You Can't Hurry Change: How Not to Burn Through Billions

Lasting change doesn't come from the top. Systems that no longer work must be rebuilt from the bottom up, says Fred Hassan.

In 2003, Schering-Plough was burning through cash at the rate of a billion dollars a year. Profits were down 72%. And the company's problems went deeper than productivity: exclusive patents on revenue-driving drugs such as Claritin were about to expire, while legal battles - including the largest fine in FDA history - had left the pharmaceutical giant in need of life support.

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That year, Fred Hassan was hired as CEO. Hassan had a reputation for producing dramatic turn-arounds from ailing corporations in the health care industry, having successfully resuscitated and sold Pharmacia to Pfizer in 2002. The change of course at Schering-Plough was no less sensational, culminating in a $41 billion acquisition by Merck.

A rarity in the era of the rockstar CEO, Hassan's success seems to be more attributable to his skill at putting out fires than igniting them. His strategy for restoring Schering-Plough was based on two principles:

  • planning from the bottom-up
  • engaging managers in his vision to create front-line advocates for change
  • Instead of forcing an agenda on employees dictatorially, "if one can get them to be a part of the change, if one can get them to start to understand the strategy so they can repeat it without a PowerPoint, they can internalize it and become ambassadors of it to their people." 

    This process takes both time - 3 to 5 years - and trust, neither of which are plentiful in the post-2008 environment. But it pays off in the end. Once momentum has been built organically, "it is amazing how quickly productive energy gets released and the change process occurs."

    What’s the Significance?

    The bottom line is, you can’t force growth from the top. “You have to get the whole system to be a part of the change process and you have to make the case for change," says Hassan. That happens by showing, not telling. Communicate your observations and make your actions a model that people can aspire to. Most importantly, "Do not over-promise about what you’re going to do. Just get in there and listen to people.”

    Whatever the goals, says Hassan, a good leader ensures that everyone contributes to coming up with a plan for achieving them. Compensation is an important part of reinforcing a company’s culture, but it’s not everything. Even more essential than financial rewards is recognition - giving employees that sense that their perspectives have been heard and that no success has gone unnoticed.  

    Frontline managers can play a major part in seeing that this happens on a day-to-day basis, as well as in the long-term. “There may be many ways you can reward people, but it’s a cycle of motivation. It’s showing the way. It’s going the way. It’s being fair on compensation, differentiating among those who are the locomotives versus those who are valued team players, and then reinforcing that whole process all over again." 

    That means hiring people who are “very good in their own areas, but who also believe in the team succeeding together, who root for the person next to them.” Hassan’s challenge: “You cannot have passive resisters. You must have culture carriers as you go forward.”

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    • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
    • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
    • The research raises many ethical questions and puts to the test our current understanding of death.

    The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

    But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

    What's dead may never die, it seems

    The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

    BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

    The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

    As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

    The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

    "This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

    An ethical gray matter

    Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

    The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

    Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

    Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

    "This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

    One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

    The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

    "There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

    It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

    Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

    The dilemma is unprecedented.

    Setting new boundaries

    Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

    She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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