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CHAPTER 26 Interstitial Cystitis and Other Inflammatory Conditions of the Lower Urinary Tract 243


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We are in eager anticipation of a visit to Toronto next week from Adrian Ho, who started Zeus Jones with a bunch of folks who left then hot shop ad firm Fallon, which had rocketed from Minneapolis to the NYC indy bigs with a bullet in the early 2000’s (Fallon is now a global agency owned by Publicis).

My friend Matt Milan told me about Adrian and the Zeus gang a while back, said some intriguing stuff about the concept of “marketing as a service” (which I understood to be an idea about how to devise advertising-like communications and campaigns that created value for all it touched rather than merely extracting value from its “targets”).

The interwebs have been pretty hot just lately over the “future of advertising” (again!). A vitriolic piece by Peter Merholz not only got him in hot water with friends, enemies and a few clients, but even with some of his own Adaptive colleagues (there are now 115 comments on the post, much heat on it on Twitter and another 20+ comments on a follow up piece he wrote). Personally, I think Peter didn’t go far enough in his broadside against the industry.

The substantial claims in Peter’s piece were that we should be worried and mistrustful of the involvement of advertising folk in “user experience design” since that “discipline” relies on empathy, a trait which is, Peter believes, anathema to advertising as a practice. His ultimate charge is that “advertising, as it is widely practiced, is an inherently unethical and, frankly, poisonous endeavor that sees people as sheep to be manipulated, that vaunts style over substance, and deems success to be winning awards”.

Personally, I think the only claim here that advertising folk have any hope of defending against is that their practice may not be inherently unethical. (Peter has made crystal clear that he did not mean that all people who work in the trade are per se unethical and even apologized for giving offence).

Is advertising inherently unethical? That’s a really mucky philosophical swamp, and with way too much graduate education in philosophy I finally know better than to get lured into that morass of intellectual oneupmanship.

I’d like to back a different horse in this race: I think that advertising is simply dangerous. Not evil, not universally repugnant, but dangerous.

Personally, I think that on a good day the advertising industry merely helps the purveyors of goods and services of dubious merit sell more than they would otherwise. And herein lies the first source of the danger of advertising: it is effective. Not always, of course, but it is now very well established and understood that the various and sundry techniques of advertising do persuade us to act as we might not otherwise. The question becomes, do the actions that it engenders do more harm or good and should anybody care? I do not want to go too far with my own view here, but I think it’s a stretch for the industry itself see itself as simply benign. If it is convincing that on the whole advertising does more harm than good AND that it is effective, then we start to see the corner of the problem.

As far as I know, advertising does not have a professional ethic analagous to the Hippocratic oath of medicine, the oaths that lawyers and accountants (OK, stop laughing up there in the cheap seats!) must take, and others that are common in professions where we as a society have agreed that there is a social trust. Now it is true that a great many jurisdictions have laws that prohibit the telling of lies in advertising, so-called “false advertising”. But I know of no publicly established explicit or implicit promise on the part of the advertising industry that it will not willingly, knowingly and deliberately refrain from manipulating the decisions of the people it is “aimed” at. Certainly I don’t know of any such standard (notice this dependent clause) that people find credible.

Advertising is by and large, I think, a business of lies. We can call them “white lies”, lies with no consequences, fantasy, aspirational blah, blah, blah, etc., but lies by any other name still smell like advertising to me. Now this could be a hard claim to defend, unless we held advertising to a standard that required that it do some good. I don’t mean that it should be morally good in either its intent of effect, but that it should at least add some real value to those who pay for it: and WE ALL PAY FOR IT. Advertising claims more attention, directly or indirectly, than do many, many other things that might better or more productively occupy us (imagine the boost in cognitive surplus if we turned all the advertising off!). This is the second danger advertising poses: it wastes our time.

So, I’d ask those in the pro-advertising seats a simple question: what do you think advertising is good for? what does it deliver that we need, that is valuable and that you can be proud of producing? Personally I find defenses like Rory Sutherland’s clever and funny argument for intangible value unpersuasive.

Now, it could be argued that many industries might falter on such standards. And that’s probably true in many cases, but that’s also a red herring. Advertising has an disproportionate influence on our public culture, our society, our economy and our selves. It’s different in many ways, including the fact that it has become a virtually ubiquitous part of our built and lived environment. Just try to go 5 mins, let alone a whole day, without encountering any advertising. This is the third danger of advertising: it is inescapable.

I think that advertising is dangerous: I think that it gives has us worshiping false idols and gives us false hope, that it tells lies about quality and value, and that it helps support an economy that well functioning markets would otherwise punish.

You may not believe these things. Or you may think that advertising is not long for this world. Consider the pithy phrase a recent Fast Company article attributes to Jon Bond (wish I’d said it first): “Marketing in the future is like sex. Only the losers will have to pay for it.”

Notwithstanding the artful turn of phrase, I do not share Bond’s optimism. I think there’s more advertising than ever (though the whiners of the ad business claim there’s less and less and that it just doesn’t pay what it use to) and I worry that there’s much more on the way.

Advertising is the junk food of our attention span. We are seduced by the sweetness of its aspirational voices and excited by the salty sexiness of its inuendos.

A while back I was talking about innovation to someone who had just moved from Pepsi Co to its corporate sister, Frito-Lay. After a while I couldn’t resist being clever and provocative and I said: “so, essentially, you are in the business of selling salt and sugar at scale”? He was not impressed OR amused. He replied, in all earnest seriousness: “Actually, that’s not how we think about it. We like to say that we are in the enjoyment business.” And that, my good friends, is as clear a diagnosis of what’s wrong and dangerous about advertising as anything I could ever hope to argue or invent.

We know that as junk food has become pervasive and ubiquitous in many people’s diets that it has started to produce a dangerous disease: obesity. The pandemic of obesity is now as real (and as often denied, I expect) as global warming.

Advertising is, if anything, more pervasive and ubiquitous for even more of us. What to call the disease that it is producing in our consciousness? How about for now, we just call in CONSUMPTION.

It is often argued that its not the delicious cakes that are to blame for my being fat (actually, I’m not that fat, but I sure do LOVE cake) and that’s fair comment. We, all of us, must decide whether we think this diet we are on is OK or not. And then we must decide what we want to do about it.

Advertising folks need to be more honest with themselves and others. To those sanctimonious defenders of advertising: folks, c’mon…you are McDonald’s and Smith & Wesson. I’m not saying you should be Save the Children, but maybe its time to save yourselves?

A while back a colleague said something to me that has troubled me and defined my own professional struggle ever since. He said that those of us who sell our creativity and ingenuity to business (consultants, marketers, ad men & women) are part of an intellectual arms trade. We make and sell the weapons that allow businesses to make and meet their “targets”. Not that everything we do is bad or tainted, but we do work with explosives, combustibles and projectiles. Our tools are sharp and they cut both ways.

I don’t say say any of this to advertising folk to be holier than thou. I’m as much a sinner as anyone and unlikely to ever be a saint. But for us the “arms dealers” of the business world, we’ve all at least gotta stop pretending we are not part of what’s wrong with the global economy and that our collateral damage are mere externalities.

This week bestselling author and pundit, Seth Godin, said via blog post that his latest book, Linchpin, is the last that he plans to “publish in a traditional way.” Hallelujah!

Godin has always written books that I have thought of as great 10-20 page ideas. The economics & marketing of the book publishing industry has forced authors like Seth to write books that are far longer than their ideas merit or need for their full expression.

This state of affairs has become offensive for two big reasons:

1. it creates a now unconscionable waste of paper, ink and other resources

2. it creates an economy around books that many buy, but that almost no one reads

Godin’s books may actually be among the few exceptions to this rule with their pithy and fun style and pace.

But the vast majority of business publishing creates piles of books that nobody reads. A great many best selling books are actually the worst case of this phenomenon, because they create a false economy of both unnecessary ideas and paper.
Way to go Seth! Now let’s create the business models that make it compelling to follow his lead.

Depending on who you listen to, we are either on the brink of a global apocalypse or of an unprecedented in human evolution. This is a new story, this is an old story. Prophets of both doom and of glory have been with us for a long time. So it should come as no surprise that this age, whether it is an age of “spiritual machines” or a new Jerusalem of our humanity, should have its own distinctly digital flavors.

Ray Kurzweil has gained sufficient traction for his idea of a coming “singularity” (when humans and machines merge) that there is now an institution of higher education advocating that particular and peculiar vision. For Kurzweil it is the capstone piece of a edifice of controversial but convincing science. Many are tempted by his claim that the acceleration of the rate of technological change will make certain kinds of evolution tenable, if not straightforwardly inevitable. Softened by the evidence supporting Moore’s Law (about the acceleration of the capacity of transistors, and by implication of computing power), some are ready to grant Kurzweil some latitude in his reverie of Singularity.

Not Jaron Lanier. His recent “You Are Not a Gadget” implores us to tear away the veil of our technolust and lay bare the truth of a coming fascism, not unlike that imagined by the Washowki Brothers’ film, The Matrix. Lanier is not a Neo nor even a Morpheus, just a dude in dreads who knows better and wants us to remember our humanity before we finish building Skynet. His arguments are sometimes sparse or too simplistic, but I think that underneath them is a call for critical reflection that is never out of place.

Too many folks believe that people like Kurzweil are simply too intelligent to be understood, let alone to question. It is not so much a matter of whether they trust in what the oracle says, as it is a resignation to their inability to penetrate such mysteries of the intellectual occult.

On at least one thing, Kurzweil and Lanier appear to agree: that we are coming to a point of reckoning. They both see the divinity of the machine. Kurzweil sees eternity in its eyes, while Lanier sees the abyss. What we must all see through the fog of technology is ourselves: our fallibility, our frailty, and our future…

Technology is not like Tolkein’s one true ring. It’s heart is not in Mordor, but in the very sociality of the human animal. Our techne, the Greek root of technology (for “know how” or a knowing doing), can become alienated from the knowers, but it cannot fail or do violence, those are human errors, not machine ones. That doesn’t mean that machines, especially complex ones, may not, perhaps have already become not just a part of our living, but a kind of life. Maybe we should be less focused on the question of whether or not machines will supercede us and wonder more about the new diversity of living things.

A service which allows users to pay later for what they want to do online now. What’s wrong with that? If you don’t have a credit card, bank account or other means to facilitate your online transactions, why should you be barred from the world of commerce, especially when it is all that stands between you and powering up in you favorite online game or from buying your Foo Pet a new diamond necklace? HUH?

Ever since I read about the new services of Kwedit in the New York Times this past February, I have wanted to write about it. What is most troubling about the company is that it is so clearly aimed at the most vulnerable and gullible market on the planet: North American kids.

It is not merely that Kwedit targets kids that makes it an object of concern, but the way it connects emerging markets in “virtual goods” with real world debt. For some time now, adult online worlds like Second Life have been offering and making money from the purchase of virtual currency for real money. This allows users to transact commercially with each other within the online virtual world. Strange, but whatever, there are plenty of stranger things that consenting adults want to do.

On March 2nd, Steven Colbert skewered the premise of Kwedit in a segment called The Word on his show (US viewers can see the clip here, Canadian viewers click here). He especially ridicules the company’s incredible deflection of the charge that they take advantage of children by arguing that in fact they are providing “teaching moments” that allow adults to educate children about credit. This is a tactic the company exercises at great length in a post to the Kwedit blog.

The core of the company’s defense of its mission and the Kwedit Promise product in particular is that they do not offer this service to children, but only to teenagers (13 or older) and adults. The claim, deftly stated as if it were a chartered public service offering, is that Kwedit’s goal is “to let people pay for on-line purchases without requiring them to obtain a credit or debit card.” The company blog goes on to make the point that Kwedit does not offer credit services or loans, but is merely a payments company which ” facilitate(s) payments for people who want to make on-line payments with cash, and we try to make that as easy as possible.” Funny then, that they should choose to name such a company with a cutesy word that sounds so remarkably similar to the way a child with a cute lisp might say the word “credit”, but I am sure that is just a crazy example of serendipity.

The thing that I am particularly sensitive to is the corruption of childhood by commerce. Never mind the defense that the children concerned here are 13-18 years old. For openers, one of Kwedit’s gaming client/partners is a site called Foo Pets. Go take a look and tell me whether you think its users are primarily 13 years and older. Of course, Kwedit may be strictly speaking honest when they say they are not transacting with younger children, but it is pure fiction that this means that they cannot be customers, in effect.

Kwedit’s defense of their business model and practices is so well written that it tempts one to give them a little rope and take them at their word that what this business is really about is creating a way for people to use cash on the web. There are certainly plenty of people and places for whom that would be an enabling technology solution, without a doubt. It that really what Kwedit is aiming at? I’ll let you judge for yourself.

Maybe Kwedit CEO Danny Shader is being honest in his long post about what Kwedit is and isn’t, what it intends and doesn’t intend, but the lengths to which he goes to convince us of this in the last four paragraphs of this post make it sound as if he’s started a social mission organization. Smells like duckshit to me.

Maybe I have a hard time accepting a financial institution with cuddly cuteness. But I would point out that the fact that Kwedit neither makes loans nor offers credit plays a bit fast and loose with the truth. Fact is it offers a mechanism that enables me to promise to pay for something in the future, never mind the argument that it is bound to this fiction because the Internet doesn’t take cash. The strange loop that allows kids to buy stuff and then use the Kwedit product Pass the Duck (really, is there no end to the use of cuteness to mask dubious financial propositions?) to “ask” their parents or some qualified payor to discharge the cash debt (or should I say, what, financial obligation or just Quacks, Mr. Shader?) is worthy of George Orwell.

Regardless of the status of Steven Colbert’s satire and Danny Shader’s sincerity, we should be paying attention to the introduction of a new world order of financial services. As we continue to marvel over the hubris of investment banking’s hall of mirrors, we ought be particularly careful of financial institutions wearing duck’s clothing: ’cause you know what they say…if it walk like a duck and talks like a duck, than it just might be a snake in the grass!

I took my two girls to the orthodontist the other day, my 9 year old, Maggie, is getting prepared for head gear and braces: happy happy joy joy.

We had an experience that day, hardly a new one for the legions of us in doctors and dentist offices everyday across North America who sit in the all too aptly named WAITING ROOM: we waited. Too long. WAAAAAY TOO LONG.

After having waited 45 minutes for an appointment that I left work early to take Maggie to, FINALLY, one of the staff came and apologetically ushered to us into a treatment room. We waited another 5 minutes and the the DR. DDS showed up, made a blustery apology and then, GET THIS, headed back out to see another patient for a further 10 min before finally returning to see my daughter for what turns out to be all of 10 minutes.

OK. Now I suspect that your reaction is either, “WOW that’s a bit extreme, but I’ve certainly had similar experiences”…or…it’s, “SHIT, I can top that story”! Either way, I’m sure you’ve been there and that at least once you’ve thought about the arrogance of the implication that you can just wait until the Dr. (or whomever) is ready to see you. After all, you should be grateful they gave you an appointment in the first place, as they are booking three months in advance, etc, etc.

I don’t want to pick on doctors (OK, maybe I do a little bit) and I don’t want to oversimplify systemic problems (which certainly exist). I do , however, want to point out that there is a human decency and social graces issue that has been falling between the crack for too long.

And then I had my epiphany, my “Eureka”of the day. I knew what to do and that I wanted to suggest it to you, too. And then I thought, “I know who has to do this”, the folks at “I wonder if I know anyone who works there”? I thought to myself. It turns out I do, VP of Business Development, Scott Hirsch.

Here’s the idea. I call it an “emotional invoice”. Through a simple web-based interface (iPhone app, too?) it allows anyone to quickly create an invoice for the time that has been wasted. It then offers you a mechanism that not only allows you to email the invoice to the offending doctor, dentist, lawyer or other professional waster of other people’s time, but also to post a link to a public version of the invoice to social services from Twitter to Facebook.

The key feature of the emotional invoice is that it is not a demand for financial compensation, but rather for emotional remuneration. So, for example, I might send Dr. Metaxas an invoice for 1.02 hrs of my time wasted and that I expect to be paid for this time with a smile and sincere apology to be rendered in person on my next visit to his office.

This design allows us to both vent our anger AND to affect the markets we participate in. We all know that all kinds of people end up in professional situations where they keep people waiting (can anyone say JetBlue?) due to things they can either not anticipate or control. That’s why the emotional invoice sends a message about a non-financial obligation that has not been met. We need a mechanism that allows us to say to people, “OK, I get that you can’t change the facts of the circumstance that caused me to be kept waiting, but you CAN change how I feel about it, by simply caring about me and making me feel this.”

Imagine if we had a service that could easily facilitate the sending of such messages and the emotional invoice that fits the time-waster’s crime. Imagine, among other things, if we could put something other than raw anger and rancor back into the emotional environment of our economic lives, something that allowed us to constructively get our pound of flesh and eat it too (OK,maybe that’s a metaphor gone too far, sorry).

I hope that the folks at Get Satisfaction might consider this as a “community beautification” project. Or perhaps yo might take it upon yourself. If I had the coding & design skills I would have done it the moment I got home that day.

This idea is not so much about “closing the loop” as it is about open up lines of communication, reminding those that provide good and services in the market that they serve people, that the market is people and that people feel good when they are treated well. Treating our customers and clients well is good business. Getting everyone to do this is unfinished business.

Promising news in the world of emerging capability building this week as Dachis Group announced their acquisition of Xplane on Monday, 26 April.

Though the exercise may seem (or be) a bit like reading tea leaves, I think there are some interesting things to think about in trying to understand what Dachis actually is and whether and what kind of change it represents for enterprise capability building and innovation.

The Xplane acquisition in particular, I’d argue, makes it seem that Dachis may not simply building a “new model digital agency” group of the future. THANK GOD!

Xplane (who’s founder Dave Gray is a friend and colleague of mine) was chartered as the world’s first visual thinking company. More than simply a niche design company, Xplane has moved from pioneering visual journalism in places like Business 2.0 and visual explanations for everyone from Microsoft to the US Navy to a specialized strategic consulting practice that uses visual thinking to help organizations and enterprise wrestle with complexity.

Visual language has two core virtues, its transparency (making it easy and fast to understand) and its high informational density. It offers, therefore, a language that allows us to communicate and work with complexity with both efficiency and power. If you buy the argument that we live in a world that is increasingly complex, dynamic and volatile, then you kind of have to want to see the spread of visual language as a form of strategic literacy. I have been arguing for sometime that this language ought to be taught as a foundational competency in business.

So what does a Prada-sunglasses wearing sexier-than-thou social media tabernacle like Dachis Group (I say with my tongue firmly implanted in cheek) want with such a serious outfit? I’m not sure about the answer, but I am now a hell of a lot more interested to find out than I was before Monday’s announcement.

I don’t know what the phrase “social business design” is supposed to mean exactly, but I am starting to wonder (and hope?) that maybe someone is FINALLY starting to construct a post-advertising business model that answers the question, how do I communicate with customers and sell products and services with out being a loud-mouthed douchebag?

Jeff Dachis clearly has the credentials of someone with both innovative vision and the mentality of a builder. I hope that the social element at the heart of the Dachis Group proposition is more than a clever ruse. That is surely more than enough to seduce the increasingly desperate folks who are looking to innovate fundamentally the compromised industries and businesses around the world that Umair Haque calls the “zombieconomy“, but the rest of us need better than that.

Now that Dachis has acquire Xplane, they have as an asset a company which has truly created something powerful and new in the corporate toolkit, a language of openness rather than of concealment and secrecy. Mmmmmm. Interesting. Very interesting.

So, what do knife fighting and shipping software have in common? They both show the advantage of being prepared over being “smart”. Of course, these are not either/or choices. But there are two recent things I’ve stumbled on that make the point that being too intelligent, or too smart for your own good can either get you killed and/or crash your start-up.

Here’s a great talk that Seth Godin gave at the Behance 99% conference. In signature fashion, Godin’s talk seems to be about something goofy (complete with a rubber chicken prop), namely, our “lizard brain”. In fact, he spends most of his 18 minute talk extolling the virtues of focusing one’s efforts on shipping rather than perfecting things. His key insight is that being successful at shipping requires that we learn to quiet our lizard brains: that part of us that instinctively underlies our fight or flight system. He’s right, of course, but it begs the question: how do we do this?

The answer, according to Max Klein, lies in the lesson we can learn from the preparation of Israeli commandos. Klein says: “Being intelligent is like having a knife. If you train every day in using the knife, you will be invincible. If you think that just having a knife will make you win any battle you fight, then you will fail.”

I’ve been thinking a lot, especially in the work that Matt Milan & I have been doing on Innovation Parkour, about the importance of practice. I have been studying this in the context of things like yoga and surfing as well as in professional communities of practice. One of the interesting things that keeps coming up is about using practice as strategy for dealing with volatility. What I find particularly fascinating is the connection that some make between the social dimension of practice and the cultivation of what I call “stillness”: a kind of deliberate calm that prevents people from panicking or behaving counterproductively.

In the documentary, “Strapped”, about the innovation of tow-in surfing, several people in the film make this point, of how the social group formed by the Strapped Crew was crucial to what they were trying to accomplish: “these guys have united because of how many times they’ve been in there”…”enabling one another to ride these waves and do it safely”…”you have to be able to think really clearly about how you are gonna get out of that mess”.

It turns out that even in activities where achievement looks very individual, like surfing, there is a crucial element to learning and innovation that leads people to practice in groups. Part of this is obvious, peer learning is a clear strategy for advancement in many things, but it is interesting to note that people also use groups to create safety and comradeship to bolster courage and support risk.

Yesterday I attended a really cool event called xCAMP, organized by my friends Nabil & Riwa Harfoush (a killer father/daughter act). They have started a project to examine the opportunity for and develop a plan to scale the work of Natalie Jeremijenko’s fascinating xClinic work.

During a discussion after Natalie & Nabil had made brief presentations, I offered up a gloss on what I took to be one of the goals of their proposed project. In the process I coined a term to capture the idea of using people in networks as sensors. I called this the “Internet of sentient things”. I doubt I am the first to make this coinage, and I am certainly far from the first to discuss the underlying concept.

Then, commenting on a friend’s blog this morning I was prompted to “upgrade” the coinage to an Internet of sentient social things. Just after posting, it occurred to me that I really should have said, an Internet of intelligent sentient social things. Of course, an Internet of people would be a much more economical expression.

What I was trying to get at when I brought it up yesterday is that we are starting to design for people as beings that are augmented by their attachment to the Internet and that this connection is becoming more and more constant, at least de facto. Many things arise from this, such as the continuing erosion of the distinction between being online vs. offline, which will have policy, privacy and even cognitive implications.

Jaremijenko’s work, and certainly its possible expansion, points to the emergence of the sorts of design projects that involve working with people as sensor tech. It is not that this approach is reductive, to the contrary, Jaremijenko wants to do this, I think, precisely because the frictions that are introduced by using people as sensors provide opportunities to both rethink and rewire how we interact with complex systems like  public health and the environment.

What I find intriguing about work like the xClinic is the way its design forces the hybridization of human and non-human technologies. It reminds us that we are not slaves to our machines, but that we are deeply implicated in machines that we are building and extending. There are serious and deep issues here. They are BOTH exciting and frightening. What is comforting to me is that we are in this together. Now, more than ever.

If you are anywhere near Phoenix on 8 April, you should consider coming to our daylong Innovation Parkour Field Lab workshop, part of the pre-conference workshops of the 2010 IA Summit.

Innovation Parkour is a framework for the “open source” development of a practice of innovativeness. We believe that innovativeness, like creativity, has certain roots in native human capacity. This capacity is complex and its constituents are cognitive, social and technological.

Our Field Lab workshop is designed to introduce people to the deep theory behind Innovation Parkour, but the majority of the day will be spent in an immersive learning experience. The goal of this workshop is to provide participants with an evidentiary basis for the belief that there is a path to better innovation.

Our objective is to challenge two extremely dangerous and limiting assumptions about innovation:

  1. that only special innovation “natives” can do it
  2. that innovations are the outputs of special processes

We believe that people find better ways to create value by working at it, that this work is something we can get better at by practicing, and that our practice is more productive and fulfilling when we do it with others with whom we share purpose.