Linda M. Liau, MD (RES ’97, FEL ’98), PhD ’99, MBA, is at the forefront of research to develop an effective treatment for brain cancer. Now, as the new chair of UCLA’s Department of Neurosurgery, she faces the challenge of balancing administration among her many roles.
Linda M. Liau, MD (RES ’97, FEL ’98), PhD ’99, MBA, has never been one to sit idly. Or even to sleep. “Everyone tells me it’s going catch up to me — that I’ll die of a heart attack or something,” she says. “So I’ll go to bed, but I just wind up lying there, thinking about all the things that I need to do.” If she manages four hours, that’s a good night.
And there indeed is plenty for Dr. Liau to do. This past August, she was named chair of the UCLA Department of Neurosurgery — only the second woman in the country to chair an academic department in neurosurgery. So now, in addition to her schedule as a surgeon and researcher in brain cancer, she must handle the administrative tasks of a prominent and busy department.
Dr. Liau’s research is on glioblastoma, the most aggressive and lethal form of brain cancer, and she is the principal investigator of a $11.4 million National Cancer Institute Specialized Program of Research Excellence (SPORE) grant for brain cancer studies. Her work over the past two decades — motivated by her own mother’s death from metastatic cancer — has focused on developing a vaccine against the disease. The vaccine, which fights glioblastoma by triggering the patient’s immune system to attack cancer cells that remain in the brain after the tumor has surgically been removed, now is in multicenter phase-3 clinical trials. “I have a huge drive to prove that things that seem impossible can actually work,” she says. “When I first started working on brain tumor immunotherapy, everyone told me that you can’t mount an immune response in the brain. Now we know that’s not true.”
Dr. Liau talked with U Magazine contributor Kathy Svitil about her work and her new administrative role.
As chair, what are your goals for the department?
Dr. Linda Liau: One of the great things about being a physician-scientist is that you see both worlds — what goes on in the laboratory and what goes on within the hospital. Because of the proximity of the research and clinical enterprises at UCLA, there is a wonderful potential to take discoveries that are made in the lab directly to clinical application and then back again. But since becoming the chair of neurosurgery, I’ve come to realize that there are some cultural barriers between clinicians and basic scientists; it is my hope that these can be broken down to bring people together and further enhance these collaborations. I have been doing that within my own niche of brain cancer, but it can be done throughout the various subspecialties of neurosurgery. Sometimes, it’s just a matter of meeting people and knowing who does what, and why. And since I’ve been here so long, I know a lot of people at UCLA.
Resources are another concern. Funding from the National Institutes of Health (NIH) is tighter now, and clinical profits are much smaller than they used to be. In the past, clinical departments used to fund research just on the surplus that they made from clinical revenues. Now that surplus doesn’t exist. It is not enough anymore for young physicians or scientists to just do great science; they need the resources to help them with that. I feel it is my role as department chair to help get those resources for them.
Another of your responsibilities is to educate medical students, residents and fellows who come through the department. Do you feel that today’s trainees need a level of training that was not available to you when you first started?
Dr. Liau: The field of medicine has grown so much in the last 25 years in terms of medical knowledge, as well as engagement in clinical performance metrics, quality improvement projects, electronic medical records, et cetera. We never had to do those things to this extent when I was in training. We just went and saw the patients; we practiced medicine and did surgeries. It used to be that you would go on rounds, and then you’d be tested on certain facts about certain diseases. Now, you can get many of those facts just by looking them up on your phone. So, in order to excel, a student must know not just the facts, but also how to integrate them clinically and also simultaneously manage various different priorities. Information is easier to come by, but along with that, the expectations are higher. Ultimately, I believe that the role of an academic neurosurgery department is to produce future leaders in the field of neurosurgery, and that could be in the form of basic or translational research in terms of developing new diagnostics or new treatments, but it also can be leadership in other areas — hospital operations, quality improvement, public health issues.
What distinguishes UCLA’s neurosurgery program from other programs?
Dr. Liau: UCLA traditionally has been a very strong clinical neurosurgery program, but we also have very strong research programs in pretty much all of the major areas of neurosurgery: neurosurgical oncology — brain and spine tumors; functional neurosurgery — epilepsy and movement disorders; spine – degenerative spine disease and spinal cord injury. These programs are well-funded by the NIH. It is important for us to be able to compete and to be successful for peer-review funding.
You are the second woman to chair an academic department of neurosurgery in the U.S. How does that feel?
Dr. Liau: When I started medical school, people told me that women shouldn’t be neurosurgeons because it’s too challenging of a profession. It has been very fulfilling for me to break these stereotypes. So, from that standpoint, I don’t really think about being only the second woman to chair an academic neurosurgery department; I think of myself as a neurosurgeon, like everybody else here. The first woman to be appointed chair of an academic neurosurgery department was Dr. Karin Muraszko at the University of Michigan, and that was 13 years ago. It took more than a decade for there to be a second woman chair. This is becoming apparent in many fields — you get the first woman to crack the glass ceiling, but then there’s not a lot of traction until you get more and more women in leadership roles. I am hoping that we will have a third and a fourth and a fifth woman chair within the next year or two — not just breaking the glass ceiling, but also breaking it wide open so that it’s not unique to have a woman chair of a neurosurgery department, or to have a woman in any other position of leadership.
Your research focus is on the development of a vaccine for brain cancer. How did you come up with that idea and how it works?
Dr. Liau: When I started thinking of how to better treat glioblastoma, one thing that I noticed as a surgeon was that we would take the tumor out and the surgery would go great, but the tumor would come back six months later. That probably was from cells that were in areas we didn’t see while doing the surgery. I thought immunotherapy would be a good way to get to these cells. The concept is to take tumor cells, create a vaccine against them in the lab and then inject them back into the patient to activate his or her immune system’s T cells so that they get into the brain and attack the cancer cells when they start coming back.
We have a subgroup of patients, maybe 25 or 30 percent, who do really well after the treatment. What is puzzling is why the other 70 to 75 percent don’t do as well. What’s different? Their tumors look the same. Figuring out the reason for this variation in response has been the focus of my lab over the last 10 years, and we are moving toward new ways to personalize treatments based on predictors of response.
Is there a time frame for when you feel such a vaccine might be in widespread use?
Dr. Liau: Twenty-five years ago, I thought it would happen in 10 years. I am still waiting. But we’ve come a long way in the last 20 years in how we think about glioblastomas. When I was a resident, the outcome for a patient with glioblastoma was very dismal. We really didn’t have much hope that these patients would live beyond a year or so. Now, we have patients out 10 to 15 years. I can’t say that every patient lives a long time, but my approach to patients is much more hopeful. They could potentially be in the group that responds.
One thing that I hope also will change is the way the Food and Drug Administration approves drugs. Right now, it’s such a long and tedious process that can take 10 to 15 years before you are able to get a drug approved. So, there are scientific questions that need to be answered as well as regulatory trial-design issues that then need to be fixed before we actually can get new treatments approved.
How do you balance your time as a chair, as a neurosurgeon, as a researcher, as a teacher and as a person with a life?
Dr. Liau: Balancing my time is the most difficult part of this job; I’m still trying to figure it out. There are certain things that are priorities at different times. At one point, someone asked me, “Can you have it all? Can you do it all?” And I think my answer to that is “Yes, but not at the same time.” I don’t think you can be the best mom and the best surgeon and the best researcher all on the same day, or even all in the same week or month or year. It is a balancing act, but the balance changes over time and under new circumstances. I’m still trying to find the right balance.
You have been affiliated with UCLA for nearly 30 years, beginning as an intern in 1991 and through your residency and fellowship training. Why have you stayed in one place for so long?
Dr. Liau: I grew up in Southern California, so initially one of the reasons I came here was because my mom was diagnosed with breast cancer while I was in medical school (at Stanford University School of Medicine), and I wanted to be close to home to be with her during that period of time. She died from her cancer while I was a resident, but throughout the time I’ve been here, I’ve felt such collaborations and friendships that it’s been very hard to leave. There have been other offers, but when it comes down to it, nothing else really felt like home.
Do you think you’ll reach a point at which you will be satisfied with what you’ve accomplished and allow yourself to take a break?
Dr. Liau: Oh, no. I think I’m one of those type-A people. I feel like I have to do this and do that. I thought that maybe after becoming a chair, I’d think, “OK, this is the final point of my career.” But now, I think, “No! There’s so much still to do.”