Dynamist Blog

Kidney Blogging, Cont'd

As you may have read, a Dutch network is about to premiere a new reality show in which contestants vie for a kidney from an otherwise dying woman. (How she qualifies medically as a kidney donor is beyond me.) Writing at HuffPo, Sally Satel weighs in:

It's crazy alright. And, yes, sick and shocking. But despite my discomfort, I'm for it. Sensationalism is a powerful way to call attention to the desperate shortage of kidneys and to the tens of thousands of needless deaths each year that occur all over the world because not enough altruistic donors step forward.

Indeed, the very idea behind the De Grote Donorshow (The Big Donor Show) is to shine a spotlight on the plight of patients who need a kidney. The show is intended as a tribute to the founder of the network -- Bart de Graaff --who died in 2002 at age 35 because he could not survive the years-long wait for a new kidney.

"We think that is disastrous," said the BNN chairman Laurens Drillach to the BBC, "so we are acting in a shocking way to bring attention to the problem."

It's about time somebody with some clout got angry about this egregious situation. Kidney patients need ACT-UP. Instead, they've got the way-too-complacent National Kidney Foundation, an organization more for doctors than patients.

g1060ad910281e6dd337955a7768fa323798af14Meanwhile, in Massachusetts, Lisa Cunningham has died. She's the woman Beth Israel Deaconness Medical Center told it would refuse to transplant if she found a kidney donor through local press coverage. After nasty press, some of it from me, the hospital changed its policy. Rob Haneisen of the Metro West Daily News, who first covered her story, reported on her death:

Cunningham died because she was very sick, and in the end the right donor with the correct tissue match did not come forward to save her.

"Some patients can be on dialysis for many years and do well and others have a more malignant course in a sense," said Spiegel, Cunningham's nephrologist. "She just never did well on dialysis. Every aspect of her care on dialysis was difficult, which is why we were hoping a transplant would come her way."

Lisa Cunningham was 40 years old. She left a 10-year-old son.

UPDATE: Tim Worstall is "entirely disgusted" by The Big Donor Show, but not for the usual reasons.

UPDATE 2: Kidney donor Tom Simon adds his take at KidneyChronicles, making this very good point: "I don't understand why it is part of the story-line that the donor is dying of a brain tumor. It creates the incorrect impression that living with one kidney is a risky or dangerous proposition, and only someone who is going to die anyway should even consider it."

Wise Words

There's much buzz about Michael Arrington's post provocatively titled "Silicon Valley Could Use a Downturn Right About Now. I don't interpret it as a literal call for a downturn but as a signal that a well-established pattern is reappearing and that, as is always the case, something feels lost when the people who care most about money start to dominate the people who care most about art (great companies, great technologies). The post is fine, but the comments are the must-reads, for both wisdom and foolishness. One of the best is this one from Brendan. It's long, but here's an excerpt:

[U]p until the late 90s, the Valley toiled in relative obscurity building tech giants. Now that the world knows about it, like the world knows about Hollywood, this is the place to "make it" in technology. So people flock here, capital flows here and ideas flourish here. It is an ecosystem, highly evolved over 30+ years - to producing technology giants. It is not an accident that Intel, Oracle, Sun (former paradigm-changing, at least), Yahoo, Cisco and Google all emerged from the technology primordial soup that is the Valley.

From time to time, one of the precedent conditions gets out of whack and upsets the balance. This is almost always $$ - too many VC $$ flowing into the system. These VC $$ are provided by state pensions, endowments and other institutional investors chasing the out-sized returns that VC promises. (mostly untrue for all but the very best VCs) With so much money the VCs become indiscriminate in their funding choices - supporting too many "me-too" concepts for too long. In order to rise above the noise, these start-ups hire PR agencies and throw launch parties, creating more noise. This escalates for awhile and then it goes off a cliff. We'll be back to no VC $$ for even excellent ideas. entrepreuneurs - real entrepreneurs will bootstrap themselves again. Good ideas will rise to the top on their own merits and VCs will again begin to notice, starting the whole cycle over again. In the meantime, until the next crash, restaurateurs, PR hacks, event planners, coffee chains, commercial landlords, Porsche dealers and real-estate agents will live fat and happy. Then they won't. And they'll cry poverty. We've seen this movie before. Does no one remember?

Ah yes, no one does because the Valley has no institutional memory. That is why this will happen again, and again. And - pay attention here - this is the magic of the Valley.

My least favorite comment? Probably the naif in Australia who quotes Tom Friedman to "prove" that since the World Is Flat, Silicon Valley is irrelevant. That argument from authority is not only wrong but self-refuting. If Tom Friedman didn't work for The New York Times and name-drop like crazy, nobody would read his books. His success proves that the world is not flat, whatever that means. (Ed Leamer's Journal of Economic Literature review is the definitive word on Friedman's book, combining entertaining metaphorical parsing and serious economic analysis.)

The Aesthetic Imperative

The NYT's Damon Darlin reports on Hewlett-Packard's remarkable success with a business strategy straight out of The Substance of Style:

Hewlett-Packard's effort to transform its personal computers from low-margin commodities into more stylish devices has started to pay off.

As shown by the company's fiscal second-quarter earnings, announced Wednesday afternoon, a new PC strategy has become a major driver of growth. Revenue increased 12.7 percent from the period a year earlier, to $25.5 billion, and the PC division was an important factor.

Revenue from notebook PCs rose 45 percent, and the company was able to increase sales of desktop computers, which have been flat for the industry, by 9 percent.

Furthermore, H.P. is also making more money on each PC it sells. The division's operating profit margin increased to 4.8 percent last quarter from 3.6 percent in the period last year, and is more than double what it was two years ago....

Samir Bhavnani, research director of Current Analysis West, a market research firm based in San Diego, said Hewlett-Packard "was very wise in understanding that as the market shifts from desktops to notebooks, that style mattered."

He faulted Dell's thicker, chunkier notebooks for its weak sales. "H.P. is like the plain girl from high school that you see three years later and she is a bombshell, while Dell is the hot girl from high school who has gained 30 pounds," Mr. Bhavnani said.

Hewlett-Packard's design-focused strategy had a heightened impact at a time when corporate PC sales were flagging. Its efforts weakened Dell when Dell seemed ill prepared to react in any fashion other than by cutting prices. While PC prices continue to decline, H.P.'s average selling price--about $967, according to Current Analysis--is more than 17 percent above the industry average price of $822. It used to be at or slightly below the average. (Apple and Sony have much higher prices, and it is no coincidence that those two companies also emphasize design.)

As I always tell business audiences, there's no guarantee that better style will deliver higher profits. That depends on the competition. But these days, ignoring aesthetics is a good way to lose business.

More Yi-Fu Tuan

From Escapism:

If a small vocabulary and the frequent use of clichés promote understanding and communal solidarity, the achievement of verbal-intellectual sophistication can have the opposite effect. The more people know and the more subtle they are at expressing what they know, the fewer listeners there will be and the more isolated individuals will feel, not only at large but also among colleagues and co-workers. Let me use an architectural metaphor to show how this can come about in academic life. Graduate students live in sparsely furnished rooms but share a house--the intellectual house of Marx, Gramschi, Foucault, or whoever the favored thinker happens to be. A warm sense of community prevails as the students encounter one another in the hallway and speak a common language, with passwords such as "capital formation," "hegemony," and "the theater of power" to establish firmly their corporate membership. Time passes. As the students mature intellectually, they move from the shared life of a house to rented apartments scattered throughout the same neighborhood. The apartments are close enough that friends still feel free to drop in for visits, and when they do the entire living space is filled with talk and laughter, recapturing as in younger days not only the bonhomie but also the tendency to embrace wholeheartedly the currently headlined doctrine. Eventually the students become professors themselves. They begin modestly to build their own houses of intellect and add to the structures as they prosper. Because each house bears witness to a scholar's achievement, it can be a source of great personal satisfaction. But the downside is, who will want to visit? And if a colleague or friend does, why should she spend time in more than one room?

Social scientists claim that a tenement building where people hang out the washing or sit on the stoop to socialize can be a warmly communal place. By contrast, a suburb with freestanding houses is cold and unfriendly. I am saying that the same may be true of intellectual life as one moves to larger houses of one's own design. Both types of move--socioeconomic and intellectual--signify success, and with both the cost to the mover can be an exacerbated feeling of isolation.

Although Tuan is talking about scholarly communities, the same phenomenon can be found in political or religious groups. There are strong communal rewards for sticking to relatively simple, widely shared language (and the simple, widely shared beliefs it implies).

Political Closets



I guess there's not much chance of turning off potential customers on the Upper West Side by turning their choice of storage facility into a political statement. But it's pretty strange.

Why Use That Typeface?

helveticamovie.jpgIn a typically delightful post, Michael Bierut considers the various reasons graphic designers choose one typeface out of the many possibilities. I'm eagerly anticipating Michael's new book, 79 Short Essays on Design, due out next week.

Speaking of typefaces, if you have a chance, be sure to see the new documentary film Helvetica, now making the festival rounds (showings listed here). Believe it or not, someone made a film about a typeface--once considered THE typeface of modernity and still ubiquitous--and it's a gem. It not only vividly tells the story of the rise and fall and rise of Helvetica but uses the typeface's story to provide insight into competing concepts of modernity and into the eternal tension between the classic and the personally expressive. Michael Bierut, whose interview gets the movie's biggest laughs, wrote about Helvetica, and reminisced about the old days when typefaces were arcane lore, here. [Update: I inadvertently omitted the very important word "about" in the original version of that sentence. Michael appears in Helvetica, but he didn't write the movie.]

China vs. India

Jim Fallows discovers a striking difference, which suggests an interesting natural experiment in human capital formation. Which approach will produce a more creative, productive generation: more attention or more autonomy?

Brains & Minds II: Every Brain Is Different

Earlier this week I was the token non-scientist on a panel to discuss the future of biomedicine at the Biotechnology Industry Association's huge annual convention. (Our discussion is described semi-accurately here.) The big trend I see is the convergence of genomic information, frequent real-time monitoring of metabolic function (I got a laugh by talking about "smart toilets"), personalized pharmacology, and patient activism.

In the Manhattan Institute's online newsletter Medical Progress Today John A. Fossella writes about personalized medicine as it could affect mental health treatments. Here's an excerpt:

More recently, genomic analyses have been synthesized with brain imaging studies so that physicians and researchers might understand how genetic biomarkers that predispose individuals to mental illness can affect brain structure and function. For example, the gene for the serotonin transporter (5HTT) has for many years been shown to contribute to risk for anxiety disorders. The protein encoded by the 5HTT gene is the target of a class of effective antidepressant compounds known as selective serotonin reuptake inhibitors (SSRIs).

recovering patientIn 2002, the first link between variation in the 5HTT gene and brain activity was found to occur in a brain region known as the amygdala, where emotional memories are stored and relayed. Individuals who carry a type of 5HTT genetic predisposition for anxiety were found to have a more active amygdala when viewing stimuli designed to illicit [sic--vp] emotional responses. Thus, a complete synthesis between brain activity, genetic variation and pharmacotherapy has been accomplished, and it is now possible to view the effects of drug treatment through brain imaging. The implications are far reaching, but at face level, serve to match a certain biological process to more effective treatment options.

In order to better realize the promise of this basic research, the NIH Roadmap has recognized and mandated the need for translating these fundamental and highly technical findings into layman's tools that facilitate the everyday relationship between physician and patient. For instance, successful medication selection is one of the most long-standing challenges in psychiatry. Patients taking antipsychotic medication often experience side effects such as tardive dyskinesia, weight gain and diabetes.

Some of these side effects can now be addressed with genetic information; patients with certain variants of the CYP2D6 gene metabolize medications more poorly and thus experience greater risk of side effects. The FDA-approved AmpliChip® provides a clinical platform for screening of this and other metabolic genes. A number of other studies point to the dopamine D3 receptor gene as a mediator of tardive dyskinesia, while other studies have identified specific genetic variants that influence the magnitude of obesity-related side effects.

Fossella's website is here.

ArchivedDeep Glamour Blog ›

Blog Feed

Articles Feed