This series, which ran January–July 2016, re-examines the concurrent controversies at the Cancer Prevention and Research Institute of Texas and MD Anderson Cancer Center. This examination is possible in part because of new insight provided by Alfred Gilman, the Nobel laureate who served as the first scientific director of the state institution that distributes $300 million a year. Gilman died on Dec. 23, 2015.
Part I: The Hazard of Promising
Alfred Gilman’s approach to distributing public funds wasn’t particularly difficult to understand: he wanted to pay for the best science available. Period.
The pot of money entrusted to Gilman was vast. In 2007, Texas voters approved the largest investment in cancer research outside the federal government: $3 billion, to be spent over 10 years. By way of comparison, NCI grants going to Texas researchers and institutions added up to $240 million a year. CPRIT more than doubled that money. Only Texans were eligible to apply.
Part II: Cancer’s Butt
CPRIT’s review process appeared to have become a major annoyance to those who wanted to redraft the criteria for dispensing the princely sum of $300 million a year. Texas geography and Texas politics did matter—a lot.
The cross-state competition between MD Anderson Cancer Center and UT Southwestern Medical Center proved to be especially important.
Part III: 18,000 Bosses
Between the fall of 2011 and the spring of 2012, I watched MD Anderson from afar, and I didn’t think about CPRIT at all.
Friends who attended early meetings with Ronald DePinho soon after he became MD Anderson’s president said that he was literally grading presentations made to him by faculty members and administrators.
“This was a C-,” he would say.
It was difficult to get a B.
Part IV: Nobel Laureate in Crosshairs
In early 2012, Gilman was under the impression that CPRIT was functioning smoothly.
Then, to his surprise, the first of a series of controversies surfaced.
CPRIT’s peer reviewers had evaluated 40 applications for Multi-Investigator Research Applications, the largest CPRIT grants designed to fund team science, recommending that seven of these project receive funding. This was no small undertaking. The applications described multiple projects and core facilities.
Proposals for these projects—abbreviated as MIRAs—take a long time to write and a long time to review. The CPRIT committees worked hard to complete the review, but committee members were enthusiastic. There was a lot of good science on the table. In fact, one of the grants received the best score ever for an application of that type.
Part V: Gilman’s Resignation
Gilman’s letter of resignation, dated May 8, 2012, concludes with a hard slam:
“The purpose of this letter is to indicate my intention to resign from CPRIT, effective (with your permission) on October 12, 2012. At that time I will have worked for CPRIT for over three years—I believe longer than originally anticipated.
“During that time we have launched strong programs because funding decisions have been based on high-level competitions, where the judges have been some of the best cancer researchers and physicians in the country—free of conflicts of interest and all coming from outside of Texas.
Part VI: The Provost’s Choice
After my conversation with Gilman, I called MD Anderson and asked to talk with somebody about the $18 million grant for a biotech incubator.
First, folks at the press shop told me that they view the controversy arising from the application as CPRIT’s problem.
Let’s see: the wife of president of MD Anderson gets a grant seemingly out of turn, causing a political disaster, and this is not an MD Anderson problem?
DePinho was initially silent on the controversy, but after the Houston Chronicle published a hard-hitting editorial that laid out a series of questions about the grant, he responded with a letter that portrayed the central question in the controversy as a “difference of opinions.”
Part VII – DePinho’s Stock Tip Revisited
On May 25, 2012, I received an email from Len Zwelling:
Paul: It can’t get worse than having our President pushing his own stock on TV. Len
I clicked on the provided link to CNBC. What I saw was indeed difficult to process: a video of Ron DePinho, extolling the virtues of the stock of AVEO Pharmaceuticals Inc., a company he co-founded.
On the CNBC program “Closing Bell with Maria Bartiromo” May 18, DePinho brought up AVEO in the context of the upcoming meeting of the American Society of Clinical Oncology.
Part VIII – A Conversation with DePinho
The $18 million never made it from Austin to Houston.
MD Anderson’s initial stance was to deflect all CPRIT-related questions to CPRIT, but this didn’t make the controversy go away. So, the cancer center suggested that the grant undergo scientific review, as well as commercial.
Recently, I asked Dan Fontaine, MD Anderson’s executive chief of staff why the money never changed hands.
Part IX – “Furnituregate”
I first heard something about a red sofa that cost an impressive amount of money soon after I started to cover the controversy at the Cancer Prevention and Research Institute of Texas.
The sofa, I was told, was to be purchased with MD Anderson funds for the office of Lynda Chin. I wanted to look into it, but I want to look into many things, and some take precedence over others. This seemed to be fun, but it was undeniably trivial.
The sofa in question was intended for the same entity CPRIT was being asked to fund. Had I been able to get it through my thick skull that the furniture was a part of the same story that was causing the ungluing of CPRIT, I would have filed my freedom of information requests sooner.
When it finally appeared, my friends referred to this story as “furnituregate.”
Part X – Silencing Faculty Voice
In the fall of 2012, just before Al Gilman’s departure, MD Anderson officials cracked down on internal critics.
On Sept. 26, 2012, Raphael Pollock, head of MD Anderson’s Division of Surgery, was summoned to the office of Thomas Burke, then the executive vice president and physician-in-chief, and was relieved of his duties.
Pollock, who is Jewish, was fired on Yom Kippur, the Day of Atonement.
Part XI: Gilman’s Teachable Moment
During our first conversation in the spring of 2012, Gilman said that he would go public unless he received assurances that CPRIT would retain its integrity after his departure.
He wanted guarantees that the structure he built would not be turned into a political pigsty. With guarantees being hard to come by, it was obvious that he would end up slamming the door hard. Publicly.
Part XII: Scientists Vote with Their Feet
In their op-ed piece, Gilman and Sharp stated what it would take to fix CPRIT’s problems. That was the polite version of the Gilman Plan.
The spoken version was more blunt: get rid of the “assholes” on the oversight board, jettison the administrators, then—maybe—CPRIT’s credibility would be restored.
Maybe the place will become functional someday, but only the oversight committee is sent packing and after the Gogolesque characters are kicked out of CPRIT’s offices in Austin. Until that occurred, an effort to rebuild would require CPRIT to turn to the scientific establishment on some other planet.
Chair of CPRIT Oversight Committee: “Better to Get Them All Out of the Way Now”
What were Texas politicians and CPRIT officials thinking as they were pounded by blistering letters of resignation?
Condemnation seemed to be rolling off their backs as they marched toward what they thought was their great triumph.
Jimmy Mansour, chairman of CPRIT’s oversight committee, mistakenly hit Reply All, sending an especially contemptuous email to a scientist who was announcing his resignation from CPRIT. In the email that came into public view because of his sloppiness, Mansour, a telecommunications entrepreneur, belittles scientists and the peer review process.
The email is also remarkable because it illustrates the reluctance on the part of CPRIT officials to recognize that the institute that distributes $300 million a year in state funds is, in fact, in the midst of a crisis.
Part XIV: How Al Got It Right
Gilman’s resignation enabled him to retain the most precious of all privileges: the ability to look at himself in the mirror.
By slamming the door loudly and publicly—and by triggering an impossible-to-ignore resignations of scientists who conducted peer review at the Cancer Prevention and Research Institute of Texas—he made it clear that the institute’s scientific review was in danger of being subverted, and that its funds were at risk of being raided by politicians.
“I built something I am proud of, and now it’s being taken apart,” Gilman said to me at the time. “I can’t work for people who are pushing their own interests at the expense of the interests of cancer patients.
“A wise and experienced friend said to me: ‘This is always the way it works when you put a large amount of public money on the table. The vultures and the hyenas lie low for two or three years to see how the system really works. And then they come in for their feast.’”