CTRL-ALT-DEL

By

Leonard Zwelling

         My experience with IS Help lines, whether 4-INFO or some
others, is that when I call in with a problem, the first suggestion given is to
either shut off the computer and restart it or do a reboot; CTRL-ALT-DEL. This
has become a metaphor for a solution to a situation that while having been
initiated with the best of intentions, has now deteriorated and is clearly
failing. Fixing is not an option. It’s best to just start again.

         My mentor at the National Cancer Institute, Dr. Kurt Kohn,
used to describe biology’s similar response to overwhelming damage in a cell or
organism. Rather than fix something, sometimes an organism’s best contribution
to the whole of nature is to die. Apoptosis is the cellular equivalent and for
the whole organism, it beats the cell misfiring in trying to repair itself or
its DNA and becoming malignant. Sometimes, it is in the organism’s best interest
to have a damaged cell die rather than try to repair it.

         The way Kurt put it was that a palm tree might be better off
if a damaged leaf just fell off rather than the tree trying to repair it. If
for no other reason, it requires far less energy to lose the leaf and reduce
the chaos produced by the damage than to have the tree try to repair it. Nature,
like computers, can be best served with a reboot. Some things are beyond
repair.

The
same is true of human organizations and the rules employed to guide them called
laws. Sometimes the energy needed to reduce the entropy and chaos caused by
organizational damage that occurred secondary to poor decisions or bad
legislation is best handled by starting again.

         We are witnessing a very public reboot of ObamaCare. Many of
us knew from the beginning that the President’s statement about health
insurance, that “if you like what you have, you can keep it”, was a false
promise for the President never had the power to force insurance companies to
sell anything. If a company viewed a product it was selling as insufficiently
profitable or not in compliance with the rigid requirements of the ACA, the
company could simply stop offering the coverage regardless of who liked it. Furthermore,
large companies could pay a per capita penalty (a known fixed cost) and shed
the administrative burden of providing its employees with health insurance.
Those now insurance-less employees who liked what they had could use the so-far
dysfunctional exchanges to get coverage no longer offered by their employers. There
was nothing anyone in Washington could do about it and there never was. It was
a foolish promise to make. When you add this to the helter-skelter expansion of
Medicaid around the country (thank you Justice Roberts, et al) and the
inability of healthcare.gov to allow most Americans to assess the possible
benefits of the law by identifying better insurance at lower costs with or
without subsidies and you have a law that has left the tracks and is not coming
back. As my teacher former Chief of Medicine at Duke, Dr. Eugene A. Stead, Jr.
might say, “Just say for me, CTRL-ALT-DEL”.

         The UT Board of Regents has been facing a similar
predicament for over a year. They secured the services of a new president for
MD Anderson who is not an oncologist, exhibited severe problems with ethical
judgment on national television, violated his own institution’s conflict of interest
rules and hired his own wife into a very powerful position in which she
controls a large chunk of institutional resources. The DePinhos have also
proven to be arrogant and rude in their interpersonal interactions, displaying
a clear lack of understanding of the most minimal requirements of their jobs as
MD Anderson leaders. And they have apologized specifically for nothing.

For
Dr. Cigarroa and Dr. Greenberg, who witnessed the discontent among the MD
Anderson faculty for themselves in the Hickey and beyond a few weeks ago and
for the Regents to whom they report, the time has come to press those three
magic buttons in a co-temporal fashion. CTRL-ALT-DEL.

         Both ObamaCare and the appointment of Dr. DePinho need a
recall.

         In health care, the country needs to have an open and honest
debate as to whether access to affordable, quality health care is or is not a
right of citizenship prior to devising a system to get it done. Never in my 9
months on the Hill did I hear this discussion take place among the members of
the US Senate Health, Education, Labor and Pensions Committee. As I have
written many times, the ACA is not a law about health care. It is a financial
deal about how the US will pay for health insurance for those currently without
it. At this point, it is time to do with the ACA what we should have done in
Vietnam. Declare victory and leave. CTRL-ALT-DEL.

         As for the MD Anderson presidency, those making the
selection (Dr. Shine and the Regents) had a very different view of MD Anderson
and its future than those who actually work there and generate the money to
keep the buildings cool in the summer. They also did a very poor job of due
diligence as any call to those working with or for the DePinhos in Boston could
have told them they were tacking into heavy winds and waters. A discussion as
to what MD Anderson’s role is in the world of American and global medicine
might be timely right now, as would a real strategic and business plan, and these
discussions MUST include those who will be charged with making that vision a
reality—the faculty. If this does not occur, don’t be surprised if many of faculty
members decide to reboot their careers and CTRL-ALT-DEL their way to other
institutions.

         We know that men like President Obama and Dr. Shine, Harvard
men both, have trouble saying “I’m lost, I’m wrong or I’m sorry”. This is why I
am proposing that women get involved and save the men from themselves and save
us all in the process. Big mistakes have been made—some by women like HHS
Secretary Sibelius, but the time has long since passed when the words “I’m
responsible for this mess” are enough. They need to be followed by “here’s how
we are going to fix it and here’s who is going to pay for failing”. How can the
faculty or the Congress be held accountable for what they do until President
Obama and President DePinho are held accountable for what they have done?

Leonard Zwelling