Chapter 32: The MD Anderson Presidents

Chapter 32: The MD Anderson Presidents

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Dr. Hortobagyi first gives an overview of R. Lee Clark and sketches a portrait of MD Anderson in 1974, when Dr. Clark recruited him. Dr. Hortobagyi tells a story to show how solicitous the Texas Legislature was of R. Lee Clark’s requests for money. He goes on to talk about the many good recruitments Dr. Clark secured as well as his incredible vision. Dr. Hortobagyi then describes the situation in Texas in 1941, when Dr. Clark conceived of the new Cancer Center, then describes his administrative style. Dr. Hortobagyi recalls his fellowship period and notes that Dr. Clark always knew who he was and remembered the project he was working on. Dr. Hortobagyi also remembers that fellows would sleep on a couch in Dr. Clark’s office, and he’d nudge them out in the morning when he came in.

Dr. Hortobagyi praises Dr. Clark’s practice of developing international connections. As a result, he says, MD Anderson trained many international students who became leaders in the global cancer community. Dr. Hortobagyi then shifts to Charles LeMaistre, offering background on his research, then noting that he was a more reserved administrator, with primary skills in political interactions with the Legislature and with higher education. He talks about the difficult years of Dr. LeMaistre’s tenure, when about two thousand employees were laid off, “dampening the spirit of the institution.”

He then shifts to John Mendelsohn, who was able to “lift the institutions spirits in an hour” by going on record and saying that MD Anderson was doing fine. Dr. Hortobagyi give some background on Dr. Mendelsohn’s administration, noting his fundraising skills, his innocence, candor, and ability to talk to anyone. He describes him as “a communicator.”

Dr. Hortobagyi then talks about the growth of the Development Office under Dr. Mendelsohn and his ability to recruit good people. He also notes that Dr. Mendelsohn “didn’t have a mean bone in his body,” which was a disadvantage when it came to making painful decisions. Dr. Hortobagyi offers an example of decision making about laboratory space that was held back because of this limitation. He also observes that Dr. Mendelsohn’s administration was tarnished in the last years of his tenure and that he became more enclosed with his inner circle and lost touch with the faculty. Dr. Hortobagyi then shifts to Dr. DePinho, saying that he was a surprise choice, never having led a patient-care institution. Dr. Hortobagyi hopes that he picks up those skills and that the four missions stay in balance.

Identifier

HortobagyiGN_05_20130315_C32

Publication Date

3-15-2013

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Key MD Anderson FiguresPortraits Funny Stories Personal Reflections on MD Anderson Human Stories Offering Care, Compassion, Help This is MD Anderson MD Anderson History Building/Transforming the Institution Growth and/or Change Obstacles, Challenges Controversy

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Tacey Ann Rosolowski, PhD:

I wanted to ask you about—to reflect a bit on leadership—your own and then also you've worked with three MD Anderson presidents.

Gabriel Hortobagyi, MD:

Four.

Tacey Ann Rosolowski, PhD:

Four? Ah, okay, yes. Well, maybe we could start with the presidents then—just some commentary on their leadership styles, the mark they left on the institution, and kind of a critical view of them.

Gabriel Hortobagyi, MD:

Well the first one was R. Lee Clark. Lee Clark was, I think, a flight surgeon. He was the first and founding president of MD Anderson, and he was instrumental in really the very beginnings. When he was recruited MD Anderson didn't exist. He went through the transition of when MD Anderson was in a couple of disabled railway cars, the first buildings, and he recruited virtually every one of the first faculty members at MD Anderson. When I came in 1974, we were then constructing, I guess, the third and fourth buildings of MD Anderson which were the Lutheran Pavilion and what is now the Rose Zone. Because at that time the central core existed and the one that is parallel to that—I guess it's the Bates-Freeman Building. I no longer remember those names because I no longer use them. Lee Clark was an amazing character with a great deal of charisma, a great deal of social graces in the sense of people skills. The joke used to be that Lee would go up to Austin when the legislature was meeting, and he would present the MD Anderson budget, and there would be dead silence. And then someone would timidly ask, "But Dr. Clark, are you sure that's all you need?" (laughs) So he had a great deal of influence in Austin, and he knew how to use that influence and how to use that power. He made some extraordinarily good recruitments. He recruited a very strong first chairman for radiation oncology in Gil [Gilbert H.] Fletcher. He recruited a very good surgeon, Ed White. He recruited a number of internists, and I never met the first head of Internal Medicine, but certainly there was a strong cadre of individuals. The first group of radiologists was outstanding. The first group of pathologists was outstanding, and Lee Clark had an incredible vision.

Tacey Ann Rosolowski, PhD:

Just put yourself in the situation of Texas in 1941. This was a backwater town, and how people lived here without air conditioning and in a swamp that had endemic malaria and yellow fever in a very primitive state—we are still a somewhat backward state culturally but light years ahead of what this was at that time. And he had to struggle nationally with the perception from the Brahmins from the northeast—who thought and still think that they are superior human beings—that he was going to develop a competitive, first-class cancer center in the middle of Texas. You have to have incredible vision and courage. Not only did he do that, but in a very short period of time he managed to put this institution on the map. He managed to get some national financial support, and he continued to recruit people. He had a great administrative style. I don't know if I mentioned to you that when I was a fellow here, I would walk through the hallways going from point A to point B and I would cross Dr. Clark who was, of course, the great god. He would know who I was, and he would greet me by my first name, and he would know what I did. "How is your project with x, y, or z? Are you working hard enough? I don't like the tie you're wearing today" or something like that. He was very personable. When we took call, there were no quarters for the house staff to sleep, so there was a couch in Dr. Clark's office. So we would sleep there whenever circumstances permitted, and there was a shower in his bathroom. But he would come in early and he would sort of nudge you and tell you, "Get out because I’ve got a meeting in about ten minutes." (laughter) And that was on the top floor of the central core. That's where his office was.

Tacey Ann Rosolowski, PhD:

So, in his own way, without being a scientist—because he never presumed of being a scientist nor was he really a scientist. He didn't have the training for that, but he was apparently a very good surgeon. And he had this vision and the political skills and the people skills, and he built this institution from scratch. So in some ways it is of much greater merit than the subsequent presidents. Without taking anything from the other three—each of whom has enormous merit—but Lee Clark was sort of the founding father. He also had the vision to develop incredible international relationships. Lee Clark was very much involved with the UICC. He invited a number of very prominent cancer specialists over the years to come to MD Anderson to talk, to visit, and he had numerous interactions. So MD Anderson was pretty well known around the world—perhaps even better than inside the US—by the time I came here. That's the reason I took that. We were training a large number of international students. Today in many parts of the world, the leaders of their cancer community or cancer research community were trained in the US—certainly true for Japan, certainly true for much of Western Europe, but also true for South America and parts of the Middle East and North Africa and Asia and whatnot. So he was very, very influential, and he left a huge mark on the institution.

Tacey Ann Rosolowski, PhD:

Then when he stepped down—and I think he stepped down because he reached the age limit—then Mickey [Charles A.] LeMaistre was recruited. I think Mickey had been—he was not a cancer researcher. He was a pulmonary specialist, and his specialty was, in fact, tuberculosis. But he became interested in the problem of tobacco and its relationship to lung cancer, and that's how he came about towards cancer. But he was really—I think he was selected as president of this institution because of his role as chancellor of the University of Texas. He never presumed of being a cancer research specialist. I think his major skill was the political interactions both with the University of Texas and the Board of Regents and the higher education establishments throughout Texas. He was very, very good at that. By the time he took over, of course, Nixon had signed the war on cancer thing, and we had become an NCI-accredited cancer center. We were one of the first three. So by then MD Anderson was on the map. Mickey was also very effective at raising funds—not as much as Mendelsohn—in part because we didn't need it as much. In the mid ’70s the legislature was throwing money at us, and we had plenty of money. In fact, we didn't have a development office at that time. People who wanted to contribute just wrote a check, and I guess they sent it to Mickey's office or to Lee Clark's office. But Mickey was a much more reserved administrator. I got to know him much better after he stopped being president than while he was president. I seldom saw him walk around the institution. He sort of focused on his inner circle and worked with them. He worked also very much with potential donors, but it was just the big picture as opposed to really developing that.

Tacey Ann Rosolowski, PhD:

Then came John Mendelsohn, and John was—the last few years of Mickey LeMaistre's tenure were painful because it was around the time when managed care started to make a dent in Texas. To prepare for that, there was this apocalyptic vision that this would be a terrible scene, so they hired some consulting organization. As you know, consultants are people from out of town with a business card. So they came, and they gave us a horrible report. They charged us probably a million dollars to tell us that we would go belly-up, and there was no way we would survive because being a freestanding cancer center we had no referral base. So Mickey and his administration took that very seriously. We laid off something like 2000 people; and at that time we were much, much smaller than now, so that represented probably a quarter of our workforce. It was enormously painful, and we lost a lot of very valuable employees at a time when we were just recovering from the 1988 Wall Street crash, so a lot of people got hurt. It turned out that it was totally unnecessary. The advice we got was junk. Pretty soon we had to rehire a number of people because we were growing, and we had no way to take care of individuals. But it left—it sort of dampened the spirit of the institution, and when Mickey finally stepped down, the faculty were demoralized, and the employees were fearful of when were they going to be RIF'd. That was a term—RIF—reduction in force.

Tacey Ann Rosolowski, PhD:

So then John Mendelsohn came in, and John Mendelsohn came in and his first act was to give grand rounds and go on record saying, "We are doing fine. We are going to be the best cancer center in the world. We are going to be doing that on the basis of research-driven patient care and the best education we can provide to our students, our faculty, our patients, and our community." And it was so invigorating that he really just lifted the spirits of the institution within a question of hours. He was, of course, and is a scientist—a card-carrying scientist who has contributed in a major way to what we know about cancer. He had been a cancer center director before in San Diego. He was a department chair at Memorial in New York. He ran a large lab in New York. So he had many, many skills and something that we didn't know that he also had: he turned out to be a monster in terms of fundraising. He has been, without doubt, the most successful fundraiser I have ever known. He's now seventy-six or seventy-seven, although he doesn't look his years. But from the moment he arrived until now, he has this incredible innocence that is transparent. He never got a big head like many very prominent and famous people—especially scientists and physicians—so he has this ability to have this very candid and down-to-earth conversation with anyone—with you, with me, with the donor who wants to give five dollars—and he makes everybody feel comfortable. It has been amazing to me to watch this man communicate with a variety of people but especially with those who are extremely wealthy. Many of the wealthy ones—not all of them but many of them—are very sophisticated people. They have been around for a long time. They have made a lot of money. They have had the ability to interact with a lot of other sophisticated people. They are well traveled, and some of them are well read. Most of them are well educated, so you can't just pull the wool over their eyes. And John just links up with them without any effort and without trying to sell them a bill of goods. He just has this uncanny ability to convince them that what we are doing is inherently good, that what we're doing is important, and that they need to contribute.

Tacey Ann Rosolowski, PhD:

He was really the one who started our Development Office. I believe there was a development office before he came, but the development office before he came was essentially an office with one person and a secretary, and I think they just processed the checks that came in without anybody asking for it. Since Memorial at that time had a very effective—and they still have an enormously effective development office, John sort of imported that concept, and he recruited a professional fundraiser. Today our Development Office is one of the most successful development offices in the country. We're still not as good as New York, but we are very good. Could we do better? Of course, but our development efforts have been very good and as a result you see all of what you see around us, and at least much of it—not all but much of it—has been paid for with philanthropy, and that's very largely John's contribution to the institution. John also contributed a lot to recruiting some good people, but he is a profoundly good human being. I don't think he has a mean fiber in his body, which to some extent is a disadvantage for a CEO and for a president because presidents frequently need to make painful decisions, and some of the painful decisions that would have been and probably are still necessary for this institution were not made during his tenure. He made some, but he left some others unmade.

Tacey Ann Rosolowski, PhD:

Can you give me an example?

Gabriel Hortobagyi, MD:

Examples. Over the years, a number of individuals on our faculty stopped being productive. They stopped getting grants. They stopped writing papers. They stopped working hard or trying, and they continued to be carried on with the institution paying for their salary, providing for their office, their secretaries, all of their maintenance, providing them laboratory space, and resources, and whatnot. That was just all going down into the black hole, and the decision to trim the deadwood was never made. Ever since I've been here, we've been fighting for laboratory space. There's never enough laboratory space. So during John's tenure—and of course when you walk around the institution, you walk through labs that are full of cobwebs, and a human being hasn't been sighted for years, but they belong to someone. Finally when it was obvious that this thing of we don't have enough lab space was ridiculous, the administration under John put together this committee that would assess the productivity of each lab. So they sent around questionnaires that every department chair had to fill, and then they visited all the labs, and then they came up with a scoring system. There were some labs that got all ones. There were some labs that got twos and threes. There were some labs that got fours. And there were a few labs that got fives, meaning they weren't doing a damned thing. Never. There was never any repercussion to that. No follow through, nothing that said, "Listen you guys, you got straight five. What are you going to do about it? We're going to repeat this in one or two years, and if you're still below, let's say, the average, your lab space is gone." It never happened. So that's the type of hard decisions that were not made.

(end of audio 1b) 0.00:00 (begin audio 2)

Gabriel Hortobagyi, MD:

I understand it’s very hard to do that. It’s very hard to confront someone who—especially someone who has a strong feeling of ownership and tell them, “Charlie, you’re out of luck. I need that lab space and I’m going to give it to Smithie.” So that tarnished a little bit the last few years of John’s tenure. The other thing that towards the end of his tenure happened was that he became increasingly enclosed in his inner circle, surrounded by the chief financial officer and the chief legal officer and the vice president for the physician-in-chief and vice president for hospital and clinics. He was less available to the rest of the faculty, and I think that was problematic because he became isolated. During the last few years before Ron DePinho arrived, the administration clearly lost touch with the faculty. I’m sure you will hear that from many others in the institution, because it was so obvious that it was painful. Of course, you can understand part of that because the institution grew enormously under his leadership, and the larger an organization is the harder it is to stay in touch because there are so many things to attend to.

Tacey Ann Rosolowski, PhD:

It was also a really rapid growth.

Gabriel Hortobagyi, MD:

Tacey Ann Rosolowski, PhD:

It was also a really rapid growth.

Tacey Ann Rosolowski, PhD:

Tacey Ann Rosolowski, PhD:

And managing that shift in such a short period of time—

Gabriel Hortobagyi, MD:

Absolutely.

Tacey Ann Rosolowski, PhD:

Tacey Ann Rosolowski, PhD:

—enormously complicated.

Gabriel Hortobagyi, MD:

Tacey Ann Rosolowski, PhD:

Absolutely. And then there were lots of recruitments, and there were reorganizations here and there and restructuring and—so there are many explanations but—so that’s how I remember sort of the good and the not so good from that administration. Then our fourth president, who was a little bit of a surprise to all of us—not because he’s not an outstanding scientist. He is, but he has never been in charge of a healthcare institution, and he doesn’t have the experience of leading a patient-care-related organization. That requires very different skills from running a lab or from being a brilliant scientist. I just hope that he picks up those skills or that he recruits individuals who have those skills, because currently we don’t have them in the upper structure of the institution. I hope that we get to a point where there is—we go back to the balance—that perfect balance where our four missions are all at the same level. And right now we are not at that point. I think it would be very important for us to keep that because that’s what got the institution to where it is now—not where it is now but what we have become. You can argue whether we are indeed the number one institution in the country or not. That’s a little bit of an artificial thing because of the way it is done by that magazine, whatever that is called. I think we are very good, but we can always be better.

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Chapter 32: The MD Anderson Presidents

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