publication date: May. 6, 2016

 

Slamming the Door

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.

Gilman was the exact opposite of a narcissistic scientist in search of the next tantrum opportunity. Rather, he had considered the politics and the principles involved, and examined all the options with the inner circle of his scientific advisors. To Gilman, seeking advice of scientific colleagues was a formal process honed over a lifetime in the academia. Being well plugged into the Texas political circles, he brought the stories of Texas backroom shenanigans to the attention of his scientific peers and weighed their advice.

It was clear that he would turn his departure into a teachable moment. There was also a chance—albeit a small one—that he would prevail. Let’s define “prevail.”

No, Gilman didn’t want to stay in the job beyond the deadline. He wanted to get rid of the oversight committee appointed largely by then-Texas governor Rick Perry. His other goal was to oust Bill Gimson, the CPRIT executive director.

As he went public, Gilman’s first step was to explain the principles in play.

He did this in an op-ed piece, which he co-wrote with Phillip Sharp, chairman of the CPRIT scientific oversight group, an institute professor at the Koch Institute for Integrative Cancer Research at MIT, and a fellow Nobel laureate.

After the principles were described, members of his inner circle of advisors would resign one by one.

Gilman circulated the piece to a small circle of people he trusted. Though he lived and worked in Dallas, he chose to give the piece to the Houston Chronicle. This was mainly because over the years he had developed a better relationship with the Chronicle. The fact the biotech incubator that started the entire debacle was at MD Anderson, a Houston institution, added to the overall impact.

The draft of the op-ed piece, which was circulated to a small circle of advisors, connects the CPRIT controversy with the MD Anderson incubator.

Killing CPRIT was not the goal. Gilman’s goal was to lead America’s most important cancer scientists in a public reaffirmation of support for peer review. The lesson: platitudes don’t cure cancer, and neither does breast-beating.

The plan was akin to a scientific experiment, with the outcome that remained to be seen. If the message got through, all the top CPRIT bureaucrats and the institute’s politically-appointed oversight committee would be given the boot. Of course, Gilman realized that this was too much to ask for.

On Oct. 12, 2012, Gilman’s last day at CPRIT, it was clear that great forces had been unleashed and there was no way to predict how the game would play out. Politics and science were at equipoise.

 

 

“Reliance on peer review to identify the best science must continue to guide CPRIT in the future,” Gilman and Sharp wrote in their op-ed piece, “Of course, there are other ways to distribute public funds, but they are worse.

“Their side effects include infamy and they end in irrelevance.”

The piece connects the events at CPRIT with the MD Anderson incubator:

“The past eight months were difficult [for CPRIT]. Controversy flared when several well-regarded, multi-investigator, multi-institutional collaborative research projects were put in the freezer for months—not brought to the Oversight Committee for funding after strong recommendation by the Scientific Review Council.

“This delay was at least partially based on the concern that several of these projects came from one institution. CPRIT’s executive director has offered different and conflicting explanations for this action.

“Simultaneously, an expensive ‘commercialization’ proposal, constructed and submitted in unorthodox ways that circumvented CPRIT’s rules, was rushed to the Oversight Committee and approved for $20 million for its initial year of operations, despite the absence of description or scientific review of its drug development program. This was ultimately corrected, albeit with great effort.”

The piece echoed a hubristic quote from Charles Tate, the Texas financier who played a role in engineering the MD Anderson-Rice incubator. In a press release announcing the funding of the project six months earlier, Tate said: “One of the biggest obstacles to getting life-saving treatments to patients is not a lack of good ideas or good science, but a lack of business expertise. CPRIT is proud to support a center that will ensure the best cancer-fighting technologies can make it to market and into the hands of the people who need them the most.”

Actually, no, the biggest obstacle is getting the science right, Gilman and Sharp wrote.

“Science must come first; commercialization is essential but comes second. Businesses hunger for great insights to turn into great products…

“Texans deserve to hear the truth about cancer. They must understand that miracles will not happen in a short time. Progress will not be made by those who simply proclaim without explanation that they can do better than hundreds of skillfully staffed and well-financed pharmaceutical and biotechnology companies.

“Real progress requires the concerted high-quality efforts of basic, translational and clinical investigators from the academic community collaborating with counterparts from the private sector when appropriate.

“There is no single ‘cure’ for cancer. Cancer is hundreds of diseases, and victories will come one or a few at a time. CPRIT will have an enormously positive impact on society over time, both in terms of the health of its citizens and its economy. Texans must understand this and demand that CPRIT continues to adhere to its core principles.

“Academic institutions and for-profit companies have very different cultures, and these differences must be respected. Academics strive to develop new knowledge and, usually, disseminate it widely (i.e., by teaching, broadly defined, and publishing). Companies operate much more competitively and in many cases in secret, with the goal of providing financial returns to investors by bringing useful products to society. There can and should be synergy between the two types of institutions, with academic knowledge being used to further the commercial activities of companies, and there can be links between the two. But the relationship shouldn’t be excessively intimate. Secretive behavior impedes education and research training and therefore doesn’t belong in academia. There are also questions of compensation, ownership, neglect of academic responsibilities, etc. CPRIT needs to understand this as it strives to facilitate commercialization of its research activities.”

In the opinion piece, Gilman and Sharp call for removal of the CPRIT oversight committee:

“How can CPRIT once again become a program respected by scientists across the U.S. and the world?

“A commission should be appointed to determine whether individuals tried to violate the public trust in the actions described above. If so, they should be removed from their positions.

“CPRIT’s governing board should have sufficient expertise to do its job. Only one member of this 11-person Oversight Committee has any direct knowledge of cancer, medical practice or research.

“The Oversight Committee should promote policy, provide broad oversight of personnel and operations, and ensure legal and ethical behavior. Members who meddle in day-to-day operations of the organization to further their own interests should be removed.”

 

 

Members of the CPRIT scientific review council followed Gilman out of the door.

Would CPRIT be able to survive this display of condemnation on the part of some of the world’s most important cancer scientists?

I decided to call CPRIT chief executive Gimson, Gilman’s nemesis. I wanted to know whether the sound of slamming door had awakened his to reality.

Gimson did not return my call, which was just as well. Instead, CPRIT issued a public statement:

“With the departure of Dr. Gilman, CPRIT is entering a new era. It is no surprise that some of the current reviewers have chosen to leave at this time.

“We have identified several exceptional candidates to succeed Dr. Gilman as Chief Scientific Officer, and this individual’s first order of business will be to recruit outstanding cancer experts to serve as peer reviewers under his or her leadership. We have every confidence that CPRIT will have a full cadre of expert peer reviewers in place for the next scientific review cycle.

“CPRIT stands by the integrity of our peer review process. Dr. Gilman was instrumental in establishing what is now considered the “gold standard” in the industry, and that process will remain intact. The process has in fact been improved over the last few years, as we have proactively seized opportunities to strengthen it.

“Any assertions that the peer review process has been compromised or that CPRIT’s staff or Oversight Committee members are trying to influence the peer reviewers are false and misinformed. Since CPRIT’s inception, every single grant that has been recommended to the Oversight Committee by the reviewers has been approved.

“It has been reported that CPRIT asks peer reviewers to reconsider their scores. When there are divergent scores among peer reviewers, in fairness to the applicants, the process allows for further review or discussion of the variances during panel discussions.

“Unlike the prevention and research review process, the commercialization review process includes in-person presentations by the applicants, which the scientific reviewers do not attend. If new information comes up from the in-person question and answer period, it is shared with all reviewers—including those who were not in the presentation so all reviewers have the same information.

“The final decision on whether to revise scores rests with the individual reviewer.

“We are proud of our many accomplishments to date and many more to come. Through our Future Directions initiative, we have received a great deal of input from diverse stakeholders across the state.

“This process is ongoing and no decisions have been made; this valuable feedback will inform the Oversight Committee’s direction for CPRIT over the next seven years. Above all, we hold fast to our mission of reducing the burden of cancer in Texas.

“Texans’ lives are at stake, and in honor of those affected by this heinous disease, we won’t back down.”

 

 

It was uplifting to see the members of Gilman’s scientific council follow him out the door. They explained why they were leaving, using the slamming of the door as a teachable moment.

Here are the letters of resignation from six members of the CPRIT Scientific Review Council:

 

Phillip Sharp, institute professor at the Massachusetts Institute of Technology David H. Koch Institute for Integrative Cancer Research:

I write to submit my resignation as Chairman of the Council of CPRIT effective Oct. 12, which coincides with the effective date of the resignation of Dr. Al Gilman.

I agreed to chair the Council to advance cancer research and cancer care in Texas after the State’s wonderful decision to commit $3 billion to this purpose.

A strong and objective peer review process is essential to achieve this end and the Council members and panelists assembled by Dr. Gilman were the best in the country. They all shared the same objectives for CPRIT and executed their duties in an exemplary fashion and free of conflicts of interests. It has been an honor to chair this group and work with Dr. Gilman.

However, this past Spring the peer review system of CPRIT was dishonored by actions of CPRIT’s administration when a set of grants were delayed in funding because of suspicion of favoritism.

Further, a proposal based on science similar to that previously reviewed by the CPRIT council was selected for funding using other criteria. These events ultimately led to the resignation of Dr. Gilman. The same events motivate my decision to resign now.

The promise of CPRIT requires an unswerving commitment to peer review. I would be willing to help future CPRIT leaders if convinced that this commitment is central to selection of cancer research to be supported.

I believe that certain changes in CPRIT leadership would be essential to demonstrate such commitment.

The past four years have greatly advanced cancer research in Texas and hopefully this record will continue.

 

Tyler Jacks, the David H. Koch Professor in the department of biology and director of MIT’s Koch Institute for Integrative Cancer Research:

I am writing to inform you that I am resigning my position as the Chair of the BCRC-1A Review Panel of the Cancer Prevention and Research Institute of Texas (CPRIT) effective immediately.

I am grateful for the opportunity to have worked with Al Gilman, Phil Sharp, and my fellow panel chairs in helping to establish a system that set the highest standard for rigorous scientific review and deliberation.

Sadly, this system was tainted by baseless accusations by members of the CPRIT Oversight Committee that our review of a series of multi-investigator grants in the spring was influenced by regional or institutional bias and the consequent failure to advance these grants for funding consideration in that cycle.

These accusations, as well as the failure to mandate scientific review of so-called incubator grants during this period, served to undermine the careful work of my committee and the sanctity of the larger CPRIT scientific review process. Under the circumstances, I feel that I have no option than to resign my position.

Over the past three years, I have been privileged to lead a group of outstanding scientists on my panel. They have work diligently to evaluate the merits of hundreds of grant applications from Texas investigators.

Through their efforts, we approved the funding of many outstanding grants, which collectively hold the promise of important breakthroughs in our understanding of cancer development and new opportunities for treatment and prevention.

I believe that the CPRIT program—and current and future cancer patients— benefited significantly by the efforts of this group. To date, three of my panelists have indicated that they are stepping down.

I will communicate my decision to the entire panel shortly.

They will decide for themselves as to whether to continue on, assuming they are welcome to do so.

The citizens of Texas deserve tremendous credit for choosing to fund the CPRIT program and doing their part to support the discoveries that will lead to improvements in cancer care and prevention in the future.

In turn, they should expect administrative and review systems that ensure that their tax dollars are used appropriately, without bias, political influence or conflict of interest.

I believe that the actions of the Oversight Committee over the past several months corrupted this process. For the sake of the program and for all of those cancer patients who stand to benefit from the proper use of these funds, I hope that CPRIT manages to regain what it has lost.

 

William Kaelin, professor of medicine in the department of medical oncology at Harvard University and the Dana-Farber Cancer Institute:

As I indicated in my letter of May 14, I was willing to devote my time to CPRIT, despite having a wife who was recently diagnosed with a brain tumor, because I believed CPRIT could transform biomedical research in Texas and ultimately improve the diagnosis and treatment of cancer patients.

CPRIT was a brilliant idea and both the Texas legislature and the people of Texas are to be commended for it. In that same letter, however, I expressed my concerns regarding the events that eventually led to Al Gilman’s resignation.

These events included the circumvention of the peer review process by the MD Anderson/Rice “commercialization” proposal and the suggestion that Dr. Gilman (and by extension, myself and the members of my study section) was giving preferential treatment to grants submitted by UTSW investigators.

I also indicated that the eyes of the scientific community were now on Texas to see which course CPRIT would take moving forward (as borne out by subsequent pieces in Nature, Science, and The Cancer Letter).

Neither you nor any member of your staff responded to my letter to address my concerns.

Moreover, it has become increasingly clear that the potential for “commercialization” is going to take on greater importance moving forward.

For example, I recently learned that at least two scientific reviewers who had given non-fundable scores to a commercialization project were asked by CPRIT to “reconsider” their scores so that they would be in harmony with those given by the commercial reviewers, who were far more favorable (both of the scientific reviewers are very sophisticated with respect to the needs of industry and correctly responded that trying to commercialize flawed science is a prescription for failure and waste).

The recent posting on the CPRIT website lauding the MD Anderson “moonshot” initiative also creates the impression that the future “winners” have already been chosen and that there will be increased focus on perceived short-term deliverables.

In this environment, I am not confident that scientific quality and rigor will triumph over grandiose promises and hucksterism.

For these reasons I have chosen to resign from CPRIT effective Oct. 12, 2012. I would be happy to discuss serving in the future but only if you succeed in replacing Dr. Al Gilman with a person who, like Dr. Gilman himself, embodies scientific excellence and personal integrity and I can be convinced, through structural changes at CPRIT, that my concerns have been adequately addressed.

 

Charles Sherr, chair of tumor cell biology, co-director of the Molecular Oncology Program, and Herrick Foundation Chair at St. Jude Children’s Research Hospital:

The purpose of this letter is to tender my resignation as the Chair of the CPRIT Basic Science Cancer Research Committee-3 (BCRC-3) and as a member of the CPRIT review Council chaired by Dr. Sharp, effective immediately.

In a separate email addressed directly to you on May 3, to which you did not directly respond, I communicated my personal displeasure regarding events that would soon lead to Al Gilman’s resignation.

Briefly stated, my previous letter concerned the manner by which Dr. Gilman had been inappropriately pressured to step down as CPRIT’s Chief Scientific Officer and my dissatisfaction with the then emerging notion that a political agenda would subvert decisions about supporting only the very best medical science deemed most likely to accelerate prevention and effective treatment of cancer.

These matters were soon echoed in a separate joint letter from the CPRIT Council addressed to members of the Oversight Committee and widely quoted in the press.

Despite my unease, I thought it prudent to remain with CPRIT through the round of review just completed in September 2012, thereby allowing those investigators in Texas who had formulated new proposals in the last months to receive careful consideration of their scientific initiatives by the BCRC-3 group.

Having now completed these efforts, I feel free to step down. I had already alerted you to the fact that many other members of BCRC-3 were equally offended by the events of recent months, and I suspect that you may be hearing from others in this regard.

There have been a series of widely publicized incidents that have been visibly documented, in particular by reporters at the Houston Chronicle and in issues of The Cancer Letter broadly circulated to cancer centers throughout the country. In my personal judgment, one of the most problematic events concerned the proposed funding of the Institute for Applied Cancer Science (IACS) at the MD Anderson Cancer Center.

Their short proposal of less than seven pages was reviewed solely as a commercial “incubator” project, but without rigorous scientific oversight by any of the more than 100 out-of-state experts already employed by CPRIT who could have offered informed opinions.

The IACS proposal was approved within several weeks of its receipt, overriding Dr. Gilman’s strong objections and even disregarding caveats offered by some of the persons who were asked to participate in its “commercial” review. The level of funding of the IACS greatly exceeded that of proposals that had been previously adjudicated by our Council and review groups, underscoring preferential treatment given to this one application.

As reported publicly, the IACS proposal’s budget was not reviewed by the MDACC provost, Dr. DuBois, who recently resigned his post at MDACC. Despite your proclaimed enthusiasm and that of other CPRIT Overseers, but given widespread press coverage and criticism, the IACS proposal has been withdrawn pending re-review.

New guidelines for Requests for Applications (RFAs) for “incubators” which were to be drawn up have yet to appear, and I wonder whether some persons believe that forward movement in funding the IACS would be facilitated by Dr. Gilman’s departure and the possible elimination of other naysayers, myself included.

When you [CPRIT executive director Gimson] phoned me last week, I reiterated that it has been an honor and a privilege to serve CPRIT under Dr. Gilman’s aegis, to participate in the deliberations of the CPRIT Council in recruiting top quality investigators to institutions in Texas (including Drs. Chin, Allison, and others to the MDACC), and above all, in leading a committee of highly distinguished scientists from outside the state who have worked diligently and with keen collective insight in adjudicating applications referred to our review panel. Indeed, the opportunity to work with esteemed colleagues on the Council and the BCRC-3 Committee has been the best such panel review experience of my scientific career, bar none.

Our singular collective concern was that we would attempt to fund the very best transformative cancer science, whether clinical, translational, or basic.

Investigators at different institutions throughout Texas were given a fair and balanced hearing by a coterie of national referees – our deliberations paid no attention to geography or political pressures within Texas, and we had no hidden agendas or conflicts of interest.

I fully accept that it is the purview of the Overseers and, ultimately, the citizens of Texas to decide how their funds should be best spent. Under current circumstances, however, I cannot lend my approbation to the changing of the guard.

 

Sanjiv Sam Gambhir, the Virginia and D.K. Ludwig Professor in the department of radiology and bioengineering, chair of the department of radiology, director of the Molecular Imaging Program, and director of the Canary Center for Cancer Early Detection at Stanford University:

I am writing to inform you that I am resigning my position as the Chair of the Interfaces Review Committee (IRC) Review Panel of the Cancer Prevention and Research Institute of Texas (CPRIT) effective immediately.

I will be available to help in the upcoming transition in any way that I can so that cancer researchers in the state of Texas as well as patients who have already been diagnosed and those yet to be diagnosed are not harmed due to my resignation.

It has been great to help in a small way by reviewing grants and to help the state of Texas attract the best minds from all over the country to the great Universities and medical centers throughout the state.

I am highly thankful to my review committee of outstanding scientists and physician-scientists from all over the country who have carefully reviewed many grants over the last three years.

Their hard work and dedication is matched only by that of the Texas cancer researchers. I only wish even more highly meritorious grants could have been funded. It is a highly challenging time for biomedical researchers everywhere, and I am so happy the Texas taxpayers have helped to support excellent biomedical research for such a deadly disease.

The citizens of Texas are to be commended for their investments that will benefit cancer patients worldwide.

I am also very thankful for the opportunity to have learned from Drs. Al Gilman, Phil Sharp, and my fellow panel chairs. They have always worked with the highest principles to make decisions that are unbiased and at times quite difficult. I want to particularly thank Dr. Gilman for taking a firm stand against the CPRIT oversight committee for their actions that undermine the rigorous scientific review process that was championed by Dr. Gilman. Politics and science at times must mix, but at other times such as this, they should clearly not.

 

Everett Vokes, the John E. Ultmann Professor, chairman of the department of medicine, and physician-in-chief at the University of Chicago Medical Center:

This note is to indicate my intention to resign from my position as co-chair of the Translational and Clinical Review Committee 1A/2A of the Cancer Prevention and Research Institute of Texas effective immediately.

CPRIT has been a powerful and highly impactful institution that has succeeded at funding innovative research and attracting scientific leaders in cancer research to the state of Texas.

I have been highly honored to be a member of this process and to serve under the scientific leadership of Drs. Al Gilman and Phillip Sharp and work with the many exceptional reviewers on our committee.

CPRIT is in a state of transition following the events of the last several months. I hope that the disruption and distraction that has resulted from this transition can soon be ended and that new credible leadership be appointed. Should at that time my services be of interest, I would be willing to consider future interactions.

 

Click Here to read the rest of Slamming the Door, a series by The Cancer Letter

Copyright (c) 2020 The Cancer Letter Inc.