REVIEWS AND VIEWS OF LIFE

GENERIC DRUGS

Katherine Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.

Books of Interest
Website: chetyarbrough.blog

Bottle of Lies (The Story of the Generic Drug Boom

By: Katherine Eban

Narrated By: Katherine Eban

Katherine Eban (Author, American investigative journalist focused on public health issues.)

Katherine Eban’s book is tedious, but it tells a story that challenges the generic drug industry and exposes the strength and weakness of capitalism. Eban makes one suspicious of the efficacy of generic drug treatments. Society depends on drug discoveries that can return one to health when struck by known and unknown malefactors. At the same time, Eban indirectly attacks capitalism as a primary force for discovery of life saving drug treatments. Capitalism is motivation for drug manufacturers to discover new drugs, but profit motive and human nature incentivize deception that can harm the public.

America’s police department for the drug industry is the Food and Drug Administration.

The difficulty of a policing function is in human nature and an investigators’ effort to find incriminating evidence that proves guilt. The consequences of poor policing in the generic drug industry are loss of health, and sometimes, life. The FDA is responsible for protecting public health by ensuring the safety, efficacy, and security of human and veterinary drugs manufactured or imported to the U.S.

Just as every police force is not perfect, the FDA has made mistakes and failed to uncover evidence for crime. There have been instances of drug manufacturers around the world, including America, that have adulterated approved generic drugs. (A U.S. generic drug manufacturer, KVK Research Inc in Pennsylvania, pled guilty in 2024.) Generic manufacturers and distributors around the world have misled the public on the efficacy and/or addictive qualities of drugs. A primary source of generic drug manufacturing crimes is the lure of increased profitability.

Eban focuses on a pandora’s box opened when the world’s generic drug industry began producing substitutes for previously patented drugs.

Patents for new drugs have a determinate shelf life but expire after a stipulated period of time. One can complain and challenge the price of patented drugs, but patented drugs require a level of scientific experiment and reporting to prove efficacy. When patents expire, there is a rush by generic manufacturers to produce the same drug at a lower cost. The trouble arises when a generic drug’s lower cost is achieved with substituted or reduced ingredients; also, it may be adulterated by poor manufacturing practices.

Eban offers the history of the AIDS’ epidemic to illustrate how generic drugs became supercharged in the 1980s.

Three companies in India and one in South Africa began working with the Clinton Foundation to offer an AIDS’ generic drug that fell to a cost of $.40 per day when patented AIDS’ drugs cost as much as $8,000 per year. Millions of people were at risk, none more than those who live in Africa. However, the effectiveness of the generic drug came under suspicion. It was found that data was being falsely created by India and Africa. It was manufactured data that falsely reported generic drugs effectiveness in treating AIDS. The generic African and India manufacturers were cutting corners in production to increase profits. No one checked the effectiveness of the produced drugs and posted false patient reports. Because the data was not based on patient experience but on falsely created data, it became unclear whether the drug was working. Without any reports showing the generic drug’s effectiveness, incentive grew to continue reducing costs. Manufacturers pushed production, compromised AIDS ingredients, and falsely reported treatment results of patients.

Dinesh S. Thakur (Received the Joe A. Callaway award for Civic Courage in 2014.)

Eban explains how Dinesh Thakur. a former executive at Ranbaxy Laboratories, became a whistle blower who “spilled the beans” on falsely created data sent to the FDA.

Thakur was the Director and Global Head of Research information & Portfolio Management at the Ranbaxy company. He began asking questions of the people reporting the generic AIDS Drug efficacy data. Thakur found that 50% to 100% of information on generic AIDS drug’ efficacy was manufactured and not related to actual use by AIDS sufferers. Ranbaxy Laboratories pleaded guilty of falsifying information in 2003. Ranbaxy agreed to pay $500 million to settle their guilty plea.

Despite the Ranbaxy settlement, the author shows generic drug misinformation is still being produced. Further reviews by FDA inspectors found continuing violations of protocol and testing of generic drug manufacturing and reporting.

Ranbaxy is no longer an independent company. It was purchased by Sun Pharmaceutical Industries Ltd in 2014. Eban explains how FDA inspectors fell victim to India manufacturers malfeasance by accepting luxury hotel accommodations and gifts that clouded their judgement about the companies they were investigating. A bad report from an FDA inspector could and did cost millions of dollars to companies that produced tainted generic drugs.

Eban explains the FDA has changed their policy of giving advance notice of inspections while inferring inspectors are advised to avoid conflicts of interest in their inspections. One takes this inference with reservation because human nature is an immutable force.

The incentive for increased profitability by reducing the cost of manufacturing generic drugs continues to threaten the public. Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.

BEST & WORST OF US

Trump’s mass deportation idea is draconian and inhumane. A system of deportation should be organized to repatriate some undocumented immigrants but not to expel them without fair consideration of their circumstances and the needs of the American economy.

Books of Interest
Website: chetyarbrough.blog

Real Americans

By: Rachel Khong

Narrated By: Louisa Zhu, Eric Yang, Eunice Wong

Rachel Khong (Author, American editor in San Francisco. Born in Malaysia to a Malaysian Chinese family.)

In a 1931 book, “Epic of America”, James Adams described America as a land where life should be better and richer for everyone, with opportunities for each according to their ability or achievement. This was written in the depths of the depression that began with the stock market crash of 1929. Of course, illegal immigration was nearly impossible in the 1930s, but still–there were 500,000 American immigrant arrivals in the U.S. during that decade. That amounted to 11.6 percent of the U.S. population at that time. Rachel Khong’s vision in “Real Americans” tests the next four years of Trump’s administration.

Khong writes a fictional story of a romantic relationship between an undocumented young Puerto Rican woman who is about to be deported and an equally young South Korean American who is falling in love with her.

Both are well educated by the American education system. The boy is interviewing for entrance to Yale while the girl is meeting an immigration lawyer to see what can be done to avoid deportation. The girl lives with a feckless “Wanna-Be actor” father and driven mother who is struggling to make a living in America. The daughter is shown to be quite intelligent with the ambition to become a data analyst.

Mass deportation without fair consideration of immigrant circumstance and their societal contribution is inhumane and foolish.

The developing affection between these two characters is beautifully created by the author. They are an example of why resident status needs to be treated fairly when immigrants are found to violate the immigration laws of the United States.

The idea that immigrants take jobs away from native American workers is a false flag.

The agricultural industry will be seriously impacted by mass deportation of undocumented labor.

The need for workers in America will continue to grow in the foreseeable future of the largest economy in the world. The demographics of an aging American population (that is not replacing itself) requires immigrants to grow and maintain the economy. The two characters of Khong’s story may not be every immigrant but they show how some are the future of American prosperity. Mass deportation of illegal immigrants will harm the American economy.

Immigrants have played a critical role in what America has become.

Khong is just telling a fictional story about American immigration, but it clearly illustrates how political rhetoric devolved into political lies and misinformation about the value of all human beings. America does have a history of Indian and Black murder and enslavement, but it also has a history that ameliorates discrimination and past misdeeds. One hopes the blunt force of immigrant deportation is not a policy that repeats America’s societal mistakes. American needs a carefully adjudicated immigration policy for the betterment of society.

Today, the total percentage, including 11,000,000 undocumented immigrants, is estimated at 14.3%. In the 1930s, 11.6% of the American population was immigrant. The question is whether the undocumented should be deported, regardless of the contribution they make to American productivity.

An aging population in America is not being replaced by native born Americans. Worker loss of undocumented immigrants may be harmful to American productivity.

Trump and his deportation Czar, Tom Homan.

Khong’s story is entertaining fiction, but Trump’s deportation plan is a threatening work in progress.

CULTURE WARS

The tragedy of cultural conflict fills the pages of Frazer’s history of the Mayflower adventure. Listeners are numbed by the many mistakes made by both Americanized English and indigenous natives in an interminable cultural war, a war that is still being played and paid for today.

Books of Interest
Website: chetyarbrough.blog

Hollywood Park: The Mayflower

By: Rebecca Fraser

Narrated By: Kate Reading

Rebecca Fraser (Author, British writer and broadcaster, former president of the Bronte Society.)

In the early years of the 17th century, Puritans fled to America to escape persecution by King James I of England and his mother, Mary Queen of Scots. Though King James was not as much of a doctrinarian as his mother, it was dangerous for non-Catholics to live in England or Scotland. Fraser explains many English Puritans sought refuge in Holland. “The Mayflower” is a history of the first years of the Kingdom of England’s and Scottland’s Puritan settlements in America. Three of the most famous Mayflower’ passengers were William Bradford, Myles Standish, and William Brewster. Both Bradford and Brewster sailed from the Netherlands to England to board the Mayflower. Bradford became the first governor of the Plymouth Colony in America. Myles Standish became the military leader of the settlers. William Brewster was the spiritual leader of Puritan followers.

Fraser explains how Standish became important in the Mayflower’s cramped quarters, rough seas, and limited food. Standish maintained a level of discipline while Brewster provided spiritual support to the Pilgrims and non-religious separatists. The author reveals how shoddy the accommodations were on the Mayflower and how poorly prepared the ship was for such a perilous voyage. Provisioning was inadequate and the ship became overloaded when their sister ship had to return to England because of its unseaworthiness. More passengers were added to the Mayflower when the sister ship headed back to England. There were no doctors on board. A baby was born with the help of a mid-wife. Fraser gives one a picture of a two-month voyage that was hellish. Five of 102 passengers died at sea.

Upon arrival, survivors were faced with November winter conditions.

Forty-five of the 102 passengers died from a lack of shelter, poor rationing, and cold temperatures. The Mayflower was used as a shelter for much of the winter. No Native Americans greeted the travelers when they landed. It was March before an English-speaking Native named Samoset from the Wampanoag tribe met and talked to the settlers. Samoset introduced another English-speaking Native named Tisquantum, aka Squanto. Squanto taught the newcomers how to grow corn, catch fish, and find edible plants. Without that help, one doubts even these 57 settlers would have survived.

Fraser reveals the complicated relationship between settlers and indigenous natives.

In some ways it reminds one of the difficulties America has had with interventions in modern foreign countries. Not living the life of other cultures, the threat of losing a native’s way of life, and innate suspicion of those who are not like you, creates misunderstandings and conflict. These are conflicts within America today; let alone relations with other nations in modern times.

As Fraser continues her history of America’s newcomers, differences in cultural beliefs, whether religious or secular, show why all nations in the world are challenged by difference.

Two indigenous natives, Samoset and Squanto, opened the door of communication between cultures. Squanto learned English because of his capture by John Smith’s men in 1614-15 with the intent of enslavement. Squanto escapes and returns to his native land. Because he could speak English, despite his kidnapping, he used what he learned to help settlers know how to plant corn, fish, and hunt beaver for survival.

Indigenous native cultures evolve with the influence of the Puritan settlers. They adopt a conception of Kings that rule over others.

Two Indian brothers rose to the level of kings in the Wampanoag tribe of New England. They were the sons of chief Massasoit who saved the pilgrims from starvation by helping them understand how to cultivate the land and fish for survival. As the pilgrims multiplied, human nature led to conflicts between indigenous natives and themselves. Though the initial source of value exchange began as wampum (shell bead), it evolved to printed currency which changed the nature of life, labor, and trade.

Human nature is freighted with the desire for money, power, and prestige.

Those desires lead to conflicts between native cultures and the Pilgrims. The desire for land began to infringe on the culture of native tribes. Soon, these conflicts escalated to war between English settlers and leaders of native tribes. Fraser details the rise of King Alexander and King Phillip of the Wampanoag tribe that began to organize against the settler’s encroachment on native lands. Alexander is killed but his brother becomes a great leader among many indigenous natives and begins what seems an interminable and savage war against the settlers. The savagery on both sides escalates with scalping, dismemberment, and pilloried heads on spikes.

NARCISSISM

Jollett concludes his memoir by arguing his mother is a narcissist. Who is the narcissist in “Hollywood Park: A Memoir”? Mikel Jollett fails to understand how difficult it is for a single mother to raise children on her own.

Books of Interest
Website: chetyarbrough.blog

Hollywood Park: A Memoir

By: Mikel Jollett

Narrated By: Mikel Jollett

Mikel Jollett (Author, American musician, frontman for Airborne Toxic Event.)

Narcissism is an excessive sense of self-importance and a lack of empathy for others. Though Mikel Jollett shows skill as a writer, his assessment of life as a child grown-up exhibits a personal blindness about the hardship of single parents.

Every child has a story. This is a memoir of Mikel Jollet’s life. Jollett’s story is about his family that joined what became a cult in the 1960s. It was called Synanon, a rehab program in Santa Monica, California for addicts that began in the late 1950s. The rehab program evolved into a religious movement. As it became a religious movement, its harsh policies drove some residents to flee. Jollett’s story is about leaving with his mother and brother when he is five years old.

Jollett’s mother leaves the Synanon commune and the father of her children to return to her parent’s house to re-start her and her children’s lives.

To Mikel, leaving was a dramatic break from the Synanon way of life and a father he misses. Jollett’s father was an addict and former convict who lived what seems a vagabond life until he joins Synanon. Mikel’s mother decides to secretly escape with her two boys as the Synanon life became more and more harsh. Despite its growing religiosity and authoritarian milieu, Synanon survives until 1991 when it faces numerous legal issues related to forced sterilizations and violence toward members.

As a single parent, Mikel’s mother struggles to regain an identity and her own life.

Some of the religious teaching at Synanon appears to have remained with her. After living with her mother and father in California, she chooses to move to Salem, Oregon. The move is motivated by the high cost of living in California and a job she finds in Salem. After some time in Salem, she meets a reformed alcoholic who comes to live with her and the boys. Mikel grows to like the reformed alcoholic, but his mother’s new companion falls off the wagon and leaves the boys and their mother. He returns sometime later, only to leave again.

Bonnie who was close to Mikel when they lived in the Synanon community became a companion with Mikel’s father in California.

The boy’s paternal father remains in California and eventually looks up his wife’s children in Oregon. Upon visiting the boys in Salem, he tells them they will be invited to visit him in California, where he lives near the beach. In their first visit they become reacquainted with Bonnie who had been in the Synanon program. Mikel had been emotionally attached to the woman when at Synanon, so he was pleased to see her.

Mikel reminds reader/listeners that many children in America are not raised in “Leave to Beaver” families.

Life is a struggle for most children, even in unbroken families. Being raised in a single parent home, particularly when the single parent is a woman is harder because of societal inequality. Mikel and his brother are boys, so they have better chances for breaking poverty’s cycle, but their mother is faced with greater obstacles. Mikel’s story shows a better chance for success than some children raised by a single parent because of a precocity recognized by the principal at his school in Salem. Precocity is no guarantee of success but being a male and smart are significant advantages.

Mikel and his brother, Tony, had older brother/younger brother conflicts.

Tony, as the older brother, was sometimes cruel or uncaring about his younger sibling. As Mikel grew older, he found ways to punish his older brother for his cruelty. As they matured, they reconciled but both left their mother to live with their father in California. The baggage their mother had from her experience at Synanon, her husband’s abandonment, and the circumstances of poverty became too much for Mikel to understand the trials of being a single mother with two children. Mikel’s judgement is that his mother was too narcissistic.

Sexual inequality are two strikes against women in life. Some women overcome great odds to become economically independent; most do not.

Women struggle with life’s inequality in ways that escape understanding of masculine society, i.e., particularly male children who live with a single mother’s nurturing through the formative years of their lives. Divorced or abandoned mothers often do what they must do to raise children that fathers mostly neglect during the formative years of life. Male parents escape responsibility by leaving their children with mothers. Ex-husbands have the privilege of regaining an independent life in a world that offers better opportunities for men than women. They often re-marry which is what Mikel’s father does.

Jollett concludes his memoir by arguing his mother is a narcissist. Who is the narcissist in “Hollywood Park: A Memoir“? Mikel Jollett fails to understand how difficult it is for a single mother to raise children on her own.

AMBITION

It takes more than ambition to build a successful organization or company. Unless one is a genius who can continually innovate, it takes management structure that encourages others to innovate and work for a common organizational purpose.

Books of Interest
Website: chetyarbrough.blog

Bad Blood (Secrets and Lies in a Silicon Valley Startup)

By: John Carreyrou

Narrated By: Will Damron

John Carreyrou (Author, French-American investigative reporter for the NY Times)

Ambition is the strong desire or drive to achieve something. The public story of Theranos is examined by investigative reporter, John Carreyrou. His subject is Elizabeth Holmes, a bright young woman who drops out of Yale to pursue an idea. Her idea is to create a blood testing system intended to diagnose medical conditions with potential for measuring effectiveness of drug treatment for existing disease. Her ability to sell an idea exceeded her ability to organize a company to create a product that accomplished that end.

Most companies or organizations will either fail or stagnate when led by only one innovator. There are exceptions but it requires an extraordinary leader, like a Steve Jobs, Ginni Rometty, Mary Barra, or Elon Musk. Their leadership skills may rub people the wrong way, but they have a superior perception of reality that is not singularly based on loyalty. They have the innate ability to offer enough innovation to grow their companies. (At the risk of offending supporters, loyalty is the threat of Trump’s management style. Trump principally bases his organizational decisions on loyalty.)

Elizabeth Holmes may have had a great idea, but her poor management skills are appallingly revealed in Carreyrou’s interviews with former employees of Theranos.

The only consistent management criteria practiced by Holmes is loyalty. If an employee appears disloyal to her vision of the company, they are fired. Any organization that principally relies on loyalty discourages innovation and becomes entirely dependent on orders of its leadership. Particularly in the tech industry, innovation is critical.

Elizabeth Holmes misled investors, patients, and doctors. She is convicted for fraud and conspiracy in 2022. She is serving an 11-year sentence in a Federal Prison Camp in Bryan, Texas.

Holmes’ ambition, in addition to her prison sentence, led to a $500,000 SEC’ fine and the return of 18.9 million shares of a company that no longer exists. Furthermore, the SEC ordered a ten-year ban on serving as an officer or director of a public company which, of course, becomes moot with her imprisonment. The irony of Carreyrou’s story is that Holme’s idea is presently being pursued by Babson Diagnostics, Stanford Researchers, and Becton Dickinson. Whether she will ever reap any reward from another company’s success seems remote, but it will presumably be based on patents filed, and licensing agreements based on former Theranos patents.

“Sunny” Balwani was also tried and convicted for Theranos’ misdeeds.

The 16th century phrase “birds of a feather flock together” comes to mind when Ramesh “Sunny” Balwani joins Theranos in 2009. He had loaned the company $13 million but he also knew Holmes from her days when she was learning Chinese in a Stanford summer program. At some point they became lovers despite a 19-year age difference. Carreyrou notes Balwani became a multi-millionaire with the sale of his tech company, Commerce One” in 2000. He was convicted of tax evasion for the sale but claimed the evasion was caused by his tax accountant which he sued for recovery for back taxes he had to pay. (There is a settlement amount between the tax accountant and Balwani, but it is not revealed.) Carreyrou explains Balwani was a martinet who brooked little disagreement when he became COO of Theranos in 2009. (Part of Holme’s defense was that Balwani was the principal behind Theranos misdeeds, but the court obviously disagreed.)

In 2022, Balwani was sentenced to 13 years in a federal prison for his involvement in what is characterized as Theranos fraudulent activities.

There are business management lessons in Carreyrou’s book about the misdeeds of Theranos. It takes more than ambition to build a successful organization or company. Unless one is a genius who can continually innovate, it takes management structure that encourages others to innovate and work for a common organizational purpose.

CATACLYSMIC EVENTS

The elephant in this room is damage to the Fukushima Daiichi nuclear plant that is considered among the worst nuclear disasters in history, i.e. right alongside Chernobyl.

Books of Interest
Website: chetyarbrough.blog

Ghosts of the Tsunami: Death and Life in Japan’s Disaster Zone

By: Richard Lloyd Parry

Narrated By: Simon Vance

Richard Lloyd Parry (Author, British foreign correspondent, Asia Editor of “The Times of London”.)

In 2011 the 9.0 Tōhoku earthquake and its subsequent tsunami killed over 18,000 people with injuries to an estimated 6,000 more. Over 123,000 homes were destroyed. The estimated cost of the disaster is the equivalent of $220 billion American dollars. Richard Parry explains Japan’s Prime Minister lost his job because of the disaster and influenced the loss of a second Prime Minister’s position. The highest disaster cost in America was Hurricane Katrina at an estimated $125 billion in 2005. No natural disaster in America has caused as many deaths as Japan’s earthquake and tsunami.

Richard Parry offers a primer on what a person should expect when a natural disaster disrupts their lives. Every continent is subject to either natural or manmade cataclysmic events. In terms of the cost of human life and reconstruction, only war exceeds the loss of life that occurred in Japan’s 2011 earthquake and tsunami. Like recent wars in Ukraine and Gaza, the most heartbreaking consequence is the death and crippling of children. Parry explains what happened in a Miyagi Prefecture grade school that exemplifies the social and personal consequence of a natural event that rivals the bombing of Hiroshima and Nagasaki.

hiroshima - ant walkers — The aftermath of Japan’s nuclear blasts left thousands of people with few apparent injuries. They wander in a fog of confusion, like ants in long lines following each other, single file to nowhere. They were, as Pellegrino explains, the “ant walkers”.

Though there are no wandering ant or alligator people from a nuclear bomb blast, there are thousands of Japanese who undoubtedly still suffer from the loss of their children, family, and friends from the 2011 tsunami. It is most clearly evident in Parry’s detailed story of the Okawa elementary school. Many survivors are shown to blame school administrators, and the government for their failure to protect their children. The truth is that every disaster is responded to by imperfect human beings. Blaming someone for the death of innocents is a natural human response to things beyond one’s control. It is simple to look back on a disastrous event and find the mistakes made by those who are the adults in charge. There is a human catharsis in being able to blame someone for the death of a loved one.

Humans will always make mistakes in dealing with disasters because they are human.

The decision by school administrators to not abandon the school for higher ground seems taken out of context. There is snow on the ground, it is cold outside, and the school’s location is approximately 2.5 miles from the sea. To the administrators, it appears protection of the building seemed more important than moving to higher ground, in the cold and snow, a mistake that caused the death of 74 children.

Perry interviews many who survive the disaster. Their stories are heartbreaking. Some parents have never found their children.

An estimated 132 bodies remain unidentified with at least 2 children’s remains are unfound.

The vision of survivors sifting through mud and debris to find layers of children’s bodies stays in one’s mind as they listen to Perry’s book.

The families of 23 children who died at the school were awarded compensation of $12.8 million equivalent U.S. dollars with a judgement saying the school failed to evacuate students to higher ground when the tsunami became knowingly imminent. The decision was based on a loud-speaker government warning for the school to be evacuated. Perry notes there were evacuation plans at the school, but they were inappropriate for a tsunami that requires high ground. The adult teachers were given enough time after the loud speaker noticeto evacuate the children to a nearby hill. They could have survived.

The court’s decision is based on the truck-delivered speaker’ warning that is ignored by the school’s adult supervisors.

Some argue the significance of that ruling in Japan is the mandated creation of disaster-preparedness’ plans for school evacuations in a crisis. This school had a written plan, but it did not properly prepare for the consequence of a tsunami. The final warning is the basis for the three-judge panel’s decision, but the truth is any plan still depends on the judgement of adult school’ supervisors.

The elephant in this room is damage to the Fukushima Daiichi nuclear plant that is considered among the worst nuclear disasters in history, i.e. right alongside Chernobyl.

POWER IN INTIMACY

Purnell’s biography implies the drive to succeed for women is based on intimacy rather than inherent human equality. Though that is not the intent of Purnell, intimacy has historically been the avenue women have had to take in society to open opportunity’s door.

Books of Interest
Website: chetyarbrough.blog

Kingmaker (Pamela Harriman’s Astonishing Life of Power, Seduction, and Intrigue)

By: Sonia Purnell

Narrated By: Louise Brealey

Sonia Purnell (Author, British journalist, worked at the news magazine “The Economist”)

Every writer is influenced by the country in which they were born. Sonia Purnell writes an interesting biography of Pamela (Digby-Churchill) Harriman in “Kingmaker” but from the perspective of a British journalist. This is not to argue Purnell’s interesting perspective is wrong but that there is a spin that is nationalist, more than objective, about Pamela Harriman’s life.

During the beginning years of WWII, America avoided the war until Pearl Harbor when it became clear that a policy of isolationism would not work.

The reluctance of many American businessmen and industrialists like Joseph Kennedy and Henry Ford would not see Hitler for what he was, a fascist racist planning to dominate as much of Europe as Germany’s war machine would allow. Some in the American government, like Franklin Roosevelt, understood Hitler was a threat to all of Europe if not America. Roosevelt maneuvered the government to support England with a Lend/Lease program to defend themselves against German aggression, despite a political majority’s desire for isolationism.

A SIDE NOTE: Donald Trump believes a negotiated settlement to cease hostilities, even with losses for Ukraine, is best for America. Trump reminds one of Joseph Kennedy and Henry Ford who implied peace and appeasement would avoid war.

Getting back to Purnell’s history of Pamela Harriman, Purnell explains the important role Pamela played, before Pearl Harbor, that mobilized America’s entry into the war. Pamela Harriman is unquestionably an English patriot. Her close relationship with Winston made her an ideal conduit and influencer in smoothing the relationship between America and the British government. The intimate relationship she developed with Harriman is a tribute to her contribution to the formation of an allied force to defeat Germany.

The massive Lend-Lease program is created in the late 1930s because of the Neutrality Acts that kept America out of direct engagement in the early days of WWII.

The program began in 1939 as a cash and carry program that evolved into a Lend-Lease program in 1941. American could lend or lease military equipment and supplies to any country that allies themselves with the U.S. if it were to enter into the war. The United Kingdom, Russia, and China were considered crucial to any alliance that might be created to defeat Germany. The complexity and logistics of Lend-Lease required astute management by American managers. Harry Hopkins was its first administrator, but Averill Harriman was needed to become a diplomatic political expediter for the process.

Purnell argues the political process in the American/United Kingdom relationship was smoothed and improved by Pamela Digby Harriman who was married to the son of Winston Churchill, Randolph Churchill.

Randolph has at best, a mixed reputation. He was a heavy drinker, reckless, and rude. He was married and divorced twice and had gambling problems that were a constant debt problem that disrupted Pamela’s life. She became closer to Winston Churchill than to her husband and became much more politically involved and astute than her husband in government affairs. That experience made her a perfect match for building a closer relationship with Avrill Harriman that became an affair between two married adults. Harriman was twenty-eight years older than Pamela but had a reputation as a suave ladies’ man.

Purnell reflects on the many affairs of Pamela Churchill Harriman beginning with Averell Harriman, then Edward R. Murrow, and proceeding to John Hay Whitney, Prince Aly Khan, Gianni Agnelli, Alfonso de Portago, Baron Elie de Rothschild, Frederick L. Anderson, Sir Charles Portal, and William S. Paley. The story becomes stale.

There is a cloying sense of unfairness in “Kingmaker ” because Pamela’s skill seems trivialized by her sexuality.

Pamela simply wanted an equal opportunity to succeed in the pursuit of money, power, and prestige, i.e. all the secular objectives men take for granted. Purnell’s biography implies the drive to succeed for women is based on intimacy rather than inherent human equality. Though that is not the intent of Purnell, intimacy has historically been the avenue women have had to take in society to open opportunity’s door.

BRAIN SURGERY

Two points that offer the greatest value in Schwartz’s history of brain surgery is that those who survive become different human beings, sometimes disabled or cognitively impaired. The second–those who need a neurological operation should look for an empathetic doctor who limits his/her excision of brain matter to what science knows of its consequence.

Books of Interest
Website: chetyarbrough.blog

Gray Matters (A Biography of Brain Surgery)

By: Theodore H. Schwartz

Narrated By: Sean Pratt

The largest part of Dr. Schwartz’s book is about the history of brain surgery. The first chapters address his education for brain surgery and the history of well-known Americans who died or might have survived from its practice. It addresses the consequences of brain trauma of modern times but leaves tumor and disease treatment for the remaining chapters. “Gray Matters” is about the 19th and 20th century history of brain surgery, how it evolved, and the pioneers who most influenced the author. Schwartz personalizes brain surgery by explaining how he treated what he estimates to be over 10,000 patients.

William Macewen (1848-1924) Scottish surgeon who pioneered neurosurgery,
Harvey Cushing (1869-1939) American neurosurgeon–father of modern neurosurgery,
Wilder Penfield, (1891-1976) American-Canadian neurosurgeon–noted for mapping the brain,
Carl-Olof Nylén (1892-1978) Swedish otologist who pioneered microsurgery with a surgical microscope he designed,
Wolfgang Draf (1940-2011) German otolaryngologist who pioneered Skull Base Surgery using sinuses as the avenue of entry to the brain.

Schwartz identifies Wiliam Macewen (upper left photo) as the pioneer of neurosurgery. He notes Harvey Cushing (upper right photo) is referred to as the “Father of Modern Neurosurgery”. Cushing was the first to employ X-rays to diagnose brain tumors and introduced the use of the elector-cautery device to minimize blood loss during surgery. Dr Wilder Penfield (middle left photo), a Canadian neurosurgeon pioneered brain mapping by stimulating the brain with mild electrical shocks. Brain mapping gave neurosurgeons a guide that let them know what areas of the brain would be affected when making decisions on diseased tissue removal. Microsurgery on the brain is pioneered by Carl Nylen (middle right photo) in the early 1900s. In modern times, Dr. Wolfgang Draf (bottom photo) began using a skull cap microsurgery device to remove brain tumors through nasal passage access. This less intrusive form of brain surgery is used and detailed by the author.

Dr. Kris S. Moe (Board certified surgeon at UW Medical Center, University of Washington Facial Plastics and Reconstructive Surgery.)

Schwartz explains one of his most important training experiences was in Seattle Washington with Dr. Kris S. Moe. Moe pioneered what is called transorbital neuroendoscopic surgery (TONES) that influenced the field of minimally invasive neurosurgery. Schwartz explains how Moe would test patients during an operation to identify areas of the brain being affected during treatment for tumor removal. Schwartz gave the example of a series of pictures shown on a monitor seen by the patient during surgery. The patient is asked to name the object in the picture as the surgeon is operating to determine whether the tumor being excised affects his/her ability to identify the image. In Schwartz first attendance at one of these surgeries, he accidentally spilled the pictures across the operating floor. Moe directed him to reassemble the pictures and went on with the surgery when they were reassembled. The embarrassed Schwartz admired Moe because he never brought the incident up after it happened and completed the operation without criticizing Schwartz.

BRAIN TRAUMA

Schwartz’s book implies the NFL’s prevention and protocols for brain trauma are a cost of doing business. Sadly, this seems similar to the American public’s misinterpretation of the “right to bear arms” and its resistance to gun control.

Books of Interest
Website: chetyarbrough.blog

Gray Matters (A Biography of Brain Surgery)

By: Theodore H. Schwartz

Narrated By: Sean Pratt

Theodore H. Schwartz (Author, American medical scientist, academic physician and neurosurgeon.)

“Gray Matters” feeds a curiosity for those interested in the human brain. Written by a brain surgeon, it offers a clearer understanding of brain function while offering insight to the causes and consequences of brain trauma. The author has treated many patients with brain infections and trauma and offers analysis of athletic, gun-related, and accident injuries of people who have died from or survived brain trauma.

Schwartz explains the arduous education for one to become a brain surgeon and how physicians surgically treat brain disease and trauma.

He explains how long hours as an intern are required after spending years to become an academically qualified physician, let alone surgeon. Not only are the hours long but acceptance into an internship is highly competitive and difficult to achieve. That seems counterintuitive in view of the public’s need for qualified medical help. One suspects the fundamental cause is the cost to the hiring hospital and the staffing required to teach new physicians.

The brain is protected by a skull, three layers of membrane, cerebral spinal fluid, a blood barrier, skin, and a scalp.

These structures, cells, and tissues protect the brain from physical damage and infections so the brain can provide organic function, thought, and action. Physical or infectious damage to the brain can affect any one of these natural human’ functions.

Schwartz reviews incidents of gun-shot brain trauma of famous figures like Abraham Lincoln, John F. Kennedy, Robert Kennedy, James Brady, and Gabrielle Giffords. He notes the differences in the bullets used as well as the power of the weapons to explain the damage done. He argues John Kennedy had no chance of survival while suggesting Lincoln, because of a lower power weapon, might have survived with today’s advances in treatment. However, he suggests Lincoln would have lost much of his skill as an orator and political theorist because of damage to a particular part of his brain from Booth’s attack. Schwartz believes Robert Kennedy might have lived with more rapid and qualified treatment but would have been physically and mentally disabled. James Brady, Ronald Reagan’s press secretary, lost speech clarity and physical mobility because of his brain trauma. Similar consequences occurred with Gabriell Giffords’ injuries, but she relearned how to walk, talk, and perform basic tasks. Schwartz notes the only positive political accomplishment to come out of these violent acts was the Brady Handgun Violence Reform Act.

Schwartz goes on to explain non-traumatic brain injury from infection and stroke to traumatic brain injury from Shaken Baby Syndrome (SBS) to Chronic Traumatic Encephalopathy (CTE) with Second-Impact Syndrome often seen in athletes. Diagnosis of SBS from a shaken baby’s head has changed to include the shaking accompanied by impact with a hard surface.

Diagnosis of CTE and Second-Impact Syndrome in sports are still being defined. The return of football players to the field of play is a judgement call by a sideline physician which raises questions about qualifications, let alone judgement.

The NFL initially objected to the brain trauma threat of their sport based on improved protective equipment.

However, Schwartz writes they have increased their protocol for injured players and have paid over a billion dollars to former athletes suffering from symptoms of brain trauma. Some big names in football like Junior Seau, Frank Gifford, Ken Stabler, and Tommy Nobis were autopsied after their death to show they suffered from CTE.

The lure of fame and money are unlikely to change elite athletes desire to compete despite the threat of brain injury. Schwartz’s book implies the NFL’s prevention and protocols for brain trauma are a cost of doing business. Sadly, this seems similar to the American public’s misinterpretation of the “right to bear arms” and its resistance to gun control.

FOUR MORE YEARS

Andrew Leigh’s brief history of economics reminds listeners of a threat America faces in the next four years.

Books of Interest
Website: chetyarbrough.blog

How Economics Explains the World (A Short History of Humanity)

By: Andrew Leigh

Narrated By: Stephen Graybill

Andrew Leigh (Author, Australian politician, lawyer, former professor of economics at the Australian National University, currently serving as Assistant Minister for Competition, Charities and Treasury and Assistant Minister for Employment in Australia.)

Andrew Leigh offers a bird’s eye view of the history of economics. He provocatively explains why the European continent, rather than Africa (the birthplace of the human race) came to dominate the world. He suggests it is because of economics and the dynamics of the agricultural revolution.

Because Africa offered a more conducive environment for natural food production, Leigh infers natives could live off the fruits and nuts of nature. He infers farming and agricultural innovations (like the plow) were of little interest to Africans.

One may be skeptical of that reasoning and suggest the primary cause is sparse arable land for early African inhabitants. Without arable land, there was little advantage from the agricultural revolution.

Nevertheless, Leigh’s history is a wonderful reminder of great economic theories that improved the lives of an estimated 8.2 billion people on this planet. He touches on the lives of Adam Smith, David Ricardo, John Maynard Keynes, and Milton Friedman. Each made great contributions to the history of western economics.

Adam Smith is considered the father of modern economics. (1723-1790)

Leigh notes Smith was a deep thinker who sometimes neglected the world he lived in by forgetting to properly dress himself or falling into a hole while thinking about economic theories. Some of his key theories were “Division of Labor”, the “Invisible Hand”, “Labour Theory of Value”, “Free Markets and Competition”, and “Capital Accumulation”; all of which remain relevant today. One that seems so important today is “Free Markets and Competition” and the disastrous idea of tariffs that are being promoted by the pending Trump administration.

Smith notes natural resources are not equally distributed in the world. Some countries have more raw material than others, more available labor at a lower cost, and can produce product at lower prices. With free trade, all citizens of the world are benefited by lower costs of goods. With tariffs, product costs are artificially increased when they could reflect actual costs of production. Of course, the producer can increase costs, but the market will find an alternative if the costs become too high.

David Ricardo (1772-1823)

Ricardo’s theory of competitive advantage suggests some countries can produce product at less cost than others. This reinforces the critical importance of free trade. Free trade flies in the face of both the Biden’s passing administration and Trump’s future administration; both of which believe tariffs protect jobs in America. They don’t; because tariffs artificially increase product costs while protecting labor inefficiency that increases consumer prices. Tariffs are a lose-lose proposition. It may affect jobs in the short term but there are many jobs that can be created by government and private companies in human and public service industries. Those investments would offset inefficient product production and ensure future jobs.

John Maynard Keynes (1883-1946)

Leigh notes that Keynes was bisexual and a pivotal figure in modern economics. He believed in the theory of Aggregate Demand meaning that “…spending in an economy is the primary driver of economic growth.” He advocated government intervention when demand was low, and that government should increase spending and cut taxes to increase demand when a recession or depression threatens the health and welfare of the public. Interestingly, Trump believes in reducing taxes but objects to government spending that improves employment. The effect of reducing taxes only increases income inequality and does little for employment because the rich are wary of investing in a weakening economy.

Milton Friedman (1912-2006)

Both Keynes and Friedman believe in government intervention, but Friedman exclusively believes in using only monetarism as a tool. Keynes agrees but had the added dimension of government spending that creates jobs. In contrast, Friedman argues there is a natural rate of unemployment and when government intervenes it creates inflation. He strongly agreed with free markets which suggests he would be against tariffs but at the expense of higher unemployment. The cloying part of that argument is it increases income inequality by making the rich richer, the unemployed and middle-class worker poorer.

Leigh’s book is a brief review of western economics. It glosses over much of the science, but it is highly entertaining and worth listening to more than once. Additionally, Andrew Leigh’s brief history of economics reminds listeners of a threat America faces in the next four years.

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