At one point, when I talked about industry cover ups of disastrous drug trials, the insurance exec—apparently looking for the upside— smiled hopefully and said, “Well, on one level you’ve got to admire them”. I was staggered and retorted, “Yes, on the same level I admire Hitler”. That was pretty much a conversation stopper.

 I wondered later why I had so much trouble keeping my cool in that moment. It wasn’t just that fraud and corruption are wrong. To say the least. To the tune of hundreds of thousands of unnecessary deaths and injuries a year in the US alone. But on a certain level, I was irked to the very degree that I know corruption isn’t the key to success.

Since it really does look like someone died and made pharma king, it probably sounds outlandish to suggest that the mainstream pharmaceutical complex is a failing venture. Pharma currently has the biggest, richest lobby in the world. Industry has so much power that they’ve come close to deciding whether our country goes to war (industry lobbied Congress to invade Indonesia over a broken AIDS drug patent several years ago). Success or failure of the pharmaceutical industry seems to fall more on the scale of the Roman Empire. The Roman Empire is no more and I tend to think if you kill off your customer base (and I include global polluters on that score), you’re sort of bound to fail—even if we all have to wonder which of our future generations might get to see the GlaxoRocheSanoMerckLillyPhiForrest (etc.) fire sale or if the end of humanity will come first.
I’ve read a lot of books to try to understand how things can get so bad and why people throughout history let jerks and tyrants be jerks and tyrants and why they let destructive forces gain power. It was the first conversation my husband and I had when we met and what happened to our children has given us more to think, talk and read about since, unfortunately. You could probably measure how desperate I am to find answers by how dry some of these tomes sound, though the books are actually downright interesting.
Earnest Becker’s “Escape From Evil” goes a long way towards explaining humanity’s tendency to associate status with immortality. Richard Wrangham’s study on violence and evolution focuses on the similarities between negative ape and human hierarchies (HERE).

Composer and Stalinist purge survivor Dmitri Shostakovich’s “Testimony” has a chapter which begins with the words “I hate Toscanini” and goes on to deconstruct the human delusion that evil bastards are capable of producing or even recognizing great art. Books on posttraumatic stress and the bystander phenomenon can explain the human tendency to assume that “good things happen to the worthy and bad things happen to bad people”.

Another Stalin survivor and poet, Yevgeni Yevtushenko writes:  “Be careful what you forgive. The young will not forgive in you what you forgave”. I reread Chekhov’s “The Three Sisters” after learning about his disdain for the medical profession (he was a doctor himself). In the play, the physician Chebutykin, whose incompetence kills a patient during a fire, drops a clock once belonging to the love of his life and says, “It may be that I didn't in fact break it, but it only seems as if I broke it. It may be that we only appear to ourselves to exist, but in reality we are not here. I don't know anything, nobody knows anything.” That was a head scratcher but later I thought it was apt: that those in the medical industry only begin to devalue life and develop nihilism after seeing the effects of their own incompetence; it’s too painful to value what you can’t stop destroying. 

Then I recently read the book, “The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t” ( HERE ) by Robert I. Sutton, a PhD in organizational psychology who chairs in the same department as his friend and my uncle James March, a Professor Emeritus at Stanford University. Dr. Sutton is currently Professor of Management Science and Engineering in the Stanford Engineering School, and Co-Director of the Center for Work, Technology, and Organization.

This book really rang some bells. It reads as a deliberately accessible survival guide written by someone who does not generally write populist material (but is good at it). The author conferred with many experts in the field before deciding that “asshole” was in fact an accurate and academically acceptable term. And he thought long and hard about the risk that, upon publishing the book in 2007, he would forever after be known as the “asshole guy”, despite a lifetime of previous academic work.  But, like hiding your kid’s spinach in a meatball, Sutton tucks a great deal of organizational science and statistics into the text to make the point that assholes aren’t necessary for organizations to succeed; they generate an environment of fear, toadying, and negative competition which do not generally promote innovation and productivity in group endeavors; they tend to chase away the most creative minds; invariably replicate themselves and, worse, evidence shows that assholery (as I call it) is contagious, via something Robert Sutton calls “asshole poisoning”.

On avoiding asshole poisoning at any cost, Sutton cites research on the benefits of fighting back or avoidance when one isn’t in a position to quit a job or get someone fired. He lists real life tales and strategies for dealing with, putting off or putting down assholes via deflection, humor, public shaming, even if this requires being a “temporary asshole” to manage an impossible situation in the moment.

I think what I appreciated most about Sutton’s ideas is the advocacy and activism implicit in his approach, the lack of ethical constipation: he doesn’t write as much, but choosing the identifier of “asshole” immediately implies that it’s okay to fight back and fight hard if necessary.

But throughout the book are reminders to avoid ending up “one of them”. Everyone is an asshole from time to time, even by admission the author himself, so we’re advised to be ever so careful about who we label with the “A” word. There are also people with “rough exteriors” but “hearts of gold” who don’t deserve the term and personally I hope some of my behavior during that four years of double-autism-sleep-deprivation isn’t held against me. For clarity, Sutton lays out a certification process for what constitutes a “certified asshole”:  the mark of a true asshole is “Kiss up/slap down”. They shoot fish in a barrel. They humiliate, intimidate or unleash “status slaps” on those less powerful or systematically and gratuitously put others down to raise themselves up. 

Sutton reluctantly devotes one chapter to the “virtues” of assholes on the advice of colleagues, who said the book would be too shallow without it. Yes they can create cults of personality, gain enormous status and wealth for themselves and motivate intense perfectionism in underlings through fear and intimidation, but it’s at the price of crushing innovation and creativity among other members of a group, people who may in the end have contributed more than the top dog.

After reading the book, since all roads lead to the epidemic in my mind, I had a revelation about the day-to-day culture of the pharmaceutical industry and other industry-embedded entities which could have led to the current catastrophe. Regarding some of the broader ugliness in the pharm arena, specific instances came to mind—bizarre events within medicine, industry, government, media and the justice system as it pertains to vaccine injuries and autism. There are the stories of witch hunts against whistle-blowers within US regulatory agencies (HERE). There are the modern horror stories of human research disasters, deadly drugs and cover ups of same. There’s always the foremost travesty of what happened to Drs. Wakefield, Murch and Walker Smith and their treatment in the press in both the US and UK.. Then there’s evidence and anecdote of how the AAP is asshole-training pediatricians to overcome parental resistance to excessive vaccination through the use of intimidation and arrogance.

There are stories of children with autism being snatched from their parents for refusal to use accepted but dangerous mainstream medical products and for suspicion of the use of alternative treatments for clinically established environmental injuries ( the Tseglins  HERE;  the Ben-Elkanas .HERE  ; The Arizona Five HERE ; The Wendrows  HERE ). There are stories of school abuse, deaths and injuries to children with autism on buses and on school grounds. All of this goes far beyond the dismissive label of “asshole” into the realm of real evil.
But Sutton’s book really made me wonder how much the on-the-ground behavior and actions of individuals within these contexts lends to the larger events. I can’t help imagining that the US and UK health regulatory agencies, pharmaceutical companies and other enmeshed organizations must be really lousy places to work these days.

Unless you’re one of them, no perk in the world seems worth being forever trapped in conference rooms and at staff dinners with a pack of flaming creeps, sociopaths and suck-ups, even ones who’ve cultivated a degree of professional charm. And I don’t know that everyone gets used to it. I can’t—and I’ve been around. I was once seated next to the advisor of the Holy See of Rome at a dinner event in the heyday of the church sex abuse cover up. I was 22 and knew nothing about it, but sure felt the chill. 

 We see the hints of gross individual conduct in the pharm realm: why did twenty members of the Department of Justice laughed uproariously in open court when the judge in the Hazelhurst appeal denied the claim of an injured child? You know, I want to go out drinking with those guys. Maybe we can watch re-runs of children shot in drive-bys for kicks. And what’s up with Offit’s sneering as he ambles past a vaccine safety demonstration? Why wouldn’t Thomas Insel of the National Institute of Mental Health get on an elevator with an injured boy and his mother? Why is Gardiner Harris of the New York Times so consistently rude to autism parents who write to him (long before I ever mocked him on Age of Autism HERE)? Even if you knew nothing about the destruction he’s wrought, Brian Deer could be listed in the dictionary under “A” (HERE ). Were these people born assholes or did they go to school for it? Is it genetic or environmental?

For the reverse side of the coin, there’s no end to the personal accounts that certain leading lights in the movement are truly decent human beings: Dr. Rimland was and Dr. Wakefield is. It’s also a little known fact that Bernadine Healy—one of the few public health officials to call for more, not fewer studies into the vaccine-autism link (HERE )—came down hard on rampant sexual harassment and abuse within the National Institute of Health during her tenure as director. If there is such a thing, Dr. Healy seems to be an all-purpose anti-asshole.

With these issues on my mind, I called my uncle—the colleague of Robert Sutton— to talk about my thoughts about the book, and to ask questions about the author. Uncle Jimmy described Sutton as “a good man and a good friend” and attested that they shared many ideas and a similar distaste for the current environment of corporate cheating.  Basically these guys study organizations, the way people work together and the outcomes of collective environments in terms of quality of work and impact. And though my Uncle Jimmy would never put it so glibly, they both have issues with assholes and bullies.

The call to my uncle was also personal. He didn’t know what had happened to my kids because other family events had made this difficult to discuss, especially when visits and phone calls are so hard to make with two sick kids. Last month was the two year anniversary of the death of my father and my uncle Robert, who died within two weeks of each other, and close to the seven year anniversary of the death of my cousin and Jimmy’s nephew, who was murdered. Depending on how one looks at it, along with my children, the losses may have all had a common thread. Though I’m not at liberty to discuss all the details, I’m haunted by the question of how otherwise critically thinking people sometimes drop their guard when it comes to medicine and healthcare.

 In any case, when I asked if my uncle Jimmy was a “bit” suspicious of pharmaceutical industry conduct, he said something to the effect of that being a huge understatement.  We went on to talk about how the “microcosm of interpersonal aggression and negative hierarchies might lead to macro impact and destruction via a breakdown in the quality of output”. Or as Sutton might put it, why do assholes produce so much incompetence?  My uncle didn’t think it was always an environment of fear but also the obvious irresistible financial and status rewards that drive individual capitulation in a corrupt system. Obviously the vicious treatment of whistleblowers acts as overarching intimidation, no matter how much glad-handing might occur on the surface. The question was, is this kind of dynamic what comes with success?

For some clarification on the family tree,  my mother and her brother Robert became step-siblings with my uncle Jim as adults when, in her sixties, my grandmother remarried a family friend, fellow widower and rumored very distant cousin, James March Sr., a professor of accounting for whom it seemed the discipline was a form of numeric ethics. My step-grandfather had been a senior accountant for Arthur Anderson and was disturbed at the direction the firm went after his retirement. I don’t know that he would have mourned the fact that the investment house is now history.

My grandmother’s second marriage did more than bring two families together but also sparked a sort a revolutionary think tank on the psychology of organizational ethics, which was also one of my uncle Bob’s main fascinations. His theories of management developed when he worked his way from product engineer to vice president of development for Dynamic Controls in the sixties. Though the company’s profits exploded during his tenure, he was frustrated with the typical corporate culture’s tendency to stifle creative contribution from employees.  This interest probably had even deeper roots, since his and my mother’s birth father, at one time an engineer for Warner and Swasey, had suffered the theft of industrial patents for turret lathes. Like the children of Robert Kearns and their battle against Ford over the patent for the intermittent windshield wiper, my family developed an interest in changing the game.

Adriana Gamondes is a contributor to Age of Autism, manager of the AofA FaceBook page and resides in Massachusetts with her family.