Is there a Path?

Yesterday, I was involved in a program for talented youth in which we were introducing the children to business concepts.  I had great help from four fellow faculty, from two current students, and from two alumni of the business school.

One of the students led a session in the morning about what life as a business school student was like.  One of the parents asked about a path to success.  The student gave a great answer--although one that I doubt most parents of kids in a gifted and talented program would like to hear--"There is not one path.  There are as many paths as there are people."

In short--the student presenting had a path.  His path is just that--his path.  Not right for anyone else and not predictable.  His classmates have their paths.  Each of the parents in the class has their own path.  And each staff and faculty member at the school has his or her own path.

My path has not been predictable.  I have pivoted many times.  Changing career interests. Changing personal interests.  From chemistry to health policy to public health with economics to business.  From research to education.  From individual activity to group leadership.  Each change was not something that would have been predicted.

I like joining things together.  I like solving problems.  That has remained constant.

Yesterday, a perfect example of bringing things together was one of the kid groups.  They were stuck on having an idea to make a pitch about.  I reminded them of the importance of having a passion for whatever they decided to make a pitch about.  I asked, "What is your favorite activity?"  Of the five kids, I got 1 for technology, 2 for technology, 1 for basketball, and one who said, "I don't know."  I suggested that they think about how to put technology and sports together.  They did.  Another faculty member told me that she was impressed with how I helped the kids to integrate their ideas.  It all seems natural to me.  That is the one thing that I hope to maintain forever.  Other than that, I'll continue to make my path as I go along. 

How to Demonstrate an Understanding of a Concept

Recently, the Chinese economy and its growth have been in the news a lot.  One thing that caught my attention was the statement that the rate of growth in the Chinese economy had slowed more than was expected.  I found that interesting because my mind immediately went from the statement to thinking about third derivatives.  Why, you ask?  In part because even after all these years, I remain a math geek.  More importantly, because the way I teach, I am always interested in ways to figure out whether people understand the concepts rather than just are capable of remembering a formula.  

If I wanted to test students on third derivatives, I could, of course, give an equation and ask the students to calculate.  But what if I were to ask the following question:

The news reported that investors were spooked about the Chinese economy.  While the economy is still growing, the rate of growth slowed more than expected form the middle of 2014 through the end of 2015.  Draw a graph that is consistent with this comparison of two growth paths.  From the description of the news, what, if anything, can you say about the signs of the first, second, third, and fourth derivatives.

This would be a cool way to see if people can visualize something and relate it to a mathematical concept.  It shows the ability to translate the concept into something meaningful to help with an interpretation.  By asking about the fourth derivative, a student would have to demonstrate an understanding of where the information ends.

I always like to test students on their capacity to apply ideas to real like.  I am much more interested in that type of understanding and learning than in whether they can plow through equations.  Of course, the highest level of expertise means doing both.  But I think that sometimes we train people to do far too much on equations and not enough on understanding what it all means.

And I am someone who cares about what it all means.  If it means nothing, then why bother learning it in the first place?  

Giving, Mentoring, and Financial Literacy

This morning, I had the opportunity to attend a breakfast that was hosted by the United Way and sponsored by a central Maryland for profit organization (so that the money did not need to come from United Way donations). I was able to invite guests, and I chose to invite two.  The first is someone with whom I run who is a third year law student at another local university in whose professional success I have taken an interest while I have gotten to know her over 3+ years of marathon training.  The second is a graduate of the Johns Hopkins Carey Business School who continues to look for the best matching full time job whose success is of great interest to me. I believe they both appreciated the invitation and opportunity to network, hear about the United Way, and hear the speaker. I believe it is a critical professional responsibility for me to provide opportunities like this for individuals for whom I have some mentoring role.  And it is just fun to have people I know with whom to discuss the speaker afterward.  

This morning was also great as I had a chance to meet staff from Johns Hopkins Hospital, the University of Maryland Medical System, and other local employers.  And the speaker was Peter Franchot, Maryland's state comptroller.  

He talked about many things.  Working across party lines with the governor was one of the most interesting topics.  But I was most impressed by his discussion of a financial literacy program that was originally developed in Fairfax, Virginia, and has been adopted in Prince George's county, Maryland.  He was hoping that all other jurisdictions in the state would adopt it.

I had a chance to ask him a question and he made a fascinating observation.  I asked whether there was enough long-term data from the implementation in Fairfax to know if kids later ended up with improved overall well-being or a better quality of life.  His answer was essentially that there is a lot of information supporting the idea that financial literacy leads to improved well-being.  He did not think that we needed a big study to know how many of the kids who are exposed to this particular program would retain the information moving ahead.  But he concluded by mentioning that he knows lots of people who make a lot of money but who are not happy as they do not understand how to create wealth, how to gain control of their funds, and how not to spend everything.  Thus, even for those who are highly successful he indicated the importance of financial literacy to give people piece of mind and to give them a feeling of certainty as much as possible,

That was a powerful observation.  And one that I am not sure all high income individuals appreciate.

As an academic, would I like to have a better idea of what proportion of kids retain what they learn in eighth grade ten years later and ask whether there might be an alternative program that costs less to implement and that has a higher retention rate?  Of course, that it the type of question I'd ask as an academic.  But am I just glad that someone in state leadership is promoting this important topic?  You bet.  

And this type of insight is why I like to attend these types of presentations and invite those whose professional development might benefit to join me.  Their future is longer than mine.  Hearing about important public policy, new ideas, and tough decisions (things I have heard about over the years at these breakfasts) will affect their years of work and retirement for more years than I will be affected. 

Mentoring and Parallels

I am on a committee at the University level that is looking at issues of faculty mentoring.  It is interesting to me that most faculty think of mentoring only as research mentoring.  I think of mentoring as "life mentoring."  If a person can help me improve my research, great.  But when I think of a mentor, I am really looking for someone who can help me think through decisions.  These could include decisions about:

• My career
• How to figure out how life and career fit together
• How to focus my activities or have them remain diffuse
• How to think about research, teaching, and service
• How to think about leadership

This is clearly a lot more than just research.  Does it mean that everyone should seek mentoring in all these things?  Of course not.  But it does suggest what I try to do when I mentor.

Am I good at all of these?  I like to think that I am at least decent at each of these.  But I am not necessarily great at all of them.

Today, I had the opportunity to meet with someone with whom I'd exchanged mentoring emails for a year and a half.  She was a Penn State Schreyer Honors College graduate just like I was.  (Although I graduated 23 years before she did.)  And we chatted.  What types of opportunities she has taken.  What she is looking for.  Whom I know in the DC area doing similar things.  My experiences in parts of the world she is going to travel to.  How I'd made a major transition in my career almost three years ago.  And how I'd been successful without being laser-focused.  All of this helped to answer a variety of questions she had.  Does she still have most of them?  Probably.  My story is just one example.

But sharing that example shows that it is possible to succeed and lead a full and happy life while doing a whole bunch of different things and getting to know a whole bunch of people.  I emphasized on multiple occasions how a lot of what makes me happy is imagining how exciting things can be, figuring out how to connect the dots for myself or others, and then sharing the experience afterwards.
This is what my career is about.  Not a particular line of research.  (Although I do like eye care.)  Not a particular class to teach.  (Although I do like teaching microeconomics.)  But all of the things that come along with research and teaching and developing new programs and implementing existing ones, and figuring out just how it all fits together for the benefit of those who are helping to make it happen and for the benefit of the faculty and students who make up the educational enterprise.

In an economic sense, I like to think that it is a matter of putting things together that might not be obvious to others so that efficiency can be gained.  Seeing new ways to produce more and better outcomes.  To get the best out of a situation.  

The Risks We Are Willing to Take

There was just an article in the Wall Street Journal (http://www.wsj.com/articles/poor-contact-lens-hygiene-puts-users-at-risk-of-serious-infections-1441648413) that provided a list of poor hygiene practices for contact lens wearers, talked about the proportion of contact lens wearers that take these risky behaviors, and discussed the possible impacts of these poor hygiene practices.

The numbers are notable.  According to the article there are over 40 million contact lens wearers in the United States.  And, according to a CDC survey, ninety-nine percent of contact lens wearers reported at least one questionable practice. 

For disclosure, I am a contact lens wearer and I will occasionally shower with my contact lenses in.  Why?  Because I started wearing contacts mostly due to the fact that running in glasses is not fun.  I run in the morning.  I then take my shower and get on with my day.  Since I use daily disposables, I don’t face any of the risks that are associated with wearing lenses that need to be stored.  And since I actually dispose of my lenses each day, I don’t expose myself to any of the risks of sleeping in contacts and using them too long.  I had actually not realized that just showering in contacts was a bad thing.  But I’d literally get just an hour to three hours (depending on how long I’m running) use out of my contacts if I didn’t shower with them in.  Still, there are risks associated with organisms that are in tap water that I expose my contacts to when I shower.  Seems like a pretty low risk. 

But then again, the risks described in the article also seemed pretty low to the people who experienced infections that leave them at risk of permanent damage.

And why are people willing to accept the risks?  Because, as with many behaviors, it is about saving time (not having to take the contacts in and out and deal with cleaning) and money (replacing them less often than they should be). 

So, for future contact lens development, anyone who can find a way to reduce the risk could make a lot of money.

And, it makes the discussion of a tradeoff between wearing contact lenses and undergoing laser surgery to correct refractive error and even more interesting discussion.

Finally, it gives eye health educators something to consider in how they talk with individuals who need contacts to help them grasp what the risks are and the importance of avoiding the risks where possible.

Do I expect everyone to avoid every risk?  No, that is not human nature.

What I hope is that reading articles like the one in the Wall Street Journal or hearing from health educators will give contact lens wearers a better understanding of the risks so that they can make well reasoned decisions about the tradeoffs between different types of contact lenses and different behaviors with the contact lenses in. 

Soda and Cities

The ongoing issue of how public health officials should be trying to minimize overweight and obesity in the United States brings us once again to the issue of sugar-sweetened sodas.

A piece in the Wall Street Journal shows how things are playing out in San Antonio and several other places around the country.

The soda industry claims it is being singled out.  The soda industry counters that it has made large donations to programs in cities that encourage exercise and seek to improve public health.

The key question is whether this is a good business decision and whether it is a good business decision that can overcome regulatory pressures.

Of course, anything that can be done to try to limit public employers taking away soda as an option in vending machines or taxing soda is going to help the soda industry maintain demand for its product at current levels or even higher levels.  So, as long as the choice to make a donation and get positive press leads to sufficient positive publicity to maintain or increase demand this is essentially part of the marketing budget.

The key question is whether public officials should then decide to treat soda any differently, particularly regulating or taxing it less than they would otherwise.  Whether this happens or not is truly an interesting story of regulatory capture and political lobbying.

If local jurisdictions can keep the money received and good will for the companies generated by private, for-profit companies partnering in public health efforts truly separate from any consideration of whether those same companies can be taxed then perhaps the public officials can have their cake and eat it too.  (Perhaps the old cliche should be changed to have their healthy snack and eat it too?) But if not, it may be another case of regulatory capture in which a substance that clearly contains a very large amount of sugar and clearly is associated with a large amount of sugar and calories is allowed to remain on the market and not be questioned in public health promotion efforts.

It is interesting to ponder how I would want to act if I were a member of a company that could be regulated very strictly by the federal government.  And it is interesting to consider whether cities should just turn money down to minimize even the potential for seeing this as a conflict of interest for the regulator.  

Vaccine Injury Payouts

A very interesting article in the Wall Street Journal today discussed the increase in payouts for vaccine related injuries.  This is interesting for a number of reasons:

(1) The claims are paid from a no fault system
(2) The system was designed to avoid discouraging companies from making vaccines and individuals from getting vaccines
(3) The increase in payouts has been for injuries related to the administration of the vaccines

It seems like the risk that this was supposed to deal with was a risk faced by the manufacturers of their vaccines.  If what was in the vaccine caused harm to someone (even after all the appropriate testing had been done to get the vaccine approved) the company would not suffer economic consequences.  This seems to be in line with item #2 above.  And if patients feel confident that they will be compensated for harm and not have to go through a traditional court to do so, they may be less likely to be discouraged to get a vaccine.

However, the risk of causing an injury to a patient because the vaccine is administered too high in the shoulder and may cause damage to the musculoskeletal system, is not a risk that the manufacturer has anything to do with.  This is a risk created by the health care provider (and potentially the health care system for whom the provider works.)  Covering these shoulder injuries under the same claim system reduces the risk for a very different stakeholder.

And given the actual number of cases, the trajectory in the number of cases, and the size of the awards, it is easy to imagine that these injuries will could account for a very large proportion of the payout.

Policy makers should take stock of the situation and decide whether this removing the risk from the providers and the organizations for which they work is appropriate.  While there may be clinical risks from the vaccines that show up in 1 in 1,000,000 patients that would never be detected in a clinical trial for approval of the drug, appropriate administration of the vaccination is a medical practice that is completely under the control of the practitioner and for which there are clear best practices.  Placing the risk back on the provider and the organization for which a provider works would provide a very strong incentive to vaccinate appropriately.  Unless it is determined that there is so much uncertainty that the government should also bear this risk in order to avoid discouraging the providers and organizations from administering the vaccines.

This tradeoffs here are interesting.  But the level of risk and the control over the risk seem much different.  Public policy should not be "one size fits all" for solutions.