the Hell Is It?



     As I write this on March 15, the Malaysian
Airlines Boeing 777 is still missing. It is very hard to understand how, in the
era of Facebook, Twitter, Skype, CNN under your bed and gotcha on live TV,
humans have misplaced a huge airplane. First thoughts usually go to a mishap of
the technical variety or even pilot error, although this usually happens much
closer to the ground than this plane appeared to have been when it vanished.
For those of you old enough to remember the Twilight Zone, I guess you are
wondering whether it went back or forward in time. The more up-to-date TV hawks
probably assume it is Lost near an island in the ocean. More and more, however,
it looks like a far less mysterious solution to this modern mystery is likely.
Someone stole the plane.

     The latest headlines say the plane flew on
for about 4 (perhaps 7?) hours after it left radar detection (perhaps), radio
communication and transponder broadcasting. It may have gone west or east or
anywhere in between, but if it took the acute turn that is thought likely, it could
not have been by accident. Someone steered it that way which makes the
likelihood of hijacking far greater than was first imagined. I have also
considered that perhaps this was brilliantly schemed and the plane actually
landed in a controlled fashion somewhere and everyone on board is safe.
Hey!  This is my blog and I like happy
endings. Let’s hope.

     In essence, what was once thought to be an
accident, is now presumed to be quite purposeful. Whether my happy ending ensues
or a more catastrophic one does, I think this all being attributable to bad
luck is no longer high on the list of probabilities.

     Which, like everything else, of course,
beings me to another large vessel of seeming inviolability, thought to be once impervious
to bad navigation, the good ship MD Anderson (see the mid-campus building and
then vote for the flag on top: American, Texas, Libyan or Jolly Roger)?

     My understanding (see previous blog) is
that things from 35,000 feet at MD Anderson look as good as they did from the
Boeing 777 just before radio contact was lost. Smooth sailing.

The money is pouring in.  The science has never been better with 2
members of the NAS and 5 IOM members on the faculty. Growth and expansion is
occurring all over the country and world. What could possibly go wrong?

     As far as I can tell, from the vantage
point of the 21st floor, nothing. But from the clinics and labs,
just above the white caps on the American medical ocean, the view is anything
but pleasant.

     Grant money is hard to come by and more
necessary than ever to keep a job in academics. Patients are sicker, more
demanding and have higher expectations of the ability of modern oncology to
alter the natural history of their malignant diseases. The push to DNA sequence
all of nature—malignant and non—has yet to yield a great deal of strategies for
enhancing medical care, but that is stopping no one from spending on technology.
Things that could really work in the sphere of prevention go largely unapplied
to the population as a whole as no one wants to pay for it.

     Most people acknowledge all of this and
then say, “but what can I do to change things?” The answer is start small and
keep going. If the physicians and other providers will not advocate for
themselves, then do so for the patients. Stop doing what doesn’t work. Stop
over testing. Send people home (or prevent them from even coming) if there is
nothing that MD Anderson has to offer them that will make whatever time they
have remaining better or longer. Refocus on doing work that is uniquely in the
bailiwick of an academic cancer center. Stop using pricey drugs and therapies
(e.g., proton radiotherapy in prostate cancer) of unproven efficacy outside the
context of a clinical trial. In essence, just say NO to the politicians,
administrators, drug reps and bean counters who have forced medicine to take an
abrupt turn leading to…where? The Indian Ocean is a distinct possibility.

     We need to regain radio contact with
reality, right the plane’s course and keep the needs of the patients at the
forefront of our actions. The next thing the Navy will be looking for if we
don’t, is us.

     Just admit that a human hand was the
critical force in all of this. The doctors sat back on their heels as the
insurance industry, drug companies, federal government and hospitals all took
turns at the trough of the health care industrial complex leaving the docs the
orts on the floor. This was no more random than the flight path of the
Malaysian airliner appears to be.

     Once again, I say what Jane Fonda said in
The Newsroom: “GET IT BACK!”

       Here’s my latest from the Houston Chronicle


Leonard Zwelling