The Ignorant Math of “Saving Just One Life.”

New York governor Cuomo recently spoke and justified his actions in putting the whole state on lock down:  “All this is worth it if saves one life.”  That approach seems laudable and the logic bulletproof. Who wouldn’t want to save a life?  But in reality, this approach is sentimental and displays some ignorance about how the world actually works. Economist Thomas Sowell said, “in the real world there are no solutions, only tradeoffs.”   In the real world, taking major action in one area effects change in other areas. My concern here is not to evaluate the decisions of the governor, but rather this logic, which I believe is dangerous.  Many of his decisions are good and justified. So please don’t hear this as a criticism of the shut down orders. But across the country this kind of thinking is leading some officials to ignore (or justify) the damaging implications of policy decisions as if we are playing a game with a simple scoreboard consisting of coronavirus deaths.

This concept of tradeoffs is fairly obvious in other areas. When the police pursue a deadly criminal in a high speed chase in order to keep the public safe from a dangerous criminal they put the public at risk in other ways (10,000 injuries and 321 fatalities in 2002) Widespread use of mammograms to detect breast cancer has led to an estimated 30% over diagnosis of the cancer, and all the problems that come with that diagnosis.  The real word is not a simple financial ledger with one column measured in coronavirus deaths.  It is more like a teeter totter where moving one side up or down affects the other side. 

As an example, following the terrorist attacks of Sept 11, 2001 many Americans opted to drive instead of fly on commercial airlines. The reason was presumably fear. Airplanes can get hijacked. Driving a car would seem to be safer. But it wasn’t.  Use of air travel by Americans fell 12-20% in the year following the attacks, while automobile deaths increased around 1,595.  That number is about half the number that died in the terror attacks. Americans unknowingly embraced the real danger of automobile accidents to avoid the potential danger of terrorist attacks. The tradeoff was there, but not as obvious as those who died in the twin towers. 

In another example this author attempts to track “indirect deaths” from the Japanese earthquake in 2011. “Following the March 2011 Great East Japan Earthquake, which left more than 18,000 dead or unaccounted for, roughly 3,700 people have been recognized as victims of indirect death, including 2,250 in Fukushima Prefecture, where large numbers of people were forced to move from one evacuation shelter to another due to the radioactive fallout from the meltdowns at Tokyo Electric Power Co.’s Fukushima No. 1 nuclear power plant.” The choice to move out of earthquake damaged buildings into shelters took lives as well. 

These kinds of numbers are the domain of public health and epidemiology. However, panic and widespread fear can distort our perceptions of reality. Fear can make us focus on one danger so intensely that we don’t see the speeding car that is about to hit us.

The massive an unprecedented steps we are taking to save lives from the coronavirus may indeed reduce deaths in this one area (and we should pursue that), but we should not be ignorant or indifferent to the impact of our actions.  It may end up that the response to the coronavirus is the largest and most coordinated disaster in US history.  Bringing entire cultural, political, economic, and healthcare ecosystems to a halt will cost lives as well. 

In my estimation this is an important part of the equation that we are not talking about. After listening to a podcast with Dr Marty Makary a public health expert from Johns Hopkins, I was concerned that the tradeoffs were given very little consideration. To be fair, he admitted that half of Americans have less than $400 cash available. This is far less than a person needs to purchase 3 months worth of food (his recommendation) to allow one to shelter in place.  Experts are asking us to deliberately cause one very certain disaster in order to avoid another very scary potential one based on the projections of experts.   We cannot carefully make these decisions without seeing the cost on both sides.   

Here are some areas where there will be a price to pay in lives. I have posed them as questions:

What is the life/health impact of shutting down all nonemergency medical and dental care for months? I worked in EMS as a paramedic in Los Angeles and San Bernardino Counties from 1995 to 2006. We ran emergency calls at doctor’s offices constantly. People come in for routine care only to find out they had a serious problem. What would happen if we shut down the regular non-emergency healthcare of for the whole nation (330 million people)?   And this is exactly what has already happened in California.  The shelter in place order that was issued affected around 23 counties without a confirmed case of the virus at the time of the order. 

What is the health impact of a potential worldwide depression/recession on personal health insurance, stress, and nutrition?  

What is the health impact of millions people losing their jobs, retirement savings & homes? Especially among the lower income poor and self employed?   This can lead to huge amounts of stress and all the poor outcomes that come with it (addiction, PTSD related to disaster, suicide). 

What is the health impact of people staying away or delaying care from the ER for serious illnesses out of fear of infection? (This has been happening in our town) A person with an infected appendix or gall bladder that waits an additional 12 hours to get help can become much worse off. 

What is the impact on pregnancy stress from our response on maternal and newborn health in pregnancy?  It is known that miscarriages, premature births and neonatal deaths all go up in time of national disaster. This can be related to stress and/or women not getting routine preventive care.  This article discusses the effects after hurricane Sandy.

This 2015 article suggests 4.4% loss of male fetuses (which are more sensitive to stress) following the Taiwan earthquake. 

I want our government officials to take action. But let’s not pretend that the only thing that matters is saving lives from Coronavirus. There is much more going on here.  We need leaders that can see and acknowledge the whole situation, including the devastating impact of their own policies.

The Not-so-secret Secret to Job Success

I am recently reminded of a growing work ethic problem. There are a number of workers (and unemployed people) that don’t understand basic issues of responsibility and reliability. It seems that simply showing up is becoming  a problem.. I have had several recent conversations with employers that have highlighted this.
A friend who is a director of a non-profit that works with children is trying to hire an entry level worker, and he pays several dollars an hour more than comparable jobs.  9 people submitted resumes, but none of them have returned his requests for interviews, or showed up for the interview once it was scheduled.
A friend who runs a large dental practice said it is very difficult to find reliable office help. He said he routinely has to hire 10 people in order to find 2 that will be able to maintain employment. The “no call/no show” is a common problem. People just don’t come to work, and they don’t call with warning or explanation.
Many years ago I was a training officer at an ambulance company and worked with new hires.  The majority of people (most of them younger) who were fired, lost their job because of chronic attendance/tardiness (NOT family or medical issues) and other simple issues like wearing the proper uniform. (And the uniforms were provided by a laundry service)   These were NOT entry level employees, but folks with years of education and licenses.
I also worked as an externship coordinator at a vocational school. Same story. The major complaints from potential employers (clinics, doctor’s office managers, etc) had little to do with technical skills and everything to do with attendance, attitude, staying off your cell phone at work, avoiding drama, etc. Almost all these problems involved attitude and life skills that don’t cost anything in terms of education or accomplishments.
If you want to bypass 80% of the competition in the workforce… if you want to keep a steady job… if you want to promote and be given more responsibility the first steps are simple: Show up on time, be ready to work, and do your job without having a babysitter.  Hard work covers a multitude of sins in the work place.

Our Problem With Public Apologies

I just had a thought, are there any similarities between Kathy Griffin’s apology for a mock beheading of Trump, and other public apologies from the right side of the isle (just reflect on what happened before the election with Trump and his treatment of women)?
Do we have a problem with public apologies as a culture (maybe as human beings), rather than just partisan problem? Do we have a problem with apologies that are designed more for PR and damage control than honestly accepting responsibility for bad behavior? Do we as Americans have problems blaming others for our transgressions rather than owning them without qualification?
What would it look like to say: I was wrong, there is no excuse for that. No one else is to blame for my choices but me. I am sorry for the damage I have caused and apologize to those I hurt. I am going to do what I can to make amends, and I accept the consequences.
 
This is really, really, hard. But I think anything less hurts everyone involved. When we are more concerned with saving face, than owning the truth we perpetuate the problem.
This is a hot topic, just google the issue of organizations, governments, law enforcement, or doctors apologizing and you will see that we have a big problem.

Some Leadership Lessons From The Hunt For Bin Laden

Leadership is leadership. The same principles apply when leading in sports, music, business and war. But these principles may be expressed in different ways. Sometimes seeing elements of good leadership on display in another realm can help to us to understand these lessons without so much background noise.  How about the hunt for the most wanted man in history?

“The CIA is a global institution that undertakes high-risk missions to defend the United States. Its analysis is scrutinized every morning by no less an exacting customer than the president of the United States. Its successes are largely unknown; its failures are legendary. Simply put, CIA has one of the toughest jobs in all of government.”

And it should be no surprise, the main lessons have to do with priorities, focus, and taking the long view.

Source: The Former Head of the CIA on Managing the Hunt for Bin Laden

You Can’t Slow Things Down by Speeding Up – Or- You Need Time To Delegate

The problem with being over-busy is that you might actually get more done. But this only lasts for a brief period of time at the beginning. But invariably the rushing/exhausted pace leads to bad decisions and the inability to make judgments about what is really important. This is the lesson I am trying to work out in my own life.

Here is more fuel for the fire on this whole discussion:

“If I take some time off – on a holiday, over the weekend, or even just not checking mail in the evening after closing time – my decisions get better. I don’t just keep grinding it out, trying to get strategic by processing ever more detail. I start to notice what is really important so I can leave the rest, or delegate it to someone more qualified or more motivated to do that thing.

“When running at full tilt I don’t even have time to think of passing it off to others.  I’ve seen this over and over again in my work with people leading teams. Things are stuck not because there is no one to do them, but because the person who has them on their plate doesn’t have (or take) the time to clarify who should be doing them.”

Source: You Can’t Slow Things Down by Speeding Up – Next Action Associates

Job Interviews, False Impressions, and Why People Get Fired

Here is a brief article with some fascinating ideas on how to avoid the reality of false impressions and deception in the job interviewing process. A short read, and worth it. The “car test” is very interesting… Also using the interaction with the secretary.

An interesting tidbit on the real reasons people get fired:

“According to one study, only 11 percent of new hires who failed in the first 18 months did so due to deficiencies in technical skills. The majority washed out due to problems with motivation, an unwillingness to be coached, or a lack of emotional intelligence.”

Source: The 1 Job Interview Technique You Need to Use | Inc.com

Essentialism Chapter 6 Discussion Questions

 

Finding What matters

Questions for Essentialism

Chapter 6

This is a list of discussion questions to help work through the content of the book “Essentialism” By Greg McKeown.

You can Essentialism Questions Ch. 6

Major principles:

It is easy to get lost in the raw details and miss the significance of the facts. We have to learn to find the “lead” in our lives the way journalists analyze a story.

Key examples/illustrations

  • Nora Ephron’s experience in journalism class in finding the lead of the story.
  • Eastern Airlines flight 401 crashing a sound airplane by getting focused on a broken warning light.
  • Thomas Friedman filtering the conversation
  • The d.school at Stanford and the development of the affordable incubator for premature babies, the “embrace nest.”
  • The importance of clarifying the question you are trying to answer when solving problems.

Questions for Reflection

  1. On p. 73-75 Nora Ephron’s account about the epiphany in high school journalism class is told. What is the difference between the “facts” of a story and the meaning or significance of a story?
  2. According to Ephron a good jounrlist is one that can not only see, sort and analyze the facts, but also give a sense of why it matters.  She says this works in life as well as journalism.  Are there areas in your life where you are swamped with data but don’t know what it all means? How can you make sense of this?
  3. In discussing the crash of flight 401, the crew focused on the light. The malfunctioning light was important, but not important enough to distract the crew from flying the plane. What are the warning issues in your life right now?
  4. Write a list of the top 5 priorities in your life (limit it to 5). How might the warning light issues in your life distract you from these?
  5. What is the 1 single problem that leads you to consistently hyper focus your attention from the big picture?  Explore the story of how this has been happening?
  6. McKeown recommends keeping a journal as a tool to see the lead in our lives and identify subtle patterns.  Complete one of the following sentences:
    1. I don’t take time to journal because _________.
    2. I do keep a journal but struggle with this because __________.
    3. I do keep a journal but I need to do better in this way ____________.
  7. If you keep a journal, go back more than 3 months and read over at least 1 month worth of entries. What are the headlines? What is the meaning of what you read?  What are the trends?
  8. McKeown tells the story of a design team attempting to create an affordable incubator (less than the $20K average cost) in order to save the lives of premature babies. The team was successful when they visited places like Nepal to see where children throughout the world are born.  Name 3 challenges that you are facing right now and think about how you can step away, and get a longer perspective for clarity.  Reflect on ways you can “get out into the field.”
  9. sometimes we face problems that are resistant to classical solutions. Think of the problems you listed in #8 and write down some of the unusual details. What are the ways in which your problems and context are unique?

Why We Love Being Burned Out- It Is Easier

Why We love burnout

I was reading some old journal entries. This is a great practice that helps put our blessings and struggles in perspective over the long haul. Too often I exaggerate the severity of the average crisis and forget the many blessings. Anyway, I came across something that I wrote last year during a time of exhaustion. At that moment I was trying to unravel why I have such a hard time resting and so often tend towards busyness and burnout. Reading this old entry was helpful for me, and perhaps it will encourage you.
“Why do we like/love the burnout trail? Being busy makes us feel important or even superior.

This level of busyness [to the point of exhaustion and burnout] though hard in the long run is emotionally easier in the short run Than:

  • Defining priorities
  • Saying no to people and risking their disappointment
  • Facing the fear of missing out
  • Disciplining myself to follow through on decisions and priorities
  • Doing the hard work of thinking ahead about calendar issues
  • Investing in people and giving them feedback”

I was struck at how often frenetic busyness is the way I avoid the really challenging and important emotional work that needs to be done.  God help me to grow!

Essentialism Chapter 7 Discussion Questions

The Value of Play

 

Questions for Essentialism Chapter 7

Download a printable pdf version here.Essentialism Questions Ch. 7

This is a list of discussion questions to help work through the content of the book “Essentialism” By Greg McKeown.

Major principles:

Recreation and play does not threaten a productive life, it is vital part of helping us grow and become more creative.

Key examples/illustrations

  • The story of Mr. Banks from the movie Mary Poppins. His dreary life is transformed by something as simple as flying a kite
  • Author Ken Robinson has expressed how our education system is killing creativity in children.  This transformation arrived with the Industrial Revolution.
  • Stuart Brown and the National Institute for Play. He has published scientific research about the impact of play on our brains.
  • The correlation between survival in animals (like the grizzly bear) and rates of survival.
  • Edward M Hallowell, psychiatrist, speaks about the effect of play on the executive function of the brain.
  • Throughout history many great discoveries happened during times of play.

Questions

  1. McKeown defines play as, “Play, which I would define as anything we do simply for the joy of doing rather than as a means to an end.” What are some activities in your life right now that fit this description? Use this definition to make a list of things you have done in the last 6 months for play.
  2. As children we did not need to be taught how to play.  Children play at all times, even during sickness and tragedy. What does this suggest to you about the importance of play?
  3. It is easy to view play as a waste of time.  Highly driven people and teams may even consider it something trivial or unproductive. What is your view? How do you feel about playing? What does your inner voice say to you when you stop work to engage in recreation?  What pressures or beliefs are communicated to you by your peers and culture regarding play?
  4. There are some people that are “all play and no work.” These excesses may prevent us from seeing the virtues and benefits of play.  Do you know someone in your life that is a productive and playful person? Someone who is highly effective and yet takes time for hobbies and recreation? Describe this person and their productivity as well as their play.
  5. The author uses the term imaginative play. What does this mean to you? Is there a difference between imaginative play and other kinds of play? Is one better than the other?
  6. Sir Ken Robinson says that imagination produces achievement. If imagination is a muscle, then play exercises that muscle. Do you agree with this?  Why? In your experience how has play helped you to develop your imagination?
  7. You have probably heard someone explain how they ruined a hobby by turning it into a “for profit” business.  How can you guard your important hobbies or play from the obligations that might destroy them?
  8. Stress kills creativity. Play can help to decrease stress. What stresses are you facing currently? How can you use recreation and play to decrease your stress?
  9. Which activities help you to feel light and free? Which activities help you to forget your problems?
  10. Many great discoveries and inventions happened during play. Have you ever had a breakthrough during a time of play?
  11. Many successful companies incorporate play in their corporate structure.  Examples include Google, Twitter, Apple, etc.  does your business or work encourage play? Why or why not?
  12. What activities outside of work do you must enjoy? Which activities would you like to try? Make a list
  13. How can you add these activities to your calendar next week?
  14. Which activities were your favorite as a child? Explore this.  Does this play history reveal anything about you or what you enjoy doing?
  15. How can you use this knowledge to help you learn how to play as an adult?

Is It Too Little Butter, or Too Much Bread? Another Brilliant Blog Post From Seth Godin

Seth Godin is the master of the short blog post. And that is refreshing! I follow his blog by email and have read several of his books. He always has a unique angle on things. This post was really enjoyable, and I read it out loud to my wife. I thought I would share it with you here. If you don’t get his stuff, wander over to his site and sign up.

BTW, in addition to his blog he is always working on cool projects. I listened to his entrepreneur “Start UP School” podcast a while ago and was challenged. Find it here:

“Bilbo Baggin’s great quote about being stretched thin (“I feel thin, sort of stretched, like butter scraped over too much bread.”) reveals a profound truth:

Most individuals and organizations complain of not having enough butter. We need more resources, we say, to cover this much territory. We need more (time/money/staff) to get the job done.

What happens if instead of always seeking more butter, we find the discipline to cover less bread?

Spreading our butter too thin is a form of hiding. It helps us be busy, but makes it unlikely we will make an impact.

It turns out that doing a great job with what we’ve got is the single best way to get a chance to do an even better job with more, next time.”

Source: Seth’s Blog: Is it too little butter, or too much bread?