To: Mark Zuckerberg and Elon Musk
From: Joe Mathews
Re: Acquisition and Reputation

Have you two lost your minds?

Both of you are suffering through long-running, self-inflicted public relations crises. Mark, Facebook’s self-serving and ever-shifting policies, the way its platform polarizes politics, and growing alarm about the health effects of social media, have turned you into a lightning rod.

Elon, you are over a barrel for strange behavior, including attacking financial analysts, crying during a New York Times interview (which included the revelation that you use Ambien and recreational drugs), and tweeting yourself into a Securities and Exchange Commission investigation.

Neither of your predicaments is really surprising, given the way the two of you combine planet-sized ambition with questionable management. What is puzzling is your failure to escape these crises.

Why haven’t you taken advantage of the obvious, cheap, and proven way to launder your reputations and curry favor with the media?

That method is straightforward:

Buy your local newspaper!

There’s no better balm for a billionaire’s press clippings than saving a newspaper.

Exhibit A is Amazon’s Jeff Bezos, who was known for tax avoidance and cold-blooded ruthlessness in remaking the American retail landscape until he purchased The Washington Post for some loose change ($250 million). Despite being the world’s richest person—the sort of thing that used to make you a target of media types—Bezos is now described as a defender of democracy (“Democracy Dies in Darkness” is the Post’s Bezos-era motto) against the madness of President Trump.

In California, Dr. Patrick Soon-Shiong is taking the reputation-burnishing possibilities of media ownership to the next level. Soon-Shiong has long received bad publicity—for questions about the drug business that made him a billionaire, for self-dealing in his philanthropic and cancer test endeavors, for a troubled L.A. hospital chain he bought, and for allegations of financial improprieties lodged by people including his brother and Cher.

But then the good doctor rescued the L.A. Times and San Diego Union-Tribune from the clutches of a Chicago-based entity called Tronc. Now Soon-Shiong is being celebrated by hard-bitten reporters for restoring local ownership and investing in investigative reporting.

Sure, buying a paper isn’t free, but it’s cheap for billionaires, and can even pay for itself. Soon-Shiong had to overpay—$500 million—to wrest the Times and the Union-Tribune away from their Chicago owners. But the purchase has provided him a valuable ballast of virtue that could reduce questions about his other businesses.

In Boston, billionaire John Henry—who was educated in California, and built his investment company in Orange County—purchased The Boston Globe essentially for nothing, since he made back more than its $70 million purchase price by selling its headquarters land for more than $80 million.

Likewise, owning the Post sure hasn’t hurt Bezos’s business. The state government of Maryland, which the Post reports on, has offered an astounding $8.5 billion in tax incentives to convince Amazon to build a second headquarters there.

Of course, there are other rewards for buying newspapers, if you care: namely, that you’ll be doing a public service. Today’s newspapers are in deep trouble, struggling for revenue and constantly shedding staff. By buying papers, you two—if you’re willing to spend a little on the product—would provide stability to vital if weakened institutions that still try to get the facts and bind communities together.

Think of the opportunity—you could do a good deed, and help your public image in the process.

Now, to be fair, you’re still rich and famous and will face public scrutiny. And if you too blatantly deploy your newspapers to serve your other interests, you could run into trouble. (Soon-Shiong’s reported habit of using his philanthropy to serve his business ventures suggests that conflict with journalists at his papers is likely.) But once you own the paper you’re likely to be less of a target. Journalists have limited time and money to go after subjects; they’re not keen to devote precious resources to biting the hand that feeds.

So what should you buy? For you, Zuck, the obvious target is your hometown paper, the San Francisco Chronicle. You once told the paper’s editor, Audrey Cooper—according to an open letter she wrote to you—“how important The Chronicle’s work is in the Bay Area and how invested Facebook was in helping us to do it.”

Of course, in that same letter, Cooper called you out for not dealing honestly and consistently with the Chronicle and other publishers, and abdicating your responsibility to improve the public discourse. The good news is that, by buying the paper, you could work with her to show your commitment to said discourse. It would be a chance to demonstrate that the days of “move fast and break things” are behind you.

Since your press is even worse, Elon—your nasty habit of attacking reporters and suggesting you’d produce a rating system for journalists has predictably backfired—you’ll need to buy a tougher target: Digital First Media. That’s a newspaper group owned by Alden Global Capital, a New York-based hedge fund.

You don’t have to buy the whole chain. It would be enough to grab the pieces of the chain from Southern California, where you live; this means everything from the Orange County Register to the Los Angeles Daily News.

Alden, which has ruthlessly cut its staffs and newspaper offerings, is one of the few institutions with a worse reputation among journalists than yours. That’s good news for you. If you bought the papers and restored staffing and investment in the news product (maybe your Saudi buddies could help), you’d find yourself transformed overnight into a journalistic hero.

And if the papers lose money, well, they’ll fit in well with other pieces of your portfolio, like Tesla, which still isn’t profitable.

Yes, I know that newspapers are not the business you want to be in, but they still shape public narratives. So, Mark and Elon, you face a choice. You can keep complaining about all the bad press you get. Or you can buy your own newspapers, and, in the process, give a boost to media and civic life in your own state of California.

If you two are as smart as you’re supposed to be, your next moves are obvious.

The post Why Two California Billionaires Should Buy Newspapers appeared first on Zócalo Public Square.

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Soon-Shiong was introduced to the crowd at the Petersen Automotive Museum by Arizona State University President Michael Crow, who is also a scientist with a background in innovation and technology transfer. “Meet Batman,” Crow told the audience. Like Bruce Wayne, Soon-Shiong is a polymath and businessman using “mysterious technologies” to wage a war–not on crime but on disease and avoidable early death. Soon-Shiong aims to extend, in a cost-effective manner, our “healthspan”–that is, the healthy and productive years of a person’s life.

What, Crow asked Soon-Shiong, is driving you to take on a monumental problem that even the government can’t seem to tackle?

I’m driven “from the position of physician,” said Soon-Shiong, who is also a surgeon and was a professor at UCLA’s medical school. Over and over again, he has seen patients receive the wrong treatment–and suffer as a result–not because the right treatment didn’t exist but because doctors don’t have the needed cognitive support or enough information to make the right decisions. “I’m driven by opportunity lost not just for the patient or for our country but mankind,” said Soon-Shiong.

There are three barriers, said Soon-Shiong, to getting doctors the information they need: knowledge, delivery, and payment.

The knowledge barrier “is exploding every day,” he said. In the past five years we’ve made more scientific discoveries and breakthroughs, and developed more tools for improving our health, than in the last 50 years in medicine. But this knowledge takes an average of 17 years to get to patients.

The barrier to better healthcare delivery is in transferring information and coordinating care from the clinic to the lab and the hospital to the home; patients aren’t getting the decision support they need and could receive.

Our payment system is the final barrier. Doctors and hospitals are reimbursed not to keep you healthy but to do as much as they can when you’re sick. These “perverse incentives,” said Soon-Shiong, get in the way of patients receiving preventive care.

These problems are massive, but Soon-Shiong decided that they could be integrated into a single solution by attacking them in their most severe manifestation: when a patient is diagnosed with cancer. “If we can address illness and fix the system in a state of emergency, then we can fix it in [a state of] wellness,” he said.

Two million people are diagnosed with cancer each year, but the “scariest statistic,” said Soon-Shiong, is that 32 percent of the patients receive the wrong treatment.

Crow explained that most cancer drugs work for a small number of patients but are administered to a much larger number of patients in the hope that they’ll somehow work.

It doesn’t have to be this way, said Soon-Shiong. We have the ability, with our knowledge of the cancer genome, to find out what caused a person’s cancer at the molecular level and to treat that specifically rather than administering a blanket treatment that has a low statistical probability of success. The cost of this sort of treatment is also decreasing. This year, it will cost $1,000 (less than a CAT scan) for a complete genomic analysis of a blood test, which can identify with great precision what’s going on when you’re ill.

This molecular medicine, coupled with wireless technology, could change how cancer and other diseases are treated and how preventive medicine is administered. Computer and cloud technology has made it possible to monitor our vital signs in real time and to share this information with our doctors wirelessly–as well as to have it analyzed, and to have that analysis sent to patients on their smartphones.

“It sounds crazy, but that’s what we do, and what we’ve done,” said Soon-Shiong. His October announcement will reveal how he’s successfully implemented this technology and how it could improve care across the board, level the healthcare playing field, and be exported from the U.S. into other countries. It’s taken seven or eight years, investment in a host of institutions, and the integration of the work of doctors and computer scientists, nurses and healthcare providers. But Soon-Shiong thinks it may revolutionize U.S. healthcare and the treatment of a host of chronic diseases, from heart disease and diabetes to Alzheimer’s. Soon-Shiong has already introduced the program to 8,000 oncologists, whose rate of treatment error he says has gone from 32 percent to zero in treating cancer patients.

Crow asked Soon-Shiong to address some of the privacy concerns patients might have about their health information being transmitted wirelessly. “You need to recognize that this is your data,” said Soon-Shiong–it’s something that a patient shares with a doctor, not the other way around.

So what, asked Crow, is stopping you from implementing this right away?

Soon-Shiong explained that waste is embedded in our healthcare system: “Some people’s waste, other people’s profit,” he said. “There’s not one penny being spent [by the government] on what I just talked to you about.” The pharmaceutical industry doesn’t see the upside in developing a drug that can treat 100 people. The insurance companies don’t exist to keep patients healthy but as brokerage systems. And in academia, silos are keeping research and clinical practice separate.

In the question-and-answer session, audience members asked Soon-Shiong if the FDA is posing another hurdle, what the medical school and hospital of the future will look like, and if there’s a point in getting genetic information that doctors can’t act on.

Regarding government drug regulation, Soon-Shiong said that he has “a fabulous personal relationship with the FDA.” He had 70 drugs approved in 10 years when he began developing drugs. The FDA’s Critical Path Initiative is also working to speed up the process of developing drugs and adjusting to the speed of the new world of molecular medicine. “I’m hopeful,” he said, about the future of the drug test and trial process.

“If I have a complete genome analysis and find out that in the future I will have breast cancer, what do I do with that information?” asked an audience member.

Soon-Shiong said he shared this skepticism a decade ago when the genome was discovered, thinking that predictions and probabilities would cause more stress than they were worth. But today, genomic medicine has evolved to the point where an abnormality or illness can be identified and treated as it’s occurring. “If you’re going to do a test for something for which I can do nothing, don’t do the test,” he said. “But if you can do a test that can change the direction of a treatment, you should do the test.” The concept of the genome is really for treatment of illness, he concluded.

Another audience member asked Soon-Shiong what he thinks medical schools and hospitals will look like in the future. Soon-Shiong predicted more integration in medical schools among not just physicians and nurses but other fields like economists. He thinks we’ll also see a reversion back to a form of medicine that’s more like the home care he received growing up in South Africa–the doctor coming to the door with a black bag. The doctor will become more like a priest, with a great deal of personalized information about patients–but patients, too, will have access to the same deep level of information.

Watch full video here.
See more photos here.
Read medical professionals’ opinions on how our routine physicals will change in the next decade here.
Read about the challenges facing L.A.’s biomedical industry and its potential here.

*Photos by Aaron Salcido.

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Going to the doctor and getting your chest bumped and your arm squeezed might feel reassuring, but the physical, like primary care physicians, is on the wane. The good news is that we’re likely to be a lot better at testing, monitoring, and interpreting the data we get. Gizmos will change the game. In advance of the Zócalo event “How Can Biomedicine Fulfill Its Promise?” three medical professionals offer a forecast of what to expect from the physical of tomorrow.

Say goodbye to the routine physical

What will change most about our routine physicals over the next decade is that they will not exist. The truth is, routine physical exams are largely useless. Even the AMA states that the primary value of the physical is to maintain a personal connection to your physician–not to discover health problems early. If we can get our political and social act together, we have the technological capability to revolutionize how we monitor our health. Biometric information (temperature, blood pressure, etc.) will be monitored wirelessly on each individual for retrieval and analysis. People are already starting to do this.

What will change things most is that we will have the means to routinely and comprehensively screen ourselves for any disturbance in health. A patient will regularly mail in a drop of blood or saliva for analysis. Within days, a central lab will post the results to the patient’s personal web site, and screening will allow for the detection of the earliest stages of almost any disease. The data will be yours to share and analyze as you wish.

Eventually, instruments for reading your blood or saliva samples will be in your home. It will essentially be real-time monitoring. The data will be yours to control. The word “patient” will have passed from the lexicon.

Dr. Stephen Johnston co-directs with Dr. Neal Woodbury at the Center for Innovations in Medicine (CIM) at the Biodesign Institute at Arizona State University.

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We’ll get our care online–but fancy technology comes with new costs

The healthcare systems of most developed countries are organized to provide all the care you need, whether or not you can afford it. America’s healthcare system is aligned to provide all the healthcare you can afford, whether or not you need it. As a result, Americans pay more for their healthcare than anyone else on earth. No other country comes close.

Americans can be justifiably proud of their prowess in biomedical research, but this knowledge has to be applied carefully. Otherwise, the “promise” of biomedicine could prove to be a curse. Rather than getting a routine physical in 10 years, much of our preventive care will be accomplished online. Will preventive care in the future also include an analysis of each person’s genetic code? I hope not.

We hear a lot about the benefits of genomics but very little about its risks. These include: false-positive test results that trigger needless worry and costly diagnostic workups; the detection of a gene that might (but probably won’t) cause problems later in life; labeling otherwise healthy people “high risk,” potentially rendering them uninsurable and possibly unemployable, and the prospect of consigning hundreds of thousands–perhaps millions–to an interminable series of doctor visits, follow-up tests, and treatments to prevent disease in a few.

In a nation long fearful of healthcare rationing, we are just beginning to come to grips with the opposite problem–the enormous costs and grievous harm that come from excessive testing and needless treatments. Don’t forget–an American’s odds of living a long and healthy life still depend more on his zip code than his genetic code. That won’t change until we make healthcare more affordable.

Dr. Arthur Kellermann, an emergency physician, holds the Paul-O’Neill-Alcoa Chair in Policy Analysis at the nonprofit, nonpartisan RAND Corporation.

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We’ll have Onstar for the body

In the future, medical exams will be personalized and tailored to the individual, to a person’s specific genetic profile. Some exams will be annual, some monthly. Some will be augmented by telemedicine or other forms of contact between the patient and clinical care team, but in-office visits will be far fewer.

Medical devices will allow for steady, rather than occasional, monitoring. Instead of a doctor performing a random spot check once a year, a widening array of mobile devices, including wearable sensors, will monitor blood pressure, blood sugar and other health-related metrics on a steady basis. Among the devices to expect: mobile-phone-connected blood-pressure cuffs, wearable pedometers to track exercise regimens, sleep monitors, even home-based “medical tricorders,” for which an X-prize was recently launched.

Artificial Intelligence (AI), or, as I prefer to call it, IA (Intelligence Augmentation) will play an important role in interpreting the data, helping to correlate signs and symptoms. It will also offer clinical guidelines and other information to augment the skills and decision-making of the clinician, who in many cases will be a nurse practitioner.

To prevent an overflow of information from multiple sources, data will need to be integrated into dashboards to lead to meaningful and actionable information. I envision integrated systems similar to those of modern cars, which have hundreds of sensors and an onboard diagnostic computer which can help detect problems early and indicate to the driver what is going on. All of us will have Onstar for the body.

Daniel Kraft, MD, is executive director of FutureMed.

*Photo courtesy of Shutterstock.

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