Three subjects combined into one post today. They're connected, and you'll see how as you read.
(1) The Truth About Frames
As I've mentioned before,
I spent a good deal of time in 2003 doing debriefs with business
colleagues after major presentations (my own and others') to assess
just how much knowledge was imparted, and how accurately: My conclusion
was that almost no knowledge is transferred during business
presentations, and not much during business meetings, either. That got
me reading about frames, the mental mechanisms, lenses and filters
through which we internalize what we see, hear and otherwise sense.
George Lakoff has argued that different frames account for the
inability of liberals and conservatives to communicate effectively with
each other (or change each other's minds), and that to bridge the gap
you need to reframe an issue in a way that is understandable to your
adversary, and which also allows them to see a different perspective
'through new eyes'. He puts it this way:
Frames trump facts. All of our
concepts are organized into conceptual structures called "frames"
(which may include images and metaphors) and all words are defined
relative to those frames. Conventional frames are pretty much fixed in
the neural structures of our brains. In order for a fact to be
comprehended, it must fit the relevant frames. If the facts contradict
the frames, the frames, being fixed in the brain, will be kept and the
facts ignored.
So if we want to persuade people that a zeal for natural solutions and
a reverence for nature is an essential part of the solution to the
world's problems, for example, we need to get people out of their
anthropocentric (humans-as-separate) frames and create a new, credible
ecocentric (humans-as-intrinsic-part-of-all-life) frames. Until we do
so, we'll be seen as romantics, hopeless idealists, neo-survivalists,
even anti-humanists. And if liberals want to persuade conservatives of
the value of universal health care and universal high-quality
education, they shouldn't be trying to appeal to conservatives' sense
of fairness and egalitarianism (these are liberal constructs) but
rather to fundamental moral principles: "Working
people shouldn't be living in poverty" and "Everybody should have
health care." And rather that talking about the minutiae of Kerry's
programs in these areas, they should be hammering the Bush record using
'grammar' that conservatives relate to: "We're weaker in education, and
here's
why. We're weaker in health care,
and here's why..." A similar approach is needed to bridge the gap
between management frames and labour frames, between male frames and
female frames, between theistic frames and agnostic frames. In fact,
every individual has unique frames, that translate, ignore, or
misconstrue the vast majority of what he or she hears from others. It's
amazing that such dysfunctional communication doesn't cause more
catastrophic consequences in business than it does, and it explains why
repetition, to the point of being annoying, and many redundant
conversations, are needed before important views, ideas and perceptions
are imparted and understood. It also explains why so many couples keep
arguing over the same things, again and again, without resolution. They
might as well be speaking to each other in different languages. In many
ways, they are.
Reframing issues is a precarious and challenging process. It's not a
job for amateurs. But there is a simple and subversive way to reframe
an issue: Tell a story. The
story should have a moral, but it is not necessary (and it is sometimes
unwise) to state the moral explicitly. The more I study and learn about
stories and narratives, the more awesome and powerful I perceive them
to be.
My personal action plan to help prevent social, economic, political and
ecological collapse of our planet by the end of this century currently
includes these three things:
- Completing and publishing my utopian novel, The Only World We Know, to tell a story about a better way to live.
- Forming a think-tank, tapping into the Wisdom of Crowds, to
come up with ways to achieve this better way to live, to get there from
here.
- Working on two specific initiatives, resulting in the
establishment of Model Intentional Communities and a powerful network
of Natural Enterprises, that to me, intuitively, have to be part of the
road to this better way to live. Specifically, I want to teach people,
especially young people, how to set up MICs and Natural Enterprises
successfully, and how to network these brave experiments with others.
But I've become aware that making the transition to that better way to
live is going to require billions of people to 'buy in' and be totally
committed to a radically different philosophy, politics, economics, and
social framework than the one we have been brought up to believe in.
And I'm aware that some of the steps that may be needed to get there
will be difficult and confront long-standing taboos -- in fact I know I
have lost some otherwise-sympathetic readers by merely mentioning the
possibility of some of these steps, as a last resort.
Clearly I need to reframe these arguments and possibilities in ways
that are less controversial, confrontational, and off-putting to
people. I'm beginning to believe that my novel is just the first of a
whole series of stories I need to craft, if I have any hope of being
credible and successful as anything more than an off-the-wall thinker
who got a lot of other people thinking about the need for radical
personal, social, political, technological, educational, and economic
change, but couldn't persuasively articulate how to get the job done.
Progressives who care about the state of our world are going to have to become expert
story-tellers, very quickly. I'm vowing to learn, and then to teach,
that art, as a fourth major program to add to the three bulleted above.
So look for a lot more about stories and narrative in the future in How
to Save the World. Maybe we can learn together.
(2) The Truth About Drug Costs
In this week's New Yorker, Malcolm Gladwell smashes
a lot of the prevailing wisdom about the skyrocketing cost of drugs.
Here's a synopsis, but please read the whole article if you have time,
and if you haven't subscribed to the New Yorker yet, this should convince you.
- Shortly before its patent for the enormously expensive and
profitable heartburn medication Prilosec was to expire, pharma giant
AstraZeneca concocted a scheme to get patent approval for a virtually
identical drug, Nexium, and then spent half a billion dollars in one
year very successfully hoodwinking patients and care-givers into
prescribing it as an 'improved' medication -- at $120/month/patient --
instead of the patent-expired over-the-counter Prilosec (now
$20/month/patient, to compete with generics).
- Marcia Angell, former editor of the New England Journal of Medicine, has a new book out (The Truth About the Drug Companies)
that uses the Nexium story, and others, to charge the "troubled and
corrupt" drug industry with overcharging, deceptive research, poor
quality products, stealing most ideas from government-funded
scientists, and bribing doctors with gifts, and of being "primarily a
marketing machine to sell drugs of dubious benefit." Big pharma is extraordinarily profitable, with an ROI unmatched in any other sector of the economy.
- Angell also criticizes big pharma for spending too much
producing and publicizing me-too imitations of competitors' profitable
drugs, instead of on needed, but probably less profitable, new drugs.
- Gladwell says Angell oversimplifies the problem by blaming
the pharma companies alone. He also blames: (1) doctors who don't do
their homework and prescribe expensive medications instead of
inexpensive alternatives with essentially the same efficacy [this
practice is illegal in Canada -- doctors must justify any prescription
for a specific brand where a lower-cost generic is available, in the
absence of which the pharmacist is compelled
to fill the prescription with the lowest cost equivalent]; and (2)
insurance companies, which could institute policies for coverage
similar to Canada's policy for pharmacists -- and only pay for the
cheapest equivalent.
- Gladwell says once drugs patent protection period expires,
competition among generic providers is so fierce that Americans
actually pay less than other countries for them; only drugs still
covered by patents are cheaper in Canada and other places.
- Gladwell also argues that what has contributed most to the
double-digit annual increase in aggregate drug costs is not price, but
the skyrocketing number of people being prescribed more drugs, higher
doses and more 'cocktails' of combinations of drugs. By contrast, the
double-digit increase in hospitalization costs is due entirely to the
increase in the price per patient per day, not to more patients or
longer stays. In fact, there are studies suggesting that doctors
actually under-prescribe drugs compared to what is recommended in
National Institute of Health guidelines, so the suggestion that doctors
are pill-pushers is also somewhat dubious.
- Another factor to blame that Gladwell hints at, but does
not specifically suggest (but I bet he's researching it as we speak) is
that Americans are actually getting sicker, due to contaminants and
poisons in food, water, and air.
- A new class of health-care workers called Pharmacy Benefit
Managers are now mitigating drug costs by drawing up and circulating
lists of equivalent, cheaper drugs and treatments, to employers and
insurers. That's more aggressive than just determining chemical
equivalence of drugs: For example, with Vioxx now off the market as
unsafe, PBMs are not just suggesting Celebrex as an alternative, but
much cheaper and proven non-steroid anti-inflammatories like generic
ibuprofen.
- Gladwell concludes: "It's up to us; it requires physicians,
insurers, patients, and government officials to reach some kind of
consensus about what we want from our medical system, and how much we
are willing to pay for it. AstraZeneca was able to do some chemical
sleight of hand, spend half a billion on advertising, and get away with
the 'reinvention' of its heartburn drug only because that consensus
hasn't yet been reached.
My only beef with the article is that Gladwell seems to be quick to
blame patients for being all too willing to rush into their doctor's
office after they hear ads and ask if "X is right for them". That's
asking a lot from patients who are dismally ignorant of medicine, prone
to overdependence on their doctors, and gullible when they're worried
about the health of loved ones.
(3) An Obscene Story
Also in this week's (Oct. 25th) New Yorker is writer Susan Sheehan's
heart-rending account of the life of Cassie Stromer, a 76-year-old
widow living in Virginia who personifies perfectly America's poor in
this age of disappearing middle class. I can't summarize this story,
you need to read it in its entirety. And, alas, it's not available
online. It's only 7 pages, so please seek it out in your store or
library. This is a story everyone needs to hear. Her annual pension
income is $9600, which puts her $300 over the poverty level and
disqualifies her from full Medicaid benefits. Much of her income goes
to pay for medical expenses, and the way she budgets her money so
carefully and lives a meagre but dignified life is nothing short of
heroic.
So why is this story obscene? Here's the last few sentences, which speak for themselves:
This May, Cassie got some good
news. Because of a formula involving her medical expenses, her rent was
being reduced from $72 a month to $42. In September, however, she
received a notice from the state telling her that her $58 Medicare
premium would no longer be covered, meaning she would have to pay it
herself. Earlier this month, Cassie's lower denture broke again. "This
time it's shattered", she says, "It's harder to eat now. I can't really
chew anything." She has to cut up her food into small pieces. She says
there's nothing she can do about it. "I don't have any more money today
than I did last February, and I won't have any more tomorrow."
Meanwhile,
the f***ing politicians, bargaining in backrooms for favours
for their corporate donors and friends while drinking expensive
champagne and fifty-dollar entrees paid for by taxpayers, continue to
spout the rhetoric that "most" Americans have good health care, and
that it would be "too expensive" to provide universal health care to
all, while insinuating that abuse of the system is widespread and that
those that don't have coverage are somehow responsible for their own
misfortune. Cassie's story belies these cynical and horrendous claims.
And the fact that so many brave and proud Americans, tens of millions
of undeserving poor with stories like Cassie's, are mere pawns in this
rich-man's debate, is what's obscene.
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