Father, husband, farmer, cowboy, scientist, clinician, technical surgeon, pharmaceutical executive, inspirational leader.
Meet John Lee, MD, FACS, who currently is the only otolaryngology–head and neck surgeon in Pierre, South Dakota, and the surrounding 300 miles. He’s on call 24 hours, 7 days a week, and yet, his service extends beyond treating patients in the community.
Dr. Lee played a key part in changing the course of treatment of the most rapidly growing forms of head and neck cancer. He truly is a man for all seasons—a modern-day Leonardo da Vinci.
Pierre (rhymes with cheer) is a surprising place. With 14,091 individuals inhabiting the town, it is the capital of South Dakota. One often imagines this part of the US as a flat plain and semi-arid, but the area surrounding Pierre is astoundingly beautiful with broad vistas, beautiful fields of farmland, untouched prairies, and a majestic river flowing through the town.
The state capitol building lies near the center of town as does the governor’s mansion. Across the street from the governor’s residence, under the shade of lovely trees, sits an unassuming, elegant house where Dr. Lee and his wife, Kim, reside. It might seem an unlikely place to find Dr. Lee, who grew up on a dairy farm in Minnesota.
Surgeon Guided by Skill and Compassion
Dr. Lee is an instantly likable individual. He is soft-spoken with a ready smile and quick to laugh at himself and the ironies that led him through an extraordinary career. Upon meeting him, you think you’d like to have him as a friend.
After talking to him for a while, you would hope he would be your doctor if you were seriously ill. Dr. Lee is a person who believes patient-centric care is the essence of being a surgeon. He is technically skilled as evidenced by a series of thyroid surgeries extending over 5 years and some 500 cases—without a single nerve or parathyroid injury.
However, the reason Dr. Lee went into medicine was to make a positive impact on the human condition, not just to be a superlative technician of the profession.
As a young man, Dr. Lee flirted with earning a doctor of philosophy degree, but as he studied, he quickly learned that funding was limited, and the possibility of having a high impact was remote.
Medicine offered both the chance to be a true scientist and translate that research quickly into improving outcomes for many people. So, he instead chose to attend medical school at the University of Minnesota in Minneapolis. Fate and his native intelligence landed him in the otolaryngology residency at The University of Iowa (Iowa) in Iowa City, where he learned both general ear, nose, and throat (ENT) surgery and advanced head and neck procedures.
He fell in love with cancer. That may seem odd to many nonsurgeons. To the general public, the word “cancer” has only negative connotations. It is death, battle, survivorship; not something to be loved. So why does Dr. Lee love cancer?
“It is life or death,” Dr. Lee explained, adding that the stakes are high, but there also are rules and clear outcomes that other fields lack. In addition, he could have long-term relationships with patients. Cancer surgery is complex, delicate, anatomically complicated, and constantly challenging. No individual cancer patient nor their tumor is exactly the same when under the knife.
At the time he did his early training, cancer of the head and neck was clearly not being cured by surgery—except in rare instances. That was the challenge, and Dr. Lee pursued developing his own lab at Iowa and later at the University of South Dakota (USD) in Sioux Falls, at a time when a divergence of tumors was being recognized. Instead of the typical heavy-drinker, heavy-smoker patient, ENT surgeons saw a rapidly growing set of patients without those typical carcinogenic factors, marked by the rise of human papillomavirus (HPV)-associated squamous cell cancer.
In the lab, Dr. Lee studied homogenic mice in which he could reliably reproduce this tumor. He developed and became an expert in murine tonsillectomy for mouse tonsillar cancers. Through his murine research, he compared results of immunocompetent and immunoincompetent mice to HPV cancer treatments that eventually led to the discovery of immunomodulating therapies that have revolutionized the treatment and prognosis of this tumor.
Actor Michael Douglas is one of the most famous individuals often associated with HPV-induced cancer and a survivor likely because of research originating in Dr. Lee’s lab.
Dr. Lee described the experience of one of his early patients who, after receiving immunomodulator therapy prior to other treatment, said his tumor was tingling. Dr. Lee remembers that moment well and the fact that this patient’s tumor was undetectable by the time he was eligible for traditional surgery and chemoradiation after the immunotherapy was remarkable.
