In the Saturday, December 22, 2012, issue of The Wall Street Journal, there was an inspiring story written by James Zweig called “The 107-Year-Old Stock Picker.”  The subject of the story was 107-year-old Irving Kahn, the chairman of the Kahn Brothers Group, an investment management firm based in New York City.  As Zweig describes him:

“He personifies the virtues that Graham (Benjamin Graham) spelled out in his classic 1949 book “The Intelligent Investor,” from which this column takes its name.”

Later on in the story, Zweig tells us more about Kahn:

“Discipline has been a key for Mr. Kahn. He still works five days a week, slacking off only on the occasional Friday.”

In answer to a question about his remarkable longevity, Kahn responds:

“Millions of people die every year of something they could cure themselves: lack of wisdom and lack of ability to control their impulses.”

Irving Kahn appears to be an individual firmly grounded in the real world, and as active as a 107-year-old can possibly be. Zweig commented: “In some ways, Mr. Kahn says, these are the good old days.”  As an investor, he correctly notes that he has more tools than ever available to level the playing field between investors and those from whom they buy securities.  His goal is to know more about the stock he is buying than the investor who is trying to sell it to him. He is energized by his job and his daily life, and his physical faculties have declined relatively slowly.

Although I have had many role models in my life, certainly Mr. Kahn has to be added to them.  I believe that the key to health and longevity is a continuation of one’s passionate commitment to family and friends, causes, and work.  When someone completely “retires” from active living, he or she actually increases his or her psychic burden.

The other key to healthy longevity is to live every day with the appreciation of life that a productive very old person carries through the day.  When I have met such people, very little that bothers me would bother them, because they have had a few extra decades in which to put life into perspective.

How do they think differently from someone at my age or someone far younger than I am?

• They have been through enough up-and-down cycles in life to realize that neither success nor adversity is permanent.  Life has a mix of both every year for us.
• Just as those who have had near death experiences tend to worry less about just about every other problem, those who have relatively short life expectancies tend to consider daily problems to be of lesser consequence.
• They celebrate small successes every day.  At first glance, this would appear to be an acknowledgment that a person has failed to achieve more ambitious goals, but it actually increases the likelihood of more ambitious accomplishments.  Efficiently taking small, successful steps often gives an individual the ability to adapt to changed conditions and achieve success with fewer big failures.

Conversely, by encouraging older people to retire and disengage from active work, we inadvertently put them in a much more psychologically vulnerable position.  They lose the ability to see past the news headlines into the many good things that are happening.  They get fearful, when they should be celebrating the progress we are making on many fronts.

Why do I believe that to be the case?  Someone in the flow of the business, political, cultural, and community world has a much better understanding of reality than someone who gathers information from the mass media.  The TV media, in particular, is designed to report what it calls “news,” but what is typically a highly distorted and negative selection of the broader flow of events and trends.  Initially local news editors, but now national and global news editors as well, on all news stations select stories for broadcasting or printing based on the principle of “If it bleeds, let it lead.”

For this reason, although the world is less violent than it was two decades ago, and the absolute level of crime is the lowest it has been for decades, the sensational reporting of crimes gives the impression that violence is at an all-time high.

Recently, I met a highly accomplished journalist and author named Greg Behrman, who feels the same way I do.  We spend far too much time covering what’s wrong in the world, and not enough time spotlighting the things we are doing right, and that require considerable innovation in solving problems.  Think about this point for a minute in a number of contexts:

• As a country, we are seeing a significant increase in the percentage of people that are overweight or even obese.  We have a true public health crisis in slow motion.  That is no longer news.  We see it all around us, particularly in the Southeastern United States, and in the lower income parts of big cities.

However, I learned that New York City has actually stopped and even reversed the incidence of childhood obesity, but I did not learn it from the news media, but from a speech given by Dr. Tom Farley, the City’s Public Health Commissioner.  I am sure that the advisory board meeting at which Dr. Farley spoke was not the first time at which this news was made public, but it would be difficult to find this story in the popular media.

• We get the impression that we are a more violent world than ever before, but Joshua Goldstein recently published a book called Winning the War on War, which documents that the absolute level of armed conflict is declining over time.  Why do we not see these statistics dominating the airwaves?

• The U.S. has had great success in several public health campaigns over the last four decades in reducing the percentage of adults who use tobacco, the likelihood of automobile related fatalities, the likelihood of workplace-related accidents, and the incidence of alcohol abuse.  This is not broadly or frequently reported.

• Our air is cleaner, there is a lower incidence of acid rain, and the level of hazardous waste discharges in our factories is far lower than it was 40 years ago, but there is very little reporting on these positive environmental trends.

• In many respects, medical science has enabled us to achieve a better quality of life than was possible when I was growing up.  My wife was an early beneficiary of lasik surgery, which eliminated her need to wear contact lenses or glasses for everyday distance viewing (although she still wears reading glasses.)

Whenever I am down, I think of Irving Kahn, but more importantly, I think of the old Frank Sinatra song That’s Life, particularly one section of the lyrics:

I’ve been a puppet, a pauper, a pirate, a poet, a pawn and a king

I’ve been up and down and over and out and I know one thing

Each time I find myself flat on my face

I pick myself up and get back in the race

That’s Life, That’s Life

I tell you, I can’t deny it

I thought of quitting, baby but my heart just ain’t gonna buy it.”

We should take a moment upon reading this and celebrate Irving Kahn and everyone like me who keeps getting “back in the race.”  For, in doing so, he has clearly discovered the true fountain of youth.

Every once in a while, a single comment in a book or article prods us to think very differently about a broadly discussed issue.  One that comes to mind is a statement in Steve Coll’s essay in the online version of The New Yorker magazine.  That essay, entitled “Is Chaos a Friend of the NFL,” posted on December 26, 2012, discusses two issues that have the potential to damage the NFL’s brand and economics over the long term: the “bounty” issue and the injuries that have led to many cases of long term damage to present and former players, including dementia, depression, alcohol and drug abuse, suicides and murders.

http://www.newyorker.com/online/blogs/comment/2012/12/is-chaos-a-friend-of-the-nfl.html

The comment that caught my attention was about the “bounty” issue, that is, the practice of coaches or players paying other players for success in injuring opponents so badly that they had to be removed from games or, worse yet, unable to play in future games. The practice is bad enough in creating injury risks for individual players and is offensive on that basis alone.  Indeed, it becomes another source of the second problem, causing long-term injuries to players in order for a team to win a game or to secure a better position in an individual season.

(more…)

In talking with Dr. Robert Green, one of the handful of leading-edge researchers and thinkers on the promise of genomics in transforming health and healthcare, I have gained some quite interesting insights.

Dr. Green is a physician-scientist at Brigham and Women’s Hospital and the Harvard Medical School and has focused much of his professional life on a subject of great passion to me, patient empowerment.  As strange as it may sound, he has had to do a considerable amount of clinical study work to prove to the medical community that the consequences of doctors telling patients that they are at serious risk of a degenerative and currently incurable disease are, on balance, positive.  His work in that regard has been done through a series of studies called the REVEAL Study, for which he has been the principal investigator.

(more…)

I have not written recently about my work with the Boston University Alzheimer’s Disease Center, but our Advisory Board ended up making a suggestion that eventually resulted in Boston University getting funded to undertake research that led to the findings that are now in the headlines of every sports page and in discussions on every TV and radio sports talk show.  I am speaking about the discussions about the National Football League’s decision to issue a directive to officials, teams, and players that particularly “vicious” hits will be punished with player suspensions as well as penalties.

I commend NFL Commissioner Roger Goodell for having the good sense to address this issue decisively, although, as I will point out, the BU research findings are potentially far more transformational for contact sports than the commentators about the findings have communicated.  What is most interesting, and, to some degree, saddening, is the fierce resistance of many players and commentators to an action that will benefit the players and the sport in the longer term.

(more…)

Having just recently attended a meeting at the Boston University Alzheimer’s Disease Center, which I find to be exceptionally entrepreneurial, collaborative across many disciplines, departments, and even schools, and innovative, I am struck by the huge opportunity our health care system has available by focusing on good genetic risk assessment, prevention screenings, and early diagnosis and treatment for medical conditions.

We have made considerable progress over the last 20 years in covering preventive screenings in health plans, and in publicizing the importance of screenings such as mammograms for breast cancer, colonoscopies for colon cancer, and Pap smears for cervical cancer. We also are getting more people than ever to test for blood sugar to test for diabetes.

However, we still have too many medical conditions that go undiagnosed until it is either too late to treat them, or prohibitively expensive to do so. The investment in early diagnosis for many treatments is hugely positive for a health plan. For example, I learned that a diagnosis of breast cancer at Stage 1 results in a $1,500 per month treatment cost. A later-stage diagnosis results in a $9,500 per month treatment cost. The HealthCheckUSA blog provides more details about the specific benefits linked to health screenings of all kinds. (more…)

Consistent with my philosophy of finding the “road less traveled,” one major area of interest for me is Alzheimer’s disease, which actually is the third-highest cost medical condition in our U.S. healthcare system, far more than HIV/AIDS and many other conditions that get more publicity and funding.

I should confess that I have a personal interest in Alzheimer’s.  I have had family members that either had Alzheimer’s or some other form of dementia.  I do not know whether my loved ones had Alzheimer’s because autopsies were not done, and, as I understand it, an autopsy is the only definitive way to determine whether a person has had Alzheimer’s.  Fairly definite diagnoses can be made through memory assessment, and the earlier memory assessment and diagnosis can be done, the more can be done for an Alzheimer’s patient.

I help advise the Boston University (BU) Alzheimer’s Disease Center, one of the slightly more than two dozen centers designated as a center of excellence by the National Institutes of Health in a highly-competitive process.  On June 20, I attended an advisory group meeting at BU Medical School.  I also visited a few university mail centers on this trip, and spent some time with one of our top sales professionals who has sold products to many colleges and universities. 

Several conclusions jumped out at me:

• While we want world-class research in trying to find breakthroughs for diseases like Alzheimer’s and we get it at institutions like BU, our government and other donors put ridiculous bureaucratic obstacles in the way of focusing on research and clinical care.  For example, as one college director of operations told me, universities and other research centers have to account for individual pieces of mail and other low-ticket items because of the government’s obsession with making sure that no dollar is “wasted.”  At the same time, no one in government thinks about the waste or opportunity cost of high-skilled researchers or physicians worrying about the cost of single letter or photocopy and charging it to the right account.
• Donors of all kinds congratulate themselves on restricted funding that is targeted only on research and not on “overhead” costs like administrative support, equipment, supplies, and facilities.  Yet, no institution can survive without some amount of overhead.  I have talked to many CEOs and Chairmen of non-profits who have seen the same thing I have.  Many worthy organizations hit a wall on their ability to accept restricted grants and perform on them because their funding for the necessary, but mundane, administrative tasks does not keep pace.
• Government funding for breakthrough medical research and clinical care is declining in relative and absolute terms, even when it would produce significant and measurable payback in future years.  Governments at all levels are so fixated on current-year budget-balancing activity that they routinely mortgage the future.  Medicare, in particular, ludicrously controls the payouts for individual clinical interventions for Alzheimer’s, and, I am sure, other conditions, to reduce today’s costs, but ignores opportunities for investments in health that will save on future costs.  By the way, this is one of the reasons I am strongly opposed to any “single-payer” health system in the United States.  Given our approach to democratic government, I have no confidence that politicians, who tightly control and micromanage Medicare and its clinical processes, would think beyond the current fiscal year in how they manage medicine.  If there were a single-payer, the whole medical system would make these dysfunctional trade-offs, instead of just the part controlled by Medicare.
• To a greater degree than many other centers of excellence, BU focuses on the less-glamorous activity related to bringing down the cost and devastating burdens of Alzheimer’s.  It focuses on genetic risk assessment, actions that might prevent Alzheimer’s, memory assessment programs to facilitate early diagnosis and treatment, and approaches that would slow down the progression of Alzheimer’s, as well as the needs of caregivers.  As a society, we are conditioned to have researchers look for “cures” for diseases.  I always think about the telethons for various diseases which use some variant of the phrase “there is no cure, but there is hope.”  I am glad that we care passionately about finding cures, but the more practical and better investment of resources has to be targeted at prevention and the infrastructure for early diagnosis and treatment. 
• The other concept presented to us was the notion that some of the capacity challenges for Alzheimer’s victims may not be memory-related, but may be perception-related.  For example, an Alzheimer’s victim may not have forgotten where he or she put the car keys.  That person may not be able to see the keys where they were placed.  That insight suggests that we can help Alzheimer’s victims to function by improving their perceptual capability with various kinds of tools.

I am confident that significant progress will be made in the next 10 years to slow down disease progression, and maybe even stabilize patient situations.  I would hope that we will see a time that the progression of this disease can actually be reversed.