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. 

Owning My Position

So, I have held my position of Vice Dean for Education at the Johns Hopkins Carey Business School for a little over two years now.  Today, I felt for the very first time, that I fully "owned" the position.  I think it is worth thinking about what it means and why it took me so long.

Today was the first day for the fourth cohort of the dual degree program in which students get an MBA from the Carey Business School and the MA in design thinking program at the Maryland Institute College of the Arts.  We call it the MAMBA program.  That is MA and MBA together.  As a business school we generally emphasize the MBA part over whatever dual degree program we work with, but the pronunciation is so much easier as MAMBA rather than MBAMA that we decided to go with what students were calling it.

In any case, I was the first speaker after an introduction by the Carey Business School program manager.  While I did not have any slides to present, the screen behind me had the Carey Business School home desktop that is found on all the classroom computers.  It says "Teaching Business with Humanity in Mind."  That is a key phrase that clearly reflects the value of the school.  I did not go so far as to say, "This is my idea of what it means," but I did not attribute it to the Dean today either.  Next time, I will tell students, "This is what I think it means."  And while I mentioned the Dean a bit in the presentation (for the difference that he has made in the school), for this day I simply presented that as a useful fact for students to be aware of.  For the first time, I really focused on my story of Carey.  My ideas about Carey.  Giving credit where credit is due to parts of the school like Career Development, Student Services, Academic Advisors, and program administrators but it was my story.  Not any "standard" story.  Not the Dean's story.  But my story.  And in the process of telling my story, I had the chance to introduce myself to each student individually before my welcoming statements, and I had a chance to speak with numerous students during the first break. That included one who was interested in fashion, one who worked for Cover Girl, one who works at Under Armour, and one who was involved in a large capital campaign for Everyman Theater.  And in the future, I will talk to each of them to get a better feel for their incredible sets of interests.  This is now a class that I will begin to get to know. I will come to understand. And I will represent myself to--particularly in a case study that we will discuss on August 4.  Thus, it really is becoming my position, my set of ideas, and my set of interactions with the students whom I will then be able to follow through the entire program.

In the meantime, I do wonder why it took so long.  I believe that part of it was really taking two years to settle in to understanding all that I need to know about the field. But it is also the case that I now feel like I have a set of connections that I could ad for the students.  What do I know about Hunt Valley in the area where the Cover Girl offices are located?  What do I know about local fashion?  How about Under Armour?  How about theater?  I mean, the student said I sounded like a local theater aficionado.  I don't think of my life that way, but I do realize that I have been to see local theater maybe a lot more than others and that it is a critical part of my life.  So, this year, I truly felt that I had something to add to these students' experiences and to these students' lives rather than just giving a cursory introduction.  I could not have said that a year ago.  But I can say it now.  

And that is a good thing for staking out my place in the school.  Contributing to the success of the school. Contribution to the future success of the students.

I find it interesting to hear others' stories of how long it took them to understand their organizations well enough to feel completely comfortable in their positions--particularly when representing their organization to outside or brand new customers.  

It’s a Matter of Perspective

Sometimes, it is hard to remember that not everyone comes to the table with the same information, the same background, and the same ideas of cause and effect or automatically draws the same conclusions when presented with the same data.  Today, I had a fun example of that at the grocery store.  But it made me think—what are the assumptions that I have, what are the assumptions others bring to a discussion, and if I miss or fail to anticipate the differences what could be the impact.

As it is Father’s Day, I have three things that happen almost every Father’s Day: I run the 5K that benefits the NICU at GBMC (a local medical center at which my kids’ pediatrician is the Chair of Pediatrics); we take my middle son to his boychoir’s summer camp; and I wear my “World’s Greatest Dad” t-shirt, that really isn’t appropriate to wear any other day of the year. 

The day started off as usual.  A solid 5K run.  I was second in my age group to a guy I had been running with since the 0.5 mile mark but I couldn’t shake him and he had more than I did at the end.  My youngest son ran his best race ever by over 2 minutes and came in third among boys 10 and younger.  My good friend and training partner was second female overall.  And we won a team trophy for the second year in a row. 

And, after this entry, we will take my son to camp.

But this is a story about the shirt.  Walking to the milk/cheese/egg/yogurt aisle of the grocery store, I was greeted by an employee who mentioned that he had the same shirt (minus the foot and hand prints of my kids).  We got to chatting, and I pointed out that the shirt has only two sets of prints.  I now have three sons.  And the son whose baby or toddler feet are on the shirt now has his driver’s permit. 

I thought it was a comment about growth and long-term parenting goals and how long items of clothing that only get worn once a year last.  The employee said, “That’s a testament to you that it still fits so many years later.”  The employee was a little hefty.  I thanked him and moved on.

But I really thought about it.  I just take for granted my running and my fitness and my weight.  But there are plenty of guys my age who have put on a few pounds since their now 15 year olds were 2 or 3.  So, the fact that I have a shirt that still fits from when my kids were little makes a big impression.  Maybe he has had to replace his entire wardrobe.  His experience and assumptions are a lot different.

As an employee at the grocery store I may never see again, understanding his assumptions and impressions is not that important.  But when this happens in the workplace and people cut off conversation early and don’t explore that they may have drawn different conclusions about the same piece of data and then understand why—bad things can result. 

It’s a reminder to me to make sure that I always ask what conclusions my colleagues have drawn and if we’ve drawn different conclusions follow up with an effort to uncover what their beliefs and assumptions are and ask “Is there more” until we understand how differently we are approaching things. 

First Impressions are Key

Yesterday, I had the pleasure of meeting a member of the Department of Microbiology and Molecular Immunology for the first time.  He came to visit me in my office at the Johns Hopkins Carey Business School and was impressed by the view from the 12th floor of the building in which we rent space in the Harbor East area of the city.  He was visiting from the Johns Hopkins Bloomberg School of Public Health.  While we had been colleagues (in much different departments) for 7+ years in public health before I changed schools, we had never met.  It actually turned out that our commonalities went much further back--having graduated from the same College at Penn State in 1991.  That was how he started the meeting.

Then, I took my turn.  As an economist, I am not sure if he had any idea of what I brought to the table in terms of understanding the science and the underlying topics that he was about to discuss.  Or that I would have much room on my plate for new activities.

However, I shared with him all sorts of different projects I had worked on.  Pancreatic cysts.  Wegener's granulomatosis--studied by someone in the vasculitis center.  Surgical treatments for dysfunctional uterine bleeding and the different between ovulatory and anovulatory bleeding.  And my eye care work.  And I could speak about some of these with some degree of authority.

After I closed my 5 minutes of "isn't cost effectiveness with any type of condition fun?" I made the comment that I wasn't sure if I had told him more than he had ever wanted to know about my background.

He said, "No."  And he commented that it was actually good that I had worked on a lot of different things that obviously fascinated me and kept my attention.  It suggested to him that I might not shy away from yet another new topic.  He was coming to talk to me about genetically engineered mice.  That was new.  But it was exciting.

It was part of a two day period in which I heard about everything from mice to HPV to worrying about a student's dissertation to admissions issues to our online MBA to accreditation and many other topics. It is part of what I like about my job--so many different aspects constantly shifting.

Sometimes colleagues think I should be more focused.

But I learned (as I have many times before) that sometimes colleagues are looking for those who can be open to new ideas, think about new things, and expand their horizons.  First impressions are key.  

Business with Humanity in Mind

I have both a personal blog and a professional blog.  It is usually pretty clear to me which blog an entry belongs in.  For this one, I debated.

I don't usually think of writing about the Roman Catholic mass at which my middle was confirmed as a professional blog topic.  So, let me share a few of the interesting personal details and then give three quick lessons that tie over professionally.

First, this was by far the most inspirational Confirmation mass I'd ever experienced.  That includes my own many, many years ago, and about five or six I played for at St. Pius X over the years including my oldest son's confirmation.  Why was it so inspirational?  My youngest son was involved in ushering and helping to make sure the mass ran smoothly.  My oldest son is--as I am--an alumnus of the musical group that plays and no longer plays with them at our church, but did come to see his brother get confirmed.  And a young woman whose singing I have heard off and on for almost a decade gave the most beautiful solo for a song Sacred Silence I'd ever heard.  Plus, the gentlemen who had led this group of youth getting confirmed at the start of their journey and who had passed away in December was remembered in a wonderful way.  All inspiring enough.

But then the three other things that link to professional experiences.

First, I received the wine as part of the Eucharistic celebration from a young woman whom I had taught in religious education years ago.  It is a sign of how long I have been part of the parish.  It is a sign that the kids I taught are not just "growing up" but truly maturing.  Coming into their own.  And seeing the process is amazing.  I have helped doctoral and masters students through their studies.  I have mentored undergraduates at my undergraduate alma mater.  But this has been a year to see one of my old religious education students first become a lector and then become a Eucharistic minister.  It shows how being a part of one organization for so long can give a perspective on the growth and development of the organizations and those within it that just can't be appreciated in a year or two.  And when I appreciate the long term perspective, it also makes me think of the range of stakeholders, and to being to practice what the Dean of the Johns Hopkins Carey Business School calls "business with humanity in mind."  I like to summarize it as realizing that there can be a lot of humanity that can be affected by business decisions other than the most immediate stakeholders, i.e. customers and owners.

Second, the idea of the sacrament of Confirmation in the Roman Catholic church is about making a big commitment.  And as I think about business and business with humanity in mind, I think about commitments.  Becoming an entrepreneur is a commitment.  Becoming any type of professional is a commitment.  Becoming a leader is a commitment.  Sharing idea--commitment.  Everything about being successful requires commitment.  And thinking about business as not just focusing on the bottom line but focusing on all the stakeholders including the customers, the employees, the community immediately around the business, and the entirety of humanity requires a commitment.

Third, my son got a "shout out" from the Bishop at mass.  He was one of at least two who in their letters to the Bishop mentioned the feeding the homeless service experience.  This service experience exposed the youth in our parish to problems in the city.  These are not exactly the same problems that led to the recent unrest in Baltimore, but the roots of at least some of the problems are the same.  The gentlemen who had started the journey toward Confirmation with this year's class but passed away half way through told the children after the service experience--you fed these people today, but who will feed them tomorrow, next week, next month, or next year?  In part, there is a service answer to this question.  But in part, there is a business with humanity in mind answer to this question.  Why are there not jobs?  Why are there not economic opportunities?  Why are opportunities lacking for these people?  And what is the meaning of business?  What is the role?  How can we who train future business leaders and the current and future leaders find ways to create economic opportunities in these areas?  How can business consider all the stakeholders and help everyone?  Is it ultimately business's responsibility?  No. There is charity and there is government.  But if business stays only at the sideline and does not figure out how to contribute, there will be something missing.  At least some of the solutions to the problems that we see in the world are, in fact, ones that business can solve if we have creative leaders who can find ways to convince others of the value of their ideas, secure resources, and move themselves and those working for their organizations ahead.  

So, this year's confirmation mass illustrated three important ideas for business with humanity in mind--seeing the long horizon that gives a different and more informed perspective on the full scope of stakeholders, making a commitment to something, and having business as part of the solution to the problems of society--not just a cause of problems in society.