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The Roles of Doctor and Patient Are Changing

November 11, 2019 By David Griesing Leave a Comment

On a train to New York City, I found myself sitting next to a doctor from Johns Hopkins. Mid-career. Confident. As it turned out, he was also from a family of doctors. 

In his career, he said he’d alternated between research and seeing patients and I asked him if he was getting what he’d hoped out of it. He said he had at the beginning, when he could practice more the way his dad had, like taking the time he needed to treat his patients. But more recently, demands from the government and insurance providers were requiring him to spend more and more patient time gathering information and creating medical records about their visits.

It gave him “an awful choice,” he said. “I can either spend much of my patient time looking down at my pad or tablet and taking notes or I can look them in the eye. I went into medicine to establish healing relationships, it’s how I saw my dad practice, but now this beast has to be fed every day.”

“What beast,” I asked. “Because I’ve chosen to keep talking to my patients,” he responded, “I still have to record all their medical information before I forget what we talked about, so almost every night I spend between 9 p.m. and midnight ‘feeding the data beast’  because, of course, my wife and kids get to see me for an hour or so once I get home.”  “The volume of it is grinding me down,” he continued, “but our insurance system requires it. What I looked forward to as a doctor every day is getting harder to come by.”

I’ve noticed this from the other side too. When I go to a specialist or for my regular check-ups I’m faced by my doctor as well as “a record keeper” with a touch screen. I’m always asked whether “I mind” having record keepers there and can always ask them to leave if I want to talk “one-on-one,” but it changes the entire dynamic in the room. Is this visit about me or my medical information?

It’s not whether electronic record keeping is working as intended, or is actually helping to manage medical costs that caught my eye this week. Instead, it’s how the generation and use of patient data is placing more obligations (with fairly profound ethical implications) on the so-called healing arts, and how far those obligations extend beyond data privacy and confidentiality.  Among other things, it got me wondering whether even our best doctors and medical caregivers are treating us as collections of data points instead of “as whole patients” in the grind of it all.  

For centuries, a doctor’s ethical obligations have been set forth in the Hippocratic Oath, with its standards being tailored to current understandings about health and healing.  For example, to reflect our growing environmental awareness, a current version of the Oath widens the focus of care from the individual patient to the health of the community and the planet itself:

I swear to fulfill, to the best of my ability and judgment, this covenant:
 
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
 
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
 
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
 
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
 
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
 
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. 
 
My responsibility [also] includes these related problems, if I am to care adequately for the sick:
 
I will prevent disease whenever I can, for prevention is preferable to cure.
 
I will protect the environment which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.
 
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those [who are] sound of mind and body as well as the infirm.
 
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

In the light of today’s Hippocratic Oath, it was easy to find several of its shadows.

Can our doctors provide “warmth, sympathy and understanding” while they are also filling in the blanks in their paperwork during the few minutes they are allotted to spend with us?  
 
When it comes to my data, how is it being used, who is using it, and how exactly is “my privacy” being protected?
 
Is this data collection primarily designed to make “the business of medicine’” more cost effective and efficient, or does it also promote my health and healing?  
 
What is my responsibility as a patient, not only as a collaborator in my medical outcomes but also regarding  “the multiple lives” of the data I’m providing?
 
In these regards, some food for thought this week came in the form of a new Hippocratic Oath that has been proposed by West Coast doctor Jordan Shlain. I think you’ll agree that in some ways his proposed Oath makes our jobs as patients and our doctors’ (and other medical professionals’) jobs as healers even more fraught than they were already. 
 
Here’s Dr. Shlain’s proposed Oath, with my initial impressions [in brackets] following each of its statements.
 
1. I shall endeavor to understand what matters to the patient and actively engage them in shared decision making. I do not ‘own’ the patient nor their data. I am a trusted custodian.
         
[Instead of doctors doing and patients receiving, the emphasis on joint decision-making shares the health and healing burden more equitably. Unanswered is whether patients should own their medical data.]
 
2. I shall focus on good patient care and experience to make my profits. If I can’t do well by doing good and prove it, I don’t belong in the field of the healing arts.
 
3. I shall be transparent and interoperable. I shall allow my outcomes to be peer-reviewed.
 
[Both 2 and 3 confront “the business of medicine” squarely in the Oath, acknowledging that care should be delivered with greater transparency around a doctor’s outcomes for patients, which the data now allows. As the business of medicine publically proves its worth, patients will become more like shoppers in a marketplace. What this new reality means in terms of accessibility or quality of care is, of course, uncertain.]
 
4. I shall enable my patients the opportunity to opt in and opt out of all data sharing with non-essential medical providers at every instance.
 
[Recognizing a patient’s interest in his/her data, information will need to be disclosed about essential and non-essential users of that data and about each patient’s ability to limit how it is shared.]
 
5. I shall endeavor to change the language I use to make healthcare more understandable; less Latin, less paternal language; I shall cease using acronyms. 
 
6. I shall make all decisions as though the patient was in the room with me and I had to justify my decision to them.
 
7. I shall make technology, including artificial intelligence algorithms that assist clinicians in medical decision-making, peer-reviewable.
 
[As AI and augmented intelligence programs become more common in medicine, protecting proprietary business information should not inhibit validation of the tools a doctor is using to treat us by his or her professional peers.]
 
8. I believe that health is affected by social determinants. I shall incorporate them into my strategy.
 
[This one goes further into the community behind the patient. As Dr. Shlain argues: “Someone’s zip code can tell you more about their health than their genetic code.”]
 
9. I shall deputize everyone in my organization to surface any violations of this oath without penalty. I shall use open-source artificial intelligence as the transparency tool to monitor this oath.
 
[With doctors working until midnight to feed the data beast and stressed about market competition from other practice groups, their willingness to open themselves to these kinds of ethical challenges from within their organizations seems almost utopian, but at the same time, this part of the proposed Oath acknowledges that patient/consumers alone won’t be able to police this rapidly evolving profession.]  
  
Increasing reliance on data collection and algorithm-driven automation is changing the medical profession into a business. It also changes our jobs as patients, Where once we were passive recipients of “the healing arts,” we are now being called upon to become more engaged consumers, with rights to more information about our care and additional options in the marketplace. Moreover, we should be as concerned about the uses of our medical information as we are about how our other personal data is being used (or misused) by Google, Facebook or governmental bodies like the police and IRS. 
 
At the same time that doctors should be anticipating more changes to the Hippocratic Oath, the job of being a patient and the responsibilities that come with it are also becoming more burdensome. It’s not doctor “up here” (with all the responsibility) and patient “down there” (with almost none of it) any more. We’re confronting an uncertain future together now.

This post was adapted from my November 10, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Filed Under: *All Posts, Being Proud of Your Work, Work & Life Rewards Tagged With: AI and augmented realiity in medicine, doctors, electronic medical records, ethical obligations, Hippocratic Oath, medical data collection, medical professionals, medical work ethic, patient care, patient responsibilities, proposed changes to Hippocratic Oath

Nostalgia Can Help Us Build a Better Future

October 29, 2019 By David Griesing Leave a Comment

There is a widespread consensus that we’re on the cusp of a workplace revolution that will automate millions of jobs and replace millions of workers. 

Among the many questions is whether these displaced workers will still be able to support themselves because technologies that are on the rise, like augmented and artificial intelligence, will spawn millions of new jobs and a new prosperity.

Those fearing that far more jobs will be eliminated than created have argued for fixes like a universal basic income that would place a minimum financial floor under every adult while ensuring that society doesn’t dissolve into chaos. How this safety net would be paid for and administered has always been far less clear in these proposals.

Others are arguing that the automation revolution will usher in a new era of flourishing, with some new jobs maintaining and safeguarding the new automated systems, and many others that we can’t even imagine yet. However, these new programming and maintainence jobs won’t be plentiful enough to replace the “manual” jobs that will be lost in our offices, factories and transportation systems. Other “replacement jobs” might also be scarce. In a post last January, I cited John Hagel’s argument that most new jobs will bunch towards the innovative, the most highly skilled, what he called “the scaling edge” of the job spectrum.

On the other hand, analysts who have considered the automation revolution at McKinsey Global Institute noted in a July, 2019 report that automation will also produce a burst of productivity and profitability within companies, that employees will be able to work more efficiently and reduce their time working (5-hour days or 4- day work weeks) while gaining more leisure time. With more routine tasks being automated, McKinsey estimates that the growing need to customize products and services for consumers with more time on their hands will create new companies and an avalanche of new jobs to serve them. At the same time, demands for more customization of existing products and services will create new jobs that require “people skills” in offices and on factory floors.  

As we stand here today, it is difficult to know whether we should share Hagel’s concern or McKinsey’s optimism.

Predicting the likely impacts at the beginning of a workplace revolution is hardly an exact science. To the extent that history is a teacher, those with less education, fewer high-level skills and difficulties adapting to changing circumstances will be harmed the most. Far less certain are the impacts on the rest of us, whose education, skill levels and adaptability are greater but who may be less comfortable at the “scaling” edges of our industries.

Then there’s the brighter side. Will we be paid the same (or more) as we are today given the greater efficiency and productivity that automation will provide?  Will we work less but still have enough disposable income to support all of the new companies and workers who eager to serve our leisure time pursuits?  Maybe. 

It is also possible to imagine scenarios where millions of people lose their livelihoods and government programs becomes “the last resort” to maintain living standards. Will vast new bureaucracies administer the social safety nets that will be required? Will the taxes on an increasingly productive business sector (with their slimmed down payrolls) be enough to support these programs? Will those who want to work have sufficient opportunities for re-training to fill the new jobs that are created?  And even more fundamentally, will we be able to accommodate the shift from free enterprise to something that looks a lot more like a welfare state?

While most of us have been dominated by the daily tremors and upheavals in politics, there are also daily tremors and upheavals that are changing how we work and even whether we’ll be able to work for “a livable wage” if we want to.

As I argued recently in The Next Crisis Will Be a Terrible Thing to Waste, the chance to realize your priorities improve significantly during times of disruption as long as you’re clear about your objectives and have done some tactical planning in advance. As you know, I also believe in the confidence that comes with hope OR that you can change things for the better if you believe enough in the future that you’re ready to act on its behalf.

Beyond finding and continuing to do “good work” in this new economy, I listed my key priorities in that post: policies that support thriving workers, families and communities and not just successful companies; jobs that assume greater environmental stewardship as essential to their productivity; and expanding the notion of what it means for a company “to be profitable” for all of its stakeholders.

From this morning’s perspective—and assuming that the future of work holds at least as much opportunity as misfortune—I’ve been not only thinking about those priorities but also about things I miss today that seemed to exist in the past. In other words, a period of rapid change like this is also a time for what Harvard’s Svetlana Boym once called “reflective nostalgia.”  The question is how this singular mindset can fuel our passion for the objectives we want—motivate us to take more risks for the sake of change—in the turbulent days ahead.

Nostalgia isn’t about specific memories. Instead, it’s about a sense of loss, an emptiness today that you feel had once been filled in your life or work.

Unlike the kind of nostalgia that attempts to recreate a lost world from the ruins of the past, reflective nostalgia acknowledges your loss but also the impossibility of your ever recovering that former time. By establishing a healthy distance from an idealized past, reflective nostalgia liberates you to find new ways to gain something that you still need in the very different circumstances of the future that you want.

Because the urge to fill unsatisfied needs is a powerful motivator, I’ve been thinking about needs of mine that once were met, aren’t being met today, but could be satisfied again “if I always keep them in mind” while pursuing my priorities in the future. As you mull over my short list of “nostalgias” and think about yours, please feel free to drop me a line about losses you’d like to recoup in a world that’s on the cusp of reinvention.

MY SHORT LIST OF LOSSES:

– I miss a time when strangers (from marketers to the government) knew less about my susceptabilities and hot buttons. Today, given the on-line breadcrumbs I leave in my wake, strangers can track me, discover dimensions of my life that once were mine alone, and use that information to influence my decisions or just look over my shoulder. Re-building and protecting my private space is at the core of my ability to thrive. 

I want to own my personal data, to sell it or not as I choose, instead of having it taken from me whenever I’m on-line or face a surveillance camera in a public space. I want a right to privacy that’s created by law, shielded from technology and protected by the authorities. The rapid advance of artificial intelligence at work and outside of it gives the creation of this right particular urgency as the world shifts and the boundaries around life and work are re-drawn.

– I miss a time when I didn’t think my organized world would fall apart if my technology failed, my battery went dead, the electricity was cut off or the internet was no longer available. I miss my self-reliance and resent my dependency on machines. 

If I do have “more free time” in the future of work, I’ll push for more tech that I can fix when it breaks down and more resources that can help me to do so. I’ll advocate for more “fail-safe” back-up systems to reduce my vulnerability when my tech goes down. There is also the matter of my autonomy. I need to have greater understanding and control over the limits and possibilities of the tech tools that I use everyday because, to some degree, I am already a prisoner of my incompetence as one recent article puts it.

One possibility is that turning over [more] decisions and actions to an AI assistant creates a “nanny world” that makes us less and less able to act on our own. It’s what one writer has called the ‘Jeeves effect’ after the P.G. Wodehouse butler character who is so capable that Bertie Wooster, his employer, can get by being completely incompetent.

My real-life analogy is this. Even though I’ve had access to a calculator for most of my life, it’s still valuable for me to know how to add, subtract, multiply and divide without one. As tech moves farther beyond my ability to understand it or perform its critical functions manually, I need to maintain (or recover) more of that capability. Related to my first nostalgia, I’d meet this need by actively seeking “a healthier relationship” with my technology in my future jobs.
 
– I remember a time when I was not afraid that my lifestyle and consumption patterns were helping to degrade the world around me faster than the world’s ability to repair itself. At the same time, I know today that my absence of concern during much of my work life had more to do with my ignorance than the maintenance of a truly healthy balance between what nature was giving and humankind (including me) was taking. 

As a result, I need greater confidence that my part in restoring that balance is a core requirement of any jobs that I’ll do in the future. With my sense of loss in mind, I can encourage more sustainable ways to work (and live) to evolve.
 
-Finally, I miss a time when a company’s success included caring for the welfare of workers, families and communities instead of merely its shareholders’ profits, a model that was not uncommon from the end of World War II through the 1970s.  I miss a time, not so long ago, when workers bargained collectively and successfully for their rights and benefits on the job. I miss a time when good jobs with adequate pay and benefits along with safe working conditions were protected by carefully crafted trade protections instead of being easily eliminated as “too expensive” or “inefficient.” 
 
While this post-War period can never be recovered, a leading group of corporate executives (The Business Roundtable) recently committed their companies to serving not only their shareholders but also their other “stakeholders,” including their employees and the communities where they’re located. As millions of jobs are lost to automation and new jobs are created in the disruption that follows, I’ll have multiple opportunities as a part of “this new economy workforce” to challenge companies I work for (and with) to embrace the broader standard of profitability that I miss.

+ + +

Instead of being mired in the past, reflective nostalgia provides the freedom to seek opportunities to fill real needs that have never gone away. With this motivating mindset, the future of work won’t just happen to me. It becomes a set of possibilities that I can actually shape.

This post was adapted from my October 27, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Filed Under: *All Posts, Being Part of Something Bigger than Yourself, Building Your Values into Your Work, Work & Life Rewards Tagged With: artificial intelligence, augmented intelligence, automation, future of work, making the most of a crisis, reflective nostalgia, relationship with technology, sustainability, Svetlana Boym, workforce disruption

The Work That Our Fragile World Needs Now

October 21, 2019 By David Griesing Leave a Comment

(photo by lyle owerko)

After 9/11, I had a two-part image in my head. 

I recall the strikingly clarity and vividness of that morning as if it were yesterday.  A storm had swept the Northeast the day before, giving rise to a rare meteorological phenomenon known as “severe clear.” I remember looking up while I was walking Rudy and just diving into its photorealism, inhaling everything that was rejuvenating about it. I know where I was standing when it hit me.

But then, like a punishment, the clarity and wonder almost got dashed by the weeks and haunting years that followed, but still I remembered the daybreak that started it all, and how different its offering was.

Maybe because both branded me so powerfully, both have stayed—conjoined in my head—down to this morning. Promise then punishment. Hope then pain.

Has that ever happened to you, where opposites find themselves standing side-by-side and it becomes impossible to forget their inevitability?

That you should never fall for the one because there’s always the other.

As it’s turned out, there was another terrible prophecy in that cerulean blue sky 18 years ago, and it’s two-part disharmony is proving equally indelible. It’s the daily splendor I see outdoors together with all that our failures of stewardship have wrought, as Greenland melts into the sea and hot spots pop up in Rhode Island and now, right across from me, in New Jersey. 

I live in a kind of arboretum that frequently astonishes me with its beauty–whether it’s Rudy or now Wally who lets me stop and look up at it, down and all around at it every morning.

In my mind’s eye, I refuse to harness the promise of “severe clear” or even of more dappled mornings to the degradation that almost daily seems to be marching my way.

When I see the one I no longer want to see the other. But it takes daily acts of faith, hope and love to break them apart. 

A Deeper Future Than Man Can Make On His Own

When I read Robert MacFarlane’s Underland: A Deep Time Journey last summer, I responded to it with notes, markings on the page and, at least twice, with a “Wow” and exclamation point. The book chronicles MacFarlane’s intrepid wanderings through caves, excavations, sink holes, labyrinths, the quietest tunnels of bedrock, and some of the world’s remotest places. I regularly wondered “why” he was seeking out these claustrophobic and often dangerous destinations and his answer always seemed to be: because he was somehow drawn to them.

For more than 15 years now, I have been writing about the relationships between landscape and the human heart. What began as a wish to solve a personal mystery — why I was so drawn to mountains as a young man that I was, at times, ready to die for love of them — has unfolded into a project of deep-mapping.

These “relationships” between landscape and the human heart are richer and more complicated than Nature gives, on the one hand, Man takes or Man destroys, on the other. In ways he couldn’t always explain, MacFarlane was convinced that there was more to it than that, and whatever was calling out to him might be found if he climbed higher, probed deeper and kept better maps. He described his current motivation this way:

Our ‘flat perspectives’ feel increasingly inadequate to the deep worlds we inhabit, and to the deep time legacies we are leaving

With his “why-question” in mind, my first Wow came towards the end of a chapter called “The Understorey (Epping Forest, London)” about the extraordinary subterranean connections that fungi make to unite the trees into the organism of a forest. MacFarlane finds the modern words that we have—our human-centric words–inadequate to describe what the trees and the fungi have accomplished here, so he looks to a Native American language. (“In Potawatami, not only humans, animals and trees are alive, but so too are mountains, boulders, winds and fire.”) Acknowledging the life around them and their almost intentional roles, native language always made humans integral to the world but never at the center of it because all these other intentionalities have their priorities too. If we’re to restore the relationship between landscape and the human heart, we need to look deeper than the language-based understandings we have today.

The real underland of language is not the roots of single words. but rather the soil of grammar and syntax, where habits of speech and therefore also habits of thought settle and interact over long periods of time. Grammar and syntax exert powerful influence on the proceedings of language and its users. They shape the ways we relate to each other and to the living world. Words are world-makers—and language is one of the great geological forces of the Anthropocene [or Age of Man].

As we consider the underland of today’s language amidst the trees of Epping Forest, MacFarlane suggests that we can reshape, with words, the world that we experience into one of interdependence or symbiosis—create what one philosopher has dubbed “the Symbiocene”—instead of furthering a language-driven age that is dominated by human imperatives alone.

Another Wow came towards the end of a harrowing rite of passage. It delivered MacFarlane to an ancient cave on a remote Norwegian island that had been decorated with paintings of people dancing in the fire that had by brought by pilgrims since the dawn of time.

His Norwegian hosts, only too familiar with the environs, ask him why he is so driven to travel there alone in a dangerous, storm-tossed season, but his “reasoning” seems “weak” to explain it, so he doesn’t even try. It’s likely because the pull of a “thin place” like this, where “the borders between worlds or epochs feel at their most fragile,” is deeper than either reason or emotion, buried in heredity, like some instinct to find a better way to survive. And indeed, it’s the very different life force of our ancestors that MacFarlane manages to encounter deep in a cave in Lofotens, Norway.

At first, depleted by the penitential route, he can’t even see the cave paintings. But in his battery’s light:

when I open my eyes and look again, there is—yes, there, there—the flicker of line that is not only of the rock’s making. The line is crossed by another, and joined by a third, and there, there, yes, is a red dancer, scarcely visible but unmistakable, a phantom red dancer leaping on the rock. And there is another, and another, here, a dozen or more of them, spectral still but present now, leaping and dancing on the rock, arms outstretched and legs wide, forms shifting and tensing as I blink.
 
Their red is rough at its edges, fading back into the rock that made it, blurred by water and condensation, and all of these circumstances—the blur, the low light, my exhaustion, my blinks—are what give the figures their life, make them shift shapes on this volatile canvas in which shadow and water and rock and fatigue are all artists together, and for once the old notion of ghosts seems new and true in this space. These figures are ghosts all dancing together, and I am a ghost too, and there is a conviviality to them, to us, to the thousands of years for which they have been dancing here together.

MacFarlane’s story–about risking your safety to see what ancient joy and celebrating life might have looked and even felt like–ends with a modest claim about its significance. He even lets someone else make the necessary comparison.

Shortly after the Nazi death camps were liberated during World War II, the prehistoric cave paintings of Lascaux, France were discovered:  an extraordinary counterpoint about the nature of humanity. Fifteen years later, when an escalating nuclear arms race was foreshadowing a different kind of doom, philosopher George Bataile went down into the Lascaux caves. When he returned to the surface, MacFarlane quotes him as saying: “I am simply struck by the fact that light is being shed on our birth at the very moment when the notion of our death appears to us.”

MacFarlane’s job as a writer is to connect the underland of his instincts and intuitions with his readers’ world.  As we’re pressed each day with the “inevitability” of a dying, unsustainable planet, he shows us that there are deeper ways to envision our future in the language that we use as well as in the ways we can recapture our truer natures beneath the cerulean sky.

It’s embedded within us. We’ve done it before. There are maps that can help us find it.

 A Modern Photo Arc and Additional Irrational Acts

Joel Sartore is a National Geographic photographer who has been documenting the world’s captive animal species. Many of them are on the verge of extinction or are endangered or may soon be. He’s already photographed around 9,000 out of around 12,000 in captivity, and his pictures—which are taken in special sets to highlight each animal’s unique characteristics (a story in itself)—are strikingly beautiful at the same time that they engage us with their plight.

To Santore, the zoos where he takes his pictures are no longer warehouses or curiosity shops but conservation centers providing hopeful bridges from where we are today to where we may be headed. As Sartore recounted in a 2017 interview, by the turn of the next century we could stand to lose half of the earth’s current species and many of his photographs could merely be reminders. Or maybe far more than that.

His project is called the Photo Arc. His photos are featured in a series of books, in magazine articles and on his website. They glow like votive candles.

More than a documentarian, Sartore is also a storyteller with an eye for the funny or moving details that make his critters come alive when he talks about them. (He is the man that you hope will bring out the armadillo to meet your children at the zoo.) But as wonderous as the Photo Arc project—his protecting on film these animals that may soon be lost—it was not nearly as compelling to me as what he and some of his fellow naturalists are also doing right now to sustain the animals that still remain.

As Sartore heralds in his interview, one of these Noahs is Tilo Nadleer, who was an electronics specialist but now runs a primate center in Vietnam. Nadleer noticed that the police who were capturing animal smugglers had nowhere to put the animals they also recovered (baby primates, mostly) so they would euthanize them. It seemed unthinkable, but what could he do? So he took on the job of caring for these orphans himself, eventually building huge enclosures, feeding them with native vegetation from an adjacent national park. Nadleer tried to release them back into the wild but his primates kept getting shot, eaten or captured by smugglers again, so he now has successful breeding colonies, with a big percentage of the world’s population of three or four species. Sartore calls him “a time capsule.”

He started a project that he knew in his lifetime would never be complete. He is buying time for many of these animals, hoping that people will quit shooting them and people will leave the forests intact,

His work is an act of faith, hope and love.
 
Don and Ann Butler’s work at Pheasant Heaven in North Carolina is too. They’re breeding species of pheasant that are extinct in the wild. And then there is Santore himself, call it his second job. He bought land in Nebraska, where he lives, that included “alkaline wetlands and really steep uplands” where a rare breed of bird (long-billed curlews) along with other migrating species, like avocets and sandpipers, happen to breed. “I just wanted to save a little piece,” he said, “to save a little corner, protect something,” not really knowing whether it would make a difference, but feeling that he had to anyway.
 
These aren’t coins in a wishing well, but counter-testimony that Nadleer, the Butlers and Santore are giving (without breast-beating or fanfare) so that their actions are also recorded in the record of degradation and destruction around them. What else could they do? Well, they could do nothing because there is no assurance that their work will even begin to turn the tables. But they’re doing it anyway.
 
As Robert MacFarlane might put it, they’ve chosen to deepen the relationship between landscape and the human heart. And that, just that, might end up making all the difference.

This post was adapted from my October 20, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Filed Under: *All Posts, Being Part of Something Bigger than Yourself, Building Your Values into Your Work, Heroes & Other Role Models Tagged With: acts of faith hope and love, climate change, global warming, interdependence, Joel Sartore, Photo Arc, Robert MacFarland, stewards of the earth, sustainability, Underland, world creating language

Valuing Nature in Ways the World Can Understand

October 14, 2019 By David Griesing Leave a Comment

Nature has a big problem. 
 
Too few of us believe that climate change will happen here or will affect us personally if it does. But these misperceptions are only one aspect of the problem.
 
Too many decision makers–and too many workers caught in the cross-hairs of the debate–still believe that the costs of changing how we consume, digest and expel the world’s resources are too high for the benefits that might be realized once we start paying for them. They don’t see “the benefit of the bargain” I see (and maybe you see) so clearly, only their share of an unacceptable price tag.
 
And indeed, the high costs of changing how we do things today tend to crop up everywhere in the climate change debate.
 
If we want to stop over-fishing, there are the costs to the livelihoods of the fishermen. If we want to reduce our reliance on carbon-based energy, there are the impacts on those who build and maintain today’s energy infrastructure, and on the communities that depend on those workers and suppliers. It’s dismantling one economy—the lost jobs and abandoned investments—for a new one whose economic upsides often seem to be worth less than the high costs of changing how we do things now.
 
In market-based economies, the challenge is proving that these transition costs will be justified by the long-term economic gains. A rough apples-to-apples type exchange between likely benefits and likely costs needs to be argued, presented and accepted by enough stakeholders for “the human family” to “voluntarily” undertake the expensive steps that are necessary to confront climate change.
 
Put another way: will the “value” of a healthier planet tomorrow cover the “costs” of ensuring it today?  Perhaps the biggest challenge facing those of us who are alarmed by climate change is filling in the “quotation marks” in this cart-before-the-horse equation so we can convince the many hold-outs who still need convincing. But until now, we’ve mostly failed to do so.
 
Only quite recently have the number crunchers begun to calculate the cost benefits of a healthier planet that will, over time, offset the costs of ensuring it today.  It’s the dollar-spent for dollar-earned scenario that is essential if we’re to turn climate change advocacy into meaningful action.

In the places where we work, most supporters that we’ll need to realize our visions start out skeptical if not flat-out opposed to the better worlds we can often “see” so clearly, so we need to translate our versions of both the problems and solutions into stories they can understand.  Like it or not, that’s usually the economic story where we trade tangible costs for tangible benefits as we undertake the often painful changes that will be needed along the way. It works almost every single time, but until now that story has not been properly told in the struggle to confront climate change.

Well the time to start telling it is now.

The Economic Benefits of Whales Versus the Lobstermens’ Costs to Protect Them 

According to a recent story, there’s been an on-going showdown between lobstermen and environmentalists off the coast of Maine. The point of controversy is right whales that environmentalists argue are dying when they get caught in the lines that secure local lobster pots. The whales are threatened with extinction. The lobster industry, which is already undermined by warming waters, will be further crippled by putting down fewer pots or otherwise reducing the number of lines that secure them.
 
Is there a way that the value of having more whales in this ecosystem might cover the high costs that lobstermen, their families and their coastal communities will have to incur to protect them? 
 
Until quite recently, I would have said “no.”  But before finding a better answer, it might help to have some additional background about the Gulf of Maine controversy.
 
The right whales got their name because they were the “right” whales to push towards extinction with our commercial activities, first with the harpoons of whaling boats and more recently by accidentally slaughtering them with boat propellers, fishing nets and lobster pot lines. These bus-sized mammals are slow moving and “built by evolution to be oblivious forage feeders,” according to a NOAA Fisheries’ official. It makes these whales unusually susceptible to getting ensnared and killed.
 
NOAA estimates that today’s population of right whales is only about 400, with fewer than 95 breeding females remaining, which means that the entire population is jeopardized by a single death each year. But more than 30 of these whales have been found dead since 2017. While the reason for these fatalities isn’t always clear, it does not appear that they are dying from natural causes according to investigators.
 
To address the problem, NOAA has proposed new regulations to clear fishing lines from the whales’ path. While the regs will cover all New England waters, Maine lobstermen, who “dangle more than 800,000 lines from buoys to ocean-floor traps in their busiest months,” clearly have the most at stake. To satisfy the proposed standards, they will need to remove at least half of those lines from the water. Says one lobsterman in blunt response: “We don’t want to go extinct either.” In addition to 4,800 harvesters working these waters, the lobster industry supports thousands more jobs on shore while contributing $1.5 billion a year to the state’s economy. 
 
During the rule making period that we’re in today, scientists will be arguing about whether the proposed regulation goes far enough to protect the whales while those alarmed by its likely impacts will be making their case for reasonable accommodations or to reject the new restrictions altogether.  
 
As tensions escalate, and opponents refine the dollar amounts that are likely to be lost if NOAA’s regulation goes into effect, it seems a useful time to ask whether anyone in that debate is calculating the economic benefit that is provided to Maine (and indeed to all of us) by the survival of these whales. 
 
Is anyone enabling an apples-to-apples comparison of costs and benefits so that both sides in this controversy are (more or less) in the same ballpark, with the opportunities for tradeoffs and compromises that “speaking the same economic language” might allow?  
 
And beyond that, is there a way that the “value” of preserving these whales can cover the costs that will have to be borne by these communities if they can ever come together to protect them?

The Startlingly High Value of a Whale

In the past week or so, I came upon another whale story. This one involved a team of visionaries at the International Monetary Fund (IMF).

As is often the case, I overheard bits of the story in a Morning Edition segment on NPR, which took me to a story that had been published that day in National Geographic, and eventually to a much deeper analysis in an IMF publication. It was worth getting to the bottom of the story. 

As far as I can tell, what the IMF team discovered about whales and ended up proposing for the sake of both nature and industry was not in response to the Gulf of Maine controversy, but it could certainly help to resolve it.

The IMF’s approach considered all the whales in the world’s oceans. Because of its boldness and breadth, it could make a significant enough dent in species degradation, at a rapid enough pace, to reduce the number of ocean-based harms that we can no longer repair.  At the same time, its approach would utilize the whales’ enormous environmental “value” to help compensate the global fishing and transportation industries for the costs of adopting “whale saving” practices. Here in a nutshell is their argument (although I urge you to read the entire IMF article and to enjoy the visualizations they’ve included in it).

Essentially, the IMF team realized that a whale’s economic value comes from its extraordinary ability to capture and then sequester carbon. “When it comes to saving the planet,” they write, “one whale is worth thousands of trees.”

In building their economic analysis, the team relied on 2014 research about how whales remove (and help others to remove) carbon from the environment as well as upon international programs that have developed mechanisms to fund the preservation of carbon capturing eco-systems. The team’s signature innovation may be focusing on a particularly helpful as well as beloved animal to support this kind of cost-benefit analysis on a truly global scale.

According to prior research, a whale sequesters as much as 33 tons of carbon dioxide per year on average compared to only 48 pounds per land-based tree. Whales eat phytoplankton, which not only contribute at least 50 percent of the oxygen in the earth’s atmosphere but in doing so also capture 37 billion metric tons of carbon dioxide or 40 percent of the entire amount that is produced globally each year.

Whales have what the IMF team call “a multiplier effect” on the phytoplankton when they eat them and produce waste products (primarily iron and nitrogen) because these waste products are precisely what is needed for more plankton to grow. As they dive and rise again to the surface, whales “pump” these minerals to the surface across their vast migration patterns, increasing both the amount of plankton and the whale populations that feed on them as long as the whales can do so in relative safety.  Moreover, when whales die, the carbon they have sequestered in their enormous bodies from eating plankton in the first place descends to the ocean floor and (according to the National Geographic’s coverage of the IMF plan) “is taken out of the atmosphere for hundreds to thousands of years, a literal carbon sink.”

Of course, whale populations would need to recover significantly to produce the greatest benefits. Continuing their “if-then” analysis, the IMF team notes:

If whales were allowed to return to their pre-whaling number of 4 to 5 million—from slightly more than 1.3 million today—it could add significantly to the amount of phytoplankton in the oceans and to the carbon they capture every year. At a minimum, even a 1 percent increase in phytoplankton productivity thanks to whale [pumping] activity would capture hundreds of millions of tons of additional C02 a year, equivalent to the sudden appearance of 2 billion mature trees. Imagine the impact over the average lifespan of a whale, more than 60 years.

(To put these benefits in a slightly different context, National Geographic cites economists’ calculations showing that these great whales alone could either capture or help more plankton to capture 1.7 tons of C02 per year, which is more than the annual carbon emissions of Brazil today.)
 
The question, then, is how to restore whale populations to pre-whaling levels. Those causing the current threat include nations that still allow whale hunting, industries (like fishing and ocean going transport of people and goods) that jeopardize migrating whales, as well as the actions of individual fishermen. Without covering the very real costs of changing these practices, it is nearly impossible to imagine that the necessary changes will be undertaken voluntarily. 
 
With the aim of meeting these costs, the IMF team made “conservative estimates” of each whale’s value. For the largest so-called “great whales,” they used science-based estimates of how much CO2 each one sequesters directly or indirectly in its lifetime along with CO2’s market price. To this base number, they added value for a whale’s other economic contributions, including fishery enhancement and ecotourism. The IMF team concluded that the value of the average great whale is more than $2 million and that the current value of the global stock of great whales alone “is easily over $1 trillion.”  
 
By using this “value” essentially as collateral for raising the necessary funds, monies would become available (from environmentally oriented companies, non-profits, consumers and even countries) to compensate those who are likely to suffer economic losses by changing their current business practices to protect the whales. “For example,” the team notes, “shipping companies could be compensated for the cost of altered shipping routes to reduce the risk of [whale] collisions.” 
 
What is perhaps most noteworthy about the IMF team’s “good work” is the change in mindset that their cost-benefit analysis invites to help resolve one of our most challenging global problems: the seemingly irreconcilable conflict between nature and industry until now. The team recognized that the necessary changes will never be made unless those incurring those costs can be paid and the world can unite around sufficient compensation mechanisms to ensure that they are. Finding new ways to “value” and “leverage” nature (or “earth-tech,” as they call it) is the key they have identified.

+ + + 

What the IMF team proposes doesn’t fit into a tidy package as yet, and a myriad of details still has to be worked out. In other words, the economic benefits from nature and the costs to industry of protecting it are not quite apples-to-apples yet. But this proposal boldly offers a new approach to balance the needs of both nature and industry on a global scale.
 
While it’s a financing mechanism that’s aimed only at whales, it introduces a framework for thinking about other carbon-rich ecosystems like sea grass beds or the forest elephants of the Congo River basin.
 
Proposing an earth-tech solution instead of an artificial, man-made one is inspired for another reason. When I worked in the energy industry, I studied carbon sequestration plants that were being developed at the time and know first-hand about both the technology challenges and the prohibitive expense of these man-made solutions. By contrast, nature can perform much of the same work “naturally,” if only we’d let it.
 
And for the on-going battle between the right whales and the lobster industry in the Gulf of Maine, there is now a rudimentary framework that, with imagination and a sense of urgency, may actually be able to serve both of them. 
 
Good work often achieves its loftiest objectives by finding new ways to confront the dollars-and-cents obstacles that are right in front of it.

This post was adapted from my October 13, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Filed Under: *All Posts, Building Your Values into Your Work, Daily Preparation, Entrepreneurship Tagged With: carbon capture, carbon sequestration, climate change, cost benefit analysis, costs and benefits, earth tech, financing transition costs of confronting climate change, global warming, IMF, right whales, value of a whale, value of nature, whales

The Next Crisis Will Be a Terrible Thing to Waste

September 30, 2019 By David Griesing Leave a Comment

(photo by Markus Spiske temporausch.com @pixels)

We are moving into less settled times both here and in the rest of the world. Several different storms are gathering along the waterfront today:
 
– in politics, with gridlock both breaking down and intensifying over impeachment and the future course for America, in the UK over its relationship with the rest of Europe and what it wants for itself, in the battles between populists and traditionalists elsewhere;
 
– in economics, with weakening global prosperity and the likelihood of a financial pullback that will affect almost all of us as the fundamentals weaken;
 
– in the environment, with increasing alarm over the current effects of global warming, the longer-term outlook for the health of the planet, and state actors’ halting efforts to respond to the challenge; 
 
– in the world order, with a rising China, a demoralized and divided West, and a handful of nations around the edges that are both willing and able to take advantage of the uncertainty; and
 
 – in the prevailing spirit, perhaps the most impressionistic of these storms but potentially the most powerful, as pessimism, alarm, hysteria, backlash and hostility get reduced into urgency in their boiling cauldron—a drive to do something, anything to move off the dime.
 
The silver lining is that chaos, confusion and uncertainty also provide opportunities. When you’re clear about the priorities behind your work, your chances to advance them are always greatest when the storms finally break as long as you’re ready to rebuild the storm-tossed world in the ways that you want. Now is the time for getting ready, because the chances to address our most pressing problems–and the rewards for us and others that can flow from that–may never be greater.
 
When the work we do helps us realize our priorities, it becomes more purposeful and satisfying.  As I argued here last week, in many of our jobs it is both possible and desirable to align our priorities with that job’s broader objectives. Improved health. Greater fairness. A more sustainable way to live. 
 
In other words, it’s tying what you want yourself to almost every job’s higher purposes. Not only does the alignment reduce friction between you and those impacted by your work, it can also produce an esprit de corps with your bosses, co-workers, customers, suppliers and members of the broader community as they support your efforts. You’re experiencing the shared benefits of a productive community while taking home both the pride and satisfaction that comes with it. 
 
Of course, another essential of “good work” is its future focus: anticipating circumstances that might enable you to take bigger-than-usual strides towards realizing common priorities. It is being aware of the obstacles and opportunities today so you are ready to act when the storms break and the lay-of-the-land shifts, weakening those obstacles and providing those with a vision of the future a path for realizing it. That’s because everyone who has weathered the storm wants to put the pieces back together and is unusually receptive to putting it all back together in some better way.
 
Realizing your particular work ethic in times of crisis has almost nothing to do with luck but everything to do with your mindset and plans. It’s having a vision of the better future that you want, keeping your eye on that goal line as the game degenerates into chaos, and, when everyone is finally able to listen, inviting your fellow survivors to help in rebuilding something that you’re convinced will be more durable and sustainable than all of you had before. At such times, aligning your personal priorities with a higher, common purpose will not only be satisfying for you, it can also make changes that seem impossible today, possible tomorrow.
 
My priorities (in search of this broader resonance) would include the following:
 
Thriving workers, families and communities.  Most of us have jobs as citizens of democratic countries with capitalist economies. We regularly make our preferences known by choosing leaders who share our priorities. As citizens during unsettled times, what kinds of change would we support and priorities would we pursue?
 
In large part because “thriving workers” are the foundation for other kinds of positive change (such as reducing income inequality, gaining affordable health-care and safeguarding the environment in our communities), I’ll be looking for leaders with the courage to say they are foregoing other “hot button” reforms to invest in retraining today’s workforce for a more automated world; to support trade buffers so that workers here don’t lose their jobs to cheap foreign labor when they’re compensated more fairly or work under safer conditions; and to support new public policies like bolstering the economic security of low-wage workers by supplementing their incomes through payroll deposits, thereby encouraging their continued work and improving their chances to start building wealth for their families and communities.
 
We don’t hear politicians making hard choices between costly alternatives.  Or willing to make the engines of capitalism more democratically-driven by ensuring that working men and women have a larger seat at the table with business owners. In the wake of the economic storm that’s coming, there will be many citizen-driven opportunities to support leaders who are eager to rebuild the future on the backs of thriving workers, while admitting that to realize that goal means putting many other goals on a back burner. It should also be a bi-partisan issue. As citizens, our focus and support can help them to accomplish this one important thing as the political process bottoms out and it struggles to identify new, common goals.
 
Environmental stewardship. As Alain de Botton argues persuasively (and often amusingly) in The Pleasures & Sorrows of Work it can be difficult to understand the wide-ranging impacts of your paying job given the global supply chains that feed it and the distribution networks that bring your “goods or services” to consumers. Difficult yes, but hardly impossible.  Among many other things, De Botton invites us to learn more about the consequences of our work, both for better and for worse. I’d argue that when we do, we’ll be able to see “how we can work better in the future” in a common light that includes “greater environmental stewardship.”
 
Is the product I’m selling or helping to sell, is the service I’m providing and the ways I’m providing it, improving the health of the planet or reducing it? Raising consciousness in the workplace about an issue like environmental stewardship provides opportunities for alignment with others–including  bosses and even owners—who may share your concerns. The accelerating storm of today’s climate debate and the quest to find our way out of it will likely present many opportunities to change business practices (and even nudge them in groundbreaking directions) where we work. 
 
Righting the balance between people and profits. Connecting your paid work to its wider-world impacts is not just limited to environmental stewardship. As global economies get roiled and we begin to look beyond these upheavals, we can be thinking now about how our jobs can provide greater benefits to us and our communities and not simply about how we can assist business owners in becoming profitable again. To ensure that you and I are not merely helping to restore the profit-dominated status quo after the next recession, we could be learning now how to connect our labor to “more of its fruits” than higher corporate dividends. 
 
As I argued last March, administrators of a global education test are using that test to assess independent thinking, collaborative problem-solving and building better communities. On the theory that we “treasure what we measure,” students globally are now building these aptitudes in their classrooms because they will ultimately be tested on them.

By the same token, employers could assess (and reward) their employees–and be assessed themselves–for “aptitudes” beyond profit-making, including their success at tying company productivity to greater community benefits. For example, workers could push their companies to retain them (even with reduced hours) instead of firing them during economic downturns because policies like this maintain stable communities, or to take less profit from a product or service if it will keep a job here instead of losing it to a foreign worker. Moreover, employees who can demonstrate that they have strengthened the company-community bond would be rewarded for doing so. 
 
The groundswell for this broader focus needs to come from forward-looking employees as well as executives and owners, and the time to be thinking about more community-oriented work assessments and broader exercises of corporate responsibility is now.
 
After we’ve weathered the next downturn, are looking for better ways forward and desiring greater corporate accountability for common problems—that’s when you can stand up with your new way to determine economic success.

That’s when you can argue that what’s good for the company needs to be good for the community too, and that the economic fallout might be reduced next time if the broader community were part of the equation from the start.  

That’s when you can gain even more pride and satisfaction than is usually available when you help to solve common, work-related problems, because now you’re helping to humanize the foundations of democratic capitialism itself.

+ + +

We are far enough today from the economic recession that began in 2008 to gain at least a measure of historical perspective.  Two new books are arguing that Barrack Obama was so eager to restore economic stability and the health of the American banking industry that he failed to “use” this crisis (as FDR had used the Depression) to seek fundamental—and to these authors—necessary changes to the country’s economic policies. 
 
For example, in the course of re-building America’s way out of the last recession, they observe that Obama (like Clinton before him) never challenged the economic imbalance between the corporations and ordinary working people that had been a hallmark of the Democratic Party from the 1930s through the 1980s. When it came to punishing wrongdoing, Obama refused to insist that the bankers who had profited from the bubble they had created in the housing market be held accountable. When it came to economic initiatives like the Affordable Care Act, he favored market solutions over government policies and direct interventions (unlike the alphabet soup of initiatives during the Thirties or The Great Society programs of the Sixties).
 
According to Reed Hundt’s Crisis Wasted (out last April) and Matt Stoller’s Goliath: The 100 Year War Between Monopoly Power and Democracy (coming in mid-October), Obama sought to preserve the pro-business status quo rather than rectify the economic imbalance that disadvantaged workers, families and communities while benefiting the American business owners who held (and continue to hold) a disproportionate share of the country’s wealth.
 
I agree with them that a crisis is a terrible thing to waste, and that the last one was a string of opportunities neither taken nor pursued. None of us should be willing to waste the next one.

+ + +

I’m defining a “crisis” here as a ground-deep unsettling of prior certainties. A political/economic/environmental/moral crisis tends to prove that “the ways we used to do it” are no longer working and, for a brief window of attention and opportunity, regular people are willing to explore (and even support) both different and better ways forward. It’s why from the perspective of our work, we need to be ready with arguments, data, plans, hope and visions for the better world that each of us wants when that window finally opens.
 
We don’t need to agree on the changes. (The bold-faced objectives above just happen to be some of mine). But I’d argue that all of us need to be active parts of the conversation, even when it’s full of anxiety and has a fevered pitch. Because it’s when your work really can “change the world” and when the personal satisfactions and sense of purpose that come with it can be similarly transformative.  
 
In 2016, a group of forward thinkers who were clustered around the University of Sussex in the UK created educational materials for anyone who is interested in seizing the opportunities of a world in flux. Those materials begin with powerful examples from history where:
 
– radical changes occurred in disruptive times that would not have been possible otherwise;
 
– to nearly everyone’s surprise, immediate changes were accepted by the public fairly rapidly; and 
 
– longer-term improvements followed, with some expected and others exceeding expectations.
 
The Sussex materials also describe how, in a host of practical ways, change-agents can capitalize on the opportunities crisis presents and maintain forward momentum. 
 
There is a broader discussion of their approach and a link to additional materials here.  If you’re interested in readying yourself to take full advantage of the opportunities after our gathering storms break and the re-building begins, I think you’ll find their approach empowering. 
 
Our work can always be aligned with deep motivations and high purposes, but the rewards are never more satisfying than when you’re helping to build a better world out of one that may be ending.

This post was adapted from my September 29, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Filed Under: *All Posts, Being Part of Something Bigger than Yourself, Being Proud of Your Work, Building Your Values into Your Work, Continuous Learning, Daily Preparation, Work & Life Rewards Tagged With: balance between people and profits, crisis wasted, economic policy, employer and employee assessment, environmental stewardship, opportunity during crisis, priorities, rebuilding, thriving workers, work, working

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David Griesing (@worklifeward) writes from Philadelphia.

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