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It's hard to say no to Carl Icahn.

Just the latest example: Hologic Inc. of Bedford welcomed two of the activist investor's lieutenants onto the medical product company's board of directors Monday. At the same time, Hologic also named Stephen MacMillan as its new chief executive and made a point of telling everyone that MacMillan arrived with Icahn's blessing.

This is the way it often goes at companies in which Icahn takes a substantial interest (he bought more than 12 percent of Hologic's stock two months ago). Companies usually react first by drawing up a "poison pill" shareholder's rights plan to block the possibility of a hostile takeover and then negotiate a deal to put Icahn people on their boards. After that, things can get really interesting.


MacMillan reports that he talked to Icahn last weekend and they got along just fine. "I know he can scare off a lot of folks, but his teams have brought a lot of value to companies," MacMillan said. So far, so good.

Icahn's influence is being felt far and wide in Massachusetts at the moment. Besides his recent interest in Hologic, Icahn and his investment funds have bought nearly 19 percent of Nuance Communications Inc. shares. The Burlington speech recognition company recently created two new board seats for Icahn's representatives.

Then there is Alex Denner, a longtime Icahn associate specializing in biotechnology who started his own activist hedge fund this spring. Denner's fund bought more than 6 percent of Ariad Pharmaceuticals Inc. two months ago, after shares of the Cambridge company plunged on very bad news about its cancer drug.

Icahn has been a force at Massachusetts companies for several years. He made a bundle buying Biogen Idec Inc. shares, pushing the chief executive out in the process, and later jumped profitably into Genzyme Corp. shares when the company became a takeover target.


Icahn, at 77, has been rattling cages for a long time. He became famous in the 1980s when activists were called raiders and generally reviled as greedy investors who would do anything to make a buck.

Now, Icahn is more successful than ever. He's on the cover of Time magazine this week, described as a "master of the universe" and "the most important investor in America." He's worth more than $25 billion, according to Bloomberg, which tracks the change in fortunes among the world's richest people every day (yes, it really does that).

Here's the kicker: Icahn's personal net worth has increased by an astonishing $9.8 billion this year, Bloomberg says. This year!

And Americans — at least those who can choke down the idea of anybody making that kind of money — don't seem to have a big problem with Carl Icahn anymore. How can that be?

The rules of engagement between activist investors and the companies they target have changed a lot since the 1980s. Despite all the hostile takeover defenses raised by companies like Hologic and Nuance, such transactions aren't threatened and rarely happen.

Activists demand seats on boards and then push for some kind of change — sell something, maybe sell it all, or replace managers. They'll often try to build a consensus among investors for change.

Icahn has made headlines a lot this year by targeting very big companies. He wants Apple Inc. to do something with all the billions of cash on its balance sheet. He spent months fighting over the terms of a plan to take Dell Inc. private. Who gets worked up over that?


But the issues that attract activist investors and changes they demand aren't always so benign. Both Hologic and Nuance probably showed up on Icahn's computer screen because their stock performance stinks. Nuance is one of the few investments that has lost money for Icahn this year. Not good.

So the new chief executive at Hologic will have his hands full with the company's biggest investor. "I've been brought in to grow the business and I think he's supportive of that," said MacMillan.

It won't take long to find out.

Steven Syre is a Globe columnist. He can be reached at syre@globe.com.