An interview with Professor David Hill

Tuesday 26 October, 2010

The following is a transcript of an interview with Professor David Hill in the lead up to his retirement in April 2011, after 44 years at Cancer Council Victoria.

Professor David HillHow do you feel about the upcoming retirement?

I feel positive and nostalgic because it's been such a long time. I've stayed here because I think it's a wonderful organisation and it's always provided me with the opportunities to do things that are interesting and appear to be valuable.

On the other hand, I'm quite keen to perhaps re-gain a bit more depth of knowledge in some of the research fields that I've come from.

I have several ideas for research programs that arise from the experience I've had in the past few years that I think need to be investigated. I'd like to apply for funding to develop those. I'm interested in perhaps supervising one or two PhD students from one of the universities, and I'd also like to continue to work with the Union for International Cancer Control (UICC). I'm hoping there will be opportunities to stay involved in the Global Access to Pain Relief Initiative.

There's plenty to do. Everyone who works at the Cancer Council would know what I mean when I say there's no end to the amount of useful things you can apply yourself to. People work long hours here because the job is never finished. On the other hand, it's incredibly rewarding.

You've been here since 1966, how has Cancer Council Victoria changed and developed over that time?

Well when I started, the focus of the organisation was on raising money to fund research that was conducted in outside organisations such as medical and academic departments in universities. We were just beginning to do what we call ‘public education' about cancer. We were conveying the message about early diagnosis being valuable. We were informing people about the so-called ‘seven warning signs' of cancer and we also had a program of providing financial support to people. It was pretty basic, but in truth the fundamental scope of Cancer Council Victoria's work was set at that time.

We've added two big dimensions to our activities since then. One is advocacy and from the late 60s Cancer Council was very deeply involved in the tobacco issue, trying to get governments to take action. The other thing we didn't really engage in until the mid-80s was to introduce the conduct of research within our own walls. The organisation decided it could afford, and needed to, have specialised research units in epidemiology and behavioural research – and the rest is history. Those centres are very successful and have a good reputation internationally as well. Cancer Council Victoria was recently voted highest in Australia in an international league table of research impact.

I also want to point out that although we were doing anti-smoking activities at that stage, we didn't receive any government money for doing it. Now we're an organisation that is approximately half funded by charitable donations and half funded by contracts and research grants we get from government.

So that's a nice balance strategically – it means we have plenty of potency with money we raise ourselves to set our own strategic directions. On the other hand, we get a lot of money to do things that are very important (that we don't have to raise money for because government gives it to us). The biggest example of that category is Quit, where most of the money comes from government sources. We're lucky to be recognised to have the infrastructure and the skill-base to conduct the program on behalf of the community.

What achievement are you most proud of?

Certainly I've spent a lot of my time on tobacco and prevention programs and the research to underpin effective tobacco programs. So there's no doubt that of all the things we've done in cancer control, bringing male smoking rates down with the consequent fall in male lung cancer death rates is the biggest achievement in cancer prevention to date, no question. Any part I've played in that is extremely rewarding to me personally; I've been a small player, but in terms of the outcomes we can be confident that there are many people alive today, particularly men, who would have smoked if there hadn't been our programs to persuade and help them to quit. They just wouldn't be alive. So it's nice to think about that.

What does it take to be the Director of Cancer Council Victoria and to lead the organisation?

It's been a great privilege to have the opportunity to lead the organisation since 2002. I find it impossible to analyse what it takes. I do what I do and I try not to get into trouble doing it. It's really for others to judge.

How would you like others to remember you?

Well, other than fondly, it's nice to be liked but it's more important to be effective than liked, I suppose. There are things I've done that please me, and that I would like to be remembered for after I've left the organisation. The main category would be the application of the discipline I was trained in – which is psychology and behavioural science – to create public information and prevention programs that are more effective than they would be if we weren't applying the science to the programs. And I think in Victoria we can be quite pleased that we've shown leadership in the application of knowledge about human behaviour to the issues of cancer prevention.

How does Cancer Council Victoria compare on a global level in terms of the work we do?

We took a contingent of people from the Cancer Council to the World Cancer Congress in China in August. I was really proud of the quality of our work and how it compared with the work that was being presented by people from other parts of the world. And I think those who were fortunate enough to go to the meeting also remarked that it was nice to see that they were able to be proud of their work in relation to approaches in other countries.

Now, of course everybody learned a lot of things from the meeting about ways in which we can do better. But the feedback we get on our work is very positive from other organisations. In fact, just in the last few months we've had delegations from Hong Kong, Denmark, Samoa and Jordan, who wanted to come and look at us because they've heard we're doing well. So if people want to come and visit and check us out, then that's quite a good indication of quality.

Another way I can tell how well we're doing is the number of invitations our senior staff get to go overseas and give lectures. Those invitations come with a cheque attached for travel expenses – we rarely pay for the cost of them going. So you know it's serious when people ask you to come and speak, and offer to pay the fare as well!

What direction would you like to see Cancer Council Victoria head in, and what do you want to see achieved that perhaps wasn't able to be achieved in your time here?

My observation would be that the need to continue to support research is self-evident. So that needs to go on. That's what the public wants. But equally important is the need to make sure that the results of research are applied quickly and effectively. And society is not very good at applying the benefits of research in a whole lot of fields, including cancer, as rapidly as it should.

There's a new term called 'implementation science' and that really is a behavioural issue. Why is it that people who have the power and opportunity to implement the benefits of scientific knowledge don't? Are they too lazy about finding out about what works? Are they self-interested and a different way of doing things challenges their confidence? What are the barriers to applying new knowledge? So I think Cancer Council should continue to play a role to do its best to facilitate, through advocacy and training programs, the uptake of knowledge as quickly as possible.

But there are systemic issues you encounter. The results for cancer treatment in Victoria, I'm now convinced, are equal to the best in the world. It's not a bland statement because we're involved in some international benchmarking where we're able to actually compare our results with a number of highly developed countries, and I know we're doing OK.

Having said that, there are still variations in care. You can look at patients who have exactly the same profile, same stage of disease, same age profile, and yet the treatment they receive can be different within our system. When you see these variations in care, it's a cause of concern because there may be differences in the outcome for the patient. This is an example of what I mean about identifying the best, most effective form of treatment, making sure it's available and then making sure it's taken up by the clinicians who have to deliver that treatment.

What do you think is the key to overcoming cancer?

If we applied everything we know 100% effectively in prevention – so nobody smoked, didn't get overweight and obese, people were SunSmart, and people who should be screened were screened, and there are other things you could add to the list – there'd be a huge reduction in the mortality from cancer. That's without any more new discoveries at all.

Of course, I'm very keen on considering the quest for new discoveries. But I really think there should be greater emphasis on the social science of giving all the participants, whether they be the patients, the doctors or the health bureaucrats, the benefits of new knowledge flow through.

Do you think this is something that could happen in your lifetime?

It's very difficult; I think we're a pretty disappointing species in our proclivity to waste the advantages of knowledge. When I look from the outside into other fields, such as transport, the environment, even social welfare, we don't do things where there's evidence where we know it works. I think that it's symptomatic of a general tendency of humans to be pretty wasteful of knowledge.

Who or what influenced you to start in this field in the first place?

I suppose the motivation for me to get an education was very strong and it was because of growing up on a very marginal dairy farm in Tasmania and realising that was definitely not what I wanted to do! My father did that out of necessity but my parents and I were certainly very keen that I wouldn't follow in his footsteps. So as with everything, education is the key to the way forward, so I was keen to get a university education.

I'd never heard of psychology really and it was only later at university when I understood that I was really interested in human behaviour, and the opportunity to apply that in the practical issues of cancer were very intriguing to me.

When I first came here I had the most amazing mentor, Dr E.V.Keogh; he was the inspiration. He was a wonderful Australian. Gallipoli veteran, very senior in the Second World War in the army medical core and he was the medical advisor at the Council. He was just a gifted mentor and he really taught me so much about science and how to investigate any issue. He used to bring a very rigorous scientific mind to bear on issues. I learnt a huge amount from him and was very privileged to work with him. And Dr Gray, one of the previous directors here, was also a significant mentor.

What inspires you and keeps you motivated?

With great regularity, about every 5 to 7 years, I've found a completely new opportunity opening up. So all through that period, the actual work I've done here has varied and progressed. And this last stage, as being Director, has been a great opportunity to broaden out, and being promoted from within the organisation I've found it very challenging and interesting.

What will you miss most about Cancer Council Victoria?

It's like a big second family for me. That really is something I've loved about it, so I will certainly miss the people. And although I've said I'd like to be narrower and have greater depth in my work, equally I'll miss the whole spectrum of things we do here.

Do you have any regrets?

No, I don't believe in regrets. I've made plenty of mistakes but I don't dwell on them. I'm not regret-minded.