On Trying To Be A Bellwether
By
Leonard Zwelling
A bellwether (note the spelling: “wether,” not “weather”) is something or someone that leads the way or signals what’s coming. It’s an early indicator of a trend.
The word comes from sheep farming. A wether is a castrated ram, and shepherds would hang a bell around the neck of the one the flock followed. By listening for the bell, they could tell where the whole flock was going.
The above is what Rabbi Claude of Temple Anthropic had to say about the origins of the word bellwether. I, personally, had no idea what the genesis of the word was, but surely knew what it meant despite having pronounced improperly for a long time.
For all of its 15 or so years, this blog has tried to do only two things. The first is to explain what I believe is happening in the real world be that the world academic medicine, politics, or even the arts once in a while. The second, and far tougher goal of the blog, was and is to try to see into the future and extrapolate from current events what is likely to happen next. I tried to be a bellwether. This requires my acquisition of good data (often gossip, but often from good sources) and then applying my 50 years in academic medicine to posit what I think will occur in the future, especially in MD Anderson’s future.
During its early days, the blog was pretty sure that Dr. DePinho could not last very long. This was based on my assessment of his stated directions and strategies for MD Anderson and his naivite about clinical oncology, clinical trials, and the mindset of the MD Anderson faculty when he took over. It took a while, much longer than it should have, but my prediction of his limited longevity was prescient. One day, he was gone long before he wanted to be, but not soon enough for the MD Anderson faculty.
In the case of the most recent MD Anderson president, I had a bit more to go on. First, I was no longer on the faculty, so was not subject to retribution as I was under DePinho. (The Ronald lambasted me in his office in front of the Faculty Senate leadership for leaking slides to the press. I didn’t leak anything and I didn’t have the slides anyway. He just liked to intimidate people. In my case, he was unsuccessful.) Second, I had several meetings over breakfast and dinner with Dr. Pisters and his wife and assessed that he was not ready for this job, had no understanding of the key institutional assets he was hired to nurture, knew nothing about research, and would not be capable of gathering people around him who could make up for his deficiencies. That, too, turned out to be prescient, but it took far longer for those in charge in Austin to figure this out. Nonetheless, one day, he too was gone.
Neither DePinho nor Pisters lasted anywhere near as long as their three predecessors who each led for more than fifteen years.
As for my current view of the future for Anderson, it is not one of optimism. The Board of Regents, the Chancellor, and all the rest of the hierarchy at UT right up to the Legislature and the Governor and Lieutenant Governor seem to have no understanding of what MD Anderson is or what the UT System would like it to be beyond staying the number one place for cancer care and making money.
It is evident, beyond any shadow of a doubt, that oncology’s future rests with the genetic characterization of the cancers of individual patients then using these data to devise unique gene product- and immunologically-based treatment strategies, possibly on a patient-by-patient basis. This is likely to upend the current model for clinical trials. How can you test a treatment against similar cancers if no two cancers are alike?
In addition, forward thinking cancer centers will apply artificial intelligence to their massive amounts of clinical and laboratory data to go deeper and deeper into the process of individualization of a patient’s cancer and bringing to bear on the cancer the best of novel therapies. The future of clinical trials may be that every trial has an N of one as no two cancers are identical; no two patients are identical; no two treatments for cancer will be identical.
In retrospect, Dr. DePinho had the right idea, but did not have the managerial, administrative, or leadership chops to pull it off. Pisters was clueless.
The next president of MD Anderson will need to be a real physician-scientist (yes, both!) who understands the complexities of AI and omics, and how using these disciplines in a clinical setting. This may completely alter the manner in which clinical trials are done.
He or she also has to be inspirational. The personal and professional challenges facing all faculty and staff will be novel and unpredictable. The current MD Anderson building projects are ambitious and require lots of cash. Where is that going to come from and what role does the faculty have in generating that money? How will the new president get the faculty on board with his or her own programs? How will research be supported when the federal government is no longer dependable?
A really good start on the presidential search process would be for the Austin decision-makers to ask for the assistance of current and former members of the Anderson faculty, and I would exclude incumbent Division Heads, department chairs, and vice presidents appointed by the prior president who I consider a failure. I do mean the rank-and-file faculty. We alumni might be of use, but we are surely less important than the current faculty is. Get their input on the process and the job description. Keep them in the process as candidates are evaluated even if the faculty does not know the identity of the job seekers, their credentials should be evaluated by these faculty.
The leadership in Austin has failed on two successive tries at finding an MD Anderson president who could last as long as the three first incumbents in the job. Why? What is going wrong?
It does not take a seer or a bellwether to know what the problem is. The people making the choice have no idea what they are doing. They have neither the experience nor the wisdom to make a good choice. However, if they avail themselves of the current faculty’s experience and wisdom, this blogger thinks they might have better luck.
However, the one thing I can predict is that I cannot predict what those political appointees will do. Nor would I ever try.
Leading an academic medical institution is a fraught job in 2026. Funding streams are challenged at the federal level and everything costs more. The pharmaceutical industry has cornered the market on new therapeutics and the insurance companies are squeezing institutions on what they will pay for and how much they will pay. Being the President of MD Anderson is a tough job. It is also the best job in academic oncology. This time I would surmise the applications will be from stellar people. The process of choosing should also be filled with stellar people. If the Regents don’t include the faculty, they are making yet another mistake.
I don’t predict, but I fear, that they will make another big mistake. I have no faith that the Regents know how to call for help. I believe many in the chain of command in the UT System are men and we all know what men can’t say.
I’m wrong.
I’m lost.
I’m sorry.
If the Regents started by saying those three things in reference to their prior two choices for MD Anderson president, they might be on the right track this time.
