Nancy Andrews Interview, January 8, 2019

Abstract

In the January 8, 2109 interview, Andrews discusses her family background; early interest in science; undergraduate education at Yale; pursuing MD PhD at Harvard and MIT; fellowship research on red blood cells; influence of David Nathan, chair of pediatrics at Harvard Medical School; development of research on iron; and administrative roles at Harvard

Interview

Interviewee: Nancy Andrews
Interviewer: Joseph O’Connell
Date: January 8, 2019
Location: Nancy Andrews’s office, Nanaline H. Duke Building, Duke University Medical Center

Joseph O’Connell: 00:01 We are recording, and I’ll go ahead and identify the recording. My name is Joseph O’Connell, and I’m interviewing Dr. Nancy Andrews, and it is January 8th, 2019, and we are in Dr. Andrews’s office. This recording is for the Duke University Medical Center Archives and Libraries’ oral history program. So thank you first of all for sitting down and doing this recording with me.

Nancy Andrews: My pleasure.

O’Connell: And I usually try to document some biographical details at the outset, so I wonder if you could tell me your full name and your birth date and where you were born.

Andrews: 00:47 Ok. My full name is Nancy Catherine, with a c, Andrews. And my birth date was November 29th, 1958, and I was born in Syracuse, New York.

O’Connell: 01:00 Okay. And of course, you were dean at the medical school for about a decade. And can you tell me your current positions?

Andrews: 01:12 So my current positions are Dean Emerita and Vice Chancellor Emerita. That just means I was dean basically. And, also I’m the Nanaline H. Duke Professor of Pediatrics, and I’m a professor in the Department of Pharmacology and cancer biology.

O’Connell: 01:32 Okay. And so could you describe just very briefly what each of those roles entails now at this, at this point in your, time at Duke?

Andrews: 01:42 It’s really just about being a professor. Well, for the most part, what I do is, essentially try to help out however I can. I provide any advice that either the dean or department chairs would like. I help out with nominations for various honors taking advantage of knowledge I have from working with the American Academy of Arts and Sciences, the National Academy of Medicine and the National Academy of Sciences primarily. And I’ve been on selection committees for some of the major medical honors and so I have some insight into what the selection committees are looking for for those. I help out with recruitment. I help out with mentoring of junior faculty, and sometimes senior faculty, and I also represent Duke, nationally for a variety of organizations, including those I’ve already mentioned.

O’Connell: 02:58 Okay. Thanks. 03:00 And I do want to talk a little bit about your upbringing and, am I correct in thinking you grew up in the Syracuse area?

Andrews: I was there until I went off to college.

O’Connell: Okay. And can you describe your family?

Andrews: So I’m the oldest of four children. I have three younger brothers. My father who’s no longer living, he died in 2015 at the age of 90, was a lawyer for his career. Initially, had a major interest in services for underserved communities within the city of Syracuse. He was also active in politics, locally serving in a number of offices and at one point running unsuccessfully for mayor, and later in his life, put his attention to legal cases related to arson. I think he probably at another time would have been a scientist, but was very interested by the science behind fires. 04:16 My mother is still living. She’s 88, and she spent her career as a social worker in a number of different roles, including working at Planned Parenthood, counseling prison inmates, working just as a private counselor therapist. She taught some at Syracuse University and probably other things I’m not thinking of. And she’s probably been retired for 10 years, maybe a little bit less. My brothers are all younger than I am. The oldest is an economics professor at State University of New York at Oswego, I believe he’s currently chair of the department, although lose track of those kinds of things over time. The next brother is a judge in Syracuse, and in the city court. And then the youngest brother has spent most of his career in Washington, almost all of it, and in a variety of different roles–most recent government role was Deputy Secretary of Commerce. And his current position is as the global vice president for public policy for a company called Softbank based in Japan.

O’Connell: Wow. Ok. And so, an eclectic group of siblings.

Andrews: Yes.

O’Connell: And what were your parents’ names?

Andrews: My father’s name was William Andrews. Went by Bill, and my mother’s name is Virginia Rogers Andrews.

O’Connell: 06:07 Okay. Yeah, I always like to document that information in case anybody’s doing genealogical research or anything like that.

Andrews: Yes.

O’Connell: So another thing that I’m wondering about is at that time in your life, during your upbringing, were there things that contributed to your, to the formation of your interest in science or medicine that you think of as connected to your youth?

Andrews: 06:38 You know, it’s hard to say going way back. I think I was broadly interested in many things. Most of the way through high school I was very interested in music and very involved in music. Interested in languages and took full advantage of all of the language, foreign language offerings at my high school. I loved math and finished my math curriculum early in high school. And, I think was first intrigued by science just because it was in some ways more challenging than those other areas, at least for me. And I had some outstanding science teachers. I had outstanding teachers and other areas as well. But, in particular I had a chemistry teacher who took a special interest and encouraged me to apply for different kinds of summer opportunities and enrichment opportunities and those worked out and, or at least one major one that I remember worked out, and I think that accelerated my interest in science.

O’Connell: 08:04 Is the one that you have in mind what I read about where you had the opportunity to work in a university lab as ahigh school student or is it something different?

Andrews: 08:10 It was something different, but it was actually kind of related to that. It was an experience where for five or six weeks, I could go to Cape Cod and work on a marine biology project as part of a group. And, I loved that it was a lot of fun, and in fact, there were two terms over the summer. My scholarship was for this first term, but I talked them into letting me stay for the second five to six weeks so that I could keep going. And in exchange for keeping me I was the cook for the whole team.

O’Connell: Wow. What a cool opportunity.

Andrews: It was fun. And so the high school project came out of that. I think that was probably the summer after my junior year of high school. 09:05 Yes, that’s right. And I got interested in a particular kind of crab, the horseshoe crab, which is an ancient creature that has blood with a very interesting property, which is actually exploited in medicine or in making medicines. If it comes in contact with a tiny, tiny bit of a product from nasty bacteria the blood clots. Not necessarily so great for the crab, but very interesting. And so I wanted to follow up on that. And I went with a bunch of friends from high school back to Cape Cod after school started and we collected about 30 of the crabs, and I brought them home and put them in saltwater tanks. And I approached a professor at Syracuse University who was working on a different kind of crab to see if I could work in her lab, and she was willing. And so I would walk over there after school, taking one of my victims, or subjects, I guess in a bucket. And then worked in her lab trying to begin to get an understanding of why the blood clotted when it came in contact with this bacterial product. Others figured that out. I didn’t, but it was fun.

O’Connell: 10:36 Yeah. Wow. I have so many questions. That just sounds like such a unique set of activities for young person to be engaged in. I guess I’m curious about how the adults around you were thinking about this. Like for example, when you came home with a bunch of horseshoe crabs and you wanted to hang onto them for a while. What did your parents think of that?

Andrews: 11:03 They were generally pretty good about it. Actually, amazingly good about it. Maybe because my bedroom was up on the third floor of the house, so they were kind of out of sight in general. I brought back not just the 31, I think, horseshoe crabs, but also, at least one blue clock crab or blue crab. And that was a bit of a problem because somehow it got out of the tank and disappeared. And those have very sharp pincers and it didn’t attack anyone. But, many months later it was found on the floor of my father’s closet.

O’Connell: 11:46 Wow.

Andrews: But they were great about it. 11:49 And they let me set up the saltwater tanks and, I don’t remember all of the details of how I did that. I just remember having a bunch of big tanks in my bedroom and having to re-circulate the water. We brought the crabs back from Cape Cod in big plastic garbage cans full of salt water. And I don’t remember for sure if I use that water and just kept cleaning it or how it worked. But it worked pretty well.

O’Connell: 12:23 The other person that I’m curious about their reaction was the scientist that you approached at Syracuse University. How did that conversation come about, and how did it go?

Andrews: 12:35 So I had an inside track because my father was her lawyer and he said, “My daughter’s interested in science, would you talk to her?” So I went over to talk to her and she was wonderful about taking the time to hear what I was interested in, and really teaching me how to do the basics. Teaching me herself. She had a very small laboratory. I think there might have been two other people, maybe a technician and a graduate student. And she took the time herself when I went over there to show me how to make chemical solutions and how to use the kinds of columns that you used to prepare protein extracts and how to use centrifuges and really, I don’t remember anyone else ever being responsible for me. I think she did it all herself.

O’Connell: 13:35 Wow. That’s amazing. Yeah. What was her name?

Andrews: Her name was Marilyn Kerr.

O’Connell: Okay. And I know that no one thing that you’ve discussed in some of your other interviews is the role of women in science and the underrepresentation of women in science. So, did it make an impression on you that to see a woman in a role of a science professor at that point? Was that unusual?

Andrews: 14:07 You know, I think my most influential science teachers, different for math, that was all men, but, and different for physics, but at least for biology and chemistry, my most influential science teachers in high school were women and I don’t think I ever really thought about women being underrepresented at that point.

O’Connell: 14:29 Yeah, that makes sense. So would I be right in saying that the research that you were dealing with the horseshoe crabs connected to the research that you did subsequently–was it scientifically related?

Andrews: 14:52 Only in a very indirect way in that it had to do with blood, and I became a hematologist later. People have red blood, horseshoe crabs have blue blood. It actually looks blue because it’s copper based and copper tends to turn things blue or be blue when it’s in a number of different forms. And our blood is red because iron tends to be red. If you see red soil for example, you know it’s got iron in it or rust or blood. But it was in retrospect kind of a maybe an early connection because there–we used to watch science movies in class, probably in elementary school and, probably from the 1950s, so it had been around for a while, there was a set of movies about a character called Hemo the Magnificent, and it was to teach us about blood and about red blood and blue blood. And so I loved those movies. I think it made a big impression on me. Actually years later. I don’t know that I have them here, but I actually got a couple of them from Ebay. Because I just thought that’s something I’d like to keep.

O’Connell: 16:20 Wow. Did you get them on the old film reels?

Andrews: 16:25 I think I got them as video cassettes. I actually never watched them, but at least I have them. Or never watched them as an adult.

O’Connell: That’s right. At least, you know that you’ve got them if you ever, if you ever want to reference those again. Maybe some future research project.

Andrews: Yes. That’s right.

O’Connell: Yeah. Okay. And so with the horseshoe crabs, did you ever learn anything concrete from those experiments?

Andrews: 16:55 No, not in a scientific sense. Only in learning how to be in a lab. And in that way it was very useful because I, became more comfortable with the kinds of, equipment and procedures that you do in a science lab.

O’Connell: 17:13 Okay. Yeah. And from what I understand, you went to undergraduate at Yale?

Andrews: Yes.

O’Connell: And, it sounds like you probably already knew that you were on a science track when you entered Yale. Is that accurate?

Andrews: 17:31 Yes, I–at that point I was pretty sure that I wanted to be a chemist or when I learned about biochemistry, maybe a biochemist, so definitely.

O’Connell: 17:43 Okay. And I’m curious about what your experience was like an undergraduate student and what the culture around you was like at the time. How did you–how did your interests and your approach to school, how was it similar or different to your peers? Did you find sort of a community of likeminded people were or not there?

Andrews: 18:10 I think that I did, although it was a very different time. When I went to Yale, I was in the fifth or sixth class that accepted women. Accepted women from the beginning. I don’t remember what year that started, but we were still only about 20% of the class, if I’m remembering correctly. And so that was quite different from high school. Not so different from medical school later–about the same, but I think Yale was still pretty early on in figuring out how to have a coed institution. And, in retrospect I think that probably influenced things at the time. Just seemed like fun to be, have a lot more boys than girls. But I think it was probably a different experience. I got involved in science pretty early on. 19:15 I had a bit of a handicap because our school didn’t have an opportunity for AP science courses. I didn’t even really know they existed. And so, I had some catching up to do with students who had come from schools that had stronger high school academics. But it all worked out, you know, after a year or two, I was able to catch up, and I think my friends were sort of a mix, maybe more non-biology majors than biology majors. But labs are very social environments, and I worked in two different labs and so also had some good friends who were from the lab rather than from the college.

O’Connell: 20:15 So in general, it felt like a good place to pursue what you wanted to do.

Andrews: 20:19 I think so. As a freshman I went to a guy, a biology professor, who I knew had gotten his PhD at Syracuse University. So we had a connection, and asked if I could work in his lab. And he debated for a little while and then agreed to let me be sort of a work study student there. And so I took care of his frog colony and I made solutions. But it was fun just being back in a lab environment. And then later on, I was able to actually be involved in research projects in a different lab.

O’Connell: 21:04 I think I read that there were a few scientists at Yale whose labs you spent some time in who had done some pretty high profile research or went on to do some pretty high profile researcher. Is that accurate, that there were some fairly well known scientists that you got to rub elbows with.

Andrews: Yes, absolutely. But, so the person from Syracuse University was a biologist named Joel Rosenbaum. And after I finished my work study time in his lab, actually after I started to get course credit for lab work, it made more sense to be in a different lab. And I worked with Joan Steitz, who is still living, she was quite young at the time, and she’s one of Yale’s superstars, has been since the time I was there. And we’re still in touch from time to time. In her lab I met a number of people who went on to great science careers themselves and, it was a very–her lab was very interactive with other nearby labs and so I also got to know people through that.

O’Connell: 22:21 Okay. So who would have been some of the biggest influences on you during that time? Is there anybody like to say a little bit more about in particular?

Andrews: I think probably Joan herself. She was and is a very rigorous scientist and has a great both rigor and creativity in her science. And one of the very exciting things was while I was in her lab she figured out that small RNA molecules are involved in RNA splicing, how you take a piece of RNA and remove the unnecessary stuff to make it a mature, what’s called Messenger RNA. And Joan first discovered several classes of small RNA protein complexes and then made it a huge leap in predicting– and it turned out to be true, and she and others proved it–that those RNA protein complexes, some of them were involved in the process of RNA splicing. And so I was in her lab as that happened, and that was very exciting. I think the other thing about it, well several other things that were very influential. First, I learned a lot of techniques that are rarely used today but occasionally turned out to be pretty helpful. And so I learned a lot about how to be a scientist and what scientific tools were available from being in her lab. But probably the most important lesson was she had–actually, let me just take a sip of this.

Andrews: 24:32 She had heard that patients with a variety of autoimmune disorders had antibodies that seem to be against RNA–small RNA molecules. Sorry, I got that a bit wrong. That seemed to be against complexes of RNA and proteins. And for a variety of reasons, she thought that was interesting. And in an experiment that would be a lot more complicated to do these days because of different regulations, a graduate student in her lab was able to get some patient blood samples and show that the patients did have auto antibodies or a self reacting antibodies against RNA protein complexes, but that the RNA molecules were–sorry, I’m losing my voice.

O’Connell: That’s ok. Take your time.

Andrews: The RNA molecules were small and previously unknown. And those are, these small RNA protein complexes, some of them turned out to be involved in splicing. But it was a huge lesson for me that not only can lab work teach you about diseases and taking care of patients, but you can learn from patients certainly by what they tell you. 26:16 And that came later. But also, that biological specimens from patients could help you learn about fundamental aspects of biology. And for me that was very, very exciting to have that two way transfer of information from the lab to the patient and through the biology of the patient’s disease from the patient back to inform discoveries in the lab.

O’Connell: So those discoveries were a really practical illustration of how, how medicine and science we’re kind of reciprocal.

Andrews: In the very best way. Yes.

O’Connell: Yeah. Okay. And I’m curious to ask a little bit more about that lab since it seems like it is actually historically significant. And you mentioned there were some kind of techniques that aren’t as common today that you learned. I wonder what are those techniques, what are those like?

Andrews: So one of them for example, was to sequence RNA. 27:28 And you hear a lot about people sequencing DNA or sequencing CDNA, which is a DNA copy of RNA, but using enzymes with varying specificities for the components that–the building blocks of RNA–it was possible to deduce the sequence of the RNAs directly. No one does that anymore. Very few people would do it anymore. But in doing that, not only could we get important information, but also I learned a lot about how it works. About the science behind the technique. Joan’s lab was also one of the very first labs at Yale to be able to do sequencing of DNA. Now there are big machines that do huge amounts of DNA sequencing very fast. But in those days it was quite an ordeal and it was something of an art. And what you had to do was first to, well at least setting up the experiment, the first thing we did was to pour a gel. 28:46 And what that meant was you would make a mold out of pieces of glass and then pour a solution into the mold that would polymerize and form something that was like gelatin basically. Although, but the chemical structure is completely different, but same idea. But what made it difficult was that in order to, in the early days do DNA sequencing, those gels had to be super thin, like half a millimeter thick, which is very thin. And they had to be very long. They were about three or four feet tall. And so we had to do some special tricks to be able to get this gel that we needed for DNA sequencing. And then we also had to do a bunch of chemical reactions and first an enzymatic reaction to label DNA. This is probably more detailed than you want.

O’Connell: 29:53 It’s a little bit over my head but I think if somebody is interested in the science, they’re going to want to know those details.

Andrews: Okay. So you have to, 30:03 first label the end of DNA in a precise way so that you know what that end is and then separate the two strands of DNA and then do chemical reactions, partial chemical reactions, to get all of the different kinds of products you would have gotten if you did that chemical reaction at only one place in the DNA. This is complicated, but at any rate, the short version is it took about a week to set up and to do and to get your DNA sequence and at best, if you did a terrific job with it, you might get 80 or 90 base pairs. Now there are machines that can get hundreds of thousands of base pairs, you know, in a much shorter time. But that was early days and it turned out that that was a very useful thing to know because when I later went on to graduate school, I was one of very few people who knew how to do that and could help out in doing that.

31:12 But that was in 1978, 79, early part of 1980, and that was just when DNA sequencing was emerging as something that could be done in multiple labs.

O’Connell: So that was pretty innovative. It was–I can see why you would call it an art because it sounds like it’s very delicate. Like you– there’s not a lot of room for error.

Andrews: And one of the technicians in Joan’s lab was a calligrapher and she needed a paying job, I guess. And so she worked as a technician in the lab and Joan actually hired her because she was so precise in her calligraphy that Joan thought that would translate into being able to do these very careful, meticulous tasks in the lab. And it was true.

O’Connell: Wow. So having a steady hand was actually one of the most valued characteristics in the lab.

Andrews: And being very detailed oriented helped, helped in this case as well.

O’Connell: 32:21 Okay. Wow. That sounds fascinating. And yeah, I– I’ll move us along just so that we don’t get too far behind for the day, but I know that after Yale you went to Harvard, is that right?

Andrews: Yes.

O’Connell: And can you say a little bit about why you made that choice and what you were expecting or what you were thinking about for your future at that point?

Andrews: 32:56 So inspired by Joan’s lab and by the things that I just told you, I decided that I wanted to also be an MD PhD student. I had worked with a number of them in Joan’s lab and I thought that the mixing of medicine and science was really exciting. And the service aspects of medicine appeal to me and the intellectual aspects of science. And so I applied to MD PhD programs for graduate school for medical school and graduate school. And actually ended up going to Harvard even though that was the only place where you couldn’t immediately join an MD PhD program. And the reason that I went to Harvard was that there was a much bigger selection of possible labs to work in than there had been at any of the other institutions, and I didn’t know for sure what I wanted to do, but I liked the breadth and the mass of the science there.

O’Connell: Ok, so just the panorama of options was part of the draw for you.

Andrews: Yes. And they had assured me that in my second year I could join the MD PhD program, which is what I did.

O’Connell: 34:26 Okay. And, at some point during your doctoral education, was that when you decided that you wanted to look specifically at iron disorders?

Andrews: 34:39 No, that came much later.

O’Connell: Oh, okay. 34:42 So how did your interests take shape as a doctoral student?

Andrews: 34:47 Well, I was interested initially in immunology and I went to David Baltimore’s lab at that time. He was very—he’s continued to be for many years, but he had started recently to be interested in immunology and started my PhD work on a project related to how immunoglobulin genes rearrange. And my work was following up on something that someone had done in the lab before I got there. And it turned out that the interpretation of the earlier results was wrong. And so my project fizzled. There was no longer a reason to do it when we realize that the earlier results were just mistaken or the interpretation of the earlier results was mistaken. And so at that time I switched to working on polio virus, something completely different. And did for my graduate work what was sort of a continuation of my advisor, David Baltimore’s, graduate work 20 years earlier. And so I finished my PhD. I did my PhD work over at MIT because that was an option for us. And I liked their program very much. But it wasn’t until actually I was a faculty member that I got to iron.

O’Connell: 36:15 Okay. And you were on faculty at Harvard after–?

Andrews: 36:21 At Harvard. I finished school. I got both of my degrees. I did residency training in pediatrics, a fellowship training in pediatric hematology, oncology, and then, for fellowship research joined Stuart Orkin’s lab, which was in the hematology division. And there worked on red blood cells and how they–basically how they made hemoglobin–or part of, a piece of the process of making hemoglobin. And finished my fellowship, joined the faculty at Boston Children’s where the Orkin lab was and–which is one of the Harvard medical school hospitals. And only a year or so, well, a few years after starting my own lab did I move to iron.

O’Connell: 37:16 Okay. So that was really the end of a long sequence of different, different kinds of—

Andrews: Yeah. Different kinds of science.

O’Connell: Okay. Well, so what year was that that you set up your own lab? Do you remember?

Andrews: 37:33 Yes, it was April of 2000–sorry, 2000–April of 1993. My daughter was born in November of 1992 and so I–actually it might even have been a little earlier than April. But I took a few months off when she was born and then when I came back very shortly afterwards, my lab space was ready and so I moved in.

O’Connell: 38:05 What do you think about skipping ahead to that point? Do you think there are big topics during your previous research that we should touch on before we get there?

Andrews: I think not, not so much related to the research, probably.

O’Connell: Okay. And any particular people that we should talk about who were a part of your Harvard education or MIT education that made a particularly big impact on your thinking or your approach to your work?

Andrews: 38:36 I think one person who should be mentioned is David Nathan, who was the physician in chief at Boston Children’s hospital, chair of pediatrics at Harvard medical school when I was a student. And then later was the president of the Dana Farber Cancer Institute. He’s now retired. He’s going to turn 90 in a few months and is no longer active. But as a medical student I had some difficulty deciding whether I wanted to go into pediatrics or internal medicine. And so the dean for students at Harvard sent me to see David Nathan because he had been an internist who became a pediatrician as a faculty member. And David has been a really key person ,role model, and mentor for me for many, many years.

O’Connell: Can you describe what his style is or what you’ve learned from him?

Andrews: Wel, we’re very different in many ways. He’s a pediatric hematologist or was, and I think what we have in common was, is that he’s passionate about the things that he’s interested in, whether that’s taking care of patients or research in his laboratory. 40:06 He was a physician scientist. He–once he sort of latches onto a problem, he won’t let it go until he’s found a solution. And I think I tend to be like that also. Another thing I learned from him was that even though he was this big guy in charge of everything, he was very down to earth and extremely supportive and interested in my career. And an example of that is, when I was pregnant with my daughter, my first child, I went into early labor, too early, and was put on a medicine to try to stop the labor and sent home for bed rest. And David knew me well enough to know that it was going to be hard to, you know, prevent me from doing things. That was a time when I had a lot of really interesting stuff going on in the lab.

Andrews: 41:06 And we were just about to get out a paper, which I actually finished the night before my daughter was born. But he, so he heard that I had been in the hospital for a week, actually I think he came to see me there, and then I was sent home and I wasn’t supposed to do anything. And as soon as he heard that I had arrived at home, he drove over to my apartment in Cambridge from Boston, marched up the stairs and said, you’re not going anywhere. You’re staying right here. We’ll buy you a fax machine. There was no email in those days so that you can keep in touch if you want to, but you’re not going to do anything except stay in this apartment. And I said, Dr. Nathan, I have to take the pediatrics boards in a week, and I need to leave to do that.

Andrews: 42:01 And he went into my kitchen, got on the telephone. This couldn’t happen these days, I don’t think. Called up the head of the American Academy of Pediatrics and said, I have someone here who needs to take the boards, and she can’t leave her apartment. So I’m going to ask my executive assistant to come and proctor her, and I want her to take the exam at home. And amazingly they said yes. And so I took two days’ worth of pediatrics boards sitting in my dining room with David’s executive assistant. And so that was just the way he was. He would get very personally involved in the things that he cared about, whether it was taking care of a patient or taking care of one of his residents or junior faculty members. So that made a big impression.

O’Connell: 42:51 Yeah. And it sounds like he showed an interest not just in your career but also in your wellbeing as a person. Is that fair to say?

Andrews: Yes. Absolutely.

O’Connell: Well we are running up on 45 minutes. So I think we should talk a little bit about your lab and the sort of, the highlights of some of your research achievements. Especially with iron disorders and diseases. Yeah.

Andrews: 43:28 So we got interested–I got interested in iron originally in part because I was studying red blood cells, and we didn’t know a whole lot in those days about how red cells or the body in general handled iron. But we did know it was very important for making hemoglobin and making the red cells red. And also because there was a medical student at Harvard who was very, very interested in iron and there was nobody around for him to work with. And so long story, but we connected with each other and he really became the first person in my lab and ultimately helped push the whole lab towards iron. We started out asking the question how iron gets in and out of human cells or, we worked in mice but could easily extrapolate those results to humans. And after we had figured out answers there, we went on to asking how those processes of iron moving in and out of cells were affected in different diseases. 44:46 And we got some insights there. We–I started to hear about patients from all over the world who had different kinds of iron disorders that nobody could figure out. And because that was becoming my specialty, I had a lot of referrals and we asked what was going on in those patients and figured out the biological cause of their diseases in several different types of diseases. One was, well actually it’s too much detail, but at any rate, which was a lot of fun, and then we did a bunch of other things to just try to understand the missing puzzle pieces in understanding how people and mice use iron and make sure that you have enough of it without having too much.

O’Connell: 45:52 And were there, immediate applications of that research during that time period? Did you start to see the benefits of your insights in practice at that point?

Andrews: 45:55 It gave me some insight into how to take care of patients I saw with iron disorders. I think it was probably most helpful for understanding those disorders being able to diagnose those disorders. So for example we found that patients who had an inherited form of iron deficiency anemia had mutations in a particular gene, and now all over the world, when patients come in that might have that disorder, the gene test can be done to confirm whether or not they do. So I think more useful for diagnosis, for predicting the course of diseases, than directly from our work for treatment, although pharmaceutical companies have followed up on things that we did to try to make new kinds of treatments.

O’Connell: 47:11 Okay. Yeah. And I’m curious about how your evolution as a leader intersected with your research. Were you, let’s see, I believe that your first administrative role was in ‘96. Does that sound right?

Andrews: Yes. That’s right.

O’Connell: And was that a major change for you? Was that something that you anticipated?

Andrews: 47:40 So I was still very early in my career at that point. I started my own lab. I’d joined the faculty in 1993, so I was only a few years into it. And that role had to do with being the chair of the Admissions Committee for the MD PhD program at Harvard and the associate director of the MD PhD program. I was interested in that not only because the students were fantastic, but also I– when I was asked to do it, I agreed because I knew problems with the program that had been problems since I had been a student that still weren’t fixed and I was anxious to be able to work on those. There was always a balance between my research and my administrative work. Early on it was also a balance between my clinical work, my research, and my administrative work. 48:39 From very soon after I opened my lab, I was an investigator of the Howard Hughes Medical Institute. And Howard Hughes provides very generous support. At least it did in those days. I think it still does, but one of the requirements was that 75% of your time had to be towards research. And so it slimmed down the amount of clinical work and later administrative work that I could do. And so it in a sense helped me strike a balance. It defined what the balance had to be. But for administration, I moved to higher and higher positions along that sort of physician-scientist-leadership pathway.

O’Connell: 49:28 Yeah. And you mentioned that there were certain problems that you saw that you encountered during your career prior to this that kind of motivated you to want to step into a leadership role and change some of those things. Can you say a little bit about what those problems were and what you–how you were able to address them in this phase?

Andrews: 49:53 So, one of the problems with Harvard’s MD PhD program was that in contrast to other institutions you had to be accepted into the program in your second year of medical school, as I had been. They had already fixed that one, but there was very little integration between the medical school part and the graduate school part, and I thought there were better ways to do that. There was very little sense of community among the MD PhD students. They were really just considered medical students when they were doing the medical school part or graduate students when they were doing the graduate school part. And there were some issues with–technical issues with the funding. I felt like I had a very strong sense of what was broken and wanted to try to help, particularly early on, in helping the students feel more supported and more part of a community. I think the real turning point was in 1998, 1999 when Harvard almost lost the grant that supports its MD PhD students because other schools had gotten further faster. And at that point there was a change in leadership, and I became director of the program, and in that role I could finally do much more to implement the changes that I thought were important.

O’Connell: 51:33 Okay. Alright. Yeah. Well, let’s see. So we’ve been talking for about 51 minutes, and I don’t want to eat into too much of your day here. But if we pick up tomorrow with starting to talk about your—

Andrews: Thursday.

O’Connell: Thursday, right, exactly. You know, talking about your decision to accept that the deanship here. Is there anything from this previous part of your career that you think that we should make sure to touch upon that we kind of glossed over?

Andrews: 52:15 I don’t think so. There was just one more step between being MD PhD program director and coming here. After I did that for four years, I became– well for one year it was called associate and then dean for basic science, basic sciences and graduate studies at Harvard Medical School. And that was the position above the MD PhD program director, but also had a bunch of other responsibilities, and I think that was really outstanding preparation for coming here to do this job. And so it was–it was fun. It covered a lot of areas. I had oversight of a lot of areas that I was interested in from science to education. And it was really good preparation.

O’Connell: 53:05 So that was sort of the bridge to taking on something like a dean of a academic medicine center like Duke.

Andrews: Yes.

O’Connell: Well, I guess one thing I am kind of curious about is sort of like, what do you think that–when you were promoted in these leadership roles–what do you think it was about what you had to offer that made you an attractive candidate and that led to these opportunities?

Andrews: 53:49 Hard to know for sure, but I think I was very reliable. You can’t overestimate the importance of that for leadership positions. I was very willing to roll up my sleeve and sleeves and try to tackle the more challenging problems. I didn’t push them off to someone else or procrastinate. I just did it. I think that I was very trustworthy, you know, if I said something people could believe it and I think that was important. And I think I at the time that I wouldn’t have put it this way for sure, but I think in a sense I had a vision of, where these different roles, where things could go and how to get there. If you had asked me at the time if I had had vision for the role, I would have not known what you were talking about, but looking back, I think I had in my head, another way to say it is what needed to be fixed or what we could do strategically to be much better. And I suspect that, even if I couldn’t see it, others, others could see it.

O’Connell: 55:10 Yeah. They could tell that you had a grasp on what would work, from an organizational standpoint and how to–how to improve the way that the school was working as a unit

Andrews: 55:24 And take–and find opportunities and take advantage of them. I think so.

O’Connell: 55:29 Okay. Great. All right. Well, unless you have anything else that you want to add at this point, then we could end this part of our interview and pick up again on Thursday.

Andrews: Sounds good.

O’Connell: Okay. Thank you.

Andrews: Thank you.