Same Old, Same Old When New Is Needed

Same Old, Same Old When New Is Needed


Leonard Zwelling

         It never ceases to amaze me that people in groups that have been battered continue to stick with the leadership that caused them to be reduced to minority status.

         It was amazing to me even as a small child, that the Democrats could run Adlai Stevenson again in 1956 after he was so soundly beaten by Dwight Eisenhower when I was four in 1952. Republicans continued to roll out the leaders representing the old party line in John McCain and Mitt Romney despite having lost the popular vote in 2000 and barely winning in 2004. Then the Democrats repeated the GOP mistake running yesterday’s candidate in Mrs. Clinton and having her beaten by an upstart like Mr. Trump who was off the grid by any measure of GOP power a mere two years before he was elected to be the 45th President.

         Now the Democrats in the House of Representatives have done it again, choosing Nancy Pelosi, the 76-year old former Speaker to lead their caucus rather than go with the new blood offered by Tim Ryan, albeit not really new at all as he voted with Pelosi most of the time.

         When are these people going to learn that sometimes it is important to jettison old leadership and go in a new direction?

         I was once that person needing jettisoning.

         In 2004 after many battles with many faculty members over compliance issues in clinical research and after having clearly overstayed my welcome and after having Dr. Markman arrive to functionally lead clinical research, I stepped aside and ceded control of the infrastructure governing human subjects research because it was time for me to go. Nine years was enough of my oversight. New thinking was needed and I did not have mural dyslexia. I could read the handwriting on the wall and acted accordingly.

         Where in 1995, I might have been the man to build the infrastructure, in 2004 I was no longer the man to run it. Step aside. I did.

         Mrs. Pelosi should have done the same even if Mr. Ryan is not really going to set a new direction. At least he is from a place (Ohio) where the Dems need a lot of work, not from California (Nancy Pelosi’s home) which is as blue as blue can be.

         Now let’s venture back a bit and see how the power shift of 2011 at MD Anderson reflects this same group thinking.

         If anyone was a change from Dr. LeMaistre in 1996, it was John Mendelsohn. He was a prominent physician-scientist and oncologist. He saw the need to link academia with industry as a means of sustaining research as well as getting academic discoveries to patients. Fine.

         Dr. DePinho has taken that to a new level where he now states that he has a good balance sheet while having a disastrous income statement. This, I assume, must derive from assets he has wedged from industry into the MD Anderson asset column on said balance sheet. Of course, I would like to see and understand all of these figures as I cannot quite see why industry is parting with money to him. What are they getting in return?

         It is my argument that this philosophy of an academic-industry partnership that borders on the seamless such that where the university ends and the company begins is hard to discern is exactly the wrong way for a university cancer center to go.

         If MD Anderson returned to first principles of excellent patient care and reducing overhead so that the charge master becomes competitive and that the place only does the research it can actually pay for without the largesse of Austin, (See p. 235-237 of the November 9 Regents minutes for the $8M payment from patient care funds for a cell line and $52M in contracts for consultants when the leadership is demanding more clinic time of the faculty and no celebratory cakes for successful grad students). ( perhaps then the income statement will perk up. This would necessitate a different kind of leadership. It would be leadership like MD Anderson used to have where the major concern of the leaders was excellent patient care and clinical research, not margins and electronic medical records and efficiency over precision.

         When the folks in Austin finally realize that the experiment that they began in 1996 didn’t exactly work out the way they planned, particularly with them doubling down in 2011, then the income statement can finally right itself because the focus will be on strength and core competence not competing with Pfizer.

         As I recently wrote, it is pretty hard to compete with big pharma, large hospital chains, and other research universities all at once. I cannot quite see the strategy that brings this all together in a working model.

         I would suggest that the Board of Regents convene some outside experts to take a good hard look at MD Anderson and how it came off the financial rails in such a brief amount of time. Something is clearly amiss. My suggestion is to start at the top.

         As for the grad students, let them eat cake.

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