Mixed
Emotions
By
Leonard
Zwelling
It is difficult for me to think about
MD Anderson. The difficulty stems from all the fond memories of the great
people with whom I worked and who taught me so much juxtaposed with an absolute
administrative mess that I see engulfing all the good like a rapacious black
cloud or a polar vortex from Boston that has swept over 1515. It is quite
remarkable how many things have come to haunt Houston from Boston, Jeremy Lin
being an outstanding exception.
Having arrived here in 1984 from the
National Cancer Institute, I was naïve in the ways of the real world and for
that matter the truth about cancer care. It’s a lot easier to care for patients
when you pay for all of their care, hotels and transportation and can reject them
if they don’t fit a protocol as was the case at the NCI. That’s not MD
Anderson.
Anderson faculty cared for Texans who needed
the help and those from all over the world as well. But they also tried to
identify those they could uniquely help or, honestly, those who could uniquely
help us in our quest for improving standard cancer care through the performance
of cutting-edge clinical trials. Now, I am told, the requirement to enter
Anderson’s doors as a patient is a pulse and/or a pocketbook, preferably the
latter. Beds are filled with patients unlikely to improve not because
everything has not been tried, but simply because everything has and it is time
for the inevitable end-of-life care, despite the fact it is less lucrative than
a third line clinical trial with conventional drugs. Unfortunately, life is
still a pre-existing condition with an end both ineluctable and final. Some
oncologists and most Americans have not come to grips with those facts quite
yet. This is one of the drivers of accelerating medical costs in this country.
As far as research is concerned, I was
astonished when I got here how creative some of the laboratory research was.
Fred Becker was doing everything he could to improve the level of this research
and I actually believe John Mendelsohn might have gotten there had his
entanglements with some seedy business folks not sidelined his drive for
“raising the bar”.
Now, by any stretch of the imagination, with
the new basic science talent brought into Anderson, the bar may be rising big
time, but the drive toward commercialization and the conversion of MD Anderson
into a drug company can only stifle that creativity. Academic centers need not
justify themselves on the basis of market forces and in fact, letting such
forces in the door invite their friends conflict of interest, nepotism and
self-dealing in, too. These tend to undermine the vary fabric of academia and
raise tremendous doubts about the objectivity of the science emanating from
labs with commercial as well as academic intent.
MD Anderson has come to a true crossroads in
its history. It is clear that its new leadership wishes to augment or replace
the shrinking revenue from clinical care with profits from commercial ventures.
The problem with that is that drug development is a very unpredictable business
that is very cash intensive with a high degree of failures. The leadership
claims to have a method to improve the hit rate of drugs, but thus far has kept
that method a well-guarded secret. (If their foresight with the Aveo drug is an
indication of their vision, an ophthalmology consult is in order). I guess if
MD Anderson is now a commercial force, what used to be publishable is now a
trade secret and patentable. So much for academic freedom.
That goes double for the governance of the
place which is hopelessly antiquated, top heavy and more concentrated in the
hands of a few than ever. The clinical leadership is virtually non-existent.
The Division Heads have retreated into their foxholes to wait out the shooting
war in the trenches below and above, after one of their own was sent packing.
Below the faculty struggles to get through a day. Above the 5 white guys in
charge count their cash and play chess with the lives of others.
So, of course I have mixed emotions. I am
grateful for everything MD Anderson gave me and allowed me to try to pay back.
I am saddened that if a young, arrogant, brash and ambitious guy like I was in
1984 showed up now, he might not have the same opportunities I had because the
group think would overwhelm the creativity that my bosses encouraged in me. If
Irv Krakoff was nothing else, he was tolerant—especially with me.
The once and future MD Anderson still lives.
It will take you, dear faculty, to make it a reality yet again.
The sword in the stone is not in Arizona,
New Jersey, or Abu Dhabi. As ET said, “I’ll be right here”, as he pointed to
Eliot’s head.
The real MD Anderson is right there, in your
hearts and your minds. Now—as Jane Fonda said on Newsroom when the broadcasters
lost the public’s trust over a false story:
“Get it back!”
