It Helps To Have A Plan; It Helps To Tell People What It Is
By
Leonard Zwelling
Make no mistake. The United States of America is at war yet again. Also, make no mistake that, yet again, it is a war of choice. Like Vietnam, Afghanistan, and Iraq before it, our current attack on Iran is wholly voluntary and the case has not been made that it was necessary in any way.
In addition, this voluntary war has neither been justified nor explained. No one knows what the facts were that mandated our attack, what success looks like, or what we expect to get out of this expenditure of blood and treasure. Trump’s plan seems to be “trust me, I know what I’m doing.” Really? Have you done it before?
Finally, while the extent of the bombing of Iran has been massive and, for certain, assisted by artificial intelligence, real (not artificial) intelligence might have identified the girls’ school destroyed early on as being a school and not a military target. For sure, if you feed AI bad data, it will make bad decisions. That seems to have been the case here where the site of the school was a military target ten years ago, but not today.
Thus, it is self-evident that Mr. Trump has no plan. He has not articulated it, if he really has one. He has not made his case to Congress which is supposed to be the first step when America goes to war. He has not even had the courtesy to address the American people before he sends its sons and daughters and tax dollars into harm’s way.
I do not know how this will end, but as in Gaza, my guess is that there will be piles of rubble, massive death, and no change on the ground. Hamas is still running Gaza and the ayatollahs (really the Republican Guard) will still be running Iran when Trump declares victory and leaves. Other than disrupting the world’s economy and killing a lot of people, what has the U.S. gotten out of this military adventure? Nothing.
In fact, less than nothing. The exit to the Strait of Hormuz is still blocked. Perhaps only by blocking its entrance and starving out Iran will the United States prevail.
Billions of dollars that could have been used to improve life for Americans, exactly as Mr. Trump pledged to do during his campaign, have instead been blown up in another foreign war in the Middle East.
Finally, as Israel has taught us, these wars to degrade the ability of the enemy to be an existential threat, are never over. As Tom Friedman has noted time and again, it is never “once and for all in the Middle East.” We bombed Iran in June of 2025. We bombed Iran in February of 2026. When will we choose to bomb Iran again because this will not be over this time? Israel understands the need for repetitive “mowing the lawn.” America doesn’t get it. Trump wants this to end like an episode of his favorite game show. No. This is reality and far more messy. As a good friend often says about careers at MD Anderson, “this doesn’t end well.”
And speaking about my favorite cancer center, I am going to compare this situation in Iran to what is happening at MD Anderson where, as in the White House, a strong man rules with no plan and, in the case of Anderson, no guardrails and no Congress to which the leader might answer. No, as far as I can tell, no one is dying in combat although careers are being destroyed by the back-biting politics of academic medicine combined with egos the size of unneeded buildings. (Do we really need a children’s cancer hospital in Houston to match the one in Memphis? Make the case besides a gift of $150 million. That’s not a reason. That’s a windfall looking for a reason. The only benefit to MD Anderson of the merger with Texas Children’s in pediatric oncology is Pisters acquiring additional in-patient beds and off-loading the cost of a department that was always a loss leader.)
There were no good plans for this merger and still aren’t. How will the disparate salaries of pediatric faculty at Anderson and those at Texas Children’s be reconciled? What about the large difference in benefits? Who is really in charge of a combined service that is to start on April 14? Will the adult oncologists at Anderson still be willing to share access to experimental therapies with pediatricians they do not know? Will the pharmaceutical companies be willing to work with doctors they don’t know at Texas Children’s? Has anyone considered all of this?
And, more generally, what is the plan for the future of cancer care at Anderson? Will the center devise its own clinical trials or, in effect, be the hired testing ground for pharma? What are the plans to advance science at Anderson and how will AI be used to do just that? Other clinical sites have already gotten rid of the ubiquitous keyboard that was between doctor and patient supplanted by iPhones recording patient visits and AI generating the doctor’s note. Is that happening at Anderson? And what will be used to replace the federal grant dollars no longer flowing to Anderson? I suspect many previously well-funded faculty members may not be able to raise 40% of their salary. Then what?
How has Anderson utilized the resources of UT Austin, A and M, or Rice to develop new diagnosis and treatment regimens to offer patients something different? Is cancer care at Anderson unique only because of the continued excellence of the clinical faculty who may be laboring without the most modern of tools? Tell us, Peter instead of tweeting about your latest award.
To both President Trump and Peter Pisters I ask, what’s the plan? Tell us so we can be enthusiastic supporters. And if you don’t have plans, please step aside so that someone who has the vision and will to grasp the current situation can make a plan and tell us what it is. Please.
