Fred Lee Jr., MD accepted the Gold Medal, the highest honor that the Society of Interventional Radiology (SIR) bestows, at the society’s annual meeting in March. This honor is awarded to individuals who have demonstrated an unwavering commitment to the field, dedicated their talents to advancing the quality of patient care, and helped ensure the future of interventional radiology.
Dr. Lee is a passionate researcher, dedicated clinician, and superb educator. His work has resulted in nearly 300 scientific publications, 22 book chapters, more than 70 major awards, 25 patents and inventions, and substantial federal and industrial grant support. His commitment has had a lasting impact on cancer care; it is estimated that over 80,000 cancer patients have received treatment from tumor ablation devices that Dr. Lee invented. He has inspired and supported countless medical students and trainees in his 30-plus years as a professor at UW–Madison.
To celebrate this incredible honor, we took the opportunity to interview Dr. Lee about his illustrious career.
When you accepted the award, you had fellow faculty members, trainees, and even alumni join you on stage. Can you share why it was important to you that colleagues in all levels of the field joined you?
I get far too much credit for the successes of our team, and it was only fitting that we celebrate together. I stand on the shoulders of some incredible people, and it was fun to have them join me and take credit for helping push our ideas and UW forward.
Can you share what the receipt of this award means to you?
When I went on stage to accept the gold medal, the only word that sprung to mind was “wow.” I suddenly felt the weight of previous generations on my shoulders, and I started thinking of all the sacrifices that my predecessors made so that I could stand on that stage.
When you come from an immigrant family like I do, you are highly aware that you are only there because of what others did — my life has been very easy compared to my grandparent’s and parent’s generations. Our father’s family grew up in the ghetto of Buffalo, NY and seven kids were put through college, medical school, engineering school, and pharmacy school by their hard work at our Chinese laundry where they both lived and worked.
The kids were expected to start working in the laundry at 6 years old and they didn’t have a place to live, so they slept on the floor amongst the laundry equipment. When I flash forward from the ghetto of Buffalo to accepting the gold medal on that stage…Well, I think you can see why the moment seemed unreal.
Much of your career has been focused on cancer imaging and tumor ablation – was there a defining moment that sparked this interest?
My father, Fred Lee Sr., MD, is the one that got me interested in tumor ablation in the early 1990’s. He would come to UW to work with me in our animal laboratory, and while he was mostly interested in prostate cancer, he encouraged me to explore using tumor ablation for treating liver and kidney cancers.
At about the same time, I had been following work from Italy by Luigi Solbiati on using heat-based treatments for liver cancer, and felt like I was looking into the future. I came back to UW and asked our chair at the time, Joe Sackett, to purchase RF and cryoablation devices for our department, and the rest is history.
Looking back at it now, it’s amazing that Dr. Sackett took such a big chance on me and this “experimental” technology. I had only joined the faculty a few years before and was highly unproven — particularly in light of the risky nature of these procedures. Lots of people called me crazy and reckless and even worse things. Thus, his support for me took guts and hopefully he now thinks it was worth it!
Another key moment was when Dr. Louis Hinshaw joined our faculty. Until that time, I was personally doing every case, trying to run the abdomen section, and struggling to translate ideas into devices. Louis quickly became arguably the world’s best practitioner of ablation, did a number of “firsts” including the first NeuWave case in the world, and pushed the limits on how and why we do procedures.
The next step was when Meg Lubner and Tim Ziemlewicz joined and we could concentrate on growth and more innovation, and finally our most recent wave of faculty (Erica Knavel-Koepsel, Paul Laeseke, and John Swietlik) has allowed us to push the frontiers once again into histotripsy. None of this would have been possible without them.
It’s been almost 30 years since you established the Tumor Ablation Laboratory at the UW, can you speak to the changes and breakthroughs you’ve seen (and taken part in!) in ablation since the lab’s establishment?
I’m proud to say that the UW Tumor Ablation Laboratory leads the world in the invention, development, and translation of tumor ablation devices. There is no other laboratory or company that has come up with so many of the devices that are now used all over the world.
For example, we invented percutaneous cryoablation for the kidney and liver, multiprobe RF ablation, high-efficiency MW ablation that formed the basis for NeuWave Medical, multiple probe MW ablation, tumor ablation confirmation software that is the subject of a world-wide trial, and most recently we have led the development and translation of histotripsy for clinical use.
When I say “we” though, I truly mean it. Chris Brace, Dan van der Weide, and Paul Laeseke led much of the MW development. Paul Laeseke, Tim Ziemlewicz, John Swietlik, Martin Wagner, and Erica Knavel-Koepsel are leading the histotripsy push, and I have been mostly along for the ride.
You’ve invented and contributed to the invention of numerous devices; can you share some of the process or ideation behind the development? What drives you to invention?
As someone who studied history in college, I have always been interested in why people make disastrous decisions that in retrospect were obviously wrong. For example, we look back on the use of amputation for even minor limb injuries during the Civil War as barbaric, but at the time it was considered state of the art. The doctors performing those surgeries thought that they were practicing modern patient-centric care! No matter how hard we try to deliver high quality health care today, in 50 years people are still going to be appalled at our ignorance and barbarity — that’s just the nature of history.
The way I think about it is that as a physician-scientist, one can either be pushing to try to define the future or be passive about it and let the future come to you. I want to be someone who is shaping the future of medical care, and have tried to apply this principle through making procedures less invasive, more effective, safer, less painful and with fewer complications. I’m fortunate to have found an environment and people who have not only allowed me to do this, but have encouraged me and cheered me on.
For some reason all of our chairs have been huge supporters, from Joe Sackett who helped purchase our first ablation equipment, Pat Turski who didn’t fire me when I lost the rat in the CT scanner and gave me my first leadership position as abdomen section chief, Tom Grist who encouraged the translation of our ideas into products that have changed the world, and now Scott Reeder who is pushing us to get histotripsy into widespread clinical use. This is a special place, and we shouldn’t take it for granted.
Your tumor ablation devices have been used to treat over 80,000 cancer patients. How does it feel to have made a difference in the lives and health of so many individuals, many that you may not have even met?
One of my mentors, Rick Katzberg, always told me that if you are going to work on anything, make sure it’s something important. All of us in our personal and/or professional lives know how terrible cancer is – not only for the individual who is afflicted, but also for an entire community of family and friends. When I think about the impact we have had on treating cancer, I’m proud of not only the ideas that our team has come up with, but also the incredibly hard work of getting our devices and ideas out into the world. No one benefits from great ideas that never see the light of day.
Of course, being university-based we have promoted our ideas through the usual academic channels of publications, presentations, and grants, but maybe just as impactful was the development of university spin-off companies catalyzed by WARF. Our lab was the birthplace of NeuWave Medical which we sold to Johnson and Johnson in 2016, but also Elucent Medical which develops and markets devices for use in breast cancer and soon lung cancer. We have also worked very closely with HistoSonics to develop and translate histotripsy for clinical use. Tim Ziemlewicz even travelled to Spain to assist on the first human case in the world, and he was also the PI on the #HOPE4LIVER trial that was the basis of a recent FDA approval for histotripsy of liver tumors.
Looking back on your career, what are some of the most significant or impactful moments that you’ve faced?
One thing that I find a little strange as I look back over the years is how the “crazy” things that we worked on and introduced to the world are now considered mainstream, and frankly not all that exciting. I used to only give scientific, “New Horizon,” and “future development” talks and now am routinely invited to do review articles, consensus panels, and refresher courses. For someone who considers himself a disruptor, it’s been a strange transition. Hopefully I have a few more surprises in me.
There have been lots of “firsts” along the way, including watching Louis perform the world’s first human NeuWave MW case (scary moment to be sure), Meg do the first PR probe case (invented by Chris Brace, and now the best-selling probe in the US), Tim do the first lung case as well as the first-in-man histotripsy case. But, I have to admit that the thing that brings me the most joy is when one of our researchers/trainees gives a talk and nails it or receives an award for their work. Fortunately, this is a common occurrence nowadays it seems!
What advice would you give to young radiologists, or students who are interested in entering the field?
First, I have been fortunate to work with incredible trainees, researchers, and students during my 33 years at UW. Working with the next group of leaders is the best part of my job and there is nothing better than watching them grow and take over the world! Our current team is pretty darn hard to beat: Meridith and Adrienne Kisting, Annie Zlevor, Katrina Falk, Ayca Kutlu, Orhan Ozkan, and Grace Minesinger are all researchers who are on the way towards MD’s, PhD’s or both. Our current group of trainees include Allison Couillard, Anna Sorensen, Maddie Jentink, and Erik Winterholler. Over the last year each of them has done at least one paper and oral presentation at a major scientific meeting and they absolutely rocked it!
I’ll say the same thing to them that I said at the Gold Medal award ceremony: Do not be satisfied with the status quo, take calculated risks, be relentless, and break things. The status quo will change, and the only question is whether you are the one doing the changing or someone else is. Seek out supportive environments and then give it your all!
Is there anything else that you’d like to share?
This is an exciting time in radiology and medicine but we shouldn’t lose sight of the arc of history and the natural progression of medical advances. Every physician and researcher thinks that their time is unprecedented and unique. It’s not! While technology and the practice of medicine might change, the basic components of success are always the same: Work hard, seek out great mentors, work on important projects, and take chances.
There is a big component of luck thrown in there somewhere too, and I have to admit that luck probably played the biggest part in any success that I have had. For me, the luck came in the form of being born into a great family, working with great people, and finding myself in a place that supported my career. A big thank you to the people that supported me even when success was not assured, to my great partners, and to our researchers and trainees. I was the one lucky enough to receive the gold medal, but I am acutely aware that I stand on the shoulders of giants.
