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Advice and Resources for the Biotech Industry

Advice and Resources for the Biotech Industry

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Summer Reading List 2019

It’s time once again for my annual roundup of some of the best books I read this year. As usual, my focus is mostly on nonfiction tales from the world of science, medicine, and technology. A master list of all books that I recommend can be found here, and you can also check out my previous book recommendations from 2018, 2017, 2016, and 2015.

I couldn’t wait to read John Carryrou’s detailed expose about biotech shooting star Theranos Bad Blood: Secrets and Lies in a Silicon Valley Startup (2018), and it didn’t disappoint. This book recounts all of the sordid details of the company’s meteoric rise and spectacular flameout amid accusations of fraud, intimidation, and paranoia. It’s as engaging a read as you will find in any contemporary detective story. CEO and founder Elizabeth Holmes and her boyfriend/business partner/company enforcer Ramesh “Sunny” Balwani are the villains eventually toppled by investor lawsuits and federal civil and criminal charges. The book traces the early days of Theranos from an idea of Stanford dropout Holmes as it steadily builds itself into one of Silicon Valley’s most valuable unicorns (startups that are worth more than $1B on paper). However, the company had a fatal flaw: it was a tech company with no solid science behind it. The eventual crash and burn was inevitable, but the lies, intimidation tactics, secrecy, and bullying all add up to a terrible tale of talents wasted and patients harmed. Employee turnover was tremendous. Questioning of the company’s efforts to build a blood analyzer using finger pinpricks (instead of venous draws) were met with dismissal. Tremendous courage is displayed by former employees as well as the author, all of whom faced serious threats of financial and professional ruin at the hands of Theranos’s ultra-aggressive lawyers. What really amazed me was how many of Theranos’s investors failed to demand proof that the company’s technology actually worked. Some of them, including individuals (e.g. Betsy DeVos) and organizations (Safeway and Walgreens) lost tens of millions of dollars when this technological house of cards collapsed. The story also illustrates the danger in having a board of directors (made up almost entirely of political movers and shakers) who knew absolutely nothing about science and biotech. It’s a well-told cautionary tale for entrepreneurs, biotech investors, and those who seek employment at these types of companies.

Bad Blood was an entertaining read, but I’d characterize the Pulitzer Prize winning Evicted: Poverty and Profit in the American City by Matthew Desmond (2017) as an important book to check out. It provides a devastating look at poverty in America that’s specifically focused on rental evictions, which financially hammer the inner city poor again and again. This is one of those books that reveal, in gritty details, a seamy underside to our economy that most of us thankfully will never experience. After reading this book I was left wondering how any of the poor ever manage to escape the grinding cycle of poverty into which many are born; the deck is stacked against them in so many ways. The book documents, using case studies and other approaches, the challenges faced by many people (disproportionately those of color) in Milwaukee, WI over a period of several years. There are in-depth looks at the circumstances that led to the eviction of people from various apartments and trailer parks in the North side of the city. The author points out that the numbers are actually far worse that the official statistics would suggest (and those are terrible) because landlords often tell people they have to be out in the next three to seven days, and they leave without waiting for an official court-ordered notice to be issued. Once evicted, it’s a challenge to find another place because most landlords will not accept tenants with a record of evictions. Those evicted wind up cycling between couch surfing/apartment sharing/homeless and bus shelters while trying to find a new living arrangement. This often means calling 70, 80, or even 90 apartment listings before a new place can be found, and this is usually done without benefit of computers. A large percentage of these people are single mothers. Time spent looking for housing often leads to job losses, substance abuse, and arrests. The stress causes chronic health problems, often leads to the making of bad choices, and interferes with the kid’s educations because they change schools many times in a single year. The author ends the book with some proposals on how an expanded government housing voucher program might help solve the problem, and how the root cause of the eviction crisis, and much of poverty overall, is the lack of affordable housing in a large number of American cities. Highly recommended!

Americans dealing with a changing workplace landscape are the folks seen in The View from Flyover Country: Dispatches from the Forgotten Country by Sarah Kendzior (2015). This book is a compilation of essays the author, a St. Louis based journalist, wrote between 2012 and 2014. As a result, there is a bit of repetition between the stories as she returns to topics of interest multiple times. As she describes it, the essays, “cover topics such as the collapse of the US economy, the abandonment of the American heartland, the loss of opportunities for youth, the rise of paranoia and the erosion of social trust, the soaring cost of living, and the transformation of industries like media and higher education into exploitation schemes for elites.” The style is hard and biting, lamenting changes that have eroded the economic lives of a number of Americans by forces beyond their control. While similar books (e.g. Strangers in Their Own Land and Hillbilly Elegy) look at the lives of mostly blue-collar workers, this book is different in that it also looks at the damage done to the highly educated. For example, it describes in a number of essays how the vast majority of university professors are not tenure track employees but adjunct professors. These educators make so little money that many of them qualify for food stamp programs, even years after earning their PhD degrees. The new gig economy and a change in our social climate has brought hardships to many groups, and this book does an excellent job of shining a light on how this has unfolded over the past few decades.

Regular readers know I love a good expose, and another excellent addition to the genre is Shane Bauer’s American Prison: A Reporter’s Undercover Journey into the Business of Punishment (2019). The author weaves two stories together into a very compelling narrative. One is the U.S. history of for-profit prisons, which really took off after the Civil War to exploit prisoners (mostly black freed slaves who had run afoul of the law) by putting them to work harvesting cotton or other crops. He traces this history up to the present day, when companies such as the Correction Corporation of America take over the running of correctional institutions that were previously under state control. They make bids that undercut the price per prisoner that the states were spending in order to win the business. You don’t need an MBA from Wharton to guess that the way they’re going to accomplish this is by cutting costs. That means worse food, fewer guards, less medical care, and deteriorating facilities. Bauer goes undercover and takes a minimum wage job as a guard at the Winn Correctional Center, a Louisiana state prison. His stories from his work time there paint a grim picture of how life in one of these prisons is not only tough on prisoners, but how it extracts a large emotional toll from the guards as well. Highly recommended.

Want to know why you shouldn’t be getting your healthcare advice from Gwyneth Paltrow and her ilk? Are you planning on getting in front of the public to debate vaccines with anti-vaxxers? Check out Paul Offit’s latest book Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information (2018). Dr. Offit is a very well known vaccine expert who led a successful effort to develop a vaccine against rotavirus (which can cause fatal diarrhea). This vaccine is saving the lives of hundreds of children across the world every day. This short book is a fast read and basically covers two ideas. About half of the book explains why much of the information available from people with no training in medicine or science is at best mostly worthless, and at worst sometimes dangerous. He also gives some very good advice for scientists who are planning on engaging with the press to challenge this bad information. Much of this advice is based on his (few) professional career missteps and is meant to guide you to effectively handle (and hopefully avoid) lawsuits, death threats, biased debate moderators, and ineffective arguments from those you engage with.

Why is the middle class falling behind financially in the U.S.? Alissa Quart attempts to answer this question in Squeezed: Why Our Families Can’t Afford America (2018). This book takes a unique approach to answering this question by focusing on particular situations, not on overall macroeconomic trends. Some of the groups that get the authors attention are women who are pregnant or thinking of becoming so, day care workers and nannies, and men who have been forced into the gig economy as their “regular” jobs disappeared. It also looks at how robots will continue to displace workers, and why owning a house has become unaffordable for so many families. Two other topics were of particular interest: first, how being a lawyer, which used to be a ticket to a well-paid existence, no longer is the income guaranteed profession it used to be. Non-tenure track academics are also profiled here as an example of the highly educated yet poorly paid. These are folks with PhD degrees who earn a shockingly small amount of money (about $2,400 on average) for teaching an entire semester college course. Economic inequality gets the blame for much of the decline in the earning power of the middle class. I wish the book had included more citations up front for the studies that provided the data (this is mostly buried in the notes section in the back of the book), and there is an over-reliance on anecdotes to make a case. Overall, an interesting look at what changes in our economic system have wrought.

In a similar vein, I’m also going to recommend Steven Brill’s portrait of America in decline in Tailspin: The People and Forces Behind America’s Fifty Year Fall – And Those Fighting to Reverse It (2018). This book is not an easy read, as it is fact-dense and a bit on the wonkish side. The author covers a lot of territory here, going back to the 1960’s to paint a picture of how American society has gone off the rails, while also describing the efforts to bring it back on track. He finds both major political parties at fault, although most of the blame falls on the Republicans. Much of the focus is on how society has abandoned the poor, and in the process laid the seeds for the degradation of the middle class. The rise of the meritocracy (at the expense of the aristocracy) plays a big role, because meritocracy brought with it many unexpected problems. The role of money in politics is highlighted, as are key SCOTUS decisions, the decline in national infrastructure, the loss of union jobs, and how the minimum wage hasn’t come close to keeping up with the rate of inflation. The book paints a portrait of America in 2018 as not being great, and doesn’t really offer a detailed recipe of how that can be improved. It does point out numerous organizations and individuals who are working to right our dysfunctional ship of state. Exhaustively sourced and notated, the book really outlines the depth of the problem we find ourselves in, and why fixing things will be anything but easy.

The story told in The Good News Club: The Christian Right’s Stealth Assault on America’s Children (2017), by Katherine Stewart, starts off in an elementary school less than two miles from my home. A new after-school program is brought into the school, The Good News Club. It brings the kids all sorts of tasty snacks along with a message that they are sinners who must confess their sins to Jesus and embrace him in order to be saved. No amount of good deeds will get them into heaven if they aren’t saved. Friends who aren’t in the program, well, they’re ticketed on a one-way trip to an eternity in hell. What at first appears to be a rather innocuous program after-school program for little kids turns out to be an educational landing zone for evangelical Christians trying to recruit converts via the nations schools. The book reminded me of Jane Mayer’s Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right. Both books make you aware of an extensive program that’s been going on for years, but so quietly that most people will not have heard about it. The author explains how and why evangelical groups decided to focus efforts to bring new disciples to Jesus from public schools, specifically focusing on kids between the ages of 4 and 14. The book outlines their plans to establish (they would say re-establish) America as a Christian nation. They believe that the founding fathers opposed, not supported, the separation of Church and State, and that prayer should be allowed in schools because, after all, it is free speech. Those who don’t subscribe to their philosophy are clearly seen as enemies, and that includes not only Jews and Muslims, but also Catholics and other Christian groups that don’t share their vision of one nation under Jesus. The story has a bit of a modern political bent in that two members of Donald Trump’s inner circle, Betsy DeVos and Jay Sekulow, are featured players in this chilling tale of the re-education of America’s youth. An eye-opening read.

I really got into Winners Take All: The Elite Charade of Changing the World (2018) by Anand Giridharadas. Well written and with a powerful message. The basic idea here is that big business (referred to throughout the book as MarketWorld) has given up on assuming responsibility on a global level for their actions. In its place they support philanthropic ventures, most of which, as the author points out, are really focused on supporting the mission and actions of these companies. Democracy itself is threatened at times by these organizations, since their leaders were not elected and their decisions extend far beyond their own corporate offices. The power amassed by MarketWorld companies not only contributes to, but also drives economic inequality. The author holds politicians in both major parties responsible for allowing these companies to achieve societal dominance at the expense of all but the rich. The author also looks at the psychology behind this, and how the elite come to justify their efforts. Ronald Reagan argued that Big Government was the principal problem in America that was holding back society, and big business was the solution to the problem and can only be admired. Giridharadas takes the opposite view that government is really the only protection we have from being taken advantage of by big businesses that exploit their workers and often pollute our nation. Discomforting to read, but highly recommended.

Another terrific read is The Poison Squad: One Chemist's Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century by Deborah Blum (2018). This is, in some ways, a prequel to her previous effort The Poisoner’s Handbook. This book fills three niches: it’s a biography, a history, and a cautionary tale about what happens in a world that lacks regulations. There was no regulation of foods or medicines in the U.S. back in the late 1800s. The book details the efforts of Harvey Wiley, who headed up the Bureau of Chemistry labs in the Department of Agriculture, to clean up an ocean of abuses he found in the marketplace. The book details his career investigating just how poor quality many consumer items were in that era. Whiskey, coffee, ketchup, milk, and spices were seldom what they were claimed to be. You couldn’t tell this by reading the labels because they weren’t required to list the ingredients. They were sold to millions of unaware people, many of whom were sickened by them. Foods and medicines were widely adulterated (e.g. formaldehyde added to milk; ground up walnut shells substituted for spices), mislabeled, misrepresented, unsanitary, dangerous, and often contaminated. Efforts to fix this problem were repeatedly beat back by companies that sold these goods with the help of politicians that they supported. Wiley’s efforts were ultimately successful and led to the Pure Food and Drug Act of 1906. The group he led eventually morphed into our modern era FDA. This should be an eye-opener for those folks who want to live in a country unencumbered by regulations and who think we have too many now. Modern consumerism and protective laws had their birth in this era, and that’s what makes this a fascinating read. It’s also extremely relevant to what’s happening today in terms of rolling back environmental regulations to the detriment of all of us.

I’ll also recommend Dr. Peter Hotez’s newest book Vaccines Did Not Cause Rachel’s Autism (2018). Hotez is a long time vaccine expert as well as the father of a 26-year-old girl with autism. This combination gives him some unique insights into debunking the “vaccines cause autism” viewpoint. The book nicely weaves together two different narratives: one is the challenges (and there are many of them) of raising an autistic daughter (now an adult) who still requires a great deal of help from her parents. The other details a look at his academic career in vaccine development, along with a clear explanation for why vaccines don’t cause autism, full stop. Well-written by an authoritative source, this book serves as a guide for deconstructing the arguments of vaccine opponents by explaining why their various theories are simply not supported by facts. The book is an easy read, and even if you’re not interested in the science. It gives a heartbreaking view of the struggles he and his wife Ann endure in dealing with Rachel’s many problems, and their efforts to help her build a good life for herself.

If you’re not afraid of reading books that are depressingly accurate in their reporting, I recommend Beth Macy’s Dopesick: Dealers, Doctors, and the Drug Company that Addicted America (2018). Macy lives in Richmond, Virginia, and the region surrounding her home has been decimated by the opioid crisis. The book mostly focuses on a series of affecting personal stories of young people (and their families), whose lives were ruined as OxyContin and heroin rained an addictive madness across their community. Macy blames much of the problem on Purdue Pharma, the family-owned business that pushed their prescription pills at an astounding rate on the small towns that dot the area. These communities were already hollowed out by job losses in the coalfields and factories that disappeared decades earlier. She shows how area doctors routinely ignored their “first do no harm” professional obligations by writing prescriptions for pills that they clearly knew were being abused. The drug dealers, who also share much of the blame, surprisingly come across as some of the more sympathetic characters. Unlike the drug company and the doctors, they were driven into their actions by a terribly depressed economy that had left them behind as well.

It’s a bit outside of the books I usually recommend, but I’ll add Seattle author Ijeoma Oluo’s So You Want to Talk About Race (2018) to my list. It’s well written, but at times a bit tough for white people to read because it forces you to deal with a reality that is often hidden away in plain sight. It covers a number of racial issues, all of which are worth thinking about and reflecting on. For those of you who think that racism no longer exists in America, this book will explicitly disabuse you of that fallacy. It’s candid and has a number of good suggestions of how to talk with both black and white people about race, and even more importantly, how NOT to talk to talk about certain racial issues.

One more quick recommendation for This Land is My Land: A Graphic History of Big Dreams, Micronations, and Other Self-Made States (2019) by Andy Warner and Sofie Louise Dam. The book features very brief snapshots of numerous efforts throughout history to set up new nations as people sought to build a better society. I had never heard of the majority of these efforts, few of which lasted more than a few years. The abbreviated descriptions are really just an introduction to the subject, many of which are the subject of lengthier books that should prove even more illuminating. Being a graphic book, it’s a quick read.

I’m afraid I can’t recommend Charles Graeber’s The Breakthrough: Immunotherapy and the Race to Cure Cancer (2018). While the author does a good job of reviewing historical research in the area of immunotherapy, I was put off by the poor job done explaining modern immunotherapy treatments. These concepts and details are, no doubt, difficult to communicate to a lay audience, but the explanations here are difficult to follow and at times factually incorrect. I had similar issues with Dave Scadden’s Cancerland: A Medical Memoir (2018; written with Michael D’Antonio). The book is a memoir tracing the author’s career as a scientist physician in the field of hematology/oncology, with a later turn into stem cell biology. He seems like a great, caring doctor, but the descriptions of what he’s accomplished are so watered down for a general audience that it makes the results and concepts difficult to follow.

Also, just a marginal recommendation for Zucked: Waking Up to the Facebook Catastrophe by Roger McNamee (2019). The book provides a good intro into how Facebook was created. The author was an early advisor, and later an investor, for Mark Zuckerberg. Now he’s a big critic of Facebook, Twitter, and Google, citing their monopolistic powers along with a few specific complaints (the clearest of which is the Cambridge Analytica disaster). The book is highly repetitive, short on facts and actual examples, but long on warnings of how AI is going to enable these organizations to dominate the world. Thought-provoking, but not a very compelling argument.

Happy reading!!!