Chapter 10: Strategic Planning, Budgets, Physical Space, and Industry Partnerships

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Chapter 10: Strategic Planning, Budgets, Physical Space, and Industry Partnerships

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In this chapter, Dr. DuBois summarizes several areas of activity with broad institutional impact. First he talks about the members of the Executive Committee who met with John Mendelsohn every week and describes the strategic plan that committee had worked out prior to his arrival.

Next he talks about the committee's relationship with the Board of Visitors in addressing the "assumptions we are making about the future of the institution." As an example he notes Dr. Thomas Burke's role managing the clinical burden and the $250 million margin that created a low margin in context of other businesses. Dr. DuBois next notes that he was surprised at the degree to which the institution's financial team wanted to ensure a return on any investment. He gives an example of the improvements that Dr. Ronald DePinho proposed to make on South Campus to foster research, and also talks about the Proton Therapy Center and the Center for Biomedical Imaging. He mentions a discussion of indoor walkways to connect the south and north campuses, which leads to a discussion of the importance of designing physical space.

Next, Dr. DuBois speaks about efforts to build partnerships with industry, also explaining how Texas laws about intellectual property hamper development of these collaborations.

Identifier

DuBoisR_02_20181114_C10

Publication Date

11-14-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Building/Transforming the Institution; Research; Institutional Processes; Overview; Definitions, Explanations, Translations; MD Anderson Culture; Working Environment; The Business of MD Anderson; The Institution and Finances; Industry Partnerships; Controversy; MD Anderson and Government; On Texas and Texans; MD Anderson Product Development and IP

Transcript

Tacey A. Rosolowski, PhD:

So important to put the supports in place. What were some other—well, let me ask this question. When you arrived, obviously you had working relationships with Dr. Mendelsohn and other people on the executive team. Who were those folks and tell me a little bit about your working relationships and your shared vision for the institution.

Raymond DuBois, MD, PhD:

Well, the team was really led by Dr. Mendelsohn, and Tom Burke was the physician in chief, and I was the provost and executive vice president, really for all the academic and research affairs. Then eventually, they appointed me to chair the international whatever --oncology committee. We had a lot of international connections at different centers abroad, and so that was a big enterprise actually back then, and then Leon Leach, who was the financial and business executive vice president. We met every week. There was an agenda. We all got along extremely well. We were all on task with the mission and goals for MD Anderson, which they had just gone through a strategic planning enterprise a few months before I got there, so those were all clearly articulated and I was totally onboard with those.

Tacey A. Rosolowski, PhD:

What were the elements of that strategic plan?

Raymond DuBois, MD, PhD:

Well that was the plan that outlined the development of all these new institutes and research centers, and it really served as the basis for the funding campaign, the philanthropic campaign, that was started to support those endeavors and raise money for all those programs. So all of that was totally aligned. And you know, I think the finance and business part of the institution wanted to make sure that we were optimizing our investment in new faculty, and so by me increasing the requirement for extramural support for their salary, they thought that was a real positive thing and took a little bit of a burden off the other parts of the institution to support that. We also had a Board of Visitors and there was an executive group as a part of that and they were very engaged as well, and from time to time we would meet with them and give updates about what was going on, what we were excited about, what we were trying to do to make the whole system work better. There were a lot of business people on there, so they always gave a lot of feedback and suggestions about how to improve.

Tacey A. Rosolowski, PhD:

Who was the president of the Board of Visitors at that time, do you recall?

Raymond DuBois, MD, PhD:

You know that’s a good question, because it changed during my time, so I’d hate to say the wrong person.

Tacey A. Rosolowski, PhD:

That’s okay. It’s one of the things we can correct later.

Raymond DuBois, MD, PhD:

It was the guy who came from Exxon Mobil, I think.

Tacey A. Rosolowski, PhD:

Is that Ben Love? No, no.

Raymond DuBois, MD, PhD:

Love started—he was there right when I started and he stepped down and another person came on

Tacey A. Rosolowski, PhD:

I can’t remember the name of the guy.

Raymond DuBois, MD, PhD:

Love was very dedicated to MD Anderson and I got to know him, Also, he was a grad of Vanderbilt, so he and I shared interests in both institutions.

Tacey A. Rosolowski, PhD:

Interesting. Well, we can add that other name later. This is a little bit of a complicated question, I was trying to figure out how to ask it actually. So you’re in this new situation with these individuals and you have this—you have an affinity to their strategic goal. Now the question I wanted to ask is what was being assumed, that you didn’t realize until later when you looked back? Because you know, there’s something, here’s this institution. What were the assumptions you were making about the future of the institution?

Raymond DuBois, MD, PhD:

Well, you know based on the interviews that I had with everybody and my understanding of things, I think we were all pretty well aligned in terms of improving the quality and impact of the research. There was always an issue to try to see more clinical patients and generate revenue that way, and so we were constantly looking at that, and Tom Burke did a fantastic job of managing that whole enterprise. During my whole time there, our margins were always pretty good. I think the lowest margin we made was around $250 million and the highest was well over $500 million, and so for an academic institution, that is a very good outcome. But it can always be improved, and we were constantly examining that and trying to make the clinical appointment scheduling more efficient, and the whole process as efficient as possible for the patients, because patients come first. Everybody’s concerned about that. So I guess one of the things that—I don’t know if I was surprised, but that became clear-- is that the financial team really wanted to make sure that everything we did had some return on the investment. So there was a lot more focus on that sort of business aspect of the institution that I had seen at Vanderbilt or other places, but in the long run, I think it was probably well placed and made us all conserve resources a lot better and really think about things before we invested in new equipment or infrastructure to build new buildings and other things, to make sure that it was something that was really going to make an impact.

Tacey A. Rosolowski, PhD:

Was there a particular discussion that you recall around this issue, I mean just to give an example?

Raymond DuBois, MD, PhD:

That’s a good question. There were lots of discussions about building the new buildings on the South Campus, and whether or not that was where we wanted to spend. [background noise]

Tacey A. Rosolowski, PhD:

Yikes.

Raymond DuBois, MD, PhD:

I don’t know what that is. I’ve never heard that before.

Tacey A. Rosolowski, PhD:

Hopefully it will be brief. [laughter]

Raymond DuBois, MD, PhD:

We can move to another room if we need to. And so, we had a lot of discussions about that but ultimately, we decided to build those buildings, as you know, and one of the issues what the Imaging Center [Center for Advanced Biomedical Imaging—CABI] down on the South Campus.

Tacey A. Rosolowski, PhD:

The Proton Therapy Center?

Raymond DuBois, MD, PhD:

No, that had already happened before I got there.

Tacey A. Rosolowski, PhD:

Oh okay, that’s right, for 2005, yeah.

Raymond DuBois, MD, PhD:

That actually was a private venture, which I think worked out well. Now, that equipment is pretty old but at the time it was really cutting edge.

Tacey A. Rosolowski, PhD:

And pretty controversial too.

Raymond DuBois, MD, PhD:

Yeah it was. There are still some issues with that, because you know they’re advertising it for prostate cancer. It doesn’t really offer a huge advantage over current therapy for prostate cancer. It’s extremely important for childhood cancers, where the cancer is located close to the spinal cord and we use it a lot for that, and it really has a better—it’s better than the standard therapy for those purposes, but that’s not a huge population of patients.

Tacey A. Rosolowski, PhD:

Right. So, you were—the Imaging Center.

Raymond DuBois, MD, PhD:

You know, there was the Imaging Institute.

Tacey A. Rosolowski, PhD:

Oh, the Center for Advanced Biomedical Imaging.

Raymond DuBois, MD, PhD:

So, there was lots of discussions about that, because we had to put in a lot of very expensive equipment to make that happen, you know basically MRI machines that could scan animals. To make isotopes, you had to put in a whole bunch of specialized equipment for that and you know, it was very expensive. I think it was the right thing to do but there were lots of questions about whether or not that was going to be a good return on that investment and ultimately, before everything was said and done, we did have to change the leadership of the director there, who had gotten a little bit off track. I think everybody in the end, thought it was justified and went ahead with it, and I think it’s one of the leading imaging research centers in the country right now.

Tacey A. Rosolowski, PhD:

I interviewed Donald Podoloff [oral history interview] and yeah, it was pretty interesting to hear his narrative of how the field had basically changed, and it was even hard to communicate to people, the way in which it had changed, to require some of the really sophisticated equipment that was being put into CABI.

Raymond DuBois, MD, PhD:

Basically, we had to make—they wanted to make their own unique isotope, so that requires digging a huge hole in the ground and being able to generate those isotopes right on the property, and I think that thing cost $80 million just in and of itself, so it’s a huge investment.

Tacey A. Rosolowski, PhD:

My gosh. Yeah.

Raymond DuBois, MD, PhD:

It was an emerging field, one that everybody thought was going to be important for cancer, and so we went forward with it. Then, there were other—you know the Smith Building is the one that I started off in, so that is one of the older buildings there and it was really out of date. I think they had done whatever they could to renovate it and keep it up, but we really needed some new, modernized research space there, and so ultimately that did happen. I don’t know if they built more, but we built two sizeable buildings down there on the South Campus.

Tacey A. Rosolowski, PhD:

I remember being shocked when I interviewed Bill Daigneau [oral history interview], because of course I suppose most people always assume that—

Raymond DuBois, MD, PhD:

He was involved in all of that stuff.

Tacey A. Rosolowski, PhD:

Absolutely. I’m sure the average person on the street thinks that the surgical suites would be the most important to build, and he quickly corrected me about that, no it’s the research space.

Raymond DuBois, MD, PhD:

Well, that requires a lot more technical input. One of the things that I guess we never agreed on, was we wanted to put a walkway all the way from the South Campus, to the North Campus, because it’s so hot and it rains and everything, so people didn’t have to drive back and forth and worry about parking and stuff like that. I think the finance team just felt like it wasn’t worth the investment, and I guess you would have to get a right of way to go through some of that space and everything, but I still think it would have been wise to have everybody connected, because those connectors on the main campus are so important for people to get from building to building.

Tacey A. Rosolowski, PhD:

They’re incredibly important. I also, I can’t remember who it was that I was interviewing, who said that they actually had to shut down some studies because, with the shuttle system, when they took a sample from a patient, it took so long to get it to the research lab that the—

Raymond DuBois, MD, PhD:

It was damaged.

Tacey A. Rosolowski, PhD:

It was damaged, yeah, and so it was interesting. [background noise]

Raymond DuBois, MD, PhD:

Do you want to move?

Tacey A. Rosolowski, PhD:

I think maybe we should. All right.

Raymond DuBois, MD, PhD:

Let me talk to Anita. I didn’t realize they were going to be doing that today.

Tacey A. Rosolowski, PhD:

I’m pausing the recorder at about seventeen minutes of eight. [Pause in Recording]

Tacey A. Rosolowski, PhD:

Okay, we’re recording again and it’s about thirteen minutes of eight, and we’ve changed conference rooms to try to escape the sound. All right, let’s see. Oh, you were talking about the walkway from South Campus and all that.

Raymond DuBois, MD, PhD:

Well, that was a dream. I think even when some of the former leaders of the institution were imagining that the Texas Medical Center would have these electric trains and all this stuff, moving people around, people movers, it just never happened. And now, it’s gotten so large and so many administrative units as a part there, you know like the Texas Children’s, and Baylor, and all these other people that it’s hard to get everybody to agree to be able to move people around and they’re competing for patients and other things now. But I thought just getting a connectivity between the South Campus, and even that large administrative building that was built in between would have been a nice move.

Tacey A. Rosolowski, PhD:

(inaudible), yeah, absolutely, because the one thing that comes up in interviews, for people who have been at the institution for many, many years, is how much the expansion of the institution physically has changed the culture, and how much more difficult it is to run into people to resolve problems, for example. So many people said oh, you know, when we used to have a cafeteria, you’d run into so and so, and there was this issue and I happened to see the financial guy, and we just talked about it and solved it. Now, it’s hard to run into people.

Raymond DuBois, MD, PhD:

Right.

Tacey A. Rosolowski, PhD:

So, I think there is a struggle, how can space be managed so that people don’t feel so disconnected.

Raymond DuBois, MD, PhD:

Right, right. Yeah, it’s a challenge and I think it became obvious when we expanded the South Campus, that there was a need to do something, and even—you know, not even an enclosed walkway, one that just had a sort of shade structure on it, to help facilitate just walking back and forth.

Tacey A. Rosolowski, PhD:

I think people don’t realize how the weather is really an issue.

Raymond DuBois, MD, PhD:

It’s either really hot, raining or other issues, and so if you had some protection there, it would have helped a lot I think.

Tacey A. Rosolowski, PhD:

Yeah, absolutely. Also, Dr. Mendelsohn mentioned, in his interview, that he really had a dream for South Campus, that that whole area would become something of a technology incubator, kind of analog to Silicon Valley but in the medical field. What’s your feeling about that and was that on deck?

Raymond DuBois, MD, PhD:

He shared that vision with me and I was very much onboard with it. He actually had plans drawn up, to have some green space there and some workout space, and really make it a campus. He had been at University of California at San Diego earlier and he really liked the way the campus was laid out there, and he had always thought that that could happen at the South Campus. I think hopefully it will evolve at some point. There’s still more land there, so incubator space could be built and you know, I think it could enhance the industry/academic partnerships.

Tacey A. Rosolowski, PhD:

Were those something that were being explored at that time, the connections of industry and academic functions?

Raymond DuBois, MD, PhD:

There were traditional connections with support for clinical trials and other things, and there were some novel drugs that were developed over the years, at MD Anderson and so those were always pitched to the industry, to see if they were interested in investing in that, but we never really, at least during my tenure, we never really talked specifically about a partnership where we have space together and stuff like that. There was a group from Pfizer that came down, and they have collaborated with a lot of academic institutions, but we just never came to a conclusion on that to where we did something.

Tacey A. Rosolowski, PhD:

What were some of the impediments to that? I shouldn’t say it that way, maybe the reasons why that didn’t evolve.

Raymond DuBois, MD, PhD:

You know, there are lots of issues with regard to the state of Texas, and how sharing intellectual property works, and stuff like that, that some of the industry partners didn’t find that advantageous at that point. They could have been improved since then, I don’t know.

Tacey A. Rosolowski, PhD:

What were some of those restrictions? Nobody’s ever mentioned that before.

Raymond DuBois, MD, PhD:

Well, there’s some in the Texas law, and how they manage the University of Texas System. Since it’s a not for profit, sort of tax exempt organization, there’s only a certain percentage of the revenue that can be coming from a for profit type of activity. So, our legal team was always reminding us of that and making sure that we limited that to a low percentage so that we didn’t exceed whatever the law was there. There was concern about it, and I don’t know the details of that, but I know the legal team was always concerned about that.

Tacey A. Rosolowski, PhD:

Were there other concerns that people on the executive team had, creating those partnerships?

Raymond DuBois, MD, PhD:

Just to make it all above board and make sure everybody knew what the potential conflicts were, so those were declared and things like that.

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Chapter 10: Strategic Planning, Budgets, Physical Space, and Industry Partnerships

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