Disorientation. Reorientation.


Leonard Zwelling

         The coronavirus changes everything.

         These three articles from The New York Times on April 24 make several important points. Those points not only apply to nations, but also to academic medical institutions.

         The first article describes what might be the most successful effort in the world to eradicate the coronavirus and covid-19. It is taking place in Australia and New Zealand, two island (big advantage) countries with very different governmental philosophies. Australia is led by a conservative prime minister.  New Zealand is led by a darling of the left. Yet both countries have used early recognition of the threat, decisive moves to limit commerce and schooling and, most importantly, great trust in the federal government based on adept communications with the people to hold their case and death numbers very low and may well have tamped the virus down completely or at least to a manageable level. Of course, that’s for now. It’s fall in the Southern Hemisphere. We shall see.

         Now admittedly, these are smaller countries than the United States, but they seem to have used skillful governance and scientifically-based decision making to spare much of their populations the scourge that is plaguing New York and Italy.

         The second article discusses the astonishment of the Europeans at the lack of effective leadership by the United States in the current challenge. As we discussed recently, it has yet to be shown that the United States will be the predominant international leader in the 21st century that it was in the 20th.  Given the disorienting stance taken by the Trump Administration on what to do about the coronavirus, and especially the waxing and waning about who is in charge, Mr. Trump or the state governors, it is no wonder that states like Taiwan, Germany and South Korea have plowed their own paths with widespread testing, contact tracing, mitigation and quarantine to have better results with regard to the number infected and dead. Europe is not looking to the U.S. for leadership any longer. After Trump’s withdrawal from the Paris Accords and the Iran Nuclear Deal, who can blame Europe for expecting no leadership from the United States.

And that leads us to the last piece about the breakdown of the federalist system in America.  Not only are the countries of Europe no longer looking to the United States’ central government for guidance, those united states aren’t either. Governors like Cuomo, Newsom, DeWine and Inslee are going their own way as are most of the governors around America. What is clear is that America cannot get on the same page with regard to how to handle the virus—Georgia style or New York style. Mr. Trump won’t lead so each governor has to assume that role and some are even forming regional confederacies (oops, did I use that word?) since Washington cannot supply the leadership needed to protect the people of the states.

Many sites of academic medicine also have had very centralized leadership for decades. This was not always the case, even at MD Anderson. During the time of Dr. LeMaistre’s presidency, he gave his departmental leaders long leashes on which to operate only tugging back when absolutely necessary. There was a clear balance between who would set the direction taken by any given department at Anderson and how much influence the president might exert on that department’s leaders. Dr. LeMaistre was neither a bench scientist nor an oncologist, but he respected those who were and let them guide the academic activities of their departments.

Over time, this changed. I was part of a move to centralize some administrative functions in the mid-1990s that progressed all the way to 2011 where it reached its zenith with a president who called all the shots, everywhere.

The current leadership at Anderson has exerted massive control over the institutional response to coronavirus including the suspension of a lot of necessary, but not emergent surgery, stopping of a great deal of research, and emptying the halls of most personnel. It will be up to the Board of Regents to determine the wisdom of these decisions, but they were clearly those of the central authority, not of the academic departments or faculty. Oh, I am sure there were all kinds of committees formed to “advise” leadership, but in the end these were central decisions made by one person.

         This coronavirus challenge may be the perfect opportunity to address the structure and function of most academic institutions, but particularly those with very centralized power. Is this the wisest way to run the ship? If so, who will oversee this immense centralized control? Someone local needs to.

         The real lesson of the coronavirus crisis might be that the world has changed. American exceptionalism may no longer apply and the world may start looking elsewhere for leadership. States may realize that Washington does not have their backs to the extent they thought and they may have to rethink how they deal with the federal government. The same may be true at academic medical centers which have morphed over the past 40 years into money-making profit centers with exempt tax status and billion dollar margins.

         This may be the moment to reorient how we choose to run society, states, the federal government and the world all of which were disoriented by this virus. But like everything else, including how a country responded to the coronavirus, it’s a choice.

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