Academic Bracketology

By

Leonard Zwelling

         It’s March Madness time again. I assume this season has this name because
the fans of over 60 teams will be mad by the end of the month because their
favorite college basketball team is not among the Final Four.

As a graduate of a
university with many Final Four appearances and four national championships
who, when I attended Duke in the late 1960’s, never thought he would live to
see the Blue Devils win even once, this is all gravy. My life dreams about
college basketball were fulfilled in 1991 and three more times since. No
complaints from me.

         That
being said, Sunday evening, the “brackets” came out and all
over the country office pools are forming and bracket predictions are being
completed in a year where it is likely that upsets will be common and even picking
the Final Four will be a challenge for the greatest of hoop mavens.

         At
MD Anderson, bracketology lives. The Division of Cancer Medicine, Division of
Internal Medicine, Department of Biochemistry, a host of clinical department
chairs, and a few vice presidencies are all vacant and awaiting choices. In
this lottery, only one person’s choices matter so the betting is muted.
But it shouldn’t be.  How about a pool for the
first person to correctly fill in the MD Anderson brackets? Dr. DePinho can’t play. Lynda can’t play either.  Conflict of interest.

         The
real question is what principles and strategies are guiding the choices so far?
To date, until the recent announcement about a new chair in Medical Breast
Oncology, most of the clinical vacancies have been filled from the inside. That’s sort of like picking your kid to be your point guard. He may be
great, but how about a little diversity. And while we are on the subject of
diversity, how about a few women and other people of color being included in
the lists distributed to the search committees. I know, I know. What search
committees? We can always dream like I did as a Duke undergrad. (Remember that
4 letter F word—FAIR).

         What
I really want to know is what is the guiding principle in the selection of the
next generation of clinical leadership at MD Anderson?

         For
many years, it was clinical excellence. The leaders of the clinical areas were
all of significant note as deliverers of patient care as well as the
performance of research. This was especially true of those leaders who
developed therapies and diagnostics that altered the care of cancer patients
worldwide. (Just let it be noted that there are several members of the current
faculty who have developed real cancer treatments or diagnostics that are in common clinical use today. Let it also be noted that most, if not all of them, are over 60).

In more recent
years, ability in the lab became more important than it had been previously, and
the “physician-scientists” became the model for academic
leadership among the clinical divisions and departments. This made perfect
sense as it was logical to assume that the major breakthroughs occurring in the
genetic science of cancer would be the source of the cures of tomorrow. It made
sense, but as yet may or may not prove to be true. Empiricism and serendipity
still have contributed more to the treatment of human cancer than molecular
insights. Perseverance and obstinacy also contributed greatly. Cancer is a
formidable foe and pushing back the dark at the bedside is not for the faint
hearted.

         But
with a lab-based surgeon assuming departmental leadership of the phase 1 program
and somewhat inexperienced oncologists taking over other departments, one has
to wonder if the principles guiding the selection of the successors of the
physician-investigators may not be competence or clinical spurs but rather
political expediency and the willingness to push patient volumes in service of
the bottom line.

         Let’s hope that we at least get back to the earlier days of MD Anderson
when the best doc was the leader. After all, as far as I can tell, that’s still why people flock to 1515 from all over the world. Clinical
expertise is still the engine that drives the train that is the number one
place for cancer care in America.

         It
should be for it is very likely that if that is not the case, MD Anderson will
not be there cutting down the nets when Cancer History is really Made.

Leonard Zwelling