The New Head of the
Division of Cancer Medicine


Leonard Zwelling

         I suspect that the MD Anderson community has had its fill of
the Gonzalez-Angulo trial by now. It should end on Monday with some form of
sentencing after the closing arguments of the penalty phase. Regardless of the
ultimate outcome, this will have a lasting effect on the principals and even
some of their colleagues, but the public will move on to the next scandal. I
may never be the same for the sight of my friends giving testimony about their
inaction when the smallest of moves might have saved two lives was
disheartening at least and disgusting at most. The doctors once again did not
acquit themselves very well.

         MD Anderson cannot afford to move on just yet though.

         A fact that was lost in all the commotion surrounding this
trial is that the poisoner and the poisonee were from different departments,
but the same Division, Cancer Medicine. Cancer Medicine is the largest clinical
division at Anderson and is essentially a medical oncology, malignant
hematology, laboratory investigations academic behemoth. The Head of the
Division recently retired after 13 years in his position. It was he who was in
charge when the events that were described in the 248th District
Criminal Court for the past two weeks transpired. His name never came up and he
did not appear. In fact, he disappeared.

         If you believe that what happened among the faculty of the
Division of Cancer Medicine that landed one faculty member in the intensive
care unit and the other in jail, was an isolated instance of consenting adults
ruining one another, personally and professionally, then I guess who was in
charge doesn’t matter.

         I just don’t believe that.

         I believe this crime occurred in the context of an
institution and profession that is in grave danger of alienating the good will
of the patients and their families essential to its longevity.

Anderson, like most of academic medicine, has become consumed by the drive for
money. The leadership of Anderson, and other such places, will do anything for
cash. They will pack clinics with too many patients many of whom will not and
cannot benefit from the time they spend at Anderson. They will drive faculty to
apply for more and more grant dollars and penalize those who are unsuccessful
despite the fact that only about 10% of NIH grant applications receive fundable
scores. They will take large sums from foreign governments with heinous
reputations so they can construct concrete laboratory altars to themselves and
their donors. Their leadership talk about rewarding team work rings false when
all the meaningful rewards from money to tenure are doled out to individuals.
And worst of all, the putative example setters in the Executive Suites and
elsewhere in these organizations behave abominably in both their professional and
personal lives and get away with it because of their position, money or both.
In every way, academic medicine is for sale as Marcia Angell wrote in her
article in the New England Journal of Medicine in 2000.

Heck, even history is for sale as the “moon shot” of the 1960’s is completely misrepresented in a ploy to raise money.

         But, with the retirement of the Head of the Division of
Cancer Medicine who had knowledge of at least some of the events that led to
the trial downtown, there is an opportunity to make a break with the past and
clean up the mess he left. I think that would be a very positive first step.

         To do this will require hiring a special person with special
powers to be the new Head of the Division of Cancer Medicine.

         This person must be an exemplary medical oncologist and
clinical investigator well versed in the current trends in academic oncology as
well as the latest developments in community-based patient care. This person
must know science first-hand, at the bench and have had competitive research
funding and run a research lab. Budget and financial matters cannot be
unfamiliar. The person must be a thoughtful, wise and considerate mentor and a
great listener. And, that person MUST not come from inside MD Anderson. If you
believe as I do, that the prevailing culture at Anderson contributed to the
poisoning of George Blumenschein and the imprisonment of Ana Maria
Gonzalez-Angulo, then a clean break from that culture with the establishment of
new merit-based transparent one with full faculty participation in decision
making and joint governance will be essential.

         That is my suggestion. Without a doubt, it will be ignored.

         To do what I suggest requires no firing or riffing of
anyone. No one has to lose a square foot of laboratory space and no research
programs need be disrupted. All that is needed is one good man—or even better—one
good woman.

Leonard Zwelling