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A Sign of the Times: ASCO’s Relationship with the Pharmaceutical Industry

Dec 11 2015
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In my 25 years as an ASCO member I have watched the relationship between ASCO and the pharmaceutical industry evolve from almost incestuous to almost antagonistic. In my 25 years as an ASCO member I have watched the relationship between ASCO and the pharmaceutical industry evolve from almost incestuous to almost antagonistic.  Attending the 2012 Annual Meeting I am reminded how important industry is to ASCO, not only in its financial support of our organization via participation in the commercial trade show but also through its support of discovery and development of new treatments and technologies that contribute to our science, our practices and many of the very advances we present and discuss at our annual meeting.  While there needs to be a robust firewall between industry and academia to assure the integrity of vital peer review and regulatory processes, the firewall does not have to include antagonism or imply that the pharmaceutical industry is somehow evil or bad.  On the trade show floor of the 2012 Annual Meeting, signs were placed in all aisles that suggested that what pharmaceutical company personnel do within their proscribed exhibits is objectionable enough that extending it to other areas of the trade show floor was a serious violation warranting expulsion and other sanctions.  While I agree that promotion in the aisles and leisure areas is undesirable and a policy to restrict it is reasonable, the placement of multiple signs throughout the trade show and the wording implies that industry personnel cannot be trusted and are a threat to ASCO members. If ASCO was trying to send a message to its members that pharmaceutical personnel cannot be trusted, it couldn’t have been done any better.  If the intention was to demonstrate that the ASCO was on duty policing the relationship between the pharmaceutical industry and ASCO members, the mission was accomplished but with an unnecessarily heavy hand and with a message to members that could further damage the already fragile relationship that ASCO has with industry.  Our ASCO leadership was pretty busy last weekend with the Annual Meeting, but I hope that someone will take the time to think about this vital relationship and examine how these signs found their way into the flow of what was otherwise a spectacularly conducted meeting.- Richard Leff, MD6/11/12Apparently the signs were not aimed at pharmaceutical reps. A quick and appropriate response about this issue was received from Allen Lichter, CEO of ASCO. It is posted below:- Thanks, Allen.I saw your posting and want to correct a misconception. What was happening in the exhibit hall was aggressive salespeople, many of them without booths, were roaming the hall and approaching company representatives in their booths trying to sell them services. The industry complained about this disruption of their activities. It was at the request of industry that we created a policy that prohibited this practice and posted signs to make sure those who were in the hall legitimately were not being harassed by those who weren’t.We will be responding to your blog so the record can be set straight. Let me know if you have any questions or concerns.

Good to Great

Dec 11 2015
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Leadership The type of leadership required for turning a good company into a great company is not what you think:We were surprised [author and support staff], shocked really, to discover the type of leadership required for turning a good company into a great one. Compared to high-profile leaders with big personalities who make headlines and become celebrities, the good-to-great leaders seem to have come from Mars. Self-effacing, quiet, reserved, even shy—these leaders are a paradoxical blend of personal humility and professional will. They are more like Lincoln and Socrates than Patton or Caesar. . . . We expected that good-to-great leaders would begin by setting a new vision and strategy. We found instead that they first got the right people on the bus, the wrong people off the bus, and the right people in the right seats—and then they figured out where to drive it. The old adage “People are your most important asset” turns out to be wrong. People are not your most important asset. The right people are.Jim Collins, Good to Great.All of us have read headlines about larger-than-life CEOs with enormous egos and outsized personalities. Although they attract all of the attention, the research and facts are crystal clear: modest, humble, determined, and fearless CEOs are the most successful over the long-run. Collins and team make a compelling case that the most successful leaders don’t spend a lot of time talking about themselves but focus more on the company and the talented people around them. People who work with successful leaders are likely to describe them as humble, understated, self-effacing, modest, reserved, and quiet.- Jeff Giampalmi

Drive

Dec 11 2015
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Motivating people Intrinsic motivation is much more powerful than extrinsic motivation:Another study of artists over a longer period shows that a concern for outside rewards might actually hinder eventual success. In the early 1960s, researchers surveyed sophomores and juniors at the School of the Art Institute of Chicago about their attitudes toward work and whether they were more intrinsically or extrinsically motivated. Using these data as a benchmark, another researcher followed up with these students in the early 1980s to see how their careers were progressing. Among the starkest findings, especially for men: “The less evidence of extrinsic motivation during art school, the more success in professional art both several years after graduation and nearly twenty years later.” Painters and sculptors who were intrinsically motivated, those for whom the joy of discovery and the challenge of creation were their own rewards, were able to weather the tough times—and the lack of remuneration and recognition—that inevitably accompany artistic careers. And that led to yet another paradox in the Alice in Wonderland world of the third drive. “Those artists who pursued their painting and sculpture more for the pleasure of the activity itself than for extrinsic rewards have produced art that has been socially recognized as superior,” the study said. “It is those who are least motivated to pursue extrinsic rewards who eventually receive them.”Daniel H. Pink. Drive: The Surprising Truth About What Motivates Us. RiverHead Books.We all know that hiring, developing and retaining the ‘right people’ is the key to every successful organization. If an organization has the ‘right people’ there is less need for structure, restrictive policies, and hierarchy. Our company spends considerable time identifying intrinsically motivated individuals, and we believe these employees will enable the company to experience sustained growth.- Jeff Giampalmi

Brain Rules

Dec 11 2015
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Multitasking When it comes to paying attention, multitasking is a myth:Multitasking, when it comes to paying attention, is a myth. The brain naturally focuses on concepts sequentially, one at a time. At first that might sound confusing; at one level the brain does multitask. You can walk and talk at the same time. Your brain controls your heartbeat while you read a book. Pianists can play a piece left hand and right hand simultaneously. Surely this is multitasking. But I am talking about the brain’s ability to pay attention. It is the resource you forcibly deploy while trying to listen to a boring lecture at school. It is the activity that collapses as your brain wanders during a tedious presentation at work. This attentional ability is not capable of multitasking. Recently, I agreed to help the high-school son of a friend of mine with some homework, and I don’t think I will ever forget the experience. Eric had been working for about a half-hour on his laptop when I was ushered to his room. An iPod was dangling from his neck, the ear buds cranking out Tom Petty, Bob Dylan, and Green Day as his left hand reflexively tapped the backbeat. The laptop had at least 11 windows open, including two IM screens carrying simultaneous conversations with MySpace friends. Another window was busy downloading an image from Google. The window behind it had the results of some graphic he was altering for MySpace friend No. 2, and the one behind that held an old Pong game paused mid-pong. Buried in the middle of this activity was a word-processing program holding the contents of the paper for which I was to provide assistance. “The music helps me concentrate,” Eric declared, taking a call on his cell phone. “I normally do everything at school, but I’m stuck. Thanks for coming.” Stuck indeed. Eric would make progress on a sentence or two, then tap out a MySpace message, then see if the download was finished, then return to his paper. Clearly, Eric wasn’t concentrating on his paper. Sound like someone you know? To put it bluntly, research shows that we can’t multitask. We are biologically incapable of processing attention-rich inputs simultaneously. Eric and the rest of us must jump from one thing to the next.John Medina Brain Rules: 12 Principles for Surviving and Thriving at Work, Home, and School.Businesses and Universities constantly praise multitasking but the brain is a sequential processor. Overloading it with too many attention-rich stimuli will result in mistakes and reduce productivity. In our world of smart phones, tablet PCs, and social networks, we should consider Medina's comments and always remember our brain’s limitations when it comes to paying attention.- Jeff Giampalmi

The “BIG” Error

Dec 11 2015
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It's always a shock when something we were taught in our training and used for years turns out to be wrong and even harmful.  The latest, that we have been under-dosing obese patients with chemotherapy for decades, is not the first or the last in this category but it certainly involves a lot of patients who were treated in the past 30 years.  When I was a fellow I was carefully taught that total body water content did not increase linearly with BSA in very obese patients so that BSA overestimated the true volume of distribution.  As a result, we believed that doses should be reduced from the ones based on actual BSA, particularly in obese bone marrow transplant patients where the therapeutic index was particularly small.  (In fact, if my memory serves me correctly, I think there may have been a question about just that on my Oncology boards.) Good theory if only there had been data to support it.But there were other conditions 30 years ago that made the decision in the direction of safety rather than efficacy reasonable.  Back then most of our therapies were given with palliative intent with many fewer curable patients treated.  It was much easier to rationalize doing no harm when the upside of therapy was much less than it is today and the downside related to toxicity was greater.  Our options to treat the complications of our therapies were much more limited.  Hospitalization for 7 to 10 days with IV antibiotics for neutropenic fever was not uncommon as we had not yet seen the benefits of growth factor availability.  In addition, IV antibiotics which routinely included aminoglycosides carried more risk, particularly of renal damage.  Blood products were not as safe as they are today and anti-emetics would have to be described as rudimentary in comparison to our tools today.  So we live and we learn.Aside from changing our dosing for obese patients what lessons have we learned from this issue? We need to develop better ways to examine the systems and rules we use every day in our decision making and we need especially to regularly question the paradigms that drive our specialty, were taught to us by our mentors and are rarely questioned by most of us. Perhaps we can spot the next mistake (opportunity for major improvement in current vernacular) before we have been doing it for 30 years.- Rich Leff, MD

The Two-Second Advantage

Dec 11 2015
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Exceptional predictive capability is what drives talent. Many successful people are able to make accurate predictions about specific activities. Consider the following quotation from The Two-Second Advantage: How We Succeed by Anticipating the Future:The human brain is a predictive machine. Intelligence is prediction. This is a relatively new concept in neuroscience, coalescing into broad acceptance only in the 1990s and 2000s. While the connection between prediction and general intelligence is generally understood, an even newer-and largely unexplored-idea has emerged in neuroscience: exceptional predictive capability is what drives talent. Most successful people are really good at making very accurate predictions-usually about some particular activity-just a little faster and better than everyone else….The salesman who sells more than anybody else has developed a talent for anticipating people’s reactions to his pitches, allowing him to steer the conversation before it goes off course. The teacher who seems to get the most out of her students with the least effort had developed predictive models in her head for how kids behave and respond to certain teaching methods.Vivek Ranadivé and Kevin Maney. The Two-Second Advantage: How We Succeed by Anticipating the Future – Just Enough. Crown Business, 2011.- Jeff Giampalmi

Drive

Dec 11 2015
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Motivating people Intrinsic motivation is much more powerful than extrinsic motivation:In the middle of the last century, two young scientists conducted experiments that should have changed the world—but did not. Harry F. Harlow was a professor of psychology at the University of Wisconsin who, in the 1940s, established one of the world’s first laboratories for studying primate behavior. One day in 1949, Harlow and two colleagues gathered eight rhesus monkeys for a two-week experiment on learning. The researchers devised a simple mechanical puzzle. Solving it required three steps: pull out the vertical pin, undo the hook, and lift the hinged cover. Pretty easy for you and me, far more challenging for a thirteen-pound lab monkey. The experimenters placed the puzzles in the monkeys’ cages to observe how they reacted—and to prepare them for tests of their problem solving prowess at the end of the two weeks. But almost immediately, something strange happened. Unbidden by any outside urging and unprompted by the experimenters, the monkeys began playing with the puzzles with focus, determination, and what looked like enjoyment. And in short order, they began figuring out how the contraptions worked…. …Nobody had taught the monkeys how to remove the pin, slide the hook, and open the cover. Nobody had rewarded them with food, affection or even quiet applause when they succeeded…. Scientists then knew that two main drives powered behavior. The first was the biological drive. Humans and other animals ate to sate their hunger, drank to quench their thirst… But that wasn’t happening here…. …If biological motivations came from within, this second drive came from without—the rewards and punishments the environment delivered for behaving in certain ways. This was certainly true for humans, who responded exquisitely to such external forces. If you promised to raise our pay, we’d work harder. If you held out the prospect of getting an A on the test, we’d study longer. If you threatened to dock us for showing up late or for incorrectly completing a form, we’d arrive on time and tick every box… But that didn’t account for the monkeys’ actions either. As Harlow wrote…, “The behavior obtained in this investigation [viz. with the rhesus monkeys and the puzzle] poses some interesting questions for motivation theory, since significant learning was attained and efficient performance maintained without resort to special or extrinsic incentives” [emphasis added]. To answer the question, Harlow offered a novel theory—what amounted to a third drive: “The performance of the task” he said, “provided intrinsic reward.” The monkeys solved the puzzles simply because they found it gratifying to solve puzzles. They enjoyed it. The joy of the task was its own reward… …Perhaps this newly discovered drive—Harlow eventually called it “intrinsic motivation”—was real [emphasis added]. But surely it was subordinate to the other two drives. If the monkeys were rewarded—with raisins!—for solving the puzzles, they’d no doubt perform even better. Yet when Harlow tested that approach, the monkeys actually made more errors and solved the puzzles less frequently.Daniel H. Pink. Drive: The Surprising Truth About What Motivates Us. RiverHead Books. http://bit.ly/Aq4DZn We all know people who “love what they do” and for these people work is not a chore or task but a rewarding experience. I truly enjoy being CEO of Conisus and my focus has always been on the challenge of developing people, making our company successful, and helping oncologists and allied healthcare professionals improve patient outcomes. For me, the jobs I have enjoyed the most have never been about the money but about the challenge.- Jeff Giampalmi

The Two-Second Advantage: How We Succeed by Anticipating the Future

Dec 11 2015
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One measure of talent is the ability to anticipate the outcome of decisions before they are made. Consider the following quotation from The Two-Second Advantage: How We Succeed by Anticipating the Future:Like Gretzky on ice, the most successful people in various fields make continual, accurate predictions just a little ahead of and a little better than everyone else. It is the one common denominator of almost all consistent success. Talented people don’t need to have a vision of the future ten years out or even ten days out. They need a highly probable prediction just far enough ahead to see an opening or opportunity an instant before the competition. That’s true for athletes, artists, businesspeople, or anyone in any field.... In other words, talented people have a two-second advantage.In this context, authors Ranadivé and Maney refer to Malcolm Gladwell’s 2005 best seller titled Blink: The Power of Thinking Without Thinking, in which Gladwell makes the case that “judgments made in two seconds are often more accurate than those made after months of analysis.” Frequently, we all get consumed with measuring talent through test scores or solely based on aptitude. But for any given field or discipline, Ranadivé and Maney argue that talent comes with thousands of hours of deliberate practice framed in a mere two seconds. Vivek Ranadivé and Kevin Maney. The Two-Second Advantage: How We Succeed by Anticipating the Future – Just Enough. Crown Business, 2011.- Jeff GiampalmiAdditional Information: YouTube video of Ranadive and Maney discussing their book: http://www.youtube.com/watch?v=i3XSR6turQsAmazon link: http://www.amazon.com/Two-Second-Advantage-Succeed-Anticipating-Future-Just/dp/0307887650#_Twitter Post: Ranadivé and Maney on the difference that 2 seconds make

The single most important thing you can do to improve brain function is exercise.

Dec 11 2015
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The following is from John Medina’s book Brain Rules:  “Exercise gets blood to your brain, bringing it glucose for energy and oxygen to soak up the toxic electrons that are left over.”  Furthermore, “Aerobic exercise just twice a week halves your risk of general dementia and cuts your risk of Alzheimer’s by 60 percent.”Jeff Giampalmihttp://www.conisus.com/sites/default/files/12brainrules.pdf

Study Shows Memory Loss Can Start as Early as 45

Dec 11 2015
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Loss of memory and other brain function can start as early as age 45, posing a big challenge to scientists looking for new ways to stave off dementia, researchers said on Thursday. The finding from a 10-year study of more than 7,000 British government workers contradicts previous notions that cognitive decline does not begin before 60 years of age, and it could have far-reaching implications for dementia research.- Jeff Giampalmihttp://www.cnbc.com/id/45897910