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ADVICE ON ACQUIRING FINANCIAL SECURITY

William C. Roberts, MD.

Herb Shriner (1918–1970), American humorist, radio and television personality, and famous harmonica player, once said, “Our doctor would never really operate unless it was necessary. He was just that way. If he didn’t need the money, he wouldn’t lay a hand on you.”

Similarly, a Punch cartoon in 1925 illustrated this conversation:

Doctor: What did you operate on Jones for?

Surgeon: A hundred pounds.

Doctor: No, I mean what had he got?

Surgeon: A hundred pounds.

Physicians are often faced with dilemmas: one option may provide a nice financial reward to the physician and the other, none or little personal financial benefit. Physicians of course have a fiduciary responsibility to do only what is best for the patient. Financially insecure physicians might be less prone to obey this fiduciary principle than financially secure physicians. Physicians, in my view, should always have an income where a decision for a patient is never influenced by personal financial reward! This type of thinking prompted this piece about physicians’ acquiring financial security. It is based on investing in the stock market over a 50-year period.

1. Save. Saving is the key to building wealth. Be frugal. Small sums saved regularly add up to large sums over time. Learn to get as much pleasure out of saving a dollar as spending a dollar. Never buy a house or an automobile that you cannot afford. Before purchasing anything, ask yourself if you really need it. Forget the $4 cup of coffee. Don’t smoke (a pack of 20 cigarettes now costs $10). Eat out less. Vegetarianism is not only a healthy lifestyle but also an inexpensive one. Trade babysitting with friends instead of hiring a babysitter. Check for unnecessary charges on monthly bills. Learn to do routine maintenance projects around the house.

2. Invest in the stock market. Despite what is going on presently (COVID-19 pandemic), the stock market is the best place to increase your monetary worth over a long period.

3. Acquire a certain amount (ideally >$10,000 or the equivalent of 4–6 months’ income) to respond to emergencies (getting fired, medical bills, coronavirus, etc.), before investing in stocks. A low-fee Standard and Poor’s Stock Index Fund might be considered. This fund provides ready diversity, but it also includes purchasing the bad stocks as well as the good ones. For those who don’t want to spend the time necessary to become relatively savvy with stocks, it is also probably better than buying individual stocks. A preferable alternative might be Warren Buffett’s Berkshire Hathaway, a collection of about 80 companies plus shares in a variety of companies not managed by Berkshire Hathaway. In contrast to the Standard & Poor’s collection of stocks, Buffett has few bad stocks!

4. Learn patience. The market always swings, going up and down. Do not panic. Most stock owners buy stocks when they are too high and sell them when they are too low. Doing the opposite is the way to make money. If price swings are too much for your nervous system, stay out of the market.

5. Diversify. Do not overweigh any one area: technology, financials, industrials, transportation, utilities, health care, telecommunications, oil and gas, basic materials. One area is usually up when another is down. Those who invested predominantly in technology in the 1990s lost a fortune. Try to buy stocks in the area that is down for the moment.

6. Favor stocks that pay dividends. If a stock goes down and it pays a dividend, you still earn money during its down cycle. You potentially lose money only when the stock is sold.

7. Recognize the beauty of compound interest, which Einstein called “the greatest invention.”

8. Put a limit on the price you will pay for a stock. Never indicate buy “at market.”

9. Have an investment goal and stick to it.

10. Beware of stock tips from friends and neighbors. No one has a monopoly on successful stock picking. Have a good reason for purchasing or selling a particular stock.

11. Avoid mutual funds and annuities. The fees are too high. There are no fees now for buying or selling a stock online!

12. Never buy or sell all at once. Start buying slowly. If the price falls, buy more; if the price rises, do not feel obligated to chase it.

13. Have a list of stocks to watch so when the price falls sufficiently you can jump on it.

14. Avoid shorting stocks unless you become a knowledgeable pro. Be a long-term investor.

15. Never borrow money to buy stocks. “Margin accounts” are dangerous.

16. Survey your stocks daily. It takes only a few minutes. The correct number of stocks to own varies with your interest in keeping up with them. Always be on the lookout for good buys. Know why you purchased or sold a particular stock.

17. Be more conservative as you get older. Take more risks when young.

18. Beware of bonds. They are for old people. With stocks you buy shares of the company—a part ownership. Bonds represent loans to companies.

19. Beware of trying to time the market—when it will rise or fall. Always keep some cash available for purchasing stocks when their prices are low.

20. Invest for the long term. Frequent trading rarely pays.

21. Before buying a stock, know its price/earnings (P/E) ratio (its price compared to its earnings), as well as its dividend, debt, percent of its net used to pay its dividend, range of its stock price at least in the last year, views of various analysts, and whether it presently has legal issues. I tend to avoid stocks with high P/E ratios. But, be cautious when the P/E ratio falls considerably because the price of the stock may have fallen considerably. Check on the number of years that the stock has paid a dividend and on whether the dividend increased or decreased through the years.

22. Look favorably at stocks that Warren Buffett owns. Consider purchasing them as soon as you learn what companies or stocks he has recently purchased. (He does not have to announce his purchases until he has had them for 6 months.) Buffet is not perfect, however. He has lost big on airlines recently, for example.

23. Listen to business channels. Nearly every stock has its proponents and detractors. Learn if your instincts are good and, if so, go with them.

24. Buy stocks in companies you believe in. Refrain from buying stocks in companies that produce products not good for your health—tobacco companies or fast-food chains, for example.

25. Subscribe to The Wall Street Journal and Barron’s. You can deduct their subscription costs from your taxes. Barron’s, particularly, provides many ideas for stock market investors.

26. Do not ignore trends and try to get out early. Recent trends, for example, relate to retail stores, particularly those located in malls (the overwhelming power of Amazon) and one-product companies (upstart pharmaceutical or technology companies).

27. Stay out of debt. You can never make much money in the stock market or elsewhere if you are in debt. Never have credit card debt! The interest rate is too high, nearly 20%. Try to make mortgage loans a 15-year proposition, not a 30-year one. Do not take a loan that has penalties for paying it off early. Try to obtain a mortgage that allows you to pay next month’s principle with the present month’s principle plus interest. Then, the next month’s interest is nullified. Try to save for the next car during the years between car purchases so that a car loan will not be necessary. Unless you plan to keep your vehicle for 10 or more years, consider a used car. Leasing is more expensive than buying.

28. Try not to divorce. Get a prenuptial agreement. Marry a frugal person!

29. Beware of sales. Although, of course, sales save the buyer money, many of us buy things we do not need when they are on sale.

30. Do not confuse the price of a stock with its value. Fallen stocks are certainly worth investigating, as their problems may be temporary, but they also may be facing insurmountable challenges that will sink them further. Think twice about selling a stock near its 52-week high. The best stocks tend to keep hitting new highs over decades, rewarding patient investors. Beware of purchasing very low-priced stocks (<$5).

31. Have a monthly budget. Know where your money is going. Start with recording any fixed monthly payments: rent or mortgage, loan repayments, cable bills, cell phone charges, gym membership fees, and prescription drugs. Next, record variable monthly expenses: groceries, restaurant meals, clothing, recreation, transportation, and electricity. Next, record infrequent or nonrecurring expenses: insurance, vacation travel, dental work, tuition payments, etc. Finally, subtract your total spending from your total income. Ideally, be able to cover your monthly expenses and still save 10% of income for savings and investments. Find ways to shrink spending—which is required if spending exceeds income. Call your credit card company at year’s end for a summary of your year’s spending.

32. Avoid retiring early. Start saving early for retirement. Do not procrastinate. Wasting less time usually leads to wasting less money.

33. Calculate stock profits and losses annually. If you buy a stock for $40 and it rises to $80, that is a 100% gain (“a 2-bagger”). If it goes from $40 to $44, that is a 10% gain. But, if the $40 stock at purchase falls to $20, to get back to $40 it will need a 100% gain; if it falls to $10, to return to $40, the stock would need to quadruple in price.

34. Don’t be fooled by the splitting of a stock. If you own let’s say 100 shares of a company at $10 each, a forward split might increase the number of shares to 200 but each share would be worth $5. Thus, there is no financial gain. Unfortunately, there is the reverse split (a red flag), whereby the stock price is increased and the number of shares is decreased. Let’s say you own 100 shares of a $4 stock and the company executes a 1-for-10 reverse split. You will then end up with a $40 stock but own only 10 shares of it. Citigroup did this a few years back. Occasionally, a company will pay its dividend by providing shares of its stock.

35. Study the 1929 US stock market crash, the worst event that ever happened to the US stock market. In October 1929 in 2 days (28th and 29th), the Dow Jones Industrial Average (“Dow”) fell 25%. (In the coronavirus crash in 2020, the Dow fell 30% in 30 days!) The 1929 crash in today’s terms would mean more than a 6000-point drop in 2 days. The Dow peaked at 381 on September 3, 1929, and finally hit “bedrock” at 41 on July 8, 1932, a 90% decline in 35 months. That does not include reinvested dividends, but most investors in those days took their dividends in cash. That fall is equivalent to investing $1 in the stock market and its shrinking to 10¢. No one foresaw how long and how terrible that bear market would be. The Dow did not surpass its 1929 high until November 23, 1954, 25 years later! The exact reasons for the 1929 crash remain unclear.

36. Own some gold in your portfolio, ideally about 5% to 10% of your investments. Buy gold coins and put them in your bank safety deposit box.

37. Stay healthy and live long. Good health is better than gold, as Mahatma Gandhi advised.

A side benefit to picking individual stocks is that you learn a great deal about yourself: whether you are basically conservative or a risk-taker; the degree of your patience; your worry level; your reasoning and analytical ability; whether you find buying and selling stocks pleasant and educational or unpleasant; and, finally, how you handle “the winning hand,” “the losing hand,” and uncertainty in general. I have found the decision to buy a stock to be far easier than the decision to sell a stock.

DR. JOSEF MENGELE (1911–1979)

David G. Marwell, former director of the Museum of Jewish Heritage in New York City and former Mengele investigator at the Justice Department’s Office of Special Investigation, has written Mengele: Unmasking the “Angel of Death.”¹ What follows was taken exclusively from his splendid book.

Joseph Mengele was born and raised in Günzburg, Germany, as were both his parents. He grew up in a loving home; his father owned his company, his mother was a devout Catholic, and in his younger years, he was a churchgoer and later married in a Catholic church. He had a secure childhood surrounded by parents, grandparents, two brothers, and household help. At university, he was recognized as a brilliant student who surely would become an academic physician.

Josef joined the Greater German Youth League in 1924 and from 1927 to 1930 was the leader of the Günzburg chapter, which numbered 60 boys and 30 girls. In April 1930, Josef left his home in Günzburg to begin studies at the Ludwig-Maximilian University in Munich. He threw himself into the study of medicine and related disciplines of human genetics and anthropology. His choice of subjects was particularly timely with the rise of National Socialism; both topics grew in importance and eventually enjoyed “a symbiotic relationship” with the Nazi state. A particular attraction of medicine to Mengele was its wide scope.

Adolf Hitler understood the importance of medicine and had distinct ideas on how it should be practiced in the new Germany. In an early speech before the National Socialist German Physician’s League, Hitler argued that, while he could do without lawyers, engineers, and builders, he needed National Socialist doctors: “I cannot do without you for a single day, not a single hour. If not for you, if you fail me, then all is lost. For what good are our struggles if the health of our people is in danger?” When Hitler spoke of the “health of our people,” he was not referring solely or even primarily to the well-being of individuals. Central to his concept of German medicine was the notion that physicians’ first responsibility was to the nation. This critical change in focus allowed German physicians to treat patients in ways that were previously unthinkable, without, in their minds, violating their Hippocratic responsibilities. Hitler’s call for racial hygiene was to become the primary responsibility of the physician in the new Germany, and that view was soon reflected in the medical school curriculum and in the infrastructure of the profession. They were now offering courses in genetics, anthropology, racial hygiene, and eugenics.

After two semesters at the University in Munich, Mengele transferred to Bonn. (At that time, it was common for German students to study at a number of universities, and Mengele would experience five before he was finished.) He grew politically active in Bonn. Mengele felt a strong attraction for the National Socialist’s program and its entire organization. Mengele remained in Bonn for three semesters, completing his fifth semester of the study of medicine, which allowed him to sit for the medical examination, which he passed. In September 1932, he returned to Munich for his sixth semester at the university. Three months later, on January 30, 1933, Hitler was appointed chancellor. Within a month, just a week before the end of the semester, the Reichstag burned, providing a pretext for the beginning of the end of parliamentary rule and the start of the Nazi dictatorship.

Mengele spent the summer semester of 1933, his seventh of university study, in Vienna. There in their pediatric clinic, the chief of pediatrics advocated euthanasia for babies with physical or mental disabilities, routinely sending children to the infamous Spiegelgrund Hospital, where hundreds were murdered under the Nazi euthanasia program.

In the fall of 1933, Mengele returned to Munich where, in addition to medicine, he began to study anthropology under anthropologist Theodore Mollison, one of the most prolific mythological and technological innovators in the field of measurement and photography. Mengele’s research there involved the examination of 122 lower jaws originating from six different racial groups. (They were part of the university’s anthropological collection.) Mengele’s study convinced him that the front sections of the jaws of the examined racial groups were different enough to distinguish between the races. Mengele’s dissertation received the magna cum laude designation.

In the summer of 1936, he had completed his medicine training and began his 1-year practicum, equivalent to an internship in the USA, which he did from September through December 1936 in Leipzig, and from January to July 1937 in Frankfurt at the University Institute for Hereditary Biology and Racial Hygiene. There he met Baron Otmar von Verschuer, a prominent German physician and eugenicist, who headed the newly established institute for hereditary biology and racial hygiene at the University at Frankfurt. The Frankfurt Institute had been founded in the spring of 1935 within the faculty of medicine at the University of Frankfurt. Verschuer instituted a large-scale project to identify all twins in the Frankfurt area, a clear indication that twin research was one of the most important approaches in the field of biology. His studies incidentally were supported in part by the Rockefeller Foundation.

In September 1937, Mengele had fulfilled all the requirements for his medical degree and received his appointment. He started on his second doctorate, this one in medicine with Otmar von Verschuer as his mentor. The topic of Mengele’s second dissertation was entirely consistent with the research program of the institute. He chose to investigate the related birth defects of cleft palate and jaw—malformations that had emerged as particularly interesting in the context of racial hygiene, since new surgical interventions could correct them cosmetically, camouflaging a trait that would normally have identified a racially compromised individual. For his dissertation, Mengele was able to identify 110 children who had been treated for an oral cleft by a surgeon of the university clinic between 1925 and 1935. From these cases, he narrowed the number to 17, selecting those living in the Frankfurt area who had both a cleft lip and a cleft palate. Through discussions with the parents of these children, Mengele was able to reconstruct genealogical tables for the 17 families, which contained entries for 1202 living individuals. He concluded that the anomalies were clear indications of inheritance. Mengele’s dissertation was submitted and defended in the summer of 1938. His mentor wrote that the dissertation was an original, independently executed scholarly work, whose execution required not only industry and tenacity in overcoming significant obstacles but also keen skills of observation and care in carrying out the examinations. Mengele’s dissertation was published a year later in Zeitschrift für Menschliche Vererbungs und Konstitutionslehre (Journal for Human Heredity and Constitution Theory).

His work coincided with the July 14, 1933, law for the prevention of hereditarily diseased offspring, known as the “sterilization law,” which came into effect in January 1934 in Germany. Mengele’s work, with its proof of a high degree of hereditability of oral clefts and their connection to other developmental disabilities, served to underpin the legislation, the enforcement of which resulted in the forced sterilization of 375,000 individuals between its enactment in 1934 and the beginning of World War II on September 1, 1939. The Marital Health Law, promulgated in September 1935, prohibited the marriage of a healthy person to anyone who had a hereditary condition, including those with oral clefts. A 1936 modification of this law also prohibited marriage between healthy individuals and those who had been sterilized under other legislation.

In May 1938, Mengele joined the Nazi Party and around the same time also joined the Schutzstaffel (SS). The combination of his studies in medicine and anthropology provided Mengele with a perfect scientific complement to Nazi politics. In 1938, Mengele was made a permanent assistant at the Frankfurt Institute. In the 1940 issue of Der Erbarzt, Mengele published a paper on the inheritance of fistula auris congenita, a sinus opening in the external ear.

Beginning in April 1933, new German legislation required that individuals prove their racial bona fides. During the 12 years of the Third Reich, state and party authorities issued 2000 statutes, ordinances, and regulations establishing legal rights on the basis of “racial status.” Much was at stake in terms of one’s rights, status, and occupation.

While at the Frankfurt Institute, Mengele placed his scientific knowledge at the disposal of the state by preparing expert opinions for the Reich’s genealogical office and the health courts that had been created to enforce the various racial and eugenic laws designed to implement the Nazi worldview and to protect and “improve” the German race. Mengele’s judgment in the numerous cases he studied was more often than not beneficial to the person being examined, finding that the individual was not a “full Jew” more than two-thirds of the time.

On July 28, 1939, Josef Mengele married Irene Schönbein. Marriage was not easy for a member of the SS. Heinrich Himmler had issued the SS Engagement and Marriage Order on December 19, 1931, requiring all unmarried members of the SS to secure permission before marrying. A raft of paperwork was required, as was a medical examination proving the absence of congenital diseases and the capability to bear children. For the SS, marriage meant two people of racial quality procreating. The Mengele–Schönbein marriage took place in a civil ceremony at the Registry Office, immediately followed by a Catholic service in a small chapel. When questioned by two researchers working on a book on Mengele 50 years later, Irene stated, “I knew Josef Mengele as an absolutely honorable, decent, conscientious, very charming, elegant, and amusing person. Otherwise, I probably would not have married him. I grew up in a good, prosperous house, and I did not lack for marriage possibilities.”

Five weeks after the wedding of Josef and Irene Mengele, Germany invaded Poland and World War II began. In June 1940, Mengele joined the military, initially attending the “military physician training course,” which of course he passed. His first assignment was unpleasant and that stimulated him to apply to the Waffen-SS, where he was assigned to the medical inspectorate in August 1940. For the Nazis, the war offered the possibility not only of “removing threats to the German race” but also of taking “positive” steps to preserve and cultivate the German racial community. Since race and nation were synonymous for the Nazis, they claimed the right and obligation to safeguard German blood wherever it was found.

Shortly thereafter, Hitler appointed Heimlich Himmler as the Reich Commissioner for the Strengthening of Germandom. Himmler saw this task as the creation of a new racial order that gave him a fiduciary responsibility to preserve, protect, nurture, and cultivate German blood. He was specifically charged with the repatriation of ethnic Germans and the “elimination of the harmful influence of alien parts of the population, which represent a danger to the Reich and German national community.”

Mengele’s first assignment as a Waffen-SS officer was as a medical inspector at the Central Immigration Office, where he was assigned to the health office as an expert in hereditary biology. The immigration office had been established at the beginning of October 1939 to evaluate ethnic German immigrants to determine their suitability for resettlement in recently captured Poland. Toward the end of 1940, Mengele was transferred to the Fifth Waffen-SS Viking Division, a frontline combat unit. He was assigned to the Engineer’s Battalion of the Viking Division as a troop physician, and he remained with this unit without interruption until the beginning of 1943, when he was transferred to Berlin. His major responsibility was to provide general care for the men in his unit, which included treating a wide range of maladies. For a physician with limited clinical experience, the responsibility was particularly demanding. In June 1941, the unit was part of the German invasion of Russia. The Viking Division was composed, for the most part, of recruits who had been socialized in the schools of Hitler Youth and other organizations of the Nazi state, which had instilled in them a great degree of the radical nationalistic, racist worldview of the National Socialist regime. The necessity of a brutal, ruthless struggle against Bolshevism along with anti-Semitic themes was part of their training. The Waffen-SS viewed the war as both a military and racial struggle. As this unit invaded Russia, there was indiscriminant shooting of Russian soldiers and civilians in large numbers and the killing of any Jews they saw. The consequence was a number of large massacres by the Viking Division. It was calculated that members of the Viking Division murdered between 4280 and 6950 Jews in the week or so following their first engagement against the Soviet Union. For Mengele’s contribution, he was awarded the Iron Cross for bravery in combat.

In mid-January 1943, Mengele was transferred from the front line to Berlin, where he wasted little time in contacting his mentor, Otmar von Verschuer. In Berlin, Mengele was assigned to an SS replacement unit. Although he was still formally associated with the Frankfurt Institute, he established a close connection to the Kaiser Wilhelm Institute of Anthropology in Berlin and enjoyed the status of a “guest scholar.” Mengele’s 4-month association with the institute in 1943 laid the foundation for a crucial link between scientists at the institute and a colleague who would soon be instrumental in supplying all manner of human specimens and data to advance their work, namely Mengele.

In May 1943, Mengele was assigned to Auschwitz, the “capital of the Holocaust.” It was both a concentration camp with punishment and exploitation and an extermination camp. It was made up of three camps: Auschwitz I, Auschwitz II–Birkenau, and Auschwitz III–Monowitz. There were nearly 50 subcamps, ranging from agricultural estates to coal mines in which people were forced to work, often to death. Auschwitz was where the ultimate expression of Nazi racial policy was inflicted, primarily among Jews, but also for other victims from all over Europe.

There is some dispute about how Mengele came to be assigned to Auschwitz. Did he apply for the post? Was it arranged by his mentor, Verschuer? Or was he simply assigned there in the regular course of business? Clearly, Mengele did not go there against his will. Although Mengele was at Auschwitz from May 1943 to January 1945, a total of 20 months, it was here that Mengele came into his own; he found expression for his talents, so that what had been potential became actual. He was only 33 years old when he arrived at Auschwitz. Mengele made a name for himself quickly at Auschwitz as an effective fighter of the various epidemics there: typhus, scarlet fever, and measles.

At Auschwitz, Mengele was one of a number of camp physicians involved in pro forma medical care for prisoners, which included admitting and discharging them from the camps’ infirmaries, making diagnoses and recording treatment, and checking the medical conditions of newly arrived and released prisoners. Beyond these tasks, the camp physicians played a role in mass murder. They carried out selections on the ramp of prisoners arriving at Auschwitz, determining who would be killed immediately in the gas chambers and who could first be exploited for their labor. They also carried out selections of already admitted prisoners in the camp infirmaries to ascertain who was still capable of working and who should be killed. In addition to the assigned official duties, Auschwitz camp physicians engaged in experiments involving inmate subjects.

The most extensive experiments at Auschwitz involved perfecting a method for advanced and reliable mass sterilizations which the Nazis planned to use on Slavs and others. These experiments were ordered by Himmler. Another parallel experiment was on sterilization, including irradiation of the testicles and ovaries of Jewish male and female prisoners, seeking the most effective dose. There were also experiments on the effects of starvation. Other experiments were done to unmask the various methods of malingering that were becoming widespread among German soldiers, including self-inflicted wounds, abscesses, fever, and infectious hepatitis. Using Jewish prisoners, one staff physician attempted to “provoke” the same symptoms displayed by the malingering soldiers. There were experiments on tuberculosis, schizophrenia, and depression. In contrast to those experiments conducted ostensibly for “practical reasons,” Mengele’s research, which he carried out on his own time, almost exclusively involved the science that had occupied him since he had begun his university studies. He was almost certainly planning to use his Auschwitz research to further his academic career.

The most chilling and familiar image of Auschwitz is the confrontation on the “ramp,” where incoming prisoners, disoriented and frightened, exhausted and starving, exited from the train cars and were stripped of their property. The selection process was carried out by the camp physicians. The use of physicians reinforced the view that the killing of Jews was a matter of public health, an effort to protect and preserve the racial community. After exiting from the trains, the prisoners were divided into two lines, one for men and one for women and children. These groups were made to file past the camp physician on duty, who would carry out the “selection,” dividing the oncoming line to the left and right—life and death. The weak, the sick, the elderly, the young, and the pregnant were selected for death. Mothers with young children were condemned to die with their offspring. After the initial selection, three groups were formed: women who were to be admitted to the camp; men who were to be admitted to the camp; and those men, women, and children who were to be gassed immediately. Prisoners gathered the luggage and other belongings and transported the loot to the warehouses, where it would be inventoried and made available for local use or transported back to Germany for distribution. Crews cleaned the trains. Depending on the number of arrivals, the entire operation could be over in an hour or two. Every attempt was made to reduce anxiety among the prisoners by offering a catalog of lies and reassurances about their fates.

When Mengele was on the ramp, he always called for anyone with a medical background to step forward. Most people who encountered Mengele on the ramp shortly after arriving at Auschwitz did not survive. Mengele, however, took advantage of his service on the ramp to “recruit” a cadre of exceptional physicians, anthropologists, technicians, and other medical professionals who could assist in his research. He also consulted the registration records of admitted inmates to inquire about prisoners with a particular medical specialty. The physicians also regularly conducted selections inside the camp and camp infirmaries to make room for arriving inmates and to cull the camp of unproductive people who were too ill or weak to work and who posed a public health threat because of sickness. Although there is no evidence that Mengele performed these selections more often than his colleagues, he appeared to have served as an example for those who found the assignment difficult.

Mengele created his own research institute at Auschwitz. He staffed it with inmates, specialists in a wide variety of medical and scientific fields, as well as a cadre of technical assistants, nurses, illustrators, and clerical help. At the beginning of his time there, he dedicated a barrack in the Gypsy camp as his laboratory and supplied it with medical instruments and equipment. The scientific program of this “institute” included the treatment of noma facies; twin research; the collection of eyes from individuals with heterochromia (eyes of different colors); experiments relating to eye color; the collection of blood samples for a project on specific proteins; the collection of growth anomalies (like dwarfism and giantism) and physical anomalies (club foot, hunchback); the preservation of Jewish skeletons, human embryos, and deceased newborns; and the anthropological study of Gypsies. The “institute” conducted research not only in the service of Mengele’s own professional interest and professional advancement but in collaboration with colleagues at the Kaiser Wilhelm Institute for Anthropology. His institute also supplied specimens to the SS medical academy in Graz for the training of the next generation of SS physicians.

Auschwitz provided, in other words, access to an unprecedented resource for all the research interests of Mengele. The sheer number of people who came through the camp ensured that a robust sample of human beings with the full range of human traits was available. Twin births, for example, occur in approximately 1.1% of live births. Given the number of people deported to Auschwitz—approximately 750,000 during Mengele’s time there—it follows that a large number of twins were available to him. Current rates of dwarfism are about 1 in 40,000, suggesting that Mengele would have encountered a number of dwarfs among the deportees. The same holds true for the wide variety of rare conditions that affect human beings. For the anthropologist and geneticist, access to the sheer number of these unusual cases, in a context that permitted unbridled research, was unprecedented.

Mengele had a special interest in Gypsies. He took advantage of the twins who could be found among them and also the anthropological insights they offered. He enlisted an inmate artist to paint portraits of Mengele’s Gypsies. The illustrator was convinced that Mengele was going to use her paintings as illustrations for his planned book.

Noma was a rare disease rampant in the Gypsy camp when Mengele arrived in the summer of 1943. Although once common in Europe and North America, the disease had virtually disappeared in developed countries by the 20th century except for its recurrence at Auschwitz and Bergen-Belsen. Noma generally starts as a gingival ulceration. If the ulcer is left untreated, it progresses rapidly to involve the cheek or lip. It swells and within days a blackish furrow appears where intraoral tissue is being lost. The necrotic tissue eventually becomes a hole. Although this disfiguring and usually fatal disease was a product of the camp itself, simple measures of sanitation and a modest standard of nutrition were all that would have been necessary to prevent an outbreak.

In Mengele’s twin research, he was searching for the secret of multiple births. Twin research had been a defining pursuit of Mengele’s mentor, Verschuer, and the two important institutes that he led. Unfortunately, neither Verschuer nor Mengele studied the parents of the twins. A prerequisite for twin research was the successful determination of whether a pair of twins was fraternal or identical. Distinction was not easy for physicians in the first half of the 20th century.

Mengele was overheard apparently more than once saying that not to utilize the possibilities Auschwitz offered would be a “sin, a crime, and totally irresponsible toward science.” Mengele often spoke “enthusiastically” of his scientific work and about the material that was available to him, a unique opportunity that would never again be offered. He was at the cutting edge made sharper by the unique potential that Auschwitz opened up for him. Although Mengele was certainly a Nazi, one of his coworkers indicated that in her opinion Mengele had an apparent genuine and serious interest in scientific work. Unique among his studies on twins was that he could determine when they died and do autopsies on both of them at the same time.

Mengele’s eye studies were particularly horrifying. Multiple witnesses described him introducing chemicals into an experimental subject’s eyes, either with an eyedropper or by injection. His goal in these experiments was to change the subjects’ eye color to an Aryan blue (Aryanization). His eye research included the harvesting of eyes from children with a particular condition and shipping them to the Kaiser Wilhelm Institute for Anthropology in Berlin. He had a particular fascination with heterochromia. Mengele considered heterochromia as an affliction. On occasion Mengele introduced adrenaline into children’s eyes, which the twin survivors recalled with horror and dread.

Mengele studied specific proteins as means to determine a person’s race. He believed that every individual, every family, every race, and every species possessed a unique biochemical signature that arises out of the protein structure. He wanted to develop a reliable “race” test; discover a biochemical basis for racial identification and a way of distinguishing fraternal and identical twins; and discover a new basis for determining paternity and related ancestral questions. He collected 200 samples from inmates at Auschwitz and sent them to Verschuer.

Mengele supplied colleagues at the institute in Berlin with medical and biological samples. In addition to blood samples and eyes, he shared a range of specimens. There is no way to estimate the number and range of samples provided by Mengele, but his access to the huge reserves of human variation and his control of a well-staffed pathology laboratory provided him with every opportunity.

Mengele was tightly connected to the scientific community both before and after his arrival at Auschwitz. He kept comprehensive records of his scientific work. He was in fact in the scientific vanguard, enjoying the confidence and mentorship of the leaders in his field. The science he pursued at Auschwitz was not anomalous but rather consistent with the research carried out by others in what was considered to be the scientific establishment. Thus, he and his colleagues considered their research not criminal and monstrous but, because of the absence of all barriers that ordinarily serve to contain and regulate the temptations and ambitions of investigators, a duty and ethical.

For members of the SS, a posting at Auschwitz had significant advantages over a combat assignment. Beyond enjoying relative safety, they had the opportunity to live with or receive visits from their spouses and family members. Indeed, the camp administration encouraged families to live together or make visits, believing that this kind of contact provided psychologic support for the SS members performing such “difficult service.” Mengele’s wife visited him twice, once for an extended stay, while he was in Auschwitz. Each family employed a young Polish girl from the area to help with the children and to carry out other household responsibilities. There was a commissary, tailors, and shoemakers at the camp to alter and repair items for SS members and their families. Dirty laundry and linens were taken to the camp laundry. Prisoners were available to remodel and repair SS homes, stock coal cellars, work in the gardens, and distribute fresh water for washing and cooking. The man who prepared weekly baths for the SS officers described Mengele as “very polite and good looking. He never screamed or beat the prisoners.”

In January 1945, the Soviet advance toward the West threatened Auschwitz, and the SS prepared for withdrawal. The inmates who were deemed able were forced to evacuate Auschwitz, embarking on the so-called death marches to camps in the West, without adequate clothing in the harsh weather. Thousands died from the elements or were murdered by the accompanying German guards. After dynamiting the gas chamber/crematorium complexes and destroying camp documents, the SS evacuated Auschwitz on January 17, 1945. Mengele feverishly packed his files and all his notes and prepared them to be shipped. He escaped to a camp near the city of Breslau.

In the final days of the war, Mengele appeared at a German field hospital in Saaz. He joined the hospital medical corps, allowing him to shed his incriminating SS uniform and dress himself like a German Army officer. In August 1945, Mengele was released from a prisoner of war camp and provided a discharge certificate, a crucial document that proved he had been screened by US authorities and properly released, allowing him to register with local authorities when he got home and permitting him to receive rations and other necessities. After the war, German nationals who had been held as prisoners of war were released, except those in automatic arrest categories, namely SS men and war criminals. With over 3 million German prisoners in custody, dwindling food supplies, and a significant and growing displaced person population, the release seemed the only feasible strategy. The presence of a tattoo was considered conclusive evidence of membership in the SS, and tattoos could be used as a litmus test in evaluating prisoners. Prisoners without shirts and with raised arms were forced to file past inspecting guards who would immediately filter out those with tattoos for further examination and interrogation. As an SS medical officer, Mengele had been responsible for implementing the blood type tattooing in his unit but was able to avoid it himself.

Mengele found work on a farm and for the next 3 years lived in a small hamlet near Riedering. The farm consisted of 23 acres, 10 cows, and a few horses and grew potatoes, grain, and fodder. It was well off the beaten path—an ideal place to lie low. By this time, Mengele was going by the name Fritz Holmann. The farm owner was a no-nonsense boss who required Mengele to work every day except Sunday, rise at 4:30 am, and spend 12 to 14 hours in the fields or in the barns tending to the crops and animals. The work earned him 10 marks per week. The owner’s brother, who roomed with Mengele, indicated that Mengele did everything the farmer asked him to do. He was physically very strong and got steadily stronger with the work. He learned quickly. He never spoke much. He was neither friendly nor unfriendly but always very controlled, disciplined, and industrious and always reading and writing. The farmer’s wife noticed that he kept to himself and rarely spoke about himself. He occasionally went to church on Sundays but rarely left the farm.

Mengele’s wife learned of Mengele’s atrocities at Auschwitz and after the war acted as if her husband was dead. She wore black and observed other conventions of a woman in mourning. Irene took steps to have her husband declared officially dead by the authorities. The ruse worked. In the fall of 1948, Mengele decided to leave Europe. He hoped to resume the possibility of scientific pursuits. Fortunately, his parents provided the necessary money. He arrived in Buenos Aires, Argentina, in June 1949. From that point, he had a decade or so of relative obscurity. He went under the name Helmut Gregor. Mengele also returned to his science during this period, publishing an article on genetics under the name G. Helmut that appeared in 1953 in Der Weg. The article’s title was “Heredity as a Biological Process,” and it is an introduction to genetics, covering the basics of hereditability, common Mendelian laws, and genetic pathology.

In Buenos Aires, Mengele renewed his life as an intellectual and mingled with similar persons. He went to Germany in 1956 to visit his family and his son and then returned again to Argentina. In 1960, Eichmann was captured in Buenos Aires and brought to Israel. Thereafter, Mengele’s name started to appear prominently in newspapers, so he changed his name again and moved to Paraguay to escape capture. From there he moved to Brazil and was never captured. He died in 1979.

Just over a year before he died, his son Rolf visited him. They had never really gotten along. His son quizzed him on his activities at Auschwitz, and Mengele argued that he did not “invent” Auschwitz. It had already existed. He stressed that one of his jobs was simply to clarify “able to work” or “unable to work” persons. He emphasized to his son that he labeled people “able to work” as much as possible. He thought he had saved thousands of lives that way. He hadn’t ordered extermination and he was not responsible. Also, the twins owed their lives to him. He had never harmed anybody personally.

Mengele never made an admission of guilt or responsibility. He believed that his actions had been justified or even understandable. He was unrepentant to the end and expressed no remorse. He told his son that he was not moved in the slightest to “justify” or even excuse any decisions, actions, or behavior in his life. His worldview was little changed from the summer day in 1944 when he first stalked the ramp at Auschwitz-Birkenau.

DETERMINING WHEN LIFE SHOULD END

Diane Rehm who hosted The Diane Rehm Show in Washington, DC, for 36 years, has written a book entitled When My Time Comes.² In it she presents interviews of 26 individuals about who should determine when life ends. The foreword was written by John Grisham, who set the theme in the first sentence: “I believe it’s wrong to sustain a life beyond the point when it should not be sustained, when it should be terminated. … I think that it becomes immoral if a person is brain dead, clinically dead, and is being kept alive by machines.” He emphasized, as does Diane Rehm, that when to terminate life should be the decision of the patient.

In her preface, Rehm described her beautiful mother who had fatal cancer and wanted to be put out of her misery, but in 1955 there were no means despite her mother’s begging to die. Oregon became the first state in the country to adopt a right-to-die law, and that was in 1998. Washington and Montana followed in 2009, Vermont in 2013, California in 2015, Colorado in 2016, the District of Columbia in 2017, Hawaii in 2018, and New Jersey and Maine in 2019. Thus, nine states plus the District of Columbia have laws where individuals are permitted to choose when to cease their suffering through the use of medical aid in dying. Now, numerous state legislatures are having fierce debates between those who believe that each of us has the right to choose when our suffering should end and those who argue on religious or moral or ethical grounds that no human being has the right to hasten his or her death. Switzerland and the Netherlands have long had laws allowing doctors to respond to requests from individuals to end their lives, some because of physical illness and others because of emotional distress.

The interviews in this book are of many people: patients with terminal illnesses, physicians, nurses, ethicists, and those left behind. These interviews will appear in an upcoming television documentary When My Time Comes, which is a companion to this book.

There are so many ways today to keep us alive, and yet the incredibly sophisticated means of keeping us alive do not always consider what people themselves want. We concentrate on extending the absolute duration of life, irrespective of how dismal and degraded and burdensome the quality of that life may be. In the last month of life, we are replacing humanity with technology. Having a good death, dying at home, surrounded by family is the way I want to go.

Most people do not choose “aid in dying” because of extreme pain. Their suffering may be anhedonia—lack of joy or pleasure, loss of autonomy, or loss of dignity when you rely on someone else to clean you up every day, you cannot take care of yourself, or you are incontinent. Only one-third of those who sign up for aid in dying actually end up taking the medication to do so. They just want the option. In Oregon, there are about 35,000 deaths every year, and in 2019 only 170 people took the aid-in-dying medication, about 0.2% of the deaths in that state. About half the people who begin the process die before they get through it. States have included various protections in the law: there is a waiting period of 2 weeks, and two different doctors have to see you and sign paperwork.

Historically, most people who use aid in dying have been cancer patients, but that is changing a bit now. Amyotrophic lateral sclerosis, terminal emphysema, and heart failure patients are using this route. The enemy is terminal suffering. Honoring people’s choices, preventing suffering, and comforting individuals at the end of life is the goal.

One of the medical students asked one of the lecturers, Dr. David Grube, the national medical director of Compassion and Choices, “How do states that don’t allow medical aid in dying justify the idea that palliative care is so much better than medical aid in dying?” Dr. Grube answered: “Continuous deep sedation, which we used to call ‘palliative sedation’ or ‘terminal sedation’ is a very high-tech thing. This can be done only in a facility, not at home. It is controlled by the physician, not the patient. The patient is put to sleep and the medicines are given so that the patient stays asleep until he/she dies.” About 98% of people who choose aid-in-dying in authorized states have insurance, which pays the bill. Medicaid also pays for it. The medicine is self-administered! Patients are counseled to never take the medicine alone, never take it in a public place, and to tell their family about it.

THE CORONAVIRUS AND THE LABORATORIES IN WUHAN, CHINA

Mr. Tom Cotton, US senator from Arkansas, had a piece in the April 22, 2020 Wall Street Journal describing the Institute of Virology and the Wuhan Center for Disease Control and Prevention and how these laboratories in Wuhan may have been the source of the coronavirus.³ The Chinese Communist Party, of course, denies that possibility. Beijing has claimed that the virus originated in a Wuhan “wet market,” where wild animals are sold, but evidence to counter this theory emerged in January 2020. Chinese researchers reported in The Lancet on January 24 that the first known cases had no contact with the wet market. There is no evidence the market sold bats or pangolins, the animals from which the virus is thought to have jumped to humans. And the bat species that carries the virus is not found within 100 miles of Wuhan!

The Institute of Virology is 8 miles from the wet market, and the Wuhan Center for Disease Control and Prevention is barely 300 yards from the market. Both labs collect live animals to study viruses. Their researchers travel to caves across China to capture bats for this purpose. While the Chinese government denies the possibility of a lab leak, its actions tell a different story. The Chinese military posted its top epidemiologist to the Institute of Virology in January. In February, Chairman Xi Jinping urged swift implementation of new biosafety rules to govern pathogens in laboratory settings. In early January, enforcers threatened doctors who warned their colleagues about the virus. Among them was Li Wenliang, who died of COVID-19 in February 2020. Laboratories working to sequence the virus’s genetic code were ordered to destroy their samples. The laboratory that first published the virus’s genome was shut down. The evidence is circumstantial, but it all points toward the Wuhan labs.

PRESIDENTS DURING OTHER US EPIDEMICS OR PANDEMICS

Allen C. Guelzo, a senior research scholar at Princeton, had a piece in the April 27, 2020 Wall Street Journal on actions taken by previous US presidents during epidemics.⁴

The yellow fever epidemic of 1793 struck Philadelphia, then the US capital, with considerable violence. The virus took only 2 months to kill 5000 of the city’s 21,000 inhabitants, with the death toll topping 1000 a day in mid-October. Thousands attempted to flee the city only to be turned back by vigilantes and militia. President George Washington left Philadelphia on September 10, 1793, for Mount Vernon (Virginia), where he stayed in comparable safety until the epidemic curve had flattened, returning on November 10. Meanwhile, for 2 months the federal government stopped operating; the post office ceased deliveries. Real leadership fell to Philadelphia’s mayor, Mathew Clarkson, who reported daily to his office. He struggled to keep the city’s streets clean and clear.

A pandemic hit the US in 1832, when trade carried cholera from India to Europe and then North America. Cholera is caused by intestinal bacteria, and its path through Europe was lethal. Out of Berlin’s 240,000 inhabitants, 2220 were sickened and 1401 died; in Vienna, 3980 out of 300,000 were stricken and 1898 died. The New York mayor quarantined shipping on February 2, 1832. But cholera surfaced there anyway on June 27, and by the beginning of September it was causing 178 deaths a week. When the outbreak ended in mid-October, 3471 out of the 250,000 New Yorkers had died from cholera; Philadelphia saw 935 deaths from 2314 cases. President Andrew Jackson did nothing. He left Washington for Tennessee, urging his extended family and advisers to do likewise.

The so-called Spanish flu hit the US in 1918. This H1N1 virus was probably brought to Europe from China by laborers recruited to fill home-front jobs in Europe torn by World War I. It struck the US amid wartime mobilization and eventually killed 675,000 Americans. On a single day in October 1918, 202 died in Boston; 4500 died in 1 week in Philadelphia, 837 on October 12 alone. In Washington, DC, churches closed, and Congress and the Supreme Court adjourned. By 1918, the federal government had more public health resources to deploy than in the previous century, beginning with the newly reorganized US Public Health Service, which recruited 1000 doctors and >700 nurses to fight the epidemic. But so much of the country’s health infrastructure had been swept into the war effort that again most of the burden fell on local authorities. President Woodrow Wilson made no public statements about the Spanish flu and in January 1919 left the US for France, where he hoped to manage the Versailles peace negotiations. President Wilson came down with the Spanish flu himself on April 3, suffering with fever of 103° and violent paroxysms of coughing, which were so severe and frequent that they interfered with his breathing.

Although President George W. Bush did not face a similar US epidemic, he became alarmed by reading John M. Barry’s The Great Influenza. Mr. Bush ordered the creation in 2005 of a National Strategy for Pandemic Influenzas to ensure stockpiles of “everything from syringes to hospital beds, respirators, masks and protective equipment.”

In response to the COVID-19 pandemic, President Donald Trump imposed travel restrictions, convened a national response strategy, and demanded cooperation from both the public and private sectors, substantially more than Washington, Jackson, or Wilson did in their hours of health crisis. Except for two 1-day visits, President Trump has remained in Washington, DC.

Russian President Vladimir Putin, after telling provincial governors to do the best they could and ceding to them neither power nor resources to accomplish much, left Moscow.⁵ His chosen refuge was Stalin’s former dacha, outside the town of Valdal. Russia, like many other countries, has been hit hard by COVID-19. As of April 23, 2020, there have been at least 58,000 confirmed cases and 513 deaths. Russia entered the crisis in a weakened state. Its average growth has been about 1% annually since 2009, and that has eroded many of its citizens’ income. In the third quarter of 2019, almost 18 million or 12% were below the subsistence minimum, which in 2020 their government defined as about 11,000 rubles a month ($146).

MARRIAGES DECREASING

The share of Americans getting married has fallen to its lowest level on record, according to government figures released in April 2020.⁶ The US marriage rate fell 6% in 2018, with 6.5 new unions formed for every 1000 people, according to a report by the National Center for Health Statistics. That was the lowest rate since the federal government began keeping data in 1867. Marriage rates plunged near the start of the Great Depression in the 1930s, then rebounded sharply after World War II, hitting a high of 16.4 marriages per 1000 people in 1946. The marriage rate began a steady decline in 1982 that lasted until 2009, then remained near flat before inching upward in 2014.

Many Americans are now opting to form households without tying the knot. Strained finances may be the top reason. In recent years, much of the marriage decline has come from middle earners and those with only a high school education. Declining religious adherence and growing acceptance of unmarried cohabitation have also played a role. About 5 in 10 American adults were living with a spouse in 2019, down from about 7 in 10 in 1970. About 7% live with a partner in 2019, up from <1% in 1970. The fallout from COVID-19 is likely to further discourage marriage in the near term since financial insecurity, coupled with travel and social gathering restrictions, are matrimonial deterrents. The situation is unfortunate since marriage is correlated with positive health outcomes, longevity, and economic security. Age-adjusted death rates are lowest for those married vs those not married.

INSECTS VANISHING

The May 2020 issue of National Geographic had a piece entitled “Where Have All the Insects Gone?”⁷ The point of the article was to show that bugs are disappearing at an alarming rate and the result could be disastrous for the planet. Light traps set up mainly in forests show steep drops of insects—as do automobile windshields. Climate change, habitat loss, and pesticides have all been implicated. When entomologists from Krefeld, Germany, collected flying insects for 2 weeks in August 1994 and at the same site with an identical trap in August 2016, they observed a 96% drop in insect biomass between 1989 and 2016. Similar data came from 63 other German protected areas. Researchers working in a protected forest in New Hampshire found that the number of beetles there had fallen by more than 80% since the mid-1970s, while the bug diversity—the number of different kinds—had dropped by nearly 40%. A study of butterflies in the Netherlands found their numbers had declined by almost 85% since the end of the 19th century, while a study of mayflies in the upper Midwestern US found their populations had dropped by more than half since 2012.

Insects are far and away the most diverse creatures on the planet—so much so that scientists are still struggling to figure out how many kinds there are. About 1 million insect species have been named, but it is generally agreed that many more—by recent estimates some 4 million more—have yet to be discovered. Just one family of parasitoid wasps, sometimes called Darwin wasps, contain something like 100,000 species, greater than the number of all known species of fish, reptiles, mammals, amphibians, and birds combined. Other insect families are similarly big; for example, perhaps 6000 species of weevils are known.

There are five general categories of insects:

Providers: These insects are in nearly every food chain. Any larger animals—birds, bats, amphibians, and fish—eat insects before they in turn are eaten by predators. The death of insects is suspected to be the leading cause of declines in the bird population.

Decomposers: Waste-eating insects unlock nutrients for use by the ecosystem that would otherwise stagnate in dung, dead plants, and carrion. Dung beetles process parasite-breeding and grass-killing cattle dung in 23 months vs the 28 it would take without these insects.

Pest controllers: By feeding on crop-threatening pests, predatory insects perform the role of pesticides without chemicals. This cuts pest control costs and increases yields, saving agricultural industries billions of dollars every year while reducing toxic pesticide residue on crops.

Pollinators: Nearly 90% of flowering plant species and 75% of crop plant species depend on pollination by animals, mostly insects. Overall, 1 out of 3 bites of food humans eat rely on animal pollination in the production process. A bumble bee can visit and help pollinate 3000 flowers a day.

Soil engineers: Termites and ants can transform soil in hot, dry climates. Their tunneling aerates hard ground, helping it retain water and adding nutrients. In some regions, the introduction of termites has turned infertile land into crop land within a year.

What can be done to reverse these trends in insect loss? According to a number of entomologists, it depends on what is driving the loss. If it is primarily climate change, then it would seem that only global action to reduce emissions could really make a difference. If pesticide or habitat loss are the main culprits, then action on a regional or local scale could have a big impact.

BIG HAT NO CATTLE

The first edition of The Millionaire Next Door was published in October 1996.⁸ In January 1997, the book hit the New York Times bestseller list and stayed there for 179 consecutive weeks (15 years), and it ultimately sold >3 million copies in more than eight languages. The thesis of the book is to work hard, be diligent, and be frugal and time will allow households to become wealthy even without large salaries. The governing principle is spending less than you earn and investing the difference so it can grow over time. Certain decisions, such as choice of spouse, career, and where to live, are described as playing a large role in building wealth. The central theme of the book is to find your passion, work hard, save for the future, and eventually enjoy the fruits of your labor with your friends and family.

One of the chapters in the book is entitled “Time, Energy, and Money.” The theme is that the wealthy allocate their time, energy, and money efficiently in ways conducive to building wealth. The chapter discusses the concerns, fears, and worries of Dr. North vs Dr. South. Both are physicians who make a similar income. Both are gifted and highly trained specialists. During the year that each was studied by the two authors—Thomas J. Stanley and William D. Danko—each earned $700,000 and that was 1995, not 2020. The authors indicated that among all major high-income–producing occupations, physicians have a significantly low propensity to accumulate substantial wealth. Too many overconsume and underinvest.

In this book, Dr. South and Dr. North are the same age, and both have relatively equal family responsibilities, but Dr. South is an overconsumer and underinvestor and Dr. North is a prodigious accumulator. Prodigious accumulators of wealth do not squander income. They know that planning, budgeting, and being frugal are essential parts of building wealth, even for very high-income producers. They live below their means so that they might be financially independent. And if one is not financially independent, one will spend an increasing amount of time and energy worrying about one’s socioeconomic future. Thus, controlling consumption is key. To build wealth, the goal is to set aside for investing purposes at least 15% of one’s pretax income each year. Dr. South spent a great deal of his income on expensive automobiles and clothing instead of the stock market. In contrast, Dr. North and his wife allocated their spare time to activities that they hoped would enhance their wealth.

I strongly recommend that every physician read this chapter on Dr. North and Dr. South.

William C. Roberts, MD

May 15, 2020