We can’t believe that we forgot the X-factor in the medical wars, the one constant in an ever-changing medicinal universe in a town struggling to get to the big leagues in so many ways.

The no-factor.

We’ve always thought Mayor Oscar Goodman had a point when it comes to his push for an academic medical center in Las Vegas, although we don’t necessarily think it must be built downtown. Thousands of people — including two governors and one former mayor — leave the valley for medical care every year. Specialists in certain fields are hard, if not impossible, to find. So an academic medical center is a fine idea in concept.

But along comes Sunrise Hospital and Medical Center to say “no.”

When last we left Sunrise, they were saying “no” to Clark County, which was trying to keep the for-profit hosptial from opening an trauma center, possibly inflicting injury on the existing top-tier trauma center at county-run University Medical Center, or the overall trauma system. Sunrise said “no” because it wanted to open a trauma center of its own, and despite a state moratorium on the process, it eventually got what it wanted.

Before that, Sunrise said “no” to a proposed children’s hospital at UMC, perhaps the only truly good thing former Clark County Commissioner Erin Kenny did during her tenure (amidst the deal-making and bribe-taking). The measure went to the ballot, where it was defeated.

So it should come as no surprise that Sunrise is saying “no” once more, this time to Goodman’s medical center idea. Instead, the hospital suggests, local doctors and institutions should band together and do their own thing. The idea appeals to some local doctors, who worry that Goodman’s proposed partner in the academic medical center — the University of Pittsburgh — might want too much control.

Besides, says Sunrise, do we really need such a place? “If there’s a big demand for heart, lung, liver [transplants] or whatever else, one of the corporations would have done it,” says Ann Lynch, Sunrise’s chief spokeswoman, in an interview published in the Review-Journal.

Yes, that’s the program in a nutshell: If there’s a big demand (read — “money to be made”) then corporations will do it. If there’s no money to be made, let ‘em eat cake over at UMC. And if there’s a prestigious teaching component? Well, let’s just say no just in case there might be money to be made by Sunrise down the road.

Goodman has a point when he talks about Las Vegas needing to step up if it wants to be a real city. And one component of that might be to say no to the people who have made an art form of saying no in the past.

The Las Vegas Sun announced it has hired former Los Angeles Times editor and reporter Tom Gorman to write a new column, one of the changes made by the paper as it prepares to become an insert into the morning Review-Journal. (By the way, we would never want to rain upon anyone’s parade, but this business about the Sun becoming a morning newspaper is a bit overblown. The Sun will be inserted into a morning newspaper, and by virtue of that insertion will circulate in the morning. But the R-J is the morning newspaper, plain and simple. The Sun’s identity, already a mystery to many Las Vegans, especially the new ones, will be further subsumed by its placement.

Still, the Gorman hire is a good one. (Read about it here. Sun Editor and President Brian Greenspun said “I’ve known Tom Gorman for a long time and I’ve always envied the Los Angeles Times because they had him and we didn’t. Now we’ve got him and it’s just the beginning.”

Our question is, what took so long? What kept the Sun from doing something that seems genetically impossible at the gentrified R-J: Innovation? As the smaller paper, the Sun has never had the obligation of being the paper of record, yet it always insisted on covering the same stories as the R-J instead of forsaking the day-to-day news to focus on in-depth pieces, analysis, commentary, perspective and investigations. Quite frankly, there have always been talented people at the Sun capable of doing those things, although the afternoon paper has its share of deadwood, too.

Finally, we may be seeing that happen at the Sun. We say, it’s about time. Now let’s see how the R-J competes with a newspaper trying to innovate that is going to circulate not close to home, but actually inside its home. Should be fun.

Oh, and for the record, we at Various Things and Stuff worked at the Sun covering police and City Hall from 1993-1997, and at the R-J writing political commentary from 2000 until 2005. So as always, take what we say with a big old grain of salt.