Decide

By

Leonard Zwelling

            Leaders
lead. Faced with a series of possible choices, often difficult, nuanced, and
uncertain in predictable outcome, a leader must decide on a course of action.
Even doing nothing is a choice.

            For
many months, the Assad government in Syria has been engaged in a civil war with
rebels of various factions wishing to topple it. Not surprisingly, the
outgunned rebels have suffered grievous losses. The deaths from the conflict
are estimated at 100,000.  Refugees
are streaming out of Syria to neighboring countries. This threatens to
destabilize the entire region. The United Nations is of no use because the
Russians and Chinese in the Security Council do not want the Assad government
ousted. The United States has resisted giving all but token assistance to the
rebels for fear that these rebels too, like Assad, do not really represent the
interests of America. Al Qaeda may actually control significant factions within
the rebel forces. In the main, neither the US President nor the people he
governs has much tolerance for yet another war in the Middle East that has no
predictable benefit for Americans and is sure to cost us lives and treasure.

            It
is thus surprising then that the American government now states a “red line”
has been crossed with the putative use of chemical weapons by the Assad
government on its own people. This attack, still being documented by the UN
among others, may have killed around 1000 people, including children. Thus, one
has to conclude that the fact that 100,000 Syrians died was not enough to get
the United States to act but that 101,000 was OR, HOW they died matters. This
is a rather strange posture for the only nation to ever use nuclear weapons in
war. Nonetheless, at the time of this writing, with our closest ally in Great
Britain sitting this one out due to Parliamentary action, President Obama is
making the case to Congress for a military strike on the Assad government in punishment
which, in all likelihood, will have no strategic effect on the combat on the
ground.

            This
is President Obama’s call as to whether he will respond with some sort of token
yet damaging (oxymoron?) missile attack or redraw his own sketched red line.
This latter move would put him in the same category as Israeli Prime Minister
Natanyahu with regard to drawing red lines and then ignoring them.

            This
sort of decision making is not ideal, but may be required in a murky world
filled with people wishing to do us and our friends harm and who do not
subscribe to our morals as we define them at any given moment, relative though
these may be. President Obama is also being hampered by his predecessor’s rush
to war with Iraq on the premise of weapons of mass destruction threatening us
when none were ever found.

            On
a very much smaller scale, the strategy of Dr. DePinho to invest heavily in
basic science, new recruitment and drug development by untested leaders as a
means of opening a new revenue stream for MD Anderson must also come to
judgment on two levels by the leaders of UT in Austin. What was done and how
was it done? Do both parameters matter?

            If,
as President Obama is suggesting, how things occur is as important as that
things occur, how would the Regents rate the DePinho first two years?

            Well
, we haven’t cured cancer yet, but we have three more years to go on that
promise.

            How
the internal business of MD Anderson has been conducted by its leadership team
can be easily graded. F!

            The
command and control, bullying style of grandiose pronouncements, flouting of basic
ethics and profligate spending while starving the clinical faculty of even a
modicum of a share of their labors is not conducive to a happy work
environment. There’s nothing new about the President of MD Anderson reaching
into the revenues generated by the clinicians for his own purposes, but it
hasn’t been done with such impunity and hubris before.

            What
you decide does matter as much as why you decide it. How something is done
matters as much as what is done. It’s true in war. It’s true in a cancer center.
In both, a poisonous atmosphere is a bad idea.

            The
decisions that the folks in Austin might have to make are far less weighty than
the ones that have to be made in Washington and I am certainly not suggesting
that the possible use of weapons of mass destruction in the Middle East and the
financially draining weapons of mass construction being waged by the past two
presidents of MD Anderson are of equal gravity. But what you decide, why you
decide it and when you decide it is important. It’s playing out on the
world stage in Syria and perhaps on a much smaller one closer to home.

Leonard Zwelling