Penn Medicine: Where Hypocrisy Thrives and The Truth Hurts

 

One of the pleasures of Gregory Zuckerman's "The Shot to Save the World" is the portraits of the persons and personalities involved in one of the greatest scientific achievements of all time: The race to develop effective vaccines for COVID 19.

In the Michael Lewis mode of introducing the players and then just letting the story spin out from their stories, Zuckerman follows the dogged Dr. Katalin Kariko, who immigrates from Hungary, where nobody was interested in her zealous pursuit of mRNA as a potential platform for therapeutics, and winds up at the University of Pennsylvania School of Medicine, where the powers that be lose faith in her, demote her, kick her off the track to tenure, move her, virtually, to a broom closet, and where she feels humiliated and reviled. They do everything but out and out fire her, but she persists and eventually connects with Dr. Drew Weissman who thinks she might be on to something. Together, they publish the paper that opens the way for mRNA vaccines.

There were, as is so often true in science, many others working with mRNA but mostly people thought mRNA was simply too fragile and evanescent to hold much promise.

Now, unless there are others who can lay claim to the inspiration, Katalin Kariko and Drew Weissman are the obvious choice for the next Nobel Prize in Medicine. Like Banting and Best who uncovered and pushed insulin forward, this pair saved millions of lives despite the best efforts of competitors and colleagues alike to discourage them.

Kariko eventually felt so humiliated she left Penn and took a job in industry, but retained an "adjunct professor" status.

Now that mRNA is looming as one of the great advances in 21st century medicine, Penn has launched an advertising campaign to claim the credit for Kariko's accomplishments:

The ad running in the New York Times and elsewhere declaims:  "Their work has saved countless lives and will undoubtedly save countless more. Some may call it forward thinking. We call it changing the world. Penn Medicine. The birthplace of mRNA vaccines."

This is the classic wicked, scheming stepmother claiming the credit for Snow White's triumph at the Prince Charming ball.

Penn really has no shame. But it does have a department of communications, i.e., an in house marketing department, and those folks don't know from mRNA; all they know is they have a star and they are going to bask in the reflected glory, not to mention the patents for mRNA achieved through Kariko's efforts.

This is not a first for Penn:  There is the story of Leber amaurosis blindness, a form of congenital blindness which some Penn researchers discovered could be cured by a single injection in each eye in infancy. The details are difficult to track down, but the story as it has floated around is these scientists decided to charge $1 million per injection or $2 million for full, binocular vision. How did they arrive at this amazing price? They explained they went to court records and found that when someone lost vision in one eye, say in an industrial accident, juries typically awarded $1 million in damages. So that's what vision in a single eye is worth--or $2 million for restoring vision in 2 eyes. 

So this is forward thinking.

Penn calls it changing the world.

Saying the Unspeakable: Words We Are Afraid to Say

 

Cohen v California

George Carlin's famous riff on the 7 deadly words you cannot say on the airwaves made its way to the Supreme Court. (FCC v Pacifica Foundation)

Mr. Carlin

"There are over 400,000 words in the English language," Carlin noted, "But these 7 words must be awfully bad: They'll grow hair on your palms, and, Heaven Forbid, make us leave Vietnam without honor."

But, before this, in another case, Cohen v California (1971) the lawyer for the defense managed to win his case by speaking the unmentionable word in the Supreme Court chambers, "Fuck the Draft"  the lawyer said. "That's what was printed on the jacket of the defendant, and it is his first amendment right to have it there."  Had the lawyer not had the courage to say the word "fuck" in front of the Supreme Court, it has been argued, he would have been conceding the case to the prosecution, that there are some words which are simply so horrible, they cannot be said in public.

Orthodox Jews of some sect believe the word for God, "Yaweh" or "YHWH" is so sacred it cannot or ought not be uttered by the lips of mere mortals.

I would submit there are words which we dance around with euphemisms like "the N word" or "the F word" which should be stated and written, not with * marks to replace the letters we all know, for fear of what? Of staining the purity of the women and children in the room?

Consider Randy Newman's wonderful, powerful song, "Rednecks" in which he calls out squeamish Whites who think themselves pure and holier than thou because they don't use the word "Nigger" all the while denying them jobs, freedom and opportunity.

Randy Newman

Now your northern Nigger's a negro
You see he's got his dignity
Down here we're too ignorant to realize
That the North has set the Nigger free

Yes he's free to be put in a cage
In Harlem in New York City
And he's free to be put in a cage
On the South Side of Chicago
And the West Side
And he's free to be put in a cage
In Cleveland
And he's free to be put in a cage
In East St. Louis
And he's free to be put in a cage
In Fillmore in San Francisco
And he's free to be put in a cage
In Roxbury in Boston
They're gatherin' 'em up from miles around

Keepin' the Niggers down!

They are too genteel to say the N word, but they are just fine with putting them in cages.

I would submit there are no words so sacred or so profane they ought never be spoken. That position is one of fear and feeble wokeness. 

That words are bleeped out in podcasts, which are actually subscription items, not on the airwaves which could be inadvertently tuned into by the father driving his child to school with the radio on, strikes me as an expression of faint heartedness and prissiness to the extreme. 

Use the words, to shock, as that lawyer did in the Supreme Court. He thought he would be bodily dragged out of the Court that day, but speaking the word allowed the justices to consider the actual fact, rather than suppressing truth and refusing to face the actual issue.

For the same reason, I believe Pornhub and other porn channels which show actual people having actual sex is a significant advance in sex education and a benefit to 21st century life and mental health.  Once sex is actually shown, Western Society does not dissolve; likely many children have watched, fascinated, and been unimpressed, after the 50th video and they realize: There, I've seen this secret thing, and it's not all that earth shaking--it's just sex.

Using * to replace offensive words is a snowflake move. It is born of fear and an effort to suppress expression and opinion. 

Use of words like "fuck" and "shit" are most often the result of inadequate vocabulary and are a sign of  mental immaturity.  They are verbal exclamation points, at best and a verbal/mental tick, at worst.

In "Billy Budd" the simple, pure Billy Budd strikes his superior officer, Claggart, because Budd is incapable of formulating his own defense against an unjust charge, verbally, so he strikes out with his fist. This is what so many vocabulary/verbally deficient people do when they throw "fuck you" or "you're a shithead" at their opponent. All this should be discussed openly. The resort to this sort of four letter rejoinder means you've already lost. That ought to be said, taught in school. Everyone should understand this. 

Another reason "The Wire" should be required viewing in school.

The Wire: Fourth Season

I'm not saying students in a formal setting, like a classroom, should be free to tell the teacher to "fuck off." The student should know there is a difference between private settings and public settings. The student should know the words he hears his parents' home will not be tolerated in a public classroom, and that this demand for different behavior is not the oppression of the White man but simply what constitutes discipline and rules. And he learns rules are important if he wants to guide his destiny to success rather than school expulsion and, ultimately, jail.

And Io think these lessons should be taught directly in inner city schools and discussed in suburban White majority schools, frankly and openly.

The Academy (Hampton, NH)

We should discuss in schools why some words are offensive and we should discuss why some dress is inappropriate in school but not necessarily at a nightclub.

This is part of what we should learn and what should be addressed, not taught, but openly explored, in public schools.

Rethinking Nixon; Reconsidering Our Parties

 

Now, I have reached the age when I understand those faint smiles from my elders when I was a kid telling them about something I had read or seen on TV about history they had actually lived through.

Construction Workers Attack Anti War Demonstrators

The most stark example of this, I have mentioned before, when I was 9 years old, having been raised on newsreels, Hollywood films and magazine articles about the great heroic war which had ended just two years before my birth and which still governed the consciousness of the generation which fought that war, and those of us who followed in it's immediate aftermath. They were still wrapping up the Nuremberg trials when I was born.

So, there I was standing by, watching a hired man wield a pick-axe in the side yard of our new home, bought with the GI bill (available to veterans only if they were White); he was  hacking out a hole for a lavender tree. I was fascinated by this man because he really seemed to know his way around a pick-axe and he had fought in the war. In the Army, it turned out. I was a Marine Corps fan myself. 

"Oh," I said in my 9 year old assurance--this war was something I thought I knew all about. "Well, you were fighting the Germans. They weren't as tough as the Japanese."

He never missed a beat, throwing in that pick-axe, never looked up at this 9 year old White boy, but said something in his deep Georgia drawl/Black dialect which I could not understand. 

I asked my father what he had said, once we were back in the kitchen.

"He said," my father smiled. "They fought like Hell."

"Who?"

"The Germans," my father said. "The guys he was fighting in Europe. And they surely did."

Even today, on Youtube, if you are a World War Two buff, there are plenty of episodes comparing the utter suicidal zeal of the Japanese to the dogged efficiency of the Germans, but none of them know what that man knew.

Now, having lived through the 1960's and 1970's, I thought I knew the history of that time in a way which makes me laugh at what I see on Youtube and Twitter today. 

But, it turns out, I didn't know as much as I thought I knew, and in some ways, I'm still like that 9 year old kid in a Washington, D.C. suburb who thought he knew something.

It turns out, that utter sleazeball, Machiavellian Richard Nixon was not the guy I thought he was, and the sainted Democrats who opposed him, were not so saintly after all.

Here was a man who championed national health care, a national minimum wage, started the Environmental Protection Agency and the on job safety agency, OSHA, and who forced through the integration of construction workers and trade craft labor unions  which were, when he took office almost entirely White, a "Father/son" monopoly.

As Melvin Urofsky details in his "Affirmative Action Puzzle," Nixon was faced with the explosion of rioting in inner cities and his advisers noted that one reason Blacks had no compunction about burning down the ghettoes they lived in was they had no stake in those neighborhoods, nothing to lose. 

Why was this? 

They were shut out of any but the most menial jobs by all white labor unions which controlled construction trades, plumbing, HVAC, electricians and carpenters. "I never knew anyone who wanted Niggers in our union," George Meaney, the head of the AFL told Nixon's secretary of Labor. 

Nixon told his secretary, George Shultz, to push through a quota system to integrate the trade unions. 

Some have argued Nixon did this cynically, just as he had a Southern Strategy to win Dixiecrats to the Republican Party. Lincoln was a Republican and so that name became an anathema in the South, but when Lyndon Johnson pushed through the Civil Rights Act, old Dixiecrats like Strom Thurmond, switched parties to the Republicans, who, under Nixon, promised to save Jim Crow and segregation in the South. 

But the labor unions had always been solidly Democratic. Labor and minorities got out the vote for Democrats. 

Labor, however, in the construction trades, was White. Go through the names of the unions' rosters and you saw Polish, Irish, but no Blacks. You got your job and your place in the union because your father had his, and Blacks had no place.

The idea that the playing field be "leveled" was insufficient, because there were no exams to get into labor unions.  So Nixon agreed the only thing to do was to assure an outcome, not to talk about a process. If only 1% of the steamfitters union was Hispanic, Black or Asian, and collectively these groups accounted for 14% of the population, then you had to have 14% minorities in the unions building the buildings for any contract with the government.  He wasn't going to lose votes for Republicans in the labor unions, but he might get some from minorities. He effectively split the Labor/Black coalition, which had always managed to live together when there was no expectation Blacks would ever challenge the stranglehold Whites had on the trades.

Democrats had managed to hold together a fractious coalition by winking at the exclusionary practices of some of its adherents: Labor was more Archie Bunker than Tom Hayden. 

Kennedy had such a tenuous hold on his office, he could not afford to offend the racists of the Deep South and he only acted when the TV images of Southern racism became so appalling they could not be ignored. 

Nixon felt no such constraints. He became a more liberal President than Kennedy ever had been. It took a Nixon to go to China, and also to affirmative action, guaranteed income, national healthcare, and environmental protection. 

Life in the Shire

 

When, after a 16 year journey through college, medical school and post graduate training, I returned to the town of my birth and public school education through high school, Washington, D.C., I told myself the choice of this place made sense, as there was a recession on, and this town is recession proof, and my father still lived there and if we had kids, as my wife insisted we were going to have, it would be nice to have a grandfather around and besides, we had visited Washington during a gorgeous Spring weekend and the azaleas were in bloom, so it made sense.

It may have also been true that I had some unresolved issues from high school, which I had left with a vague sense of defeat, and so there I was, there we were.

And Washington did offer some fun, excitement and interesting people and we found a little village to live in hard by the Potomac and my two sons took full advantage of the river and the woods surrounding us and the public schools were good.

But, more and more often a story, likely apocryphal, I had heard about Tony Fauci when I was still at The New York Hospital burbled up from somewhere deep in my brain. The story was told by Lou Drusin, an odd duck who hung out in the hospital cafeteria, eating with medical students or interns, or anyone really. Lou still wore his medical school nametag on the lapel of his white lab coat, even though he was 10 years out of med school. It was never exactly clear to me what Lou was doing at the hospital; it was rumored he worked for the Department of Public Health, which had almost no status at the medical school and wasn't even housed in the hospital itself, but across the street in a derelict town house. 

But Lou was the best source of hospital gossip ever and he was good company at dinner, and he forgave you if your beeper went off and you had to bolt in the middle of one of his stories. 

The story Lou told about Tony Fauci, he told me when I was a fourth year medical student in 1973 and there were about three of us fourth years at the table listening.

As Lou told it, the day Tony finished his year as Chief Medical Resident, they called him into the resplendent offices of the Department of Medicine, into the main conference room, with it's gleaming, long oak conference table, and the framed photos of all the men (and was only men, in those days) who had been Chief Medical Resident lining the walls, along with portraits of the luminaries of The New York Hospital, men like Dr. Papanicolou, who developed the Pap smear, and the high and mighty men of the New York Hospital gathered round and presented him with his framed certificate for doing the Chief Residency and with a document appointing him to the faculty of the Cornell University Medical College and then, with the letter granting him "admitting privileges" to the hospital, so he could go find an office on Park Avenue and exercise those privileges to admit his patients to the hospital and to receive consultation referrals from the rest of the hospital staff. It was like being granted partnership in a big law firm, or credentials at the New York Stock Exchange, or a job at Goldman Sacks.

Fauci said thanks but no thanks. It was an honor and a privilege, of course, but no thanks.

"If he had set off a bomb, it couldn't have rocked that room more," Lou said.

One of Tony's friends chased him down after he left the room.

"Tony, how could you turn it down?" his friend asked, incredulous to the point of disorientation.

"Some day," Fauci replied, "I will be either very rich or very famous...But, if I stay at the New York Hospital, I will be neither."

And so Dr. Fauci embarked off to new adventures at the National Institutes of Health, in Bethesda, Maryland, just three miles down the road from my office in Chevy Chase.

As the years rolled by, sitting in my office, I contemplated whether I had made the choice, the safe, expected choice Tony Fauci had walked away from.  Coming back home, hanging up my shingle, reconnecting with old friend from high school and the old neighborhoods had been a regressive move, in some ways. It wasn't moving forward, exploring new frontiers.

There were certainly rewards in the practice I eventually built and there was something which felt predestined in the act of return, but there was also something stultifying about going backwards.

We often, in America, question the restlessness of our society, where people move away from their families and childhood friends, and we say this contributes to a lack of community to a sense of alienation, but I think that's untrue.

The people we knew when were were 12 or 16 are not the same people we still know when they are 52 or 66. They may have the same names and they may even live in the same neighborhoods, but they have been transformed by time and experience.

At some point, I reached the same conclusion Dr. Fauci had reached, that there was no way to really make progress in life unless I left that cocoon of my birth and found something new.

New Hampshire has been new and different.  The ocean is 3 miles away, biking distance.  Two hours north are the lakes and the mountains.  I cross country ski when it snows, right out my front door.

And I've found people I genuinely like, some I adore. I haven't known them for 50 years, as I knew some of my friends back in Washington, but in some ways, they allow me to know them better than my old friends ever did.

Watching my own kids, who lived in New York City and then packed up for LA and places I'd never have thought of, I have to think: good. Try something new.

You may never be rich or famous, but at least you'll explore new worlds. And trying to stay in the old world is a fool's errand: The old world never stays the old world. It keeps changing along with you.