For The Lack Of Expert Advice
By
Leonard Zwelling
One of the things that characterize many populist movements including the MAGA movement is a mistrust of elites, entrenched bureaucracies, and experts. Mr. Trump was very fond of saying he would drain the swamp of the typical politicians in Congress and, in his second term, clear out most of the establishment in the executive branch of the federal government (the Deep State) and replace these bureaucrats with MAGA loyalists.
Let’s see what that has gotten us.
Elon Musk and his DOGE group of teenage drones decimated many of the branches of the executive branch including the NIH and the CDC. The country is clearly the worse for their actions. I dare you to try to get help from the IRS.
Congress is more stagnant and inept than ever. Rather than replace entrenched leaders and very old members in “the swamp,” both parties have dug in their heels, retained their traditional positions and elderly members, and there has been no progress at all. Congress can’t even insist on debating whether the United States should be at war in Iran.
As for that war, how advisable was it?
The Strait of Hormuz was open to all shipping before the war and is now closed on one side and blockaded on the other. The price of gas and fertilizer has climbed dramatically in a matter of weeks. There is no one on this Earth who has not felt the detrimental effects of the action of the American President.
Iran still has the capacity to develop nuclear weapons. Nothing much has altered that.
The theocracy of the ayatollahs and the Republican Guard remain in place despite the killing of many Iranian leaders by the Americans and the Israelis. It is a philosophy we are at war with, not the leaders who seem to be interchangeable.
Oil-producing states in the Gulf that had no vote in whether there would be a war or not have been adversely affected as their infrastructure has been damaged from Iranian drone and missile strikes.
In other words, without any doubt, things are worse for the entire world because Donald Trump chose to take the United States to war against Iran and I do not believe for a minute that Bibi Netanyahu talked him into it. Did Bibi want war? Of course, he did. Any military action that damages the existential threat that Iran poses to Israel, Israel will join. The difference is that Israel knows that it will have to repeatedly “mow the lawn” to prevent an Iranian break out to a nuclear weapon. The United States thought it could bomb Iran into submission “once and for all.” But, as Tom Friedman has noted there is no once and for all in the Middle East. That Iran is still standing and an even greater extorter of the west by controlling the Strait of Hormuz makes everything worse than ever.
In the attached broadcast from NPR’s Fresh Air on April 14, Aaron David Miller, a former State Department official who worked for both parties, outlines the reasons for our current situation. In essence, any expert on the Middle East could have told President Trump what would happen if he chose the course he did. Trump either didn’t ask the right people, hasn’t hired them, or doesn’t listen to any “experts” on the Middle East.
His MAGA supporters may not like experts, but those people are experts for a reason. They have studied an area, know it well, and can formulate the various scenarios that any action in the region might precipitate.
On the same day as the Fresh Air broadcast, as I understand it, the Pediatrics Department at MD Anderson that was once led by Dr. Kleinerman and embodied expertise in cutting-edge pediatric cancer care because it wisely parlayed the knowledge and drugs of the adult oncology service at Anderson as well as its own laboratory research into novel clinical trials, is gone. The $150 million gift from the Kinders to build a new free-standing cancer hospital for kids to rival St. Jude prompted the merging of the MD Anderson pediatric oncologists with those at Texas Children’s Hospital. Even as the Kinder building itself is at least five years away, the pediatric oncologists of MD Anderson have been physically moved to Children’s. How the variance in salaries and benefits between the two faculties will be resolved is unknown. Ditto who is really in charge. The man who was the leader of pediatric oncology at Children’s has been unseated and I believe it very unlikely that the current leader of Pediatrics at MD Anderson is up to leading the newly combined service, nor do I think Texas Children’s would allow this anyway.
What is far more likely is chaos in the clinics, hospital floors, and intensive care units at Children’s. The cultures of the two services have always been far apart. Merging them will take visionary and sensitive leadership which has been absent since the start of this merger.
As this blog has said, this merger is a boon for Peter Pisters of Anderson as he has just off-loaded a major cost center and gained 35 beds for adult cancer patients which should up MD Anderson’s income. Texas Children’s gets what it always wanted, full control of pediatric oncology in Houston.
Had anyone sought the expert advice of the few senior pediatric faculty that still remain at Anderson, the problems that are arising now would have been pointed out in advance and a better merger strategy could have been developed. This one is poor.
Is this merger good for the Anderson Pediatrics faculty? Probably not. My bet is that on September 1, 2026 they will get Children’s Hospital-Baylor contracts with reduced salaries, inferior benefits, and no SAP.
Texas Children’s will seize control of the entire Kinder project. MD Anderson will contribute nothing to the fundraising effort for the new hospital once it jettisons the Pediatric Service. Dr. Pisters has other building projects on his desk in both Houston and Austin. He will be raising money for these, not for a hospital over which he will have no control. There has already been a move to eliminate pediatric radiology at Anderson. Pediatrics at MD Anderson is, for all intents and purposes, gone. My guess is that the few remaining basic scientists in Pediatrics will be assigned to other basic science departments at Anderson and their lab space repurposed or eliminated for obsolescence. The MOD Building, the current site of Pediatrics Research, is long overdue for razing.
Perhaps the consequences of Trump’s call to war not being thought out is comparable to the thinking behind the logistics of the merger of the two pediatric cancer programs. While experts could have warned Trump of the consequences and he could have rethought his bellicosity, Dr. Pisters could have been warned of the impending mess in Pediatrics following the merger, but he could care less. While Trump is unhappy with the price of gas, that the salaries of Pisters’ former faculty decrease is no longer his concern.
In Pisters’ case, perhaps he needed no expert advice. The outcome is just the one he wanted.
What Mr. Trump wants and what he will settle for to end the war is very unclear at the moment. Both men might have benefitted from expert advice. Obviously, in Pisters’ case, he did not need it and surely did not want it.
