Duke Medicine makes major administrative appointment

FC here. Probative. Provocative. Sorry but I cannot get the check mark to work on this new computer. Windows 7 is a disaster.

Loyal Readers, when is the last time you found us excited -- in the most positive sense of the word -- about a new administrator?

OK. OK. We can't remember either.
But there's an appointment at Duke Medicine -- so far announced only to the staff and not in a press release -- that we'd like to share with you.

First of all, this is a promotion. On a campus that is notorious for bringing in outside people rather than encouraging and developing from within. Yes, there was a vigorous national search, and they found right guy down the hall.

Second, he's an alumnus. On a campus where we believe the only member of the President's cabinet, for example, who attended Duke is the PR guy.

Third, he's a medical doctor, a cardiologist, who saw his career gravitate so he went over to Fuqua Business School to earn an MBA. How many people who were were trained in a discipline -- perhaps as an English teacher or political scientist -- later found themselves dealing with multi-billion dollar universities they seemed unable to grasp?

And fourth, this guy is not perfect. But when he's been wrong, he's told us so. Just flat out said so. Wow. We like this.


Dr. Michael Cuffe, who went to MIT for his undergraduate degree, is a graduate of Duke Medical School '91. He stayed at Duke for his residency and a fellowship in cardiology, which is quite an honor in itself. And then he joined the faculty.

Moving from full time practice, research and teaching, he has had a list of administrative offices in the past decade, most notably in our view as vice dean of the Medical School. His Fuqua MBA came in 2009.

One of our sources says Cuffe leapfrogged over other candidates and is destined for even higher assignment. Another source is just plain effusive, a source we respect and trust and admire, one who has been very persuasive in discussing all this with FC.

Cuffe's new title - a morph and expansion from one of his old ones -- is Chief Medical Officer for all of Duke Medicine. Big. That puts him in the inner circle, a member of the highest council.

He will also be vice president for ambulatory affairs. This is a new position -- more or less -- and it is worth considering, for it puts Cuffe right at the vortex of medical reform, the waves of the future:

-- when patients will no longer have a single doctor, but rather a team with a doctor, physician's assistant, nurse and support staff all coordinating care.

-- when patients will see more and more services in offices and urgent care centers rather than in Duke Hospital. Cuffe will oversee this expanding network, and insure every patient has a common quality experience. And then there is the unification of computer systems, so every doctor in the Duke system has access to ambulatory records. alike.

-- when budgets are in dagner of being severely crimped by cuts in Medicare and Medicaid. These cuts -- under discussion in Washington along with the debt ceiling -- go deep, affecting more than patient care. They also will likely slice into federal payments for the training of doctors. (Duke is calculating how much; three New York teaching hospitals estimated this week they will lose $1 billion a year from their training budgets and subsidy for intensive medical services like burn units.)

-- private insurers are replicating the government, eyeing cost controls and tightening their reimbursement rates.

-- when people are living longer, creating an increased need for medical care. And when research makes possible new therapies, often at greater and greater cost.

That's a full plate. I will stop.

Let's get back to the mistakes. We first learned of the promotion when a Loyal Reader wrote FC telling us about the internal announcement, reminding us of Cuffe's role in the Potti Mess, and anticipating we'd cream him. Perhaps a headline like "Key Potti Mess official gets big promotion."

Sorry, FC is fair. We shall discuss the Potti Mess in a little detail since that's where we've encountered Dr. Cuffe before and written about him.

Three issues.

A) After a long and extended hue and cry within the scientific community, Duke's administration ordered up a a formal look at Potti in the winter of 2009-10. At this time, his cancer trials -- experiments on human patients with lung, breast and ovarian cancer -- were prevented from enrolling new people, but people already in the trials were allowed to continue.

As this investigation began, researchers at the distinguished M D Anderson Comprehensive Care Center at the University of Texas, who had been atop the Potti situation, wrote a detailed letter to Duke specifically detailing his errors and shortcomings. That's a rare letter. Someone telling Duke that its rising star, a guy extremely well funded by grants, was foul.

Several people in the administration -- including Vice Dean Cuffe -- decided to conceal that letter from the investigation. They felt it could prejudice the investigation; FC challenged this conclusion vividly. After all, the investigators were all very sophisticated MD's and PhD's from the faculty, with tenure.

It was a horrible decision -- compounded when the investigation found Potti was on the up and up. Rather than remanding the conclusion for new consideration in light of the material from M D Anderson, the administration let Potti resume taking new patients.

Cuffe subsequently said this was just plain wrong and he had learned from the experience. He spoke clearly, forcefully and unequivocally. That's all we can ask.

B) As more and more became known about Potti in the months after the investigation -- including the faked Rhodes Scholarship -- people wondered if Duke was negligent in hiring him in the first place and then in allowing his drug trials to go forth from day one. "In retrospect, these trials should not have been done."

Cuffe subsequently said the trials were a mistake and should not have occurred. Good heavens, an administrator admitting he's wrong and saying he's learned!

As an aside, please let FC note that a source in Duke Medicine have said that, applying current standards and protocols of genome research, clearly the trials should not have occurred. But five and six years ago, when Potti was seeking grants and getting started, those standards did not exist and our source says it may have been appropriate to start the trials.

C) The Dean of the Medical School, Dr. Nancy Andrews recused herself from Duke's pursuit of Potti because her husband is a researcher who co-authored with Potti. FC felt that Dr. Cuffe -- and vice dean Kornbluth too -- having been appointed by Andrews and reporting to her, should also have recused themselves. We stressed that we had no information indicating they had been influenced by the factors we cited in calling for their recusal.

Thank you for reading FC. Stay healthy and have a good day.

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