A Very Sad Day          May 22, 2013

By Leonard Zwelling

            I
attended the Faculty Senate meeting last evening. In many respects it was like
most Senate meetings. It got started late as we awaited the arrival of many
busy clinicians trying to serve both their patients and their fellow faculty
members as senators. The Chairman was even late as he too was caring for his
patients.

            We
heard reports of all kinds from reviews of the past forum to determining the
focus of future ones. We heard testimonials to the progress being made in
relationships between the Faculty Senate leadership and the institution’s
executives. An offer was made to have “off-line” (what does that mean) meetings
with Dan Fontaine. No takers on that one. A new committee is being established
to improve the infrastructure supporting research. These all seemed like good
ideas.

            Except
that they missed the point.

            The
Senate still does not have adequate financial reports to make reasonable
judgments as to why there is a margin gap despite the increase in clinical
activity. The Senate still does not have a game plan as to how to close this
gap from those in charge other than to drive the faculty harder (the beatings
will continue until morale improves). The Senate still does not have any
concrete assessment of the costs of the Moon Shots, the Global and Regional
clinical programs, the so-called “platforms” and most importantly the Institute
for Advanced Cancer Sciences where salaries are in excess of those elsewhere at
MD Anderson.  

            It
was reported that a spreadsheet was provided to Dwain Morris to obtain these
data. Nothing has been received. This suggested to me that either those data
will not be forthcoming or they are not available. I suspect it is the latter
because I doubt that our accounting system is such that one could trace an
in-coming clinical dollar to the place where it is spent.

            I
heard the part about no clinical revenue going to the Moon Shots. But what
exactly does that mean? How are the Moon Shots, platforms, and IACS being
supported if not with clinical revenue?

            Then
how about just answering this. If 82% of the revenue comes from clinical
activity (this is from a Sr. VP), what percent of the expenditures goes to the
Moon Shots+IACS+platforms+Global Programs and Regional Centers? If that is in
excess of the 18% that does not come in from the clinic, that would suggest
that clinical dollars are being used for these expenses. Surely those data
should be easy to obtain.

            There
is still no accounting for the President’s actions with regard to Aveo
including the facts surrounding his CNBC appearance, the reason his equity is
not in a blind trust even yet despite Dr. Shine promising just that weeks ago,
and when exactly he should have been aware of the disappointing clinical
results surrounding the testing of Aveo’s one and only product.

            I
tried to make some of these points last evening, but I felt strongly that they
were falling on deaf ears. It wasn’t that my colleagues rejected my ideas or
doubted me. It was that they felt rather powerless against the juggernaut of
the 20th floor and many were still certain that this can’t be as bad
as all that.

            I
respectfully disagree. It is as bad as all that and is likely to get worse as
the tension ratchets up on the revenue side with no attention being paid to the
cost side, the only side actually under our control. The notion that we can
somehow, predictably turn our research into a reliable revenue stream is a
really long bet. To do so at the cost of the excellence of our clinical care
simply because the faculty are straining to meet the demands being made of them
while trying to keep some semblance of an academic career going and perhaps
seeing their families once in a while makes no sense to me.

            Walking
to the parking garage after the meeting I felt profoundly sad and lost. A good
friend had died. That friend is the belief that MD Anderson matters to the
world and that the faculty members matter to each other. Yesterday felt like
that was all gone, having followed the annual faculty party with the ice sculpture, the red
marble and the Anderson Mayfair into the sunset of distant memory. Gone. And, indeed, that was all gone, replaced
by a culture of corporate thinking and outright greed that undermines the very
fabric of who we are.

            May
21, 2013. A pretty sad day for me. 
What about you?

            Last
week I was discussing all of this with a faculty member who had decided to
leave, having graduated from the LTL, “looking to leave”. This faculty member was equal parts sadness and anger, regretting that the
assumption of growing old with colleagues at Anderson was not to be.

            Indeed,
nostalgia mixed with melancholia seems to be the predominant humor of the MD Anderson
faculty?