Promises
By
Leonard Zwelling
From an early age, we learn that a promise made ought to be a promise kept. We are disappointed when a promise to us as children is broken. If your father says he will take you for ice cream after dinner, but he is called back to the office in the evening, you resent his job and why it made him break his promise. If your mother promises to attend your after-school softball game, but her afternoon meeting with her boss runs late and you look up into the stands and she is not there, and the other girls’ mothers and even some fathers are, you feel hurt. All of this is a normal part of growing up, but that doesn’t mean you readily accept a promise unkept.
This is also true of our corporate, academic, and governmental leaders. These men and women often make promises to those hiring them or to those they lead that they are unable to keep.
The current President of the United States did keep two critical promises. He secured the southern border from illegal immigration, something his predecessors could have done, but failed to do. He also forced our NATO allies to spend more of their budgets on defense. Promises kept.
But in two large, and far more important areas, Donald Trump has failed badly to keep his promises.
First, the economy is not better than it was under Joe Biden. The job market is just fair. Inflation is on the rise again, precluding any interest lowering by the Federal Reserve. Even the stock market is trembling because of Trump’s second unkept promise.
That one was that he definitely promised that the United States would get into no further foreign entanglements or forever wars. Yet, with his attack on Iran and the subsequent Iranian control of the Strait of Hormuz and the continued mischief by Iranian proxies surrounding Israel, he has done exactly what he promised not to do.
As this blog has noted, this puts everything Trump wanted to accomplish in jeopardy. Forget about the arch, the Reflection Pool, and the East Wing. Substantive matters Trump swore would not occur are occurring because of decisions that he has made, because of promises he has broken.
Closer to home, Ron DePinho promised to cure five cancers in five years, at least that was what many of us heard. I think he probably promised the Board of Regents the creation of an alternative revenue stream through his development and commercialization of targeted drugs. All of that fell flat, as most of us knew it would. DePinho didn’t last very long in a leadership role at MD Anderson.
His successor hasn’t made a whole lot of promises that I can tell. He did not promise better research. He did not promise better educational programs. He did not promise an advancement in prevention or its dissemination into the community. All he promised, it seems, is to work the clinical faculty harder to increase revenues which subsequently he seems to be plowing into new clinical buildings in Houston and Austin and an ever-increasing salary for himself. He has not broken any promises as far as I can tell because I have no idea whether or not he made any. He seems to have no strategic plan at all. If you are aware that Pisters has a plan, please write me and tell me what it is.
One promise that I am going to predict will be hard to keep is the “merger” between MD Anderson Pediatrics and pediatric oncology at Texas Children’s. It is my understanding that this merger has been a promise made by MD Anderson and Texas Children’s to the Kinders after their $150 million donation for a new children’s cancer center. I imagine that there are many prominent Houstonians who believe that a promise to build a children’s cancer center to compete with St. Jude has been made.
Unfortunately, it is likely that this endeavor will cost over $1 billion. I do not know how much additionally has been raised to date beyond the $150 million. The plan to overcome the barriers to merging the two faculties has yet to be elucidated. In other words, there does not seem to be a viable blueprint for a combined children’s cancer service in Houston.
The promised merger was a response to pressure from the big money in Houston as well as local politics. The logic of having one children’s cancer program has been there for years, but TCH always wanted control and the leadership of MD Anderson and The Children’s Cancer Hospital at MD Anderson said no. Now, a more compliant MD Anderson president tastes the money and does not want to be left out. Besides, why wouldn’t Dr. Pisters want to generate 35 additional in-patient beds for adults and off-load the burden of the cost of the Pediatrics faculty in the near future.
But:
What about the children with cancer at Hermann? They were cared for by MD Anderson faculty? What now?
The merger is supposed to utilize the MD Anderson expertise in clinical trials, but what if a lot of that expertise depended on the access to new drugs secured first by the adult oncologists at MD Anderson who may be reticent to deal with Texas Children’s?
Won’t all the MD Anderson protocols have to approved by the Baylor IRB before a single patient can be treated on a current MD Anderson trial at Texas Children’s?
And what was the hurry to merge the faculties in one clinic and send the MD Anderson patients to TCH so soon? The new Kinder Children’s Cancer Center building is at least five years away. Was it so Dr. Pisters could use the vacated Pediatrics beds for higher paying adult patients as I say above?
Who promised who what in this combination of clinical services with different cultures, different pay scales, different benefits, different health plans, and dramatically different attitudes around clinical research?
Promises have been important to us since childhood. Leaders use promises and keeping them as evidence of their leadership expertise. Promises are being broken in Washington, D.C. and in Houston and no one is likely to benefit. The only question is will anyone be held accountable?
