Dave’s Top Ten Problems In NCI-Designated Cancer Centers

Dave’s Top Ten Problems In NCI-Designated Cancer Centers


Leonard Zwelling

         I bet you think this is a top ten list from David Letterman. Nope. It’s a top ten list from David Rubenson in the November 4 issue of the Cancer Letter.

He is the current director of the scientific communications company called nobadslides.com and spent 16 years as a senior administrator in NCI-designated cancer centers. I do not know him at all, but if his logic is matched by his credentials, he’s the real deal.

         Here, in abbreviated form, is his list:

         Ten, designated cancer centers promote a race to the middle when what is needed is exceptional insights. The models of most cancer centers are broad-based and similar when it will take exceptionalism to conquer cancer.

         Nine, the review of designated centers is ritualized. The metrics for success have more to do with the volume of patients on trials and institutional grant dollars than on actual discoveries or progress against cancer.

         Eight, Cancer Center gamesmanship and grantsmanship. This is a corollary of nine, goosing the numbers to look better than a center really is.

         Seven, the management pieces of the center are reviewed by scientists and docs. What do they know about management?

         Six, there is an overemphasis on translational research. All research projects are relevant—not! And many that seem most irrelevant at the time of discovery go on to win Nobel Prizes and actually help sick people. Translational research is over-rated.

         Five, politics. University officials see designation as a political feather in the state’s cap. That won’t cure cancer.

         Four, inflation. There are way too many centers because everyone wants one. Eight centers in the 1960’s are now 69. The money is being diluted. Do we really need almost 70 designated cancer centers? Doubtful.

         Three, the process is silly. Entire swaths of personnel spend inordinate amounts of time over five years getting ready for the written application and site visit. Better those resources go to research.

         Two, no fresh faces, no fresh ideas. The centers, the reviewers and the advisory boards are one big incestuous happy family. They may be happy, but this is not supposed to be group therapy for the nation’s cancer researchers.

         One, the system cannot reform itself. Why would it? Everyone’s getting fat except Mama Cass.

         The suggested solution is an overall review of the entire system and processes in it by people unassociated with it currently. This should be scientists, physicians and business and operations experts, not the current NCI infrastructure or anyone involved with a currently designated cancer center.

         MD Anderson could do this itself. Just hire some people who actually know what they are doing and who are not products of the mind-set that has given birth to this distorted system aimed at making progress against cancer. Because, it ain’t working!

         So thanks to Dave Rubenson for his new top ten. It is dead on target and any one of the NCI-designated centers could fix themselves, but it will take placing some trust in outside experts with no conflicts of interest and no stake in the outcome of the audit.

         If you believe that will happen, I got a bridge from New Jersey to New York to sell you and another in Brooklyn.

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