Flawless Execution

Sitting at the keyboard, I try to visualize my readers. An audience of casually, but neatly, attired adults from early 30s to late 50s, probably a bit more than half female, most with an interest in health care. Everyone out there knows that older people faced with physical tasks move more slowly than those middle-aged and younger. And I suspect that, like me when I was a mid-career physician, you attribute this slowing to the physical impact of increasing years on one’s strength, flexibility, and fitness. But there’s another factor, not widely appreciated, that gains in magnitude as one ages: the requirement for flawless execution.

Let’s take a task as simple as preparing the breakfast coffee. A mid-30s mother of two can do this without really focusing on it, multi-tasking while making sure two youngsters are dressed, fed, and on their way to school with everything necessary for the day. In contrast, a retired physician in his mid-70s knows that if he were to accidentally swing a glass coffee pot full of water against the edge of a granite counter, the impact would result in shards of glass and puddles of water all over the kitchen floor. The dog would want to inspect it all, with great hazards to her paws. The results of the error would require getting down to the floor, no longer a quick or easy process. Glass shards are hard to see. Would he find them all? What if he needed more paper towels — another up and down?

Or suppose, just suppose, in the confusion the bag of ground coffee were to fall over on the counter? Another clean-up! And if some of the coffee has some fallen off the counter-top onto the floor, then there’s another up-and-down with its inevitable question, “Did I get it all?”

With advancing years, one has the advantage of having repeated the simple tasks of daily life thousands of times. We seniors have our habits and routines. But daily life becomes a constant struggle with gravity. Earth wants to draw not just our artifacts but our bodies themselves ever nearer. Wading a trout stream, walking the dog, climbing the stairs, all these activities require flawless execution. Otherwise, gravity will extract the inevitable penalty for error.

So, younger colleagues, the lesson for the day is patience. The older people among you may want a bit more time. Watch them carefully, though, and you may well get to see flawless execution.

Government in Your Daily Life


Much of the current controversy in American public life seems to reflect dramatic differences of opinion about the role of government in our society, particularly our public life. The debate is often disturbing, largely for the neglect of historical data on both sides.

If we are asked to name the government agencies that we all interact with in our daily lives, the Internal Revenue Service (IRS) would probably top the list. After all, it’s had to escape the tax man. But what agencies would come next? Those who travel a lot might push for the Federal Aviation Agency (FAA), and investors might list the SEC or the Federal Reserve system. My candidate might not be one you would immediately think of — the FDA. Yes, the Food and Drug Administration.

Why? Well, you may think about drugs first. A few years, ago a Mayo Clinic study[1] documented that almost 70 percent of Americans take at least one prescription drug; more than half take two. Here are more recent, and more granular, data from the CDC website:

  • Percent of persons using at least one prescription drug in the past 30 days: 48.9% (2011-2014)
  • Percent of persons using three or more prescription drugs in the past 30 days: 23.1% (2011-2014)
  • Percent of persons using five or more prescription drugs in the past 30 days: 11.9% (2011-2014).

But you are even more likely to interact with the FDA at the grocery store. Who sets the standards for food labeling? Who’s in charge of health and safety in the food industry? Who investigates outbreaks of food-born illness? Answer: the FDA, for all of the above.

In her new book[2], The Poison Squad, Deborah Blum tells the story of Dr. Harvey Wiley, chief chemist of the US Department of Agriculture, set in the context of America in the late nineteenth and early twentieth century: a rich tapestry of unscrupulous businessmen, reformers, activists, muckrakers, and a few dedicated public servants.

Blum recounts in detail food adulteration with toxic “preservatives” and coloring agents, and adds in the fascinating conflicts over whiskey labeling. The primary theme is Wiley’s lifelong dedication to the scientific study of chemical food additives and to accurate labeling, but the story includes the colorful figures of the times including journalist/writer Upton Sinclair and President Teddy Roosevelt.

The separation of food and drug regulation from the Department of Agriculture and the birth of the FDA represented the culmination of decades of conflict. The price, mortality and morbidity paid in food born illness and toxicity from unregulated “medicines” by countless numbers of our ancestors will never be known.

The Poison Squad will give readers a good story, well told, about the forces that brought about the FDA. In a larger sense, it provides a case study of the question of the role of government in our society, set at a time when America was growing more complex and industry more powerful. The narrative will surely open some readers’ eyes to the positive aspects of regulation.

As Alan Wolfe writes, “The idea that liberalism comes in two forms [“classical” and “modern” or “social” liberalism] assumes that the most fundamental question facing mankind is how much government intervenes into the economy… When instead we discuss human purpose and the meaning of life, Adam Smith and John Maynard Keynes are on the same side. Both of them possessed an expansive sense of what we are put on this earth to accomplish. […] For Smith, mercantilism was the enemy of human liberty. For Keynes, monopolies were. It makes perfect sense for an eighteenth-century thinker to conclude that humanity would flourish under the market. For a twentieth century thinker committed to the same ideal, government was an essential tool to the same end.”



[1] Wenjun Zhong, Hilal Maradit-Kremers, Jennifer L. St. Sauver, Barbara P. Yawn, Jon O. Ebbert, Véronique L. Roger, Debra J. Jacobson, Michaela E. McGree, and others. Age and Sex Patterns of Drug Prescribing in a Defined American Population. Mayo Clinic Proceedings, Vol. 88, Issue 7, p697–707

[2] Penguin Press, 2018. New YorkCuba 2