A First Look at “The Decision Tree”
Thomas Goetz’s first book, The Decision Tree, was released yesterday. Though his role as the executive editor of Wired Magazine guarantees his ability to tell a tight story about a complex subject, it is his master’s degrees in public health and American literature that qualify him to write passionately and insightfully about patient navigation of the American health care system.
The subtitle of the book, “Taking Control of Your Health in the New Era of Personalized Medicine,” confirms that this is a manifesto of patient empowerment. “Know thyself” is the implicit theme of much of the book, as Goetz ardently advocates gaining knowledge of one’s own genetic and environmental health factors to the fullest extent possible; from simple activities such as measuring daily weights to privatized personal genomics — having your DNA assessed for predisposition to thousands of different health conditions by vendors such as 23andMe and Navigenics. Goetz explores and refutes the idea that certain knowledge, such as the knowledge that you have a terminal illness for which there is no treatment, can be toxic in it’s own right. Rather, he seeks to illustrate — with the results of several clinical studies — that all knowledge about your personal health is valuable and should be sought after.
Goetz cautions, however, against the pitfalls of countless regularly administered screening tests, particularly with regard to patients’ understanding of the results. One of the more notable examples he discusses is the PSA test for prostate cancer, known in the medical community to produce both a high number of false positives (men who screen positive but don’t actually have cancer) and false negatives (men who screen negative but do in fact have cancer). A knowledge of what the test actually does (and doesn’t) prove is thus vital to anyone considering such screening, especially when treatment options typically include surgery or radiation therapy, both with frequent side effects such as impotence and incontinence.
Goetz also specifically touches on the value of “computerized decision tools… available to help people understand their situation and make good calls.” He concludes that “these these tools can have a remarkable impact on the quality of our decision making.” Goetz elaborates,
Do these tools actually help patients? Do they overcome our fuzzy thinking or confuse us all the more? To answer that question, Dr. [Annette O'Connor, PhD; professor of nursing and epidemiology at the University of Ottawa] reviewed nearly 200 studies that assessed a specific decision tool. These tools helped patients face specific situations, from breast and colon cancers, to diabetes, to osteoporosis treatments. The cumulative answer divined from these 200 studies was that yes, decision tools lead to better decisions, as demonstrated by all sorts of metrics. Fewer patients using decision aids reported feeling uncertain or unclear about their options, and more had made up their minds on a course of treatment after using a decision aid. What’s more, patients using decision aids had better understandings of the risks and rewards of treatment…. Patients using decision aids seemed to get better care than those acting solely on their physician’s guidance. And compellingly, patients chose less surgery when they understood their options. They preferred a behavioral or drug therapy over an invasive procedure 24 percent more often after consulting a decision aid.
Perhaps of most interest to me personally, Goetz takes a deep dive into the realm of online patient support communities, specifically PatientsLikeMe. The internet, and particularly social media, is a relatively new resource for patients, and one that definitely “unnerves the medical establishment.” Back in 2001, the American Medical Association made a more candid statement: “Trust your physician, not a chat room.”
But the 40,000 registered members of of PatientsLikeMe, who have bypassed HIPAA entirely by volunteering their own personally-identifiable health information, are clearly not only finding emotional support through their online interactions, but gaining valuable knowledge about their conditions through the experiences of others. My own, limited, firsthand observation of PatientsLikeMe over the past six months tells me it’s a breakthrough platform that will only continue to gain momentum as a resource for sufferers of chronic conditions.
The Decision Tree is a remarkably accessible book for the amount of scientific and medical knowledge conferred to the reader. Whether or not you have a professional interest in the health care system, you should certainly have a personal interest in your own health; and in that case, I recommend you get your hands on a copy.
(Cover image respectfully borrowed from www.thedecisiontree.com. I make no claim to any rights thereof.)
Rupert Murdoch’s Misunderstood Plan to Institute Paywalls Might Just Work
If he were still alive today, the legendary and unconventional San Francisco ad man Howard Gossage might be the only person around voicing support of Rupert Murdoch’s plans to turn his content into a walled garden. While I don’t agree with Murdoch’s political views, I am an ardent disciple of Gossage, and so to me this application of his principles is worth exploring.
In August 1965, Gossage published an essay entitled “Our Fictitious Freedom of the Press.” This piece expressed one of many seemingly contradictory perspectives held by “The Socrates of San Francisco,” given his position as the head of an ad agency: it took issue with the very fact that publications relied so heavily on advertisers.
In this century we have seen effective control of our press shift from the public, for whom it presumably exists, to the advertiser, who merely uses it to sell his wares to the public. It has shifted so much that the life or death of a publication no longer depends on whether its readers like it but whether advertisers like it.
If you doubt this, consider that well within our lifetime over half of the daily newspapers in this country have folded and that most of them have done so with their circulations more or less intact; that magazines with circulations into the millions have gone under not because their readers didn’t love them, but because advertisers didn’t.
Gossage goes on to explain how we got into this mess in the first place:
Originally, a publication was almost wholly dependent upon its readers for financial support and therefore charged them accordingly; if a magazine was worth five cents, they paid five cents for it. However, with the growth of advertising the publication enjoyed more and more income from paid space. Now this was a very pleasant situation indeed: the advertising revenue was, in effect, found money. Moreover, it provided yet another reason for getting new readers: more could be charged for the advertising as more people bought the publication — still at a profitable five cents. Now here was an incentive plan. My God, how the money rolled in.
But not for long. At some point two opposing economic spoilsports — rising production costs and competition — started to ruin the whole lovely thing. On one hand it was necessary to raise the price to the reader; on the other hand it was desirable to keep the price down so as to attract more circulation and more advertising dollars.
Well, the publication couldn’t do both, so it made a decision, a fateful one as it turned out, for it thereby committed itself to an increasingly irreversible course, which it still pursues. It probably didn’t seem like much of a decision at the time, however. Why antagonize the customers and help the competition by raising the price from a nickel to a clumsy figure like six cents? No, what we’ll do is give the reader a break so we can keep up the circulation and get more advertising.
Some break. On the day the reader first bought a publication for less than it cost to produce he lost his economic significance and became circulation. Moreover, he traded off his end of freedom of the press. It was a forced sale; the publisher had already traded off the other end. Of course the editor was still free to write anything he wished without government censorship, but there are other freedoms upon which this freedom depends — the freedom to publish, for instance. Is freedom to publish really significant if the power to kill it has been assigned to outsiders? … None of it means a damn if the rug can be jerked out from under it by a third party.
Gossage offers a solution: forgo the allure of advertising revenue, and return to a sustainable model of subscription pricing.
Do you know what I’d do if I had a magazine that was in trouble? I think I’d change it back more or less to what it was before…. At least I’d try to give them the same feel. And then I’d let the readers in on the act: I’d write them all letters and explain to them what I was doing and why I was doing it. I think I’d level with them about some of the economic facts I’ve talked about here: of how effective control had slipped from their hands into the hands of advertisers, and that to readjust this imbalance we were going to cancel all trick subscription deals and raise the price from, say, twenty-five cents to forty cents or fifty cents, whatever it took to do it. And I’d tell them that the net result might be that the circulation would go down to perhaps three million, but they’d be the three million subscribers who really wanted the magazine; it would be their magazine, not something put out to cadge advertising revenue. If advertisers liked it, fine, but that was incidental to the purpose of putting out a magazine in the first place.
This story is eerily familiar (once you account for inflation). It’s been a big year for magazines closing their doors, and everyone is struggling to figure out how to save journalism.
One man has announce a bold, reactionary approach. Rupert Murdoch wants to stop giving away his content for free, and even go so far as to shut Google’s crawlers out of News Corp media properties. In an interview with Sky News, Murdoch discussed these two key elements of his plan.
In the age of transparency, of “new media,” this is heresy. Some even find this idea laughable. Mashable, a leading voice in the social media echo chamber, provided their analysis in a post titled “Rupert Murdoch Plans To Hide His Sites From Google, The World Yawns” back in November:
I honestly can’t understand what’s his plan here. If he plans to charge for websites, why hide them from the search engines? If you can’t actually read the content without paying, then making the content at least partly accessible to Google and other search engines can’t hurt? In fact, the WSJ that he mentions as an example isn’t hidden from Google’s indexes, you can easily find Wall Street Journal articles via Google.
This is just one part of the quite lengthy interview, but it all boils down to this: Mr. Murdoch is not ready to accept any of the changes brought forth by the Internet and the social media movement. Moreover, he doesn’t seem to understand how some parts of it work.
[Does anyone ever step back and reflect on how much "the social media movement" sounds like a cult? Just calling it a movement makes me shudder.]
I don’t mean to imply that Mashable is alone in laughing (or yawning) off Murdoch’s plan. It’s an easy position to take because his approach seems so counter to what we think we know about successfully producing content on the web; it’s just so un-Cluetrain Manifesto. But that alone is not enough reason to discredit it just yet.
News Corp’s chief digital officer, Jonathan Miller, later provided some additional context on the plan.
There is real tension surrounding the free versus pay debate. It will play out in the next two years. We believe that the value of high quality content is not recognised online [by giving its away for free] so something needs to happen.
He also went on to explain why News Corp is willing to give up all of the traffic coming from Google:
The traffic which comes in from Google brings a consumer who more often than not reads one article and then leaves the site. That is the least valuable of traffic to us… the economic impact [of not having content indexed by Google] is not as great as you might think. You can survive without it.
An interesting observation. Sure, Google is driving millions of visits a month to News Corp properties, but maybe those visitors aren’t really worth all that much — a visitor is not a visitor is not a visitor. They apparently don’t contribute to time on site. It’s not hard to imagine (although I’m just speculating) that they’re significantly less likely to support News Corp’s advertisers (i.e. click on banners). And they certainly aren’t the folks who are going to be willing to pay a subscription fee for News Corp’s content.
So in fact, it seems Murdoch might not have all that much to lose by closing his doors to freeloaders.
In the end, of course, it will come down to Murdoch’s ability to convince his most loyal readers of the value of a paid subscription to what will necessarily have to be content of the highest quality. His pitch to them is simple: you will receive a superior editorial product as the result of the increased independence from advertisers and search engines. If he can deliver on that, he might just discover a sustainable model for journalism — in fact, the original model. Stay tuned.
The Back of the Napkin
This book was an impulse buy at Borders over the weekend, and I’m already telling anyone who will listen to go out and buy it themselves. Even as someone with an addiction to words, I have an entirely new appreciation for visual problem solving.
Seriously, it’ll only take you a few hours to read the whole thing. Most of it’s cartoons anyway (who doesn’t love cartoons?). Go make yourself a better communicator already.
The Purpose of Writing
I used to hate writing assignments, but now I enjoy them. I realized that the purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. With a little practice, writing can be an intimidating and impenetrable fog!
– Calvin (of Calvin and Hobbes)
A couple of things I’ve read recently have shifted the way I now think about writing for this blog. Most recently, I came across an article from Cory Doctorow on how he approaches writing. Along with some great tips from a seasoned pro, he makes the inarguable point that “there’s always 20 minutes to be found in a day, no matter what else is going on.” So I’ll be making a concerted effort to write more frequently — there’s just no excuse.
The second bit comes from a chapter of Peter Drucker’s Management, on taking advantage of your own learning style. He writes:
Alfred Sloan — the man who built General Motors into the world’s largest, and for sixty years the world’s most successful, manufacturing company — conducted most of his management business in small and lively meetings. As soon as a meeting was over, Sloan went to his office and spent several hours composing a letter to one of the meetings participants, in which he brought out the key questions discussed in the meeting, the issues the meeting raised, the decisions it reached, and the problems it uncovered but did not solve. When complimented on these letters, he is reported to have said, “If I do not sit down immediately after the meeting and think through what it actually was all about, and then put it down in writing, I will have forgotten it within twenty-four hours. That’s why I write these letters.”
It’s certainly interesting to think about blogging as a tool for personal development — solidifying knowledge and distilling ideas. Sure beats the alternative — that we’re all just talking to ourselves.
The Mirror Test
The following excerpt comes from Peter Drucker’s mythic Management (Revised Ed.), which I finished yesterday on the train back from New York City where I had attended Social Media for Social Change. In the context of stressing the importance of ones personal and professional values, Drucker relates an anecdote establishing what he calls “The Mirror Test”:
As the story goes, the most highly respected diplomat among all those of the Great Powers in the early years of the twentieth century was the German ambassador in London. He was clearly destined for higher things, at least to become his country’s foreign minister, if not German federal chancellor. Yet, in 1906, he abruptly resigned. King Edward VII had then been on the British throne for five years, and the diplomatic corps had been planning to give him a big dinner. The German ambassador, being the dean of the diplomatic corps–he had been in London for close to fifteen years–was to be the chairman of that dinner. Kind Edward VII was a notorious womanizer and made it clear what kind of dinner he wanted–at the end, after the dessert had been served, a huge cake was going to appear, and out of it would jump a dozen or more naked prostitutes as the lights were dimmed. The German ambassador resigned rather than preside over this dinner: “I refuse to see a pimp when in the mirror in the morning when I shave.”
Take the High Road
Just something to noodle on over the weekend. This is from a study (Feltovich, Harbaugh, and To) cited in The Art of Strategy, which I’m finally almost finished with. (Great read if you like game theory, but especially if you know nothing about game theory.)
The nouveau riche flaunt their wealth, but the old rich scorn such gauche displays. Minor officials prove their status with petty displays of authority, while the truly powerful show their strength through gestures of magnanimity. People of average education show off the studied regularity of their script, but the well educated often scribble illegibly. Mediocre students answer a teacher’s easy questions, but the best students are embarrassed to prove their knowledge of trivial points. Acquaintances show their good intentions by politely ignoring one’s flaws, while close friends show intimacy by teasingly highlighting them. People of moderate ability seek formal credentials to impress employers and society, but the talented often downplay their credentials even if they have bothered to obtain them. A person of average reputation defensively refutes accusations against his character, while a highly respected person finds it demeaning to dignify accusations with a response.
Seemingly obvious observations, but I think about the last sentence in particular within the context of a recent post about defending your brand online.
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How Social Media Can Change The World
(This is a long one, but an important topic, so I hope you’ll read it through and share your thoughts.)
A few days ago I touched on the idea of why the “social media” component of Social Media for Social Change is so significant. ”The importance of SM4SC is unquestionable,” I commented over on the SM4SC blog the following day. But why? Why is this a bigger idea than Auto Mechanics for Social Change, or even CEOs for Social Change? The answer, I think, is that we in the social media space have the power, and thus the responsibility, to do more — to leverage the tools we use every day to reach millions of people, and to continue to build new tools to allow messages of social change to be acted upon.
I’m currently reading The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good, an eye-opening a book by former World Bank economist William Easterly. Easterly advocates small, direct, piecemeal solutions to real problems on the ground in developing countries, rather than the “Big Plan” mentality of Jeffrey Sachs and others. As a result, I’ve been thinking a lot lately about the potential of social media when it comes to aiding serious humanitarian causes. The conclusions I’ve come to are: 1) yes, social media provides the most valuable platform to social causes that the world has ever known; and 2) it’s going to take some visionary people to connect the right tools with the right organizations to maximize the measurable benefits.
The first conclusion may seem bold, but to me it’s strikingly obvious. For the first time in the history of humanitarian aid, individual donors and worthy organizations can connect meaningfully on opposite sides of the world.
Whether or not you take the time to think about it when you file your tax return each year, you are already sponsoring domestic non-profits and foreign aid organizations abroad. But a portion of your contributions also goes to the pockets of your state and federal government officials, and another fraction goes to World Bank president Robert Zoellick’s salary and expense account. I won’t try to calculate what percentage of your taxes allocated to social causes actually make it there, but I’m not sure I’d even want to know.
In contrast, you now are beginning to have the tools at your disposal to have a direct, measurable impact on these causes — to help solve the immediate problems, on the ground, in communities with the most need. You can help build a school in Southeast Asia, provide clean drinking water for an entire African village, or prevent domestic abuse in your own neighborhood, with the social media tools you use every day. The real solution is in going straight to the source, and it doesn’t take much:
Medicine that would prevent half of all malaria deaths costs only 12 cents a dose. A bed net to prevent a child from getting malaria costs only four dollars. Preventing five million deaths over the next ten years would cost just three dollars for each new mother.
Easterly points out that the real tragedy is that the Western world has spent $2.3 trillion on foreign aid over the last five decades and still failed to accomplish these remarkably simple goals.
But you no longer have to stand by and let someone else decide how to divvy up your contributions to worthy causes. If wanted to give $20 towards saving the world, or even saving a single life, my guess is you wouldn’t donate it to the United States government or the World Bank. Fortunately we are entering an era where, with social media, you can choose to make a difference yourself.
Social media addresses two of the biggest hurdles of social change: reaching the people who can actually make a difference, and providing the means and channels for them to do so. Only very recently has it been possible for individuals like Tim Ferriss to raise over $250,000 in one month for the construction of new schools in Vietnam and elsewhere – a campaign organized exclusively through blogs and Twitter. Tim wasted no time raising another $15,000 for a school in Nepal, again promoted solely through social media and word of mouth.
This is earth-shatteringly great news for NGOs and non-profits, in the US and abroad, not to mention the deserving recipients of their services. Not only are the tools available (for free, no less) to broadcast an organization’s message to the people who can help the most, but those messages are actionable, meaning help can be delivered directly, immediately.
Where I see the need for visionaries is in establishing platforms that close the loop between the cause, the message, the individual contributor, and the quantifiable result. I don’t mean a central organization equivalent to the World Bank or IMF, who gets to decide who is worthy of aid and who is not — this is social media we’re talking about here, in the age of transparency, where the vox populi dictates the direction of change. Some resources already exist as steps in the right direction. In terms of raising awareness, Change.org is a great central resource for information on humanitarian, social, and geopolitical issues. Applications like Causes in Facebook provide the back end, allowing individuals to contribute directly to the organizations of their choice. And the countless blogging and microblogging platforms provide the channels to promote and connect the two.
There are countless worthy causes out there in need of support from you and me. Many of them can only be served through larger organizations like the United Way, UNICEF, or the federal government. Don’t get me wrong, these organizations do an immense amount of good in the world, but they add a lot of overhead to the contributions they take in. Social media is the key to bringing a new level efficiency to enacting social change.
How would you spend $20 right now if you knew 100% of it would be used directly by a worthy cause? And how far away do you think we are from this becoming a reality?
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