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Serious efforts began in 1982 to install a Gamma Knife at Presbyterian University Hospital. I then met with the CEO of the hospital, Dan Stickler, who suggested that I begin to marshal support from others in both the fields of neurosurgery and radiation oncology. This led to one of the most classic letters ever written about technical innovation. Stickler called me into his office to see a letter written by the radiation oncologist in charge of Magee Women’s Hospital, where much female cancer care was performed. The letter was brief, but I remember it word for word: “Dear Mr. Stickler, I do not know what the Gamma Knife is, but I am against it.” Additional efforts were forthcoming in order to persevere after this taste of anti-innovation. In truth the number of publications were limited, since a total of less than 1,000 patients had been treated by 1982 at any of the initial four sites. Seeking the highest level of medical evidence in today’s world – often used by insurance companies to deny coverage – regularly kills the innovation developments that facilitate medical progress.

The estimated cost of the Gamma Knife in 1982 was USD 1 million based on my discussions with Larry Leksell. Working with the hospital development office, we obtained approximately half of the cost by foundation grants from the Pittsburgh McCune Foundation as well as a major Pittsburgh benefactor whose husband had been a leader of the Pittsburgh steel industry (then rapidly winding down).