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The Great Rationality Debate

I did a very brief summary of a review of research on irrational behaviors and why we make decisions that appear seemingly contradictory to our best interests or to “rational market forces”. I’m sharing this summary of the various decision-making concepts as entrepreneurs can definitely take away important lessons in how we work AND how our clients may decide. Source material: Tetlock, P. E., & Mellers, B. A. (2002). The great rationality debate. Psychological Science, 13(1), 94-99. Copyright is by permission of the © American Psychological Society.

1. Change v. States
We judge our gains and losses via our perception of status quo, not via an absolute scale (for example we compare our wealth with peers to judge whether we feel rich regardless of what we actually have).

2. Gains v. Losses
We don’t mind losing what we haven’t gotten but we hate losing what we already own.

The taxi driver example: instead of working more on “good” days to make more money, taxi drivers quit once they make that threshold dollar amount (example: “I expect to make $500 a day”) and then work longer day than the norm on a very “slow/bad” day. A rational approach would be to use an average (example: “I expect to make an average of $500 a day”) and then on good days work longer to make more $ and on slow days work about the same hours or shorter (example: day 1: $500 / day 2 $1500 / day 3 $100 / day 4 $400 / day 5 $0 [got mugged/got sick] = average $500 a day working about the same or even shorter hours)

3. One v. Several
Declaring loss hurts more than keeping a “paper loss” by keeping account open.

[I glossed over this one but it could use more substantive examples than keeping a losing stock example – I may come back to it.]

4. Narrow v. Broad Bracketing
We tend to evaluate and decide based on examining 1 item at a time versus overall picture (looking at the trees instead of the forest).

Example: When 25 divisional executives were asked to accept a project with 50% chance to gain $2M and 50% chance to lose $1M only 3/25 accepted the risk. On the other hand the company CEO was happy to accept 25 of these investment risks. This is because the divisional execs perceive the “trees” / small picture while CEO look at the “forest” / big picture. In the big picture, this is a smart calculated risk.

5. Inside v. Outside Views
We tend to decide based on self-centered analysis versus “objective” outside/situational analysis, risking overconfidence in how well our choice will play out.

Example: entrepreneurs entering excessive crowded market in spite of the market appearing saturated.
(Another example is me taking this class thinking “Of course I can handle it” while situational analysis all points to, “are you nuts?! You have no time!”)

6. Stable v. Constructed Preferences
This reminded me of the 1st concept where perception drives the decision. Preferences are made on the spot using current available cues versus weighing factors in the decision more absolutely.

Example: I need to buy a good, substantive music dictionary. If I am given individually a new looking dictionary of 10,000 entries versus a worn torn dictionary of 20,000 entries, I am more likely to choose the new looking product. On the other hand, if I am given BOTH (therefore I have a comparison) then I’ll pick the 20,000 entries option, which was what would better serve me because 20,000 entries > substantive than 10,000 entries regardless of appearance of delivery vehicle (appearance of the book itself).

7. Linear v. Nonlinear Decision
We tend to risk more when we think the probability to return is small. We tend to risk less when compare decision against a guarantee.

20% chance to win $4000 v. 25% chance to win $3200.
“I don’t have a good chance anyway, let me go for $4000”

80% chance to win $4000 v. 100% chance to win $3200
“I’m picking the sure thing: $3200 even if it’s less than $4000 and 80% is still a very good chance.”

8. Wholes v. Parts
This concept is about “unpacking a scenario” — the more details we gain around an event, regardless of the probability of these events, the more we will believe in the event happening — in other words we begin to add for ourselves the probability in our minds of this happening.

Example:
There may be a massive flood in N. America that will kill >1000 people.
“Yea….. right.”

versus
There may be an earthquake that causes a dam to crack in California, causing a massive flood in N. America that will kill >1000 people.
“OH MY GOD! WE NEED EMERGENCY SUPPLIES!”

9. One v. Many Utilities
People use their experience in the “ending” of an event and decide on their feeling about this experience, instead of the good or bad of the experience itself.

Painfully cold water for 1 minute
v.
Painfully cold water for 1 minute then less painfully cold water for 30 more seconds

people picked the 1.5 minute submersion in cold water just for that 30 seconds of “less painfully cold” (but it is still painfully cold! just less.)

This is part of my study notes for enrollment in Coursera’s A Beginner’s Guide to Irrational Behavior by Dan Ariely. This is my first time taking a Coursera course and I’m excited that I have picked the right one to begin this online learning experience! Of course, I also think taking this class, at this time in my life, given how many things I’m juggling on my plate, is completely irrational in and of itself….

Dream and Nightmare of Web-Scale Pharmacovigilance

I’m not going to tap into fear-mongering of why Microsoft is involved in the study that pulls adverse event (side effect) data from the internet, but I’m wondering what’s taken people so long to figure out the vast pool of patient experiences available online. Oh wait, those of us involved in industry know about this, only we don’t want to know about it.

There is at least one valid reason: you need to have a full picture of what is involved behind a side effect, to say with some level of confidence that your reported side effect experience came from the drug you said you took, not the other drugs you’re conveniently not saying you’re taking (especially the not-so-legal kind), or that you have a drinking habit (alcohol has major interactions with every drug under the sun), or that you’re taking 20 supplements you got from the nutritional store, and some prescription med you got off the internet by some shady doctor who asked you a few questions before writing you the Rx…

But reality check. Web-scale pharmacovigilance is here, and needs to be here, and should be leveraged conscientiously and systematically.

2013-03-10 09.16 AM74

Some years ago I gave a talk at a DTC conference in New Jersey about the patients’ voice when it comes to safety information. I am not in the business of web-based pharmacovigilance, nor did I set out to collect this information, but patients started sharing their personal experiences with an antidepressant on my mental health website. Yes, there are paroxetine/Paxil-related reports, but for the most part patients talk about bupropion/Wellbutrin, and over the span of many years there are hundreds of patient reports that are consistent in terms of their side effect experience.

This all started with one reader asking a question about a particular side effect of bupropion, and whether there were any published studies about a particular side effect. I’m sure there are scores of data from the manufacturer, but like much of drug data, these are kept “proprietary” with the ever-present “data on file” label on clinical slide presentations that the manufacturer supplies to a well-selected public (doctors).

Industry shouldn’t fear it or revile it: pharmacovigilance is critical for gathering drug information over time as part of safety monitoring, and the FDA sucks at making this an easy task for anyone with the desire to report adverse events with bureaucracy.

Read NYT’s take on web-scale adverse event reporting and drug safety monitoring.

Performance Enhancement Goes to Antlers

This sounds like something out of a Chinese traditional medicine apothecary: deer antler velvet are harvested and then processed to become delivery agents for supplements that enhance athletic performance.

The controversy with this is that there may be substances within the harvested velvet that are not permitted by the sport.

Nutraceuticals are a large business and unlike pharmaceuticals, nutraceuticals have cool stories like this to market to consumers without the FDA oversight that constricts pharmaceuticals.


Via: Nutronics Labs

Before You Start a Home Based Business or Career

FIRST, YOU NEED A SOUND FINANCIAL BUFFER.

This is an under-appreciated aspect of starting any business, including a home-based business (entrepreneurial) or a home-based career (freelance, including as writers).

Image by Svilen MilevPeople who supply you with products and services don’t care how big your passion is.

I’m sorry that they don’t care, but they don’t care. They’ve heard all this before, from would-be consultants with starry eyes.

The electric company cares about whether you can pay the electric bill. The phone company cares about whether you can pay the phone bill. The landlord, if you decide to rent, wants to make sure you have enough for 6-12 months lease.

This requires you having some form of collateral or a “large” bank balance. “Large” means 6 months of living expenses, which is something I’d recommend any parents to save up anyway, regardless of employment status.

I saved up 12 months of living expenses prior to starting my consulting business. I realize I’m on the conservative side and 6 months can work as well of a financial buffer.

Also, the more years you’ve been at this, the easier it becomes to get an average income to show people that you aren’t a fly-by-night “consultant/writer/blogger/entrepreneur” and that you are in serious business.

Until then, you need to have a substantive bank account.

I realize some of you do this out of necessity than a carefully engineered choice. Hopefully you already have an ’emergency fund’ saved up for a few months’ living expenses and this can serve as your “start-up financial buffer” if you cannot save up any more before launching.

This financial buffer is also helpful to get you focused on starting on the right foot, which does not look like you’re desperate to pitch for every prospect and to throw yourself at the foot of every possible client.

NEXT, YOU MUST HAVE A CLEAR CUSTOMER IN MIND.

I’ve given people the following 2 exercises to try, as a way to get them brainstorming in the right direction. I will use consulting as a general example: you can change the labels for your industry’s term for “customer” if you like.

Exercise 1. You are now a consultant, congratulations! You are sitting at your desk when the phone rings. You pick up. The voice on the other end of the line says,

“I am so glad I got through, Jane. I’ve called around 5 other consultants and at this point, I think you are the right person to help me. I have this problem and this is right up your alley, do you have time to talk about this?”

  • Tell me the job title and psychographic/demographic profiles of this customer and his/her business/industry
  • Tell me what the customer’s problem is
  • Tell me why YOU and not 5 of your other competitors are the right person to deal with this

Exercise 2. Imagine you get a green-light for a very exciting consulting project. You receive the budget for the next 3 months on this consulting project and you start Monday.

  • Write the role description for yourself (list 3-5 major activities).
  • Write the profile of your target audience in this role.
  • Write the 3 key results you should achieve by the end of this business quarter (3 months).

FINALLY, BE VERY FOCUSED ABOUT WHAT YOU WANT TO TRACK.

This trips me up every time. I pile too much on my plate, then at the end of the day or week I felt like I haven’t accomplished much.

I’m not a “stay at home” parent. I’m not a “working” parent. I am a stay at home + work from home parent, this is an important distinction and hybrid model to define. My living space is both my home and work. I have access to work load and parenting duties and I never know when I’m called for either (or both at the same time, which I try not to have happen too often).

I’ve learned to go back to the early days when I was a sleep deprived, semi-delirious new parent and focus on one key item per day.

This doesn’t mean I don’t have many projects in the burner at once. But I stopped beating myself up over not getting to all of them within the same day. I also make the goal manageable per day because I don’t want to feel guilty about not spending enough time with my child or not getting enough done with my work.

Jane Chin

Whatever Ethics We Are Legislating, Money is Overriding

Back in 2003 when I worked in pharma, this would have been major mind-boggling news (when Pfizer paid over $400M in fines). Now, almost 10 years later, pharmacos “set aside money” for penalty and this sort of news is no longer news. Whatever ethics we are legislating, it is obviously not working against financial incentives that drive this behavior.

http://www.nytimes.com/2012/12/19/business/amgen-agrees-to-pay-762-million-in-drug-case.html

Patients Shouldn’t be Trusted with Their Own Vital Data

I was reading a recent issue of The Economist that talked about possible innovation of something akin to a medical tricorder, and there was a paragraph about the amount of resistance from the medical establishment because it does not believe that patients could be trusted with their own data:

Not everyone is excited about patients taking matters into their own hands. Health care is a very paternalistic industry, and “physicians don’t want patients to become independent and too empowered,” says Mr Wasden of PwC. “The medical community has always been very conservative,” says Yan Chow, director of innovation and advanced technology at Kaiser Permanente, a non-profit health-care provider. “It’s very hard to change things.”

Moreover, doctors may be reluctant to use data collected by patients. Instead of measuring vital signs at an annual check-up, they could find themselves being asked to examine huge data sets created by patients—raising the question of legal liability if something is missed. “The irony is that a doctor is more comfortable with the liability in a system that does not have rich data than in a system that does have rich data,” says Mr Wasden. Another difficulty is that electronic health records are not designed to allow for the inclusion of patient-generated data, says Dr Chow.
“As medicine becomes more of an information science, some tasks could be taken on by patients.”

Some of the new diagnostic tools may be financially threatening to doctors, especially in disciplines such as optometry, dermatology and paediatrics, says Dr Topol. Why would you visit a specialist, he asks, when a mobile device lets you test your eyes, diagnose skin lesions or determine whether your child has an ear infection? But as medicine becomes more of an information science, some mundane and simple tasks could be taken over by patients, which could free up doctors for more demanding problems, argues Mr Jones.

I’m wondering how long the stronghold of the establishment can keep.

One of the upside of social media and technology is that patients are beginning to self-educate AND self-advocate (instead of only “self-medicate” as in days past) — and once we have a level of awareness, we start asking questions about what’s happening with our care and what’s happening with our vital data.

Even infants grow up one day to expect a level of self-reliance from their fathers.

Dear medical establishment, you can’t infantilize patients forever, even in the name of “patients’ own good.”

How People with disabilities May Find Gainful Employment?

A. Prioritize components of gainful employment.

Pick and choose / prioritize components from the “9 components of gainful employment (source: http://en.wikipedia.org/wiki/Gainful_employment). These include Variety of work, Safe working environment, Income, Feeling of Purpose, Friendship at work (among others.)

While we may desire all 9 components to feel “fulfilled”, we may not all rank these components the same. Thus, identify your personal ranking based on your self-knowledge and how you best thrive as a person.

B. Identify elements of gainful employment that, for you, requires some level of accommodation

For example, under the “Variety” component, you may desire variety but within certain parameters because of your special situation. The same may be said for “safe working environment” — we can use a very broad definition of “safe” to include safety from physical harm or harassment.

However, you may have additional considerations. For example, someone whose epilepsy may be triggered by certain kinds of lighting will need to look at a parameter that her peers may not think twice about, because of this special consideration.

C. Analyze the Risk/Benefit Ratio of accommodation.

This is truly the root of the matter. Employers want to behave in the most enlightened manner and they also must conduct some form of “risk/benefit” analysis when looking to include employees of all different abilities. This is where we can engage our creative muscles and look for a working solution.

For example, there are workers who need a certain level of “quiet” or they cannot function because they have such sensitive hearing it is painful to be in a regular workplace with ambient noise. Telecommuting may be a way to include workers like these. The limitation is that telecommuting requires other technologies like video or teleconferencing to “link” that worker to a work-hub. Telecommuting is also limited to work that can be done virtually, and does not require physical collaboration (for example, you cannot telecommute as a baker).

I suggest that you do the following:

  1. Go through A, B, C (prioritize, identify, analyze)
  2. Brainstorm various scenarios of “work environments” that can leverage your skills and talents
  3. Research where these work environments may exist, or what work environments lend well to becoming productive work environments for you, with some accommodations
  4. Sometimes you may do well by finding other with similar abilities and create a consortium or some type of a work group (I don’t have specific examples but just brainstorming this and throwing it out there for someone brilliant to have an ah-ha moment and add comments to this answer.)
  5. Sometimes you need to create your own job (and this is where looking at freelancing opportunities are needed, although I know this means you don’t get one of the most critical benefits of employment: healthcare benefits.)

I Believe in You!

Patient Hot Buttons in Pharma: Absurd Advertising

Series with Casey Quinlan

Absurd Advertising (Lyrica + Cymbalta for example) that make potent meds seem like something for a rainy Monday.

We in pharma have only a limited (less than 1 minute) of air time, and part of our challenge is to combine increase in awareness of something that used to be seen as “fault of the person” (i.e. depression as a character flaw, not a medical problem) with usage/safety. So it comes across as if we’re making light of the potency of med — obviously we like our meds to be potent so they get approved and look better than our competition — but we also are balancing this perception of “potency = seriousness of my condition, and I want to deny that I have a problem.” How do we improve this balance without turning off people we can truly help?

I don’t see this as a TV-only issue at all – the wide array of advertising, particularly in print and online, are in many ways both more annoying (how many pages will I have to turn in this mag before this drug ad ends?) and a huge waste of company $$ (I know that the lawyer’s chorus of massive small print is FDA-required). What’s the ROI on an ad that no one looks at?

This is true. I will look at only the 1st page of the ad and pretty much ignore the other 30 pages (I’m exaggerating, it’s a bit less than 30 pages…) but yes, pharma companies cannot print only 1 page, they’d love to, but they can’t, because of the requirement to include key data and safety information as mandated by the FDA. I think this is the FDA’s conspiracy to empty drug companies’ coffers through expensive advertising that no one looks at, which counteracts the FDA’s original intent of having patients and consumers exposed to fair balanced (safety especially) information, because no one will look at the whole ad to get the balanced picture.

continued in the COMMENTS portion — jump into the fray with us!

Patient Hot Buttons in Pharma — Series with Casey Quinlan

Introduction: I met Casey Quinlan in October 2011 when we both presented at a Digital Pharma industry conference hosted by DTC Perspectives. Casey describes herself as a “rabble rouser”, and of course, I cannot resist. This is a series of conversations with Casey on various “Patient Hot Buttons in Pharma” that we will be relay-blogging.

Casey

Jane

Segments of this Series:

Absurd Advertising

Lack of Transparency

Behind the scenes manipulation we sense but can’t see

Lack of Presence

Cost

Vaxil Cancer Vaccine Hardly a Breakthrough

I’m not going to exhaust too much research time on this. But I’ll address specifically the article claims.

Again, as with my answer to Are the hospitals known as The Cancer Treatment Centers of America really effective? I will give the company itself the benefit of the doubt, because this was not an official press release put out by the company. Instead it is an article posted in blog format by an non-medical/healthcare organization.

Still, here’s red flag #1:

“It’s a really big thing,” says Levy, a biotechnology entrepreneur who was formerly CEO for Biokine Therapeutics. “If you give chemo, apart from the really nasty side effects, what often happens is that cancer becomes immune [to it]. The tumor likes to mutate and develops an ability to hide from the treatment. Our vaccines are also designed to overcome that problem.”

Putting aside my bias against describing a cancer vaccine as “a really big thing” (this could be a language issue) — Levy, who is the company’s CFO (where is the chief medical / scientific officer? Medical director? Why aren’t they being quoted?) — attempts to describe the evolution of metastasis that then leads to a false claim (if he were in the U.S. governed by FDA’s mandates.)

There is no data from the company that suggests the vaccines were designed to “overcome that problem” — and which problem, exactly? The “immunity” problem? The “mutation” problem? The “ability to hide from treatment” problem? Each of these could be specific traits to a cancer cell, or according to Levy, would collectively describe one cancer cell. These can also be traits for either solid tumors or liquid tumors. But Levy is vague, when the investigational drug is being targeted for development against multiple myeloma, a blood cancer (liquid tumor.)

Red flag #2 Claim of “Breakthrough”

Is this “breakthrough” describing the idea of using a vaccine against cancer? No: Cancer vaccines aren’t a breakthrough. The immunotherapy concept has been around for decades. http://www.cancer.gov/cancertopics/factsheet/Therapy/cancer-vaccines
Is this “breakthrough” describing the application of the vaccination concept against a specific cancer, namely multiple myeloma? No: As of November 15, 2011 there are 16 different cancer vaccine trials actively targeting multiple myeloma (Vaxil Bio’s trial is listed too). http://www.cancer.gov/clinicaltrials/search/results?protocolsearchid=6406649
Is this “breakthrough” describing a novel target? No: The MUC1 gene has been described back in 1984 when it was first observed in human breast carcinomas: http://www.ncbi.nlm.nih.gov/pubmed/6094338?dopt=Abstract&holding=npg
Is this “breakthrough” describing a particular characteristic of the investigational target? Maybe: According to the company’s website: “Unlike other vaccines which target the entire MUC1 protein or other domains, ImMucin does not contain any non-specific epitopes, which could dilute and disturb specific anti–cancer immunity. ImMucin™ was shown to selectively be expressed on tumor cells, thereby ensuring specific anti-cancer activity.” http://www.vaxilbio.com/index.php?option=com_content&view=article&id=18&Itemid=27

In conclusion:

Hardly a breakthrough,
may be an interesting agent to add to the mix in a cancer that currently has multiple therapeutic options (including antibody-based therapies considered as “novel” agents — see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001609/),
with limited clinical trial involving more than 15 patients in one site http://www.vaxilbio.com/index.php?option=com_content&view=article&id=24&Itemid=37

Free advice for the company: I’d save the big claims language until I see progress free survival and overall survival data…. because isn’t a true breakthrough grounded in patients getting the outcomes that matter the most to them — an acceptable balance between extended quantity of life with a reasonable quality of life?

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