Atonement: When Does a Good Outcome Justify Bad Behavior?

Atonement: When Does a
Good Outcome Justify Bad Behavior?

By

Leonard Zwelling

         What would happen if Dr. DePinho really did cure 5 cancers
in 5 years as he said he would do (but now denies ever saying it). We all heard
it, and certainly greater Houston did, so I really do think he said it or at
least implied it. He surely used the word cure and cancer in the same sentence,
which is foolish enough. But—let’s say he did it—tomorrow. Let’s say he cured
just one previously incurable cancer. Would that be enough to justify all the
bad karma he unleashed upon his arrival and ever since?

         David Brooks raises such an issue in the NY Times on Friday, July 31 in an op-ed
piece called “Two Cheers for Capitalism,“ but he’s not writing about cancer,
biology or even science.

         Brooks is reporting on a keynote address given at a
gathering of non-governmental organization (NGO) leaders at the Aspen Action
Forum by his colleague Anand Giridharadas. In the address, Anand argued that a
new reality has dawned in the NGO world so dependent on charity. The rich
donors are to be lauded for their generosity while escaping criticism for the
actions the same donors took to make them rich that often run counter to what
would generally be considered “good.” Capitalism gifts the fortunate or lucky
with wealth and is not particularly judgmental with regard to how the flush
acquired the money. The telling quote from the address is:

         “Sometimes I wonder whether these various forms of giving
back have become to our era what the papal indulgence was to the Middle Ages: a
relatively inexpensive way to get oneself seemingly on the right side of
justice, without having to alter the fundamentals of one’s life.”

         Hmmmm…..

         These “donors” stack the markets and manipulate the politics
and politicians in ways that make them even more money. They increase the
burden of risk and toil to their workers. They are more remote from their
communities than ever not caring what benefits they remove from their employees.

Brooks
inferred the speaker was calling for government intervention in such matters
but the speaker did not expressly call for this. Brooks, a conservative,
objects to such government intervention as he says, “no group of experts is
smart enough to allocate the resources to society well.” He believes the
markets themselves should be the arbiters of where the money flows, but, of
course, that does not guarantee good at all.

         Nonetheless, Brooks is right. While raw capitalism may
indeed allow the truly evil to try to absolve their sins through charity, the
alternative, government control of wealth, is even worse. It is usually called
communism.

         Which of these situations is at play at Anderson as it tries
to Make Cancer History?

         I would argue that in the past, Anderson was a hub of raw
capitalism. When I arrived in 1984, I never saw a place like Anderson, where if
you could think of it, and if you could pay for it, you could do it. Today,
money is harder and harder to come by and the vast majority of it is from
patient revenue and thus under the control of very few people. In essence the
“government” of Anderson, Dr. DePinho and his band of merry men (all men),
control what gets done because they control the means of how to pay for getting
it done. There is very little true capitalism as the Moon Shot Programs
consolidate more and more of the research effort in the hands of fewer and
fewer by the allocation of those patient care dollars to the FORDs, the Friends
of Ron DePinho.

         You have to believe that this centralization of resources
and power at MD Anderson is likely to hasten the DePinho vision of a cancer-free
world to justify this pseudo-communistic nonsense. Many have. It stuns me to
see some of my former colleagues who are apologists for the unbridled throw weight
of the DePinho Boston-centric juggernaut as it uses conflict of interest,
nepotism, self-dealing and other forms of bad and very close to illegal
behavior to keep control of the means to actually alter the natural history of
cancer in real patients.

         I wish Dr. DePinho the best of luck in curing cancer in 5
years. He’s almost down to his last year. His foray into commercialization at
Aveo was a complete bust despite his attempts to prop up the stock on CNBC.

         If we are in an era where the money needed to do cutting
edge research is no longer reliably coming from the NIH or other peer-review
funders, but rather has to come from the pharmaceutical industry or patient
revenues, the equivalent of an NIH study section must be used to distribute
those resources to those with the best ideas in the eyes of their colleagues
not at the behest of an oligarchy at the top of Pickens. The very idea of the
Moon Shot has never been debated as a good or bad idea. I happen to think it is
awful and that the historical analogy evoked by the use of the term Moon Shot
is completely wrongheaded as cancer and space travel and the success of
conquering each have no bearing on one another. The Moon Shot was an
engineering challenge. Cancer is a scientific one. If you don’t get that, you
don’t understand the problem so it should be no surprise you have made little
progress toward its solution.

Perhaps
if Ron and the FORDS conquer cancer tomorrow, all will be forgiven for what
they have put the institution through in the past 4 years. Since the first is
unlikely, the second would be unseemly.