Essay: What an American Neurosurgeon Can Teach Us About Wealth and Values
I needed to travel from Los Angeles to China. Standing at the departure gate and about to board a 1 a.m. flight, an overhead announcement declared that a small light on the plane had failed. Since a replacement could not be located, the flight was canceled. Good heavens, what a mess!
Suddenly hundreds of dispossessed confused passengers were now milling about the early morning hours. Someone shouted, “Go get your luggage.” Moments later I joined the throng in running to baggage claim to retrieve an all too heavy suitcase. Exhausted and dispirited, while stumbling around in a daze, my fellow travelers and I exited the airport to await the rising sun and the start of a new day.
The next evening, I returned to the airport and repeated the previous night’s routine — check in, go through security, go to the lounge for coffee, and so on.
But this time no little light kept me from getting on a plane headed to China. Upon boarding I went into business class and immediately confronted a pang of regret for flying Air China; this plane only had seats in pairs, yet I was most accustomed to sitting alone. After finding the proper row for my window seat, I encountered a gentle-looking 50-something American guy who was already occupying the adjacent aisle seat. He quickly stood up to help me stow my suitcase into the overhead compartment. After a brief thank you, I settled into my window seat and watched as he sat down next to me.
Having gotten little sleep the night before, I was exhausted. The flight attendant brought me a glass of water that I used to gulp down a much-appreciated sedative. Asking her not to wake me for meals, I turned inwards, covered my head, and was soon consumed by a deep sleep.
I awakened several hours later to find my seatmate illuminated by the small reading light attached to his seat reading a book, interestingly an airplane pillow was propped up so as to block the weak light from reaching my eyes. It was somewhat strange to encounter such a considerate fellow passenger.
Sitting up straight, I turned to look at him and asked, “Are you going to Beijing?”
He said yes.
“Is it your first time?”
He smiled and said, “Nope, this is my 12th time this year.”
“Wow!” I exclaimed, “What kind of business has you travelling so much? “
“It’s medical equipment.”
“That’s a serious business, but you don’t look like a businessman.” I joked.
He smiled and said, “I’m not, I’m a brain surgeon.”
“Well, that’s impressive.”
A moment later I said, “I met an American neurosurgeon once, a Harvard graduate.”
He gave me a quick glance, coupled to a faint smile with a hint of slyness. I was startled by a sense of familiarity, but I couldn’t remember where or how we might have met before.
“I might know him if he graduated from Harvard,” he said, handing me his business card. Blinking in the dim light, I put on my glasses to read his name. It said clearly:
Professor, Stanford University School of Medicine
I sat there stunned, my heart popping out of my chest. The feeling, the situation, felt like an unbelievable movie plot. Too hilarious to be real. I turned my head and stared at him. Blue eyes, blonde hair, yes ... just ... more wrinkles. Time’s merciless passing also left me feeling a bit sad.
Meanwhile, he too was smiling, yet looking at me uncertainly. “What’s up?”
I sighed, “Nothing.”
After a long silence, I said, “You must know him, because IT IS YOU.”
It was in the early fall of 1991. We had just finished “The Pacific Century,” a 10-episode documentary. The producer, Alex Gibbney, asked me if I knew Bill Moyers.
“Oh, of course I know him!” I replied, “He is one of America’s best-known and most respected TV commentators.”
“I’ve recommended you to him. He’s going to make a TV series about Chinese medicine for PBS; the producers are anxious to see you,” Alex said.
I flew to Boston the next day, and stayed at the house of Alice, the producer. The weather was hot and humid. Alice’s kitchen counter was covered with coffee cups from all over the world. I was lying on the bed in the guest room repeatedly watching Bill Moyers’ show, when Alice announced that we had a dinner date with the rest of the team later that evening in Boston.
Driving through the narrow streets of downtown Boston appeared to be quite the challenge even for a native like Alice, while finding parking proved even more difficult. I still remember that Boston parking was much more expensive than in my Los Angeles. Upon walking into a dimly lit formal restaurant, we encountered two well-dressed men already standing inside seemingly in expectation of our arrival. We introduced ourselves to one another. David, the slightly taller man, had dark curly hair as well as a beard with soft gentle features and the general appearance of an East coast intellectual. Having studied traditional Chinese medicine for more than a decade and having visited China many times, David was now a doctor at Harvard Medical School and he would serve as the medical consultant for the proposed documentary. David introduced his former Harvard Medical School classmate and acquaintance, John Adler, who himself was a neurosurgeon. Blond haired, blue eyed and pale skinned, a bit like a broad-in-the-shoulders Harry Potter, John looked quite serious. However, in short order John’s self-deprecating wit and humor made us all laugh before he then wandered off to join other medical colleagues inside the restaurant.
Alice went through the schedule and shooting plan briefly with all of us, asking me to go to China two weeks in advance to make detailed preparations. While eating, I talked in some depth with David about his technical requirements — the “danwei” (institutions or departments), doctors, patients, locations that I should get in contact within China as well as other related matters.
After finishing his other meeting John rejoined our table. I asked him if he had ever been to China. John shook his head no but then he added that his grandfather had once done business with faraway and truly exotic China, during a long-ago era prior to World War II.
In what appeared to be a little dig, David joked, “John is unusual; he’s a real dreamer!”
John looked more than a little sheepish about diverting the attention toward himself, but cheerfully acknowledged that David’s characterization was generally accurate.
From my viewpoint as a bystander, I sensed some rivalry between them.
That was the full extent of my first meeting with John Adler. Absolutely nothing extraordinary. Having zero to do with our upcoming documentary, John was merely an accessory to a business dinner in Boston. Upon parting we both politely said, “See you soon!” Yet over time, nearly all memories of that evening encounter faded.
Although our surprise reunion on the delayed flight to Beijing wasn’t a complete miracle, it was enough of a coincidence to excite both of us for a while.
John explained that no wonder I had at first looked familiar to him. For fear of appearing inconsiderate, John hadn’t dared to ask too many questions; he sheepishly admitted having difficulty remembering Asian faces in much the same way that foreigners look alike to Chinese. John told me repeatedly and enthusiastically about watching our Chinese medicine documentary on PBS shortly after our first meeting. He recalled liking the film a lot, even remembering a couple aspects of the film better than me. We talked about Bill Moyers, David, etc. I pointed out to him that if my flight the previous night had taken off, our encounter today would never have happened. We both smiled. Fate had brought us together again.
After settling down, I asked, “David once told me you were a dreamer. Did any of your dreams come true?” After giving my question a moment of thought John nodded his head firmly and uttered, “Almost.”
John told me that for more than two decades, his focus in life had been on one thing: inventing a machine called the CyberKnife to enable a world of totally non-invasive cancer surgery. His technology was now treating patients around the world, and the company he founded to commercialize his invention had treated many millions of patients. At one point even Steve Jobs had been a patient of the CyberKnife, his life being extended without invasive surgery.
I asked John to describe the CyberKnife in words a lay person could understand. He said, “The CyberKnife very precisely converges hundreds if not thousands of tiny beamlets of highly energetic x-rays onto a tumor located anywhere in a patient’s body, transforming the effect of the radiation in much the same way that a magnifying glass converges sunlight onto a point, and thereby transforms the power of the sun.” This technology literally kills malignant and benign tumors without having to cut open a patient’s body. CyberKnife surgery is short and utterly painless, far safer than conventional operations. And there’s no recovery period, and in a few patients, improvement can happen almost instantly.
As John tells it, “There are limits to what human surgeons can do. Especially with brain surgery, the delicate nature of the human brain means that even small variations in surgical technique can profoundly affect a patient’s outcome. But the extreme precision of the computer controlled CyberKnife, means the risk is greatly reduced.”
Over the past decade, John turned his energies to inventing an even more highly specialized surgical robot the ZAP-X, but this time the machine is designed only for brain surgery. While the first such Zap-X had been installed in the United States, the second was installed in Beijing’s prestigious 301 Hospital. With clinical trials required by the Chinese government about to start, John needed to travel to China frequently, where he would give lectures, provide training, and help to organize the upcoming patient study.
Adler shows his ZAP-X surgical robot to former U.S. President Donald Trump, Foxconn founder Terry Gou and Softbank CEO Masayoshi Son at the Wisconsin Medical Exhibition in June 2018.
I said, “That sounds incredible. You mean it can remove a brain tumor without opening a patient’s head?”
He nodded yes.
“Really?” I asked, again.
He smiled and nodded again. “Yes. … Really.”
I was getting increasingly excited by what I was hearing. “That’s incredible! Does everyone know why you need to come to China so often?”
“Because China has so many brain tumor patients, especially in some regions, such as the Northeast China. The incidence of brain tumors there is very high.”
“Yes, I had a really good employee once. It saddens me to think about him. He lived in Northeast China when he was a teenager, and later developed a malignant brain tumor called a glioma. After surgery, the doctors even kept his skull open to permit another surgery if the tumor came back. Eventually he died.” I said.
John said, “99.9% of patients still don’t know about the ZAP-X. It is intended to be the most advanced medical technology in the world ever, but promotion and education take time. Change involves much more than technology. Change is always hard. For example, the ZAP-X affects the interests of countless doctors and patients everywhere in the world and thereby poses a challenge to the existing medical ecosystem. But anyway, it’s cutting-edge, and it will change medicine, just as the internet came to change so much of our lives; Amazon changed all shopping at physical stores, and Netflix transformed Hollywood’s connection to movie theaters. I intend Zap to change surgery to the same extent.”
John took out his phone and showed me a picture of ZAP-X, a futuristic-looking semi-circular device with deep purple lights. In this picture there were also four people standing next to him and this device: the then-president of the U.S., Foxconn’s Terry Gou, SoftBank’s Masayoshi Son with John in the middle.
I exclaimed, “ZAP looks really amazing. This is incredible! How did you invent it?”
“Absolutely, she’s hot.” As if describing his lover, John made no secret of his pride.
Then he continued calmly, “At the very beginning, Zap-X started as a mere wish on my part to do better. From there it morphed into a dream that I might be the one to make this wish come true. It is truly not that hard to go from fantasy to a concrete idea if the dream is irresistible enough. However, the last and hardest step is mustering the will to make a dream a real. Without human will, the biggest dreams evaporate quickly crushed by inertia and the relentless realities of life. So I started from the basics, improving little by little, step by step while failing countless times over the decades. That is how it works … always! As for my wish and my dream … I merely want to save the lives of 2 million patients each year.”
In the darkness of our plane seats, jetting somewhere above the mid Pacific ocean, I remained silent, not knowing what to say; words seemed inadequate.
At 5:50 a.m., the flight landed at Beijing’s Capital International Airport. Before we said goodbye, we added each other on WeChat, exchanged phone numbers and reminded each other to keep in touch going forward. Someone with a sign picked John up outside baggage claim, and as he exited the airport, he waved back at me.
That afternoon, during a 5 p.m. meeting, I received a text message from John who said that he was waiting at Beijing’s Capital International Airport for a flight back home to Silicon Valley. I had no idea his trip would be over so quickly. I told him by text that he moved much too fast. In fact, I had hoped to invite him to Dadong Roast Duck Restaurant for dinner after he recovered from his jet lag. It clearly was not going to happen now.
When I got home that night, I searched John Adler online and discovered that he was in many ways rather famous. Seeking to learn more, I found an article that John had published in fall of 2009 about the process of inventing the CyberKnife, especially the trials and tribulations of what it took to make his dream come true.
Reading it carefully, I was deeply moved. John’s journey had been incredibly hard, beginning with a severely underfunded research and development effort. Without a major funder John needed to raise money incessantly and from untraditional sources. He emptied not only his own pockets, but also, as they sometimes say in the startup world, that of friends, families and fools. John faced unrelenting failure, snubs, betrayals, and, above all, humiliations. Even friends referred to his CyberKnife quest as “Adler’s folly,” yet John endured. No matter how much failure was rubbed in his face, John never gave up on his dream. His will was made of truly unbreakable iron. Meanwhile, John’s unabashed honesty made the story he told and the lessons he learned both funny and sad. For example:
1. Not knowing everything when you start out also makes one blind to all the reason’s you might be pursuing a fool’s mission; so being naive is often a very good thing if accompanied by an adventurous spirit.
2. Louis Pasteur said that “chance favors the prepared mind.” But without a little luck, one’s ideas go nowhere.
. . .
13. If you can’t convince people with your God given talents, do your best to fake it!
14. Stick to what you love, and don’t let money be a primary motivation.
15. For doctors, entrepreneurship is simply a means to the end of bringing new treatments to the world and saving patients’ lives in other ways.
Later, John and I would chat remotely.
I said that his words reminded me of Benjamin Franklin, especially the sentence “If you can’t convince people with your talents, do your best to fake it.” We were both amused. But he also said Franklin was a particular hero of his. In fact, John had won a Benjamin Franklin Scholarship as a student at Harvard. Coming from a middle-class family, that scholarship helped him to attend Harvard after graduating from high school, almost two centuries after Franklin’s death.
John’s notable response was, “I’ll never know, but with a little luck, maybe my own ideas about non-invasive surgery will also endure for two centuries?”
Having lived in the U.S. my entire adult life, I have been trying to understand the so-called “American spirit,” as well as the basic values that underlie it. Having read Franklin’s writings many times, I found them, honestly speaking, to be rather simplistic. Of note, his “Poor Charlie’s Almanack” is quite similar to the “Three-Character Classic” read by Chinese children, the latter of which includes such ethical teachings as: “When Huang Xiang was 9, he would warm the bed for his parents. When Kong Rong was 4, he would offer his brothers the bigger pears.” Upon further reflection I realize that Franklin’s straightforward approach to morality is rather like that of traditional Chinese culture, and at their core, both express universal values. Yes such “simplistic” teaching is unapologetically pragmatic. It seeks to encourage the common man or woman to improve their social well-being through diligence, self-reliance, hard work, honesty, helping others, careful budgeting, earning money and sometimes even getting rich. Unafraid of authority, the American spirit embodied by Franklin believes fervently that individual social mobility can perpetuate the well-being of the citizenry at large.
Like many countries in the world, the U.S. has an elite. However, in the U.S. there are two distinct groups that occupy this aristocracy and between them there has always been an ongoing rivalry.
One group derives its status from inherited wealth, born with a proverbial “silver spoon” in their mouth. The other, the group with which Franklin greatly identified, achieved their social and material success through individual hard work. American literature of the past two centuries is full of images mocking vulgar “self-made” Yankees who have learned the elegant manners of the elite but retain the hard-working essence of the working class. Meanwhile, those” fortunate” enough to be born into money are deeply insecure about their status, oftentimes desperately seeking the admiration of the masses by engaging in self-aggrandizing philanthropy, lacking any other socially redeemable attributes.
As a student of the arts, I was always greatly influenced by romanticism. At an early age I came to admire the emotional dimension of life in general and the transcendent belief in my own human spirit. So for me, Franklin’s secular and utterly unheroic philosophy, much of it centered on financial prudence and the pursuit of material well-being, lacked great appeal. In the past these values felt so simple to me, too superficial and lacking in nobility. Yet I have come to appreciate that many of these ideas are comparable with the profound and subtle mysteries espoused by many masters of Chinese culture, let alone the exquisite and noble theories of European philosophy. Over two centuries Franklin’s austere pragmatism, with distinctive middle-class characteristics, has earned the admiration of most Americans and has come to define their calm and composed spirit.
Today I acknowledge that the thoughts of brilliant scientists or other pragmatic thinkers are anything but hallow. To use a common saying, the essence of a great scientist is that of “having both feet firmly on the ground.” To be a great scientist one cannot be arrogant or prone to aristocratic airs. Science is by default humble, tolerant, open-minded, and built upon both dedication and hard work. Like the characters depicted in many Hollywood movies, scientists, like Franklin himself, are ordinary people, living simple lives. They avoid using overly big words and eschew all appearances of nobility, instead trusting scientific thinking to guide the social order. Although low key and often overlooked, in a crisis, scientists will step forward, allow their brilliance to reveal itself, before again disappearing back into ordinary lives.
During the Covid pandemic of 2020, I was stuck in Los Angeles. Meanwhile, John was stuck in Silicon Valley, where he constantly worried about his ZAP customer in Beijing. It was during this time that John invited me to see his creation up close. I got vaccinated and drove six hours to the Bay Area in Northern California.
It was a sunny afternoon when I arrived at ZAP Corp.’s headquarters. John started my visit by touring the various departments, each filled with dedicated engineers and researchers whose heads were down seemingly engrossed in their work — a very different experience than the film studios with which I was familiar. John invited me to take a photo next to the Zap-X, both of us still wearing our masks. After which he asked me to take a walk with him along the nearby seaside.
Adler and Jinhua Yang in Silicon Valley in July 2020.
As we walked, I asked John if he was doing all this for money? He was already a famous and financially well-off doctor, why was he throwing that away for a life full of incessant challenge and failure?
“Because I am a doctor,” John replied.
As John explained it was hard for ordinary people to understand what brain surgeons face every day. His world was filled with so much suffering, and where life or death choices are commonplace. During his long career as neurosurgeon John had experienced the great joy of saving countless patients’ lives, but also the near unbearable pain of witnessing so much death, the most painful of which involved the inadequacy of his own hands and knowledge. In particular, the dying of children was beyond heartbreaking. Once at a patient funeral, unable to control himself, he cried harder than the deceased’s loved ones, and it was they who comforted John.
“Yes, there were many times I didn’t want to do it anymore. I wanted to just give up. But I can’t”
I was silent for a moment. “Sino-US relations are terrible now. You’re not afraid that Americans will hate you for taking your best equipment to China? Or that the Chinese will hate you too just for being American.”
John froze for a moment. “I’m a doctor. My first duty is to help patients. It doesn’t matter if they’re African, Asian, European, or American, or whether I know them or not. Besides, China and the U.S. are primarily competing to influence the world of today; I don’t want us to be so self-destructive that we allow ourselves to hate each other.”
I looked at him, feeling his naive optimism.
“I’m destined to do what I need to do. It’s not about money or glory, but rather my responsibility to the millions of cancer patients in the world today who aren’t getting the best treatment. By my count, there are more than 3 or 4 million cancer patients each year who suffer needlessly from conventional invasive surgery or radiation treatments. Even though I don’t know them, I do feel responsible,” he said softly.
A thought flashed through my mind. In near every culture, we extoll the hero who kills so many of “the enemy.” However, can a man who saves the lives of many people, even perhaps those of the “enemy,” also be counted as a hero?
“I’m an ordinary person who at this stage of life is truly tired. I am beyond reluctant to be attempting something so difficult again. But if I don’t do it, no one else will. I cannot escape the fact that this is my destiny, and there is no way out for me. If a man can accept his destiny, life tends to get a little easier emotionally,” John said.
“Who are the investors?” I asked.
“Mr. Terry Gou is my primary Angel investor, and I am so very grateful to him for that,” he replied.
I was a little surprised. “There has been a lot of bad news about Terry Gou. He’s often described as an autocratic, greedy and somewhat of a ruthless capitalist. How do you know him?”
“Well, I was in part a doctor to his brother Tony” John paused. “Terry Gou is one of the few rich people who has a sense of social responsibility ... even if he can be hard edged sometimes. Most of the moneyed class, especially the so-called venture capital community, are today only interested in making more money, ever faster. They obsess over “deal size” and “exits.” They hardly care at all about the social utility involved in their decision making or how their choices impact people’s lives. Moreover, they can break their promises in an instant.”
Then he continued, “I think very differently. I think rich people, who have benefitted from so much good luck in life, have a huge responsibility to contribute back to society in every conceivable way. The wealthiest need to recognize their good fortune and to the best of their abilities, help the less fortunate. Otherwise progress in human civilization, and especially in medicine, will grind to a halt.”
“Agreed, without the Medici of Florence, people now might never have heard of Michelangelo,” I nodded.
At that moment, I experienced my own heartfelt respect for Terry Gou.
It was a breezy day, and California’s bright orange poppies were blooming along the coast, their thin stalks swaying in the wind, adding to the beauty of the scenery.
We walked in silence, each thinking his own thoughts.
John saw me staring at the flowers and said nervously, “You can’t pick them. It’s illegal.” I glanced at him, amused.
Finally, I said, “I’ll help you.”
He laughed. “How can you help?”
He was right, there was nothing I could do. I’m not rich, and I’m not an investor, a scientist, an engineer.... In a word, I’m useless.
I smiled a wry, self-mocking smile. “I don’t know ...”
Yes, maybe there was nothing I could do for him. But someday, John really could help us. Something unexpected could happen at any time. If we, or a family member, friend, classmate, relative, or teacher, was unfortunate enough to develop a tumor, in that moment of hopelessness, he might just be able to offer each of us that glimmer of hope.
So, please remember the name John Adler.
Jinhua Yang is a film director and producer, CEO of RDR Culture and Communication Co. and president of Soulpower Film Corp. USA
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