Kakistocracy: Government
By The Worst Persons

By

Leonard Zwelling

         In Saturday’s Wall
Street Journal
(AUG 6-7, p. A13) Peggy Noonan, my Republican voice of
rationality, wrote a piece called “The Week They Decided He Was Crazy.”
Obviously, this was an essay about Donald Trump and the seemingly endless
missteps, misspeaks, and mistakes he continues to make despite all efforts by
Hillary Clinton to outdo him by her lying about what the FBI Director said with
regard to her email behavior. No matter how inept Mrs. Clinton seems to be at
saying, “Yes, I lied to you and I knew there were classified emails coming to
me because I was the Secretary of State and there had to be,” she cannot top
The Donald for making a mockery of the truth from the Muslims celebrating 9/11
in New Jersey to the plane with the $400 million unloading in Iran. He’s
clueless. President Obama is the cause of ISIS? Please! 

         Thus, the title of this piece borrowing from a term coined by
one of Ms. Noonan’s friends—kakistocracy, government by the worst persons. We
now are guaranteed this for the next four years. Of course, for those of us who
actually worked in that government during the 21st century, this
will not be new or news. I was staggered by the anti-intellectualism and sheer
mindlessness of what I saw occurring before me in the US Senate when I was a
member of its staff trying desperately not to contribute to the mediocrity. I
fear I failed. I have been trying to correct that since I left Capitol Hill in
August of 2009.

         What has concerned me far more than the paucity of insight by
the elected on Capitol Hill let alone in the White House, has been a similar
deficiency in the halls of academic medicine. From the meaner and meaner
environments established by the leaders of academia, to the free-for-all trying
to get grant money from the federal government, to the avarice of big pharma,
to the greed in the corner offices of most academic centers looking for more
and more money and higher and higher salaries, medicine is not what it used to
be any more than are the members of the Congress.

         Academia is even short on thought.

         The electronic medical record is a joke. It is a tool for
the billers to extract every dollar out of the work of the physician faculty
members. It was never about quality or more accurate patient care. Even its use
for research is stymied by the privacy rules.

         Genomics is the answer to any question. It’s like reverse
Final Jeopardy. In cancer this may well have reached its most absurd point as
the combination of big data and big sequencing are being used to promise big
cures. So, as my grandmother would say, new? Where are they? The revolution in
cancer immunology is far more likely to yield real clinical benefits than is
the massive sequencing of every tumor known to man, but even that has a ways to
go.

         And the prices of the new drugs are outrageous and will
blunt any real progress made because many cancer patients in need will not be
able to afford the newest therapies—even if the drugs actually work, although
until that is proven, that too is a pipedream.

         We in medicine are not being led by the best or the
brightest, because those young folks are staying away from medicine anyway.
Instead, we are being run by the health care industrial complex of
Congressional whim, Presidential wham, pharmaceutical company greed, and green
eye shade back room billers and coders who really control what is happening
behind the examining room door in cahoots with the insurers.

         Just as the country must reject Trump, academic medicine
must reject the imposition of assembly line medicine on the faculty of major
academic centers. These places need to get back to doing what they uniquely do
well—care for the unusually sick and do research and teach. And if that does
not generate a billion dollar “margin,” so be it.

         We in academic medicine, like those on Capitol Hill and 1600
Pennsylvania Avenue are supposed to represent the best of America not be the
leaders of a kakistrocracy.

            

Leonard Zwelling