Saturday, December 6, 2014

At Big Bend Regional Medical Center

             My first hospital was run by the Daughters of Mercy and the nuns said to treat every patient “as if he’s Christ Himself.” But what if you’ve never taken care of Christ? Or Virgin Mary—or Little Baby Jesus? What do you do then? What if the patient is handcuffed to the bed? Not that there's anything wrong with that.
             So, this guy's name was Juan and he was twenty-two or twenty-three years old, at that moment in the custody of the U.S. Border Patrol, this was in West Texas near Marfa at a recent time but, for you, probably far far away.
The patient had been arrested after spending five days crossing the high Chihuahua Desert on foot only to be caught when he reached the outskirts of Alpine where the hospital is. His first stop after arrest was the E.R. while he was checked out, the word from the Border Patrol was that Juan was spotted behind an abandoned building and that’s where he got busted on the outskirts of town.
             So, he actually looked pretty good for a guy who’d been drinking from water holes and sleeping outside, especially this outside, for almost a week. His clothes weren’t particularly dirty, when he was arrested he said he was on his way to Colorado where he had friends, that’s what he told me too. So, like, he was assigned to me and that meant he had to be admitted which is a pain for the nurse not the patient. We went through the list, family history of heart problems, diabetes, stroke, the usual suspects, wasn’t much there and contrary to what the nurse sometimes hears Juan’s history appeared to match Juan’s condition. He looked really good. If crossing the desert on foot did this for people—celebrities ought to try it instead of fat farms or spas or whatever—at least that was my feeling doing the paperwork at the time.
There wasn’t even a pinch of fat around Juan’s middle, he had well-defined musculature like a pro athlete, great veins that had already been tapped by the emergency room for a couple of lines. In build he was an inch or two taller than me but probably twenty pounds lighter—and about two inches shorter and forty pounds lighter than the Border Patrol officer in the room which pleased me too although it seemed unlikely Juan was going to cause any problems or get out of hand. The hospital actually gets a lot of prisoners from the local courthouse or the jail in Marfa that houses federal “detainees,” most of them caught sneaking into the country, yeah, people like Juan. After they’re sorted out and charged or not charged they’re returned to Mexico or wherever as the federal government sees fit. That’s the system. The big question for me as the RN was actually who came to sit with him or her in the room. If—when the Border Patrol grabbed him or her—there were already signs of any kind of medical condition he or she was in the custody of the feds. If on the other hand they were already in jail in Marfa when they got sick or were determined to be sick the Presidio County Sheriff deputies had custody in the hospital.
So, like, my preference was for the Border Patrol.
If you got the sheriff’s people they were nice enough and watched the prisoner well—even when he had to walk the halls, for the hospital cure so to speak, there were two guards, one deputy on either side ready to catch the guy if he fell or catch him if he ran, which is unlikely post-op, the pain and all, but you never know. Listening to their conversations the sheriff’s people seemed to live in their own work-related world talking about who was taking what shift at the Presidio County Jail and the details of their duties in a desolate part of the state best known for the uncertain delights of Marfa and Big Bend National Park. The Border Patrol guys and girls frankly had more game. They were more “cosmopolitan” and able to hold a conversation about something other than work, or their own particular work, and since most of them weren’t from the area they knew another slice of life which is important for a nurse if you’re going to get tied up in a room for any amount of time, you want somebody to talk to. Juan was a man of few words. He was watching TV when he wasn’t sleeping. The London Olympics were on, the Border Patrol guy sitting with Juan was looking out the back window of the room at the desert his prisoner had just crossed, in summer, on foot, the officer mentioned the landscape kind of reminded him of Iraq where he was a contractor back in the day. The only difference he said in Iraq the temperatures could reach 120. And—presumably, although he didn’t mention it—people were trying to kill you.
             So, his comment was interesting only because this area of Texas is all about heat. Practically everybody who gets admitted to the hospital in Alpine for whatever reason, heart problems or diabetes for example, infections maybe—microbes seem to grow really well in the high temperatures—has a secondary diagnosis of dehydration. Especially the old people unless they have heart failure and they’re actually being hospitalized to get rid of extra fluid. Alpine is a nice little town, almost a mile up, usually you don’t feel the sun, there’s a breeze most nights and we’re talking low, low humidity during the day. The sun just sucks the water right out of you and you may not even notice.
We had a patient right after my start on the unit, not that this is important although it kind of is, so he was an older gentleman living on his own somewhere in Brewster County, a little bit of Alzheimer’s or dementia going on—so it’s hot as hell one day and he goes home and turns on the air conditioner but because of the dementia he doesn’t realize he’s actually turning on the heat. Luckily someone went out to visit him, it’s that kind of community, people watch out for each other, someone called the paramedics before this older gentleman was cooked. He made it, he survived. The take home lesson is, like, it’s hot and with the breeze sometimes you don’t even feel it. High desert is still desert. Juan for example was getting rehydrated, he had fluids running, an IV. You know those little cups of orange juice they serve in hospitals? He liked those. But he wasn’t desperate—he wasn’t dying of thirst—his white count was high, that’s probably why they admitted him in the first place, that or just to get a better look at the guy, whoever he was he’d just had an experience that would have killed like 99.95% of the adult population of the State of Texas—and all the kids—but he looked pretty damn good if you asked my opinion which Dr. Luecke did that afternoon when he made rounds. If the federal government even knew what this guy was capable of they would give him a visa—that was my opinion but nobody actually asked me.
So, Dr. Luecke came in and said the high WBC count might be the result of dehydration, with less fluid in his veins his cell counts were all exaggerated, Juan had an antibiotic running just in case he picked something up drinking with cows, he also had air in his chest wall—don’t know what that was all about—the doc said it would probably get reabsorbed. This wasn’t Dr. Luecke’s first time at the rodeo, he’s a good doctor, he’s been here long enough to have delivered like half the county—he has kind of an old-boy aura but he went to Stanford University and his brother is some kind of math whiz at the university in Austin. So, he told Juan in Spanish that he’d be okay. Juan smiled like he already knew.
So, you know, Juan wasn’t a difficult patient but he was interesting, you know? It wasn’t like he was going to kick—or code—just keep a good eye on him for 24 hours or so and he’d live to wade the Rio Grande another day.
             There was a surgical patient in another room who was ex-Border Patrol and he told me that back in the day when he’d pick up guys coming from Mexico they were usually carrying limes in their packs. The water the cattle drink on the ranches is brackish and these guys, on the trek north, squeeze a little limejuice in to adjust the pH to make it safe for humans. That’s what it means saying that you can talk to the Border Patrol officers. They know stuff. Not that the Marfa deputies don’t, no offense, there it is. It's not a difference in knowledge base, it's more about communication skills, the deputies’ conversations are more limited not that there’s anything wrong with that. They’re all—Border Patrol and Sheriff’s people—carrying cuffs and guns, that’s what’s important if you ask me.
             So, like, being in the hospital is an opportunity for a lot of prisoners and if you’re a nurse you have to keep alert, not to intervene thank you very much—even if a patient is trying to escape it’s not in the nurse’s job description to stop him, your job is to render care as if the patient is “Christ Himself,” or whoever, but not tackle somebody sprinting down the hallway, at least not in this RN’s view. So, like, before coming to Alpine to tell the truth my last interaction with a handcuffed prisoner was not so good. That influenced me, certainly.
              And the experience still made me anxious with Juan.




             So, this was in the Pacific Northwest on a neurosurgery unit and a night shift—which is always problematic or seems to make problems worse or at least makes my problems worse working nights. So, at that time, on that shift, my plate was already full—it seemed in my modest opinion that my patient load was already heavier than anyone else on the unit although that was apparently not a widely held belief because the charge nurse called me over and said a new patient was coming to the unit and would need “a male nurse.” So, next thing an ICU nurse was wheeling over a gurney with a patient and a sheriff’s deputy following not far behind.
So, to deal with the most important detail at the beginning the patient was cuffed to a bed rail, but not his wrists.
             The handcuff was actually a leg chain joining him, one hoped, inescapably to his new bed. He wasn’t going anywhere but he had free use of his hands.
             So, like, we got the patient settled in and the deputy sheriff guarding him settled in a chair and then the ICU nurse who was kind of hot—not that that’s important although her exceptionally-steamy appearance did mean she got my complete attention for the five minutes it takes to give report—she took me into the hall to tell me about my new guy. So, of course, first thing the ICU nurse does is launch into the psycho-social aspects of the patient’s case, his home life, my eyes rolling back in my head—but that’s actually when it got interesting. Really interesting. You get cynical working in a hospital after a while, you think you've heard it all—what she was telling me about the guy in cuffs—he'd been found a couple of days before behind the wheel of a vehicle parked in a public park. He was unconscious and covered with blood, that's what the ICU lady said.
             So, he was taken to an E.R. and checked out. He was in a coma at the time, apparently drug-induced, perhaps the result of an overdose, perhaps not, but what most interested everyone in the E.R. was the blood on him and on his clothes. Because—and this is the crucial fact—he had no wounds on his body. Pretty cool, huh? A mystery. The police went to the guy’s house to look for the source of the blood. And they found it. The blood belonged to his wife.
So, the patient looked to be in his forties, balding, milquetoast manner, a pale used-up little guy: the kind of guy you could pass on the street every day of your life and never notice, so someone might say. So, eventually, for whatever reason, he’d lost it and killed his wife, the sheriff’s deputy was sitting off in a corner of the room playing all night with his cellphone but me—you know, doing vitals, getting blood, the assessments and all—that required close proximity which was cool because he was cool, the patient. So, we fed him that night after he came out of the coma and in the morning me getting ready to give report to the day shift, cleaning up the area for whoever followed—this guy’s dinner tray was still there and there was a knife on the plate. A real knife—not plastic—steel, something you could stab people with, which is presumably what he had done to his ex-wife, and the knife was within his reach for like the last ten hours and it occurred to me that if he went off again, like he did with the late Mrs., guess who would have gotten cut? Not the sheriff’s deputy sitting over there in the corner with a nine-mil on his belt.
 In nursing school an old psych nurse told me that if someone has a knife and is within a few feet of you, even if you have a gun the person with the knife can kill you before you can shoot him. Or her. That's a happy thought, so—me being a coward personally—the danger that night made an impression on me and my feeling since then has been it’s always best to check security first, no matter if it’s just somebody like Juan who you have no fear of. Because shit happens. That’s why hospitals were invented, right: Shit happens, that's actually my theory of nursing practice as well, the idea is that shit happens, yeah, but for it not to happen to you.
             Or more importantly to your patient.



Seemed for a while that we were getting a lot of prisoners in the hospital in Alpine not that there’s anything wrong with that.
The inpatient area of Big Bend Regional Medical Center is divided three ways. You come down the hall from the emergency room and turn left to have a baby, go straight if you've come out of surgery or right for any kind of medical condition that requires hospitalization.
              Even though the next few prisoners were all surgical patients they were all placed in the medicine area, on the right if you’re facing the nurses station, because the rooms are bigger and allow the guards to stretch out and because there’s a big exit on that side. Leads out into the desert actually. If the patient does escape which is not likely you want the first thing he sees to be “EXIT,” no matter what’s beyond the door. No lie. The hope at a lot of hospitals is if the cuffs don’t hold ‘em, hopefully an easy out will lure an escapee from the facility. You may say that’s grasping at straws but medicine, it seems, in my modest nursing opinion, is the ultimate percentage game. Generally you have to follow the percentages. Whatever the likelihood that an escaped prisoner is going to be lured by an “EXIT” sign—or not—it’s still better than the alternative which is that the guy decides to go to the cafeteria or visit the nurses station, you feel me?
             The three prisoners along with Juan were also illegal, some people do not like that phrase, it is descriptive, they were picked up by the Border Patrol but by the time they reached the hospital they were in the custody of the good people of the Presidio County Sheriff’s Office: they were experiencing Marfa, you might say, through the bars not in the bars, or in the art studios. All three were appys.
             The first one had gang tattoos which made people a little anxious taking care of him but he turned out to be quite nice or as nice as anybody can be who’s handcuffed to a bed after surgery and has two sheriff’s deputies in close proximity. The guy’s mother, wife and kids actually lived on this side of the border which may have explained his attempts to cross into Texas and they came to see him in the hospital and my responsibility as charge nurse that day was to go out into the waiting room and explain that when you’re a prisoner in the hospital it’s not like being an ordinary patient. You can’t have visitors if the guards say no and the guards say no now. Sorry. Everybody will have to wait for visiting day in the jail. They took it well.
One of the other guys was taken care of by Marisa and the third guy by Jess. So, like, Marisa and Jess are both very attractive young women, and very good nurses, and it was interesting to watch their interactions with the prisoners which was kind of my job on those particular days. Both Jess and Marisa were pregnant which meant they were moving kind of slow but that didn’t affect their nursing skills. Marisa’s husband Carlos is Border Patrol so she kind of knows the population and both she and Jess treated their guys as if they weren’t handcuffed which as supervisor is what you want to see, you want the nurse to treat the patient no matter who he is or why he’s in the hospital like any other patient, or like “Christ Himself” as the Daughters of Mercy would say. There were psycho-social issues too, sure, Marisa’s guy was already in jail when he got sick and he said the other inmates laughed at him when he started complaining of belly pain, calling him a whiner or whatever, they thought he was just bellyaching or whatever—until people realized he really was sick. Jess’s guy was really macho and it was funny because at first he didn’t want to take pain medication from her but he took it from me. You would think a really macho guy would take the morphine from a young female nurse before he’d take it from a male RN but this guy kind of acted like he didn’t want to show any weakness in front of a woman. Dude! If you’ve just had surgery for a burst appendix take the medicine from whoever’s offering it, that was my advice to him. Actually something Marisa’s husband told me kind of influenced my view of prisoners as patients in general and my guy Juan in particular.
 So, before coming to West Texas, Marisa and Carlos were stationed in Arizona and he said sometimes out on patrol in the desert they’d find skulls, not often but often enough to make you wonder how many people didn’t actually make it to arrest. The desert gets them.
              So, like, the take home lesson for me as a longtime city-dweller was that the desert is a bitch, that’s still my feeling now, you may know that already but you may not know how big a bitch it is. My idea at the time taking care of Juan was that the federal government should have a contest—a kind of Olympics or World Cup—a filmed series like “Survivor,” maybe, featuring the U.S Border Patrol, whoever gets out of the desert gets the visa. You feel me?




So, we had a patient one night in the hospital who was attacked by a mountain lion.
             No lie.
             Seems like there’s an attack in the national park about once a year, sometimes fatal, usually not, this young lady was European—not that there’s anything wrong with that, she was from Spain or Portugal, somewhere in there—and so she was walking in the park with some friends when a big cat picked her out to eat.
             So, this was not my night to work to be honest, all of this came to me secondhand and a while later but my source was impeccable. So, first, let me digress. This will lead back to my guy Juan but not immediately. So, like, before getting to the almost-eaten Spanish lady: we had another patient in the hospital once and we were talking and you know—just me and him in the room, just passing the time—you know, me asking him what kind of work he did for a living he told me he was “a mountain lion hunter” which, you know, sounded like complete bullshit to me. Like saying you’re a secret agent—or a rocket scientist, you know?
But later people told me it was really true, hunters really were hired to “cull” lions that attacked cattle on the nearby ranches. So, like, this guy, the “lion hunter” told me the rule with mountain lions, unlike bears, is if you're unarmed you want to make a fuss when you see one. That’s actually useful to know around here near Big Bend National Park and all. So, that was news to me being from the big city.
            Once, hiking years ago in Glacier National Park somebody told me that if you run into a grizzly on a trail your best bet is to act demure, look down, don’t piss the bear off by making a big scene. He or she is either going to eat you or not, it's completely the bear's call. “Never run from a bear!” the expert in Montana told me.
           But not in West Texas!
           How cool is that?
          Working in Big Bend the lion hunter told me the rule is the exact opposite: “Make yourself big”— whatever that means—whoop it up, escape if you can, but mostly make the feline think you are about to be the worst meal she will ever eat. The theory, one supposes, is that cats are basically lazy and even mountain lions avoid prey that looks like too much work. That’s the theory.
           So, that’s basically what the European chick’s companions did. They scared the cat off—whooping and yelling presumably—waving their arms, successfully, whereas if it was a grizzly, which do not live in Big Bend National Park, by the way, whatever the girl’s friends did wouldn’t make much difference. Basically my feeling is if a bear has shown an interest in you your time on earth is very limited no matter what you do—that’s just my view—not that it’s particularly relevant here because we’re talking about big cats and Juan.
So, this Spanish or Portuguese young woman, let’s call her Spanish for simplicity, like Juan she wasn’t in bad shape. She was scratched up pretty bad but apparently nothing serious, the emergency room was going to ship her to a big city to see a plastic surgeon, you want to do that quickly while the wounds are still fresh and before they’ve begun to form scar tissue.
              So, she was waiting for the plane or whatever and she came down the hall from the E.R. to use a shower in an empty patient’s room and the people at the nurse’s station said she looked “spooked” walking down the hallway. Yeah, you think? One minute you’re hiking in a park and the next minute a mountain lion is trying to eat you. You’d be spooked too. Any of us would. So, the point here is that’s the fate Juan escaped too. He was actually a pretty cool guy even if he had just violated numerous laws of the United States of America. He spent five days in the desert, in existential heat, thirsty and facing a possible run-in with a mountain lion, you feel me?
 So my view of him at the time, taking care of him, being proud to be his nurse, not only the respect you want to show any patient—like "Christ Himself" as the Daughters of Mercy say—but feeling awe and admiration as well. This guy kind of reminded me of the athletes up on the television screen showing the Olympics, "illegal" or not Juan was a pretty cool dude, he’d just done something that only a very small percentage of the world’s population was physically or mentally capable of.
He was smart too, maybe not book-smart but certainly clever and resourceful, ambitious or at least he had a goal—in his case reaching Colorado.
My best guess?

He’s there now.

Sunday, November 30, 2014

The Two Wives of Don Justino

            The two wives of Don Justino are joined together by love of a good man and separated by a wide arc of the Pacific Ocean.
            One lives in Panama and one lives in Colombia and Don Justino whose work takes him between the two countries in a small open boat can enjoy the company of one woman and when the time comes for whatever reason go back to sea and return home—to his wife.
            Justino Ortiz Londono is 85 years old, a former schoolteacher from Nuqui who is the “best known” figure along the border between Choco Department in northwest Colombia and Darien Province, the farthest southernmost part of Panama where Central and South America meet. There's no road just Justino.
Locals on the Colombian side call him “El Profe,” a term of endearment since he taught so many of the people here although he’s long retired from the schoolhouse. About once a week now he operates a “shuttle”—a fiberglass launch with a 40-horsepower outboard engine—carrying a handful of passengers between Choco’s main port and the first Panamanian town, Jaque: the beginning and ending respectively depending on what direction you’re going of a stretch of the most wild real estate in the world, the Darien Gap. If you want to see the region in its famous commercial role which is unfair because there's much more here including awesome nature but is still kind of accurate—think cocaine going north and guns and cash coming south.
People here are amazed by Justino’s stamina both in the cama and at sea. A decade ago the locals were already saying that he was too old to continue his taxi service, six or eight hours on the open Pacific that can be a challenge even to a younger man. Times have changed in such a way however to make the importance of Profe’s work even more critical to the community than his teaching. You get what you pay for with Justino, safety. He travels with an assistant because it’s the prudent thing to do, on a recent voyage to Panama the mate stayed at the bow on the lookout for stray logs that seem to be found frequently on this stretch of coast, floating evidence of illegal timber activity that like illegal mining is stripping Choco of natural resources. Oh well. Our captain insists that the real physical danger is not the weather nor the sea itself, not drug traffickers or ocean-going guerillas. The real danger is seasonal and comes in April and ends in September: humpback season when whale moms and their calves are a frequent sight.
“They like to sun themselves just below the surface,” Justino says. He’s been “tapped” before by a whale mother who didn’t know he was passing but never turned over.
The human population of Bahia Solano is not seasonal: it’s growing continuously.
              A Choco-based immigration official recently estimated that there are now 10,000 people in town, a doubling in just a few years: a list of illegal foreigners arrested passing through the area was printed in the newspaper recently and included east Indians and Chinese. A fisherman who was born in Bahia Solano but has lived the last 20 years in Buenaventura just returned with his children saying the big southern port has become unlivable due to “delicuencia,” the polite term for that potent mix of guerrillas, traffickers and ordinary dockside thugs who plague down the coast.
Bahia's own growing pains are also clear. Two husbands were arrested for killing their wives earlier this year, women have to take to the streets to protest small-town machismo and violence, still it’s not like Buenaventura where bombs go off and the Marines have to patrol in speedboats along the docks. A laundry opened two years ago in Bahia Solano, that is how progress is measured here, there’s now a dive center/hotel operated by a Medellin expatriate and a network of small stores, a gentleman from Kentucky opened a backpacker hostel on the nearby beach El Valle near Utria, the national park. The local community is still mostly Afro-Colombian and indigenous and many here appear to believe the future is eco-tourism: the biggest growth in Don Justino’s trade may soon be backpackers, the gringos are not coming, they’re already here. A recent journey by this Pacific route leaving the dock behind the seafood market near the old town in Panama City on a Friday afternoon and arriving six days later at Hostel Trail in Popayan in the Andes cost less than $400 total via Don Justino and Bahia Solano: arriving in Buenaventura and being four hours by bus from Cali on a road you may share with the FARC. Don't take a bunk near the engine on the freighter leaving Bahia Solano, the noise is positively physical, this last sea leg of the journey cost $75 and takes at least a full day and night. The dock where you arrive is beside the road to Cali, you don't really have to spend any time in Buenaventura itself (highest murder rate in the world for a while, if you do go into the city remember in Colombia women are more dangerous than men) it's a tough town but there's a lot to see and do, especially if you have significant vices.
Don Justino charges $125 or $150 for his speedboat ride from Panama to Colombia or vice-versa, a hefty sum for a few hours trip at a price he describes as necessary for "fuel costs." On the Panamanian side there are also expectations of a further increase in demand for Justino's services. The government in Panama City appears to have ignored Darien with the exception of the National Police barracks, re-engineered recently from bunks for 40 officers to bunks for 140 in Jaque very near where Justino's speedboat arrives and leaves. 
The only constant in this changing world is Don Justino himself. He looks back on a teaching career that began when he was 19 and continued when he moved to Bahia Solano more than four decades ago. He retired a decade later—he believes, he can’t really remember—after teaching all the subjects in the local schools including English “even though,” he smiles, “I don’t speak the language.” A small trim man he has a quick smile riding his bicycle around town and a slightly more severe manner at sea, like a school teacher, yeah, when he's at the rudder. As with all small boat captains his constant fear on the water is the right balance of weight to avoid any risk of capsizing. And of course those whale moms.
Don Justino declines to discuss his personal life—although everyone else does—except to say that he finds big-city women like those from Medellin and Cali “no confiables,” undependable, while the local women especially the Afro-Colombianas know how to treat a man right. As for his second career he’s not retiring anytime soon:
            “The sea gives me life.” 

Saturday, November 8, 2014

Women of the FARC

A young woman carrying a designer bag steps out of a taxi on a provincial street in southern Colombia. She’s wearing a sheer blouse, slim-cut jeans, black stiletto heels. Her hair looks as if it was just styled but probably always looks that way. As she gathers her purchases and turns to walk away she takes a frightened look at a locksmith in greasy clothes across the street.

Suddenly he’s approaching her carrying a bucket of water. Words are exchanged. There appears to be some class tension in the conversation between the workman and the lady as well as a note of concrete disagreement, perhaps over past services, late payment or such. The woman steps away. Not fast enough, because of the heels. Water cascades over her head: blouse soaked, hair dripping—still struggling to move tactically in her talons she totters around a second taxi just stopped in the middle of the street. The taxista who was passing with a customer saw the attack and braked like any gentleman in this part of the world. 

His hand shoots out as the Colombiana passes his car window, he sprays her with shaving cream. What a mess. At least it wasn’t the same driver she just paid. Blanco y Negro—as the Popayan games are called—is better than running with bulls because no one gets hurt—better than the World Cup because everyone can play, ultimate street games, every year since the king of Spain ruled here there’s street fighting in Cauca. This unscripted action from which no one is immune begins January 5th sometime around noon and ends basically when the city goes to sleep on the night of the 6th. No one who steps outside during these 36 hours escapes—not cops, not soldiers nor public officials, women, children, the very old, even the infirm, no one is immune, everyone is a potential target for a healing splash. Like a paintball fight gone ballistic, full of passion but usually no pain: face paint—for example—applied to all parts of an opponent’s body except, usually, the face. There are no real teams, no real “sides,” whole families come out of the house in the afternoon of January 5th and by the time they return home that night they’ve attacked complete strangers as well as each other. If you’re outside—it doesn’t matter if you’re Mother Theresa’s holier sister or President of the Fucking Republicmany of them have played here too—secular or religious—terrorist or counter—you’re a fair target. The Popayan games say something basic about human desire, about why we like fighting and conflict especially when nobody gets hurt. This action also teaches tactics—which is why the gamers come. None of the lessons seem to have been put to use to end the country’s other intractable issues—those problems are strategic not tactical—but it’s fun and seems to reduce tensions in a society with deeply-etched class and ethnic fault lines. 

The best part—whether you’re gringo or guerrilla, Colombian armyAmerican adviser or paramilitaryNational Police or Departamento de Administracion de Seguridad—FARC or ELN, the so-called “other teams”—you can play too!



The pace of life in the Andes is different.

The “First World” ritual of trying to get an early start on a New Life on January 1 is not the custom in Popayan where you slide into the New Year pretty much the same way you slid out of the old: family, good food, considerable time off work and alcohol, maybe something stronger, to smooth the transition. In Popayan carnival is a last gasp of life before the business of another year begins. My intention was to give it a miss. Parties are not my thing, especially not big street parties which is how the action was described to me. Only bad planning found me still in town noon of the 5th.

Everyone was still trying to get home from school, from work, from church, foot traffic squeezing up against walls on the sidewalk below my hotel window, people hoping not to get wet before they had a chance to change into old clothes and fill a balloon or, alternatively, open a bottle of Chilean white and wait out the next two days. There was an English chick staying on another floor of Hostel Trail (my usual lodging in Cauca, there or the Caracol, both run by Tony and Kim) and suddenly this English ho from the other floor appeared on the street below my window and she was wearing only a raincoat and a pair of running shoes, looked like she was nude under the gear, which was, you know, all right with me. It wasn’t raining. So, for a moment she glanced up and the expression on her face was something primal like a huntress—a cavewoman looking for meat—Boutica vs. the Romans, whoever, no mercy, nothing less than a kill would do. She disappeared around a corner.

There was a bucket in the hostel hallway that la muchacha used to water plants and you know, like, my feet—without me wanting them to—without any free will on my part whatsoever—not wanting to participate in this silliness in any way—my feet carried me to the other side of the hall just in time to catch a mom and her seven- or eight-year-old daughter as they tried to sneak up on somebody farther up the street. My aim was perfect. Not to brag or anything. Basically the same principle as a B-52, you have to bomb what’s ahead not what’s below—well, like, not to brag but the water caught the little girl on her shoulder and with the splatter she was, like, completely soaked. Made me fell pretty good, actually, a hit like that on a complete stranger on my first serious shot, the mom looking up and smiling as if to say, “Well-played,” at that moment it became clear to me how wars begin and conflict escalates. It’s fun. Not because mom smiled but because the hit itself felt really pretty good, even on a third-grader—especially on a elementary school kid. With escalation it all seems so natural, you feel me? Ten minutes later a fire hose wouldn’t have been enough.

Carnival in Popayan is officially called Blanco y Negro: it’s supposed to be white one day and black the next, it didn’t start with water balloons either, goes back to when the Spanish were here and it was decided by someone wise, perhaps the king, that one day every year black people should know what it feels like to be white and whites should experience the blackness of slavery. That’s how it was explained to me.

That’s where the face painting came in. So, the tradition took shape and January 5th whites put on black face, and the next day blacks put on white face and put on the slaveowner’s airs. Something like that. For that day only they were not property, these pre-revolutionary niggers learned what it was like to be free, to be white in the white man’s world—role-playing—the unofficial beginning of the current-day games, the big difference with the rules here vs. anywhere else: in Popayan everyone has to participate. If you’re outside—you’re fair game. There are no exempt categories (supposedly there's been debate about pregnant moms, like, should they get a pass, but no consensus, so at the time of this writing the consensus is they’re fair targets too). Your only choice is stay home, that was what the king decided, back in the day. It’s just, like—to explain the timeline—the balloons came later. So you can’t stay inside and just drop bombs on people although as an American you’re familiar with the concept. You’re familiar with the idea of taking out an enemy without endangering yourself—it’s just no fun. The joy of carnival is like Christmas, getting as well as giving. A couple of blocks short of the town square a balloon hit me in the back, never saw who threw it, it bounced off without exploding, didn’t hurt, didn’t explode because it wasn’t thrown hard enough, you’re not trying to hurt people, you just want to get them wet.

A couple of players took advantage of an intersection of two streets that passed either side of the supermarket, like, a target-rich environment, the similarities with real war were striking, you tried to open fire at as great a distance as possible to take out the enemy and avoid getting hit yourself, but the farther away the poorer your aim and more likely you would take out someone innocent, it’s called “collateral damage,” again as an American you’re probably already pretty familiar with the concept. But in Popayan during Blanco y Negro no one is an unintended target! How cool is that? Everyone is a player. Whether they want to be or not. Sweet. Like, Colombian rules, in other words total fucking chaos.

My escape route back to the hostel carried me back safely and this time after being schooled in tactics it was easy from two floors up to take out a couple of couples entering the chicken restaurant on the bottom floor of the building. So, there was this group of chicks, which is where we’re going here, some hot Colombian females wearing very little, actually. And they appeared in the view from Hostel Trail's window. They were wet, these chicks—well, first a little background. The mountains around Popayan are full of guerrillas. . . . 





So, the insurgents are so much an established presence here that some people in Popayan can tell you what unit of the FARC operates in what part of the surrounding countryside, in the cordillera, in the mountains, in these Andes. A couple of years ago when special forces tracked down and killed the FARC commander, nom de guerre Cano, the firefight happened in the hills north of Popayan, northern Cauca, kind of near the road to Cali and the Cauca River where the guerrilla culture is present along with so much good herb. 

They brought Cano’s body to Popayan and the President of the Republic who used to be Defense Minister flew in and there were photographs in the paper the next day not just of the site of the firefight but of the FARC commander laid out like Che, they say they tracked him with candy, he had a sweet tooth and they knew where his people bought the chocolate and the Army put a tracker in a box—that’s what “they” said, that's what "they" told me. Whether it’s true or not it’s the kind of detail people in Popayan appreciate, tradecraft, how you capped a motherfucker, yeah. So, that afternoon, in Popayan, during Blanco y Negro, there was this group of hot Colombian chicks you could see from my window. It was late on the 5th and there were people wearing ragged clothes carrying water balloons on the street below—at that point still mostly the hardcore players, the dangerous ones who are just as likely to get you before you get them. The mass of slower-moving targets wasn’t yet on the streets, the generalized mayhem was still an hour, maybe two hours away, a lot of people would have dinner first or a glass of wine, a few beers to lubricate the soul then go out. That was my plan too. To go hunting. So, what caught my eye, these girls, in shorts and running shoes, bikini tops or torn T-shirts, sexy, yes, but something more

They were jogging single file up a hill you could see from the hostel window, they had water balloons in hand and there was just something about them, they moved like a team, young women with confidence, maybe athletes from the university or med students or police cadets, there’s a lot of heat in Popayan actually, not that there's anything wrong with that, army, special forces, they say that if the guerrillas ever hit the town, which is unlikely, “Cali tiene batalon,” soldiers can come from Cali locked and loaded they can be in Popayan in 45 minutes by chopper depending on how fast they mount up. Anyway, my guess about these chicks was that they were actually the other side, the girls’ team from the FARC. Not that there’s anything wrong with that, everyone is welcome at Blanco y Negro.

So, the young women’s backs were muscular like they were not just used to working out but actual physical labor and each one kept a good distance from her sister ahead and behind, as if they were afraid of being caught in a group. Their hair was not a giveaway because they were already wet, it's said that's how you spot a guerrilla girl in town, by her hair, not long and lustrous like so many Colombianas, they can't care for their appearance in the jungle or in the mountains, whoever these chicks were they’d already seen action, wherever they were coming from, the parque central maybe, the supermarket, wherever, what would have been their ponytails or shags or whatever were already plastered by water to shoulders and necks. Maybe they weren’t FARC or ELN. Maybe they were cadets or young officers, it’s hard to tell ideology at a distance, you couldn’t discount either possibility though, forces of order or forces of disorder, both sides like to play. It’s kind of like training, you learn about quick formation and dissolution of alliances and how temporary the decisions you make in life can really be. Popayan is only the 20th biggest city in Colombia but a single stat tells all: more Presidents of the Republic have come from here than any other city, seventeen—someone told me, something like that, two digits, for sure—more than Bogota and Cali combined.




The boat up the coast was scheduled to leave the next afternoon and a taxi would pick me up at four in the morning to begin the trip to the dock at Buenaventura. So my last water fight never took place.

Hard to imagine what Day Two would have been like. Would the fighting start before noon or would the drinking and fornicating the night before require a delay? 

Would the streets lock down with the splashes so tight that no one could get to the store? Would the supermarket even open? Would the chicks be wearing less? That was the important question. My last trip from the hotel before catching my taxi was mundane: There was a betting shop on a corner a block or so from the hotel and the shop remained open like a few other critical businesses, but it was a no-water zone, you were not supposed to throw balloons or spray into businesses or homes and, surprise, the rule was obeyed. Not much business was getting done.

As we waited together, under cover of commerce, a young mom kept looking my way as if she were afraid of being splashed or painted when she pushed the carriage out of the shop. This was just after my second aborted attempt to reach the central park. My game was over but she didn't know that. So, we're standing there, me and the young mother, and she had that particular look of fear on her face that mothers of young children show in any kind of dodgy situation, fear not just for themselves but for the defenseless child. Her apprehension was justified. She wasn’t pregnant after all, not about to deliver—and don’t feel sorry for old ladies either, that’s my advice, it may seem harsh but during Blanco y Negro you have to get Granny before she gets you. That's the way it is in this town during carnival: 

If Abuelita can lift a glass of water she’s technically in play, no matter how old. 

If you catch her on the street don’t believe when she says she’s going to Mass, if that’s what she tells you, okay, but she better run because they’re pretty good, those old ladies, they’ve been playing for a while. You see them up on their balconies with a water can and she acts like it’s for the geraniums but that’s not what’s really on her mind. So, like,anyway, about that baby in the betting shop?

Laying there in the stroller looking up, bright eyes, peachy skin, so innocent: As it turned out, they were both lucky, the mom and this kid. There was no ammunition in the shop—no flour or face paint—a bucket of water would have been perfect for the mother, that was my thought at the time:

But what to get baby?

Friday, October 24, 2014

Henrietta Lacks Part 2




Medical ethics have reached a series of critical turning points prompted by technology, money and Ebola and the best you can say is that a few of the turns taken appear to be the wrong ones.
             We're now confronted with the actions of two prominent figures in American healthcare—Dr. Clay Johnston, new dean of the new Dell School of Medicine at the University of Texas in Austin and his former boss Dr. Susan Desmond-Hellmann, the just-appointed leader of the Gates Foundation. These two physicians were apparently the point people as the University of California San Francisco started plans rolling last year to get more black kids for medical research by looking to the darker and poorer East Bay.
            UC President Janet Napolitano recently announced in a talk before the Public Policy Institute in Sacramento (available on YouTube) the “acquisition,” as she called it, of Oakland Children’s Hospital by UCSF which will ultimately serve that purpose whether intended to or not. To recap, last year UCSF’s Clinical and Translational Sciences Institute (CTSI) which is the medical commercialization arm of the university and includes research participant recruitment—then led by Dr. Johnston—was approached by Dr. David Durand, head of pediatrics at Oakland Children’s Hospital with a proposal to increase “catchment,” as Dr. Durand called it, of black children for medical studies. (More recently you may recall Dr. Durand from the nightly news as chief spokesman defending Oakland Children’s during the Jahi McMath fiasco—in which a 13-year-old black girl was left brain dead after entering the Oakland kid's hospital for a tonsillectomy.) The scientific reason for the move to acquire more African-Americans for study was actually explained coincidentally, around the same time, by the chief geneticist at UCSF Dr. Neil Risch, who in written response to questions by Ta-Nehisi Coates of The Atlantic Magazine noted the special value of African-ancestry individuals for medical study: a greater variability of genetic information.
This was also about the same time that Dr. Desmond-Hellmann, known as SDH, who was then UCSF chancellor, implored the public to “share your data” with researchers, during a TedMed talk. In an interview on KQED radio before she left for Gates—joined during the chat by Frances Collins of the NIH and Margaret Hamburg on the phone from the Food and Drug Administration—SDH also noted the bad history of minorities in medical research and now she and Dr. Johnson have just provided one more reason. “Recruitment in San Francisco can be especially challenging,” according to the synopsis of the Oakland Children’s proposal on the website of UCSF’s CTSI, then run by the man who has just been chosen the new UT medical school dean in Austin. “In particular there is simply a limited pool of children living in San Francisco for pediatric studies, as well as a limited pool of African Americans of all ages. Fortunately there is a population of more than 2 million individuals in the East Bay which, for the most part, has not been tapped for UCSF-based clinical trials.”
First there was a "research agreement" between UCSF and the hospital and now Oakland Children’s is being described as “acquired” by UCSF under new UCSF chancellor, Australian pediatric researcher Dr. Sam Hawgood. Last year, at the time of the announcement of the research agreement, assurances were made publicly that Oakland Children's was not being taken over. President Napolitano just said it was. That there is a certain level of shame apparent at UCSF is clear from the fact that the university kept the acquisition off its website. The "research agreement" with Oakland Children's was mentioned earlier this year on UCSF's site—but it was up to President Napolitano to call the transaction what it really was. The institution that was Oakland Children's Hospital is now UCSF Benioff Children's Hospital in Oakland to go along with UCSF Benioff Children's Hospital at Mission Bay which opens soon near the new and extended research labs and where the UC Regents meet in Genentech Hall. The enterprising Dr. Durand now does his magic for UC.
              "Several times we mentioned pediatrics, we mentioned the Children's Hospital San Francisco, the Children's Hospital Oakland," Dr. Deborah Grady, interim head of UCSF's CTSI upon Dr. Johnston's departure said after the latest CTSI retreat, "and I think we need to have a focus on promoting pediatric research to the extent we can." At the retreat the acquisition of Oakland Children's was described as a "leverage opportunity" for CTSI's renewal of National Institutes of Health funding next year; there was talk of apps "for recruiting for clinical trials"; use of local pharmacies to facilitate the outpatient drawing of blood for medical studies; and Bay Area-wide databases on children, Dr. Grady said.
             "We're talking big data in the extreme," Keith Yamomoto who is the UCSF vice chancellor for research told an audience at the Chautauqua Institution a few months ago, also available on Youtube, "data of different kinds in the extreme, imaging through microscopes and DNA sequences, behavior of various ethnic groups in large cities—large and small." The only thing UCSF's majority white physicians and scientists who wish to tap minority health data don't report having done is consulting the community affected, especially blacks who appear to be the main study target of the university. Indeed UCSF has done its best to keep its plans under radar. "There are other UCSF strengths, there are big activities going on right now in precision medicine and if you think about it a lot of what the precision medicine folks need to do or want to do," Dr. Grady said after the UCSF business-science retreat, "is the same thing we've been talking about. They need to have a lot of information on a lot of people, they need it in some uniform way, they need access to [patient] genetics and other [gen]omics measurements."              

 The cynicism apparent in all of this is breathtaking in scope and is a throwback to the Tuskegee experiments of a prior century. Keep in mind that at the same talk when she revealed the Oakland Children's acquisition President Napolitano described UC as the fourth largest medical provider in California and the eighth largest in the country. Healthcare makes a lot of money for the university and privately for many UCSF scientists as well.

 Pediatricians in San Francisco complain that they cannot even get some new-age high-tech parents to vaccinate their children. Mostly white and predominantly affluent parents in S.F. will not offer their kids for medical experiments, so the University of California looked east and took over a hospital that serves lower-income minorities. Nor is it a surprise this is happening at UCSF—perhaps the most segregated campus in the most diversity-challenged major public university system in the country. Bakke or no Bakke, affirmative action allowed or disallowed, UCSF physicians and scientists depend on a pool of lower-income minorities for the raw resources to do their jobs and to instruct the university's healthcare trainees. Even Dr. Johnston in an interview at his new gig in Austin slammed his prior employer's lack of diversity: "I'm certainly not going to defend UCSF and its track record; we both know it needs to be better."
            There's a symbiosis here that's not entirely fair, in fact it's kind of parasitic, you don't even have to consider the creepiness of a headline like "UC targeting black kids for medical trials," what UCSF is offering in return for patient data is actually second-class healthcare. Outcomes for minorities cared for by white providers are statistically worse, a fact that has not deterred the university. The #2 guy on campus Executive Vice Chancellor Jeffrey A. Bluestone, the university's commercialization guru on the pecking order between Dr. Johnston and SDH announced his resignation two days after the real reason for the Oakland Children's plan was publicized. Now the two other doctors who presided over the original reception of the Oakland Children’s expansion have been loosed on other vulnerable populations: Dr. Johnston will be coordinating the new teaching hospital and first medical school in Austin while Dr. Desmond-Hellmann runs the Gates Foundation which does good works all over the world. Bill and Melinda Gates may have actually made the right call by hiring SDH, however.
Potentially the most controllable factor in high healthcare costs are drug prices and before going to UCSF—SDH was Big Pharma incarnate. She was at Genentech for a decade before becoming chancellor at UCSF, and the idea at Gates seems to be that she'll be successful fighting for lower drug prices especially in the Third World because she knows the industry so well. So too she may be valuable in the pharmaceutical response to outbreaks like Ebola.
               SDH knows the industry, certainly—she made tens of millions of dollars from drug development over her time at Big Pharma, only her judgment is in doubt. Now she'll theoretically be working without profit in mind but with Dr. Desmond-Hellmann's history (see prior posting “Choosing Dr. Johnston”) it's probably prudent to wait and see. That argument is much less effective in the case of Dr. Johnston (see prior posting “Choosing Dr. Johnston.”) Like SDH he was also selected by the University of Texas for business ties—he was in charge of research participant recruitment at UCSF, an institution that has become world renown for both good medicine and bad influence by industry. SDH may solve a problem for the Gates Foundation, for all of us in fact. But that Dr. Johnston has come to Austin likely only means creating more of the problems Dr. Desmond-Hellmann is supposed to fix.

Wednesday, October 22, 2014

Choosing Dean Johnston



Earlier this year the New York Times sponsored a conference on the future of healthcare hosted by the University of California’s major healing-arts campus, in San Francisco. The questions were asked by the Times’ chief medical correspondent Elisabeth Rosenthal who trained as a physician and on the dais Dr. Rosenthal recounted a Kafkaesque conversation she had with a UCSF trainee. “I was speaking to a young student, a MD-PhD student who was working on research on Lou Gehrig’s Disease,” she told the well-heeled, medically-literate audience, “and I was all excited to hear about his work, and I said to him, so, you’re going to become a neurologist and he said to me—really seriously, you know—‘No, I just want the patent.’” Seated next to Dr. Rosenthal at that moment was Nobel Prize-winning UCSF neurologist Stanley Prusiner who discovered prions that cause Mad Cow. Dr. Prusiner remained diplomatically silent, at UCSF people like to do their talking in the lab, there’s a lot of investigative audacity but the researchers are not really big on speaking out. Right and wrong on this campus can be kind of like a laboratory test, “right” is what gets results.
The chief of UCSF’s translational science office—that’s commercialization of medical discoveries—Dr. Clay Johnston, another neurologist with an interest in patents was just chosen as dean of the newest medical school in the country, in Austin. Two of the other finalists’ names were accidentally made public and were apparently deans in Houston and in New York, both traditional academics, Clay Johnston is more like a business consultant who helps physicians be “medical entrepreneurs,” that’s the UCSF tradition, moneymaking as much as medicine—and within weeks of the new dean’s appointment the long arm of the University of California business office was already reaching out to the Texas capital. Dr. Maninder Kahlon, Dr. Johnston’s principal deputy at UCSF—after the announcement of the new dean’s appointment in Austin—wrote an email to a S.F.-based company called Practice Fusion that provides an electronic medical record system to physicians. The Practice Fusion service is “free” to the MD but includes advertisements for meds on the screen the physician charts on, keyed to the patient condition: perhaps a Zyrtec spot, a commonly cited example, if the patient has seasonal allergies.
“I’ll put my head together with Clay,” Dr. Kahlon wrote to Practice Fusion’s associate vice president for product development, “to get a sense of when might be good to have a conversation around the Austin opportunity. If readily available, would appreciate any info you have on penetration of PF in Travis County.” Dr. Kahlon is now coming to Texas too. Her new post just hired by Dr. Johnston is Dell Medical School’s vice dean of “partnerships,” Clay Johnston’s right hand from S.F. suddenly reattached in Texas so to speak. UCSF’s medical school is 150 years old this semester and has been doing whatever it does for a long time, long before the modern medical industry like Practice Fusion came into being. One of this biggest and baddest players in Big Pharma today was actually born in a laboratory at UCSF and it’s hard to imagine how this school of medicine—which UT Austin’s new medical program is being patterned after—could be any more tied to industry unless the docs put sponsor’s names on their white coats.
Traditionally the history of UCSF is framed by the number of Nobel Prizes won—that’s the way greatness is measured at the University of California—in this case four, the most recent two years ago for an advance in stem cells. But the university’s modern history actually goes back decades earlier to an achievement that changed healthcare fundamentally yet won no Nobel prize—a lot of the monetary kind though—when two researchers, one from UCSF and one from Stanford University discovered an “easy” way to cut sequences of DNA and reattach them. That’s it. For a moment don’t think about the science which was beautiful, consider the money which was obscene, the Stanford researcher went back to the lab while the UCSF guy found a business partner and started Genentech, the first biotech firm during those heady early days of Silicon Valley—Hewlett-Packard et al, don't you know—the same people who financed H-P also gave upfront money for UCSF’s experimental child Genentech during the beginnings of the venture capital age. The result was a company that was sold to Swiss drug-making giant Hoffman-Roche five years ago for $47 billion, half the average annual budget of the State of California, that’s where the University of Texas entered the picture actually, that year, the year of the big sale of Genentech to Roche. When you hear about new UT Dell School of Medicine Dean Clay Johnston you may think that San Francisco is corrupting our bucolic clean-living hilltop community, here in Central Texas, that’s the expected narrative—but what goes around comes around, eventually—included in Dr. Johnston’s bag on his flight from Baghdad on the Bay to our Hill Country home is bad mojo—bad medicine literally from whence it came.
So, five years ago—the recession hit with a thud, tax revenues down, costs up and tuition rising, to preserve the state’s main think tank and business incubator (the ten campuses of the University of California) the UC regents brought in a new president, from Texas, Mark Yudof. Originally a Philadelphia lawyer, literally—not that there’s anything wrong with that, "Philadelpia lawyer" can have a good connotation or a bad one—Yudof did what the Regents of the University of California wanted, he got the job done. Specifically the old leader of the S.F. campus Nobel winner Mike Bishop was stepping down after a long decade on the job, talking about “a return to the lab,” looking tired and having taken a few hard ethical falls himself, some of it played out in the pages of the Times—that was when Genentech was being sold to Roche. A new head of this healthcare campus to replace Dr. Bishop was needed in the context of a lot less money coming from Sacramento and Yudof turned to industry for a leader, something he learned at the Texas Capitol working for W and then for Rick Perry; at UT Yudof served as enabler in what would later be called the original Perry episode of “crony capitalism.” In San Francisco new UC President Mark Yudof reached out to Big Pharma and found an energetic and charismatic cancer specialist—a former UCSF chief resident and all-around wonder woman named Susan Desmond-Hellmann, SDH for short who was, at that moment, we’re still talking five years ago, 2009 or thereabouts, head of product development across the way at, you guessed it, Genentech. 
 A recent authorized history of UCSF published by University of California Press found that conflict at this campus has most often related to allocation of research money and laboratory space. More recently race, gender and conflict of interest have been big players. Both Dr. Bishop’s chancellorship and SDH’s time at the wheel involved Biblical themes, right and wrong in an Old Testament sense, each period of leadership scarred by one or two major areas of wrongdoing—mixed with good science—Dr. Bishop’s issues being gender and money and Dr. Desmond-Hellmann’s focusing on racism and poor business ethics, mostly her own. SDH did better on the former than the latter and even on the former she didn’t do particularly well, still she proved to be a talented woman, she came back to UCSF, you might say, and did a job, just like Mark Yudof did at the UC president’s office (UCOP) across the bay in Oakland. The intellectual foundation for SDH’s very practical-minded approach to fixing the university’s money woes by selling research and access to research, as if that wasn’t already happening, by getting more study participants as we’ll see—allowing Big Pharma to contract out drug discovery and development, another win-win for the University of California and industry “partners,” Sacramento’s version of crony capitalism, you could call it, San Francisco-styleUC instead of UT—brought to you by the director of UCSF’s Clinical and Translational Science Institute: Dr. Clay Johnston, the new dean of medicine at UT. That would be the narrative outline here and it would be one of many narratives but it would be a pretty accurate description of what went down recently at the campus on Mt. Parnassus in San Fran. From her start back at UCSF this time as chief administrator of what she called “the enterprise,” consisting of the university and the huge and profitable medical center, SDH complained about the school’s endangered financial resources but Dr. Desmond-Hellmann actually had a list of big money backers to die for. UCSF has been the largest public recipient of federal biomedical research dollars in the country for the last few years not just because the university does good science but because the local member of Congress—bringing home the bacon—is House Minority Leader Nancy Pelosi. The university does good science in part because it gets a lot of money to do it. 
The real political power at UCSF is indeed a woman but it’s not Representative Pelosi, not even close, Senior U.S. Senator from California and Chairwoman of the Select Committee on Intelligence Dianne Feinstein who is also a former S.F. mayor and supervisor, Harvey Milk and all that, that DiFiDianne Feinstein's father is said to have been the first Jewish surgeon at UCSF; these ties are strong, and being a UCSF booster also usually means boosting Genentech. The Times outed the company for running a program a few years ago that prompted members of Congress to utter favorable Genentech comments in the Congressional Record. At UC not to be incestuous or anything Feinstein’s husband is on the Board of Regents and was chairman of the board and leader of the search that brought in both Mark Yudof and Susan Desmond-Hellmann, not that there’s anything wrong with that. Regent Blum did a job too, you might say. Janet Yellen, new chair of the U.S. Federal Reserve and probably the single most powerful woman in American government was president of the San Francisco Federal Reserve Bank when Dr. Desmond-Hellmann left Genentech and crossed over to UCSF, and SDH was placed on the advisory board to the San Francisco federal bank. If you had a problem with any of this insiderism—if you wanted to sue the university for ignoring open records requests or charge anyone with a crime like conflict of interest which is where we’re going, yes—there might’ve been a problem until very recently because for the last few years the chief judge of the San Francisco Superior Court has been Katherine Mariano, Dianne Feinstein’s daughter by her first marriage, Judge Mariano left the bench recently announcing she’s going to seek higher office, another S.F. girl making good.
What happens next to Dr. Desmond-Hellmann—earlier this year named CEO of the Gates Foundation—remains pretty much wholly a Bay Area question, one or more of a group of very powerful women deciding whether SDH takes a fall or not. That mostly depends on another San Franciscan, California Attorney General Kamala Harris who during the time in question, circa 2010, was D.A. on the streets of San Francisco—the wrongdoing happened on her watch, so to speak, if there was wrongdoing which it kind of appears there was. It’s by no means a done deal, it has by no means been decided that SDH is going down, with or without others, SDH may or may not have a come-to-Jesus moment like the good Catholic girl she says she is, depending on the University of California’s stroke which should not be underestimated. Kamala Harris’s mom was a professor at UC Berkeley as are Janet Yellen and her husband, everyone promotes his or her own idea of what the University of California represents—usually white, wealthy and well-connected—there’s a lot of talk that UC is bloated too, the Office of the President kind of seen like the Caliphate in old Baghdad, unless you’re powerful or bearing gifts don’t bother to visit. "Right" is what works at UCOP in Oakland, too.
Still the political lineup supporting the university boasts all power players—all power forwards you might say, some of them maybe not so nimble anymore but somehow still fast—who all get significant ball time and usually score for the school, or for themselves. Lately though they’ve made the same mistake that university leaders always seem to make. You would think politicians and college presidents would learn because as has always been true at UC campuses not just Berkeley but also San Francisco: You never want to ignore the students.



So, there was someone coming from Texas, like President Yudof from Austin, specifically, a graduate student who arrived just before the new leadership and would do battle with UC. The student was a nurse and nurses do have a reputation for speaking out. As SDH transitioned into office an incident occurred in an UCSF-run kids clinic.
So, this RN who happened to be an African-American and a guy, not that that’s important, raised the question of race in the clinic where he was doing practice for his degree. His question was—if the clinic was seeing almost all minority children which it was—why were there no Hispanic or black NPs or physicians for a clinic population of almost exclusively black and Hispanic children? That’s bad medical practice by definition today—especially at a big academic medical center where everyone has read the Sullivan report on minorities in healthcare, which dictates good practice today, you just can’t do that, not run an all-white shop. The patient outcomes are statistically worse, enough said, at UCSF they presumably knew this, that's what the brother figured since that’s what they were teaching him in class. 
             The head of clinic, a professor of pediatrics named Shannon Thyne—a white woman whose clinic faculty looked a surprising lot like her, white females—told the RN that she couldn’t “find qualified minorities” and when he didn’t accept that explanation he was failed less than 24 hours after first raising the issue and removed from practice for his degree. Dr. Thyne sought a restraining order to keep him out of San Francisco General Hospital, he was followed on campus by UCSF police and to underscore the university’s point, in case he missed it, his UC Nursing Student loans were called in for payment. The university told the U.S Department of Education Civil Rights Office that the student withdrew himself. That is the UC way, it resembles the Mafia but these wise guys all have advanced degrees.
So, this RN started looking for something—“leverage” you could call it, “ammunition,” others might say—to defend himself after he questioned why the university didn’t want minority providers present for care of minority children. He needed something to get SDH’s attention, so to speak, since right and wrong is the wrong argument to make at the University of California, before they choose sides people at UC want to know what’s in it for them or how much power you can muster. A year later—nothing having been done to return him to classes, the Regents refusing to hear an appeal, saying the Board had no power to intervene—the RN got his hands on SDH’s financial disclosure form and the investments included the name “Altria,” which is the Marlboro brand, not that there’s anything wrong with that, and the description “Tobacco” written in a neat scientific hand, a spelling mistake in one column of tens of millions of dollars in investments crossed out with a single line as required in good medical charting and initialed “SDH”—as an earthquake was about to shake UC System. The nurse looked around, he read the newspapers and both the L.A. Times guy and the San Francisco Chronicle lady covering UC seemed to be in bed with President Yudof. The NY Times got the call. We pick up our story after the shit hit the fan. Luckily for a very embarrassed SDH she got help redefining the issue of conflict of interest in academia, her partner in rewriting the rules once again the versatile Dr. Johnston, new dean at the University of Texas in Austin but at the time chief business guy for UCSF biomedical research.
“Academic institutions have responded to revelations of conflict of interest by setting more explicit policies. These policies include requiring full public disclosure of all financial ties and,” Chancellor Desmond-Hellman and Clay Johnston co-authored in an important opinion piece in Nature written together with Dr. Stephen Hauser, head of UCSF’s Department of Neurology, a researcher who has previously been criticized for catering his research to, yes, Genentech, “setting strict limits on the types of ties and amounts of compensation. However, in the heat of apprehension and sometimes embarrassment, such policies may have unintended negative consequences, driving a wedge between academia and industry. The atmosphere of inquisition has forced distance, with many faculty avoiding contacts with industry in fear of being called out as corrupt.” An atmosphere of “inquisition” these UCSF docs called it, this view echoed by the leader of the national Institute of Medicine’s committee on conflict of interest—a bioethicist who, coincidentally, was also a UCSF MD and who described UCSF’s own standards as exemplary. For his part Dr. Johnston went further out on the proverbial limb defending “business partners,” specifically the biopharmaceutical industry and even upping the ante on what Big Pharma could do.
In a separate article—in a medical review—he argued for even higher drug charges, an uncommon position to take in a country where healthcare accounts for almost a fifth of all spending already and pharmaceutical costs are much of the expense. In the case of someone going to an emergency room with signs of a stroke—according to the pricing scale Dr. Johnston’s advocated in a journal for his medical specialty, neurology—if the patient is given the standard treatment, a med called tPA, and if the medication breaks up the clot and helps the patient achieve, let’s say, 20 additional years of quality life—the med could legitimately be charged for at a rate of $50,000 for each of those additional years, in other words: a million dollars conceivably for a single medicine given in the ER—having your life saved in the hospital and paying for it all your remaining days. That tPA’s sole distributor in the United States is—you guessed it—Genentech was not mentioned directly in the article. (Dr. Johnston's further explanation offered in a written response for this posting: “The paper was meant to encourage investigators to think again about developing better treatments or more effective ways of delivering tPA. Sadly, there are very few treatments that save society money but tPA for stroke is one of them. This opens the door for even better treatments. The paper was derived from a talk meant to encourage more focus on delivering a great drug or creating a better one.”) He didn’t really have to come out and say it, at UCSF you can assume influence by one company or another, it’s part of the university culture—ties to industry are not merely for researchers but the University of California at large which reported $106 million in royalty income last year mostly from medicines and medical devices, UCSF’s contribution beating out Berkeley, UCLA and UC San Diego all of which are also hotbeds of business activity. For UC System the first big money came from defense, weapons and rocket systems and all that, nukes and nuclear technology, prompted in part by the legendary Chester Nimitz who grew up in our own Texas Hill Country, in a German-speaking home in Fredericksburg, and went to the Navy and beat the Japanese and retired to the Bay Area and the Board of Regents—so it’s not like Texans are innocent of what UC has become. A lot of the early defense work was done at Berkeley. UCLA is where they invented the Internet for the Defense Department, literally. Big Medicine came next. New UC President Janet Napolitano who left the White House to replace Mark Yudof just announced publicly the university’s next wave of research, science for science’s sake but also to earn a buck and pay bills—Big Food, capitalizing on California’s premier role in agriculture.
People think of UCLA and Berkeley as the first-stringers in the California system of public research universities but the San Francisco campus actually houses the crème of students and faculty and not just because like cream it's mostly white. Gov. Jerry Brown is said to have had surgery there, Facebook founder Mark Zuckerberg’s wife graduated UCSF med school, how cool is that, and finished her pediatric residency there a little while ago too, allegedly at San Francisco General Hospital, or at least a rotation there, so they say, her time on UCSF’s fog-shrouded Mt. Parnassus campus maybe coinciding with the studies of Al Gore’s daughter. There have long been rumors of preferences in admissions (not to doubt either of these young women’s credentials) but UCSF refuses open records requests about any kind of influence—recent race statistics among faculty and students are also closely guarded and not because they are good. What has been made public seems very connected, very political and very Caucasian in a state that is more than half black and Hispanic—like the healthcare providers in the UCSF peds clinic, where the RN spoke out, a lot of young white females, which is cool too, but not diverse—men are the minority now as trainees and minority men are almost unheard of: UCSF’s student body is officially two-thirds female and at least equally white—instead of the old boy’s network in S.F. these are mostly white women. 
   It's woman power in action and networking up the yinyang whether intentional or not: Anne Wojcicki—estranged wife of Google leader Sergey Brin and founder of genetic testing startup 23andme was appointed by SDH to the UCSF advisory board even though the FDA restricted sales of her genetic tests. There’s actually been a lot of appointing going on, Dr. Desmond-Hellmann was appointed to the board of Proctor & Gamble shortly after coming back to UCSF and just two or three years later chosen for the Facebook board. Not everything has been high connectivity and good times for patients however: A spokeswoman for the California Department of Public Health told reporters during SDH’s tenure that a high error rate by UCSF providers was worrisome and a UCSF surgical team committed the ultimate sin—a wrong side cut—no timeout prior to procedure as required, the incident reported to everyone at the medical center in an email from the chief of staff, with a warning to follow the guidelines in the future, but the Department of Public Health said nobody told them. Last year the Philadelphia Inquirer described UCSF as an example of a hospital with a great rating and yet a reputation for error: an academic medical research institution can be judged by its treatment of indigent patients and lab animals and here, too, UCSF is exceptional in the wrong way. During SDH's tenure and after she had been there long enough to own the mistake the university made worldwide headlines for the second time in a decade for grossly mistreating a wide variety of laboratory animals, among them mammals, including the failure to provide post-operative pain medication—those kind of standards of right and wrong, one of the few critical UCSF reports by the S.F. Chronicle, which earns a lot of money from UCSF advertising. 
But what should have led to departures from UCSF were the plans to use Oakland Children’s Hospital, across the bay, as part of an effort to get more black kids to be medical research subjects. How it all went down is easy enough to explain. But—regarding the Genentech “master contract” that SDH pushed—the context was more important than the crime.



Earlier this year a UC professor at the Davis campus near Sacramento pled guilty to felony conflict of interest for receiving secret research funding from a private company. According to press reports the argument of the University of California lawyers was that there cannot be criminal conflict of interest in research, but apparently the prosecutor and judge disagreed. Which is kind of the situation that SDH finds herself in now. At the time research agreements were made with Genentech, among other agreements SDH reached with Big Pharma, Chancellor Desmond-Hellmann was serving as a paid member of Genentech’s science advisory board, a position that she only left after the black nurse took another look at her financial disclosures and began asking what was up with that.
SDH’s pay from Genentech on the advisory board was said to be fifty large a year—still a small amount for a woman who is a millionaire many times over—she allegedly sold $30 million in stock options when she left The Company, and her husband is also said to be loaded—but not a miniscule amount under law, according to the California Public Reform Act of 1974 as cited by the University of California Office of Ethics, Compliance and Audit Services in a webinar that is available not on UC’s website but on the University of Texas System’s site, part of UC’s efforts to share California’s ethical standards with backward Texans: 
            “The Act requires UC employees to disqualify themselves,” the UC voiceover and Power Point inform us, “from making or participating in the making of any University decision in which they may have a disqualifying financial interest.” So, bottom line, it seems it’s not so much that Clay Johnston came to Austin as that he left San Francisco. Ditto SDH. SDH was out the door one day, right after the questions about Genentech payments—even when the UCSF instructors failed the RN for “communication” they praised his question-asking ability, the problem was actually, you might say, not the questions he asked but UCSF’s answers. Dr. Johnston was out the gate right after SDH, the announcement that he was leaving came like two or three weeks later, max. Suddenly one day too, around the same time, SDH’s name disappeared from Genentech’s scientific advisory board on the Genentech website—and a little later Clay Johnston’s name got chiseled in marble in River City, not that there’s anything wrong with that, first dean of the new medical school and all. A University of California spokesman said recently that Dr. Johnston was not required while at UCSF to file a financial disclosure form, it’s kind of interesting nonetheless that since arriving on the banks of the mighty Colorado River the new Dean of Medicine has been speaking proudly about his work solidifying UCSF’s ties to industry, Pfizer for example, Quest Diagnostics, whoever, but he won’t answer questions about the big G: Genentech is like the third rail at UCSF, there’s a lot of juice running between the two locations but if you touch the connection wrong you get fried.
Dr. Johnston himself seems to be a good guy on a personal level just as SDH is a clever and attractive woman, he’s got a boyish smile, smart and charming, Harvard med school don’t-you-know—he and his wife adopted kids from Guatemala, he likes to tell people he’s a proud dad. SDH and her husband did AIDS research in Uganda when they were young, she likes to say, before she went corporate, before she swore allegiance to the other side of the force and kissed Satan’s ring, so to speak. Dr. Johnston is analytical and thoughtful, talking to large groups his favorite subject is the spread of the American railway network during a prior century, that’s a business model not public health but that’s what he mostly does, business, him and SDH both. They went too far, together or separately in S.F., at the campus on Mt. Parnassus or at the new labs out in Mission Bay. Or across the bay at the UC Office of the President because Mark Yudof is gone too, he resigned for reasons of “health” in the middle of an investigation of his handling of the retaliation against the nursing student, Yudof was swimming in it by then and it was mostly of his own making. (At that point he had twice blocked the black student's access to the Academic Senate, which is a right of all students.) The new UCSF chancellor tried to cover for Clay Johnston et al recently in an interview with the Austin newspaper—spreading it a little thick, yeah, calling Dr. Johnston “one of our top guys, but I couldn’t be more proud of him . . . He’s looked at other top leadership positions in the past . . .” no hint given that anything was amiss in the Bay Area. Something happened in S.F., two people who know for sure are the former chancellor and Dr. Johnston, they packed and left so quickly one after another a good bet is that whatever it was it had something to do with the “acquisition” of Oakland Children’s Hospital, part of UC’s new strategy to lure colored kids for research studies—or something to do with Genentech because everything that happens at UCSF has something to do with Genentech.
It’s a little scary to think of SDH at the Gates Foundation now, she’ll be dealing with vulnerable populations again, she doesn’t seem to have gotten the ethics part down yet as a physician perhaps because they didn’t teach it in med school back in the day. God knows she didn’t learn it during her residency at UCSF or her time at Big Pharma, Genentech nor Bristol Myers Squibb before that. In a way the Gates Foundation makes sense for her—for a women of her talents and abilities—Seattle may be exactly where she needs to be. It’s the foundation’s money after all without much regard to California law. Attorney General Harris not Bill or Melinda Gates holds SDH’s fate in her hands however, Harris was the cop on the beat in S.F. when this all went down, whatever went down, when the Genentech “master agreement” as it’s called, got signed, even if SDH didn’t sign it she orchestrated the action, that’s what they even say on the UCSF website, kudos to SDH, something like that. According to the UCSF's open records coordinator "hundreds" of individual Genentech agreements have actually been executed. That’s presumably what Mark Yudof brought her in for, to do a job, and it’s hard to see former D.A. Harris going after a former member of the first-string girls’ team of which Kamala herself is a big player but it’s not like it’s a difficult case either, except finding out who else was involved, whoever gave the orders. Regent Blum is certainly worth a look but he’s untouchable, he’s a made guy with that wife, he'll never see the inside of a grand jury room—maybe the UC General Counsel or UC “chief of ethics compliance” who was supposed to know better but still approved everything including removal of the whistleblower black nurse. Like Dashiell Hammett first said it in the Maltese Falcon, it's the fundamental question in San Francisco, the same whenever shit goes down, just like in Austin, actually, at the Texas Capitol: Who takes the fall? That is a completely different question from who actually did it. Any investigation would certainly seem to require a talk with the new dean of the Dell School of Medicine, some people might actually like Clay for fall guy, the statute of limitations is running out and soon SDH will be in the clear. 
Susan Desmond-Hellmann appears to be viewed now in San Francisco as suspect, a hard-working and resourceful amateur who didn’t make it as a starter or didn’t last—too many unforced errors, something like that, which is okay because the Regents brought in Janet Napolitano to take her place in the line-up. With or without SDH, Northern California has a pretty strong all-girls team which is very un-Texan and kind of cool. These chicks play hard. In any kind of showdown with any of these ladies a guy is lucky to escape with his gonads intact.
But as was true with SDH—chicks foul out just like guys.



The RN who raised the alarm was ordered to sign a “contract” limiting communication as condition for return to class which he declined. President Yudof refused to release his complete record, including the all-important email which would have allowed him to defend himself. Three UC investigations over the course of three years found nothing amiss—just as the Regents paid $10 million to a UCLA professor of surgery earlier this year not because the university retaliated against him for speaking out about fellow UC surgeons’ ties to industry but, as a UCLA spokesperson explained, to put the episode behind the great school.
Ditto last year when the Regents paid $4.6 million to another professor of surgery, an African-American, for discrimination, UC did nothing really wrong but wanted to move on. At UCSF the only subject more sensitive than conflict of interest is race and the San Francisco campus actually engages in an annual exercise to clear its conscience, a “celebrating diversity” conference in which anyone can come and face the leadership and ask a question: at last count the “chancellor’s cabinet” consisting of one black diversity officer, one Hispanic international health expert and eight white men and women who actually run the medicine and medical research and who all looked extraordinarily uncomfortable sitting there in Cole Hall fielding questions from the audience. (New UT dean Clay Johnston said recently, in an email interview, of diversity at his old gig: “I’m certainly not going to defend UCSF and its track record; we both know it needs to be better.”) At this year’s diversity conference in May, much to the discomfort of the university administration, someone in the audience asked why the University of California always claims to want a diverse body of employees yet it’s always the person you knew at the beginning of the process was going to get the job who does in fact get it. That seems to be a good description how Dr. Johnston got the position in Texas, too.
The year before Clay Johnston arrived in Austin another figure from San Francisco landed softly at the University of Texas: Robert Messing, a UCSF neurologist whose research funding was being phased out in San Francisco was hired by UT President Bill Powers as Vice Provost of Biomedical Sciences. Among Dr. Messing’s first tasks—including getting his funding reinstated—was to lead the search committee for the new medical school dean—a search for that most elusive combination, a “diverse body” of applicants, and still ended up choosing the white guy who had the office down the hall from Dr. Messing at UC San Francisco, Clay Johnston.
Solike SDHDr. Johnston managed a soft landing after leaving S.F., for whatever reason, Susan Desmond-Hellmann's departure from the university may have been soft too but was also sure. She had to go. The new gig is pretty cool running the Gates Foundation and all, maybe she’ll learn compassion working with the good people in Seattle—if not she has some pretty serious explaining to do because at the end of last year while SDH was still UCSF chancellor the Washington Post in a story about Genentech’s pricing strategy for one of its meds highlighted once again Dr. Desmond-Hellmann’s confusion about the difference between right and wrong. The story was actually about two Genentech drugs—Avastin and Lucentis—one that costs $50 and the other $2,000 a dose and both of which do the same job in preventing blindness-causing macular degeneration. So, like, the story was about SDH’s time as Genentech president of product development, 2004-2009, right before she returned to UCSF and the article recalled the extreme efforts she took to push the more expensive drug by misrepresenting the cheaper one.
Not that there’s anything wrong with that.
“When Lucentis did go on sale,” the Post reported, “Genentech’s blockbuster drug already had a competitor [Genentech’s already existing and cheaper cancer drug, Avastin, which worked just as well for macular degeneration.] How could the company convince doctors and hospitals that Lucentis had any major advantage over Avastin? Over and over again [The Company] sought to discourage use of Avastin by raising concerns about its safety. They told doctors that Avastin was not approved by the FDA for use in the eye—Lucentis was. They reminded doctors that if the repackaging firms cutting Avastin into smaller doses were careless, infection could be introduced. And despite the lack of conclusive evidence on the point, they said that Avastin patients might suffer more side effects than Lucentis patients. Sometimes, senior FDA officials said, these warnings stretched the truth.” The named culprit in the misrepresentation in which patients facing blindness were forced to pay $2000 a dose for a med rather than $50 was one Susan Desmond-Hellmann—recently chancellor of the University of California San Francisco and new CEO of the Gates Foundation although the authors of the Post story did not appear to know who she was when they published, in December last year, before Christmas, around when the black RN graduate student was asking about SDH’s continuing paid role at Genentech. Dr. Desmond-Hellmann announced her resignation shortly thereafter, to take effect in a couple of months, seems she wasn’t much seen again on campus after telling everyone she was going, the only thing the University of California fears more than budget cuts is bad publicity. Genentech had stopped selling Avastin to repackaging companies that cut the med into smaller doses, the Washington Post reported, in order to force sales of the 4000% more expensive Lucentis.
“In October 2007,” the Post reported, “the company’s president of product development at that time, Susan Desmond-Hellmann, explained in a letter that Lucentis was already available. Moreover, she said that in a routine FDA inspection of the company’s Avastin manufacturing facility, ‘concerns were raised by inspectors relating to the ongoing ocular use of Avastin because it is not designed, manufactured or approved for this use.’ An FDA ophthalmology official, Wiley A. Chambers, told colleagues that that company had misconstrued the agency’s position. The routine FDA inspection at a Genentech plant, Wiley told his colleagues,” per the newspaper, “was unrelated to the intrinsic safety of Avastin in ophthalmology. Instead, it showed that Avastin had been contaminated by glass particles, a danger that could have harmed cancer patients [for which Avastin was originally created, in another feat of awesome science by a UCSF-trained investigator, working for Genentech] or eye patients. ‘Genentech has found a way to blame FDA for their decision to limit distribution of Avastin,’ Wiley wrote to colleagues.” The result was that Genentech under SDH pushed a med that was 40 times more expensive and no more effective because that math was better for the company, 2,000 dollars a dose versus fifty bucks. During SDH’s time as chancellor an open records request asking if the UCSF medical center itself was using and charging for the more expensive Lucentis instead of Avastin was never answered by her administration. Since then, UC General Counsel Charles Robinson has repeatedly refused to answer the same open records request. In any case, so, like, SDH was toast after that, immediately before or immediately after the Post story ran, before or after the question about the money she was still getting from The Company, from the Big G, UCSF's baby, Genentech. At her new home at Gates, Dr. Desmond-Hellmann has promised to work on reducing drug prices in the Third World, good luck with that, good luck to Africans or whoever ends up working with her, she obviously has the guts to do the job, it’s the heart that’s missing—ultimately the big question is not the money but what to make of Sue? 
She’s just Big Pharma, she never denied that or downplayed her willingness to do what needs to be done. That may be why Bill Gates chose her, it takes a thug to cap a thug, that kind of logic, it takes Big Pharma to negotiate with the drug industry, SDH has some pretty big ones God knows—her courage is not in doubt—it’s her judgment, actually, that’s scary. She was made chancellor because the UC Regents wanted to formalize the marriage with Big Pharma, one side or the other becoming the obedient spouse, the only question is which? The problem for SDH and her colleague Dr. Johnson is that her relationship with Genentech is not her biggest sin.
Those black kids in the East Bay are the ones we really need to worry about.




Before announcing her departure from San Francisco, SDH was speaking on a radio program together with the leaders of the Food and Drug Administration and the National Institutes of Health, in other words the main federal regulators—the only person missing in this clinical trial nexus would have been Julie Geberding, also from UCSF School of Medicine, who was W’s leader of the Centers for Disease Control and runs Merck’s vaccines division now.
So, during previous public chats, among them TedMed conferences “dedicated to ideas worth spreading,” Dr. Desmond-Hellmann encouraged members of the public to “share your data” with physicians and medical researchers although SDH admitted on the radio program, in answer to a question about blacks, “There’s a bad history of clinical trials about minorities.” It’s not hard to see why. Big Pharma’s wish is that black people, especially, will share data—in other words DNA.
Dr. Neil Risch—one of the country’s foremost geneticists and director of the famed Institute of Human Genetics at, none other, yes, UCSF—said in response to written questions from Ta-Nehisi Coates of The Atlantic magazine last year that the attraction of African-ancestry individuals for medical research is a wider variability in some genes, which may ultimately translate into a greater potential for sequencing diseases and preparing medicines than the genes of whites. The late Henrietta Lacks now famous for her cell line (originally ripped off on the East Coast, back in the day) has been put to work in practically every lab in the country and is still going strong. The California Supreme Court ruled that UCLA stole cell lines from a patient, in Moore vs. Regents, but also ruled there’s not much that patients can do about it. That makes taking cell lines even unfairly a potentially good business proposition. This must have been brought home to some of Risch’s colleagues at UCSF last year when the chief of pediatrics at the then-independent Oakland Children’s Hospital across the bay wrote a proposal to UC San Francisco that was reviewed by Clay Johnston’s Clinical and Translational Sciences Institute to increase the “catchment,” that was the word actually used—all of this is on the CTSI website although maybe not for long—of pediatric patients especially African-Americans for UCSF study purposes. One of Dr. Johnston’s major responsibilities at CTSI was not just commercialization but also to increase the number of study participants because there is, after all, little medical research without the public to test it on. Operations were run out of Dr. Johnston’s “Participant Recruitment and Study Management Services.” 
“Recruitment in San Francisco can be especially challenging,” according to the synopsis of the Oakland Children’s proposal on the website of CTSI, then run by the man who has just been chosen the new University of Texas Dell School of Medicine dean in Austin. “In particular there is simply a limited pool of children living in San Francisco for pediatric studies, as well as a limited pool of African Americans of all ages. Fortunately there is a population of more than 2 million individuals in the East Bay which, for the most part, has not been tapped for UCSF-based clinical trials.” “Tapped,” can’t be much more direct than that, the thinking here is that all those digital-age moms and high-tech dads in San Francisco, many of them hipsters or geeks and who have few children anyway and sometimes don’t even want their kids vaccinated, no way they’re going to be medical study participants—but in the historically poorer and darker East Bay, in other words heavily-minority Oakland, black parents will trade study participation by their children for healthcare. That’s the deal, in effect, and it’s pretty cynical any way you look at it. This idea to get more African-American kids was only delayed when the same Oakland Children’s physician who shopped the proposal to Clay Johnston—Dr. David Durand, head of pediatrics at Oakland Children’s Hospital—became embroiled in an ugly national patient rights’ struggle involving a 13-year-old black girl, Jahi McMath, who was declared brain dead after going to Dr. Durand’s hospital to have her tonsils out.
Dr. Durand was suddenly on the nightly news, not in a good way either, the white face of the administration of a hospital that takes care of minority kids, a kind of we-bury-our-mistakes arrogance that didn’t play well for many people black and white—parents whatever their color. Undeterred, weeks later the new UCSF chancellor who succeeded SDH, former Dean of Medicine Sam Hawgood, a pediatric researcher from Australia who approved failing the black nurse for speaking out in clinic and who tried to cover for Dr. Johnston in the interview with the Austin newspaper—Dr. Hawgood completed a research agreement with Oakland Children’s which, among its consequences, will bring a higher flow of African-Americans from the East Bay to UCSF. This isn’t science fiction—it’s hard science and big business. It’s Henrietta Lacks, Part Two.
A switch to kids actually fits most of Big Pharma’s new goals. There’s a lot of money to be made, the basic plan of pharmaceutical giants is now, according to a recent New Yorker analysis, to move away from widely-used blockbuster drugs to costly designer-drugs for less common chronic conditions. That’s no secret—market analysts talk about it openly on television. What isn’t talked about is that children fit some of the best profiles for buying medication because they will take the pills for a long time—into adulthood—allowing Big Pharma to get the most from its investment. That’s UCSF thinking, there are a lot of kids’ conditions out there, the goal may no longer be so much to find cures as to find “therapies” that manage a disease and must be taken and paid for, for decades, hence the UCSF MD-PhD student who told the Times's Dr. Rosenthal that he just wanted the patent. The best example for Big Pharma may actually come from the archetypical kid’s illness, asthma. Once again a location for exploitation is UCSF medicine specifically San Francisco General Hospital, the county hospital of Baghdad on the Bay and for part of Mateo County, a very old-style “treat-everybody” public facility managed under contract by UCSF. San Francisco General’s pediatric research which means UC San Francisco’s pediatric research is now all abuzz—directed at an interesting racial difference that Big Pharma may be able to "treat."
Asthma remains the single most common chronic health problem among children and, per recent UCSF stats, those who suffer most are blacks and whites at about equal percentages but not Hispanics except Latinos from, of all places, Puerto Rico. That’s the buzz. This difference is presumed to be genetic and is being studied at SFGH-UCSF with an eye towards an eventual “therapeutic” because the ultimate goal in UC’s model is commercialization, making money—not that there’s anything wrong with that, the university researchers get a 20-30% cut but the lion’s share of royalties is supposed to go to the university itself, that was Clay Johnston’s responsibility under SDH, under Mark Yudof, and what Dr. Johnston has said he will do at UT too—he plans to get his biopharma on, in River City—which means increased startup activity. Probably he'll also try to get pediatric study subjects (more blacks if possible but black numbers are way down as Austin like San Francisco completes gentrification: ain't no Negroes left, basically, or not enough to tap for industry's needs) and show how to make money from the resulting discoveries. The pediatric patient population at San Francisco General has been used to study asthma—it was in the same S.F. General Hospital kid’s asthma clinic where the Negro RN called the code and Dr. Thyne, a pediatric asthma specialist, who tried to place a restraining order on her last critic, was boss, not that there’s anything wrong with that. Since then she has been busy with, yes, minority children, not that there’s anything wrong with that either, recently co-authoring a paper on genetic differences among kids with asthma—not that that’s creepy or anything, although it is. Kind of. Especially if you believe this isn't being done for the kids it's being done for industry, which it is. Meanwhile, the University of California has taken the next step in Oakland, in the East Bay, after the sad escape of Jahi McMath. In an expanded view of what constitutes a “research contract,” UCSF has brokered the takeover of the whole Oakland Children’s Hospital. In a speech before the Public Policy Institute in Sacramento a few weeks ago UC President Janet Napolitano announced the good news, talking about the move as the “acquisition” of Oakland Children’s by UCSF, the university website doesn’t really say much about the transaction because there’s a charm offensive being waged online right now aimed at black families to get them to UCSF healthcare. The UCSF-Oakland Children's agreement, a highly-redacted version of which was released by UCOP, was signed by Senior UC Vice President for Health Sciences and Services John Stobo who is actually former leader of the University of Texas Medical Branch under then-UT leader Mark Yudof and who Yudof brought with him from Texas where Dr. Stobo got in trouble for steering a contract to a member f his family, out on Galveston Island, at UT Medical Branch—a family member who, also coincidentally, arrived at a healthcare-related private equity firm in the Bay Area about the same time Dr. Stobo arrived at UCOP in Oakland. Not that there's anything wrong with that. Now Stobo runs the eighth largest healthcare system in the country.
What was called Oakland Children’s Hospital a few months ago is now officially UCSF Benioff Children’s Hospital at Oakland, something like that, a mouthful, sister to the new UCSF Benioff Children’s Hospital at Mission Bay in what was the old minority part of S.F., before the hipsters and PhDs arrived. 
             So, the new San Francisco kid’s hospital is opening next to the new research labs in an area at Mission Bay that SDH's publicity people liked to call, during her time on campus, "the biggest medical research complex under construction in the world." You could say she built that too. 
             The “Benioff” in Benioff Children’s is Marc Benioff—not that he’s involved, although the coincidences are, like, once again, pretty interesting—he's founder of Salesforce.com, a tech company that with SDH’s help—another “strategic partnership” for UC, only to pay the bills of course—is becoming the major IT solution for the university. Salesforce.com also gave seed money to found Practice Fusion, the “free” electronic health record that Dean Johnston showed an early interest in for Austin, isn’t that a coincidence, the small world in which we live. 
              Practice Fusion’s other investors include the legendary firm Kleiner, Perkins which also provided up front cash for Genentech, Google and Amazon.com—we’re talking some of the first money guys in Menlo Park, they were there at Creation when God first uttered the words “venture capital”—Kleiner, Perkins did Sun Microsystems too and has been a big part of the history of the digital/medical rich. Now Benioff’s company has just moved across the water to do IT for Janet Napolitano too, in Oakland, the new UC president’s explanation would be it’s all about surviving in an atmosphere of less support from Sacramento—research funding cutbacks from D.C. too, don’t you know? You can’t quite escape the feeling people at UCSF are helping themselves, not that there’s anything wrong with that. The Benioff move appears like a merger—or, that Salesforce.com is somehow grafting its business onto the University of California. Whatever the case UCSF has now reached Texas, actually it was already here, not UC System but specifically the San Francisco medical campus which under SDH opened an office in Dallas to do business with the UT med school in the Big D. Soon, UCSF will be holding sway in the Live Music Capital of the World, UT Austin has asked for and received protection from the Texas Attorney General to keep confidential any new Genentech agreements but that’s not the only way to know some potentially unhealthy behavior is going on. There’s one fact about the hiring of Clay Johnston away from S.F. that’s especially interesting. Make of this what you will. In the recent dispute between a University of Texas regent and UT President Bill Powers, the regent was said to have taken an uncalled for interest in Powers’ wife, an Austin real estate lawyer named Kim Heilbrun. How you feel about what you're going to hear depends entirely on your level of comfort for paranoia.
So, if you’re living in Texas or even in northern California and didn’t see something in the news about the dispute you weren’t breathing, the fight dragged on and on, but a particular detail is crucial that you may not know or may not have heard or cared: It was rumored early on, in this very public argument—that it was somehow “inappropriate” that Heilbrun was Professor Bill Powers’ student at UT School of Law, back in the day, when the couple first hooked up. Like who cares who was sleeping with whom thirty years ago, right? 
            This was three decades ago at UT law school back when Austin was still a small town, when no one was even thinking of a medical school, back when Bill Powers was just a law professor, specializing in business, and Mark Yudof—coincidentally—was the assistant dean of the School of Law, not that there’s anything wrong with that, a fortuitous happenstance nothing more. So, like, it’s hard to see anything wrong with two people falling in love whatever their circumstances—we’re not talking Powers and Yudof, although there may be a man-crush at work there, these guys have always been close, it was Mark Yudof who chose Bill Powers as president of UT Austin after all, not that there's anything wrong with that—but Bill Powers and Kim Heilbrun, husband and wife. Like, who cares right—especially if they have since raised a family together as Powers and Heilbrun have done? But that doesn't mean that the couple’s time together in law school is not of interest in more recent academic history—specifically, the choice of Clay Johnston as first dean of the Dell School of Medicine in Austin.
Genentech already has a presence in Texas, a group of a half-dozen or so lobbyists who represent the company before the legislature. The head guy on this influence team is a lawyer named Randall Erben. “I don’t even know Dean Johnston,” Randy Erben protested recently in a phone call and that may be perfectly true. Again, you have to be conspiracy-minded to appreciate this but it’s actually pretty cool. And really scary.

Randy was in Kim’s class at UT School of Law.

Not that there's anything wrong with that. But that means Bill Powers was one of his professors, right? And Mark Yudof was the assistant dean. That was a while ago, sure, but university records show that much more recently Randy Erben has been invited as a guest to President Powers’ private box at Longhorn games. Like, what do you think?
Is that, like, just a coincidence—or is the public about to get screwed again? 


Edited by Jake Schloss

Schloss.Jake@gmail.com