I Would Have Done It For Free


Leonard Zwelling

you ever heard the presentation from Faculty Academic Affairs about the Faculty
Assistance Program, you might have seen the statistics about which type of
faculty pursued the free sessions of psychotherapy granted by the program.  When I saw the presentation, there was
exactly one vice president who took advantage of the service. That VP was me.

saw Mike Klaybor on and off for several years (using my own money after the
third visit) and always found his insights helpful. I am not sure that I ever
would have resigned as head of clinical research infrastructure without his
assistance, weathered my firing when my vice presidency was eliminated three
years later or found a new career in Washington, DC. I owe Mike a lot and I
only found him through the FAP.

our many sessions Mike labeled me a “fault finder”. Of course, he is exactly
right. I will find the one blemish in a beautiful tableau and see little else.
This can be a real pain in the neck to others but of great value to those
running organizations where adherence to principles and regulations are
intrinsically important to the business’s continuing growth. Since this was
precisely what was needed when I began my tenure overseeing the clinical
research infrastructure in 1995, I was, as the therapists say, egosyntonic with
my job. My office spent a lot of time developing systems to find and correct
errors in the performance of research to keep the Feds at bay and we largely
succeeded despite, as I have admitted, being real pains in the neck at times.

say this because a friend and blog reader recently said to me, “they should pay
you for writing that blog. You find all the problems they need to fix”.

never thought of the blog this way, but he makes a good point. If the
leadership had paid attention to what I and others have made them aware of that
is not functioning well, MD Anderson would be a different place today. What’s
more, all of us have given this advice for free as part of our service to the
institution we love. It is just most unfortunate that it has been largely
ignored. Here are but a few examples:

still have clinical services run by nurses and administrators independent of
the faculty. This is a large error.

The governance of the institution is largely in the hands of five people with
the faculty really without sway on matters of clinical care, strategic planning,
research infrastructure or financial accountability.

The infrastructure servicing the faculty is largely in the hands of people with
no idea what it means to care for a patient, do research, write a grant or
teach a class.

No one in the leadership until recently had a clue what clinical research
really was and the appointment of a surgeon to lead the phase 1 program
suggests that they still don’t.

Walkabouts are not substitutes for “do-abouts”. The president is simply too
distant from the rank and file faculty and has terrorized the faculty leaders
by summarily dismissing some giants in American oncology on what appears to be
a whim. It may not be, but without a viable explanation, it sure looks that
way. His decisions appear arbitrary and untethered to an overall plan. His
ethics are worrisome and his basic understanding of the cancer problem is more

We continue to hear about financial shortfalls in the clinical revenue area
while the leadership spends its brains out on activities unlikely to generate
any money.

The leadership also has yet to show any empathy or understanding of what it
takes to see complicated cancer patients in a clinical care system that is
overwhelmed and under-managed.

The IS issues have been amply identified and have yet to be corrected. Frankly,
I understand 70% of the cell phones in use are Android-based yet our IS does
not send basic MD Anderson email to Android phones. What the heck is that
about? And an electronic medical record is still in the distant future as is a functioning
system to track research administration and P and L statements for labs and
departments. Will anyone take responsibility for any of this?

write this list to remind the leaders who may read it what the problems are. I
have omitted many including a generalized attitude of superiority on the part
of the Harvard newbies that seems totally misplaced given the contribution of
that institution to cancer care vs. ours.

blog has been an extension of my psychopathology as identified by Mike Klaybor
all those years ago. I am indeed a “fault finder”. But being a pain in the neck
doesn’t make me wrong! Besides, they had me on the payroll, why not evaluate
what I said and reject or accept it on its merits? I think the leadership might
find it of use and I would have done it for free.

fact, I did.

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