Where does the real battle for change lie?

Is soda consumption unfairly attacked/regulated? This post by Aaron Carroll suggests it does. Look at the graph at the start of my post. Throw this in a Pareto chart and see where the largest number of calories lies. If I was looking at change, soda would be part of the ash and trash of this meal. The real culprit for weight gain would be the ribs and the artichoke dip. Yes, Chili’s has managed to make something with vegetables be incredibly unhealthy for you. Go to a restaurant with an under 500 calorie section on their menu and count how many salads they have there, and then count how many salads are on other parts of the menu.


Special interest food groups

There are many special interest groups in the food market. Think of all the ads and commericials that are blasted on tv and radio. The one I have been seeing recently is orange juice from Florida’s Natural Growers touting the benefits of orange juice. Others include beef, pork, and especially milk. Think about the ads with famous people and their milk mustaches. Many of these ads proclaim the benefits of regular milk consumption. Here’s a study looking at milk’s impact on bone density and risk of fractures later in life.

Here’s the abstract:

Importance Milk consumption during adolescence is recommended to promote peak bone mass and thereby reduce fracture risk in later life. However, its role in hip fracture prevention is not established and high consumption may adversely influence risk by increasing height.

Objectives To determine whether milk consumption during teenage years influences risk of hip fracture in older adults and to investigate the role of attained height in this association.

Design, Setting, and Participants Prospective cohort study over 22 years of follow-up in more than 96 000 white postmenopausal women from the Nurses’ Health Study and men aged 50 years and older from the Health Professionals Follow-up Study in the United States.

Exposures Frequency of consumption of milk and other foods during ages 13 to 18 years and attained height were reported at baseline. Current diet, weight, smoking, physical activity, medication use, and other risk factors for hip fractures were reported on biennial questionnaires.

Main Outcomes and Measures Cox proportional hazards models were used to calculate relative risks (RRs) of first incidence of hip fracture from low-trauma events per glass (8 fl oz or 240 mL) of milk consumed per day during teenage years.

Results During follow-up, 1226 hip fractures were identified in women and 490 in men. After controlling for known risk factors and current milk consumption, each additional glass of milk per day during teenage years was associated with a significant 9% higher risk of hip fracture in men (RR = 1.09; 95% CI, 1.01-1.17). The association was attenuated when height was added to the model (RR = 1.06; 95% CI, 0.98-1.14). Teenage milk consumption was not associated with hip fractures in women (RR = 1.00 per glass per day; 95% CI, 0.95-1.05).

Conclusions and Relevance Greater milk consumption during teenage years was not associated with a lower risk of hip fracture in older adults. The positive association observed in men was partially mediated through attained height.

Here’s Aaron Carroll’s blog about the study and comments below:

Researchers followed people for 22 years to see if drinking milk as a teenager affected the rate of hip fractures during the study period. What did they find? There were more than 1200 hip fractures in women and almost 500 hip fractures in men in the follow-up period. But it turns out that each additional glass of milk per day as teenagers was associated with a 9% HIGHER risk of hip fractures in men later in life. Drinking more milk had no effect in women.

In other words, regardless of what the ads say, as a teen there’s no protective effect of your “bones getting stronger” in terms of preventing hip fractures later in life by drinking milk. In fact, the evidence shows that it may make it more likely that males will develop hip fractures.

Don’t believe the hype! Fight the milk industrial complex!

RD: Beware the agenda of others. Especially when they want you to buy something to improve (insert topic of your choice). Be a skeptic. Take this article for example. A researcher working for a tabacco company claims smoking makes your brain work better. It’s hard to take his claims seriously (who knows they might be true) because you know who he is working for. We should be just as skeptical of the claims these special interest food groups make. Any catchy phrase could be inserted here…I’ll go with two. Show me the money (who are they working for) and Where’s the beef (where’s the proof)?

America’s prison problem?

Very interesting article about America’s prison problem. prisoner population rates around the world

It is amazing that there are over 2.4 million people in the U.S. in prison, approximately 0.7% of the population. This equates to for every 100,000 people in the U.S., over 700 live behind bars. With its 2.4 million incarcerated individuals, America ranks #1. Does America really have this many people who have done acts so heinous they deserve to be incarcerated? I seriously doubt it. Think about where America would be if we only incarcerated those that posed a true harm or threat to society? How much money has been spent on the prison system and the lost productivity of this population?

The Officer as a Gentleman. Toxic antidote?

Good post about what we as Army officers should strive to be. Gentlemen who leave a positive lasting influence on those we work with and come into contact with. People won’t remember every word you say, but they will remember the way you treated them and made them feel.

Henry V 4.3

We have been talking about this for a decade now, at least since Colonel George Reed published his paper on toxic leadership in Military Review, an article that has fueled innumerable leadership journal clubs in and out of the military.  It happens that in the ensuing years the military has been embroiled in a series of increasingly unpopular wars that have asked much of leaders at every level.  It is very likely as General Martin Dempsey, Chairman of the Joint Chiefs said, that our system has favored “competence over character.”  The need for short term results (within the two years or less of a short command tour) instead of an investment in the long term – including leader development – may be an unanticipated consequence.  Regardless, senior military leaders are increasingly characterized in the press as toxic and displaying poor moral judgment.

Toxins are poisons.  Toxic leaders poison those…

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In praise of passivity

From the quotation of the day off of Cafe Hayek. It is from the abstract of Michael Huemer’s article, “In Praise of Passivity.”

Political actors, including voters, activists, and leaders, are often ignorant of basic facts relevant to policy choices. Even experts have little understanding of the working of society and little ability to predict future outcomes. Only the most simple and uncontroversial political claims can be counted on. This is partly because political knowledge is very difficult to attain, and partly because individuals are not sufficiently motivated to attain it. As a result, the best advice for political actors is very often to simply stop trying to solve social problems, since interventions not based on precise understanding are likely to do more harm than good.

I haven’t read the full article yet, but it has sparked my curiosity. Reminds of an article we read last year about Folk Economics.

Folk economics is the intuitive economics of untrained persons. It is concerned with distribution, and does not allow for or understand incentives. Folk economic notions evolved in our ancestors in circumstances where there was little in the way of specialization, division of labor, capital investment, or economic growth. It can explain the beliefs of naive individuals regarding matters such as international trade, labor economics, law and economics, and industrial organization. It is important that voters understand economic principles. Economists would do a better job of persuading others and of teaching if we paid explicit attention to folk economics. Because untrained individuals do not fully understand gains from trade, training in economics is likely to improve welfare by increasing the number of trading opportunities. There is evidence that this is in fact true.

RD: We try to boil complex issues into these cute little anecdotes. We see a “problem” and we rush in to fix it without fully understanding if it is a problem and what is the root cause of the problem.

Creative destruction and S&P 500

Creative destruction” coined by Joseph Schumpeter in Capitalism, Socialism, and Democracy (1942) is:

The opening up of new markets, foreign or domestic, and the organizational development from the craft shop to such concerns as U.S. Steel illustrate the same process of industrial mutation—if I may use that biological term—that incessantly revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one. This process of Creative Destruction is the essential fact about capitalism. (p. 83)

Basically, some new product comes along, and by its coming along, destroys the old product.

This article by Richard Forester looks at creative destruction in the S&P 500. Some key highlights from his article:

• 61-year tenure for average firm in 1958 narrowed to 25 years in 1980—to 18 years now.
• A warning to execs: At current churn rate, 75% of the S&P 500 will be replaced by 2027.
• To survive and thrive, leaders must “create, operate, and trade”— build new divisions and trade mature ones at the pace and scale of the market without losing control of their company. Few companies have been able to do so over the longer term.

According to Foster, the life span of a corporation is determined by balancing three management imperatives: 1) running operations effectively, 2) creating new businesses which meet customer needs, and 3) shedding business that once might have been core but now no longer meet company standards for growth and return.

The problem is that the innovation that is needed to create significant new businesses
can often directly conflict with the operational effectiveness of the current business. Under these circumstances large companies slowly fall behind the pace of
change of the economy. Most companies end up succumbing to the siren call of continuing
on their current course rather than managing for long term evolution of their product lines to keep pace with the overall changes in the economy.

Ultimately, the challenge faced by all companies is to grow at or above the pace of their industry without losing control of their operations.

So how do these companies embrace creative destruction in order to outpace the market:

The first step in the process of embracing creative destruction is to envision the corporation as if it is a market itself: one that must “create, operate and trade” its assets without losing control of its operations. This must be done at the pace and scale of the overall market.

Drawing lessons from these market leaders, Foster suggests that the CEO and Executive
Committee ask themselves three questions:
1) “Are our operations world class?”
2) “How fast do we have to change to maintain our position within our industry?”
3) “Do our control systems work effectively?”

As we head into a time of stronger growth coupled with increase technological change,
the message for senior executives is clear: if you aim to maintain control of your
corporation and deliver value to shareholders and customers, you must embrace creative
destruction rather than wait to become a victim of this unstoppable force.

RD: Fairly interesting article on strategy. It’s one way to view the world around your organization. Don’t be complacent because your top product today may be replaced by a newer product from your competitor. Creative destruction happens, is your organization ready? As this article points out, there was a large churn in the S&P 500 which may indicate they were not ready when creative destruction struck.

Alarm fatigue

Heard this article on NPR this morning on alarms used in hospitals.

Highlights from the article:

Alarms are good and necessary things in hospital care, except when there are so many of them that caregivers can’t keep track of the ones that signal a crisis that requires immediate attention. Then it may be that less technology can actually be more effective.

In the case of Boston Medical Center, an analysis found that 7 North was experiencing 12,000 alarms ­a day, on average. That kind of cacophony was producing a growing problem known as “alarm fatigue.”

“Alarm fatigue is when there are so many noises on the unit that it actually desensitizes the staff,” says Deborah Whalen, a clinical nurse manager at the Boston hospital. “If you have multiple, multiple alarms going off with varying frequencies, you just don’t hear them.”

That can be dangerous. Patients can die when an important alarm is missed, or an electrode on a patient’s chest comes unstuck, or a monitor’s battery goes dead.

Boston Medical Center is attracting national attention as a hospital that apparently has conquered alarm fatigue. Its analysis showed the vast majority of so-called “warning” alarms, indicating potential problems with such things as low heart rate, don’t need an audible signal. The hospital decided it was safe to switch them off.

The hospital also upgraded some low-level “warning” alarms to a higher level, signifying “crisis” — for instance, a pause in heart rhythm. And nurses were given authority to change alarm settings to account for patients’ differences.

“Once that happened,” nurse Deborah Whalen says, “many, many, many alarms disappeared. And instead of 90,000 alarms a week, we dropped to 10,000 alarms a week.” That’s on 7 North alone.

The article also mentioned that alarm fatigue is one of the top priorities for the Joint Commision

RD: This article reminds me of a lot of the meetings I sit in. We want to track everything, just in case someone asks us a question. It doesn’t matter if what we are measuring is really important or not to the health of the organization. Some leaders think that what they need is more information to make a decision. I think some use it as an excuse to keep from making a decision. Because of this constant need to measure everything, we get bogged down in the noise, and fail to hear the true alarms. The alarms that are going off to signal the impending doom of an organization.