Imperial Executive Rule Is Bad For Business And Bad For Academic Medicine
By
Leonard Zwelling
This piece by Tim Higgins appeared in The Wall Street Journal on November 3. It describes how the CEOs of the dominant technology companies are manipulating the different classes of purchasable stock shares to assure the CEO founders of the companies remain in total control. This is not the corporate structure I was taught about in business school in 1993. It is, however, the structure that has governed MD Anderson from its beginning and it has only gotten more heavily cemented into the institution’s DNA with the current Texas Legislature and Board of Regents.
To summarize in brief, the President of MD Anderson is the King of MD Anderson.
The UT System’s recent directives to the presidents of each of the components, academic and medical, give the leaders carte blanche autonomy with regard to all matters on their campuses. They can fire any faculty member they wish to regardless of tenure status and do so without cause, hearing, or recourse. They can end entire programs on a whim and get rid of everybody in the program.
This is a terrible system. When combined with the dissolution of Faculty Senates ordered by the Texas State Legislature and MD Anderson’s leadership’s refusal to even consider forming a faculty-chosen representative presidential advisory committee, the MD Anderson president is, indeed, imperial. This might have been fine when R. Lee Clark invented MD Anderson. It is not fine any longer.
The reason is simple. Medical care, especially in clinical oncology and in lab-based and population-based research, is expensive and complex. Educating the next generation of cancer care givers and investigators is more important than ever. No one person can excel in all these areas, but whoever the president of MD Anderson is, he or she must be facile with all of these areas while surrounding himself or herself with true world’s experts in all the disciplines of academic oncology.
Clinical care is far more demanding to deliver than ever. There are more drugs from which to choose in treating systemic malignancies from immunotherapies to gene-product-targeted agents to laboratory-grown cell therapeutics. If an academic oncologist is caring for a patient on a clinical trial, the consent process is lengthy and the paper work increasing with the ever-greater demands of drug company sponsors who themselves are bowing to the co-temporal demands of the FDA. And, of course, the hospital administrators are constantly pressing patient volumes upwards so that they can fill their institutional coffers and inflate their own salaries. All of this occurred under the last president of MD Anderson.
Research is just as hard to do as clinical care and far more difficult than it was when it filled my day. Grant money is impossible to come by and the very system used by the NIH which had at least, on the surface, appeared to be merit-based in the past, has been politicized by the Trump Administration so even securing a single-digit percentile score on an RO1 application does not guarantee funding if the subject of your application does not fit with the Trump political, social, or culture war agenda. Research is also much more costly—technology, animals, and reagents all cost more. So does technical help.
Education is an afterthought. Let’s face it. Other than deans, no one gets paid to teach. Sitting on student panels and PhD exam committees costs time and gets faculty nothing. In fact, for the most part, sitting on just about any committee in an academic center like Anderson is without any meaningful or spendable remuneration.
As for cancer prevention, I think this is largely given lip service beyond the appreciation of the money coming in for colonoscopies and mammograms. Many aspects of Anderson’s cancer prevention programs like health disparities and nutrition research are not valued by the current administration at all.
The last president of Anderson was a surgeon who knew next to nothing about research of any kind and fancied himself a high-powered CEO manager after taking a few courses at Harvard. He was ill-equipped for his job and that job was designed to be imperial in every way. Only great humility and a highly-developed sense of judgment can compatibly manage in a system designed to be led autocratically, even as this is not the most effective way to advance progress or create a nurturing environment for faculty and staff alike.
The Board of Regents would be wise to do the following:
- Start the search for a new president of MD Anderson if one truly has not been initiated. Plan to have him or her hired by September 1, 2027 the start of the next academic year.
- Put in the job description the necessary areas of expertise this person should have. As far as I can tell, only John Mendelsohn had the right stuff to be MD Anderson president since Lee Clark stepped down. Dr. LeMaistre was a known entity to the people who hired him. Neither Dr. DePinho nor Dr. Pisters were wise choices and neither man had a longevity record like their predecessors.
- During this new search process, the Board of Regents needs to acquire input from the current MD Anderson faculty about what needs to change to improve life at the cancer center and how to reconstitute something like the Faculty Senate. Then demand during the interview process that candidates pledge to adhere to the faculty’s suggestions and develop a way to continue a dialogue between the president and the faculty.
- Publicly establish what success looks like for the new president and delineate the metrics of success for the institution.
It is my belief that this moment in the history of MD Anderson could be similar to the one that brought Dr. Kleinerman and me here in 1984. The push toward excellence began the year before with the hiring of Drs Krakoff, Kripke, and Fidler. The following year brought Ki Hong, Bernard Levin, and us to implement what the leadership wanted—better science, more compliant clinical research, better training, and more imaginative clinical care. We all tried to do that.
The time for MD Anderson’s renewal is upon us. The Board of Regents needs to get on with the search. When the finalist is identified, that person must pledge to end the imperial MD Anderson presidency and seek the guidance of the faculty through a new dialogue between elected representatives of the faculty and the new president.
Elon Musk, Dario Amodei, and Mark Zuckerberg are unlikely to relinquish the control of their companies to anyone, let alone their own shareholders. Such dictatorial leadership could see the companies they lead to ever greater profit. It could also lead to disaster if one man makes all the decisions.
Academic medicine need not follow the model of the imperial CEO, even if such institutions, like MD Anderson, might have been created this way. Things change. Anderson can change. First, Anderson needs a new president—as soon as possible, but no later than September 1, 2027.
