LeMaistre Vs. DePinho: Optimism Vs. Fear

LeMaistre Vs. DePinho: Optimism Vs. Fear


Leonard Zwelling

(This was written a day before I learned of Dr. LeMaistre’s death. It is dedicated to him).

It was a pleasure to work for Mickey LeMaistre. It was always a pleasure to speak with him. My kids loved listening to Dr. LeMaistre when they met him at the convocation at which Dr. Kleinerman received a faculty award. My sons could not believe how “with it” a ninety-year old man could be. I could. Nothing about Dr. LeMaistre surprised me.

As I got to know him over the 30+ years since I came to MD Anderson, through most of which I could not bring myself to call him Mickey, but only Dr. LeMaistre, I was always awed by his perspective on his job as president. I remember the day he nixed a kind of window for the new hospital because, “our patients wouldn’t like it.” That was Mickey. The patients came first. Always. The public came second. He studied note cards on trips to raise money so that he would know all of the people who would be at the event and their wives’ names, and those of their children and dogs.

To some extent, both Dr. LeMaistre and his successor were caught up in external events. For Dr. LeMaistre it was the threat of managed care and the Clintons’ proposals to remake the health care system that had allowed MD Anderson to prosper even though all its patients had to be referred by other physicians. This led to the eventual suspension of the referral mandate, the failure of the Clinton health care plan, and huge profitability for Anderson. When Dr. LeMaistre stepped down in 1996, he did so with the institution doing well. He told me that the weight of the world had come off his shoulders that day. He showed me that by moving the globe off his shoulders in a gesture of relief.

Dr. LeMaistre’s successor began his tenure on a high note and for five years performed brilliantly.

Then he was caught up in two large business scandals and the economic downturn of 2008 causing non-operating revenue to drop. This presented a need to pump up the clinical volumes to sustain the institution’s margin. He too left the institution in good shape when he stepped down in 2011, but as with Dr. LeMaistre, real world events had tarnished the luster on his early stellar accomplishments, and no doubt tired him out, although given his present pace, he might deny it.

In 2011, Dr. DePinho came to power. It was quite evident that power was his thing from the very first minute of his very first address to the larger MD Anderson community. Nothing less than curing cancer would be his mission using the JFK moon shot analogy replete with videos and research budgets that probably exceed anything Fred Becker or Margaret Kripke could have dreamed of.

Where are we five plus years out.

In the red.


The current administration’s favorite scapegoat is EPIC and there can be no doubt that the acquisition of this electronic medical record slowed patient care significantly. But we are approaching a year into the EPIC Era. Most hospitals around the country that have installed EPIC have recovered from the EPIC lag (although my understanding is that some have not). Nonetheless, it is hard to attribute one hundred percent of the $50M+ shortfall of December 2016 to EPIC alone.

In the New York Times on January 27, David Brooks wrote an op-ed piece making a scathing comparison between President Trump and President Reagan. Where President Reagan exuded optimism and the sunny face that America turned to the world, Mr. Trump is full of fear. He views the world with fear. Mexicans are to be feared. Let’s build a wall to keep them out. Syrians and all Muslims from the Middle East are to be feared. They are all terrorists. Let’s keep them all out. Trump wants to bring back torture and toss out multilateral trade agreements. He is a classic isolationist waving a big stick at ISIS that he doesn’t know how to use and has forgotten is both a snake and a double-edged sword. How is Trump going to combat the forces of radical Islam by hiding behind walls and keeping the world at arms-length?

Mr. Trump inhabits a world of unlimited wealth and power coupled with the fear of the unknown. President Reagan was the perpetually optimistic American afraid of nothing.

Dr. LeMaistre was very much like Ronald Reagan in his perpetual optimism. Dr. DePinho is very much like Mr. Trump shrouded in secrecy, narcissism, paranoia and xenophobia. The latter is all I can call developing a drug company on your own when the large drug companies are acquiring others with better ideas than those emanating from their labs.

MD Anderson is sorely in need of some of that old LeMaistre optimism. Layoffs and the threat of more of them with continuing budget deficits and no hint as to what all the money is being spent upon only creates more fear.

Outside events like the competition in the market place for cancer care, depressed reimbursement, adverse payer mix and a host of other developments in the health care-industrial complex have finally caught up with MD Anderson. How Dr. DePinho negotiates his way out will determine the success or failure of his tenure.

At about year five of his tenure, Dr. LeMaistre rocketed MD Anderson into the 1980’s with a massive series of superb hires in key positions of academia within the institution. This included both clinical and basic science chairpeople. MD Anderson prospered even as the price of oil fell. Such was the legacy of Mickey LeMaistre despite the turmoil that surrounded his final years.

It was at about year five of the Mendelsohn presidency that Enron and ImClone broke as major scandals. It was a lot of catch up after that, especially after the market crash of late 2008.

We are in year six of the DePinho presidency and what was simply disquiet in the body faculty has turned to chaos with layoffs and shortfalls galore.

Perhaps the test of a president occurs at year five or six. At least at MD Anderson. Just say for me, I prefer the LeMaistre optimism to the DePinho fear. What about you?

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