Surrounded: As By


Leonard Zwelling

         It was observed by the famous sage of Washington, DC, Lewis
Black, that the End of the Universe was the corner of Shepherd and West Gray.

at this busy intersection, was one Starbucks across the street from another
Starbucks. In the intervening years it has actually gotten worse. For next to
the Starbucks on the north side of the street and across from the one on the
south side of the street is a Barnes and Noble bookstore in which is located—a Starbucks!
Thus, within about 100 linear yards, are three places to get overpriced burnt
coffee (See Jackie Mason). When you are at the corner, you are engulfed by
Starbucks. They’ve got you surrounded.

         This comes to mind when I see the latest talking heads
commercial for MD Anderson where the “world-class care” is clearly disposable
enough to be disseminated widely in Houston. This is, of course, antithetical
to the notion of world-class anything. There is only one Broadway. There is
only one Golden Gate Bridge. There is only one Eiffel Tower, French Laundry,
and Great Wall. You get my drift. World-class things don’t come in multiples
and cannot be reproduced like a franchised hamburger or even a cup of coffee.

         It is highly unlikely that you will get the same level of
care in MD Anderson Sugarland (let alone MD Anderson, New Jersey) as you would
at 1515 Holcombe. Why not?

         First, world-class academic physicians don’t come to Houston
to work in Katy or Sugarland.

         Second, even the best of the young docs in these outlying
sites cannot bring the depths of experience to patient care that can a Chris
Logothetis, Debbie Kuban, or John Davis for the care of prostate cancer, for
example. That thinking is just not rational.

         If the powers that be at Anderson really want to convince
people that the care they receive at an outlying site is the same as that which
they would receive at 1515, they had better come up with some outcome numbers
to prove it. I personally don’t believe it nor would I refer a patient with a complex
malignancy to one of these secondary units.

         Academic centers are destinations for patients with the most
complex of conditions. Cancer Treatment Centers of America virtually advertises
on this line (and they also identify the talking heads in their commercials as
real doctors like our friend Maurie Markman). The talking heads in the Anderson
commercials could be anyone. They are anonymous. Why take their word on
anything? Would you trust a stranger with advice on your cancer care?
Apparently, the geniuses at Anderson think that you would.

         I am afraid that Anderson has drifted off the tracks. It has
been, and must always be, a destination for those needing its unique services.
As insurers become more picky in reimbursing for highly specialized care (like
genomic analyses), they are going to have to be assured that they are getting
their money’s worth. If you can get the same care in Katy that you can get at
the Mother Ship, why pay premium prices at the Mother Ship? And premium prices
will need to be charged to defray the costs of all those buildings and all
those people in the Good Ship Mendelsohn who generate—not a dollar.

         I don’t get this business model. MD Anderson cannot be
Starbucks and convenience cannot be the selling point for coming to Anderson,
especially given the usual waits at 1515 (lengthy—a friend who is a patient
always brings a large book on his clinic day).

         Holcombe between Fannin 
and Braeswood cannot become for cancer care what the corner of West Gray
and Shepherd is for coffee. Of course, they may start putting your first name
on the side of a cup in a clinic in Katy. If they do—run!

Leonard Zwelling