Strategy. Innovation. Brand.
Animal Fats and Multiple Sclerosis
Maybe not.
As a person who has multiple sclerosis, I read with great interest “STAT”, an article by Maria Bustillos that appeared recently on the Longreads website. (Click here to access the article). Bustillos describes her very unpleasant experiences when her 24-year-old daughter was diagnosed with MS. She also advances the hypothesis that animal fats are an important and overlooked factor in the cause and progression of MS.
If Bustillos is right, then removing animal fats from your diet should alleviate – or even eliminate – many symptoms of MS. I hope she’s right. Controlling MS through diet would be much simpler and less costly than many other alternatives. However, I have my doubts and want to summarize them here.
By way of background, I am a sixty-something Caucasian male who was diagnosed with MS in 2008. I have the remitting-relapsing form of the disease and have not had a relapse for almost eight years. I am also an active volunteer for the National MS Society (NMSS). I participate in their fundraisers – Bike MS, Walk MS, etc. – and I currently serve on the Board of Trustees for the Colorado-Wyoming chapter. It’s worth noting that the opinions stated here are mine alone.
The Animal Fats Hypothesis
Bustillos proposes that animal fats are a significant factor in causing MS and/or exacerbating its symptoms. She writes, “Animal fats appear to play a significant role in making MS patients sicker; fish oils help keep them healthier.” Based on this analysis, Bustillos recommends a vegan-plus-fish diet to manage MS. Let’s call this the animal fats hypothesis or AF for short.
Other Hypotheses
While the AF hypothesis is useful, many other hypotheses about MS exist. One that I find especially intriguing is what I’ll call the clostridium hypothesis as proposed by Dr. Timothy Vartanian and his colleagues at the Weill Cornell Medical College.
The clostridium hypothesis derives from research conducted in the Faroe Islands, an isolated chain in the north Atlantic. Prior to World War II, the inhabitants of the Faroe Islands – the Faroese — had never recorded a case of MS. During World War II, the British established a naval resupply station in the islands and brought in scores of troops and pack animals, especially mules. The first recorded case of MS occurred in 1943 and heralded the beginning of an MS epidemic. Researchers have documented three successive epidemic waves since then. (Click here for more detail).
What changed in the Faroe Islands to enable the rise of MS? Dr. Vartanian and his colleagues suspect – but certainly haven’t proven – that the cause is a specialized subtype of the bacterium clostridium perfringens. The subtype produces the epsilon toxin, which can degrade the myelin sheath that protects the nervous system. Degraded myelin is a hallmark of MS.
Clostridium is associated with grazing animals and is often found in the soil where they feed. Vartanian’s team has found the epsilon-producing form of clostridium in soil samples from the Faroe Islands and also in stool samples of people who have MS – both in the Faroes and elsewhere. Dr. Vartanian and his team suspect that British pack animals introduced clostridium perfringens to the Faroe Islands and created an environmental trigger for MS. There’s no conclusive proof of this hypothesis but clostridium is certainly a bacterium of interest.
MS has traditionally been viewed as an autoimmune disease. For unknown reasons, the immune system attacks the body and degrades myelin. The clostridium hypothesis suggests that the immune system is reacting to a bacterial infection. It’s a very different model and potentially yields very different therapies.
Could a change in diet have caused the eruption of MS in the Faroe Islands? It’s possible but I haven’t found any evidence that the Faroese changed their diet substantially during or after World War II.
I’ve highlighted the clostridium hypothesis because I think it’s intriguing. But there are many other hypotheses as well. One, for instance, suggests that MS is related to a deficiency in Vitamin D. This is based on the observation that the incidence of MS is higher the farther one is from the equator. Presumably one gets less Vitamin D from the sun in far northern or southern latitudes. (Click here for more detail). My point is that there are many hypotheses and we shouldn’t consider the AF hypothesis in isolation. We can compare hypotheses to determine which one explains our observations best.
(Click here, here, here, here and here for more articles on the clostridium hypothesis).
Norway and Colorado
Bustillo’s argument relies heavily on a study of the incidence of MS in post-war Norway. The study, by the neurologist Roy Swank, was published in 1952 in The New England Journal of Medicine. As Bustillos writes, Swank found that “…the incidence of MS in remote, mountainous dairy-farming regions, where there was a high consumption of beef and dairy products, was eight times higher than on the coast, where the predominant diet was based on fish.”
Bustillos and Swank conclude that diet was the causal factor behind these differences. That’s certainly possible but I’m not convinced. The evidence I would point to comes from my home state of Colorado, which also has an unusually high incidence of MS. In Colorado, the incidence of MS is about 182 cases per 100,000 people. In the United States as a whole, the ratio is 135 cases per 100,000 people.
Why the difference? Perhaps it’s Colorado’s altitude. That would fit nicely with the Norwegian study, which found that highlanders contracted the disease more frequently than coastal dwellers. Or perhaps it’s the fact that Colorado is the center of a large livestock industry. We have millions of grazing animals and I suspect our soil is chockfull of clostridium. This would lend credence to the clostridium hypothesis and the Faroe Island experience.
I can’t think of any dietary differences between Colorado and the rest of the nation that would account for the differences. As far as I can tell, the Colorado example doesn’t support the animal fats hypothesis — but doesn’t refute it either.
As Bustillos points out, Swank did considerable research on the vegan-plus-fish diet. Indeed, it’s often referred to as the Swank diet and is promoted by the Swank MS Foundation. (Click here for more detail). Bustillos claims that the National MS Society does not provide information on this diet. That’s not quite right. Here’s an article from 2008 on the NMSS website that summarizes a variety of diets, including Swank’s.
Beef Consumption and MS
If the AF hypothesis is correct, one surmises that there should be a correlation between beef consumption and the prevalence of MS. But I can’t find such a correlation in the available data.
Here, for instance, are the top five countries in terms of beef consumption per capita.
Hong Kong 123.51 pounds per capita per year
Argentina 96.95
Uruguay 81.59
Brasil 60.40
USA 53.84
(Click here for the full table of 61 countries)
On average, the worldwide prevalence of MS is 30 cases per 100,000 people. Yet Argentina has only 18 cases per 100,000 people. Uruguay has 26. Brasil has 15. The USA has 135. (I couldn’t find data on MS in Hong Kong).
At the other end of the spectrum, Sweden and Norway don’t even rank in the top 61 countries in terms of beef consumption. Yet Norway has 160 MS cases per 100,000 people and Sweden has 189.
The data here and here support the Vitamin D hypothesis much more than the animal fats hypothesis.
Other Diets
Based on the animal fats hypothesis, Bustillos concludes that a vegan-plus-fish diet is a good way – perhaps the best way – to manage MS. Let’s remember that other diets have also been proposed to manage MS.
In a popular YouTube video, for instance, Dr. Terry Wahls attributes her success in managing her MS symptoms to a diet rich in leafy greens, colored fruits and vegetables, seaweed, meat from grass-fed animals, and organ meats. She also stresses the need to reduce sugar and gluten as well as the need to reduce stress. Dr. Wahls’ MS symptoms were severe enough that she could no longer walk and was chronically fatigued. When she switched to her new regimen, she regained her energy and her ability to walk.
What intrigues me about Dr. Wahl’s diet is that it includes meat. In fact, her diet is quite similar to the popular paleo diet. Numerous testimonials suggest the paleo diet can help manage MS. (See here, here, and here, for instance).
All of these diets include meat, which a vegan-plus-fish diet excludes. If the AF hypothesis is correct, it seems that the paleo diet should exacerbate MS symptoms rather than alleviate them. It seems that either the vegan-plus-fish diet or the paleo diet might work to alleviate MS symptoms. But I’m hard pressed to explain how both could work. But perhaps we’ll soon find out as the National MS Society recently announced new research into both the Wahls and Swank diets. In cooperation with the Univeristy of Iowa, NMSS is investing $1 million in a 36 week clinical trial to measure the effectiveness of “…a low saturated fat diet (Swank diet) or a modified paleolithic diet (Wahls diet)”. Stay tuned. (Click here for more information).
Evidence Based Medicine
Bustillos writes a long critique of evidence-based medicine or EBM. She clearly believes that we should not accept EBM as the be-all and end-all of medical research. I agree. So does the medical establishment.
For some years now, medical researchers have used a hierarchy of evidence that includes at least four levels. The most stringent level of evidence – Level I – involves randomized, double blind experiments that are replicated in multiple locations. This is the gold standard of evidence-based medicine.
The least stringent level of evidence – Level IV – includes testimony from a panel of experts. Ideally, the panel will include experts from multiple institutions and represent multiple disciplines. The panel reviews the existing evidence and presents it in a public forum where interested parties can question their findings.
Based on what Bustillos writes, it appears that the animal fats hypothesis does not yet rise to the Level IV standard of evidence. Perhaps a useful next step for AF proponents — while we await the results of the NMSS/Iowa study — would be to organize a panel of experts and present their findings in public.
(Click here for more detail on the four levels of evidence or here for an alternate version that includes five levels).
Character References
Bustillos offers sterling character references for researchers who agree with the AF hypothesis. She describes them as “distinguished”, “eminent”, “prominent”, and “highly qualified”.
I’m sure she’s right. I would similarly like to offer sterling character references for the neurologists, biologists, researchers, and clinicians that I have met in the MS community. Many of them have close personal connections to MS. Indeed, many of them have the disease themselves. On the whole, I find them to be highly professional, creative, and open-minded. They’re looking for answers and they’ll pursue any clue that seems promising.
I made my career in the computing industry and I recognize the Not Invented Here syndrome when I see it. I don’t see it in the MS community.
Medical Therapies
There are currently 14 FDA-approved disease modifying therapies (DMTs). None of these is a magic bullet that stops or reverses the course of the disease. However, the DMTs can slow the progression of the disease and produce useful outcomes in both the short term and long term.
Generally, the sooner one begins treatment with DMTs, the better off they are in the long run. Mark Freedman’s research, published in the journal Neurology (click here), suggests that, “…that early optimal treatment aimed at reducing disease activity can improve longer-term outcomes by delaying disease progression.”
My Case
Like Bustillos, I believe that good diet is essential to good health. I’m intrigued by the vegan-plus-fish diet. Yet, I’ve managed my MS symptoms successfully without it.
I eat a healthy diet but it’s not nearly as strict as vegan-plus-fish – or paleo for that matter. I follow the recommendations of various heath organizations like the American Heart Association. I don’t each much sugar but I don’t worry too much about gluten or dairy. I eat a lot of fish and vegetables but I also toss in a hamburger every now and then. Why? Because I believe that occasional pleasures are essential to good health as well.
I also do a lot of yoga. Perhaps that’s what makes the difference for me. Perhaps we should research yoga’s impact on MS more thoroughly. I think we could build a strong case for yoga – perhaps equally as strong as the case that Bustillos presents for the AF hypothesis.
The Newly Diagnosed Experience
Bustillos writes about her experiences in the immediate aftermath of her daughter’s diagnosis. By and large, she describes it as a nightmarish period in her life.
My own baptism into the MS world was more benign. The first thing my doctors told me was that there’s a lot that we don’t know. I accepted that and did a lot of research on my own. I discovered various therapies including the paleo diet, yoga, massage, and acupuncture. I adopted those that made most sense to me.
I’m sorry that Bustillos and her daughter had a negative experience. But I don’t think that’s relevant to whether we accept or reject the AF hypothesis. I think we should share as much information as we can about as many therapies as possible. But I don’t think we should promote the vegan-plus-fish diet as the one true solution. There’s just not enough evidence.
Where To?
I’m interested in the vegan-plus-fish diet but not yet ready to convert. I’m well versed in Pascal’s Wager and I don’t require Level I evidence to pursue a potential therapy. But I would like to see some evidence that’s at least at Level IV. I have an open mind here but I need to know more.
I hope that Bustillos — and others who are intrigued by dietary therapies – will also keep an open mind about disease modifying therapies. The evidence is quite clear that it’s better to start DMT therapies earlier rather than later. It’s Level I evidence and it’s quite convincing.
Perverse Incentives and Wells Fargo
But don’t read the comp plan.
The papers today are filled with the story of the “brazen sham” at Wells Fargo. Apparently, 5,300 employees opened “566,000 phantom credit card accounts” and charged customers $1.5 million in fees for accounts that they didn’t know existed. Why did employees do that? Because their compensation plan told them to.
Wells Fargo seems to have spawned a set of perverse incentives in the credit card division. Rather than incenting employees to do the right thing, the incentives led employees to cut some ethical corners in order to earn bigger bonuses. The company professed one set of values but paid employees to abide by another. That’s perverse but not uncommon.
(For more on perverse incentives, click here, here, and here).
Why are perverse incentives so common? In my opinion, it’s poor message discipline. The company delivers different messages to different audiences.
As it happens, I’m a Wells Fargo customer (though not of the credit card division). I receive a lot of their information and, being a student of branding, I actually read it. I’ve always been impressed by the consistent tone and content of their communications. The messaging managers are doing a good job and building a good brand.
I’ve also had a number of students who work for Wells Fargo as junior to mid-level managers. Without exception, they speak highly of the organization. They report that Wells Fargo uses the Strengths Finder tools to help employees identify their strengths and weaknesses and to help managers build well-balanced teams. They also report that the company has a diverse employee base and a very positive culture. In short, my students who work at Wells Fargo seem to love the place.
The messaging is remarkably consistent, whether it’s coming directly from the company or indirectly through employees. As the New York Times reports, the message consistently focuses on trust: “Wells Fargo has long tried to separate itself from Wall Street…..the bank has sought to portray itself as a bank for Main Street. Its entire ethos, Wells Fargo has long suggested, is one of trust and ethics.”
That message came through clearly and consistently for me. But the people in charge of message consistency missed one critical document: the comp plan.
It’s often said that a company speaks to its sales force through the comp plan. In other words, the comp plan is a messaging document and requires the same discipline as any other messaging document.
Sales people don’t read company brochures and websites to learn how to behave. Instead, they read the comp plan. If the brochures focus on a culture of trust but the comp plan focuses on closing deals at any cost, we almost automatically get perverse incentives. The company is saying two different things to two different audiences. The best that can be expected is confusion. The worst is fraud.
Can Wells Fargo recover? I suspect so. In fact, though somewhat disappointed, I’m still a satisfied customer. They’ve done a good job by me and I appreciate their attitude and, yes, their ethos. Now they have to deliver one consistent message to all audiences, both internal and external.
Greetings from quit.snacks.humid
My house — quit.snacks.humid
How do you tell someone where you are? Most of us would use some form of a postal address to identify our location. But what if you’re in a place that doesn’t have a postal address? In other words … most of the world.
If there’s no postal address, I might use latitude and longitude. For instance, our home is located at 39.714549 latitude and -104.971346 longitude. If you understand the system, you’ll realize that my house is 39 degrees north of the equator and 104 degrees west of the prime meridian that passes through Greenwich, England.
(I have an 18th century French map that gives longitude as the number of degrees east or west of Paris. It was part of a long-running dispute about where, precisely, the center of the world is.)
Longitude and latitude give us precise locations, but they’re not human friendly. It’s like noting that the current temperature is 287.039 degrees Kelvin. That’s accurate but not terribly meaningful to most humans.
So, is there a way to map the world that would be easier for humans to manage? Well, how about we divide up the entire surface of the earth into squares that are approximately three meters per side? Each square is nine square meters or roughly 90 square feet. As you’ve no doubt calculated by now, we would need about 54 trillion such squares.
That may sound complicated but, really, how hard is it to manage 54 trillion squares? The researchers at What3Words – a start-up company in London – figured out that you only need 40,000 words in three-word combinations. That yields about 64 trillion combinations – enough to address the world and have a few trillion combinations left over.
In the world of What3Words, our home address is quit.snacks.humid. It’s easy to remember and precise enough to guide you to our front door. If I wanted to guide you to our driveway, I would instead use the words refuse.fake.limbs. If I wanted to send you to the highest summit in Colorado – a place that doesn’t have a postal address – I would send you to penned.metro.inspections.
According to What3Worlds, the system is already in use to deliver mail in unaddressed areas like Mongolia or the favelas of Brazil. Similarly, Steven Spielberg is using What3Words addresses to get his actors and crew to the right place at the right time as he films his latest movie. I can imagine Colorado’s Alpine Rescue Team guiding rescuers to acutely.jumbo.popcorn rather than saying, ”The injured party is about 3.3 miles northeast of the Mt. Elbert summit on the east flank of a small ravine.”
What3Words already has some interesting use cases and, if it develops fully, it should help us with logistics, emergency services, scheduling, and materials management. But its real potential comes from the fact that it’s released not as a solution but as a platform. As we know, (click here, here, and here) platforms are innovations that generate innovations. As other application developers adopt and adapt the platform, we could see a rich ecosystem of solutions that even the What3Words folks can’t imagine today.
By the way, I’m taking a few days off. If you need me, I’ll be at tent.quarrel.charm.
Are You A Super-Recognizer?
I recognize you!
If you met somebody from your third grade class, would you recognize her? How about someone you last saw a decade ago at a company where you used to work? How about a person you saw in a mug shot at the Post Office?
If you answered “yes” to any of these, you may be a super-recognizer. Super-recognizers literally never forget a face. They may also give us the next great leap forward in law enforcement.
We haven’t known about super recognizers for very long. Over the past 20 years or so, researchers have learned a great deal about the opposite condition known as prosopagnosia or face blindness. Some people – perhaps two percent of the population — just can’t remember faces. They’re “blind” to the faces around them. They can interact with you perfectly well while they’re with you but they won’t recognize you the next time they see you.
Researchers initially thought that this was a binary condition – either you were normal or you were face blind. Then someone had the bright idea that the ability to recognize faces might be distributed along a normal curve. If face blind people are clustered under one tail of the curve then the other tail should include people who are exceptionally good at recognizing faces – the super-recognizers.
It turns out that they were right. In 2009, Richard Russell and his colleagues published the first academic paper on the subject: “Super-recognizers: People with extraordinary face recognition ability”.
It seems like a typical academic topic but the story took an unusual twist when the Metropolitan Police Service in London took up the idea. As detailed in a recent story in The New Yorker, the Met experimented with super-recognizers as detectives. London has more security cameras than any other city in the world but couldn’t turn the images into a crime-fighting advantage. The city had millions of low-resolution images of potential criminals and nobody to interpret them.
The Met tried to change that with an organized team of super-recognizers. The super-recognizers browse through mug shots and then review footage from security cameras that have recorded a crime. In a surprising number of cases, the super-recognizer has an “aha” moment and links a miscreant to a mug shot.
How good are they? The Met calls super-recognizers “the third revolution in forensics” after fingerprints and DNA evidence. The Met solves about 2,000 cases a year with fingerprints and another 2,000 with DNA. By comparison, the super-recognizers solve about 2,500 cases.
At this point, you may be wondering just how good you are at recognizing faces. Here’s how to find out – the Cambridge Face Memory Test. Click here and you can take the same test that the Met uses to screen applicants for the super-recognizer team. If you get a high score, you might just apply for a position with your local police force.
Managing The Matrix
Task: Assemble the best team.
One of my largest clients is re-engineering its organization to focus on functions rather than geographies. It’s a classic move from top-down management to matrix management. I think it’s very much the right thing to do but it’s making some of the managers nervous. How does one shift from managing a team to managing a matrix?
I went through a similar transition at Lawson, the last major software company that I worked for. We transitioned from geographies – Sweden, Western USA, Australia/New Zealand – to global teams that focused on vertical markets like healthcare, food and beverage, and fashion. We focused on industries rather than geographies and became expert advisors to our customers.
And what did I learn about managing in a matrix? Here are the key ideas that stood out for me.
Connectors succeed – in a geographic organization, a manager gets to know her team and learns how to accentuate their strengths and minimize their weaknesses. Team members are often physically close to each other. There’s no need to connect them; they’re already connected. In a matrix, the ability to connect people is the most important single skill. People who are natural connectors are often the best matrix managers.
Diplomacy counts – diplomacy is a useful skill for any manager. It’s especially important in a matrix. In a top-down organization, a manager could simply give orders without much tact or diplomacy. Not so in a matrix. A matrix manager is forever building teams – one team to address Issue X, and another to address Issue Y. A matrix manager is always recruiting and needs a positive attitude, good diplomatic skills, and a good understanding of what motivates people.
A good manager can build all-star teams – let’s say I wanted to sell Lawson software to the Swedish fashion house, Filippa K. With the right diplomatic and connecting skills, I could assemble an all-star team to sell the account. My team might include a design expert from New Zealand, a cut-and-sew expert from New York, and a retail expert from Stockholm. I pull them together and focus them intently on the task of selling to Filippa K. Once they sell the account, the team dissolves and the team members reassemble — perhaps with other teammates – to focus on a different project. The good news is that a matrix manager gets to work with all-stars all the time. The not-so-bad news is that a successful matrix manager needs to continually assemble and re-assemble teams in ever-changing patterns.
Talent spotting becomes more important– in a geographic organization, employees do multiple things in a designated area. They become jacks-of-all-trades. In a matrix organization, employees are much more likely to specialize in a given function. They can master the skill. The successful matrix manager knows how to spot the most talented employees and recruit them to her (temporary) team.
Flexibility and adaptability count – flexibility is the strongest point of matrix organization. Managers can quickly assemble and re-assemble teams based on changing needs. This only works if managers are equally flexible. Managers must be fluid; they can’t stay attached to a permanent structure. There is no permanent structure.
Managers must work effectively with each other – in a matrix, an employee often has more than one manager on a given project. For instance, that retail expert from Stockholm would report to me temporarily while working on the Filippa K account. At the same time, she would also report to the overall head of the retail team, who might be located in Melbourne. It can get confusing and roles need to be clearly defined. At the same time, managers need to work effectively with their peers cross the matrix. If I have a beef with the manager in Melbourne, things will go downhill quickly. Again, diplomacy and good communication are key ingredients for success.
The matrix changes the culture – in geographic organizations, teams may easily fall into competition with each other. I would have no incentive to lend my retail expert to another geography. That would only crimp my chances of making my number. A matrix, on the other hand, emphasizes cooperation. If a manager doesn’t make her all-stars available, she doesn’t get access to other all-stars. Sharing becomes more important than competing.
Ultimately, good managers have nothing to be afraid of in a matrix organization. Even in traditional top-down organizations, good managers are likely to be effective communicators and motivators with good diplomatic skills. Those are the same skills that are required to succeed in a matrix.
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