Angst On Holcombe
By
Leonard Zwelling
In my last blog entry, I tried to lay out the facts as I see them with regard to the presidential transitions that have occurred over my forty plus years as an MD Anderson faculty member and retiree. I hope that was helpful. I hope I got it right. Any criticisms or corrections are welcomed.
I also put in a plea to the Regents that they do a lot more homework as they select the next president for MD Anderson and that they get on with it and not have a long lag time without a permanent leader. The building projects alone require attention, and, in my opinion, a fresh eye as to their necessity and the wisdom of the proposed expenditures. Is there really a large enough demand for all of that new brick and mortar? Is this massive investment in space the wisest decision given the current, ephemeral nature of federal funding? Might those philanthropic dollars be better invested in research? It seems a thorough reassessment of the strategic plan for the UT cancer center might be in order before more shovels are put into the ground.
But the most important issue facing the Regents as they determine what is next for MD Anderson is how to bridge the tremendous gap that has grown even wider of late, between the administration of the cancer center, its leadership, and the faculty that actually produces the product that will alter the natural history of cancer in a patient’s life or in the world at-large. There will always be tension between those making critical decisions on top of an organization and those affected by the decisions, but it does not have to devolve into animosity. Dr. Clark, Dr. LeMaistre, and Dr. Mendelsohn proved that. Each had periods of mutual respect with the majority of the faculty.
Someone recently asked me what I thought the major areas of cancer research as it applies to patient care are. I think the latest developments in sequencing-dependent, oncogene product-based therapies, as is the case for lung cancer, certainly is one, as is the use of custom-made mRNA vaccines as has recently been accomplished for melanoma. But an eye on the price of these therapies is critical. The healthcare system in the United States cannot withstand the cumulative cost of $200,000 per patient treatments for every patient with cancer. We will need to establish how much benefit is likely from each new treatment to compel insurers to bear the financial burden. The country already spends 17% of its GDP on healthcare. Will everyone eligible for such individualized therapies get the treatment they desire paid for by insurance or only those cancer patients where the therapy will increase their lives by ten years? Who will decide?
Another area likely to yield productive research is the development of new screening tests for cancer. Can a blood test be commercialized to detect ovarian or pancreatic cancer when it is in its earliest stages and surgically curable? Such a test could be game changing for thousands. But, how will we know if early detection prolongs life or just produces lead-time bias—finding cancer earlier with the patient’s date of demise unaltered?
And perhaps of greatest importance is the use of AI in the management of patient care, in the interrogation of already collected clinical and pathological data, and in the actual performance of lab-based research (see https://www.nytimes.com/2026/08/27/science/scientists-experiments-replication-ai.html?searchResultPosition=1). The next president of MD Anderson will have to decide which from among these areas and countless others deserve the greatest attention and resources, not to mention new recruiting.
Thus, it is imperative that the next president of MD Anderson be a cancer doctor who has done and understands bench research. The last person to hold that job with these credentials was John Mendelsohn. The last two guys did not even qualify for the job they were given and the whole place suffered, especially the faculty.
The angst I refer to in the title is what is running through the faculty today because:
The faculty know that the current leaders at Anderson at the executive, divisional, and departmental levels are largely inadequate. Most were protected by the retiring president. If I were those leaders, I’d be buffing up my resumé.
Whole departments may disappear and the people in them now will be looking for work. I refer directly to Pediatrics. I believe that the Anderson clinicians now moved to Texas Children’s will be Baylor faculty within a year or two and those left on the Anderson side of the street in the labs will have their positions eliminated as can be done according to my reading of the new legislation governing presidential discretion in the UT System. A president can eliminate any program at a UT component and all of the jobs in that program can end.
Finally, I believe that the new president will have to ask himself or herself whether or not MD Anderson really needs to have 22,000+ employees, many of whom don’t even come to work any longer. That’s a huge fixed cost. Is it paying off? Will the new president instill discipline, strategy, vision, and ethics into an organization that has lacked all four for years?
Obviously, I have no idea, but these are the issues I hear being discussed by the faculty caught by surprise at the Pisters retirement announcement, elated that it has finally come, but worried about the uncertainty it brings. Pisters was the devil they knew, just as DePinho had been before him. Wouldn’t it be special to have a president of MD Anderson who does not consort with felons, does not make ridiculous claims about the eradication of cancer in five years, and is willing to answer unscripted questions before a group of faculty members?
MD Anderson has been without this kind of competent leadership for 25 years. The field of cancer research has never been moving faster or in a more productive and life-saving direction. If MD Anderson is going to participate in the coming revolution in cancer care, it needs a president who can actually read and understand a scientific journal article, know which end of a stethoscope goes in the ears, and not chase felons for more money for himself.
Is that too much to ask? Well, it has been for a long time. Let’s see if the Regents can right the ship or will they choose another leader who doesn’t remotely qualify for the job. Only time will tell.
