Government in Your Daily Life

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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

 

Polarization, 1900

“How can I maintain a balanced, centrist, well-informed point of view in such a polarized society?” This was the major problem as the United States headed into the election of 1900. William McKinley was nominated by acclaim at the Republican convention. After a brass-knuckle back-room fight, McKinley had to accept Teddy Roosevelt as his running mate, largely as a concession to keep TR away from New York state electoral office. As in 1896, McKinley faced William Jennings Bryan, this time with Adlai Stevenson as Bryan’s vice-presidential hopeful. The front page of the Akron Daily Democrat of Friday July 6, 1900 covered the three polarizing issues. The democrats had pinned their hopes on the free-silver plank, and the “overthrow of imperialism and trusts.”

 

The free-silver issue rapidly lost steam as improvements in mining technology expanded production and filled the stores of the US Mint. In his first term, McKinley had put the United States firmly on the gold standard, and there it would stay. The trust issue also slipped to the back burner for the time being. McKinley, the prototype incrementalist, viewed trusts largely as a problem for the states.

 

Meanwhile, imperialism came to the fore. The United States, under McKinley, had acquired Puerto Rico, Guam, and the Philippines as the spoils of the Spanish American War and had added Hawaii as a territory by annexation. Not all Americans celebrated these island acquisitions. The “robust opposition movement included former presidents Harrison and Cleveland, …college presidents and academics, labor leaders, prominent clergymen, and famous writers….” There was no shortage of opposition to, and polarization about, American “imperialism.”

 

With the parties firmly at odds, the New York Times described Bryan’s democrats as “the army of the discontented.” Bryan proposed changes in “currency, banks bonds taxes, trusts, wages, and labor law.” He faced McKinley, “who spoke to the sober-minded, conservative, property-owning Americans.”   (Merry, p.445)

 

Into this fray rode Teddy Roosevelt, the former “Rough Rider” hero of the Spanish American War. “In eight weeks of campaigning, he traveled 21,209 miles in delivering 673 speeches to an estimated three million people in 24 states.” (Merry, p447) How important was TR to McKinley’s election victory? How much did his image as an outdoorsman and his popularity with the troops he had commanded help to swing a large segment of the populist vote to the Republicans? These are still issues for historians to debate.

 

The lessons 1900, however, are more straightforward. The 1900 electorate was highly polarized, between populist Democrats and middle-of-the-road incrementalist Republicans. Today, the labels are reversed but the divisions are not all that different. Who brought the country back together? A somewhat manic Harvard graduate that no one wanted on the ticket – no one, that is, except the voters.

 

High marks for Robert W. Merry’s book, President McKinley: Architect of the American Century.  Simon & Schuster, New York. 2017

How Often Do You Pull Out the Map?

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The photo above, taken on our recent visit to New Zealand, illustrates an irrevocable commitment. We did not explore this particular activity, bungee jumping, at any level deeper that photography!

This week, The Packet has arrived with two items, both well-seasoned, about leadership and learning.

Here’s some news from 1898. At the time, William McKinley was the President of the United States, the last president to have served in the Civil War.

On May 1, 1898, Commodore George Dewey led a United States Navy fleet to victory in the Battle of Manila Bay, in the Spanish-American War. In the words of Robert Merry, author of a recent, well-received biography of McKinley, Dewey’s victory “brought forth a kind of serendipitous imperialism.”

As a result of a very short conflict, the United States had gained control of Puerto Rico in the Caribbean, and Guam and the Philippines in the Pacific, and annexed Hawaii as well.

To continue Merry’s story, “The president, it was said, began his education on the Philippines by tearing a small map from a schoolbook, and when a government official arrived with more detailed charts he received them avidly while acknowledging his limited knowledge. ‘It is evident,’ he said, ‘that I must learn a great deal of geography in this war.’”

My point? McKinley had enlisted in the Union Army as a private; he attained the rank of brevet major. Before he was elected president, he had served in Congress, and as the governor of Ohio. Faced with the sudden, unexpected turn of events that transpired in the Pacific, what did he do? He immediately set out to educate himself.

That’s what leaders do; they look for information.

Fast forward to the New York Times Magazine of October 12, 2010. In a piece by Peter Baker titled “Education of a President, Baker says, “To better understand history, and his role in it, Obama invited a group of presidential scholars to dinner in May in the living quarters of the White House. Obama was curious about, among other things, the Tea Party movement. Were there precedents for this sort of backlash against the establishment? What sparked them and how did they shape American politics? The historians recalled the Know-Nothings in the 1850s, the Populists in the 1890s and Father Charles Coughlin in the 1930s. “He listened,” the historian H. W. Brands told me. “What he concluded, I don’t know.”

The two items span 112 years. There’s not much recently.

Come back soon for more photos of New Zealand.

Sending off the final draft

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This is Monday, January 08, 2018. About 3 PM on Friday the 6th, I sent my (new) publisher the final draft of a new book, a memoir-conversation with my long-time friend and double-sculls partner, Bernie Witholt. It’s like sending a youngster off to prep school. Someone else will look at her and correct a word here, or delete a comma there. She’s not ready to graduate yet. She needs proofing, formatting, and a pretty cover. But she’s largely out of my hands.

Over the weekend, I have thought a lot about her. I would like to introduce her. How about just three paragraphs in which Bernie describes his first symptoms?

I was one of some 150 people at a Zurich Stock Exchange Symposium on new high-tech startups emanating from the ETH and other Swiss universities. I came in late and, finding no seat, stood leaning against a steel railing. I did not feel good and I wondered why a few of my students, seated only a few meters away, did not jump up to offer me a seat.

About an hour after the meeting started, after the first two or three talks, I felt a strange rattling in my chest. This was new and quite unsettling. Was this a heart attack? What else might it be? I felt weak, eager to sit down, but there were no empty seats. The next speaker had just started. I looked around; no one else seemed to hear the rattling. I leaned harder into the railing. After ten or fifteen minutes the rattling subsided; the speaker finished his presentation, and I felt better.

With the rattle gone there seemed to be no reason to leave immediately, and so I stayed. The meeting ended a few hours later. I had no interest in chatting with other participants, but had some juice and left. This meant negotiating stairs from the auditorium level up to the higher street level. This was unpleasant. When I reached my car, I sat contemplating what had happened. Whatever it was, it did not seem trivial. I decided to go home this time, but to go to the emergency room of the University of Zurich hospital if it happened again.

Her name, unless the publisher decides to change it, is “240 Beats per Minute. Life with an Unruly Heart.”

Sending her off has left me with what people in my generation called “post-exam letdown.” As we advanced academically, end-of-semester exams became more and more important. At least, we thought they did. Performance on exams determined where we went to graduate school, medical school, or law school. And then, once in a graduate or professional school, better exam performance would mean a “better” post-doc, internship, or clerkship.

As a result, we studied intensely and after all the bubbles were filled with #2 lead pencil and the blue-books turned in, we crashed. Or, at least, we deflated. So it is with sending off the final draft. Even though now, it’s just a matter of hoping that people will like her.

I have neglected my blogging in the push to get her ready. Now that she’s out the door, I’ll take a deep breath and get back at it. Next week.

 

Cold nights are coming. Curl up with a good book

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The Amherst gymnasium, the site of JFK’s last speech.

 

Although Paul Dimond’s novel, The Belle of Two Arbors, appeared in April of this year, the epic story begins in the early twentieth century. Based on the temporal setting, the Weekly Packet can bring it to your attention without violating the underlying principle of reporting well-seasoned news.

I’ve just finished reading the 800-plus page story. I will admit that I am a “story” reader, not an “ear reader.” I skimmed lightly over many of the poems that Martha Buhr Grimes contributed to the novel in the guise of Belle, the central character.

Set primarily in what is now northwestern Michigan’s Sleeping Bear Dunes National Lakeshore, and in Ann Arbor, Dimond has constructed a rich story line with a dynamic female protagonist, a complex and powerful family, three world-famous poets – Frost, Roethke, and Auden – and the academic politics of two great American institutions, the University of Michigan and Amherst College.

The 200 to 250-page novel has become fashionable in recent fiction. Dimond’s 800-page story reminded me of Annie Proulx’s Barkskins. Both authors have created complex and fascinating families and followed them through generations. In both books, the author’s passionate commitment to the environment infuses the story, and each writer addresses the injustices done to native Americans.

The story of Belle and her family makes for the old-fashioned reading experience than I enjoy most: curling up in a big leather chair with a lap-blanket and escaping to another world for an hour or two in the evening as the story unfolds. Immerse yourself in it, and reap the rich rewards.

The author, Paul Dimond, is an Ann Arbor lawyer and writer, and an Amherst alumnus, Class of 1966. He, too, was in the audience in October, 1963 when President Kennedy spoke about poetry and power at the dedication of Amherst’s Robert Frost Library. Like many who heard that speech, Paul credits it with a long-lasting impact on his life and his career.

A fifty-four-year retrospective assessment of the impact of a single speech on a single day is fraught with hazard. The possibility of overweighting JFK’s words in the balance of long-ago decisions certainly exists. Nonetheless, I urge you to read The Belle of Two Arbors. As you enjoy the story, you’ll be amazed by the depth of Paul’s research and the clarity of his values. Surely with this sustained creative work, he has honored Kennedy’s proposition that, “art establishes the basic human truths which must serve as the touchstone of our judgement.”

Summer Reading. (Not required, but worthwhile)

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What did you think about over the past two major holidays, Memorial Day and the Fourth of July?

As I often do, I spent a lot of time wondering how we got to this strange point in our national history, and a smaller time hoping that the federal bureaucracy, in its nautical role as our national ballast, has sufficient inertia to hold the course in foul weather.

I’ve just finished reading two books that I want to recommend; both are appropriate for the packet. They are not new, but ripe for reading now.

The first is Fredrik Logevall’s Pulitzer Prize-winning Embers of War, a history of Viet Nam that focuses on the period from the end of WWII to 1959, at the beginning of the second Viet Nam war, the one the US fought.

The three main players of the story include war-weakened France, struggling to retain its colonial domination over Viet Nam, a home-grown independence movement desperate for military and economic support, and the suddenly superpower, the cold-war United States, operating on the basis of the “domino theory” and committed to halt the spread of “Communism.”

As Logevall tells the story, the players cannot shed the blinders that limit their vision and condemn them to act out their roles, no matter what the consequences. France poured blood and treasure into Viet Nam that could have helped stabilize her in Europe. Ho Chi Minh made a Faustian bargain with the Chinese, after his efforts to lead his country to independence were rebuffed by the US. Meanwhile, with the US caught up in the madness of McCarthyism and the “loss of China” political finger-pointing, the irrational political pressure to support first the French and then Ngo Dinh Diem and the South Vietnamese was overwhelming.

Logevall, a history professor, writes clearly and unobtrusively. As events unfolded, as a reader I could only shake my head, wondering, “Why?”

The second recommendation is Jean Edward Smith’s Eisenhower in War and Peace. Smith focuses much of the book on Eisenhower’s military career, an important approach in order to understand how Ike functioned as President. Eisenhower was extraordinarily fortunate throughout his career in gaining brilliant senior military men as mentors, probably because they recognized his extraordinary capabilities.

Smith emphasizes Ike’s skills at the card table, his perspective in structuring “carrot and stick” decisions for both his peers and his subordinates, and his ability to delegate responsibility.

The two books, taken together, help to clarify the complex path that led to the United States involvement in Viet Nam. The relationship between Eisenhower and DeGaulle, the political pressures within the Republican Party, the pressure to use tactical nuclear weapons, all played a role.

What’s my message here? We live with our successes, and with our mistakes. Americans should celebrate the 4th of July. The essential document of the day, the Declaration of Independence, stands as a remarkable example of our successes. And on Memorial Day, the Civil War and the Viet Nam War stand as stunning examples of the consequences of our mistakes. It takes about a half-century, a reasonable time for the dust to settle, to see how the mistakes were made.

The photos are all from Havana, Cuba. I think they speak to some of the issues. The lady in the rain was photographed on the grounds of the Hotel Nacionale in a sudden downpour. The red Buick was originally, I believe, a 1954 Roadmaster. The missile is an SA-2 Guideline surface-to-air missile of the type that shot down Rudolf Anderson’s Lockheed U-2 aircraft over Cuba on October 27, 1962,during the Cuban Missile Crisis. The wrecked engine of the U-2 is displayed below the missile.

“Outside of a dog, a book is man’s best friend. Inside of a dog it’s too dark to read.” ― Groucho Marx

About a year ago, two reviews of Annie Proulx’s novel, Barkskins, appeared in the New York Times. Neither was particularly favorable.

I bought an audiobook recording of the novel and have listened to it, all 26 hours of it, while driving up and down I-75 from Ann Arbor to the Upper Peninsula. I finished the last disc a few days ago driving west on M-28.

Two of Proulx’s previous works, The Shipping News and Brokeback Mountain, have won a Pultizer Prize and a National Book Award. Barkskins probably won’t scale those heights. Nonetheless, the book appealed to me at several levels.

First, Proulx is now over 80, and any octogenarian who has the dedication and energy to write and publish a 717 page novel spanning 300 years is OK in my estimation. Second, the tale is a prolonged, slowly intensifying, protest against the wholesale exploitation of natural resources for corporate profits. It’s a protest that might be more effective at a fraction of the length, but it certainly conveys the intensity of her feeling. At this stage of life, having intense feelings about issues seems to me extraordinarily admirable. And from time to time, she delivers positively lyrical descriptions.

Finally, though, I was drawn to her failure to get the story ended. I’m sure we have all sat through to one or another piece of classical music in which the audience raises its’ collective arms, ready to applaud and get the damn thing over with, only to have the orchestra continue on, repeatedly swelling toward but not achieving a grand finale. In the last chapters of Barkskins, Proulx just can’t stop the music.

Most stories often have natural endings. The detective solves the crime. The traveler returns home. The horse wins the race. But Barkskins won’t end for Annie.

I find that appealing. She doesn’t want to hang it up, to say, “There, that’s all I have to say about that.” Good for her!

I don’t think many Weekly Packet visitors will head to the local bookstore to buy this very long novel. You just won’t have time to read it. So, here’s an offer you can’t refuse. Anyone who is facing a long drive, for instance, New York to Los Angeles by way of New Orleans, can let me know. I’ll send the audiobook to the first reader I hear from. You’ll enjoy it.

The Day After April Fool’s

True confession. If one refuses, and I do, to write about current political events, then finding subjects can be challenging. As I wondered how to appropriately memorialize the day after April Fool’s, I thought about my recent reading. “Gosh, I thought, I haven’t read much lately.” Then, I looked around the room I call “my office.” (My wife calls it something rather different; let’s not go there.) I really have read quite a lot, but mostly related to “The President and the Poet,” a project that is worth checking out  if you are not familiar with it. (Also, have a look at Reunion ’64 and please consider some modest support, $10 or $20, for the project on Kickstarter.)

Then, I thought about my Kindle. Yes, I’ve read a good bit on it, too. Most recently, I completed Aldo Schiavone’s Pontius Pilate. Deciphering a Memory. The book received a nice review in the New York Times, but there are two problems. First, the translator was very fond of obscure academic English terms. He lost me, not once, but several times, in a dense fog of theological scholarship. Second, the entire historical record can be summarized in two sentences. Solid historical evidence indicates that a Roman, Pontius Pilate, governed the territory around Jerusalem around the time that we have arbitrarily picked as the beginning of the “common era.” A brief interaction between Pilate and an itinerant Jewish teacher named Jesus resulted in the latter’s death. Building a full book from those sentences requires injecting a lot of material that, at the best, could be called ‘scholarly interpretation.’  Not highly recommended.

So then, I really looked around the office. I’m struck that the books I keep coming back to are the ones I should write about. The two that never get far off my desk these days are Daniel Kahneman’s Thinking, Fast and Slow and Leonard Mlodinow’s The Drunkard’s Walk. How Randomness Rules our Lives.

Back in the early 1980s, I thought that game theory might offer a useful approach to understanding clinical decision-making. I published a little-known paper about this, but the real bonus was that the background reading lead me to Kahneman. I have been a fan ever since.

I found Mlodinow after I started working at Scios and realized that I was so inept at statistical thinking that I did not even know how to ask statisticians good questions. This ineptitude became embarrassing when it was revealed on an almost-daily basis, and it accounted for my purchasing a number of books. Mlodinow’s is one of the better ones; his strength is that his language makes critical concepts accessible for lay readers.

So, as I look around the office, I’m going to come up with a new rule. I hope you know some of my old ones, for example “Sicker patients do worse.” Or, “Non-fatal diseases generally get better.”

Here is the new rule, based on the concept of “presentness,” (last post) and the two books I have just discussed…

“Any intuitively obvious conclusion based on present data is very likely incorrect.”

CAT

Presentism

In high school, I learned that writing offered an opportunity to display one’s vocabulary, and thus, presumably, one’s erudition. Complex sentence construction was laudable, save for the dreaded “comma splice.”

Then I arrived at Amherst, where Theodore Baird dominated my freshman year. Baird lived in a Frank Lloyd Wright “Usonian” house, and was a friend of Robert Frost. In his course for freshmen, English 1-2, Baird taught writing. He rewarded simple straightforward sentences. He derided complex constructions.

A few years ago, Dan Chiasson reviewed Baird’s book, English at Amherst, and said, “It would be an exaggeration to say that getting Frost right was the great mission of English 1-2. For one thing, the course read no Frost. In fact, after its early, provisional years, it read nothing: no literature, no text of any kind. But I think it is true to say that the air of Robert Frost pervaded English 1-2.”

I agree.

With this background, I was drawn into a recent New Yorker book review titled “The Illiberal Imagination” by Adam Gopnik, a long-time staff writer for the magazine. He pulled me in with two sentences. “Of all the prejudices of pundits, presentism is the strongest. It is the assumption that what is happening now is going to keep on happening, without anything happening to stop it.”

The review covered three books: Pankaj Mishra’s Age of Anger, Joel Mokyr’s A Culture of Growth, and Yuval Noah Harari’s Homo Deus. I understood very little of Gopnick’s commentary, which was obviously erudite and involved quite a lot of Rousseau and Voltaire. On the other hand, I really liked the concept of “presentism.” More accurately, I liked Gopnick’s identification of the concept as faulty.

“That’s what I’ve been trying to say!” I thought. That’s what I had in mind when I wrote that I wanted to capture the perspective of the reader who is delighted to have a month-old newspaper arrive on the mail packet.

Thinking about presentism seems important to me. The past is debatable. For instance, the slogan “make America great again” seems patently false. What was great about the Depression, polio, segregation, the Cuban missile crisis, or the Viet Nam war?

The future is, by definition, unknowable. This leaves us with the present. Here and now is what we have to work with, and where we have to become engaged. We must not fall into “the assumption that what is happening now is going to keep on happening.”  Presentism is disheartening, paralyzing.

But this is when the month-old newspaper arrives, like the cavalry coming over the hill. We read it. My goodness, that was terrible! But whatever it was, it ended. By now, something else has happened. The present, whatever it is, will change. How invigorating!

Shaping the outcome of today, shifting a bit toward something better, becomes the relevant question for us. This is the antithesis of presentism. How do we bend toward better without breaking something? Ah ha! Read the month-old paper, carefully. Did yesterday’s crisis require solution, or did it self-resolve? How did the leadership muddle through? Just as important, what were the unintended consequences of what they implemented?

Chiasson had another thought about Theodore Baird. He wrote, “If you can convince a large number of 18-year-olds that making up sentences is an act of deep moral imagination, you do it, no matter how much work that entails.” By extension, recognizing good sentences when reading can also be important. So thank you, Mr. Gopnick, for those good sentences.

Scottish mysteries. A great get-away vehicle.

My goodness, it is difficult to write without diving straight into politics. I’m going to try to avoid the subject by telling you about a couple of really good books.

The first is Peter May’s new Coffin Road, a mystery set in Scotland and the Outer Hebrides. May writes both beautiful descriptions and complex, but credible plots. In this tale, he also weaves some serious environmental concerns into the mix of memory loss and murder. If you’re not already familiar with Peter May, start with his Lewis trilogy. The first of the three books is The Black House, followed by The Lewis Man and The Chessmen.

The second is Out of Bounds by Val McDermid. This is another Scottish murder mystery, and McDermid will have you turning pages as fast as you can! There’s also a marvelous subplot addressing the flood of Middle Eastern immigrants in Scotland. And she writes with a recognizable voice and accent.

Where am I going with this? There’s a whole world of marvelous writing and thinking going on that will, for a few hours at least, transport you away from the faux-immediacy of Wolf Blitzer and the talking heads. Enjoy it.

On a totally different topic, my wife and I have had some fairly routine interactions with the health care system over the past two months. As a patient, I sense the intrusion of the electronic health records (EHR) system in the process, and resent it. Both our primary care and specialty physicians have adopted the use of “scribes.” The presence of the scribe, with his or her laptop, becomes a “gorilla on the table” in terms of conversation with the physician. There has to be a better way!

Speaking of the EHR, I followed a couple of links in my morning e-mail and learned that M.D. Anderson Cancer Center had losses of over $100 million last year. “Dan Fontaine, the chief financial officer, attributed much of MD Anderson’s financial difficulties to the rocky implementation of an electronic health record system in 2016.”

Finally, Nesiritide. The Rise and Fall of Scios received a nice review in Kirkus Reviews. Please have a look and add your comments on the site.