health care


Robert Wood Johnson President, Risa Lavizzo-Mourey, posted these maps which hold implications for business. They show how zip code statistically trumps genetic code as a determinant of health. This is intuitive for global zip code differences. However, these are statistical differences in health profiles within a county or across some subway stops.

Health outcome is the most fundamental determinant place could have.

Place in the U.S. also varies with outcomes in GDP, education, home ownership, income and disposable income per capita, percent living below poverty, and attracted venture capital.

It’s widely assumed that business is attracted to regions with low corporate taxes. In Russia business has enjoyed low taxation over long periods alongside no deluge of investment funding or business gravitation to that region vs. elsewhere like the American west coast. West Virginia and Mississippi with low taxes experience relatively poor innovation, while highly innovative states like California and New Jersey harbor the highest tax rates. In actual business zip code trumps taxes too. The role of place in business innovation and startup culture has been chronicled in the work of Richard Florida on creative classes.

Or rather it bans big sugary drinks. It’s one of the shrewdest moves I’ve seen in the public sphere around psychologically resetting beverage serving sizes and, by extension, sugar and caloric intake per serving.

Given NYC Mayor Bloomberg’s ban’s arguable practicality it’s interesting it’s just now happening, though admittedly, it’s not for the risk-averse. A mayor of the free world’s largest city has a fiduciary duty to the citizenry to take on big problems in creative and efficient ways. A national epidemic of overweight and obesity requires such an official to vote. And the ban will meaningfully add to an experiential public health and policy database about what levers may alter behavior affecting the public’s health interest. It’s a bold stroke of leadership. I support it.

It’s unclear where behavioral change thresholds are for big sugary drink servings. But Bloomberg is willing to search. We do know Americans don’t eat or drink purely due to hunger or thirst–so by definition serving size is malleable.

Naysayer group 1: “big government”

These opponents are misdirected: Any nation’s first duty is self-defense. So in a country without conscription, government has a primary duty to regulate the health profile—among other things—of the general population from which the military is  drawn; hence, vaccinations for public school teachers and pupils, regulation of the agriculture industry, quarantine law, etc.  Some of our most important and long-instituted food regulations and nutritional standards today derived straight from the Department of Defense. We can’t source a military with insulin dependents.

Naysayer group 2: “too many loopholes”

They claim folks will just buy two 16-oz big sugary drinks to get the old 32 oz. they used to.  Not necessarily: It’s less convenient and inconvenience is a tax. From web pages that load seconds too slowly; to stepping well outside to smoke; to voice-automated menus with excessive steps; to merchandise too low on a shelf; to right houses in wrong locations; we avoid inconvenience. Over the course of one New York City minute and time-sensitive day, that can include queuing up for a refill, additional beckonings of a waiter, multiple treks to the movie concession area, or carrying 2 drinks vs. 1 from the start. Lastly, even if they refill, the point is they refill at a lower caloric rate—sugar and calories per refill. That’s a plus.

For the record, of course, overweight and obesity cost.

Great story. High school freshman, Jack Andraka, develops a paper sensor for detection of blood proteins signaling some early stage cancers. Certain proteins get over-expressed in the blood for different cancers at early stages.  Tests categorized as ELISA (enzyme-linked immunosorbent assay) are part protocol for early cancer diagnostics. Jack’s discovery—now with the patent lawyers and Johns Hopkins—seems factors more efficient and accurate than ELISAs, the first of which was invented over 40 years ago.  For perspective, here’s how ELISA was celebrated only in 2006.

I note:

  • Jack attends public school.
  • Like the rest of us he was also “home-schooled”, i.e, he learned stuff at home.
  • Jack did research outside the advantages, constraints, accoutrements and professional politics of a conventional research grant-based environment.
  • Jack had supportive parents and teachers.
  • He had fun.
  • Jack seems personable, well-mannered and easily conversant with a balance of complexity and simplicity, and people seem to want to work with him. (TRANSLATION: Jack’s emotional IQ doesn’t appear inversely proportional to his conventional IQ.)
  • Jack focused on a little part of a really big something.
  • Jack is 15.

Much cancer work is on treatment. In conventional medicine—whose professional impulses in the grimmest cast mimic complacency if not a more honorable abject surrender—cancer is a given.  Oncology’s whole start. And in truth there are problems about which we know little to do and cancer’s surely among them. Viruses too. They stump us for similar reasons and it’s no coincidence we’ve cured neither.

But this  freshman is focusing on proteomics and detection— upstream. Because everything is a rate. And he’s  valuing the simple proposition of earlier diagnostics—plus better ones—as, yes, a prelude to earlier treatment.

Thinking about big problems can be daunting—cancer is big.  But the ability to focus on a small piece is key.  But research tradition—even in the fine exploratory arena of a progressive Johns Hopkins lab—can sometimes obscure how legitimate little pieces look.  Some fruit, I fear, hangeth too low for view by the fanciest eyes.  Or a more accurate explanation may lie in this random literature from an LSAC publication:

“Many major scientific discoveries of the past were the product of serendipity, the chance discovery of valuable findings that investigators had not purposely sought.  Now, however, scientific research tends to be so costly that investigators are heavily dependent on large grants to fund their research.  Because such grants require investigators to provide the grant sponsors with clear projections of the outcome of the proposed research, investigators ignore anything that does not directly bear on the funded research.”

A Yale management professor said it takes 10 years of doing something to become an expert—there are studies. Yes. It takes volume. Volume takes time. But that’s not the story, increasingly. First, whole industries now rise and die in 10 years. You won’t get that window to “master” in.  Secondly, you’re due to know something after 10 years, but the question is whether it’s optimum. Lastly, even if you get to master something, your frequency of innovation over the course—e.g., Jack-style—is something else. And that’s business’ whole deal.

Quite opposite dismissing children because of youth or no volume, I particularly attend. I follow them on twitter. In science great questions and discovery, as Jack teaches, not only can come early before you’re a conventional expert and often seem to come in part because you’re not, but increasingly in a competitive world, they must.

My brand is rocket fuel. It would take this brand 10 years to get to where I can take it in one year.”Sean “Diddy” Combs

Diddy signed a 2007 deal with Diageo PLC entitling him to a 50% stake in Ciroc Vodka.  Here’s how business has done since he signed, and for simple comparison, how the Air Jordan sneaker business did for the same period after Michael Jordan signed his famously successful shoe contract with Nike.  It’s a succinct graph but in both categories sales were either flat or growing unremarkably up to the contract:


It’s one of many new deals between the alcoholic beverage industry and proven influential lifestyle brands in industry moguls and icons.

In the March 2011 Forbes column “Why Diddy Will Be Hip-Hop’s First Billionaire” , Forbes staff noted:

“…Executives at Diageo could never have expected just how much Diddy’s presence would boost sales. In 2007 sleepy Ciroc was moving cases at a rate of 60,000 per six months, or 120,000 per year. In 2009 Diddy’s second year with the brand, Ciroc moved 400,000 cases. This year Ciroc is on pace to sell more than 1 million cases. The boom was fueled in large part by Diddy’s diligent shilling—on billboards, in lyrics, on Twitter and even through a self-proclaimed nickname, “Ciroc Obama.”

Diageo management framed Ciroc’s success after the Combs partnership:

“Only twice in my career have I seen an immediate response in our brand tracking”…“We saw it really take off in the African-American community, and it has started to broaden its appeal. Throughout the entire economic recession, it was one of the few brands that never slowed down.”… “As a community, African-Americans are leaders in terms of style, fashion and image,”…“They can take brands and make them very big themselves.”–Jim Mosely, Diageo Senior Vice-president for consumer planning 

Other examples of non-textbook breakthrough African American marketing influence can be found in industries of fashion and accessories, food and non-alcoholic beverages, fragrances, electronics, automobiles, and even travel.


The New York Times reported today that a little medical device company, Biotronik, with 5% market share in pacemakers and defibrillators, is Big Daddy in one certain medical center (some of whose doctors it hired) with 95% market share.  And it got there in 3 years from 0% market share. Technically, that’s a growth rate of infinity. Many a firm is emboldened by 10%. This is a quick change of heart—devices. Plus clinical trial (all expenses paid).

Casualities in this story—at least 3:

  • evidence-based medicine
  • competition
  • ethics

Narrated by Cokie Roberts and recommended by Risa Lavizzo-Mourey (current President of the Robert Wood Johnson Foundation, the nation’s largest healthcare philanthropy), this Kaiser Family Foundation animation attempts a summary low-down on health reform.

%d bloggers like this: