A Walkable Read

The Jetsons would have us believe that flying cars and moving sidewalks are just around the corner. It turns out that the Jetsons live in an unhealthy environment in which the citizens would be fat, isolated and unhappy. The book, the Walkable City: How Downtown Can Save America, One Step at a Time, by Jeff Speck [1] gives an alternative, and brighter future.

This blog is part of my ongoing effort to remember what I have read. I have tried to write it for your enjoyment, but its primary purpose is a better recall of this worthwhile book.

Having interesting things to look at is a key feature of a Walkable City.
Having interesting things to look at is a key feature of a Walkable City.
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Searching for Big Pharma

In my ongoing effort to remember what I have read, some notes on The Drug Hunters: The Improbable Quest to Discover New Medicines; Donald R. Kirsch, Ogi Ogas.

The popular media portrays pharmaceutical companies as fat cats scheming to make the most money from those unfortunate enough to require their product.  While there are some cases of this, drug companies are better compared to gold-prospectors who find enough mineral wealth to pay the bills with the occasional strike-it-rich dream to keep them motivated.

Tile Mosaic – Graz Austria

The Next Big Thing Challenge

New drugs are very difficult to find and bring to market.  By one estimate, only 1 in 20 (5%) of all projects are funded by a pharmaceutical firm. Of these funded, only 1 in 50 yields a drug.  In other words, if a drug prospector has an idea for a cure, there is only a 0.1% chance it will become commercially viable.  Drug companies spend most of their effort on creating copy-cat drugs of those already approved.  For original research, the focus is on drugs treating chronic conditions in which the medication needs to be taken for months, years or decades.  A quick cure is a bad business model if your return on investment chances are less than 0.1%

The Drug Eras

Kirsh breaks drug hunting into a series of time frames, the earliest being simple trial, error and superstition from our early ancestor days.  Botanical origins trace the role the emerging fields of science had on identifying plants that could cure disease.  Industrial and Synthetic eras continue the use of science to better hone drug finding. 

Mostly Art Supported by Science

Kirsh is an insider with a sympathetic view (mostly) of the drug industry and thus makes a good commentator.  He provides some excellent examples of both well-known discovery stories (penicillin, quinine for malaria) and those less well known (the birth control pill and a cure for syphilis). 

The conclusion of the book is that drug research is not an engineering process (although copying an existing drug to create a copy cat is pill is) it relies more on luck and artistic merit; it is akin to knowing how to develop a block buster movie:

…drug companies can never be sure that they will get a drug that works the way they hope it will.  The reason is as simple as it is profound: there still are no clear scientific laws, engineering principles, or mathematical formulae that can guide an aspiring drug hunter all the way from idea to product… The thing about trial and error is that if you keep on trying and keep on being willing to make errors, eventually you will find something that works.Big Pharma must price their few successful drugs to cover the immense costs from their myriad unsuccessful drugs.

 A good read for those interested in history, business, medicine or how did that pill get to the bottle in your bathroom. 

The Bus Chronicles

New Year’s resolutions are dangerous affairs, so dangerous that most people quickly abandon them for the familiar arms of bad habits. It is with this in mind that I am sharing my resolution: I no longer plan to drive to work.  Dear boss, don’t worry, I am planning on coming to work just that I don’t plan to drive there.

The Motivations on the Bus Go Round and Round …

There are of course a number of reasons to not drive:

  1. Concern about climate change and reducing your carbon foot print;
  2. Unable to drive for reasons beyond one’s control (blindness, illness)
  3. Unable to drive for reasons in your control due to poor choices (drunk driving, loss of a license)
  4. Trying to save money. 
  5. Other reasons.

I am comfortable enough with my parsimonious-ality to let you know my motivation is a combination of numbers #4 and #5. As for the other reasons (#1), I doubt my little Ford Ranger will make that much of a difference to climate change as compared to the 259 NEW GW of coal-fired generation plants China is bring online.  Fortunately I am both capable and legally allowed to drive (#2 and #3).  Besides, like the vast majority of people, I am an above average driver!

Transit Snobbery 

Having just come back from Vienna with a world class transit system, I will be using a system that is definitely middle of the road.  Not chickens in cages seated next to me but definitely not at the Western European standard either.  My son swore off the bus when going to University with horror stories of them blowing past waiting passengers at bus stops, arriving late, excessively early and surly drivers.  Hopefully my adventures are more pleasant.  

U2 U-Bahn (metro) crossing the Danube heading into Vienna City Center

The Economics of the Bus

 But back to my motivations and the first is economics and while the cash flow is positive it is not great, here is how driving versus the bus stacks up:

Factor Driving Bus
Bus Pass per Month 116.00
Gas Costs*/Month 130.00
Parking Pass**/Month 126.15
Insurance/Maintenance $$$
Total Cost 246.15 116.00
Cost per Work Day$$ 12.30 5.80
Driving time # 30-45 minutes/day 60-90 minutes/day
  • * I get about 7km/litre and have a ~45km commute per day.  Assuming $1.00 per litre (currently gas is as $0.90) this works out to $115 – $120/day.
  • ** Technically I don’t pay for parking but I am charged a taxable benefit of $145/bi-weekly.  Assuming a 40% marginal tax rate this results in a cash cost of $126.15/month.
  • # These are highly variable, I have gotten to work on a quiet Sunday in 20 minutes and other times it has taken me 2 hours to get home due to the weather.  Overall though, I suspect that the impact on time will be a bit of a wash of driving over transit.
  • $$$ I haven’t calculated this yet, see failing fast below before I change my insurance.

Assuming 20 work days per month ($$), the difference in cost is about $6.50/day or about $130.00 per month or perhaps a grand a year.  Mehhh, not really big enough money to be spending 100% more time in my commute, so why would anyone want to give up a comfy(ish) Ford Ranger for a bus?

Reading, Riding and A-Rhythmic-Meditation

My motivation is the 3.2km walk from my house to the bus depot.  3,200 metres in the morning is about 3,000 steps (of a suggested 10,000 per day total) and 40 minutes in walking meditation.  Once on the bus , I plan to read.  While I can listen to books in my vehicle, taking notes while driving is not recommended.  There is also something peaceful about letting someone else worry about the stop and go of traffic while you either read or stare into middle space.  Finally, the most important reason involves a bike. 

I hope to bike commute more this year.  Not having a parking pass is like burning my boats; there is no going back!  Okay, I can pay for expensive day parking but that metaphor is not nearly as good as smoldering boats.  

Wish Me Luck and Failing Fast

So that is my new year’s resolution and given that I just dropped $116 on a pass to get started.  If I can get through January, then February should be easier, etc..  Wish me luck and if not, see you on the road in February.   

Guts, Gory and the Organization

Giulia Enders has written a delightful book on our Guts.  If the title was not sufficient the sub-title describes it all: Gut: The Inside Story of Our Bodys Most Underrated Organ.

Gut is a good read for anyone who digests food (which pretty much covers everyone living) and is a potential lesson for organizations that there is more complexity in a system then we can ever imagine.

Have Some Guts, Read Gut

Gut is a pretty easy read.  Enders presents the physiology of the Gut in a very accessible manner and explains the key functions of the major organs (e.g. stomach, small/large intestines, liver, etc.).  Originally published in German, the English translation has great cheek and humour.  In fact, Gut would make an excellent text-book for junior or senior high school biology given its easy accessibility.

As a microbiologist, Enders delves into the other organ of our body, the microbiota of the gut.  Based on current research, Enders makes the case that the dividing line between where our cells start and bacteria and other germs end is not as clear cut as we may think. For example:

  • Children born via Caesarean section are not endowed with the bugs found within their mothers’ birth canal.  As a result they must source their bugs from the environment and these may not be the most beneficial.  These children take months or years to develop a healthy gut microbiota.  They are also at a risk of developing asthma or allergies.
  • Breast feeding has a similar impact on allergies and the like.  Mothers milk not only feeds the baby but also contains nutrients galacto-oligosaccharides (GOS) to feed the child’s gut.
  • The gut’s bacteria helps to train our immune system to not only recognize threats but to also not over-react to them.  As a result, this reduces allergies, asthma and potentially juvenile diabetes.
  • We periodically wipe out all or portions of our microbiota through the use of antibiotics, poor diet and stress.  When the good bugs depart their spots can be replaced by the less than desirable who then can be difficult to displace.
  • The appendix is not a slacker who does not realize its time has passed.  Current research indicates that the appendix is a store house of good bacteria that can repopulate the gut if the intestines have been flushed due to diarrhea.

Organization’s Need Guts

Ender has not only written a very accessible book that discusses such delicate matters as what our poop should look like, she has reminded us that perceptions of systems are based on best available information at a point in time.  For the gut, bacteria are necessary to not only break down food but to also stress the immune system so it does not over or under react.  Structures such as appendices may appear useless but turn out to be vital to our long term health.

The gut can be used as an analog for organizations.  Poop jokes aside, a healthy organization is more complex and mysterious then it first appears.  While we may be inclined to oversimplify them, organizations have interactions and systems that may not be immediately apparent.

Elevators are Like Guts – They Mix and Separate

Here is one small example: riding elevators.  In my building a new system has replaced the traditional ‘up’ button with destination buttons.  Rather then jumping on the first elevator going up, you select your floor and proceed to that lift going exactly to that floor plus perhaps a few floors above and below yours.

This system has dramatically improved the speed by which people are carried to their floors – and it has cut the accidental and random interactions of people.  Previously who you got on with was chance.  As a result, there was an opportunity to interact with a variety of people who you may only see intermittently.  Now the elevator ride is much more homogenous – you ride with people from one floor above or below.

More efficient, yes – beneficial to the organization – not necessarily.  In as much as good bacteria trains our immune system and a diverse flora is better for us, random interactions and non-sterile organizational mixing is also of value.  Good organizations need slight agitation, a diverse culture and some randomness to be effective and healthy – just like a good gut.  In addition, organizations should recognize that individuals who may not seem to be part of a main structures may in fact have a disproportionate impact on the health of the culture.  Introducing the occasional disruptive employees/contractors, the mail room clerk who is a clearing house of information across many floors or a cafeteria that promotes chance encounters vertically and horizontally across the organization.

Embrace your Internal and Organizational Micro-biota

The gut is more complex than we ever imagined and has a stronger influence well beyond converting food to energy and nutrition.  In the same way, organizations are more complex then we can imagine and elements we may think of being without use can turn out to be instrumental to its health.  Enjoy Enders’ gut and good luck with your biotas – both the micro and organizational varieties.

The Healthcare Ethos – A Definition

Overview –Motivating People is Hard Work

Motivating people is hard work.  If you are responsible for more than yourself, you know the difficulties in keeping your staff engaged.  As tough as your circumstances are, consider this question.  How do you keep staff motivated working in a hospice in which every single client will die?  How do you motivate staff on a paediatric oncology department in which too many of the children will lose their battle with cancer?  How about within a mental hospital; how do you motivate the staff whose clients sometimes face limited cure possibilities, a life of poverty, loneliness and an ostracizing stigma?

A black sofa is seen amongst a backdrop of vibrant green.

Couch amongst the bushes.

These are the motivational challenges facing managers who work in healthcare.  Yet despite the seeming difficulty, the vast majority of people who work in healthcare enjoy their job and generally look forward to helping the patients and clients that they serve.

Motivators and Organizational Ethos

Good pay and benefits help, but as Herzberg pointed out, lack of pay and benefits may lead to job dissatisfaction but they are not themselves motivators.  Thus the enigma of what keeps a nurse, a doctor, or an aide going back to work, day after day and dealing with circumstances that are by definition life shattering?

The enigma of course is also the solution.  A number of separate studies of nurses have consistently shown that the prime motivation to enter that profession is to make a difference, engage in the human connection, a need to be needed and altruism.  Individuals working directly with patients are exposed to many of the strongest and most powerful human emotions.  Pain, suffering, despair are balanced against hope, joy and relief.  Thus frontline healthcare workers are active participants in the human condition.  For most healthcare workers, this exposure is life affirming and positive.

Of course healthcare workers are not unique in this regards.  Police officers, firemen, teachers or soldiers can also experience intense emotional environments.  In each case, a fraternity develops amongst the workers and there is a desire to do ‘good’.  In the case of healthcare I call this motivation and fraternity the healthcare ethos which is defined as follows:

“The vicarious emotional impact felt by healthcare workers as they experience the human condition indirectly through their patients.  This impact acts at the individual and group level as a motivator, driver to protect patients and as an affirmation of purpose and importance of the work done by the group or individual.”