Metaphors: MD Anderson as
the United States

By

Leonard Zwelling

         In a particularly insightful column in the May 13 NY Times, Frank Bruni discusses what he
believes is the real problem facing the United States and which will largely
determine who the next President will be.

Apparently,
for some time now, the NBC News/Wall
Street Journal
poll on whether or not the US is on the right track or wrong
track has leaned heavily on the “wrong” side. The country has been going
through a crisis of confidence for years now. I would date it all the way back
to November 22, 1963 but others choose Vietnam, Watergate or other such tipping
points of the 60’s and 70’s or as recently as 9/11, the Iraq War or the Wall Street fiasco of 2008. What is worse, we decided to assuage our anxiety with sex, drugs and rock and roll rather than face the problem and fix it.

         Bruni’s point is that the candidate who can best articulate
the problem and the fix of American drift, both abroad (war after war without
end) and at home (stagnant growth, falling buying power and the shrinking
middle class) will be the next President. That person will get yet another
crack at repairing the deep wound in the American soul that seems not to have
been fully whole since the end of WWII.

         I fully agree with this analysis and what’s more believe this applies to MD Anderson as well. The cancer center has become a metaphor for the United States.

         The Clark and LeMaistre years were the WWII of MD Anderson.
It seemed as if Anderson could do no wrong and was continually hiring
excellence to fight cancer in the lab and in the clinic and doing so as a team
of happy warriors. 

         John Mendelsohn was brought to Anderson to boost its bona fides as a true research-oriented
cancer center at the dawn of the personalized medicine/cancer genetics age.
Unfortunately, things got off track 5 years into Mendelsohn’s run. Instead of
stepping up and fixing the untoward after effects of Enron and ImClone, the
Board of Regents chose to ignore the largest corporate collapse in Houston’s
history and one of the great screw ups in the annals of cancer drug
development, both of which involved the President of the flag ship cancer
center of the UT System. Dr. Mendelsohn was also caught up in a conflict of interest issue involving 195 Anderson patients who received the drug he developed from the company in which he had an interest without having any of this disclosed to the patients. The Regents left Dr. Mendelsohn in place for another 10
years. What had once been a drive for better science became one for bigger
buildings. The member of the National Academy that John so assiduously pursued
never came to Anderson. The financial downturn on Wall Street impacted Anderson during his watch. Instead of preparing for a financial downturn, the leadership of Anderson oversaw the fixed costs stretched to the breaking point while the institution and its financial guides tried to live on
investment income. The clinicians saved the day, but then, of course, came Ron.

         And here we are, a cancer center once unequalled, now a pale
shadow of its former self having regressed to the mean of all cancer centers with lack luster leadership and an addiction to money
that no amount of rehab can fix. No, no no!

         I don’t know what the solution is to restore the country’s
confidence in itself or the world’s confidence in the United States. But I do
know what needs to be done on Holcombe and, as Deuteronomy 30:11 says:

“For this
commandment that I command you today is not too hard for you, neither is it far
off.”

         We can do this
thing to correct the past 15 years of misguided choices.

         We need to get
back to the future. Reemphasize clinical care and clinical research. Take
patients we can help or who can help us at 1515 and send the rest to the
regional centers. Stop overwhelming the clinical faculty members with work so
they cannot think. Shrink the work force in the TMC to reduce the fixed cost
and stop the need for huge revenue generation. Take the faculty off the salary on
grants nonsense and support those deemed worthy of being hired as faculty. Update the information systems and put the doctors back in charge of all aspects of
patient care—even nursing.

         This is not rocket
science. It may take rocket science to fix the US. It will not necessitate that
much to fix MD Anderson. But:

         We need a vision
of where we are going

         We need a plan to
get there.

         We need to accept
that it will not be easy.

         We already know it
will be worth it.

Leonard Zwelling