Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for January, 2022

Sunday musings…1/16/2022

1 Obstreperous. Noisy and difficult to control.


2 Emu. Google “horses asshole emu”.

Think obstreperous flightless bird.

3 Rainbow. My very good friend and his family escorted their black lab Gus across the rainbow bridge today. In the last 3 1/2 years the White family has lost 2 dogs and 2 horses. It never gets any easier. Saying goodbye to our pets guts me every time.

Grace and peace to my friend Rob and his family. Gus was a very good boy.

4 Somebody. “The grains of sand that pass through the funnel of life’s hourglass are only dry and colorless if they are observed from afar; up close each one is as colorful as any rainbow, as full of energy as any thunderstorm. Poetry is there for the asking.” DEW 1/16/2017.

While everyone isn’t necessarily “A” somebody, everyone is somebody who matters. My Dad was heroic in this regard. He remembered everyone. The lower on the economic food chain someone may have been, the more he remembered them. Janitors, waitresses/waiters, maintenance workers…he knew all of their names. He’d ask you about your story, ask you to describe the grains of sand in your hourglass, and if you told him he remembered. Dad would be dumbfounded by the denigration of these and other physical jobs so prevalent on mainstream media and other outlets.

Dad had a way with frontline workers. It was natural, a gift for sure, but he obviously worked at it, too. Did you have a problem getting THAT gift this year? Turns out, that’s not a new phenomenon caused by “COVID-related supply chain issues.” My Dad had a coronary artery bypass graft surgery (CABG) in 1985 at the peak of the Cabbage Patch Doll craze. Somehow he found a Cabbage Patch Doll for every nurse in the Coronary ICU to thank them for their care.

So what’s the point? It shouldn’t take a pandemic that interrupts every aspect of everyday life for us to notice the folks who aren’t anywhere near the top of the economic food chain. CEO’s saved the world in the early parts of the pandemic (Sunday NYT)? Bullshit. Company X allowed the economy to survive because it made “stay at home” work possible? Yeah, that’s bullshit, too. The person who answers the phone in my office or the person driving the garbage trucks had just as much impact as that self-satisfied CEO who’s biggest sacrifice was skipping Davos this year.

There’s no such thing as a small life. Each life is full, vibrant, colorful, and important. Each little grain of sand flowing through the hourglass is as meaningful as the next.

It’s been years since my Dad died and yet I return to his lessons on a daily basis. I see him talking to the guy who swept the floors in the factory. There his is, sitting down to lunch with a banker. If I close my eyes and just listen to the personal banter it’s hard to figure out which is which. The sands of time that flowed for each looked the same to my Dad. He heard the poetry, saw the beauty. My Dad made every life he touched bigger.

Everyone was a somebody.

5. Cost. Mark Cuban has launched a website/business called “Cost Plus Drugs” (costplusdrugs.com) to much fanfare, especially on Social Media of all sorts (Cuban is a plays SM like Yo Yo Ma plays cello). The concept is quite simple: buy generic drugs at wholesale cost, mark ’em up 15%, add a handling fee of $5 and ship ’em off to a waiting patient. The fanfare part comes in the marketing on the website. Each drug is compared with the retail price of the branded drug from which it was spawned. For example, $41 for a chemo drug compared with $9,600 for the brand. Brilliant, right?

Meh…not so much. First of all, if a super expensive drug is off-patent and there is now a generic equivalent on the market, essentially no one prescribes the branded drug anymore (caveat: equivalent in potency, side effects, etc.). Secondly, there are several options out there already doing a very nice job of this, thank you very much, without the hullabaloo surrounding Mr. Cuban’s offering. GoodRx and Costco come to mind. There’s somebody out there, can’t remember who, offering hundreds of generics for $4.00 a month. To the extent that Cost Plus Drugs continues to pressure the pharmaceutical industry and its high prices I suppose Cuban’s entry is a net positive.

Let’s step back and look at the real issue here, though: groundbreaking, new treatments are too expensive. I’m not talking about the outlandish prices of these branded, patent-protected drugs that people like Mark Cuban bandy about to make the price of their generic look so virtuous. No, I’m talking about the amount of money that comes out of the pockets of the people who need the newer medications for which a generic equivalent is not available (or who for whatever reason cannot take a particular generic). For all of Cuban’s bluster and bravado, the bruises that he is getting from patting himself on the back are all for naught. With very few exceptions people aren’t struggling to pay for generic chemo drugs, they are breaking the bank on the newer, more effective drugs.

In general, new drugs come in one of two varieties: minimally changed versions of existing drugs/”me too” drugs from a competing company in order to be in the market space, or truly innovative and new drugs that are a measurable upgrade in all ways from existing treatments. Yes, to be sure, there are some newcomers into a therapeutic space that have a similar mechanism of action as legacy drugs but really do work better in that treatment pathway, but they are a small minority; most are the same drug with a slightly different concentration or secondary delivery ingredients, patented and priced as if they were groundbreaking, new developments.

Where we need someone of Mark Cuban’s intellect, entrepreneurial zeal and all-around chutzpah is when the very best treatments, standard of care treatments, are not available as generics. Here the unholy triumvirate of manufacturer/pharmacy benefit manager (PBM) and insurance company put profit before patient (and healthcare worker) welfare. New, innovative treatments are priced so that the manufacturer can give a handsome rebate (kickback) to the PBM. A patient is then charged a co-pay which is a percentage of that artificially elevated price. This co-pay reduces the financial obligation of the insurance company to pay for the medication. If you’ve ever wondered why a medicine which was priced at $100 ten years ago is now $1,000, this is it.

If the Mark Cubans of the world want to have a real impact on the healthcare costs that matter, the costs to the patient themself, let them turn their attention here. It does us no good to have another do-gooding middleman saving patients a few dollars on widely available generic medications. This is the equivalent of hitting a single when you’re down 10 runs in the ninth. In eye care we don’t need someone to shave off a couple of bucks from the cost of Avastin as the first-line treatment for the devastating, sight-stealing disease macular degeneration; it’s like $50, so patients drop 10 bucks in the bucket on the way out. At big places like the Cleveland Clinic they pay more to park.

No, what we need is someone to step in and figure out how regular folks can afford Eylea or Lucentis, the branded medications that a majority of these patients end up needing when the Avastin stops working (as it almost always does). At $2000 a pop that 20% co-pay can run into thousands of dollars each year for folks who need injections every few weeks, sometimes forever. Cancer treatments that cost $40,000 per dose or truly revolutionary, life-saving drugs like the hepatitis C drugs that came out a few years ago that are now “only” $10-15,000. 20% of that is meaningful to most folks. Step up to the plate and take a swing at these, Mr. Cuban. Figure out how people who have terrible diseases that aren’t really all that rare can afford their medicine. You’re not a singles hitter. Figuring this out is the equivalent of hitting a walk-off grand slam in the 7th game of the World Series.

You were made for this, Mark.

I’ll see you next week…

Wisdom to Share: Birthday musings…1/9/2022

“How old would you be if you didn’t know how old you were?” –Satchel Paige

Another trip around the sun. 62 years old. How odd, to have a “6” in front of whatever my age is. 60 really wasn’t cataclysmic, at least not in the existential way 50 was. Kinda matter-of-fact, 60. 62? About as nothingberger an age as they come. They seem to be coming fast and furious now, the birthdays. It’s a little hard getting worked up about them to be honest.

Still, New Year’s Day and birthdays lend themselves to a bit of introspection, or at least a little bit of taking account of the “state of you”. Happily, since my birthday is only 7 days into January, I can knock it all out in a single “musing”. It’s interesting, the older I get the less I find myself keeping track of. Sure, I still track sleep metrics, and I’m certainly aware of not only my regular, routine retinue of snaps and crackles but every single new pop that shows up to join the band.

But there’s nothing really new here. As I’ve gotten older my genetics have caught up with me. Thankfully I have two good friends who are my docs and they simply won’t let me pretend I can diet or exercise my way out of chromosomal destiny. I sleep better (and so does Beth) when I drink just a little bit less at dinner. Nothing else really registers. I would fit into my shirts and pants a little better if I either exercised to match my diet, or ate to match my activity. Again, not really revelational, either of those. I’ve long ago made peace with the fact that I am simply a happier human being, more fun to be around, if I relax a bit about buying pants with a bigger waste size for the first time in 10 years.

So what am I actually thinking about? The last couple of paragraphs could certainly give the impression that I’m pretty satisfied with where I am. That I’ve put it in cruise control. That’s not actually true, though. I think ol’ Satchel was talking mostly about how old he felt physically; everyone always wanted to know how the ageless wonder could be so good for so long on the baseball field. Who knows how old he actually was when he finally hung up his glove, but I’m betting it was 10 or 15 years before 62.

Honestly though, I really don’t know how old I feel in ways not physical. There’s so much out there to learn. Wouldn’t it be cool to learn new stuff as readily as a 5 or 10 year old? I’m sure that my neural pathways have become much less “plastic”, but still, I feel like I’m young enough to not only learn new stuff in my comfort zones so that I’m better at my regular stuff, but also start fresh with some stuff that’s totally different. I know it’s not microsurgery, but learning how to make a decent cappuccino with a “manual” espresso machine was kinda cool.

A couple of weightier things have coalesced around 62. Two gentlemen are on my mind as I look toward a horizon coming ever closer. I’ve written about the first before. We shared a ski lift a few days before my 40th birthday. I must have shared that the prospect of my 40’s was somewhat daunting. His response was inspirational, and in retrospect dead-on accurate. Your 40’s, he said, were the years when you are as close to every peak you have ever, or will ever experience. You will still be close enough to the athlete you were as a younger man to participate in almost any physical pursuit you wish. If your work is physical you’ve done your 10,000 reps and then some; you will move with efficiency and grace. And with 40 years under your belt you have accumulated wisdom and are beginning to take on the polish of maturity.

All of this will make you better for everyone who depends on you, everyone to whom you are responsible.

This brings me to another friendly acquaintance, this one from my early years in the CrossFit world. Andy Stumpf is a former Navy SEAL who was part of the management team of a younger CrossFit, Inc. and who is now a leadership consultant and a life coach of sorts. It’s likely that I haven’t actually talked with Andy for 6 or 7 years at least, but I stumbled upon his podcast while driving home from our South Carolina vacation. While I was learning how to work my new espresso machine I had him on in the background.

The first thing that Andy said that made me perk up (sorry) was the general admonition to “be the better version of yourself.” Not the best version; no one knows what that really is. The “better version”. I’m familiar with this concept, this game. My alter ego in the CrossFit world was a guy named “bingo”, an avatar created not from bits but from words that represented what I felt was the better parts of who I was at any given time. This isn’t a new thing for me in any way. I’ve tried to find and apply this better version since my wedding day.

What Andy said next, and I’ll be paraphrasing, is what really made me stop and listen. Your better self is not one that is directed straight ahead, along a path solely in front of you, but rather one that looks first to the left and to the right to see who you might be able to take along. Andy, the former SEAL, is using a military analogy of course, describing the best teammates and leaders as those who check on the teammates or subordinates alongside them, choosing the course that is also best for them. Or even the course that is better for them then even for you.

Returning to my friend on the ski lift for a moment, your 60’s are the years when your inevitable physical decline is balance by the continued accumulation of knowledge and experience. The sum of these two characteristics is wisdom. These are the years that bring the wisdom to share. As I join these two men and their counsel I find a tiny kernel of inspiration on this birthday/New Year’s reflection: if one is fortunate enough to be asked, now is the time in life where one shares whatever it is that is their “better self”.

I’m not sure if I ever saw the guy on the ski lift again after that weekend, and Heaven knows if I will ever have the privilege of talking with Andy again. But I am deeply grateful to them both for where I’m going with their gifts. Our “better self” is an attainable goal that is worth seeking. As we leave behind pieces parts that cannot be better, like the skier I was at 40, we put our efforts toward those that can. Like the continued attainment of wisdom. We look outside ourself, look to see who is standing to the left and to the right of us, with the wisdom gained to lead all three of us to something or somewhere we might call “better, still”.

So I guess that’s where I am at 62. Not a bad place to start my next trip around the sun.

I’ll see you next week…

2022 New Year’s musings…

1 Revolutions. Maybe it’s because of all the news and commentary about January 6th and the Capitol whatever you want to call it, but every time I say “New Year’s Resolutions” it comes out “revolutions”.

I’ll be 62 in 5 days. Highly unlikely I’ll be making any “revolutions” for New Year’s.

2 Risk. “I just thought I’d see more, you know, scorpions and quick sand. And anvils. I thought life’s dangers would include more flying anvils.” Lovely Daughter Megan.

Love that kid.

3 Address. Beth and I are wrapping up our holiday week in our new place near Megan. Our first week away from Casa Blanco in which we stayed in a home we own since we sold our beloved ski home in Utah (damn the Great Recession). Once we got the staging for photos out of the way it started to feel like “home” to me, as places always do once Beth has put her touch to things.

But what really made it special, more “home”, is that it is 20 minutes from Megan and our son-in-law Ryan. We are blessed beyond belief that our sons Dan and Randy and their families live within a few miles of Casa Blanco. Even though they are all kinds of busy we get to see them quite often. It’s an event when we get Megan and Ryan (and their dogs!) Traveling to the Low Country will now be easier since we (and OUR dogs) won’t have to impose on them by invading their space for days (and eventually weeks) at a time.

We find ourselves once again at the “where do you want to be” stage. The last big “visit” there was around our 25th Anniversary, a time when it looked like none of our kids would be in NE Ohio. Where do you live when there is no family in the immediate area? Mind you, we were 10 or so years younger at the time, a life stage we could reasonably assume we’d survive intact. Still, we spent a year or so in the deciding, in the end coming to the realization that “place” had become “home”, at least for the time. That our boys came home and settled was a wonderful stroke of luck.

Now? in our early 60’s (how weird to type that!) we look forward to what is now known as “aging in place” at our beloved Casa Blanco. Surrounded by friends we’ve know for almost 30 years in addition to 5 grandchildren (Happy Birthday today to Lakey!!). But man, those Cleveland winters are brutal, climate change notwithstanding. Another year’s worth of searching, both physically (dry runs on both coasts of Florida in addition to coastal South Carolina) and emotionally (friends our age and a horse who winters in Florida, none of our siblings have chosen a winter spot, our only not-in-CLE child) bring us to the logical next place. For at least a couple of weeks every year, Condo Blanco sits 5 minutes from the Atlantic in South Carolina.

25 minutes from family.

4. Resolution. Meh, I’m still nearly 62. You and I both know I need to make all of the standard issue resolutions. Eat better and eat less. Drift back to a more formal, more structured, more disciplined fitness regimen. (As an aside I drifted over to CrossFit.com for the first time in many months; thanks for the “bingo” shout-out JS Smith!). Find a hobby or two that bring me in contact with men my age (haven’t really done anything like that since discovering CrossFit).

Hardly revolutionary.

I find myself going over some of my earlier writing. You know, checking out what seemed important to me at the time. What seemed important in the world at the time. It’s interesting to note that the world around me has been “on fire” in “unprecedented ways” for 15 years now. Funny. I grew up in the 60’s and 70’s. Years of epic tumult and conflict, domestically and abroad. Double-digit inflation. Controversial military conflicts. College campuses convulsed in protest about, well, everything. Sounds kinda familiar, doesn’t it?

Is nothing different today, then? Well, yes and no, I guess. No, in that it is naive at best and willfully intellectually dishonest in the likeliest sense to hold that our political, moral and other conflicts are in some way unique simply because they are our conflicts of the day. I mean, come on, we had kids getting shot on college campuses by the National Guard in one instance and a crazed sniper firing from a clock tower in another back then. Streets on fire in cities around the country…back then. If anything might be different it is that in addition to traditional information sources we now have a “man in the street” viewpoint available on all manner of social media.

No, the world is no more or less in an uproar than when I was young. We just know more and know it faster.

So what’s the point? Where’s the resolution in all of this? It’s simple: behind every idea, every position taken on any or all issues, lies a person. A real, live human being who gets up each day, eats a square or three, goes to work, and tries to make it to the next day. Perhaps there’s some joy there, too. A bit of sorrow, for sure. We all have a bit of sorrow. But if we are talking about the majority of the developed world, we are talking about millions of people who aren’t hungry, who aren’t outdoors. People who strive for just a bit better, who want just a bit more of better for their children and grandchildren.

People are not internet addresses, @whatevers or avatars. Behind whatever drivel might come out of their fingertips and land on Facegram or TwitTok lies the same challenges we all face. Maybe most of them spend less time than I do parsing the “big ideas”, but other than that, the same. Countless studies large and small have shown that removing the screens that sit between us restores some of that humanity on both sides of pretty much any issue. Did you ever see that Heineken commercial there they sit people with opinions that are poles apart and just set them to talking? It’s extraordinary watching them find their own common ground.

And that, my friends, is where the resolution will come from. There is far, far more common ground we all share than whatever differences we may have. We live in a world of vast commonality. That which we share dwarfs any differences we may have. Regardless of how much time we spend in the echo chambers of our pet peeves or primary pursuits, what we find there is still only a fraction of what we bring there. We are each much, much more than a vessel for some hot button issue or cause. More than that, as I quoted from the movie “I, Tonya” years ago, we are each much more than our worst decision or our worst act.

Here, then, is my resolution, one that I hope you will share with me: in 2022 I will step out from behind whatever barriers I may have erected, or may have been erected around me., both on SM and IRL. I will remember that there is almost no “other”, only different. I will seek to understand that different, but only so that I may better seek that which I share with those in all of the people who orbit my life and whose lives I orbit. For those who have made bad decisions I will do my best not to judge them solely on my knowledge of those decisions. I will trust (and, yes, verify) that they are, indeed, more than just the sum of their mistakes.

I resolve to see people first.

Happy New Year my friends. I hope 2022 finds us together in some way, somewhere, sometime.

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