Monthly Rounds (September 2020) - Charity and Capitalism

Hi friends,

Below is my favorite content from September.


As a physician, I am all too familiar with the devastating consequences of the opioid epidemic. What I am not as familiar with is the depth and complexity of the opioid drug trade, and how (and more importantly why) it consumes the lives of so many. This piece about a group of teen wrestlers building an opioid smuggling ring is both depressing and frightening.

“Lance and I decided we needed to get our own oxy scripts,” Dodd recalls. “It was a common tactic used by junkies, to avoid getting busted.” A friend showed the pair how to fake the MRI test: arch your back slightly, twist to apply pressure to your lower spine, and then hold the position while the machine imaged the back. Dodd and the Little General had arrived at the central truth of the pain-pill epidemic: Back pain was difficult to properly diagnose, and the experience of pain was completely subjective. If someone claimed to be suffering, there was really no way to prove they were lying — especially not if the MRI showed any evidence of abnormality.”


For most of us, our material desires in life seem to grow in proportion to our ability to obtain them — earn more, desire more, spend more. But for a select few, perhaps none more notable than Chuck Feeney, there is curiously no relationship between income and spending. The two variables are entirely unrelated.

"The man who amassed a fortune selling luxury goods to tourists, and later launched private equity powerhouse General Atlantic, lives in an apartment in San Francisco that has the austerity of a freshman dorm room. When I visited a few years ago, inkjet-printed photos of friends and family hung from the walls over a plain, wooden table. On the table sat a small Lucite plaquethat read: “Congratulations to Chuck Feeney for $8 billion of philanthropic giving.”

“Chuck was a cornerstone in terms of inspiration for the Giving Pledge,” says Warren Buffett. “He’s a model for us all. It’s going to take me 12 years after my death to get done what he’s doing within his lifetime.”


I loved this piece about the concept of “giving away your legos” as a mental model of how to adapt to change during phases of rapid growth. The people that comprise an early-stage startup are the DNA that will be replicated many times over as the company scales. As the quote below highlights, “early hires plant seeds."

"Google, Facebook and others have all conducted studies about what predicts the performance of a new hire. The single biggest indicator is who they were referred by. If you have high performers referring people, you’ll hire high performers. If you let low performers stay on staff because you’re too scared or insecure to fire them, then you’re building your future company in that mold. Early hires plant seeds.”


I’ve been reading a lot of profiles recently, and I particularly loved this one about Tyler Perry. Before this piece I was unaware of the magnitude of his impact, wealth, and influence in the industry… it turns out he’s a really big deal.

"The 51-year-old entertainer owns the entirety of his creative output, including more than 1,200 episodes of television, 22 feature films and at least two dozen stage plays, as well as a 330-acre studio lot at the edge of Atlanta’s southern limits. He used that control to leverage a deal with ViacomCBS that pays him $150 million a year for new content and gives him an equity stake in BET+, the streaming service it debuted last September. Forbes estimates Perry has earned more than $1.4 billion in pretax income since 2005, which he used to buy homes in Atlanta, New York, Los Angeles and Jackson Hole, Wyoming, as well as two planes….

“I love when people say you come from ‘humble beginnings,’ ” he says. “[It] means you were poor as hell.” It also makes success sweeter. “Ownership,” he adds, “changes everything.”


A fascinating piece on Milton Friedman’s free-market capitalism and how it should be amended in today’s world. Should we shift from “shareholder primacy” to “stakeholder governance? Is greed always good? Should companies have a social conscience?

“The shareholder-primacy view of the corporation — which gives little voice to the workers, customers and communities that are impacted by corporate decisions — has been the modus operandi of United States capitalism. Why did this view become so dominant? One rationale was a practical one. Rather than being asked to balance multiple, often conflicting, interests among stakeholders, the manager is given a simple objective function. More important, though, was the naïve belief, dominant in the Chicago school at the time, that what is good for shareholders is good for society — a belief that rested on the assumption of perfectly functioning markets. Unfortunately, such perfect markets exist only in economics textbooks.”

And from Howard Schultz, "In 2013, I stood in front of Starbucks shareholders and posed this question: “What is the role and responsibility of a for-profit public company?” Friedman’s flawed answer is not his legacy. His legacy is the question itself — which today’s leaders must answer with a renewed commitment to balancing moral purpose and high performance."


As always, I would love to hear updates about your life and what you have enjoyed reading, watching, and engaging with over the last month. If you are free to catch up or reconnect, please reach out. And if you know anyone who else would enjoy receiving these content, feel free to direct them here.