Disproportionate Force

By

Leonard Zwelling

         This phrase has been thrown around a lot in the past few
weeks.

The
claim by many, especially in the media and on the left, is that the Israeli
government has employed disproportionate force in attacking the Palestinian
population of Gaza. There are several reasons they make this claim. First, the
kill rate between the two sides is about 20 to 1. Second, the skill and power of
the IDF cannot be matched by Hamas. (It’s just not fair!) Third, the majority
of the Israeli dead are military personnel and most of the Palestinian dead are
civilians. Right, right and right. And irrelevant.

         Israel did not pick the current fight. Hamas built the
tunnels using concrete meant for schools and hospitals and Hamas is lobbing their
rockets at Ashkelon and now Beersheva. That the Iron Dome worked is not an
issue. Sorry Hamas doesn’t have one? Not in the least. But what is really
annoying is that the master of disproportionate response in war is—The United
States.

The
US dropped the first and second (and thus far only) nuclear weapons used in
war. The US killed about 100,000 people in three days 69 years ago. Now THAT’S
a disproportionate response and perhaps a justifiable one for all the same
reasons the response from the IDF in Gaza is understandable. In war there can
be no disproportionate responses. Either you win or you lose (it’s worse than a
game 7.  There it’s lose or go home. In
war it’s lose and you have no home) and we could not afford to lose nor to send
in troops to overwhelm the Japanese islands in 1945. I still don’t understand
why a second bomb was needed but I am not a student of that history.

                  Whether
it is the rockets of Hamas or the Zeros of Japan over Pearl Harbor, they
started it. We will finish it.

         Let’s shift gears to Ferguson, Missouri. Here a
disproportionate response was way out of control, unnecessary and very costly.
It may turn out that Michael Brown did try to rob a convenience store and that
a policeman ought to have stopped and possibly arrested him. But if it turns
out the eyewitness accounts are true and he was gunned down while unarmed, that
officer must be prosecuted. Burglary is not war and a disproportionate response
is untenable in a fair American justice or law enforcement system.

         Finally, let’s turn to MD Anderson. Is the current response
to the faculty morale unrest disproportionate? Yes it is. It is underwhelming.
Disproportionate responses can come in two forms, too much and too little.

         I have no idea what the leadership of MD Anderson is trying
to do clinically or in research. I do not get a business model that seems to be
combining a key central location, many local satellites, and a world-wide
network of affiliations. What is the strategy? Is the MD Anderson leadership
trying to make as much money as possible by seeing as many people as possible
or are they really doing personalized medicine that requires slow and careful
thought through a process of determining who best to serve because MD Anderson
has the most to offer these patients with cancer, but not those who can be
treated in the community? In research, are they still insisting on sequencing
the world or will the latest developments in immunology make that
unnecessary?  And what of the Moon Shots?
Have we got even an Alan Shepherd shot down range from the Cape to show for the
first 3 years let alone Apollo 11? I have no idea.

         There are many kinds of disproportionate responses.

         In war, overwhelming is good.

         In policing, proportionality is crucial to long-term
effectiveness and community relationships.

         In academic medicine, underwhelming, confused, unfocused and
self-serving are not the adjectives one wishes to have associated with the plan
to improve the health of Americans, particularly those with cancer.

         Perhaps it was calling the latter effort a War on Cancer
that created the confusion for it is not a response that requires unlimited
money although that would be nice. It is not a response that requires shooting
from the hip either. It takes a considered, slow, thoughtful effort in which
the validity of every good idea is weighed against all the possible ideas and
the best of them pursued not because one person thinks so, but because many do. 

Leonard Zwelling