When the Extraordinary Becomes Ordinary: How To Get MD Anderson and the United States Back On Top By Choosing Life

When the Extraordinary
Becomes Ordinary: How To Get MD Anderson and the United States Back On Top By Choosing


Leonard Zwelling

         Good is not always easy to recognize. Great, usually is.
See, I will show you. Frank Sinatra, Beethoven, Woody Allen, Willie Mays,
Johnny Unitas, Michael Jordan, Bill Cosby. Ooops! Well, it used to be.

         Without any shred of a doubt, the United States between the
end of WWII and Watergate was a great nation. Economically, militarily,
ethically and intellectually it was the envy of the world. Then something

         Some think the American century began after WWI and ended
with Bush v. Gore. Some think it started in 1945 and stretched only to Jimmy
Carter or only until the JFK assassination. Some believe it persists to this
day. I do not. 

the inability of the US to bend the world to its will today (Iran talks, invading
Afghanistan, invading Iraq, watching ISIS remove American heads from American
bodies, running from Yemen, even defending an unappreciative Europe) suggests
that the sort of throw weight we threw around after we saved the world from
totalitarianism in 1945 is neither as heavy nor as potent as it was in the
past. Despite spending more on defense than the next 26 countries combined, we
cannot simply drop troops into any part of the world that we desire changed and
change it, unless we are willing to be the government after we eliminate the
one we desire removed. That is why Iraq and Afghanistan remain messes, Syria is
a country of poor alternatives for the US (ISIS or Assad?), and the Arabian
Peninsula is coming unglued in a Shia-Sunni 30 Years’ War.

humorous part of all of this is that the one country we could invade
successfully and then turn over to its own educated and competent people is the
one we won’t bother with. That’s Iran. Instead of freeing the intellectuals
both in country and exiled to actually run Iran, we are bargaining with
religious fanatics and John Kerry is surprised that he is getting nowhere. (And
we all know that even if Kerry and Obama get a deal, the Iranians will cheat 5
minutes later with help from the Russians and God knows who else).

         The notion of American exceptionalism is a thing of the past
despite the far right wing saying it is still so. American exceptionalism in
science, education, medicine and surely in politics has diminished to the
ordinary. The United States is just another big country. We just have more

         This is not to say that the US cannot ascend to being
extraordinary again. Opening its doors with welcoming arms to immigrants,
freeing all its citizens from putative religiously-based prejudice (think
Indiana), investing in its educational system, teaching its young people how to
learn, eat, run and not destroy themselves with hamburgers and tobacco could
restore the United States to its previous place of greatness in this world.
This takes more will than money and will, discipline, deferred gratification
and the absence of video games all seem low on the national agenda at the
present time.

         MD Anderson too has seen better days.

         The influx of great clinical and basic science that
characterized the LeMaistre-Becker years and the openness and controlled growth
of the first five Mendelsohn years have given way to corruption, greed, over
bloat and an addiction to money that has undermined the core values of caring,
integrity and discovery. What MD Anderson faculty looking to leave discover
when they interview for other academic jobs, is that the other places are just
as bad. In the past, Anderson faculty would not even look for they were sure no
place could be better than the place at which they were working. Even when they
looked, they found inferiority everywhere. 
Now, they just find the same old crap they are dealing with on Holcombe.
They don’t leave because there is no place better to go, not because they are
already in the best place.

         Anderson exceptionalism is over.

         But with even less energy than it would take to recoup the
reputation of the US in the world, Anderson could recoup its.  Here is what has to happen for Anderson to be
great again:

1. Anderson must have great leadership. It has not for
some time. (Please see today’s Chronicle for the first inkling that we are on
the right track). (http://www.houstonchronicle.com/opinion/editorials/article/Code-blue-6173491.php)

2. Anderson needs to get back to emphasizing clinical
care and clinical research as its main products. It cannot become a drug
company or behave like a corporation. Ethics needs to make a comeback.

3. It must have a real oversight board that watches the
behavior of the leadership and crafts with that leadership a real strategy to
compete in a rapidly changing medical market place. Financial transparency
would be nice, too and no more foreign money for buildings.

4. Anderson must find partners in the city of Houston in
all its areas of expertise from patient care to research and especially in

5. Every member of the MD Anderson faculty must act like
an ethical human being and a member of a great team. Everyone cannot be in it
for him- or herself. I give you Coach K’s (Krzyzewski in this case) five
fingers of the fist of success: Communication, Trust, Collective Responsibility
Caring and Pride. That is Duke basketball. At MD Anderson, that used to be us.

6. There is only one pot of money at Anderson. Stop the
interdepartmental scorekeeping system that has undermined the very nature of
clinical care delivery at Anderson and created competition out of collegiality.

7. Honor the retirees. Have a place for those with the
grayest hair at the tables of decision making so that institutional memory and
wisdom accompany the phony childlike enthusiasm and genuine avarice of current
leadership as drivers of strategic direction.

things are not hard. Deuteronomy 
30:11-19 (my favorite part of the Torah and the part that says to me
that we have free will and the onus is on us, not God, to make this world the
best it can be):

11 Now
what I am commanding you today is not too difficult for you or beyond your

12 It
is not up in heaven, so that you have to ask, “Who will ascend into heaven to
get it and proclaim it to us so we may obey it?”

13 Nor
is it beyond the sea, so that you have to ask, “Who will cross the sea to get
it and proclaim it to us so we may obey it?”

14 No,
the word is very near you; it is in your mouth and in your heart so you may
obey it.

15 See,
I set before you today life and prosperity, death and destruction.

16 For
I command you today to love the Lord your God, to walk in obedience to him, and
to keep his commands, decrees and laws; then you will live and increase, and
the Lord your God will bless you in the land you are entering to possess.

17 But
if your heart turns away and you are not obedient, and if you are drawn away to
bow down to other gods and worship them,

18 I
declare to you this day that you will certainly be destroyed. You will not live
long in the land you are crossing the Jordan to enter and possess.

19 This
day I call the heavens and the earth as witnesses against you that I have set
before you life and death, blessings and curses. Now choose life, so that you
and your children may live

         Friday, April 3 is the holiest and most
solemn day in the Christian calendar, Good Friday. This is the day of the

That same evening marks the beginning of the Jewish Passover,
the seminal holiday in all of Judaism as it marks the true beginning of the
Jewish People’s freedom and relationship with a land it still has to fight to
keep every day.

We are in heavy times here in Houston, but there is always
light and life. Choose life for America and for MD Anderson. It is not “too
difficult for you or beyond your reach.”

Code Blue, according to the Chronicle, is here. The first step in reviving the patient known as MD Anderson, is getting it a new doctor.

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