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.
