One Duke Vs. One MD Anderson

One Duke Vs. One MD Anderson

By

Leonard Zwelling

I have been struggling all this weekend, Duke Medical Alumni Weekend and my 50^th medical school reunion. How can I express the enormous vibrancy in the Duke Health System, which now includes the Duke University School of Medicine and its formerly for-profit Private Diagnostic Clinic? Our friend and recent MD Anderson convocation speaker Dr. Mary Klotman is now the Executive Vice Chancellor of Health Affairs and the dean of the medical school for the entire Duke Health System. Dr. Klotman is a visionary. When she talks about One Duke, she means bringing to bear all the resources of the university on any problem that needs solving. She did exactly that during Covid when the entire research and public health apparatus of Duke Health geared up to do testing so that the students of the university could safely attend classes.

During this weekend we heard many presentations of the exciting research occurring here at Duke. The most impressive is their meticulous assessment of the safe and beneficial implementation of artificial intelligence in all aspects of medicine from research to patient care. When Duke uses AI the technology will do what it is intended to do without risky downsides as the safety and efficacy will be determined before large scale application. This will be done in a fashion analogous to what the FDA does for drug and device testing.

What is also impressive is the amazing loyalty of the faculty to the vision of the leader which is continually reiterated, refined, and repositioned in response to the latest challenges facing Duke. That’s One Duke. They’re not number one yet, but they are always trying to be.

Contrast this with the Peter Pisters concept of One MD Anderson, as I understand it. It is basically trying to reduce the faculty to employees. So rather than use teamwork to solve a problem, Pisters is using leveling to have the institution regress to the mean of mediocrity while being complicit with the state legislature in trying to eliminate tenure and compromise faculty security and well-being. Burnout remains meekly addressed.

There is no doubt that Duke is attracting the best and the brightest new faculty. We heard from some of them. At the same time it has two recent Nobel laureates on the faculty who actually did their prize winning work at Duke.

A free-standing cancer center is never going to look like a large, integrated university health system. But, as MD Anderson is one of the largest employers in Houston, Duke is the largest in North Carolina. These are big, ocean-going, academic institutions which should have similar cutting-edge missions in research, patient care, and education. The BW and I are products of the latter mission area of Duke. But we are also part of the MD Anderson history.

Our first-hand recollection of that history begins in 1984, when Dr. LeMaistre was leading a vibrant cancer center and Dr. Becker was growing the research area hiring Drs. Kripke, Fidler, Lennarz, De Crombrugghe, Hong, Levin, and many others. It appears to me that the vibrancy of that era at MD Anderson is thriving at Duke. Not so much on Holcombe.  The difference is the vision of the respective leaders. One harnesses her resources and those of the entire university to change the face of health care. The other works in an antiquated university system without any vision at all under a passive Board of Regents and a reactionary governor, lieutenant governor, and legislature.

Guess where our support goes!

MD Anderson could learn a lot from Duke, but the current leadership of Anderson is beyond educatable. As this blog has said a number of times, the entire executive leadership of MD Anderson needs replacing and this time with visionaries who understand all the mission areas of the cancer center. After twenty years of wandering in the desert, MD Anderson needs a leader to get it to the promised land. This crew ain’t it.

One Duke will solve problems by mustering the full force of the university to address critical issues in health care. One MD Anderson will demoralize the very faculty needed to solve such problems in cancer care and research. Now, how smart is that Board of Regents?