Leonard Zwelling



The definition is simple. It’s a government led by the least desirable citizens. There are lots of examples including right here in the United States where no one could possibly believe that we have had truly qualified leadership for decades—in the White House or on the other end of Pennsylvania Avenue either. I worked there for a year. Trust me. Your senators and congresspeople are not the sharpest knives in the drawer on either side of the aisle.

It seems to be the case in Israel now and surely in Russia. How can this be happening especially in free societies with open elections as is the case in the US and Israel?

This occurs when the citizenry is lulled into believing that the unworthy can deliver on the greatest concerns of the population and it is the unworthy who are drawn to leadership when the truly talented sit on the sidelines.

In Israel it’s always all about security, but it’s also about the expansion of Arabs living in Israel proper (about 20% of the population), the desire on the part of West Bank settlers to expand into additional territory further diluting any chance of a two-state solution to the Palestinian question, and the lack of a constitution leaving so many decisions up for debate between the legislature and the judiciary. The real solution to the Israel dilemma is a constitutional convention not the Knesset taking over the Supreme Court.

It happened here too, most recently (but not only) with the election of Donald Trump. I am thinking that Richard Nixon, Jimmy Carter, and George W. Bush proved to be undesirable leaders over Watergate, the Iran Hostage Crisis, and the Iraqi Invasion after 9/11. These were not our finest hours and these were not our finest leaders. They were the heads of state of a kakistocracy.

Surely a set of ground rules of any governance structure provides a touchstone when leaders are not up to the task of governing. This is what so troubles Israel now. Without a set of by-laws (a constitution), the government can drift astray.

But kakistocracies are not limited to nations. Any organization can be led by the least qualified. This too is having a field day in today’s marketplace with the fall of cryptocurrency, the fall of Bernie Madoff, and surely with the collapse of Theranos, Elizabeth Holmes, and Sunny Bulwani. These last few leaders wove a web of lies that convinced otherwise smart people to follow them, part with their money, and watch the kakistrocratic leaders go to jail.

MD Anderson has been plagued of late with such leaders and the current occupant of the corner office has taken this to new heights (or depths) by having few if any qualifications for his job and then cementing the last guy’s hold on the organization by hiring the team that torpedoed the last president of the cancer center and promoting the least qualified to the biggest jobs.

Fortunately, the president of MD Anderson has two additional bosses who could right the ship. The first and most obvious is the UT Board of Regents who have been fooled once with Ron DePInho and now have been fooled again. You have to wonder what is going through the minds of the Regents when they pick their leaders. Apparently, not the qualifications for the job.

The second boss of MD Anderson is its most valuable asset—the faculty. It is well within the power of that faculty to remove the kakistrocracy in place now. All it would take is a no confidence vote by the Faculty Senate.

Perhaps things haven’t gotten bad enough yet. But they are likely to.

As the institutional memory of past excellence is lost to the mists of time with the retirement of senior faculty, the current kakistocracy can continue its race to mediocrity–a regression to the mean.

The United States, Israel, and MD Anderson all could use a change at the top. Can the best and the brightest ever rise again? One can hope.


Dr. Zwelling’s new novel, Conflict of Interest: Money Drives Medicine and People Die is available at:


on amazon if you search using the title and subtitle, and

directly from the publisher Dorrance at: https://bookstore.dorrancepublishing.com/conflict-of-interest-money-drives-medicine-and-people-die-pb/

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