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Why Your Mother Is Right
Years ago, I was visiting the drug store with a friend who was looking for a cold remedy. As we zeroed in on the right product I noticed her reaching for the branded cold meds.
"Why not buy the generic?" I asked, gesturing to the store-branded product which was two-thirds the cost.
"My mom always said generics don't work," she said. "And, I figure why take the risk?"
"What risk?" I retorted. "It's the same active ingredient. You're just paying a premium for the packaging."
At the time, it seemed obvious she was making an irrational choice. I had recently listened to a Freakonomics podcast comparing how experts and non-experts purchase medicine. According to the economist being interviewed, domain experts like pharmacists and doctors are more likely to buy the cheaper generics versus the expensive name brands. While the economist stopped short of calling the rest of us rubes, it left me certain I didn't want to be the type of consumer who fell for this scam.
The memory of debating with my sick friend re-emerged recently after listening to Petter Attiaโs interview with Katherine Eban, the reporter who uncovered the staggering level of fraud that's been taking place in India and China's generics industry.
Recalling the incident, I couldn't help but cringe remembering how certain I had been that I was smarter than my friend's โsuperstitiousโ mother. Reflecting on where my thinking had led me astray, I recalled a lesson from Nicholas Nassim Taleb's book Skin in the Game:
"Rationality is not what has conscious verbalistic explanatory factors; it is only what aids survival, avoids ruin."
In other words, we all must make decisions with incomplete information. When the consequences of those decisions have the potential to be catastrophic, we need to switch our focus from finding the option that appears โoptimalโ to finding the one thatโs least risky. While a belief like "generics aren't as effective" may appear irrational because thereโs no apparent difference between branded and white-label products, there may be hidden differences that introduce unseen risk. Said another way, in a complicated world, you canโt be 100% sure that generic drugs wonโt risk your health or even your life because of those hidden differences.ย
This capacity to follow traditions, often without question, has aided humans in our domination of the planet. To illustrate, author Joseph Henrich shares what happened when ritualistic traditions around food preparation were abandoned. The following passage from his book The Secret of Our Success concerns the preparation of manioc, an edible tuber that if eaten too often can result in cyanide poisoning:
โIn the Colombian Amazon indigenous Tukanoans use a multistep, multiday processing technique [to prepare the manioc] that involves scraping, grating, and finally washing the roots in order to separate the fiber, starch, and liquid. Once separated, the liquid is boiled into a beverage, but the fiber and starch must then sit for two more days when they can then be baked and eaten.
Such processing techniques are crucial for living in many parts of Amazonia, where other crops are difficult to cultivate and often unproductive. However, despite their utility, one person would have a difficult time figuring out the detoxification technique. Consider the situation from the point of view of the children and adolescents who are learning the techniques. They would have rarely, if ever, seen anyone get cyanide poisoning, because the techniques work. And even if the processing was ineffective, such that cases of goiter (swollen necks) or neurological problems were common, it would still be hard to recognize the link between these chronic health issues and eating manioc. Most people would have eaten manioc for years with no apparent effects. Low cyanogenic varieties are typically boiled, but boiling alone is insufficient to prevent the chronic conditions for bitter varieties. Boiling does, however, remove or reduce the bitter taste and prevent the acute symptoms (e.g., diarrhea, stomach troubles, and vomiting).
So, if one did the common-sense thing and just boiled the high-cyanogenic manioc, everything would seem fine. Since the multistep task of processing manioc is long, arduous, and boring, sticking with it is certainly non-intuitive. Tukanoan women spend about a quarter of their day detoxifying manioc, so this is a costly technique in the short term. Now consider what might result if a self-reliant Tukanoan mother decided to drop any seemingly unnecessary steps from the processing of her bitter manioc. She might critically examine the procedure handed down to her from earlier generations and conclude that the goal of the procedure is to remove the bitter taste. She might then experiment with alternative procedures by dropping some of the more labor-intensive or time-consuming steps. Sheโd find that with a shorter and much less labor-intensive process, she could remove the bitter taste. Adopting this easier protocol, she would have more time for other activities, like caring for her children. Of course, years or decades later her family would begin to develop the symptoms of chronic cyanide poisoning.ย
Thus, the unwillingness of this mother to take on faith the practices handed down to her from earlier generations would result in sickness and early death for members of her family. Individual learning does not pay here, and intuitions are misleading. The problem is that the steps in this procedure are causally opaqueโan individual cannot readily infer their functions, interrelationships, or importance. The causal opacity of many cultural adaptations had a big impact on our psychology.
Wait. Maybe Iโm wrong about manioc processing. Perhaps itโs actually rather easy to individually figure out the detoxification steps for manioc? Fortunately, history has provided a test case. At the beginning of the seventeenth century, the Portuguese transported manioc from South America to West Africa for the first time. They did not, however, transport the age-old indigenous processing protocols or the underlying commitment to using those techniques. Because it is easy to plant and provides high yields in infertile or drought-prone areas, manioc spread rapidly across Africa and became a staple food for many populations. The processing techniques, however, were not readily or consistently regenerated. Even after hundreds of years, chronic cyanide poisoning remains a serious health problem in Africa. Detailed studies of local preparation techniques show that high levels of cyanide often remain and that many individuals carry low levels of cyanide in their blood or urine, which havenโt yet manifested in symptoms. In some places, thereโs no processing at all, or sometimes the processing actually increases the cyanogenic content. On the positive side, some African groups have in fact culturally evolved effective processing techniques, but these techniques are spreading only slowly.
Perhaps the traditionalists who followed every step of the traditional manioc preparation process were ridiculed for being irrational by those who took shortcuts. Weโll never know. Thatโs because the traditionalists managed to pass on their genes and cultural learnings to future generations, and the short-cutters didnโt.ย
What does this have to do with buying branded versus generic drugs? Like the traditionalists, my friendโs mom was practicing and transmitting her own useful beliefโ not about the nature of generic drugs but rather about the perils of doing business with a party that lacks sufficient skin in the game.ย In his book, Alchemy, author Rory Sutherland explains the connection between brands and reputational investment:
"While a brand name is rarely a reliable guarantee that a product is the best you can buy, it is generally a reliable indicator that the product is not terrible...someone with a great deal of upfront reputational investment in their name has far more to lose from selling a dud product than someone youโve never heard of, so, as a guarantee of non-crapness, a brand works.โ
Ultimately I don't remember whether my friend chose branded drugs or generics. Maybe her meds weren't made by a corrupt firm. Or perhaps this product was made to the standard. The point is I donโt know. So instead of trying to outsmart momโs advice, the โrationalโ thing to do is simply to heed it. Revisiting Talebโs advice on the topic:
"When you consider beliefs do not assess them in how they compete with other beliefs, but consider the survival of the populations that have them."
Recommended Tool
As an experiment, Iโm going to try recommending a new tool each month that Iโve been liking. This month Iโm recommending: Plectica
If youโre in a generative phase of building something, affinity diagrams can be a great format to organize your thinking. Iโve tried out a few different mapping tools, and Plectica has blown the others away. To get a sense of what it can do, check out some of their examples.
Recommended Content
๐ฐ Taxonomy of Moats
(24-minute read)
I love seeing smart people create models of their domain. After five iterations, Jerry Neumannโs taxonomy of competitive moats has become pretty robust. It posits that moats are created by four forces:
The state โ governments enacting policies to restrict competition
Special know-how โ possessing specialized institutional knowledge
Scale โ advantages that appear or increase as a company gets bigger
System rigidity โ advantages that arise due to the high cost of change
Hereโs the latest version of the model. To get more clarity on the individual branches, check out the post which explains them in detail.
๐ง How can we develop transformative tools for thought?
(83-minute read)
How often do you invest hours into reading a book only to find that you canโt recall any of the salient points?
While we know of techniques like spaced repetition that have a powerful effect on retention, there hasnโt been much of an effort to incorporate these principles into our reading material.
In this essay, Andy Matuschak and Michael Nielsen share the promising results of their experimental essay format that combines testing and spaced repetition into the content of the article.
The article explores some of the principles that make for an effective question and how this technique can be incorporated into video content. Itโs a worthwhile read for anyone interested in creating educational content or remembering more of what they read.
โ๏ธImprove your communication by learning from the best
In an effort to become a better communicator, Iโve been on the lookout for good resources. Here are three good ones with tips from the military, McKinsey, and Amazon respectively. After all, why not learn from the best?
๐ Running an All-Hands
(12-minute read)
One of the best ways to get a sense of how a company operates is to watch how its employees gather. Does the CEO do all the talking? Whatโs the tone of the conversation? Administrative? Intimidating? Congratulatory?
This post, written by Gokul Rajaram of Square does a great job breaking down the purpose of an all hands:
An All-Hands does three things. It celebrates people and accomplishments; it drives alignment around mission, strategy and priorities; and finally, it provides a forum to ask and answer questions.
He goes on to explain how to pull that off and how to know if youโve done it right:
After an awesome All-Hands, every attendee feels invigorated (the celebratory aspect), empowered (the alignment piece) and educated (the Q&A part).
๐ The YouTube Revolution in Knowledge Transfer
(5-minute read)
Popular opinion would tell you that YouTube is making us dumber. Itโs shortening our attention spans and distracting us from grappling with the type of complex ideas that are best articulated through the written word. That may be the case, but itโs not the whole story.
YouTube is also facilitating the mass transmission of procedural knowledge from some of the worldโs leading master practitioners. Given the importance of cultural knowledge transmission in the success of the human species, an argument could be made that YouTube might one day โbe evaluated in the same category as the printing press or the telegraph.โ
๐ What I wish I knew five years ago about building a career in โcontentโ
(11-minute read)
There comes a point for most individual contributors when they must understand how their efforts contribute to the larger goals of the company. Sean Blanda does a good job of articulating what this looks like for content marketers:
To truly increase your value, you need to understand what drives the companyโs long-term growth and focus maniacally on that. This means elevating your mental frameworks from tactics (i.e. โI must publish three articles a weekโ) to strategy (i.e. โI must find a way to help our events team sell more ticketsโ). And it means structuring the content operation to lead to outcomes (i.e. โwebinar signupsโ) and not outputs (i.e. โpublishing 10 tweets a dayโ).
An employeeโs ability to cross this gap will have a big effect on how much runway he has left in his career.
๐ So a Rabbi and an atheist walk into a podcast...
(104-minute watch)
To be honest, I didnโt expect I was going to get much out of Eric Weinstienโs conversation with Rabbi David Wolpe, but man was I wrong. Here are a few points from their conversation that have stuck with me:
Judaism is more of a set of cultural practices than a religion. If a Christian stops believing in God, he is no longer a Christian, whereas if a Jew becomes an atheist, he is still seen as Jewish.
Rather than judging a religion by things in the texts that do or donโt make sense in modern-day, a better test is whether the religion has made its followers successful.
Interesting theory: Seinfeld (the show) did a great job of updating and transmitting the ethical dilemmas in the Talmud to a wider and more modern audience.
Thereโs a tension within the idea of multiculturalism. Some think of it as โpainting with a lot of distinct pigments.โ But more and more the term is coming to mean mixing all of the colors, which doesnโt make the beautiful rainbow they hoped. Thatโs because, multiculturalism is built on culturalism, and culturalism is built on exclusion with some amount of permeability. So if you care about multiculturalism figure out whatโs special about your own and preserve it to share with others.
For any culture or religion to survive, its followers must believe that they are exceptional. That doesnโt mean they need to argue that their beliefs are superior.
Community
Shoutouts
Kushaan Shah asked what it takes to consider yourself an expert.
Matias Honorato published a first-principles approach to growth.
Great profile of Matt Davidโs work on Data School.
A few weeks ago I got to sit in on MK Hurbuttโs class at Chorus. Itโs sort of like meditation, but Iโve never finished a meditation with that kind of body high. If youโre based in SF I recommend you try a class.
Namika Hamasakiโs great work got featured by Figma
Great interview with Nicole Quinn in Refinery29
Rachel Carlson and Britt Stitch continue to kill it, most recently landing Guild on Forbesโ the Cloud 100 list
Nice work Roy Bahat on raising a fund number III
Congratulations to Ryan Caldbeck on raising a new fund for CircleUp
*Header image credit: Katharina Mitteregger