Two Views of the Future, Donald’s and Bernie’s: Which One is Ron’s and Does It Make Sense?

Two Views of the Future,
Donald’s and Bernie’s: Which One is Ron’s and Does It Make Sense?

By

Leonard Zwelling

         To Donald Trump’s eyes, we have shrunk as a nation. Our
leaders are worthless and stupid. Our Congress is dysfunctional and corrupt.
Only he is capable of making a deal so you had better pull yourself from your
sick bed in Iowa or New Hampshire and support him. His view is that the America of tomorrow
is the America of yesterday. He does, after all, want to make America great
AGAIN. This clearly implies a return to a mythic view of the country that
probably doesn’t reflect reality, but is a great applause line.

         To Bernie Sanders, America needs to have a political
revolution. He does not want to return to anything. He wants to blast into an
American future of centralized health care insurance, government-supported
college tuition, and a redistribution of wealth from the truly rich to the
working class through the taxation of the wealthy and the subsidization of
those in more need. Bernie is just taking the New Deal to its logical conclusion
in a fashion last advocated in the 1960’s with the Great Society and the advent
of Medicare and Medicaid as well as with communal living. It is modern day Western
Europe.

          These are very
different views of America’s future and the American people may have the
opportunity to weigh in on which of these two visions they best like.

But,
I doubt it.

         First, neither of these visions is realistic. Donald Trump
is painting an imaginary picture of a country that was last painted by Norman
Rockwell and that was 50 years ago. We live in a far more interconnected world
than one like that which the US strode across to win WWII and dominate the
1950’s and 1960’s. Back then there was no major economic force in China. We
were fighting the Soviets in a Cold War of attrition that we won in the 1980’s.
There was no European community and no one ever heard of a Palestinian let
alone Al Qaeda or ISIS or Bill Gates. Donald’s view of today is so clouded by
his rosy view of a Camelot of a yesterday that never existed that he cannot
possibly be entrusted with the future.

         Second, America is a right of center country. The
communitarian streak is still secondary to the John Wayne individualism of the entrepreneur.
After all, could Mr. Trump even get arrested on 5th Avenue or anywhere
else if it were not for the freedom in America to make a fortune—more than once
despite previous bankruptcies. Bernie’s left leaning democratic socialism seems
great to 20-year olds but less great to their parents and grandparents who have
worked hard for what they have and are tired of entrusting more of their tax
dollars to irresponsible gerrymander-ensconced politicians on Capitol Hill.

I
may think that Medicare for all is a great idea (and I do). Most people don’t
and I get that. Medicine will evolve into something like a single payer system
for most with a private, component for concierge care and high-end insurance
for the wealthy, but this will take time and will be guided by economics, not
by political fiat.

The
real problem with ObamaCare is that the crisis in American medicine is at its
root economic and will require an economic solution, not a political one open
to the manipulations of the very people feeding at the trough of the current
health care-industrial complex.

         It is far more likely, no matter who is elected the next
President, that the country will continue to struggle along thinking it is
making great progress because it can tweet more (can 200 characters be far in
the future?)  and faster, when in fact
the major changes that have occurred from the late 1800’s through the Second
World War are the ones that really changed the lives of ordinary Americans
(electricity, indoor plumbing, sanitation, vaccination, antibiotics, and
telecommunications). (See http://www.nytimes.com/2016/01/31/books/review/the-powers-that-were.html?ref=books&_r=0).
(I am going to argue here that space flight really didn’t change the lives of
most Americans beyond those innovations in telecommunications that came with
the use of satellites. Going to the moon meant nothing to most of us except it
was cool to beat the Russians there.)

         Given this thesis, where does MD Anderson’s future lie? Is
it a return to the MD Anderson of clinical excellence and human subjects
research of the highest caliber or does it lie in a future of genomic
sequencing, drug development based on scientific breakthroughs and modern
screening and prevention? Or is even that a false choice?

         I am going out on a limb here and once again saying neither
a return to yesteryear nor the development of MD Anderson as Ivy League biotech
company is the right course of action for the former greatest cancer center in
the world.

         Dr. DePinho’s moonshot program is, like the original
moonshot in the 1960’s, a technological solution. Fortunately, the Apollo
Program was a technical answer to what was basically a technical problem, so
was successful albeit both cool and useless to the lives of most Americans. My
guess is that the same will be true for the DePinho moonshot BECAUSE it is a
technical solution to what is still a scientific problem. It’s a simple answer
to a complicated problem and it is probably wrong.

         If the answer to cancer lies in defining the disease, the
solution lies in the labs of scientific exploration and the imaginations of
individual investigators not in assembly line screening and gene sequencing
from explanted cancers. Or silly TV commercials that are beautiful but
non-informative like the latest blonde local weather person.

         Like The Bern and The Donald, The Ronald has misperceived
reality and thus proposed a solution that while romantic, enticing and
infinitely sellable, is neither realistic nor achievable. Like America, MD
Anderson needs to rely on its values (Caring, Discovery and Integrity) while
finding new solutions to the old problem of cancer eradication through science.
This will not be a throwback to Anderson’s past greatness nor the pursuit of a
course of tumor grinding reductionism that can be assessed as being unwise even
now.

         If you want to make MD Anderson great again, a course needs
to be charted that neither tries to return to a day that was not as great as we
remember it to be, nor to a future of dependence on central control a la
DePinho and the FORDs. The future of MD Anderson is where it always was—with
individuals and groups of like minded dreamers who can differentiate between
the impossible and inevitable and chart a third course. Those individuals are
called faculty.

         I will leave you with a quote from my favorite politician of
all time, Robert F. Kennedy in 1966:

“Few will have the greatness to
bend history itself; but each of us can work to change a small portion of
events, and in the total of all those acts will be written the history of this
generation.”