past midnight in Aukland so here you go!!! 
Happy New Year.

Vuja De



         If Déjà vu is the feeling that you have
been there before, Vuja De is knowing damned well that you have—many times. Two
articles in the newspapers today, December 31, gave me a strong sense of Vuja
De for they bring up two of my favorite bloggable issues: leadership and
genomics in clinical medicine.

         As readers know, the greatest surprise
I had during my year in Washington was my association with Senator Tom Coburn
of Oklahoma. The senator is one of the most conservative members of the
Congress and a physician who gained fame as “Dr. No” for his use of his
filibuster power to block bills he thought bad for the country, despite some of
them having broad support. It seemed unlikely to me that I would ever come to
agree with him. As usual during my year in DC, I was wrong.

         Senator Coburn was and is my favorite
senator for not only is he a member of the club to which I am most proud to
belong, the docs, but he was always prepared, always clear-thinking and
continues to be a true thought leader among those of us who believe the
American people deserve a Congress better than the one it currently has.

         Senator Coburn wrote a brilliant op-ed
piece in today’s Wall Street Journal that skewers the entire American
government for mushy thinking and lack luster performance. In the middle of his
piece he uses these words:

         “But saying something is true doesn’t
make it so. When a misleading message ultimately clashes with reality, the
result is dissonance and conflict..deception is destructive. Without truth
there can be no trust. Without trust there can be no consent. And without
consent we invite paralysis, if not chaos”.

         I don’t think I could describe the
current state of the American government or the mood at the number one cancer
hospital in America any better than that.

         My understanding is that the latest
troop of DePinho underlings is trying to understand the faculty and staff morale
problem that has haunted Anderson for several years stretching back to a time
that pre-dates Dr. DePinho’s arrival. Just because Austin discovered the
problem in September, doesn’t mean it was new. It isn’t. The “new” morale
problem is no newer or truer than is Making Cancer History or blaming the
Anderson financial downturn of 2008 on a hurricane.

Just as mistrust in government goes all the way back to
Vietnam, Watergate, Iran Contra, Monica and WMDs, the mistrust in the MD
Anderson leadership goes back to Enron, ImClone, rampant conflict of interest,
Aveo, CPRIT and IACS. If the current leaders of Congress and of MD Anderson
wish to reverse the trend of galloping mistrust, stop the hemorrhaging. Own up
to the errors, paint your vision of the future of administration-faculty
cooperation rather than domination of the latter by the former, work with the
faculty and staff to devise a plan to get from today’s morass to tomorrow’s
clear vision, admit that it will be hard, but that it will be effort well
placed with a worthwhile result for all.

Personally, I cannot imagine this happening on either
Capitol Hill or 1515, but as Senator Coburn points out, at least in Washington,
“If you don’t like the rulers you have, you don’t have to keep them”. I know
most of my readers at Anderson do not believe they have the same power as American voters
do in changing their leaders. I disagree and so do all the great faculty
members who have left Anderson and voted with their feet.

The second article was in today’s NY Times:

A young healthy graduate student at Columbia University,
Kira Piekoff, sent her DNA to three different companies that offered to inform
her of her risk of developing several chronic diseases by analyzing her
putatively normal DNA. All three use SNP technology to calculate this risk.
Each company gave Ms. Piekoff (who authored the article) different and at times even contrary answers as
to her risk of developing several diseases. The article goes on to discuss the
fact that standards have yet to be set for this testing, that the generation of
useful or actionable information using these tests is very limited, that using
these costly tests without the help of a trained professional is ill-advised,
and, as noted ethicist Arthur Caplan is quoted as saying: “If you want to spend
money wisely to protect your health and you have a few hundred dollars (the
cost of these tests), buy a scale, stand on it, and act accordingly”.

Again, this is vuja de to the readers of this blog. Genetic
testing is in its infancy and is at best of limited and highly specific use.
Short of actual sequencing, the utility of the information from these analyses
is quite small, not generalizable and clearly in the realm of research not
standard care. And if that is true for somatic cell DNA, it is only more so for
DNA extracted from the cytologically heterogeneous cancers of actual patients.
The FDA must agree for they have sent 23andMe a warning letter about its
genetic testing.

If there are two more important issues for the Anderson
community to consider next year than its leadership and what constitutes
research and support for it, I cannot think of them. Here we have two examples
of people, Senator (and Dr.) Coburn and Ms. Peikoff, who are fully capable of
clear thinking and clear writing. I advise reading both pieces and thinking for
yourself which is always my suggestion—including about what I write.

If Dr. DePinho really wants to address the morale problem,
he might start by simply acknowledging the depth of the problem, much of which
he inherited, but managed to make even worse. If the world wants to sequence
tumor DNA as a way to “personalize” cancer treatment, at least admit that it is
an experiment and don’t expect insurers or MD Anderson itself to pay for it.
It’s research. Faculty pay for research with grants and contracts. Patients and
their insurers should not bear this burden and that which MD Anderson supports
should be determined through peer-review not first-come, first-served at Dr.
Hamilton’s doorstep.

If 2014 simply brings some honesty to two challenges facing
the Anderson community—faulty leadership and a lack of clarity on what is
research and how it will be supported–2014 will be a much better year than

Leonard Zwelling