Month: February 2021

Politics, as usual?

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Matula Thoughts March 5, 2021

2987 words

Politics, as usual?

One.

Last month was Lincoln’s birthday and a new biography, Abe by David Reynolds, merits comment. Fundamental issues of Lincoln’s times remain fundamental issues today and Reynold’s book permits you to be a “fly on the wall” in the rooms where consequential things happened. You need not be historian, constitutional lawyer, or elected politician to weigh in on these issues – literacy in today’s complex world is an existential necessity, political literacy for health care professionals in particular. 

Lincoln took office at an extraordinary moment of bitter partisanship and threat to the nation. His first inauguration was preceded by ugly political fighting amidst divisive and turbulent social conditions that Lincoln navigated deftly, although sometimes uncertainly. Many ideologies, “isms” and factions created a toxic climate that divided the nation into uncompromising strongholds of opinions as to which way the country should go. Lincoln was the consensus choice of the voters, but his perceived ideology was contentious to a vocal minority.

A recent article by historian Ted Widmer tells how on February 13, 1860 (a day after Lincoln’s 51st birthday) a mob tried to enter the Capital to disrupt the confirmation of the election. The mob, lacking passes to enter the Capital (and ignoring how American democracy was intended to work with peaceful transfer of presidency), was blocked by soldiers and protested loudly outside the building. Tempers also flared inside House and Senate chambers but American democracy and Lincoln won that day at the Capital. [T. Widmer, NYT, Jan 10, 2021.]

Reynolds argues convincingly that Lincoln distilled the toxic climate of opinions and centered his political course on the central defining idea of the nation as he saw it,

“.. Slavery, he declared in August 1856, ‘should be not only the greatest question, but very nearly the sole question.’ Noting the diversionary tactics of the proslavery side, he stated, ‘Our opponents, however, prefer that this should not be the case.’ He again drove home his main point: ‘The question is simply this – should slavery be spread into the new territories or not? This is the naked question.

Along with the naked question went a central idea. ‘Our government rests in public opinion … Public opinion, on any subject, always has a central idea, from which all its minor thoughts radiate. That central idea in our political public opinion, at the beginning was, and until recently has continued to be, the equality of men.” [D. S. Reynolds, Abe, Penguin Press, 2020, p. 434-435.]

This was a historically sound and prescient argument. Lincoln boiled down the entire national acrimony to the single organizing (and aspirational) principle of the Declaration of Independence – human equality.

Inasmuch as the Declaration was the primary justification for the new nation, it was an obvious corollary for Lincoln that the nation could not be divided, leading him to the famous biblical reference in his House Divided speech of June 1858. 

“ ‘A house divided against itself cannot stand.’

I believe this government cannot endure, permanently half slave and half free.

I do not expect the Union to be dissolved – I do not believe the house to fall – but I do believe it will cease to be divided. It will become all one thing, or all another.” D.H. Donald, Lincoln. Simon & Shuster, NY 1995. p.206.]

For all the subsequent debate over the conflict between the aspirations of the Founders and the ugly facts of “state’s rights” to hold human beings as “property,” the reality is that neither the Declaration nor the Constitution provided for such personal rights to own property in human beings – a concept totally dissonant from the foundational mandate and words of the Declaration.

Both documents had required consensus among all 13 colonies. Three provisions of the Constitution reflected the wills of slave-holding states, yet the document deftly steered clear of asserting any claim to the noxious idea of human slavery itself – “property in man.”

The first Constitutional provision (Article I, Section 2) allowed for congressional representation and apportionment of taxes for the states based on their “respective Numbers” of “free Persons” (these were assumed to be white men only, although that was never explicitly stated) plus:

“…those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons.”

This cynical inclusion gave the slaveholding states the extra edge of additional votes and tax reapportionment for three-fifths of all enslaved persons. Ultimately these provisions were obliterated by the Thirteenth and Fourteen Amendments.

The second provision, another bone thrown to the slaveholding states, came in Article 1, Section 9 but it was time-limited.

“The migration of Importation of such Persons as any of the States now existing shall think proper to admit, shall not be prohibited by the Congress prior to the Year one thousand eight hundred and eight, but a tax or duty may be imposed on such Importation, not exceeding ten dollars for each Person.”

The final provision is in Article IV Section 2:

“No person held to service or labor in one state, under the laws thereof, escaping into another, shall, in consequence of any law or regulation therein, be discharged from such service or labor, but shall be delivered up on claim of the party to whom such service or labor may be due.” 

The framers of the Constitution clearly expected “property in man” to wither away, little expecting the Missouri Compromise of 1820 would allow the inclusion of a new slaveholding state and the Kansas-Nebraska Act of 1854 would allow the “popular sovereignty” of new states to make their own decisions on the matter. Rather than withering away slaveholding was resurgent in the days leading up to Lincoln’s first term and civil war was inevitable.

Lincoln set a course for the war with principle and perseverance, although as it ground on undecidedly, the Union will flagged and Lincoln feared for his reelection. By July 1863 the tide turned, in spite of draft riots in NYC, and Union victories in Vicksburg and Gettysburg fueled optimism. In August the president decided to sit for a picture.

Photographs in those days required long exposures, lasting many seconds or minutes and, as Lincoln sat for a glass plate portrait in August 1863 at Alexander Gardner’s studio in Washington, a fly alighted on the president’s trouser leg below his right knee. Lincoln was unperturbed and continued to sit still for the photograph, without troubling the insect. [Above: Gardner’s photo. Below: detail of the famous fly under Lincoln’s knee on the posterior crease.] 

 

Two.

Health care in Lincoln’s time hardly compares to health care today, but the matters of human inequality in terms of life, liberty, and the pursuit of happiness underpin our modern acrimony just as they underpinned the great national dilemma in 1860, especially so today in matters of health care. [Above: Harper Hospital, original hospital complex in an 1884 drawing  710 of The history of Detroit and Michigan or, the metropolis illustrated …, by Silas Farmer p. 710. British Library.]

In Lincoln’s lifetime it was unusual for a person anywhere in the world to go into a hospital. Medical care was delivered in doctor’s offices, people’s homes, or on battlefields. Hospitals offered very little to their unfortunate patients, aside from a bed. Lincoln died just when the germ theory emerged from Ignaz Semmelweis, Louis Pasteur, and Joseph Lister. The medical world was starting to change. During the Lincoln presidency, Ann Arbor had no hospitals, while Detroit had several, the newest being Harper Hospital, built in 1863, largely to attend to soldiers injured during the Civil War. 

Health care reflects the values and aspirations of economic and political systems of any given community and society. Modern nations seem to be see-sawing between democratic rule and authoritarian/central rule. Yet this is not a simple bipolar contest. Democratic rule provides elected representatives to express “the will of the people” but requires significant central/federal authority that may verge toward authoritarian leadership (as was claimed during FDR’s presidency on numerous occasions). Authoritarian control of a society responds poorly to the needs of the people, stifling education, inquiry, and innovation but is ultimately (and ironically) contingent on acceptance of that authority by enough people in the society (as revolutions have proven again and again). As Lincoln said, our government rests on public opinion. And public opinion should be informed by basic Constitutional literacy. 

A scathing critique of modern hospital care is recounted in the recent small book by noted historian Timothy Snyder, Our Malady. Lessons in Liberty from a Hospital Diary. He offers the provocative opinion that liberty in the political sense and health care in personal terms are directly linked, gleaning that perspective from his near-fatal illnesses and suboptimal hospital care.

“America is supposed to be about freedom, but illness and fear render us less free. To be free is to become ourselves, to move through the world following our values and desires. Freedom is impossible when we are too ill to conceive of happiness and too weak to pursue it. The word freedom is hypocritical when spoken by the people who create the conditions that leave us sick and powerless. If our federal government and our commercial medicine make us unhealthy, they are making us unfree.”

 

Three.

Freedom of enterprise and thought have brought great accomplishments in medicine and science but not a unified system of heath care. We often are told “Our health care system is broken” but the  complaint is not quite right. No purposeful system exists, rather a variety of organizations and systems that have evolved in response to the myriad needs and challenges of healthcare. Each system may work well enough for its purposes and stakeholders, but they function independently, often in competition with other systems and their stakeholders. The common good of the public, individually and at-large, tends to be a secondary concern. The “broken system” complaint, although misconstrued, is relevant and global. The individual patient is the ultimate stakeholder, but gets lost in the systems. 

Health care should be many things – accessible, equitable, effective, efficient, timely, safe, kind, and universal. But it usually falls short. This is obvious to 7 billion people –  advantaged and disadvantaged populations alike. Local, regional, and global inequities are visible every day on public streets or in countless newsfeeds. Even if your individual health care seems secure, it is precarious – predicated on a job, a bank account, health status, social status or caste, location, family member, public safety, and other particularities.

The frameworks of healthcare organizations reflect the values that underpin them in each locality and their nations. Most perform adequately in terms of their business success, some excellently, but few do well in the matters of personal care, coordination, excellence, equity, and value. Business success (revenue optimization) is not the primary purpose of non-profit healthcare organizations. That’s not why society grants them no-for-profit status.

The State of California recently sued Sutter Health for anticompetitive practices that raised the cost of health care in northern California for little reason beyond increase in revenue. 

We, the public, should care about this. Most large health care organizations enjoy the benefit of “non profit” status. The public gives these organizations tax breaks that are not given to “for profit” organizations like Amazon, Exxon, or Johnson and Johnson, that have a central defining objective of maximizing shareholder value. “For profit” organizations of course have other protections carved out by the public, notably limited liability status, that enhance their abilities to succeed in the business world, but “not-for-profits” serve larger public values.

 

Four. 

Management by accounting uses performance metrics and these have spread into the non-profit sector, health care in particular. Metric domination tends to deform missions. When governing boards use performance incentives to inspire a CEO, CFO, or CMO to cut nursing positions, eliminate overtime, or decrease benefits, then those things are likely to happen even if they damage the quality of products, the performance of employees down the ladder, or the culture of organizations. The entire brand of any organization is at risk, not-for-profits especially. Governing boards optimally should govern and not manage (and micromanage) their organizations. They need wise management leaders with holistic (and accountable) reign over their domains in the organization to best advance the mission of the enterprise, which naturally involves financial responsibility but not to the detriment of mission or brand. [Above: bean counting. Illustration from Margarita philosophica, 1503, by Gregor Reisch (d. 1525). Houghton Library, Harvard University.] 

Financial responsibility in health care, essential as it is, cannot not be constrained to the next quarter’s balance between revenue and expenses. Immediate “financial margin” is important, but no less essential are quality, value, stakeholder satisfaction, financial liquidity, investment in enterprise strategy, investment in research and innovation, health care education, debt leverage, leadership succession, community responsibility, workforce health-retention-recruitment, organizational culture, policy development, public health, etc.

Health care is a huge and complex bucket of obligation in the modern world, far too complex for any of its myriad organizations to be primarily managed by key performance indicators or incentive directives.

 

Five.

Presidential inaugurations used to occur at this time of year because slow communications and clumsy political processes of this nation in its earlier history required at least four months from national elections to the peaceful transition of power that distinguished the American experiment in democracy.

The first inauguration, that of George Washington, took place on April 30, 1789, but subsequent ones occurred in March until March 4, 1933, the last March presidential inauguration, when Franklin Roosevelt replaced Herbert Hoover (above) – after a contentious election in the dark days of the Great Depression, but the two statesmen executed a graceful transfer of power in the finest tradition of American Democracy.

New technologies of communication and shortened news cycle in Roosevelt terms allowed inaugurations to be moved to January –  the second inauguration of Roosevelt was the first of these after the Twentieth Amendment to the U.S. Constitution moved the beginning and ending of presidential, vice presidential, and congressional terms from March 4 to January 20.

The past presidential election degenerated into fraudulent claims of voting irregularity, dozens of dismissed lawsuits to overturn results, and efforts to block the transition of power by congressional mischief or threat of armed force. The election results were counted, recounted, inspected, certified, and ligated over two months, but cynics may seek to restore that original prolonged interval between actual election and inauguration to allow more time for shenanigans.

Unfortunately, something so important as political leadership falls into the hands of all sorts of men and women called politicians, whom history proves again and again cannot be uniformly trusted to “do the right thing.”

This ultimately comes down to personal assessment, but what are the right things? Are they the right things for politicians, their constituencies, or the right things for society at large? The answers comes back to the Declaration and Constitution: life, liberty, and pursuit of happiness with Constitutional fidelity. This means fair and equitable education, justice, public health and safety, and opportunity.  Much of this is measurable with public health and safety data, poverty statistics, crime rates, equity in housing and education, and “happiness” ratings such as Likert score surveys.

Roosevelt’s four terms derived from democratic elections and he functioned with a strong hand, discovering new essential federal roles in rebuilding a nation from economic collapse and then guiding it successfully (along with much of the rest of the world’s nations) through a massive war. Hitler, in contrast,  manipulated his appointed position as chancellor into authoritarian rule that precipitated and lost that war, incurring unimaginable devastation in his 12 years as dictator.

Political systems, transcending individual leaders and terms, are essential to carry out the “will of the people” and protect them from threats whether they be human threats, economic threats, biologic threats, or environmental threats. Political literacy is an existential necessity. 

 

Postscript.

On the walls.

Metaphoric elevation of lowly and annoying houseflies (Musca domestica) to miniature sentient journalists imagines the precarious nature of the invertebrate, in imminent danger of destruction by authoritarian swat. [Above: Housefly, Wikipedia.] 

A related metaphor, the bugging of a room, came to life in the real world and literary genres of crime and spy stories. 

After President Obama successfully eliminated an annoying fly during a CNBC interview in June 2009 a number of journalists recalled Lincoln’s greater tolerance in August 1863. The organization People for the Ethical Treatment of Animals (PETA) chastised Obama mildly and sent him a “handy-dandy bug catcher” according to its newsletter Animals Are Not Ours. [Alisa Mullins, “Obama and the fly,” June 17, 2009.] 

This was not President Obama’s last public brush with the unruly insect order, it happened again in January 2013 during a White House briefing when he announced his selections to head the Securities and Exchange Commission and the Consumer Financial Protection Bureau. An emboldened fly briefly alighted on Obama’s forehead, but escaped to buzz another day, although journalists were quick to record the event. Vice President Pence, among countless others, also had his historic moment with Musca domestica, at the October 2020 Vice Presidential debate, once again showing that politicians sometimes tolerate flies on the walls and bugs in the rooms where things happen.

American re-enlightenment. The George Floyd moment of 2020 illuminated much of the American condition from its original sins to present disparities that so impact the aspirations of life, liberty, and the pursuit of happiness.

My friend and Army colleague, pediatric surgeon Victor Garcia, recently sent me a book by a teacher at his alma mater, West Point, Ty Seidule. Robert E. Lee and Me. A Southerner’s Reckoning with the Myth of the Lost Cause. This timely book, explains how attitudes are formed in cultures, how they persist, and how or why they can change. [T. Seidule, St, Martin’s Press, NY. 2021.]

The difficulty of changing beliefs and myths – through rational argument, historical analysis, and scientific process – is an existential challenge that our species seems to be failing. Flies on the walls watch and invertebrates may yet win the day on this planet, even though Homo sapiens is capable of doing so much better. 

Thanks for looking at Matula Thoughts, March 5, 2021.

David A. Bloom

University of Michigan, Department of Urology

 

 

February makes us shiver

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Matula Thoughts 

February 5, 2021

2311 words

 

One.

One. 

February made me shiver…  Of all the songs and phrases that accompany most months, this timely phrase from Don McLean’s 1971 song American Pie echoes especially strongly in the minds of many of us who lived through that era of American political unrest and the Vietnam War. I was a surgery intern in Los Angeles back then when the song was making its rounds and even though I didn’t fully understand all of its imagery, the lyrics and music struck a responsive chord. In fact, I wasn’t clear if it was a musical poem rich in metaphor or a pleasing musical jabberwocky of nonsense.

At eight minutes and 36 seconds, it was a long song but the words were authentic for my generation. McLean was only 26 years old at the time, but nostalgia dominated the first paragraph, celebrating the music of “A long, long time ago” before the cold snap mentioned in the second paragraph, “But February made me shiver,” referring to the plane crash that killed legendary singer Buddy Holly on February 3, 1959. McLean’s phrases and tune come back to me every year at this time. [Above: Don McLean singer. Below: Donald Maclean surgeon, UM Bentley Library.]

 

Two.

Another Donald Maclean (1839-1897), a surgeon unrelated directly to the singer, played an important part in the story of Michigan Medicine. Born in Canada to Scottish parents, this Maclean attended Kingston College in Ontario. He studied medicine in Edinburgh, Scotland and fell under the spell of the great surgeon and teacher, James Syme, who had earlier taught Joseph Lister (Syme’s daughter Agnes married young trainee Lister). Maclean returned to Kingston as professor of surgery but came to Ann Arbor in 1872 as fifth sequential replacement for the founder of UM surgery, Moses Gunn. Unlike the previous short-term intermediaries, Maclean had staying power in Ann Arbor, lasting until 1889 and teaching a generation of UM medical students in the Pavilion Hospital, including William Mayo (UMMS 1883). Just as his predecessors in the Ann Arbor Surgery Chair, Maclean managed his private practice in Detroit and commuted by train to Ann Ann Arbor for classes and teaching demonstrations. Accordingly, Maclean was one of the strong voices who wanted to move the clinical teaching programs and professional practices of the UM medical faculty to Detroit with its larger population and relative abundance of hospitals.

Dean Vaughan, university president James Angell, and the UM regents had a contrary vision of retaining the medical school, clinical practice, and hospital in Ann Arbor, so when the issue came to a head, Maclean and the other “exiteers” were no longer welcome on the faculty. It was at that point that UM established a “full-time” faculty position and university clinical practice for its next chair of the Surgery Department, Charles de Nancrede, who would serve from 1889 to 1917. The university also recognized the need for a more modern hospital facility, and that opened on Catherine Street in 1891, although it quickly proved inadequate for the needs of the times. After de Nancrede retired in 1917 Cyrenus Darling provided a weak interim period of leadership until 1919 when the next chair would be the celebrity urologist Hugh Cabot.  

 

Three.

A paradigm shift occurred between the eras of surgeons Donald Maclean and Hugh Cabot in Ann Arbor. It actually wasn’t such a terribly long long time ago in the grand scheme of things although, to contemporary medical students and trainees, Maclean’s era certainly must seem to be the distant past. Actually, that was the time of my great-great-grandparents. 

Horace Davenport, UM’s great physiologist and historian of the Medical School, uncovered representative surgical cases of Maclean at UH in 1881-1882, that were published in Physician Surgeon by Maclean. The range of procedures is remarkable considering that Maclean was the sole surgeon and the surgical facilities in the Medical School and Pavilion Hospital were rudimentary. Maclean’s attention to reporting of results, although also rudimentary by today’s standards, was laudatory for his times. [D. Maclean, “A tabular statement of the surgical work done in the Department of After Maclean 1881 and 1882,” Physician Surgeon, 5 (1883): 387-396.] [H. Davenport, Not Just Any Medical School, p. 20.]

The astonishing paradigm shift that followed Maclean delivered surgical (and medical) specialization to mankind and the first steps of minimally invasive surgery – most widely and effectively evidenced in the urology arena.

Hospitals that were once dormitories for the sick became complex healthcare factories with a multiplicity of diagnostic and therapeutic capabilities. Costs escalated greatly and new parties eagerly began to divide up the monetary pie of health care. Research embedded in medical schools and hospitals generated new knowledge and tools. Medical education expanded from four years of medical school to internships and residency training programs equivalent in length of time or greater than that of medical school. Teams replaced individuals as health care providers. Public health joined with individual health care as responsibilities of modern societies and myriad systems (small practices, community health centers, medical centers, and large healthcare networks) self-assembled to create the modern and postmodern meta-systems of health care in the U.S., Canada, and other nations of the world.

 

Four.

Hospitalization today is a commonplace phenomenon. In Maclean’s time hospitalization was unlikely for an individual in their lifetime. In modern times, however, most people in industrialized nations are likely to undergo hospitalization at some point in their lives for childbirth, surgery, trauma, cardiopulmonary conditions, infectious diseases, or a wide variety of other conditions.

A friend endured a difficult (non-Covid) hospitalization this winter, emerging successfully but not without much suffering, a number of failed communications, fumbled hand-offs, and errors. All that that provoked another friend to make the common observation that “the system is broken, and broken beyond repair.” Happily, our first friend (the patient) made it home, even as the concomitant covid syndemic exploded, driving UM and St. Joe’s daily inpatient Covid patients above 100 each for the first time since spring. 

I feel responsible for our organizational imperfections my friend endured, even though I’m no longer in a position of organizational responsibility. When our Faculty Group Practice (FGP) evolved in the early 2000s I believed that our new UM clinical leadership structure could provide the best hope for aligning the complexities of modern health care to the triple academic mission while taking into account the harsh economic marketplace and changing public policies. Now, as our FGP has become the UM Medical Group (UMMG) under the banner of Michigan Medicine, I still believe this is true, although we have a long way to go, as evidenced by my hospitalized friend. 

After I apologized for our systemic imperfections of fumbled “hand-offs” and glitches in processes of care to my friend and his family, I reflected on the common phrase that “the system is broken.”  The sad familiar phrase is nonspecific and unhelpful – what actual system was being referenced as broken? It’s almost like observing that the planetary environment “system” is broken, which may well be true, but doesn’t offer much help in solving the universally recognized problem. More accurately, many systems actually work very well, but mainly in serving their own particular needs rather than needs of individual patients and the public at large. 

The vast array of enterprises and systems in national health care are variably interconnected, but not united operationally to produce the purposeful and elastic system that we crave. The idea of a single centralized (governmental) system to fulfill the myriad needs of a nation’s health care is not easily imaginable when it comes down to specific functions, in fact that experiment has been tried and failed in 20th century China and Soviet Russia. It doesn’t seem reasonable to think we could build (even with Artificial Intelligence) a systemic set of rules, laws, and organizations to deploy the myriad aspects of personal and public health care, accounting for the needs of workforce education, research, innovation, public policy, crisis preparedness, safety nets, private sector, and professional organizations. 

We presently witness the astonishing multinational development of multiple effective vaccines in response to the global pandemic, decelerate in the implementation phase with clumsy national and local policies, supply chain issues, political rhetoric, false narratives, vaccine deniers, and worldwide healthcare disparities resulting from poverty and racism. A tiny virus has thrown every national and health care system into states of confusion and exacerbated the known inadequacies and disparities.

 

Five.

Making health care work. The charge that “our system is broken” is aimed most acutely at the fundamental parts of health care – the delivery of individual ambulatory and inpatient care, while supporting the public health of a population. It is a certainty that any given integrated organization, such as Michigan Medicine, can go a long way toward making health care work better and more fairly for their individual patients, workforces, and regional stakeholders. 

The operation of a large regional health care system such as Michigan Medicine is not amenable to any algorithms known to mankind.  Expectation that artificial intelligence might provide efficient and humane central management will likely be disappointed, just as other exclusive central systems failed to provide societies the full range of health care in its particular clinical, public, educational, investigative, and innovative dimensions. It’s difficult to identify any society that has pulled off this pent-fecta, although it’s not for lack of trying. For now, the best hope is management by teams that distill content expertise of specialties and stakeholders, to aligning them to the needs of the individual patient, the public health, and the larger aspirations of society. 

It was big news at UM in Ann Arbor in mid-month when David Miller was named as President of Michigan Medicine, taking over from David Spahlinger, who had done great service in the role of President of UMHS and Executive Vice Dean for Clinical Affairs, a position he held in its various names through two decades of astonishing change and growth. [In modern health care camouflage: above David Spahlinger and below David Miller and Justin Dimick.]

 

Postscripts. 

Another Donald Maclean (1913-1983) evokes the spirit of the late David Cornwall. This Maclean was a member of a Cambridge spy ring that passed British and American secrets to the Soviet Union in WWII and during the cold war. The Gaelic surname in its various spellings means alternatively ‘son of Gillean’ referring to Gillean of the Battle Axe of Ireland around 1200 or ‘servant of St. John.’ The Scottish Clan MacLean has been powerful throughout the history of Scotland and all the MacLeans, Macleans, McLeans, McCleans, McLaines, and McClains may well derive from a single mitochondrial mother “Eve.”  [Below: Donald Maclean the spy, Wikipedia.]

Maclean made headlines in 1951 when he exfiltrated to the Soviet Union, along with fellow conspirator Guy Burgess, and they would be followed in 1963 by Kim Philby. Maclean’s family accompanied him to Moscow but after an affair with Philby, Mrs. Maclean returned to the West 1979, dying in NYC in 2010. The three Maclean children each married Russians, but all subsequently also returned to the West, leaving their father behind, working as a foreign policy analyst at Moscow’s Institute of World Economy and International Affairs. He died, reportedly of cancer at age 69, and was cremated and honored in Moscow in 1983.

A Fourth Man, fellow spy Sir Anthony Blount and art historian and Surveyor of the Queen’s Paintings, stuck it out in England and was unmasked in 1979, but lost only his knighthood. The Cambridge Four later turned out to have been the Cambridge Five, after John Cairncross (code-named Liszt) was confirmed by KGB defector Oleg Gordievsky in a 1991 interview as the Fifth Man. Cairncross, a literary scholar from Cambridge had previously been known as an atomic secrets spy, confessing partially in 1951 and losing his civil service job. He moved to the U.S. as a lecturer at Northwestern and Case Western Reserve, where he confessed more completely in 1964 to British investigators who had opened his case after Philby’s defection. Cairncross moved to Rome in 1967 to work for the U.N. and then in 1970 to Provence, France. He died in England in 1995. 

These convoluted truths may seem stranger than fiction, but made for great stories from the late great spy novelist John le Carré, the pen name of David Cornwall (19 October 1931 – 12 December 2020) in the enduring tales of George Smiley and other memorable protagonists.  

 

February each year manages to get the work of a month accomplished in fewer days than the other longer months. This, of course, is a hyperbolic thought, as if a month is a purposeful agency instead of an arbitrary block of time. Yet, this playful conjecture is an inverse run of Parkinson’s Law by which work expands to fill the time or other resources available for its completion.

Parkinson, a British naval historian and academic in Malaya, in his later career, wrote a short piece in the Economist in 1955 that he expanded into a book in 1957. He thus fulfilled his own law –  expanding words rather than more vaguely defined work – to explain the same idea of Parkinson’s Law, laid out in the brief Economist article, later in his book.

Like most rules of organizational theory, Parkinson’s Law needs to be taken with the proverbial grain of salt, although Parkinson took it pretty far, mathematically modeling it out based on an analysis of the British Admiralty staff from 1914-1954. He considered how the administrative staff grew inexorably, unrelated to number of commissioned ships, wars, or other obvious factors: more personnel, but no additional work. His formula predicted that management staffing increased annually on an average of 5.75% (with a modeling range of 5.17 to 6.5%) regardless that the amount of work was static, without annual increase, but factoring in ages of appointment and retirement, and man-hours required for communication among personnel.

Parkinson’s self-styled rule, was greatly (but not entirely) satirical, much like Willie Sutton’s rule for success (go where the money is) or Robert Sutton’s organizational No Asshole Rule (don’t retain “jerks” in the organization) for successful teams.

 

Thanks for reading Matula Thoughts, this February 2021.

David A. Bloom, University of Michigan, Ann Arbor