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Slamming the Door - Jul 1, 2016

Slamming the Door
How Al Gilman Taught Texas a Lesson in Science
This series 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.
Slamming the Door
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.’”

Issue 25 - Jun 24, 2016

CL42-25 (729 downloads)

Stanford, Intermountain and Providence Use Syapse Platform to Integrate Their Data
Three health systems—Stanford Cancer Institute, Intermountain Healthcare and Providence Health and Services—have agreed to eliminate the electronic barriers between their medical records, tumor registries and genomics databases.
The three entities said they have started to use a common IT platform to achieve interoperability and guide clinical decision-making.
That platform is Syapse, a startup that is emerging as an important player in the ongoing conversation on bioinformatics and data sharing in oncology, led by Vice President Joe Biden and the National Cancer Moonshot Initiative.
• Related Coverage of the Cancer Moonshot
Conversation with The Cancer Letter
Hirsch: I Dropped Out of Stanford to Start Syapse
Jonathan Hirsch was studying neuroscience at Stanford University when he wandered into two oncology classes and saw an opportunity to change the way health systems handle genomic data.
“I started getting really immersed in molecular oncology, and the challenges in implementing molecularly guided treatment started coming together with the challenges in utilizing complex data,” Hirsch said to The Cancer Letter.
Joint BSA-NCAB Meeting
The Moonshot’s Metric for Success: Avoiding a Single, Tangible Endpoint
How will the success of the moonshot be measured? NCI Acting Director Doug Lowy touched on the subject during the joint meeting of the institute’s Board of Scientific Advisors and the National Cancer Advisory Board June 21.
The moonshots of the 1960s were essentially engineering problems that had tangible goals. Cancer is an evolutionary problem, and the stated goal of the moonshot in cancer research, led by Vice President Joe Biden, is perhaps deliberately vague: to achieve a decade’s worth of progress in just five years.
“Has there been any discussion of an endpoint that you can point to—like planting the flag on the moon, or sequencing the three-billionth base pair of the genome project?” asked BSA member Lincoln Stein, director of the Informatics and BioComputing Platform at the Ontario Institute for Cancer Research, during the meeting. “Something that looks like an achievable endpoint?”
Funding Opportunity
SU2C, Merck Taking Proposals for Keytruda
Stand Up To Cancer announced a request for proposals under SU2C Catalyst, a program supporting clinical trials and translational research.
In Brief
- NCI Surgery Branch resumes enrollment in immunotherapy trials
- Rajesh Garg named president and CEO of Cancer Treatment Centers of America
- Prostate Cancer Foundation names 24 Young Investigator Award winners
- Shuanzeng “Sam” Wei and Phillip Pancari join Fox Chase
- MIT’s Tyler Jacks, Susan Hockfield, and Phillip Sharp publish report on convergence
- Pancreatic Cancer Action Network lobbies Congress for research funding
- Leukemia and Lymphoma Society and the American Society of Hematology to collaborate on promoting AML treatment research

Issue 24 - Jun 17, 2016

CL42-24 (31 downloads)

Moonshot May Play Role in $400 Million Annual Contract to Run NCI’s Frederick Lab
The contract for operations and technical support at the Frederick National Laboratory for Cancer Research could be accepting proposals as early as next month—but NCI advisors said they are hoping to slow the recompetition process to reform the laboratory’s mission.
Moreover, NCI should consider how the laboratory could contribute to Vice President Joe Biden’s National Cancer Moonshot Initiative, members of the Frederick National Laboratory Advisory Committee said at a recent meeting.
Task Force Adds Tests to Colon Screening Guideline
The final version of guidelines for colorectal cancer screening by the U.S. Preventive Services Task Force differ substantively from the group’s draft version published last October.
The final version—unlike the draft—lists CT colonography and FIT-DNA as screening methods that are equal to others.
It’s unclear whether political pressure had any role in prompting the panel to broaden its list of detection strategies from three to seven in the past six months.
Conversation with The Cancer Letter
Guideline Edits Rooted in Science, Former USPSTF Member Says
“I don’t see this recommendation as differing in any substantial way from some others that we’ve made, where we suggested that patients talk with their clinicians, and the important messages here is that colorectal cancer screening works, that colorectal cancer screening reduces deaths from colorectal cancer,” said Douglas Owens, a who has rotated off the U.S. Preventive Services Task Force, and was involved in developing the colorectal cancer screening guideline published earlier this week.
In Brief
- President Obama names six appointees to the NCAB
- Stand Up to Cancer to host fifth-biennial televised fundraiser
- Kety Duron joins City of Hope as chief human resources officer
- Miami Cancer Institute takes delivery of 220-ton proton therapy cyclotron
- Takeda and M2Gen to collaborate on ORIEN genomic data
- Mayo Clinic and Kiyatec to collaborate on ovarian cancer care
- St. Jude receives pathology accreditation through College of American Pathologists
Drugs and Targets
- Canadian review agency delivers positive opinion for Opdivo in NSCLC
- Genomic Health launches Oncotype SEQ Liquid Select biopsy test