What I'm Reading (Feb. 14)

By Chuck Dinerstein, MD, MBA — Feb 14, 2020
On this week's menu: Why is it harder to get a Chick-fil-A franchise than to get into Stanford? ... The CVS-Aetna monopoly on pharmaceuticals would put John D. Rockefeller's Standard Oil to shame. ... Wind may not be as green an energy sources as we thought. ... And finally, the genes we share: we are more alike than not.
Springtime by Claude Monet Courtesy of the Walters Art Museum

“In America, the majority of fast-food restaurants aren’t owned by the corporation itself, but by franchisees — individuals who pay for the right to use a brand name.

Instead of buying and developing new properties with their own money, most national chains (franchisors) will allow a party or individual (franchisee) to front the development bill and take a stab at ownership in exchange for a cut of the sales.

Many people dream of buying a fast-food franchise of their own, but few can afford it.

All told, it might cost a franchisee upwards of $2m to develop, build, and buy the right to open a McDonald’s or a KFC. Many chains won’t even look at your application unless you have a net worth of $1m and $500k in readily spendable cash sitting around.

But there’s an exception to this: A franchise at Chick-fil-A — one of America’s oldest, largest, and most profitable chains — can be yours for just $10k.”

Chick-fil-A has a great chicken sandwich and has been controversial with its “Christian” values, including being closed on Sunday. But did you know that Stanford accepted more students, 4.8%, and Google hired more new employee applicants, 0.23%, than individuals succeeded in applying to franchise a Chick-fil-A? From the Hustle, Why it only costs $10k to ‘own’ a Chick-fil-A franchise

“Pharmacists are not robots, and they do personalized service because medical advice has to be given based on the individual’s needs. And yet, CVS corporate uses automated systems and terror to attempt to remove the human element from the process.

Pharmacy staff members are expected to call dozens of patients each day, based on a computer-generated list,” Gabler wrote, and pharmacists are evaluated based on whether the patients do what they want. Pharmacists complained these practices were harsh and unsafe, and that they were retaliated against if they complained. CVS responded with the argument that metrics were meant to help patients.”

CVS-Aetna is a growing force in healthcare, combining the knowledge of an insurer, with a supplier of pharmaceutical, a benefits manager, and now more recently, primary care prescribers. This type of vertical organization is the new shape of monopolies. As a physician, I find their entry to be particularly disturbing. Their monopoly on information, in the opaque world of pharmaceutical pricing, can be used for good or evil; but no matter how you view it, it will be used to optimize and enhance their profitability at your expense. Matt Stoller writes every week about the new age of monopolies forming before our eyes. I found his report on CVS to the point. How CVS Became A Health Care Tyrant

 

The wind is one of the green energy resources. But it makes use of turbines, that like all machinery have a functional work-life. The blades on those turbines wear out; where have all the wind turbine blades gone? Evidently to landfills, every one. As it turns out, there is an unintended cost to wind energy’s green appearance. This has been covered by Bloomberg, and the BBC, among others. Here is the report from NPR. Unfurling The Waste Problem Caused By Wind Energy

 

“TP53, CYP51, TAS1R2/TAS1R3, and opsins. Each, over eons, has been critical to the development and health of living creatures.”

They affect somatic cell protection, cholesterol synthesis, perception of sweet, and visual/photoreception. Together they appear in humans, plants, and animals and represent common crucial life functions. From Nautil.us, a great interactive infographic showing you how much we share with all of life on our planet, The John, Paul, George, and Ringo of Genes. 

 

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