Former NIH Director Spins Through Revolving Door, Ends Up at Sanofi-Aventis

A bit of news that got little attention this month was a new job for the former head of the US National Institutes of Health (NIH).  Dr Elias Zerhouni had left the NIH in October, 2008.  Here is the Reuters version of the story of his hew career:
French drugmaker Sanofi-Aventis (SASY.PA) replaced its head of research and development with a leading academic and former top U.S. health official on Tuesday to raise its game in medical innovations.

The company said Elias Zerhouni would lead R&D of drugs and bring R&D for vaccines under his control too as Sanofi reshapes its portfolio and looks to vaccines as one area for growth to offset sales losses from mounting generic competition.

The appointment of Zerhouni, a professor of radiology and biomedical engineering, comes as Sanofi battles to buy U.S. rare disease specialist Genzyme.

Chief executive Chris Viehbacher brought in Zerhouni in February 2009 as his scientific adviser, shortly after taking charge of the group which he has been transforming to include the development of drugs based on biotechnology.

Zerhouni's Embrace of Corporate Health Care

Although Zerhouni ostensibly left the NIH to return to academia at Johns Hopkins University, note that by February, 2009, four months after his resignation was announced, Zerhouni was already advising the Sanofi CEO. 

Soon after he joined the corporate health care world in earnest.  In April, 2009, he was proposed for membership on the board of directors of Actelion Ltd, a Swiss biotechnology company.  On December 8, 2009, he was elected to the board of Danaher Corp, a diversified technology corporation which makes medical devices.  At some time he had become President of the Zerhouni Group, which advertised itself as a resource to "pharmaceutical and biotechnology companies, trade organizations, sovereign wealth funds, government agencies, and research entities around the globe."

Zerhouni at the NIH: His Response to the Conflict of Interest Scandal

There is more than a little irony inspired by Zerhouni's quick circuit through the revolving door.

Zerhouni became director of the NIH in 2002, and announced his departure in October, 2008. In December, 2003, David Willman published his landmark article in the Los Angeles Times on severe conflicts of interest affecting NIH scientists and leaders.  It revealed that formerly stringent conflict of interest policies at the Institutes were rescinded by then director Dr Harold Varmus in 1995, during the Clinton administration, and increasingly since 1998, disclosure of NIH personnel's conflicts of interest had been reduced.  Thus, in 2002, Zerhouni had taken charge of an agency already deeply affected by conflicts of interest affecting many of its leaders, even though that was not yet public.  He initially did nothing about the situation. 

Willman published another series of articles revealing even more breathtaking conflicts of interest in December, 2004.  (See our post here.)   By then, a Los Angeles Times editorial said there was the "appearance of corruption" at the NIH, and called for Dr Zerhouni's resignation. 

Only after the second series of articles did Dr Zerhouni swing into action (see post here).  In February, 2005, he announced that he would now hold the NIH to a "higher standard."  Yet new conflict of interest stories kept surfacing and their handling kept provoking concern (e.g., see this post from 2007, and this post from 2008), and concerns about how NIH deals with conflicts of interest affecting the extramural researchers it funds persist to this day (e.g., see this post). 

By the late 1990s, the NIH, like many other government agencies, seemed to have become extremely cozy with the world of big corporations.  Dr Zerhouni did nothing to obvious to reduce the local version of this coziness until it had become a public scandal.  His actions let questions about the relationships of the NIH, once a pristine example of a government run biomedical research agency, with big health care business persist to this day. 

So it should perhaps be no surprise that he so quickly transitioned from the government that is supposed to be"of the people, by the people, for the people" to top leadership positions in corporate health care.

Other US Government Health Care Agency Leaders Transit the Revolving Door

Meanwhile, the previous commissioner of the US Food and Drug Administration, Dr Andrew von Eschenbach, is Senior Director for Strategic Initiatives at the Center for Health Transformation, a group whose membership includes some of the biggest health care organizations, many of which have had their own moments in the sun on Health Care Renewal.  For example, see Charter Members, AstraZeneca, Sutter Health, and Wellpoint; and Platinum Members, GlaxoSmithKline and Merck.  Dr Eschenbach is also on the board of directors of Histosonics Inc. 

Also, the previous director of the Centers for Disease Control, Dr Julie Geberding, became President of Merck Vaccines in late 2009. 

Conclusions

So the revolving door just keeps spinning, its revolutions suggesting how closely tied together big government and big corporations have become in what is now the health care business.  Whatever the motivations of Doctors Zerhouni, von Eschenbach, and Geberding were, the message to every person in a leadership position in health care in the US government has to still be: you too can earn big corporate compensation soon after you leave here.  Who knows how much that siren song will lead current government leaders to avoid antagonizing the leaders of big health care corporations during their government "service."  That is, of course, not what we want them to be thinking about if government agencies ae to serve the people, not the CEOs of big corporations. 

I am sure that the career transitions of Doctors Zerhouni, von Eschenbach, and Geberding were perfectly legal.  If we want government health care agencies to put the peoples' interests ahead of those of the CEOs of big health care corporations, should not, however, the law be changed to at least slow down the revolving door?

AD Jameson - Stories like dreams, leading the reader into an alternate universe, but also back to the author as a mysterious and malignant force

AD Jameson, Amazing Adult Fantasy, Mutable Sound, 2011.

"A D Jameson, quaint and childish, tired ex-wife of a rodeo angel, owner of an antique tortoise-shell comb, nice-mannered, respectable, having been seen crawling quickly across the dinette set, destined to someday become a vice president at the bank, and whom you long ago bought and sold, is nodding off. If you let him, he’ll fall fast asleep on the unread page in your lap. He’s still wearing the camisole that you gave him, the one embroidered with his initials. He still has the cameo that you stuck in his Christmas stocking.
His hands were too clumsy. He’s sorry about how clumsy his hands were, the butter he handled you with for a while. He didn’t know better. He didn’t know otherwise in those days, in the obsolete past, about how his ascot became unfastened, about the way his suspenders snapped, about how his penny loafers were always scuffed and broken. He couldn’t help that his fedora was missing a feather, or that his appearance was rendered old-fashioned by passing years. He’s still amazed that you let him touch you, that you submitted to his caresses. He wasn’t amazed when you finally flinched and said, “OK now, man, that’s enough.” And when you left him without any warning, his feelings weren’t ruffled. His feathers weren’t left out of sorts in a huff.
Since then, he’s tried to become more refined. He’s tried to shape up. He might have become a rodeo dancer, or maybe a college graduate—we’ll never know. To hear the tales, he might have entered a program at Harvard, then finished the program. But we can’t be certain about those tales: when questioned, he tore up his diploma and ducked out the back.
Because he was feeling hungry for Thai food, he moved to Thailand. He stuck the two halves of his degree in a steamer trunk, and he set out at once. He learned where to go to get the freshest coffee in Bangkok, the freshest pad thai. He scouted the neighborhoods there for two years, just asking questions, just riding the buses. Just keeping his mouth shut, taking in heat and humidity. Just learning to keep both his buttery hands to his little old lonesome.
He missed you while living there, missed you terribly. He talked with his neighbors, and swam and rode every bus in Bangkok. He wrote an essay about how it felt to live in Thailand, and live there without you. He knew you were waiting for that essay, that you were checking your mailbox each morning. But he’d forgotten the look of the English language, its punctuation and letters. He got angry about how the characters looked on the page. He tore that essay in half every time he tried to write it, and crumpled those halves, and stuffed those torn and crumpled halves in his steamer trunk.
He tried to forget you. He took the liberty of buying you a coffee; he remembered how much you like coffee, and how you bought a cup every morning. He took the liberty of dropping a red and white peppermint in it; he remembered how much you like red and white, and how they filled your Christmas stocking. He’s kept that peppermint coffee warm for you ever since, inside a Thermos that he bought at a weekend market.
While he was in Thailand, he became friends with a passing gumball for a while. He befriended a passing tortoise, also. He ate the tortoise when it begged him to, when it cried and forced its chewy fins in his mouth. He placed the gumball inside a locket, a scuffed antique with a broken clasp, which he scotch-taped together and wears round his neck to this very day.
Now he lives in Chicago, has been spied living there for four years. He wasn’t corrupted, not very much; he isn’t easily corrupted. He still has the money that you lent him, the shiny new hundred. He’s turned down his many chances to spend it. He’s felt little pressure. He’s found he can get by with very little. He can get by on no more than a tortoise’s winter rations.
Ever since then, he’s been hanging around here, half-asleep, his hair combed, his eye out for your arrival. He’s still in love with you; he loves people just like you—kind souls who can handle his minor corruption. A little corruption might be precisely what you will need—you can’t be so certain.
As soon as he spies you, he’ll smile and wake up and say, “Hello and good morning to you.” The moment he sees your oblong face and remembers your name, he’ll fold his hands and bow and whisper, “Sawasdee krap.” He’ll say, “While sleeping, I wrote a book of short stories for you—accounts of the dreams that I had while I missed you, while living in Thailand. I hope that you like them.”
Until then, feel free to take a closer look at him. You can stare. You can take a long gander. He’s resting his head on that dream-laden book; he’s using its stories as a pillow. He knows that you’re destined to return at any moment; he’s foreseen it. He’s dreaming about you. His lips shape your name. He expects you to be back at any minute." - www.mutablesound.com


"What does it mean to be a writer? Who are writers? What do they do?
- For me, writing’s a form of thinking. It allows me to express ideas that I couldn’t express otherwise, because my memory isn’t good enough. And because writing possesses a logic all its own. It’s a meditative activity and a form of discipline that allows me to clarify some thoughts, and muddle others.
There exist more writers than people suspect, including all those whom “real writers” usually won’t acknowledge. There’s a disturbing tendency among high lit folk to not take seriously other writing, even if they enjoy it: genre fiction, commercial television, comics, children’s books, writing by actual children, zines, journalism. Also excluded: slam poets, performance poets, conceptual artists, and many others. This is elitist, short-sighted and unfair, not to mention a huge mistake. The people who wrote G.I. Joe and Star Trek are very much so writers. They wrote all over me! They wrote me!
Your stories seem a response to the current state of fiction. How would you characterize that current state?
- My central complaint against fiction today is how insincere (and therefore inconsequential) so much of it is: so ironic, so commercially-minded, so abstract. Most of it slides right past me, unmemorable, unaffecting. If writing is thinking, then a lot of the thinking being done by writers today is poor.
For example, I have little patience for what I call “ironic realism,” which some might call hipster writing (but which extends beyond that). Irony has been stripped of its powers, because we live in ironic times. Such fiction may be clever and amusing, even entertaining, but it’s superficial and deeply unsatisfying. All it can offer is entertainment, and reaffirmation of shared, conservative values. It criticizes and complains out of habit, and it has nothing else to offer. As the Where the Wild Things Are movie demonstrated, when the ironic realist is stripped of his irony, he has nothing left save platitudes like “group hug” and “all is love.”
I’m also troubled by how naïve and nostalgic so much of today’s writing is. US culture is disturbingly self-indulgent and infantile. So when I found myself wanting to write about pop culture icons, I initially recoiled. I didn’t want to write ironic G.I. Joe stories!
Who or what are your influences?
- First I’ll give the proper writer answer: AAF was influenced by Kathy Acker, Donald Barthelme, Guy Davenport, Steve Katz, Carole Maso, and Yuriy Tarnawsky. Katz exerted a particularly strong influence. Anyone who looks at his marvelous collections Creamy and Delicious, Stolen Stories, and Moving Parts will see how much I’ve pilfered.
But I was also influenced by popular culture of the 1980s and early 1990s, when I was a child and young adult. Like lots of geeky, friendless kids, I grew up reading G.I. Joe comics, X-Men, Teenage Mutant Ninja Turtles. I think the most conventionally “literary” thing I’d read by the time I was twelve was Lord of the Rings. And Michael Crichton.
Meanwhile, I watched Star Wars repeatedly, Star Trek, Indiana Jones — those were my religious texts. Between the ages of seven and fourteen, I wanted nothing more than to be a Jedi, or a ninja. As well as a mutant. I actually wondered what my mutant power would be, when I reached puberty. (Answer: the ability to suffer.)
So when I wrote, of course I imitated those things. I wrote a TMNT/X-Men crossover, and fantasy novels. I had a superhero comic series that I planned out in exhaustive detail. In junior high I drew a 350-page comic book adaptation of Mega Man II; I spent over five years working on it, using Bic pens and colored pencils and blue-lined Mead tablets. My love of awkward language comes as much from mistranslated Nintendo games as it does from Donald Barthelme’s “back-broke” sentences.
Is there something you are trying to work out in your stories?
- All of my writing is rooted in some conflict, some tension that I don’t otherwise know how to resolve. The stories are a way of thinking things through.
I started some of the stories in the collection, the earliest drafts, in the late 1990s, right after I finished college — not too long, really, after I stopped wanting to be a ninja. By then I wanted to be a literary writer instead — a postmodernist, like Barthelme or Acker, my new influences. But all I really knew about was pop culture.
I was also reading a lot of fan-fiction then, so I decided to write “literary fan-fiction.” And my initial impulses were juvenile and ironic: to drag out the Star Trek characters and kick them around, to vandalize them. I can claim now that this was a Situationist impulse, or punk, but it was also hip and ironic. I ended up writing what were basically parodies: “Mario and Luigi’s Super Midlife Crises.” This kind of stuff is everywhere now, online. It’s cute, but it’s also easy and shallow.
It’s mostly impossible to vandalize pop culture, impossible to “take down” Indiana Jones, or TMNT, or Oscar the Grouch. Those things are much stronger than we are, much bigger. And the second you approach them ironically, thinking that gives you an edge, you’re really just capitulating to them. As a college professor of mine, Pat Trimble, wisely put it: whether you watch Friends or Simpsons or Star Trek or Twin Peaks, you’re still watching television; you’re still watching commercials. You’re still sitting on the couch, or behind your computer monitor, eating corn chips.
The moment I realized this (and it was a gradual realization), I realized that although I’d been through college, and had taken writing classes, and had supposedly outgrown those childish loves, I was still, in essence, hunched over my parents’ kitchen table, making a Mega Man II comic book. X-Men vs. Turtles.
The stories are initially very playful, but as the collection progresses that playfulness is increasingly overwhelmed by a larger eeriness. I became both confused and intrigued, facing a world that is neither real nor imaginary.
- Well, what happened was that I put these kinds of stories aside for a while. I tried to focus on proper literary topics: adult relationships, the workplace, buying cars. Grandparents dying, pets dying, kids and spouses dying — the whole dead deal. But when I was honest with myself, I still wanted to write about my childhood. I didn’t know anything about adulthood. I knew only ALF!
And so I decided to acknowledge that desire, that the saddest thing I could think of was ALF dying. But at the same time I wanted to call myself to task, to admit how pathetic that was, how juvenile.
I returned to those pop culture stories, because I realized I needed to write them, to exorcise something. Amazing Adult Fantasy was my long dark night of the soul. Ingmar Bergman tormented himself over religion, and I, I agonized over — Kermit the Frog.
Your stories read like dreams, leading the reader into an alternate universe, but also back to the author as a mysterious and perhaps malignant force. What is the source of this?
- If the stories are malignant, it’s because I tried to recognize how my desires are malignant. And how the pop culture forces are, before that, themselves malignant. Injurious and untrue.
The stories in the first half of the collection, in the “Fiction” section, are all fan-fiction. They’re about Star Wars, Star Trek, Indiana Jones, Oscar the Grouch… They’re about things I loved as a child, and still love, even if my love is conflicted and bittersweet. And they’re fantasy stories: fantastical, unrealistic.
Any fantasy, if it’s good, is also perverse. It asks you to believe in a world that isn’t true, an alternative to our real world. It’s escapist. This isn’t bad, per se — we need fantasies. We enjoy them. We use them for all sorts of useful things. But fantasy is particularly dominant right now in our culture — look at the movies out there, month after month. I can name every single one of the X-Men, summarize hundreds of issues of those comics. I’ve seen the Star Wars movies more times than tongue can tell. Big Bird and Mr. Snuffleupagus are like real persons to me; they’re my childhood friends, as real as my downstairs neighbors (and not as loud). There’s something sad and terrible about this. And yet I can’t stop loving those things.
How does one get out of such a dilemma? Can one?
- Another, more theoretical influence helped me come to some terms with this, to write through this problem: William H. Gass’s formalism, in particular his essay “The Concept of Character in Fiction,” and his 1970s debates with John Gardner. (So Gardner, too, was an influence.) Gass defined characters as linguistic constructs: proper nouns that other words “go to be about.” Gardner, meanwhile, took a more realist or illusionistic approach, arguing that characters are instead apparitions, dreams.
Their debates resonated very strongly with me. I agreed with Gass’s formalist approach, but I also felt great sympathy for Gardner’s view: the very problem I was having with these childhood pop icons was that they were apparitions. They were ghosts, haunting me. Or demons, in a very literal sense: divine beings that provide for us, and that determine our fates and fortunes. Attendant spirits.
After reading those debates and Gass’s essays, I found myself able to approach those dreamlike apparitions more abstractly, more as verbal constructs. Gass writes that the character is not real, but rather just a noun that other words modify. That insight helped me to see through some of the illusion.
So I tried sending other words to be about those characters, which in fact opened up a lot of room. These characters, these demons, are so well known, they’re so strong — that’s their appeal — that I found I had a lot of room to redefine them, and thereby deform them. So I could call Indiana Jones “Indian Jones,” and write that he now lives in Brooklyn, buying vanilla Cokes at the corner shop and squeezing the straws until they crinkle and tear. And at the start of that story he’s a young man, about to set out on his first adventure, about to become Indian(a) Jones. But he can also be an extremely old man, later on in the story, a man who “never found a single priceless artifact; instead he used his butterfly hands to become a sculptor.” Because Indian Jones, Indiana Jones, can be whatever I want him to be.
The first half of the collection is about redefining these characters, giving them new identities. This, too, is ultimately impossible, but I found it a better approach than mere ironic vandalism. The language could become something stranger and more troubling than guarded yet unabashed love letters.
The second half of the collection, “The Solar Stories,” is a rewrite of the first half — a dark mirror. The pop culture references disappear, replaced by a new, self-enclosed mythology. I think of the book as getting “older”: the first half is pre-pubescent, while the second half begins with puberty. The toys of childhood get cast aside, but not before they’ve been absorbed. And what replaces them is a much darker mythology, one more fiercely embraced. This dark reflection goes back to pollute the first half, I hope, and vice versa. The insular teenage fantasies are built on the naïve childhood loves, even if the teenage self won’t dare name them.
Do you follow any particular formal methods when writing, or would you call yourself more intuitive?
- It’s a mixture of form and intuition. It was important to me that the structure played a meaningful role in the collection, organizing and commenting on the stories. And different stories in the collection used different styles and writing methods.
But I never want to sacrifice writing to adhere to form. If something feels right, then I’ll go with it. I want there to be tension, and form permits digression.
To what extent is media a guiding force?
- The stories are mine, but saying that just calls into question what “mine” means. I’m definitely ceding some control in my choice of subject. And even as I wrote away from my sources, deforming those pop icons, I consistently felt a lot of pressure to return to their original concepts. The solution that worked best, I found, was to keep the characters protean. They’re endlessly mutating verbal constructs. So, for example, in “Oscar the Grouch” the title character is at first a radio broadcaster and successful poet, but a few paragraphs later he’s a neurotic young man, and very shy. And a little bit later he’s a lecherous, elderly Beat. But he’s also at the same time a disgusting, mangy creature who lives in a garbage can, like a bum.
Meanwhile, the narrator of that story, the “I” — that “I” is another character, too, another word that can be modified as well. And so the narrator, just like Oscar, also keeps changing: at first she’s a sickly little girl, then a student, then a groupie, then a teacher. She and Oscar continuously mutate around one another, defining and being defined by one another. And I hope that, when you’re reading that story, those transformations are pleasantly confusing, but also critical. Because who are you when you embrace Oscar the Grouch as your personal demon, as your totem animal? And how does that embrace deform you?
Claude Levi-Strauss said that we personify animals because, just like how some animals are “good to eat,” some are “good to think.” These stories look at those pop culture creations and ask how they are “good to think,” but also “bad to think.”
Are you opposed to pop culture?
- No, certainly not. In some ways it’s too big to oppose. Can one ignore it? Condemn it? I don’t watch TV any more, and I read a much wider variety of literature than when I was a kid, and I have a lot of theory under my belt — but those pop stories, those characters, those franchises — they got their hooks into me before anything else. I was seduced at an early age: I can’t remember my life before Star Wars. The very first movie that I saw, when I was four years old, was The Muppet Movie. So I’ll no doubt always love Star Wars, and Kermit the Frog. And I’ve tried to be up front about that: “This before anything else.”
(A friend of mine was teasing me about these stories, arguing that I should just let my childhood go, like she did. She’s a sculptor who makes soft, animal-like fabric pieces. I asked her what kind of toys she’d played with as a child, and she said, “Oh, I had tons and tons of stuffed animals…”)
It’s important to resist one’s love for such things. We need them to some extent, but they were also the products of extremely pervasive capitalism — gimmicks for wresting cash from our parents’ fists (and then our own open hands).
The problem here becomes one of nostalgia, which is a kind of melancholy. Originally nostalgia was considered a disease: in the 1700s and 1800s, Swiss soldiers living abroad deserted in droves, because they couldn’t stand being so far away from the Alps. They were said to become particularly homesick when they heard the “Ranz des Vaches,” a farmer’s song. Their doctors and generals of course considered this a problem (they banned that song).
But today, nostalgia is a condition that we openly embrace. Our culture is very, very happy to sell our childhoods back to us. In my late teenage years, when I found myself at college, I struggled to cast aside the playthings of my youth. I stopped buying X-Men comic books, and action figures, and video games. I chose to stop going to see the new Batman movie, the new Star Trek. I wanted to have done with all of that, to move on. To no longer live like a child.
In some ways the culture helped: the more it insisted that I should care about the X-Men, the easier it made it for me to not care about the X-Men. George Lucas keeps tinkering with Star Wars, making it less and less like the Star Wars I remember — some people are upset because of that, but I’m actually somewhat grateful; I appreciate that alienation from Star Wars. The Batman that kids love today is not the Batman that Tim Burton gave me, the vision that he seduced me with…
…But this also makes nostalgia much more tempting. I actually bought some action figures one year ago: the NECO Teenage Mutant Ninja Turtle figures — because they’re based on the original comics version, you see, not the cartoon… And they just released a second series…
It’s difficult to get away from these things!
I took as my motto, “They will betray you.” They will never stay the same. They promise that they are divine, eternal, but they are the products of many different writers, of different places and times — which is part of their strength, but also part of their callousness, their injurious untruthfulness. They are greater than you; their masters are greater than you — and they do not know you, do not need you (just your paycheck).
This, then, is the tension that fueled the collection: my desire to write about these things, because I love them, and always will love them, but at the same time my very strong need to examine that love critically. And to hold myself accountable for feeling it." - Interview at Mutable Sound


Excerpts:

Rock Albany!

Indian Jones

A Sad Story of Factory Girls” (PDF, page 33)

Korawik Wattanakul

The Speculative Turn – To depart from the text-centered hermeneutic models of the past and engage in speculations about the nature of reality itself

The Speculative Turn: Continental Materialism and Realism, Levi Bryant, Nick Srnicek and Graham Harman (editors), re:press, 2010.

"Continental philosophy has entered a new period of ferment. The long deconstructionist era was followed with a period dominated by Deleuze, which has in turn evolved into a new situation still difficult to define. However, one common thread running through the new brand of continental positions is a renewed attention to materialist and realist options in philosophy. Among the current giants of this generation, this new focus takes numerous different and opposed forms. It might be hard to find many shared positions in the writings of Badiou, DeLanda, Laruelle, Latour, Stengers, and Zizek, but what is missing from their positions is an obsession with the critique of written texts. All of them elaborate a positive ontology, despite the incompatibility of their results. Meanwhile, the new generation of continental thinkers is pushing these trends still further, as seen in currents ranging from transcendental materialism to the London-based speculative realism movement to new revivals of Derrida. As indicated by the title The Speculative Turn, the new currents of continental philosophy depart from the text-centered hermeneutic models of the past and engage in daring speculations about the nature of reality itself. This anthology assembles authors, of several generations and numerous nationalities, who will be at the center of debate in continental philosophy for decades to come."

Table of Contents:

Introduction

1. Levi Bryant, Nick Srnicek, and Graham Harman, ‘Towards a Speculative Philosophy’

2. Alain Badiou, ‘Interview with Ben Woodard’

Speculative Realism Revisited

3. Graham Harman, ‘On the Undermining of Objects: Grant, Bruno and Radical Philosophy’

4. Iain Hamilton Grant, ‘Mining Conditions: A Response to Harman’

5. Ray Brassier, ‘Concepts and Objects’

6. Iain Hamilton Grant, ‘Does Nature Stay What-it-is? Dynamics and the Antecendence Criterion’

7. Alberto Toscano, ‘Against Speculation, or, A Critique of the Critique of Critique’

After Finitude

8. Adrian Johnston, ‘Hume’s Revenge: À Dieu, Meillassoux?’

9. Martin Hägglund, ‘Radical Atheist Materialism: A Critique of Meillassoux’

10. Peter Hallward, ‘Anything is Possible: A Reading of Quentin Meillassoux’s After Finitude’

11. Nathan Brown, ‘The Speculative and the Specific: On Hallward and Meillassoux’

Politics

12. Nick Srnicek, ‘Capitalism and the Non-Philosophical Subject’

13. Reza Negarestani, ‘Drafting the Inhuman: Conjectures on Capitalism and Organic Necrocracy’

14. Slavoj Žižek, ‘Is it Still Possible to be a Hegelian Today?’

Metaphysics

15. Quentin Meillassoux, ‘Potentiality and Virtuality’

16. François Laruelle, ‘The Generic as Predicate and Constant: Non-Philosophy and Materialism’

17. Levi Bryant, ‘The Ontic Principle: Outline of an Object-Oriented Ontology’

18. Steven Shaviro, ‘The Actual Volcano: Whitehead, Harman and the Problem of Relations’

19. Graham Harman, ‘Response to Shaviro’

20. Bruno Latour, ‘Reflections on Etienne Souriau’s Les différents modes d’existence’

21. Gabriel Catren, ‘Outland Empire’

Science

22. Isabelle Stengers, ‘Wondering about Materialism’

23. Manuel DeLanda, ‘Emergence, Causality, and Realism’

24. John Protevi, ‘Ontology, Biology, and History of Affect’

Conclusion

25. Slavoj Žižek, ‘Interview with Ben Woodard’


"I conceived the collection one drunken night as I was cooking dinner, full of warm and euphoric sensations from the chardonnay I was drinking (yeah I know, lame, but for some reason chardonnay makes me very euphoric, sentimental, expansive, affectionate, and happy whenever I drink it), and flush with excitement from reading Meillassoux’s After Finitude and from encountering Graham’s work, much to my embarrassment, for the first time. Prior to that, I only knew of Graham as the guy from DePaul (Loyola’s Continental rival) who had published a book fresh out of grad school and who was wearing a fidora in his books cover picture, i.e., I encountered him as an object of my envy and ressentiment. The original title of the collection was to be Post-Continental Realisms, but that title quickly got shot down– rightfully –by Bruno who observed that we have far too many “posts” in philosophy. “Let’s just do philosophy, eh?” At any rate, with the project fresh in my mind and wine diminishing my judgment, I immediately contacted Nick Srnicek, whose work I admire tremendously, who knows far more about the speculative realists than I ever will, and who I also owed for so generously citing me in his thesis.
Nick and I set about contacting the “big four” (Brassier, Grant, Harman, and Meillassoux), as well as others doing important work with a realist orientation (Stengers, DeLanda, Johnston, Hallward, Badiou, Protevi, Hagglund, Pepperell, etc). We were shocked and overwhelmed by the enthusiasm with which our proposal was met. Along the way we struck up a friendship with Harman and he did so much work promoting the collection that there was no way we couldn’t make him an editor. Graham is a work-horse, filled with enthusiasm for everything he does, and a mover and shaker. I really don’t know where he gets the time to do all that he does while also doing such creative and original philosophy.
As I sit here today, not even a year later, watching the articles begin to roll in, I am amazed by how much this project has changed my own thought process and philosophical orientation. One of the things I really like about this collection is that it is a work written by moles and being published by moles. Here I am not using the term “mole” in the sense proposed by Jon Cogburn, but rather in the sense of the old spy movies as someone who infiltrates a foreign organization and undermines it from within. On the one hand, nearly all of the contributors to this collection are moles in the sense that they are on the fringes of mainstream Continental philosophy, somewhat excluded from academia and traditional Continental scholarship. What made this strange alliance of moles possible– as moles are generally solitary creatures –was the internet, which allowed for networks of burrows to be formed, creating the possibility of strange cross-fertilizations of ideas and philosophical orientations that are otherwise so disparate. Although moles are generally peaceful creatures, content to burrow and feast on the grubs and delectable roots they find, nomadic mole armies are fearsome forces, despite their myopia. Indeed, their myopia or devotion to burrowing lines of flight are their strength.
On the other hand, Re.Press is a mole press, publishing the work of authors and thinkers that otherwise would have a great deal of difficulty getting their work published by more mainstream Continental presses, due to the manner in which these works tend not to be organized around commentary on a particular thinker. In this respect, the name “Re.Press” is a double entendre, capturing Freud’s dictum that repression is always accompanied by the return of the repressed.
However, if Re.Press is a mole press, then this is because through open access publishing that makes its texts available to the general public online, it allows for networks of burrows to be formed, alliances to be forged, that would otherwise be significantly restricted by exclusive paper publishing. Like the scene in Fight Club where Ed Norton’s character beats himself up, the voice-over remarking that something has been growing around and behind his boss that couldn’t be seen, open access publishing as well as blogs allow for mole collectives to be formed that skirt the established hierarchies of the academies and the morphogenetic role they play in defining the canon. If you read Peter Gay’s biography of Freud you discover that a mere handful of psychoanalytic theorists managed to transform the world through weekly meetings in Freud’s living room over coffee. The internet intensifies the formation of such networked assemblages and alliances. Moreover, it is high time that we Continentalists shoot back at ridiculously priced presses like Continuum and Palgrave that both inhibit the propagation of thought, hurt academic careers by keeping the work of emerging authors in obscurity due to the price of their texts, and that promote a sort of implicit elitism by restricting readership to those that can either afford the texts or who have access to a good library. And, of course, there are all the ecological issues behind paper publishing as well.
As far as my own contribution to this project goes, I’d like to express my great thanks to Jon Cogburn, Nick Srnicek, Reza Negarestani, John Protevi, and Nathan Gale for the exceedingly helfpul comments they gave me on my article “The Ontic Principle: Outline of an Object-Oriented Philosophy”. While not shirking on critical comments, all of you have been extremely encouraging and helped me to better develop my own vague intuitions. I owe all of you." - Levi Bryant,


"The Speculative Turn, edited by Levi Bryant, Nick Srnicek, and Graham Harman, has now been published. This volume gives the fullest account to date of (so-called) “speculative realism” in all its varieties. There are articles by the four initial speculative realists (Graham Harman, Iain Hamilton Grant, Quentin Meillassoux, and Ray Brassier), together with work by other thinkers who have influenced them (Laruelle, Latour, Stengers, Delanda, etc) essays by later contributors to speculative realist trends (Bryant, Srnicek, Reza Negarestani), brief interviews with Badiou and Zizek, and more. The volume contains my own article/critique of Harman, “The Actual Volcano: Whitehead, Harman, and the Problem of Relations,” together with Harman’s response." - Steven Shaviro

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Spine Surgeons Reticent About Disclosing Huge Medtronic Payments

Starting in 2007, we posted (here, here, here, here and here) about the payments, often huge, that five manufacturers of prosthetic joints (Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Stryker Orthopedics,a unit of Stryker Inc, Zimmer Holdings, and Smith & Nephew) revealed they made to orthopedic surgeons and various academic and other organizations. We also noted that some of the leadership of the major orthopedic societies have received substantial amounts from these companies, as have the societies themselves.

In 2008, our post on this subject noted the minimal disclosure some of the surgeons receiving these huge payments made when writing scholarly articles on related topics.  In 2009, an article in the New England Journal of Medicine showed that almost 30% of surgeons who got such payments in 2007 failed to disclose them when they presented at the 2008 American Academy of Orthopedic Surgeons meeting.(1)

Medtronic's Payments to Spine Surgeons

This month, the media reported that Medtronic also made payments, sometimes huge, to orthopedic and spine surgeons (see this post by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog, and our summary post here.) 

Now further investigation by John Fauber of the Milwaukee Journal-Sentinel suggests that surgeons receiving often huge payments from Medtronic may not have been good at disclosing them either.

The article examined payments made to surgeons who authored two major studies about bone morphogenetic protein-2, a biologic drug manufactured by Medtronic used to promote bone growth at surgical sites:
Over the last decade, a small group of prominent surgeons from around the country has been enlisted by medical device-maker Medtronic to do clinical research or write articles about the company's new spine surgery product.

This year alone, many of those doctors received payments of hundreds of thousands to millions of dollars each in royalties for a variety of other Medtronic spinal devices, according to a Journal Sentinel analysis of newly released company payments. Medtronic began disclosing the payments this year, in advance of a federal requirement set to take effect in 2013.

Since it won approval for narrow uses in 2002, the product - bone morphogenetic protein-2, known as BMP-2 - has been an increasingly dominant force in spinal fusion surgery, with sales of about $800 million a year, often for use in other procedures.

Independent doctors say the product's success is due largely to positive findings made by the surgeons affiliated with the company.

Doctors involved with two of the many research articles on BMP-2 published since it was approved - one in 2002, the other in 2004 - received a combined $6 million in royalties this year for other Medtronic spinal products, the newspaper found. The payments went directly to the doctors or business entities they are associated with.

No Disclosure in a 2002 Article

The Journal-Sentinel article referred to two scholarly articles written about BMP-2. Regarding the first,
At the time BMP-2 was approved in 2002, little was known about the financial connections between Medtronic and doctors associated with the clinical trial. Likewise, little was known that year when the Journal of Spinal Disorders & Techniques published the article on the trial.

The paper made no mention of doctors getting royalties or having any financial connection to the company.
[Note: I am unable to find this article using standard search techniques, so I cannot give a citation for it.]
Regarding the lack of disclosures made in the first article,
The four co-authors of a 2002 paper about that trial received a total of $2.8 million this year from Medtronic in royalties for products not including BMP-2.

The paper made no mention of any financial relationship between the authors and Medtronic.

Burkus, who also was involved in the 2004 study, again declined to say if he was receiving royalties from Medtronic or if had some other financial connection with the company at the time the 2002 paper was published. He got $573,000 through September.

Curtis Dickman, a Phoenix surgeon, did not respond to phone calls and e-mails. He and Vantage Investments LLC received $306,000 in royalties.

Matthew Gornet, a St. Louis surgeon, and Gornet Enterprises got $591,000 in royalty payments.

Gornet said he did not have a financial connection with the company at the time of the study, though he developed a relationship as a consultant right after the trial, an arrangement that ended after about a year.

He said his patent rights with Medtronic did not begin until 2003 and none of his royalties involves BMP-2.

The last author listed was Thomas Zdeblick, an orthopedic surgeon at the University of Wisconsin School of Medicine and Public Health. Through September, he and Taz Consulting received $1.4 million in royalties for a variety of products.

Other records show Zdeblick has received more than $23 million in royalties from Medtronic since 2002.

In an e-mail, Zdeblick said he had no financial interest in BMP-2. He does receive royalties for the invention of the LT-Cage, which was used in the BMP-2 clinical trial, but the two products are sold separately.

Little Disclosure in the 2004 Article

Regarding the second article,(2)
Three of the four authors of a 2004 article on the study of the productare listed as receiving nearly $4 million this year in royalties from Medtronic for a variety of spinal products, not BMP-2.

That paper was important because it involved a clinical trial that had to be stopped because the product was causing troubling bone formation in the spinal canal of patients. In the paper, that finding was downplayed, with the authors describing the results as 'encouraging.'

[Professor Dan] Spengler, the Vanderbilt orthopedic surgeon and former medical journal editor, said he doubted the paper would have been written in such positive terms by authors without financial ties to Medtronic.

He described the article as egregious, saying it 'just blew off the complications. It's a horrible article.'

Orthopedic surgeon [University of California - Irvine Clinical Professor Charles] Rosen said the paper was biased, calling it 'more of a marketing paper than an objective scientific study.'

Regarding the disclosures made in the second article,
The article described three of the authors as consultants to Medtronic, though it did not disclose that any of them were receiving royalties at the time.

Regis Haid, lead author of the article and an Atlanta neurosurgeon, told the Journal Sentinel he was getting royalties for other Medtronic products. Haid noted disclosure rules for medical journals have become more stringent in recent years.

He said BMP-2 provides excellent benefit to patients, adding he had it implanted in his own neck in an off-label procedure. ;I have BMP in me, and I would put it in you . . . ,' he told a reporter.

Through September, Haid and Spinal Engineering LLC received about $2 million in royalties this year from Medtronic.

Meanwhile, co-author Ken Burkus, a Columbus, Ga., surgeon, and RBCK Research & Consulting, received $573,000.

'Very importantly, you cannot assume that such royalty payments were made prior to 2010,' he said in an e-mail, declining to say whether he got royalties at the time the paper was written. 'I follow the rules to my fullest ability as put forward by the specific journal.'

He took issue with criticism that the paper put a positive spin on a troubling clinical trial.

'I believe the words used were appropriate . . . ,' he said. 'I believe the words used were neither 'positive nor negative' but rather were representative of the data presented.'

He said if other doctors have problems with the paper, they should take it up with the editor of the journal: 'They can write a letter to the editor.'

Co-author Charles Branch Jr., chairman of neurosurgery at Wake Forest University, and the university itself have received $1.2 million in royalties this year.

A spokeswoman for the university said it owns the intellectual property rights to Branch's patents and that royalties generally are split with 35% to the individual and 65% to the university. None of those royalties involved BMP-2, university media relations manager Bonnie Davis said in an e-mail.

She said Branch and Wake Forest were getting royalties at the time the paper was published, but not when the trial was going on.

In a separate e-mail, Branch said use of the term 'encouraging' in the paper 'was not a strong endorsement,' but, rather, recognition that patients getting BMP-2 had superior results to those receiving a traditional bone graft.
Summary

So here we go again.  Once again we see an example of a single medical device company paying heroic amounts, hundreds of thousands to over a million dollars a year, to surgeons ostensibly as royalties for their intellectual property.  The company and the surgeons were all rather cagey about the nature of the intellectual property for which the money was paid, and about the justification for the size of the payments.

While it is likely that the payments have been going on for a while, previous influential articles written by some of the surgeons receiving the payments contained at best minimal disclosure of their financial relationships with Medtronic, and gave no hint about the magnitude of these relationships.  These previous influential articles seemed more enthusiastic about a Medtronic product than was justified by their results.  Of course, maybe getting hundreds of thousands or millions of dollars a year from a commercial health care firm could lead to some excess enthusiasm about its products.

It seems that every drug, biotechnology, and device company has its stable of highly paid physicians and surgeons who can be counted on for their enthusiasm about the companies' products, and their reticence about their financial relationships with the companies.  We have often discussed the pervasiveness of the web of conflicts of interest that seems to link most commercial health care firms with most influential medical academics and practitioners.  The web seems even more pervasive than we once imagined, and the conflicts seem even more intense. 

Those who laud ties between academic medicine and industry may perseverate about how collaboration leads to innovation, while denying that mere money can influence professional judgement.  However, it is difficult to imagine how even the most well-intentioned professional would not be influenced by hundreds of thousands or millions of dollars a year.  When professionals hide the magnitude of such relationships, it only raises more suspicions that they know they have something to hide because they realize they have been bought.

The ever increasing revelations about conflicts of interest pervading academic medicine should inspire extreme skepticism about clinical research or clinical teaching supported in any way by commercial interests.  At the very least, these revelations justify the need for detailed and complete disclosure of all financial relationships among commercial health care firms and academic and practicing physicians, and others who make or influence health care decisions. 

I suspect that if such full disclosure took place, physicians, other health care professionals and the public, at least those who had not been paid themselves, would be so aghast that such relationships would not remain legal for long. 


References
1.  Okike K, Kocher MS, Wei EX, Mehlman CT, Bhandari M.  Accuracy of conflict-of-interest disclosures reported by physicians. N Engl J Med 2009; 361:1466-1474.
2. Haid RW, Branch CL, Alexander JT, Burkus JK. Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cates. The Spine Journal 2004; 4: 527-539.

Kellie Wells - He wanted to feel those feathers, to feel them brush his knees and open the closed places in his body, pass through him like hot nails

Kellie Wells, Skin :A Novel, University of Nebraska Press, 2006.

“From within the deceptively commonplace bodies of the inhabitants of a small Kansas town with the deceptively homespun name of What Cheer, Kellie Wells unleashes the clamorous, resistless, marvelous voice of our world's collective unconscious, the language of ecstasy and despair in all its manifold registers. Reading Skin is like finding yourself inside one of the great medieval paintings, every last detail (a sycamore tree, a TV, a firefly, a set of dentures in a glass, a meadowlark) perfectly rendered, and exploding with celestial meaning.”— Kathryn Davis

"In her first novel, Skin, Kellie Wells tackles theological questions of eschatological proportions within the complicated web of What Cheer, a small town in Kansas. God peeks through the clouds with ominous and alarming force, knocking men to their knees and demanding nourishment with insatiable hunger. What Cheer's residents live in a violent, premillennial reality where the only spiritual peace is inside your skin, below the veins and obscured by body tissue.
Wells eschews chronological narrative form, jumping through her characters' lives with a different kind of arc. Their futures mix with their pasts, creating a chaotic present without a clear protagonist. Instead, a cast of interconnected sinners trapped in various physical, philosophical, and emotional purgatories trades leads. Degrees of pain flirt with pleasure in a way that is just barely tolerable yet undeniably compelling.
The prologue sets the tenor for the body of the novel. Wells begins by describing the intoxicating scent of gardenia hanging in the air. The smell is so powerful it makes her characters forget what the body is reasonably capable of and the language so crisp it makes readers forget to question rationally impossible plot twists. Within the first two pages Rachel wills herself to shrink, her daughter Ruby dreams of the day she will let her mother relax in the safety of a pocket, and Zero floats into the sky until his body becomes merely a "matter of faith." Miracles are commonplace, theophany is never ruled out, and penitence is relished. Wells closes the prologue with guilty people ready to be consumed by their creator - "Thin clouds prowl across the sky like cats stalking sparrows, and all the residents of What Cheer who stand in their greening yards, hands reaching toward a trickle of sun, look above to see the sky eddy with the ylem of imminent consequences, kneel beneath the heft of sins they've yet to commit."
Throughout the novel, Wells uses Christian imagery to flirt with existential questions. God feeds us himself in the form of the Eucharist, but who feeds God? What is life? "Who's to say we are not floaters in God's eyes, making him a little less lonely behind his dimming vision?" What is heaven? Is it real? Could it be a place where "blood means the same as milk or rain or wine?" In What Cheer, God's name is Harold and he consumes whatever he chooses, answering these questions with swift blows. Abuse is divinely sanctioned and even envied. Masochism is the path to happiness and divinity. "It's a balled-up fist you hit yourself with, but you like it that way 'cause the beauty of contusions is that they disappear."
The world Wells creates is complex. At times the pain is so beautiful it invokes guilt. Wells succeeds in getting the reader to acquiesce to abuse, describing it with language so romantic that only later does reality catch up. She plows through issues that don't bring joy - domestic abuse, death, and self-mutilation - yet somehow leaves the reader with a smile. The book is not funny, but the prose so pleasurable it lulls the reader into seeing God in every bit of pain and loving him anyway. Wells manages to weave layers of storyline into each other from generations past and present without faltering, and she makes miracles rational, vigilantly retaining her audience in that heady, intoxicating cloud of What Cheer gardenias." - Rebecca Turnbull

"In Skin, Kellie Wells' novel-in-stories, scars are sites of healing as much as they are repositories for suffering. The motifs of skin and scar appear repeatedly throughout the book, and the structure of the novel itself forms a tissue of interrelated, almost symbiotic smaller narratives. For Wells, skin is not just the vast organ that protects the human body; it is also the narrative fabric that connects the human community, and the membrane that separates the otherworldly from the all-too earthly.
Skin follows the lives of the residents of What Cheer, Kansas, where the "gardenia-scented air fills them to their gasping gills with a barren hunger no fecundity could ever answer." This hunger winds throughout the novel and highlights the longing that each of its characters experiences in different ways. Evangelical Ansel Dorsett, for example, hungers for word from God, while his neighbor, the elderly Charlotte McCorkle wishes for an end to her physical presence on earth and a reunion with her husband. As the "sporadic seer" of What Cheer, McCorkle has the ability to imagine the lives of even unfamiliar residents, and her prophetic voice helps to draw all the other voices together. Like most of the residents of What Cheer, McCorkle is independent and pulsing with life. She underscores the importance the novel places on how humans differ from all other beings in their ability to experience through their sense of touch. "Touch is an underrated sense," she says. "We are tyrannized by the visual, and nearly as often led around by the ears, but what if we lost tactility, what lesser creeping creatures would we be could we not feel?"
Wells is at her best when in the realm of the body. One does not read her words as much as sense them through the fingertips. A sensual writer, her prose is both fleshy and often blurrily erotic, especially when she conjures angels: "He wanted to feel those feathers. He wanted to feel them brush his knees and open the closed places in his body, pass through him, tearing like hot nails, feel them die violently, all blood and sun, then feel them light as nucleolus rise up inside him like resurrection, scattering on the wind, the pollination of a restive demi-divinity."
In Skin, angels signify the tension between the body and the spirit, and the general sense of abandonment that permeates the novel. Wells' angels do not have perfect, white wings or receive messages from God. Instead, they can be seen feasting on the carcasses of animals in a field or visiting their human companions for a game of Triple Yahtzee. They age and grow sickly, are at once too corporeal and disembodied. Gabriel, Charlotte McCorkle's nephew, is one such angel. After several operations to remove his wings, they "came in all cockeyed and sickly, curling out to the sides like corkscrews with shriveled, musty feathers, and each time they grew back they came in more gnarled and in less and less likely places." In What Cheer, angels suffer, perhaps even more than their human counterparts. As Mrs. McCorkle explains, "When we are in the midst of a celestial burgeoning that walks among us, we tend to look the other way, hope we'll be spared."
Angels are not the only supernatural elements in Skin. Zero Loomis floats, and his eight-year-old niece Ruby Tuesday grows lemons in her abdomen. There are encounters with skin-stealing aliens and talking animals. Wells' brand of magical realism is reminiscent of Garcia Marquez, but also distinctly American. Her descriptions of the supernatural are as humorous as they are incantational: "You will wamble and flap at your own limitations, and molting feathers will twist to the floor. She will gather them and make a picture to comfort you. She will trace her hand on construction paper, a sweet hand small enough to fit comfortably inside your mouth, and she will glue your fallen feathers to the outlined fingers. She will fashion the body and head and wattle of a turkey out of brightly colored kernels of Jolly Time popcorn.
The impetus for Skin grew out of the author's short story, "Compression Scars," featured in her collection of the same name, which won a Flannery O'Connor Award for Short Fiction. That story is, like Skin, both tragic and comical. In a lesser writer's hands, the metaphor of scarring might come across heavy-handed, but Wells treats misfortune with tenderness and levity. Much is accomplished through the lively voices of her characters, but one senses the author's voice too, just below the surface, reminding the reader that there is a fine line between "grace and desolation," and it is through the skin that we negotiate that line, that we are reminded not only of how alone we are, but also of how connected we are to each other in our shared experience of aloneness." - Rachel Swearingen

"Wells gives us a series of linked stories with a prologue and epilogue. Although the setting is the small town of What Cheer, Kansas, the citizens of that town not only do the usual chores—cut the grass, watch television, search the sky for weather signs—they are also obsessed with divinity. Does skin reign? Or does divinity in some form or creed enter the skin, hinting that there are angels? What Cheer is, indeed, a very strange place. I need only quote some passages: Rachel Loomis "imagines soon she'll be able to see her soul showing through, a faint glimmer near the hipbone, between her ribs...." Ivy Engel, a teenager, gets "a little spooked, thinking maybe [the bats] had gotten their coloring from blood feasts, like maybe steady blood plasma transfusions had begun to redden their skin and fur...." Martin LeFavor sees angels: "Clearly great mysteries coursed between the extraterrestrial skin, drooping from their bones like melting wax." Are the people who live in the heartland crazy? Wells doesn't bother with simple terms because she writes of experiences beyond words. And her special gifts of metaphor and image gradually draw us into uncommon - to say the least! - states of mind or being. We begin to think that "skin" is haunted, enchanted, spooky. And Wells puts us in a mood of "continuing speculation." We will no longer see the natural world - flowers, crocodiles - as it "is." I cannot think of many novels that alter our perceptions, that make us think as old Rachel does: "The world is ending, the world is ending. I'm thinking about it. I'm thinking about it." - Irving Malin

"The residents of What Cheer, Kansas, are a fractured and tortured lot, wrangling with questions of personal responsibility, spiritual absolution, and cosmic uncertainty. What cheer, indeed? There's Ivy Engel, contemplating her mysterious tree filled with bats, and her boyfriend, Duncan, dressing all in blue to hide the scars ambushing his body. Next door lives evangelical Ansel Dorsett, whose piety is too much for the infirm Charlotte McCorkle to bear, laboring as she does under the delusion that she killed her husband, while in reality, he languishes in a nursing home across town. Ansel's savior may be the precocious child, Ruby Tuesday Loomis, who sees possibility in words written on cows, and dreams of fruit springing from her body, though such otherworldly skills confound Ruby's mother, Rachel, who still bears the childhood scars wrought upon her by her father's violence. In this surrealistic phantasmagoria, Wells writes with an intoxicating lyricism of the magic and mystery that lurk within and without the frailest and finest among us." - Carol Haggas

Prologue: Spiritus Monday


Kellie Wells, Compression Scars, UGA Press, 2002.

“By turns achingly poignant and downright hilarious, rendered in prose as supple and surprising as it is consistently brilliant, these stories take us into a world of angels and grotesques, of grace notes and grave truths, of the lost and, finally, the found.” — Ellen Akins

“Distinguished by a compressive force born from invention and intensity rather than economy, Kellie Wells's aptly titled Compression Scars is a memorable debut. The writing is consistently fresh and often beautiful, though for Wells beauty is a by-product. The primary function of her language is incantation—necessary to effect the alchemical transformations that inform each story.” — Stuart Dybek

“Slyly comic yet deeply felt, Kellie Wells's marvelous fiction embraces the sacred weirdness of everyday life. These are magical stories, in every sense of the word, by a writer with a conjurer's feel for the hidden compartments, death-defying escapes, and lighter-than-air levitations of language.” — Peter Ho Davies

“Even in a crowded field, it is a rare pleasure to come across a prose stylist like Kellie Wells, whose intellect and language bid one another beautifully to a dance. A thrilling debut from a writer so agile and subtle in her terms that, like Walter Abish and Kathryn Davis, she dares to be at play in the most unsettling questions of her day. Surely when the present generation of writers shakes down to its unique and irreplaceable voices, Kellie Wells will be one of them.” — Jaimy Gordon

"In Kellie Wells’ Flannery O’Connor Award-winning collection, Compression Scars, the body is a problem. The bodies in these stories are blind, deaf, pierced, headless, scarred, ridden by tumors and shingles and leukemia, plagued with heart palpitations, ugly, and, more often than you’d expect, dead. They suffer from what the fatherless narrator of “Star-dogged Moon” calls “the corporeal rap.” Characters occasionally approach sex, that most body-affirming of acts, but it remains out of reach. After one failed seduction, a woman, apparently by way of “good-bye” to her uninterested partner, “raises one side of her shirt, exposing a breast as small and fragile as a teacup.” Strange, sad and beautiful, a chord this book plays many times. It's no surprise, then, that these characters often want spiritual relief. The stories use mystical means - seances, ghosts, imaginary and rhetorical flights - to escape, transcend, ascend; or to use Wells' own consistently brilliant language: each story is "a fast burning centrifuge spinning spirit from flesh." At the magical conclusion of the title story "Compression Scars," bats descend to brush bugs from the protagonist's bare belly, a spectral touch that contrasts with the earthier sex she can't accept from a young man with devastating compression scars spreading throughout his body. But Wells occasionally balances this spiritualizing impulse with a character willing to give the flesh a go. Even the pre-adolescent Hallie, in "Hallie Out of This World," when confronting a knife-bearing sexual predator who "just" wants to look at her, exhorts him to "Touch me." Whether that touch would be worse than what the man has already subjected her to is hard to say. In any case, the story withholds that touch, as these stories generally do, as if, in Hallie's words, "a plate of glass separated us."
Plotwise, these stories also tend to be a bit disembodied. A typical narrative puts a character suffering from the loss of a loved one through a seemingly meandering series of memories and encounters, set to the music of Wells' inventive, finely detailed, funny, and sometimes bracingly intellectual sentences. When the music is about to stop, we find that the story has deftly managed to locate itself directly above a trapdoor leading into feeling or insight - and out of the story. Without the unfolding of dramatic action to bring on their resolutions, something which depends on purposeful bodies moving through time, the stories often require imagined rather than enacted endings: a dead father returns for a conversation in "Star-dogged Moon"; Hallie imagines leaving this world with her friend Oedipus and an experimental cow named Gretel. But, in most of these cases, the power of Wells' language leaves me feeling that definitive plot action is for squares.
Interestingly, the story most grounded in familiar emotions and motivations is the amazing "Secession, XX," a story which also has the most body-crazed premise: conjoined twins, brother and sister, survive long enough to attend high school and fall in love with the same person. It's as if having paid off a massive debt to strangeness, Wells feels comfortable getting down to jealousy and desire. Here the climactic rhetoric (climactic maybe for the collection as well), spoken by the brother who has begun to thrive as his sister declines, gives the body its due: "I sense that it is, after all, in the body that one knows whatever one can claim to know about God; redemption occurs, courageously, at this site of pain and decay." but in the last story, the will to escape the flesh is re-ascendant. Yet as the characters at the end of "Hallie Out of This World" rise into the sky, ready to "burn ourselves out of this world," I'm tempted to say, "Not so fast. Down here, in our bodies, is the only place we can live." Then again, Wells knows this, deeply, and that's why she's written these beautiful, pain-streaked stories." - Andy Mozina

"For this debut collection, creative writing instructor Wells won the University of Georgia Short Fiction Prize. Her characters are unable to avoid disaster in a world where "things can get so strange, so fast." Fathers and mothers disappear; children are left alone to cope with their fears and fantasies. In "My Guardian, Claire," the young narrator is trapped in a role reversal. In "Godlight," a Jesus-like figure, Jonas, replaces burned-out light bulbs in the Hyatt Regency Hotel. The light that he keeps for himself the light that comforts him is the light he sees when he imagines his dead daughter in heaven. The people in these stories are vulnerable, eccentric outsiders attempting to find their way in a world that puzzles and dazzles them. Wells adeptly portrays both their vulnerability and their fortitude. Her strong, unaffected prose contrasts sharply with the surreal quality of many of the stories. This collection introduces a writer of startling imagination and great promise. Suitable for all public libraries." - Marcia Tager

"Brother and sister conjoined twins; a teenage boy who believes he is dying from excessive scar tissue; a child conceived with the purpose of providing bone marrow for his cancer-stricken sister. Such abnormal afflictions lie at the core of Wells' debut collection of luminous short stories that reflect both the fragility and the flexibility of the human spirit. Emotionally and physically damaged as they may be, Wells' characters struggle with scars that are both internal and external, though they often fail to realize which of the two is the more disfiguring. Like Hallie, the teenage heroine of "Hallie Out of This World," Wells, too, can be said to "romanticize misfortune... the shortcomings, disabilities, grief and misery of others." What saves Wells, and what elevates her characters, is the inner strength and sublime compassion that compel them to assist others in singularly unconventional ways. Sometimes dark, frequently droll, by turns heartbreaking and humorous, Wells' phantasmal stories shimmer with a dreamlike vibrancy that continues to haunt long after the last word has been read." - Carol Haggas


"In the lobby of the Gramercy Park Hotel in Manhattan, fiction writer Kellie Wells, M.F.A. ’91, tells how from an early age she recognized “how persuasive words can be.” She pauses to think. “Potent,” she says a moment later. “That’s a better word.”
Word by word, sentence by sentence, Wells crafts her stories. “I write very slowly,” she says. “In paragraphs rather than pages.”
That approach has built a body of work that has garnered the Flannery O’Connor Award for short fiction, publication in prestigious literary magazines, and most recently, a Rona Jaffe Foundation Writers’ Award, which has brought her to New York.
The cadence of language and the unconscious element of idea generation are two aspects of writing that intrigue Wells. It is not surprising, therefore, that her language casts a dream-like spell on readers, engaging their imaginations with oddball and often shockingly vivid imagery.
Her first collection of stories, Compression Scars, is being publicized on Amazon.com as “eloquent and original… vibrantly captur[ing] the oddities of both the everyday and out-of-this-world.”
In the story “Swallowing Angels Whole,” for example, protagonist Aimee Semple McPherson, a preacher with many stories, many truths, questions the ways of the world around her. She wonders whether “[Darwin] had felt the walk out of the water into the light click in his own bones, the weight of that forward movement pressing down on his skeleton. Bones remember. The ache that starts at the base of the spine is a bone memory of another posture.”
The evening of the Rona Jaffe Foundation Writers’ Awards ceremony, sixty-five floors up in the pavilion of Rockefeller Center’s illustrious Rainbow Room, the best word to describe Wells and her writing was lofty. Overlooking a cloud-enshrouded New York City skyline, the literary world’s top publishers, agents, and editors assembled in late September to honor six emerging writers.
The writers are all women in the early stages of their careers who, in the words of the foundation, “demonstrate exceptional talent and promise.” Others to receive the $10,000 award this year are: Eula Biss, Adrian Blevins, Gabrielle Calvocoressi, Ladette Randolph, and L.B. Thompson
A saxophone’s soft jazz filled the partygoers ears, fancy finger foods filled their mouths, and the names of future literary giants claimed their minds’ attention as author and philanthropist Rona Jaffe announced each winner.
Literary greatness, however, was not of foremost importance to young Kellie Wells. She was aware of words’ potency, yes, but did not immediately gravitate toward them.
“I was not one of those kids who wrote all the time,” she says. Only after college, when she found herself in a copywriting job at a public television station, imprisoned behind the strict confines of thirty-second spots, did she see the path that lay ahead of her.
“I found myself yearning beyond the thirty seconds,” she remembers.
"Wells had earned two bachelor’s degrees from the University of Kansas, Lawrence—the first in English, the second in journalism—and decided to test out the limits of fiction and poetry by enrolling in the M.F.A. program at UM in 1989. She received an extra incentive when honored with the University of Kansas Kate Stephens “Get the Hell out of the Midwest” fellowship for graduate study. It stipulated that its winners attend graduate school east of the Alleghenies or west of the Rockies. (Missoula, she says, was “exotic” in comparison to her hometown of Kansas City.)
“Being in school was something I was good at and enjoyed,” she says. “I was casting for an identity and couldn’t find one. I stayed in academe because I knew who I was when I was there.”
After earning yet another M.F.A. with a concentration in fiction from the University in Pittsburgh, she decided to make a career for herself in higher education. She studied abroad in Berlin and Hamburg, gained fluency in German, and received her doctorate in English and creative writing from Western Michigan University in 1999.
Though she says she “never lets naiveté get in my way,” she was struck by how demanding teaching was. Now an assistant professor of English at Washington University in St. Louis, she does not get much writing done during the semesters she teaches. She simply does not have much to give to the creative side of things; teaching consumes so much of her energy.
To teach literature, Wells says she must first craft aesthetics and defend her positions. Students often ask her why she refers to certain readings, and she must be able to rapidly produce articulate answers. This process, she says, pushes her forward to do the work—the thinking—that she perhaps wouldn’t do on her own.
“It allows me to change, revise, and grow in a way that comes quickly,” she says. “I’m forced to be reflective all the time.
“Lots of writers who teach complain that they have no time to write,” she continues. “But for me, the only way to survive academia and writing is to see the symbiosis—how one feeds into the other.”
The Rona Jaffe Foundation bestows cash awards on its winners in the spirit of providing them with a cushion of time during which they can achieve a high level of reflection and creative output. Some winners use the money to cover the cost of childcare; others pay the rent for cubicle space. Wells plans to journey to Egypt to research Queen Hatshepsut.
At work on her second novel while making finishing touches on her first, she says her characters often get interested in subjects about which she is not personally knowledgeable, like ancient Egypt. “Sometimes an image pops into your head and attaches to this one character,” she says.
Her second novel, tentatively titled Fat Girl, Terrestrial, is still in the “embryonic stages.” Yet Wells already knows that one character, an amateur Egyptologist, would be interested in going to Egypt to visit Queen Hatshepsut’s tomb.
Wells says her writing process is two-pronged. At times she becomes grounded in language first, getting to character through language. Other times there is a character dilemma that she wants to work out through prose.
Her first (not yet published) novel, Skin, is set in the mythical town of What Cheer, Kansas. In this work Wells explores various crises of identity simultaneously. In what she describes as a “Midwestern magical-realism” genre, What Cheer residents grapple with big abstractions of body and spirit and work out the “consequences of the imbalances” in their daily lives.
Creative ideas like this one have been attracting attention to Wells for years. Nancy Zafris, fiction editor of the Kenyon Review, is a good friend of Wells’ from the days when Kellie was a student at the University of Pittsburgh. Zafris says she remembers Wells as a shy and unassuming student who had a mind full of thought-provoking ideas.
“She’s just so smart,” Zafris says. “She expresses herself really, really well and has an extraordinary vocabulary. At the same time, she is very modest, shy, and thoughtful. When she did say something, you wanted to listen to it.”
The class Zafris taught in the early 1990s was a literature class; the students handed in little of their own creative work. Yet, something about the way Wells talked about the readings provoked Zafris to ask for a writing sample. And what she saw—the beginnings of the title story in Compression Scars—blew her away. She urged Wells to write to an agent, which resulted in Wells getting representation.
“I sort of see her as a female David Foster Wallace in her own way. I hope she rises to the top. She’s the best literary fiction has to offer,” Zafris says.
Though Wells says she has been fortunate throughout her career, the past year has been exceptionally propitious. She published in the Gettysburg Review and the Kenyon Review, was nominated for the Pushcart Prize, moderated a panel discussion on “The Figure of the Female Grotesque” at the Associated Writing Program’s annual conference, and landed her assistant professorship at Washington University.
She has come a long way since winning the “Get the Hell out of the Midwest” fellowship. Having been launched “into the stratosphere” after dwelling in obscurity for many years, she says, “This past year has been dizzying.”
Booklist reviewer Carol Haggas called Compression Scars a collection “of luminous short stories” that “reflect both the fragility and the flexibility of the human spirit. Emotionally and physically damaged as they may be, Wells’ characters struggle with scars that are both internal and external, though they often fail to realize which of the two is the more disfiguring.”
Haggas also recognizes that the characters appear to be saved by “inner strength and sublime compassion that compel them to assist others in singularly unconventional ways.”
Wells says that she is pleased that critics are picking up on the refuge her characters find in compassion.
“A lot of the world’s ills exist fundamentally as a result of a lack of empathy,” she says, adding that she is intrigued by the small places in which people find hope." - Jodi Werner


Interviewed by Dan Wickett

Kellie Wells: Digesting the Father (story)

Kellie Wells: Secession, XX (story)

Kellie Wells, Threnody (story)

Kellie Wells: Gaythal Dethloff, Mother of Murder (story)

How Marketing Mixes Into Medical School Curricula - an Example from Canada

Misery loves company, so here is an interesting case reported by the Canadian Press, via CTV News, about how students in a pain management course at the University of Toronto complained that marketing seemed to have been mixed into their curriculum:
The complaint centered around students being provided a book on managing chronic pain that was funded and copyrighted by the maker of the prescription pain killer OxyContin. The book had been brought in by a non-faculty lecturer with financial ties to the drug company.

It turned out that:
From 2002 to 2006, the pain course was funded by donations, included $117,000 in unrestricted educational grants from four drug companies -- Merck-Frosst, Purdue Pharma, Pharmacia Canada and Pfizer -- although they had no input into course content. Since 2007, the program has been funded solely from faculty budgets.

[Dean of Dentistry Dr David] Mock said Purdue's copyrighted book on pain management had been brought in by Dr. Roman Jovey, an unpaid guest lecturer and co-author of the book who left copies 'for anyone to take.' Jovey, medical director for a chain of clinics called the Centres for Pain Management, is a member of Purdue's speakers' bureau, paid by the company to conduct workshops and lectures.

Dr Jovey defended handing out the free book produced by his part-time employer:
Jovey confirmed he had left copies of the 371-page book, entitled 'Managing Pain: The Canadian Health Care Professionals Reference,' for students.

'It was a gift from Purdue. I'm not at all embarrassed or ashamed. I think it's a darn good book.

"If we all want to be politically correct and have the appearance of being politically correct, then I guess I get it, that nothing that has any kind of pharma logo or name or ownership should be given out to medical students,' he said Wednesday.

'But the losers are the medical students because I think it's a high-quality book, it's very readable and they're deprived of it this year because of this controversy. And I guess they will be in the future.'

However, it appeared that the "darn good" book's content was biased in favor of Purdue's product, Oxycontin:
Dr. Irfan Dhalla said he has concerns about the content of the book, which a medical student taking the course brought to his attention.

'There are definitely things that are not consistent with the evidence,' said Dhalla, a staff physician at St. Michael's Hospital and a lecturer at the university. 'For example, oxycodone ... is listed as a moderate-potency opioid, when I think everybody agrees it's a very strong opioid, up to twice as strong as morphine.'

While it's appropriate to prescribe oxycodone for severe acute pain or cancer pain, Dhalla said the book suggests that physicians can prescribe the drug for chronic non-cancer pain with relative safety for the patient.

'And I think people with experience know that that is just not the case. When you prescribe to people with chronic non-cancer pain, it's very difficult to do that safely,' he said, noting that the book pays little attention to issues of addiction and deaths from overdose.

'The book in several places makes reference to a claim that the rates of addiction if opioids are used for chronic non-cancer pain are very low. And they're not nearly as low as is claimed in the book.'

In fact, a study by Dhalla and colleagues published last year showed prescription rates for opioids -- including OxyContin, a long-acting form of oxycodone -- soared in Ontario over the last two decades, as did the number of deaths linked to the narcotic.

A subsequent inquiry has recommended revising the curriculum and dispensing with the drug company funded book.

This is another example of how marketing has infiltrated medical education. It suggests that market influenced education likely includes not only opinions in favor of the specific product being marketed, but distortions of fact to support the product that are hardly evidence-based.

Furthermore, it shows how conflicts of interest facilitate marketing influenced medical education. Note that the bringer of the biased textbooks in this case was being paid honoraria to speak on behalf of the pharmaceutical company, but presumably not to teach the particular course in question. However, his enthusiasm readily carried over to his work in that course.

We have discussed how pharmaceutical marketers regard the "key opinion leaders" whom they pay to speak as salespeople. One would expect salespeople to be enthusiastic for their product even outside of their normal working hours. In my humble opinion, this is why no medical academic should be allowed to simultaneously be a commercially paid "key opinion leader."

By the way, note that this case also suggests how the issues we discuss on Health Care Renewal are relevant globally, not just to the US. I tend to be wary of blogging about cases in other countries, since there may be subtle difference in context across countries that might make interpretation of cases more difficult when viewing them from abroad. However, I think that the facts and language here are straightforward enough for me to be fairly confident about what was going on. Nonetheless, if any Canadian think I have got this wrong, please let me know.

Meanwhile, if anyone is blogging about similar issues from beyond the US shores, please let me know so I can add their work to our blog roll.

Hat tip to Prof Margaret Soltan on the University Diaries blog.

Mick Farren -Vinnie wants to sell me Hitler's Brain, The Aztec Calendar Just Ran Out, Just a Poor Dogpoet Who Finds Himself Locked Out Of The Cathouse

Mick Farren, Zones of Chaos, Borderlands Books, 2009.

"Mick Farren is a legendary poet, musician, author, critic, activist, countercultural icon, and one of the last true gonzo journalists. Enter his paranoid, radical, drug-addled and excruciatingly beautiful world; go to jail during the L. A. Earthquake, meet Doc Holliday and take a ride in Diabolo's Cadillac. ZONES OF CHAOS is a maelstrom of poetry, prose, essays, lyrics, commentary, and fiction."

"Michael Moorcock's introduction describes this hallucinatory concoction of Farren's poetry, song lyrics, essays, short fiction and social commentary as a display case of his obsessions from demons to dope to the dangers and rewards of remaining alive in an increasingly berserk universe. In Enter the Swordmaid, vampire Victor Renquist encounters a woman with a sentient sword and gets a nightmarish glimpse into another dimension. The Voodoo Chile Experience is a psychedelic roller-coaster ride through extreme user fatal video gaming. Jailhouse Rock chronicles Farren's experiences in a Van Nuys jail during a major California earthquake. A 1975 comic book entitled Rock & Roll Madness shows an aging Elvis-like character becoming president. Farren is equal parts drug-crazed madman and poetic prophet, and his work both predates and transcends modern bizarro apocaliterature." - Publishers Weekly

"Mick Farren is one of the unsung heroes of the modern "underground" - writer, musician, journalist, anarchist, prankster and unrepentant sinner. A godfather of punk and heavy metal, his bands have shaped the music of two generations - He has worked with The Deviants, The Pink Fairies, Hawkwind, Motorhead and many more. As a writer, his dystopian visions helped lay the groundwork for much of what we now expect of science fiction, yet always with a smirk and sense of humor often missing from most recent books and films.
In "Zones of Chaos", Farren throws down with a collection of prose and poetry (and even cartoons) with titles like "Vinnie wants to sell me Hitler's Brain", "The Aztec Calendar Just Ran Out" and "Just a Poor Dogpoet Who Finds Himself Locked Out Of The Cathouse".
"Zones" is an outwardly chaotic mixture of lyrical storytelling, but each piece in the book is a gem, strung together on a broken guitar string that changes quickly from a charming necklace to a garrote, and back again. In" Jailhouse Rock" he tells the tale of spending the Northridge Earthquake locked in the Van Nuys jail. The story, in seven short pages, has it all- drama, humor and biting social commentary. The poem "Anthropomorphism", a eulogy to cartoonist Edward Barker, is full of sweetness and anger, and "Envy" tears apart rock'n'roll idolatry in a mere hand full of words.
Farren is unafraid to show his roots and cultural references- reading his work is like watching a great poker player playing an open hand. No tricks, no secrets, no bluffs- just raw talent, well-honed skills and a lifetime of experience that tells him what to throw out, what to keep in, when to fold early, when to go all-in.
The great Michael Moorcock, in the introduction to "Zones" describes Farren's work best - "Mick Farren is an original. Read him and rage. Read him and laugh. Read him and weep. He still has more energy, more life and more creativity than most of those who have come after him. And He's still ahead of his own game. Doing what comes naturally. Cocking a snoot at convention. Telling it like it is. Living in a present made incandescent by his very existence. Showing just how good it is to be alive. " - Ricardo Feral

Hackensack University Medical Center CEO's $5 Million Golden Parachute: "the Public Will Perceive the Institution as a Kind of Insider's Group"

Last year was an embarassing one for Hackensack University Medical Center (HUMC), a large academic medical center affiliated with the University of Medicine and Dentistry of New Jersey.  In April, former state senator Joseph Coniglio was convicted of fraud (against the public) and extortion for a scheme that involved him being paid $5000 a month for undefined consulting work for HUMC while he promoted the hospital's interests in the state legislature (see post here).  A subsequent investigative report revealed widespread self-dealing on the part of the HUMC board (see post here).  Soon after, the HUMC CEO, John Ferguson, announced his retirement, per the Newark Star-Ledger.

Scandal Leads to Apparent Reforms

So when I read an article from last week on NorthJersey.com entitled "Hackensack University Medical Center works to revamp reputation hurt by trial" I hoped that these travails lead to some real improvements in the leadership and governance of the institution.  Hope springs eternal, and the article did describe some apparent progress.

The medical center's board of trustees was streamlined:
the hospital's board of governors — once a 57-member behemoth run by a core group of powerful and politically connected members — was whittled to less than half its former size and is now overseen by what the hospital is calling a 'reinvigorated' parent company, Hillcrest Health Service System Inc.

Conflicts of interest and self-dealing were apparently banned
Members of the two boards may no longer do business directly with the hospital — a significant change because some of them own or work for companies that have been paid millions of dollars by Hackensack. In 2009 alone, these companies were paid $13.2 million by the hospital, according to its federal tax filings. They were paid $17.4 million in 2008.
The Devil in the Details
Although the board was reduced in size, it gained almost no new members, and the politically-connected members who previously were accused of self-dealing remained:
Serving as chairman of the board of governors is Joseph M. Sanzari, a construction magnate, multimillion-dollar donor and longtime board member. His company, a joint venture with former board Chairman J. Fletcher Creamer Jr., has been one of the highest-paid independent contractors at the medical center.

Also,
There were no new board members until Tuesday, when two were appointed. Many who held influential positions on the board of governors — including Sanzari, Creamer and Joseph Simunovich — are still in key roles.

Furthermore, there was a big loop-hole in the apparent ban on conflicts of interest and self-dealing:
members of both the board of governors and Hillcrest can still do business with the hospital as long as they work as subcontractors or move to the foundation board or a newly created advisory panel that doesn't have voting or fiduciary powers.

Also,
Members of the board of governors and Hillcrest still can be hired as subcontractors.

The ban on doing business with the hospital also doesn't cover members of the advisory panel or the board that oversees the foundation. About a dozen members of these two groups are affiliated with companies that have made money — millions, in some cases – in work with the hospital.

As one outside expert noted,
'They may have changed the structure, but if you don't change the people, you don't change the culture,' said Jamie Orlikoff, a governance expert who advises the National Hospital Association.

Furthermore,
'People who had influence and clout when they were members of a fiduciary board will still have influence and clout even if they are moved to an advisory board,' Orlikoff said.

So,
'The concern is that the public will perceive the institution as a kind of insider's group and things are being done to benefit them,' said Daniel Borochoff, president of the American Institute of Philanthropy.
The CEO's Golden Parachute

Hope spring eternal, but is too often crushed.  However, at least the former CEO is gone. But it turns out he got quite a going away present. As described in a companion article,
John P. Ferguson received a severance package of more than $5 million when he was forced out as president of Hackensack University Medical Center last year, bringing his total compensation for 2009 to $7.7 million, according to recent federal tax filings.

The other executives who presided over HUMC in 2009, the year that its former consultant was convicted, also did very well for themselves,
His senior vice president for operations, Doreen Santora, received $2.6 million — including more than $1.5 million in severance — when she left in the executive reshuffling that followed, the documents show.

In all, seven top executives at the non-profit hospital each received more than $1 million in total compensation in 2009, up from five the year before.

This extremely generous compensation could not be related to the financial success of the hospital at the time:
The compensation packages came in a year in which tax filings show the 775-bed medical center employed 317 fewer staff and Moody's Investors Service downgraded its credit rating to Baa1, leading to higher interest payments when new debt is issued.

If this was pay for performance, by what measure these executives' performance was measured was not clear. Actually, who even decided to award them such sumptuous pay was unclear:
only a handful of board members were aware of the millions of dollars in pay and perks that had been handed out to executives over the last few years. Several employees saw their overall compensation double or triple.

Board members expressed 'sticker shock' when they first learned of the compensation numbers at a fall 2009 meeting, said J. Fletcher Creamer Jr., who completed his term as chairman of the board of governors in March.

'We went through every single executive' whose salaries must be disclosed on the IRS form for non-profit institutions, Creamer said in an interview earlier this year. 'It's the first time they actually saw it. … We always made the numbers available if they wanted to come see it, but not everyone looked.'

Keep in mind that per the first NorthJersey.com article, Mr Creamer will still be in a "key role" at HUMC, his failure to think that top executives' compensation was something his fellow board members needed to consider notwithstanding.

Summary

Is this any way to run a hospital "which has a national reputation for quality care?" The hospital leadership did and still appears to be an "insider's group" which works to promote its own self-interest.

As we have said before, far too often the leaders of not-for-profit health care institutions seem more interested in padding their own bottom lines than upholding the institutions' missions. They often seem entirely unaware of their duty to put those missions ahead of their own self-interest. Like the financial services sector in the era of "greed is good," health care too often seems run by "insiders hijacking established institutions for their personal benefit." True health care reform would encourage leadership of health care who understand health care and care about its mission, rather than those who see a quick way to make a small fortune.

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