CEO Salaries vs Value and Competence

A few weeks ago, I stumbled into a bizarre discussion about Apple CEO Tim Cook’s 2023 salary “cut” (from $83 million in stock awards, $12 million in incentives and $3 million in salary to $49 million in total compensation for 2023). I argued that it would be impossible for one person to be worth anything near Cook’s 2023 income, let alone the insane compensation he received in 2022. A couple of “CEOs” (“Chief Extortion Officers”) argued that Cook should be compensated based on Apple’s performance (Since “Cook took over as CEO in 2011, Apple stock has returned 1,212% versus 290% for the S&P 500”). One self-described CEO wrote, “When you look at how much his salary is compared to the worth of the company, he's being paid a small % of the worth of the company he's leading and his guidance and decisions are what drives the company and shares.”  Hilarious.  Anyone stupid enough to believe a CEO has ANYTHING at all to do with a company's performance deserves to be beaten to death with a handful of wadded-up preferred stock.  

Cook has been compensated with well over a billion dollars since 2011. I would argue that, mostly, the company’s performance represents how repressed the engineers and designers had been under Jobs’ deranged “leadership” and general megalomania. As for stock value, Apple stock is valued at 10X it’s 2011 price which is impressive but not anything close to exceptional for tech companies during that period. I’ve known and “worked with” (in quotes, because none of the CEOs I know ever did a moment of productive work) a solid dozen CEOs from $20-50M/year to $500,000,000/year corporations and I have yet to see any of them do anything that would positively effect the company’s bottom line.

I am entertained by the idea a CEO’s compensation should be based on the company’s performance or value. It’s pretty obvious that the flotsam and jetsam that bobs to the top in the sewers of corporate politics never make that argument when their companies’ stock tanks. This is just more of the Harvard MBA “pull credit up and push blame down” tactic. If there were a financial connection between CEO performance and income, there would be a bunch of ex-CEOs littering the nation’s homeless camps.

John Carreyrou’s Bad Blood: Secrets and Lines in a Silicon Valley Startup tells a different kind of story about the kind of halfwit who floats to the top of corporate toilet bowls. Assuming you don’t believe that Elizabeth Holmes exerted some kind of magical witchcraft on the susceptible minds of executives from Safeway, Walgreens, the US Army’s General James Mattis, Henry Kissinger, George Shultz, Jim Mattis, Rupert Murdoch, the Walton family, the DeVos family including Betsy DeVos, the Cox family of Cox Enterprises, Carlos Slim Helú, Larry Ellison and several dozen tech-venture capitalists, a passel of idle rich wannabes, and way too many technical employees who should have known better, it’s pretty obvious that most rich people got that way through luck. Holmes only “qualification” as a biotech entrepreneur was her physical attractiveness and some pretty shaky presentation skills.

50 years ago, I was a young, gullible electronics tech who fell for the promises of an employer who eventually ripped me off for several tens of thousands of dollars. For a couple of years I worked closely with this character, following him to trade shows, county and state fairs, and on-site watching him con all sorts of customers (all rich farmers and ranchers) into equipment they didn’t need and would never figure out how to use. Often, at the fairs, my boss would wander around the other vendor booths and he’d buy the dumbest shit. In the end, I realized that (like most salespeople) he believed his own bullshit and when he heard the same lines from someone else he’d fall for it every time. His main “skill” was being in the right place at the right time with a big pile of cash his father had handed him in hopes that he’d find his idle way in the world.

As I read Bad Blood, I saw my small town boss over and over again. Except now he was wearing handmade Italian suits, driving overpriced Eurotrash cars, and taking meetings where he’d hear presentations from other rich people who didn’t know what they were talking about.  But that wasn’t a problem for him because he never knew what he was talking about, either. Hundreds of millions of dollars flowed out of the hands of these rich farmboys (and girls) into the hands of a couple of con artists pretending to be sophisticated biotech engineers. Worse, they weren’t even doing a good job of pretending to be engineers or biologists.

George Santos is another example of how easily the so-called “sophisticated” crowd can be fooled. It wasn’t just the usual bimbo Republicans who fell for that bumbling con artist. The so-called, self-styled sophisticates of New York’s Long Island were easily duped by a dude who couldn’t sell watches in a Midwestern shopping mall. So if you are intelligent enough to realize that you were conned by Ronnie Reagan, G.W. Bush & Co, or Maralardo, don’t feel bad. You’re in the “good” company of the nation’s oldest, richest, and most educated “talent.”

An un-surprising postscript about the Theranos scam is that neither Holmes or her chubby Indian co-conspirator, Ramesh "Sunny" Balwani, have spent a day in jail, as yet. Supposedly, Holmes will surrender to prison authorities sometime in April for an 11 year sentence. In the meantime, she’s puking out her 2nd baby and living the high life at her $135 million Silicon Valley estate. She supposedly married William "Billy" Evans, an idle rich heir to the Evans Hotel Group, and they’ve spawned two pups. She used her 2nd spawning to put off her trip to prison after she and Evans failed to pull off a one-way trip to Mexico before sentencing.

Men’s Reproductive Rights and Other Fantasies

Back in the 60’s, when I was about 15 or 16, I read an article about vasectomies. My father and step-mother were two of the most unsuited-for-parenthood humans who ever lived and by the time I was 17 I was pretty certain those genes had been passed on to me; and, most likely, my siblings.. Like most college kids of my generation, I had a health insurance policy that was an add-on to my tuition and I asked a local doctor for information about how I might go about getting a vasectomy. He wouldn’t even discuss the possibility and even told my father what I’d asked him. Telling my father wasn’t as much of a deal as it could have been, but by then I had been living on my own for a couple of years and my father’s outrage, if there was any, wouldn’t have been particularly influential or important to me. However, I did feel totally disrespected by that doctor and have not been a big fan of American medicine (one of the world’s most cynical oxymorons) since.

While I was looking for something completely different, I stumbled on this Chicago Tribune article, “Young, Single Men Choosing Vasectomies.” I sort of hoped that times had changed and that meant men were being allowed as much reproductive freedom as women have today. I was wrong.

This piece of “information” was presented pretty early in the article,, “’While any man older than 18 can legally get a vasectomy, doctors can turn men down if they don't believe them to be mature or sure enough of their future plans.

“’I received a call from an 18-year-old high schooler, and that was a no-no,’ said Dr. Arif Agha, owner of the Vasectomy and Reversal Center of Chicago, in Oak Brook, Ill.”

Seriously? A doctor who uses the phrase “a no-no” is considered adult enough to make decisions for other men? That half-wit shouldn’t be allowed to play with butter knives.

The article pretty much established that nothing significant has changed in at least the last 50 years. In 1973, after our 2nd child was born, I found a urologist in Amarillo, Texas who would at least interview me about the possibility of a vasectomy. Most likely, my wife would have continued popping out babies until it was no longer possible, but I was working 80-100 hours a week to provide for our family, pay the hospital bills, and keep the rest of the wolves at bay. Any life I had visualized for myself at that point was clearly in the pipedream category, but I needed to gain some control of how far down that rabbit hole I could be driven. What I learned in that interview was that, according to the doctor, Texas law would allow him to perform the operation if I had already fathered two children (check), I could get my wife’s written permission (maybe checked), and she would be present at his office the day of the surgery to ensure her agreement.

I have two brilliant daughters and one brilliant granddaughter. In many ways, because of them I have been a “feminist” all of my life. However, when it comes to issues like birth control and abortion, I’m on the sidelines. If men can’t decide their own reproductive fates, mostly due to idiot arguments like the claim that young men are five times more likely to want a reversal surgery than are men over 50 (even those the total number who do want that surgery is below 5%), I’ll wait till this is an equal opportunity debate. Still today, “while any man older than 18 can legally get a vasectomy, doctors can turn men down if they don't believe them to be mature or sure enough of their future plans.” When characters like Agha and his ilk are allowed to decide when another man is “mature,” men are not on anything resembling equal footing with women’s reproductive rights.

I recently discovered that Planned Parenthood facilities, occasionally, provide vasectomy services. Disgustingly, the Affordable Care Act requires most insurance plans cover birth control with no out-of-pocket costs, but that does NOT include vasectomies. Supposedly, some plans do provide minimal coverage, but I couldn’t find any evidence of that in Minnesota, for example. The Rochester, MN (home of the Mayo Clinic) PP offices provide no services for men. There are several facilities in Minneapolis/St. Paul that offer “Men’s Health” services, but drilling down into the websites of those specific facilities I found no evidence that vasectomies were among those “services.” I would love to be a contributor to Planned Parenthood’s mission. I am a member of the Zero Population organization and absolutely believe that the average human’s reproduction has nothing of value to offer to either the species or the planet. There are eight billion of us now, which is about seven billion more than the planet can sustain. I asked Planned Parenthood if it is possible to commit a contribution to men’s reproductive services and received a solid “no.”

Repeated studies have found that “Although children in the house make men less happy, just being a father has no appreciable impact on men's happiness.” Women are equally (or more) unlikely to be happy as mothers. That pretty much flies in the face of the propaganda men are fed about the “fulfillment” of being a parent. There are societal interests in reproduction, but individual interests are being steamrolled for those interests and the fact is that the overwhelming majority of humans (men and women) are lousy parents and should not be allowed to be occasional babysitters, let alone parents. Until both sexes have complete control of their reproductive rights, it is delusional of society to imagine that children are going to be wanted, happy, and secure in their homes and the costs of that are astronomical.

What American Medicine Does and Doesn’t Do

A recent article in a terrific reoccurring physician’s column in the Duluth Reader titled, “14 Lies that Big Pharma and Their Academic Psychiatrists Teach Medical Students” that details the many fables and fairy tales Americans believe about what the FDA does and doesn’t do. (Hint: What it doesn’t do is insure drugs and devices are safe for use.) This particular article is about the delusions Americans regarding the safety and effectiveness of the drugs and devices approved by the FDA. Americans are weird in that they distrust their government for the easy stuff and are as gullible as newborn babies about the hard stuff. Dr. Gary Kohls article in the Duluth Reader bursts some bubbles about the FDA’s part in the mental health drug business and that is a pretty important story. He describes the lack of sophistication in the actual drug development, testing, and application while pointing out how much better Big Pharma’s marketing and politics are than their science. "The so-called Selective Serotonin Reuptake Inhibitors have been deceptively mis-named by Big Pharma because those amphetamine molecule-based SSRI drugs do NOT mess only with serotonin neurotransmitter systems! In fact, they do not actually raise total brain serotonin levels as advertised. Actually, SSRI drugs deplete serotonin long-term while only “goosing” the release of serotonin at the synapse level while at the same time interfering with the storage, reuse and re-cycling functions of the serotonin synapses that, by the way, are far more abundant in the human intestinal tract than in the central nervous system." You wouldn’t get that from any of their ads, would you?

I have a mixed history with the FDA; the old and the current. When I worked for a pacemaker/implantable cardio-defibrillator (ICD) company in Colorado, Telectronics Pacing Systems, that was eventually closed down by the FDA and bad publicity for a variety of awful Class 1 recalls. While all that was going on, with FDA inspectors and manufacturing experts roaming the halls of our company, many of the company’s engineers were saying, “Thank God there is an FDA,” because the British Pacific Dunlop executives would have been willing to carve the company’s patients up for meals if it meant they’d get a bigger quarterly bonus. As it was, Telectronics had pacemakers and ICDs with defective connector block seals that leaded body fluids into the electronics and caused sudden and unpredictable device failures and leads that included a “forming wire” that would poke through the leads’ insulation and carve chunks out of patients’ atrium walls. Yes, that would often kill them.

Telectronics’ product failures were eventually exposed when an autopsy of a young woman who died from the atrial carving revealed a piece of wire sticking out of the atrial “J” wire’s insulation. The pathologist, a friend of the cardiologist who performed the pacemaker implant, described the wire to the cardiologist; assuming his friend had accidentally left a guiding stylet in the atrial wire. The cardiologist was absolutely certain that wasn’t the case and asked for further investigation, risking his own reputation in the process. The resulting investigation eventually involved the FDA investigators and the discovery that several similar incidents had occurred in the past, with no certain knowledge of how many such failures had resulted in patient mortality and morbidity. That knowledge and the discovery that the company had covered up the knowledge of both types of failure brought the full attention of the FDA. At that time, Dr. David Kessler was the commissioner of the FDA and he took the job very seriously. Appointed by Bush I and replaced in 1997 by Clinton, with practically nothing of substance from then on, Dr. Kessler ran an FDA that was both active and patient-oriented. After Kessler’s FDA, American patients have been pretty much on their own as far as anything resembling federal regulation of food and drugs.

One of the experiences I had with Telectronics was in a team of folks who were writing the clinical trial plan for the company’s ICD products. I got to study chemotherapy and cardiac therapy drug trials and their methods and results. The results were every bit as interesting as the methods, since the results were so ambiguous that I don’t know how anyone could conclude either of those drugs worked worth a damn. Statistically, every clinical trial we looked at demonstrated that the state-of-the-art drugs were inconsistently the equivalent of placebos. Sometimes, the drugs were slightly worse. As Dr. Kohls explained with his, “Myth # 3: ‘FDA approval means that a psychotropic drug is safe long-term’” In fact, FDA approval means nothing. Drugs and devices "are usually only tested in human clinical trials for a couple of months before being granted marketing approval by the Big Pharma-conflicted FDA. " FDA approval is just a stamp applied to practically anything the medical industry wants to foist off on patients and medical providers.

The next train wreck, I mean medical devices company, was CPI/Guidant. When I first applied, it was still CPI, the company that invented the ICD. CPI had a reputation for being “conservative,” in the real definition of that word. Their devices (pacemakers and ICDs) weren’t tricky, but they were reliable, had long battery lives, and had only the features necessary to do the job well. CPI was acquired by Eli Lilly corporation in 1978 and Lilly added a pile of medical devices company to its portfolio until 1994 when it spun those companies off into Guidant/CRM and the rest of the mess that became Guidant. I interviewed  in 1995 and early 1996 and by the time I started work in March of 1996, Lilly had separated itself from Guidant and the retirement and pension package I’d been promised vanished without anyone bothering to tell me about it. Since Telectronics was being pulled to pieces for the patents and valuable employees, it probably wouldn’t have made a difference, but it would have been nice to know what I was getting into.

What I was getting into was a carbon copy of the situation I’d just left. Guidant eventually collapsed under its own avarice and incompetence. To make a long, painful story short, one “Quality Committee” meeting illustrated the company’s philosophy perfectly. When a team of quality assurance engineers presented their analysis of a defective device that needed to be notified on, the executives in the committee asked, “How will that affect our bonuses this quarter?” Since the device failure was a life-threatening malfunction, no one had done the necessary research to determine how that would affect executive compensation. Imagine that.

Eventually, and after hundreds of patient injuries and a few deaths, a few doctors began to suspect their corporate beneficiary was less than benevolent. Even weirder, a couple of those doctors did the minimal research necessary to discover that even their own small group of patients had been affected multiple times by Guidant product failures. I had collected more than 600 such failures for one of the products I monitored and I waited for more than a year for one patient-oriented cardiologist to ask me, “Have you ever seen this before.” Never happened.

When Guidant died, 95% of the company’s products were under FDA Class 1 recall, but the FDA deserves little-to-no credit for uncovering the company’s many problems. Like the physicians profiting from selling these defective products, the FDA’s attitude was summed up by something an “investigator” said to me not long before I quit medical devices, “We don’t care what kind of product problems you have or how many patients you kill as long as we don’t read about it in the paper first.” As long as the FDA wasn’t embarrassed by being shown up by a media investigation, they will let Pharma and Devices do whatever the hell they want with patient safety and therapy effectiveness. To them, patients are nothing more than “lab rats who clean their own cages.”

#163 The Really Good Die Young and Unnoticed (2006)

[This is the last of the Rat reprints. All of the stuff I wrote after 2006 went to the blog and the website, simultaneously. This essay was also posted to the blog when I first wrote it, but I think Dr. Jeevan Paul deserves all the notice he can get. He is missed and was an American hero. If I'm still alive in 2016, I'm sure I'll still miss him. If I'm not, this will be the last thing I intended to post on this blog. Either way, we all win.]

All Rights Reserved © 2006 Thomas W. Day

NPR's Prairie Home Companion fans will be disappointed to here that, regardless of what NPR's Garrison Keillor says, Saint Paul is an armpit of a city, compared to Minneapolis, St. Cloud, Rochester, or any other city in Minnesota. Like every state in our nutty nation, the state capitol is the state's official embarrassment; the most corrupt, the most degenerate, the most poorly managed, and the one place in the state that most adversely affects the state's average IQ. Think Topeka, Kansas or Albany, New York or even Sacramento, California and you'll know what I'm talking about. Austin, Texas is an exception, but that city is surrounded by an armpit of a state. You could be forgiven in thinking that we've decided to put all of the worst people we know in a common location so that, if we ever decided to be a rational nation, it would be easy to identify where most of the problems reside. I stumbled into more evidence of our national capitol perversion this week when I decided to see a doctor for a ailment that has been persecuting me for the past month. 

To build a little background, I spent a decade in medical devices during the 1990s and the most valuable thing I learned from that experience is that Ted Sturgeon's rule ("90% of everything is crap") more than applies to medicine. In fact, Sturgeon is optimistic. Most of the physicians I met were mediocre talents, barely involved in their profession, disconnected to the pain and suffering of their victims, and almost as principled as Enron executives (or any other company's executives, for that matter). From that experience and my history of minimal medical difficulties, I hoped to avoid contact with doctors whenever possible.

At the end of that miserable career path, I found myself exactly where I'd hoped never to be: looking for a competent doctor. Our of necessity and through a referral from someone who's opinion I valued, I met Dr. Jeevan Paul in August of 2001. I was in terrible shape and had been in and out of a dozen doctors' offices since May, with no result other than continued degeneration of my condition and increased frustration. Dr. Paul gave me a complete physical, his complete attention and empathy, and identified the source of and several possible solutions for my problem in a single visit. 

Unfortunately, my corporate insurance did not include his clinic, so I was forced to return to the other 90%, armed with the information Dr. Paul had provided. The cost of the tests he'd performed was high, since the laboratories he used were the usual suspects of medical practice. So, he helped me negotiate with my insurance company and, eventually, they paid for a portion of the lab costs. He stayed in touch with me for several months, through e-mail, to follow-up on the treatment I received from my insurance provider. 

Like most Americans, I've been uninsured or under-insured for the last four years, so my contact with doctors has been limited to desperate times only. Once freed from my medical problems, I haven't had much cause to hang out with doctors, even the one I actually liked and trusted; Dr. Jeevan Paul. A couple of months ago, I decided to get back in touch and discovered that Dr. Paul died in 2005. He was thirty-seven years old. Typically, his brief memorial, buried in the back pages of the Minneapolis Star Tribune, requested that any memorials be sent to his favorite "hobby"; Medicins Sans Frontiers (Doctors Without Borders). 

Since I last saw Dr. Paul, he had moved to a different facility and a new specialty; chronic pain. He was active in the Minnesota Medical Association and constantly worked to provide medical services to low income patients and other disadvantaged citizens who are typically unprotected by our current profit-driven medical system. He posthumously received an award from a Minnesota physician's organization which described Dr. Paul in this simple statement, "Increasing access to care for under-served communities was the cause closest to Dr. Paul's heart, said Dr. Tooker. A general internist, Dr. Paul spent most of his career working at a community health center in St. Paul, where he worked to break down barriers to care for low-income patients."

Now, back to my original premise, the one that stated my opinion of St. Paul's low status as a city. Dr. Paul was active in local and state politics. He regularly participated in a physicians' outreach program that annually attempted to inform our state legislators of critical issues regarding the state's health care systems. I doubt that anyone in the state did more to promote community, compassion, or sacrifice than did Dr. Jeevan Paul. 

In recognition of his life and death, the St. Paul Pioneer Press didn't even bother to post a notice of his passing. No mention was made in the state legislature of the loss of this great man. If it weren't for the Minneapolis Tribune's brief mention in the obituary column. 

Maybe this makes sense to you. Maybe you really believe that the piddling activities of professional athletes warrants a seven page section of the newspaper? Maybe you think movie reviews are critical to the progress and outcome of civilization. Maybe you think government is wisely spending its time jabbering about gay marriage, abortion, finding more ways to reduce the tax burden of the wealthy, and slipping more corporate tax loopholes? I, on the other hand, think all this crap is wall-to-wall signs of a decadent society that has no moral guidelines, no purpose, and is so intently concentrated on greed and corruption that we won't even have Nero entertaining us with a violin solo when the walls crumble down on our heads.
October 2006

The Price of Thankfulness

We have a lot to be thankful for this season. We’re in a home we like, in a town we’ve loved for two decades, with new friends and a close family nearby. Financially, we’re better off than most people our age and who were without any significant kind of inheritance or hand-up from our parents. While I was marveling at our good fortune this morning, some not-so-pleasant memories of how we got here came back to me.

In my 30+ year career in music and manufacturing music equipment, I pretty much broke even, economically. The ten years I burned in medical devices—first with Telectronics in Denver followed by Guidant in Arden Hills—were pretty much the source of our current financial stability. After a move to Indiana to work for Washburn/Soundtech turned to crap, a friend opened the door for me into medical devices. Mostly, I took the job because I’d thought medicine had actually done my father some good when he had a heart attack and several bouts with cancer. In retrospect, I probably misread/misinterpreted that event, too. I jumped into medical devices with both feet and as little head as possible. After a 25 year career in manufacturing and field service, I felt that I had a lot to learn and a lot to give to my new employer. Five years later, Telectronics Pacing Systems was all but dead, due to a series of FDA Class I recalls and stupid management decisions and I was looking for a new employer.

I had, however, learned a lot. I’d been part of teams that studied drug and device clinical trials and helped write Tele’s Implantable Cardio-Defibrillator (ICD) FDA trial and product submission. I’d been tossed into the field to learn how to assist in pacemaker implants as part of a trial-by-fire “training system.” I was included in the Education Department’s line-up of “experts” who trained sales representatives and doctors and nurses on the company’s products. I took a large hit in income to get into a new industry, but my temporary single marital status and Colorado’s cost of living was so far below California’s that I made up for a lifetime of living-on-the-edge in a year. Suddenly, I was a homeowner and had savings. My starting wage at Telectronics was pretty sad, but I made up for it by living cheap and repairing a crap-load of audio gear and selling it until I had a stake for a down-payment on a house.

Five years later, Tele was in shambles but I had a “career,” a substantial salary history in medical devices, and some expertise in Tele’s unusual technology that was marketable. So I marketed it. I hustled myself to several pacemaker/ICD companies and ended up getting a good offer from CPI which was about to become Guidant. There were some glitches; CPI separated from Lilly and the pitched and promised pension vanishing before I arrived was one serious glitch. The company hired me like I was a fairly experienced journeyman AAA pitcher, though. A signing bonus, a generous moving allowance, living quarters assistance, substantial assistance in buying a home in Minnesota, and the kind of income I’d made in California, plus bonuses, minus California's cost of living.

I’ve been poor and I’ve been middle class. My “personal Great Depression years” were long, instructive, and sobering. Anytime I’ve been paid more than minimum wage I’ve assumed that something, sooner or later, will go wrong and I’ll be back on the streets without notice. I may be the most economically conservative person I've ever known. I always assume bad times will quickly follow good, even though that has only occasionally be true for me.

The "something that went wrong" with Guidant was Guidant. The company had a reputation, when it was Minnesota's CPI, of making solid, reliable, long-lasting devices with no flash, a little too much size and weight, and basic features. The new Indianapolis Lilly/Guidant management was—empowered by way of outrageous stock options and bonuses—to drive that staid car over a cliff. They pushed marketing and features over the traditional CPI product and corporate qualities and severed the links between manufacturing, quality control, and product development. I moved departments, a couple of times, and my last assignment—quality assurance engineer—was where I finally realized that nothing I could do would affect any outcome in that homicidal, suicidal, and grossly mismanaged corporation. My last assignment was to decouple a product failure database—that I’d spent two years building from scratch—from component and field failure descriptions. The reason for scrambling my database was to prevent the FDA from easily determining relationships between similar and reoccurring product failures; resulting in investigation and likely product recalls.

The Fortune Magazine article, rating Boston Scientific’s acquisition of Guidant as the “2nd worst deal ever” said this about the company’s misfortune, “Guidant CEO Dollens agreed to postpone his retirement to shepherd the transaction with Johnson & Johnson. But what should have been a victory lap turned into a slog through the swamp. In March of 2005 a 21-year-old student named Joshua Oukrop, who had a Guidant defibrillator implanted in his chest, died of a heart attack while bicycling. The defibrillator short-circuited, failing to release the shock that could have saved his life.

“Guidant had discovered the short-circuiting problem three years earlier and had corrected it in new models. Yet the company never informed doctors that devices already in use carried a small but potentially fatal risk of failure. Oukrop's cardiologist complained to Guidant that it should immediately warn doctors about the short-circuiting problem. With the story about to break in the New York Times, Guidant finally came clean, issuing a recall of the flawed defibrillators in June. ”

As usual, Fortune and the major media got most of the story wrong. That “small . . . risk of failure” was actually pretty substantial in the Ventak Mini I & II devices and the PRIZM I & II “fix” didn’t do much to make Guidant’s later devices better. Guidant’s ICDs failed often and catastrophically, sometimes delivering a fibrillation-inducing shock as the device’s last “act” before battery failure. Every one of those failures crossed my desk and ended up in my database. About the time in early 2000 when I was ordered to de-link those product failures, the database contained just short of 1,000 such failures with an unknown number of related patient injuries and deaths.
(Unknown because no one wanted to know that number.) Not long after I got the order to scramble my database, I had some sort of mental breakdown and lost the ability to read. (No, I’m not kidding. I couldn’t even sort out the text under newspaper pictures. Even sportswriters went beyond my capabilities.) For more than a year, I sat at my desk watching product failure data collect dust in my file cabinet, hoping for one patient-advocate doctor to call and ask “Have you ever seen this before?” Finally, it was obvious to me that I was broken and I went on medical leave for a month; until I terminated my Guidant employment rather than carry on the farce that I could do that work again after I "recovered." If I were to keep doing that work, I would have died in more ways than one.

One of those injured patients was a young woman, a single mother my daughter Holly’s age, who had experienced some sort of cardiac issue that gave her cardiologist an excuse to ablate much of her heart’s electrical system. As a result, she was dependent on the device for her heart rate and had been convinced that the defibrillation feature was also useful. (It rarely is.) She’d experienced one of the Mini I failures (and survived the associated shock) and had received an “under warranty” Mini II as a booby prize. Along with that “warranty replacement” came an additional $100,000+ in debt. The company had added about $20,000 to her debt load, since the Mini II was that much more expensive than her failed Mini I, and the hospital and doctors made up for the rest. She wasn’t really calling to complain, but she was hoping there was something I could do to help her find a way to something more reasonable, debt-wise. We had several conversations, as I collected information on both her product failure and the procedure’s billing history. She was the only patient/medical professional I’d talked to who could verify that the device delivered an unintentional shock before failure.

I called everyone who would talk to me about her medical and financial situation. The doctors didn’t give a shit. The company’s sales rep was downright hostile. The hospital accounting people were clueless. Finally, I lucked into discovering that hospitals sometimes have “patient advocates.” This hospital had one who actually wanted to do her job. We came up with a deal, the hospital would absorb all of the charges except the doctors’ bills if I could get the company do refund the replacement device charges. She went first, so I could use that to shame our accounting/sales assholes into doing the right thing. Finally, Guidant’s bean-counters coughed up the refund. Now, I had an ethical hospital doing the right thing and a let’s-pretend-we’re-humans company doing the right thing, so I went back to the doctors. I got the anesthesiologist to kill his bill and the cardiologist gave back a little of his. That was the best I was going to get, so the $100k bill was down to about $8k. Still way too much for a single mother who’d been kicked in the head with medical problems and expenses, but it seemed pretty good to me at the time.

I called her back and got an older woman on her phone. It was her mother. I explained why I was calling, sort of proud of myself for having done something “good” for the first time in my 10-year medical device career. She listened and said, “Thanks for calling, . . . [she] died last week. She had another heart attack.” Another “heart attack.” From what I knew, the chances were good that her Guidant device had blown itself up and killed her. We talked a little more. I hung up and went home for the day. The next day, I called the sales rep and tried to get him to have the device explanted and sent back for analysis. It had been cremated with her, which happened all the time even though cremating lithium-ion batteries is a really bad idea.

You can’t beat cremation for an evidence destroying procedure, though. The doctors didn’t want to know what had happened, the sales rep sure as hell didn’t care, the company was working hard to be sure its ass was covered, and I felt like I might as well have killed her myself.

Not long after that, I left the industry and wrestled with myself for months before I went back to fixing music equipment and, later, teaching. Every Thanksgiving since, I’ve thought about her and my involvement in her “care.” If you want to know why I dislike and distrust doctors, here’s Reason #1; not one doctor in the hundreds I talked to cared why their patients’ device failed. If they’d have asked, I’d have told them. I have no idea who Joshua Oukrop’s doctor was, but he is the needle in a haystack of careless, selfish, lazy and rich doctors who don’t care about patients any more than corporations like Guidant do. Finding a good (as in “not evil”) cardiologist is harder than finding a moral and honest Republican.

I kept a floppy disk with all of my device failure data until we moved this past year, in hopes that someone might ask for it for the first few years and out of habit after that. Tossing that disk into the trash was almost like a ceremony of resignation. Along with it went my medical device resume and all of the stuff I’d written for that industry over my 10 year career. I wish I could forget it ever happened, especially to me.

The experience broke a few bits of me that will never heal. When my wife and I recognize how lucky we are to be where we are today, in retirement and in our home with friends and family, I can not help but remember what I did to get us here. And who paid for it.

Nothing Changes, Nothing to See Here

Forty-three years ago, in 1972, Democratic Presidential nominee George McGovern selected Thomas Francis Eagleton to be his vice-presidential partner. By August, McGovern had abandoned Eagleton because of his history of depression treatment. Supposedly, a poll found that 77% of prospective Democratic voters said "Eagleton's medical record would not affect their vote." I’d find that hard to believe, but Americans wanted to imagine themselves to be more civilized than they do today. Eagleton returned to the Senate, won two more elections, and retired after a weird blackmailing affair with a niece, a local lawyer, and the Scientology organization. Eagleton was a key player in the Senate's foreign relations, intelligence, defense, education, health care, and environmental legislation. He was an important Clean Air Act and Clean Water Act sponsor. He and Frank Church sponsored the amendment that halted the bombing in Cambodia and effectively ended American involvement in the Vietnam War. Still, to most conservative Americans (the majority of Americans), Eagleton was the “crazy McGovern VP.”

The Greek father of medicine, modern or otherwise, Hippocrates described “melancholia” as a disease with both mental and physical aspects. "fears and despondencies, if they last a long time"¹ as the earliest and not yet improved upon description of depression. Freud discovered or pronounced nothing new about depression and not much of value has come about since. So, a couple thousand years of avoidance and denial has led us to where we are today with a minimum of 7% of the US population suffering from a well known, totally misunderstood mental disease that offers largely unsuccessful therapies and the joy of social stigma. The modern approach is to bury the patient in side-effect-laden but ineffective and dangerous drugs (“Why Are More than One in Ten Americans at Risk for Suicide?”). While these drugs are barely or rarely as effective as placebos,  they are a big money-maker for the dope peddlers. In 2013, the dope dealers made $11B on antidepressants alone. No wonder these assholes are spending so much money fighting marijuana legalization. They are just fighting off the competition.

Since 1974 a lot of noise has been made about improvements in mental healthcare but there is no reality behind that noise. The stigma that existed 100 years ago remains, largely, unchanged today. In 2013, 41,149 US citizens committed suicide. Suicide is the 10th leading cause of death for Americans.  And that is with the unmentioned understanding that suicides are dramatically underreported due to . . . yep, the stigma of mental illness. Even the survivors are unable to admit their loved one was ill. As an illustration of that national reality-avoidance, no accurate national suicide attempt statistics are kept. However, in 2013 494,169 people were hospitalized for “self-harm behavior.” There is a sexual component to US suicides, too. Men are 4 times more likely to kill themselves, but women try to kill themselves 3 times as often. You could argue that women are more likely to make a “cry for help,” but you could also argue that men are just more mechanically competent in their attempts. Men are a lot more inclined to use guns for this purpose and firearms account for 51.4% suicide deaths.

The first requirement to fixing a problem is to admit you have a problem. The only admission allowed to mental illness is suicide or at least a fairly serious attempt, which in 1-out-of-12 examples doesn’t do much to fix the problem for the person making that admission. The effectiveness of further attempts is depressingly high. The medical profession ridicules poorly executed attempts as “a cry for help.” If that were true, it’s pretty obvious that crying for help in the direction of American medicine is misguided. You might as well ask a tiger to care for a baby lamb. If US doctors don’t see a dollar sign swirling around your head, they’re not interested.

Outside of the drug profits, all of this self-destruction is socially expensive, too. The estimated US suicide death expense was more than $44 billion in 2010. Even the failures are far from cheap, costing about $2 billion for medical care plus $4.3 billion in lost wages and productivity and other costs. In a so-called capitalist society, you’d think the shear expense of suicide—successful and unsuccessful—would make us do something about all of this self-destruction. Don’t get me wrong. We’re not the worst, most suicidal, country in the world. In fact, we’re #30 behind such wonderful places as Greenland (#1), Lithuania, South Korea, Kazakhstan, Croatia, Russia, Poland, and South Africa. Also, we’re slightly less self-destructive than Japan, Belgium, Finland, Austria, and France. The top ten suicidal countries have some pretty amazing rates of self-destruction from 83/100,000 down to 20/100,000. From there on, though, the next 50 slowly decline in self-annihilation from 20/100,000 to 10/100,000. The USofA is pretty much in the same territory as Bulgaria, Germany, Sweden, Czech Republic, Cuba, Romania, and the UK. Apparently, political and economy systems are disconnected from suicide rates. Neither capitalism, monarchies, fascism, communism, socialism, dictatorships, democracies, anarchy, order, rich, poor, middle class, rural, urban, suburban, and every other description I can use with which to describe a society seems to produce relatively the same rate of self-hate.

Greenland, for some reason, is a standout with 1-in-4 Greenlanders attempting to kill themselves every year and with the world’s highest rate of self-destruction. Greenland’s streets are decorate with signs advertising suicide prevention hot lines, “The call is free. No one is alone. Don't be alone with your dark thoughts. Call." So far, that tactic has been ineffective. People, especially teenagers call the hot line and discover that they are, in fact, alone. We are all alone in ourselves. I suspect that, once they hear the usual perfunctory “we are all in this together” drivel they are even more inspired to put an end to their misery.

In the last couple of decades, I’ve lost three friends to suicide. For a while, back in the 80’s, it seemed like everyone I knew was contemplating—out loud—suicide and taking a shot at it. Supposedly, suicide is “catching” and I’ll admit that knowing people who have checked out for a variety of non-medical motivations makes considering the option a little easier. Malcolm Gladwell calls that a “contagious idea.” That’s possible, but I doubt nearby suicides are the cause of following events.

The fact that the sacrifice needed for any hope of a cure for depression is to suffer the slings and arrows of exposure, stigma, ridicule, followed by even more isolation looks more suspiciously causal to me. Asking for help when the brain doing the asking is the source of the disease is not much different than requiring a cancer victim to administer his own radiation therapy. That is, of course, unacceptable. Because if we admit we need help, we’re weak. If we can’t fix ourselves, all by ourselves, we’re just like that “crazy McGovern VP.” Americans can forgive drunks, drug addicts, cowards, liars, criminals, draft evaders, traitors, National Guard A.O.W.L. rich kids on a bender, complete idiots, greedy bastards, adulterers, and every sort of low life. But our society is incapable of forgiving people for mental illness. In fact, we’re going backwards. The general distain for a “mental illness defense” is evidence that our societal tolerance and compassion for the mentally ill is going backward. Texas and Florida appear to revel in executing the mentally ill and a few other states are showing signs of jealousy.

I don’t think any of this bodes well for any honest attempt at attempting to contain our suicide epidemic. And, if we were capable of honesty, it’s pretty obvious that any physical disease, product, or activity that caused this kind of death, destruction, and expense would be front page news and Fox Views and the other panic generators would be freaking out.

¹ Hippocrates, Aphorisms, Section 6.23

#96 Hairy Jealousy (2004)

All Rights Reserved © 2004 Thomas W. Day

The older I get the more I notice idiotic little things popping up in my psyche.  Thirty years ago, I watched “suits” march off to work and marveled at how robot-like they seemed.  While I was not exactly a freak, I was confident in my safe distance from the average working man.  I had hair over my shoulders.  I wore sandals to work.  I played guitar and wrote stories and read science fiction.  I was cool.  Thirty years later, I was a minor league suit.  Monday through Friday, I wore a tie and shoes that are less comfortable and more socially acceptable. 

More than the tie and dumb shoes, I think a sign of my sellout is that I sometimes caught myself thinking another man’s long hair is “unprofessional.”  You know the guys I’m talking about.  The lawyer with a ponytail.  The computer programmer doing a Jim Morrison imitation.  The dreadlocked engineer.  It only passes through my mind for a moment before I snuffed it out, but it irritated me that it was there, ever. 

I admit that a lot of  the origin for the thought comes from my work environment.  I’m was an engineer in a medical devices company.  There is probably no more stodgy, uncreative, mindlessly, conservative business in the world than those companies producing products for doctors.  No one with half a talent world ever work for an established medical devices or drug company, because those places are so stifling that ideas slip out of their hands like a bar of buttered, wet soap.  In a medical products company, “unprofessional” means anything from not being properly dressed to discussing screwed-up  products out loud.  You can stumble into more “career limiting mistakes” in that business than you can on a battlefield.  People are judged by microscopic social errors and inane business traditions and surviving every workday is a painful test.  So we get really critical of diddly, unimportant things.

But that isn’t what the hair thing is about.  Long hair is a completely different “professionalism” issue.  Being successful and letting your hair grow flaunts male modesty.  It’s a way of saying, loudly, “I don’t give a damn what you think. I don ‘t have to kiss anyone’s ass.  I’m talented enough, or rich enough, that don’t need this job.” 

Men don’t mind brilliant or rich men who conform, like the rest of us, to robot-ness.  But it really annoys us to have our own menial, gutless, slave status thrown back in our faces.  Bill Gates, Warren Buffett, Ross Perot, Arnold Swartzenegger, and the majority of rich, famous guys respect this ritual.  They wear uncomfortable, geeky looking clothes.  They cut their hair so short that their ears protrude from their heads like microwave antenna.  While we might resent their wealth, we never have to resent their freedom.  For some of these guys, the richer they get the more enslaved they look. 

That’s comforting, from a sick, pack animal kind of logic.  That’s the way it should be, as far as the herd is concerned.  Don’t show off your wealth and your freedom, pick one and keep the other hidden from our view.  We can deal with a long haired dude flipping burgers or pushing a broom.  A pony tail and a Mercedes is too much of a blow to our pride.  Success and freedom are so far out of the reach of the average working stiff.  We don’t want to think about what we’ve given up to be useful corporate fodder.  So keep your hair under your hat if you don’t want to be called “unprofessional.”  Like you’d care.

September 2004

#78 Medical Warranties (2003)

All Rights Reserved © 2003 Thomas W. Day

You might be of the delusion that companies offer warranties on products out of the goodness of their hearts. You might as well believe in tooth fairies or honest politicians. Product warranties are clinically determined based on product design, expected product use, and product and consumer life expectancies. Once the expected failure rate is calculated, the cost is added to the price of the product and that prediction is tracked to tighten up the process for the next generation of products. Really large and competently managed companies (of which few reside here in the United States) get so good at warranty calculations that they often spend exactly what they anticipated spending in warranty costs at the end of a product lifetime.

Doctors, especially American doctors, suffer the delusion that they are scientists and professionals. Very little about the medical profession reflects either science or professionalism, however. Doctors fling medicines and medical procedures at their customers with almost no honest justification and if a customer were crass enough to ask for a warranty on the success of a procedure, no one would be surprised at the negative reaction that would come from physicians.

Why is that? You’d think there would be some history of the success rate of medical practices. Using the corporate model for warranty generation, a hospital ought to be able to offer a patient a warranty on the effectiveness of a procedure. It’s not like doctors work cheap, for so little profit that they couldn’t put some of their own money at risk against a patient risking his life on the doctor’s competence and honesty. You’d also think that insurance companies would insist on procedure warranties. Supposedly, these companies are so close to the financial breakeven point that they are constantly lobbying politicians for protection from their customers and tax breaks for their hard-pressed and over-worked executives’ salaries. Rather than passing all of the expense of procedures that are fumbled, unnecessary, unreliable, and/or downright ineffective, why not make doctors put their money where their mouths are? Doctors aren’t famous for taking responsibility for their profession, so don’t count on anything useful coming from that pack of pampered PhDs and “specialists.”

In some hospitals, doctors are so arrogant that they force administrators to pay them more than 100% of a procedure’s total cost to perform a procedure. Yep, I mean that a doctor might receive, say, $60,000 for a $55,000 surgery. So, the hospital loses a few thousand on every operation but makes up for it in quantity and government subsidies.

Talk about arrogance!

Not only don’t doctors offer warranties on their work, they want to be paid more than they earn. If there was ever a system out of control, US medicine is it.  I propose a fix for this broken machine. To receive Medicare, Medicaid, or any other government financed funding, hospitals (and their over-priced employees, doctors) should be forced to offer warranties for their procedures.

Worst case, hospitals come up with ridiculously short warranties and patients have the information they need to decide if the pain and suffering caused by a procedure is worth the miniscule likelihood of a positive outcome. By a warranty, I mean a warranty: if the procedure fails to cure the symptom within the warranty period the hospital will either refund your costs or provide an alternative therapy at no cost.  For example, you discover you have lung cancer, after a lifetime of sucking on cancer sticks. Your doctor offers three possibilities; 1) surgery and chemotherapy, 2) radiation, or 3) you take the rest of your life off and party till you drop. The warranty on option #1 is three months. The warranty on option #2 is two months. The warranty on option #3 (your life expectancy with no medical intervention) is six months. Of course, the doc will tell you that if either #1 or #2 is successful, you could have years of life left to enjoy. However, the doc doesn’t have enough data, confidence, skill, or the guts to put his own money on the odds that either procedure will be successful. If he isn’t willing to risk a little cash, should you be willing to risk your life? That’s for you to decide, but at least you’re deciding with some information to work with.

Would you buy a car that came with no warranty? Would you spend $40,000 on a product that was presented as a “buyers beware” purchase? I doubt it. But patients give up everything they own, on a regular basis, for medicines and procedures that have the kind of performance records that would deserve the old “90 days or 90 feet, whichever comes first” used car warranty. I say we should stand up for our rights as consumers and say “we’re mad as hell and we’re not going to take it anymore.” People who spend their own money on perfectly useless medical treatments have that right, but if a doc wants to take the government’s money, he ought to have to prove that he knows what he’s doing by offering a normal amount of assurance to his customers. If it works for the government, and they are providing about 80% of the investment currently being mismanaged in medicine, insurance companies will follow. After a few years, only quacks would be warranty-free and medicine would have taken a big step toward becoming an honest profession.

November 2003

#67 Science and Academia (2002)

[Yet another misread of history, government, and science. At the time I wrote this, it seemed logical to conclude that if nations with socialized medicine were devoid of creativity that the socialized medicine was the problem. How that I possess an Australian fake hip and a German heart stent, I realize that those nations are simply more conservative than the U.S. and didn’t jump into the business until their products were sorted out, unlike our medical system that leaps first and thinks later.]

All Rights Reserved © 2002 Thomas W. Day

Recently, I stumbled upon an article, by a person who I respect greatly, Dr. Richard O'Connor, calling for a different way for drugs to be developed and tested.  His motivation was, in part, due to the disclosure of the close, financial link between drug companies and a physician, Dr. Martin Keller of  Brown University, who is a recognized "expert" and is a clinician whose research is most commonly cited as the justification for an entire group of medications.

The Boston Globe found that Dr. Keller received more than a half-million dollars in "consulting fees" from the companies whose products he's "tested."  The Boston Globe reported that the doctor didn't bother to report "his relationships to these companies" to the medical journals that published the results of his clinical trials.  Personally, I'm not convinced that medical journals are more ethically bound than physicians, but I could be wrong.  This kind of conflict of interest is as common in medical research as misspelled words in a personal letter from G.W. Bush. 

Dr. O'Connor's conclusion from this un-shocking discovery is that taxpayers and patients should consider changing the way medical products are developed.  He states that he's "willing to pay a lower price and a higher tax, and let the government fund research.  Profits and healthcare are a dangerous combination."   That's probably a logical conclusion, based on a belief in government funded research and the hope that medical research is done, primarily, to benefit humanity. 

Unfortunately, that hopeful vision is probably unfounded.  If government funded medicine were capable of producing worthwhile research, Europe's various socialized medicine systems would be the source of an occasional breakthrough in medicine or technology.  If not-for-profit research were a functional idea, our own university systems would be hotbeds of creativity. 

For the last thirty years, the only purpose served by European "research" has been to provide a source of human lab rats for American biotech experiments.  Every US company does its initial product testing in Europe.  And if it weren't for US-subsidized clinical trials, European physicians would be completely deprived of evidence that they do any science at all.  Since most physicians are fond of imagining themselves to be scientists, so that would be a serious blow to the ego. 

We Americans are always being told, by our intelligenza, that European-everything is better than the mess we've made out of capitalism.  If "better" means classically, traditional, functionally unproductive, and unchanged by reality or necessity there is no question that European values rock and rule.  If anyone could beat a dead horse on the right spots (with a precision-made buggy whip) to make it do work, Europe has the experience to get the job done. 

But the fact is, government managed medicine stifles creativity and initiative.  For that matter, government managed anything can always be counted on to crush the life out of whatever is being managed.  So our only government sponsored hope might be with those shining faces and hopeful dreamers in higher education.  Well, now we're sunk for sure. 

Our own academics, secure and comfortable with tenure, pensions, and graduate students to do their grunt work, don't seem to be able to produce anything interesting without corporate sponsorship and initiative provided by royalties.  Even with those initiatives, many academics want more.  Our universities are well stocked with researchers who not only earn six-figure salaries but who also own the patent rights and corporate sponsorships to their research.  In other words, these state and private institutions are doing nothing more sophisticated than providing state funded facilities and cheap, highly educated manpower to corporations.  I think this is called "corporate welfare," but I might be minimizing the welfare aspect of the situation.

If a sociologist ever wanted to examine the effects of greed on society, our medical and university research systems would be a fine place to start.  The ineffective sugar pill control model would be Europe.  So far, the statement that democracy is an inefficient, perverted form or government, but it's the best we have so far, also applies most accurately to capitalism and research.  Which means we're not going to see any amazing breakthroughs until somebody comes up with a better system.

I hope you're not holding your breath while you wait.

Footnote: http://www.undoingdepression.com/news05.html

November 2002

#58 Rats and Ships

All Rights Reserved © 2002 Thomas W. Day

It's been a while since I've Ranted.  It's been an eventful year for all of us, me included.  Eleven days before the media decided that "the world changed" for many Americans, I changed my own world, for good or bad.  On August 31, I quit the best paying, most secure, least challenging job I've ever had. 

After thirty-five years of continuous employment, I became unemployed at the end of August.  On purpose.  Go figure. 

Less than a half-month later, a bit of the country was in flames and all of it was, officially, in a recession.  I'm not sure if it's better or worse to be unemployed during a recession.  But, so far, it certainly feels better to be unemployed and happy than it did to be employed and miserable.  And that is something it took me 40 years to learn.  I may be a Rat, but I clearly don't know how to work a maze and there's a lesson in here, somewhere, but I'm not bright enough to uncover it.

In times of political crisis it's usually a good idea to be as politically correct as possible.  Keep your head down.  Stay in the middle of the pack.  Don't make waves.  All of these are valuable clichés that my father did his best to instill in me; and he failed.  I don't know why.  I'm probably not smart enough to listen to good advice.

So here goes.  I'm about to stick my foot into a trash can, once again.

Something that really grates on my frayed nerves is the phrase the media keeps repeating, "everything changed on September 11."  Or "the world changed" on that date.  Every time I hear or read those phrases, I want to puke.  Or go find a news writer and beat the snot out of him/her. They're a bunch of spoiled and gutless wimps, so they'd be easy to beat up, which is an appealing aspect of the second option.  I'm old and need defenseless targets.

Nothing about the world "changed" on September 11th, 2001, except that the nightmare that most of the world has lived for the last forty years finally came to us; Americans.  Nothing about September 11th topped the kind of terror the 20th Century stuck to Vietnamese, Koreans, Argentineans, South Africans, or many of the residents of eastern Europe, Africa, South America, Asia, and Indonesia.  It's been a pretty awful several hundred years for a lot of the world. 

In our country, the media has never been lazier than it is today.  Mostly, because our "fee press" is owned by major corporations who have no interest in freedom, democracy, progress, justice, or anything else that might lessen their stranglehold on the world economy. 

If it weren't for the internet, there wouldn't be any useful information at all.  That's the way of democracy, though.  Something usually comes along to keep us from destroying ourselves.  When one voice of truth gets bought out, another takes its place.

For me, damn little changed on September 11th.  It's just more of the same, nasty stuff.   Any idiot who lived through the 1970s and 80s ought to have some grasp on how the 3rd (and most of the 1st) world thinks of us.  We're the country who set up strawman dictatorships all over the world, governments who tortured and enslaved their own populations to make the world safe for our corporations to exploit everyone's natural resources.  We knocked down democratically elected governments and assisted in the assassination of the leaders of those governments, when they weren't friendly to corporate interests.  Even when those corporations were multi-nationals who were behaving damned unfriendly to our own working population.

In the late 1950s, we picked a backwards Third World nation as a safe place to "make a stand" against communism and practiced every sort of terrorism known to history on that country's population.  In the 1960s, we dropped napalm and phosphorus bombs on rice paddies and straw hut villages, for Christ's sake!  We used untested chemicals to indiscriminately defoliate that country to make it easier to find and kill the population.  On the basis of that war, alone, we're the Twentieth Century's most careless polluter and the damage we did to our own citizens is still being discounted and suppressed.

And we had a President who planned to collect and imprison Americans for disagreeing with his "right" to carry on this national terrorism.  As usual, this didn't even shake up most of the freedom loving citizens of the U.S.  That President was re-elected so he could finish his damage to the Constitution and that Third World country.  Fortunately, for freedom and democracy, bits of history's best written Constitution brought Nixon down.  That and his own arrogance and stupidity.

So,  I'm supposed to have had my innocence damaged by September 11th?  I haven't felt innocent since 1968, when Chicago's finest went gonzo on American kids who mistook the Constitution's guarantee of free speech as some sort of protection on the streets of Chicago.  I need a spell checker to type "innocence," that concept is so foreign to my world view.

The folks who are in charge of setting the world right make me nervous, too.  If it doesn't bother you that our conservative, religious nutballs are supposed to make the world safe from their conservative religious whackos, I'll be jittery for you. It's one out-of-control system against another.  A true holy war, in every sense of the historical term. 

This may be "America, the land of the free," but there have been people working to change that for more than 200 years.  That crowd is back in charge.  I've lived through Eisenhower and Nixon and their mouthpiece, Joe McCarthy.  I suffered with Nixon and Spiro, Ronny and George the First.  I hope to survive our current corporate stooge, George II.  But I don't have to like it. 

So far, I don't have to be quiet about it.

January 2002

#46 Scary Marketing (2000)

All Rights Reserved © 2000 Thomas W. Day

I had the honor and pleasure this week to attend a marketing training presentation for a new, incredibly complicated medical product. The presentation was competent and informative . . . and scary.

The thing that has always amazed me about the medical industry is how dumb the customers must be. In case you're under the mistaken impression that medical "customers" are patients, get real. Nobody gives a flying flock of spotted and buttered desert turtles about patients. The end-all-be-all in medicine are doctors.

For a few moments, in the early 90's, there was a thought that HMO's and hospital administrators might slither into that driver's seat. Doctors saw that coming and grabbed those positions, too, putting themselves back in control faster than  Hillary could shout "Willy, put that back in your pants and zip up!"

Since doctors are the target audience, the tenor and content of medical product advertising is what makes me nervous. You'd like to think that a device that can save or lose lives would be taken seriously, wouldn't you? If you wouldn't, I will, twice, to make up for your limitations. We'll all be disappointed.  The gist of all medical product marketing is "lots of pretty colors and catchy pictures." Useful information is hidden deep (and small) inside the product packaging and is thrown away with the bloody towels and used pointy objects after surgery. The constant message aimed at these highly educated, occasionally respected physicians is "this device will not require you to do any work or know anything" about your profession.

The marketing message is full of New Age nouns turned to verbs (by tacking "ize" on the end) and verbs turned to nouns with old fashioned misuse. Spiffs and perks abound.  Companies put together "care packages" of free junk for physicians and their lab underlings. They box up loads of useless gadgets and print all kinds of mindless messages on sticky notes, for the sales reps to give away, when they interrupt what ought to be a physician's busy day. The product names are catchy (or funky, depending on your perspective) acronyms that remind you of new cars or video games. There are dozens of non-technical "product training" meetings presenting information that could be understood by a grade school kid.  All training meetings are held in uncompromising places like Maui, Disney World, the Bahamas, and Vail. These training vacations are somewhat scaled down for nurses, but offer "let's pretend we learned something here" CEU's so the nurses and techs won't have to suffer through real accreditation classes.

Does this kind of marketing really influence physicians and surgeons? Damn straight.  The industry line is that medical product sales is a "relationship business." That means the doctors have a dependent relationship on the sales representatives for everything from babysitting services to tickets for athletic events to the fee for the afternoon golf game. Often reps are also responsible for providing a basic understanding of which organ is being operated on during a given medical procedure. The only other "profession" with this kind of relationships is Congress and the soft money lobbyists. Just like the politicians, doctors have become so comfortable with the constant bribery that it's necessary to do this stuff just to get to talk to a physician about a new drug or device.  Just like Senators and Representatives, not that many of the target audience knows enough about the subject to understand the technical details.

All this has led us to a very scary place in medical development. The products, both drugs and devices, have become incredibly specific, complex, and powerful. Properly used, we can compensate for the failure of just about any physical or mental function. Improperly used, current technology can replicate most physical or mental catastrophes.

Engineers, kept isolated from customers and product users by anti-tech Marketing goofs, create more and more complex products with features to treat non-existent maladies. To justify these pointless features, the "more is better" philosophy gets thrown into an endless loop between R&D, Marketing, and the docs. Nobody understands the purpose for anything, but we keep adding more things to prove we can fill all available space.

Marketing tactics use "creative" terms and acronyms that explain absolutely nothing useful. Detailed explanations are abandoned in the drive to prove that "less words, more pictures" will catch the customers' attention.  Industry uses inventive, non-physiologic scenarios to sell product features to docs who, apparently, don't know enough about physiology to question those fabrications. We blow statistical smoke up their butts until they can't tell the smog from the patients.  Product planning uses logic like, "Biowhatsit has three retro-bozo-refabulators in their Bonqulator, we need five in ours to be competitive." We build in five and find a doc to run a "clincal" to prove that five of these useless things was clinically necessary.

In the real world, the overwhelming majority of all medical products are used in their "nominal" condition. Docs take a neurostimulator, a pacemaker, a mechanical heart, or a surgical tool out of the box and use it as it was preset by the factory. Docs may be untrained and operating totally in the dark, but they know better than to fool with the stuff because they don't have the slightest clue how it works.  Sometimes a physician will actually resort to asking the sales rep what to do and I can't begin to describe how bad things can get when that happens. I have abandoned sports equipment in my garage that has more surgical capability than the average MBA-clone sales rep.

At the other end of the knife what do we, who may become patients, do to protect ourselves? My first advice is to be very careful what you sign if you ever find yourself in a hospital. If you assume that your physician is not much more interested in your well-being than a used car salesman, you'll be in a pretty accurate frame of mind. There is no place in life where a second opinion is more valuable. Third and fourth opinions are good, too.  What we ought to do as a population of prospective patients is to get the FDA and Congress off of their butts and make them fix this system or find employment flipping burgers and bobbing for French fries.

Once we boot the lobbyists out of Washington, we ought to be working at booting the bribery out of medicine.  Currently, medicine has taken the military-industrial complex's place at the federal funded corporate welfare trough. Just like the pack of vampires who sucked the country dry building useless and incompetent weapons in the 1980's, medical drug and device manufacturers drained the country of vital juices in the 90's and are still at it.

Personally, I think it's time to put some teeth in the nation's treason laws and start going after those who become rich cheating the public. After a dozen or so ex-CEO's take the needle or suck down a lung full of cyanide gas, get out of the way of industry reforms.  If the execs have to pay the price for their corporate failures, change will happen, with or without doctors knowing what they're doing.

November 2000

#24 Watching the Doc Stocks (1999)

All Rights Reserved © 1999 Thomas W. Day

Medicine and it's associated hardware are the aerospace industry of the 90's. Don't believe me? Just look at the relationship. The government is the primary customer (52% of all "insurance" coverage issued as of the 1997 census), through Medicare and Medicaid, military, and government benefits. The national health costs are expected projected to total $1.3 trillion and reach 14.3 percent of Gross Domestic Product (GDP) by Y2k. $594 billion of this cost will be paid directly by public financing. $723 billion will be paid for by private sources, but a substantial percentage of the "private" funds are actually purchased with public funding, via military and government employee insurance coverage.

The only portion of the country's medical costs that is absolutely privately financed is $222 billion of out-of-pocket payments. The government never pays for anything out-of-pocket. Since cosmetic surgery gets wrapped into "medical" cost statistics, it's probably not hard to figure out where most of that $222 billion gets spent.

So, it's a fairly safe bet that either the government is paying the bill or it's plastic surgery for rich geeks. Sounds like the military-industrial complex, doesn't it? Either the government is buying their products or it's gangbangers, terrorists, or drug cartels. I wonder how many of the second group needs cosmetic surgery?

Whatever. The real deal is, the medical industry has its hands into the same ultimate deep pockets as their aerospace predecessors. Boeing, Harris, McDonald-Douglas, Fairchild, GE, General Dynamics, and the rest of those now-burnt-toast companies gorged on public funding until they popped. Popped they did, though. When that brand of corporate welfare ran out, so did the gangsters who profited from it. It would be interesting to see how many of the escapees, who didn't take the bank with them, ended up in medical device and drug companies.

As investors, this is the reason we all have to closely monitor these investments. If you think have found a medical device company that is running efficiently and producing products that sell for something resembling a real-world price, you need to look again. From the incredibly fat cats at the top to the field personnel, these companies don't spend a penny where a dollar will do. This is the home of limos for every excuse, thousand dollar lunch meetings, expensive booze on every occasion, expensive cars, multi-million dollar stock options and golden parachutes for the totally incompetent, and money spent like Y2k (or the next three-day weekend) is the end of time.

Just like the bomb manufacturers, the differential between the haves and the have-nothings, power-wise, is as wide as the spectrum of what Danny Quayle doesn't know. The execs are packing their pockets and golden-parachuting their way into mansions on the cliffs of Mendocino and the beaches of Hawaii. All the while, folks on the assembly lines might as well be knitting labels on sweatshirts or picking cotton, since corporate affluence only trickles down when it slips through the executives' fingers. This is always a sign that no one's building a business that's expected to last long enough for the cement to dry.

A short attention span is the shape of the industry. These aren't companies that spend time worrying about the distant (more than six months') future. The "big picture" is being painted today and tomorrow may require digging a whole new gold mine. The little companies are hoping to slither through their clinical trials and get bought up by a big company. The gangsters who run the big companies hope to get through the next couple of quarters with their stock options and bonuses intact. Once they bank their payoff, who cares if the business swirls down the drain? If the check didn't bounce, the millions the executives rake off of the top will set them up for a lifetime of luxury. Did you expect them to go job hunting afterwards?

On the fringes of corporate maneuvering, the FDA looms over everyone and those dreams of massive independent wealth. One significant product recall and the whole show goes down the tubes. Stock analysts are totally incapable of knowing anything about this aspect of a stock's value. In fact, the most important criteria for a medical product company CEO is how well he can lie about rumors of product problems. The second most important ability is hiring an idiot who will take the fall if the inspectors with the handcuffs show up looking for someone to blame for the latest homicidal product screw-up. The only way to get advance notice of this sort of impending disaster is to work in the bowels of the company's Reliability Assurance Department. Is your financial security worth that kind of sacrifice? Even the FDA's inspectors rarely go into those dark and depressing places.

Even if the company isn't run by a pack of Mike Milkin and Charley Keating clones, the future is beating hard on the door of this industry. Someday, a manipulated strand of DNA will put all kinds of implantable devices out of business. Pacemakers, ICDs, stents, catheters, and all of the cardiac paraphernalia could become ancient history with one good breakthrough. The same goes for dialysis equipment, transplant technology, cochlear implants, and, even, drugs. What's gold today could be dust tomorrow. And tomorrow could, literally, be tomorrow.

These are the reasons that knowledgeable analysts (if they still exist) consider medical device companies "high risk." The bubble could break, for a half dozen very good reasons, on any company at any point in the near and far future. This may be the ultimate in "buyer beware" in the stock market.

August 1999

#19 The Company You Keep (1998)

All Rights Reserved © 1998 Thomas W. Day

One of "the rules to live by" that my Midwestern background ground into me is "you are known by the company you keep." What my parents wanted me to get out of that concept was that hanging out with musicians and motorcycle riff-raff would limit my chances of ever getting a college degree, becoming an certified public accountant, and ending up in middle management. They were right and they were wrong. These days, the consequence of violating that code has taken on slightly different meanings for many of us.

Our associations come in a lot of flavors. On a large scale, the company we keep is the company we work for, the corporation, even the industry. Military-Industrial complex ex-employees carried a "government work" stigma throughout the seventies and eighties. Of course, federal and state government employees carved out well-earned reputations for inability and inactivity (except for postal workers who are occasionally dangerously active) that has been established since the first civil servant sneered at the first civilian victim. Higher education is the refuge of the overpaid, under-worked, and irrelevant aristocracy. My home territory, the medical industry, is earning a wonderful reputation for gouging the sick and dying, but paying, public and doing everything possible to avoid social responsibility. Your mileage may vary, depending on your perspective and source of income.

Companies can carry a certain stigma or identity. There are tales of mythical companies that allow their employees a mind-boggling sense of pride in both the work and their contribution to communities. People often include unicorns and magic crystals in the same conversations, so this could all be a load of rancid rabbit kidneys. Still, I can imagine that it's possible. Remember, I'm a sixties guy and flashbacks are our middle name.

Most companies make you feel like you are an unwilling step-sibling in Chuck Manson's family. Between the executives with four shining rows of regenerating teeth and products that are flung from assembly lines with critical parts scattered around the floor, it's tough to feel like one of the good guys. It's hard to imagine that you've ever known a good guy; or saw one once in a movie When the few people who actually accomplish work are the first thing to go, when economic times turn inconvenient, it's pretty tough to believe in company loyalty. So no one does, except the extremely gullible.

But some companies are a lot worse than the average awful sweaty shop. Xerox, for instance, will go down in history as being as well managed as an overflowing cat litter box. These execs stumbled into the computer technology of the future, way back in the late 70's, tripped over their own incompetence, and flushed away the most incredible inventions since Og discovered barbecue sauce. We can thank them for Apple's Macintosh, Windows, networks, the Internet and the Web, mice (not the squeaky kind), laptops, palmtops, and more cool stuff than Jeff Beck owns. We can also laugh at them for not making a cent on most of that stuff. What a bunch of maroons!

IBM, Bell Telephone, Braniff Airlines, Apple, the long-dead CP/M computer companies, General Dynamics, and a zillion others all had (or have) brain-dead corporate attitudes that led to lost customers, dumb products, overpaid-useless executives, and monster crashes that forever screwed up lives and reputations. Admitting that you work/worked for one of those companies is about the same as admitting that you occasionally wet your pants while sucking your thumb.

Finally, sometimes the nastiest "company you keep" is the sector of the company you hang with. Executives have always been looked at as "the enemy" by labor, at least since the first feudal system. The Robber Barons had to spend their time with other Robber Barons, or by themselves, because they didn't make human friends easily. Like FBI or IRS agents, the Bill Gateses of history have had to make their friends at work or not at all. Funky Bill was not the first bazillionare to buy a life and a wife and still end up looking like a refuge from the intro to "Revenge of the Nerds."

An awful lot of people who would make excellent managers do their best to avoid management, simply to avoid being stuck in rooms with manager type ilk. The quality of conversation in executive meetings is several steps below good soap opera dialog. The quality of thought and ethical behavior doesn't even register on a scale created for politicians. If you get caught doing a good job or allowing anyone who works for you to do a good job, it's back to the MBA factory, yuppie-boy. Competence? We don't need no stinking competence.

Or you could be a proud member of one of the many self-preserving unions. You could be an electrician or a plumber whose union bought off politicians so that you are banned by law from "donating" your labor for anything but the full hourly union wage. Even if you were weird enough to want to do a little work for Habitat for Humanity or your own church, you can proudly decline the urge ("I'd like to help, but that's against the law.") because your union dues have made it so. After all, it's tough to keep the Mafia in zoot suits and still have time for other worthy causes, isn't it?

When you think about it, there's a reason why the vast majority of workers hang out in the low-to-mid-income territory. It's safe. it's where all the most interesting people live. And you don't have to feel guilty about who you're seen with.

May 1998

Mixed Motives

In his book, Why We Get Fat (and What to Do About It), Gary Taubes points out a terrible truth and a massive flaw in the for-profit motive in all things critical when he describes the slippery slope the medical profession slid down when it bought into and began to promote the flawed argument that saturated fats are bad and carbohydrates are good. "We are told to eat less fat and more carbohydrates, and rather than avoid heart disease and get thinner, as the authorities had hoped we would, we've had as much heart disease as ever, and dramatic increases in obesity and diabetes.

"A more insidious problem is that all involved--the researchers, the physicians, the public-health authorities, the health associations--commit themselves to a belief early in the evolution of the science, arguably at the stage at which they know the least about it, and then they become so invested in their belief that no amount of evidence to the contrary can convince them that they're wrong."

It turns out almost everything on this chart is wrong.

This is the great flaw in all bad ideas that have the unintended consequence of generating a lot of easy profits. Literally, everything from junk food to our military industrial complex is based on some kind of poor science and misunderstood information. Once the "experts" put the nation on the wrong high-carbohydrate path, they created a two-headed monster of obese citizens and a mindless, amoral corporate empire of carb-and-sugar loading fat-people-producing industries. Now, we have a public that is convinced that red meat is unhealthy and sugar coated processed-flour cereals are "part of a balanced breakfast." We are a public that has been fed the grossly erroneous FDA "food pyramid" for 50 years and, now, nobody from the doctors who screwed this one up to the health research organizations who bought into the persuasive but unproven arguement too early and with too much vigor to the real gorilla in the room--the fat factory junk food manufacturers who are pretending to be "heart healthy" and upstanding corporate citizens--wants to turn this ship around and admit they were wrong, but we should believe them now.

Americans love bashing "experts," from the television weatherman to real scientists, and medicine is going to have to take a beating for a while to change this direction. Like most Americans, doctors have become smug, self-righteous, lazy, overfed, overpaid, and sensitive about all of that.  If they begin to contradict the advice they gave us, so confidently, just last week with data that iis nearly the exact opposite, today, the majority of Americans will run to witchdoctors and evangelists for moral support and their usual pile of bullshit and bacon. Turns out, the bacon is good, but the bullshit is still bullshit.

Food isn't the only place where this irrational behavior, at both ends of the information spectrum, takes place. For more than 200 years, Americans have been fed the lie that a strong military is a defense against the forces that threaten freedom and democracy. All of the world's history proves this to be more bullshit. Almost every instance in human history when a democratic government has been overturned, overrun, and/or corrupted the core to the rot has been that country's military. When Richard Nixon and his pet neofascist, Henry Kissinger, wanted to wreak Chile's democratic government, they knew where to spend our money to do that job; on Chile's naturally corrupt military. The ancient Greek semi-democracy found its ruin through a series of idiotic military invasions on their neighbors and the resulting retaliation that spelled the end of that brief period of democracy and an empire.

In American history, every war we've fought to "protect the American way" has resulted in lost civil rights and a more militaristic society. The more we invest in our military, the less stable our nation becomes. The stronger we make our military forces, the more likely it is that the government will turn against the citizens and impose martial law. It has been true for every other civilization in human history and, contrary to delusion, we are no different than any other humans. The thing to be proud of as an American was our feeble attempt at democracy and the thing to be most ashamed of is allowing that democracy to fade and be replaced with a military dictatorship.

Like the doctors who will eventually be the ones to bite the bullet and admit to 50 years of delusion and error when they slowly try to turn the Western diet around toward something that actually works, those American citizens who "served" in the military will be the ones who will have to do the hardest work in correcting the American military delusion. The doctors are at the bottom of a huge food chain that is purely profit driven and as cold as Willard Romney's shriveled little heart. There is plenty of blame and more than enough pain to be shared by all of the culprits in the American heart health scandal, but the American SYSOP is always to blame the privates while rewarding the generals for every kind of treason or incompetence.

The same rules will apply to America's citizen-soldiers. If we are going to face the fact that our huge, brutal, incompetent military is the greatest threat to our democracy, that realization will have to be driven by ex-soldiers who tell the truth. Guys like John Kerry, Bob Kerrey, James Webb, Al Gore, Daniel Ellsberg, Bradley Manning, Paul Markin, Liam Madden, Jonathan Hutto, and the 72% of American soldiers who believed that we should get out of Iraq two years before that happened are the people who are going to force this direction change, if it ever happens. Or, at least, if it happens before we see the end of the American Empire and the economic and social collapse of this nation.

The damage done to these soldiers is permanent. Their lives will forever be contaminated by what their nation asked them to do in the name of "freedom" but in the service of profits. As Bob Kerrey said about his Vietnam experience, "You can never, can never get away from it. It darkens your day. I thought dying for your country was the worst thing that could happen to you, and I don't think it is. I think killing for your country can be a lot worse." This needs to be said by every intelligent soldier who hopes to represent and honor his country, the United States of America, until the fear mongers, weapons dealers, and bought-and-paid-for politicians are afraid to raise their heads out of their sewers.