Our "Big Idea" Obsession

Why We Should Embrace Incrementalism 

Public relations and advertising agencies never receive RFPs for little ideas. Boards of Directors don’t select CEOs for their promises of small improvements. Politicians don’t get elected on a platform of incremental steps. We’re conditioned to expect the big idea, to go big or go home, to swing for a homerun, to throw the Hail Mary for a touchdown.

That’s why President Obama was criticized last month for talking about hitting “singles” and “doubles” in his foreign policy efforts. But he did say, “Every once in a while we may be able to hit a home run. But we steadily advance the interests of the American people and our partnership with folks around the world.” And then admitted, “That may not always be sexy. “That may not always attract a lot of attention..."

He was right and his critics were not happy. Maureen Dowd, in her New York Times opinion piece entitled, “Is Barry Whiffing,” told the President to “stop whining.” Ms. Dowd wrote, “What happened to crushing it and swinging for the fences? Where have you gone, Babe Ruth?” And then, “It doesn’t feel like leadership. It doesn’t feel like you’re in command of your world.” 

My readers, clients and students know I hate this type of mutual exclusivity. (I’ve addressed it before in this blog and in my book, Camelot, Inc.) Of course we need big ideas and bold gestures. But small things can be out-of-the-box and innovative, too. The answer is we need both vision and execution, the large goals and the little objectives, and the short-range and the long-term views. If we can’t always strike that “grand bargain” what are the alternatives?

It’s the same line of reasoning used to block investment in solar or wind energy because it would only be a drop in the bucket compared to our overall energy needs. Or the strengthening of background checks on gun purchases because the effect on violence can’t be fully quantified in advance. Or, it could be taxes and the deficit. The so-called millionaire’s tax can’t get any traction because, the logic goes, it would do so little to cut into our national debt.

But we need to start some place, some time. We’d like to get to the goal line in one play but we can’t. It’s certainly not going to happen with our largest and most complex problems. We’ve all heard Voltaire’s “The perfect is the enemy of the good.” Well, incrementalism is hard to accept but, in so many cases, equally hard to forswear.

I’ll remind the politicos that our country is nothing but a timeline of incremental advances. Many of the Founding Fathers wanted to abolish slavery, while others insisted it remain. So, the Declaration of Independence in 1776 and the Constitution in 1787 were compromises. They were steps. We had to wait nearly a hundred years for the Emancipation Proclamation and then another hundred for the Civil Rights Act.

As I wrote in another piece, “Compromise and incremental success may not seem satisfying, but it’s the way most things operate and succeed. Baby steps can sometimes add up to a completed marathon. We need to reject the all-or-nothing mentality and reward the smaller but still important measures. We need to learn from the past, not live in it.”

Between blog posts, I invite you to follow me on Twitter @pauloestreicher.

P.S. After posting my blog, I came across an article on the Celgene web site, Paving the Way for Cancer Breakthroughs: Small Steps Make a Big Impact on the Lives of Cancer Patients and Our Understanding of the Disease. They warn against "holding out for those large steps" and ignoring the reality of cancer's complexity. Cy Stein, M.D., Ph.D. and Chair of Medical Oncology at City of Hope Comprehensive Cancer Center commented, "One advance leads to another. Although the advance might be incremental, it's a step beyond." The article concludes, "If we are only interested in revolutionary therapies, patients will miss out on the improvements in care that smaller advances offer. In the end, these advances can help us transform cancer into a chronic, manageable disease."

Angelina Jolie's Fearless but Flawed Message

This article also appears in Medical Marketing & Media.

 A good chunk of humanity is talking about Angelina Jolie’s double mastectomy today. She penned a remarkable Op-Ed in The New York Times about her decision to have preventive surgery and breast reconstruction following the results of a genetic test. The variant of her BRCA1 gene gives her an 87% risk of breast cancer and 50% risk of ovarian cancer. (Clearly, she’ll need to confront the latter issue at some point and I wish her the very best.)

I join the millions who are happy to read that Ms. Jolie is making a fast recovery. Her story is another reminder of the need for education and outreach, and brave decisions. And, she points out the crucial issues of access, cost and preventive health care (though the discussion is one much broader than breast cancer). As sad and terrifying as her experience must be, however, she's fortunate to have deep emotional and financial support. It’s a stark reminder of health care haves and have-nots.

Unfortunately, her nod to "wonderful holistic doctors working on alternatives" is less helpful. Steve Jobs was famously regretful of his choice to pursue alternative therapies. He wished - too late - that "conventional" (science/evidence-based) therapies had started earlier. Instead, he tried dietary supplements, juices and acupuncture for nine months while his cancer spread. I’d hate to see Ms. Jolie provide a platform to physicians like Christiane Northrup, who has used Tarot cards to diagnose illness, or celebrities like Suzanne Somers, who apply, ingest and inject unapproved products in an attempt to stay young, and Jenny McCarthy, who uses the very unfortunate story of her son to create fear and confusion around vaccines.

Of course, people die even though they had the best of what science could offer. Cancer is a terrible, complicated array of diseases. And it's true that some people get better while on alternative therapies. Is there something to it? Quite possibly. We know that many modern medicines are derived from natural substances. But the cures you often hear about could be the result of other factors including poor initial diagnoses.

When it comes to managing one’s health or the health of one’s family, most people don’t have enough knowledge to evaluate a medical product claim or even formulate the right questions to ask a health care provider. This all makes the public an easy target for purveyors of alternative medicines and bogus devices.

So, while some push for greater access to health care, a parallel effort must be made to fund research and education. Dropping information – even crucial or compelling data – onto the heads of an unprepared public, or expecting a response to another “call to action,” is unproductive and unrealistic. We need a massive, sustained effort to enhance health and science literacy.

Between blog posts, I invite you to follow me on Twitter @pauloestreicher.