Friday, 26 August 2011

Orphan Brands

One misconception often held by my students is the notion that all innovation has to be revolutionary. Evolutionary change is viewed with contempt. They seem to believe that the only way to conquer the market is to devise something brand new. Blue sky thinking is rarer than we might imagine. I've written before about Apple's tendency to design things from a blank sheet of paper, but they also buy up crucial innovations as a platform on which to move forward, such as NeXt computing for a new Operating System.

Some entrepreneurs have made a lot of money from buying up neglected brands that are no longer generating large profits for multinational corporations. Their skill is in refreshing the brand by altering the packaging and relaunching marketing to boost sales and create a lucrative, steady income stream for the long term future. One product I use that was orphaned and adopted by Asian entrepreneur Mike Jatania's Lornamead company is Stergene, a hand wash liquid.

Other brands lose money because it is no longer economical to manufacture them in the West. Car brands have been bought by Chinese companies and few are now wholly owned and manufactured in Europe and the US.

'(These are).....strategic players, companies that want to expand into new areas or bulk up existing businesses. China's Sichuan Tengzhong Heavy Industrial just agreed to buy the Hummer line of SUVs from bankrupt General Motors (GM), while Penske Automotive Group, the nation's second-largest auto dealer, plans to pick up the bankrupt carmaker's Saturn brand.'

Another category that I'd include here is medication that is no longer fit for its original purpose but has been found effective for another complaint.

The most famous brand is Viagra, a medication originally targetted at angina, but was found by chance to be effective in treating erectile dysfunction.

Medical staff struggle to deal with brain cancer. Current treatments work for a small per centage of cases caught at an early stage. Other cases are merely delayed.

Researchers have identified that an old anti depressant, clomipramine, shows good results with brain tumours. A BBC Radio4 programme 'Treating Tumours: Old Drug, New Tricks' reviewed the evidence and lack of research into this treatment. As an anti depressant it has fallen out of fashion because of the side effects and been superseded by drugs such as SSRIs (the Prozac group).

As a licensed drug some cancer specialists are using where nothing else can be done for a patient, with promising results. It is cheap, the side effects are known, so clinicians argue that it's worth doing further research to check whether it's worth prescribing for this difficult condition.

Thursday, 25 August 2011

Grief and grains

2 high profile Americans are said to have consulted Dr Dean Ornish for a diet to improve their health after a major challenge.

His dietary recommendations are as follows:

* Consume 10% of calories as fat, with a ratio of polyunsaturated fat to saturated fat that is greater than 1
* Consume 70-75% of calories as complex carbohydrates and 15-20% of calories as protein
* Limit cholesterol intake to less than 5 mg per day
* Consume whole grains, fruits, vegetables and legumes in unlimited quantities
* Exclude all meat and dairy products, except egg whites, nonfat milk and nonfat yogurt
* Eliminate caffeine from the diet and consume sugar, salt, and alcohol in moderation

Bill Clinton had a heart attack and quadruple bypass surgery in 2004 and was fitted with a stent in 2010. He talked about the vegan diet that has helped him improve his heart health.

Observers, such as Dr Michael Eades, comment that Clinton seems to have lost most of his muscle mass and does not look good.

Steve Jobs has been a pescetarian for some time. Jobs had pancreatic cancer since 2004 and a liver transplant in 2009. He is reported to have consulted Ornish on a diet to beat cancer.

Steve Jobs' latest public appearance to launch the Apple iCloud service, was greeted with concern as he appeared very thin and unwell.

Few people in the forefront of research agree with Ornish. There is still much debate about appropriate macronutrient ratios, particularly protein and carbohydrate levels. However, those who focus on the science and causal relationships rather than simple correlations seem to agree that for most people a high fat diet is healthy. They also tend to agree that a high intake of starch from grains is not good for health, particularly the heart. They would agree with Ornish about eliminating sugar. One cancer specialist focusses on the impact of sugars on cancer.

Dr Steven Gundry has clinical and personal experience of weight loss and heart health by reducing grains and increasing vegetable intake. He believes animal protein is important, but in smaller quantities.

What's the problem with a high starch diet, particularly from grains?

The answer is glycation. The process which alters the lining of blood vessels throughout the body occurs when blood sugars are consistently higher than normal. High fat is not the problem, but sugars that attach to proteins.

I wish Bill Clinton and Steve Jobs long life and good health, particularly in avoiding the onset of dementia through too little fat intake and high blood sugars from excess starch. Dr Larry McCleary refers to this as Type 3 diabetes. There are mental health concerns about certain vegan and vegatarian diets.

More posts on Steve Jobs here.

Friday, 19 August 2011

The visionary systems thinker

Zen and the art of digital design could be the title of the Steve Jobs story. His focus is on beautiful design, simplicity, integrity and the user experience of technology.

'He will reject something which no one will see as a problem. But because his standards are so high, people sit there and say, “How does Apple do it? How does apple have such incredible products?”'

Apple is often criticised for not licensing some of its innovative technology to other companies, but the refusal stems from the need to stop people tinkering and blemishing the beauty of perfection.

'Steve believed that if you opened the system up people would start to make little changes and those changes would be compromises in the experience and he would not be able to deliver the kind of experience that he wanted.'

John Sculley, former CEO who was kicked out by Apple after 10 years, describes Jobs' methodology and how this drove the company even when he had left to start Next.

'The user experience has to go through the whole end-to-end system, whether it’s desktop publishing or iTunes. It is all part of the end-to-end system. It is also the manufacturing. The supply chain. The marketing. The stores. I remember I was brought in because I had a design background and because I was a marketer. I had product marketing experience. Not because I knew anything about computers.'

The charismatic Jobs was able to work across a huge range from the 'change the world' level down to the detail of designging and building products. He insisted that the core team could never be more than 100 people. Even though Apple now employs thousands of people at its Cupertino HQ, the product development division is still small.

Jobs looked beyond the computer world of USA and Europe and admired Ako Morita of Sony and the way his Japanese factories were laid out.

The hierarchy at Apple puts designers at the top, followed by engineers and both above managers in levels of respect.

'Microsoft hires some of the smartest people in the world. They are known for their incredibly challenging test they put people through to get hired. It’s not an issue of people being smart and talented. It’s that design at Apple is at the highest level of the organization, led by Steve personally. Design at other companies is not there. It is buried down in the bureaucracy somewhere… In bureaucracies many people have the authority to say no, not the authority to say yes. So you end up with products with compromises. This goes back to Steve’s philosophy that the most important decisions are the things you decide NOT to do, not what you decide to do. It’s the minimalist thinking again.'

The user experience includes Apple Stores (a long way from the glass, carpet and chrome fortresses that were Apple Centres in the early days.)

'He brought one of the top retailers in the world on his board to learn about retail (Mickey Drexler from The Gap, who advised Jobs to build a prototype store before launch). Not only did he learn about retail, I’ve never been in a better store than an Apple store. It has the highest revenue per square foot of any store in the world but it’s not just the revenue, it’s the experience.'

The futuristic design ethos is reflected in plans for the new Apple HQ in Cupertino, nicknamed the iSpaceship.

Jobs constantly changed the hardware and removed aspects that customers took for granted. His eye was on the future and the changes to come.

The iPhone brought with it apps and the beginning of an integrated portable internet access through dedicated platforms rather than Web browsers. These work better and fit better into the lives of consumers. They also enable companies to make money more easily on these platforms.

Commentators note that working trends are shifting with the increasing use of Blackberries and own gadgets. Some individuals are tired of using dinosaur technology supplied by their employers and resort to using their own up-to-date equipment. This makes them more productive with interesting consequences for data security.

“This is a huge change,” says Citrix’s Andrew Millard. “As the boundaries between office hours and personal time become less distinct, managers are losing control of how people 'work’, as individuals want to prioritise what they do. It is no surprise therefore that there is so much resistance to 'workshifting’.” With the right kit, however, it’s a trend that should be hard for employers or employees to resist.

Chris Anderson and Michael Wolff discuss the evolution of internet use in a recent Wired article. They draw on Jonathan L. Zittrain's 'The Future of the Internet — And How to Stop It.'

CISCO estimates based on CAIDA publications, Andrew Odlyzko

IP and TCP protocols enable a range of communication on the internet. The web with its HTML data is in decline, accounting for less than a quarter of internet traffic. Peer-to-peer, file transfers, email, company VPNs, machine to machine communication of Skype calls, online games, Xbox Live, iTunes, voice-over-IP phones, iChat and Netflix movie streaming are expanding. Many of the newer Net applications are closed, often propietary networks.

'And the shift is only accelerating. Within five years, Morgan Stanley projects, the number of users accessing the Net from mobile devices will surpass the number who access it from PCs. Because the screens are smaller, such mobile traffic tends to be driven by specialty software, mostly apps, designed for a single purpose. For the sake of the optimized experience on mobile devices, users forgo the general-purpose browser. They use the Net, but not the Web. Fast beats flexible.'

I've discussed news media response to the increasing move to digital content. Businesses are challenged by the changes and the increasing difficulty of deriving income from web based content.

'The Internet is the real revolution, as important as electricity; what we do with it is still evolving. As it moved from your desktop to your pocket, the nature of the Net changed. The delirious chaos of the open Web was an adolescent phase subsidized by industrial giants groping their way in a new world. Now they’re doing what industrialists do best — finding choke points. And by the looks of it, we’re loving it.'

Articles appear announcing the death of the PC.

'Apple CEO said that PCs are going to be "like trucks" in that they'll still be around and useful for certain work, but only a smaller percentage of the users will need one.'

This view is challenged, but perhaps at the level of semantics:

'Just what is a "personal computer", anyway? Is it defined by the operating system it uses - Windows, MacOS, or Linux? Does a physical keyboard make it a PC? A processor that uses more than some arbitrary amount of power? Is it size? It can't be size - a MacBook Air is a personal computer, and it's about the same size as an iPad. You could easily argue that today's smartphones are personal computers, as they're easily as powerful as the PCs of five or six years ago.'

'The world isn't moving away from the PC, it's just transitioning from the PC being defined as a "personal computer" to "pervasive computing." Computers will fill our lives with specialized capabilities in various form factors, sizes, and locations.' Here's an example from British Airways.


Steve Jobs has resigned today as CEO and asked to become Chairman of the board, director and Apple employee. Jobs recommends Tim Cook to replace him as CEO.

Apple demands total commitment from staff and a blurring of work/life boundaries, where late night phone calls to discuss a new idea are commonplace. Jobs has health challenges and is unable to maintain that level of intense involvement.

"I believe Apple's brightest and most innovative days are ahead of it. And I look forward to watching and contributing to its success in a new role."

Ironically the biggest tributes to Steve Jobs have come from staff in the field of medicine.

One example is how the iPad enables collaboration between doctor and patient:

"The laptop was a barrier. It was like a screen being put up between the two of us, my eyes were focused on the laptop and not on the patient," Halamka said. "Then the iPad came along and was a game changer because it invites the doctor and the patient to look at this device together. Just think about the way you hold it, it is not something that you have a wall between you and the patient, so I can show the patient their x-rays or lab tests. What I and many other clinicians have experienced is that the iPad invites shared decision making as opposed to patient and doctor alienation."

Update 2

Steve Jobs died on 5 October 2011 aged 56.

There's only one Steve Jobs and attempts to recreate his spirit at the company may lead to failure as happened at Sony, according to Time magazine.

More posts on Steve Jobs here.

Thursday, 18 August 2011

Reluctant entrepreneurs

Twin brothers, Ben and Jonathan Finn, tackled the challenge of bringing music scores into the 20th century by creating a computer programme they called Sibelius (after the famous Finn).

At first they retained it for their own use, but soon decided to capitalise on the time and effort it took to create the programme. Their plan was to hand over manufacture, marketing and sales to others, but this was no easy task. Music publishers tended to know nothing about computers and computer companies knew little about music.

The brothers decided to sell the programme from home and targetted composers. There was strong interest, but scepticism because the concept was so novel. Home demonstration of the product led to instant sales, which included the whole package including hardware and software as well as a printer.

Sales increased rapidly, but expansion was restricted to the UK because of the Acorn platform for which the software was written. Once the brothers wrote a version for Windows, exports took off.

Sibelius was bought by US firm Avid Technology in 2006. The 37 year old brothers planned to spend more time composing their own music.

Finding a mentor

Are leaders born or made?

Some of the myths surrounding successful leaders and companies give the impression that, like Mozart, these people were crafting strategies in their playpens.

One example, Jose Mourinho, led 150 home league matches unbeaten between 23 February 2002 and 2 April 2011. This is in addition to silverware brought home by various teams under his command.

How did Jose Mourinho get to the top?

He found his mentors by moving sideways into the role of interpreter to top managers, Bobby Robson and Louis van Gaal.

Mourinho built strong relationships with both men and became involved in coaching and developing tactics. He complemented Robson, who excelled at attacking football, by drawing on his own strength in defence. van Gaal delegated more responsibility to Mourinho, handing over responsibility for the B team at FC Barcelona.

'One of the most important things I learnt from Bobby Robson is that when you win, you shouldn't assume you are the team, and when you lose, you shouldn’t think you are rubbish.'

When do you cut the apron strings of your mentor and step out on your own as a leader?

Robson had some concerns about Mourinho's approach at Chelsea:

"That's the only thing I'd say in warning. Jose, and Chelsea, should be more careful of stepping over the line. I would also tell Jose to keep his mouth shut. Why is he trying to get involved in issues outside his domain? He doesn't need to take on Fifa or Uefa or get involved in tapping up. If I was behind him at Chelsea I would say, 'Jose, step aside. I'll deal with that for you.'"

Others comment on similarities and differences between Mourinho and van Gaal.

Mourinho's route to the top shows intelligence and a willingness to do lowly work to get close to successful leaders and learn from them.

Tuesday, 16 August 2011

Pure, white and deadly

Professor John Yudkin was a pioneer in health and nutrition in the UK. He had a clear view of the science and an ability to communicate to the public.

One target of his work was sugar. Yudkin was one of the first to emphasise the link between sugar, diabetes, heart disease and obesity.

His books, written for a popular audience, were written in the '50s, '60s and '70s. How come they seem to have had so little impact on consumers, doctors and Department of Health guidelines in the UK?

Perhaps the sugar industry and its PR body, the Sugar Bureau, may have had something to do with it.

Dr Robert Lustig cites Yudkin as one of his heroes in the fight for health and decent nutrition.

I was reminded of this in a talk given by US neurologist, Dr David Diamond. Why listen to a neurologist talking about nutrition? He reversed his own high risk blood lipid levels by adopting a controversial diet:

Saturday, 13 August 2011

Tricks of the mind

Swedish photographer, Erik Johansson, takes everyday scenes and applies some of the perspectives of artists like Rene Magritte and M C Escher:

Erik made a video series called 'Mind your step' showing a street illusion he installed in a square in Sweden and the reactions of passers by:

The eye tricks the brain.

Thursday, 11 August 2011

Statin the wonder drug

As children, we are brought up on tales of Superheroes who save civilisation from imminent collapse. That world view seems to leak into adult life and our view of threats. In the medical field we seek a magic bullet to destroy problems such as AIDS, cancer and heart disease.

In recent decades focus has shifted in the West from tuberculosis, flu epidemics and malnutrition to the monster threatening us with heart attacks.

I have written before about the curious use and abuse of science to formulate theories and guidelines on the impact of certain food groups, notably fat and protein, on the risk of heart disease. The key theory is the lipid hypothesis which proposes that dietary fat increases blood lipids and these are laid down in the heart and blood vessels. This has been distilled down into the universal guideline on reducing cholesterol to prevent heart disease. In the UK we discuss the difference between LDL (bad) and HDL (good), but make no distinction between large and small LDL particles.

One indicator of risk is high blood pressure. National Health guidelines on 'normal' values have reduced in recent years. Government incentives lead to GPs ending a consultation for other problems by checking a patient's blood pressure. This may prompt a discussion about medication to reduce risk of heart attack.

What are the wonder drugs of choice for this purpose? Statins.

Stephanie Seneff is a senior research scientist who has scrutinised research literature on statins and their effects.

In addition to restating the essential life enhancing properties of cholesterol, her article systematically refutes claims for life saving qualities of the drugs, lists the destructive side effects associated with long term use and suggests healthy alternatives to maintain heart health.

Dr Malcolm Kendrick states the facts succinctly as part of his BMA Leeds lecture:

(His blog is pretty good too.)

Dr Duane Graveline worked for NASA and became a fervent advocate of statins. He took high doses of the drug and experienced such severe side effects that he was barely able to walk and function. He now campaigns to prevent these drugs from being used for widespread primary prevention, rather than targeted at those with a history of heart attack. He argues that statins damage the mitochondria in cells.

Kurt Harris wrote a clear account of statins and cholesterol hypothesis in this blog post. He uses the analogy of crime statistics correlated with the number of police on patrol.

Uffe Ravnskov claims that women are least likely to benefit from general prescription of statins to prevent cardiovascular disease.

We banned thalidomide because there was a clear cause-effect link to devastating deformities in babies born to mothers who took the drug.

How do we demonstrate clear links between statins and their side effects so that doctors are more cautious in prescribing them?

We went through a long process before benzodiazepines were dropped as the drug of choice to combat insomnia and depression. Campaign groups such as Tranx worked hard to educate patients and doctors about side effects and dependencies associated with this medication, before SSRIs became commonly prescribed for mental health problems. The PROZAC groups of drugs may still cause abreactions in some patients and doctors are not always alert to the risk of suicidal thoughts caused by SSRIs in some people. Tranx, founded by Joan Jerome, seemed to have been made redundant by a change in prescribing practice in the UK. Recently it appears that benzodiazepines are still prescribed for insomnia and continue to create dependency and adverse symptoms.

Starting at the bottom and encouraging people to learn about drugs and their effects before accepting a prescription seems to be the most effective way of combating bad science and the profit motive.

Let's also remember patient reports of increased suicidal thoughts when cholesterol drops. Beware those who plan to put statins in the water supply.


A health warning is now planned for Statins: they may cause memory loss and diabetes.

Tuesday, 9 August 2011

Socially responsible science

Scientists often say that science is neutral and aims to uncover layers of truth through research. If that were so, I doubt if we'd benefit from legislation and practice to protect our health. Some change requires an altruistic scientist to pursue the research and push for improved conditions.

Derek Bryce-Smith was a chemist with a social conscience. He died in June. Part of his work focussed on lead added to petrol to improve performance. He was concerned about the effects on children's brains and behaviour from the increase of lead in the environment resulting from the additive.

Much of the funding for research came from petrochemical companies and his colleagues were unhappy that money began to dry up as a result of his persistence and vocal opposition to leaded petrol.

Des Wilson, the New Zealand born activist, launched the Clear campaign in 1982 to ban lead from petrol. He remarked that Bryce-Smith was no politician and wanted an immediate ban, rather than phased withdrawal to cope with the lifetime of current car engines.

Bryce-Smith's son believes that Derek's career was damaged by this work. He quoted his father as saying that if it turned out he'd made a mistake on the science of leaded petrol, he'd be forgiven, but if he was right, he'd never be forgiven.

Change is not easy. It requires persistence and personal sacrifice. Success involves a pragmatic outlook and some political compromise. Each individual has to weight the pros and cons to decide if the effort it worth it.

Pinchot believed that an intrapreneur needs to come to work each day willing to be fired. In today's world that translates as: be prepared to come to work each day willing to lose your funding or opportunities for career advancement.

Are we willing to do what we believe is right or take the easy road for the sake of security?