Little thoughts from my ‘Around the Deck’ chair

Issue: August 25, 2022

ByDarrell E. White, MD

Fact checked byChristine Klimanskis, ELS

Summers mean slowing down. At least, they should. Even if it’s just a little bit.

My Father’s Day gift this year was a pair of “Around the Deck” chairs, our family’s tongue-in-cheek name for what the rest of you call “Adirondack” chairs. They lend themselves to slowing down, no matter what deck they adorn or whose derriere they support. Mine look out over one of the inland oceans of America’s North Coast. Sitting in the shade of an umbrella and reading the sports page, I imagine one of my Canadian colleagues on their deck gazing back at me over the horizon.

Darrell E. White

Here, then, is my annual summer collection of “little thoughts.” A tip of the hat to the great sports columnist Bill Reynolds, who plied his trade for more than 3 decades before retiring last year. Each Saturday, his column was filled with random thoughts on the state of sports, with the occasional quiz or book review snuck in to keep his readers on their toes.

Karl Stonecipher is ophthalmology’s Most Interesting Man! If there’s anything he can’t do, I’m not aware of it. Karl is the most generous person I know, sharing his wonderful experiences with everyone. When I’m presented with my options for a summer’s day, I like to ask myself, “What would Karl do?!” Hey, that sounds like a bracelet — WWKD!
It’s summertime, and the living is supposed to be easy. Are you taking care of yourself? Eating well? How about exercise? Sleep? I can’t begin to tell you how many of our colleagues have struggled with work-related physical ailments. Proper ergonomics in the office and the OR, along with a purposeful fitness program, go a long way toward inoculating the microsurgeon against the physical stress of our jobs. Add in 40 winks, and you’ve got a fighting chance.
Summer quiz: Speaking of nutrition and health, here’s a trivia question from OSN New York, dry eye division. Hank Perry is one of the true pioneers in the dry eye disease (DED) world. He became afflicted with DED in midlife (mind you, Hank is gonna live longer than Keith Richards and Willie Nelson combined, so midlife for him has a different meaning!) when he stopped eating what for lunch? Answer below.
The 150th edition of the British Open begins in a couple of days. It will be history by the time you read this. Tiger Woods, the most compelling golfer in the history of the game, may be making his final appearance at the Old Course at St. Andrews. Will we see him bid the game adieu from the Swilcan Bridge? Kinda choking up just thinking about it.
In-person conferences are the best. For sure, having the opportunity to view the educational content remotely and receive CME credits is a terrific benefit. But let’s be honest: The most actionable insight we gain at all of our professional gatherings is garnered in the hallways, over lunch or chatting with your “neighbor” in the lecture hall. Thank heavens they are back.
Where those conferences are held matters, don’t you think? I started writing this while sitting in one of my “Around the Deck” chairs and worked on it while attending the American-European Congress of Ophthalmic Surgery (AECOS) in Deer Valley, Utah. I don’t know about you, but I just seem to learn a whole lot more if those little sidebar chats with my colleagues take place in the mountains of Utah or a few blocks from the Pacific in San Diego.
Without in-person conferences, I would have no way to meet and get to know the newest generation of ophthalmologists. It’s especially fun to get a chance to do this at smaller, less formal gatherings like Hawaiian Eye, AECOS and Kiawah Eye. Maybe there’s something about not wearing a tie or high heels. Maybe if we swap out the folding chairs for “Around the Deck” chairs at OSN NY ...
Having said that, one of the cities on our standard rotation for American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery meetings is in trouble. Have you been to San Francisco lately? Man, what a mess. The highly trafficked hotel and convention areas have seen a significant influx of folks “living outdoors.” This has brought an increase in “personal crimes” like theft and assault, but more importantly, it has made the San Francisco experience much less pleasant. Rumor has it that at least one of our organizations has told the city we won’t be back, which is a shame.
Summer reading tip: City on Fire by Don Winslow. Have you read any of Winslow’s drug cartel stuff? It’s really good. It turns out that he grew up spending summers on the Rhode Island shore. So did I! City on Fire is about the Italian and Irish crime families operating in and around Providence in the ’80s. Winslow captures the rhythms of the language and the rhymes of my youth. The first of a trilogy, City on Fire belongs with you in an “Around the Deck” chair this summer.
Man, have I learned a ton about the generic drug market. For every latanoprost generic identical to Xalatan (Viatris), we have brimonidine. There’s something called an “authorized generic.” One of these is precisely the same as the brand because either it’s actually made by the brand manufacturer or the exact recipe is licensed. Right now, three of the four Restasis “generics” are made by Allergan. So weird.
On July 11, Joe Grogan and Casey B. Mulligan wrote a laudatory op-ed in The Wall Street Journal in defense of pharmacy benefit managers (PBMs). What a load of bunk! They proclaim that PBMs are responsible for billions of dollars in savings — for the insurance companies! Somehow, they think PBMs increase a patient’s adherence to treatment. These guys, both paid PBM consultants, don’t live in my world. Uh-uh. Out here, PBMs are responsible for increased patient costs and decreased treatment adherence.
Anybody watch the Wimbledon men’s finals? The only thing more thrilling than the tennis was trying to decipher who Kyrgios was talking to and if they answered. At least you knew what John McEnroe was raging about and who he was addressing each time he went off. Can you imagine if a surgeon carried on like that during an operation? They’d lock us up in a nanosecond.
Lots of “dry powder” out there. All of our super large “strategics” are sitting on piles of cash and looking for stuff to buy. Many have big holes in their pipelines, large gaps between what they have on the market now and when their next internal drug will make it through the FDA. Be on the lookout for big deals in the DED world over the next few months. Gonna be exciting!
Quiz answer: Hank ate a tuna salad sandwich 5 days a week for decades until he was diagnosed with mercury toxicity. When he stopped eating the tuna, he developed DED, launching his interest in omega-3 fatty acids.

Well, that’s all I got this summer. The sun is setting over my inland ocean, and my Aussies Sasha and Bohdi are getting antsy. They’re sitting by my “Around the Deck” chair, each with one of my walking shoes in their mouth, ready for an adventure. We send you warm wishes from America’s North Coast. Sasha, Bohdi and I hope that your summer has been peaceful and pleasant, and that you have had at least one adventure worthy of Karl Stonecipher.

I’m looking forward to seeing you at our upcoming in-person meetings.

Reference:
Grogan J, et al. In defense of pharmacy benefit managers. https://www.wsj.com/articles/in-defense-of-pharmacy-benefit-managers-drugs-rebates-patient-costs-premiums-transparency-innovation-regulation-ftc-11657571932. Published July 11, 2022.

For more information:
Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.

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Sources/Disclosures

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Disclosures: White reports consulting for Aldeyra, Allergan, Avellino, Bausch + Lomb, Johnson & Johnson, Kala, Novartis, Orasis, Rendia, Santen, Sight Sciences, Sun, Tarsus and TearLab; speaking for Allergan, Kala, Novartis, Santen and Sun; and having ownership interest in Orasis.

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Little thoughts from my ‘Around the Deck’ chair

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