"Hatred corrodes the container it's carried in..."

Former U.S. Senator, Alan Simpson, spoke at President George H.W. Bush's memorial service a few weeks ago and said something that really resonated with me.  Simpson talked a lot about what kind of person our nation's 41st President was, as well as how he lived his life.  He said of Bush, "He knew what his mother and my mother always knew: hatred corrodes the container it's carried in." 


That was the first time that I've ever heard that saying specifically, and unfortunately I don't know where it came from.  Mark Twain supposedly once said, "Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured."  It probably doesn't matter who said it or where it came from as much as what is says.  The message is a powerful one, especially given how prevalent hatred is in our world today.


We could (and we should) learn a lot from Simpson's quote.  There are so many problems in our world today that we need to solve - and we will only be successful at solving them if we join forces, hand in hand, and work together.  Hatred does not solve any problem.  Rather, hatred creates new ones.  As the Buddha once said, "Hatred does not cease by hatred, but only by love; this is the eternal rule."


We may disagree with someone's opinions, beliefs, choices, or even lifestyle.  So what?  That doesn't mean that we can't treat one another with kindness, compassion, and understanding.  Just because we don't agree on how to solve the problems of today (we may even not agree on what those problems are) doesn't mean we should be disrespectful, mean, or bitter.  Big problems are hard problems.  Big problems require big solutions.  And big solutions are hard solutions.  Hatred is not the solution.


If we hope to find success, and if we want to be respected, appreciated, and loved, we need to avoid hatred.  At all costs. 

"Let There Be Peace on Earth"

I recently sent out a message via Twitter, referencing a recent New England Journal of Medicine article called "The major causes of death in children and adolescents in the United States."  There was a graph in the article that showed the dramatic drop in these deaths from motor-vehicle accidents especially, as well as some of the other common causes of childhood deaths (cancer, congenital heart disease to name but a few).  What was interesting was the increase in deaths from firearm-related injury.  Notably, the deaths from firearm-related injuries have increased in other age groups as well, but only in the United States. 

In the tweet, I made the comment, "If this doesn't disturb you, then nothing will" and added the hashtag #ThisIsMyLane (notably, this hashtag has gone viral, as many physicians in the last month have made the correct claim that firearm-related injuries are a public health issue that physicians absolutely have the right to address).  Of course, the hashtag caught the attention of a few gun rights activists.  One in particular made some comment questioning my intelligence as well as those who would believe the data I referenced.  The reply made me think - why is it that we can no longer disagree with someone without insulting them?  Why do we have to be immediately offended by anyone who questions our political views, values, or beliefs?

We have lost the practice of civil discourse in this country.  Perhaps we never truly had it, but I think most of us would agree that things are much worse now than in the past.  I don't think we can blame our current political leadership (although they have certainly contributed) - the blame rests solely on all of us.  We are to blame.

If we are ever going to have peace and justice in this world, it has to start with all of us.  I am reminded of a Christmas carol, called "Let there be peace on earth" that really is rather poignant.  The lyrics go like this:

Let there be peace on earth
And let it begin with me
Let There Be Peace on Earth
The peace that was meant to be

With God as our Father
Brothers all are we
Let me walk with my brother
In perfect harmony.

Let peace begin with me
Let this be the moment now.

With ev'ry step I take
Let this be my solemn vow
To take each moment and live
Each moment in peace eternally
Let there be peace on earth
And let it begin with me

It really makes perfect sense.  Peace begins with each of us as individuals.  And if we want peace, it has to start with civil discourse.  Go ahead and have that conversation with someone who doesn’t necessarily agree with you - we should be having that conversation.  We need to have that conversation.  Agree or disagree - it’s okay.   But always, always be respectful.  Always be courteous.  And always be kind.

May you both have peace and give peace this Christmas season.

The Innkeeper's Tale

The Christmas season is upon us.  Regardless of whether or not you celebrate the Christmas holiday, this is also the season where we close out one year and begin another.  It's a time to pause and reflect on the past year's accomplishments, as well as a time of hope for the future.  It's one of my favorite times of the year.


I always enjoyed hearing the Nativity story when our family went to church on Christmas Eve (both while growing up and even now to this day).  For those of you who are not familiar with the story, Mary and Joseph have to travel to Joseph's hometown of Bethlehem because the Roman emperor wanted to conduct a census.  Once they get there (presumably after a long journey), there are no places to stay.  Now, historians say that there weren't hotels or inns back in those days, at least what we think of hotels today, but regardless, the young couple goes to a local innkeeper to find shelter for the night.  The innkeeper tells them that there are no rooms left, but he was probably sympathetic to the fact that Mary was quite pregnant and offered the use of his stable.  Later that evening, Mary gives birth to Jesus, and the rest as they say is history.


I haven't really ever considered the Nativity story from the perspective of the innkeeper.  I am not really sure why that is the case, as you could certainly argue that the innkeeper played a crucial role.  For example, imagine if the innkeeper refused to offer Mary and Joseph the use of his stable.  What would have happened then?  Thankfully, that is not what happened.  The innkeeper offered the use of his stable, which was better than nothing.  And that, my friends, is an incredible gift.  The innkeeper saw someone in need, and he gave them shelter.


I have been reading a lot lately about something called effective altruism.  Basically, effective altruism, in a broad sense, is evidence-based charity or giving with the goal of having the greatest possible positive impact on the greatest number of individuals.  The movement was founded by the philosopher Peter Singer, Facebook cofounder Dustin Moskovitz and his wife, Cari Tuna, professional poker player Liv Boeree, and Oxford researchers William MacAskill and Toby Ord.  William MacAskill recently gave an interview for the "Daily Stoic", and his TED talk now has over one million views. 


There are two fundamental tenants of effective altruism.  First - we have both an obligation and duty to help other people.  Just as the innkeeper in the Nativity story, we should always be ready to offer our assistance to those in need.  Second - we should try to have the greatest impact on others in need by being effective and efficient.  And, when it comes to helping others - even complete strangers - the members of this movement definitely put their money where their mouth is - MacAskill made a commitment in 2009 to give every dollar of his income over $30,000 each year to charity!


Not everyone is willing to make the same kind of commitment that MacAskill has made, and that's perfectly okay.  However, I think we all have an obligation to lend a helping hand to those in need.  Whether it's through our time, talent, or treasure, we can all make a difference.  There are so many problems in the world today, and our help is desperately needed.


There are a number of great resources available to help you decide where to invest your time and energy.  Charity Navigator is an organization that evaluates charities (in terms of how effective they are, how much money they spend on administrative fees or advertising, etc) in the United States and is a great place to start.  Similarly, Give Well also analyzes charities and other giving opportunities to help you decide where your money can have the greatest impact.  The organization, 80,000 hours (so named because we will spend 80,000 hours at work over our lifetimes) provides information on careers that have high-positive impacts.


In this season of giving, this season of hope, let us all remember that there are people in this world who are in desperate need of our assistance.  Let us all remember the words of Carl Satterwhite - "You give to get to give!"  Give.  Advocate.  Volunteer.  And be like the innkeeper of old.

"All that is gold does not glitter"

I can't remember exactly when I first picked up the book, The Hobbit by the author, J.R.R. Tolkien.  All I can say is that once I read it, I was hooked.  For life.  I soon moved on to Tolkien's The Lord of the Rings trilogy, which I confess I must have read at least 10 or so times during my childhood and adolescence.  In addition to being a great writer and philologist (philology is the study of languages in both written and oral forms), Tolkien was a gifted poet.  One of my favorites was a poem called, simply enough, "All that is gold does not glitter", or alternatively, "The Song of Aragorn."  The title (and first line) is borrowed from William Shakespeare's play, "The Merchant of Venice" (which, in turn, is taken from an ancient proverb similar to the phrase, "You can't judge a book by its cover"). 


Tolkien's poem is referring to the character, Aragorn, known in the first book of the trilogy, by the name, Strider.  Here is the text of the poem:


All that is gold does not glitter,
Not all those who wander are lost;
The old that is strong does not wither,
Deep roots are not reached by the frost.
From the ashes, a fire shall be woken,
A light from the shadows shall spring;
Renewed shall be blade that was broken,
The crownless again shall be king.


Simply put, the character Strider is a much more important character than he first appears.  He is infinitely more than he looks.  He is, to borrow another well-worn phrase, a diamond in the rough.


There was a recent article in the magazine, Strategy+Business called "The Four X Factors of Exceptional Leaders" that I think is appropriate here.  The article begins with an analogy involving the National Football League's scouting combine.  Every February, college athletes go through a series of skill tests and drills (e.g., 40 yard dash, vertical leap, bench press) and personality assessments in front of team owners, coaches, and scouts to determine if they have what it takes to be successful players in the NFL.  Not every player who scores exceptionally well on these tests goes on to a Hall of Fame worthy career - indeed, some never make it after training camp.  Moreover, not every Hall of Fame player was identified by the combine either.  So, you could argue (as some have) that the tests that are used at the NFL combine don't have a lot of predictive value.


So the logical question then - how effective are we at predicting the success of our leaders?  Can we use a set of processes or tests to identify which individuals will be great leaders?  Does having a certain background or set of credentials predict success for, say, a hospital CEO?  As the Strategy+Business article points out, there is an inherent bias (first described by the cognitive psychologists, Daniel Kahneman, Paul Slovic, and Amos Tversky) here that is called the illusion of validity.  As the authors of the article state, "this error arises when organizations use the profiles of historically successful leaders within the business to assess the traits of current candidates" for leadership positions. 


There are certain qualifications or skills that many boards of directors view as "table stakes" (previous CEO experience, articulating a vision and having a strategic mindset to accomplish it, executive-level "presence", and financial acumen, typically demonstrated by previous P&L experience).  The question then is whether these are really "table stakes" - do checking the box off on a checklist of typical "CEO-level attributes" necessarily predict whether someone will be a great CEO.  The authors argue not.  Instead, they identify four so-called "X factors" of exceptional leaders, listed below (not necessarily in order of precedence):


1. They simplify complexity and operationalize it.
2. They drive ambition for the whole enterprise.
3. They play well on teams they don't lead.
4. They build leaders.


Not a bad list actually.  And, by focusing on the classic "table stakes", we may miss out on that "diamond in the rough" or the ranger who will become king.  If we don't recognize that "all that is gold does not glitter" - we miss out on someone who can and will be an incredible leader.

"Sometimes it rains"

There was a great movie about baseball that came out in 1988 called "Bull Durham", starring Kevin Costner, Susan Sarandon, and Tim Robbins.  It happens to be one of my all-time favorite sports movies.  Robbins' character, Ebby Calvin "Nuke" LaLoosh has a memorable scene at the end of the movie where he leaves us all with a great quote (he actually borrowed the quote from Costner's character, Crash Davis) that goes like this:


A good friend of mine used to say, "This is a very simple game.  You throw the ball, you catch the ball, you hit the ball.  Sometimes you win, sometimes you lose, and sometimes it rains."  Think about that for a while.


"Sometimes it rains."  Well, isn't that the truth?  I think what Nuke is saying here (and I think he surprisingly got Crash's point here too) is that things don't always go your way.  Sometimes you win (or succeed).  Sometimes you lose (or fail).  Sometimes there are sunny days.  Sometimes there are rainy ones.  It really doesn't matter.  What truly matters is you - your attitude, your perseverance, and your resilience.


I suspect that most of us enjoy sunny days far more than the rainy ones.  Rain has certainly been used as a metaphor throughout the ages, but the metaphor is often a complicated one.  For example, I don't think anyone would question that dark, dreary days filled with storm clouds, thunder, lightning, and rain are often used to symbolize feelings of sorrow, loss, failure, despondence, and gloom.  However, there is a deeper meaning to the rain here.  The rain itself often symbolizes healing and rebirth.  Note the common sayings, "Let the rain wash away the pain of yesterday" or "You can't have a rainbow without the rain."  Rain, at least as used here, provides a kind of spiritual cleansing.


I am reminded of a Led Zeppelin song called, simply enough, "The Rain Song".  There is a stanza at the end of the song that goes like this:


These are the seasons of emotion
And like the wind, they rise and fall
This is the wonder of devotion
I see the torch
We all must hold
This is the mystery of the quotient
Upon us all, a little rain must fall


In other words, you can't have the sun without the rain, or at least you can't appreciate the sun without living through the rain every once in a while.  Rain again is life-giving.  It means renewal and rebirth.  We appreciate the bad, as well as the good.


So, next time you are dealing with a frustration in either your personal or professional life, remember that you have to experience the lows to really, truly enjoy the highs.  The next time you fail to get that new position or promotion, remember to be grateful for the job that you currently have.  The next time you receive negative feedback or a formal letter of complaint, remember the times when you received a letter of thanks or positive feedback.  In other words, remember Nuke LaLoosh.  Remember "The Rain Song."  Remember, "sometimes it rains..."

A Big Red X

It's about that time of year again - you know, the time when everyone (well, almost everyone) starts talking about their New Year's resolutions.  I am just like everyone else in this regard - just to prove my case, I started this whole blog as a New Year's resolution!  However, unlike the vast majority of resolutions that I have made, we are still going strong with this one.  In fact, nearly 80% of New Year's resolutions fail by the month of February!  Another commonly cited statistic suggests that only 8% of all individuals stick to their resolutions.  So, what do the experts have to say about what we all should be doing to keep our resolutions?  As it turns out, they have a lot to say.  These sure-fired ways range from the simple to the complex.  I have found a trick that has worked very well for me, and it's surprisingly easy.

Several years ago, I set a goal to lose weight by eating less and exercising more.  I was looking for ways to track both my calories consumed and my calories burned.  I ended up using a free app called My Fitness Pal.  There are a number of apps that are freely available, so I am not saying that you should use this one in particular.  However, one of the features that "My Fitness Pal" uses that I found extremely helpful is a "Days Streak" - in other words, every day that I logged either my diet or exercise, I received credit.  After several days, I had built up a streak of consecutive days that I used the app.  As the number of days in my streak increased, I felt this unbelievable pull to keep going in order to maintain my streak.  Letting the streak get back to zero was just not an option that I found acceptable.  At one time, my streak was well over 600 days!

Only this past year, I decided that I wanted to teach myself to read, write, and converse in German.  I really had no particular reason other than wanting to learn to speak a different language.  I thought that it would be easier to learn German, as I had at least some knowledge of the German language from taking it in high school and college.  I used an app called Duolingo - it's another free app that basically helps you spend as little as 5-10 minutes per day writing, speaking, and listening to German.  Again, the app has a built-in feature of a "Days Streak" - again, there is an unbelievable pull not to let the streak fall to zero!

A few years ago, the actor and comedian, Jerry Seinfeld, admitted that he too used the "Days Streak" method to meet the goal of writing comedy every day.  Comedy is just like everything else - it requires practice.  Every year, Seinfeld would buy a calendar, and every day that he practiced comedy, he would draw a big red "X" on the calendar day.  He found, just as I did, an unbelievable pull to continue the streak of big red X's on the calendar. 

I am not saying that this method will work for everyone.  Admittedly, it's not always worked 100% perfectly for me - witness that my current "My Fitness Pal" streak stands at 50 days and my current "Duolingo" streak stands at only 4 days.  However, I am here to tell you that there is a huge weight off my shoulders every day when I am able to see the streak counter on both these apps increase by one!  It's just like a big red "X."

So, this year, for your own New Year's resolution, try Seinfeld's "big red X" method and see if it works for you.  It may not work, but if it does, you may find that you are losing weight, exercising more, writing a blog, or even learning to speak German!

Auf Wiedersehen and Viel Gluck!

Our National Embarrassment

The Centers for Disease Control and Prevention (CDC) released a statement on November 29, 2018 stating that the U.S. life expectancy had declined again for second time in three years.  According to CDC Director, Robert R. Redfield, MD:


The latest CDC data show that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide.


Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.


CDC is committed to putting science into action to protect U.S. health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.


According to the most recent statistics (the full report is available on the CDC website), the average U.S. citizen will live to about the age of 78 years (though the average life expectancy declined from 78.9 years in 2014 to 78.7 years in 2015 through 2016, with a further decrease to 78.6 years from 2016 to 2017, the most recent year for which these statistics are available).  The age-adjusted death rate increased overall by 0.4% from 728.8 deaths per 100,000 population to 7321.9 deaths per 100,000 population (see CDC brief), with the age-specific death rate increasing in the 25-34, 35-44, and 85 and over age groups (there was a decline in the age-specific death rate for those 45-54 years of age).  Notably, the decrease in life expectancy is occurring at a time when the life expectancy in almost every other country in the world is increasing!


These statistics should be alarming to everyone who calls the United States home.  We are, after all, the United States of America, the world's largest economy (a position that the U.S.A. has occupied since 1871) with a Gross Domestic Product (GDP) of approximately $19 trillion in Purchasing Power Parity (PPP).  Unfortunately, we rank 45th for average life expectancy out of more than 200 countries for which this statistic is available (of interest, the U.S. territories of Guam, Puerto Rico, and the U.S. Virgin Islands rank higher than the U.S.A. as a whole).  If you want to live a long life, move to Hong Kong which ranks first overall with an average life expectancy of 84.5 years. 


There is another side to the story that Dr. Redfield calls out in the CDC's press release above.  The number of Americans who are losing their lives to opioid-related deaths and suicides continues to increase rapidly.  The age-adjusted death rates from drug overdoses increased by 9.6% compared to 2016, while the age-adjusted suicide rate increased by 33%! 


We should be embarrassed by these statistics.  What is concerning is that these trends really aren't all that new - the opioid crisis has received incredible attention in both the lay press and medical literature for the past few years, while suicide has been the 10th most common cause of death since at least 1980.  Consider also that accidental deaths have held a solid place in the top 10 list of causes of death.  Moreover, many of the most important risk factors for the top four causes (heart disease, cancer, stroke, and COPD) can be modified with changes in lifestyle (see an important article from Dr. Ralph Keeney at the Fuqua School of Business at Duke University, "Personal Decisions Are the Leading Cause of Death").  For all of the criticisms against the U.S. health care system (some that are completely justified), we could find as much fault with our (lack of) social safety net and an insufficient focus on the social determinants of health.


So what is the take-home message?  While two data points does not make a trend, our nation and our industry should be very concerned about these statistics.  Here is our rally point, where we begin to look to turn things around before the numbers become a trend.  Health care organizations can't do it alone, but we certainly need to do a better job investing in the social determinants of health.  As Major Dick Winters (from one of my favorite TV series "Band of Brothers") said, "If you're a leader, you lead the way.  Not just on easy ones, you take the tough ones too."  Health care organizations need to "lead the way" on this issue.  We will need to work with the local, state, and federal government, as well as nonprofit organizations and other advocacy groups to address these issues.  It will take work, but the rewards will be worth it.