LETTERS FROM THE GLOBAL PROVINCE

GP 12 October 2005: Lorenzo's Oil

Strategic Alliances.  We visited this week with one of the world’s most agile entrepreneurs who has put together a turbocharged company that’s ever accelerating inside an economy that’s not firing on all cylinders.  Four or five goliaths have tried to buy him out, but, after brief flirtations, he has turned them down.  Instead, he has made them into customers, forging joint ventures where he uses their market presence to open up brand new niches for his business.  As well, he has forged close dialogues with both foundations and academia.  This very much fits our theory that freewheeling, handshake alliances are now the only way to create value in the global game of business.  He and his shareholders and employees will do very much better because he has not merged himself into an arthritic mega-corporation. 

This is not an original thought.  In penning an article about strategic alliances this week, we were reminded of an essay Peter Drucker wrote back in 1999 about the merger boom.  What he had to say then was that there wasn’t any boom, that the mergers and de-mergers actually just about cancelled each other out, adding up to a zero sum game economically. 

Instead, said Drucker, the signal business development of our era had become alliances, partnerships, joint ventures, informal cooperation—an agreement to do things together, however named, where nobody owns the other guy.  This free-form, fluid relationship  between companies became the global rainmaker in the last 20 years of the 20th century, and the only problem was for captains of industry to adopt a new mindset where big things got done because nobody was king and everybody was treated royally.  In some ways, Von Neumann’s Game Theory might lead us to believe that this kind of kinship is the only way we can hope to win on a global canvas where there are so many unknowns and so many players (http://cse.stanford.edu/classes/sophomore-college/projects-98/game-theory/neumann.html).  What we are learning in the global knowledge economy is that the rules of scale are being turned on end: for both enterprises and nations, small is better, while an extended network is all important.  Large-scale enterprise only endures because of monopoly power allowed by an imperfect marketplace, not because of economic vitality.  David is simply better than Goliath.  If this view is correct, we will be not measuring companies by the weight of their balance sheets in the future but by the quality of their global relationships.  GAAP—generally accepted accounting principles—have become next to worthless, a hopelessly outmoded measurement system. 

This looser model, incidentally, has not only become a formula for business to business connectivity.  Increasingly, it describes the neurological pathway between workers as well.  The very humanistic English business thinker Charles Handy remarks that some of the more advanced companies now only have 20% of their employees on their payrolls:  the rest of their workers are outside the company gates, working for themselves or outsourcing companies.  Very elastic changing relationships form the new kind of compact between company and company, worker and worker. 

Collaborative Researchers.  We think it is in the field of healthcare that one can best see why collaboration is a more productive form of association in a knowledge-intensive world than structures founded on ownership and hierarchy.  As we all know, in the doctor-patient relationship we have historically treated our doctors like oracles, have gone to their offices to let them read the tea leaves for us, and then have retreated to our  homes to take their assorted medicines.  That has worked fairly well, as long as we were not terribly sick.  But there is story after story of patients and parents of patients who have very much bettered their hopeless predicaments because they became passionately interested in the whys and wherefores of serious disease and then dramatically pushed the state of the art and the course of their treatment beyond medical dogma.  Only the afflicted bring the intensity and commitment to the party that produces astonishing breakthroughs. 

In this vein we have previously urged you to look at the websites of those afflicted with debilitating conditions because they simply work at knowing more than average healthcare workers.  Rick Mendosa wants to be the best writer about diabetes around the global quadrangle and, of course, he’s a diabetic. See Rick Mendosa’s Diabetes Directory.  As well, spinal injury sufferers are well advised to consult Matt Ginop’s Sci-Info Pages: he is a quadriplegic who created the site for himself and then decided to share his findings with fellow sufferers.  It’s an award-winning website.  Laura Landro of the Wall Street Journal is a top healthcare writer simply because she has been hit not once but twice by devastating cancer. 

As importantly, one finds that parents of young children who suddenly come down with debilitating conditions are often the best detectives and best advocates for their loved ones.  Karen Murray, president of menswear at Liz Claiborne, saw a raft of specialists about her son Michael, but none offered an accurate diagnosis.  Surfing the web, she discovered Marfan’s Disease, a rare yet common enough connective tissue disorder that turned out to be his complaint.  He was then put on beta blockers to prevent aortic enlargement.  See “En Garde.”  Likewise, the most affecting, intelligent article we have read about autism is authored by Molly Finn, parent of an autistic child.   See “All About Autism.”  

Lorenzo’s Oil.  Even the best of doctors can use the help of passionate parents.   Certainly Dr. Hugo Moser, director of the neurogenetics research center at the Kennedy Krieger Institute (www.kennedykrieger.org) in Baltimore and professor of neurology at John Hopkins University, is all of that.  In 1983 Michaela and Augusto Odone brought their 5-year son to him: Lorenzo had been diagnosed with ALD, a hereditary disease, and Moser was the world’s expert (www.kennedykrieger.org/kki_staff.jsp?pid=1841).   

Basically the very caring Moser told them there was nothing to be done and that the adrenoleukodystophy was more or less fatal.  Death was predicted in two or three years. In this disease the myelin, or nerve sheath, is damaged by a buildup of fatty acids.  The Odones refused to accept this outcome.  Learning that oleic acid might lower the fat levels, they began to add it to Lorenzo’s diet.  Augusto theorized that it would work better in conjunction with other acids, and stirred some erucic acid, a rapeseed extract, into the cocktail.  This brought down the fat levels considerably even though it did not reverse the overall condition (www.myelin.org/aboutoil.htm). Lorenzo lives on today, now all of 24, though mentally unresponsive to external stimuli. (By the way, you can read about the Odones in “The Doctor, the Father, the Movie and the Medicine,” Wall Street Journal, October 8-9, 2005, pp A1 & A8.  Having started abysmally, the weekend WSJ is now showing some promise.)  

In the course of events, after the Odones took their story to the media, a movie, which exaggerated the extent of Lorenzo’s recovery, panned the doctor, and extolled the parents, appeared nationwide to wide critical acclaim.  “Lorenzo’s Oil” created enmity between Moser and the Odones, a distance only healed after the death of Mrs. Odone of often-fatal lung cancer.  Since that time, they have become very close.  Moser authored a paper on the promising results his work yielded within a small sample population through the use of oleic acid, and generously added Mr. Odone to the credits as a co-author.  Mr. Odone now suffers from Normal Pressure Hydrocephalus and goes for therapy to the Kennedy Krieger Institute, where the remarkable Moser frequently visits him.  The co-authorship given to Mr. Odone salutes, in our eyes, the fruitful collaboration between scientist and lay person, collaboration that will, in the future, propel many of our medical advances.   

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