Supply Chain Failure 1: Medicine

We will have a second part to this type of supply chain problem.  Our subject for the moment is prescription medications, which in the United States where increasingly any one type of drugs is often only sourced from one provider.

A secondary issue of this concentration, is that it makes regulators job much more difficult because if they try and stop eggregious practises they risk the entire product chain collapsing.

Shortages of Key Drugs Endanger Patients

Rob Stein, Washington Post, 26 April 2011

A record 211 medications became scarce in 2010 — triple the number in 2006 — and at least 89 new shortages have been recorded through the end of March, putting the nation on track for far more scarcities.

The paucities are forcing some medical centers to ration drugs — including one urgently needed by leukemia patients — postpone surgeries and other care, and scramble for substitutes, often resorting to alternatives that may be less effective, have more side effects and boost the risk for overdoses and other sometimes-fatal errors.

The causes vary from drug to drug, but experts cite a confluence of factors: Consolidation in the pharmaceutical industry has left only a few manufacturers for many older, less profitable products, meaning that when raw material runs short, equipment breaks down or government regulators crack down, the snags can quickly spiral into shortages...

“The types of products we’re seeing shortages of are really concerning,” said Valerie Jensen, who heads the FDA’s Drug Shortages Program. “This is affecting oncology drugs, critical-care drugs, emergency medicine drugs. We’re doing everything we can under our current authority to try to deal with this situation.”

Practise and the fear of failure

The ceramics teacher announced on opening day that he was dividing the class into two groups. All those on the left side of the studio, he said, would be graded solely on the quantity of work they produced, all those on the right solely on its quality. His procedure was simple: on the final day of class he would bring in his bathroom scales and weigh the work of the "quantity" group: fifty pound of pots rated an "A", forty pounds a "B", and so on. Those being graded on "quality", however, needed to produce only one pot - albeit a perfect one - to get an "A".

Well, came grading time and a curious fact emerged: the works of highest quality were all produced by the group being graded for quantity. It seems that while the "quantity" group was busily churning out piles of work - and learning from their mistakes - the "quality" group had sat theorizing about perfection, and in the end had little more to show for their efforts than grandiose theories and a pile of dead clay.

From Art and Fear, David Bayless and Ted Orland ht LW.

The obvious caveat that the cost of practise cannot be too high.  You probably don't want to try the throw it against the wall and see what sticks methodology with skydiving.  When you have practise with a potential for severe negatives (football, skydiving, live-round combat) there is likely to be a point of diminishing returns on the more costly forms of practise.  Thus football teams don't practise full contact every day.

Back when I was in Junior High, I did play for a football team where the coach decided to toughen us up by full contact practise all week.  Some of our already mediocre talent was hurt and we still were not very good:  but it was fun.

Osama bin Laden, master preparer, is dead

Osama bin Laden is dead, Obama says, the CNN Wire Staff , May 2, 2011 12:39 a.m. EDT

The mastermind of the worst terrorist attack on American soil is dead, U.S. President Barack Obama announced late Sunday night, almost 10 years after the attacks that killed more than 3,000 people.

Osama bin Laden -- the longtime leader of al Qaeda -- was killed by U.S. forces in a mansion outside the Pakistani capital of Islamabad along with other family members, a senior U.S. official told CNN.

U.S. officials have taken custody of bin Laden's body, Obama said. No Americans were harmed in the operation, he added.

I had just seen a piece that went over his detailed preparations prior to the U.S. invasion of Afghanistan.

Bin Laden's great escape: How the world's most wanted man made fools of elite troops who'd trapped him in his mountain lair, Guy Walters, The Daily Mail,  April 30, 2011.

Ben Laden had chosen his redoubt with care. For several years, Bin Laden had developed an intricate network of caves and dwellings 14,000ft up in the White Mountains, in a settlement known as Tora Bora.

‘I feel really secure in the mountains,’ he told a Palestinian journalist in 1996, and he had good reason.

Bin Laden knew that if the Americans managed to track him down, his hideout — so high up in the almost impenetrable mountains — would be hard to attack on foot, while the deepness of the caves protected him from the air. Furthermore, as Tora Bora was just a few miles from Pakistan, he would easily be able to escape as Western troops closed in.

In preparation, Bin Laden had spent hundreds of hours exploring the area on foot, much to the annoyance of some of his 11 sons, forced to accompany their father on his grueling 14-hour treks. Years later, his son Omar bin Laden recalled: ‘My brothers and I all loathed these treks that seemed the most pleasant of outings to our father.’

He was able to greatly outlast another former ally of ours.



Tora Bora



Collapse of Illusion

Daniel Boorstin The Image: A Guide to Pseudo-Events in America, 1958.

We risk being the first people in history, to have been able to make their illusions so vivid, so persuasive, so ‘realistic,’ that they can live in them.  We are the most illusioned people on earth.  Yet we dare not become disillusioned, because our illusions are the very house in which we live, they are our news, our heroes, our adventure, our forms of art, our very experience.

We are haunted, not by reality, but by those images we have put in place of reality.

I would add that in the decades that have passed, that most of the rest of the world has joined us.

Were we once had heroes, we now have celebrities.  George Washington was celebrated because he was a hero. We do not have many people left who we celebrate for the bravery.  We celebrate the famous, the wealthy, and the powerful.

Wounded marines booed and hissed John Wayne when he visited them in a hospital in Hawaii during the Second World War.   Wayne, who never served in the military and for the visit wore a fancy cowboy outfit that included spurs and pistols, would later star in the 1949 gung-ho war movie The Sands of Iwo Jima. The marines, some of whom had fought at Iwo Jima, grasped the manipulation and deceit of celebrity culture, and social control and elicits behavior that is often self-destructive. from  Chris Hedges Emprie of Illusion.

To us, the image of booing John Wayne is odd.  Most people veiw him as a partriotic archetype.  But the reality is that he was a movie actor.  The heroics he portrayed, were the sanitized heroic of others.  He needed them; they did not need him.