Dr. Fabiana Gregucci is an Italian university researcher and administrative director specializing in oncology. Currently working at Weill Cornell Medicine in New York, Dr. Gregucci tells us in this interview how her “American dream” began long before she physically arrived in the United States. From an early age, her love of studying and reading pushed her toward the humanities and biological sciences. Today, in the United States, she continues to grow professionally, appreciating the cultural differences and opportunities offered by the American system.
Dr. Gregucci, how did your “American dream” begin?
This question makes me smile, and would lead me to answer it with another question: what is the “American dream”? For me, the American dream is a state of mind before it is a physical place. It is the set of successes (unremarkable) and disappointments (highly motivating to do more or do better). It is a very strong emotion at the center of a thousand thoughts. It is awareness, determination, liberation, affirmation, commitment, resilience, boldness, love of life, curiosity about the unfamiliar, desire to grow and discover/discover beyond the limit (because I believe that to grow and learn is never ending). With this in mind, my American dream began at a very young age, as a student struggling with the early school years that immediately gave me a love for studying, reading, and knowledge, in the broadest sense. So many whys and so few answers, mostly incomplete and superficial. Then, over time, my immense passion for the humanities and biological sciences grew and I found myself enraptured in the world of biographies of great Italian scientists who were an immeasurable source of inspiration. I remember vividly when I first read Rita Levi-Montalcini’s “In Praise of Imperfection” when I was 11 years old. It was a thunderbolt that became the love of my life. I was certainly not mature enough to fully understand it, but I was dreamy and determined enough to believe that each of us has a purpose in life, which is not summed up in the goal but is realized in the journey during which difficulties, fears and mistakes are opportunities to ask questions and imagine solutions, to try and try again. This is how my “American dream” was born, long before I physically arrived in the United States, and in particular in NY. My “American dream” is the genuine love of research, it is the promise I renew every day with myself to persevere, pursue and keep alive what are my ideals of knowledge and growth, personal and professional.
What motivated you to pursue a career in medicine and specialize in the field of oncology?
Nothing and no one. It was never a push in pursuing a career as a physician first and as an oncologist later, in the path of specialty training. Rather, it was a growing awareness that my innate passion was and still is the study of medicine, understood as a science that studies the nature of the human being and the physiological and pathological processes of life, in its wonderful complexity. I could not imagine being any different than I am; I never think of my profession as a job or a career, but an essential part of my being. The world of oncology and particularly radiation oncology has given me the opportunity to combine my passions and cross-cutting interests in medicine, biological sciences, and technological sciences. I often abruptly run into the stereotype of the physician understood as a “professional who heals the sick.” One may or may not heal a disease, which is still a natural process of life and evolution of human beings on this planet. But what one can certainly do is to care for the person, avoiding his or her identification through his or her illness. My being a “physician-scientist” (unfortunately, we do not have an effective translation in Italian) is expressed in making available to others the knowledge that I have acquired and developed in my course of study and that I continue to enrich, and at the same time to devote my time and effort in trying to produce and disseminate knowledge.
What cultural and labor differences have you noticed between the two countries, especially in the field of medical research and practice?
This is a very complex question that from my point of view has no answer. Certainly Italy and the United States have very profound cultural and labor differences, without notes of merit or demerit. They are such different systems that they are not comparable, even more so in the sphere of research and medical care. I often discuss with Italian colleagues who trivially cut short the diversification of the U.S. health care system with a trite “the system is private, and where there are private economic resources everything works differently, too bad for those who cannot afford private health care.” This is an example of a stereotypical view of the U.S. model that comes from misinformation and second-hand knowledge that often does not correspond to reality. On the other hand, I must say that I rarely discuss the Italian health care system with my U.S. colleagues. In general, Americans greatly appreciate our culture, our preparation, our organization, our ability to multitask and problem-solve, and rather than spend their time on words, they look for a way to make us stay, become part of the everyday made USA to enrich their cultural background. After all, who is the fool who has a great resource at home and lets it slip away or doesn’t do everything to try to retain it?
In America there is a lot of investment in scientific research, technology-especially in the medical field-and in young minds. Since coming to America have you noticed any differences on this compared to Italy?
Based on my experience, the main difference I have noticed is the career opportunities that the American organizational system offers. In addition to specific scientific skills, it is important to develop soft skills such as project management, scientific writing, and communication. The United States highly values innovation and entrepreneurship, so being proactive in coming up with new ideas and projects can lead to great opportunities for growth.
What has America given you over the years?
America has given me and continues to give me the opportunity to express myself 360 degrees in the professional field, not confining my skills and knowledge to the physician-patient care routine. It has given me the chance to discover myself as a “scientist” and to learn much more than I expected. Personally, it gives me the chance to question myself every day, to confront a world culturally and linguistically very far from what I knew, from my comfort zone. Every day I face a new challenge, whether it is trivially arguing with my neighbor to explain to him that panettone is a typical Italian Christmas dessert and not a cake to be eaten all year round, to slightly more complicated situations such as worrying about my nine-year-old son being too Italian to be American and too American to be Italian. America has also made me realize the importance of citizenship, a right we often take for granted, and is making me passionate about legislature, politics and international economics. In particular, NY in this adventure is an exceptional city, an unparalleled experience. A metropolitan jungle that thrives on unique times, rhythms, rules, cultures, and has the ability to overwhelm and captivate me at every corner at every moment. At the same time, however, America has not only given me, it has also taken some things away from me, especially on an emotional level. It took away the closeness of some people I considered friends, the peace of mind of being able to visit my family members frequently and in times of need. It took away the illusion that truth is unique and objective and that life flows slowly. It took away the perfect grammatical and lexical handling of my native language. Every now and then I think “at least I used to know one language well, now I know 2-3 (Italian, American, and some Spanish), but badly or very badly.” In short, stories of an ordinary expat, with its lights and shadows.
In the past she even went so far as to win a grant for a project in Texas. Tell us about this transition.
The months I lived in Texas were wonderful, and I thank AIRO, which is the Italian Association of Radiotherapy and Clinical Oncology, for giving me the award that allowed me to go on this journey. I can never forget the excitement of my first day at MD Anderson Cancer Center. I remember that there was a bus coming to pick me up from close to home (distances in Houston are superhuman and public transportation poor) to take me to the research center with “cancer” crossed out with a red line, reinforcing the idea of the purpose of the research. There I was able to learn more about the study of stereotactic radiotherapy, on tumor lesions in the lung, pancreas and liver, and the study of radiomics, a field of research that allows one to look at radiological imaging not with sight but through complex mathematical analysis that provides information that the human eye could not perceive. And then it was Houston, the city that put man on the moon. In short, there were so many details in this parenthesis that made it important. Houston gave me a different cross-section of the United States than NYC, and I can only appreciate the opportunity to have known different stories of the same tale.
Instead, she currently works as a University Researcher and Administrative Director at Weill Cornell Medicine in New York. What exactly are you involved in and what is the most important challenge for you at the moment?
Exactly. At this moment in my professional career I am privileged to be able to devote my full attention to clinical and translational research, in the Department of Radiation Oncology, under the leadership of Prof. Silvia Formenti, and I have the great fortune to collaborate with outstanding colleagues, internationally renowned scientists and physicians from different parts of the world. In particular, I am involved in the development of new studies and treatment protocols in the field of oncology, as well as in the collection and analysis of data from trials that were initiated in the past and are now mature enough to allow us to derive results that can change the course of oncology. After all, the motto of Weill Cornell Medicine is “We’re Changing Medicine,” and in these few but incisive words, my daily commitment and that of all the professionals working at Cornell is perfectly identified. Professionally speaking, the most important challenge I am facing is discovering myself from a top-level management perspective through administrative leadership of a large NIH/NCI (National Institutes of Health/National Cancer Institute) funded grant called ROBIN. This unique opportunity allows me to combine my skills and knowledge in the medical, biological and research fields, with the other side of the coin concerning the ability to organize, direct, and finalize so many different tasks inherent in this complex project, not least of which is also the economic-financial aspect, related to the management of funds.
Tell us about the ROBIN project.
As mentioned ROBIN, which is an acronym that stands for “Radiation Oncology-Biology Integration Network,” is an extensive NIH/NCI-funded clinical-translational research project that brings together numerous prestigious groups, such as Weill Cornell Medicine, Memorial Sloan Kettering Cancer Center, University of Chicago, University of Maryland, Thomas Jefferson University, Cleveland Clinic Foundation, Emory University, Washington University, Harvard University, University of California San Francisco, with the aim of:
Supportare la ricerca per capire meglio come le radiazioni influenzano la funzionalità e la biologia delle cellule sane e delle cellule tumorali;
Raccogliere campioni biologici prima, durante e dopo il trattamento radiante da pazienti trattati con radioterapia;
Formare una squadra multidisciplinare di esperti e scienziati che abbiano competenze trasversali, coinvolgendo clinici, fisici, biologi, biotecnologi, genetisti, biochimici, statistici, bioinformatici, matematici, per migliorare gli studi clinici sulla radioterapia, utilizzando l’applicazione della scienza omica.
Trying to give a more complete explanation, we have to consider that about 50 percent of cancer patients are treated with radiation therapy during their course of treatment. Since radiotherapy was introduced as a treatment for cancer more than a hundred years ago, progress and research have increasingly focused on the technological approach and mathematical calculations to optimize treatment, neglecting a very important aspect concerning the biology of the cancer cell and the healthy cells in the body exposed to radiation. Recent discoveries in human genomic research, together with the availability of large amounts of data and new molecular tools used for precision medicine, have not yet been fully exploited in radiation oncology. In this context, ROBIN offers an opportunity to apply this new biological/genomic/biochemical/bioinformatics/biostatistics knowledge to open up knowledge about this unexplored world and improve radiotherapy treatment and its efficacy in combination with other oncology drugs, not through the development of a technique/technology but through the development of knowledge about what happens and how cells function when exposed to radiation.
Historically, most research in radiobiology has been done on cells in the laboratory or in preclinical models, with very little data collected from actual human tumors. This has created a situation where the technical accuracy of radiotherapy has improved, but the understanding of how tumors and normal tissues respond to radiation over time has lagged behind, especially in humans, compared to other forms of cancer therapy, creating a knowledge gap and an unmet need to characterize radiotherapy treatment to improve tumor cell killing and reduce side effects on healthy tissues. Lo and behold, ROBIN seeks to do all this and more. In fact, another equally important component of the program is not only to create knowledge, but to bring forth professionals who are experts in that knowledge and who can disseminate it to the world. Within ROBIN, right now, more than 100 scientists collaborate, divided into five groups, named ImmunoRad, OligoMet, GenRad, KIDSROBIN and METEOR. We meet, virtually, about 5-6 times a month, every month, and once a year in person, to discuss and share our various achievements, whether positive or negative, trying to support and help each other to achieve a goal of knowledge that goes beyond the notoriety of the individual center, aiming at a common good for all humankind. All this would not be possible without the great support from the scientific and financial side of NIH/NCI.
Do you have any advice for other young researchers and aspiring doctors who would like to achieve their American dream?
This may sound like trivial advice, but what I can suggest is to never give up, to always believe in yourself, to dream big, to look to the goal but at the same time to rejoice in the journey. Look at difficulties and failures as opportunities to imagine and implement solutions you had not thought of before. I wish everyone to find their America and pursue it unconditionally, wherever it is and whatever it means.
The article Dr. Fabiana Gregucci talks about university research and cancer medicine comes from TheNewyorker.
