My wife Mykala is a woman who knows how to wear some sweatpants. As the owner of a veritable library of them (nearly the antithesis to my own wardrobe), Mykala reintroduced me to sweatpants through persuasion and sheer exposure.
In elementary school, I had these red sweatpants which I wore to school once. I’m sure no one said anything about my pants, but possessing the misplaced assumption that everyone was looking at me, ready to laugh, I was certain derisive snickers and outright insults were bound to rain down upon me. Mykala and I have a short-hand for this type of self-consciousnessness: I imagine a world where everyone has giant eyes — mercilessly following my every move. This (of course) is patently false now, as it was then. Even at my young age, I was unusually intent on details, and I think there was a small darn on one of the legs… as far as I can tell, all this freaked me out sufficiently to keep me out of sweatpants for about a decade afterwards. What a shame.
Now, returning home from school, I regularly put on my pair of sweatpants from my sister Katy — they are everything scrubs are not: warm, soft, stretchy, fuzzy, cozy.
When I first started designing as a hobby, I hated
everything I made. I knew it was terrible, and no matter
how hard I tried, I could never make it good enough for
myself. But I didn’t give up, and after a while something
clicked. I started to sort of like my work. But I am
still not satisfied; every day I reach higher, trying to
grasp the level of awesomeness that I can feel but can’t
recreate.
This is so unbelievably true. And the Ira Glass video about storytelling that Curtis links really really crystallized the concept for me. Of course its about satisfying your inner critic! My inner critic continues to drive me.
As Toyota built better cars than its competition for less
money, it won new customers. Some rivals matched its
successes (as Honda did); some lost market share (as
Detroit did). No such dynamic exists in health care.
William Lewis, a former director of the McKinsey Global
Institute who studies productivity, says that the
economic benefits from the various quality movements have
been quite large but that they are also largely in the
past. Most industries have incorporated Deming’s big
ideas and are now making only incremental progress.
“However, there is one big exception,” Lewis adds. “You
guessed it: health care.”
Why? In part, it is the faith
that patients have in their doctors. When people are
buying a car, they often consult Consumer Reports or Road
& Track. When they are choosing a place to have surgery,
they ask their doctor to recommend a surgeon and go to
the hospital where that surgeon works. Hospitals that
provide less than top-quality care are rarely punished in
the way that General Motors and Ford have been.
So, there’s no impetus for quality improvement. On top of that, when doctors must deviate from routine, they end up administering a battery of tests, which can increase costs dramatically. What’s the solution?
Reform theory
The basic idea of Dr. Brent Jame’s reform is most effective in these situations where doctors would normally run a bunch of tests — by establishing an exhaustive catalog of baselines for treatment (doses, protocols, equipment settings, et al.), the costs of treating patients becomes simultaneously lower and more effective. For example: inductions before 39 weeks of pregnancy were reduced from 30% to 2% of deliveries — evidence went against conventional practice, changed the flawed practice, and resulted in far fewer babies in intensive care.
Fee for health system
Wouldn’t such an obvious beneficial change be quickly adopted around the country? Not if it doesn’t make financial sense:
As long as doctors and hospitals are paid for each extra
test and treatment, they will err on the side of more care
and not always better care. No doctor or no single
hospital can change that. It requires action by the
government.
As articulated by this article, the solution becomes tricky in practice: let’s say you try to control costs by bundling — a set fee for different diseases/illnesses. BUT, this gives the hospital an incentive to turn away the sickest patients. The article’s response to this? “Medicare or private hospital groups would most likely monitor outcomes to make sure the incentives didn’t lead hospitals to skimp on care or turn away the sickest patients.” I don’t think the solution lies in more regulation, but instead in building a system with some inherent checks and balances. I do not know how that could be done.
As the article states, “…the only sensible strategy is to try anything that seems promising.”
Aggression scores increased in the rejected groups. But
the IQ scores also immediately dropped by about 25 per
cent, and their analytical reasoning scores dropped by 30
per cent.
“These are very big effects - the biggest I’ve
got in 25 years of research,” says Baumeister. “This
tells us a lot about human nature. People really seem
designed to get along with others, and when you’re
excluded, this has significant effects.”
The patent for Abacavir (ABC) (trade name Ziagen), a reverse transcriptase inhibitor (RTI) effective against some resistant strains of HIV, expires this December. Incidentally, a guest lecturer in microbiology came to us to speak about HIV. Here’s where it gets interesting:
Using public funds, researchers at the University of Minnesota analyzed primary literature and hypothesized a novel RTI. After testing revealed its efficacy, Abacavir was patented. GlaxoSmithKline then sold the drug as Ziagen… without proper rights to do so. Mark Yudof, president of the University in the late 90s (and a lawyer), decided to sue for royalties. Settlement: 400 million dollars. This is the largest intellectual property case in the U of M’s history.
The other prominent case centers around the Honeycrisp apple. After having one, many people call the Honeycrisp the best apple they’ve ever had. As noted by a grower: “It has a first-of-its-kind crispness that no previous apple has ever possessed, its juiciness is unsurpassed, and it can be held for an unusually long period of time, compared to other apple varieties, in prime condition.”
Now, I dont’ know the details of the suit over the apple — and I’m not that interested. The story of the apple, however, is rather remarkable. The University of Minnesota has been breeding apples for over 150 years and they “release” new breeds to apple growers fairly regularly: e.g. Haralson in 1922, Beacon in 1936. In 1960, crosses were done with existing apple breeds (one known: Keepsake, the other unknown) to produce, ostensibly, the first Honeycrisp seedling in 1961. Over the next decade plus, absolutely nothing remarkable was noted about the variety.
At the U of M orchard, in the late 1970s, The remaining Honeycrisp trees were marked for destruction. The entire Honeycrisp variety owes its existence to the fruit breeder David Bedford:
Apparently no one on the face of the earth tasted a
Honeycrisp apple from the time it was numbered in 1974
until Bedford picked some in 1983. Nine years! Bedford
himself never tasted fruit from the original tree. It was
out of existence for a number of years before the four
first-generation trees came into bearing, and they existed
based only on a very weak, non-descript 1974 report, the
last report ever made on the original tree’s fruit. When
Bedford marked the four trees for removal and then, upon
reconsideration, removed the discard tags that would have
forever obliterated Honeycrisp, he had never tasted the
apple.
And here we are: an incredible apple with an amazing taste — which is now the Minnesota state fruit, was very nearly tossed out as a part of regular orchard breeding program maintenance.
It seems to me that science is all about fortune favoring the prepared: nobody explicitly mapped out all the desired characteristics of an apple or an RTI drug — they make some educated guesses, and then watch for results.
I haven’t read an article in a long time with such a gigantic vocabulary. Lot of dictionary use on this one. It is still very understandable, though — so I submit to you The Meaning of Information Technology:
Human beings need to understand one another in terms of
primordial intimacies because man has no other tools for
understanding the solicitations of man. But if the size
of the world is no longer amenable to intimacy
technologies, then mankind must invent information
technologies that rehumanize the world.
Thus the
proliferation of social software on the web.
Social software doesn’t solve the communication problem — we’ve already solved that. It mitigates the drowning in information problem.
On our honeymoon, I trapped a moment in my mind when I was standing behind Mykala with my arms around her waist, on the beach in Hawaii, at sunset. And I said to myself then, “Never ever forget this moment; carry it with you as long as you live.” It’s nice to visit at times like this. Times when I just spelled “systemic” like this: “cystemic.” A little weary, but holding up still.
