What Academic Cancer Centers Can Uniquely Do
By
Leonard Zwelling
https://www.nytimes.com/2023/06/23/magazine/golden-age-medicine-biomedical-innovation.html
It had been assumed for the entirety of what I had for an academic career, that academic medical centers and, indeed, the cancer centers in which I spent 38 years, had three major missions: research, patient care, and education. Maybe a good faculty member was good at two of them. I surely was only good at two on my best day running a lab and teaching MD-PhD students. But, the two articles attached here are making an argument that things have changed.
The first is from The New York Times Magazine on June 25 and describes how we are at “the cusp of an era of astonishing innovation” in modern medicine and a lot of that innovation is in oncology. Pick up any recent issue of The New England Journal of Medicine and you are likely to see a new treatment for one malignancy or another and many of these new therapeutics are more effective and less toxic than conventional chemotherapy. All have been based on research sponsored over many years by two sources—the federal government and the biopharmaceutical research industry.
The second article profiles Hagop Kantarjian, the long-time leader of the Leukemia Service at MD Anderson, and a close friend, colleague, and co-author. How do these two articles go together?
The first outlines the amazing strides taken in biomedical research based largely on CRISPR and mRNA vaccine technology along with new insights into the human immune system and how to harness it for therapeutic good. The second describes the master in how to integrate the traditionally separate missions of academia and blend them by using the resources of the pharmaceutical industry and the insights of a great clinician to actually cure malignant disease. Dr. Kantarjian has done just that for which he was recently honored with the Karnofsky Award from the American Society of Clinical Oncology.
Awards are nice, but that’s not the point. The point is that academic clinical investigators now, more than ever, must be masters of basic research, clinical care, business negotiation, and pedagogy. You can’t just know more and more about less and less and succeed in actually moving the needle in the fight against cancer. That was true when I was a faculty member. No longer.
The modern academic physician-investigator must know what is happening at the very cutting edge of research in the basic science lab, know what company is developing that science into a product, get to the company or be so prominent that the company comes to him or her, and then be able to design a trial AND get it up and running quickly to test whether a new treatment has indeed been discovered.
Never in all of medical history is that discovery more likely to happen and be developed by the private sector into a product that only a great clinical investigator can ascertain is superior to conventional treatments.
What does that mean for the strategy of academic cancer centers?
First, it means that the clinical faculty must be more than simply cogs in the wheel of high throughput clinic visits. Seeing complicated patients receiving complicated experimental therapies takes time. It cannot be done in 15-minute increments in a busy clinic, yet somehow the routine of patient care must be shifted to the performance of high-powered research.
Second, it means that the clinical investigator of today must have a good business sense, be able to negotiate with the private sector, and understand how to do clinical trials for reasonable, even if exorbitant, amounts of money.
Third, conveying how to do this clinical investigator dance to the next generation of faculty members is of vital importance. They need to be caring physicians and clear-eyed scientists all at once.
Fourth, there must be a constant reinvention of the infrastructure supporting clinical research to facilitate the approval and implementation of innovative trials. With improving the infrastructure, I include the minimization of red tape, the de-emphasis on peripheral issues like DEI and the constant training by HR, and a clear examination of whether or not the electronic medical record actually improves patient care and research.
Finally, the academic cancer centers cannot seek to compete with general hospitals for money and patients. The academic centers are the only places at which the benefits of new cancer treatments can be assessed. That’s the main function of these places. Do the science, get it into a workable product, and try it out. That is what Dr. DePinho had in mind. He just got too greedy. By contrast, Dr. Pisters seems to emphasize external awards for political correctness leaving it to people like Dr. Kantarjian to keep MD Anderson at number one in cancer care.
These articles make a strong case for a new model to improve cancer survival rates and a great example of someone who knows how to do it and has trained others to follow in his footsteps just as he followed in Dr. Freireich’s.
It’s a new dawn. It will take new models to be the leader in medical innovation. Fortunately, the wheel need not be re-invented. Dr. Kanarjian is a pro from Dover. We need as many pros as possible.
Dr. Zwelling’s new novel, Conflict of Interest: Money Drives Medicine and People Die is available at:
barnesandnoble.com,
on amazon if you search using the title and subtitle,
and
directly from the publisher Dorrance at: https://bookstore.dorrancepublishing.com/conflict-of-interest-money-drives-medicine-and-people-die-pb/m
