Fakin’ It (and Extra—Ch-ch-ch-ch-ch-changes…)
(With apologies to Simon and Garfunkel and David Bowie)


Leonard Zwelling

         Just when you think it has gotten cold enough that all the
nuts have frozen on the trees, my favorite story of 2013 drops like an apple on
Sir Isaac’s head. The harassing San Diego mayor was not enough. The crack
smoking, alcohol addled Toronto mayor was not enough. Even the knuckleheads of
the Board of Ob-Gyn who want to disown their members for trying to help men in
need and who I wrote about yesterday were not enough. The story of the year is
the signing interpreter at the Mandela funeral who wasn’t. He was fakin’ it.

         Now I don’t know if he just got tired, saw angels or forgot
his meds, but clearly he got awfully close to the President of the United
States without anyone knowing that he wasn’t who he said he was. Why worry
about drones when guys like this can sidle up to the POTUS in front of millions
and translate what the President says into meaningless gibberish that insults
those who cannot hear and who depend upon the signing, as well as calling into
question the competence of those putting on the event with major world leaders
that close to a fraud.

         But before we designate this a “one off” event, let’s
consider how much fraud we have heard about of late and seem to shrug off as
“that’s the way it is”.

         Exhibit A has got to be Bernie Madoff, of course. He kept
telling people, mostly wealthy ones, what they wanted to hear as he built a
Ponzi scheme that most analysts understood as soon as they bothered to look. I
guess no one looked.

         Then there is the recent declaration by those investigating
the misbehavior at CPRIT that only Jerry Cobbs, the CPRIT 1, did anything
worthy of criminal prosecution. Yet, supposedly, he was indicted for
misinforming the board about the vetting that had taken place over the Peloton
grant. What about the larger MD Anderson grant that was not reviewed at
Anderson at all? Who perpetrated the idea that this was proper? After all, it
was that MD Anderson grant that caused Dr. Gilman to quit, the various review
boards to dissolve and CPRIT to go into the deep freeze when it came to
awarding grants. I guess no one is responsible for that.

         Then, of course, there’s my favorite fraud of all—that we
are about to cure cancer (aka Making Cancer
History). This is the one I only wish was not a fraud but this is the one where
the fraud is clearly visible to anyone willing to look. I don’t care if it is
President Nixon in 1971 launching the War on Cancer (even longer than Afghanistan), Andy von Eschenbach when he led the NCI or Dr. DePinho
and his Moon Shots, it is rather evident that the more we examine the
complexity of the cancer problem, the more that complexity seems to grow. The
good news is that may give us newer in-roads to fight the good fight against
the disease, but it certainly makes the struggle more daunting.

         It is obvious to any medical oncologist that cancer is a
systemic disease that is likely caused by the failure of several homeostatic
systems from the immunologic to the vascular to the bone marrow to genetic to
the local factors that allow malignant transformation to take hold, grow and
spread. Cancer is a very complex misfiring of bodily maintenance mechanisms and
reducing its solution to anything less than the realization that the nature of
cancer is based on the nature of life itself is a fraud.

         Fraud is everywhere. The reason Medicare spends under 5% on
overhead and the major private insurers much more is because Medicare pays
first and investigates the legitimacy of the claim second, if ever. The private
insurers and their stockholders cannot operate with the luxury of borrowing
money from abroad as the federal government can. And that’s why there is so
much Medicare fraud. There can be.

         I had a Social Studies teacher in high school named Ms.
Guido. She said, “that it’s not that I think you’ll cheat. I know damned well
you will”. No take home exams in that class.

         It is the nature of humans that some of them will try to
perpetrate frauds on some others. The phantom Funeral Signer (not to be
confused with the Wedding Singer) is just the latest to get away with it in
public, almost. But for the medical community to over-promise as a means to
separate the rich from their money for research purposes is really pretty much
like a Madoff maneuver. Besides, as they taught me on Capitol Hill, if you
don’t lie, you don’t have to remember what you said.

         Let’s refocus on Making Cancer History not Faking Cancer

EXTRA: Ch-ch-ch-ch-ch-changes

Several former colleagues
forwarded me the email announcement of the changes at the top of MD Anderson
with Tom Burke’s long overdue lateral slide and the resurrection of Tom
Buchholz to the EVP/PIC job overseeing the hospitals and clinics. The latter is
a bit disorienting given Dr. B’s discipline, radiotherapy, has little if any in-patient
service, but why quibble, right? I guess you become the CMO when you are
first-runner up for the Provost’s job. Go figure? I wonder what happened to
Miss Congeniality.

I also see that Mr. Coleman
has accepted a new job in Wisconsin proving that he too can hear Kenny Rogers
and knows when to fold ‘em. Gerard is not a mural dyslexic.

Finally, just to give
everyone a smile (or perhaps a laugh), after 10 weeks here at Legacy, I learned that the CMO,
my boss, is moving on to greener pastures back in industry from whence he came
and I have been asked to step in for him while they conduct a nationwide search
for the new CMO. No, I am not a candidate, nor should I be. I may be tan,
rested and ready, but overseeing patient care should be no more than a
temporary activity for me.

It just struck me as odd that
our relatively small organization (about $50M annual budget and 500 employees),
which is orders of magnitude smaller than MD Anderson ($3.3B+ and 19,000
employees) chose to do a nation wide search for a new CMO yet MD Anderson,
where the CMO oversees the activities of the most crucial of MD Anderson’s
activities, patient care, can be appointed on a presidential whim and with some
serious questions about his experience for such a role.

My take on that one is that
Dr. DePinho has still learned nothing about how to manage, lead, make decisions
or use the experience of those around him to further his goals.

I think Dr. DePinho should borrow Mr. Coleman’s Kenny Rogers records.

Leonard Zwelling