Archives For collaboration

Humans often proclaim that “intelligence” is what sets our species apart – the ability to analyze, to imagine, to organize, to then cooperate and execute. A unique gift that enables us to be remarkable.

Monuments to humanity’s capability are sprinkled all across the world — early works are colossal demonstrations of ingenuity coupled with brute strength. Consider the statues of Easter Island, Rome’s Colosseum, Egyptian, and early American pyramids, or the Great Wall of China as examples, each demonstrating a singularly human ability (and need) to reshape our world and leave evidence of our presence.

And as time and talent has unfolded, the complexities of our contributions have advanced as well.

Just imagine Michelangelo toiling day after day, for three years, on a suspended ceiling scaffold to complete his Sistine Chapel masterpiece in fresco (an arduous painting technique that uses freshly mixed wet mortar). In his mind, he had assembled the nine-paneled piece that retells the book of Genesis. Then to return again 25 years later, to the same sacred chapel, the actual room from which all future Popes would be selected, to toil for another seven tireless years painting the massive Last Judgement. What drove him? Was it intelligence, or something more?

Or consider the four stoic faces of Mount Rushmore. Originally intended to feature celebrities of “the wild, wild west,” sculptor and principle engineer Gutzon Borglum would have no part of that ill-considered idea. His vision was to record “leadership greatness,” in massive stone. With congressional funding and President Calvin Coolidge’s personal endorsement in hand, Borglum and four hundred fearless souls dutifully chiseled 60-meter granite renderings of Presidents Washington, Jefferson, Lincoln, and Roosevelt as a timeless (and today yet again timely) reminder of how “great character” is core to “true greatness.” Mount Rushmore is an engineering and artistic marvel, but here, too, something more was required.

These, and countless other examples, are certainly demonstrations of human intelligence.

But intelligence relies on something else unique to humans. Excellence in analysis, imagination, organization, cooperation, and execution all have a shared co-dependent variable. They each deeply inter-depend on us — the actor, the agent, the painter, the human — to truly and deeply care. Each is pulled forward by a personal purpose. By our durable (and uniquely human) interest in the consequence. For when we care, remarkable things can happen, and when we don’t, they won’t.

Sadly, for one of the most consequential and economically critical topics in our lives, “healthcare,” it seems we don’t actually care. Or, we don’t care soon enough.

Why is that?

There are many, many reasons for this, but the major contributor has been the fact that caring about our health early just hasn’t mattered much. For most of us, it has not felt as though caring before we need to would have much consequence.

What could we have actually cared about?

Well, we could keep an eye on our weight and/or what we consume. Perhaps we could “count our steps” and try to be more active. We could make certain that our children were vaccinated in a timely and complete way. Or we might regularly get our annual check-up and our gender/age-appropriate recurring tests. With some attention, perhaps we could try to get enough sleep.

If you generally took good (enough) care of yourself, you would have nearly the same risk of getting a disease, as say, your neighbor. If either you or your neighbor were eventually (and inevitably) unlucky and converted from being “complacent” to becoming “a patient,” the doctors and insurance companies stood ready to jump into action.

This general maintenance is about as much “caring” as we do, and it has mostly worked — until now.

In the near future, the way we care for ourselves should change.

The first actionable item we must work on is reversing healthcare passivity. As it turns out, most diseases have long incubation periods. And for most of these diseases, when detected early, our ability to curatively treat them is much higher than when treatment begins after symptoms entrench – cancer perhaps being one of the best examples. Even many infections are more effectively treated when caught early.

At the individual level, “caring” about healthcare in the future is to participate in the collection (and pooling) of the data needed to understand and eventually detect diseases at their earliest stages. The types of data involved will be highly diverse and increasingly captured by lower and lower cost in-home systems. These will soon move beyond today’s conventional medical tests (e.g. genetics, blood test, imaging, and so on) to capture a larger swath of our real-time exposures and biological responses (e.g. consumption, voice, eyes, gait).

And for patients undergoing any active medical intervention, their ubiquitous participation will provide the dynamic real-world data sets required to continuously optimize care delivery and generate the evidence needed to confirm the economic efficacy within the lives of every customer.

Advances in collection technology will minimize the personal effort required to participate, but the healthcare data itself must be owned by the individual who will be compensated for its use.

The greatest of humanity’s achievements have been made possible not only by intelligence but by a collective resolve — a societal push to reshape our world.

Our shared need to travel, to power, to transact has enabled the extraordinary infrastructure of our roads, airports, electric grids, sewers, banking systems, weather forecasting, space exploration, the internet, all of which were made possible by our pooled resources, rigorous covenants of compliance, and defined economics for their use.

As humanity’s knowledge base accrued past what shared stories and local apprenticeships could teach, mandatory (and free) education for all children was swept across the world. Again, a human achievement made possible and underwritten by the collective.

Healthcare must escape the constraints and shared stories of our past.

The secrets that distinguish between health and disease are written within the daily biological transcripts of every human life. These crucial bits of information are largely lost today, but they await our capture, assimilation, integration, pooled use, and returned reward.

But first, we must “care” enough to enable and empower their collection. Second, we must robustly underwrite their security, ownership, and privacy. And lastly, we must fairly value and transact upon their pooled use.

Death and disease will not overlook us. But in a preemptive healthcare system of the near future in which the biology and experiences of all individuals are pooled, analyzed, and used to optimize the outcome of everyone, we can remove “the hand of fate from our shoulders” for a much longer fraction of our lives.

It all depends on us “caring” enough to share, and being intelligent enough to look past the past.

As Elie Wiesel teaches, “the opposite of love is not hate. It’s indifference”.


Societies come and go. Yet central to them all is sustained, and shared subsistence followed by (hopefully) increasingly competent organizational leadership – what we have come over time to call “government.” Diverse living examples are spread across the world today and often built directly on top of those have preceded them. Each demonstrating the innovations by which humans have tackled the paired challenge of feeding and leading scaled-societies. And how collective creativity can foster increased productivity. Tucked into the mountain folds of the Peruvian Andes, the remarkably productive and stunningly short (only 300 years) Inca civilization or “Tawantinsuyu” as it was called then is a telling exemplar. Just before its precipitous collapse, it was 12 million citizens strong.

The Inca civilization is perhaps more famous for how in 1533, at the hands and treachery of the Spanish Conquistador Francisco Pizarro and his 180 horsemen, it was swiftly conquered. But the far more fascinating chapters of the Inca 300-year story are those of the Inca’s rise. For as breathtaking as the Andes are in beauty, their imposition on transportation, climate, and agriculture remain formidable to this very day.

In the year just before Pizarro’s expedition had made their way deep into Inca Andean territories. Being tragically preceded with their deadly gift of smallpox, the (what was to become the last) Inca Emperor Atahualpa had just completed quelling a revolt and consolidating his rule. Upon arriving in the Inca capital of Cusco, Pizarro invited the ascendant Emperor to attend a feast organized in his honor. Atahualpa accepted and joined with what is estimated to be several thousand but unarmed Inca soldiers. At dinner, Atahualpa was asked to abdicate his rule to the Spanish Emperor Charles Vth and accept the sovereignty of Christianity as the only and one true religion. After refusing both, Pizarro had his hidden cannons open fire; and his soldiers simultaneously launched a deadly horse-mounted attack. In the chaos that ensued (Incas had never seen guns nor cavalry) thousands were slaughtered and Atahualpa captured.

In exchange for his release, Atahualpa promised and then delivered over 24 tons of Inca gold, in what was then the largest ransom ever paid. But Pizarro reneged. He put Atahualpa on trial for treason against Spain for the murder (of his half-brother) for which he was convicted by a Spanish puppet tribunal on all counts – then handed a swift sentence of “death by fire or strangulation.” He chose the latter and the last breath of their Inca leader and a remarkable Tawantinsuyu sovereign society vanished together – Spain claimed its newest conquest and the so-called “Peru” was etched onto all maps that followed. Although so much had been lost, as the Incas did not have a formal writing system and so much of what had been painstakingly built has since been plundered, what remains provides telling and timeless lessons.


Millions visit Peru every year; and all marvel over the Inca’s architectural prowess and stone craft. Though many historic sites are just remnants of their original scale, examples such as mountain-perched Machu Picchu dramatically illustrate the Inca’s inspiring architectural vision coupled with highly detailed engineering and execution skills.

But what can easily go comparatively unnoticed are the Inca terraces – cascades of countless plateaus carved into the sheer mountainside. Each one is topped in imported and carefully enriched soil, often vividly green with growing food crop and all interconnected with vast aqueducts and water flow control systems that feed from mountain aquafers built hundreds of years ago and still working wonderfully even today.

To provide shelter is one thing, but to sustainably feed a rapidly growing population is wholly another. In food production, the Inca were particularly sophisticated with their agricultural terraces being the key enabling innovation. To feed a society of 12 million citizens in the high and arid Andean climate requires extraordinary sophistication and planning. This chapter of Incan history remains vivid in the Peruvian markets and products of today – a region that presently produces over 6,000 distinct varieties of potatoes, as just one of countless examples.

But how, in such extreme climates and topology did the Incas create such extraordinary agriculture diversity and productivity? As you might expect, they focused on scientific methods and attention to detail. One of the more telling examples is Moray, their elegant agricultural laboratory.

Moray is a set of cascading circular terraces that begin at an elevation of 11,500 feet and drop down ~100 feet in precise increments. Although stunning to witness and ponder their construction (by hand and shovel!), the effectiveness of this ancient laboratory is even more telling. Each resulting terrace results in a distinct micro-climate (27 degrees Fahrenheit differential from top terrace to bottom). Each terrace level then being indicative of a specific temperature range that one can expect to extrapolate to the countless other terraces spread across the empire. On the terrace arrays of Moray, each variety of agriculture product could be tested for fitness for a specific micro-climate and the specific planting and harvesting schedules could be precisely optimized. This, coupled to a steady and reliable source of water, enabled the early Incan agricultural experts to shift from experimentation to mass food production.

As we prepare for a climate-changed world where the availability of water is rapidly changing, and mean temperatures shift upward, the prescient planning of the Incas is a wonderful reminder of how creativity can enable productivity, even in the most trying of environments. Clearly, it is (was) hard work and takes long-term planning. But the “mouths of the masses” will always be eagerly waiting.

All About Transitions

February 19, 2018

Olympic Games bring out the best in all of us.  Athletes from across the world set aside national differences and reconvene to honor the pursuit of excellence.  To stand shoulder-to-shoulder as the world’s best, each hoping to take center stage of behalf of their nation – fourteen days during which anthems and admirations stream across the world.

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February 7, 2018

“The Red Apple” was the elusive prize of medieval conquest for an uninterrupted 800 years.  Secured behind what had proven to be the most formidable combination of building ingenuity and natural defenses was the fortress city of Constantinople.  Dedicated in 330 AD by its namesake Emperor Constantine the Great, it quickly became the center of wealth and commerce of the Middle Ages.

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JPM at 15

January 4, 2018

To “skip a stone” takes more than just practice.  It requires discriminating selection, as only a tiny subset of stones will do.  The perfect stones for this are those that have been polished by time – rounded of rough edges and protected from too much mid-body girth. 

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Yesterday the Nobel Prize in Physiology or Medicine was awarded to multiple people, inviting discussion of why two (or more) brains are often better than one. History is full of creative pairs whose impact stemmed from collaboration – from Watson and Crick, to Lennon and McCartney, to Langer and McGuire. How can creative tension drive success in the innovation and start-up worlds?

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In the nascent “sharing economy,” ownership is highly fractional and consumption is collaborative. Individuals have caught on, giving rise to new ways of sharing bikes, cars, and even homes in exchange for value. Diverse healthcare corporations are beginning to understand the value proposition inherent in this model as well—offering a sneak peek into a vision of the future healthcare R&D model.

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It’s remarkable how often, when asked to reflect on how to spur innovation, the most successful inventors wind up talking about architecture.

At its peak Bell Labs housed 1,200 Ph.D.s who worked in an ingeniously designed space created by modernist architect Eero Saarinen. As Jon Gertner’s book The Idea Factory: Bell Labs and the Great Age of American Innovation points out, Bell Labs understood even back in the early 1940s that they would increase their odds of success by creating a space in which smart people naturally bumped into other smart people to have unplanned but potentially productive discussions.

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