The Real MD Anderson: It’s Not About The Money


Leonard Zwelling

I arrived in Houston a reluctant recruit, following my wife to her dream job at MD Anderson. I soon learned I had also landed a dream job of my own.

I was recruited to do translational research, biochemistry with clinical relevance. My Division Head, Dr. Irwin Krakoff, had been brought to Houston to heal a problem in academic credibility. The medical oncology leadership at MD Anderson there before him was daring and innovative, but somewhat outside the mainstream of acceptable research practice with regard to the manner in which it managed clinical research—trials with cancer patients. Dr. Krakoff was recruited to more align MD Anderson with the standards of the day while still maintaining modern innovation. That included the building of a large laboratory component to the research within the clinical area. I was part of that laboratory research component.

What I found when I got here in 1984 was a combination of cutting-edge ideas with the most primitive of infrastructures to support those ideas. We attempted to change what was needed while maintaining what was so uniquely good. I think we did pretty well under Dr. LeMaistre’s leadership.

Things changed in the mid-1990s. The Clintons were in the White House threatening to shake-up American medicine and the leadership at Anderson was concerned that the revenue stream coming from patient care that supported most of the activity in research and education would be negatively affected by the proposals in Washington should they become law. It was then that a fateful decision was made.

Up until that time, every patient coming to MD Anderson had to be referred by a physician. Every Texan needing the care of Anderson and referred to Anderson would get that care regardless of his or her ability to pay for it—if he or she could get referred to Anderson. Then the leadership of MD Anderson got then-Governor Bush to lift the referral mandate. Patients could refer themselves to MD Anderson. Then the Clinton plan that threatened to curtail the revenue stream of all hospitals failed. MD Anderson was suddenly swimming in money.

In the mid-1990s, a new president came to Anderson with big plans to bolster the science being done there and to commercialize the discoveries made in the name of the people of Texas using federal government money acquired via NIH grants. Many more employees were hired and buildings erected.

In 2011 the game plan was taken up a notch with new investments in basic and applied research and a greater emphasis on commercialization. Now what was once both a profitable and benevolent institution had grown to a 21,000-person behemoth with a $111,000,000 deficit through the first three months of the current fiscal year. No new cures have emanated from the Moon Shot program as were promised five years ago. Morale among the faculty and staff is at an all-time low and the loss of critical talent has reached an all-time high. What happened?

In effect, MD Anderson and those in Austin charged with overseeing its well-being took their eyes off the ball. MD Anderson is not about money. Its core values are Discovery, Caring and Integrity. The institution has lost track of those core values in the press to cash in and to grow for growth’s sake. MD Anderson is indeed big. But is it the quality place it was when I got there?

If MD Anderson is to return to its previous leadership role, and I don’t mean in some trumped up poll in US News and World Report, it will require a new vision from new leaders. MD Anderson needs to reclaim its core values. Here’s how.

Instead of another string of presidential appointments at the executive level there ought to be only three vice presidents; one for Caring who ought to be a clinician or a nurse with expertise in oncology; one for discovery who ought to be a scientist familiar with both cancer research and its regulation; and one for integrity who should be someone with expertise in BOTH law and ethics as well as shared governance with the faculty and general civility.

The president himself or, better yet, herself, ought to be someone for whom those core values have resonance and be someone from MD Anderson’s recent past who embodied those core values as measured by her behaviors and accomplishments.

If these small but major changes were made, MD Anderson could reclaim its past glory. If not, I fear it will regress to the mean of mediocrity, not because of active bad decisions, but because of incompetent neglect.

There is still time, but it is not forever. There is more competition than ever in Houston, Texas and the country for exemplary cancer care. MD Anderson can rise again to the top. All it needs to do is remember and embody its core values. But it must do so expeditiously.

(This op-ed was rejected by the Houston Chronicle as “not meeting its needs.” I beg to differ.)

Leonard Zwelling