Making Cancer History by James S. Olson: An Important Book

Making Cancer History by
James S. Olson: An Important Book


Leonard Zwelling

         This book is a revelation.

         I bought and read it for a number of reasons.

         First, I wanted to know about the early history of this
great institution to which I hooked my personal star in 1984. I am still discovering
aspects of its past that resonate through its hallways today.

         Second, I am preparing to write a compilation of my blogs as
they speak to the political and ethical developments of MD Anderson since 1996
and thought I better know what happened before then because it would
undoubtedly inform what happened after.

         Third, I knew most of the players in the book. Although many
are gone some like Dr. Freireich are still here and continue to inspire the new
members of the MD Anderson family. I wanted to read more about how they behaved
and what they accomplished (a lot!) when they were younger than I was when I
got here.

         What I have discovered thus far should surprise no one.

         R. Lee Clark, the true architect of MD Anderson, knew
exactly what he was doing when he, along with a group of friends and colleagues,
created what was to become the single greatest cancer center in the world.
Having been heavily influenced by his time at Mayo Clinic, he knew he wanted
his faculty on salary, not competing with each other for patients, but free to
refer patients to each other with only the patient’s best interest in mind. He
created the Physicians’ Referral Service so the faculty’s salaries came from
their earnings, not from state funds. He created the University Cancer
Foundation to support research and the Board of Visitors to preserve MD
Anderson’s relationships with some of its most important supporters. He
understood the need for educational programs early on. He was quick to identify
new trends in cancer treatment beyond surgery and hire those expert in
delivering it (Gilbert Fletcher and Frei and Freireich among many others). Dr.
Clark was a master leader and manager who knew talent when he saw it and would
not take no for an answer.

         Is the tradition initiated by Dr. Clark still in effect
today? I think not.

         Faculty are pressed to generate their own salaries.
Departments compete for patients with one another. Score is kept on the basis
of revenues, new patients and consults seemingly denying the importance of
continuing care to those already in the MD Anderson system. Far more money
appears to be spent on the salaries of basic scientists (especially the newly hired ones) and administrators than
on the master clinicians whose work truly sets MD Anderson apart from the rest
of the world—or at least used to. ‘Salaries on grants’ is prematurely sinking
research careers at a time when NIH funding is cratering. Peer-review of
promotion and tenure is falling victim to Presidential vetoes. This is not the
MD Anderson Dr. Clark envisioned when he created what would become the anchor
of the Texas Medical Center and helped put Houston on the medical map because
the MD Anderson Foundation was willing to put up the money to get the State of
Texas to build its cancer center in Houston by matching what the state would
allocate for the endeavor.

         The legacy of R. Lee Clark is being soiled by another
iteration of a shadow President sitting atop MD Anderson as has been the case
since 2001. Admittedly, MD Anderson was never a democracy under any of its
Presidents. Dr. Clark didn’t design it to be. He did understand that if a
centralized despotic regime was to run a cancer center, it had better employ a
benevolent despotism and one in which patient care was first, clinical research
second, and basic research an important but adjunctive part of the mission. Dr.
Clark made sure that above all else, MD Anderson was its name and its faculty.
Has that been the case with his last two successors? I think not.

         All is not lost. Dr. Clark is no longer with us but the
truth of his vision is embedded in the pink marble beneath the new facades of
an ever-expanding and budget straining physical plant of Sheikh-named
facilities and laboratories in which commercialization is trumping investigation
into cancer’s etiology.

         Once again I say, Making Cancer History? The latest crew
seems to want to make Clark’s MD Anderson history. They are to be resisted.

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