Strange Bed Fellows


Leonard Zwelling

         In today’s Houston Chronicle, an opinion piece appeared in
the Outlook section by Drs. Kantarjian and Mendelsohn called “Medical advances
continue to help in cancer fight”.  Here
it is:


         The piece is a brief stroll through the past 40 years of
clinical cancer research and the various strives in the application of basic
science to the treatment of human malignancy. As is often the case in such
pieces from medical oncologists, the obligatory tip of the cap to prevention concludes
the litany of progress which, also as usual, is followed by no real outline for
the future nor any road map or plan to improve upon the findings related in the
text. Also as usual, it begins with why progress has been modest abetted by the
usual provisos that cancer is really many diseases, “breakthroughs: are not
cures and cancer death rates are only a little improved. For an opinion piece,
it left me with no opinion based on its lack of focus and absence of what is to
be done to improve things. Instead it is the usual academics’ insistence that
the progress being made is real and that the public has been largely misled
into thinking the cancer community has failed them since the War on Cancer was
declared over 40 years ago by Richard Nixon.

         I guess you can try to fool all the people all of the time despite the supposed impossibility of same according to our 16th US President.

         While Kantarjian and Mendelsohn do lay out the progress,
they do so with very few numbers. Ones that might have been helpful are:

·     How far has the cancer death rate dropped over the
past 40 years?

·     How much has been spent on
research—government+non-profits+pharma and what have we gotten for all of that

·     In the case of solid tumors (no leukemia or lymphoma
included) how much has the life expectancy been lengthened by all of the
progress Kantarjian and Mendelsohn identify?

These are the really important questions that the
American people need to ask those charged with the stewardship of their
research money distributed by the NIH and National Cancer Institute.

From a more personal perspective, the joint authorship
by these two prominent oncologists is almost as funny as when Dr. Kantarjian
and I published a host of editorials and op-ed pieces in the past few years.

Back in 2001 and 2002, the Leukemia Service that Dr.
Kantarjian led and still leads got into a bit of hot water with the
Institutional Review Board (IRB) at MD Anderson that oversees clinical research for the federal government. (The IRB does not report to the MD Anderson President). The IRB was supported (but not
reporting to or run) by the office I then ran. My office supplied the IRB’s staff and the computer systems that served it. This became a major scandal as
the faculty lined up on either the side of the Leukemia docs, two of whom were
docked their clinical research privileges by the IRB, or on the side of my office whose audit
group did the assessment for the IRB that demonstrated the failures in compliance the IRB
had suspected. The FDA even came in to audit and confirmed the findings of my

Unfortunately for me, this was also the time when Dr.
Mendelsohn, then the President, had his hands full with the ImClone scandal
involving Mendelsohn’s corporate benefactor Sam Waksal and Martha Stewart. This
was also when Enron went under with both Drs. Mendelsohn and LeMaistre on the
Enron board. The confrontation between my office and the Leukemia Service was
small potatoes compared with Dr. Mendelsohn’s other problems. Eventually, in
classic academic form, a Blue Ribbon panel appointed by Dr. Mendelsohn ascertained
that my office and me had too much power and this lead to Dr. Markman’s hiring
and my walking away from clinical research oversight by 2004 and handing those reins to Dr. Markman. Within 3 years I
was gone (Markman left soon, too) and now I am the Chief Medical Officer of the largest federally-qualified
health clinic in Houston after a sabbatical sojourn on Capitol Hill. Go figure.

With that history, the most unlikely of authorship
teams would have been Hagop and me, but to his credit, Dr. Kantarjian had some
valuable messages to get out to the public about clinical research, its funding and the prices of cancer drugs, and sought my help to do this after
I had published a host of op-eds about health policy. You would also be
surprised to see Drs. Kantarjian and Mendelsohn joining forces except for that
old adage about politics making strange bed fellows.

As I related in my last blog, it is my contention that
Dr. Kantarjian would like to follow in the footsteps of Dr. Hong as DoCM
division head. This will require broad support and who better to have on your
team (and as a co-author) than the immediate past president of MD Anderson?

This op-ed piece may reflect strange bed fellows, but
no more so than the ones Hagop penned with me. He is a clever man and is more
than happy to let by-gones be by-gones to get what he wants.

It is just too bad that putting their considerable
resources together, Kantarjian and Mendelsohn could not give us a better blue
print for going forward. I guess that suggests part 2 of the series will be
Kantarjian and DePinho on the Moon Shots as the answer to cancer.

“Whatever gets you through the night….”

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