Looking Back

Looking Back


Leonard Zwelling


Linda Greenhouse has been writing about the Supreme Court for decades. Her latest op-ed in The New York Times on July 10 discusses what conservatives might have imagined possible on the day John Roberts became Chief Justice, September 29, 2005, almost 18 years ago. The end of Roe? The end of affirmative action? The triumph of religious beliefs over civil rights? Gay marriage? Justices on the take? A chastised executive branch being brought to heel with regard to its regulatory authority? Probably this was beyond the wildest imagination of even the most hardline conservative. Yet, it all has come to pass as America’s center moves further right and the Court moves with it.

I want to take a similar view of American medicine.

Twenty years ago, could we have imagined treating cancer with antibodies targeted at cancer causing molecules let alone aberrant immune cells? Could we really alter the natural history of human disease with gene therapy? Could we have imagined a system by which the physicians’ notes would be fully computerized and used mainly for billing purposes? Were hospitalists even an idea in anyone’s mind? Would medicine shift from being dominated by scores of small businesses to having those small businesses inhaled by huge, corporate entities? Who would have called a doctor a provider? And who would have imagined that we would have a major overhaul of American medical insurance and still lead the world in underinsured and uninsured citizens? Not me.

Closer to home, in 2004, I determined that my run at leading the infrastructure for clinical research at MD Anderson had reached its natural ending point. Rather than be shown the door, I walked through it. In 2003, I could never have imagined doing it, but, obviously, things change. Or maybe some people just eventually grow up. I didn’t really grow up in 2004. It took several more years and year in DC to wake me up to reality. But even old dogs can change.

But do they necessarily change for the better? Not always. Oh, my quitting oversight of human subjects protection had been long overdue by 2004, and it was best for the institution and the faculty, but the changes in the American landscape thanks to the Supreme Court and the changes in American medicine thanks to its corporatization are not my idea of good changes.

Then I look back at my old institution and view the changes MD Anderson has been through since 2003. John Mendelsohn was president then, but he had been severely weakened by his corporate toe-dipping at ImClone and Enron and the lawyers had taken over the operation of MD Anderson. If every problem is viewed as a legal one, the lawyers retain all the power and that’s pretty much what happened. And it’s never gone back.

Ron DePinho came and went without leaving so much as a meaningful ripple except for gifting the institution with a motley collection of leaders who enjoy their positions to this day while never having advanced the mission of the cancer center save for Jim Allison. The new president has no vision nor can he articulate one beyond professionalism, diversity, and One MD Anderson.

Looking back, you have to be concerned that the country, the medical profession, and MD Anderson have all not had a good twenty-year run. All of these entities are suffering from a lack of real leadership and clear-eyed direction.

The Supreme Court is likely to continue its rightward drift. The question will remain. When will that drift go beyond that of the American people? Clearly, not yet.

Medicine is struggling to find its voice and regain the confidence of the American people. The people fear that they themselves have become cogs in the medical-industrial complex—something they want no part of but are forced to utilize. As for MD Anderson, we know where the future lies. That is in the hands of leadership of the UT System in Austin and the Board of Regents. If they remain happy with the direction the institution is taking, then nothing will change unless—the faculty speak with one voice and say-ENOUGH!

The American people get to speak every four years. How long will the faculty wait to do the same?

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, 


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

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