John Mendelsohn: The TT Interview

As the University of Texas System Board of Regents meets this week, among their chief orders of business is whittling down the finalists for the next president of the University of Texas MD Anderson Cancer Center in Houston. Dr. John Mendelsohn currently holds the post, though only until a new leader can be found.

Mendelsohn took the helm of MD Anderson in 1996.  After what he calls “15 years of the happiest and most productive period of my life,” he announced last December his intention to step down. The 74-year-old won’t be retiring, but will stay on as a faculty member and take over as co-director of the new Institute for Personalized Cancer Therapy.

“It’s good for new blood to come in and new ideas,” said Mendelsohn, under whose leadership MD Anderson has expanded dramatically. With budgets being slashed on the state and federal level, his successor will likely have to take a different approach.

Mendelsohn recently talked with the Tribune about what budget cuts mean for MD Anderson, the value of public research and his advice for his successor.

The following is an edited transcript.

TT: What is the University of Texas MD Anderson Cancer Center facing budget-wise?

MENDELSOHN: We’re facing what every academic medical center faces. From the point of view of clinical care, the insurance payers are going to be paying less for each patient. Our state budget is being cut. As you know, there are plans to cut Medicare. There are going to be a lot of new patients in 2014 that are going to be brought into the medical care system and the payment will probably be at Medicaid or Medicare rates or lower — it isn’t all worked out yet. So, we’re facing a challenge in the clinical care part of our mission, which is one we share with all providers, and it’s going to be a major effort to figure out ways to cut costs in medical care that we’ll all have to work on together. And in research — of course research, not only drives new knowledge here, but it also drives the clinical research program at MD Anderson, which is the largest in the country. We put about 10,000 patients on clinical trials every year, and those are patients where standard therapy has failed. And, unfortunately, for about a third of cancer patients it does eventually fail. The research budget here is going to be curtailed partly because of cuts in state appropriations, the National Cancer Institute budget, the National Institutes of Health budget is being cut this year. We’re blessed with very generous philanthropy and opportunities to raise money with drug companies because we do a lot of research with their drugs. But if we’re going to continue to be one of the leaders in developing new therapies, new approaches to cancer treatment and understanding the disease better, we’re going to have to work harder to get our research funding too. So, it’s been a great 15 years. We’ve grown steadily and expanded our programs, and we’ve always found ways to fund the expansion. Of course, clinical expansion is driven by demand from patients for our services. Now, we’re going to have to be even more clever about how to enable ourselves to do what we want to do.

TT: Is it inevitable or just likely that you will have to do more with less?

MENDELSOHN: It is inevitable that there will be less money per patient for taking care of people with any disease. We cannot afford to go beyond 17.5 percent of GDP for medical care. We’ve got to find ways to reduce the cost of care. Some of that may not come from actually withdrawing services from patients. Most of it, I hope, will come from being more effective and efficient in how we deliver care and how the United States system reimburses care. We must begin to incentivize outcomes and health rather than incentivizing by paying for every test and service we provide and all the drugs we order. We’re incentivizing the wrong things, unfortunately, in our health care system. We’re incentivizing the wrong things in our population. Thirty percent is obese. Obesity causes increased heart disease, cancer, hypertension and diabetes. That’s half of all medical admissions right there. And we still smoke. The public’s got to do its part. We’re going to do our part. And everyone will have to figure out how to reduce the cost of taking care of folks.

TT: If nothing changes other than reductions in funding, what will that mean?

MENDELSOHN: It’s going to change. It has to change. The American public will not tolerate a reduction in the basic quality of the care they get. The majority of Americans, who are not among the uninsured, get a very high standard of care. They’re not going to want that cut. They’re going to want us to find more effective ways to deliver care and incentivize cost savings. They don’t want cuts. Everyone in Congress has a hospital they go to, and they don’t want cuts. We’ve got to roll up our sleeves. We’ve got a very challenging task to do. We’re all looking through different lenses. We’ve got to start looking at the same target. That is cutting the cost of health care. Part of it has got to be the electronic medical record. We have to have interoperative electronic medical records, so I’m making my records the same way a doctor in Dallas is making his records the same way a person out in San Francisco is making his records. That way they can be interchangeable and passed back and forth and we can cut down on paperwork. None of that is happening at the level it could happen.

TT: Could you cut costs by letting research be done in the private sector?

MENDELSOHN: Right now, the pharmaceutical industry puts more money into research than the public sector does. The NCI and the NIH are very generous. The budget is about $30 billion in biomedical research. There’s some contribution that’s very important from the American Cancer Society, Leukemia Society and a lot of societies that specialize in diabetes and heart disease and things like that. The answer is probably that it has to be a partnership. When I first got into medical research in 1970 in my own lab, the majority was funded by the government. Today the majority’s not. But you need both. Academic institutions are the places where fundamental new discoveries are more likely to be made and the initial research that points to the right targets for therapy are made. Maybe even the first attempts at developing a drug are made. But the costs of actually creating a pharmaceutical product or a biologic product that’s going to be FDA approved and marketed are huge. We need industry to do that. These partnerships are going to increase. They are starting to increase. We’ll find ways to, I hope, to collaborate better and not worry so much about intellectual property and get a little more help from regulatory agencies and move things forward quickly. This is a group effort. We’re talking about collaborative answers to health care delivery. We’re talking about collaborative answers to research. But taking research and putting it in private institutions is going to really cut back on what’s discovered. The United States is number one right now in biomedical research and we train a lot of great people. China, Europe and Japan are doing really fine research in academic institutions. And I hope we don’t give that away.

TT: What is your advice for your successor?

MENDELSOHN: My advice for my successor is: Continue to build on the wonderful strengths of this institution, which has a very strong tradition of collaborative care of the patient. That’s something I’d advise the new president of MD Anderson to nurture and empower. And to continue to build on bringing in all the new technologies, on our special expertise and well-deserved reputation of being a place that takes... discovered science here or elsewhere and [brings] it into the clinic and [makes] it available to patients to improve their outcomes. When you’re No. 1, you‘d like to do what it takes to merit being No. 1 and sustain the wonderful accomplishments this institution has produced in its history. But be prepared for some economic challenges.