Category: Books

Michael Milken Applies “Entrepreneurial Zeal” to Quest to Live Forever

(p. B3) Michael Milken wants to live forever.

. . .

Milken in April [2023] published “Faster Cures,” a book that is part memoir, part a recounting of his efforts to bring the results of medical research to patients more quickly.

. . .

Shortly after his release from prison in 1993, he received a diagnosis of terminal prostate cancer and was told he had 12 to 18 months to live. He survived thanks to a relentless pursuit of the latest treatments and a dramatic change in diet. Longevity is one focus of the Milken Institute.

. . .

While at Berkeley, Milken read a book called “Corporate Bond Quality and Investor Experience” that examined, among other things, yield charts and default rates for bonds issued by railroads, utilities and industrial companies between 1900 and 1943.

The data revealed something surprising, he recounted in “Faster Cures:” While risk and return had always been presumed to be directly correlated, the reality was that the market had historically overestimated the risk of higher-yielding investments. Investors actually got lower returns on a portfolio of high-grade bonds than they did on a portfolio of low-grade ones over time because the higher yields more than made up for the higher level of defaults.

Milken continued his work on high-yield bonds while pursuing an M.B.A. from the University of Pennsylvania’s Wharton School. When he graduated in 1970, he joined the staff of Drexel, where he had previously worked as a consultant.

Bonds issued by Drexel were the primary source of financing for the likes of cable-industry titan Ted Turner, cellular pioneer Craig McCaw, fiber-optic entrepreneur William McGowan and casino magnate Steve Wynn.

“There was an entrepreneurial zeal in that firm that I haven’t seen since,” said Ted Virtue, a Drexel alumnus who now runs private-equity firm MidOcean Partners.

. . .

Milken’s work on prostate cancer has also made him an influential figure in medical research, where he has developed a reputation for being data-driven and impatient with bureaucracy. Every year he hosts a summit for scientists working on prostate cancer.

“Mike looked at the problem of cancer like a business problem to be solved,” said Dr. Karen Knudsen, CEO of the American Cancer Society. “He wasn’t focused on the flashy. He really focused on what is going to make a difference.”

When the Prostate Cancer Foundation lacked the resources to fund a major study Knudsen needed to conduct to advance her research, she said, Milken introduced her to executives from a pharmaceutical company who he thought would be interested in the science. The company ended up funding the study.

For the full story, see:

Miriam Gottfried. “Bond King, Felon, Billionaire Philanthropist.” The Wall Street Journal (Saturday, July 15, 2023): B3.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story was updated July 14, 2023, and has the title “Bond King, Felon, Billionaire Philanthropist: The Nine Lives of Michael Milken.”)

Milken’s book on how to cure more diseases faster is:

Milken, Michael. Faster Cures: Accelerating the Future of Health. New York: William Morrow, 2023.

“Persistent Plucky Outsiders” Innovate a Better Way to Stop Bleeding

(p. 20) Charles Barber’s “In the Blood” treats a consequential topic, and contains moments of real insight, drama and humor.

. . .

Though hemorrhage is a leading cause of death in both war and peacetime, we learn, the techniques for stopping it haven’t improved significantly for millenniums. Barber explores the mysteries of the “coagulation cascade” — during which diverse proteins activate in intricately choreographed sequence to facilitate clotting — as well as the “lethal triad” of hypothermia, acidosis and coagulopathy (impaired clotting) that can send the body into shock.

We watch a surgeon at a Navy hospital in Bethesda slit the femoral arteries of a herd of 700-pound pigs, then apply different hemostatic agents to the spurting wounds, to see which substance stops the bleeding best. Most products, backed by biotech and medical companies, fail: The poor beasts bleed out. But zeolite, a simple mineral with hitherto unknown hemostatic properties, saves their bacon every time.

Barber’s earlier books feature persistent, plucky outsiders who strive to change the world, and he finds two more likely subjects in the men who brought zeolite’s lifesaving properties to light. Frank Hursey is the brilliant, nerdy engineer who discovers that this cheap, highly porous mineral, used by industry to absorb radiation, chemicals and bad odors, also happens to accelerate clotting, by mopping up water in the blood and thereby concentrating its coagulation agents. (Later Hursey finds that another inexpensive mineral, kaolin, works even better.)

Barely anyone pays attention to Hursey’s discovery until he partners with Bart Gullong, a down-on-his-luck salesman who rebrands Hursey’s invention “QuikClot” and persuades a military scientist to try it out on people. Hursey and Gullong are soon befriended by iconoclasts within the armed forces medical establishment, more of Barber’s appealing, quirky, determined Davids, who together take on two of the biggest Goliaths around: the military-industrial complex and Big Pharma.

For the full review, see:

Tom Mueller. “The Home Front.” The New York Times (Sunday, Aug. 20, 2023): 20.

(Note: ellipsis added.)

(Note: the online version of the review has the date July 26, 2023, and has the title “A Fight to Save Soldiers, From the Lab to the Battlefield.”)

The book under review is:

Barber, Charles. In the Blood: How Two Outsiders Solved a Centuries-Old Medical Mystery and Took on the Us Army. New York: Grand Central Publishing, 2023.

Phage Therapy Renaissance-“Once Derided as an Idea for Cranks and Commies”

(p. C7) As engaging as it is expansive, “The Good Virus” describes the distinctive biology and murky history of bacteriophage (generally shortened to “phage”), a form of life that is remarkably abundant yet obscure enough to have been termed the “dark matter of biology.”

. . .

In a South London research institute in the early 1910s, the meticulous English bacteriologist Frederick Twort set out to grow the smallpox virus in petri dishes, hoping it could be “observed and studied like bacteria.” He succeeded in growing only contaminating bacteria, but within these colonies he noticed the occasional small clearing, as if something invisible was killing the bacteria. With the outbreak of World War I, Twort lost funding, closed his lab and published his results in 1915, cautiously suggesting that a virus could be the cause of the observed phenomenon. Few took notice.

Twort’s unlikely competitor would be Felix d’Herelle, a free-spirited Frenchman . . .

. . .

He found the same glassy spots that Twort had observed and (with noticeably less restraint) announced in 1917 that he had discovered a new form of life, which he called “bacteriophage.” D’Herelle went on to use phage to treat five sick boys successfully. But his “wild and abrasive style” (in Mr. Ireland’s words) antagonized his peers, who conspired to undermine him.

D’Herelle’s discoveries inspired many, including George Eliava, a microbiologist from the Soviet Union’s republic of Georgia. In 1936, he would establish the first institute (and still one of the few) devoted to bacteriophage research. Unfortunately for Eliava, he soon ran afoul of the Soviet secret police, who disappeared him in 1937. The institute continued to pursue the development of phage therapy and scored many victories—phage helped treat soldiers suffering from gangrene, for example. But there were also frustrating failures, in part because the phage weren’t adequately purified and often because they weren’t appropriately matched to the specific strain of infecting bacteria.

. . .

. . ., the “dubious and unreliable nature of commercial American phage products” in the 1930s, we learn, meant that “whether they worked for a particular patient was a complete lottery.”

During World War II, the West turned decisively to newly discovered penicillin, sharing the formula for it with the Soviets but not the methods of mass production. Thus the Soviets continued to rely on phage as the therapy of choice for bacterial infections. When a Soviet researcher tried to obtain production rights to penicillin in 1949, he was arrested by government authorities and died under interrogation, all for the crime of nizkopoklonstvo—adulation of the West.

. . .

Once “derided as an idea for cranks and commies,” Mr. Ireland writes, phage therapy seems to be enjoying a renaissance. Having been sustained for years by an idiosyncratic global community of true believers, phage-based medicines have now attracted the attention of high-powered biotechnologists and investors.

For the full review, see:

David A. Shaywitz. “The Enemy of My Enemy.” The Wall Street Journal (Saturday, Aug. 5, 2023): C7.

(Note: ellipses added. In the original, the Russian word nizkopoklonstvo is in italics.)

(Note: the online version of the review has the date August 4, 2023, and has the title “‘The Good Virus’ Review: An Unlikely Healer.”)

The book under review is:

Ireland, Tom. The Good Virus: The Amazing Story and Forgotten Promise of the Phage. New York: W. W. Norton & Company, 2023.

Allow Us to View the “Artifacts of Human Suffering” That Enable Us to “Appreciate the Epic Achievements of Medicine”

(p. D1) The Mütter Museum, a 19th-century repository of medical oddments and arcana at the College of Physicians of Philadelphia, attracts as many as 160,000 visitors a year. Among the anatomical and pathological specimens exhibited are skulls corroded by syphilis; spines twisted by rickets; skeletons deformed by corsets; microcephalic fetuses; a two-headed baby; a bound foot from China; an ovarian cyst the size of a Jack Russell terrier; Grover Cleveland’s jaw tumor; the liver that joined the original “Siamese twins,” Cheng and Eng Bunker; and the pickled corpse of the Soap Lady, whose fatty tissues decomposed into a congealed asphalt-colored substance called adipocere.

. . .

The celebrity magician Teller, a Philadelphia native, called the Mütter a place of electrifying frankness. “We are permitted to (p. D5) confront real, not simulated, artifacts of human suffering, and are, at a gut level, able to appreciate the epic achievements of medicine,” he said.

But, like museums everywhere, the Mütter is reassessing what it has and why it has it. Recently, the institution enlisted a public-relations consultant with expertise in crisis management to contain criticism from within and without.

The problems began in February [2023] when devoted fans of the Mütter’s website and YouTube channel noticed that all but 12 of the museum’s 450 or so images and videos had been removed.

. . .

Ms. Quinn had tasked 13 unnamed people — medical historians, bioethicists, disability advocates, members of the community — with providing feedback on the digital collection. “Folks from a wide background,” Ms. Quinn said in an interview.

. . .

Blowback to Ms. Quinn’s ethical review was ferocious. An online petition garnered the signatures of nearly 33,000 Mütter enthusiasts who insisted that they loved the museum and its websites as they were. The petition criticized Ms. Quinn and her boss, Dr. Mira Irons, the president and chief executive of the College of Physicians, for decisions predicated on “outright disdain of the museum.” The complaint called for the reinstatement of all web content and urged the college’s board of trustees to fire the two women immediately. (To date, about one-quarter of the videos have been reinstated.)

Moreover, in June [2023], The Wall Street Journal ran an opinion piece entitled “Cancel Culture Comes for Philly’s Weirdest Museum,” in which Stanley Goldfarb, a former director of the college, wrote that the museum’s new “woke leaders” appeared eager to cleanse the institution of anything uncomfortable. Robert Hicks, director of the Mütter from 2008 to 2019, voiced similar sentiments this spring when he quit as a museum consultant. His embittered resignation letter, which he released to the press, stated that Dr. Irons “has said before staff that she ‘can’t stand to walk through the museum,’” and it advised the trustees to investigate her and Ms. Quinn, both of whom Dr. Hicks believed held “elitist and exclusionary” views of the Mütter.

. . .

Dr. Hicks remains unhappy with the new perspective. “Dr. Mütter would have been confused at the dictum that the museum should be about health, not death,” he lamented in his resignation letter. “The principle emblazoned at the entrance of many anatomy theaters, ‘This is where the dead serve the living,’ is readily understood by museum visitors without special guidance by Dr. Irons.”

For the full story, see:

Franz Lidz. “Should a Hall of Human Curiosities Dial It Down?” The New York Times (Tuesday, August 15, 2023): D1 & D5.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the date Aug. 13, 2023, and has the title “A Museum of ‘Electrifying Frankness’ Weighs Dialing It Down.”)

For more on the innovative surgeon who founded the Mütter Museum, see:

Aptowicz, Cristin O’Keefe. Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books, 2014.

Deregulation “Unleashed Powerful Forces of Innovation and Consumer Benefit”

(p. A13) The railroads harmed small merchants who were tied to the older system of roads and canals. But even those who benefited from railroads—notably farmers and producers of raw materials—feared the power of the enterprises that provided them with large new markets. The anxieties of innumerable small players generated powerful political energy, culminating in the Interstate Commerce Act of 1887, which created the ICC—and with it the template of the independent regulatory commission.

The historian Gabriel Kolko famously argued that the ICC was created by and for the railroads themselves, as a solution to a problem of intense competition. But more-recent research has shown that the interests of shippers were also at play, and by the early 20th century the ICC had essentially been captured by the shippers. The result for the railroads was absurdly low rates of return and an inability to raise capital. The ICC also became a bottleneck through which virtually all railroad business decisions had to pass.

Thus began the long and steady decline of the American railroad industry, which wasn’t arrested until surface freight was deregulated (and the ICC ultimately abolished) in the 1970s. Throughout its life, the ICC repeatedly stood in the way of innovation, including containerized shipping.

. . .

It is fashionable nowadays to dismiss unleashed powerful forces of innovation and consumer benefit of the late 20th century as an unfortunate if fleeting episode of “neoliberalism.” In fact, dismantling some of America’s rigid and retrogressive regulatory institutions unleashed powerful forces of innovation and consumer benefit. Before we attempt to rebuild those structures, we need to examine the lessons of history.

For the full commentary, see:

Richard N. Langlois. “Warren and Graham Emulate History’s Failed Regulators.” The Wall Street Journal (Saturday, Aug. 5, 2023): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 4, 2023, and has the same title as the print version.)

Langlois’s commentary can be viewed as an application of the narrative in his book:

Langlois, Richard N. The Corporation and the Twentieth Century: The History of American Business Enterprise. Princeton: Princeton University Press, 2023.

The Elite Are Politically Progressive as a Way to Reduce Their Guilt for Rejecting the Uneducated

David Brooks, the author of The New York Times column quoted below, views himself as an anti-Trump member of America’s elite educated class.

(p. A18) Donald Trump seems to get indicted on a weekly basis. Yet he is utterly dominating his Republican rivals in the polls, and he is tied with Joe Biden in the general election surveys. Trump’s poll numbers are stronger against Biden now than at any time in 2020.

What’s going on here? Why is this guy still politically viable, after all he’s done?

. . .

This story begins in the 1960s, when high school grads had to go off to fight in Vietnam but the children of the educated class got college deferments. It continues in the 1970s, when the authorities imposed busing on working-class areas in Boston but not on the upscale communities like Wellesley where they themselves lived.

The ideal that we’re all in this together was replaced with the reality that the educated class lives in a world up here and everybody else is forced into a world down there. Members of our class are always publicly speaking out for the marginalized, but somehow we always end up building systems that serve ourselves.

The most important of those systems is the modern meritocracy. We built an entire social order that sorts and excludes people on the basis of the quality that we possess most: academic achievement. Highly educated parents go to elite schools, marry each other, work at high-paying professional jobs and pour enormous resources into our children, who get into the same elite schools, marry each other and pass their exclusive class privileges down from generation to generation.

Daniel Markovits summarized years of research in his book “The Meritocracy Trap”: “Today, middle-class children lose out to the rich children at school, and middle-class adults lose out to elite graduates at work. Meritocracy blocks the middle class from opportunity. Then it blames those who lose a competition for income and status that, even when everyone plays by the rules, only the rich can win.”

. . .

Members of our class also segregate ourselves into a few booming metro areas: San Francisco, D.C., Austin and so on. In 2020, Biden won only 500 or so counties, but together they are responsible for 71 percent of the American economy. Trump won over 2,500 counties, responsible for only 29 percent. Once we find our cliques, we don’t get out much. In the book “Social Class in the 21st Century,” the sociologist Mike Savage and his co-researchers found that the members of the highly educated class tend to be the most insular, measured by how often we have contact with those who have jobs unlike our own.

. . .

Elite institutions have become so politically progressive in part because the people in them want to feel good about themselves as they take part in systems that exclude and reject.

For the full commentary, see:

David Brooks. “What if We’re the Bad Guys Here?” The New York Times (Friday, August 4, 2023): A18.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Aug. 2, 2023, and has the same title as the print version.)

The books cited by Brooks in the passages quoted above are:

Markovits, Daniel. The Meritocracy Trap: How America’s Foundational Myth Feeds Inequality, Dismantles the Middle Class, and Devours the Elite. New York: Penguin Press, 2019.

Savage, Mike. Social Class in the 21st Century. London: Pelican Books, 2015.

Milton Friedman’s “Unflinching Defense” of Libertarianism

(p. A3) . . . [Milton] Friedman was highly influential. In academia, he did pioneering work on consumer behavior, monetary history and the unstable relation between inflation and unemployment. Outside the ivory tower, he is remembered for his unflinching defense of classical liberalism—a position that today is often called libertarianism. “Capitalism and Freedom” is the best entry into Friedman’s lucid mind. You will enjoy reading it even if you disagree with most of his judgments. A socialist student at Harvard once told me it was one of his favorite books. “Why?” I asked. “Because it clearly explains the point of view I have to argue against.”

For the full review, see:

N. Gregory Mankiw. “Five Best: Economics Primers.” The Wall Street Journal (Saturday, Aug. 18, 2023): A3.

(Note: ellipsis, and bracketed name, added.)

(Note: the online version of the review has the date June 2, 2023, and has the title “Five Best: Economics Primers.”)

Friedman’s best popular book, developed from lectures first presented at Wabash College that were co-organized by my mentor Ben Rogge, is:

Friedman, Milton. Capitalism and Freedom. Chicago: The University of Chicago Press, 1962.

Well-Intentioned Antislavery Colonists Accidentally Spread Yellow Fever Plague

(p. C9) Hardly anyone noticed the first to die in the sultry August of 1793—a few foreigners, a sailor, an oyster seller. Most Philadelphians brushed off the deaths as the result of air fouled by rotting coffee or fish near the docks. Then the healthy and affluent began to die: public officials, ministers. The plague that was sweeping the young nation’s temporary capital was yellow fever, a contagion little understood at the time. Writes Robert Watson in “America’s First Plague,” the outbreak was “one of the worst epidemics in American history.”

In the course of three horrendous months, between 6,000 and 9,500 people would die, constituting 15% to 20% of Philadelphia’s population.

. . .

The source of the plague is a story in its own right. It apparently derived from infected mosquitoes that had bred on a ship named the Hankey. Earlier in the year, the Hankey had transported an expedition of antislavery Londoners to an island off the coast of present-day Guinea-Bissau, where they hoped to found a model biracial colony. They were instead beset by hostile natives and rampant yellow fever, which the few desperate survivors carried with them across the Atlantic to ports in the Caribbean and eventually to Philadelphia. Mr. Watson, a professor of history at Lynn University in Boca Raton, Fla., notes that “the ship inadvertently unleashed death at every port where it docked.” (A riveting account of this hapless colonial experiment may be found in Billy G. Smith’s “Ship of Death,” published in 2013.)

Fortunately for those who remained in the city, Philadelphia’s capable mayor, a businessman named Matthew Clarkson, aided by a beleaguered committee of brave volunteers, did his best to organize public-health measures and burials.

. . .

Among the doctors who struggled to cope with a disease they couldn’t cure, Mr. Watson rightly emphasizes the polymath Benjamin Rush. A signer of the Declaration of Independence, Rush incarnated both the humanistic best and medical worst of the early republic. Although his treatments were widely accepted, they were disastrous. He believed dogmatically in violent purges, forced heat to blister the limbs and above all bloodletting. He bled his patients of as much as 10 ounces a day, probably killing more of them than he saved. When he himself fell ill, he subjected himself to the same brutal regimen but survived to persist in his malpractice.

For the full review see:

Fergus M. Bordewich. “When Yellow Jack Attacked.” The Wall Street Journal (Saturday, June 10, 2023): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date June 9, 2023, and has the title “‘America’s First Plague’ Review: Attack of the Yellow Jack.”)

The book under review is:

Watson, Robert P. America’s First Plague: The Deadly 1793 Epidemic That Crippled a Young Nation. Lanham, Maryland: Rowman & Littlefield Publishers, 2023.

The “riveting” book mentioned above is:

Smith, Billy G. Ship of Death: A Voyage That Changed the Atlantic World. New Haven, CT: Yale University Press, 2013.

Mass Internment of Hundreds of Thousands of Muslim Uyghurs in Communist China

(p. C3) Tahir Hamut Izgil watched as parks emptied of people, naan bakeries boarded up their windows and, one after another, his friends were taken away.

The Chinese government’s repression of Uyghurs, the predominantly Muslim ethnic minority to which he belonged, had gone on for years in Xinjiang, the group’s ancestral homeland in China’s northwest. But in 2017, it morphed into something more terrifying: a mass internment system into which hundreds of thousands of people were disappearing. Millions lived under intense and growing surveillance.

Izgil, a prominent poet and film director, feared that one day soon, the authorities would come for him. So he did what few have managed — in the summer of 2017, he escaped with his family, and once settled in a Virginia suburb, he wrote about the experience.

In his memoir, “Waiting to Be Arrested at Night,” published this week by Penguin Press, Izgil brings his discerning eye for detail to describe the impact of China’s policies on the people who live under them.

Scholars and journalists have detailed the architecture of the surveillance system against Uyghurs. There have also been memoirs by Uyghur authors and intellectuals in exile. But few possess Izgil’s firsthand knowledge and analytical acuity, said Darren Byler, a leading scholar on Uyghur culture and Chinese surveillance and a professor at Simon Fraser University, in Canada.

“This is the defining account of what it’s like to live through this moment,” Byler said. “This will be the book that, in 10 years or 20 years, people will turn to if they want to understand that moment.”

For the full story, see:

Tiffany May. “The Toll of a Life Spent Under a Heavy Hand.” The New York Times (Tuesday, August 8, 2023): C3.

(Note: the online version of the story has the date Aug. 1, 2023, and has the title “A Poet Captures the Terror of Life in an Authoritarian State.”)

The book discussed above on the mass internment of the Uyghurs is:

Izgil, Tahir Hamut. Waiting to Be Arrested at Night: A Uyghur Poet’s Memoir of China’s Genocide. Translated by Joshua L. Freeman. New York: Penguin Press, 2023.

With Repetitions Surgeons Gain Informal Knowledge, Such as “Muscle Memory”

(p. C6) Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.

. . .

. . ., the results suggested if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers.

. . .

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.

. . .

. . ., a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age.

. . .

The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59, and 6.3% for surgeons over age 60.

Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications, and choose better surgical strategies.

What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand—age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”

For the full essay, see:

Anupam B. Jena and Christopher Worsham. “Do Younger or Older Doctors Get Better Results?” The Wall Street Journal (Saturday, July 8, 2023): C6.

(Note: ellipses added.)

(Note: the online version of the essay was updated July 8, 2023, and has the same title as the print version.)

The essay quoted above is adapted from the book:

Jena, Anupam B., and Christopher M. Worsham. Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health. New York: Doubleday, 2023.

Bullshit Is Worse Than a Lie

(p. A17) Professor Frankfurt became best known for a single, irreverent paper largely unrelated to his life’s main work.

The paper, written in the mid-1980s under the same title as his eventual book, discussed what to his mind was a pervasive but underanalyzed feature of our culture: a form of dishonesty akin to lying but even less considerate of reality. Whereas the liar is at least mindful of the truth (if only to avoid it), the “bullshitter,” Professor Frankfurt wrote, is distinguished by his complete indifference to how things are.

Whether its purveyor is an advertiser, a political spin doctor or a cocktail-party blowhard, he argued, this form of dishonesty is rooted in a desire to make an impression on the listener, with no real interest in the underlying facts. “By virtue of this,” Professor Frankfurt concluded, “bullshit is the greater enemy of truth than lies are.”

. . .

For all this sang-froid, Professor Frankfurt was heartfelt in his philosophical pursuits. Throughout his career, he was drawn to lines of inquiry — about freedom, love, selfhood and purpose — that he said appealed to him not only as an academic but also “as a human being trying to cope in a modestly systematic manner with the ordinary difficulties of a thoughtful life.”

For the full obituary, see:

James Ryerson. “Harry G. Frankfurt, a Philosopher Eager to Cut the Bull, Dies at 94.” The New York Times (Tuesday, July 18, 2023): A17.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date July 17, 2023, and has the title “Harry G. Frankfurt, Philosopher With a Surprise Best Seller, Dies at 94.”)

Frankfurt’s best-known book is:

Frankfurt, Harry G. On Bullshit. Princeton, NJ: Princeton University Press, 2005.