Who’s On
First or Is That Hwu?



       In what might be the most famous two-man
comedy routine of all time, Bud Abbott and Lou Costello describe a baseball
team with a very strange line-up starting with the first baseman-Who. Thus it
all starts when Costello asks  “Who’s on
first?” and Abbott says yes. And away we go.

       It’s probably best if you watch it:


       For folks of my generation and for that
matter, my parent’s, this routine was woven deep into the DNA of American
comedy. But I think we are about to enter a period when the question sounds the
same but is spelled differently. When it comes to the naming of Dr. Hong’s
successor in Cancer Medicine, I believe Hwu’s on first.

       Patrick Hwu has been the chair of the melanoma
and now the melanoma-sarcoma department for a number of years having come to
Anderson from the National Cancer Institute in 2003. He is a prominent
immunologist and cell therapist adept at developing novel ways to treat highly
resistant forms of cancer like melanoma. From my vantage point, he seems to
have built a reasonable department and his reputation is for being a “good
guy”. I have no reason to doubt Patrick’s popularity. He seems like a nice
enough guy to me.

       However, he has been quite a vocal supporter
of the new President as well and has bought into the entire Moon Shot concept.
Thus he has politically placed himself well to ascend into the hierarchy of MD
Anderson much like the new Chief Medical Officer, Head of Surgery and a host of
clinical department chairs, especially in Cancer Medicine. This may lead to a
very chummy atmosphere, but very insular thinking (true group think?) in
medical oncology as all the appointments of clinical leaders in and out of
medicine seem to be coming from within the institution, always a troubling

One of MD Anderson’s great strengths over the years has been its
ability to attract outsiders with new ideas to the culture of cancer fighting,
even those whose only interest was in laboratory based science. Now it seems
that ONLY the lab sciences can attract outsiders, usually with wads of cash,
and the clinical services seem to be hiring on the cheap. In Cancer Medicine,
where the imminent retirement of Dr. Hong was the worst kept secret in American
oncology, part of the difficulty in identifying candidates for empty chairs in
neuro-oncology, breast medical oncology and sarcoma (Hwu was on first to pick
this up) might have been the fact that perspective candidates would not know
who their boss would be two years into a new job and whether or not promises
made would be kept when there was a new Division Head.

For this reason, I believe that the search, if there is one, for
the new Division Head of Cancer Medicine will be perfunctory and Hwu will be on
first. Much like Hillary Clinton, it’s his to refuse.

The good news here is that I suspect once this occurs, the vacant DoCM
department chairs can be filled, maybe even from outside of Houston. This would
be a welcome change for the clinical leadership under DePinho was become very
limited in its scope and experience beyond 1515. In breeding doesn’t work well
with people or institutions and the result of a lack of influx of outside
talent could be an academic medical version of the opening scenes in
Deliverance with a whole host of banjo players around the tables of power.

The bad news is the unintended consequences among those NOT getting
the DoCM leadership job. Most of the other chairs in the DoCM are either too
far along in their careers and life times for this job, or too new to be ready
for this level of administrative challenge. There is one, however, who is equal
to Dr. Hwu by all measures and possibly has made even more contributions over
his career. That would be the department chair of Leukemia, Hagop Kantarjian.

It is very hard for me to believe that Hagop would not throw his
hat into the ring to succeed Dr. Hong, but his great longevity here (more time
to make adversaries), lesser lab-based accomplishments than Hwu and his
wonderfully prickly nature may make him less acceptable to a DePinho administration
that seems to centralize all objectionable personality traits in the presidency
(or his household) while retaining academic leadership from the cast of the
Brady Bunch.

Just say for me, game on. While I am sure there will be many who
would like the DoCM job, my suspicion is that the camps will line up within. How
they line up, how they persuade the powers that be, and how Dr. DePinho views
the future of Cancer Medicine will critically determine winners and losers.

Yes, I believe Hwu’s on first, but when competition begins, don’t
underestimate the man from Lebanon. I did and look where it got me.

For those of us with a penchant for spectator sports and academia,
this is a beauty. I can’t wait to see how it rolls out, but I am almost certain
that bruised feelings and egos are likely to result (don’t they always) and
that the leadership of Anderson will face a challenge like no other for the
DoCM both directly and indirectly accounts for a huge chunk of the clinical
revenue. These are the guys that order the blood tests and imaging studies that feed
the budgets of everyone else.  Grant
money is tighter than ever. The drug companies are not in the mood for love
either. The next Head of the DoCM will have many challenges. It will be
unlikely that he (or she?) will be able to keep their hands any cleaner than
the prospective retiree did.

Ki was very good at getting others to do his dirty work. Now he can
join his patron, John Mendelsohn, in the Institute for Personalized Wealth and
enjoy the view with the rest of us.

       Tennis, anyone?  

Leonard Zwelling