The Missing Element: Trust

The Missing Element: Trust


Leonard Zwelling

In The New York Times on February 7, Ezra Klein writes about the key missing ingredient in America’s response to the coronavirus pandemic—trust. We don’t trust the government and we don’t trust each other. Countries with greater trust ratings did better in the pandemic, particularly in Asia (Japan, South Korea, and Singapore).

Trust was undermined almost immediately in the US. First, we didn’t need masks, then we did. Then schools were closed down for unclear reasons and people had to work from home. We were disinfecting our groceries when it turned out this virus was transmitted through the respiratory route, not on surfaces. Then there’s the whole question of vaccine mandates which probably would have been better handled by not needing them because the case for vaccines was effectively made by the CDC and NIH which obviously did not happen. Oh, they tried, but it didn’t work. Many did not trust the government.

The United States still lags the rest of the world in the percentage of people vaccinated despite a lot of government people (including President Biden) making a lot of pleas for people to get the vaccines. The pleas fell on a lot of deaf ears or at least untrusting ones.

Then you combine that with the cacophony of voices on the internet claiming the effectiveness of treatments that really don’t work and the acquiescence of the FDA in some of the schemes and you get—well, where we are today—in trouble.

This blog is not here to debate Mr. Klein, because I believe he is exactly right. This not only applies to our response to the virus which was dismal (over 900,000 dead and millions infected), but to our politics as well. If one of our major political parties is taking the position that the January 6, 2021 assault on Capitol Hill was ordinary political dissent, then we are off the deep end for sure.

This need for trust is true in all organizations and I believe is starting to erode the tenor of debate at MD Anderson as well because the faculty does not trust the administration—a relationship that has always been tenuous at best.

Perhaps the greatest move by the administration to undermine faculty confidence was the unilateral movement of the Physicians’ Referral Service—the practice plan—to Human Resources without consulting or even informing the faculty beforehand. Perhaps the leadership of MD Anderson is unclear on where the money to run the place comes from. It’s clinical revenue. Clinical revenue is the result of the activities of the clinical faculty. The clinical faculty and the clinical staff as a whole need a greater voice in matters that affect them. The same is true on the research side where this blog has already outlined decisions about institution-provided masks and environmental shortfalls that have further eroded confidence in the administration.

What has surprised me is the speed with which this has all transpired and the occasional viciousness of that administration in its use of outside law firms to persecute the faculty and staff. And I thought the last guy was bad!

There is a virtual war between the Faculty Senate and the President with many senators caught in between wanting to improve relationships with the leadership, but unable to effect a strategy to do so.

I have to admit I learned this lesson the hard way when I was a vice president. I had worked very hard to establish trust with the faculty, particularly the clinical research faculty, but then undid it when we had a severe mishap in human subject protections oversight that could have been handled more collegially than I did at the time. Big mistake. I never really recovered from that.

I am afraid that the CDC and Dr. Fauci similarly suffer from over-exposure and under-trust. It’s probably time to bring in a new team of overseers for the country’s pandemic response team. People like Peter Hotez, Michael Osterholm, and Paul Offit have proven to be better communicators with better information than those in the current administration. The same may be true at Anderson. It may be time for the MD Anderson president to replace his leadership team with people of high credibility and judgment and preferably with some real-world experience in managing as well as in clinical care and in bench research. So far, the advice he is getting is not very good or worse, he’s listening to no one at all. Either way it is time for rethinking the direction of the UT cancer center unless the fate of the last guy befalls the new guy.

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