Making American Medicine
(and MD Anderson) Great Again


Leonard Zwelling

         Why has Donald Trump so captured a significant proportion of
the American electorate?

         Both he and his hats claim to be able to Make America Great

         But Hillary Clinton has this right. America is great and
always has been. And Governor Kasich is also right saying, of course, we have
problems that need to be addressed, but that doesn’t mean we aren’t up to the

         I think Mr. Trump is appealing to a certain American whose
prospects are not great right now and are not likely to be in the future no
matter what their hats say. Data unveiled by Chuck Todd on Meet the Press Sunday, March 13, revealed an important truth. Mr.
Trump does best in states with greater than average (5%) unemployment and
African-American populations above 8%. Chuck’s explanation? These are the
depressed states that have lost many manufacturing jobs and also have large
minority populations that white people can blame for their plight. These are
the Trump voters: white, male, not well-educated, blue collar, the former
backbone of America who high tech jobs and the need for a college degree have
left in the dust. Their jobs are not coming back despite what Mr. Trump says.
In the global economy, we must be selective in growing our manufacturing
sector. It cannot supply all in this category of American with jobs. Retraining
will be essential for these unemployed and under employed Americans.

         I am personally very sympathetic to these people and
understand both their anger and their frustration. I also understand their
gravitation toward a demagogue. It happened this way in the Europe of the 1930s
and can happen again here (see my recent blog on the German American Bund).

         If the current Trump steamroller is to be stopped, it will
have to be stopped in the manner Mrs. Clinton suggests. With votes. If all
those threatened with discrimination under a Trump regime get out and vote
against him, this will be over and duly noted as the Trump Blip like the
Wallace Blip in 1968 or the Perot Blip of 1992. But remember what happened to
Bobby Kennedy in 1968 and to Wallace 4 years later and you can grasp the threat
to all the candidates’ safety and the need for every candidate to eschew even
the hint of the rightness of violence, let alone stop telling his crowds he wants
to punch people in the face.

         If Donald Trump becomes President, we will have gotten the
candidate we deserve. Let’s not deserve this. He’s not great. America is.

         This is also true of American medicine, previously the envy
of the world now pricing itself out of reach of so many Americans that an
entire industry of health tourism has arisen as Americans seek superior care
for less money in the Far East and elsewhere. What happened?

         We physicians got greedy and so did the insurance industry,
drug companies, and hospitals. Libby Zion, an N of one, altered the on-call
schedule of every American trainee and dumbed down the resultant docs because
they left post-graduate training with inadequate experience. (You cannot learn
how to do a spinal tap at midnight snuggled up in your bed). The ACA locked in
this system of greed called the health care-industrial complex, with no checks
and balances against price increases, cost increases, difficulty with access,
and no reasonable measures of quality. The American medicine of Michael
DeBakey, Jonas Salk, C. Everett Koop and Marcus Welby has been supplanted by
that of Dr. Oz, David Agus, and Dr. Phil.

Anderson was a true mecca of clinical care until the bar was raised in science
(although it was not jumped over). Then the Regents and Dr. Shine fell in love
with a con artist for President of its signature cancer center disguised as a
doctor. It was akin to what has happened to many Americans falling for a con
artist disguised as a businessman running for President of the US. The purity
that was the care provided at MD Anderson has been supplanted by a high
throughput model of revenue generation in service of drug discovery by people
who have never discovered a drug while these same people fire people who
actually have developed a cancer therapy. I believe a very bright neurosurgeon
characterized the attitude of the current leadership of MD Anderson at a
faculty assembly as the “patient as an ATM.” How true!

         America is great. Yes, we need work. Our infrastructure is
collapsing. Our schools are not as good as those around the globe. Our health
care system is a mess. We still are fighting the Civil War and we need to stop

         American medicine is still great at the high end. Most
Americans don’t need high end care, but they do need some sort of basic care
that is not guaranteed to them currently unless they are older than 65. It
ought to be.

         MD Anderson needs to get its eye back on the ball known as
clinical care and clinical research. MD Anderson will NEVER be a mecca of basic
science that competes with Harvard, Southwestern, or UCSD. It just won’t. Get
back to what MD Anderson used to be great at—taking great care of people with
malignancies and serving as the clinical laboratory for all of the great ideas
from other academic institutions as well as from big and small pharma.

         The United States, American medicine and MD Anderson are all
still great, but they may not be heading in the right direction and course
correction might be wise. America needs more resolve. American medicine needs
to be free of economic incentives for people to behave badly. MD Anderson’s
problem is far more fixable. Start that search from 2011 up again. This time
hire an oncologist not an entrepreneur using other people’s money disguised as
a doctor.

Leonard Zwelling