Because of Whitney Houston’s recent tragic death, a number of articles have been written about the continuing challenge of helping prevent and treat drug and alcohol addiction.  Not surprisingly, the articles have particularly focused on the failure rate of treatment programs used by entertainers and other celebrities.  As a former CEO, and a 30-year veteran of life in a big organization, I knew, and became aware of, many people with drug and alcohol addictions.  I even have a few long time friends who are recovering addicts.

I am not surprised by hearing that celebrities enter an expensive residential drug or alcohol treatment program, and then experience a relapse relatively soon after finishing the program. The first critical success factor in addressing an addiction is recognizing that the behavior occurs in a particular set of social settings.  Success means removing the addicted person from the social settings supporting the addiction.  Unfortunately, most celebrities return to the same world from which they came, and, even if they disengage from the particular relationships that spawned the addiction, they find other destructive relationships.

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I am continually amazed by how experts who make excuses for why certain problems have remain unsolved overlook simpler and less expensive solutions to these problems.  For example, a whole population of advocates have pointed out that low-income people living in inner cities, particularly those lacking access to an automobile, are trapped in what are now called “food deserts,” that is, areas in which people lack access to affordable healthy food. Very often, the food deserts have abundant access to less-healthy junk foods, cigarettes, alcohol, and, of course, illegal drugs.

The usual solutions are to put supermarkets in the inner city, or to have farmers markets in the inner city or urban gardens in abandoned lots.  While all of these solutions are excellent long-term answers, all have problems or limitations.

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In the Friday, March 26, 2010, issue of The Wall Street Journal, there was a very thought provoking article entitled “Reynolds Faces Very Tough Test with Smokeless Tobacco Lineup.” The article specifically details the strategic intent of the tobacco companies to address the public’s concern with the harm created by smoking by moving their customers toward forms of tobacco ingredient ingestion that do not require the inhalation or the creation of smoke.  The article identified lozenges and other forms of orally ingested nicotine products.  In effect, the product becomes nicotine and the other addictive ingredients of tobacco, not the cigarette, cigar, or other delivery system for that nicotine.

The theory behind this strategy is that smoking, not ingestion of harmful ingredients, is the health risk both to the user and to bystanders.  Clearly, when someone orally ingests nicotine, there is no second-hand smoke problem for others, and, for the user, there is no problem with small particulate matter in the lungs.  The remaining hazard is the chemical alteration of the body from the ingestion of nicotine and other substances.  Smokeless ingestion systems are less harmful than traditional cigarettes, but some degree of harm remains.

Even more interesting, Altria recently acquired a company that markets smoking cessation products, which positions it to offset the decline of sales of cigarettes.

This article poses two big strategic questions in the battle to improve health:

• Can we enlist those who have produced unhealthy products and services to transition to healthy or, at a minimum, less unhealthy offerings?
• Should we support the marketing of transitional products that retain addictive behaviors which are still harmful, but are less harmful than what they replace?

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In the Saturday November 21 New York Post, reporter Michelle Malkin writes a scathing op-ed piece on the Service Employees International Union,  entitled “The Union That Hates the Boy Scouts.“.  The major point of her piece is that the SEIU strongly opposes volunteer work in many communities, because they believe that volunteer work takes paid work away from union members.

Her description of certain union positions rings true to me because I recall that the Stamford Youth Foundation (Stamford, Connecticut) could not staff the variety and volume of after-school activities that it would have liked because union contracts required it to pay every teacher for the extra hours worked after the regular school day.  This deeply bothers me.

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This has been a most interesting week for me, especially the first two days I spent in Los Angeles with my older son in meetings relating to three investments in performing arts projects: a small commercial independent film called Fog Warning, (a trailer is viewable on YouTube), a reality TV production company called LongStoryShort Productions, and a film script on which my son Mike and I are working together.  From these meetings on all three investments, as well as other conversations I have had with many people in the performing arts business, I have learned about the challenges artists have with agents, distributors, or other intermediaries.

In the recording industry, the intermediary is the record label.  In movies, screenwriters have to approach producers through agents, and film producers have to reach the marketplace through sales agents or distributors.  TV producers have to go through agents to reach TV networks and other content buyers.  This is similar to what I experienced and saw in the broader business world: there are always gatekeepers between product and service producers and the end customer.

What is great about the Internet is how it has the potential to give those who want to reach a customer the ability to bypass intermediaries and create a better balance of power with those intermediaries.  I love the fact that Paranormal Activity, a movie produced for $15,000, which used predominantly low-cost direct marketing channels, including social media, has grossed over $100 million since its release. Too many intermediaries would be threatened if that became the norm on how to get a movie to the public.

Related to this, I was so happy when my younger son became a very capable online seller during his senior year of high school, and my daughter learned about to get harp performing engagements directly without needing a booking agent.

I believe strongly that we will see far more prosperity and a more equal distribution of income and wealth if individuals have the skills to sell their products, services, and labor directly to those who need them.  Intermediaries can serve a very valuable role, and many are essential to the people they serve.  However, just like any monopoly situation, when they have sole or primary access to the end customer, they can get complacent and not do the best possible for the seller.  That’s why I like the potential direct marketing opportunities the Internet provides.  It gives any seller, including me, the ability to say to an intermediary: “Either be as passionate and single-minded about what I am selling as I am, or get out of the way.”

One of my experiences was a lunch at a popular New York City restaurant on July 8.  When I looked at the menu, every item was labeled relative to the calorie content of the item.  I was ready to order the caesar salad as a low-calorie alternative, when I was shocked to find out that the salad contained 790 calories, and that the salad with chicken was 1,325 calories.  To my surprise, the 10-ounce filet mignon was only 390 calories, so I ordered it and also had a cup of soup.  Undoubtedly, absent the disclosure, I would have ordered the salad.

I also wear a pedometer every day and almost always am able to walk or run sufficiently to get to 10,000 steps per day.  On July 8, on my way to the restaurant, I was taking a subway from East 86^th Street in New York to Grand Central Terminal at East 42^nd Street.  While I was on the subway, I noticed that I had 20 minutes to spare when the train pulled into the 59^th Street station, and that I needed to log a number of steps.  As a result, I exited the train at 59^th Street and walked the rest of the way, because I saw that it would be difficult for me to get to my target.

At Pitney Bowes, we took one further action relative to marketing the benefits of walking.  At the bottom of our 3^rd floor stairway in our World Headquarters, we have a sign that informs someone that if they walk up and down these stairs every for a year instead of taking the elevator behind the stairs, they would lose 5 pounds.  I watch people make the discretionary decision to take the stairway rather than the elevator.

The Wall Street Journal article notes that the same behavior occurs relative to electricity usage when a home has a power monitor that informs the home owner minute by minute how much power has been consumed.  The author, Geoffrey Fowler, cites an Oxford University study in 2006 that found that “people getting direct feedback on their power consumption reduced use 5% to 15%.

There are two implications to these data points:

•       If we want to reduce overeating or to increase exercise, measuring, monitoring, and disclosing the quantitative aspects of a behavior will change the behavior.
•       Conversely, if we want to change an unconscious behavior by altering the environment that produces it, that will be successful as well. Eating, exercising, and other behaviors, good and bad, have a heavy unconscious, automatic aspect to them.

Reflecting on my behavior in the restaurant and on the subway, I am more convinced than ever that mandatory nutritional labeling works if it is quantitative.  Warnings like the Surgeon General’s warning on cigarette packages are much less effective because they are not quantitative.  Similarly, disclosures on prescription drug packages relative to side effects are also relatively ineffective because they are not quantitative.

My good friend Dr. Elliott Fisher of Dartmouth’s Health Policy Institute introduced me to a different form of disclosure relative to prescription drugs, a one-page chart that lists every side effect, but that specifically supplements the disclosure by listing in quantitative fashion the results of the clinical trials conducted for that drug.  Thus, for example, the chart does not simply say that Drug X has been shown to cause headaches in some people.  It specifically discloses that of the 2,500 people who took the drug, 17 of them, or .68%, experienced headaches.  There are some indications that individuals confronted with quantitative information react differently.  Some pay attention to the disclosure and decide they do not want to take the risk; others are reassured by a low-percentage risk disclosure and decide they will take the risk.  In both cases, the quantitative disclosure altered behaviors.

Because of all these experiences and observations, I have become a strong believer in more detailed labeling and disclosure, as well as much more quantitative disclosure, whenever such disclosure is not false or misleading.

As I delve more into the study of health and health care, I find myself learning more about the influence of government food policy on what we eat, and what is causing our epidemic of diet-related conditions: diabetes, cardio-vascular disease, strokes, and even cancer.

Michael Pollan wrote an exceptionally informative article in the October 12 New York Times Magazine, entitled “Farmers in Chief.” Among other observations, he makes the following points: (more…)

In the July 1 New York Times, there was an interesting article about the effort of the Congressional Black Caucus to get the addition of menthol to cigarettes banned because menthol cigarettes are the choice of 75% of African-American smokers. There is a clear recognition that menthol and other sweeteners added to cigarettes make them more attractive to vulnerable populations, like young people, minorities with health risks that make smoking health-threatening and young women.

When I read this article, it occurred to me that the misuse of menthol and other sweeteners to attract people to cigarettes can be turned on its head to make healthy foods more attractive to eat. When our younger son, who is now 17 years old, was under 10 years old, we had a great deal of difficulty getting him to eat anything other than junk food. We had particular difficulty getting him to eat green vegetables. (more…)

I believe strongly that health is enhanced by healthy behaviors, such as good nutrition, exercise, and healthy lifestyles. To some degree, we can mandate healthy behaviors by law and regulation, or by centralized controls.

However, just as I noted in a blog several months ago in which I described some of the findings in the book Mindless Eating, authored by Brian Wansink, the best behavior change drivers are those of which the individual is not conscious. Steve Victor’s Fit For Life blog provides a brief summary of the book’s key takeaways.

For example, in our World Headquarters at Pitney Bowes, we have created a healthy environment by the food we serve and the way we price it. We have an on-site clinic and on-site fitness center, and we have many outreach programs for preventive screenings and immunizations. (more…)

In my last posting, I referred to parts of America that have been described as “food deserts,” meaning that residents living in those areas do not have access to supermarkets or other food stores or restaurants from which they can purchase affordable healthy food. One of my Pitney Bowes colleagues referred me to a satirical YouTube posting called The Bronx Bodega, which powerfully illustrates what I have noted in a few postings: in many poorer communities with less healthy people, not only is healthy food unavailable at affordable prices, if it is available at all, but the unhealthy food is exceptionally inexpensive and attractively packaged.

But I have learned that the absence of healthy food is just one form of deprivation for low-income communities. They lack four other prerequisites for healthy living:

• Safe outdoor play areas, like parks, to get exercise;
• Primary care clinics for treatment of minor illnesses and injuries, preventive screenings, and immunizations, as well as referral to medical specialists;
• Pharmacies; and
• Information sources. (more…)