Trick or Treatment

There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.

-Hippocrates of Cos

I just finished reading a book by Dr. Edzard Ernst and Simon Singh. Dr. Ernst began his career practicing in a homeopathic hospital in Munich. He is the first professor of alternative medicine in the world, and the only one in the UK. And, he chose to begin his book with this quote. The rest of the book continues in this spirit. Throughout the book, in (mostly) engaging prose, he examines various “alternative” approaches to health. He wishes to dismiss nothing out of hand, and sees value in some areas of alternative medicine. Repeatedly, however, he asks (and answers) several basic questions:

• How is an approach claimed to work?
• What is the evidence for a therapy’s efficacy? What is the quality of the evidence?
• What risks are involved in a therapy?

Along the way and throughout the book, he provides numerous anecdotes to illustrate his point. He talks of James Lind, who conducted one of the first documented clinical trials and determined an effective cure for scurvy. He tells of various “mavericks” in medical history, such as the man who lost a libel case when he criticized bloodletting, a process which eminent doctor Benjamin Rush used freely. (He also notes that many mavericks were not “ahead of their time”, but simply wrong.) He describes the methods that exist for determining a treatment’s efficacy, leads his readers through the reasoning behind these methods, and examines numerous “complementary and alternative” therapies through the lens of evidence. Though it can get a little long, it’s written engagingly, and with an open-minded, inquiring, but thoroughly evidence-based approach. I enjoyed the book, and I’m guessing some of my acquaintances would enjoy it as well–even those who like alternative medicine much more than I.

From an initial chapter titled “How Do You Determine The Truth?”, the book proceeds through chapters on acupuncture, homeopathy, chiropractic therapy (the history of the field is fascinating!), and herbal medicine. A number of other therapies, including aromatherapy, “energy” treatments, and others, are treated much more concisely in an appendix. After finishing this book, you’ll be much better equipped than before to evaluate existing or new kinds of “alternative” medicine.

Highly recommended: Trick or Treatment: The Undeniable Facts About Alternative Medicine, by Simon Singh and Edzard Ernst. It’s available via Amazon or the alternate bookstore of your choice.

For further reading, see this article about Ernst.

Reading lists

Originally posted 2005-05-24

Hints of this have come through in this blog already, but in case it’s not clear enough: I like to read. My family used to be known at the local library as the people who’d come in with laundry baskets to carry their selections (to be fair, we did live some distance out of town). I’m really a rather (sob) culturally deprived individual, having grown up without the great blessing of a TV at home (interpreted: I’m one of those intellectual snobs who likes to decry the “atrophy of the mind” arising from prolonged, repeated passive consumption, whatever the content being consumed). More positively, I appreciate good books, especially those relating in some ways to my interests. If you share such an interest, a few books to get you started (no kickbacks –to me, at least, for referrals here):

• DeliLama’s reading list. I first encountered DeliLama on The Motley Fool’s message boards, and I like the way he thinks. Many of the books on this list pertain to one’s finances, but the core theme is strategy, whether in one’s business, personal life, or even on the battle field. Interestingly, elements of strategies applicable to one area can often apply to other spheres in one’s life as well. From a Chinese general’s dicta on how to conquer and to rule (often applied to the “business battlefield” today) to learning exactly how various forms of influence (and potentially manipulation) work in our lives, the books present an interesting selection.
• Joel Spolsky’s list of books that any programmer or would-be programmer should read. Interestingly, there’s some overlap with DeliLama’s list. Especially check out Hofstadter’s book on the list; obviously, read it critically, but (as I recall from reading it years ago) it’s an amazing melange of everything from computer science to paradoxical or mathematical artwork to Zen philosophy!
• One book I’m in the process of re-reading, Why Smart People Make Big Money Mistakes And How To Correct Them (no-commission link). The title’s a mouthful, but the book will pay for itself many times over unless you’re a paragon of rational financial intelligence. I hope to write more about this book later.

The Fortune at the Bottom of the Pyramid

Originally posted 2005-05-04

As promised, I’m posting a review of C. K. Prahalad’s book The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits.

I’ve just finished slogging through Mr. Prahalad’s book. “Slogging” does seem, in this case, to be the most appropriate word for the activity. It’s not that Mr. Prahalad doesn’t have excellent points. It’s not that he doesn’t present interesting illustrations of how organizations are successfully working with “the bottom of the pyramid”. My only complaint, in fact, is with his writing style. The book has one of the highest acronym densities I’ve seen (with the possible exception of computer acronyms, to which I’ve become fairly desensitized), and it feels as though it loops back on itself again…and again…and again. With that said, though, the book still provides worthwhile insights into how companies can successfully work with the poorest segments of the world’s population.

The main idea of the book is a valuable one: that people at the “bottom of the pyramid”, the 4 billion people in the world who live on less than two dollars per day, are a large market, and that companies can both profit and improve the lives of poor people by selling to these “bottom of the pyramid” (BOP) people. Prahalad bases most of his book on a number of case studies, but starts with an argument for dealing with people at the BOP. Several of his points:

1. There’s a lot of money at the bottom of the pyramid, by virtue of the number of people there and the potential for economic growth.
2. We need innovative ways of reaching BOP people; he cites several examples in his case studies.
3. People at the BOP care about brands, but are simultaneously extremely value-conscious.
4. People at the BOP are increasingly “connected” in various ways.
5. BOP people are quite open to adopting advanced technology.

Prahalad also presents several recommendations for businesses:

1. Focus on price/performance ratios. He provides some incredible examples of this.
2. Adapt technology as necessary.
3. Create solutions that are “portable” across national and other boundaries.
4. Maximize efficiency, to a different magnitude than we’re accustomed.
5. Products must be oriented toward their use in a BOP context.
6. Selling to the BOP often requires development of new processes.
7. Minimize required skills.
8. Maximize customer education.
9. Design products for hostile environments.
10. Rethink interfaces; a lot of BOP customers can’t read!
11. Think through distribution methods thoroughly.

As you may have noted, Prahalad stops far short of providing a “cookbook” for starting a business selling to the world’s poor. Instead, he fleshes out his prescriptions by looking at several successful companies who have built markets at the BOP. A few of the organizations he examines include the Aravind Eye Care System, Jaipur Foot, and Cemex. Aravind offers cataract surgeries for people at the BOP, providing free surgeries to many and a standard of care better in almost every respect than that in the U.K. Their cost: $25 per surgery. Jaipur Foot provides a foot prosthesis fitted in a day, serving its user as well as a prosthesis costing $8,000 in the U.S. The cost of producing this prosthesis: $30. Cemex presents less immediate drama, but is a company that, by introducing a program to help individuals save to add on to their homes, has both increased its market and contributed to the standard of living of the poor. Prahalad presents various other examples of companies that seem to have succeeded in bringing benefit to both themselves and the people with whom they have dealt, and explores some of the means utilized by these companies to accomplish their goals.

Overall, I found Prahalad’s book an interesting, if somewhat repetitive, read. He presents examples of the benefits that can accrue to all involved when companies become seriously involved with people at the bottom of the pyramid. The two aspects of the book that I questioned were:

• The implicit assumption that “consumer culture” will be a net positive to people at the BOP. It’s hard to find fault with someone ensuring that he or she will have enough to eat or with his or her adding a room to have a little more living space. Further down the path of the “consumer culture”, though, lie many of the aspects of American culture today, “gifts” without which it seems even people at the BOP may be better off. Ultimately, people at the BOP will have to choose their own paths.
• Many of the organizations evoke, to varying degrees, a bit of the MLM/groupthink vibe. I suspect that some of this perception may arise from cultural differences; some of it may just be that people are trying to institute significant changes, and this sort of personal or group influence is an effective way of doing so.

Overall, I’ll give the book a 4.5 out of 5 for content, and perhaps a 3 for readability.

Subversion, Legacies, Microfinance, and Capital

Originally posted 2005-04-29. In moving to a new blog, I’m “un-linking” book references.

…OK, so I don’t consider either microfinance or capital to be subversive. The title refers to several books that I’ve either read recently, am reading, or hope to read soon.

First, the subversion. This actually refers to Pragmatic Version Control Using Subversion, the first book in the Pragmatic Programmers’ Pragmatic Starter Kit trio. I’d highly recommend their The Pragmatic Programmer: From Journeyman to Masterfor any software developer, and the Pragmatic Bookshelf books elaborate on the techniques that they recommend in PragProg.

The “legacy” similarly has a meaning rather different from the conventional one. In this case, it refers to “legacy code”, the politically correct way for a software developer to refer to a certain category of code. The “political correctness” stems from the character of “legacy code”–it’s usually code written by a kid just out of college or someone who never learned good programming practices. Typically, no one really understands it; it’s a “black box” that we all hope works, and that, when we have no other options, we gingerly reach into, adjust ever-so-slightly so that it gives us the results we want, and close back up. The Jargon File has a more colorful term for a subcategory of legacy code: the “crawling horror”!

With that background, Michael Feathers’ book Working Effectively With Legacy Codeis a welcome addition to the office library. Feathers uses a new definition of “legacy code”, though: it’s any code that isn’t covered by unit tests. According to that definition, the code you’re creating right now might be legacy code! From this starting point, Feathers goes on to explore numerous methods of getting pre-existing code under tests. I’ve greatly enjoyed reading this book.

Leaving technology behind for a bit, I finished reading Muhammad Yunus’s book Banker to the Poor a couple of weeks ago. Yunus was the man who founded the Grameen Bank in Bangladesh, establishing a model for microfinance across the world. Yunus was an economics professor, but in a famine in Bangladesh he began exploring ways to help poor people in his country. He found that he could greatly benefit over 40 people by loaning them a combined total of around twenty dollars. As of November 2004 (per Wikipedia), the bank had loaned over $4.4 billion to poor people. The story provides an inspirational example of how innovative approaches to dealing with poverty can work.

I’ve just started on C. K. Prahalad’s The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits, which looks so far like an excellent book on how private enterprises can both profit and benefit underserved populations; I’ll try to post more on this later. Another book that I haven’t even started on (beyond the introduction, at least) is Natural Capitalism by Paul Hawkins and Amory and L. Hunter Lovin. The basic thesis there seems to be that we need to recognize the value of natural “services” and the economic costs of harming natural systems.

Anyway…I hope to post some actual reviews soon (perhaps after finals–if not, ah…mañana!). Until then, let me know what you think!