The Process — Mountains Beyond Mountains

Solving the problem of MDR-TB is circuitous at heart. In order to address the growing costs of treating drug-resistent TB, there must be measures taken to lower costs of second-line drugs. In theory, this can be done by finding generic drug manufacturers and asking these parties to produce cheaper medicines. But in practice, drug manufacturers are only willing to produce cheaper generics if there is the demand to justify their investment. In order to create this demand, PIH hoped to collaborate with WHO to modify the processes used to treat tuberculosis (see previous post). From the perspective of WHO, changing treatment processes for MDR-TB are only economically feasible if the costs incurred by second-line drugs is significantly reduced. And then return to “there must be measures taken to lower the costs of second-line drugs.”

I’ve come to realize that this process is something we’re all familiar with. We start a project hoping for the best out of people — that everyone does their fair share and everything goes as planned… but then things start to go wrong. Deadlines are missed and project proposals are rejected. Publishers don’t like our book, and scientific journals aren’t compelled by our research. The truly successful, however, are persistent — they have plans, and backup plans, and even backups of backup plans. In the case of PIH, plan B involved coordinating the efforts of nonprofit organizations. Paul Farmer and Jin Kim managed to raise several million dollars to combat drug-resistent TB, and created demand for cheaper drugs through their successes.

Regardless of what projects we work on, we will always be the most passionate about growing our brainchildren. So we shouldn’t rely on any World Health Organizations, or drug manufacturers, or even nonprofits, to get us where we want to go. That’s for us to pursue on our own.

On Gumption — Mountains Beyond Mountains

I’ve been diligently chipping away at Mountains Beyond Mountains, but in the interim I’ve also been reading Zen and the Art of Motorcycle Maintenance, a gem by Robert Persig.

Persig discusses the idea of “gumption” in the latter half of his book. In summary, gumption is motivation, diligence, and persistence all bundled into one word. It’s the driving force behind our focus when times get rough. When we suddenly encounter a bug we can’t fix, or an argument we can’t seem to win, strong gumption will win us that extra 1%. Weak gumption, on the other hand, leads to frustration, burnout, and boredom.

I can’t help but wonder how Pel Farmer keeps a steady supply of gumption… He stares tuberculosis in the eyes in areas where people are much too poor to help themselves. The world’s leading political health specialists have turned against Farmer, pronouncing resources are wasted on MDR-TB patients (multi-drug resistent TB patients). Even worse, the then-current standards in place to combat TB only stymie the treatment of MDR-TB. Standard treatment for TB called for a second round of two first-line drugs — drugs designed to treat two common types of TB-bacilli. But repeated treatment with identical drugs encourages the evolution of other drug-resistant bacteria. Even the dominant political stakeholders refuse to amend their treatment procedures to reflect the evolution of the illnesses they are trying to address.

Farmer and his PIH project are the only salmon swimming against the currents of medical professionals, government institutions, and billions of bacteria. But in the face of all of this, Farmer still dedicates himself to his cause, dumping hundreds of thousands of dollars into a program he helped create. He flies to and from Boston, where he is still doing his clinical rounds as a resident, starts a family, and battles Hepatitis A. Farmer never wavers, and never burns out.

His job is harder than most, but he sticks with it. It’s a cliche, but that’s something everyone can admire and learn from.

A Thought on Our Strengths — Mountains Beyond Mountains

Several of my friends and I had an interesting conversation over last weekend about the merits of socioeconomic affirmative action. The topic of the conversation stemmed naturally from that of affirmative action. But let’s try our best to stay away from discussing the pros and cons of either of these for now…

I personally believe that family backgrounds are an important factor in building the work ethics of students today. In view of Paul Farmer, I noticed that there were certain qualities he gained as a child that have persisted to the present day (his incredibly strong work ethic and ability to work anywhere). These personality traits aided Farmer in obtaining a strong education at both Duke and Harvard, and have contributed to his successes with his hospital in Haiti. But on the other hand, Farmer is the most academically successful of his siblings, one of which pursued a career in athletics (seemingly the opposite of academia).

As people from all walks of life, all races and all all socioeconomic statuses, how do we develop the skills necessary to unlock our true potentials?

The Idea of Professions — Mountains Beyond Mountains

There are two things I want to discuss from reading Mountains Beyond Mountains: the first is Paul Farmer, and the second is Paul Farmer being a doctor.

Last week I discussed briefly my interpretation of the concept of burn-out. It’s what happens when we work too hard, too fast, for too long, after we’ve bit off a little more than we can chew. We fall into that weird, half-depressed, half-tired state where things seem out of proportion and just a little impossible. But what if we’re Paul Farmer, and the “bit off a little more we can chew” is the poorest part of one of the most impoverished countries in the world? Every day, we work from sun-up until sun-up, at least more than four months a year. We fly between our $125,000 dollar professorships at Harvard Medical school and our home in Haiti, dialing our wife and daughter along the way. And when we’re doing none of those things, we’re the primary practitioner on call for any infectious-disease-related case at a very hectic Boston hospital.

By the way, we’re also broke, because all of our $125,000 paycheck goes to our kids, our mom’s mortgage, and our hospital in Haiti that serves hundreds of thousands of patients every year.

All of this makes me realize that I might have been a little wrong about the concept of burn-out — maybe sometimes there’s no such thing as working too hard, for too long. I’m not sure what to make out of the case of Paul Farmer yet, but it seems to me like there’s an incredible discipline that drives Dr. Farmer. It’s something I admire, and he’s forever going to be a role model to me.

The case of Dr.Farmer (being a doctor) has also helped me realize that the generalizations I’ve made about careers and professions are deeply flawed. I believe that many university students, myself included, categorize people in a general way. There are the businessmen and women, the engineers, the history/english/poly-sci majors, and the doctors. I don’t mean to be crude in my generalizations; as someone who falls into the “engineer” category, I resent this generalization, but am partly shaped by it nonetheless.

As a student studying Computer Science, I’ve often heard the idea that C.S. will help me break down bigger problems into smaller, more manageable ones. I’ve also heard that a good programmer knows how to compartmentalize, and divvy tasks between himself and his peers. Some say that developers have a keen ability to explain and discern difficult technical literature (who knows who came up with this one). All of these claims extend the concept that oftentimes engineers are like wild-cards — they can be played anywhere, in any profession.

Dr. Farmer’s patient interactions have led me to believe that the same is true for highly attentive doctors. His extreme discipline, deep passion, and uncanny ability to relate to both his patients and his acquaintances suggest he would be an incredible fit in any career. While the material knowledge Farmer has mastered is different from the business expertise of Tony Hsieh, I believe the concepts are completely cross-compatible. I feel that, had Farmer chosen a different path, he would have been just as capable, and just as passionate as he is currently about Haiti.

Thoughts?

Mountains Beyond Mountains

This is not a blog about entrepreneurship. This is a book club. That said, a common theme amongst successful entrepreneurs is a brand of fearlessness — the people we respect most in our histories are the ones who were crazy enough to change things. And I think it’s a mentality we can all learn from.

Please join me in reading a tale about Paul Farmer in Mountains Beyond Mountains.

Great By Choice — Discipline

I finished reading Great By Choice a few days ago, and I had some time to reflect on how the book applies to my life. As I read these books, I personally like to let everything just sit and simmer. I try to bridge the gap between the businesses mentioned and my personal life, and I try to think about how the concepts introduced can apply to the business of running my life.

The thing that most impressed me with Collins’ analysis of lucky companies is how initially unremarkable each of the companies were. Collin’s jumps back, time and time again, to the concept of “Level 5 ambition” and communal leadership (both of which he touched upon in his former works). But in Great By Choice, we find that successful companies have an extra element: discipline. Discipline — in the sense that enduring companies don’t reach for the risky, high-hanging fruit. In fact, many great and enduring companies don’t climb onto the slimmer branches at all — they stay lower on the thick boughs, doing the things that have worked for them in the past. Hitting average, and hitting it consistently, again and again, with discipline.

A case study frequently referenced in this book was that of Southwest, which managed to be profitable almost every year over the past thirty years (including 2001). Through recessions, airline bankruptcies, and 9/11, Herb Kelleher and Southwest trudged slowly and surely into the unknown. It didn’t matter what was going on in the world, because Southwest had several simple tenants they treated as their bible. They knew their tenants: fly (only) Boeing 737’s, maintain quick turn-around times on the tarmmat, and remain the low-cost airline. That kind of beautiful simplicity can only be grown organically from years of discipline.

This discipline is something that I personally need more of. I think I speak for many when I admit that there are frequently discrepancies between what we want to do and what we need to do. How great would it be if we always wanted what we needed? It’s a trivial statement — and one which we all are well aware of — but we need to learn to be disciplined.

Disciplined means that we are not over-ambitions, or over-eager. I’ve told myself I can’t always do what I want in the moment. And I’ve found that things are always easier in the beginning than in the middle or the end. A cliche “Life is a marathon, not a sprint,” is extremely relevant here — I’m not going to work less than I want, or harder than I need to.

When don’t work up to our expectations, we compensate by working more on other days. And when we work harder than we need to, we compensate by allowing ourselves to justify slacking off when hard work matters most. Discipline companies are like disciplined people: they work and do what they need to do; they set goals for themselves that mark progress rather than bursts of productivity.

Disciplined companies don’t burn out, and then get desperate after they realize they’ve missed the boat. They take it twenty miles a day, and never need that lucky boat to begin with.

So here’s my 20-mile march: I’ll write a blogpost every week, and it’ll be up by the end of the day, every Monday.

I’d love to hear your thoughts.

Book Recommendation by Tony Hsieh (Zappos)

I had the pleasure of briefly meeting Tony today at a talk he gave to Zynga employees. He seemed very passionate about his involvement with the Downtown Project, an incredible initiative to vitalize downtown Las Vegas. Tony recommended that we read Great By Choice.

Several weeks ago, ex-adventure-racer Robyn Benincasa said something that will always stick with me: Luck is where Opportunity meets Preparation.

Collins’ new books analyzes the effect that luck and situation have on corporation successes. Similar to his past books, Built to Last and Good to Great (which was mentioned in a previous post), Great By Choice uses successful companies as case studies to understand what makes great companies even better (or luckier, as the case may be).

I look forward to sinking my teeth into our new book, and I encourage you all to join me in reading Jim Collins’ latest installment.

20/20 Hindsight

It’s hard to believe that once, in the early 1980’s, human beings didn’t know what a personal computer was. Most techies may argue about how the computer caught hold in general populace — whether it was Mac or Windows — but all will agree that the 80’s was the era of computer revolution.

It’s hard to believe that once, in the early 1990’s human beings didn’t know what the internet was. Blah blah blah, the internet changed the world. We’ve all heard this before. All will agree that the 90’s was really the era of the web revolution.

It’s hard to believe that once, in the early/mid 2000’s, people didn’t really do that much on their cell phones. In fact, at the turn of the millennia, most of us (or in some cases, most of our parents) didn’t even have cell phones. Many will agree that the early 2000’s was beginning of the mobile revolution.

Personally, I find it hard to believe that once, in the mid/late 2000’s, I had to call and email people to coordinate events. It really does take some effort to think about how different life was without the social networks we have today.
The way I see the last three decades is like this:
Personal Computers in the 80’s -> More computers in the 90’s, which encourages the development of a computer network (the Internet) -> Computer technology advances through the 90’s + Infrastructure for the internet -> Development of smaller, cheaper mobile devices in the 2000’s -> Larger, and larger network of both computers and mobile devices (and with the development of online identities) -> Social Networks that take people who are already connected, and fosters those connections on the web -> ?????

 

I’ve had some pretty interesting conversations about where the big, bad world is taking us, but I wanted to get everyone’s thoughts on the matter… A pretty strong answer seems to be “The World of Big Data.” This makes sense to me — people are putting more and more data on the web every day, so naturally we need utilities that can parse through and make sense of all of this data. I’d love to hear your thoughts on the matter.

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In addition, I’d like to point out that Daniel Kahneman believes that all of this thinking ahead and thinking behind is… almost pointless. Out of everything I’ve read so far in Thinking Fast and Slow, I find this point the hardest to grapple with. From a future standpoint, the progression of computing from its inception to the current day is pretty clear. One thing just naturally led to another. Look at us now — with our phones and our computers and our social networks — we find able-minded entrepreneurs are starting companies left and right. Some of us are really doing what we’re passionate about, while others are putting down bets and speculating what the future will bring.

From Kahneman’s perspective, all of this speculation is unproductive, however. In his mind, the future is just an amalgamation of different possible scenarios that may or may not take off — he believes that there’s a significant amount of managed luck that contributes to the actual development of our current technologies. To me, looking back with 20/20 hindsight is an encouragement to look forward too, to see what’s to come.

So I’m not exactly sure how I feel about Kahneman’s thoughts on the matter.

 

Thinking Fast and Slow — The Hope, The Hopeless

I’ve always liked to consider myself as someone who is uniquely special. Not just special — no no, we’re all special. Uniquely special.

In particular, I’ve always thought of myself to be someone who enjoys the game of thinking. Thinking more than others is something that I’ve always thought separated me from normal human beings. Myer’s Briggs says I’m an ENTJ, where J stands for “judging.” I guess I really do relate to the fact that I am a judging individual.

And then here, we have this Dr. Kahneman telling me that I am — in fact — not special at all. Kahneman splices our minds into two categories, which he calls System 1 and System 2. Now, if there’s anything my friend Robert Pirsig has taught me, it’s that categorizations are almost always rough approximations. Kahneman’s dichotomization of thought into these two categories seems like a heavy statement, and it’s one that I don’t necessarily agree with. But as much as I’d like to fight with him, I really do think he has a point: people live their lives on the fringes of their conscious minds, where their intuition meets rationality. On numerous occasions, Kahneman cites examples of how human intuition is actually deeply flawed — in fact, completely absent of the rational concepts of probability. And even when we are informed of our psychological shortcomings, we still fail to reform ourselves. In fact, studies suggest that most people continue going about their lives influenced by the same biases, regardless of whether they are informed of not.

This fact concerns me. In particular, I’ve always believed in the cliche that accepting you have an issue is the first step to reform. Setting aside the fact that I am uniquely special, how are we able to overcome the biases we face in our daily lives to become the best individuals we can be?

I was watching a video of Anthony Robbins some years ago, where he stated the interesting fact that the difference between success and failure is 1%. Minute changes in our perception can cause drastic changes in our character and personality. The question I ask myself is how I can make that 1%.