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The Innovator

“If not St. Jude, then who? There is nobody else who is going to step up and become the leader in research and treatment for pediatric cancer across the globe. This is what we need to do. This is our future.”

St. Jude President and Chief Executive Officer James R. Downing, MD



Nearly 30 years ago, an up-and-coming pathologist arrived at St. Jude Children’s Research Hospital for a job interview. Switching off his car’s ignition, James R. Downing, MD, considered the hospital’s two modest buildings and turned to his wife, Mariea.

“I don’t think I can work here. It’s too small,” he told her.

The Michigan native had completed his medical and laboratory training at prominent medical centers with expansive facilities. In comparison, St. Jude had fewer than 1,000 employees and a tiny inpatient department. But that evening, Downing returned to his hotel in a quiet and reflective mood.

“How did it go?” his wife asked.

“You know, this place is like no other place I’ve ever been before,” Downing replied. “I think I have to come here.”

Downing's vision for the hospital

  • Keep the patient and family at the center of everything St. Jude does
  • Significantly increase the number of patients who come to St. Jude for treatment
  • Develop a program to follow patients who have genetic variations that increase their lifetime risk of developing cancers
  • Set the global gold standard for using genomics to help diagnose and treat children with cancer
  • Enhance the hospital’s program in immunotherapy, a treatment that harnesses the immune system to fight cancer
  • Expand St. Jude LIFE, the long-term follow-up study of childhood cancer survivors
  • Expand select non-cancer programs, such as bone marrow transplantation and gene therapy for sickle cell anemia
  • Create a long-term follow-up program for patients with sickle cell disease
  • Enhance the hospital’s clinical facilities with new inpatient rooms, redesigned outpatient areas and the world’s only proton therapy center dedicated solely to the treatment of children
  • Set the global agenda on pediatric cancer by doubling the size and scope of the International Outreach Program

Defining discovery

At St. Jude, Downing found a remarkable place of discovery and interaction—a hospital where scientists and clinicians worked in tandem, moving advances from the lab directly into the clinic, and taking observations from the clinic back to the lab. It was the perfect place for an energetic young clinician to hone his research skills.

Quickly finding his niche, Downing began helping St. Jude become a world leader in the treatment of children with cancer and other life-threatening diseases. Melding clinical and research interests, Downing amassed an impressive body of research, attaining international prominence as a leader in the field of cancer genomics.

After serving the hospital in several capacities—including as Pathology chair, scientific director, executive vice president and deputy director—Downing was named the hospital’s sixth president and chief executive officer in July of 2014.

Unprecedented project

In 2012, TIME magazine heralded the Pediatric Cancer Genome Project, spearheaded by Downing, as one of its top medical breakthroughs. That project, conducted in collaboration with Washington University in St. Louis, sequenced the complete normal and cancer genomes of 700 children with cancer. Results of the project are helping scientists make new discoveries about some of the most aggressive and least understood childhood cancers.

“This information will change the field across the world, and not just for pediatric cancer, but also for adult cancer and other genetic diseases,” Downing says. He is now leading the St. Jude clinical genomics program, an effort to move genomics into the clinic to better diagnose and treat children with cancer. The ultimate goal is to sequence the genome of every cancer patient who comes through the doors of St. Jude.

“We’ll use that information to determine who is responding to treatment and who is not,” Downing explains. “If they’re not responding, how can we use that information to better treat them?”

A focused vision

Downing’s vision for St. Jude is ambitious and audacious—just like the institution itself.

“Our future must be based on St. Jude being the innovator. This is our history; this is our future,” Downing asserts.

Assuming leadership during a particularly vibrant era, Downing enthusiastically lists some of the hospital’s attributes, including its world-renowned programs in leukemia, brain tumor, translational science, survivorship and solid tumor research. “And of course we provide outstanding multidisciplinary care to our patients,” he says.

“We are a place of innovation,” he continues. “And what is the engine for that innovation? It is our focused vision. We have an unrelenting commitment to finding cures. That is what we are about.”

Moving forward

When Downing arrived at St. Jude nearly 30 years ago, he assumed he could predict the trajectory of his future.

“I figured I might be here five years. I’d get my training, I’d become a more sophisticated scientist, and I’d move on,” Downing recalls. “But then I started to learn what St. Jude was about.”

From time to time, other medical and research centers attempted to woo him away, prompting him to weigh options and evaluate the opportunities offered by other world-class institutions.

“It was always at St. Jude that I would be able to accomplish more,” Downing says, “to push the envelope and try to accomplish things that other people couldn’t even dream about.”

St. Jude retains those characteristics today, Downing says.

“I’m energized to move forward,” he says. “We have phenomenal faculty and staff, and we have a support structure that’s unparalleled. Millions of donors across the United States donate funds so that we can do things that impact every child in the United States and every child around the globe. That support allows us to do things that others can’t do and to provide services that other hospitals can’t provide.

“It’s been a great journey,” he says, “but the most exciting time is ahead of us.”

Abridged from Promise, Autumn 2014

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