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Atul Gawande: How Do Good Ideas Spread?

Atul Gawande: How Do Good Ideas Spread?
Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century. The first public demonstration of anesthesia was in 1846. On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. Four weeks later, on November 18th, Bigelow published his report on the discovery of “insensibility produced by inhalation” in the Boston Medical and Surgical Journal. There were forces of resistance, to be sure. Sepsis—infection—was the other great scourge of surgery. In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms. Far from it. Did the spread of anesthesia and antisepsis differ for economic reasons?

Coca-Cola to open startup accelerators in nine countries around the world Coca-Cola has already launched accelerators in Sydney and San Francisco. When you think of Coca-Cola do startups come to mind? The beverage giant has plans for accelerator programs in nine cities including Berlin and Istanbul by the end of the year. The accelerators in Sydney and San Francisco have already launched. According to a presentation given by Coca-Cola VP of Innovation David Butler in Sydney in early August, the Mexico City program should also already be active. The next cities lined up are Rio de Janeiro, Buenos Aires, Bangalore, Berlin, Singapore and Istanbul. “About a year and a half ago, the company stepped back and said – what are we not doing in terms of innovation?” The details so far are pretty vague – deliberately so, as it’s still an experiment for the company. A Coke-branded device to make you healthy? Butler told the crowd in Sydney that two broad areas of interest will be well being and distribution but the specifics will depend on each city and country.

Espiner's Berlin: Christiane F and the children of U-Bahnhof Weinmeisterstraße - In English - Welt 12.05.2011 11:56 Uhr Heroin and Berlin, that seemed to be co-dependents to our Columnist Mark Espiner. Now he wants to find out more about the current drug-scene. At U8's station Weinmeisterstraße he meets a girl who is addicted for years. Recently, I haven’t been able to get heroin off my mind. Christiane F was the film that first introduced me to Berlin. It was pre-wallfall heroin chic with Bowie thrown in – which naturally won it a fashionable following in the UK. But the thing that really put heroin on my radar wasn’t Zoo station, but the U8’s Weinmeister Strasse stop. I had noticed that down the road from my regular cafe was another one for addicts run by Caritas. It had a homely, welcoming atmosphere. But what about Weinmeister Strasse, I ask. I asked Reno if I could go with him on his street work rounds. Sarah (name changed) is 20. So we arrange an evening at a cafe on Alexanderplatz. “I want to stop these fucking shit drugs,” she says. She’s never been a prostitute she says.

The decline effect and the scientific method On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news. It had to do with a class of drugs known as atypical or second-generation antipsychotics, which came on the market in the early nineties. The drugs, sold under brand names such as Abilify, Seroquel, and Zyprexa, had been tested on schizophrenics in several large clinical trials, all of which had demonstrated a dramatic decrease in the subjects’ psychiatric symptoms. As a result, second-generation antipsychotics had become one of the fastest-growing and most profitable pharmaceutical classes. By 2001, Eli Lilly’s Zyprexa was generating more revenue than Prozac. It remains the company’s top-selling drug. But the data presented at the Brussels meeting made it clear that something strange was happening: the therapeutic power of the drugs appeared to be steadily waning. The study turned him into an academic star.

How a secretive panel uses data that distorts doctors’ pay “I have experience,” the Yale-trained, Orlando-based doctor said. “I’m not that slow; I’m not fast. I’m thorough.” This seemingly miraculous proficiency, which yields good pay for doctors who perform colonoscopies, reveals one of the fundamental flaws in the pricing of U.S. health care, a Washington Post investigation has found. Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs. Those values are required under federal law to be based on the time and intensity of the procedures. But the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals. If the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting.

Habits of Successful People: Start Before You Feel Ready In 1966, a dyslexic sixteen-year-old boy dropped out of school. With the help of a friend, he started a magazine for students and made money by selling advertisements to local businesses. With only a little bit of money to get started, he ran the operation out of the crypt inside a local church. Four years later, he was looking for ways to grow his small magazine and started selling mail order records to the students who bought the magazine. The records sold well enough that he built his first record store the next year. After two years of selling records, he decided to open his own record label and recording studio. He rented the recording studio out to local artists, including one named Mike Oldfield. Over the next decade, the young boy grew his record label by adding bands like the Sex Pistols, Culture Club, and the Rolling Stones. How I Met Sir Richard Branson Two weeks ago, I walked into a conference room in Moscow, Russia and sat down ten feet from Branson. —Richard Branson Start Now

Heroin: art and culture's last taboo | Television & radio | The Observer One of the easiest places to find heroin in Paris is in the streets in and around the Gare du Nord, a stone's throw away from the Eurostar terminal. I know about this place partly because I live in Paris and I am a frequent Eurostar traveller, and partly because this is where Google sent me when I typed in the request "Where to find heroin in Paris". Apparently the most popular spot for dealing is the rue Ambroise-Paré which contains a series of entrances to underground car parks where users can shoot up in relative privacy. The place permanently stinks of piss and is under constant police surveillance, as dealers and clients scurry back and forth between their hiding places. You can watch all of this action, nibbling on a snack and sipping champagne, from the front end of the Eurostar VIP Lounge which backs on to the street. In fact although there are plenty of drugs around the Gare du Nord there is not much real heroin. This is true. "No, not at all," she says.

Gut feelings: the future of psychiatry may be inside your stomach Her parents were running out of hope. Their teenage daughter, Mary, had been diagnosed with a severe case of obsessive–compulsive disorder (OCD), as well as ADHD. They had dragged her to clinics around the country in an effort to thwart the scary, intrusive thoughts and the repetitive behaviors that Mary felt compelled to perform. Even a litany of psychotropic medications didn’t make much difference. It seemed like nothing could stop the relentless nature of Mary’s disorder. Their last hope for Mary was Boston-area psychiatrist James Greenblatt. Greenblatt started by posing the usual questions about Mary’s background, her childhood, and the onset of her illness. That’s what prompted Greenblatt to take a surprising approach: besides psychotherapy and medication, Greenblatt also prescribed Mary a twice-daily dose of probiotics, the array of helpful bacteria that lives in our gut. Her parents may have been stunned, but to Greenblatt, Mary’s case was an obvious one. Read next: Amar Toor

George Saunders's Advice to Graduates It’s long past graduation season, but we recently learned that George Saunders delivered the convocation speech at Syracuse University for the class of 2013, and George was kind enough to send it our way and allow us to reprint it here. The speech touches on some of the moments in his life and larger themes (in his life and work) that George spoke about in the profile we ran back in January — the need for kindness and all the things working against our actually achieving it, the risk in focusing too much on “success,” the trouble with swimming in a river full of monkey feces. The entire speech, graduation season or not, is well worth reading, and is included below.

The Rise of the Intangible Economy: U.S. GDP Counts R&D, Artistic Creation On July 31, the U.S. Bureau of Economic Analysis will rewrite history on a grand scale by restating the size and composition of the gross domestic product, all the way back to the first year it was recorded, 1929. The biggest change will be the reclassification—nay, the elevation—of research and development. R&D will no longer be treated as a mere expense, like the electricity bill or food for the company cafeteria. It’s a great idea, if late. GDP is the main yardstick of macroeconomics—the sum total of all goods and services produced in the country. The effect of the revision will be immediate. Of course, it’s hard to work up much excitement over an upward revision in historical GDP figures. Intangible investment is far from a faddish new idea. Economic theory was ahead of accounting practice. The U.S. generates a disproportionate share of its wealth from the likes of patents, copyrights, trademarks, designs, cultural creations, and business processes. No one said this would be easy.

Toxic 'e-waste' dumped in poor nations, says United Nations | Global development | The Observer Millions of mobile phones, laptops, tablets, toys, digital cameras and other electronic devices bought this Christmas are destined to create a flood of dangerous "e-waste" that is being dumped illegally in developing countries, the UN has warned. The global volume of electronic waste is expected to grow by 33% in the next four years, when it will weigh the equivalent of eight of the great Egyptian pyramids, according to the UN's Step initiative, which was set up to tackle the world's growing e-waste crisis. Last year nearly 50m tonnes of e-waste was generated worldwide – or about 7kg for every person on the planet. Once in landfill, these toxic materials seep out into the environment, contaminating land, water and the air. An indication of the level of e-waste being shipped to the developing world was revealed by Interpol last week. The failure to recycle is also leading to shortages of rare-earth minerals to make future generations of electronic equipment.

Your Thoughts Can Release Abilities Beyond Normal Limits There seems to be a simple way to instantly increase a person’s level of general knowledge. Psychologists Ulrich Weger and Stephen Loughnan recently asked two groups of people to answer questions. People in one group were told that before each question, the answer would be briefly flashed on their screens — too quickly to consciously perceive, but slow enough for their unconscious to take it in. The other group was told that the flashes simply signaled the next question. Our cognitive and physical abilities are in general limited, but our conceptions of the nature and extent of those limits may need revising. Can our thoughts improve our vision? To rule out the possible effect of motivation, the researchers brought another group of people into the cockpit and asked them to read a brief essay on motivation. In an eye exam, we are used to start experiencing problems at the bottom third of the eye chart, where letters start to get small.

THE SIXTH WAVE: THE RISE OF THE CREATIVE CITIES Innovation is no longer driven by states or nations. It’s driven by cities. The key for the future of competitiveness is the development of local ecosystems. Some years ago, I developed the thesis of the six innovation waves. The economist Joseph Schumpeter was the first in introducing the concept of innovation in the economic literature. This view of innovation was closely linked to public R+D spending, mainly for military issues, fueled by the II World War and the Cold War. Soon, innovation emerged as a new management concept. But echoes from the automotive sector, the most competitive and R+D intense in the world said that it wasn’t enough. And the new century arrives. But, after the last international crisis, a surprising phenomenon is raising: innovation seems to stick to some specific locations. Why innovation tends to concentrate in some specific areas, and why cities offer the best scenarios to develop innovation ecosystems? But it is not enough. References:

Homegrown in Hackney: Sophie Heawood lives off the land in E8 - ES Magazine - Life & Style I said yes, since it would only be a week, and I wasn’t emptying my house, just seeing how much I could find in my hood. Not a great deal, I presumed. My daughter and I would just forage a bit of sourdough bread from the E5 Bakehouse, show willing at a farmers’ market or allotment on the weekend, and be home in time for our respective Peppa Pig and Facebook addictions, since nothing with a plug on it could possibly be made round here. Indeed, the only signs of Hackney’s industrial past in Victoria Park Village are estate agents advertising £1.2 million luxury flats in nostalgia complexes called things like The Old Oakum Workhouse for Foundlings and Rats. But beyond that I suspected this project was doomed. Until I find out that, on the way to Westfield, Hackney Wick has many more factories than I realised. Sophie outside the borough's theatre Then there is food. And there is so much booze available. ‘Sooo great for her brain development!’ Photographs by Carsten Windhorst

“Good” Patients and “Difficult” Patients — Rethinking Our Definitions Four weeks after his quadruple bypass and valve repair, 3 weeks after the bladder infection, pharyngeal trauma, heart failure, nightly agitated confusion, and pacemaker and feeding-tube insertions, and 2 weeks after his return home, I was helping my 75-year-old father off the toilet when his blood pressure dropped out from under him. As did his legs. I held him up. I shouted for my mother. As any doctor would, I kept a hand on my father's pulse, which was regular: no pauses, no accelerations or decelerations. My mother was 71 years old and, fortunately, quite fit. Together, we lowered my father to the bathroom floor. In the emergency department, after some fluids, my father felt better. My mother waited with my father. After weeks of illness and caregiving, it can be a relief to be a daughter and leave the doctoring to others. I rested my hand on my father's arm to get his attention and said, “Dad, how much would you mind if I did a rectal?” “Kid,” he replied, “do what you have to do.”

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