Know Your Red Lines

Know Your Red Lines


Leonard Zwelling

In an interview on NPR’s Fresh Air on October 26, author David Rothkopf was discussing his new book, American Resistance, about how the so-called “deep state” (the permanent government agencies in the executive branch) saved the nation from Donald Trump’s crazy ideas like building a moat along the southern border filled with alligators. I’ve ordered the book as nothing interests me more than how good people behave under adverse circumstances yet manage to triumph.

During the interview Rothkopf was asked about what the best piece of advice the in-coming Trump appointees got and from whom. He said it came from former national security advisor in the Bush 43 administration, Stephen Hadley. The advice was to “know your red lines.”

What this means is to know ahead of time what thing or things that you might be asked to do that would cause you to tender your resignation. What line won’t you cross?

Rothkopf’s example of one of Trump’s asks like the “Muslim ban” should have been easy as it was both unethical and illegal. However, in administrative work or even in the course of being a faculty member, you might be asked to do something that is either illegal, unethical, or repulsive. It is key to recognize that red line and be prepared not to cross it. I know because I crossed it once.

When I was Vice President for Research Administration, there were more than one scandal that hit the upper reaches of MD Anderson. Some of them I had to deal with, but the one that should have been my red line was when I was asked to justify the fact that Dr. Mendelsohn’s drug, Erbitux from ImClone, was being tested in clinical trials at MD Anderson by people who reported to him in protocols whose informed consent documents did not identify the president’s interest in the outcome of the trial. He was on the board of ImClone and had loads of ImClone stock. Why wouldn’t the faculty members want the trial to be positive so as to make the boss happy? Shouldn’t the patients know that the president might directly profit from their participation in a clinical trial?

And, yes, this happened about the same time as Enron collapsed and Mendelsohn was on that board, too.

Once I was pressured by the press to rationalize that which could not be rationalized on ethical grounds (Mendelsohn’s conflicts of interest), I should have quit. I eventually did leave the oversight of clinical research to Dr. Markman, but it took me too long. I was too enamored of my position. My red lines had blurred. Shame on me.

I hope the current group of presidential appointees at MD Anderson know their red lines. This nonsense about professionalism and the associated faculty head hunting that accompanies it would stop tomorrow if the leaders of the institution reporting to the president refused to buy into this lunacy. Good people are being let go. Talented people. People not easy to replace. How wise is that?

I suggest all the vice presidents, and senior vice presidents, and executive vice presidents, and division heads, and department chairs spend five minutes (alone) identifying their red lines and writing them down. Then when they get asked to do something reprehensible, like fire a faculty member because he or she might have had a cross word with someone or less, they will quit instead. A few resignations might go a long way.

Rothkopf’s book subtitle is “The Inside Story of How the Deep State Saved the Nation.” I was once the deep state. At times I preserved the integrity of the institution when the government came calling about mishaps in the performance of clinical research. At other times I failed by going with the flow. Going with the flow was not in my job description and if it had to be, I should have left the job.

Know your red lines.

2 thoughts on “Know Your Red Lines”

  1. This was an excellent post because it also happened to me. I loved my role at MD Anderson. I was not clinical, just mid-level management, but I had an excellent working relationship working with the research teams and investigators because I spent many years as a research coordinator, and understood what their clinical days really looked on a daily basis and how heavy their work load was. This was during Ron’s days, and when you were still there successfully posting on the faculty blog (I was fairly new at that point).
    I watched all the bad decisions Ron made and the embarrassment he put our institution through. I watched as he ensured many of our most talented faculty & those that had the courage to speak up were eliminated.
    It became too much for my most high-level boss. And when she resigned, our department, who really was able to get things done and affect change in an impartial manner, while maintaining good relationships with faculty & staff, started to decline. Why? Her incumbent did not have her ability the maintain good relationships while still holding people accountable. That should have been my red line.
    I tried to hold on, hoping she would figure it out, but the department ultimately became a “yes” department.
    The day I left MD Anderson, I cried. I loved what I did. I loved my working relationship with the study teams, but my department had been so infected with the new culture, I could no longer in good faith stay.

    I appreciate you still keeping MD Anderson leadership accountable. I left around the time he was being ousted, but I still read your blog quite regularly. I had great hopes for Pisters, but one of my colleagues made an interesting comment to me the other day. He said Pisters has effectively “neutered” my old department, so they don’t even speak up when invited to meetings or to advise on important matters. That’s really unfortunate. He needs to go.
    Please keep holding him accountable. I appreciate all the MDA folks that feel safe coming to you to share what’s really going on behind the curtain.
    MD Anderson is only going to be great again if they have a great leader. Maybe third time will be a charm?

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