Updated: 29/08/2003; 9:59:57 AM.
What are the forces that create and diminish health? How can we reduce our reliance on Health care?

Friday, August 29, 2003

New movements tend to stall when the "in group" want to keep the movement within the
"in group"

The same may be true for blogging. The number of people that know about what a blog is among my clients is very small.  Intuitively I would say less than 2%. What would put them off? Anything technical. Blogging has to be made really easy.

Why do I mention St Paul? At the outset of Christianity there was a huge debate. The "In Group" as lead by the surviving disciples of Jesus insisted that to be a Christian you had to be a Jew. This meant adult circumcision for the men and backseat behind a screen for the women. Quite a "technical" hurdle!!!. Paul argued that all men and women should be able to become Christians - guess who won? Pride in coping with the technical sides of blogging is a block for take-up.

The real opportunity is when a group of "Ingroup folks" maybe like "socialtext" really engage with organizational life and find the fit. Step 1 has to be"Easy does it" Easy does it demands that anyone who can type can set up a good blog and that there are a number of great templates. We are exploring Typepad to see if we can make it even easier.

Step two has to be finding the immediate felt benefit. This is more challenging and I think demands that we find parts of an organization where building a community will help - maybe in the entire support area. This is where the whole KM issue rears its head. The idea of content management is an exceptionally stupid idea that flies in the face of how we understand knowledge. Only a small fraction of knowledge is explicit - the vast bulk is implicit - ie it is ten times better to talk to someone about an issue than to try and find what he has written about it. Who wants a manual when you can be walked through? BP has been a leader here in seeing that their key system issues is to find a way of connecting people with questions to people with answers. Each employee has a personal website that amongst other things has a lot of info about what they know. The deal at BP is that if you have question you search for the person.

Why should we care anyway? Blogging is our path back to being human at work. Blogging reveals who we are to not only others but more importantly to ourselves. For the first time mankind - the great tool maker - who has used tool making ingenuity to make the world and himself into a tool, or a thing, has created a tool that renews and brings back what it is to be human.

So like Paul - we are faced with an historic choice. We can relegate blogging to geekiness and tool making or we can work to change our relationships back from machine to human.

What do I mean by this bold statement? We can change democracy by making it essential for politicians to be real and to listen to us. We can get the issues that make sense on the table other than spin. We can make management of organizations transparent and give organizations a human Cluetrain voice. We can change how we learn - from each other rather than from institutions. We can change healthcare by empowering fellow sufferers to help each other rather than to rely on the priests of medicine. We so change the world as Paul did.



Blogs for What Business?. Jimmy Guterman's new piece on business blogging (sub. required) is sure to cause a stir. He charges the blogging community as being "self-absorbed and elitist" and says its not essential for business. He cites a Forrester study to back up his claims:

You don't have to believe me on this. Finally, some data asserts that blogs are hardly a popular pursuit. If anything, blogging is more marginal than its critics contend. Forrester Research (FORR) conducted an online survey of 3,673 people and found that 79 percent of its respondents had never heard of blogs, 98 percent had never read one, and 98 percent said they'd never pay to read or write one. Blogs can be wonderful things, but if a mere 2 percent of Internet users read blogs, the pastime is far from mainstream. The Forrester survey notes that the typical blog reader has been using the Web for an average of six years. For the most part, blogs feature the Net elite writing to the Net elite. This continues to be the case only as long as the elite are underemployed.

I believe what Jimmy is saying is that there isn't a consumer market for blogging and that it isn't essential for businesses to address it. The problem is we are at the very beginning of a technology adoption lifecycle. Some serious companies have forecasted this market to grow and made their bets accordingly. Every time a journalist tries to wrap themselves around the existing market, what's visible are early adopters. What stands out are the leaders in using blogs for publishing, who benefit from preferential attachment as the earliest entrants. And if you take the innovator dialogue to seriously it looks like a one ring circus.

The other story folks pick up on is unclueful attempts by businesses and PR firms to market to bloggers as an emerging and influential segment. Any attempt to treat bloggers as a segment will fail. Today the influence of participants who act more as producers than consumers is the attraction. The number of participants is growing at 400% per year, and that's before AOL's entry.

But the real story in the consumer market is how increasing numbers of real people are using blogs , but as a way to communicate an form their own communities. Its that skinny tail of the power-law distribution that's going to wag the market. A way to share with friends, communicate post-by-post and remain open to new people joining your community. Conversational Networks provide the most value to your average Jane.

Rick Bruner does make the case that there are lots of businesses using blogs in the consumer market and points out this is like the web in 1995 and where the weblog as publishing market is headed. And many of them are making money. I agree that more evidence in this area would help, always does, but give it time for these new ventures to tell their story.

There is another story of weblogs and business that is less visible because the real action is behind the firewall. At Socialtext we are adapting weblogs for use within enterprises. Weblogs are one Enterprise Social Software tool, because they are necessary but not sufficient for communication and collaboration.

The enterprise market is entirely different than the consumer market. What is in common is an efficient, and dare I say fun, way of having conversations that contribute to productivity. Maybe its time we start telling more of our customer stories, but the distinction between consumer and enterprise needs to be made. [Corante: Social Software]

8:57:54 AM    comment []

Saturday, August 23, 2003

Questions for all those who plan to run for office in the upcoming PEI Election

1. The economy - In the next 4 years (the life of the government) the potato processing side of our economy will collapse and will take down its surrounding infrastructure. As it collapses - US markets will close, there will be a drought/flood/ more disease etc, it will try even harder to survive and threaten our water and environment even further.

Will the new government use up all its resources to "save the jobs" or will it work to create an alternatives such as a local food system?

If they choose to "save the jobs" they risk the new future of tourism - eco tourism. A last ditch attempt to "save the jobs" will threaten in turn our landscape and will turn away the real future for this sector. The days of the beach holiday where families are satisfied with a cottage with 7 others on the Brackley Point Road are over as well - demography and shifts in values are seeing to that. Golf is also oversold and over capitalized.

Will the new government spend all their time and money in keeping this side of tourism alive and "saving the jobs" or will it support eco tourism that fits who we are and where the market is going?

We are seeing the end of the lobster fishery this year. The processors have not sold the spring inventory - changes in world taste and too much of  a production based approach - the fall season has seen stocks collapse. The industry is also over capitalized. There are too many mussels in the bays and they do not have enough feed - notice how small they are. There was huge die off of Malpeque oysters this spring. Are you looking at the reasons for this failure?

Will government "save the jobs" in the fishery? There are already $100 million in loan guarantees out to this sector alone.

Will we waste our limited resources on saving what cannot be saved or will we build the new?

Do we understand that it is our economy that produces the cash to pay for the education and healthcare that we feel is so important

2. Energy - Do we understand that we can break fee from oil by going to wind? Do we understand what this type of freedom might mean. Who chooses gas and oil over wind? Tell me why you prefer to be a slave to the oil industry when we could be free?

3. Education - is the issue about keeping schools open or is the issue how badly our kids are doing? Why is there no data available on drop out rates? Why will we not allow measurement? Why do we sit by and allow 40% of Islanders to leave school basically unable to read and write. Is the issue money? In the US they have poured money into this problem and have seen no improvement! Why are boys doing so badly? If more than 30% of boys are on drugs to get them through the school day is it the boys or the system?

Answer these question please Mr Politician before you waffle about money, school opening and class size

4. Health care - Our health care system now costs over 400 million a year and is growing exponentially faster than our economy. If this trend continues in 4 years time Healthcare will cost more than 60% of our budget. Don't talk about services anymore - tell me if you understand this dynamic! Tell me how you see what we have to do to get this growth stopped. Tell me what your plans are if you fail.

Why do you not talk about the fact that we spend half the total lifetime spend on care in the last 6 months of life in a vain attempt to defeat death. That is about 200 million a year! Tell me how you plan to help us and the medical profession deal with this most important cost driver.

Tell me that as our population ages and we have the oldest group in North America that you have a strategy for seniors that will shift them from being dependents to contributing members of society.

Tell me that you understand that drug use is growing at more than 9% compounded and will soon be the # 1 cost in the system. Tell me that you understand that most of this drug use is for lifestyle issues such as depression, hypertension and cholesterol. Tell me that you understand the research that these so called threats are minor when compared to our personal ability to cope.

Tell me that you understand that most of our ability to cope, to learn and to think is set by the age of 6. Tell me how you intend to shift resources to get behind this knowledge.


Tell me that you understand that it is not business as usual. Tell me that you understand that we are coming to end of the industrial system Tell me that you can see how fragile our world is today. Tell me that you would, like to ask us to help.

My sadness is that of course the election will not be fought around these questions but about the same old stuff of my job versus yours - of being bribed with our own money - of offering simple solutions to complex problems - of blaming the others.

It is even more sad that we have run out of time. In the next 4 years - the life of the next government - the forces will converge. Our resource based economy will fail and our primary social institutions will fail as well.

But we can surely attempt to change the political conversation? Is this not our responsibility. Politicians do not lead they follow.

Can we not use the tool of the internet to talk about the real issues? Why not pillory those who talk rubbish. Why not support those who talk sense?



11:43:11 AM    comment []

Tuesday, August 12, 2003

Several years ago, a friend of mine came close to breaking free from the institutional life. He had a foot in each place. But frightened by the unknown, he pulled back into the world he knew - confident that he was safer there where his mastery lay. Last week he was fired.

In my own life and family too we have a recurring story, a Greek tragedy, where the pull of duty and obligation to the familiar overwhelms the preservation of self. The outcome - an early death for both my father and grandfather. It seemed to be their only exit. I thought that I was exempt from this story but find that I am well into it.

I too like my friend have a choice. The  paradox is that in a turbulent time, the greatest risk is in hanging onto what seems safe. The greatest safety - to reach into the unknown. This is surely not only true for each of us as individuals but also for organizations.

Here is how Herman Melville describes this in Moby Dick

"The port would fain give succor; the port is pitiful; in the port is safety, comfort, hearthstone, supper, warm blankets, friends, all that's kind to our mortalities. But in that gale, the port, the land, is that ship's direst jeopardy; she must fly all hospitality; one touch of land, though it but graze the keel, would make her shudder through and through. With all her might she crowds all sail off shore; in so doing, fights 'gainst the very winds that fain would blow her homeward; seeks all the lashed sea's landlessness again; for refuge's sake forlornly rushing into peril; her only friend her bitterest foe! " Moby Dick - The Lee Shore Chapter.

11:56:03 AM    comment []

Saturday, August 02, 2003

Here is another view from the Whitehall study. What is shows are the rate of death from Coronary Heart Disease (CHD) your rank in the hierarchy and the risk factors. Look to the right at the longest bar chart. This shows that you are 4 times more likely to die form CHD if you are at the bottom of the pile than at the top. See that thin black line at the foot of the chart - that is your risk factor to scale if you have high cholesterol. yet what is the main topic of your conversation with your doctor? What are the best selling set of drugs, after anti deprressants? Pills to lower your cholesterol. The blank in the file (actually white so it doesn't show) is high blood pressure. Taking pills for hypertension? Even smoking is not too bad.

It's easier for us to take a pill I suppose than to face reality about our lives. Are we mainly slaves or free - that is the health question I think.

There is no doubt that many drugs are very useful but are the the only way to see health improvments?

I love this slide. It shows the relative decline of TB. Most of the battle was won in the public health sector way before the introduction of antibiotics in the 1950's.

How we feel about ourselves is another important factor.

Here we see the amazing rise in the crude death rate in Russia after the collapse of the Soviet Union. What is the main factor. A loss of identity. We see the same prcess in our native population in North America.

So what's my point? One of the factors that is causing our healthcare costs to exceed the rate of groweth of our economy is the rising cost of drugs. We seem to belive that it is only drugs that keep us from death's door. This is especially true for seniors. How do we change this perception?


4:38:19 PM    comment []

I was struck this week by seeing "Augustine's wall". In the work I am doing on health, I have come to understand that one off the most powerful negative forces on our immune system is when we lose our sense of control and identity. The modern bureaucracy strips us of both. Hence now 17% of payroll is the direct costs of absence and health in the modern workplace. Just before you scan on past this -17% OF PAYROLL!!!!.

Most disease in the developed world is chronic. Diabetes, back problems, depression. They cannot be "cured" by using the germ theory.

 This type of disease is the largest cost in the modern work force and is also driving the revenues of the drug companies who have found a gold mine in problems that cannot be "cured". Drug cost are rising at a compound rate in excess of 9% and will move soon to the top of the list of costs in the health system.

But actually it is Augustine that has a sense of where we could more profitably look for help. The emerging key to chronic disease is culture. Our immune system is compromised when we live in a culture where only a few have voice and control - the modern bureaucracy. We are also learning that the same conditions apply when we look at societies. Those that are very top down such as Sicily have much worse health and economic outcomes that say the north of Italy that has a tradition of strong horizontal links of self help. We are also learning that the same is true in families as well. Egalitarian family cultures drive the best development for their children. All this is coming together in a grand theory of culture/the immune system/development and coping.

Here is Sir Michael Marmot, the world's leading workplace researcher on the topic:

The question is what is it about position in the hierarchy that determines different rates of disease?


And given that, the hierarchy in disease does change. All societies may have hierarchies but we know that the social gradient in disease is not fixed. It?s bigger in some places than others and it can change over time. This could be that the magnitude of the hierarchies change, but there are always hierarchies. But more importantly, it suggests that it is about where you are in the hierarchy that's related to disease and can we do something about that?


So you ask is it money? Is it prestige, self esteem? And in fact what I think it is has much more to do with how much control you have over life circumstances and the degree to which you?re able to participate fully in society..?


Here is what this means in real life.

Here is a graph showing the Gradient in mortality in the Whitehall Study that looked at the UK Civil Service over 20 years. In the UK, Administrative would be the top of the heap. People at the bottom have 4 times worse outcomes. These forces are much more powerful that the factors that we currently focus on such as smoking, obesity etc.


Putnam makes the same case for the impact of community on health as well.


The traditional "paternal cultures" such as Louisiana are at the bottom where only those at the top feel they have a voice and control, and the more egalitarian cultures such as Vermont are at the top where many feel that they are in charge of their lives and that they have a say. Again these indentity and control forces are huge.


Wilms at UNB has found the same correlation in family culture as well. Those families with very traditional authoritarian cultures shut down their children and set them up for very poor development tracks. By the way really permissive parents are almost as bad.


Augustine is so on the money! My sense is that in the next 20 years we will develop an approach to health that is largely governed by our emerging understanding of how our immune system is connected to our sense of identity and voice. Paradoxically, similar "Public Health" approach in the late 19th century hit infectious diseases on the head. Clean water, good sanitation, the end of child labour, the introduction of public schools etc all contributed to a huge reduction of infectious disease well before the introduction of anti biotics. I find it interesting that as parts of society break down that diseases such as TB are on their way back now.


My hope is that as we understand the issues of control and voice, that we can shift from medication to having a better life as the "cure".

9:49:52 AM    comment []

Tuesday, July 15, 2003

70% of the US healthcare costs are driven by chronic disease. Diabetes would be at the top of the list. Read how a group of health professionals are dealing with this in the US. Would be great here
5:59:44 PM    comment []

Sunday, July 13, 2003

I am reading Simon Singh brilliant book on Maths "Fermat's Enigma". (See link) Fermat's problem is based on the one equation that even the most dunce maths brain such as my own understand - in a right angled triangle, the Square of the hypotenuse equals the sum of the square of the two other sides. - Fermat's problem is based on this simple equation. But that is not my point today. My point is that Pythagoras was struck by how the natural world, such as music and so on, was run by a series of numbers. Numbers can be found at the core of most natural phenomena and relationships. Did you know that you can calculate the actual length of a river by multiplying its crow's length, the point to point, by Pi (3.14)? How weird!

My aha for today is that, why should not human relationships be also governed by numbers? If so, we  are underplaying the importance of magic numbers. Why are nurses so unhappy? Might it be that they go to work as groups and not as teams governed by the rules of magic numbers? Why is there bullying at school? Might it be that we do not organize them by using magic numbers? Why do many of our social and work organizations need so much bureaucracy? May it be that we do not use Magic Numbers. Why do all armies have the same core organizational structures of 8 - 15 - 35 -150 and 500-600? Might it be that they have found out intuitively that these sets work best under stress. Why are all HG groups functions of 15 and 35.? Why are larger tribal groups not more than 500? Why is 150 such a perfect number for getting complex work done?

I am beginning to feel that much of the inhumanity and stress in our work place is the machine culture that pays no attention to these hard numbers.


2:54:21 PM    comment []

Saturday, July 12, 2003

It is only fair, if I was writing about Mothers and Daughters, that I should mention Fathers and Sons. There appear to be two areas of angst that I hear about the most.

The "Lost father" and the "I'll show him father" .

The Lost Father is a set up where the son feels that he never really knew his father. Where he saw his father have fatherly relationships with other young men - especially at work so he is aware that his father has the capacity to be a father but this relationship does not happen between the true son and the true father. The saddest example of this is Col John Boyd (the father of the OODA Lop and Shock and Awe) who was one of the great mentors of the modern era but who ignored his own sons. In the final irony, as he lay dying Boyd called out to his intellectual sons as his natural son sat by his bed in the vain hope that maybe, at the moment of death, his father would acknowledge him. For many of us in this category of sons, I am one, much of our adult life is a quest to find a father substitute. Sometimes these relationships can be nourishing and good - especially in the early years in boyhood or early adulthood. But others, if you keep on seeking into adult life, can be based on trying the same failed tricks to win the attention of the fake father that failed with the real father. If you are lucky, one day you find an older man who tells you that it is time to grow up and look after yourself. Thank you Fraser!

The "I'll show him father" - good examples are Rupert Murdoch and Ted Turner. Both men had successful fathers whose constant discourse to their sons was that they were no good layabouts. For these men this was the lash of ambition that drives then so hard to "show him" that he was wrong. Like much mania, the it appears that the pinnacle can never be reached and that the need to show him never ends. The sadder side of this set up is the son who believes his father's sentence of failure and acts this out his entire life.

Are there fathers whose relationships fit their sons needs? I am sure there are - but good stories are never about comfort

2:29:56 PM    comment []

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