Your Comments Matter – Reporter Resources for CODE BLUE.

Posted on | December 18, 2024 | No Comments

Thanks to Mary Ellen, a veteran health care professional for the comment above. She is absolutely right. CODE BLUE: Inside America’s Medical Industrial Complex, was written intentionally to share with policy makers how our health care arrived at this moment in history, and suggest ways to improve it. For reporters interested in following this lead, find resources HERE.

A Clash of Values Playing Out In Full View.

Posted on | December 17, 2024 | 2 Comments

Mike Magee

As the new year, 2025, fast approaches, it’s wise to pause, and gather our thoughts as a nation. Few would argue that we’ve been through a lot over the past decade. And quite naturally, we humans are prone to blame individuals rather than circumstances (some of which have been beyond our control) for creating an environment that feels as if it is unraveling before our eyes.

How should we describe our condition – dynamic, tense, complex? Is peace, contentment, and security achievable in this still young nation? Have accelerationist technocrats, armed with bitcoins and Martian fantasy, short-circuited our moment in time that had been preserved for recovery from a deadly pandemic that eliminated a million of our fellow citizens seemingly overnight?

Who do we turn to for answers, now that we’ve largely lost faith and trust in our politicians, our religious leaders, and our journalists? And how exactly do you create a healthy nation? Certainly not by taking doctors and nurses offline for miscarriages, and placing local bureaucrats in exam rooms. Are they prepared to deal with life and death decisions? Are they trained to process human fear and worry? Do they know how to instill hopefulness in parents who are literally “scared to death” because their child has just been diagnosed with cancer? It certainly must require more than a baseball cap with MAHA on it to heal this nation.

Historians suggest this will take time. As Stanford Professor of Law, Lawrence M. Friedman, wrote in A History of American Law, “One hundred and sixty-nine years went by between Jamestown and the Declaration of Independence. The same length of time separates 1776 and the end of World War II.” 

During those very early years that preceded the formal declaration and formation of the United States as a nation, our various, then British colonies, fluidly and independent of each other, did their best first to survive, and then to organize into shared communities with codified laws and regulations. It was “a study of social development unfolding over time” impacted by emotions, politics and real-time economics. At the core of the struggle (as we saw with the pandemic, and now the vaccine controversy) was a clash between the rights of the individual and those of the collective community.

This clash of values has been playing out in full view over the past five years of the Covid pandemic. In 2023, Washington Post columnist, Dr. Leana Wen, asked, “Whose rights are paramount? The individual who must give up freedoms, or those around them who want to lower infection risk?”

This battle between “individual liberty and communal good” is ancient and current at the same time, and still a source of conflict wherever and whenever humans attempt some version of “nation building.” In our current case, it has been further complicated by purposeful misinformation and misdirection on an industrial scale. In a world of “alternative facts,” who and what do you trust?

Through the past five years, public trust in doctors and nurses have managed to remain high. Literally, they have been “a bridge over troubled waters.” That is why it has been such a glaringly obvious public policy blunder to forcefully separate them from the women they care for in half of the states of this nation. By compromising the health of our women, we have compromised the health of our democracy.

It is useful to recall that we humans on these shores have come a long way. From the beginning on the shores of Virginia in 1607, these early wild settlements were essentially lawless – that is without laws. They also were wildly different in their dates of entry and their range of issues. Consider that more than 100 years separated the beginnings of the Massachusetts Bay colony and the colony of Georgia. And as historian Lawrence  Friedman noted, “The legal needs of a small settlement run by clergyman clinging precariously to the coast of an unknown continent were fundamentally different from the needs of a bustling commercial state.”

And yet, here we are together, doing our best to push back against a manmade culture war, ignited in Florida, and designed to halt our human progress, as we pursue policies that will not only widen the gap between rich and poor, but also reward billionaire technocrats with unimaginable deregulation that will almost certainly place our citizens health and safety at risk.

In many ways, the struggle to act in a civil and wise manner, that mines common values, and finds a balance between individual freedom and wise collective rules and regulations, remains our hill to climb.  

Not surprisingly, RFK Jr. finds himself under a microscope. His past pronouncements, replete with his own “alternative facts,” struggles with addiction, celebrity seeking, and mixing of good and bad ideas have placed him in a well-deserved hot seat. If trust is what we need, he may not be the best choice for MAHA.

As a fact starter, check out The History of American Law. It “presents the achievements and failures of the American legal system in the context of America’s commercial and working world, family practices, and attitudes toward property, government, crime, and justice.” Medicine lives and breaths at these very same interfaces.

How should we describe our condition – dynamic, tense, complex?  Historians might say yes to all of the above, but also proclaim that the timing for progress is perfect. We should advantage this fluid opportunity, and make the most of it. Public Health policy, debating it and formulating it, can help us manage our differences, and make wise choices for our still young nation. This is because Public Health exists at the intersection of Law and Medicine.

Not My Final Column.

Posted on | December 11, 2024 | 6 Comments

Mike Magee

As my wife often reminds me, “Comparisons are toxic.” And, in general, I agree and try to respect this cardinal rule. But these are extraordinary times. So grant me this exception.

On December 9, 2024, in my early morning survey of the news, two articles demanded my attention. The first was an editorial in the New York Times with the self-explanatory title, “My Last Column: Finding Hope in an Age of Resentment” by Paul Krugman. The second was an article published that morning in Nature titled “Quantum error correction below the surface code threshold” authored by “Google Quantum AI and Collaborators,” a blanket label for a team of 300+ engineers led by Founder and Leader, Hartmut Neven. More on him in a moment.

As a loyal reader of Krugman, I read his “last column” carefully – twice. Over 25 years I’ve admired this specialist’s (global economics) willingness and interest to wander often into generalist, cross-sector, liberal arts territory. No match for his Nobel winning intellect or pure-bred education at MIT, Yale and Princeton, I do share a history of common geography (upstate New York in our early years, and the New York metropolitan area later on); an upbringing in religious households (Jewish and Catholic); and more than two uninterrupted decades of weekly published columns.

Though I have not always agreed with his take on every issue, I count myself as an admirer. The issues that have interested him, both pro and con, over the years, are more often than not the same issues that have troubled or encouraged me. So I was not surprised that he chose, in his “last column,” to reflect on the recent election, and the current levels of anger, violence and resentment in our society. And while I agree with the findings in his examination of the body politic, we arrived at a different diagnosis.

Krugman writes, “What strikes me, looking back, is how optimistic many people, both here and in much of the Western world, were back then (25 years ago) and the extent to which that optimism has been replaced by anger and resentment. . . some of the angriest, most resentful people in America right now . . . are billionaires who don’t feel sufficiently admired.” 

As for the diagnosis, in response to the question he himself raises (“Why did this optimism curdle?”), he answers, “As I see it, we’ve had a collapse of trust in elites.” And the treatment for this disease? “if we stand up to the kakistocracy — rule by the worst — that’s emerging as we speak, we may eventually find our way back to a better world.”

Now that sent me back to Hartmut Nevin and the Nature article for a reality check.  Were American oligarchs and technocrats, with wild wealth and even wilder ideas, the cause of every day people jumping aboard the Trump cult train? 

Hartmut is 9 years younger than Paul. He is a German trained PhD physicist who came to the University of Southern California as an entrepreneurial research professor in computer science in 1998. His several start-ups which were focused on “face recognition technology and real-time facial feature analysis for avatar animation” helped make him famous and rich when they were purchased by Google in 2006. But his fantastical dream was to create a “quantum chip” that would outperform anything that currently existed. 

Six years later, he launched the Quantum Artificial Intelligence Laboratory, and by 2016, he had come up with an experiment (still ongoing) to prove “quantum supremacy.” Starting his own chip fabrication factory in Santa Barbara, his dream became concrete. He took a world view in 2020, stating:  “It’s not one company versus another, but rather, humankind versus nature — or humankind with nature.”

Nevin believes he is in the right place at the right time. The AI Arms Race is full on and relies on ever increasing data consumption to support generative self-learning. That demands enormous consuming power. In his words, “Both (quantum computing and AI) will prove to be the most transformational technologies of our time, but advanced AI will significantly benefit from access to quantum computing. This is why I named our lab Quantum AI.”

Quantum computing is measured in “qubits” (which are the size of a single atom) versus the binary digit measure of standard computers, called the “bit.” As the New York Times explained, “Quantum bits, or ‘qubits,’ behave very differently from normal bits. A single object can behave like two separate objects at the same time when it is either extremely small or extremely cold.” The test, using exotic metals cooled to 460 degrees below zero, reported out on October 9th, declared that Nevin’s quantum chip “performed a computation in under 5 minutes that would take one of today’s fastest supercomputers 10,000,000,000,000,000,000,000,000 (10 septillion) years to compute.” 

But that’s not the amazing part. In past experiments, the device was error prone, and the more qubits, the less reliable the computations. But now, for the first time, this group was able to demonstrate the more qubits in play, the more accurate the outcome. As Nevin explained, “This historic accomplishment is known in the field as ‘below threshold’ — being able to drive errors down while scaling up the number of qubits.” How big was that? According to Javad Shaman, director of the Center for Quantum Information Physics at NYU, “one of the highlights of the recent decade.”

Nevin doesn’t seem to “worry about being admired.” In his blog this week he tied his qubit “below threshold” accomplishment to “helping us discover new medicines, designing more efficient batteries for electric cars, and accelerating progress in fusion and new energy alternatives.” That seems a far cry from Paul Krugman’s highlighting of “the pettiness of plutocrats who used to bask in public approval and are now discovering that all the money in the world can’t buy you love.”

Gallup has been conducting an annual survey of “Americans Satisfaction With The Way Things Are Going In The U.S.” for roughly a half century. Currently only 22% say they are satisfied. Back in 1986, that number peaked at 70%. That was the year that Robert Fulcrum wrote a little book that remained on the New York Times Best Seller list for nearly two years. Some criticized the book as “trite and saccharine,” but 17 million copies of his books remain in circulation.

The 1986 book was titled, “All I Really Need To Know I Learned in Kindergarten.”   Here are his top ten learnings: 

1. Share everything.
2. Play fair.
3. Don’t hit people.
4. Put things back where you found them.
5. Clean up your own mess.
6. Don’t take things that aren’t yours.
7. Say you’re sorry when you hurt somebody.
8. Wash your hands before you eat.
9. Flush.
10. Warm cookies and cold milk are good for you.

I was trying to figure how members of my own family could vote for a man to lead our nation who routinely and deliberately breaks most of these rules. I’ve come up with two reasons:

1. Greed. They simply don’t want to share any of their wealth or good fortune with others.
2. Religious certainty. They do not believe in separation of Church and State, and do not respect individual self-determination and free will. And yet values can not be enforced on human beings. They must be freely embraced to become permanently embedded.

Comparisons may be toxic, but Hartmut and Paul point us toward the truth. We the citizens of America (not our leaders regardless of their human deficits) need to get our act together. We are responsible for the outcome of this past election. What will the future hold? As Nevin the information scientist teaches, optimism flows from purpose and the promise of service.  And Krugman, the Nobel economist, teaches that money alone can not buy you love – or peace, or lasting joy, or contentment.

AI and Medicine: A Brief History and Where We Are in 2024

Posted on | December 10, 2024 | No Comments

(printable PDF)

Mike Magee

The history of Medicine has always involved a clash between the human need for compassion, understanding, and partnership, and the rigors of scientific discovery and advancing technology. At the interface of these two forces are human societies that struggle to remain forward looking and hopeful while managing complex human relations.

The question has been “How can science and technology improve health without undermining humans’ freedom of choice and rights to self-determination.” The rapid rise of Artificial Intelligence (AI) feels especially destabilizing because it promises, on the one hand, great promise, and on the other, great risk.

The human imagination runs wild, conjuring up images of robots taking over the world and forcing humankind into submission. Yet it is important to take a deep breath and place science’s technologic progress in perspective. (Read on . . . )

Ten Wizards Who Shaped Our Health Care System.

Posted on | December 2, 2024 | Comments Off on Ten Wizards Who Shaped Our Health Care System.

Mike Magee

The incoming Trump Administration nominees for positions in Health and Human Services (like RFK Jr. to direct the department and Mehmet Oz to head Medicare and Medicaid Services) are names you know and apparently many trust? In this week’s New York Times, Dr. Ashish Jha, President Biden’s Covid lead, thinks he knows why. He said, “You have a large swath of the population facing a health crisis, and they feel like medicine and public health isn’t delivering…They’re much more open to people saying, ‘The whole system is corrupt and we have to blow the whole thing up.’”  As Ashish knows better than most, we didn’t arrive here out of the blue. Over the years, many of the players who had the greatest impact on America’s health care system as we know it, remain hidden behind an  historic screen. Here (in no particular order) are 10 of the least known but most influential figures who shaped U.S. health policy in our lifetime.

Sam Massengill

In spring 1937, the head of sales for S.E. Massengill Company in Bristol, Tennessee, went to the company head, Samuel Evans Massengill, with an idea generated by customer feedback. Massengill salesmen were passing along reports from doctors that there was demand among parents of young children suffering from strep throat for a liquid version of their new sulfa drug.

Massengill, charged the company’s chief chemist, Harold Cole Watkins, to find an effective solvent in which powdered sulfanilamide could be dissolved. His choice was diethylene glycol, which smoothly dissolved sulfanilamide powder and led to a concoction that was 10 percent sulfanilamide, 72 percent diethylene glycol, and 16 percent water. Flavored with raspberry extract, saccharine, and caramel, it passed the taste and smell tests, but in keeping with then current federal regulations—or lack thereof—there was no test for safety.

In fact, no one did even a rudimentary check of the literature on diethylene glycol, which would have quickly revealed that it was a highly toxic component of brake fluid, wallpaper stripper, and antifreeze that had caused a fatality in 1930.

Instead, perhaps sensing that its competition would be right behind, Massengill rushed its “Elixir Sulfanilamide” into production, then shipped 240 gallons of the red liquid to 31 states through a network of small distributors in early September 1937.

Within two weeks, children began to die. In all, more than 100 children died, but only after going through 7 to 21 days of wrenchingly painful illness including “stoppage of urine, severe abdominal pain, nausea, vomiting, stupor, and convulsions.”

The whole disaster was vigorously reported in the press, and drug safety soon inched its way up the list of New Deal priorities. By June 11, 1938, bills from the Senate and House of Representatives had been reconciled, and on June 25, 1938, President Roosevelt signed into law the 1938 Federal Food, Drug, and Cosmetic Act.

Samuel Massengill belatedly issued a statement on behalf of his company: “My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. . . . I do not feel there was any responsibility on our part.” Unfortunately, Massengill’s morally blind position reflected the letter of the law at that time. In short, the absence of effective legal sanctions meant that a company or an individual could indeed sell a deadly medication and get away with it.

Mary Lasker

Born in 1900, Mary Lasker was the daughter of Frank Elwin Woodard, the head of the local bank in Watertown, Wisconsin, and a shrewd businessman with Chicago connections. By her own account, she was a campaigner almost from birth, and she traced her interest in promoting medical research back to an event she experienced at the age of three or four. Her mother, a local community supporter and civic activist, took Mary to see their ailing servant, a Mrs. Belter, who had undergone a double mastectomy as treatment for breast cancer. “I thought, this shouldn’t happen to anybody,” Mary Lasker later wrote.

As a young adult, she began to focus on health policy issues and became a devotee to Margaret Sanger. Mary sought out financial support for the organization, turning to a dynamic advertising man, Albert Lasker, who had launched some of America’s most recognizable consumer brands, including Lucky Strike cigarettes. Known as the “father of modern advertising,” Lasker is credited for suggesting that the Control Federation of America be renamed the Planned Parenthood Federation.

When Albert asked Mary what she wanted to accomplish, she listed reforms in health insurance, cancer research, and research against tuberculosis. Albert responded, “Well, for that you don’t need my kind of money. You need federal money, and I will show you how to get it.”

When Mary and Albert married in 1940, the world was preparing for war.

Beginning in 1942, the Laskers began to cultivate science luminaries who shared their commitment to maximizing government funding of applied research. The Laskers realized early that they would need a credible health-related national organization to anchor and launch their campaign and set their sights on the American Society for the Control of Cancer, an organization created in 1913 by 10 physicians meeting at the Harvard Club in New York City. The leadership was more than happy to grant the Laskers easy entry to their Board of Trustees in return for financial support. By 1944, the Laskers had seized control of the Board, largely dumped the doctors, and renamed the group the American Cancer Society (ACS). Its leadership was now composed of name-brand corporate heads, entertainment giants, and advertising executives.

To add further glory to the idea of Big Science, Mary and Albert created the annual Lasker Awards, with the somewhat self-serving tagline “Sometimes called ‘America’s Nobels.’” She then began to collect academic researchers, promote their careers, injecting publicity and special placement on government bodies. Over a decade she was at the center of creating seventeen specialty Institutes within the new NIH, most built around her favored scientists.

Mary Lasker died in 1994, a controversial figure. In the assessment of author and political journalist Elizabeth Drew, “Mrs. Lasker has been considered an able woman who has done good things but is too covetous of power, too insistent on her pursuits, too confident of her own expertise in the minutiae of medicine.”

William Menninger

During the first major WW II battle in North Africa, a startling number of soldiers were incapacitated with “Shell Shock.” One neurologist in North Africa, Frederick R. Hanson, discovered that a bit of kindness in the form of a hot shower and a warm meal, combined with sedation-induced rest, was remarkably successful in rehabilitating the majority of the “mentally incapacitated” men under his care.

Hanson’s success did not go unnoticed by the Army’s chief of the division of neuropsychiatry in the Office of the Surgeon General, William C. Menninger. After studying his results, he decided that if psychiatric casualties in a standard unit exceeded one mental casualty for every four wounded in action, this was a harbinger of broader problems—like a breakdown in morale, leadership issues, prolonged combat fatigue, or a policy breakdown in the evacuation scheme.

Other observations included the fact that new units with limited combat experience had a higher percentage of mental casualties then seasoned units did, and that the medical officers in these units were more inclined to ship out those with “normal fear reactions.” On the other end of the spectrum, troops that exceeded 12 months of combat exposure began to experience a higher percentage of mental casualties.

The experience in North Africa had clarified for Army Chief of Staff, General George Marshall, that the plan for handling neuropsychiatric casualties in the field was seriously broken. At his request, Menninger came up with a plan that included psychiatric support close to the battlefield, reinforced by the heavy and liberal use of barbiturates and ether anesthesia if necessary for initial sedation of hysterical soldiers. In the most severe cases, other experimental treatments would be used, such as intravenous sodium pentothal, a.k.a. truth serum, to draw out (and ideally remove) the troubling traumatic memories of war.

Menninger immediately realized there were not nearly enough psychiatrists to execute the plan, so he came up with the idea to train a portion of the medical officers in what he called “forward psychiatry.” These officers were subjected to a 30-day immersion course to master Menninger’s system and make them comfortable with the liberal use of barbiturates. They were thereafter labeled “30-day wonders.”

Menninger’s plans were encoded in a diagnostic manual, Medical 203 (which was the basis of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, released shortly after the war). Today, the bible of mental health, and now in its fifth edition, the DSM-5 is a structured approach to the diagnosis and treatment of mental illnesses, including the use of those wartime barbiturates and the many chemical children they spawned.

The pharmaceutical industry responded to all these developments with an aggressive search for “blockbusters” to capture the expanding market. Some of these new medicines were designed to treat very real ailments; in other cases, the drug came first, after which the drug company’s newly energized marketing teams developed a problem for it to solve. By 1960, one out of every six American adults was being treated with pharmaceuticals for anxiety.

Hans Selye

In the early 1950s, Reader’s Digest published a ground breaking article titled “Cancer By The Carton”, informing the public that cigarettes caused lung cancer. As part of the fallout, the AMA eliminated cigarette advertising from their medical journals.

To continue selling cigarettes in the face of devastating scientific evidence of tobacco’s link to lung cancer was challenging enough, but newer evidence was beginning to reveal that the habit also led to deaths from heart attacks. The companies had to come up with an alternate explanation for the rise in cardiac deaths that clearly tracked the rise of cigarette sales.

Their savior was a Hungarian-born endocrinologist named Hans Selye, a man nominated multiple times for the Nobel Prize.  Selye was famous for his formulation of the concept of stress as the source of microscopic injuries to the cell. But he was also known for his ability to attract research funding, which was enhanced by his willingness to tailor the evidence to suit the highest bidder.

In numerous court cases during the 1960s and 1970s, the Tobacco Industry Research Council relied on Selye as an expert witness to make the argument that smoking, rather than being a health hazard, might actually provide a measurable benefit in the form of stress relief. Meanwhile, Dr. Selye was turning to the tobacco industry for major grants to support his growing research enterprise and to enrich himself.

Years later, as part of document disclosure during litigation by state attorneys general against the tobacco industry, communications between Selye and industry representatives proved that he had conspired to hold back supportive testimony and publications suggesting a link between tobacco use and stress reduction until he received his cash.

When Hans Selye died in 1982, he was regarded as a venerable scientist, but the tobacco industry’s funding of his work, and Selye’s willingness to recruit additional scientists to present tobacco’s messages in meetings and publications, was later cited by the US Department of Justice as a clear example of racketeering.

Lemuel Boulware

When the AMA began to look for someone to help fight the scourge of socialized medicine in 1960 Ronald Reagan was the ideal public opinion operative.  His training as a politician and public communicator lasted 10 years and was directed by Lemuel Boulware, who had served as Roosevelt’s operations vice chairman of the War Productions Board, and then moved on to one of the military’s largest suppliers, General Electric.

At GE Boulware had a philosophy of “going over the heads” of union leaders. Instead of confrontation, he employed comprehensive, ongoing communications and economic education directed not only at workers at all levels in his organization but also at their spouses and families. He fostered newsletters, symposia, book clubs, and courses that included a heavy dose of basic conservative economics, but they also touched on entrepreneurship, management philosophy, investment, retirement, health, and family education.

The new medium of television was becoming a factor in American life, so  Boulware decided to launch a new TV show called General Electric Theater. He turned to Ronald Reagan to host the weekly dramatic series. Over the next eight years, Reagan visited and addressed more than 250,000 GE employees and customers at 139 different GE sites, perfecting what came to be known as “The Speech.”.  The AMA hired Reagan on GE’s recommendation. Reagan’s speech and its’ views on Medicare aligned with those of the AMA, but they came out of GE,  thanks to his mentor, Lemuel Boulware.

Edward Annis

On May 20, at Madison Square Garden in New York City, President Kennedy delivered a major address on health care to a full house of 20,000 senior citizens. The speech was broadcast without advertising by all three major networks as a “news event,” and it reached an estimated viewership of 20 million. He directly challenged the AMA and its health care lobbyists, who were flooding the hallways and mailrooms of Congress.

The AMA was livid. It demanded equal time from the networks to give a formal response to what they saw as a Democratic Party political address, but it was refused.  Undaunted, the AMA board gave the go-ahead to rent Madison Square Garden and pay to televise their rebuttal.

As their voice, they chose a Tallahassee surgeon, Dr. Edward Annis, who had been a debater in high school and college. Part of the AMA speakers’ bureau, Annis, like Ronald Reagan, had been put on the road the year before to develop his own version of Reagan’s “ speech.” He had delivered it dozens of times over the past five months and along the way had publicly debated UAW officials and Senator Hubert Humphrey.

When he got to Madison Square Garden on May 22 to deliver a very personal rebuke to the president, Annis had two advantages. President Kennedy’s earlier address, as his staff would later admit, was not his best. The AMA also had Kennedy’s speech on film and was able to build a point-by-point reply.

Dr. Annis, in 30 minutes, mined the weaknesses of Kennedy’s address, referencing filmed portions of the president’s speech, and challenged the absent president directly as he went along. At the end of the speech, Annis admonished Kennedy: “The people have a right to remind their first servant that his election, even his present popularity, does not authorize him to change fundamental institutions that have proved a lasting value through the generations…There are few such things that touch so close to God. And the relationship between a doctor and his patient is one of them…To the millions of Americans who may have a doubt, who may want to take a moment to hear the views of one they know and trust, I implore you, ‘Ask your doctor. Ask your doctor.’”

And ask they did, in droves. The AMA’s paid televised address on the same networks Kennedy had accessed two days earlier was said to have reached 30 million viewers. On July 17, 1962, the health care bill went down in defeat in the Senate by a vote of 52–48.

Ed Pratt

In the 1980’s Pfizer CEO Ed Pratt was ideally positioned to lead the global charge on intellectual property (IP) protections. Pratt was chairman of the powerful US Business Roundtable and also the formal adviser to Reagan’s US trade representative, Bill Brock.

Pratt’s first move was to form a task force on intellectual property with his chief ally, IBM CEO John Opel. Their recommendation to Brock that a position be created within the Office of the US Trade Representative for a director of international investment and intellectual property sailed through.

Pratt also directed the creation of the Intellectual Property Committee (IPC) of the powerful US Council on Business. This provided a platform for the next step in organizing a global effort. In 1983, Pratt and Opel approached the leaders of 10 other large US-based multinationals, including General Electric, General Motors, DuPont, Johnson & Johnson, and Monsanto, requesting their participation on the Intellectual Property Committee and creating a united front across industries.

At Bill Brock’s request, Pratt, built a multi-sector global coalition of major corporations to engage the United Nations and World Trade Organization. Domestically, he worked the chambers of commerce, business councils, business committees, and trade associations. Pfizer executives, who occupied key positions in strategic business organizations, were directed to engage with their cross-sector colleagues in every industry.

Pratt persisted for over a decade until he won. As a direct result of his IP wins, pharmaceutical companies in the U.S. gained up to 20 years of patent protection for new drugs approved by the FDA.  In addition, the integrated internal public affairs team he created inside Pfizer for the project became the prototype for PhRMA’s  subsequent “government relations on steroids” and  the under-pinning for the integrated and strategic cross-sector 21^st century Medical Industrial Complex.

Louis Lasagna

In 1970, Lou Lasagna MD became chairman of the Department of Pharmacology and Toxicology at the University of Rochester’s School of Medicine where he founded the Center for the Study of Drug Development (CSDD), a common meeting ground for free market–minded academics, government, and corporate leaders. By 1976, he had moved his center to Boston’s Tufts University. He was now a renegade scholar, a successful entrepreneur, and a lightning rod for controversy.

From the start, Lasagna’s CSDD was a multifaceted and highly productive platform, providing professional development courses in clinical pharmacology, drug development, research processes, and pharmaceutical regulations. It generated influential white papers and reports on everything from clinical research design to the growing trend of outsourcing work to contract (or clinical) research organizations (CROs). It also provided customized reports helping individual clients design their government-relations strategies in pursuit of favorable policies.

He laid the statistical groundwork to “prove” that the pharmaceutical industry was “high risk/high gain.” Lou pegged the cost of bringing a new drug to market at $800 million and the losses associated with a one-month delay in a product review by the FDA at $10 million for the sponsoring company. Multiplied by the average approval time required for a new drug application—31 months—that added up to real money.

Lasagna labeled the problem as America’s “drug lag” and positioned himself and his fellow physicians as friends of the industry. For individual drugs, Britain in 1980 beat the US to the market for new drugs, on average, by two years. At the time, the country was in a stubborn recession. Lasagna argued that the cost of drug innovation was way too high, and that part of the problem was government ownership of any discoveries that had been funded with NIH grants.

As a brilliant strategist, Lasagna could see a number of these issues breaking his way. The stubborn recession combined with the escalating cost of employer-based health benefits was beginning to fuel the demand for innovative solutions. Lasagna was skilled at converting concern about cost into demands for efficiency and less regulation of industry. He successfully led the charge to release government patents back to medical scientists and their institutions. A decade latter, the HIV/AIDS epidemic would push massive liberalization of drug approval over the line, and Lasagna would be the director of the government’s expert committee with a young researcher, Anthony Fauci as his NIH ally.

Paul Weyrich

in 1970, a Nixon-era journalist named Paul Michael Weyrich arrived on the political scene.  A staffer at the Milwaukee Sentinel who served as a weekend anchor at the local ABC affiliate WISN-TV, Weyrich went on to serve as press secretary to Colorado senator Gordon Allott. From there it was a short walk to the offices of conservative beer mogul Joseph Coors, who was funding the creation of a new right-wing think tank called the Heritage Foundation. Weyrich became its first director, and he summed up his mission this way: “The New Right is looking for issues that people care about. Social issues, at the present, fit the bill.”

Over the next decade, working with televangelists Jerry Falwell and Pat Robertson, they together fashioned Christian white nationalists into a political body, “The Christian Right”, and helped elect Jimmy Carter. When Carter was unwilling to oppose Roe v. Wade and homosexuality, they mobilized in support of Reagan and what they now termed “The Moral Majority.” Four decades latter, with the Dobbs decision, their dream came true.

Linda Robinson

In 1997, at the age of 44, Linda Robinson was already a legend in the field of Crisis Communications on Wall Street. Well known for her role in the leveraged buyout of RJR Nabisco, the story at the center of the book and film “Barbarians at the Gate”, she had been featured in a 10-page cover story in Vanity Fair. This piece described her as “the most powerful public relations broker in the country.”

Her husband, James D. Robinson III, was the chairman of American Express, and she was on first-name terms with most of the major players in media and politics in New York City. Her father, Freeman Gosden, had been a radio personality (Amos of Amos ’n’ Andy) and a longtime Hollywood fixture close to many political figures, including Ronald Reagan. When Reagan entered the 1980 presidential race, Linda became assistant to the campaign’s press secretary. After Reagan’s victory, she became press secretary to the secretary of transportation just as America’s air traffic controllers went on strike, and the showdown between them and President Reagan became one of the lead stories of the year.

In the mid-1990s, Pfizer CEO Bill Steere was ramping up to support a product that he already knew would become infamous, Viagra.  He knew it would unleash a huge public debate, and he was focused on identifying every possible issue or public challenge that might arise. In short, he wanted to be prepared and avoid a crisis. So he quite naturally turned to Linda Robinson to head up Pfizer’s secret, internal Viagra Advisory Board filled with ethicists, theologians, sex therapists, scientists and representatives of four of the largest public relations firms in New York, including her own company: Robinson Lerer & Montgomery. This was a full 18 months before the drug was slatted to be approved.

Robinson imbedded her own staff at Pfizer headquarters at 42^nd and 2^nd Avenue, and ran the Viagra “War Room” for the first 12 months after approval until the product’s success was assured. Rather than dismantle the team, it was then repurposed as Robinson and her people helped direct the successful “hostile takeover” of Warner Lambert. The prize? Lipitor, the statin drug, which by 2010 was the first drug ever to exceed $10 billion in annual sales.

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These stories and more in CODE BLUE: Inside America’s Medical Industrial Complex (Grove/2020)

What is the Value of our Humanity?

Posted on | November 25, 2024 | 4 Comments

Mike Magee

The image of William Westmoreland, speaking direct to the camera in the 1974 documentary “Hearts and Minds”, is stark and unapologetic. He addresses the interviewer’s question about extensive loss of civilian lives during the Vietnam War this way: “Well, the Oriental doesn’t put the same high price on life as the Westerner. And as the philosophy of the Orient expresses it, life is not important.”

Thinking of him and those years again, which in many ways I’d sooner forget, and realizing that to some extent, we have managed to repeat our mistakes, and embrace the same types of biases, well, you can understand why I sighed a bit for the human race last evening.

And yet, out of the same era, from another clearly morally compromised President, Richard M. Nixon, came the historic 1970 Clean Air Act. It passed the Senate 73-0, before gaining the President’s signature, and created the Cabinet level Environmental Protection Agency (EPA) that, if some had their way, would  be on the chopping block come January 20th.

And yet, history has shown that clean air and water are pretty popular on Main Street and in the halls of Congress. In 1990, another Republican president, George H.W.  Bush, signed legislation that further strengthened the law after 89 senators, including Mitch McConnell supported the changes. Of this action, the then new incoming Majority Leader, who later decried actions of the EPA as attempts to destroy “Big Coal”, stated, “I had to choose between cleaner air and the status quo. I chose cleaner air.” President Bush’s action allowed the EPA to first begin to measure levels of ozone and mercury in our air.

The EPA has been up (Obama and Biden) and down (Trump/2016) since then. It drew a 28 page chapter in the Project 2025 playbook. Trump’s 2016 director of the EPA, Mandy Gunaswkara (originally a staffer on the Senate Environment and Public Works Committee under the late Oklahoma Sen. James Inhofe) says she’s good to go again. As she put it, “The biggest difference is we have a plan from Day One, we’re going to start implementing it, and we won’t be as susceptible to process problems that really sunk a couple of those final regulatory proposals and actions we took at the tail end of the administration.”

Heritage Foundation’s Trustee, Kevin D. Roberts, is all in. As he recently wrote, “…economic freedom is not something Americans should apologize for, but harness, spur, and give free rein—for our own sake, and everyone else’s, too.”  Their opinions on governmental guardrails and regulation are similarly strong, but in reverse. “America is over regulated. Every facet of daily life, from what cars we drive to what food we eat is subject to government’s regulatory reach.”

According to the Heritage Foundation, AI has arrived in the nick of time. To listen in on their planning, there is still time to register for the December 4, 2024 conference, “Digital Tools for Modernizing the Federal Permitting Process.” As they describe it, “The report tackles the obstacles created by the lack of transparency in the federal permitting process which needlessly increases the risk to investors while obscuring accountability in the democratic process.”

The Pew Research Center covered the same territory a few years back.  Alexander Cho, a digital media anthropologist, was not surprised by the Heritage Foundations current focus on AI.  He says that “‘digital’ acts as a magnifier, accelerator and exacerbator of historical conduits of power that may have not been as obvious to folks before.” What we are experiencing in the wake of this election cycle are “social and civic conversations that are not new but that have been catalyzed through digital media.”

Chair of Environmental Studies and Science at Pace University, Melanie DuPuis, on the same Pew centered platform, recalled David Blight’s biography of Frederick Douglas, and left open the possibility of a painfully long policy winter. In her words, technology back then was an accelerator as well. “Of course, it was technology that made Douglass’s words visible to a civic public: newspaper and, interestingly, train travel…I don’t think he would have guessed that the darkness would continue so long. I think American darkness will continue but that civil society will eventually reemerge, as it has in democratic countries over the last two centuries.”

Another participant added this, “Individuals will have to reevaluate their lives and their prospects. Whether the responses to change are successful or not depends on multiple factors, such as the current sophistication of societies, the perceived place of a shared morality and the level of education and awareness. The risk is the emergence of a disposed and disenchanted digital ‘proletariat’ whose response to change will be violent rather than reasoned.”

Others predict a backlash. One said, “The reign of Trump and other nay-sayers will lead to a countermovement that will bring about sweeping changes in the digital world. We will see a privacy set of laws similar to Europe. We’ll see the breakup of monopolies like Google that will generate new innovations.”

Where’s the common ground? All agree the debate has been engaged, and AI assisted information technology will likely fan the flames. What remains to be determined is what sprigs of new life will emerge from these ashes. We shall see what is the value of our humanity.

Thomas E. Kurtz and “A Few Good Men”

Posted on | November 21, 2024 | Comments Off on Thomas E. Kurtz and “A Few Good Men”

Mike Magee

This has been a challenging week for me, but not for the reasons you might think. Compartmentalization skills have allowed me to push the 2024 Presidential election into the back reaches of my mind as I worked to complete teaching a course on “AI and Medicine” at the Presidents College at the University of Hartford.

Along with my students, we confronted a future filled with competing visions. Promise and dread lurked side by side at every turn. In one of the final slides of the final lecture I included an image from the 1992 Alan Sorkin legal drama, “A Few Good Men.” The face of an enraged Jack Nicholson (relentlessly baited by Tom Cruise) filled the screen under the headline “You can’t handle the truth!”

This device was employed to spotlight the fact that genAI, trained on de-identified population health data, will soon reveal numerous uncomfortable “truths” about our health care system – like its’ inefficiency, inequity, and spotty outcomes; or its wastefulness, fraud, and permissive attitude toward DTC marketing designed to drive demand. 

AI’s capacity to uncover the strengths and faults of our system has already been highlighted in a January 24, 2024 JAMA article titled  “Scalable Privilege” – How AI Could Turn Data From the Best Medical Systems Into Better Care For All.”

If we want to emphasize the positive, we do well to stop for a moment and acknowledge with gratitude the passing this week of 94 year old Thomas E. Kurtz. You may not have heard of him, but you likely recall his seminal invention, the first computer programming language for the masses – BASIC (Beginners’ All-purpose Symbolic Instruction Code). As Bill Gates himself reflected this week, “The approachability of BASIC and time-sharing began what the PC and the internet took to a whole new level.” 

Bill would know. His high school had a teletype connection to the original time-sharing main frame computer at Dartmouth. But Gates was not alone or first in line. As Kurtz remembered, “I once estimated that even before Bill Gates got into the action at all, five million people in the world knew how to write programs in BASIC. There was something like 80 time-sharing systems in the U.S. that offered BASIC as one of their languages. And it was all over the world. I even got a letter from somebody in Siberia.” 

It wasn’t until1978 that Gates teamed up with Microsoft founder, Paul Allen, and received permission to install BASIC in the first customizable personal microcomputer, the MITS Altair 8800.

Kurtz was the son of German immigrants, and displayed high aptitude in mathematics early in life. He graduated from a local college in Illinois in 1950, and by 1956 had earned a PhD in statistics at Princeton. He was recruited to Dartmouth that same year by the chairman of Mathematics, John Kemeny, who had previously been a research assistant at Princeton himself under none other than Albert Einstein. Kurtz launched a new field at Dartmouth that year – computer science.

He was starting at ground level – or more accurately, below ground level since the solitary computer the university possessed was housed in the basement of College Hall where it filled an entire room. Training students in computer science required hands on engagement. As Kurtz explained some years later, “Lecturing about computing doesn’t make any sense, any more than lecturing on how to drive a car makes sense.” 

In later interviews, Kurtz make it clear that his idea didn’t meet with applause at the outset. He admitted, “The target (in computing) was research, whereas here at Dartmouth we had the crazy idea that our undergraduate students who are not going to be technically employed later on should learn how to use the computer. Completely nutty idea.”

Two barriers at the time were computer language and computer time. The main frame on campus ran on complex FORTRAN and COBOL which only a few experts had mastered. And if you wanted access, you had to wait in line. 

But eight years after he had arrived on campus, on May 1, 1964, at 4 a.m., he put his new language, BASIC, to the test with the typed command “RUN” and it worked. He modestly remembered that “The whole point of this was to make computing easy for Dartmouth students, Dartmouth faculty, Dartmouth staff, and even Dartmouth janitors.” 

One of Kurtz’s famous quotes was “always choose simplicity over efficiency.” It took only a one hour seminar to learn the system. At around the same time, he addressed the second problem – time. Developing what has been called “a clever workaround,” his new system permitted multiple users at remote terminals to access the computer simultaneously.

As with C.Everett Koop, who also died at age 96, he chose to live out the last few years of his life in near view of the Dartmouth green. And the world he left behind, one hurtling forward at breakneck speed, offers near unlimited computing access, and little time or delay between thought and action. Mistakes therefore run the risk of self-amplifying and potentially hurtling out of human control.

Mark Minevich, a well-respected AI Master Strategist focused on “human-centric digital transformation” understands the risks and benefits as well as anyone.  He recently laid out pillars for governmental management of AI. They include risk assessment, enhanced safeguards, pragmatic governance, and public/private partnerships. Channeling Kurtz, he said, “There are no shortcuts to developing systems that earn enduring trust…transparency, accountability, and justice (must) govern exploration…as we forge tools to serve all people.”

The Dartmouth flags were lowered in Kurtz’s honor on Wednesday, Nov. 20, and Thursday, Nov. 21.

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