October 2012: Another Potpourri

October 22:  Every few months, I am at a loss of what to write about in my monthly letter.  When this happens, I think about the tag line of this monthly letter endeavor:  A Monthly Letter of Musings and Meanderings.  When this happens, I simply muse and meander.  So that is what I will do this month, even though there I risk of being perceived and duly teased by Ara Topouzian for contemplating my navel.  Dear readers, I boldly take that risk.

It is early morning.  I am sitting in a Starbucks sipping coffee and writing.  Early morning is my favorite time to write though lately, for the past few years, I have been doing it at the end of the day.  I have, since childhood, liked the early morning.  The day is fresh.  If I get up early enough, there is both quiet and solitude.  I have no desire to turn on anything electronic with the exception of either iPad or PC.  There is no need for music or TV.  All of that din will come later in the day. 

I like to be alone with my thoughts.  It can be my thoughts about what I am writing, reading, or just pondering over a cup of coffee.  I feel totally connected and in charge at this time.  In charge of what?  I am not sure.  I just am not worried about the things one has to worry about when the rest of the world around me wakes up and starts imposing schedule, tasks, and other demands on my time and attention.

Growing up, we lived in a house in Detroit.  The window next to my bed had an eastern exposure.  I purposely did not lower the window shade down to the sill in the summers.  I wanted a gap where the sun would shine through at a little after dawn and wake me up.  I would do that to enjoy the quiet and peace of that hour.  I would read in bed.  I had a good hour before the rest of the house began to stir.

This being said, I probably could not be alone all of the time.  I certainly could not be, like the Tom Hanks character, stranded on a deserted island with only a volley ball as a companion.  I would need an internet connection or, minimally, a good supply of paper and pens.  I would most definitely need to and interact with people.  I relish family and friends.  I like interacting ad working with colleagues.  It is part of a healthy lifestyle. It is good for the soul.

It is good for the soul, as long as I also get my time alone too.  I am sure I am not the only person like this. 

October 23 - Sleep Deprived:  It is not like I am a captured enemy agent that they are trying to break by seriously keeping from any kind of normal rest pattern.  It is more that I am ineffective in planning and execution.  Thus, tasks pile up and I get behind.  At some point, for shear preservation, I have to pull long hours just to get things done.  The trade-off is sleep.  I have slept only four hours the past two nights.  I do not do well with this little sleep.  I get cranky.  I get sleepy and not able to concentrate at normal sub-par level.  I make idiotic errors.  You can just imagine how embarrassing this is a math instructor when plusses inadvertently become minuses, 2s turn into 7s, or the simple ability to do arithmetic in one’s head is no longer reliable.

I have to get more sleep tonight.  It is not really debatable.  I could stay up longer and try to get things done, but my productivity is slipping at this point.  I just fell asleep for a few minutes between the last sentence and this one.   Perhaps, doing my daily writing in my easy chair with my legs up was not what I should have opted for today.

Others get by on less sleep.  They somehow made it a part of their lifestyle.  It is probably just a matter of getting used to a new schedule or routine.  I read once that it takes thirteen days to acclimate.  Maybe I could get to a twenty hour day.  It would only take two weeks to get there. 

I read about armies that marched non-stop around the clock to surprise the enemy.  I have heard about artists, obsessed and driven to finish a project, working crazy hours driving themselves to get it done.  I had a professor of Mechanical Engineering once who said we could call him anytime from six in the morning until three in the morning.  I remember slowly realizing what this fellow said.  I asked if what I thought I heard was what he meant.  He said yes, I had heard right.  I was both amazed and impressed.  

I was in a coffee shop this morning near North Park University in Chicago.  It was around 6:45 am.  I was getting a little breakfast before class.  I was the only person in the store.  I had already ordered and was just waiting for my breakfast sandwich.  A younger fellow came in.  Judging from his age, demeanor, and backpack, I guessed he was a student.  His hair was a bit shaggy and he sported a German Army fatigue jacket (where does one buy such a thing?).  I thought that he would have fit in perfectly back in the day when hippies roamed the campuses.  He greeted me with a "How are you doin'?"  I answered, "Sleep deprived, but doin' OK... and you?"  I guess the words "sleep deprived" resonated.  He gave a brief soliloquy on the subject.  He talked about modern times, a 24/7 mindset, TV, electronics, and more.  He actually looked like he needed sleep more than I did.

There have always been workaholics.  I do believe that Abraham Lincoln was one.  We get the phrase burning the midnight oil because of folks like him who worked into the wee hours of the morning by candle or lamp light.  There is no stopping these kinds of driven folks from living on less sleep than the rest of us need. 

But in this modern age, there is something about to be said about television and all the other electronic media diversions that are at our fingertips.  The less motivated among us can easily keep the same crazy hours as the intensely motivated simply by plopping themselves in front of the TV and watching movies we have already seen six times.  We can log into facebook or surf youtube at 11:30 pm and... poof... an instant later it is 2 am.  What was accomplished? Nothing substantive.  The next day we might even be able to recall what it was exactly we were watching or doing.  The only certain is that we will be operating on less sleep the next day.  There is something about the mesmerizing glow of TV and computer screens that hypnotizes us.  

October 25 – Quality Mismanagement:  There is a rather distressing story in the news.  There is an outbreak of fungal meningitis that the healthcare world is dealing with.  The background of this case is unique and a bit scary.  There is a company in Massachusetts called the New England Compounding Center.  This company produces a steroid used in the treatment of back pain.  They produced tainted steroids that were used to treat back pain.  The product was tainted with a kind of black mold.  As the steroid is injected directly into the spinal fluid, unsuspecting medical professionals were basically infecting their patients and causing meningitis in a most efficient manner.

Needless to say, The New England Compounding Center is now shut down. 

Once upon a time, all pharmacists were compounders.  They made up medicines to order as needed.  They used mortars and pestles to grind and mix the various components.  Now, they are sub-suppliers in the industry.  They operate on a larger scale and not subject to the same FDA restrictions and regulations as pharmaceutical companies.   Compounding centers operate in the gray area of the world of pharmaceutical manufacturing.  These compounding centers seem to be what other industries call subcontractors or third party manufacturers.

In the world of deregulation and everyone doing everything they can to reduce costs, bad things are simply more likely to happen.  Regulations exist for a reason and are necessary.  Sure, it is easy to sermonize about freedom and the elimination of regulations that stifle free enterprise, but erring on the side of no regulation and no enforcement of regulation simply increases the risk to society in general.  Think of a deregulatory extreme of eliminating all traffic laws in the name of liberty and independence.   The result would be chaos caused by everyone valuing their independence more than every one that of everyone else. 

In the field of Quality Management, we are always looking for measures that we can use to monitor performance.  These measures are called Key Performance Indicators (KPIs).  Some measures are financial and others are process driven.  These measures are needed not only to monitor operations but the gauge if improvement activities are working.  Some measures are maximized (bigger is better KPIS), some are minimized (smaller is better KPIs), and others are optimized at a particular target.  We usually view cost as a smaller is better KPI whereas efficiency is a bigger is better measure. 

For some reason, we think these are the only two:  bigger is better or smaller is better.  We overlook the target measures.  Think of watering a plant.  Clearly the amount of water is neither bigger is better or smaller is better.   If there is no water, the plant will shrivel up and die.  If there is too much water, excluding plant that live in water, the plant will die.  There is an optimal target for watering for most plant species. 

The same is true for regulation.  Too much indeed stifles free enterprise.  Not enough leads to chaos and puts the health and welfare of people at risk.  There has to be some rules.  There most definitely needs to be more rules governing how Compounding Centers operate. 

Rules are good.   They are necessary but not sufficient.  Regulations without enforcement will eventually become the same as having no regulations.  There has to be a tangible risk of being caught and prosecuted for ignoring the regulations.  So, there needs to be inspection too. 

We have laws that forbids people from hijacking airplanes.  We have the TSA in place, at no small expense, inspecting everyone that gets on the planes and preventing them from carrying on any items that could be used to hijack an aircraft.  Everyone hates it.  It stifles our freedom and consumes our resources including time.  No one screams about regulating this.  Why not?  We collectively realize the value of this.

We need to have to do the same with foods, drugs, and medical care in general.  With the size of our population and complexities of the supply chains, we need to take some level of regulatory enforcement to protect ourselves.

One would think that pharmaceutical manufacturing must be done in a clean and sterile environment.  Medicines that cause even worse diseases than they are used to treat are something we simply assume cannot happen.  It is dependent on our society collective insisting on a certain standard of health and safety.  Government is the natural way to setup and administer this collective need ad desire. 

What The New England Compounding Center did is an egregious act and a major quality issue.  We need some regulation to keep things like this from happening.  We need budget to fund a staff of inspectors and auditors to provide "incentives" to do the right thing.  In the zero-sum, profit is all that matters, game the unscrupulous play, regulation with the proper risk of real penalties can drive proper behavior.  It is that simple.  Regulation needs to be optimized.  There is a very real difference between optimization and minimization. 

Among several concerns, investigators found a "leaking boiler" and pools of water near a supposedly "clean room" in which medicine was made, according to the report. The investigators were worried that procedures might not have been followed to ensure sterility of products; additional concerns were raised regarding a nearby recycling center operated by New England Compounding Center's parent company.  Read more.  

October 28 – On the lighter side:  I read a quote today.  I liked it so much I posted, well actually reposted it on Facebook.  It was from the great American cowboy and humorist, Will Rogers.

Too many people spend money they haven't earned, to buy things they don't want to impress people they don't like.

They used, and to some extent, still call this "Keeping up with the Joneses."  We tend to think of this buying to keep up with or to be ahead of others as a purely American thing.  It is not hard to believe this since we are the biggest consumers and spenders in the world.  I think it is more of a human condition and somewhere above safety, food, and shelter on Maslow's Hierarchy. 

Will Rogers was one smart fella.  He started off as a vaudeville performer doing a cowboy rope act.  He got to talking while doing rope tricks and his keen wit and observations gained him popularity and notoriety.   He was one of the most famous and well known men of the 1920s and 1930s.  He appealed to everyone in the tough times that were there roaring twenties, prohibition, and The Great Depression.  He was one of those comedians that, while he made fun of almost anyone, he did not offend.  He made people think, laugh, and mostly agree with him.  Here is an example of an epigram playing on another epigram.  It shows the layers and sophistication of his humor.

When I die, my epitaph, or whatever you call those signs on gravestones, is going to read: "I joked about every prominent man of my time, but I never met a man I dident like." I am so proud of that, I can hardly wait to die so it can be carved.

Note that didn't is spelled dident in the above.  Will Rogers preferred this spelling.

As he became more known as a satirist, humorist, and social observer, his career changed.  He was a constant guest on the radio, appeared in seventy something movies, and had a syndicated column that ran in newspapers across the US.  Will Rogers was just over a quarter Cherokee and grew up in Oklahoma on what was then known as the Indian Territories.  

With the election winding down, I will close this letter with a few apropos quotes from Rogers.

• I am not a member of any organized political party. I am a Democrat.
• Politics has become so expensive that it takes a lot of money even to be defeated.
• The only difference between death and taxes is that death doesn't get worse every time Congress meets. 
• Alexander Hamilton started the U.S. Treasury with nothing, and that was the closest our country has ever been to being even.
• Anything important is never left to the vote of the people. We only get to vote on some man; we never get to vote on what he is to do.