Archive for the ‘History’ Category

Today’s Class: Impeccable Timing 101

Monday, June 15th, 2020

No one will ever accuse the Republican Party of being overburdened with sensitivity. In two stick-in-the-eye moves just oozing with impeccable timing, the Grand Old Party is telling the world just what it can do with its Black Lives Matter folderol.

First, the GOP’s unquestioned leader, President Donald Trump, like a too long cooped up horse, has decided to resume his rallies, which for him seem to be better than crack cocaine. This week in Tulsa Oklahoma he and as many of his followers as campaign officials can cram into the 19,000-seat BOK Center will gather for a couple of hours of The Best Of Trump as if the COVID-19 pandemic had never happened, neither masks nor social distancing required. Reminds me of Ebenezer Scrooge discussing innovative methods to “decrease the surplus population.”

In the first of his two impeccable timing decisions, Mr. Trump announced he would hold his Tulsa rally on 19 June, known as Juneteenth, the date on which in 1865, the last of the South’s slaves were notified of their freedom under the Emancipation Proclamation. It would take until the following December and the 13th Amendment to officially abolish slavery in America.

Juneteenth is recognized as a state holiday or ceremonial holiday in 47 states and the District of Columbia (what are you waiting for Hawaii, North Dakota, and South Dakota?) and is the oldest celebration marking the end of slavery, dating from 1866.

According to the Associated Press, Trump was unaware of Juneteenth, let alone the significance of it to the Black community, when he announced his rally’s date. Consequently, he did not anticipate the blowback he would get. But get it he did. Even from his own supporters.  In a rare instance of backing down, he moved the rally to the next day, the 20th, still in Tulsa at the BOK Center.

But in America’s Black consciousness, Tulsa is known for a lot more than Juneteenth, as significant as that is. On another day in June, the 1st June day of 1921, Tulsa was the site of the worst race massacre in American history.

The day before, police had arrested a young black man by the name of Dick Rowland for allegedly attacking a white woman in a Tulsa elevator. Soon after Rowland’s arrest, rumors began to spread about a group of whites planning a lynching party. To protect Rowland, African American World War 1 veterans surrounded the jail holding him. There was a standoff with a mob of whites. Somebody fired a shot, and a firefight ensued. The much larger white mob pushed the black vets all the way to Greenwood, Tulsa’s black section.

Greenwood was the wealthiest black neighborhood in the country. Oil had made it rich. Racism was about to destroy it. Over the course of the day, 6,000 homes and businesses and 36 square city blocks were turned to ash. Pilots of two airplanes dropped turpentine bombs on buildings, instantly igniting them. Three hundred African Americans were slaughtered, most thrown into mass graves. Not a soul was ever prosecuted for anything. Then Tulsa, population 100,000, swept it all under the rug. Two generations later nobody knew a thing about it. It was never taught in schools, no books were written, no oral history passed down. It was as if it never happened.

Tulsa’s current mayor, G. T. Bynum, wants to take the rug up to see what’s hiding under it. He’s committed to investigating what happened and determining accountability. He thinks he’s found a couple of the mass graves and is having them excavated. The goal is to at least identify as many victims as possible through DNA analysis.

For the people of Tulsa, especially the black people of Tulsa, this is a deep, open, festering wound, and next Saturday Donald Trump will come riding into town on his big, very white horse to preach the gospel of Trump to 19,000 of his followers. It’ll be an interesting day.

There is one more incident of impeccable timing.

The Republican National Covention had been scheduled for North Carolina, but because North Carolina’s Democratic Governor Roy Cooper, concerned about the spread of COVID-19, would not guarantee a full house for the late August event, the Republican party has moved most of the convention to Jacksonville, Florida. The Coronation of Mr. Trump is set for the night of 27 August.

And, you guessed it, there is a black history story about 27 August and Jacksonville. It is known as Ax Handle Saturday.

The year is 1960 and the Jacksonville Youth Council of the National Association for the Advancement of Colored People (NAACP) is holding peaceful lunch counter sit-ins. Peaceful demonstrations. A group of outraged whites taking exception to this level of daring, begin spitting on the demonstrators and calling them names no one should ever be called. Then ax handles, mercifully without ax heads, suddenly appear along with baseball bats, and the demonstrators begin to get hit. Things go downhill from there. When it is all over dozens of young African Americans would be wounded in various ways. On a brighter note, nobody died, but that was probably blind luck.

To give you an idea of racial relations in Jacksonville at the time, a year earlier, in 1959, the year before Ax Handle Saturday, Nathan Bedford Forrest High School opened in Jacksonville, celebrating the memory of a Confederate General and the first Grand Dragon of the Ku Klux Klan.

The 60th anniversary of Ax Handle Saturday will be celebrated on 27 August in a park about a mile away from the convention at about the same time the balloons come down. Impeccable timing.

 

 

Racial Justice: If Not Now, When?

Monday, June 8th, 2020

Since the nonchalant murder of George Floyd our nation has galvanized behind the cause of equal justice for all. We have moved past the chaos of the first day or two to a too-loud-to-be-ignored-any-longer chorus peacefully demanding systemic changes in race relations. Now, the question of the moment is: What will come of this? After all, we’ve had demonstrations and protests when abominations like this have happened before. And afterwards, after the thoughts and prayers stuff, life goes on. Is this going to be any different? Personally, I think it will be.

Why? Let me tell you a story.

It is 31 January 1968. In Vietnam, it’s the most important holiday of the year, the Tet Lunar New Year. In years past, this seven to nine day holiday has been the occasion for an informal cease fire between North and South warring forces. But not this year. Since the previous autumn, the North Vietnamese military commander General Vo Nguyen Giap has been secretly caching weapons, ammunition and Viet Cong troops throughout the country. In late autumn 1967, in a brilliant move of military misdirection, Giap has North Vietnamese regular army regiments attack U.S. strategically placed Firebases in the highlands of central Vietnam. The ferocious  battle of Khe Sang is an example. As U.S. commanders concentrate on repulsing these attacks, Giap prepares to spring the Tet trap.

And in the early morning hours of 31 January, 70,000 Viet Cong troops attack all over the country.

The Tet Offensive takes South Vietnamese and American commanders and politicians completely by surprise, shocks the U.S. public and begins the slow erosion of public support for the war. The fiercest fighting happens in the city of Hue, the ancient capital of Vietnam. The Viet Cong capture Hue and hold it until they are finally driven out on 24 February by American forces. During the time they hold the city, the Viet Cong exact a terrible price. They go house to house arresting all people thought to be South Vietnamese sympathizers, including a convent full of Catholic Nuns. They massacre them all and throw them into mass graves. Five thousand people.

In three to four weeks, Giap’s forces are resoundingly defeated. He has spread them too thin. The Tet Offensive will prove to be a military disaster for the North, but, more important, it will become its biggest strategic victory. American and South Vietnamese politicians now realize the contest will be longer and much more deadly than they have anticipated, the mood of the American people begins to shift, and U.S. army Killed In Action increases to 500 per week.

And then, twenty days after the recapture of Hue, comes the most horrific and gruesome stain on America’s character during the entire war: The My Lai Massacre.

It is 16 March, and at the village of My Lai an American nerve-frayed platoon of the Americal Division under the command of 1st Lieutenant William Calley massacres hundreds of innocent civilians – men, women and children – as they run from their huts. Then they round up the rest of the village, line them up along a large ditch and shoot them all. According to Vietnamese records, they slaughter 547 people that day (the U.S. admits to only 304).

Calley had been ordered by his Company Commander, Captain Ernest Medina, to enter My Lai and kill the Viet Cong that Army Intelligence thought were hiding there among the civilian population. But there are no Viet Cong at My Lai that day. The Platoon troops don’t care. They kill everyone. And Calley, their commanding officer, stands by and watches. He does nothing to stop it.

Afterwards, Calley’s commanders in the Americal’s 11th Infantry Brigade will cover up the massacre by simply saying there wasn’t one. But the truth eventually comes out when American reporter Seymour Hersh breaks the story a year later (for which he will win a Pulitzer Prize). Calley is court-martialled, found guilty and sentenced to life in prison. President Nixon will reduce the sentence to three years and allow Calley to serve it by house arrest at Fort Benning, Georgia. The army also charges fourteen other people up and down the chain of command. All either have their charges dismissed or are acquitted at trial. Everyone seems to live happily ever after, even Calley, who doesn’t publicly admit any regret until 41 years later.

Why am I writing this? For two reasons. First, because the quality of leadership matters. All the leadership, top to bottom,  surrounding the My Lai massacre was horridly bad leadership, and, in the eyes of the public, leadership in many of America’s police departments is of a similar calibre. It is seen as suspect, at best, and despotic, at worst. Second, because the Tet Offensive and the My Lai massacre galvanized the American public into creating a movement that eventually became too powerful for politicians to resist and led to the end of the Vietnam war, a war that killed more than 50,000 Americans and millions of Vietnamese.

Today, we are in a similar situation of urgent morality. For hundreds of years, black children have been raised to fear whites, especially white police. “Don’t talk back, keep your hands on the steering wheel at all times, and never ever reach for anything.” Driving While Black is not fake news. The selection and training of police recruits continues to perpetuate this fundamental character flaw in the soul of America.

At the very least, what will reduce the worst in policing and increase the best is a thoroughly reimagined system of selecting and training new police officers. “Protect and serve” begins with empathy, actually seeing the people one is sworn to serve; actually listening to better understand them and their needs.

After My Lai, the army rebuilt its officer training programs. The Code of Military Justice and the Geneva Convention were given more attention. As we moved to an All-Volunteer Army, the selection criteria were rethought and enhanced. We have seen the benefit of that in our military’s improved conduct in Iraq and Afganistan. That kind of retooled selection and training has not happened in police academies. What has happened is more training in crowd control, more buying of military quality weaponry and a perpetuation of an us versus them mentality. These have been on stark display since the killing of George Floyd.

To change this will require sustained, dedicated and empathic leadership, which I’m guessing will not be coming from 1600 Pennsylvania Avenue, at least not in the immediate future. But the growing and forceful muilticultural demands for equal justice as vividly  demonstrated recently on the streets of America is a start, a start that urgently needs a finish.

Pandemics: Are We Smart Enough To Learn From Them?

Friday, May 8th, 2020

“As the world becomes more of a global village, infectious disease could by natural transmission become more threatening in the United States. Here monitoring is lax because of a mistaken belief that the threat of infectious disease has been almost wiped out by antibiotics.” American Medical Association conference on infectious disease, 2001, from Norman F. Cantor, In the wake of the plague, 2001, Harper Collins.

Pandemics and the Roman Empire: From glory to gory

History’s first pandemic, the Antonine Plague, struck in AD 165 at the height of the Roman empire, the time Edward Gibbon described as when “the condition of the human race was most happy and prosperous.” Nobody knew, but the Roman Climate Optimum (RCO) was approaching its end. The RCO was an extremely propitious climatological period (BC 400 – AD 250) that allowed the empire to keep all its ~70 million people well fed and relatively healthy, which led to the development of the greatest army the world had ever seen, and would not see again for more than a thousand years. The Antonine Plague, named for the family of Emperor Pius Antoninus, killed at least seven million of the empire’s people, more than 10% of the population.

The greatest physician of the age was Galen (born AD 129). He treated and cured a number of distinguished Romans and extensively documented the spread of the disease in his masterpiece, The Method of Medicine. He said, “Hippocrates showed the path; I made it passable.” Galen didn’t know what caused the Antonine Plague, but he did know that it spread quickly in densely packed pockets of humanity and less quickly when people stayed away from each other.

The Roman Empire survived the Antonine Plague, its imperial fibers frayed, but not broken. The empire recovered its strength. Relative good health returned. Until AD 249, that is, when the Plague of Cyprian ambushed the empire. The Plague, named for the Christian Bishop from Carthage whose writings document the event, was probably smallpox. The Plague of Cyprian lasted 20 years and, at its height, killed about 5,000 people per day in Rome.

Once again, the empire recovered, but now it was weaker with reduced resources. Moreover, the RCO was steadily ending and climate was beginning to turn unfavorable. Egypt, the empire’s breadbasket, began to experience drought, something that had never happened during the RCO. This time, the empire dissolved into anarchy and saw the emergence of the “barracks emperors,” who righted the ship of state once more – for a time. But now, disease was always just over the horizon.

In AD 378, the Roman army suffered its worst defeat ever at Adrianople where 20,000 soldiers were killed, a terrible loss of life, but tiny compared to plague deaths. In 410, the Visigoths sacked the city, the first time an enemy army had ever been inside the the Roman walls. Rome was heading inexorably toward its ruin.

In AD 541, the Justinian Plague landed the knockout punch for the Roman Empire. This greatest of pandemics, until then, anyway, was the pandemic of yersinia pestis, the agent that causes bubonic plague, and it lingered off and on for 200 years. That was when Rome descended into a high-end, Byzantine rump state, its former glory a distant memory. Roman records show the city inhabited by one million people during the time of Marcus Aurelius in AD 165, now housed about 20,000. The world would not see another million person city until London at the end of the 17th century.

Where did all the disease come from? Until the Antonine Plague, Rome had never been struck on such a grand scale. Today, experts believe it hitched a ride with people who travelled more and more in a vast empire. For example, the Justinian Plague is thought to have originated in China, making its way to Rome through trade. Just like today.

The Romans didn’t have the scientifically designed medical therapies to combat infectious disease. But even then mitigation efforts were aimed at running from the disease, creating separation, wherever it manifested. For example, in AD 452 Attila the Hun was plundering all of Italy on his way to Rome, whose soldiers were powerless against him. But then, confounding the Romans, he stopped, decamped and headed for the high ground of the Alps. Why? To get away from the anopheles mosquito. Malaria was suddenly killing his men and his horses. Which proves germs were better at killing than soldiers.

The Black Death of the Middle Ages

In the 14th century, bubonic plague (and probably anthrax, too) struck again causing the greatest pandemic the world has ever seen. The population of England was reduced by ~50% and did not recover until about 1800.

At that time, Edward III, King of England, Wales and one-third of France, was poised to add Spain to his conquests by marrying his 15-year-old daughter, Princess Joan, to Spain’s Prince Pedro. The marriage would change the face of Europe and give Edward control over most of the continent. The year was 1348, and bubonic plague struck as Joan and her large entourage were crossing the channel. They landed at Bordeaux, where the plague was suddenly and viciously cutting down the population leaving bodies stacked in the streets. The stench was terrible. People dealt with it by walking around covering their noses with handkerchiefs drenched in perfume. The 14th century’s version of face masks.

The welcoming committee advised the Princess and her party to get far away from the plague. But the English thought they knew better and settled into Chateau de l’Ombriere, overlooking the Mediterranean and dead smack in the middle of the disease. Within weeks, they were all dead except for one English minister who brought the news back to Edward.

And so the bite of a flea altered the course of history.

The Spanish Flu of 1918/1919

And in the early 20th century we were visited by the Spanish Flu, which carried off 50 million souls worldwide. We told the story of the Spanish Flu here, early in our waltz with COVID-19.

Americans then did what Americans are doing now: they kept apart, stayed home to avoid contact, and wore masks when they moved around in society. At least most of them did, just as most are doing now.

Those Americans had to wait 20 years for a vaccine that only 40% of us now take, and thousands still die every year from the flu.

Conclusion

You may say, “Why is this history, interesting though it may be, even being mentioned? Here in 2020, we’re 2,000 years removed from ancient Rome; 650 years from the death of Princess Joan, and the Spanish Flu was 100 years ago. Why bring this stuff up now?” After all, the combination of more energy, more food, sanitary reform, germ theory, antibiotics and all around jet-propelled science have led to a population boom unlike anything else in the history of the planet. People are living longer and better. So, why look to ancient history in the midst of COVID-19?

Social distancing is nothing new. Throughout history, when societies were confronted with infectious disease on a grand scale, people tried to evacuate the area. Some of them could, most could not. They had no knowledge of the value of hand washing, and hand shaking was as common then as it is now, or at least as it was ten weeks ago, so disease transmittal was rampant.

But beyond all that, although blind luck and more than a little mismanagement contributed to the decline and fall of Rome, infectious disease and climatological degradation were the driving forces. And the Romans were blindsided by both. In the Black Death period, aristocratic hubris and tremendous poverty throughout the population’s underbelly led to death on a massive scale. During the Spanish Flu, many in the U.S. ignored warnings and directives to be “socially distant.” Many chose not to mask in public. Many protested government edicts to contain the spread of the disease. And many died.

Here, during COVID-19, we’ve had:

  • Gross mismanagement from the top, as well as in some of the states;
  • Aristocratic hubris on a massive scale;
  • Profound economic inequality and, consequently, disease in large sections of our urban communities; and,
  • Misguided protesters who endanger themselves and others as they gather together clamoring for the freedom to do just that.

Science and our seeming societal sophistication have led many of us, too many, to believe we actually can plant cut flowers and watch our garden grow.

In the words of that great American philosopher, Pogo, “We have met the enemy, and he is us.”

And Now For Something Completely New And Different: May Day!

Friday, May 1st, 2020

“When the pandemic is over, our society will need to stop and think about who is essential and why should the delivery truck driver earn a tiny fraction of what is paid to the Executive Vice President for Interactive Synergy & Proactive Metrics?” ― Garrison Keillor

Boy, do we need a break. This dystopian, abnormal new normal is wearing us down.  Yesterday’s little broo-ha-ha in the Michigan Capital with wackadoodle white gunslingers roaming the gallery illustrates the point.

So, today we’ll take a break from all things COVID and bring you a touch of history. Stay with me, now.

First, a plug. For many years, Garrison Keillor has published The Writer’s Almanac, a refreshing and informative daily dollop of history and poetry that somehow finds its way to the inbox every morning. If you’re not a subscriber (it’s free), you will thank me if you become one. Today’s Writer’s Almanac told the story of May Day, all the way back to the 3rd century BC. Everyone thinks they know all about May Day, but maybe everyone should give that a rethink, especially when everyone reads about the Puritans’ views on the subject.

Here, from The Writer’s Almanac, is the story of May Day.

Today is May Day. Even though spring officially begins in March, today is the day that celebrates the height of spring, a day of spring festivities and celebrations. It is also a day to honor laborers.

Like many of our modern holidays, May Day has its roots in ancient, pagan celebrations.

Beginning in the third century B.C. in Rome, the festival Floralia, for the goddess Flora, was held in the days around May Day, April 28th to May 3rd. Flora was a goddess of flowers and fertility, and the festival was held to please her so that she protected flowers and other blossoming plants. There was a circus and theater performances, there were prostitutes and naked dancers, and a sacrifice to the goddess. Deer and goats were let loose to symbolize fertility, and beans and lupines were scattered for the same reason. Romans usually wore white tunics, but during Floralia, they got to wear bright colors.

In the Celtic British Isles, May Day was celebrated as the festival of Beltane, or Bealtaine or Bealtuinn — Bel was the Celtic god of light, and taine or tuinne meant fire. It was the summer half of the year — a time when the sun set later, when the earth and animals were fertile. Beltane lasted from sundown the night before to sundown on the first of May. On the eve of Beltane, people lit bonfires to Bel to call back the sun. People jumped over the fires to purify themselves, and they blessed their animals by taking them between bonfires before leading them to their summer pastures the next day. It was a day to walk around the property lines and assess your land for the summer season, to mend fences. Women washed their faces with the spring dew so that they would stay beautiful, and there was dancing, tournaments, parades, feasting, and general revelry. There were lots of flowers — men walked around the fires with rowan branches to keep evil spirits at bay, and May trees, or Maypoles, were set up covered in rowan or hawthorn flowers as a blessing. People danced around the Maypole, seen to be a phallic symbol to promote fertility, and villages would compete with each other to see who could produce the tallest maypole. Young couples went off into the forest to spend the night together and came back the next day with flowers to spread through the village. A young woman was crowned May Queen, and she would ride naked on horseback through the village.

Many of these celebrations continued as late as the 17th century — the Puritans were not too pleased, especially since so many young women went off into the woods and came back pregnant. Maypoles were made illegal in 1644.

Since the Puritans discouraged May Day, it was never a major holiday in America. In the late 19th century, May Day was chosen as the date for International Workers’ Day by the Socialists and Communists of the Second International to commemorate those who were hanged after the Haymarket Square riot, which occurred in Chicago in early May of 1886.

CoVid 19 And The Flu: Some Historical Perspective That Might Surprise You

Thursday, March 26th, 2020

Early in the morning of 4 March 1918, at Fort Riley, Kansas, Private Albert Gitchell reported for sick call at the Fort’s Hospital complaining of sore throat, fever and  a headache. By that noon, more than 100 other Fort Riley soldiers were at the hospital with similar symptoms. This was soon followed by similar outbreaks at other Army posts and prisons around America. Epidemiologists believe this to be the beginning of what came to be known as the Spanish Flu.

That March, 84,000 “Doughboys” shipped out for Europe, to be followed by another 118,000 in April. They brought the highly contagious flu with them. Soon, all of Europe and parts of Asia were infected. In June, Great Britain reported 31,000 cases (As I write this – 26 March – New York is reporting more than 30,000 cases of Covid 19). France and Germany suffered, too. Germany’s Crown Prince Rupprecht wrote on August 3. “Poor provisions, heavy losses, and the deepening influenza have deeply depressed the spirits of men in the III Infantry Division.” Soon, Russia, North Africa, India, China, Japan, the Philippines and even New Zealand would fall victim, as well.

The war ended on 11 November and the soldiers went home, bringing more of the disease with them. A second wave then hit America, much more devastating than the first. It infected 28% of the country’s population including my 5-year old Dad, who survived, thank you very much. It finally petered out at the end of 1919. As today, younger people seemed to combat the disease better than the aged.

From March through November, Americans did not know much about the Flu and its effect on the population. The Central Powers took great pains to censor bad news, trying to keep morale high. The first reports of the Flu came in May from Spain, a neutral country with uncensored media. Hence, it became the Spanish Flu. But when the war ended the ropes came off and the world knew it was in the grips of what would become the worst pandemic in history, rivaled only by the Bubonic Plague, caused by Yersinia Pestis, the black rat, in the mid-14th century. That plague killed more than two million people in England alone, 40% to 50% of the population, and the population would not recover to its former level until the early 1800s.

When Americans finally learned what the Spanish Flu was doing to them what happened?

Well, first of all, there was no vaccine and no curative treatment. Sound familiar? Second, because of not wanting to spread bad news, the government delayed mobilizing fully to combat a different kind of enemy. Sound familiar? When it did, what did it do? As now, with CoVid 19, the burden fell mostly on Governors, Mayors and local health officials. Because the Flu was so widespread, affecting the entire country at once, most states and cities were on their own. Many made tragic mistakes, as many are doing now. Actions in Philadelphia and St. Louis, MO, provide two 1919 examples.

As cases mounted, Philadelphia went forward with a Liberty Loan parade attended by tens of thousands, shoulder to shoulder. The disease exploded exponentially. In just 10 days, over 1,000 Philadelphians were dead, with another 200,000 sick. Only then did the city close saloons and theaters. By March, 1919, over 15,000 Philadelphians had died.

In St. Louis, the mayor ordered schools and movie theatres closed and banned public gatherings. The St. Louis mortality rate was one-eighth that of Philadelphia’s.

On the whole, Americans fought the Spanish Flu the same way we’re fighting CoVid 19 – social distancing, wearing masks and gloves, washing hands and staying at home. They had no cure; neither do we. Eventually, in the 1940s, the first flu vaccine was created. Now, sixty years later, only 40% of Americans take the trouble to get vaccinated yearly for the flu, 30,000 to 40,000 die annually and 200,000 are hospitalized.

Make no mistake. CoVid 19 is not like the flu – of today. But it is very much like the Spanish Flu of 1918 and 1919.

We will have a vaccine to combat CoVid 19. Right now we’re in the middle of a traffic jam of attempts, but it will happen. I only hope for two things. First, that the Corona Virus doesn’t mutate annually, like the flu. Second, that all Americans wake up and get vaccinated for both this virus as soon as they can and, finally, for the flu.

What Price Life? Part Two

Wednesday, December 12th, 2018

Part Two

“Insulin is my gift to mankind” – Frederick Banting

In Part One, we noted the critical need for daily insulin injections to keep Type 1 Diabetics (T1Ds) alive. We described how Frederick Banting’s team of himself, Charles Best and James Collip recovered and purified insulin from the fetal pancreases of cows and pigs in 1922, how they successfully tested it on humans, how Banting won the Nobel Prize the following year for his discovery, how the team sold the patent for the discovery to the University of Toronto for $3.00 and how they and the University agreed to license the manufacturing rights to pharmaceutical companies royalty-free, because, in Banting’s words, “Insulin is my gift to mankind.” The team and the university wanted to incentivise drug companies to improve on the Banting team’s discovery, so the University and Banting agreed to allow the companies to improve Banting’s formulation if they could and patent any new discoveries that arose. Their hope was that drug companies would share their vision of making it possible for T1Ds to live high-quality lives and to keep insulin prices low to help them do it.

Immediately after the sale of the patent to the University of Toronto, the University licensed the manufacturing rights for insulin to Eli Lilly and Company, located in Indianapolis, Indianna, and Nordisk Insulin laboratorium in Copenhagen. Meanwhile, a few kilometers away in Copenhagen, Novo Terapeutisk Laboratorium succeeded in producing a stable liquid insulin product which it called Insulin Novo. Decades later, in 1989, these two companies would merge to become Novo Nordisk.

In the beginning, the pharmaceutical companies had the best of intentions. After all, they were manufacturing and marketing the world’s first “life-saving” drug.

Over time, the “best intentions” became the quarterly bottom line and shareholder value. The emphasis was now on next generation patents, which would stifle competition and prevent the emergence of insulin generic drugs. To this day, there isn’t one.

It is not an exaggeration to say insulin made Eli Lilly and Company and Novo Nordisk two of the top pharmaceutical companies in the world. It also hasn’t hurt the bottom line of Sanofi, the company that rounds out the insulin producing triumvirate and is the world’s fifth largest pharma by sales.

In the last 20 years, these insulin producing companies have become swept up in the craziness of U.S. health care, where prices are on a rocket ride to the moon. During that time, the list price of insulin has increased more than 700%. Of course, T1Ds who have employer sponsored health insurance don’t pay list price. The price they pay, which is much lower, is  negotiated by their insurance company or Pharmacy Benefit Manager. This also applies to T1Ds who have secured insurance either through the expansion of the Affordable Care Act or some other means. They find their insulin relatively affordable, unless they have a prescription deductible which forces them to pay the full amount for insulin until they reach the deductible total. Finally, diabetics on Part D must pay 45% of list price when they fall into the infamous “donut hole.”

But children without insurance are in a very bad place, and there are a lot of them – 3.9 million in 2017 under the age of 19 (300 thousand more than 2016).

This situation is worse, twice as worse, in states that have not expanded Medicaid through the Affordable Care Act.

Kids with Type 1 Diabetes make up about .05%, of the uninsured group. That’s 195,000 children. And then there are the young, T1D adults who can no longer be on their parents insurance plan, because they are over the age of 26. Recently, we have learned of  T1Ds who have been forced to ration their insulin. This has resulted in tragic deaths. Parents and guardians have begun to protest at pharmaceutical company gates, some carrying the ashes of their dead children. Think about that.

So, here’s a question: Should anyone in the United States who requires a daily drug just to stay alive be forced to come up with the money to pay for it? Or, should that be a government-sponsored, health care right, as in the Declaration Of Independence’s “self-evident…unalienable right…to life.”

While you ponder that, I’ll leave you with this. Banting, Best and Collip would be tremendously gratified that their “gift to mankind” has enabled millions upon millions of Type 1 diabetics to lead productive, fulfilling lives. But they would be horrified that the drug’s price is now exacting a human price of obscene proportions.

 

 

What Price Life?

Thursday, November 29th, 2018

Part One

“Insulin is my gift to mankind” – Frederick Banting

A Quick Quiz

Question 1: Name a chronic disease requiring medication, which, if not taken every day, guarantees death within two weeks.
Answer: Type 1 Diabetes.

Question 2: Name the medication.
Answer: Insulin.

Question 3: What is the monthly cost of insulin for a Type 1 diabetic?
Answer: As we shall see, that depends.

Question 4: If Type 1 diabetics cannot afford the cost of insulin, without which they will surely die, what should they do?
Answer: This is happening at this moment, and people are dying.  In these two blog posts we’ll examine why and what can be done about it. But we need to first posit some truths about diabetes, and then describe how, in 1922, Canadian doctor Frederick Banting made the ground-breaking discovery that allowed Type 1 diabetics, for the first time in history, to live.

Ten Fast Facts

  1. Insulin is a hormone made by the pancreas that allows the body to use sugar (glucose) from carbohydrates in the food we eat for energy or to store glucose for future use. Insulin helps keeps blood sugar levels from getting too high (hyperglycemia) or too low (hypoglycemia). Type 1 diabetics, T1Ds, can no longer produce insulin. They have none of it. Although older adults can also contract Type 1 diabetes, it usually strikes children and young adults. Without insulin, whether old or young, they die.
  2. There are about 1.3 million T1Ds in the U.S. They comprise one half of one percent of the population. Currently, there is no cure for any of them. Without insulin, they will die.
  3. There are about 29 million Type 2 diabetics. T2Ds still make some insulin. In most, lifestyle changes will improve their health, sometimes to the point where they will no longer require insulin or any other medical prescriptions. Some will become insulin-dependent, and without it, they face life-changing complications.
  4. Diabetic Retinopathy is the leading cause of blindness.
  5. Diabetes is the leading cause of non-traumatic amputation.
  6. Diabetes is a leading cause of heart attack and stroke.
  7. Diabetes is the leading cause of kidney failure.
  8. Complications from diabetes sometimes cause workplace injuries and often exacerbate the severity and length of recovery.
  9. In 2017, the nation’s total direct medical costs due to diabetes were $237 billion. Average medical expenses for diabetics were 2.3 times higher than for non-diabetics. The extent to which diabetes added to workers’ compensation medical costs is unknown.
  10. Based on information found on death certificates, diabetes was the 7th leading cause of death in the United States in 2015, with 79,535 death certificates listing it as the underlying cause of death, and 252,806 listing diabetes as an underlying or contributing cause of death. However, diabetes is underreported as a cause of death; studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on the death certificate and only 10% to 15% had it listed as the underlying cause of death. An example of best practice would be, “Death caused by infection contracted from hemodialysis due to kidney failure, a complication of the patient’s diabetes.”

Banting and Insulin

Image result for photo of frederick banting

Frederick Banting is perhaps Canada’s greatest hero. Born in 1891, he graduated medical school with a surgical degree in 1915 and found himself in a French trench by the end of 1917. In December of that year, he was wounded during the Battle of Cambrai, the first great tank battle in history. He remained on the battlefield for 16 hours tending to other wounded soldiers until he had to be ordered to the rear to have his own wounds treated. For this action he won the British Military Cross, akin to America’s Silver Star. After returning to Canada, he continued his studies and, in 1920, secured a part time teaching post at Western Ontario University. While there, he began studying insulin Why? Serendipity. Someone had asked him to give a talk on the workings of the pancreas.

Banting became interested – and then obsessed – with trying to come up with a way to get insulin to people who couldn’t make any of their own. In November 1921, he hit on the idea of extracting insulin from fetal pancreases of cows and pigs. He discussed the approach with J. R. R. MacLeod, Professor of Physiology at the University of Toronto. MacLeod thought Banting’s idea was doomed to failure, but he allowed him to use his lab facilities while he was on a golfing holiday in Scotland. He also loaned him two assistants, Dr. Charles Best and biochemist James Collip. Collip devised a method to purify the insulin Banting and Best obtained from the fetal pancreases.

To MacLeod’s surprise, Banting’s procedure worked, and in 1922 Banting and Best successfully treated the daughter of US Secretary of State Charles Evans Hughes.

In 1923, one year later, Banting, at the age of 32, won the Nobel Prize, which, to his disgust, he had to share with MacLeod. To this day, Frederick Banting is the youngest person ever to win the Prize in Physiology or Medicine.

His discovery could have made Banting mind-numbingly rich, but he would have none of that. Along with Best and Collip, Banting patented his method and then the three of them sold the patent to the University of Toronto for the princely sum of $3.00. When asked why he didn’t cash in on his discovery, Banting said, “Insulin is my gift to mankind.” With Banting’s blessing, the University licensed insulin’s manufacturing to drug companies, royalty free. If drug companies didn’t have to pay royalties, Banting thought they would keep the price of insulin low.

And they did. For decades.

But patents expire, and capitalism being what it is, people get greedy, and greed is why we have no generic, low-cost insulin today and why, over the past 20 years, insulin prices have risen anywhere from 800% to 1,157%, depending on the variety and brand. It’s why, lacking health insurance, some Type 1 diabetics have recently been driven to ration their precious insulin. Some of them have died.

More about all that in Part Two.

 

 

 

On Empathy And Thoughtful Leadership

Thursday, May 10th, 2018

In his May 1 column for Risk & Insurance, Roberto Ceniceros, evoking the memory of Abraham Lincoln, describes and recommends a leadership style radically different from that of the tweet-driven current occupant of 1600 Pennsylvania Avenue.

Like Mr. Trump, Lincoln had quite a temper. However, over the course of his life he came to recognize it as a weakness. In many cases, when someone caused his blood to boil, which happened frequently during the Civil War, rather than immediately lashing out, he would often withdraw and write a letter to the offending party detailing in stark terms his great disappointment. He would then put the letter in a desk drawer and more often than not never send it. This mental health exercise would calm him and allow him to deal with the issue in a more thoughtful manner.

in his column, Mr. Ceniceros suggests Lincoln’s method defines a highly self-aware and empathic person. He writes that this behavioral characteristic was shared by four other historical figures described in “Forged in Crisis: The Power of Courageous Leadership in Turbulent Times,” written by Harvard Business School historian Nancy Koehn.

As described by Mr. Ceniceros, Keohn’s book:

…includes the story of Ernest Shackleton, hailed in previous business-management books for leading his shipwrecked and isolated crew off Antarctic ice flows. The other biographies feature abolitionist Frederick Douglass; Dietrich Bonhoeffer, imprisoned by the Gestapo and murdered for opposing the Third Reich; and scientist and author Rachel Carson, who raced against cancer to finish her manuscript on the dangers of mass pesticide use.

All five of these courageous people overcame nearly impossible challenges, but Shackleton, who simply refused to let anyone under his commend die on their perilous journey, and Lincoln, who simply refused to let the Union die on his watch, embody an empathy of heroic proportion.

Another person who should be included in this group is Ulysses S. Grant, 18th president of the United States. Grant was a great leader, but a total disaster as an administrator, primarily because of his trustful nature. His presidency is historically noted for profound corruption and scandals. In private life he failed miserably, both before the war and after it. In 1884, after his final business venture left him penniless, he contracted terminal cancer. His friend, Mark Twain, suggested Grant write his autobiography, which Twain would publish, giving Grant extremely favorable royalties (30%). Faced with impending death, Grant simply refused to die and leave his family in abject poverty. He raced to complete the Personal Memoirs of Ulysses S. Grant, an autobiography Twain described this way:

I had been comparing the memoirs with Caesar‘s Commentaries. …I was able to say in all sincerity, that the same high merits distinguished both books—clarity of statement, directness, simplicity, unpretentiousness, manifest truthfulness, fairness and justice toward friend and foe alike, soldierly candor and frankness, and soldierly avoidance of flowery speech. I placed the two books side by side upon the same high level, and I still think that they belonged there.

Grant died five days after finishing the book. His heirs received royalties of about $450,000, which, in today’s currency, comes to about $12 million.

 

 

Lincoln, with his letters, Shackleton, his loyalty, and Grant, with an indomitable will to provide for his family, personify dedication to others on an heroic scale. Roberto Ceniceros’s column is a poignant reminder that character matters, that a forceful personality can be used for good or ill, that humility is the foundation of empathy.

Donald Trump should start writing letters.

Automation Designed To Keep People Safe Can Produce The Opposite Result Through No Fault Of Its Own

Monday, September 18th, 2017

A fascinating article in today’s Daily Alert from the Harvard Business Review describes how our dependence on automation can erode cognitive ability to respond to emergencies.

In “The Tragic Crash of Flight AF447 Shows the Unlikely but Catastrophic Consequences of Automation,” authors Nick Oliver, Thomas Calvard and Kristina Potocnik, professors and researchers at the University of Edinburgh Business School, report on their analysis of the horrific crash of Air France flight 447 in 2009. Their research, recently published in Organizational Science, describes in riveting detail the series of preventable cascading events that led to the deaths of all 228 passengers and crew.

Although the crash of AF447 is a transportation tragedy, it also can serve as a stark reminder that employees who depend on technology, especially technology that controls dangerous work, say self-driving 18-wheel trucks, for example, need a lot of training to take the right steps when technology reacts to emergencies. Without that training, the authors contend, the cognitive ability to take manual control and successfully deal with the emergency is problematic at best.

The authors provide an example:

Imagine having to do some moderately complex arithmetic. Most of us could do this in our heads if we had to, but because we typically rely on technology like calculators and spreadsheets to do this, it might take us a while to call up the relevant mental processes and do it on our own. What if you were asked, without warning, to do this under stressful and time-critical conditions? The risk of error would be considerable.

This was the challenge that the crew of AF447 faced. But they also had to deal with certain “automation surprises,” such as technology behaving in ways that they did not understand or expect.

The point here is the technology offering up the “automation surprises” was doing exactly what it was programmed to do. The technology did not fail; the pilots, all three of them, failed in their response to the “surprises.”

We are now at the beginning of a monumental shift in the way work (and play) is done. The natural gravitational movement of artificial intelligence assuming more and more control in our daily lives is unstoppable. Think of how it has brought tremendous improvements in air safety. To prove that, consider this astounding statistic: In 2016 the accident rate for major jets was just one major accident for every 2.56 million flights. But this bubble of safety can breed terrible complacency. How humanity deals with and prepares for the rude “automation surprises” that will surely come along on the way to the future should be a critical component in the thinking of organizational leaders and safety professionals.

 

Thanksgiving And Freedom From Want

Tuesday, November 22nd, 2016

During his 1941 State of the Union address, Franklin Roosevelt articulated what he considered humanity’s four essential freedoms: Freedom of Speech, Freedom of Worship, Freedom from Fear and Freedom from Want. In American recent history those freedoms have been attacked in different ways and in different degrees. At this moment we are a hurting country in many respects.

But right around the corner comes Thanksgiving, my favorite holiday. A holiday on which families come together, put aside their petty disagreements and bond once again with love. No one tries to sell Thanksgiving paraphernalia, except maybe a recently sacrificed turkey. And for a few hours the Christmas shopping season that kicked off around Labor Day doesn’t exist.

Following Roosevelt’s Four Freedoms speech, American artist Norman Rockwell set out to depict them on canvas. Rockwell was a humble man; he called himself an “Illustrator,” not an artist. Didn’t think he was good enough for that.

On 3 March 1942, his Freedom From Want graced the cover of The Saturday Evening Post magazine. He decided the best way to portray Freedom From Want was through a family’s Thanksgiving dinner. His painting, as well as the three other Freedom covers he painted for The Saturday Evening Post that year, has become iconic.

freedom-from-want

We whose job it is to push the workers’ compensation rock up the Sisyphean mountain, all the while trying our best to help men and women who have had their lives interrupted by workplace injury or illness, have taken it on the chin lately. We’re not alone in that, of course.  So many of our fellow citizens are bruised also. Perhaps we, and all Americans, should put that aside and take a moment to ponder Roosevelt’s Four Freedoms and Rockwell’s sometimes loving, sometimes searing, portrait of them and recommit ourselves to the existential exceptionalism that is the American Dream. Perhaps we should grasp tightly the good feelings that ooze out of Thanksgiving and in that moment dedicate ourselves to helping not only those who place their trust in our professional competence but also all who are momentarily lost and searching for better lives for themselves and their loved ones.

Happy Thanksgiving.