LETTERS FROM THE GLOBAL PROVINCE

GP 15 November 2006: The Devil Really Is in the Details

Giving the Devil His Due.  When Tom, Dick, or Harry says, “The devil is in the details,” he means that we can come up with grand agreements in principle or sketch out grandly conceived schemes to give us cheaper electricity or better education, but it’s all for nought unless you can get the pesky little details straight.  Of course, this is a salute to engineers, programmers, bureaucrats, and the whole fraternity of process thinkers who take special joy out of dotting i’s and crossing t’s.  They do get the smallest things straight so that the trains can run on time and semi-reliable financial reports can come out with some regularity. 

In our work, however, we discover that the details are the devil incarnate.  That a Rumsfeld gets so deeply into micromanaging that he forgets that he has to win a war and create a peace.  We fall in love with the details, and forget what we are trying to do.  The details get in the way. 

That an itsy bitsy robot or humanoid somewhere in Asia designs a VCR or a cellphone that has a billion functions, breaks easily, is overpriced, is hard to operate, and, in the case of the cellphone, as oft as not leads to crummy calls that are full of static even when they get completed.  In fact, the quality of our cellphone has declined with each new ‘improvement’ that the cellular companies have baked into their gadgets.  Sure, “the devil is in the details,” and he just loves them, because they lead to disastrous failures. 

All sorts of people have figured this out that complex systems aren’t so great.  The great Norbert Weiner said as much in all his musings about cybernetics.  We had a go at this idea in “Systems on the Edge of a Nervous Breakdown.”  In Augustine’s Laws,  the amusing Norm Augustine, who knew the ways of governments, corporations, and technology, told us that the more electronics (complexity) we put in airplanes, the more they will break down, all the while racking up exponential increases in cost for both purchase and maintenance.  The details, it seems, take us right off the runway. 

Media Madness.  We had a fun illustration of this last week.  We spent time with a little media company (not one of our largish media clients), which exhibited all the arthritic symptoms characteristic of the industry.  Many media enterprises have become has- beens, cash cows that private equity companies like to purchase, instead of growth companies that are the darlings of public investment markets.  The 30 or so staffers we met were absolutely first-rate, nice people whom you would welcome as neighbors.  However, like Mr. Rumsfeld, they did not know what they were up to.  There was incredible hand-wringing over details and distractions.  But they could not face up to the fact that they were not putting out a good product and that their distribution system was quite broken.  In media, you have to be in touch with your audience, create something of compelling interest, and then press the product against the eyeballs or eardrums of the consumers you want to reach.  We can’t think of a media company that’s got that right, although some of the very retail-religious congregations come close.  Media is about connectedness, but most of the media-ites are very disconnected. 

Before that, we had met with some folks that had created a business out of linking people together for fun and profit: the goal was good conversation.  And afterward, we visited a spice shop where the owner knew for sure he had to get the right stuff and get it sold to people of taste.  Both understood what it takes to form a connection. 

Counter Rhythm.  What’s up here?  A lack of intuitive understanding about how to deal with complex phenomena.  There’s a saying, “If, all about you, people are losing their heads and you are a sea of calm, then you must be out of your mind.”  But this is not so.  The strategic individual must learn, time in and time out, to swim upstream.  If you find yourself dealing with a complex thicket, then it’s time to take out the shears, and make things manageable and simple.  Otherwise, you will never get from Point A to Point B. Conversely, if you are dealing with something rather simple, then your mission should be to add meaningful complexity. 

Healthcare Awry.  Nowhere is this more apparent than in our hopelessly complex healthcare system.  This nation, along with several other nations for that matter, actually gets sicker, the treatment schemes get more obtuse, the health bill gets more outrageous—as the days go by.  We do not know of a single initiative (save the gradual drift towards more preventive medicine) that promises to relieve the pain, all the nostrums being hopelessly complex both to understand and implement.  It’s now very commonly admitted that about 1/3 of all healthcare expenditures are useless or worse, and, as we look harder into this, we think the 1/3 is probably a low, very theoretical estimate.  Healthcare, at 15% of GNP and growing daily, is sucking the life out of our economy.  All the actors in the healthcare drama—doctors, drug and medical equipment companies, insurers, hospitals—relentlessly add complication to the system, each feathering his own nest. 

Amidst this mess, it’s the simple things that work, and they merit your attention. 

Checking Out Your Health.  Harvard has just put up a website called “Your Disease Risk.”  It comes from the School of Public Health, which is not hugely innovative, so we are delighted to see it sponsor something as simple and imaginative as this website.  What you do here is check on your risk for a major disease: heart ailments, cancer, diabetes, etc.  It’s a bit better than other sites attempting the same thing, tackling a few more diseases and, even more importantly, adding in more variables as it calculates your health profile.  You will note when you go to the site that the webmeisters tell you that it is running a little slow, because the usage has been so high.  In fact, American consumers have been waiting for something like this.  Eventually, however, the poobahs will have to improve this site’s quality and conquer its distribution problem, which means getting everybody to use it—the traditional dilemma of the public health industry. 

As we have said in “Lost Treasures,” schools of public health don’t do a very good job dealing with the health crises in their own backwards.  This is an example of what they have to do to pay back the communities where they live. 

Beating Super Germs.  It’s not a nifty thing to go to the hospital these days, because it may just kill you.  We’re not talking about Duke University, which can manage to put the wrong heart into your chest.  Rather, we’re talking about germs and supergerms: people have been dying almost like flies because they catch a bug in the hospital that does them in.  The major drug companies have shied away from developing new antibiotics, so there are germs wandering around that we cannot kill.  Basically the biggest and best thing we can do to deal with soaring hospital infections is to get everyone to wash their hands.  Easier said than done. 

What’s important to understand is that the doctors’ hands are filthy.  You can read about the 95% success rate on containing infection at John Hopkins and not get the point graphically enough.  In “Stitch in Time” this week we discover it on the West Coast.  Cedars-Sinai turned its nurses into spies in order to get its workers to wash up.  It got 80% compliance.  But that was not good enough.  The doctors were the horrible offenders.  So it took micro photographs of hands that showed the colonies of bacteria clustered there: these photos became the screensavers on every computer in the hospital.  Lo and behold, the doctors learned that it might be a good idea to wash their hands.  As is the case so often, the experts were not the solution to the problem.  They were the problem. 

Bacteria Abound.  In fact, germs are on the loose—and account for more than you imagine.  We are learning that infection has a lot to do with heart disease, and that we should not rely on the simplistic notions that came out of Boston that long focused solely on cholesterol.  Tersely stated, the Framingham studies are simple-minded.  Other factors play an important role in heart problems.  Infection shows up in heart disease, and we suspect it will eventually rear its heads in Alzheimer’s and other esoteric ailments.  It’s bacteria, you know, that finally were identified as the cause of ulcers.  For generations doctors had blamed them on bad eating, psychoses, stress, and gosh knows what else.  It took a couple of Australian doctors who had nothing to lose to wipe away all the half-baked theories pushed by the medical establishment and get it right.  A little antibiotic and some stomach medicine was all sufferers needed to fight off their pylori. 

The medical establishment and the drug companies may have fouled up the cure.  They have come up with a high-powered, but expensive treatment now that goes too far.  It overkills bacteria in your gut, even doing away with the good stuff.  This is one of the deep and pervasive ethical problems of modern medicine—overkill.  We suspect that we will eventually have to cure the so-called ‘platinum’ treatment now offered for ulcers. 

The Ghost Map.  Steven Johnson is just out with The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World.  In 1854 residents of Golden Square started dying like flies.  The authorities knew it was cholera, but did not have the foggiest notion of how it spread, thinking that the disease traveled around in the air.  John Snow, a doctor, and Henry Whitehead, a minister, figured it out, laying it down to contaminated water.  It’s amazing what a little clean water can do.  The health of nations depends on a few simple but widely understood thoughts. 

Too Soon to Say Goodbye.  The comedic Art Buchwald is out with a little memoir on his failure to die.  In February 2006 he was due to have his foot and leg amputated because of blood clots.  Moreover, his kidneys were failing, because of the dyes that had been used in an angiogram.  So, legless, he could look forward to spending his final days hooked up to a dialysis machine.  What he did was to skip the machine and move out of the critical care ward into a hospice, vowing to go out with a smile.  But instead he’s lived on, the kidney complaint marvelously reversing itself.  Everybody has come to pay last respects, but, being disrespectful, he has refused to die. 

Healthcare, at best, is an imperfect system that makes a lot of mistakes.  It behooves citizens to join Buchwald in laughter and to use more commonsense than the system affords in tending to their health. 

P.S.  Thanks for your several thoughts about how our newspapers and media can cure themselves.  We got a host of bright ideas.  We liked best the note from one lady who said the best thing that could happen to newspapers is for mass transit to flourish.  She does her reading in the bus.  You car riders are hopeless illiterates. 

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