Regime Change When The Governed Have No Say

Regime Change When The Governed Have No Say


Leonard Zwelling


President Biden actually said what no one else would say. Vladimir Putin cannot stay as the head of Russia if he insists on butchering a neighbor in Ukraine. Not only that, Biden wouldn’t walk it back at a press conference on March 28 when the rest of NATO is a little skittish at Biden’s call for regime change. Good for Biden. It’s about time someone manned up.

The problem is that unlike in the United States where we have elections and regime change all the time, the same is not the case in Russia, where the people have meaningless elections and the entire government is under the control of one man. Regime change in such countries is often violent and certainly tumultuous. This would be the same in Communist China should regime change occur there or as we saw in 1979 in Iran. But, as with Russia, such regime change is unlikely in China or Iran now.

Interestingly, a similar state of affairs obtains in many companies in the United States where employees have no say in who the boss is. Only the board and the shareholders of a publicly-owned company and not even that in a privately-owned one get a say in who is in charge. It’s efficient, I guess, but it does make you understand where the idea of a union arose.

Academic medical centers are even more cloistered. Take MD Anderson, for example (had you any doubts where I was going?).

MD Anderson doesn’t even have its own board. It is governed by the University of Texas Board of Regents, all political appointees, with no requisite knowledge of academic medicine or cancer for that matter for membership and no dependable way to get information about the well-being of the cancer center other than financial reports. Thus, it should come as no surprise that in its 80 or so year history recently celebrated with a gala downtown, MD Anderson has only had five regimes—Clark, LeMaistre, Mendelsohn, DePinho and Pisters.

Now some people look upon this typical longevity of leadership (well, at least the first three) as a good thing. I do not. I think the American presidential ideal of no more than eight years in office is a better idea. I could go for ten years, but no more. Bureaucracies become stale and sticky and bloated. Entitlement becomes the norm. The lack of real accountability is problematic and the faculty is summarily left out of the decision making despite the mandate for shared governance. The mandate is often ignored by entrenched interests especially at the most senior of levels. I believe that there ought to be term limits for all executives. Even I did not have mural dyslexia and resigned from the oversight of clinical research administration after nine years, although I stayed too long in a smaller vice presidency after that.

Mr. Putin has been in power for over twenty years and shows no sign of being willing to relinquish command. He’s more isolated than ever, probably listening to no one, and thus made a terrible calculation to invade Ukraine under the guise of re-establishing the “Russian Empire.” How’s that working out, Vlad?

I fear the same may be true at MD Anderson. The new James P. Allison Institute has the usual suspects as leaders as reported in The Houston Chronicle on March 29. Perhaps a new institute deserves new, visionary leadership. Divisions at MD Anderson go leaderless for years. The vice presidencies are filled with people of little note and almost all appointments are from within. If Putin is isolated so is the leadership of MD Anderson. And the vice presidents live in an echo chamber of good will, consummate politeness, and few accomplishments.

There can be little doubt that Mr. Putin listened to no one when he decided to invade Ukraine. Surely his generals would have known this was a fruitless endeavor. Likewise, I still cannot see the wisdom in the current MD Anderson course, how it will lead to the eradication of cancer, and or even how it will advance academic oncology. The major accomplishment of the current administration was the skillful navigation through the pandemic. That’s management not leadership.

When those being governed have no voice in the governance, bad decisions ensue—in Russia and in Houston. It may take regime change in both places to get the governed back involved and the ship on its proper course.



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