Was DePinho Inevitable?

Was DePinho Inevitable?


Leonard Zwelling

It is by now a consensus that the hiring of Dr. DePinho was a huge error on the part of the University of Texas Board of Regents. The Regents never like to admit error, but the latest audits and the Chancellor’s maneuvers to protect the institution from any further DePinho-induced iatrogenic harm suggest that the folks in Austin have received the message about The Ronald as they did about The Lynda. I suspect this will all get fixed pretty soon.

The real question is what went so awry in the transitions from president to president?

Let’s go back to 1996 and the coming of Dr. Mendelsohn.

That was a really successful transition with Dr. M hitting the ground running after the threatened financial downturn predicted by an outside consultant Dr. LeMaistre had hired came to nothing along with the Clinton health care plan. The end of the referral mandate under Dr. LeMaistre only fattened the purse that Dr. Mendelsohn had to work with.

Initially, Dr. M was focused on “raising the scientific bar” at Anderson, but that never did materialize. First he went through a Provost and then a COO. No National Academy members were hired and in fact the one who was the first NAS member at MD Anderson had left. The goal of upping the science was supplanted with a new goal—erecting buildings and growing the staff along with franchising the MD Anderson name.

That ran into a problem when the economy nose-dived in 2008 and the non-operating (i.e., investment) revenue vanished necessitating the clinicians saving of the institution with a huge increase in output. The lesson was not learned, however, and the spending continued. To keep up with all those people and square feet needing air conditioning, it became obvious that something beyond patient care was needed to keep the place in the black.

Enter DePinho and Chin.

These two, with absolutely horrible reputations in the city from whence they came, Boston, promised riches beyond the imaginations of the Regents through the development, patenting, and exploiting of the secret of life that only they possessed. It was most unfortunate that Dr. Shine and the Regents believed all this Moon Shot hype and here we are today.

If you choose to exceed an unlimited budget as Drs. Mendelsohn and DePinho did, you had better find an alternative revenue stream or someone who can promise he can deliver one. The DePinhos promised to deliver on the promise Dr. Mendelsohn had made and had not succeeded in developing—a drug company on Holcombe—a commercial revenue stream. I know, I know, it’s our imperative to bring the latest cures to everyone.

No it’s not. Academia discovers, industry develops and commercializes. Change that relationship and welcome to conflict of interest city. That would be 1515 Holcombe right now.

So now what? Let’s say that Ron and Lynda eventually do ride into the sunset in an attempt to get out of this town and into another whose fortunes they can bilk. What is next for Anderson?

I don’t really know but here are some suggestions:

First, MD Anderson is a component of the UNIVERSITY of Texas. It is not a company or even a non-governmental entity. Get back to the business at hand—patient care, education and research.

Second, stop expanding MD Anderson all over the world as if it were copying Starbucks. If MD Anderson is supposed to be a unique provider of cancer care, particularly cancer surgery, radiotherapy and experimental systemic therapy, it cannot do that in Katy, Arizona or Madrid.

Third, MD Anderson may have to be reduced in size. The huge fixed cost burden in an era of shrinking reimbursement may not be compatible with the generation of the margin needed to pay for research and education, especially if the powers that be in Washington cut the NIH budget.

The coming of Ron DePinho may well have been ineluctable. But his leaving is as well. All I can hope is that this time some real consideration is given in the presidential vetting process before someone is hired and that the leaders of the university cannot simply hire a president and walk away. Everyone needs to be accountable to someone.

That Dr. DePInho was accountable to no one is obvious at this point. Send in the SEALs.

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