Leonard Zwelling

         The rumors had actually been circulating for over a year. MD
Anderson was going to be dethroned as the King of the Cancer Centers. Of
course, MD Anderson was never the number one cancer center because such a designation
does not exist. What MD Anderson could claim is the number one ranking in US
News and World Report’s list of places to receive clinical cancer care. Now,
apparently, it no longer is, by the closest of margins.

         First, let’s be honest, this annual contest is simply a made-up
ploy for bragging rights and for USNWR to sell magazines. I am quite certain a cancer
patient can receive excellent cancer care at a number of NCI-designated cancer
centers and probably at many facilities that do not have NCI designation. There
are good surgeons, radiotherapists and medical oncologists in every corner of
the nation. When a true measure of clinical outcomes is used, we really have no
idea who is really the best and for what diseases using which modalities. It’s
all a guessing game in cancer care as it is with virtually every other form of
medical care. Who really knows who is any good? Does anybody really know? If
so, where is the Consumer Reports for the best therapy of lung cancer? I don’t
know either.

         So what this is all really about is the right to brag to the
rest of the world that some trumped up semi-quantitative poll determined that
one institution is better than all of the others. The problems for MD Anderson
now are several:

1. After making such a big deal about being number one
for several years, what do they make of being number two a mere three years
after the new president arrived? Surely he will have to accept part of the
responsibility for the drop in rankings.

2. To whom will he answer as there really is no local
board that uniquely oversees the value of MD Anderson, its leadership, its
faculty or its clinical care?

3. What will the MD Anderson leadership do about the drop
in ranking? Will they recommit themselves to doing better? Will they admit past
mistakes? Will they outline a new direction that will “put them back on top.”

4. Or will the MD Anderson leadership pursue its usual
posture and blame everyone else for its failures, especially the academic
clinical leadership?

         I wonder if they will have a rally around the Moon Shot
rocket with Styrofoam burnt orange fingers pointing in the air saying:

Number 2.”

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