Duke, it did hinge upon whether your wife could
do something here as well.
HANNUN: Yes. Absolutely. And we're playing it by ear now. If one of us finds a
position, it would be contingent on the other finding something acceptable.
HATHAWAY: It's happened here, and that's not always easy to do.
HANNUN: Yeah. Exactly.
HATHAWAY: The other thing is I was curious--and this may reflect my own
07:05:00ignorance--but one of the concerns of what we're trying to collect here is just
the changing face of science, and two areas, of course, are the continuing
acceptance and the push for representation of what we'll call minorities and
women. I think your lab is a good--I mean, if I look at the names, which is the
only guess I'm making, I get the sense that this may be a conscious kind of
thing for you as well.
[END OF TAPE 7, SIDE 1]
HATHAWAY: And so I'm curious. I wonder also about just the situation. That's
normally kind of thought, "Oh, husband and wife, they collaborate." Well, the
07:06:00husband's at this [high] level, and the wife is a research assistant or a
postdoc or that sort of thing. Whether you've dealt with these kind of issues
on, again, a conscious level or it's really not been and it's just all turned
out this way.
HANNUN: The issues of women and minorities in science? I think that wasn't a
conscious effort to do that. It's actually something that I'm amazed at. I
definitely see heads of labs not comfortable taking women. I've never had that
feeling, so I think it's almost like the reverse. Where women feel that they're
going to be comfortable-- Probably there aren't many labs.
HATHAWAY: I was going to say, actually, perhaps even at some points you've had
where, of course, more-
HANNUN: I've had in my lab more women than men, for example. I have minority
people in my lab.
07:07:00HATHAWAY: And again, you're not out looking for them. You find each other for
HANNUN: The other thing is-- I mean, a reason that women can be discriminated
against in science is many lab heads are very aggressive in that-
HATHAWAY: You mean in general and the way they are as men or--?
HANNUN: No. In the research activities. They look at women with some uncertainty
in terms of "Well, can they be as aggressive as men in research, and are they as
committed long-term?" You know, it becomes a self-fulfilling prophecy: "If women
don't make it up in science, maybe they're not as aggressive, and if they're not
as aggressive, I don't want to take them in my lab." Maybe they bail out when
they get pregnant. Maybe they bail out when they get married and they move with
their spouse. We always look at the woman as the one giving in in any family
07:08:00situation. I think until that changes it's going to be very difficult to change
the perception of women as always the weaker link. I've heard it from other
people, saying, "We don't take women for that reason."
HATHAWAY: So you've never had a woman six months pregnant come and say, "I want
to be a postdoc," and you thought, "Oh, she's pregnant. She's married this guy.
Her husband does this--" You just-- If she's talented--
HANNUN: Yeah. My philosophy is-- That's, I think, how I started my research lab,
because I didn't-- I mean, Bob [Robert M.] Bell is very respected in his field,
but that's not a very glamorous lab. And my area of research obviously, at least
for many years, was not glamorous. We had to build from scratch. My philosophy
was to work with every person so that they can execute their potential, not my
expectations, and work with them on that. I've worked with many people with
07:09:00different kinds of abilities. I'm happy with what they achieved. I don't think
many of them were superstars, but all of them were committed. They wanted to be
scientists, and I helped them achieve their potential. That's made my program
successful with whatever I-- As long as people were sincere and honest and
willing to learn and work.
HATHAWAY: I guess I'm coloring the conversation. I guess I see that as not the
common way that labs are built. Would you--? Or you just don't know enough other people's--?
HANNUN: I don't know enough about others. But I see many labs that wouldn't take
women, for example, or many labs that would accept [only] the best student or no
student or the best postdoc or no postdoc. There's obviously a lot of merit to
that because you get the most productivity and the most exciting interaction but--
HATHAWAY: If you get the sexiest topic and if you can turn down thirty people,
07:10:00you've got that luxury. I suppose if you had a huge waiting list, you'd think
about picking out the people who looked like--
HANNUN: Yeah. Let's be realistic. But there's always, I think, room to work with
anyone who wants to spend their career in science.
HATHAWAY: And another thing--and this may be of no interest to you--as somebody
who is-- I mean, I just don't know. Would you say that since your attitude
towards women seems to be a lot different than I guess we're talking about
American men or white men or whatever we'll call them-- I suppose that almost
sounds terrible to call them that. Do you think it's cultural? I mean, your
upbringing perhaps? The politics of maybe--
HANNUN: I grew up in a rather chauvinistic society but not totally. I was
surprised, I still am surprised, that a lot of American men are chauvinistic,
07:11:00basically. It's surprising. Many men, even in leadership positions, are not
comfortable working with women, either as their subordinates or their superiors.
Growing up and being exposed only to the movie culture of the U.S., I didn't
expect that. But one learns.
HATHAWAY: Again, your own attitude is--
HANNUN: We need to [stop].
HATHAWAY: We're going to-- This is going to be it, right?
HANNUN: I think so. How about you? [tape recorder off]
07:12:00HATHAWAY: We were talking about the women in your lab and how you sensed that
there were issues facing women, but that you wouldn't ascribe it to some sort of
political consciousness on your part. That it's not much of an issue in your
lab. And also, I think that was also the case for nonwhite, non-American people,
as well, who-- And again, if you look at the list or the roster of your lab,
that's the best indication that what you said is true. I think maybe it was more
than 50 percent.
HANNUN: Oh, I don't know-- One, two, three, four, five. Well, I think now it's
fifty-fifty. There were times when there were more women than men, for example.
Maybe I didn't mention that, but I'm also sensitive because my wife is a
professional woman, and she senses a lot of prejudice too. Again, it's something
07:13:00I don't sense. You know, it could be the same situation we're in at the same
time, but she senses prejudice that I don't.
HATHAWAY: Now, prejudice against the both of you or against--?
HANNUN: No, against her as a woman.
HATHAWAY: Okay. As a woman. Is it something that you think you've become
sensitized to, or is it still something you just don't pick up on? I mean, are
you kind of, not doubting it, but just--? You seem to be taking it seriously, so--
HANNUN: I don't doubt her when she says that. I mean, sometimes I can sense
it--maybe because I am sensitized to it--but many times I cannot sense it, which
may be more subtle. Maybe I really shouldn't say that.
HATHAWAY: There's a common, I think, misperception among people that "I'm not
racist or I'm not sexist because I feel I'm not." And they don't understand that
actually whether one is or isn't something like that isn't so much how they feel
about themselves but, of course, the perceptions of their actions and words as
others perceive them.
07:14:00HANNUN: Yeah. The one thing that I do-- There are many things that I think are
not directed against women as such--prejudice against women--but against their
level or the role they're assuming at any one time. And then it becomes a
catch-22. For example, when I was a more junior faculty and would suggest
something in a faculty meeting, it was as if I wasn't in the room. Now I can say
a more stupid thing and everybody listens. [laughter] And I think also by
keeping women sort of at a more junior level, they go through the same thing.
That's why I'm describing it, because Lina, my wife, would say that, "I was in
this meeting, and no one listens to me. They talk as if I wasn't in the room."
07:15:00And I don't know, is it because she's a woman or she's considered too junior? A
lot of the prejudice women experience is maybe more because either they're in
junior positions or because it's always assumed that they end up being the ones
who compromise. Especially working married women with children. Is it they don't
get paid as much because they're women, or is it they have to move with their
spouse--the spouse got the best job and they have to compromise?
HATHAWAY: This is kind of a self-perpetuating--
HANNUN: The prejudice may be not more at the workplace as much as the prejudice
arising more at the level of the family, that the woman is the one sacrificing
other things for the sake of the family--the husband, the children, keeping the
07:16:00family together. Maybe if more men start sacrificing, they will start being this-
HATHAWAY: I was going to say, have you noticed--? Well, you've been in
professional situations since, let's say, med school, so you've been around for
a while. Maybe in Beirut it wasn't-- I mean, I take it there were women
HANNUN: Yeah, yeah.
HATHAWAY: I mean, your wife is an example. Yeah, right, she was there. Maybe
it's unfair to ask because you've spent so much time in a culture that you think
is in more ways not so much sexist but the relationship or the role of women in
that culture tends to not allow so much for a comparison with our culture, which
is now supposedly not doing things like assigning roles according to gender and whatnot.
07:17:00Another thing I wanted to ask you, because I think by far the majority of people
I'll be interviewing are, well, I don't know, "white men" sounds almost kind of
HANNUN: Homegrown boys.
HATHAWAY: Okay. All Americans-- Caucasian males. There. I would like to take the
opportunity with my interviewees who aren't to just ask if they have a sense of
feeling like outsiders because of that. I also would like to ask you, because
you've talked quite a bit at length about that sense you had as an outsider,
not, again, being discriminated against so much, but growing up in Beirut as a non-Lebanese.
HANNUN: Well, I mean, in Lebanon I could sense that if I had to become a part of
society, a productive rather than just in a student role, that would have opened
a lot of discrimination. I could sense that. I don't think that exists to any
07:18:00comparable degree in the States. I'm still an outsider because most of my
formative years were in a different culture altogether. I'm missing a lot of the
cultural upbringing of other people in society. And there are many things not in
my consciousness that are in the American consciousness. So that forces me to be
an outsider. I come from, as I said, a culture where family ties are strong,
where societal ties are strong. They're not in this country. It makes it
obviously easier to make that switch than the reverse switch. You almost cannot
penetrate in the reverse direction. So I do have that perspective of an
outsider, and I always wonder what my children will grow up to be. I mean, they
07:19:00seem to be growing up more like totally American children, which is fine. I
don't see any necessity for giving them the dilemmas and agonies we've been
through in terms of cultural adaptation. Although they'll probably recognize
their heritage and hopefully be proud of it. The other part of your question, I guess-
HATHAWAY: Well, is there a sense of--?
HANNUN: Discrimination? Is that something you--?
HATHAWAY: Or even just rude-- I mean, just a sense that sometimes you've come up
against this situation. I'm also not unaware of the fact that here I am--a white
Caucasian male--asking you this. I don't want you to think that I'm expecting
you to just find that there is. And I hope that you're not offended that I'm
asking the question.
HANNUN: No, not at all. Again, coming from the Middle East, the fact that I'm
07:20:00now an American citizen, with equal rights like anyone else, and treated almost
I think the same as anyone else, with respect--definitely with respect for my
role and my function--if there is a problem, it can't be of any serious
magnitude. I have had the sense, very subtle sense at times, that had I been a
white American boy I would have had maybe more doors opened to me, or opened a
little easier, or people wouldn't be as apprehensive about what they're getting into.
HATHAWAY: How interesting.
HANNUN: And because I've sort of come to a more leadership position in academic
07:21:00medicine, that to me looks like an easily explained perspective. If we get an
applicant to our program from either a foreign medical school or undergraduate]
school, either applying for the medicine or for the graduate program-- You know,
if you don't have a familiarity with the program, with the curriculum, with the
degree of accomplishment, I'm sure that automatically translates into bias. I mean--
HATHAWAY: Or more, at a minimum, let's even say, it was just-- I mean, obviously
you're suggesting you would do it too. If somebody's got a medical degree from
maybe somewhere in Europe or something, automatically a flag goes up and you're
going to give that--
HANNUN: Yeah. How are those people going to do in an American environment? I'm
sure, therefore, that I was considered in that light too. I'm sure that I
07:22:00assumed that, when I was going through the system, I always-
Therefore, I assumed constantly that I always had to go the extra step before I
can achieve or-- Well, I always performed the extra steps. Whether it was really
needed or not, I do not know.
HATHAWAY: Maybe sometimes or maybe early-- I'm wondering now, though, if you
were like sitting on a committee for even a senior position, let's say an
associate or a full professor level here in your department-- You were on the
committee, and a person whose name was clearly not American came across your
desk. And let's say you had the name-- You know, something clicked in your mind,
or you knew that name or had some reason that it stood out. And then you would
kind of look through, and, indeed, the person went to a foreign medical school.
07:23:00But, you know, you have these lists of publications. They're in your situation.
Would you kind of drop that flag? In other words, because they've already kind
of gone through this process? I guess I'm asking about you now. Do you get a
sense that you have as much opportunity as your colleagues?
HANNUN: Oh, yeah. I would not only drop the flag, but I mean I also many times
play the advocate for people coming from either Third World countries or
foreigners. Especially because I know that having had no opportunities to prove
my abilities beyond just passing the courses, I appreciate the degree of
achievement. So that's always been my point of view.
HATHAWAY: That they probably went the extra steps, like you did.
07:24:00HANNUN: Yeah. If they're interested in coming to study hematology, that-- If
they're interested in academic medicine but they have not done anything coming
out of even some countries in Europe, it's probably they didn't have the
opportunity. Actually, I'd generalize it even coming out of-- For some reason,
someone stayed in x college of South Carolina or something, and now they've sort
of been turned on to academics. I would give them the benefit of the doubt. I
would be more hesitant, actually, about someone coming from Boston. Someone who
grew up in Boston, has no academic achievement whatsoever, and now is coming to
be considered for an academic position, either graduate school or fellowship or
whatever, that's where actually now I raise the flag. Because someone who's had
all those opportunities is the one that never exercised them, versus someone
07:25:00who's never had the opportunity but you can always tell that whenever they got
even the slightest opportunity they grabbed it. So, no, I don't think I practice
that kind of bias. I don't even mean bias, but what I said is I can see how the
unknown translates into hesitation, and hesitation is obviously a minor degree
of bias. And that's why I had always to sort of make sure that I went the extra step.
HATHAWAY: But, clearly, you've never had a sense that there is-- Certainly like
it's political or there are discussions beyond your earshot or something about
that-- Or the fact that you--
07:26:00HANNUN: Yeah. Not at all. I mean, remember, I am in an academic situation.
HATHAWAY: And you kind of came into one-- One hopes that usually--
HANNUN: Yes, one hopes these things don't, you know-- I've been totally unaware
of anything like that.
HATHAWAY: I was going to say, I think regions of the country and actually just
traditions in schools, I think also, perhaps, public versus private situations--
There are differences, however. For instance, I think some places are more open
to having women really finally climb way up the ladder and take equal positions
with men. I remember interviewing somebody. We tried to come up with women who
were like chairs of departments, ran institutes-- The way-out question being
"When will a woman run the Whitehead [Institute] or something like that?" And we
actually couldn't come up with very many at that time, but I've come up with a
07:27:00few more in just general reading. But what is the--? Maybe it's something you
don't particularly give a lot of thought to, but Duke and its situation-- Would
you say that there's a lot of women, and they have come up through the--? What
do they say now, it's about half and half--Ph.D.'s? Since I don't know about
M.D.'s-- Still like 20 percent?
HANNUN: No. Probably among M.D.'s the women are a much higher proportion.
HATHAWAY: Oh, really?
HANNUN: But, again, not in leadership positions. Yeah, Duke doesn't have many
women in leadership positions. I would say very few.
HATHAWAY: Like nobody is chairing a department in the medical school or
HANNUN: No, no chairs. No.
HATHAWAY: Or running a lab or a lab with a name to it.
HANNUN: Yeah. There are a couple running labs.
07:28:00HATHAWAY: I'm trying to think of a-- I was thinking like a lab that's got
special funding, that may have lots of PI's [principal investigators] in it or
something like that. Kind of like an institute within a-
HANNUN: Yeah, yeah. We don't have that, but we only have maybe one or two males
that do that. See, I know there is a lot of bias against women in the community
at large, but in academia I think the bias is not conscious bias. There is some
of that, and you can see, like a faculty member, as I mentioned, being
uncomfortable with women. You could tell that this is because of some problem.
But most of the real bias is more subtle, and I really think it's because the
successful "role model" in our society--and definitely in academia--is the more
aggressive, what you keep mentioning, the eighty-hour-a-week person. And it
07:29:00seems to me that-- First of all, I think this is a myth that one has to work
eighty hours a week to be successful.
HATHAWAY: Yeah. I'm exaggerating. I realize that too.
HANNUN: And I would sometimes question how successful someone can be if they
need to work eighty hours a week.
HATHAWAY: And maybe the determination and aggressiveness part of what you're
saying is actually a more accurate way of talking about this kind of almost
stereotyping the biology Ph.D.
HANNUN: That's what people look for when they want to choose a position of
leadership, you know, a chairman and a director and whatnot. And that
automatically selects against most women because most women with families cannot
put all their energy into being aggressive about their jobs. It also selects
07:30:00against men who want to be committed to their families. Unless I was very lucky
in setting up my operation and worked very hard on it, I can see that, if any
one component of what I was doing fell apart, I wouldn't have moved to where I
am now. So the whole system, in terms of moving on to lab operations, is
selecting for people with a more aggressive capacity.
HATHAWAY: Do you think that's something that is okay? I mean that that's perhaps
the way it will always be? Women will just have to become more aggressive or--?
HANNUN: Well, I think that's a price for wanting to get results. If you want the
doers to do things-- You know, the doers are the achievers, the more aggressive
people. If you want to solve the question of male-to-female ratios, you probably
07:31:00have to solve it as much at home and get it to a point where in half the
households the female is the person primarily career active and the husband is
the one compromising, and the other half vice versa. Then you'll have equal bias
both ways. But to undo the requirement for aggressive, sort of male-type
characteristics and leadership positions, that's talking about a major overhaul
of the system. I mean, in terms of how can you get a very laid-back person,
basically, as we say, to crack the whip and get things going, whether it's a
department or a-- I don't know. I know it's doable. I know it's doable at the
level of individual gifted people. But how do you get the whole system functioning--?
HATHAWAY: You know, perhaps there are men as well as women out there who are
07:32:00doing some big administrative or whatever sorts of jobs where they're
coordinating the work of others and more so and kind of keeping it all together.
And they're not really aggressive about it.
HANNUN: They're effective, but they're not aggressive.
HATHAWAY: They're kind of low-key.
HANNUN: Very effective. Usually they are the smarter people, the more
self-confident people. But they're the exception. And they're going to stay as
exceptions because it's a really formidable collection of traits to all put into
one person. So I don't know. I mean, that's really getting into how do you
overhaul the whole system. And I don't know.
HATHAWAY: No. And we don't want to go too much into what the future looks like
beyond your own personal-- And that's, again, to just round this out-- I guess
where I would go and what I'll ask you-- Maybe I'll put it in this way: What
07:33:00about yourself? Do you see yourself as striving toward running a department or
running an institute? Or are you going to decide that, oh, after another five
years, it's going to be your wife's turn to be the aggressive one and you're
going to stay home with the kids a little more and maybe you'll just kind of be
the laid-back type who does his own work? Or you just don't know?
HANNUN: The bottom line is I don't know. And actually, I had a discussion with
my chairman last year, and he has good insight into that because he is a very
effective chairman. He really-
HATHAWAY: And who is this?
HANNUN: This is Joe [Joseph C.] Greenfield. He's a chairman who takes pride in
having people grow under him. Because if you look around, most chairmen--or many
chairmen, many directors, many chiefs, whatever--they're much more out there to
protect their own part of the operation. And actually, they can be envious of
07:34:00other people growing in the system. So our chairman is very effective from that
point of view. What he said was--Because he's been through it. He was a
researcher, then head of the division within a department, and then head of the department.
HATHAWAY: Okay. Now, he's the head of the Department of Medicine.
HANNUN: Medicine. Yeah.
HATHAWAY: Which is really the whole--?
HANNUN: That's the whole internal medicine. A few hundred, two or three hundred faculty.
HATHAWAY: It's huge.
HANNUN: It's the biggest department in the school of medicine.
HATHAWAY: Sounds like one of the biggest departments in the country.
HANNUN: It's probably as big as all the other departments put together. And he
said, "You go through phases. Who knows what's the next phase? You may want ten
years from now to say, 'I've had enough. I've got my intellectual stimulation
from this. I want to enjoy now having other people grow under me. And, you know,
take a more administrative job.'"
There is a problem with the system, the way I see it. In medicine, in academics,
07:35:00the rewards for doing a good job, whether it's in clinical medicine or in
research, primarily are given out as administrative jobs. It's very weird.
[laughter] I think it used to be okay when departments were real small. Out of a
group of three, four, or five, one would become a chairman. So it was okay. But-
HATHAWAY: They were still obviously doing benchwork, probably.
HANNUN: Yeah. But when you talk about a department of a couple of hundred
people, that's not okay.
HATHAWAY: You mean you're not interested in it at all?
HANNUN: At this point?
HATHAWAY: At this point.
HANNUN: Well, I mean the whole system is very-- The way the system rewards--
There are very few systems to allow people to grow and be rewarded by, let's
say, staying in basic research. One probably would be the Howard Hughes [Medical
Institute] and maybe a couple of-
HATHAWAY: That's rewards in the sense of just perhaps allowing your lab to
expand, an infusion of money, and-
07:36:00HANNUN: Expand, yeah, and grow.
HATHAWAY: Maybe better salaries. I mean, earn more so you can buy the boat or
take the longer vacation.
HANNUN: And the security of being in Howard Hughes.
HATHAWAY: Sure. No more NIH applications if you don't want to.
HANNUN: I mean, how long can I stay--? What if my next grant gets in trouble for
eight months? That would be a major disappointment. How long can I stay with--?
They're minor at this point, but they could be more than minor anxieties and
irritations and interruptions to my research. You know, there are endowed chairs
here and there to do research. That's obviously one possibility for me.
Administratively, I happen to be in a specialty in hematology/oncology in which
to assume a leadership administrative position is almost a kiss of death for my
07:37:00research. I mean, our division has thirty-five faculty in hematology and medical oncology.
HATHAWAY: Right. You've become an administrator. I mean, that's not bad for
those who like to do that.
HANNUN: If I want to do it ten years from now, that may be fine. But it's not
something I see myself doing now. So I don't know. Actually, the way my wife and
I approached this career move when I first set up my lab here was to actually
give it five years. That was back in '87, late '87. Give it five years and see
what turns out with research. I mean, is it going to excite sufficiently to stay
in or not? We've passed that sort of landmark or whatever.
HATHAWAY: Did you also kind of, at that point, in five years, sit down and--?
HANNUN: No. We're sort of now in a transition where we'd like to make some
07:38:00guidelines on what we would consider as a satisfying career maybe in the next
five years or ten years.