Sunday, March 12, 2017

Trump and cancer

I subscribe to a medical newsletter called (naturally) Stat. Recently Stat published an article called “The show goes on: Trump attends controversial Dana-Farber fundraiser at Mar-a-Lago.” At the top of the page was a photograph of Brian Mulroney, former prime minister of Canada, talking to President Trump at this fundraiser, which took place on Saturday, February 18, 2017.

Here’s the gist of the controversy: “While the Harvard-affiliated Boston hospital [whose full name is the Dana-Farber Cancer Institute] has held the posh annual event at the private club since 2011, and in 2008, this year’s gala drew criticism from Dana-Farber’s staff and Harvard medical students, who saw Trump’s actions, especially his executive order on immigration, as in direct conflict with the hospital’s mission. Dana-Farber declined to cancel, saying it was too late to change plans, but said it would avoid ‘controversial venues’ in the future.”

Surely the “hundreds … of students and doctors who advocated for Dana-Farber to relocate the fundraiser” were right about one thing, as a fourth-year medical student put it: “You can’t say you’re staying out of politics while simultaneously holding your fundraiser at Mar-a-Lago.” The proof of this proposition, this student argued, was Trump’s appearance at the party – captured in the photo heading the article.

But who ever said that cancer fundraising was somehow out of politics? Quite to the contrary, Sidney Farber himself was deeply involved in politics, as he and his allies marshalled government support for cancer research, a story told in detail by Siddhartha Mukherjee in his book The Emperor of All Maladies: A Biography of Cancer (2010). How could it possibly be otherwise? The cost of cancer research and treatment is immense; politics is inevitably going to be involved in meeting that cost.

Now one might say, as the protesters did, that Trump’s actions, “especially his executive order on immigration, are in direct conflict with Dana-Farber’s mission.” The report doesn’t explain exactly what the protesters meant by this, but as Teresa reminds me, quite a few of the doctors who are working on my particular cancer, cholangiocarcinoma, happen to be foreign-born. In general, I’m sure that reducing the immigration of talented professionals will hurt U.S. health care, and meanwhile forcing illegal immigrants into the shadows is bound to hurt their health, burden emergency rooms, and, in short, conflict with Dana-Farber’s, and every other cancer treatment center’s, mission. And then there’s the impact of the Republicans’ brutal proposed replacement of Obamacare, which wasn’t yet public when Dana-Farber held its fundraiser.

But it seems obvious that in other respects holding the fundraiser at Mar-a-Lago was also, either directly or indirectly, in support of Dana-Farber’s mission. The fundraiser earned $2.2 million. It also – or so we might infer from the photo – engaged the President with Dana-Farber’s work, and gave him a sense that Dana-Farber was the kind of institution that was compatible with his club, one he clearly is proud of. To an extent that’s hard to measure, Dana-Farber’s choice of location gave them the possibility of having the President of the United States feel that he and Dana-Farber were on the same side. But if Dana-Farber henceforth stays away from Mar-a-Lago, obviously that benefit will fade away – perhaps abruptly, given the President’s well-known capacity for resentment.

So was Dana-Farber obliged to sacrifice some possibility of a positive connection with the President? Suppose the result of its doing so will be, in some modest degree, to diminish the likelihood that the President will support cancer research and federal funding for that research? And suppose that this decision will also, in some modest degree, weaken the political effort to sustain the nation’s fight against cancer over the next four years?

Quite possibly the answer is that these costs to the fight against cancer must be accepted because it is just unacceptable, at this moment in our history, for anyone committed to serving the public interest to try to collaborate with President Trump. I admit I don’t look forward to the 4 years (or 8?) of nonstop conflict that this conclusion may contribute to, but it may be necessary.

But what’s most striking to me about this fundraiser is that it reminds us of how pervasive the President’s influence is. Almost everything Americans do in some way is helped, or hindered, by the White House. And as Teresa also reminds me, now this impact isn’t just institutional but personal: Trump owns Mar-a-Lago, and any number of other sites and products, all of which those who seek influence must now choose either to utilize or not. It’s all Trump, all the way down! And for me, as a cancer patient, it’s become worryingly personal, in a way that politics hasn’t been for a long time.

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