For all of us who have been in leadership roles as well as for those who are followers, we instinctively know that Trust is one of the most important drivers of success in a relationship and a successful corporate culture.  Once you lose trust, things disintegrate fast and personal and organizational effectiveness suffers considerably.

Covey, defines Trust as follows:  “Trust is a function of two things: character and competence. Character includes your integrity, your motive, your intent with people. Competence includes your capabilities, your skills, your results, your track record. And both are vital. Trust is equal parts character and competence. Both are absolutely necessary. From the family room to the boardroom, you can look at any leadership failure, and it’s always a failure of one or the other.“  His approach is insightful and goes beyond intent – ie., if a person has good intentions then you would trust them.  In business especially, to gain trust, you must have the second part of his definition – Competence.  You might like  a leader with a good heart and caring personality, but if he can’t execute and deliver on his objectives and strategy, you won’t trust him to lead you and run the business.  Covey goes on to say:  “Simply put, trust means confidence. The opposite of trust — distrust — is suspicion. When you trust people, you have confidence in them — in their integrity and in their abilities. When you distrust people, you are suspicious of them — of their integrity, their agenda, their capabilities, or their track record. It’s that simple.”

The book goes on to explain in depth through examples from Covey’s business career and family life, how Trust can be created between individuals, and easily lost.  He also gives a little advice we could all use about giving someone else a little slack:  “…we tend to judge others based on their behavior, and ourselves based on our intent. In almost all situations, we would do well to recognize the possibility — even probability — of good intent in others…sometimes despite their observable behavior.”  It’s a tough world out there and we’re not all going to get it right all the time, but just may be, our long term average may not be so bad…  But ideally of course, what we all would like strive for is to consistently generate Trust in a consistent manner with the people we meet, live, and work with.  Covey gives a great example of a CEO who puts himself on the line and sets up high expectations for himself with everyone he meets:  “Doug Conant, CEO of Campbell Soup Company, recently told me that within the first hour of working with new coworkers or other business partners, he lets them know how he operates so that people can know what to expect. He tells them explicitly that his agenda includes building trust with them, and that he wants them to gain trust in him as they see him do what he says he will do. Additionally, Doug finds that declaring his intent not only builds trust, it also puts more accountability on him to be true to what he’s said.”  Wow, now that’s Transparency.

Lastly, Covey emphasizes that confidence generates solid results which in turn generate credibility and therefore higher trust.  It is therefore a leadership imperative to help others realize it in their work and for leaders to work hard to consistently generate their own self confidence:  “Though we all know it intuitively, research also validates that a person’s self-confidence affects his or her performance. This is one reason why Jack Welch of GE always felt so strongly that “building self-confidence in others is a huge part of leadership.” The lack of self trust also undermines our ability to trust others. In the words of Cardinal de Retz, “A man who doesn’t trust himself can never really trust anyone else.”

Covey explains that the best way for us as individuals to develop our own confidence is to keep commitments to ourselves – one step at a time.  This of course makes a lot of sense – the people who we know that seem to the most confident, set challenging goals for themselves, work hard, and achieve them: “Every time we make and keep a commitment to ourselves — large or small — we increase our self-confidence. We build our reserves. We enlarge our capacity to make and keep greater commitments, both to ourselves and to others. As you consider how you might step up your ability to make and keep commitments to yourself, let me suggest a few important things to keep in mind: First, don’t make too many commitments. If you do, you’re setting yourself up for failure. Differentiate between a goal, a direction, a focus, and an actual commitment. When you make a commitment to yourself, do so with the clear understanding that you’re pledging your integrity. Second, treat a commitment you make to yourself with as much respect as you do the commitments you make to others. Whether it’s a commitment of time (an appointment with yourself to exercise or read or sleep) or a commitment to prioritize your energy and focus, treat it — and yourself — with respect. Third, don’t make commitments impulsively. I learned this lesson the hard way one time when we were having a family discussion about health. It was around New Year’s, and as we were talking, we decided that we all needed to drink more water instead of soda pop. I started to really get caught up in the spirit of improvement, and — filled with bravado (but no humility) — I said, “I’ll tell you what I am going to do. I am going to make a commitment to myself to drink nothing but water for this entire year! No soda, no juices — nothing but water!” Well, that was foolish and I lived to regret it. I kept the commitment, but it was hard. Out of the experience, I learned to be careful about making commitments and to make sure they were made out of humility, and not pride. Finally, understand that when keeping your commitment becomes hard, you have two choices: You can change your behavior to match your commitment, or you can lower your values to match your behavior. One choice will strengthen your integrity; the other will diminish it and erode your confidence in your ability to make and keep commitments in the future. In addition, that shift in direction with regard to values — even if it’s slight — will create a change in trajectory that will create a far more significant difference in destination down the road. So I encourage you to learn to make and keep commitments to yourself with wisdom. There is no faster way to build self trust.”

Overall, a great book on what may be one of the most important determinants of success in Life and Business.

-Jay Kshatri
President, The Kensho Group
www.TheKenshoGroup.com

How Focus Defines Our Life
by JONATHAN

Photography is an amazing way to learn about focus. This is because the very act of viewing life through the lens of a camera can help to us to develop a truly empowering skill. We call that skill focus, and learning to use it properly can transform our perception of the world around us.

3 things photography can teach us about focus

1. The higher the magnification, the narrower the field of vision. This principle is what allows you to use a telephoto lens to pick out a single face in a very large crowd. As you focus in on that one subject, the rest of the crowd disappears from view. Why does that happen? Because your field of vision narrows until the entire frame is filled with that one face.

When you take the picture, the crowd is excluded. It doesn’t mean that there is no crowd. It simply means that you don’t see them in the picture because that is not what you were focused on.

Application: Your perception is determined by what you focus on. This means that we can use our ability to focus our attention in a way that causes an empowering shift in our perception. It doesn’t matter whether we are looking at a person, situation, or an experience. We can control what our picture looks like by controlling what we choose to focus on.

If you focus intently on the positive aspects of any person, place, or thing, the negative aspects will fade into the background. They will still exist, but they will be outside of your field of concentration, and will have little or no influence on the picture you see.

2. Lighting has a huge influence on how you see things, and your ability to focus. If you set your camera on a tripod and focus it on a single object, the lighting will determine how you see that object.

Imagine that you have decided to photograph a magnificent tree that is standing alone on the top of a hill. If your camera remained stationary, and you took one picture every hour from sunup till sundown, what would you have? You would have twelve (or so) completely different photographs. Why? Even though the subject remained the same, the variation in lighting changed its appearance.

Application: The degree of value we choose to assign to anything we focus on can be compared to lighting. If it is something of great importance, we put a spotlight on it so we can see every detail. If it is relatively insignificant, we dial down the light so it doesn’t distract from the things that really matter.

If we assign too much value to (shine a spotlight on) things of little importance, they will overshadow the more valuable aspects of our life.

By assigning increased value to thing like gratitude, relationships, health, and honesty, we bring those things front and center in our life. This means that they move higher on our list of priorities and capture more of our attention. As a result, less empowering aspects of life will be relegated to a lower priority and receive less attention.

3. Shutter speed affects the quality and clarity of any photograph. Under glaring conditions, exposure time needs to be reduced to avoid overexposing the picture. When the lighting is poor, a slower shutter speed allows enough time for the available light to properly expose the image.

If you use a fast shutter speed in a low light situation, the image will not register. Your picture will be underexposed and worthless as a result. Using a slower shutter speed when trying to capture an action shot will give you a blurry picture devoid of details, also worthless.

Exposure time needs to change to fit the requirements of each situation. If it doesn’t, then quality and clarity are compromised.

Application: In life, we need to make choices about what we are willing to expose ourselves to, and for how long. We only have so many hours in a day. Learning to manage the time available is really a process of deciding how much time we spend on each activity.

If you stay too long at unimportant activities (overexpose yourself), you will end up underexposing yourself to the really important ones. Once again, exposure time needs to change to fit the requirements of each situation. We also need to acknowledge that some things are not worth exposing ourselves to at all.

Making positive changes in the quality of our life requires that we assign meaningful amounts of time to meaningful pursuits. If we don’t control our time, mundane activities will expand to fill the time available. By managing your time and adjusting your exposure, you will be able to give greater focus to activities that make a solid contribution to the quality of your life.

Auto focus, is it good or bad?

For most of us, photography is a point and shoot process. Automatic cameras require very little skill to produce fairly nice pictures. Truly exceptional photographs however, still require a skilled photographer to manually control the focus and shutter speed, and to recognize or create the perfect lighting.

High quality photos are still produced by those with enough skill to make the best use of the tools available. They want above average results, and they consider it worth their time and effort to develop the necessary skills.

What Kind of results do you want?

For a lot of people, life is just an average experience, it’s a point and shoot affair. Generally, this is not because they don’t want an exceptional life. It may be because they haven’t taken the time to develop the life skills required to produce exceptional results. Or perhaps, they never had an opportunity to learn those life skills in the first place. Whatever the reason, the skills are available for anyone desiring to live a truly exceptional life.

How about you, is average good enough, or do you want exceptional? When you look at your life, what kind of picture do you want to see?

Do you find it difficult to control your focus?
How much influence do you think focus has on perception?
The lines are open!

—>>Great article in the October Atlantic Monthly about the questionable results from Clinical Trials and why…<<—

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

By DAVID H. FREEDMAN

Lies, Damned Lies, and Medical Science
MUCH OF WHAT MEDICAL RESEARCHERS CONCLUDE IN THEIR STUDIES IS MISLEADING, EXAGGERATED, OR FLAT-OUT WRONG. SO WHY ARE DOCTORS—TO A STRIKING EXTENT—STILL DRAWING UPON MISINFORMATION IN THEIR EVERYDAY PRACTICE? DR. JOHN IOANNIDIS HAS SPENT HIS CAREER CHALLENGING HIS PEERS BY EXPOSING THEIR BAD SCIENCE.

By David H. Freedman

IMAGE CREDIT: ROBYN TWOMEY/REDUX

IN 2001, RUMORS were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. “I also discovered that I really liked research.” Good thing, because the study had actually been a sort of audition. The professor, it turned out, had been putting together a team of exceptionally brash and curious young clinicians and Ph.D.s to join him in tackling an unusual and controversial agenda.

Last spring, I sat in on one of the team’s weekly meetings on the medical school’s campus, which is plunked crazily across a series of sharp hills. The building in which we met, like most at the school, had the look of a barracks and was festooned with political graffiti. But the group convened in a spacious conference room that would have been at home at a Silicon Valley start-up. Sprawled around a large table were Tatsioni and eight other youngish Greek researchers and physicians who, in contrast to the pasty younger staff frequently seen in U.S. hospitals, looked like the casually glamorous cast of a television medical drama. The professor, a dapper and soft-spoken man named John Ioannidis, loosely presided.

One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti’s study didn’t address the fact that drug-company research wasn’t measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn’t hurt as much today”). Another pointed out that Salanti’s study ignored the fact that when drug-company data seemed to show patients’ health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal.

Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can’t prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?

That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

THE CITY OF IOANNINA is a big college town a short drive from the ruins of a 20,000-seat amphitheater and a Zeusian sanctuary built at the site of the Dodona oracle. The oracle was said to have issued pronouncements to priests through the rustling of a sacred oak tree. Today, a different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I take all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me, as we contemplate the tree the day after the team’s meeting. “‘Will my research grant be approved?’” He chuckles, but Ioannidis (pronounced yo-NEE-dees) tends to laugh not so much in mirth as to soften the sting of his attack. And sure enough, he goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research.

He first stumbled on the sorts of problems plaguing the field, he explains, as a young physician-researcher in the early 1990s at Harvard. At the time, he was interested in diagnosing rare diseases, for which a lack of case data can leave doctors with little to go on other than intuition and rules of thumb. But he noticed that doctors seemed to proceed in much the same manner even when it came to cancer, heart disease, and other common ailments. Where were the hard data that would back up their treatment decisions? There was plenty of published research, but much of it was remarkably unscientific, based largely on observations of a small number of cases. A new “evidence-based medicine” movement was just starting to gather force, and Ioannidis decided to throw himself into it, working first with prominent researchers at Tufts University and then taking positions at Johns Hopkins University and the National Institutes of Health. He was unusually well armed: he had been a math prodigy of near-celebrity status in high school in Greece, and had followed his parents, who were both physician-researchers, into medicine. Now he’d have a chance to combine math and medicine by applying rigorous statistical analysis to what seemed a surprisingly sloppy field. “I assumed that everything we physicians did was basically right, but now I was going to help verify it,” he says. “All we’d have to do was systematically review the evidence, trust what it told us, and then everything would be perfect.”

It didn’t turn out that way. In poring over medical journals, he was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.

But beyond the headlines, Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.

This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”

Perhaps only a minority of researchers were succumbing to this bias, but their distorted findings were having an outsize effect on published research. To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else’s results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions.

In the late 1990s, Ioannidis set up a base at the University of Ioannina. He pulled together his team, which remains largely intact today, and started chipping away at the problem in a series of papers that pointed out specific ways certain studies were getting misleading results. Other meta-researchers were also starting to spotlight disturbingly high rates of error in the medical literature. But Ioannidis wanted to get the big picture across, and to do so with solid data, clear reasoning, and good statistical analysis. The project dragged on, until finally he retreated to the tiny island of Sikinos in the Aegean Sea, where he drew inspiration from the relatively primitive surroundings and the intellectual traditions they recalled. “A pervasive theme of ancient Greek literature is that you need to pursue the truth, no matter what the truth might be,” he says. In 2005, he unleashed two papers that challenged the foundations of medical research.

He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John’s calculations, but it’s hard to argue that the essential ideas aren’t absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine.

Still, Ioannidis anticipated that the community might shrug off his findings: sure, a lot of dubious research makes it into journals, but we researchers and physicians know to ignore it and focus on the good stuff, so what’s the big deal? The other paper headed off that claim. He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals. These were articles that helped lead to the widespread popularity of treatments such as the use of hormone-replacement therapy for menopausal women, vitamin E to reduce the risk of heart disease, coronary stents to ward off heart attacks, and daily low-dose aspirin to control blood pressure and prevent heart attacks and strokes. Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. That article was published in the Journal of the American Medical Association.

DRIVING ME BACK to campus in his smallish SUV—after insisting, as he apparently does with all his visitors, on showing me a nearby lake and the six monasteries situated on an islet within it—Ioannidis apologized profusely for running a yellow light, explaining with a laugh that he didn’t trust the truck behind him to stop. Considering his willingness, even eagerness, to slap the face of the medical-research community, Ioannidis comes off as thoughtful, upbeat, and deeply civil. He’s a careful listener, and his frequent grin and semi-apologetic chuckle can make the sharp prodding of his arguments seem almost good-natured. He is as quick, if not quicker, to question his own motives and competence as anyone else’s. A neat and compact 45-year-old with a trim mustache, he presents as a sort of dashing nerd—Giancarlo Giannini with a bit of Mr. Bean.

The humility and graciousness seem to serve him well in getting across a message that is not easy to digest or, for that matter, believe: that even highly regarded researchers at prestigious institutions sometimes churn out attention-grabbing findings rather than findings likely to be right. But Ioannidis points out that obviously questionable findings cram the pages of top medical journals, not to mention the morning headlines. Consider, he says, the endless stream of results from nutritional studies in which researchers follow thousands of people for some number of years, tracking what they eat and what supplements they take, and how their health changes over the course of the study. “Then the researchers start asking, ‘What did vitamin E do? What did vitamin C or D or A do? What changed with calorie intake, or protein or fat intake? What happened to cholesterol levels? Who got what type of cancer?’” he says. “They run everything through the mill, one at a time, and they start finding associations, and eventually conclude that vitamin X lowers the risk of cancer Y, or this food helps with the risk of that disease.” In a single week this fall, Google’s news page offered these headlines: “More Omega-3 Fats Didn’t Aid Heart Patients”; “Fruits, Vegetables Cut Cancer Risk for Smokers”; “Soy May Ease Sleep Problems in Older Women”; and dozens of similar stories.

When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you’d think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.

For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death. Instead, they track easily measurable health “markers” such as cholesterol levels, blood pressure, and blood-sugar levels, and meta-experts have shown that changes in these markers often don’t correlate as well with long-term health as we have been led to believe.

On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven’t convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer.) And these problems are aside from ubiquitous measurement errors (for example, people habitually misreport their diets in studies), routine misanalysis (researchers rely on complex software capable of juggling results in ways they don’t always understand), and the less common, but serious, problem of outright fraud (which has been revealed, in confidential surveys, to be much more widespread than scientists like to acknowledge).

If a study somehow avoids every one of these problems and finds a real connection to long-term changes in health, you’re still not guaranteed to benefit, because studies report average results that typically represent a vast range of individual outcomes. Should you be among the lucky minority that stands to benefit, don’t expect a noticeable improvement in your health, because studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller. “The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.

And so it goes for all medical studies, he says. Indeed, nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest. The exciting links between genes and various diseases and traits that are relentlessly hyped in the press for heralding miraculous around-the-corner treatments for everything from colon cancer to schizophrenia have in the past proved so vulnerable to error and distortion, Ioannidis has found, that in some cases you’d have done about as well by throwing darts at a chart of the genome. (These studies seem to have improved somewhat in recent years, but whether they will hold up or be useful in treatment are still open questions.) Vioxx, Zelnorm, and Baycol were among the widely prescribed drugs found to be safe and effective in large randomized controlled trials before the drugs were yanked from the market as unsafe or not so effective, or both.

“Often the claims made by studies are so extravagant that you can immediately cross them out without needing to know much about the specific problems with the studies,” Ioannidis says. But of course it’s that very extravagance of claim (one large randomized controlled trial even proved that secret prayer by unknown parties can save the lives of heart-surgery patients, while another proved that secret prayer can harm them) that helps gets these findings into journals and then into our treatments and lifestyles, especially when the claim builds on impressive-sounding evidence. “Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.”

THOUGH SCIENTISTS AND science journalists are constantly talking up the value of the peer-review process, researchers admit among themselves that biased, erroneous, and even blatantly fraudulent studies easily slip through it. Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.” What’s more, the peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs—as with the exciting-sounding gene linkages (autism genes identified!) and nutritional findings (olive oil lowers blood pressure!) that are really just dubious and conflicting variations on a theme.

Most journal editors don’t even claim to protect against the problems that plague these studies. University and government research overseers rarely step in to directly enforce research quality, and when they do, the science community goes ballistic over the outside interference. The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.

But even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited.

Doctors may notice that their patients don’t seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings. Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed. That we’re not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.

Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right). And needless to say, things only get worse when it comes to the pop expertise that endlessly spews at us from diet, relationship, investment, and parenting gurus and pundits. But we expect more of scientists, and especially of medical scientists, given that we believe we are staking our lives on their results. The public hardly recognizes how bad a bet this is. The medical community itself might still be largely oblivious to the scope of the problem, if Ioannidis hadn’t forced a confrontation when he published his studies in 2005.

Ioannidis initially thought the community might come out fighting. Instead, it seemed relieved, as if it had been guiltily waiting for someone to blow the whistle, and eager to hear more. David Gorski, a surgeon and researcher at Detroit’s Barbara Ann Karmanos Cancer Institute, noted in his prominent medical blog that when he presented Ioannidis’s paper on highly cited research at a professional meeting, “not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings.” Ioannidis offers a theory for the relatively calm reception. “I think that people didn’t feel I was only trying to provoke them, because I showed that it was a community problem, instead of pointing fingers at individual examples of bad research,” he says. In a sense, he gave scientists an opportunity to cluck about the wrongness without having to acknowledge that they themselves succumb to it—it was something everyone else did.

To say that Ioannidis’s work has been embraced would be an understatement. His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work—that would be a paper he published in Nature Genetics on the problems with gene-link studies. Other researchers are eager to work with him: he has published papers with 1,328 different co-authors at 538 institutions in 43 countries, he says. Last year he received, by his estimate, invitations to speak at 1,000 conferences and institutions around the world, and he was accepting an average of about five invitations a month until a case last year of excessive-travel-induced vertigo led him to cut back. Even so, in the weeks before I visited him he had addressed an AIDS conference in San Francisco, the European Society for Clinical Investigation, Harvard’s School of Public Health, and the medical schools at Stanford and Tufts.

The irony of his having achieved this sort of success by accusing the medical-research community of chasing after success is not lost on him, and he notes that it ought to raise the question of whether he himself might be pumping up his findings. “If I did a study and the results showed that in fact there wasn’t really much bias in research, would I be willing to publish it?” he asks. “That would create a real psychological conflict for me.” But his bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”

AS HELTER-SKELTER as the University of Ioannina Medical School campus looks, the hospital abutting it looks reassuringly stolid. Athina Tatsioni has offered to take me on a tour of the facility, but we make it only as far as the entrance when she is greeted—accosted, really—by a worried-looking older woman. Tatsioni, normally a bit reserved, is warm and animated with the woman, and the two have a brief but intense conversation before embracing and saying goodbye. Tatsioni explains to me that the woman and her husband were patients of hers years ago; now the husband has been admitted to the hospital with abdominal pains, and Tatsioni has promised she’ll stop by his room later to say hello. Recalling the appendicitis story, I prod a bit, and she confesses she plans to do her own exam. She needs to be circumspect, though, so she won’t appear to be second-guessing the other doctors.

Tatsioni doesn’t so much fear that someone will carve out the man’s healthy appendix. Rather, she’s concerned that, like many patients, he’ll end up with prescriptions for multiple drugs that will do little to help him, and may well harm him. “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line. What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.

Later, Ioannidis tells me he makes a point of having several clinicians on his team. “Researchers and physicians often don’t understand each other; they speak different languages,” he says. Knowing that some of his researchers are spending more than half their time seeing patients makes him feel the team is better positioned to bridge that gap; their experience informs the team’s research with firsthand knowledge, and helps the team shape its papers in a way more likely to hit home with physicians. It’s not that he envisions doctors making all their decisions based solely on solid evidence—there’s simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn’t good, doctors should know that, too. And so should patients.”

In fact, the question of whether the problems with medical research should be broadcast to the public is a sticky one in the meta-research community. Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. Ioannidis dismisses these concerns. “If we don’t tell the public about these problems, then we’re no better than nonscientists who falsely claim they can heal,” he says. “If the drugs don’t work and we’re not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn’t mean we have a right to overstate what we’re accomplishing.”

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.

“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

This article available online at:

http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

Copyright © 2010 by The Atlantic Monthly Group. All Rights Reserved.

“Game changer” recruitment requires more sophisticated approach

14 July 2010 6:16am

A top performer can generate substantially more revenue for an organisation than someone who is average, but the approach required to bring one on board differs dramatically from typical recruitment, says HR expert Dr John Sullivan.

In an article on ere.net, he describes NBA basketball team Miami Heat’s recent signing of star player LeBron James as “the most sophisticated recruiting effort executed in this century”.

Sports teams and corporations alike need all the game-changers, innovators and exceptional performers they can get, Sullivan says, pointing out that Google estimates a top performer generates three hundred times more revenue than an average performer.

Organisations can learn three key lessons from Miami Heat, he says.

Calculate the economic value of a game-changer

Most recruiting managers focus on the cost-per-hire metric, ignoring the potential return or the economic impacts that recruiting a game-changer will have, Sullivan says.

“When doing calculations, remember that the economic impacts of acquiring a game-changer are not limited to their direct contributions, but also include the attraction of investors and other high-calibre recruits that will also impact the performance of the organisation.

“In addition, recruiting a game-changer from a direct competitor may significantly impact their ability to compete. Once your executives understand the startling economic value, they will support the use of a game-changing recruiting approach.”

Realise that game-changers are different

Game-changers, innovators and top performers “truly are different and must be recruited in a unique manner, Sullivan says. Traditional recruiting models won’t work, because they don’t accommodate superstar personalities, unusual expectations and an array of influencers.

He says that while all game-changers are not alike, they have certain characteristics in common, including that they are:
Not looking for a job – and they are almost certainly treated well where they are;

Powerful – they understand their value and their importance, and expect to be treated differently; and

Difficult to approach – they are busy and in demand. To make contact, recruiters need assistance from someone who influences them.
Game-changers are often cynical of strangers and need a strong relationship built on trust before they will consider an offer, Sullivan adds.

Shift to a game-changing recruiting approach

The main difference between game-changing and traditional recruitment is the level of effort put into truly understanding the candidate and their needs, Sullivan says.

The game-changing approach is market-research and sales driven, resulting in a sophisticated candidate profile, covering the candidate’s job search process, how best to contact them, and their job acceptance decision criteria.

“This in-depth profile takes a significant amount of time and resources but is necessary if you want to have a realistic chance of success,” Sullivan says.

He recommends 10 activities, which include:
Identify the factors that trigger a job search – a combination of a positive job opportunity and a negative triggering factor in their current situation is needed. “Such events might include a corporate merger, management turnover, corporate scandal, or a significant cut to their budget”;

Determine who must do the recruiting – game-changers often expect to be contacted by professionals of a similar stature;

Identify the factors that will grab their attention initially – make sure that compelling information on those factors is clearly available on the sites they routinely visit;

Identify the decision criteria they will use to accept an interview – this requires extensive research and benchmarking, and some guesswork;

Identify who will influence their decision – game-changers are more likely than others to consult with and seek the advice of friends; and

Develop a counter-offer strategy – the normal reaction of a game-changer is to stay put in a known environment, Sullivan says. You need to research what their counter offer is likely to be, and prepare a compelling strategy to overcome it.

On the Job: Move beyond the Web to become visible to employers You may not think you have a superpower, but if the only way you’re looking for a job is by applying to companies or job boards on the Web, you’ve just become invisible. Phil Haynes says it’s these kinds of blunders that can prevent a job seeker from finding a position, but he says a revamped strategy can help bring success. “Your chances of finding a job by just applying online are about 7 percent,” says Haynes. “You want to make yourself visible to companies, but you’re invisible if you’re applying for jobs that way.” Haynes is in a unique position to know how companies are hiring. He is the director of AllianceQ, a group of Fortune 500 companies that have collaborated to build a pool of qualified job candidates to match with job openings. It not only drives down recruitment costs for employers because they are sharing resources, but candidates have access to more opportunities through a job search program known as UnitedWeWork.org. As unemployment rises above 10 percent, Haynes says that job seekers need to quit wasting time on strategies that won’t help them find a job. He suggests several ways to improve a job search process. He says some do’s and don’ts include: Don’t apply for jobs for which you’re not qualified. Employers have to weed through hundreds of resumes for even the most basic jobs, so they immediately discard ones where the skills don’t match their requirements. For example, if you’re not an engineer, don’t apply for a job that requires an engineering degree. “You do a great disservice to yourself when you do something like that,” Haynes says. “It never, never works that way. I have never seen someone picked for a job if they don’t have the qualifications.” Do take a sales approach to the job search. “Before you sell something, you have to know your product. In this case, you are the product. What can you offer someone?” Haynes advises not trying to “be something you’re not,” but instead looking at how what you know could translate into something positive for an employer. Do your homework. Haynes says you should never approach an employer about a job unless you have researched the key players in the company, what the company does and some of the challenges it faces in its industry. That information can easily be found on the Internet or by visiting a local library, he says. Do walk out the door. “Put on a suit and get out of the house,” Haynes says. “Go knock on doors. Do it the old-fashioned way: Walk into a small or medium-sized business and talk to them.” Haynes says the way you get opportunities is often by selling your skills to a company leader face-to-face. By making that personal connection, you may nab a job before an employer even considers posting it. “They may just see you as someone who can save them from going through stacks of resumes,” he says. Don’t be desperate. Never approach an employer with the attitude that you’re willing to do any kind of work. “Don’t ever tell an employer that you really need the job, but rather that you’d like the job,” Haynes says. “Never say you’re willing to do anything.” Do understand that something is better than nothing. Maybe your pride won’t let you take a certain job, or even apply for a position with less money than you were making. “Listen, you’ll feel better about yourself if you have a job and someplace to go,” Haynes says. “You can keep looking for something better, but take the job for now.” Don’t be ashamed. “This time period is not going to reflect negatively on you in your résumé,” he says. “People are taking survival jobs, and there’s nothing wrong with that.” Do follow up. Once you’ve had a job interview, don’t let the connection languish. That doesn’t mean you call and bug the person about a decision. Instead, use information gleaned through the interview to make a stronger personal connection, Haynes says. For example, if you know the person went to a certain school and had a favorite professor, find information on the professor’s latest accomplishments, or an article written by the person. Forward this information onto the interviewer, saying something like, “I thought you might find this interesting since I know this professor was a personal favorite.” Haynes also offers other words of encouragement to job seekers. “Don’t forget that while some jobs are gone forever, there are a lot of new ones evolving,” he says. “And as soon as the stock market rebounds, a lot of those 6.6 million people who are 65 and older are going to go ahead and retire. That’s a lot of jobs opening up.”

In my opinion this concept can be applied to almost everyone in every profession (in fact to personal development in general).  When we first start our careers, we are trained and mentored by more senior professionals.  If we admire and respect these individuals, then naturally we look to emulate and adopt their styles and characteristics  (and of course, some look to impose their styles on us!).  If we are too accurate in our emulation, then of course the labels of “there goes so and so Jr. ” and other diatribes.  But in most cases, over time we absorb and learn from a wide variety of influences which in turn influences who we are and how we conduct ourselves in the world.  In the best case, these influences gell together to create a more advanced and well defined persona and character – a better YOU if you will.  Of course, this happens to varying degrees in each individual and at varying speeds.

The reason this process is interesting in the world of Work, Recruiting, and Hiring is that people have come to understand that Authenticity matters in terms of personal effectiveness and happiness.  The more a leader is genuine and authentic, the more his team trusts him or her and is willing to be lead by them (former CEO of Medtronic, Bill George, has written a couple of books on authentic leadership).  And, in a hiring situation, people try hard to understand who the real (authentic) person is that they are speaking with versus the “fully prepped interviewee” that is in front of them.  The last thing anyone wants is to meet one person during the interview process and to have “a different person” show up on the first day of work.  This is important in both directions – the nice future boss who you met during the interview process (not to mention all of the potential team mates who were on their best behavior) can turn out to be quite different during the first few months on the job.  That’s where authenticity and truly “Sounding like Yourself” matters.

But more than being the right thing to do, Sounding like Yourself and being authentic can be a competitive weapon in the hiring process.  Being the “shrink wrapped” candidate and checking all the right boxes on 101 Things do on an Interview checklist will get you in the door, but in front of a thoughtful and savvy decision maker, it probably won’t take you to round 2.  The same goes for being a hiring manager, the economy is tough now so companies have the upper hand, but that will change and we will be back to the situation where the laws of diminishing baby boomers in the work force will again make clear the highly skilled professional shortage that we are facing.  Candidates then will return to making decisions where the culture and compatibility with the boss rank very highly in their process.  Both sides want to understand what the other will be really like on a day to day basis – will they be fun to work with, what skills and other traits are beyond the norm and could bring value to the team, and how can I be sure that this person has a depth of character and integrity that I and the team will be comfortable with and fit in the with the company culture?

If you have been in the work force and out of college for some time, clearly you will have built up a set of life and work experiences that will have added depth to your character and personality.  You may also be accomplished in a number of hobbies and enjoy personal pursuits that make you a multi dimensional, multi talented individual.  Those things need to come out during the interview process – they make you human, they allow you Sound like Yourself, and they separate you out from the other candidates and other hiring managers.  Along with this goes how you do these things (both work and non-work related) – are you passionate or are you more calm and well thought out?  Each has its advantages.  Give the other person examples of what and how you do things, show that you are 3-Dimensional and Unique.

Let me give you an example of this in action – I recently started on a couple of search assignments for the CEO of a Neurology Medical Device company.  This individual has a great personal story – he is an ex professional baseball player who after retiring obtained four masters degrees in 5 years (is about to finish his PhD) and started his own medical device company (he’s in his early 30′s too!).  Now, you can imagine, this is quite a personal history and it’s a compelling starting point for any discussion he has with a candidate or client.  His journey is interesting and it adds a multi-dimensionality to his persona that can and is used as an advantage – people want to speak with him.  Now, all of us can’t have this type of compelling history, but we all do have many other parts of our background that make up “Our own Unique Sound”.  If we can bring those parts out and share them with others in a compelling way, at the right time, it can be a powerful way to connect with people.

Now, some of you are saying – Jay, come on, this example doesn’t fit the 99% of the rest of us.  We don’t have anything close to share.  Ok then, let me give you another example which is more down to the rest of us.  I called a candidate the other day, a Medical Device R&D Engineer- he was out doing an errand but took the call.  Now, in a matter of a few minutes, he was able to paint a picture of himself and his character that was very compelling.  This is what happened – when he picked up and I introduced myself, he said he definitely wanted to speak, but was tied up with doing something for a friend.  It seems that his friend was building a tree house for his kids, and as he was out shopping he saw that a very old historic restaurant was taking apart an old wood deck and getting rid of the wood.  He determined that this wood was a very special hardwood that was very expensive and not easy to secure these days and as they were going to just throw it away, it would be a great find for his friend to use in his tree house.  Therefore, he was there that day picking up the wood for his friend.  I told him that I was impressed by his care and consideration for his friend.  Upon which he then told me, that his friend and he go way back and also do a lot of sailing together and so often help each other with things.   So, in a matter of a couple of minutes, this person painted a very rich picture for me about who he is, his character, his loyalty to people, and his excellent communication skills.  He was clearly someone who had found his voice and learned to Sound Like Himself.

Therefore, so can you – let the complex mix that is your personality and character shine through for other people to see – do it with stories and examples that are real and genuine.  People will notice, they will listen, and you both will benefit.

What a Texas town can teach us about health care.

by Atul Gawande June 1, 2009

Costlier care is often worse care. Photograph by Phillip Toledano.

Related Links

Audio: An interview with Atul Gawande.

Who pays the price when patients sue doctors?

* AUGUST 4, 2009

Take Two Digital Pills and Call Me in the Morning
Silicon Valley Has a High-Tech Prescription to Cure Health Care’s Swollen Costs and Inefficiencies, but the Prognosis Is Uncertain

By DON CLARK

Hospitals are costly places. Andrew Thompson hopes his company can help keep people out of them.

His Silicon Valley start-up, Proteus Biomedical Inc., is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients’ vital signs.

Mr. Thompson predicts the company’s technology will generate a wealth of new information about patients’ evolving conditions and the impact of drugs they take. Doctors might decide to intervene, for example, when they notice a heart patient isn’t sleeping well or is taking incorrect dosages — problems that could lead to congestive heart failure.

Proteus isn’t alone. Dozens of large and small companies are turning to wireless technology to achieve what the Obama administration is seeking through legislation: a health-care system that keeps people healthier for less.

“Wireless applications have the potential to change every one of these areas,” said Eric Topol, a cardiologist and genomics professor at Scripps Research Institute, at an industry event in San Diego last week.

Dr. Topol, who is also chief medical officer of the West Wireless Health Institute, a San Diego nonprofit research organization, cites a 2008 study that was distributed by a coalition of companies and organizations that support health-care reform. It put annual savings from remote monitoring at $10.1 billion for U.S. sufferers of congestive heart failure, $6.1 billion for diabetes and $4.9 billion for chronic obstructive pulmonary disease.

But claims about cost savings from new technology often don’t pan out. There are “precious few” studies that back up such promises involving remote monitoring, says Mark Holland, managing director of System Research Services, an advisory firm focusing on health-care technology. And if reimbursements from Medicare or private insurers don’t cover the cost of high-tech approaches, doctors and hospitals won’t want to deploy them.

Using wireless technology has the potential to reduce costs in part because part of the infrastructure already is in place. With more than four billion cellphones sold to date, a large percentage of the world’s population has access to devices and networks that can send medical data to doctors.
Health Overhaul Opens Opportunities

While President Barack Obama’s health-care overhaul proposals remain in flux, any new health plan will emphasize a more efficient and less wasteful health-care system. Those, unsurprisingly, are the very same promises the health-care technology companies are making.

But while such promises help improve Silicon Valley’s health, it’s less clear that technology can save the rest of the ailing industry time and money. And even if it does, networked technologies have a way of making things convenient for bad guys, too: Already, hackers have gained access to private health-care data.

But the system is so bloated and calcified that the opportunity for improvement is great — a point not lost on the venture capital industry. Venture investments in health-care companies in the second quarter totaled $2.23 billion, outpacing the $1.88 billion pumped into tech companies — the first time on record that health-care investing exceeded tech investing, according to research firm VentureSource, which is owned by News Corp., publisher of The Wall Street Journal.

Robin Bellas, a venture capitalist at Morgenthaler, says his firm has quickly invested in a number of health-care firms recently. “The tech world is still struggling to find the new, new thing,” he says, “and the billion-dollar plus markets are more obvious on the health-care side right now.”

Another factor is the advancing sophistication of sensors. Triage Wireless Inc., a San Diego-based start-up, is testing a wearable device for wirelessly measuring vital signs in hospital rooms — including a long-sought ability to continuously measure blood pressure, rather than conducting spot checks by inflating a cuff around a patient’s arm. Corventis Inc., of San Jose, Calif., is focusing on monitoring patients on the go — with a Band-Aid-style sensor called PiiX that includes measurement of respiration, fluid status and physical movements.

Chip makers, seeing medical applications as a big new market, are racing to make such devices more capable and less expensive. Qualcomm Inc., known for its cellphone chips, is also developing low-power variants for wearable medical applications.

Intel Corp. has teams of researchers studying devices to help care for senior citizens at home, including what it calls a “magic carpet” — a mat with sensors to track how a patient moves. The goal: to gather data to prevent falls, a major cause of accidental deaths and a big contributor to health costs.

While President Obama and others are debating ways to cut health care costs, entrepreneurs are talking about ways to do the same thing with cutting-edge technology. Don Clark reports.

Industry executives say they have been helped by changing attitudes in the medical community. Cellphones were once banned in many hospitals, for example, for fear of interference with medical instruments. But as those concerns have diminished, hospitals now see cutting wires as a way to cut costs.

For example, the cables that relay high-definition images from medical instruments to monitors are fragile and need to be sterilized between procedures, said William Chang, vice president and chief technology officer of the endoscopy unit of Stryker Corp. His company used technology from Israel-based Amimon Ltd. to help send such images without wires.

Smartphones such as Apple Inc.’s iPhone also have had a big impact. AirStrip Technologies LLC offers a smartphone application that allows obstetricians to remotely view data such as fetal and maternal heart rates.

But such advances come with concerns about safety and privacy, which could cause regulatory delays. Mr. Thompson of Proteus doesn’t expect its technology to arrive in the U.S. until 2012, in part because of the regulatory review. He said its circuitry is safely digestible and, in high-volume production, will add less than a penny to the cost of a pill.

Then there are cost questions. Doctors who only get reimbursed for office visits, for example, might not eagerly prescribe new technology that saves money in the long run by keeping patients at home, Mr. Holland said.

CardioNet Inc., a pioneer in remote monitoring of heart patients, believes the reimbursement system isn’t properly evaluating its technology. Shares of the Conshohocken, Pa., company fell sharply last month after it disclosed that a unit of Highmark Inc. — a regional administrator of Medicare services — had proposed a 33% lower reimbursement rate for a monitoring program using CardioNet’s technology, which had been set at about $1,100. A Highmark spokesman said the company establishes such rates after careful evaluation of Medicare requirements.

Randy Thurman, CardioNet’s chief executive, estimates that similar monitoring in hospitals costs $26,000. The company is trying to have the reimbursement decision reviewed.
—Yukari Iwatani Kane contributed to this article.

Write to Don Clark at don.clark@wsj.com

Line managers hold key to candidates’ culture fit

05 August 2009 6:46am, Recruiter Daily

The final say in any recruitment decision must go to the new hire’s direct manager, says management consultant Harry Wolfe, because a match between their attitudes is more important than any other selection factor.

According to Wolfe, an expert on “attitude” and the director of Management Dynamics International, selecting the best candidate for a job is “a challenge of intangibles, not of facts”.

The facts are simple, he says: either the candidate has the required education, qualifications, competencies, experiences and validated references, or they do not. “But discovering whether the candidate has the motivation to do the job in the way [their manager]… wants it done is a more difficult challenge.”

Selecting the candidate with the best culture fit is a matter of finding the right match with the direct manager, he says, but current selection processes often ignore this, resulting in low productivity and high attrition.

Managers want somebody they can work with, he points out. “You want somebody who has the same attitudes towards the job as you do, because they’re going to do it exactly as you want it done.

“If I think somebody should be very detailed in their approach to their job, and they’re anything but, it’s going to cause an awful lot of stress in me. And that in turn is going to cause a lot of stress in the person who’s trying to do the job. If I want somebody in a job who I know has to be outgoing and relate to a whole lot of different personalities, and they come in and sit at the desk all the time… again it’s going to stress me and I’m going to be using my influence on that person to get them out.

“[An external recruiter] can provide a shortlist of candidates who have the right qualifications and education, but the final test as to whether they’re going to be a success in the job has to be with the person who’s going to manage that person, assess their performance and hopefully reward them for having done a splendid job.”

There are two exercises managers should undertake in the final stages of recruiting to ensure they select the right person for the job, he says.

“Walk the talk”
After determining the KPIs for the job, and the behaviours needed to achieve those KPIs – for example, directive, persuasive, results-oriented, investigative, creative, imaginative etc – a manager will “talk” those behaviours during the interview and candidates quickly reflect them back in their answers, Wolfe says.

“But the behaviours you nominated for the job, even when based on your past experience, are only your perception of the behaviours to succeed in the job,” he points out. “Perception is subjective, and the behaviours listed may therefore be inaccurate.”

Managers must validate the behaviours nominated, to avoid raising false expectations in the candidate’s mind, he says. Doing so requires the manager to examine their own attitude to the job, because attitude encompasses feelings and emotions – which are inextricably entwined with beliefs and values – and “consequently attitude determines and predicts behaviour”.

A manager’s attitude to the job “therefore determines and predicts the actual behaviours [they] will ‘walk’ in managing the job holder, in that job”.

So, the manager should compare the behaviours nominated for success in the job with their own behaviours in managing the person in the role. If the two match, “you have confirmed how you ‘talk’ about the job is a match with the behaviours you ‘walk’ in managing the job holder. You ‘walk’ your ‘talk’ [and] your behaviour specification for the designated job is a valid benchmark.”

Managers who don’t “walk their talk”, Wolfe notes, “are a significant cause of people’s job dissatisfaction, high job turnover, and the prevalence of the ‘hired for his skills, fired for his behaviours’ syndrome.”

Find an attitude match
After validating the behaviour specification for a job, the manager’s next step is to identify each candidate’s “key intangible attribute” – their attitude, Wolfe says.

It is vital that the candidate’s attitude – which motivates and predicts his or her behaviour in the job – matches the manager’s attitude, he says.

“Attitude is more than twice as important for success in the job as any other attribute a candidate may have.”

Questions during interviews must invite the candidate to talk about his or her feelings and emotions, and beliefs and values, in different job situations. For example, “How do you feel when you are: working with people you dislike; congratulated; criticised; or working under pressure?”

If candidates’ replies to the questions begin with “I think…” rather than “I feel…”, Wolfe says, managers should stop them in their tracks. This is because “I think” talk is about perception and direction, not motivation. “It is vital to the success of your selection you are able to feel, empathise with, and relate to, the candidate’s actual feelings, emotions, beliefs and values, that motivate and determine his or her behaviour.”

The closer the candidates’ feelings, emotions, beliefs and values are to the manager’s (in the job situations nominated), “the better the candidate is for the job”, Wolfe says. “The greater the difference in attitudes to the job… the more unsuitable the candidate is for the position.”

When a manager selects a candidate whose attitudes match their own, they are hiring a person who naturally communicates on their wavelength, Wolfe says.

“The words you use, and the implications of your words, will have the exactly same meaning and motivation for the candidate as they do for you, and vice versa. Appointing this candidate immediately increases your own personal efficiency and effectiveness as a leader and manager. Your communications with the candidate in the position are simpler, clearer; you quickly establish trust, positive motivation, and team spirit. Within a few days you feel you have known the candidate for months, or even years.”