Reading Wills to your children
Life: Reading Wills with your children. Health: Winning against. HIV Social contract with pharma and trust. Life, art: Miranda July.
Theatre: My Death show (Jan 8, 2025)
Life: Reading Wills with your children
Health: Winning against HIV
Social contract with pharma and trust
Fellowship/Education: Nautilus project for homeschoolers, gap years and misfits
Podcast: Joanne Limburg, Letters to My Weird Sisters: On Autism, Feminism, and Motherhood
Life/Writing: Miranda July; choosing names aand comments on her work.
This week, I am re-freshing my theatre work on death. I am reflecting on the social contract within biopharmaceuticals.
If you are in London on Jan 8th, do come and see my show. Link here: My show on death is on Jan 8th, do come.
If you’ve ever wondered what song to have played at your funeral, this is the show for you! Ben has been to his own funeral five times so who better to accompany you on a weirdly fun and interactive look at the greatest certainty in life: death*. (*Ben doesn’t die in the show).
Two elements that I'd like to think about in my next showing of My Death Show is around (1) writing wills and (2) HIV deaths.
On writing wills. This might be a middle class and rich persons’ idea but Warren Buffett (billionaire investor, who is giving away much of his wealth to philanthropy, and more recently his children and their philanthropy) had a thought about reading your will with your (mature) children.
If your family is not riven by internal strife (and maybe even if it is), then I think this is a good idea.
Most often, I have found that honest transparency makes for better relationships and better decisions.
When people can understand the reasoning behind a decision, and when people are unsurprised, life moves on more smoothly.
Buffett writes in his November 2024 letter:
“I have one further suggestion for all parents, whether they are of modest or staggering wealth. When your children are mature, have them read your will before you sign it.
Be sure each child understands both the logic for your decisions and the responsibilities theywill encounter upon your death. If any have questions or suggestions, listen carefully and adopt those found sensible. You don’t want your children asking “Why?” in respect to testamentary decisions when you are no longer able to respond.
Over the years, I have had questions or commentary from all three of my children and have often adopted their suggestions. There is nothing wrong with my having to defend my thoughts. My dad did the same with me.
I change my will every couple of years – often only in very minor ways – and keep things simple. Over the years, Charlie [Munger] and I saw many families driven apart after the posthumous dictates of the will left beneficiaries confused and sometimes angry. Jealousies, along with actual or imagined slights during childhood, became magnified, particularly when sons were favored over daughters, either in monetary ways or by positions of importance.
Charlie and I also witnessed a few cases where a wealthy parent’s will that was fully discussed before death helped the family become closer. What could be more satisfying?
Of course you need a will to be able to read it with your children.
Above is part of an image of Shakespeare’s will. There has a puzzle in the will for scholars.
The will states, “Item I gyve unto my wife my second best bed with the furniture [the linens and hangings that went with it].” This line has been a subject of debate for centuries, as it seems like an unusual or even dismissive legacy to leave a spouse.
For a long time, the "second best bed" clause puzzled historians. Some interpreted it as a slight against Anne, implying she was not highly valued by her husband. Modern scholarship has provided a more nuanced understanding.
Household Custom: In Elizabethanhouseholds, the "best bed" was often reserved for guests as a symbol of hospitality. The "second best bed" would typically be the marital bed, holding significant personal and sentimental value as the bed shared by the couple.
Personal Significance: Experts now believe that Shakespeare's bequest was a gesture of intimacy and affection rather than neglect. Leaving the marital bed to Anne could symbolize their shared life and marriage, making it a deeply personal legacy.
It seems amazing that this cultural context was lost by the 1800s and was only re-interpreted more fully in the 1900s. Although I suppose not being a scholar myself, we could just be imposing our own modern views on this, it does seem to be the case and brought to more popular views from Germaine Greer's 2007 book.
I find this interesting as Greer was part of a movement - continuing today - that looks to re-examine the lives of women in history.
Joanne Limburg’s book - Letters to My Weird Sisters - would fit within that tradition. We talk about it a podcast last year.
We discuss her book Letters to My Weird Sisters: On Autism, Feminism, and Motherhood, in which she feels a kinship with historical female figures and addresses letters to them. Link here.
I met the access to medicines (or this also falls under the concepts of health equity) teams of several biopharmaceutical companies recently.
There is an implicit government/society social contract with medicines. One aspect surrounds patents. Society gives you a 10 to 20-year medicine monopoly, in exchange, biopharma develops more life-saving medicines, which also go cheap and generic after 10 to 20 years. (I say 10 to 20, as although patents are about 20 years, medicine development is around 10 years, given effective monopoly life closer to 10 years on average).
There is also a social contract aspect surrounding access to medicines, even for currently patented medicines. This social contract roughly goes: we allow you to make profits but we expect you to help poor people in rich countries, and poor countries more than rich countries. This social contract is more complicated because there is no consensus (and the range of views moves over time) over what are government responsibilities and what are private corporate responsibilities.
The strong form argues that these are 100% government or private individual responsibilities and no subsidies should be given by biopharmas. This argument would point to the fact that mobile phones are generally not given for free to poor people, and expensive medication should not be different. If a subsidy is needed then governments should fund it. This also gives stronger incentives to develop new medicines. The counterarguments are, to my mind, more obvious, and relate to the fact that people will die without access to medicines (unlike mobile phones - although some teenagers may disagree (!) ) and that people think we (including corporates) have some responsibility to mitigate this as human life is precious.
For pharma and industry some of this contract comes out in trust and reputation.
Depending on how you ask the question, trust might be more stable overall than some media headlines suggest (this is the same with trends in happiness). Ipsos did some major survey work on trust (which they found more stable than other sources) indifferent sectors. I think the 2018 - 2024 trust surveys are worth looking at.
The overall 2018 conclusion was that trust is complex and maybe not as poor as media headlines would suggest, although there were real challenges (although polarisation was already apparent). It is interesting to note high trust vs low trust countries.
The 2018 sector trust was highest in tech, which beat out biopharma in 2018. In 2021 and again in 2023, biopharma managed to improve its trust rating and overtook tech in 2023.
Although the split in emerging markets vs developed markets is noticeable, perhaps this is, in part, because poorer nations can really see how biopharmas are saving lives in their countries.
Perhaps, it is notable that trust struggles to reach >50% overall and only in a few countries does it reach that level.
In any case, to my mind, trust is interlinked with the implicit social contract. Having met many of these teams, I can report you have hundreds of people and significant sums ($100s of millions per companies) working on this. The challenge is not simply drug prices or access at point of care, but is intertwined with social determinants of health, public service infrastructure, society culture and many other non-pharma challenges.
I’m unsure if various nation states think this is enough (although it is more than most technology companies) but I was pleased to see good people trying to do good things, and arguably the trust in biopharma being linked with this.
One good thing is how we have reduced deaths by HIV over the last decade. We can do more, the challenge is not over, but in many rich nations HIV should no longer be a cause of death. And in poorer nations, there is much better access to HIV medicines and care than ever before. People living with HIV is now >40m but number of deaths pa is below 800K from a 1.6m peak around 2004.
This is a small part of my show with one main slide. But I am thinking of expanding it slightly to convey this wider trend of how the world is defeating many infectious diseases, leaving chronic diseases as increasingly the major illnesses of the world.
The story of HIV has many social determinants (high risk populations, poverty, needle sharers) to it as well as medicines. Improved medical regimes with modern anti-retroviral therapies (ART) have played a crucial role, and access to ART drugs for cost or free has been important.
This has been supported by diagnosis, testing and education for prevention (mother-to-child transmission, prophylaxis medications); technology for remote health services; policy support (NGO and philanthropy help and partners); looking at comorbidities (eg hepatitis, TB). These have all played a part.
I like the example because it’s fairly complex and its solutions are complex. It shows what humans can do when they collaborate. The challenges are not over by a long way but good has been done. In that, I see reflections in how we are tackling climate change as well.
Miranda July has started a substack now. The comments on the first fledgling post give you an insight into how people find her work, in particular her latest fiction piece which covers the life of a perimenopausal woman. It has comments like:
Stacy:
Was fumbling towards blowing up my own life and 20 year marriage when a friend who knows me more than anyone suggested I read your book. I laughed, I cried, I felt exposed. This book was about me. How did she know what I was experiencing at this very moment in time? How could this author show me more grace than the religion I grew up with?
A couple weeks ago I asked my husband if I could buy him the audiobook so he could better understand and he told me he wasn’t interested in understanding. And that’s the moment when I felt free to move on. Wish me luck because it’s not going to be easy
I like July’s work. In recent years, I’ve thought fondly of her for no creative reason but because she chose her surname as July. Supposedly, she was inspired when 15 by a character (July and Ida) in one of her friend’s stories and made it legal when she was 20.
In the New Yorker:
"As a kid, July liked to record one-sided conversations on cassette tapes, leaving pauses so that she could play them back and chat with herself. In high school, she found her voice on the page with Snarla, a feminist zine that she made with her best friend, Johanna Fateman, who went on to become a writer and a founding member of the band Le Tigre. July created a recurring series of interviews with different parts of herself—her confidence, her insecurity. Fateman depicted the pair as fictional characters, Ida and July, the name that Miranda eventually took as her own."
My eldest son has also changed his name inspired by fictional characters. Not perhaps so literary but it’s something I think about from time to time, about the nature of names and our own choosing. Her substack here.
The Nautilus fellowship (which is in part Emergent Venture supported; Zelda) looks to be great for the right type of person. Homeschoolers, passionate misfits, those who have a project they want to pursue on a gap year.
Nautilus is a three-month program for young and quirky individuals. It is designed to give you some childhood wonder back.
We select a small group of bright creatives from art, to science and entrepreneurship, that we receive in our San Francisco residence.
For three months, you live together with your peers, receive a monthly stipend and personalized guidance.
Take a break from the noise of your life to follow your curiosity and master your craft.
Apply here (by March 2025, under 22 yrs)