Giving Up Is Unforgivable
By
Leonard Zwelling
Intelligent people around the world are asking themselves a question they could not have imagined asking just a year or so ago. Can the political system of the United States and its critical role in the post-WWII alliance that kept Europe at peace and defeated Soviet Communism and its hold on much of the continent, persevere under the continuing onslaught of Donald Trump?
In response to what she perceived as a lack of interest on the part of young people like her son in understanding what they could do to preserve the American system of government, Joyce Vance, a former U.S. Attorney for the Northern District of Alabama and a legal analyst for MS Now, has written a new book. Its title is that of this blog.
Her argument is a simple one. The Founding Fathers drafted a blueprint for a government system that has three co-equal branches. That blueprint is called the Constitution and much of the philosophy within that document can be understood by reading The Federalist Papers.
These three branches must all function well if the people’s rights are to be preserved and the rule of law maintained. They function well when each branch serves as a check and balance on the other two. Vance elucidates how this system is being undermined by Donald Trump’s desire to control all three branches of the federal government while attacking and extorting the leadership of state and local governments. This latter is counter to the principle of federalism where each level of government has its own particular jurisdiction. That, too, is in the Constitution.
She then goes on to encourage all Americans to get involved at some level to push back on the Trump administration’s attempt to install a despot in the White House and bring down the system that has served the American people so well for 250 years.
The book is short, concise, and very easy to understand with great examples from history of how the system withstood previous attempts to undo it from the Civil War to January 6, 2021. She cites critical Supreme Court decisions that established how the judicial system serves as a regulator of congressional and presidential power. Perhaps her main point is that with a concerted effort by all Americans, the system can absolutely be saved, but it will take the efforts of all of us to do so.
I wish I could be so optimistic about the system of medical care in the United States. I truly believe that the medical system that used to be governed by a genuine concern for patient welfare, the primacy of the physician as the arbiter of health care decisions, and academic medicine as the source of new knowledge to be put into clinical practice is gone.
I don’t think there is any aspect of the current medical system in our country that puts the patient first. Doctors do not have enough time to really listen to patients when they have 15 minutes to assess a new complaint from a current patient and still keep the electronic medical record happy. Happy here is defined as maximizing the capture of all billable charges. Hospitals are interested in full beds and rapid turnover regardless of whether or not that is best for the patient. The drug companies have to keep their shareholders happy with ever higher stock prices meaning TV marketing new pricey drugs and maintaining drug prices high on already approved pharmaceuticals. The insurers make the most money when they say “no!” And they say no as often as they can. (See an excellent summary of “retail” out-patient medicine in NEJM 394: 1-3, 2026).
I honestly do not think this gets better any time soon. There are too many people making too much money for there to be any will to change. The horse is out of the barn when it comes to having an equitable system of health care where something other than money matters. As the subtitle of my book Conflict of Interest says, “money drives medicine and people die.”
Our Constitutional republic can be saved. Our health care system probably cannot.
What about MD Anderson? Can it be returned to its past glory of cutting-edge clinical research driving the most effective cancer care with a faculty that is fully engaged in that mission?
That is up for grabs. The current leadership of MD Anderson is ill-equipped to drive the change necessary to regain the excellence that was Anderson before 2001 and the onset of ever greedier presidents and ever more oppressive policies bearing down on the faculty.
On his best day, I seriously doubt that John Mendelsohn could have ever dreamt of a salary in excess of $5 million. Yet, that is what the current president of MD Anderson makes according to the state data I was sent recently by a blog reader.
https://www.lbb.texas.gov/Documents/Publications/Other/Admin_Acc/2026/506_Admin_Acct_2026.pdf
Considering the Pisters performance as president, this is an outrage.
But I put MD Anderson in the same category as Joyce Vance’s constitutional republic. It is salvageable.
But that is up to the current faculty. If the current faculty are happy with their work environment, their productivity, and those to whom they report, then carry on. MD Anderson will go the way of American medicine, a shadow of its former self beyond the reach of meaningful input from doctors. It is a true regression to the mean of academic mediocrity. But, if the faculty have had enough of “professionalism,” arbitrary firing, and leadership so poor as to make us retirees cringe, then do something.
Demand that something like the Faculty Senate be restored. This is not illegal. Demand some sort of participation in decision making and some sort of accountability from leaders making over $1 million each and flailing.
It’s up to you MD Anderson faculty. Perhaps you are too young to remember what MD Anderson once was. Like the young people today who have come of age knowing only Donald Trump and Joe Biden as presidents, the current Anderson faculty may have given up because they don’t believe they can make a difference.
As Luke Skywalker said, “I don’t believe it.”
And Yoda answered, “that is why you fail.”
MD Anderson faculty—believe in yourself. You can do better. Start by asking what on Earth Peter Pisters has done to warrant a $5 million salary.
Ask the Board of Regents that one, too.
