McKinsey, the FDA, and the Medical-Industrial Complex.

Posted on | April 26, 2022 | 2 Comments

Mike Magee

In today’s New York Times, Dr. Joshua M. Sharfstein, professor at the Bloomberg School of Public Health at Johns Hopkins, and principal deputy commissioner of the Food and Drug Administration from 2009 to 2011, recounted global consulting firm McKinsey’s simultaneous working relations with the FDA and Purdue Pharma. 

The Congressional investigation currently underway reveals that  McKinsey had been advising the FDA on how to reorganize its opioid oversight efforts while simultaneously imbedding a “mini-army” of advisers in Purdue Pharma’s Connecticut headquarters. 

Sadly, such evidence of an integrated career ladder inside the Medical-Industrial Complex is neither a surprise nor news, but rather a long established pattern of behavior that dates back 70 years.

Between 1950 and 1957, advertising revenue in JAMA for pharmaceutical ads increased seven-fold. At the top of the list was Pfizer and its new antibiotic, Terramycin. Between 1950 and 1952, 68% of all JAMA broad spectrum antibiotic ads were funded by Pfizer. Between 1952 and 1956, nearly every JAMA issue included Pfizer’s in-house magazine titled “Spectrum”.

The push paralleled an increase in Pfizer detail men from 8 to 2000 (including medical students). They targeted doctors and hospital pharmacies, and developed a sophisticated range of Continuing Medical Education (CME) materials for the first time. Pfizer’s agency of record? The William Douglas MacAdams Advertising Agency. The principal on the account? Arthur M. Sackler.

Arthur’s groundbreaking innovations would, in the future, be enshrined in the Medical Advertising Hall of Fame. Their tribute included the following: “Dr. Sackler was a psychiatrist who published 140 scientific papers on neuroendocrinology, psychiatry, and experimental medicine.” What they didn’t mention is that the vast majority of these were self-published in journals and “medical newspapers” that Sackler himself had launched as promotional vehicles.

During this same period, his business dealings and associations were secretive and conspiratorial. He created hidden corporations, and listed them under his first wife to hide his own ownership. Behind the scenes, he colluded with his supposed arch-rival, agency head Bill Frolick, whose company International Medical Statistics (IMS) would marry databases with the AMA physician masterfile, reselling the progeny to pharma companies, and allowing them to track individual physician prescribing behavior. His own secret ownership stake in IMS would be revealed after his death. But while alive, he quietly purchased the near dead pharmaceutical manufacturer, Purdue-Frederick, and mothballed it for future use.

In a single decade, Sackler also invented the pharmaceutical rep – a business attired professional “detail man” who would visit doctors offices with branded trinkets and provide the scientific details and new drug samples doctors needed to keep up; and launched pharmaceutical funded “scientific advisory boards” and speakers bureaus that would assist friends like heart surgeon Michael DeBakey as they climbed the integrated career ladder from academia to industry to government and back again.

In 1957, he aired the first drug advertorial on television, an extravaganza describing a new mysterious condition called “Ataraxia” which kept stressed out business men in a state of psychic distress preventing sleep and relaxation. Sadly, no cure was mentioned in the broadcast. That came a few months later when Pfizer released their new tranquilizer, Atarax.

By 1960, he represented two new drugs that risked cannibalizing each other – Valium and Librium. He skillfully promoted one for nervous tension and the other for psychic stress, making both record breaking success stories. By then, 1 in every 7 Americans were on tranquilizers.

But for Arthur, this was just the beginning. He had a grander vision, and had already laid the seeds that would create wealth beyond his wildest dreams, and eventually threaten the health and stability of our nation.

Scratching at the surface of Arthur M. Sackler’s narrative reveals the rather staggering challenge we face in addressing the systemic issues underlying what appear to be isolated occurrences like McKinsey’s conflicts of interest. In Arthur Sackler, whose praise and awards, bestowed so luxuriously by the highest levels of American Science and Medicine, in equal measure to the resources he provided to these very same bodies, can be observed the full tangle that is the Medical Industrial Complex.

Over a period of a half century, under the title of beneficent physician, Arthur Sackler built a vertically integrated empire that created pharmaceutical demand, magnified and multiplied it, and then sold into it as it rose. And at every step along the way, he was aided and abetted by those who coveted the Sackler brand.

Modern day consulting firms like McKinsey are simply enablers – the sticky middlemen who hold it all together. Those who bear ultimately responsibility are their funders at every rung of these integrated career ladders – including scientific leaders in academic medicine, corporations, and government.

Dara’s “Hero Quest” – Should He Push For Universal Health Care?

Posted on | April 26, 2022 | Comments Off on Dara’s “Hero Quest” – Should He Push For Universal Health Care?

Mike Magee

Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” Bottom line: Refusing the call is a bad idea.

George Lucas was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship. On June 21, 1988, Bill Moyers interviewed Campbell and began with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.” 

Asked to comment, Campbell said, “He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.”

Systems gone awry? Think Putinesque Russia, or Psycho-pernicious Trumpism, or Ultra-predatory Capitalism.

Dara Kharowshaki, the CEO at Uber, who took over the company from uber-bro, Travis Kalanick, is a fan of Campbell’s and understands the journey of a hero – departure, initiation, return. Perhaps that is why he defines “movement” as fundamental to life…adding deliberately the qualifier “movement in the right direction.” In an interview in December, 2021, with Brian Nowak, Equity Analyst, U.S. Internet Industry, for Morgan Stanley, he pushed for corporate engagement in a range of issues including “sustainability, safety, equity, and anti-racism – these are all issues that go to the core of who we are, and our identity.” 

How did health care escape that list, especially considering the companies investment in “Uber Health” – a health care delivery service promoting speed, care coordination, privacy, and cost-effective and reliable transport to and from care-giving brick and mortar? 

It may have something to do with the fact that Uber has fought tooth and nail to avoid providing health care as a benefit to its drivers. In 2020, the company joined Lyft, DoorDash and other gig companies in throwing $205 million into a lobbying effort in California titled “Yes on 22”.

Background: “California, with its estimated 1 million gig workers, has been the largest U.S. market for that type of labor. Officials said the workers were deprived of health care, a minimum wage, job security, and basic protections against discrimination and sexual harassment. So legislators approved Assembly Bill 5 (AB5) in September 2019 to grant benefits to certain classes of gig workers, including Uber and Lyft drivers, by making them employees.” 

“Yes on 22” was industry’s counter-response. In their successful drive, where they outspent the opposition 10 to 1, “yes” actually meant “no” for drivers, further cementing their contractor status rather than requiring that they be treated as fully entitled employees. With this bit of trickery, designed by Republican pollster, Bill McInturff, they won by a 59% to 41% margin. 

The winners argue that Prop 22 is “preserving flexibility and pairing it with new protections.” In return for the contractor status they had to agree to subsidize health coverage for its California drivers who average 15 to 25 hours a week engaged as drivers or couriers to the tune of 41% of what standard health benefits would have been.

Dara may not be anxious to provide full health coverage to his workers, but he’s right that movement is essential to life – especially if by movement you mean access to health professionals, their institutions, their diagnostic equipment and their therapies. In this arena, Dara is caught in the middle of the “hero’s quest.”

He has passed through phase 1 and “departed” the dark brotopia world, and is currently brushing up against difficult choices within a stormy phase 2 “initiation.” 

This has included a rather embarrassing incident that occurred on May 26, 2021, when Uber drivers outside of California received an email (which began with the optimistic opening line “Its a great time to get health coverage,”) announcing that the company would be subsidizing their health coverage, only to learn in a hasty follow-up email that it was all an embarrassing error. It read, “Unfortunately, we made a mistake sending this email to you, as this policy only applies to drivers and delivery people in California. We sincerely apologize for this error.”

Without naming names, Dara has clearly kept his own list of Darth Vaders in Silicon Valley. As he sees it, “Some of them grew up too fast and some of them didn’t take responsibility for their power and I think now they’re being called to reckon… I think the age of ‘I built a platform, I’m not responsible,’ that time is over. And now the question is, what does the responsibility look like? Defining it and putting guard rails around it, I think that’s a healthy thing.”

But his enemies might reply, “You know what else is a healthy thing? Health insurance!”

As Dara himself would admit life’s a journey, and movement toward hero status is filled with bumps along the way. Will he make it to phase 3, a hero’s welcome on his “return?” Earlier this year he said, “Sometimes the system ‘works too well’: I think capitalism has its claws in our democratic societies in ways that has allowed it to overly optimize for its benefit.”

These are tough times to lead – no doubt. Keeping families together, processing fear and worry, expanding opportunity and productivity – all are worthy and essential goals that can only be realized if our citizens have access to health care. That would most certainly be a “move for the better.” So why not get behind universal health care, Dara?

You could be a true hero. As Joseph Campbell stated “Is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes?”

PBM’s – Their Origins and Parentage.

Posted on | April 17, 2022 | Comments Off on PBM’s – Their Origins and Parentage.

With the controversy swirling over insulin pricing, and sticker shock for seniors meeting deductibles on their Medicare Part D choices, it’s useful to shine a light on PBM’s – their origins and parentage. They would, of course, prefer to remain in the shadows, managing a vast array of legal kickbacks with others within the Medical-Industrial Complex.

 

And yet they and their middlemen hold 6 of the top 25 spots in the Fortune 500. Here’s a starter course, excerpted from “CODE BLUE: Inside the Medical Industrial Complex” where the full story resides.

“When PBMs began, insurers and employers believed that this new entity might contribute to cost control by efficiently processing prescriptions, maintaining approved drug formularies, and holding down prices. But they soon realized that ownership of a PBM by a drug-maker, insurer, or a retail pharmacy giant allowed the owner to coordinate pricing decisions, see competitors’ pricing information, and favor some drugs over others in return for kickback payments, even if the consumer unknowingly was forced to pay more.

There are now about thirty different PBMs. But three major companies control 78 percent of the PBM market and service 180 million Americans. These opportunistic middlemen emerged from three different Medical Industrial Complex (MIC) industry sectors: a physician managed care group, a pharmacy corporation, and a pharmaceutical manufacturing company.

The first one, Diversified Prescription Delivery, was developed in 1988 by UnitedHealthcare, the insurance company that grew out of a physician-run managed care medical group called Charter Med, incorporated in 1974. They were the first to recognize that new information technology would revolutionize the health care industry. Where the WHO owned the ICD-9 diagnosis billing code databases, and the AMA owned the CPT procedure billing code databases, UnitedHealthcare ambitions were far more expansive–to control and mine patient databases themselves. From this perch, they were the first to develop pharmacy drug formularies, hospital admission pre-certification requirements, physician office software that predated electronic medical records, and tight controls on utilization beyond those of other HMO’s at the time. 

The realization that data now was king spread rapidly. A second PBM, PharmaCare, appeared as an offering from CVS in 1994, and in 2007 was renamed CVS-Caremark.  The third dominant PBM, mail order giant Express Scripts, has a complex parentage. It was formed from the purchase of a SmithKline Beecham’s PBM in 1999 and the addition of Merck-Medco in 2012.  Five years later, in 2017, Express Scripts reported revenue of over $100 billion compared with Pfizer’s $52 billion of revenue that year.

Their sphere of influence and market power derives from the fact that approximately 4.5 billion prescriptions are filled in the US each year. Americans’ appetite for legal drugs is close to insatiable. Just under 50 percent of US residents have filled a prescription in the last month, and 10 percent of our population currently takes five or more prescription medications.

Approximately $50 billion is expended each year in the manufacturing of these drugs, which move primarily through three giant wholesale distributors in the US—AmerisourceBergen, Cardinal Health, and McKesson—on their way to the retail pharmacy. Their combined revenue in 2015 was $378 billion for distributing the drugs to 60,000 pharmacy outlets, 63 percent of which are part of large retail chains. By 2017, their combined revenue reached $481 billion. 

PBMs are now the Grand Central Station of the legal trade of drugs and the primary processors of patient and insurance enrollee data. They negotiate the deals for each and every drug with pharmaceutical companies, the placement of those drugs on insurers’ and employers’ tiered insurer formulary drug lists, and the integration and management of utilization and cost strategies with pharmacies, insurers, and hospitals nationwide. Their cutouts and givebacks to both the drug and insurance industries, and negotiations with hospital systems, share the profits and are nontransparent. Nearly everyone is in on the deal—except the patient.”

Celebrating a “Lovely One” – Ketanji Onyika Brown Jackson

Posted on | April 8, 2022 | 4 Comments

Mike Magee

Human goodness was on full display today in the form of Ketanji Brown Jackson. Our newest Associate Justice of the Supreme Court had endured nearly 24 hours of rigorous, and at times deeply offensive questioning, under the glare of TV lights, to make history.

Justice Brown Jackson was born in Washington, D.C. on September 14, 1970. To honor their ancestry, her parents reached out to a relative who was serving in the Peace Corps in West Africa at the time, requesting a list of African names for their daughter. At the top of the list, Ketanji Onyika, meaning “lovely one.”

The family moved to South Florida, and Ketanji excelled at every step along the way, earning a seat at Harvard, where she met her husband, now a surgeon at Georgetown, and raising two daughters, Talia, 21, and Leila, 17.

She is amazing and qualified, but not the first, and certainly not the last black woman to change the course of America. Two others come to mind. In teaching my 2019 course, “Women of Courage in Public Health,” I met two other black women leaders from the South who epitomized remarkable excellence.

Sixty years ago, the Harlem Youth Opportunities Unlimited Project, the model for LBJ’s Head Start program, was launched. At the helm was a 45-year old African American woman, the first woman recipient of a PhD from Columbia University. Her roots were not in Harlem, but rather in the highly segregated and always controversial town of Hot Springs, Arkansas.

Mamie Phipps Clark – intelligent, likeable, and well-to-do – was born in 1917. As she herself admitted, “It was a very privileged childhood.” Her father was the town’s black doctor, a member of a very elite club – the 1.5% of black men at the time who held professional positions. Hot Springs, with its gambling and prostitution, was a favorite destination of gangsters like Al Capone. Dr Harold Phipps was not only a doctor, but also the owner with his wife Katherine of the town’s sole black hotel, the Pythian Hotel, built out of the ashes of a 1913 fire that destroyed the town.

Mamie and her only brother, Harold Jr. who would later become a dentist, graduated from the segregated Langston High School. Mamie chose the historical Black College, Howard University, to continue her education, arriving by overnight train under the watchful eyes of an armed guard her father had hired to ensure her safety in transit.

Howard was an awakening. As Mamie later recounted, “The school (referring to her segregated high school) was poor, and later I realized how much we didn’t learn. For example, there was one point when I realized I had learned no English grammar – none. And I had learned no history. But those gaps, you weren’t aware of when you were coming through high school.”

She caught up quickly and in her junior year signed up for a course in Abnormal Psychology taught by a young Master’s candidate, Richard Clark. By Spring the next year, the two – against the wishes of her parents – eloped. They then returned to campus where Mamie graduated magna cum laude one month later. That summer, Mamie worked for a young NAACP lawyer named Thurgood Marshall triggering a spirit for advocacy that would remain her hallmark in the decades ahead.

A Master’s followed the next year with a thesis that ultimately enshrined her role in Civil Rights history. Its’ title was, “The Development of Consciousness of Self in Negro Pre-School Children.” As 1940 approached, Richard and Mamie decamped to New York City where both enrolled in Columbia’s PhD program in Psychology. In 1943, she became the first African-American woman to be granted a PhD from Columbia.

It was during this period that she and Richard collaborated on what would become known as “The Dolls Test.” At a local Woolworth’s in Harlem, the couple purchased four dolls – 2 white, and 2 black. They then enrolled 119 black elementary students from an integrated school in Springfield, Massachusetts, and 134 black elementary students from a segregated school in Little Rock, Arkansas.

Each child was asked six questions:

1.”Give me the doll that looks like a white child.”

2. “Give me the doll that looks like a colored (Negro) child.”

3. “Give me the doll that looks like you.”

4. “Show me the doll that you like the best or that you’d like to play with.”

5. “Show me the doll that is the ‘nice’ doll.”

6. “Show me the doll that looks ‘bad.'”

Both groups of black children in the majority favored the white doll as “nice” and a preferred playmate, and the black doll as “bad.” What distinguished the two groups however was the integrated children were upset by the questions and in some cases began to cry, while the segregated children were unfazed – one young boy famously pointing to the brown doll and proclaiming without emotion, “That a nigger. I’m a nigger.”

By 1951, 17 southern and border-states required racial segregation of public schools – the anchor of their segregated societies. Thurgood Marshall, on behalf of the NAACP, represented the Brown family of Topeka Kansas (and 6 other families around the country) in the Supreme Court case, Brown v. Board of Education.

In deciding the case, the majority of Justices leaned heavily on the Clark’s research and effectively ended legal segregation in the United States with this statement, “To separate [African-American children] from others of similar age and qualifications solely because of their race generates a feeling of inferiority as to their status in the community that may affect their hearts and minds in a way unlikely ever to be undone.”

Mamie Phipps Clark was not the only African American woman born in the South in the early 1900’s who would earn a PhD and leave an indelible mark on American society. 953 miles due east on Christmas Day in 1904 in Henderson, NC, another baby girl was born, the 7th of 9 children. Her name was Flemmie Kittrell, and like Mamie she stood out early for her intelligence, ambition and drive.

Lacking the wealth that aided Mamie’s rise, Flemmie first step up the ladder of Public Health was funded by an anonymous donor when she was 15. It accompanied a request for admission to the Hampton Institute and testified to the youngster’s “diplomacy and persistence.” By the time she left in 1929, she had completed high school and college.

She had fully embraced the four ideals of Hampton Institute – morality, citizenship, sanitation, and vocation. She possessed a missionary zeal, and had committed herself to understanding the role of nutrition in child development. At the time, the most famous school for a new burgeoning field called Home Economics by some and Human Ecology by others was the land grant Agricultural College at Cornell.

Like Mamie, she became the first African American woman at her university to earn a PhD. Her career would carry her back to Mamie’s Howard University where she served for over two decades and founded their School of Human Ecology. With the end of World War II, and a well earned reputation by then as a “Nutritional Political Scientist”, she took the lead for the State Department during the Marshall Plan visiting Liberia, India, Japan, West Africa, Central Africa, Guinea, and Russia among others, and uncovering pockets of what she called “hidden hunger” in developing nations.

Justice Ketanji Brown Jackson joins Dr.’s Flemmie Kittrell and Mamie Phipps Clark today as national treasures and resources whose knowledge of the interface between human development, and advocacy for expanded human possibility for millions of Americans brings honor and possibility to our still young nation. Mamie turned a laser focus on her community where, as she said, “Children rise up and thrive.” Flemmie never forgot where she began in Henderson, NC, converting a rich array of friendships and learnings around the world to the betterment of all she touched.

And now, they are joined by Associate Justice Brown Jackson, whose 11 year old daughter, Leila Jackson, recommended her in 2016, to President Obama, for a vacant position on the Supreme Court left by the death of Justice Scalia. Leila wrote of her mother, “She is determined, honest, and never breaks a promise to anyone, even if there are other things she’d rather do. She can demonstrate commitment, and is loyal and never brags.

 So we will brag for her, root for her, and send blessings her way!

“The Columbian Exchange” – A Term You Should Know.

Posted on | April 4, 2022 | 2 Comments

Mike Magee

As a Medical Historian at President’s College at the University of Hartford, I focus on a single topic each year, in search of unique hidden stories that reveal and enlighten. Each year is a separate and distinct journey, and the transition from one year to the next can be abrupt. For example, here are the last four themes I have covered:

2018 – The 25^th Amendment and Presidential Health.
2019 – Courageous Women  in Public Health.
2020 – The Right to Health Care and The U.S. Constitution.
2021 – The History of Epidemics in America.

My own deep dive precedes each years output by 6 to 8 months, and generates a series of lectures (virtual and in-person), topical interviews, Health Commentary editorials, and open-source print publications.

The joy for me is in the discovery. For example, the work on epidemics entered well-known trade routes familiar to all as “The Silk Road.” But resources like Yale historian Frank Snowden’s “Epidemics and Society” also dialed in “The Columbian Exchange” and its offspring.

Until late in the 15th century, the Americas were virgin territory when it came to widespread epidemics. Not so, of course, of Eurasia which suffered three waves of pestilence driven plague, carried by fleas embedded in the fur of black ship rats sometimes domesticated as pets. Humans, rats, fleas and plague bacteria traveled together along Mediterranean trade routes. Other bacteria and viruses were chronically embedded in a range of European domestic farm animals including horses, cows, pigs and goats.

The “Columbian Exchange”, labeled by University of Texas historian, the late Alfred Crosby, in 1972, arguably deserves top ten status in historic events that determined the course of our American history.

European monarchs in the 15th century supported oceanic exploration as an extension of their power bases. New trade routes and territories carried the promise of the “three G’s” – gold, glory and God. The monarchs allied with merchants and explorers, and the Catholic Church willingly opened its coffers seeing the potential to spread Christianity to new lands.

Technologic advances like the astrolabe, the magnetic compass and sea worthy vessels made these ventures still dangerous, but feasible. The death and destruction of the indigenous people followed close behind their arrival. As Crosby documented, “Indigenous peoples suffered from white brutality, alcoholism, the killing and driving off of game, and the expropriation of farmland, but all these together are insufficient to explain the degree of defeat. The crucial factor was not people, plants or animals, but germs.”

Consider Columbus’s arrival on the island of Hispaniola (now the Dominican Republic and Haiti) in 1492. Documents suggest that he was greeted peacefully by the native Taino tribe that numbered some 60,000. By 1548, the numbers had plummeted with less than 500 of the indigenous tribe surviving. What had happened?

The arrival of Columbus and others, and their subsequent movement back and forth between the Old World and the New World led to an unprecedented exchange of plants, manufactured goods and raw materials, tools and technologies, ideas, and microbes.

In the pursuit of wealth, traders and merchants, with financial inducements by their governments, clear-cut and developed large plantation farming of cash crops like sugar, tobacco and wheat for export. These crops demand huge workforces for planting and harvesting under brutal and dangerous conditions. The plan initially was to enslave the natives they encountered and maintain a system of forced labor. To assist the effort, they also imported large numbers of domesticated animals from Europe including horses, cows, pigs, goats and sheep. At the time, the only domestic animals on the island were llamas and alpaca.

But the animals carried with them a wide range of infectious diseases including smallpox, chickenpox, measles, mumps and typhus. Over hundreds of years, the Europeans had developed immunities to these diseases. But the indigenous peoples of the Americas were immunologically naïve. By some estimates, 90% of their population in South and North America perished. Beyond the human tragedy, their demise created an enormous shortage of labor on the plantations. The solution chosen by the English, Spanish, Portuguese and French conquerors was to begin large scale importation of African slaves.

As journalist Charles Mann outlined in his book “1493: Uncovering the world that Columbus created”, “The scale of the trade was staggering. Between 1492, when Columbus landed, and the early 1800s, more than 2 out of every 3 people who came to the Americas were enslaved Africans. At the time, this human wing of the Columbian Exchange was the biggest migration in history.” Over 10 million enslaved Africans overall were transported to America, with an additional 1.5 million dying in transit.

The full story of the “The History of Epidemics in America” will be available to you on May 10^th, at noon, in a FREE live online luncheon lecture sponsored by my Jesuit alma mater, Le Moyne College, from Syracuse, NY. Registration links will follow, but mark your calendars now.

Ethical Leadership – Is There Such a Thing As An Evil Genius?

Posted on | March 29, 2022 | 2 Comments

“’Chance made the situation; genius profited from it,’ says history. But what is chance? What is genius?”  
                                             Leo Tolstoy from “War and Peace”, 1867.

 

If there ever was such a thing as an “evil genius”, the KGB’s Putin or our own Donald Trump would certainly be prime candidates. But in describing the actions of Napoleon in 1812 and 1813, Leo Tolstoy would have none of it. In his brilliant Epilogue (p.1131), he undresses Napoleon while pointing a contributory finger at an endless array of knowing followers. And in the process, he helps explain the steps and progression that led to the rise of Donald Trump. Written 155 years ago, his expose’ is poignant and devastating, and worth careful consideration from all those concerned with ethical leadership, governance, and compliance.

The Rise To Power

“(The launch requires that…)

…the old insufficiently large group is destroyed; old customs and traditions are obliterated; step by step a group of a new size is produced, along with new customs and traditions, and that man is prepared who is to stand at the head of the future movement and bear upon himself all the responsibility for what is to be performed…A man without conviction, without customs, without traditions, without a name, not even a (military man or politician), seemingly by the strangest chances, moves among all the parties stirring up (hatreds), and, without attaching himself to any of them, is borne up to a conspicuous place.”

Early Success

“The ignorance of his associates, the weakness and insignificance of his opponents, the sincerity of his lies, and the brilliant and self-confident limitedness of this man moved him to the head…the reluctance of his adversaries to fight his childish boldness and self-confidence win him…glory…The disgrace he falls into…turns to his advantage. His attempts to change the path he is destined for fail…Several times he is on the brink of destruction and is saved each time in an unexpected way…the very ones who can destroy his glory, do not, for various diplomatic considerations…”

Fawning and Bowing to Power

“All people despite their former horror and loathing for his crimes, now recognize his power, the title he has given himself, and the ideal of greatness and glory, which to all of them seems beautiful and reasonable….One after another, they rush to demonstrate their non-entity to him….Not only is he great, but his ancestors, his brothers, his stepsons, his brothers-in-law are great. Everything is done to deprive him of the last powers of reason and prepare him for his terrible role. And when he is ready, the forces are ready as well.”

Turning a Blind Eye

“The ideal of glory and greatness which consists not only in considering that nothing that one does is bad, but in being proud of one’s every crime, ascribing some incomprehensible supernatural meaning to it – that ideal which is to guide this man and the people connected with him, is freely developed…His childishly imprudent, groundless and ignoble (actions)…leave his comrades in trouble…completely intoxicated by the successful crimes he has committed…he arrives for his role without any aim…(leading to) the decomposition of republican government…and his presence, clear of any (opposing) parties, can now only elevate him.”

Self-Adoration, Mobs, and Conspiracy

“He has no plan at all; he is afraid of everything…He alone, with his ideal of glory and greatness…with his insane self-adoration, with his boldness in crime, with his sincerity in lying – he alone can justify what is to be performed…He is drawn into a conspiracy, the purpose of which is the seizure of power, and the conspiracy is crowned with success….thereby convincing the mob more forcefully than by any other means that he has the right, because he has the power.”

The Spell is Broken by a Reversal of Chance

“But suddenly, instead of the chances and genius that up to now have led him so consistently through an unbroken series of successes to the appointed role, there appear a countless number of reverse chances….and instead of genius there appears an unexampled stupidity and baseness…”

The Final Act

“A countermovement is performed…And several years go by during which this man, in solitude on his island, plays a pathetic comedy before himself, pettily intriguing and lying to justify his actions, when that justification is no longer needed, and showing to the whole world what it was that people took for strength while an unseen hand was guiding him…having finished the drama and undressed the actor.”

A Prayer for Ukrainian Children and Judge Ketanji Brown Jackson.

Posted on | March 23, 2022 | 3 Comments

Mike Magee

What a haunting display – the juxtaposition of low’s and high’s in human behavior. The goodness of Ukrainian children exhibiting courageous, adult behavior, struggling without complaint to survive while in full flight vs. entitled elected Senators relentlessly and with straight faces bullying and “acting out” like spoiled preschoolers in the shadow of a composed, elegant and determined Judge Ketanji Brown Jackson. You can almost hear in the spring breezes a collective sigh – “Must we? Must we?”

Humans do continue to surprise on the upside, and misbehave with utter predictability on the downside. How should we make sense of this?

That there is goodness in this world is undeniable. That there is evil, capable of taking root to branch and multiply with breathtaking speed and by surprise is equally the case. But little candles throw great beams, and light enlightens, while sins cast long shadows. We and our world are both evil and good. By our deeds you shall know us. All the learning, earning and yearning can’t replace a moment’s hesitation or justice withheld in the face of evil. Tyranny, poverty, disease – there is more than enough to battle to prove our inner worth. Though it’s useful to remind that the knowledge and power that accrues can always be turned upon ourselves. That we possess a conscience does not assure its use. But it can be stirred by the universe and the belief that we all have a right to be here among the trees and stars. Amid the noisy confusion people do somehow find peace inside, and dreams of a beautiful world, and a confidence (sometimes shaken but never withdrawn) that injustice is a two-edged sword and given time justice will prevail.

God Bless the Ukrainian children! God Bless Judge Ketanji Brown Jackson! And God heal the rest of us!

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Precision Medicine, Euthanasia, Abortion, Communism, Trillions of Dollars, Losing Freedom, and Town Hall Mobs BIOGRAPHY   Michael Millenson
Yearning for Universal Coverage Is Not Universal
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