Category: Entrepreneurship

To Cut Out Costs of Car Dealership Middlemen, Tesla Is Selling Direct from Indian Reservation Showrooms

(p. D6) Tesla is ramping up efforts to open showrooms on tribal lands where it can sell directly to consumers, circumventing laws in states that bar vehicle manufacturers from also being retailers in favor of the dealership model.

Mohegan Sun, a casino and entertainment complex in Connecticut owned by the federally recognized Mohegan Tribe, recently announced that the California-based electric automaker will open a showroom with a sales and delivery center this fall on its sovereign property, where the state’s law doesn’t apply.

The news comes after another new Tesla showroom was announced in June, set to open in 2025 on lands of the Oneida Indian Nation in upstate New York.

“I think it was a move that made complete sense,” said Lori Brown, executive director of the Connecticut League of Conservation Voters, which lobbied for years to change Connecticut’s law.

. . .

Brown noted that lawmakers with car dealerships that are active in their districts, no matter their political affiliation, traditionally opposed bills allowing direct-to-consumer sales.

. . .

Over the years in numerous states, Tesla sought and was denied dealership licenses, pushed for law changes and challenged decisions in courts.

. . .

Tesla opened its first store as well as a repair shop on Native American land in 2021 in New Mexico. The facility, in Nambé Pueblo, north of Santa Fe, marked the first time the company partnered with a tribe to get around state laws, though the idea had been in the works for years.

For the full story, see:

SUSAN HAIGH, Associated Press. “Tesla to Open Showrooms on Tribal Lands to Circumvent Laws.” Omaha World-Herald (Sunday, Aug. 13, 2023): D6.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 5, 2023, and has the title “Automaker Tesla is opening more showrooms on tribal lands to avoid state laws barring direct sales.”)

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.

To Charge EV on Road Required Downloading an App, Which Required Non-Dodgy Cell Service

(p. B5) The adoption of electric vehicles represents the biggest shift in our energy and transportation systems in more than a century—but it’s also the biggest shift in consumer electronics since the debut of the iPhone. On both counts, progress is accelerating in the U.S. And on both counts, we are far from where we need to be.

A recent 1,000 mile road-trip in the longest-range electric vehicle you can buy brought this home for me. That journey was as worrisome as it was thrilling, and it clarified how much more needs to be done for drivers to have a consistent and satisfying experience on par with buying a gasoline vehicle.

. . .

On my trip, there was one moment in particular when the future felt like a big step backward.

It happened when I arrived at a street charging station in Montreal, and discovered that I’d have to download an app and prepay for the electricity I wanted to use. Cell service was dodgy, and I had to find a better signal to download the app. Had I been unable to find a decent signal, I would have been out of luck. (Even once I downloaded the app, the first station I connected to didn’t work—another issue that sometimes comes up at charging stations.)

Unfortunately, having to download an app is common practice for proprietary networks.

For the full commentary, see:

Christopher Mims. “Why America Isn’t Ready for the EV Takeover.” The Wall Street Journal (Saturday, June 10, 2023): B5.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date June 9, 2023, and has the same title as the print version.)

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.

Foundations with an End Date May Honor the Donor’s Intent

(p. C6) This year, the William E. Simon Foundation is closing its doors, or “sunsetting,” in the parlance of modern philanthropy. Since it was founded in 1967 by former Treasury Secretary William E. Simon and his wife Carol, the foundation has given away almost $300 million to the causes that mattered to them—faith, family and education.

. . .

Traditionally, sunsetting a foundation has appealed to more conservative donors. Bill Simon, Jr., who manages the Simon Foundation along with his six siblings, says that his late father set a closing date because he had seen “foundations that seemed to veer off of their donor’s intent.” Simon recalls: “Dad trusted his own seven children to know where he would have put his money…But as much as he loved his grandchildren, he did not know them.”

Indeed, Henry Ford II resigned from the Ford Foundation’s board in 1977, writing that its hostility to capitalism had thrown it off course: “Perhaps it is time for the trustees and staff to examine the question of our obligations to our economic system and to consider how the foundation, as one of the system’s most prominent offspring, might act most wisely to strengthen and improve its progenitor.”

For the full commentary, see:

Naomi Schaefer Riley. “Philanthropists Discover the Value of ‘Sunsetting’.” The Wall Street Journal (Saturday, Aug. 5, 2023): C6.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 3, 2023, and has the same title as the print version.)

Blue Cross of California Seeks to End Drug Rebates and Hidden Fees

(p. A3) A major health insurer says it will jettison the complicated system that Americans use to pay for drugs, and create something that aims to be better, with partners including Amazon.com and the entrepreneur Mark Cuban.

Blue Shield of California said it is dropping CVS Health’s Caremark, the pharmacy-benefit manager it currently uses, which negotiates drug prices and wraps in other services such as a mail-order pharmacy.

. . .

Blue Shield said that, working with its partners, it aims to negotiate prices with pharmaceutical makers in a way that is different from the typical approach—with a simple net price structure that is supposed to eliminate rebates and hidden fees.

Blue Shield executives said that with one company handling many aspects of how drugs are procured through the system, it is often hard to track the flow of payments accurately.

“The current pharmacy supply chain is a forest of opacity and profit,” said Paul Markovich, Blue Shield’s chief executive officer, in an interview with The Wall Street Journal. “It is overwhelmingly complex, it is designed to maximize the earnings of the participants.” His company’s new setup, he said, will be “flipping that on its head.”

For the full story, see:

Anna Wilde Mathews. “Health Insurer Revamps Drug Pricing Model.” The Wall Street Journal (Friday, Aug. 18, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story was updated Aug. 17, 2023, and has the title “A Big Health Insurer Is Ripping Up the Playbook on Drug Pricing.”)

Nimbly Use What Is Available Now Rather Than Wait for Adoption of Perfect Global Standards

(p. A9) For more than five decades, Don Bateman led teams of engineers at what is now Honeywell International in creating and enhancing technology that warns pilots of impending disasters.

The result is an array of software and equipment, much of it mandatory, that squawks warnings and flashes digital admonitions if a plane is heading into a mountain, a ridge, a radio tower or some other obstacle.

. . .

Rather than waiting years for global industry standards to be adopted, he always wanted to use whatever technology was available immediately. Ratan Khatwa, a former Honeywell colleague of Bateman, recalled his advice: “You’ve got to work like farmers,” using whatever is available now rather than waiting for perfection.

For the full obituary, see:

James R. Hagerty. “Safety Engineer Helped Pilots Avoid Crashes.” The Wall Street Journal (Saturday, June 3, 2023): A9.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date May 30, 2023, and has the title “Don Bateman, Champion of Airline Safety, Dies at 91.”)

Socialist Alexandria Ocasio-Cortez (AOC) Buys Foreign Sunscreens Not Approved by U.S. Government F.D.A.

(p. 2) After months of prompting, I have finally managed to help my husband form a daily sunscreen habit. Whenever I see traces of paper white cream in his dark beard, I think, We’re halfway there.

Hoping to avoid the white cast, heaviness and greasiness common in many sunscreen products available in U.S. drugstores, some Americans, including Representative Alexandria Ocasio-Cortez of New York, have taken matters into their own hands, opting for sunscreens manufactured abroad. In a recent interview, the congresswoman said she toggled between Bioré in the summer and Beauty of Joseon in the winter — two Asian brands that employ active ingredients not approved for use in the United States.

“The technology is very sophisticated,” Ms. Ocasio-Cortez said. “You don’t feel like you have a layer of sunscreen on, and it kind of just feels like you’re putting on a moisturizer in that sense, which makes it easier to use.”

While sunscreen is regulated as a cosmetic in major skin-care hubs like South Korea, Japan and the European Union, in the United States, it falls under the purview of the Food and Drug Administration. Any drug product marketed to American consumers must be approved by the F.D.A., and because sunscreen “makes a drug claim” — namely, that it can prevent sunburn, decrease the risk of skin cancer and mitigate early skin aging — the agency regulates it as an over-the-counter drug.

The last time the Food and Drug Administration approved new active ingredients for use in sunscreens was more than two decades ago, and at times it can feel as if the rest of the world has surpassed the United States in the development of new sunscreen formulations and protocols. Skin-care influencers on TikTok and Instagram are in a near-constant state of frenzy over exciting new products and innovations that are nowhere to be found on American shelves. Currently there are 14 sunscreen filters approved for use by the F.D.A. The European Union employs more than 30.

Frustrated by what seems to be a wealth of more exciting options for sun protection overseas, skin-care-conscious Americans have been quick to point the finger at the F.D.A. for the delay in approving new active ingredients.

For the full story, see:

Sandra E. Garcia. “U.S. Sunscreen Is Stuck in the ’90s.” The New York Times, SundayStyles Section (Sunday, August 13, 2023): 2.

(Note: the online version of the story has the date Aug. 12, 2023, and has the title “U.S. Sunscreen Is Stuck in the ’90s. Is This a Job for Congress?”)

“Best-Funded Startup” in History Seeks Longevity by Rejuvenating Cells

(p. B1) Arch is the largest institutional investor in Altos, which already has $3 billion of committed investments, likely making it the biotech indus-(p. B2)try’s best-funded startup on record.

Nelsen is characteristically unrestrained when discussing Altos’s prospects.

“Epigenetic reprogramming is the biggest thing in healthcare in 100 years. Or ever,” he says. “We will clearly live much healthier and longer lives if this works.”

. . .

A native of Walla Walla, Wa., Nelsen studied biology and economics at the University of Puget Sound before getting an M.B.A. at the University of Chicago.

. . .

His manic energy can lead to confrontations. Nelsen drives his GMC Yukon so aggressively that some friends avoid riding with him. He’s started fights with supermarket customers who resisted using plastic bags.

“I hate plastic bag bans, because the assumption that they are better for the environment than paper is flawed and I am grown up enough to not have government choose my bag for me,” Nelsen says.

. . .

Taking cells back to their youthful, healthier state long captured the imagination of scientists, but seemed unlikely. Then a breakthrough paper published in 2006 by Japanese scientist Shinya Yamanaka and a colleague showed mature skin cells of mice could be reprogrammed into primordial, immature stem cells—called induced pluripotent stem cells—in effect resetting their molecular clocks. Yamanaka, who later shared a Nobel Prize for work in this area, is an adviser to Altos. In 2016, Spanish biochemist Juan Carlos Izpisua Belmonte, Altos’s founding scientist, showed how the age of cells could be reverted without changing their genome and identity. His work demonstrated the potential for toggling between the ‘old’ and ‘young’ states of cells—the basis for Altos’s effort to rejuvenate cells.

For the full story, see:

Gregory Zuckerman. “Fear of Death Drives A Venture Capitalist.” The Wall Street Journal (Monday, Aug. 21, 2023): B1-B2.

(Note: the online version of the story has the date August 20, 2023, and has the title “For This Venture Capitalist, Research on Aging Is Personal; ‘Bob Has a Big Fear of Death’.”)

The Enemies of Horatio Alger “Are Out to Get the American Dream”

(p. A13) Of all the institutions for investigative journalists to put under the microscope, the Horatio Alger Association of Distinguished Americans sure is a strange target.

The charity says it has awarded more than $245 million in college scholarships to 35,000 students since 1984. Its 300 or so members cross the political, cultural and business-success spectrum and include Michael Bloomberg and Oprah Winfrey.

So what explains the recent onslaught of critical press coverage? The New York Times has put eight reporters on the case and devoted two 4,000-word Sunday front-page pieces in the past two months to the Horatio Alger Association and its members. ProPublica, which styles itself “an independent, nonprofit newsroom that produces investigative journalism with moral force,” produced a 5,000-word article that credited four reporters.

The journalists and the advocates they quote say it’s a matter of judicial ethics, highlighting Justice Clarence Thomas’s role as an honorary board member of the Horatio Alger Association and his friendships with the association’s members, some of whom are prosperous.

. . .

The venom directed at the Horatio Alger Association, though, isn’t only about Justice Thomas and the court. The association’s critics are out to get the American dream.

The association’s website explains that its mission is to “educate all youth about the limitless possibilities that are available through the American free-enterprise system.” The group was founded to dispel the myth “that the American dream was no longer attainable.” Its members are “role models whose experiences exemplify that opportunities for a successful life are available to all individuals who are dedicated to the principles of integrity, hard work, perseverance and compassion for others.”

For the full commentary, see:

Ira Stoll. “Why the Left Hates Horatio Alger.” The Wall Street Journal (Saturday, Aug. 12, 2023): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 11, 2023, and has the same title as the print version.)

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.