Chapter 12: Building the Basic Sciences and Research Collaborations
Files
Identifier
MendelsohnJ_01_20050103_C12
Publication Date
1-3-2005
City
Houston, Texas
Interview Session
John Mendelsohn, MD, Oral History Interview, January 03, 2005
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Research; Definitions, Explanations, Translations; Discovery, Creativity and Innovation; Discovery and Success; On Research and Researchers; Professional Practice; The Professional at Work; MD Anderson History; MD Anderson Snapshot; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Fundraising, Philanthropy, Donations, Volunteers; Industry Partnerships
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
James Olson:
: I think the very first time I met you, before my memory was gone, after my chemo or my surgery, you had talked about – I think you had said if you’re going to look at MD Anderson’s strengths and weaknesses over the years, that you were interested in trying to strengthen the basic research. Is that still an issue for you? I think you mentioned we didn’t have a member of the national academy.
John Mendelsohn, MD:
: That’s right. I would like to strengthen the – I would like to change the public mood so that people who do the kind of research we do are welcomed in the academies, but I believe that in the past 8 years we have tremendously strengthened clinical research and translation research. You need basic research as any contributor, so Dr. Kripke is leading some recruitments in structural biology (break in audio) with the Bush endowment that we’re targeting toward some strong basic researchers and what I want is a balance of the three. There are basic researchers in every major university in the United States who are going to discover things with whom we can collaborate. But we need a strong nucleus here so you can collaborate around a lunch table and you can ask questions and the access is very open. Just building the translational researcher and the clinical researcher and not building the basic research would be the wrong way to approach things, and we’ve had these other two areas that are more than basic research in terms of national recognition. I think we have fabulous basic research here, but I would like to do more with our strong national leaders.
James Olson:
: Is there a bias against basic research in the academy?
John Mendelsohn, MD:
: Tremendous. There are only a very few in the academy who have not run (break in audio) in the medical area, in the national academy, especially, who have not run a research lab. Now you can say that most of the major contributions are made by laboratory people rather than clinicians, but I would dispute that. It’s changing though. A lot of the basic scientists are interested in applying their research more in clinical problems than any when I started in this field 35 years ago. 40 years ago.
James Olson:
: I remember, when I go through the documents around the National Cancer Act, that there was a lot of criticism from basic researchers at the time about the direction it appeared things would be going with the National Cancer Act.
John Mendelsohn, MD:
: The basic researchers have a vested interest in keeping as much money as possible feeding into their laboratories ,and they are still vocal about that.
James Olson:
: Were there merits to their criticism?
John Mendelsohn, MD:
: I think if you ask in a three-year period, would a basic research lab turn out more and innovative information than a clinical research lab, the answer would be yes. But if you said in a 10 or 15 year period, the answer would be the research lab is going to turn out just as much. It depends what your criteria is. The NIH wrote some grants that are new every three to five years, and a laboratory researcher has a much better chance making important major contributions in that three to five years, although less now since it’s gotten more complicated, and the clinical researcher isn’t going to have that information that quickly. So it depends what your target is. If your target is to improve the treatment of cancer, you’ve got to do clinical (break in audio).
James Olson:
: When you hear (break in audio).
John Mendelsohn, MD:
: I wrote a rebuttal to that. Did you get a copy of that? But I agreed with him about a lot of things.
James Olson:
: As I go back thirty years to the National Cancer Act, every handful of years, one of those kinds of articles comes up and –
John Mendelsohn, MD:
: He’s making that same point. Let’s give a little more credit and emphasis on clinical (break in audio).
James Olson:
: Other critics talk about something called the Cancer Establishment in a very pejorative sense of sort of the hospitals and the NCI and the pharmaceutical companies and (break in audio) and Mary Lasker. Are there problems with these kinds of partnerships or is this the only way to harness them is to go after the very expensive problems?
John Mendelsohn, MD:
: We have to harness them. Now, the complaint is that advocacy groups have power and then you have to complain about our whole system of government. But it works. The basis of advocacy groups. That’s how government works. So the cancer groups got together and the patients have gotten together as advocacy groups in the 70s and 80s it was mainly philanthropists with connections, but it’s the Komen Foundation and the Cancer Survivor’s Organizations and every type of organization has a lobbying group now. But that’s the American way.
James Olson:
: Right. But I can see some of the – I’ve come across (break in audio) where if a clinician here or a – is dissatisfied with a budgetary decision that’s been made, occasionally they’ll write a letter to one of these advocacy groups and try, from the back door I guess, which was never a very popular issue for the administrators I’m sure. I remember one where – I can’t remember who it was – but it was the Komen Foundation and it was – I can’t remember the details very well, but the institution decided to take the top 10 percent off of grants and donations to put into a larger, kind of institutional fund and someone got mad about that. Is the name Brinkman –
John Mendelsohn, MD:
: Brinker, Nancy Brinker.
James Olson:
: Nancy Brinker.
John Mendelsohn, MD:
: Ran the Komen Foundation, because her sister was Susan Komen –
James Olson:
: Is that right? I didn’t know that. So he writes to her, [mad at] [LeMaistre?] and then (break in audio) and [LeMaistre?] has to write a letter back to her explaining – this is exactly what happened, not what this person said happened. Does that happen much to you?
John Mendelsohn, MD:
: Yeah. There are a few people – first of all – END OF AUDIO FILE FOUR START OF AUDIO FILE FIVE
John Mendelsohn, MD:
: Interactions with advocacy groups in government are necessary. I’d like it to be coordinated. I’d like it to know what’s going on. I’d like Harry Holmes’ organization to be made aware of it. Most times faculty work so that we’re not… What I’m worried about is that we’re singing three different tunes at once, and then Anderson looks like we’re stupid and we don’t get anything done. There are a few faculty members who go around us and go right to the congressmen, and raise issues, and we ask them to stop, and in most cases they do and occasional cases they don’t. I’m afraid that the idea is nobody can contact a congressman but my office or an advocacy group is impossible. Because the congressmen and the advocacy groups are interested in our opinions too. And they should be. I shouldn’t have that kind of power. But I should be able to coordinate it and if we’re trying to develop a new program, I’d like to present that to the Coleman Foundation, thinking back on it, and explain the rationale rather than having somebody ticked off because their grant was reduced. Do the presentation. I mean how is that resolved? I’m curious. Susan Komen Foundation stood behind LeMaistre [oral history interview]. So this is the kind of issue that comes up all the time. And, it isn’t a big issue on my radar screen.
James Olson:
: What’s your greatest sort of frustration in the job? Or greatest concern is the better word. Concern or frustration.
John Mendelsohn, MD:
: The greatest concern is, obviously – the standard concern is we have meet our budget and make our margin. We have to reward our faculty and recruit outstanding faculty and employees here in general. But the newest things on the radar screen are, first of all --and obviously we want to raise the standards of our patient care at all times. But the newest things are two things I think about a lot. One is we’re growing, and it’s getting more and more complicated here because we’re big and we’ve got to get the information systems and the infrastructure in place to optimally utilize our human resources and our physical resources and the information we have. Every hospital faces this challenge, but because we’ve grown 50 percent in the last five years or more in terms of the number of employees, our budget is more than doubled. We’re opening these new buildings. The infrastructure in which we practice medicine has to be as cutting edge and as modern and efficient as the actual care of the patient and the actual research we do. We have to work hard on that. The second area is indigent care. The Indigent Care bill is going up in double-digit percentages each year. This past year was the first year our costs for indigent care are greater than our total appropriation from the legislature. We gave over $200 million. Mr. Leon Leach [oral history interview] would be the person to talk to about this. We gave over $200 million in indigent care to uninsured Texans. That’s costs. Convert that to charges, and that’s around $170 million of unbilled care. We can’t bill. These people are indigent. That’s more than our legislative appropriation for the first time. Our legislative appropriation has gone up very slightly over the past eight years, and our indigent care has gone up like this. And over the past eight years, I think it’s more than doubled actually. And we’d love to be available for all Texans, but if we’re going to be the best cancer center, we’re going to have to start rationing indigent care or work out a way to cost share. There are 250 counties in this state, and as I understand, only one participates in cost sharing, and that’s Harris County. The other 249 don’t, and their patients know if they’re indigent and come here, we’ll try to take them in, unless they’re end stage or unless there is nothing we can do. But they won’t – they’re supposed to help pay for indigent care, each of those counties, but they don’t because they don’t have the money. I think this is going to become a major issue in the state legislature, not just for cancer. How do we take care of the children and the indigents in our state? So that is a major concern to me. Those two areas on top of the usual concern of having the best patient care research and education and prevention programs. The faculty are aware of this and the staff are aware of this. I don’t know if you read my state of the union address I gave this year. You should read that. I emphasize these areas a lot. BRUNET: The new areas of clinical care, I think, are very interesting.
John Mendelsohn, MD:
: Yeah. That’s a very – I spent a lot of time writing that and it’s a very useful summary. We’ll get a copy for you on your way out.
James Olson:
: Great. Can I get a copy of your CV before I go? Can I get a copy of that.
Recommended Citation
Mendelsohn, John MD, "Chapter 12: Building the Basic Sciences and Research Collaborations" (2005). Interview Chapters. 1454.
https://openworks.mdanderson.org/mchv_interviewchapters/1454
Conditions Governing Access
Open
