Mickey

By

Leonard
Zwelling

            He only ever had two names: Dr.
LeMaistre or Mickey. I had to know him for 20 years before I switched from the
first to the second.

            I have written many times about Dr.
LeMaistre. He hired me. He nurtured me. He hired others who also nurtured me, my
career, and my personality. For all this I am incredibly grateful. I love him
for it.

            In case you missed his address to
the faculty at the last convocation, I print it in its entirety as it was
recently sent to me. All I did was edit it into paragraphs as it was delivered
to me in an email in the form he must have used to give the presentation.

            I suggest you read it carefully.
Many times. Especially those of you who aspire to lead anything. This is a
great leader giving you the playbook on how to become one.

Please note that he starts by addressing the leader of the Faculty
Senate first and the current President second. And he ends thanking the
faculty.

            This is not the message of a
confused, arrogant or glib person. This is the message of a great person. And
Mickey is just that. He gets it!

Dr.
Whitman, and Dr. DePinho.

Thank you
for your invitation to address this 2014 Faculty Honors Convocation.

My remarks
will be brief, and not the usual commendations or platitudes. Instead, I will focus
on this faculty’s responsibility to jointly lead, with the administration in
solving problems that threaten excellence in patient care.

All
comprehensive cancer centers are under financial stress caused by unnecessary pharmaceutical
prices and reimbursement policies.

No faculty
and administration is potentially more competent than this one to lead in
changes that benefit the cancer patients.

It is not
my intent today to meddle in M.D. Anderson’s internal affairs. I will focus instead, on the history of
M.D. Anderson, with the purpose of elucidating how our faculty and administration
have always responded, by jointly building successful solutions, in the best interest of
patient care.

The now
great University of Texas M.D. Anderson Cancer Center was borne in stressful
and difficult circumstances for care of cancer patients.

It is my
belief that the lessons learned from how this institution was created and how
it rose to its leadership position in cancer care have relevance to problems
today.

Let me
start with the amazing story of how this now great institution began.

The story
of the creation of The University of Texas M.D. Anderson Cancer Center begins with empathy and compassion for
cancer patients, by just four men.

These four
men first acquired the resources to achieve their goal upon the death of their
close friend, in 1939, Monroe Dunaway Anderson.

Mr.
Anderson headed the world’s largest cotton company, headquartered here in
Houston. He and his brother-in-law started the venture in 1904 with just $9,000.
His nephew died from leukemia.

In 1936, in
large part to avoid taxation, and upon the counsel of his good friends and
lawyers, Mr. Anderson created a charitable foundation with the sum of $300,000.
He served on the Foundation’s initial Board.

Three years
later, Mr. Anderson died from complications of a stroke, and his estate
bequeathed to the foundation, $21 million dollars (which today would be some
$350 million). The terms of the estate’s massive gift to the Foundation were simple
–Anderson requested only that his three close friends manage the M.D. Anderson
Foundation. There were two lawyers and a bank president – Colonel William Bates,
John Freeman, and Horace Wilkins
(who became a trustee to fill Anderson’s
seat).

You may be
surprised to learn that the charter of Anderson’s Foundation did not specify how they should use the
money. Wisely, the
Foundation’s Trustees turned to Dr. Ernst Bertner for advice. Dr. Bertner was a prominent Houston
surgeon and gynecologist, and was well known to the Trustees because of
his care for cancer patients, despite inadequate facilities
and treatment
options.

In 1939,
other events transpired that were necessary to solve the problem of how to
treat Texas’ cancer patients.

Under
political pressure from The Women’s Army Against Cancer, a precursor to the
American Cancer Society, the Texas Legislature reluctantly created “on paper,” a state cancer
hospital earmarking $500,000–but they did not designate its location.

The
Anderson Trustees and Dr. Bertner immediately seized upon this opportunity, and
quickly moved to accomplish three achievements in the following sequence:

First, the
Foundation offered to match – dollar-for- dollar – the State’s appropriation,
provided that the new cancer hospital would be located in Houston, and be named for
Monroe Dunaway Anderson.

Second, 134
acres of mosquito-infested forest was purchased by the Foundation to create the
Texas Medical Center. The Trustees envisioned that “our” new hospital would be the first
step in their plan to create the TMC.

And third,
The Trustees made known to the State, that the new “State Hospital” should be
an academic institution.

In fact,
M.D. Anderson was the first comprehensive cancer hospital to be associated with
a major University, as an independent, freestanding unit.

In 1942,
the Regents of The University of Texas System appointed Dr. Bertner, a former chief of staff at both Hermann
Hospital, and Jeff Davis Hospital,
the Acting Director of the new hospital.

Soon an
estate in downtown Houston became the new “campus”. There was an empty carriage-house, which
became the office, stables which became research laboratories, 12 surplus WWII
Army barracks were procured and maneuvered onto the estate to become patient
clinics. With the addition of 22 leased hospital beds at Hermann Hospital, the
dream became reality.

A small
faculty of physicians and scientists was recruited from U.T. Medical Branch in
Galveston, (where Dr. Bertner had completed medical school), and cancer
patients finally had a medical home.

In 1946,
Dr. Bertner persuaded Dr. Randolph Lee Clark, a native Texan to become the
President of what was to become U.T. M.D. Anderson Cancer Center. The institution did not move to its
present location until 1954 when the new M.D. Anderson buildings were ready. Dr. Clark, a widely recognized cancer
surgeon, initially concentrated on recruiting an excellent surgical faculty,
then set upon acquiring all the basic and clinical scientists and clinicians to form the bedrock of a unique academic
cancer center in the U.T. System.

From the
onset, all efforts, whether administrative, clinical, or research, were focused
upon eventually developing excellence in research-driven cancer care.

When I
arrived in 1978, the Institution was well known to me through a 13-year
friendship with Dr. Clark, and frequent visits to Houston as Vice- Chancellor
for Health Affairs and as Chancellor, of the U.T. System.

In an
ever-evolving Institution, changes need to be made constantly, and I wanted to
make them with Dr. Clark present. I asked Dr. Clark to stay in his office
for my first year, and I housed my office in the old Prudential Building (now
long gone) while I got to know the faculty and the institution.

My first
year heading M.D. Anderson was spent evaluating Basic Research and raising
funds. I visited the basic
research scientists and asked just two questions:

“What Are
You Doing?” and

“What Did
You Come Here To Do?” Their answers showed their work was driven by whoever provided the funds,
instead of by their own scientific passion, or by needed advances in patient
care. It was clear to me
that changes had to me made, in our support of Basic Science I addressed this need, to the Physician’s
Referral Service (PRS), with the following commitment:

“I will, as
Dr. Clark did, chair your meetings.

“But, I
will delegate to you all the responsibility, for how your earnings will be
spent
as long as it is in the best interest of all the patients and all the
faculty of M.D. Anderson.

“I will
reserve the right to veto any expenditure, that does not meet that criterion”.

One of
PRS’s first actions was to provide support for Basic Science, in order to
achieve a focus on research- driven cancer care, and expedite bench-to-bedside
applications. For the next 17 years, I never had to use the veto power, a tribute to
the clinical oncologist’s superb management of the PRS.

Dr. Fred
Becker was a Faculty Member and a Professor of Pathology, who became VP for
Research. Dr. Becker would typically come to my office, close the door, and tell
me all the things that I didn’t want to hear, but which were necessary to solve
problems. Together with other Faculty Leaders, we launched a high-level
recruitment drive for Basic and Clinical Scientists and Clinicians.

On the
clinical side, Dr. Fred “Bud” Conrad, retired from the U.S. Air Force, joined
Anderson’s clinical oncology faculty. At my request, Dr. Conrad spent his first
year working in all our clinics, to assess how we could improve patient care. Week one of this assignment produced an
alarming report about Station 19 where patients received their chemotherapy. It
was a wide-open room with only scant drapes in-between beds, and when one
patient vomited, all the rest quickly joined in. From this running start, Dr. Conrad
accepted the challenge to build a new type of clinic, which we now call a
Multi-Disciplinary Clinic, and he became VP for Patient Care. The first Model Clinic created was with
Dr.
Andy von Eschenbach and
Dr. Chris Logothetis, for urogenital cancers.

The far
more efficient multidisciplinary clinics, with fast coordination of support
from pathology, radiotherapy, radiology, etc., became our standard for
outpatient care. A vast number of Positive Changes at M.D. Anderson have been – Dreamed
Of and Driven By – Our Faculty with their Input and their Leadership. Time will not allow proper recognition of
each one of these leaders, including many of you here in this audience, who
have led these advances.

The
examples thus far mentioned, are characteristic of all that followed, with the
exception of one more:

When
Managed Care spread like wildfire and threatened the fiscal integrity of M.D.
Anderson, then CFO David Bachrach proposed a unique way to begin to address the
issue. His model was to
recruit volunteers from all areas of clinical care – oncologists, nurses, and
clinical administrative staff –to address the looming fiscal changes of Managed
Care by reducing our costs. 
The volunteers
needed immediate, across-the-board, fiscal training, to quickly master the
tenets of an MBA-education. Rice University’s Jones Graduate School
of Business was hired. On Friday nights and Saturdays, Rice professors taught a
total of 81 M.D. Anderson volunteers, who went on to complete an extremely
vigorous curriculum. The program produced highly competent graduates who were organized
into teams and dispersed throughout Anderson. They reported finding several dozen
excess personnel and recommended an early retirement package be offered. All but one physician took our generous
package – he preferred to begin a new career at Baylor! They recommended elimination of
non-productive bureaucratic practices, and streamlined efficiency in clinic
operation. Their analysis laid the predicate for the administration’s reduction
in costs while simultaneously increasing efficiency in patient care.

In Summary,

The
University of Texas M.D. Anderson Cancer Center’s incremental development over
73 years has never wavered from the primary passion forged by Dr. Bertner. It remains today, the obligation of every
faculty member, nurse, employee, and administrator, to place the patient’s
needs first, even in stressful financial times, such as we now have. We must not waver from this obligation.

The key to
maintaining our obligation to the patient, is simple:

We must
place at highest priority, preservation of our Oncologists’ time.

You must be
allowed to perform
 an in-depth diagnosis 
and personalized treatment of your
patient.

Your time
must be free of excess administrative chores that can be performed by others.

And you
must have the help you need to do so.

You must
have time to apply to your patients – all the benefits derived from our
research-driven cancer center.

The driving force of this great institution is, and has always been,
our faculty, and you, the faculty,
must assist the administration in solving the
current problems. You are the world’s outstanding faculty in oncology, numbering more
than 1600, with a Faculty Senate
and Term Tenure,
both necessary for your advice
to be heard
and for you to assert your academic leadership in solving this
Institution’s problems. All of you, who we honor here today,
are excellent examples of our
insistence upon preeminence in cancer care.

Among
you,
I would like to say to Dr. James Allison, that you were wise to once leave M.D.
Anderson, when our young institution could not provide you the time, the
resources, and the environment to permit you to fully develop your career.

We must
never allow this to happen again to any Faculty Member.

Welcome
home, Jim.
 We have grown to more closely match your talents.

And to my
good friend, Dr. Hagop Kantarjian, It is my honor to witness you receive the
LeMaistre Award today. Your crusade goes far beyond your responsibilities as a renowned
oncologist. When you say that the high prices of cancer drugs are “unreasonable, unsustainable,
and immoral” you speak the whole truth and nothing but the truth.

I second
your clarion call –
and I join you in demanding that the United States Federal
Government immediately begin binding negotiations with the pharmaceutical
manufacturers to bring pricing in line
with other industrial nations.

Our
patients and our Institution are suffering because of this “financial toxicity”
–
and it must end now.

In closing, I offer my congratulations to today’s
Awardees and I wish them Godspeed in their future contributions
to Making
Cancer History.

Thank you
for the honor of addressing this Faculty. I respect and revere you as the driving force
which built
The
University of Texas M.D. Anderson Cancer Center
and you will continue to do so.

Leonard Zwelling