In this edition, Jean-Luc Harousseau, MD, tells us about his double life as an international myeloma specialist and regional politician in France.
When did you know that you wanted to become a doctor?
I grew up surrounded by physicians: My father was a physician in private practice, my mother was a school doctor, and all their friends were doctors. My grandfather also was a general practitioner, so medicine is probably in my genes.
I performed well in school, so my father pushed me to take the entrance exams for the highest-level universities, leading to a career in engineering or business management. I started a two-year preparation program in Paris when I was 17, but I stopped abruptly after two months, when I realized I wanted to become a doctor instead. So, in 1965, I returned to my hometown and started my medical studies at the University of Nantes.
My roots are in the west of France. I was born in Nantes, near the Atlantic Ocean. During my childhood, we spent holidays in a seaside resort called La Barre, where I now live.
After making the decision to pursue medicine, when did you decide that you wanted to focus on hematology?
In France at the time, medical students spent at least seven years in training before taking an exam to become a specialist, which was a tough, selective process. I was selected for an internship in Paris but did not yet know which specialty to pursue. My father told me, "If you want to go to Paris, you should choose a specialty that is not available in Nantes." At that time, that narrowed it down to three specialties: oncology, immunology, and hematology. I chose hematology in part because my father, who was the director of the blood bank in Nantes, was interested in transfusion medicine.
My training program in Paris was directed by Prof. Jean Bernard, the most famous hematologist in France and a father of the specialty. In 1977, he hired me as his assistant at HÃ´pital Saint-Louis, but the only position available was in acute leukemias. One of his goals was to develop the specialty of hematology nationwide, and he was interested in creating a department of hematology in the University Hospital of Nantes. That's how I was appointed as professor of hematology in Nantes in 1980, when I was only 32 years old. I was probably the youngest professor they'd ever seen!
My task was to build a department of hematology in Nantes. Before my arrival, patients with hematology-related issues were treated in the internal medicine department. We initially decided to share the hematology patients between the two departments: Patients with acute leukemia (my focus at the time) or non-Hodgkin lymphoma came to my department, and patients with more chronic hematologic malignancies, like chronic lymphocytic leukemia and myeloma, went to the internal medicine department.
I was happy with that arrangement because, as my mentor Prof. Bernard always instructed me, "Never accept a patient with myeloma in my department. It's a terrible disease. It's painful, invasive, and we have no way to cure the patient. Focus on diseases where we can do something." Treating myeloma didn't interest me.
Eventually, you became an international expert in myeloma, despite Prof. Bernard's advice. When did you decide to switch your focus from leukemia to myeloma?
My interest in myeloma came years later, after our department started a program with high-dose therapy and bone marrow transplantation. About three years after I arrived in Nantes, a patient – a cardiologist with recently diagnosed multiple myeloma – traveled more than 100 km to see me. He said, "I know what the prognosis is, so if you have something new, I'm ready to try." I answered that I was a high-dose therapy specialist and that English specialists had recently successfully used high-dose chemotherapy and autologous transplant in patients with high-risk myeloma. I had a sterile room and a protected environment, and, if he agreed, I could treat him with high-dose therapy to try to achieve the same results.
He consented, so we treated him with high-dose melphalan without autologous transplantation and got him to complete remission, which at that time – around 1984 – was very rare. From then on, I became interested in all aspects of myeloma.
Which career accomplishment are you most proud of?
Because hematologic malignancies, including myeloma, are relatively rare diseases, I felt it was important to work with other centers across France to harmonize therapies and address strategic questions. So, in the 1980s, I created a group of centers in western France focused on acute leukemia and myeloma. Then, I brought together two other groups – in the north and south of France – to form the IFM in 1990.
One of the first randomized trials we designed demonstrated a benefit with high-dose therapy plus autologous transplantation, compared with conventional chemotherapy. The results were published in the New England Journal of Medicine in 1996, which changed the treatment of younger patients worldwide and was a big success for the IFM. Our group continued to work together, expanding our research beyond questions around transplantation to comparisons of different innovative treatments. Myeloma specialists from many European countries saw our national group and wanted to establish similar groups in their countries, so IFM has likely served as a model for groups in Spain, Italy, the Netherlands, and Germany.
I'm also proud of having had many different professional experiences. While we were starting IFM and conducting all this important research, I also started my political career.
What drew you to politics?
It happened in 1989, almost by chance. One of my politically minded friends asked me to work with him on a program for the municipal elections. I said, "Why not? It could be interesting."
It wasn't easy, because we were completely naÃ¯ve to politics. Still, one of the party members approached me with an offer to help him win the municipal election. We lost that election, but I eventually became a member of the Municipal Council of Nantes.
From there, I was involved in several municipal, regional, and national elections. Most of my political career was spent at the regional level, starting in 1992 when I was elected to the Regional Council. In the following election, 6 years later, I became vice president of France's fifth region. In 2002, I was chosen by the president of the region to replace him, as he took on a new political role.
So, from 2002 to 2004, I was Professor of Hematology at the University Hospital of Nantes, an international myeloma specialist who lectured several times at the American Society of Hematology Annual Meeting, and president of one of the most important regions in France. When I attended medical meetings in the U.S., very few people knew about my "second life" as a politician who was in charge of the railway, schools, roads, and economic development of France's fifth region.
I worked from morning until night, but I did it. It was a fantastic period! After our party lost the election in 2004, I became a basic councillor again, which gave me more time to devote to multiple myeloma and patient care.
Are you still involved in public service?
That was the end of my career in politics, but I started my "third life" in 2011, when I was 63 years old. I was still involved in the development of new agents in myeloma and director of the Cancer Center in Nantes, and I had just successfully merged the two neighboring cancer centers in Nantes and Angers. I was satisfied with my medical career but received a proposal to become president of a national agency in France called Haute AutoritÃ© de SantÃ© (HAS). HAS is an independent agency in charge of guidelines, quality of care, hospital accreditation, and health technology assessment – particularly drug assessments.
When I assumed this role, I had to almost completely stop my myeloma activities, seeing patients only once per week. This new experience was far removed from hematology, but it was important to me because I worked closely on the issues of health care equity and drug pricing.
I retired from HAS in 2016, when I also reached retirement age for university professors in France. I stopped seeing patients, but I accepted the role of Medical and Scientific Advisor at the International Myeloma Foundation, which supports research and education all over the world.
So far, in my 40-year career, I've lived three lives!
Did you ever seriously consider leaving medicine for politics?
I never wanted to be a career politician. After I got involved in politics, my patients always thought I would leave medicine, but I assured them that, if I had to choose between the two, I would always choose medicine and my patients. In fact, I had the opportunity to become a deputy in the National Assembly of France – and a good chance of being elected – but I turned it down because I wanted to continue with my patients and colleagues in IFM.
Holding both roles was sometimes frustrating because I felt that I could not give everything to my medical job, and I couldn't attain the highest level in politics because I was still involved with medicine. It was a fantastic experience, but a little bit frustrating, because I feel like I could have done more in either field if I had chosen to focus on just one.
Do you think that your experience as a doctor helped you in your political career?
To some extent, yes. Politicians want to be advised by civilians who have professional experience. And, because of my job as a doctor, I am attentive to the difficulties of others. Importantly, unlike career politicians, I did not depend on my political re-election for my livelihood. I always had my medical career to focus on.
Now that you're retired from practice, what does your everyday life look like?
These days, my most important priority is to see my children and grandchildren as much as possible – whether that is playing tennis or cycling with my sons and daughter, or spending holidays with the entire family. Altogether, my wife and I have four children: Together we have a son and a daughter, and my wife also has two children from a previous marriage whom I adopted.
My wife has been wonderful and supported me in all my career endeavors. She spent much more time with the children than I did, but I think that I was able to find some balance between my professional and personal lives. Even when I was leading two lives as a politician and doctor, I always strove to make time for my children, and I am happy to have more time to spend with them now.
We travel together as a family whenever possible. In my medical career, I had plenty of opportunities to travel internationally. Fortunately, even though I'm retired, I still am invited to meetings all over the world, so I get to visit beautiful places. One of my favorite family memories was taking my children on a trip from San Francisco to Los Angeles, passing through various national parks.
Wherever I go, I try to take the advice that I've always given to my coworkers: When you go to a new city, even if you are tired on arrival and your work agenda is very busy, try to find two or three hours to take in the city's atmosphere. It is always worthwhile doing that.