Category Archives: quotes & aphorisms

complex adaptive systems, cool, healthcare, meaning, policy, politics, quotes & aphorisms, rapid learning health systems, research methodology

A clear head shot from Jeffrey…

Not one stakeholder group left untrashed…

Great Einstein quote – the original definition of insanity presumably:

‘The significant problems we face cannot be solved at the same level of thinking we were at when we created them’

PDF: Braithwaite Delusions of health care JRSM 2014

The medical miracles delusion

Army ants subscribe to a simple rule: follow the ant
in front. If the group gets lost each ant tracks
another, eventually forming a circle. According to
crowd theorist James Surowiecki, one circle 400m
in circumference marched for two days until they
all died.1
Humans are not ants, but we often trudge together
along the same trail, neglecting to look around for
alternatives. Mass delusions involve large groups
holding false or exaggerated beliefs for sustained periods.
Humanity has a long, sorry list of these shadowthe-
leader epidemics of collective consciousness which
appear obviously wrong only in hindsight. Some last
for centuries: early alchemists intent on transmuting
base metals into gold and the Christian Crusades of
Europe’s middle ages, for example. Others have correlates
which resurface decades or centuries later:
McCarthy’s persecution of alleged communists in
the 1950s harked back to the Salem Witch hunts of
16th century America just as the 2008 Global
Financial Crisis had much in common with the
‘South Sea Bubble’ which slashed 17th century
Britain’s GDP.
In the educated 21st century, too, we blithely trust
in economic and political systems which are stripping
the earth’s resources, altering the climate and facilitating
wars. Are we then similarly mistaken, en masse,
about the capabilities of the health system?
Most of us believe in the miracles of modern medicine.
We like to think that the health system is
increasingly effective, that we are implementing
better treatments and cures with rapid diffusion of
new practices and pharmaceuticals and that there is
always another scientific or technological breakthrough
just around the corner promising to save
even more lives; all at an affordable price.
We maintain the faith despite multiple contraindications.
Modern health systems consistently deliver
at least 10% iatrogenic harm.2 Despite very large
investments and intermittent but important interventional
successes, such as checklists in theatres3 and
clinical bundles in ICU,4 there is no study showing
a step-change reduction in this rate, systems-wide.

Only half of care delivered is in line with guidelines,5
one-third is thought to be waste,6 and much is not
evidence-based,7 notwithstanding concerted efforts to
optimise that evidence and incorporate it into routine
practice.8
The reality is that progress is slowing, and medicine
seems to be reaching the limits of its capacities.
The potentially disastrous problems of antibiotic
resistance, for example, are yet to play out. This is
only one point among many. New technologies such
as the enormously expensive human genome project
have provided only marginal benefits to date. We still
do not have the answers to fundamental questions
about the causes of common diseases and how to
cure them. Many doctors are dissatisfied and increasingly
pessimistic.9,10 It must also be remembered that
although death is no longer seen as natural in the
modern era, everyone must die. Yet, we inflict most
of our medical ‘miracles’ on people during their last
six months of life. Le Fanu describes this levelling off
and now falling away of health care progress in The
Rise and Fall of Modern Medicine.11
Every major group of stakeholders has its own
specific delusion which acts to augment the metalevel
medical miracles delusion. Thus, the overarching
delusion is buttressed by a set of related ‘viruses
of the mind’, to borrow Richard Dawkins’ evocative
phrase.12
Although politicians think and act as if they are
running things, modern health systems are so complex
and encompass so many competing interests that no
one is actually in charge. Then, bureaucrats – acting
under their own brand of ‘groupthink’ – assume their
rules and pronouncements provide top-down stimulus
for medical progress and improved clinical performance
on the ground. Yet coalface clinicians are relatively
autonomous agents, so there can only ever be
modest policy trickle down.13,14
Researchers, too, support the medical miracles
industrial complex. The electronic database
PubMed holds some 23 million articles and is growing
rapidly. Every author hopes it will be his or her
results that will make a difference, yet there is far less

take up than imagined and comparatively little
investment in the science of implementation8 – translating
evidence into real life enhancements.
Nor are clinicians or the patients they serve
immune. While frontline clinicians strive to provide
good care, many myopically assume their practice is
above average; the so-called Dunning-Kruger
effect.15,16 Of course, statistically, half of all care clinicians
provide is below average. And notwithstanding
decades of public awareness, patients believe modern
medicine can repair them after decades of alcohol,
drugs, sedentary lives and dietary-excesses, despite
evidence to the contrary.
Meanwhile, the media’s unremitting propensity to
lend credibility to controversial views and to hone in
on ‘gee whiz’ breakthroughs – while ignoring the
incremental and the routine – fuels unrealistic expectations
of what modern medicine can deliver.
Throughout history, mass delusions have been
aligned with mass desires for favourable outcomes.
In the pursuit of medical miracles all of our interests
line up in a perfect circle. We seem more like army
ants than we think.
Just as the Global Financial Crisis was a wake-up
call for the serious consequences of blind fiscal faith
we must begin to manage our expectations of the
health system. Progress is always in jeopardy when
the real problems are obscured.
The challenge is to harness the tough-minded
scepticism needed to tackle this widely held ‘received
wisdom’. One realistic way forward is to encourage
stakeholders – politicians, policymakers, journalists,
researchers, clinicians, patients – to first consider
that their own and others’ perspectives are simply not
logically sustainable. This may be achieved through
genuine inter-group discourse about the health
system, where it is at, and its limitations.
As is so often the case, Albert Einstein said it best,
in a typically neat aphorism: ‘The significant problems
we face cannot be solved at the same level of
thinking we were at when we created them’.17 If we
can humbly accept that we need new perspectives
for healthcare – and radically different ways of
thinking – we will be better placed to free ourselves
from the hold of these peculiar viruses of the mind.

business, facts & data points, file note, healthy habits, musings, nutrition, policy, politics, quotes & aphorisms

“There is no freedom in addiction”

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

PN: The fallacy in the rump of this discussion is that cigarettes are not that more harmful than a big mac. I’m just as likely to die from smoking a single cigarette in front of you, as I am if I were to eat a big mac in front of you. The problems arise when you smoke/eat these products every day of your life.

http://bigthink.com/21st-century-spirituality/should-big-food-pay-for-our-rising-obesity-costs

Should Big Food Pay For Our Rising Obesity Costs?

FEBRUARY 25, 2014, 4:29 PM
Bt-big-food

Paul McDonald didn’t expect his letter to go public. The Valorem Law Group partner had queried sixteen states, asking leaders to consider investigating Big Food’s potential role in paying for a percentage of the health system’s skyrocketing obesity costs. The Chamber of Commerce got wind of this letter and made it public, setting off a national debate over food marketing, ingredient manipulation and personal responsibility.

McDonald’s premise is simple enough: if large food companies are purposefully creating addictive foods to ensure consumer loyalty, adding to the rising obesity levels in this country, they should be responsible for covering costs associated with treatment. The backlash was immediate and biting.

Comparisons to the Big Tobacco companies came first to mind. In the 1998 Tobacco Masters Settlement Agreement, major players in the tobacco industry agreed to pay $246 billion to offset health risks and diseases associated with its product. Critics of McDonald’s idea believe there is no link between tobacco and food.

Advertising

On the face of it, this would appear true: you don’t need to smoke, but eating is a necessity. Smoking is a choice, and therefore if you choose to smoke, you pay the consequences. Eating falls into an entirely different category.

Yet the neural mechanisms might be similar. A 2010 study in Nature Neuroscience found that rats consumed well past their limits when offered high-calorie foods such as bacon, sausage and cake, speculating that humans, when faced with an equivalent scenario, also choose to overeat.

Harvard University Professor of Medicine, Emeritus David Blumenthal’s study, Neurobiology of Food Addiction, found a similar link between food and drug abuse. In the summary he writes

Work presented in this review strongly supports the notion that food addiction is a real phenomenon…although food and drugs of abuse act on the same central networks, food consumption is also regulated by peripheral signaling systems, which adds to the complexity of understanding how the body regulates eating, and of treating pathological eating habits.

The argument against food addiction is a tough one, waged by industry insiders who want to keep 60,000 products on American shelves. The real question, however, is: are food companies purposefully producing addictive foods that change our neurobiology? If so, should they be held economically accountable?

American obesity costs are currently $147 billion per year. The CDC estimates that 35.7% of adults and 17% of children ages 2-19 are obese—a number that has risen dramatically over the last two decades. A joint report between Trust for America’s Health and the Robert Wood Johnson Foundation estimates that 44% of American adults will be obese by 2030. The report predicts that will add between $48-66 billion to our costs, some of which is paid for by taxpayers.

Yet food is such an emotional topic. For example, when informing someone that I’m vegan, they immediately let me know why they could never do such a thing (I didn’t ask) or that it’s ‘wrong’ for them, and sometimes by extension, me (last week’s annual blood work shows me in perfect shape).

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

Inexpensive to companies, not to consumers. Paul McDonald is striking an important nerve in how we manufacture, distribute and consume food in our country. There will be a lot of resistance and debate from both industry and citizens. But if we don’t begin this conversation now, our national and mental health is only going to continue to decline.

Image: Aliwak/shutterstock.com

data saving lives, facts & data points, healthcare, healthy habits, politics, quantified self, quotes & aphorisms, rapid learning health systems

CIA on FitBit – wearable data security

Awesome quote from th CIA re. gait identification:

If there’s one entity that knows the value of the health data uploaded to these devices, it’s the CIA. Last year, at a data conference in New York, the CIA’s chief technology officer, Ira Hunt, gave a talk on big data. During the discussion, he told the crowd that he carries a Fitbit. “We like these things,” he said. “What’s really most intriguing is that you can be 100% guaranteed to be identified by simply your gait—how you walk.”

 

Are Fitbit, Nike, and Garmin Planning to Sell Your Personal Fitness Data?

Are Fitbit, Nike, and Garmin Planning to Sell Your Personal Fitness Data?

These popular fitness companies say they aren’t selling your info, but privacy advocates and the FTC worry that might change.

—By  | Fri Jan. 31, 2014 3:00 AM GMT

 

Lately, fitness-minded Americans have started wearing sporty wrist-band devices that track tons of data: Weight, mile splits, steps taken per day, sleep quality, sexual activity, calories burned—sometimes, even GPS location. People use this data to keep track of their health, and are able send the information to various websites and apps. But this sensitive, personal data could end up in the hands of corporations looking to target these users with advertising, get credit ratings, or determine insurance rates. In other words, that device could start spying on you—and the Federal Trade Commission is worried. 

“Health data from [a woman’s] connected device, may be collected and then sold to data brokers and other companies she does not know exist,” Jessica Rich, director of the Bureau for Consumer Protection at the Federal Trade Commission, said in a speech on Tuesday for Data Privacy Day. “These companies could use her information to market other products and services to her; make decisions about her eligibility for credit, employment, or insurance; and share with yet other companies. And many of these companies may not maintain reasonable safeguards to protect the data they maintain about her.”

Several major US-based fitness device companies contacted by Mother Jones—Fitbit, Garmin, and Nike—say they don’t sell personally identifiable information collected from fitness devices. But privacy advocates warn that the policies of these firms could allow them to sell data, if they ever choose to do so.

Let’s start with the popular Fitbit. When you buy one of these bracelets or clip-on devices, you have the option of automatically sending fitness data to the Fitbit website. And the site encourages you to also submit other medical information, such as blood pressure and glucose levels. According to Fitbit’s privacy policy, “At times Fitbit may make certain personal information available to strategic partners that work with Fitbit to provide services to you.” Stephna May, a Fitbit spokesperson, says that the company “does not sell information collected from the device that can identify individual users, period.” However, she says that the company would consider marketing “aggregate information” that cannot be linked back to an individual user—which is outlined in the privacy policy as aggregated gender, age, height, weight, and usage data. (This is similar to whatFacebook does.)

Nike, which makes the Nike + Fuel Band, says in its privacy policy that the company may collect a host of personal information, but doesn’t say that it can be shared with advertising companies. Joy Davis Fair, a Nike spokesperson, says that the company, “does not share consumer data” with outside advertisers, but selectively shares it with other companies under the Nike’s corporate umbrella, including Converse and Hurley. Garmin’s policy says that users have to consent in order for the company to sell personal information. A Garmin spokesman says the company doesn’t sell personal or aggregated information to advertisers, and doing so isn’t part of the company’s business model. (Polar Flow, which makes the Polar Loop band, is the only company with a privacy policy that explicitly says it won’t sell personally identifiable data for advertising. It is based in Finland and subject to stringent European Union privacy laws.)

Jeffrey Chester, executive director for the Center for Digital Democracy, says that these privacy policies are so broad that they could allow the companies to sell health data—even if they aren’t doing so now. “When companies promise that they aren’t selling your data, that’s because they haven’t developed a business model to do so yet,” Chester says.

Scott Peppet, a University of Colorado law school professor, agrees that companies like Fitbit will eventually move toward sharing this data. “I can paint an incredibly detailed and rich picture of who you are based on your Fitbit data,” he said at a FTC conference last year.“That data is so high quality that I can do things like price insurance premiums or I could probably evaluate your credit score incredibly accurately.”

Even if the companies that make these devices aren’t selling the data, there is another potential privacy concern. Users can send their data to dozens of third-party fitness apps on their phone. Once users do that, the data becomes subject to the privacy policies of the app companies, and these policies do not afford much protection, according to the Privacy Rights Clearinghouse. The group examined 43 popular health and fitness apps last year, and found that, “there are considerable privacy risks for users.” A spokesperson for the FTC told Mother Jones that “fitness devices often work by having apps associated, and [Privacy Rights Clearinghouse’s] analysis here may be relevant.”

If there’s one entity that knows the value of the health data uploaded to these devices, it’s the CIA. Last year, at a data conference in New York, the CIA’s chief technology officer, Ira Hunt, gave a talk on big data. During the discussion, he told the crowd that he carries a Fitbit. “We like these things,” he said. “What’s really most intriguing is that you can be 100% guaranteed to be identified by simply your gait—how you walk.”

 

entrepreneurship, management and leadership, quotes & aphorisms

don’t waste time on a business plan

  • think people, not ideas – team > market > concept
  • think speed, not perfection – minimum viable product with every pivot closer to success
  • think vision, not plan – being an entrepreneur is about creating the future one step at a time.

Where there are 2 or more founders, it’s important to write down the canonical things they all agree on.They need to agree what the vision is and what the path to success will be. But don’t spend time trying to put that into a 40-page document.

http://www.inc.com/minda-zetlin/business-plans-are-a-waste-of-time-heres-what-to-do-instead.html?cid=readmore

Business Plans Are a Waste of Time. Here’s What to Do Instead BY 

Throw your business plan in the recycling bin. Instead, focus on your team and on getting to market as quickly as you can.

If you’re taking time to carefully perfect a business plan to help ensure your company’s model is sound and that it will be a success–stop. That’s the word from William Hsu, c0-founder and managing partner at start-up accelerator MuckerLab.

Hsu, who’s been both a successful entrepreneur and an executive at AT&T and eBay, says that starting a company is “a career for really irrational people. In all probability, whatever the idea is will fail. Building a reality distortion field is how entrepreneurs convince themselves and their employees that this is a good idea.”

With that in mind, he advises:

1. Think people, not ideas.

A great team trumps a great idea every time, Hsu says. “None of us is perfect, and entrepreneurs are usually great at a couple of things, such as having vision and being willing to take risks.” Entrepreneurs–especially tech entrepreneurs–come in one of two flavors: Either they’re like Steve Jobs, visionaries who understand the market but aren’t technically proficient, or they’re like Steve Wozniak, technical geniuses who don’t understand how to market to customers.

In either case, having great team members can fill in any areas where the entrepreneur lacks strength, he says. “We look for three things in a potential start-up: market, team, and concept. The team is by far the most important element, and the second is market. The idea itself is the least important.”

2. Think speed, not perfection.

“Whatever hypothesis you have about the market, it’s probably wrong by definition,” he says. “One out of every 30 venture start-ups succeeds–and that’s after getting funded. What that means is that entrepreneurs need to take a product to market as fast as they can in any form, even if it’s 10% of the original vision. They have to test it to see if it’s a market fit, if it resonates with customers, and is something they’d eventually pay for.”

Then, he says, pivot and reconfigure on the basis of that market response. “You have to iterate as fast as you can. I don’t mind if a batter has a .100 average–a 10% success rate–if the batter gets 10 or 20 at bats. The more chances you have, the better. So the team that can execute the fastest and build the most relationships with customers by listening to them will win.”

Because of this need to iterate quickly, Hsu advises building an in-house team that will have all the design, technical, and product capabilities you need. “You don’t want the entrepreneur outsourcing these types of functions, because it means there will be a cost in dollars to each new iteration that will drain capital. Every pivot should get you closer to success, rather than closer to failure.”

3. Think vision, not plan.

“A lot of entrepreneurs have a perfect deck of slides, a perfect business plan, and a perfect financial model. But that’s all they have,” Hsu says. “They think starting a business is having a business plan. But being an entrepreneur is about creating the future one step at a time.”

Does that mean you should never look ahead? Not quite, he says. “Where you have two or more co-founders, it’s important for them all to put down on a piece of paper, or a whiteboard, the canonical things they all agree on. They need to agree what the vision is and what the path to success will be. But don’t spend time trying to put that into a 40-page document. I’d rather you take that time and talk to 10 more customers instead.”

IMAGE: HENRIK SORENSEN/GETTY
LAST UPDATED: OCT 10, 2012

 

data saving lives, healthcare, quotes & aphorisms, rapid learning health systems, research methodology

the world’s most potent, booming unnatural resource: data

 

Predictive analytics is “powered by the world’s most potent, booming unnatural resource: data.”

You have been predicted — by companies, governments, law enforcement, hospitals, and universities. Their computers say, “I knew you were going to do that!”

Great quotes from Eric Siegel.

http://bigthink.com/big-think-edge/you-can-predict-the-future

You CAN Predict the Future, and Influence It Too

FEBRUARY 13, 2014, 12:00 AM
Shutterstock_64061473

We are better than ever at making predictions – whether you’re going to click, lie, buy or die, as Eric Siegel puts it.

In a lesson on Big Think Edge, the only forum on YouTube designed to help you get the skills you need to be successful in a rapidly changing world, Siegel, a former professor at Columbia University, shows how predictive analytics is “powered by the world’s most potent, booming unnatural resource: data.”

You have been predicted — by companies, governments, law enforcement, hospitals, and universities. Their computers say, “I knew you were going to do that!”

Advertising

Netflix and Pandora predict the movies and music you will like. Online dating sites select possible matches for you based on your interests. Companies can predict whether you’re going to default on your credit card statements and whether you’re going to commit an act of fraud.

So what do governments and companies do with this gold mine? In the video below, Siegel tells Big Think that these entities not only have the power to predict the future “but also to influence the future.”  And so can you.

Sign up for a free trial subscription on Big Think Edge and watch Siegel’s lesson here:

https://www.youtube.com/watch?v=Kriiamz9KqQ

Reflection Questions 
— Describe how your company is using predictive analytics to influence any operational decisions? Do you analyze who is likely to respond before initiating a marketing campaign? If not, how could this help streamline operations in your department?– How are predictive analytics at work in your life? Do you use Netflix or Pandora to predict movies or music you will like? Have you used an online dating site that selects possible matches for you based on your interests? How has this worked out for you?

— Is the use of predictive analysis exposing people to other people, entertainment, or services that more accurately match their interests or is it pigeonholing people by suggesting things they may like based only on a limited amount of information on previous decisions they’ve made?

For expert video content to inspire, engage and motivate your employees, visit Big Think Edge. 

Watch the video below and sign up for your free trial to Big Think Edge today. 

business, entrepreneurship, management and leadership, quotes & aphorisms

The Way A Cheetah Would Pursue A Sickly Gazelle – Jeff Bezos

The company’s relationship with those publishers was called the Gazelle Project after Mr. Bezos said Amazon “should approach these small publishers the way a cheetah would pursue a sickly gazelle.” A joke, perhaps, but such an aggressive one that Amazon’s lawyers demanded the Gazelle Project be renamed the Small Publishers Negotiation Program.

http://www.businessinsider.com.au/sadistic-amazon-treated-book-sellers-the-way-a-cheetah-would-pursue-a-sickly-gazelle-2013-10

‘Sadistic’ Amazon Treated Book Sellers ‘The Way A Cheetah Would Pursue A Sickly Gazelle’

JIM EDWARDS     
BezosjeffJeff Bezos

Amazon was so ruthless with small book publishers that its pursuit of new, more favourable contract terms with them was “sadistic,” according to Brad Stone’s books about the company, “
The Everything Store.”

Basically, small publishers leaped at the chance to get better distribution through Amazon in the early 2000s. But once they became dependent on Amazon for sales, Amazon turned the screws, Stone claims, demanding longer pay periods and lower discounts. Publishers who didn’t “pay to play” would get unfavorable treatment on Amazon, making their books more expensive and harder to find.

CEO Jeff Bezos regarded the publishing business as a “sickly gazelle,” Stone writes, according to a review in the New York Times:

The company’s relationship with those publishers was called the Gazelle Project after Mr. Bezos said Amazon “should approach these small publishers the way a cheetah would pursue a sickly gazelle.” A joke, perhaps, but such an aggressive one that Amazon’s lawyers demanded the Gazelle Project be renamed the Small Publishers Negotiation Program.

Mr. Stone writes that Randy Miller, an Amazon executive in charge of a similar program in Europe, “took an almost sadistic delight in pressuring book publishers to give Amazon more favourable financial terms.” Mr. Miller would move their books to full price, take them off the recommendation engine or promote competing titles until he got better terms out of them, the book says.

“I did everything I could to screw with their performance,” Mr. Miller told the writer. The program was called Pay to Play until the Amazon lawyers changed it to Vendor Realignment.

 

 

 

 

A New Book Portrays Amazon as Bully
By DAVID STREITFELD
Jeffrey P. Bezos, the founder of Amazon.com.David Ryder/Getty ImagesJeffrey P. Bezos, the founder of Amazon.com.

 

It was perhaps inevitable that Amazon would have a rocky relationship with book publishers. Publishers are analog, Amazon is digital. Publishers are New York, Amazon is Seattle. The large publishers traditionally did not know much about their customers, and did not really care. Amazon knew a lot about customers and made the most of it.

As for smaller houses, they were among Amazon’s most fervent early supporters. Amazon talked a lot in the beginning about leveling the playing field for small publishers. It did, but then things went south.

Brad Stone’s new book, “The Everything Store: Jeff Bezos and the Age of Amazon,” vividly documents just how troubled the Amazon/publisher relationship became by about 2004. The retailer’s critics, who worry about a culture where Amazon has eliminated all gatekeepers except itself, will not be reassured by this book.

In negotiations with larger publishers, Mr. Stone writes, Amazon kept demanding more as it got bigger: steeper discounts, longer periods to pay and better shipping. Mr. Bezos, Amazon’s chief executive, then turned up the heat on the most vulnerable publishers — those most dependent on Amazon.

The company’s relationship with those publishers was called the Gazelle Project after Mr. Bezos said Amazon “should approach these small publishers the way a cheetah would pursue a sickly gazelle.” A joke, perhaps, but such an aggressive one that Amazon’s lawyers demanded the Gazelle Project be renamed the Small Publishers Negotiation Program.

Mr. Stone writes that Randy Miller, an Amazon executive in charge of a similar program in Europe, “took an almost sadistic delight in pressuring book publishers to give Amazon more favorable financial terms.” Mr. Miller would move their books to full price, take them off the recommendation engine or promote competing titles until he got better terms out of them, the book says.

“I did everything I could to screw with their performance,” Mr. Miller told the writer. The program was called Pay to Play until the Amazon lawyers changed it to Vendor Realignment.

Even some Amazon employees were literally sickened by how they had to behave, Mr. Stone writes. One book group employee said he had post-traumatic stress disorder for a year after quitting. Another was fired after he said it would be unethical to revisit a contract that had already been negotiated with Oxford University Press.

Nearly a decade later, Amazon’s hold on the bookselling market, both print and digital, is much greater than it was in those early days. An Amazon spokesman declined to comment on Mr. Stone’s book, which was written with the cooperation of Mr. Bezos.

 

 

entrepreneurship, healthcare, management and leadership, quotes & aphorisms

38 lessons from Digital Health CEOs

My favourites from the list (bolded):

7. “If I wanted to be a doctor today I’d go to math school not med school.” Vinod Khosla

12. “One of the best things data can enable us to do is to ask questions we didn’t know to ask.” Vinod Khosla

16. “Turn your HIPAA status into marketing materials and put it in the sales deck with the goal pre-empting the Chief Security Officer or the like. Otherwise, you spend most of a sales conversation fighting them off with compliance questions.”

21. “When considering an acquisition, on either end, make sure your missions and operations are tightly aligned; it will make the onboarding process that much easier, and the long-term success of the marriage much more likely.”

24. “After 5 deals, start to get your pricing right. Ask a trusted internal champion (that you’ve already sold to) if they would’ve paid more.”

28. “Build trust with potential customers by teaching them about the market.”

29. “Get out of R&D, they tend to just kick around the tires.”

30. “The first hospital customer is really difficult. By 10 it gets easier. At 25, you should know how to scale.”

31. “Early on, find a ‘development partner’ hospital to work with. Find a hospital that’s well respected as well as progressive.”

33. “Don’t give away your product for free (to a hospital), or they won’t value or use is.”

35. “Find an influencer in the industry to serve as your ‘reference customer.”

36. “You can hide from the FDA until you impinge on an incumbent’s business. They’re going to point you out very quickly to the FDA if they feel threatened. Startups are always carrying that risk, and thus it’s better to be proactive.”

http://rockhealth.com/2014/02/top-quotes-lessons-digital-health-ceo/

38 lessons from digital health CEOs

Mollie McDowell
February 09, 2014

 

With keynotes from healthymagination VP and CEO Sue Siegel, prolific VC Vinod Khosla, Oscar Insurance founder Joshua Kushner, and TechCrunch Managing Editor Leena Rao on top of 20 breakout sessions with leading digital health executives, our 2014 CEO Summit covered everything from hardware pro-tips to selling tactics and ‘Fun with the Feds’.

 

Relive the magic and dive into the top 38 quotes and lessons learned throughout the day, as told by digital health CEOs.

 

The state of things

1. “Healthcare is yet to be transformed by technology.”
Joshua Kushner

 

2. “The state of healthcare today is that we are busy in the practice of medicine vs. being in the science of medicine.”
Vinod Khosla

 

3. “We humans think linearly but tech trends are exponential.”
Vinod Khosla

 

4. “People like Congress more than their health insurance companies.”
Joshua Kushner

 

5. “People don’t really understand the difference between health coverage, benefits, plans, services, etc. That’s not the way consumers think—it’s all wrapped up together.”
Alternative Delivery Models / Insurance Reform

 

6. “The net promoter score of health insurers averages 4/100. Amazon is 74/100.”
Joshua Kushner

 

Breaking in

7. “If I wanted to be a doctor today I’d go to math school not med school.”
Vinod Khosla

 

8. “You need a degree of foolishness to cause disruptive change in healthcare. Dare to dream.”
Vinod Khosla

 

9. “Learn to cold call.”
Selling to Hospitals session

 

10. “If you’re going to re-invent healthcare you have to start from scratch.”
Vinod Khosla

11. “Spreadsheets are fiction. Believing in what you’re doing and what you’re building is what’s important.”
Vinod Khosla

 

12. “One of the best things data can enable us to do is to ask questions we didn’t know to ask.”
Vinod Khosla

 

Business

13. “A great CFO can make going public all the easier; make sure you’re under good leadership, because the experience is extraordinarily difficult.”
Steps to an S-1 session

 

14. “Find your competitor’s FDA consultants (look at the predicates for your own device). A lot of times the academic site where the clinical testing was done is a good lead.”
FDA session

 

15. “HR is a cost center, a burden on the organization and getting squeezed.”
Selling to Employers session

 

16. “Turn your HIPAA status into marketing materials and put it in the sales deck with the goal pre-empting the Chief Security Officer or the like. Otherwise, you spend most of a sales conversation fighting them off with compliance questions.”
HIPAA session

 

17. “Find P&L owners (Brand Managers or Directors of Wellness); just don’t get stuck in the ‘Innovation’ group”
B2B Partnerships session

 

Money, money, money

18. “Don’t bother with crowd-funding schemes that involve selling equity in the company, they’re very confusing.”
Navigating Funding Channels session

 

19. “Do not apply for grants that are not perfectly aligned with your business. Grant writing can take hundreds of hours.”
Free Money session

 

20. “Know your ROI and how it will reduce costs.”
Selling to Employers session

 

21. “When considering an acquisition, on either end, make sure your missions and operations are tightly aligned; it will make the onboarding process that much easier, and the long-term success of the marriage much more likely.”
Building, Transforming and Disrupting Through M&A session

 

22. “It’s important that you choose investors that trust you. If you pivot or if make other wild changes, you need to know that they have your back.”
Navigating Funding Channels session

 

23. “There are so many factors that aren’t in your control when trying to go public. If the window presents itself and you have done the necessary preparations, go for it. You never know when the window will close or the market becomes too inhospitable, and you may lose your chance.”
Steps to an S-1 session

 

24. “After 5 deals, start to get your pricing right. Ask a trusted internal champion (that you’ve already sold to) if they would’ve paid more.”
Selling to Hospitals session

 

Making good products

25. “No old person wants to buy tech thats made for old people.”
AARP

 

26. “The key to good product is invisibility for the user.”
Converting Skeptics session

 

How to play well with others

27. “Partnership is going to be absolutely key to taking healthcare to the next transition in evolution.”
Sue Siegel

 

28. “Build trust with potential customers by teaching them about the market.”
B2B Partnerships session

 

29. “Get out of R&D, they tend to just kick around the tires.”
B2B Partnerships session

 

…especially hospitals

30. “The first hospital customer is really difficult. By 10 it gets easier. At 25, you should know how to scale.”
B2B Partnerships session

 

31. “Early on, find a ‘development partner’ hospital to work with. Find a hospital that’s well respected as well as progressive.”
Selling to Hospitals session

 

32. “Avoid academic medical centers early on. They move too slowly and are full of committees. For-profit hospitals move faster.”
Selling to Hospitals session

 

33. “Don’t give away your product for free (to a hospital), or they won’t value or use is.”
Selling to Hospitals session

 

34. “Typical sales cycle to a hospital is 3-18 months.”
Selling to Hospitals session

 

35. “Find an influencer in the industry to serve as your ‘reference customer.”
Selling to Hospitals session

 

Keeping the Feds happy

36. “You can hide from the FDA until you impinge on an incumbent’s business. They’re going to point you out very quickly to the FDA if they feel threatened. Startups are always carrying that risk, and thus it’s better to be proactive.”
FDA session

 

37. “You have to get the lingo down. There’s no such thing as ‘HIPAA-compliant’ unless you are the Covered Entity. You (as a startup) are HIPAA-secure.”
HIPAA session

 

38. “Go above and beyond HIPAA-secure. There’s a distinction between ‘security’ (actually secure) and ‘compliance’ (checking the boxes).”
HIPAA session