Speaking Truth To Power: Never Easy, Always Necessary

By

Leonard Zwelling

I only did it a few times.

One day the president of MD Anderson who I was serving had a cool idea. He wanted to genotype every patient with cancer (and the cancer, too) that walked through the front doors of MD Anderson and compare the laboratory findings with the eventual clinical behavior of the patient and his or her cancer.

This discussion was taking place in the president’s conference room on the eleventh floor of the Clark Clinic Building. It must have been over fifteen years ago now.

I raised my hand.

“You can’t do that,” I said in my typically arrogant fashion.

“Why not?” asked the President. “I’m the president. Why can’t I do that?”

“It’s against HIPAA,” I answered. And it was against the federal privacy law that had been passed not long before. One could not do research on tissue acquired from an individual without first knowing precisely what the research was (which gene and which outcome its expression would be compared to). One also had to inform the patient (now a human subject) of precisely what was going to be done with the tissue as well as with his or her clinical data for research purposes or obtain an IRB waiver of consent.

Frankly, I haven’t kept up with the regulations any longer and have no idea if this is still true. But it was then and the president wasn’t happy with me for raining on his genomic parade. My guess is that somehow the powers that be at Anderson have gotten around this and do acquire tissue for future use without knowing what that future use will be at the time of acquisition. My understanding is that you don’t need consent or a waiver of consent and authorization to acquire and bank the sample, but you do to use it. Gratefully for you and for me, that’s not my dog any longer.

I can say without a doubt that my comments (and my style) did not endear me to the power when I spoke truth to it. I could have done it with more skill, of course, but it was the truth.

I did it again with an equal lack of skill at another job much later in my life when I thought that my colleague physicians were being overworked and under rewarded by the leadership of the clinic where I was employed. I wrote a memo about it and it was accidentally circulated. Bad idea! I was fired. I should have been. I spoke truth to power but in an unconstructive fashion. This is not good for longevity at any organization.

This becomes an issue now in Washington.

Who is speaking truth to the power in the White House as that power drives the country toward disastrous decisions in health care reform, foreign relations, and international trade? When the President of the US is at war with his own Attorney General, there’s a big problem. Thus far, even that AG has seemed weak, meek and his future may be bleak.

So far, the answer seems to be no one will speak up.

The people who should be speaking truth to power are in the Congress. Thus far the Democrats, in the minority, have been ineffective because while we know what they are against, it is unclear what they are for.

The Republicans have been a bunch of Trump lap dogs with the alpha males being McConnell and Ryan, if that’s your idea of an alpha male. It’s not mine.

When it takes an 80-year old maverick, eleven days out from major cranial surgery, to make the case that his colleagues are essentially inept, there’s a problem.

This cannot be wasted as an educational moment for the faculty of MD Anderson. The current temporary leadership has done a great job steering the ship through the rocky seas of transition. Soon a permanent captain will be named. When that occurs, please remember to speak up when the new captain falters in his or her judgment or decisions.

Just do it more skillfully than I ever did. Maybe someone will listen.

Leonard Zwelling