Author: Serkadis

The Washington Post: “Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests” (Stein, 11/17).

The New York Times reports: “The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. …  Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. … The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services.”

The new guidelines, published online in The Annals of Internal Medicine, are aimed at preventing possible harm from overtreatment. “While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment” (Kolata, 11/16).

The Wall Street Journal reports: “…the new guidelines are likely to be controversial and confusing. They also raise concerns that health insurers will curtail coverage and reimbursements for screenings that fall outside the guidelines, according to doctors and groups including the American Cancer Society.”

“About $3.3 billion was spent on mammograms in the last 12 months, according to the American College of Radiology. … Whether the new guidelines lead to changes in insurance reimbursement is likely to be a big concern among health providers and patients. The Centers for Medicare and Medicaid Services, which administers government health benefits for the elderly and the poor, says the new guidelines wouldn’t change how it covers mammograms for Medicare patients. But that may not be the case for private insurance” (Wang, 11/17).

NPR notes: “Women in the United States are being diagnosed with breast cancer earlier than their mothers were, as well as women in certain minority groups, says American College of Radiology chairwoman Dr. Constance Lehman. ‘Black women in the U.S. develop breast cancer at a significantly younger age than Caucasian women do.’ This was not addressed or acknowledged by the task force, she says” (Wilson, 11/16). 

The Los Angeles Times reports: “Oncologists were nearly uniform in their disparagement of the guidelines, fearing the loss of a valuable cancer-prevention tool. Women in their 40s account for at least a quarter of breast cancer diagnoses. … And other groups that issue guidelines about screening and prevention, such as the American Cancer Society, the National Cancer Institute and the American College of Obstetricians and Gynecologists, immediately attacked the federal panel’s conclusion, saying that they would not change their guidelines and would continue to urge women to undergo the tests” (Graham and Maugh, 11/17).

CBS/The Associated Press: “International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years. Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year. Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated” (11/16).

CNN: “The task force is composed of 16 health care experts, none of whom are oncologists. The group reviews medical data and bases recommendations on effectiveness and risks involved. ‘All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,’ said Dr. Diana Petitti, vice chair of the task force” (Dellorto, 11/16).

Eighteen Olivet College students and two staff members spent the weekend painting the interior of the River House Domestic Abuse Shelter….The trip was conceived by the two schools’ Michigan Campus Compact AmeriCorps VISTA volunteers, Jean Paul Cortes, serving Olivet, and Monica Martinez, …

Read the entire article in the Battle Creek Enquirer

Google Chrome is now almost certain to get much better support for extensions very soon, at least in the developer channel builds. After the first clues of an online extensions gallery were spotted yesterday, Google made it more or less official with the latest Chrome release, which now features links and notifiers to a still non-existent extensions gallery. What’s more, Google’s own sample extensions are now working on in the latest Chrome builds.

While Google doesn’t say it, with the latest Chrome 4.0.249.0 ,extension support is almost fully baked both on the technology front but also in the user interface. Users will notice that the corner in the new tab page has changed and now links to an online extensions gallery. There is also a notification at the bottom, alerting users that Chrome now supports extensions and bookmark sync.

But probably the most telling clue is the fact that the extensions which Google provides as examples can now be installed with just a couple of clicks. There are three Google extensions at the moment, a Gmail checker, a feed subscriber and the BuildBot Monitor. The Gmail checker is self explanatory, it adds a small icon to the toolbar showing how many unread emails you have. The feed reader subscriber extension adds an RSS icon to the address bar when feeds are available in the page, exactly like Firefox handles the function… (read more)

“Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study,” The Associated Press reports. “The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.” The study was published in the November issue of the Archives of Surgery. Senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist, “favors health care reform and has frequently written about the inequities of the current system.” The study could add fodder to the health care debate.

“The researchers couldn’t pin down the reasons behind the differences they found. The uninsured might experience more delays being transferred from hospital to hospital. Or they might get different care. Or they could have more trouble communicating with doctors. The hospitals that treat them also could have fewer resources. … Federal law requires hospital ERs to treat all patients who are medically unstable. But hospitals can transfer patients, or send them away, once they’re stabilized. A transfer could worsen a patient’s condition by delaying treatment.” The study “analyzed data on nearly 690,000 U.S. patients from 2002 through 2006” (Johnson, 11/16).

Los Angeles Times: “The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they’re admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility. Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses because they don’t interact with them as often. All of these factors could influence whether a trauma patient is able to recover” (Kaplan, 11/17).

Other outlets are reporting on ways to get health insurance.

The Salt Lake Tribune answers a reader’s question on how long it would take before the uninsured would get coverage under health reform. While “most of the major provisions won’t kick in for a few years, all the health reform proposals include some immediate reforms, such as the creation of a new high-risk insurance pool. The pool would serve the uninsured and people … who were denied because of a pre-existing condition. The House set aside $5 billion to create the program” (Canham, 11/16).

USA Today has a tip sheet for people to avoid becoming uninsured after their COBRA subsidy runs out. “Earlier this year, lawmakers agreed to temporarily subsidize health insurance for laid-off workers, providing a big discount for coverage until they got back to work. … Mindful of the 10% unemployment rate, some lawmakers have proposed extending the benefit, but that hasn’t happened yet.” Suggestions include waiting to drop COBRA until you have another insurance option lined up, even if it is expensive, and considering different health insurance options for various members of your family (Block, 11/17).

The American Medical Association backed the House Democrats’ reform bill earlier this month, at a time when it appeared likely lawmakers would move to permanently end looming cuts to doctors’ Medicare payments that Congress defers from year to year, Politico reports. While the so-called “doc fix” was not in the final health bill, “[t]he House is expected to pass a bill later this week to permanently plug [the] shortfall …. But prospects for the bill look dim, since the Senate blocked consideration of a similar measure late last month, and House leaders stripped the proposal from their broader health reform package.”

“The conflicting maneuvers suggest that, rather than a permanent solution, the best the doctors might get is yet another one- or two-year fix, which could threaten their support for health care reform,” according to Politico. In the earlier Senate vote, the Democratic leadership fell 12 votes shy of the 60 needed to pass a bill. Fiscal conservatives have opposed it, saying it would add $247 billion to the deficit over a decade (O’Connor, 11/17).

Senate Majority Leader Harry Reid, D-Nev., is planning a “key test vote by the end of the week” on a health reform bill, according to Senate aides, Politico reports. “The vote on a motion to proceed to the bill could come as early as Friday, teeing up the amendment process to begin after the Thanksgiving break.” Reid may keep the Senate in session over the weekend (Budoff Brown, 11/17).

Democrats expect to get a CBO score on the bill Tuesday at the earliest, another aide said, which will clear the way for a vote on a motion to proceed, CongressDaily reports (Edney, 11/16).

The CBO score is key to soothing the cost reservations many Senators have, the Detroit Free Press reports. “Of course, depending on the cost of that CBO estimate, Reid may have to tweak it further before bringing it to the floor” (Spangler, 11/16).

The New York Times reports that Washington is waiting to hear what CBO director Doug Elmendorf has to say on the bill. “His detailed analyses — ‘scores’ in Washington argot — are highly educated guesswork but are more or less the final word, making him a combination oracle and judge on many of the biggest issues of the day.” Elmendorf is still working to analyze Reid’s bill — one that could “speed the process along, helping Mr. Obama fulfill his hope of signing a bill into law this year” or “could leave the White House and Democrats scrambling” depending on what his office finds (Stolberg, 11/16).

The Wall Street Journal: “Republicans will likely filibuster the ‘motion to proceed,’ which simply allows the Senate to begin debate. Delaying consideration of the bill until 2010, an election year, could jeopardize its chances and turn the intricacies of the Senate timetable into a political tool for the bill’s opponents.” Reid needs all 60 votes in the Democratic caucus to begin debate on the bill, but it remains to be seen if he can garner such support. Sen. Joe Lieberman, an independent who caucuses with the Democrats, is expected to vote for the motion to proceed, according to an aide, though his vote for passage of the bill is unclear (Hitt, 11/17).

The Hill reports that Reid can’t afford Democrat defectors on his bill. “Another complicating factor is the health of Sen. Robert Byrd (D-W.Va.), who has missed more than 130 roll call votes this year. Reid needs every member of his party because Republicans have indicated they will vote en masse against the Democratic legislation. … Democrats remain divided over key elements yet to be resolved: whether to create a government-run insurance program, how to pay for expanding insurance coverage and how strongly to prohibit federal dollars from paying for abortion services” (Young, 11/16). 

One of the centrists being courted is Sen. Blanche Lincoln, D-Ark., “who has become emblematic of the improbable distance that health-care reform has traveled, and how far it still must go before becoming law,” The Washington Post reports. “Hundreds of thousands of Lincoln’s constituents are low-income and lack insurance, the very kind of voters expected to benefit under the Senate bill. … (but) her sometimes uncomfortable role near the center of the debate could cost her in culturally conservative Arkansas. Despite the potential benefits for many in her state, polls show her support weakening, and constituents are expressing doubts about the proposed overhaul” (Murray, 11/17).

Reader Cannen alerts us to yet another column by yet another old school newspaper guy whining about the fact that “the people” now have the ability to have their voices heard. What’s funny is that his own column seems to contradict his statements.

Don’t get me wrong. I am also an outraged narcissist, but I had to work six-hour shifts in Bakersfield, Calif., to earn my stripes as a communicator. Nowadays, having a Twitter page qualifies a person to give commentary on CNN. I am not interested in the take of @stinky on the Fort Hood shootings or any other current events. I am watching CNN because I expect them to gather the news, not act as a clearinghouse for any bonehead with a computer, a cable modem and a half-baked opinion.

Ah yes, so because today it’s easier for people to have a voice, it’s bad. Yes, and you used to walk to school uphill both ways in the snow and television was called radio and had no pictures. But the world improves and progress comes along and gives more people a voice and that’s bad how exactly?

With the advent of Twitter, Facebook, instant messaging and texting, now almost any fool can set up his or her broadcast hub. Then the likes of CNN, Fox News, Oprah and even the Tribune play right into their hands, giving them instant access to the rest of the world. I beseech the online editors at this paper to turn off the “comments” after each article. If people have opinions about something that they’ve just read, let them write a letter to the editor.

Yes, but “any fool” doesn’t get quite the attention as, say, a fool who blasts the fact that people have a voice in a major national newspaper, right? Who cares that anyone can say what they want. Most people don’t see those complaints. You call it a “broadcast hub” but most people’s Twitter accounts don’t have very many followers. That’s not the issue at all. The actual complaint seems to be that CNN and Fox and others have elevated a few of these folks (a tiny percentage of the overall population using these tools), and you don’t like it because…. what, exactly? Because they compete with you in being a public “fool”?

Most of my career has been spent in radio, where call-in comments are somewhat encouraged. The main difference is that we can hang up on people.

Ok, let me get this straight. Before you were complaining that CNN and Fox were putting these people on their shows, but then you say at least on radio you could “hang up on people.” Do you not sense the contradiction? CNN and Fox can just as easily “hang up” on these people too. So what’s the difference?

Basically, it sounds like the guy is pissed off that he’s no longer the only person with an opinion getting heard. But, of course, he’s missing the point in blaming the new technology. Yes, lots of people have a voice, but most still don’t get heard very far. The folks who are getting on TV or are making their voices heard are because they’re saying something that resonates, whether it’s stupid or not. And, no, maybe they didn’t have to practice being a public moron in some small town first, but is that really a necessity?

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In the wake of the global financial crisis, HBS professor Bill Sahlman analyzes the fallout and suggests a new player to monitor management excess. What he envisions is a monitor that would “take an objective, hard-nosed look at major financial firms on a holistic basis. … [The] new monitor would learn from working with many players in an industry. Auditing the best and worst firms would create powerful tools for improving practice.”

In his working paper “Management and the Financial Crisis (We Have Met the Enemy and He Is Us …)” [PDF], Sahlman analyzes a host of management problems from the perspective of culture, incentives, control and measurement, accounting, and human capital. Opposed to quick fixes, Sahlman is in favor of soul-searching on the part of corporate managers, followed by clear steps to revise prevailing notions of risk and reward. “We have a unique opportunity to force a review of all the players in the financial system, from individual consumers to politicians and regulators to management teams at financial services firms,” he concludes.

The changing economic relationship between the United States and China as a result of the 2007-2009 financial crisis is the subject of “The End of Chimerica” [PDF] by HBS professor Niall Ferguson and Moritz Schularick. As they argue, Chinese currency is undervalued in relation to the U.S. dollar. “A continuation of Chimerica and Beijing’s undervalued dollar peg at a time of dollar weakness would introduce new and dangerous distortions to the global economy,” the authors warn. “The dollar depreciation that seems a likely consequence of current U.S. fiscal and monetary policy would be accompanied by a further Chinese depreciation relative to other major currencies.”

— Martha Lagace

Working Papers

User, and Open Collaborative Innovation: Ascendent Economic Models

Authors:	Carliss Y. Baldwin and Eric von Hippel

Abstract

In this paper we assess the economic viability of innovation by producers relative to two increasingly important alternative models: innovations by single user individuals or firms and open collaborative innovation projects. We analyze the design costs and architectures and communication costs associated with each model. We conclude that innovation by individual users and also open collaborative innovation increasingly compete with—and may displace—producer innovation in many parts of the economy. We argue that a transition from producer innovation to open single user and open collaborative innovation is desirable in terms of social welfare and so worthy of support by policymakers.

Download the paper: http://www.hbs.edu/research/pdf/10-038.pdf

Platform Competition, Compatibility, and Social Efficiency (revised)

Authors:	Ramon Casadesus-Masanell and Francisco Ruiz-Aliseda

Abstract

Katz and Shapiro (1985) study systems compatibility in settings with one-sided platforms and direct network effects. We consider systems compatibility in settings with two-sided platforms and indirect network effects to develop an explanation why markets with two-sided platforms are often characterized by incompatibility with one dominant player who may subsidize access to one side of the market. We find that incompatibility gives rise to asymmetric equilibria with a dominant platform that earns more than under compatibility. We also find that incompatibility generates larger total welfare than compatibility when horizontal differences between platforms are small.

Download the paper: http://www.hbs.edu/research/pdf/09-058.pdf

From Strategy to Business Models and to Tactics

Authors:	Ramon Casadesus-Masanell and Joan Enric Ricart

Abstract

The notion of business model has been used by strategy scholars to refer to “the logic of the firm, the way it operates, and how it creates value for its stakeholders.” On the surface, this notion appears to be similar to that of strategy. We present a conceptual framework to separate and relate business model and strategy. Business model, we argue, is a reflection of the firm’s realized strategy. We find that in simple competitive situations there is a one-to-one mapping between strategy and business model, which makes it difficult to separate the two notions. We show that the concepts of strategy and business model differ when there are important contingencies upon which a well-designed strategy must be based. Our framework also delivers a clear separation between tactics and strategy. This distinction is possible because strategy and business model are different constructs.

Download the paper: http://www.hbs.edu/research/pdf/10-036.pdf

The Devil Wears Prada? Effects of Exposure to Luxury Goods on Cognition and Decision Making

Authors:	Roy Y.J. Chua and Xi Zou

Abstract

Although the concept of luxury has been widely discussed in social theories and marketing research, relatively little research has directly examined the psychological consequences of exposure to luxury goods. This paper demonstrates that mere exposure to luxury goods increases individuals’ propensity to prioritize self-interests over others’ interests, influencing the decisions they make. Experiment 1 found that participants primed with luxury goods were more likely than those primed with non-luxury goods to endorse business decisions that benefit themselves but could potentially harm others. Using a word recognition task, Experiment 2 further demonstrates that exposure to luxury is likely to activate self-interest but not necessarily the tendency to harm others. Implications of these findings were discussed.

Download the paper: http://www.hbs.edu/research/pdf/10-034.pdf

The CHAT Dataset

Authors:	Diego Comin and Bart Hobijn

Abstract

This note accompanies the Cross‐country Historical Adoption of Technology (CHAT) dataset. CHAT is an unbalanced panel dataset with information on the adoption of over 100 technologies in more than 150 countries since 1800. The data is available for download at http://www.nber.org/data/chat. We discuss the main aim of CHAT, its scope and limitations, as well as several ways in which we have used the data so far and ways to potentially use the data for other research.

Download the paper: http://www.hbs.edu/research/pdf/10-035.pdf

The End of Chimerica

Authors:	Niall Ferguson and Moritz Schularick

Abstract

For the better part of the past decade, the world economy has been dominated by a world economic order that combined Chinese export-led development with U.S. over-consumption. The financial crisis of 2007-2009 likely marks the beginning of the end of the Chimerican relationship. In this paper we look at this era as economic historians, trying to set events in a longer-term perspective. In some ways China’s economic model in the decade 1998-2007 was similar to the one adopted by West Germany and Japan after World War II. Trade surpluses with the U.S. played a major role in propelling growth. But there were two key differences. First, the scale of Chinese currency intervention was without precedent, as were the resulting distortions of the world economy. Second, the Chinese have so far resisted the kind of currency appreciation to which West Germany and Japan consented. We conclude that Chimerica cannot persist for much longer in its present form. As in the 1970s, sizeable changes in exchange rates are needed to rebalance the world economy. A continuation of Chimerica at a time of dollar devaluation would give rise to new and dangerous distortions in the global economy.

Download the paper: http://www.hbs.edu/research/pdf/10-037.pdf

Management and the Financial Crisis (We have Met the Enemy and He Is Us…)

Author:	William A. Sahlman

Abstract

The financial crisis of 2008-2009 has revealed that our broad model of corporate governance is broken, independent of the shortcomings in the regulatory system. Managers and boards of directors in scores of systemically important firms failed to protect employees, customers, or shareholders and placed the global financial system at risk. I assert that the root cause of the crisis can be found in five related systems: incentives, risk management and control, accounting, human capital, and culture. The worst firms had lethal combinations of strong incentives, weak control and risk management, flawed internal and external accounting, low skill and/or low integrity people, and corrosive cultures. Piecemeal attempts to fix elements of corporate governance will fail. The problem, to illustrate, is not just the structure of compensation. Nor will increasing required capital prevent problems at companies with strong incentives and weak controls. I believe that we may need a new kind of external agency for systemically risky firms that would take a holistic look at the five systems to identify weaknesses, make recommendations to managers and boards, and set regulatory policies, including assessing charges for insuring against losses. Without such a comprehensive assessment and improvement plan, boards cannot do their jobs, and the system will remain as subject to calamitous events as it was before the crisis.

Download the paper: http://www.hbs.edu/research/pdf/10-033.pdf