America’s Choices In North Korea Are Similar To The Ones Facing Academic Medical Centers: Bad and Worse

America’s Choices In North Korea Are Similar To The Ones Facing Academic Medical Centers: Bad and Worse


Leonard Zwelling

Kim Jong Un is often described as irrational. He’s not.

Kim has the US exactly where he wants it. America is faced with bad choices regarding North Korea and also worse ones.

For over twenty years the United States has tried diplomacy and economic sanctions to arrest the North Korean quest for nuclear weapons. This has not worked. If North Korea truly does have hydrogen bomb capabilities and ICBMs that can carry thermonuclear devices, it poses a huge threat to the American mainland and certainly to our allies in East Asia. What does North Korea want?

I think to start with, it wants respect. It wants the right to do what it feels like (what Kim feels like) and to remain a buffer for China between a western democracy, South Korea, and Chinese autocracy. China does not want a united Korea akin to a united Germany on its southern flank.

America has begged China and Russia to intervene on behalf of western interests and tame the North Korean drive for nuclear weapons. That has not happened and now the North has the bomb and perhaps the missiles to deliver it.

What are the American choices?

First, Mr. Trump can say that he has had enough and launch a pre-emptive major strike on North Korea. That would inevitably engender at least a conventional if not nuclear strike on South Korea and probably millions of deaths. This is not an option.

Second, the US could try to shoot down the next North Korean missile claiming it couldn’t risk that it was only a test. That would be considered an act of war and we would be in a shooting war with North Korea and China as well. See last paragraph.

Third, we can continue to make bellicose statements toward North Korea, but let’s face it—the North Koreans don’t care.

Fourth, we can continue to muster the force of public opinion against the nuclear proliferation in North Korea at the UN and at all international venues. Along with that, we could shut up.

I like the latter, especially the last part. Stop rattling sabers and making threats. If we are truly the most powerful nation on earth, do we have to remind people? I think not.

Academic medical centers have a similar problem to the US vis a vis North Korea. They have a series of poor choices.

Academic medical centers have been living on the illusion that they provide superior care, but can’t prove it. They certainly supply costly care and the insurers have figured that out and would just as soon guide patients to lower cost providers whose outcomes may be every bit as good as those achieved in academia despite academia insisting that this isn’t so.

In the end, academia will have to learn to fulfill its traditional missions of specialized patient care, research and education without expecting third party payers to pay the freight. My guess is that this will entail some austerity in academia and limits on hiring, spending, and research. Insurers simply do not want to pay for research and other than the NIH, not many other organs of science want to either.

Like America in its relationship with North Korea, academic centers will have to make less noise and become more agile. Academic centers must learn to partner with the private sector without thinking they alone can dominate the relationship. At the same time, academia must be selective with regard to with whom it works. Conflicts of interest must be avoided. Universities should not own companies the value of whose stock is influenced by research at the university.

It is a difficult time in the world. The post-Cold War realignment of nations is still in flux. Europe is unsettled. Asia is dominated by China and India with millions of people looking for freedom from a repressive regime in one case and a repressive social system in another.

It is a difficult time in academia. Never has science given us more promise of impacting human disease, yet never has money become harder to apply to that quest.

The US must resist any attempt to draw it into a shooting war in Korea. We cannot win such a confrontation and neither can the Koreans on either side of the 38th parallel.

Academic medicine needs a new model. MD Anderson has a new president. Does he have the answer? Time will tell.

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