publication date: Mar. 4, 2016

 

Slamming the Door

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.”

“Some may choose to call our proposal ‘research,’” he wrote in a letter submitted to the newspaper. “We call it business, and we are confident Texans will be the beneficiaries in the future. As one who has worked in the laboratory and the clinic and founded multiple biotechnology companies, I have learned that academic discoveries will only benefit patients if they are converted into approved commercial products.”

 

 

In an off-the-record conversation, our first, Gilman told me that the proposal wasn’t reviewed by the MD Anderson provost, Ray DuBois.

This was surprising, because the role of the provost is to promote the academic mission of an institution. The rule of thumb in academic medicine is that the provost gets to sign off on any grant application that contains a budget. Plus, Gilman knew of only one way a grant application could be submitted to CPRIT, and that was through the portal, and at MD Anderson there was no way to do this except through the provost’s office.

When I asked MD Anderson press office folks to give me someone to talk to, I got DuBois.

I understood that DuBois was in an unsustainable situation, and felt bad about pressing him on whether he reviewed the Chin grant proposal. The guy had enough troubles. Alas, I had to do it.

With my tape recorder rolling, DuBois and I engaged in an awkward verbal dance:

“I guess we should first establish whether the incubator proposal went through your office,” I said.

There was silence. I could tell that DuBois was trying to decide what was more important to him: his good name or his job.

That pause was telling. I knew he would choose his good name. A liar wouldn’t have required a pause.

“The incubator proposal was a joint effort with Rice [University], and my understanding is that it went through the Rice [provost’s] office in terms of being submitted, along with the Rice proposal.”

A smoke screen. DuBois was buying time. Of course, he knew that I would follow up.

“So it didn’t go through your office?”

“We have an office of grant administration and an office of grants and management, and since this was a joint effort with Rice, the institute team worked directly with the provost at Rice. I assumed that it was routed through the grants office at Rice, since it was a collaborative effort with them. However, I have not checked directly with Rice on this issue.”

This had to be the truth, with a light smoke screen of caveats to quell anxiety, with an “I assume” thrown in.

“It did not go through the MD Anderson provost? That’s unusual; isn’t it?”

It was important to get this stated clearly, on record.

“We do process a lot of CPRIT grants that go to the scientific review panel,” DuBois continued. “This is a new mechanism—the RFA just came out several months ago—and that was apparently the preferred mechanism. I believe the institute team had worked closely with CPRIT in formulating their application, and I think this was the preferred route.”

Again, DuBois was saying, artfully but clearly, that he had nothing to do with it. That took courage.

“Preferred by whom?” I asked. “I would have thought that because this proposal has a budget, and the budget is an MD Anderson budget, you would have been given the opportunity to review it.”

By now, I realized that DuBois was slowly starting to welcome the opportunity to state and restate publicly that he had nothing to do with this.

“Well, we do joint grants with a lot of other institutions. A lot of that comes as a subcontract. That is the mechanism used when we have multi-investigator grants that are led by some of these other institutions. You would have to ask CPRIT to understand that mechanism.”

Since there were surely handlers on the line, or at least in the room, DuBois needed to make another half-hearted attempt at obfuscation.

“I was thinking more in terms of an MD Anderson question, I would have thought it would have gone through your office,” I repeated, mostly because I could, to see how far DuBois would go. “I’m just surprised it didn’t. Are you surprised it didn’t?”

“Well, I don’t know if I’m surprised, but this is the way that CPRIT and the individuals working on the incubator proposal worked it out.”

I decided to signal to DuBois know that I understood his predicament.

“I’m just trying to establish which questions you are able to answer, because if it didn’t go through your office…”

“It really didn’t go through my office. That was the route that it took. I haven’t discussed that with the CPRIT individuals, or people at Rice, or others.”

That was a good one… True, DuBois hadn’t spoken with CPRIT individuals (plural), but he had spoken with one individual (singular), and that individual’s name was Al Gilman, when Gilman called informally to find out why CPRIT had received a major proposal in a manner that bypassed DuBois and the official portal used for submission of applications. Of course, DuBois couldn’t have known that I knew this, and, of course, I was in no position to tell him.

Since DuBois seemed amenable to having the truth pulled out of him in conversation, I decided to ask him about his role in dealing with potential conflict of interest issues at MD Anderson.

I knew he was the guy in the middle, the official designated to say No to Lynda Chin.

“Wouldn’t everyone’s life be easier if Lynda Chin were working at, say, Baylor?” I asked.

“There was recognition by the University of Texas System and the executive vice chancellor, [Kenneth] Shine, when Lynda came on board of the potential conflicts of interest when you have a department chair in the institution and her husband as the president. You always worry about potential conflicts of interest, but we’ve tried to put things in place to alleviate those conflicts.

“And Lynda actually reports directly to Dr. Ken Shine. She doesn’t report to Ron or to me—it’s set up so that she reports to Dr. Shine.

“Obviously Dr. Shine and I confer on things and make sure that we are all on the same page. But that reporting relationship was set up from the very beginning, when Ron and Lynda came on board.

“The UT System has set up a sort of system-wide review panel made up of individuals from across the university system to look at those conflicts, to make sure that there is no problem there.”

How would a group of this sort be able to handle conflicts on day-to-day basis?

I briefly considered following up, but decided to leave DuBois alone on this. However, I couldn’t resist asking him about the Moon Shots.

“One other question, that I guess would fall under your purview, is, with the teams of [MD Anderson] scientists now looking for five cancers to cure, or at least make a big dent in, it feels like you can’t come up with a plan like that without restructuring an entire institution. And how is that working out?”

Here again, DuBois danced a lackluster jig, but told the truth. The idea was DePinho’s, he said.

“There is a lot of excitement at the institution about using that approach,” he said. “Clearly that is something that Ron brought here with his vision. And I would hate to speak for him, but clearly I do represent the institution, and the idea of selecting some higher priority areas is the idea of bringing a really comprehensive, multidisciplinary team together to try to tackle some of the issues related to individual cancers.

“What we’ve been doing so far is spending a lot of time bringing groups of MD Anderson faculty and staff together to talk about what it would take in some of these areas to really have a maximal impact.

“It’s a different way of thinking about tackling these problems in academic centers around the country. We set up individual experiments to answer pretty

low-level questions about different types of cancers and different issues related to cancer biology. It’s a very iterative process that depends on what the individual experimental results are from point A—and then the next experiment you design is to get to point B.

“This is actually taking a much broader look at these problems and trying to understand what it is about a certain type of cancer that we don’t know. Something that, if we did know, we’d be able to make a transformative impact in. It’s a difficult process.

“Typically, our faculty and others, and other cancer centers around the country, haven’t thought about tackling the problem this way. So, clearly, we are still in the phase where we’re developing our plans of attack and evaluating our strengths in different areas and in different types of cancers, and where we would be able to have the most impact in terms of the low-hanging fruit.

“We are sort of in the development phase of thinking about this. We’re trying to formulate these questions and we haven’t really gotten to the point where we’ve put a whole team together or selected individual types of cancers that we want to attack.

“I guess the simple answer is yes. It’s a different way of thinking about things. I think it has the potential to be transformative—if we can get the right teams together and select the truly most impactful questions to answer.

“It’s exciting to think about a single institution having such major impact on the disease. So there is enthusiasm across the campus. Individual faculty members are becoming involved in the strategic planning sessions.

“I have to be honest, we don’t know exactly what to expect, because we’ve never done something like this before. But it could be transformative.”

DuBois kept going, making more and more distance between himself and DePinho.

“It’s quite different,” he said about the Moon Shots. “I can’t take any credit for the idea, because it’s really Ron’s idea, but I think it has a lot of potential if we select the right areas and are able to formulate the most needed questions.”

 

 

In an interview in January 2016, MD Anderson Executive Chief of Staff Dan Fontaine said a simple bureaucratic error was to blame for the manner in which MD Anderson Institute for Applied Cancer Science’s grant proposal was submitted:

Let me give you the benefit of both my view at the time, and also looking back on it. And there’s some similarity between those two.

“I was always somewhat surprised that what really kind of appeared to be a clerical processing error between Eric Devroe [IACS executive director for

strategic alliances], who had recently been recruited, and [Jerry] Cobbs [CPRIT chief commercialization officer], on how to get the materials up to CPRIT, turned into as big of a deal as it did.

“Obviously, as it turned out, there were other facts at play. There were things that were going on that we didn’t have anything to do with. But I remember at the time being somewhat struck by the fact that this was the first time we submitted a commercialization grant. And so, admittedly, and I think this came out in some of the stories that I was interviewed for.

“When we go back and look at it, we had not put the proposal through Ray DuBois’s office, but when you look back and you look at the request for application, this being an incubator infrastructure that had called for a business plan—business plan sort of things usually came through my part of the institution, and in those days, even research budgets and grant budgets were also handled by our research finance group, which was in a reporting relationship with the CFO, as well as a dotted-line-reporting relationship to Ray DuBois.

“So, to me, the fact that it had not gone through Ray’s office did not seem like that big of a deal, for that reason. But also, one of the things that never seemed to get mentioned in the dialogue back then, was that the application is only step one of the process.

“Once the application meets with a positive determination, and the grant is going to be awarded, there’s a whole contracting process that goes on between the institution and CPRIT—and so certainly we would have gotten down into the details of the budgeting at that point in time. So I found that to be curious.

“The second thing was, as you know, because you reported on it, Eric [Devroe] had transmitted the material directly to Cobb at Cobb’s suggestion. And I was always struck by the fact that if there was something wrong with that, then CPRIT would have easily said: You didn’t put it through the right way. It has to be put through our portal.”

I asked Fontaine whether, with the benefit of 20/20 hindsight, the application should have gone through the provost.

“Frankly, through 20/20 hindsight, if it had to be put through the portal, the only guy that knew how to do that was [Wesley] Harrott, who worked in DuBois’s office, and we would have sent it through Wes through the portal and, two clerical mistakes made by a young guy working for IACS wouldn’t have turned into what it did,” Fontaine said.

“I think I may have made this comment to you and [Houston Chronicle reporter] Todd [Ackerman] both when I was interviewed, once this occurred. We looked at the process and said, ‘If there’s going to be more applications of a commercialization nature, it’s probably for it better to go through both. But our thinking at that time was that it would go through the provost’s office largely to go across Wes Harrott’s desk, so it could go through the portal. Because it seemed that going through the portal was the most important thing to do, out of what we had learned.”

Though the CPRIT grant was awarded, the money never changed hands.

“At the time that the consternation and the questions were being raised, things seemed to be going about internal workings at CPRIT that we were not a privy to,” Fontaine said.

“It still became apparent that there was at least one constituency within CPRIT that felt like even though the RFA had specifically said that it was going to go through the commercial review group, that it needed to go through both the commercial review group and the scientific group.

“If the process was going to change to do that, we felt that it was important to be very clear that we were happy to let the process take place a second time and have whatever we had submitted go through both review processes.

“So we wrote a letter, as you may recall, to CPRIT and we suggested two things: kind of belt-and-suspenders. We said that, number one, whatever additional review process you want it to go through, please have it go through. And if there’s questions raised, if there’s more scientific information that is wanted, since this is supposed to be a business plan—if there’s more scientific information that is wanted, we would be happy to supplement that as requested. So we would be happy to do whatever additional review process CPRIT wanted to do at that point in time.

Secondly, we also suggested that we would even allow CPRIT to hold the money in escrow for a year to see what kind of milestones we hit with progress on the grant.

They wrote us back, and said we’ll put it through the additional review process, thank you very much, and we’re not going to make you put it in escrow for a year because once we’ve gone through the reward process, we will make the award immediately.

“And I think it was a letter from [CPRIT Executive Director] Mr. [Bill] Gimson that said that. So at that point in time, we anticipated that there would be some sort of additional review process. As it turned out, I think in looking back, other things and other controversies at CPRIT began to arise. To my knowledge, they never put it through an additional process. To my knowledge, they never notified us whether they were going to put it through an additional process or not. We never resubmitted, because there was never an RFA or any communication to us.

“I know there were a couple of instances when we may of contacted them and said is there anything else—but, you’ll recall shortly after that, the controversy grew to the point that the granting was stopped at some point in time. There were directives, etc. And we never got beyond that point. We never resubmitted; they never re-reviewed. And funds never changed hands.”

Would MD Anderson officials have handled this matter differently today?

Was there a lesson to be learned?

Well, hindsight being 20/20, I wouldn’t have had two clerical errors made.

I didn’t think it was a big deal at the time—still don’t think it’s a big deal; don’t think it’s what led to anything else that went on with CPRIT,” Fontaine said. “Obviously, as you know, the story took a completely different direction with a company that they had funded, Peloton, leading to further things that took place—including a criminal trial, where eventually there was an acquittal, by an Austin jury, of Cobb.

So in looking back, a couple of clerical errors. If I could do it differently, we would have understood the process a little bit better for commercialization grants. We would have submitted it through the portal. I don’t know that DuBois’s office would have had a lot to say one way or another.

“I suspect, given the way that Ray and I worked, he would have said, “Hey Dan, this looks like a business plan—could either you or your folks look at it?”

I don’t know that that would have happened, but it seems to be the most logical thing that would have gone on. Ray and I worked closely on a number of different things in those days. But other than submitting it through the portal, I’m not sure I would have done anything different.

“Other than it going across Ray’s desk and through Wesley’s operation, I don’t know that I would have done anything else differently, and I don’t think we would have submitted anything else differently based upon what was in the request for applications at that point in time, which was calling for a business plan for infrastructure.”

Indeed, submission through the portal was a requirement, and there is no question that DuBois would have demanded that this be done. In the process, the application would have been reviewed, to make sure that it contained all the information CPRIT required.

“As it turns out, having the benefit of 20/20 hindsight, if it had been successfully granted, and if we had gone through negotiations with CPRIT, I’m sure because in those days CPRIT was doing this and I think they’d still be doing it: When they give a grant they talk about whether or not—usually there’s a term in there that if there’s commercialization that comes out of the grant, CPRIT wants some way of retrieving their funds.

“In retrospect, not having to have CPRIT involved in some of our financial decisions for some of our commercializations that are coming up may prove to be to our financial advantage. It may be the least expensive $20 million that we ever turned down.

“There’s just no way of telling that. It all depends on some of the commercialization opportunities that are going to come out of IACS in the future.”

The question of how much money is coming through IACS—both costs incurred and revenues generated—warrants an examination.

Indeed, I recently filed a request for information under the Texas open records law.

 

 

Bypassing the provost of your own institution is puzzling and unusual in the extreme.

“If a provost has heartburn about something, you want to hear it,” Arthur Caplan, the Sidney D. Caplan Professor of Medical Ethics in the Department of Medical Ethics and Health Policy at the University of Pennsylvania, said to me at the time. “If you have animal experimentation or phase I research, you need to involve all the university and hospital officials that need to be aware be aware.

“You put the institution at risk when you go off course in terms of regular review procedures.”

In a situation where a husband and wife team is employed in key positions at the same institution, the provost should play a more significant role, especially when research on human subjects and animals is involved.

A situation where a nepotism issues can arise requires more scrutiny rather than less scrutiny. “You can say, we would normally take it though the provost, but we are going to do something extraordinary because of a concern about a nepotism issue,” Caplan.

Additional review is needed in case a provost is unable to say No to the president. “In any case, it’s a mistake not to let the provost sign off on the institution’s portfolio,” Caplan said. “If they want to have a special committee look into conflicts of interest, I have no issue with that, but they should not reach out of the standard pattern.

“That creates the worst appearance.”

But there was something else he said: “You can quote me on this: This is not going to end well.”

I refrained from using this line in my story.

 

Next Week – Part VII: Conversations with DePinho

Click Here to read the full series of Slamming the Door

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