Mini-Book Review — Midler — Poorly Made in China

Midler, Paul, Poorly Made in China: An Insider’s Account of the Tactics Behind China’s Production Game, John Wiley 2009, 241 pp.

Paul Midler began his academic career in Chinese history and literature and then went to Wharton for an MBA and further graduate work in East Asian business. Fluent in Chinese, over the past ten years he spent his time in southern China working as a consultant to American importers and was witness to the economic boom that’s amazed the world.

This book, however, is about all the other things he witnessed … the methodical transfer of technology and profit to Chinese manufacturers and the methodical transfer of risk, liability, and innovation/marketing/design costs to American companies. “Poorly Made” is a master class in how ill-equipped American companies are to operate in “low circle of trust” cultures … even when those American companies are managed by savvy mercantile clans and even organized crime!

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Bubble-icious — American History and Political Subsidies

As someone who’s written several times (here and here) about the course of modern health care (its inherent complexity and cost), I’ve been watching the latest moves in US health care funding with a great deal of interest.

From the introduction of antibiotics to the breakthroughs in transplant surgery, medicine in the 20th century was in a position to provide dramatic improvements in health care (both quality of life and length of life) at relatively modest cost. Many consider it a golden age in medicine. My personal belief is that medical care is about to hit another burst of creativity and success (but at much higher cost-to-benefit) as non-invasive imaging, micro-surgery, diagnostic testing, and DNA-propelled pharmaceutical customizations kick in. I may be wrong, but I think my beliefs are a reasonable extrapolation of the trends in medical care since the end of the 1970s “silver bullet” period of medicine.

So what do my guesses about modern medicine mean in a new era of greater tax subsidies for US health care? An era which, by necessity, must politicize health care further. It got me to thinking about the hidden subsidies during earlier periods of American history, powered by the domestic political systems of the time, and driven by citizen/voter appetites. And it got me thinking about the law of unintended consequences.

After a few minutes scribbling on the back of an envelope, I came up with the following:

US Bubbles Over Four Centuries

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Mini-Book Review — Smith — The Strong Horse

Smith, Lee, The Strong Horse: Power, Politics, and the Clash of Arab Civilizations, Doubleday, 2010, 256 pp.

Strong Horse is a series of conversations, observations and recollections of the author’s experiences in the Middle East over the last decade … focusing on Cairo, Beirut, Israel and Damascus. Living in Brooklyn, Smith took the events of 9/11 as a personal challenge to study in the region. That led him to discussing the political and social culture of the Arab world with individuals as varied as Sufi scholars, Koranic recitators, Lebanese Druze warlords, and Cairo doormen … engaging as well with more famous names such as Naguib Mahfouz (Egyptian Nobel Laureate in Literature), Edward Said, Omar Sharif, and Natan Sharansky.

As the title of the book suggests, Smith feels the conflicts of the Middle East are largely an internal clash of Arab civilizations and involve the “captive” peoples (Copts, Druze, Christians, Jews, Sufis, Shia, etc.) who must somehow survive with Sunni majorities and governments in the region. The spillover of violence into the West, while constant, is therefore largely a secondary effect. The key question, the author believes, is over “who’s the real Muslim?” Since that bloody debate, by definition, doesn’t extend to the infidels, violence in the non-Muslim world is usually some form of manipulation in benefit of domestic agendas. The evidence of the last decade suggests the Arabs reserve the lion’s share of their bile and violence for each other. Though they provide unrelenting warnings about the dangers of inciting further violence by Muslims (through American actions in Iraq and Afghanistan), such concerns never seem to translate into a lighter hand by authorities within the region. It is this observation which leads Smith to propose that “strong horse” politics was, is, and will be, a enduring principle in the Middle East … and widely supported by Arabs of every persuasion.

For Smith, Arab antagonism to Americans and Westerners is fundamental, being as they are neither Muslim nor, more importantly, Arab. The various Arab tribes and sects who feud endlessly amongst themselves do not permit any profound reconciliation with the Other, either across the religious and ethnic boundaries or within them. Muslim willingness to leverage Western allies against other Muslim powers is built right into Islamic history, as outlined with methodical effort in Efraim Karsh’s Islamic Imperialism: A History, reviewed earlier on chicagoboyz here.

The author’s conclusion after his travels and conversations over the last decade is that “overthrow, domination, and eventual collapse” is a political pattern long established amongst the Arab tribes, largely reinforced (not introduced) by Islam, recognized for over half a millennium by Arab historians, and it shows little or no sign of change in the 21st century. The strong horse is the model for successful political change in the region. It was not chosen as a metaphor by Osama Bin Laden on a whim. And it resonates deeply within Arab culture. It is the aspiration of all participants in the political process in the Middle East, in Smith’s belief … and any discussion of peace (as opposed to interim truce) is a form of cultural betrayal. And punished accordingly. Despite the fact that this cultural habit reiterates destructive cycles without end, it cannot be relinquished without giving up a fundamental cultural narrative. The toxic results are self-evident to modern Arabs but if Smith is to be believed, they are caught in a situation where all they can do is “double down” on the model of political change that has served them very poorly in the past. Struggling to cope with the impact of two centuries of Western technology and culture, the Arab hope is that an Arab Strong Horse will arise. The reality is that it is the United States, and inadvertently Israel, that have found themselves in the role of Strong Horse in the Middle East. The burden of the role is that all parties in the region look to gain favor and/or manipulate the destruction of their domestic and regional competitors by playing games with the Strong Horse. As Smith quotes in passing, Arabs are better at feuding than warring. At the point at which they are able to escalate conflict to war, inevitably it is their culture and self-regard that pays the price. What was true of Napoleon in Egypt is now true of America in the Middle East.

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Mini-Book Review — Groopman — How Doctors Think

Groopman, Jerome, How Doctors Think, Houghton Mifflin, 2007.

This book is several years old but deals with timeless subject matter that might be of interest to cb readers. In the past decade or two, a major initiative called evidence-based medicine (EBM) has tried to improve how medical research is conducted and how it is used in everyday clinical practice. It’s the application of the scientific method (with all its strengths and weaknesses) to confirming how we know what we know about medical practice. Some examples of such efforts “organized improvement” were covered in a book I reviewed earlier on cb called Better: A Surgeon’s Notes on Performance by Atul Gawande. Like Dr. Gawande, Dr. Groopman writes extensively for the New Yorker. The resulting quality and clarity of his writing in How Doctors Think stands out. Either he or his editors are very good.

In How Doctors Think, the author looks at a very different avenue of medical improvement. Deductive, evidence-based, medicine necessarily involves many patients and the careful collection of information about how a treatment works for large numbers of people. This is the foundation for proving the efficacy of particular treatments for particular populations, and winnowing out cases where doctors are “fooling themselves” about their treatment. Not fooling ourselves, as physicist Richard Feynman once pointed out, is one of the great challenges of science. The folks doing EBM research always give themselves a good laugh by evaluating the mathematical and statistical skills of the average GP. Interpreting the scientific medical literature is a real skill. One that needs to be taught and reinforced. As a baseline, we can aspire for a medical profession that can dependably read, critique, and interpret its own research.

The inductive process of forming a diagnosis and executing treatment with a specific patient benefits mightily from the disciplined research of EBM, but it by no means replaces the services of skilled physicians. Checklists or AI applications in medicine can reduce egregious errors, but human judgment, matched with experience and rigorous thinking, are necessary components of health care. And that’s the focus of Groopman’s book.

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Mini-Book Review — Easterbrook — Sonic Boom

Easterbrook, Gregg, Sonic Boom: Globalization at Mach Speed, Random House: 2009, 243pp.

Sonic Boom falls within the genre of the quick-reading airport business book. Using a series of places as exemplars (Shenzhen, Waltham MA, Yakutsk, Erie PA, etc.), the author shows how a globalized economy can create prosperity from swampland, and restore prosperity to Rust-Belt and 19th century industrial hubs. The writing is crisp and smooth. The manner is often witty, and occasionally wise-ass. It’s anything but turgid … which is a great relief from many of the “big think” books which come and go on the bestseller lists.

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