Faculty Evolution: The Environmental Pressure Of Poor Leadership
By
Leonard Zwelling
This story made the front page of The New York Times on December 23. It should have.
It seems that a wild bird called a dark-eyed junco moved into the city of Los Angeles about twenty years ago from the wild. The birds particularly enjoyed the campus of UCLA.
In that time in the city, they evolved their physical characteristics to having shorter wings and stubbier beaks. It was thought that the physical changes were driven by changes to the birds’ food source. Their food source had changed from that which they ate in the wild which required the longer beaks—seeds and insects, to the source they had adapted to on campus—cookies, bread, and pizza.
But when Covid hit and the campus population stayed indoors, the birds reverted to the physical characteristics of their cousins in the wild. It took a year to manifest itself, but the change was real and reported in the Proceedings of the National Academy of Sciences.
After the pandemic shutdowns were lifted, the city birds and the ones on campus returned to their previous urban form due to their renewed access to the typical diet of a college sophomore.
It is hard to prove this was an environmentally-driven change to the birds’ physical shape, but it seems to be the most logical answer. It appears that organisms can adapt their physical characteristics quite quickly to the surrounding environment so as to maintain the species’ survival.
This got me thinking about the behavioral characteristics of the MD Anderson faculty under the various leadership environments faculty members faced over my forty plus years. How did the faculty need to change under the various environments created by MD Anderson’s leadership?
When I arrived at MD Anderson, it was the wild west. You could say or do just about anything. This led to heated but weighty discussions which often were resolved with a new protocol that successfully treated a form of cancer. That was why we came here.
Genie and Josh Fidler needed a place to test their theory that liposome-encapsulated immunomodulators could alter the survival of kids with osteosarcoma by eradicating micrometastases in their lungs. The staid leadership of the NCI in Bethesda was uninterested. The NCI leaders were foolish. The leadership of MD Anderson said, “come on down.”
I came to run my own lab free of the oppressive ideas of a supervisor with whom I no longer agreed. I also harbored a goal to learn business administration and apply it to academic medicine. I am not sure I could have done all these things anywhere else.
That was exactly what the leadership of MD Anderson under Mickey LeMaistre wanted to happen. Dr. LeMaistre wanted both of us to succeed and to grow. And we did. That was the environment we found when we got here and we did the adapting. What we could imagine, we could do, and money was rarely an issue. That was the LeMaistre environment.
Under John Mendelsohn things became a bit more regimented as he wanted to turn Anderson into a university-based research power. Researchers had to generate their own salaries on grants. Money became an issue. Space was allotted based on the dollars per square foot generated in grant money. Academic regalia was added to the annual convocation. And my role turned out to be the imposition of greater discipline in the performance of clinical research to keep the institution aligned with the Code of Federal Regulations (CFR) and out of the disciplinary clutches of the FDA. The CFR and the FDA were things no clinical investigator cared much about when we got here in 1984. Again, we adapted and so did the rest of the faculty.
Then, one day, John Mendelsohn announced his retirement. I still do not know to this day why that occurred. It did not seem to be in his plan when he presented his state of the institution address just months before his retirement announcement.
His successor, Ron DePinho, made it clear that he was going in a different direction. He was planning to create yet another new environment to which the faculty would have to adapt. Now MD Anderson would become a drug company and five cancers were to be cured in the next five years. The faculty didn’t know what to think as it all seemed preposterous. MD Anderson was not industrially-based. And the notion of curing solid tumors in five years seemed, frankly, clinically naïve.
To make a long story short, the DePinho attempt to change the environment to one of a money-generating pharmaceutical company failed largely because in this case, he was unable to create an environment to which the faculty gravitated. If faculty wanted to work for a drug company, they could have. Why come to Anderson? He tried to change the pace too quickly and without proper consideration of the effects of his personality, his nepotism, and his arrogance. In essence, he could not muster any loyalty beyond those he himself hired, many of whom, unfortunately, are still around.
Now we have Peter Pisters as president who, thus far, has been a cipher. His contribution to the intellectual, academic, research, and clinical care environment of Anderson has been negligible. He has never made these kinds of contributions himself and they were never important to him in his career. Why would that change now?
Rather he has emphasized form in lieu of substance. He’s very big on getting citations and awards for hospital quality. I suspect patient satisfaction is a big issue for him as well. He also wants to rid himself of senior faculty who might just be remembering prior administrations that allowed some personal freedom. Pisters cites these senior (and some junior) faculty for unprofessionalism and shows them the door. Or, his lawyers do. Or his friends in HR do. From my interactions with Dr. Pisters, I find him all form and no substance, too.
His environment is one of fear. He fires faculty for not getting Covid shots for religious reasons. Those faculty took him to court—and won. There are other faculty lawsuits surrounding the bad behavior of Pisters cohort members. It is difficult enough to recruit women of child-bearing age into a state like Texas. The Pisters philosophy of treating a faculty member like any old employee and his refusal to reconstitute anything like a Faculty Senate after the state abolished such bodies, but did not preclude a new format for senates, is clear evidence that the faculty should be fearful. An autocracy has set in at Anderson.
Here’s the good news. Like the junco birds in L.A. that were driven back to their seed- and insect-eating selves by Covid, and then returned to cookies and pizza once the pandemic was over, that wild and creative faculty at Anderson could return.
What would it take?
First, use some of that $1.9B Pisters raised on research funding for the current faculty and for new recruitment. Eliminate the nonsensical salaries on grants diktat of Mendelsohn. Pay the faculty with your billions.
Second, stop driving the clinical faculty to see more and more patients. Patients don’t come to MD Anderson to be seen in fifteen minutes.
Third, get rid of the concept of “professionalism.” Decades of MD Anderson faculty have successfully functioned without it. What’s it really for?
Fourth, reconstitute something like the Faculty Senate to the extent the law allows. And by the way, do as much as possible to recreate a Senate and ask for forgiveness, not permission, from the powers that be in Austin.
Finally, get the lawyers out of decisions that should be made with the consultation of the faculty once a new Faculty Senate has been formed.
I am quite confident that the MD Anderson faculty is as flexible in its phenotype as the wild birds of Los Angeles. MD Anderson could really be a great place to work again. It just needs the right environmental pressure under the right leadership. What it has now, ain’t it.
