The Symbols of Ozark Season 4

TMF Secrets Hidden in Plain Sight

Up until the day everything changed, Marty thought he lived the perfect life. Marty had the wife, the colonial framed by a white picket fence, and two picture-perfect children. Marty was reserved, logical, and in control. Marty was a top earning financial advisor. Marty was awash in money.

Regrettably, Marty also washed money… for a cartel kingpin. And on the day everything changed, the cartel had come knocking. Marty’s business partner had been caught lining his pockets with some of the proceeds, and the consequences were swift and severe. Marty, resourceful as always, negotiated for his life and bargained his way into a new, but far less profitable, arrangement: he moves his family from Chicago to the Ozarks in Missouri. Once in the Ozarks, he has only a few months to launder millions of dollars or his family won’t make it out alive.

For those of you behind on your streaming, we’ve just summarized the first episode of Netflix’s Ozark. This original drama has built a dedicated following and critical acclaim since it’s premier in 2017. We first wrote about Ozark (and the importance of clinical trial financial disclosures in the TMF) when the series burst into notoriety in 2018. Now that the finale of the series was released on April 29th, we figure it’s the perfect time to return to this much-loved series and consider how the schemes of the Byrde family apply to your TMF.

The Symbols

Each episode of Ozark features an introduction sequence where four symbols are placed inside of an oblong “O” to spell out Ozark, the show’s title. While the four symbols might seem like a random collection of objects, keen viewers will notice that each object appears in an important scene in that episode reinforcing the series’ central theme of “dark secrets hidden in plain sight”. Unfortunately for us TMF professionals, this theme also regularly applies to the TMF, as illustrated by some of the most memorable symbols from Season 4 Part 1:

A Flamingo Pool Float

A flamingo pool float seems light, summery, and carefree, a stark contrast to the dark truths of Ozark. The flamingo pool float of Season 4 represents Ruth’s and Jonah’s betrayals of the Byrde’s through their use of the Lazy-O Motel as a competing money laundering front.

Betrayal in the TMF, fortunately, is less common and dramatic than on Ozark, but this doesn’t mean that the business relationships between TMF stakeholders can be taken for granted. Both Ruth and Jonah defect from the Byrde empire when they aren’t included in important decisions that directly affect them. Your TMF stakeholders could do the same. Even when making potentially difficult or challenging decisions, be sure to solicit feedback from stakeholders and to clearly communicate decisions via one, shared channel. You’ll find that clear, open communication can mitigate most TMF quality issues before they become inspection findings.

A Spray Bottle, Bucket, and Sponge

Some cleaning supplies seem innocuous enough but not when they are used to hide a murder. When Javi forces Marty to help clean up after he murdered the sheriff, it’s only the first of many impulsive acts committed by Javi that Marty must clean up after.

How we respond to TMF mistakes (and whether we choose to sweep them under the rug) is a massive component of total TMF quality. Clinical trials are complex but deeply human endeavors. Mistakes are an inherent part of the process. When TMF stakeholders are afraid to make errors or speak out when an error is identified, small quality problems can quickly snowball into trial-threatening inspection findings. It is essential for TMF leaders to foster a culture that accepts these mistakes and leverages them as an opportunity for continuous improvement. When TMF stakeholders are free from blame, they are empowered to do what’s best for the TMF and will consistently make decisions that advance TMF health—even when nobody is watching.

A Goat’s Head

This particular goat’s head symbolizes the cookie jar that is used by Ruth to store Ben’s ashes. More than a macabre statement about life and death in the Ozarks, however, the goat’s head also suggests Ben’s broken Season 3 dream to live with Ruth in a farmhouse with goats, and the dark shadow the secret about Ben’s death casts over many of the relationships of Season 4.

Much like Ben, we all project lofty dreams for our circumstances, but sometimes resource restraints and factors outside of our control wreck our most ambitious ideas. As TMF professionals, it’s our duty to design, plan, and manage TMFs that are capable of achieving TMF health despite the real-world limitations. TMF plans should be customized to a specific protocol to reflect any risks associated with study design, study-specific documentation, and study team structure. Performance metrics should be developed based on past performance and the needs of the specific TMF, not on ideals and unsubstantiated projections. Be wary of understaffing that can provoke high turnover. Some turnover cannot be eliminated, so processes should be well-documented and robust enough to be reassigned as needed. High TMF expectations must be balanced with excellent leadership, the right tools and resources, and slow and incremental change that is cognizant of the current condition of the TMF.

A Bottle of Honey

Sharp-eyed watchers will note the bottles of honey behind Wyatt and Darlene at their booth at the farmer’s market. The honey signifies the care that Darlene takes to keep up appearances and may also symbolize the great efforts that the characters of Ozark take to chase their hidden desires and to secure their ill-gotten gains.

Many TMF teams spend considerable effort ensuring their TMF looks neat and organized. Appearances, though, can be deceiving. Incompleteness, lack of contemporaneousness, and lack of accountability can all be clouded by busy work. Unbalanced focus on small details or unnecessary manual QC processes can cause stakeholders to lose track of the ultimate purpose of the TMF: to tell the best and most complete story of a clinical trial. Processes should be continually evaluated to weigh effort against effectiveness. It is imperative that TMF leaders ensure this fundamental purpose remains their team’s core mission, no matter how complex the clinical trial.

Whether you are in the Ozarks laundering money or in your eTMF panicking about an inspection, the secrets we keep from others (and ourselves) can, and usually do, have far-reaching consequences. If your TMF is hiding its own dark secrets, be sure to attend LMK’s upcoming TMF Corporate Education Townhall on June 9th. Jackie Morrill, Executive Director at LMK Clinical Research Consulting, will introduce LMK’s portfolio of corporate training courses that are designed to mitigate the most common real-world TMF knowledge gaps that endanger TMF health. LMK’s Corporate Training portfolio is designed for all levels of experience, from novice to experts, and can be fully customized to respond to your organization’s most critical TMF needs.