The Criticality of Inflection Points and the Need for First Followers

The Criticality of Inflection Points and the Need for First


Leonard Zwelling

is only in retrospect that great historical events can be appreciated. History
is indeed one damned thing after another, but some of those things are more
important than others. There have been three such critical points in my 29
years at Anderson and we are heading for a fourth.

first occurred when Dr. LeMaistre (President 2 of 4) decided that MD Anderson
would make the move from what was primarily a cancer care delivery system
(Hospital and Tumor Institute) to an academic institution (Cancer Center). This
phase began with Fred Becker and Garth Nicholson and peaked around 1983-1984
with the coming of Fidler, Kripke. Lennarz, Krakoff, Hong, Balch, Levin and
many others. I was fortunate to be part of this inflection point when Irv
Krakoff allowed me to be what I had been at the NCI, a lab-based physician
whose major contribution was molecular pharmacology not patient care.

second occurred partly as a reaction to the threat of managed care with the
concern that the Clinton Health Care Plan would change the face of medicine
forever in America. Prior to the mid-1990’s every patient coming to Anderson
had to be referred by another physician. Obviously, our relationships with
these referring docs had to be cordial and non-competitive. This also de facto
limited our growth potential.

a stroke of Governor George W. Bush’s pen that all changed. Now it was Katy bar
the door for patients from all over the world could come to 1515 Holcombe (not
6723 Bertner) without a referral. Texas’s Cancer Center was changing quickly to
become a destination for wealthy cancer patients from all over. When managed
care passed over Texas like the Angel of Death over the houses of the Jews in
Egypt, we were left holding the bag. Bags actually. Full of money. And, like
Lawrence of Arabia after killing the man he saved from the desert, we
discovered we liked it.

third great inflection followed as it had to. We had grown and grown and John
Mendelsohn (3 of 4) did not come to Houston to shrink us. He went through the
land that had been acquired for the next 20 years in just 5 building research
building after research building, taking on fixed costs in edifices and
personnel and expanding like the American waist line. MD Anderson had become a
corporate behemoth with budgets going from millions to billions and pressing on
20,000 employees. Were we growing into Schwarzenegger or Pickwick?

in three great leaps, we went from a somewhat small deliverer of care in a
single location dependent on referrals from physicians, mainly in Texas, to a
corporate goliath, the second largest employer in Houston and the number one
place for cancer care in the country, if not the world. We had members of the
National Academy of Sciences (Lennarz was first, not DePinho), and the
Institute of Medicine. We were a real force in clinical, population-based and
basic cancer research. We had taken on all the good and bad of corporate
America from large donations to huge buildings to scandal and greed. And all
was not good.

each instance, a leader, usually the President, established a large scale
change and persuaded those around him to follow. None of this would have been
possible had the faculty, staff, executives and their supporters in Austin not
backed the direction taken by the leader at the inflection point.

our fourth President, we are rapidly moving to another such moment in time. He
has established an institute (IACS) to turn research into a revenue stream, a
major change in our culture. Such entities are usually known as drug companies.
And IACS is a drug company within the larger academic deliverer of cancer care.
Will this leadership inflection point work? He has spent a fortune already, but
other than bought followers he seems to have none. In this non-democratic system
of corporate governance, does the existence of voluntary followers even matter?

believe that it does.

exhibit A, I give you a TED talk about leadership (link below). It was first
shown to me by a friend who is a strategic planning facilitator.

show it to make two points.

no one is a leader without a follower and the most important follower is the
first follower with whom the leader must share the leadership burden.

I have tried to be the leader that would move MD Anderson away from the brink
of complete acquiescence to corporate greed, misconduct, moral relativism,
group think and near criminal behavior. As of right now, I am declaring my leadership
effort a failure.

Not a single member of the faculty was a first follower of my efforts. The only
real offer for help I have received was from a member of the classified staff. Thus,
as the video shows, I am no leader for among the faculty I have no first
follower. Every conceivable arena of pushback against our current institutional
direction —the Senate, the Division Heads, the Board of Visitors, the Board of
Regents, the Executive Vice Chancellor of Health Affairs—was and is unwilling
or unable to join my protest and create a forum for the discussion of alternative
directions for Anderson.

isn’t working for me because it isn’t working. Unlike the Dancing Guy in the
video, I have not been able to attract even one of you to help convey my

I am Dancing in the Dark, alone and that isn’t really entertaining for the

guess I will sit the rest of this out.

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