The Mourning After

By  Leonard
Zwelling

            It’s
beginning to feel like Armageddon for surely this must be the end of life as we
know it at MD Anderson.

            The
large salaries and furniture budgets in IACS clearly indicate that there is no
longer one kind of MD Anderson employee and/or faculty member. There are at
least two buckets in which all employees fall and you may well be better off in
the IACS bucket.

            Less
and less of the clinical operations are under the control of the clinicians.
While a Division Head still runs faculty activities, nursing, staffing, clerks,
administrators, billers, coders and finance people in any clinic are not even
dotted line reporting to faculty. No one is quite sure who is controlling the
front door or what the desired rules of entry are. Perhaps if we had a
strategy…..

            The
infrastructure supporting research at Anderson once occupied a leading position
in academia as a founding member of the nationwide network that implemented
some coherence to conflict-of-interest rules to being a frequent invitee to
national discussions concerning the computerization of clinical research. I
doubt that is the case now. The clinical research infrastructure is not even
certified by a national oversight and quality assurance group like the
Association for Accreditation of Human Research Protection Programs.

            Protocols,
grants and contracts, not to mention MTAs, were pushed through the approval
process with the unique cognizance that these were essential to the research
and patient care at Anderson. That’s gone and replaced by a rapacious drive for
intellectual property rights including reach through terms for the IP of others
that are inappropriate. This delays reaching agreement if it even allows it to
occur at all.

            But
surely the most painful disappearance is common civility and decency in our
everyday interactions with each other. I have been a faculty member here for
almost 29 years. You might think that my Division Head whose calls I always
took as a VP or the Provost who I once appointed to be an IRB Vice Chair might
want to discuss my non-renewal of tenure with me. You know, just out of common
courtesy. Nope. I got the same form letter as everyone else.

            Let
me be clear, I am not debating the decision to not renew my tenure. The PTC
made the right call in not doing so given the set-up they were given of me
having had only a year to re-develop a research program after a year in
Washington on sabbatical and two years doing some heavy administrative lifting
at Smithville and the Pharmaceutical Development Center at the request of
senior leadership. I was switched to the research track then (September 2011)
and had no chance of ever passing muster in a year. I did request a two-year
extension for the two years of reluctant administrative service I was asked to
perform (I even chaired the IACUC for 3 years). Nope. I was just offered the possibility of an extra year if I agreed
to stop blogging and hold off writing my book. Thanks but no thanks.

            So Friday, June 7, when I was having lunch with a senior clinical faculty
member who was venting his own sense of sorrow and mourning to me, I understood
exactly what he meant.

            For
those of you who feel like something has died inside and you cannot put your
finger on it, allow me to propose that you consider the possibility that you
are in mourning for a good friend—MD Anderson.

            We
may be able to get her back, but it will take CPR. But as in all complex
issues, medical or otherwise, first you have to recognize the problem, then you
attempt to create a solution. Even Jack Kennedy knew when he proposed the first
Moon Shot that he not only wanted to get men on the moon. he wanted to get them
back. You need to see the whole problem to solve it and admit, as in Apollo 13,
you may have to learn along the way.