Steven Patierno: A Champion For the Underserved

As a boy growing up in Schenectady, New York, Steven Patierno, PhD, could often be found out in the woods performing surgery on frogs, when he wasn’t playing sandlot soccer or a local, slightly more “aggressive” version of capture the flag.

“I always knew I wanted to be a scientist, even before I knew what a scientist was,” shared the deputy director of Duke Cancer Institute.

As a teen, he was into marine biology and gradually took up scuba diving — even volunteering with the Woodshole Oceanographic Institute following whales transiting Nantucket Sound.

Once he entered college in the mid 1970s, his scientific interests shifted.

“I became fascinated by how drugs worked in the brain, the science of neuropharmacology,” said Patierno, who received his Bachelor of Science degree in Pharmacy at the University of Connecticut in Storrs, Connecticut.

His first-generation Italian parents expected that after their son — the first in his family to go to college — earned his degree, he’d come home and work in a pharmacy like his clean-cut, tie-wearing classmates.

“They thought I’d be the guy in the short white coat behind the counter at CVS,” laughed Patierno. But the self-described “misfit” at pharmacy school, “a rebellious longhair with an earring” whose side hustle was playing keyboard and guitar in a band, “never had any desire to be a pharmacist.” The pharmacy-oriented faculty of the school were also “concerned” – until the Dean introduced him to the research faculty.  “It opened up another world,” he shared.

Patierno felt most at home in the lab where more people looked like him and thought like him; “curious and interesting people,” he said, “who were interested in making discoveries and moving science forward, not just owning a drugstore.”

After graduation and some time off to think about what was next, he would leave the northeast for the University of Texas Health Science Center in Houston to pursue his PhD in neuro-pharmacology. 

Transformation

The Duke Cancer Institute's Patierno/George/Freedman lab is led by Steven Patierno, PhD, Jennifer Freedman, PhD, and Daniel George, MD.The Duke Cancer Institute's Patierno/George/Freedman lab is led by Steven Patierno, PhD, Jennifer Freedman, PhD, and Daniel George, MD.Patierno, at 24 years old, was at the end of his first year at the Graduate School of Biomedical Science, when he decided to attend a highly advertised seminar across the street at Baylor University.  

He remembers the transformative moment as if it were yesterday. It was 1982.

“I went over to this massive lecture hall and up in the front were what we used to call the “starched white coats” with their suits and ties and grey hair all coiffed — the senior physicians and scientists who ran the place,” recalled Patierno, drawing a contrast with his chosen “uniform” of the day — torn jeans, clogs, and a Grateful Dead shirt.

He continued: “They were raving about this new technology that was going to transform the world. Finally they called Richard Palmiter to the stage. He’s got a gray ponytail down to the center of his rear end and he’s wearing jeans and a rock-n-roll t-shirt, like me. I still remember it to this day. He gets up and ambles over to the microphone and delivers this mind-blowing lecture.  By the end, I looked at him and decided then and there, That’s what I want to do.”

Palmiter and his research partner Ralph Brinster, VMD, PhD, Patierno explained, had just produced the first “transgenic” mice expressing cloned human cancer genes. He was inspired.

After chatting with Palmiter after the lecture, he walked straight to the department chair’s office and requested to change his focus from to neuro to cancer pharmacology.

“He was mad, mad, mad at me,” said Patierno.

A Vision

Patierno wouldn’t accept the directorship, however, without support for his expansive and expensive vision to address the “shocking health disparities” he’d witnessed in Washington D.C. as a volunteer on weekends ministering to the poor, the homeless, drug addicts and HIV patients.

Half the patients walking through the GW Cancer Center doors were from the impoverished quadrants of the city, where there were very few available health services.

“Like most cancer centers, we were functioning as an ivory tower, expecting the patients to come to us and not really engaging with them in their communities,” he said.

To his surprise, he got the job with the “startup package” for his vision, which included deploying a mammography van, conducting prostate cancer screenings in the community, conducting a neighborhood-by-neighborhood cancer education campaign, encouraging more minorities to participate in clinical trials, and eventually collaborating with the DC city government to turn an NCI-funded patient navigation research program (which connected patients with five major area cancer centers and multiple clinics and advocacy organizations) into a giant cancer safety net for the underserved.

Meanwhile, Patierno’s lab had begun to uncover evidence that even after removing the social and structural determinants that contribute to cancer disparities, there was still a mortality difference between African Americans and Caucasians, particularly as it relates to prostate and breast cancer.

With supplemental funding from the NCI, he and his collaborator Norman Lee, PhD, began looking into the biological underpinnings — the genomics of cancer disparities — to back up their theory. The early results were intriguing enough for Patierno to turn over his carcinogenesis grants to young faculty he had mentored; steering his entire lab into studying the biology of cancer disparities.