This graph shows recent results from the test I used to track my brain function. The test is a choice reaction task done on my laptop: see a digit (e.g.,”2″), press the corresponding key as fast as possible. The x axis shows the time of the test. The ticks (“Sat”, etc.) mark the beginning of the associated days. The y axis shows the average percentile of the reaction times. Higher percentile = faster. (Let me explain what “percentile” means: Each reaction time is compared to earlier reaction times with the same stimulus, and its percentile is computed. For example, a percentile of 60 means that 60% of previous responses were slower.) An average of 60 is quite good and 40 is quite bad. I usually do two tests per day, one right after the other, in the late afternoon (e.g., 4:30 pm).

On Friday and Saturday, my scores were close to normal. On Sunday afternoon, however, my scores were much worse than usual; the average score was about 15. A score that low might happen once per year. The next day (Monday) I tested more often than usual — both morning and afternoon — and my scores gradually returned to normal. On Tuesday I also tested both morning and afternoon. My scores were ordinary the whole time. This showed that the improvement Monday morning was not normal.

What happened Sunday? I am pretty sure the problem is my lunch at a middle-cost noodle restaurant whose English name is Flying Noodle. It is close to the Tsinghua campus but I’d only been there once before (and eaten almost nothing that time). On Sunday I had a small pickled vegetable dish and an ordinary-sized plate of fried eggs and tomatoes. I suspect the problem is the oil used to cook the egg and tomato. It might have been soybean, corn, sunflower or peanut oil, all high in omega-6. (There are also complaints about reuse of cooking oil.) As I entered the restaurant, I worried about the oil, but also thought who really knows? By the time of my brain test, I had forgotten my concern.

A friend was with me. She ate different dishes. She found that her scores on a iPhone game she often plays, which requires fast reactions, were suddenly and mysteriously worse after the lunch. Then, in about a day, they recovered.

This interests me in several ways:

1. New phenomenology. In this example and my earlier tofu results (a piece of fermented tofu reduced my brain score for two days), I noticed something never noticed before: Sharp changes (bad) in brain function. Fortunately I quickly recovered. Nobody knew this happened. It’s like looking through a microscope or telescope for the first time, but with much more relevance to everyday concerns.

2. Comparison with Super Size Me, a 2004 documentary by Morgan Spurlock, which argued that McDonald’s food was unhealthy. Spurlock ate only McDonald’s food for 30 days. Realism: Spurlock ate far more McDonald’s food than anyone would normally eat; I ate one meal. Information value: Spurlock’s test was so unrealistic and his diet so plainly unhealthy that I doubt the results — Spurlock’s health got worse, he gained weight — have any implications for the rest of us. In contrast, I find my results horrifying. Bias: Spurlock was obviously biased against McDonald’s before he started. I thought favorably of the Flying Noodle — that’s why I went there. Cost: My data cost essentially nothing, Spurlock’s movie cost $65,000, not to mention the damage to Spurlock’s health. Recovery time: Spurlock took 14 months to lose the weight he gained. I recovered in a day. Repeatability: My test is easy to repeat, Spurlock’s very difficult.

3. Public health disaster? China has a very high rate of diabetes, for unknown reasons. Chinese teenagers and college students have much worse (inflamed) skin than I see in other countries. Old people in China look much worse than old people in Japan. Could heavy use of high-omega-6 cooking oil be a big reason?

4. Where were authorities? We expect our government — in combination with academia — to protect us against dangerous chemicals in our environment. If I’m right about the cause of my low score, that didn’t happen here. Cooking oil is the opposite of a rare food. If ordinary amounts of a common cooking oil did cause these results, it suggests something is seriously wrong with the regulatory system. A big argument for personal science — and brain tracking in particular — is that you monitor exactly the environment to which you are exposed in exactly the genetic context you care about (yours).

• “We never asked: Based on what?“ A father wishes he had been less trusting of his son’s doctors.
• Does Paxil increase breast cancer? In Marin County, California, where I grew up, there is more breast cancer than expected. Could this be due to Paxil?
• Answer to criticisms of mammography study that found no benefit.
• gut bugs and brain function
• fake Nobel Laureates

When I was a graduate student, I had acne. Via self-experiment, I discovered that the antibiotic my dermatologist had prescribed didn’t work. He appeared unaware of this possibility, although antibiotics were (and are) very commonly prescribed for acne. “Why did you do that?” he said when I told him my results. As I’ve said before, I was stunned that in a few months I could figure out something important that he, the expert, didn’t know. He had years of training, practice, and so on. I had no experience at all. Eventually I gathered additional and more impressive examples — cases where I, an outsider with no medical training, managed to make a big contribution with tiny resources. The underlying message seemed to be that professional medicine rested on weak foundations, in the sense that big conclusions could be overturned with little effort.

Two recent posts (here and here) on this blog argue that eczema, which afflicts about 10% of Americans, can be cured and prevented with fermented foods. This observation makes perfect sense because of two pre-existing ideas: 1. Eczema is due to an overactive immune system. 2. Fermented foods “cool down” that system (a variant of the hygiene hypothesis). Professors of dermatology failed to put them together, but people outside medicine were able to.

After I learned that eczema could be cured easily and safely, statements by medical professionals about eczema became horrifying. A dermatologist recently wrote about eczema on Reddit:

Eczema is a chronic condition, which includes hand eczema. It’s a condition of dry and sensitive skin. Topical steroids are a useful adjunct in getting your skin clear, and – in certain cases – keeping your skin clear. I tell my patients that the most important thing in management of eczema is the skin care regimen. This means avoidance of irritating factors and restoration of the skin barrier.

The National Eczema Association:

The exact causes of eczema are unknown. You might have inherited a tendency for eczema.. . . Many doctors think eczema causes are linked to allergic disease, such as hay fever or asthma. Doctors call this the atopic triad. Many children with eczema (up to 80%) will develop hay fever and/or asthma.

The Mayo Clinic website: “The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body’s immune system.” The various remedies listed have nothing to do with the immune system.

What else don’t they know? Doctors have great power over our well-being. Imagine learning that the driver of the car you are in is nearly blind.

After reading Shant Mesrobian’s story of how he eliminated his eczema with fermented foods and a probiotic supplement, Todd Fletcher left a comment:

My eczema and other skin problems of 15 years disappeared completely from regular kefir and yogurt, which I did because of this blog.

I asked for details.

Who are you?

I live in Mesa Arizona, 49 years old, software developer.

When did it start?

I had lots of allergy problems as a child; had to have soy milk as a baby, had allergy shots for 5 years until I was 22 or so, I was allergic to trees and grass. The allergies pretty much went away after I came to Arizona and now have had no problems at all with it for many years.

I am pretty sure my eczema started in Maryland before I moved to AZ, that would put it before 1992. It started on the outside of my right shin. I can’t recall and never had any notion of any change that brought it on. It continued up until I started the kefir, though it would go dormant from time to time, often after which it would reappear elsewhere. It progressed from my shin to the back of my right knee, my right inner thigh, then my back, then my hands. It was always most prominent on my right side; I am right-handed.

Before fermented foods, what did you do to get rid of it?

I tried vitamin E both orally and topically very early. It did seem to soothe it but I hated the smell and mess. Otherwise I used cortisone when it was really bad, but tried to minimize that. Mostly I just put up with it.

What were the fermented foods?

I liked Nancy’s Peach best for kefir; it was the most sour, and the other flavors of that brand had berry seeds that I didn’t like. Otherwise I got Lifeway Pomegranate [kefir], second most sour. Yogurt was mostly Strauss Farms or Brown Cow, though occasionally I’ll get Fage if the others aren’t there. I would have probably 3 containers of kefir and one or two of yogurt a week. For the yogurt I would get unflavored and add some bananas or maybe a little honey.

After you started eating kefir and yogurt, how long until you noticed improvement?

Less than a week. I went on and off many times, both intentionally and inadvertently, and the pattern was repeated every time. Now I can go off of either one without it returning; I don’t think I have seen any eczema in more than a year even though I might go a week or two without it. I have slowed down in the kefir because most of them have sugars and stuff, I mostly go for the plain yogurt these days.

Did you expect the improvement?

Not at all. I was trying to recover from a bad stomach bug that left me with digestive distress. I only tried the kefir because I read it had more cultures than yogurt. It solved the digestive problems but I only noticed the effect on eczema when I stopped it and the eczema returned. I hadn’t noticed it had stopped since it sometimes went dormant for a few weeks at a time.

What were the other skin problems?

I had splitting of my fingertips, really painful and right on the tip making it hard to use. I assumed this was just the eczema presenting itself here, but it might have been something else. I also had generally dry itchy skin no matter how much lotion I used, which is not a problem now.

I recently blogged about Shepard Siegel‘s idea that heroin “overdose” deaths — such as Philip Seymour Hoffman’s — are often due to a failure of conditioned tolerance. In the 1970s and 80s, Siegel proposed that taking a drug in Situation X causes learning of a situation-drug association. Due to this association, Situation X alone (no drug) will cause an internal response opposite to the drug effect. For example, coffee wakes us up. If you repeatedly drink coffee in Situation X, exposure to Situation X without coffee will make you sleepy. As the learned response opposing the drug effect grows, larger amounts of the drug can be tolerated and the user needs larger amounts of the drug to get the same overall (apparent) effect — the same high, for example. Trying to get the same high, users take larger and larger amounts. But if you take a really large amount of the drug and don’t simultaneously evoke the opposing response, you may die. What is called “overdose” death may be due to a failure to evoke the conditioned response in the opposite direction.

Siegel’s Science paper about this — a demonstration with rats — appeared in 1982. Since then, plenty of evidence suggests the idea is important.

First, “overdose” death has become more common. A Washington Post article prompted by Hoffman’s death says that death due to “overdosing” on drugs — usually opiate drugs — has doubled in the last ten years and is now “the leading cause of accidental death in the United States, accounting for more deaths than traffic fatalities or gun homicides and suicides.”

Second, new data has supported Siegel’s explanation. Alex Schull linked to a 2005 case report that says: “K.J. did not return home with the heroin purchased as he did on other occasions but went to the public toilet in the pedestrian underpass at the Népliget Metro station where he injected the same quantity (0.5 gram) that he had taken the previous day in the accustomed place, at home with his wife.” The report cites other supporting evidence.

Third, new data has contradicted other explanations.The Post article includes an interview with an addiction expert named Keith Humphreys, a Stanford professor of psychiatry. Humphreys said, “Toxicology results after a fatal overdose usually indicate that the victim has consumed either their normal dosage level or a dose slightly lower than their normal level.” He also said, “Toxicology studies of overdosed people very rarely find that impurities played an important role.”

Yet Humphreys appears unaware of Siegel’s idea, even as he provides supporting evidence:

Typically overdose occurs because they’ve had a loss of tolerance. This loss of tolerance often arises because they haven’t used for a while. Maybe they had a voluntary period of abstinence. Maybe they were in jail, and their body can no longer handle the same dose.

The other leading cause of loss of tolerance is consumption of other substances. This is particularly true of alcohol, which seems to lower the body’s ability to tolerate opiates (so do benzodiazepines). Most of what we call “opiate overdoses” are really polydrug overdoses: alcohol and heroin, alcohol and oxycontin, benzodiazepine, alcohol and Vicodin, combinations like that. [This is consistent with Siegel’s explanation. The second drug makes the situation less familiar, reducing the conditioned opposing process. — Seth]

Siegel’s idea was recently mentioned in the New York Times:

A change in where a person uses his or her drug of choice can increase the likelihood of an overdose, studies suggest. “If you habitually use in your car, for example, the body prepares itself to receive the drug when it’s in that environment,” Dr. Rieckmann said. “It’s called conditioned tolerance. When people using are in an unfamiliar places, the body is less physically prepared.”

This was the first mainstream mention I’d ever seen. I told Siegel about it and he said it was the first mainstream mention he’d seen, too. He added, however, that he had come across the idea in a crime novel:

A Scottish constable, Hamish Macbeth, appears in a series of books by M. C. Beaton. In one 1999 book in the series, “Death of an Addict,” Macbeth has a conversation with a Dr. Sinclair, a pathologist on the scene of an apparent heroin overdose: “Dr. Sinclair leaned his cadaverous body against his car and settled down to give a lecture. ‘The reason for tolerance to heroin is partially conditioned by the environment where the drug was normally administered. If the drug is administered in a new setting, much of the conditioned tolerance will disappear and the addict will be more likely to overdose’” (Beaton, M. C. Death of an addict. New York: Warner Books, 1999, p. 23). M. C. Beaton is the pen name of Marion Chesney, and I wrote to her asking how she knew this. She couldn’t recall, but thought that it likely was due to a conversation she had with a Scottish police officer.

There are several similarities between Siegel’s idea and the Shangri-La Diet, which I will point out later.

A recent study in the BMJ concluded that the massive breast cancer “prevention” program — having women get annual mammograms — had done more harm than good. Women were randomly assigned to get mammograms plus self-exam or self-exam alone. The death rate from breast cancer was the same in the two groups. However, women in the mammogram group were told they had cancer and received very painful and expensive treatment far more often than women in the other group. This being modern medicine, the true situation is even worse than what you read in any article about the (very negative) study. One critic has said that the randomization was not done properly. If true, this means that medical researchers, even when told exactly what to do, don’t do it, in ways that make a multi-million dollar study useless. In spite of billions of dollars and billions of hours spent on mammograms and billions of pink ribbons, we still know practically nothing about the environmental causes of breast cancer. (I suspect bad sleep is a major cause. Shift work is associated with breast cancer.)

A new book (to be published in March), titled The Great Prostate Hoax: How the PSA Test was Hijacked by Big Medicine and Caused a Public Health Disaster says that prostate cancer screening is no better. The book is by Richard Ablin, who discovered the prostate-specific protein used in the screening test. The trouble with the PSA test is simple. First, the reading is often high for reasons that have nothing to do with cancer. Second, prostate cancer is common (cancer increases as the fourth power of age) and usually benign.

In an interview, Ablin made some good points:

The US Food and Drug Administration failed in its duty to the public: its advisers warned that routine PSA screening would cause a public health disaster, but it was approved under pressure from advocacy groups and drug companies. . . . The unfortunate reality is that no current data show that men who undergo PSA screening live longer than men who decide against it.

A few years ago Ablin wrote an op-ed about this.

On this blog, Peter commented:

Lactobacillus brevis also is found in pickled turnips. I’ve used it for weeks and noticed a difference. It seems to clear my lungs [emphasis added] (I probably have a low level infection that once cleared by taking intravenous antibiotics). I buy the Japanese style fermented turnips.

At Mr. Heisenbug, libfree commented:

I’ve taking the probiotic for just this week (twice a day plus some kimchi when I can + I started eating Kimchi at the beginning of last week) and I’ve seen some dramatic improvements. My feet have always had dry, itchy skin which has just disappeared. I have a cronic bunionette, a bunion on the outside edge of the foot, that has softened dramatically. My Rosacea hasn’t changed at all. Sinuses seem better but I’m still holding off on weather this intervention is helping. The most dramatic change has been in my lower respiratory area. My lungs are nearly free of mucus. I don’t remember a time that they were this clear. [emphasis added]

Lungs: canary in the coal mine of modern life?

I have long said that good health begins with good sleep. I came to this conclusion when I improved my sleep a great deal and at exactly the same time stopped getting obvious colds. I concluded that better sleep made my immune system work better. At the 2012 Ancestral Health Symposium, in Los Angeles, Rob Wolf said something similar about the centrality of sleep: “If a person sleeps well, you can’t kill them. If they sleep badly, you can’t keep them alive.”

Mainstream health researchers, on the other hand, haven’t figured this out. James Watson, the co-discoverer of the structure of DNA, in a recent paper about how to fight cancer, wrote this:

Long known has been PERIOD 2 (PER2) involvement as a clock protein at the heart of the circadian rhythms of higher animal cells. Later, quite unexpectedly [emphasis added], PER2 was found to function as a tumour suppressor, with the absence of both its copies causing the rate of radiation-induced cancers to rise.

When PER2 is absent, circadian rhythms disappear and sleep becomes very fragmented, spread out over the whole day. When you sleep better (which usually means more deeply), your immune system works better band does a better job of suppressing tumors. There is plenty of other supporting evidence. For example, in 2012 two studies found sleep apnea associated with higher cancer rates. The PER2 evidence is especially good at establishing cause and effect.

An article about DIY medical devices — devices created outside of big companies — does illustrate the predatory nature of our health care system:

It can still be difficult for inventors to break into the medical-device market. Amy Baxter, a pediatrician specializing in pain management, found this out firsthand. When her four-year-old son developed a fear of needles, Baxter set up shop in her basement and created Buzzy, a vibrating ice pack shaped like a bee that numbs the sting of injections. . . She says, “I decided to use my solution as a mother to be a better — more globally impactful — doctor.” Baxter held randomized controlled trials comparing the device to ethyl chloride spray and published the results. But when she launched the product in 2009, she found it nearly impossible to get her product into hospitals.

“It’s the nature of the system marketing to hospitals to pad prices and make items disposable to ensure repeat sales,” she says. Medical sales reps paid on commission will only take the time to push a new product if it is very expensive, with a high profit margin, or if it’s a cheap item that has to be reordered often, she says. “A reusable, low-cost product doesn’t work.”

On the other end, she says, hospitals’ complex budgetary processes often disconnect the physicians who order products — and pass the price on to patients and insurance companies — from their true cost. “Decisions to buy aren’t as straightforward as looking at a catalog,” she says. “There is no easy way to comparison shop, and less incentive in the medical environment.”

The result of all this inefficiency [which curiously works only in one direction — to make things worse for consumers and better for health care professionals], Baxter says, is not only notoriously inflated hospital prices — like $36.78 for a $0.50 Tylenol with codeine pill and $154 for a $19.99 neck brace — but also a high barrier to entry for devices like Buzzy, which is currently available only online, with no marketing beyond word of mouth.

A predatory relationship is one where one side is much more powerful than the other side and uses that power to take from the other side.

The article says nothing about science — better understanding of the connection between environment and health. Science is so poorly understood by so many people that even a doctor, such as Baxter, fails to understand that it exists:

The more people become involved in medical making, says Baxter, the less the human body will seem like a mysterious black box whose problems and solutions are only within the realm of experts. [Not true. Making is not science. There is still a great need for science — Seth] “The truth is,” she says, “the place where the body interfaces with the rest of the world is just engineering.”

No, it isn’t just engineering. There is a vast amount we don’t know about the world’s effect on the body. Even a small improvement in understanding how environment (including food) controls health (e.g., how to sleep better) can easily be worth billions of dollars per year, more than all DIY medical devices put together. And knowledge (and the associated benefits) spreads at no cost at all, in contrast to medical devices.

Engineers assume people will get sick. Scientists do not.

Thanks to Alex Chernavsky.

The Good Jobs Strategy by Zeynep Ton, published in January, argues that retailers should change low-level jobs in four ways:

1. Offer fewer choices — fewer versions of each product.
2. Standardize common tasks and empower employees to handle unusual situations.
3. Cross-train employees so that each employee can do several jobs.
4. Operate with slack, that is, hire more employees than seemingly necessary.

The brilliance of this book is that it addresses a major problem (bad jobs), includes substantial evidence and persuasive argument, is practical, and is exceedingly non-obvious (judging by how many retailers already follow her recommendations). Ton is an MIT business school professor whose area of expertise is operations.

I interviewed her by email.

ROBERTS How did you get into studying this? My impression is that the details of how employees are treated is not what operations professors usually study.

TON Early in my career I studied pervasive operational problems at retail stores that hurt supply chain and financial performance. My doctoral thesis was on misplaced products and the resulting phantom stockouts. I found that even retailers that were great at managing the backend of their supply chain, by getting the right products to the right stores at the right time, were pretty bad at managing the last ten yards of their supply chain. Once the products made it to the store, they would stay in the backroom or in the wrong place and often not meet the customer that wanted to buy them.

Problems like misplaced products were common, frequent, and had a huge impact on customer service, sales, and profits. When I studied what drove these problems I found that stores that had more workload for employees, lower training, and more employee turnover had worse performance.

Things really clicked for me several years ago when I was presenting my research to a group of retail managers and executives. I showed them my findings from analyzing a lot of data from Borders that showed that if stores increased the amount of people they would make more money. This finding just didn’t make sense—why would managers staff their stores with too few people even though having more would increase profits? When I asked people in the audience to raise their hands if I would find a similar result if I analyzed data from their chain, almost all raised their hands.

What I saw was that a lot of retailers were operating in what I call a vicious cycle. Low investment in employees caused operational problems, which reduced customer service, sales, and profits. When stores had low sales and profits, they had low labor budgets, which further reduced their investment in employees.

Everybody suffers from this vicious cycle. Employees have bad jobs, customer get bad service, and investors are worse off because there is a lot of money left at the table. I thought there have to be some companies that operate much better. That’s how I started looking at firms that follow the good jobs strategy.

ROBERTS How have your ideas on this subject changed over the years?

TON There was a period when I wasn’t sure if excellence was possible in low-cost retail. All the examples around me were of retailers that offered bad jobs and had poor operational performance. When I went to Spain to study Mercadona I realized that I finally had found the “Toyota Production System” of retailing. What really excited me was studying QuikTrip after Mercadona. Here were two completely different companies—the largest supermarket chain in Spain and a convenience store chain with gas stations based in Tulsa, Oklahoma. Yet they were both beating their competitors by offering much better jobs than their competitors. At the same time they were both offering low prices and great service to their customers.

When I looked into what allowed them to deliver value to their employees, customers, and investors at the same time, I saw that they were both excellent operators. They were both making a set of operational choices that reduced costs, increased employee productivity, and allowed employees to have a big role in driving profits. When I looked at Costco and Trader Joe’s, I saw they were making the same choices. In my book I highlight the four choices I observed [shared by these four companies].

ROBERTS When you present these ideas to retailers, what is their reaction? Of course there is a range of reactions, but which reactions surprised you the most? Which reactions did you learn the most from?

TON The reaction that I learned most from is the following. When Marshall Fisher, a Wharton professor and a thought leader in operations management, presented his finding that retailers could make more money by increasing staffing levels, a CEO said, “I spend my days saying no to a long line of people suggesting ways to spend money, including adding more staff. I don’t need a couple of Ivy League professors with their fancy statistical analysis giving them more ammunition!”

This really shows how retailers view their labor — as a cost to be minimized.

ROBERTS What do you think about how Amazon treats employees? Do you have any suggestions for them? [The book is published by Amazon.]

TON I have not studied Amazon.

ROBERTS Your book lacked a chapter called “What Happens When…” about what happens when companies try to implement the changes you suggest — I mean, make changes based on your research. Can you say anything about that?

TON Of the four model retailers that follow the good jobs strategy, only one went through a dramatic change. Mercadona started as a company that operated just like most companies operate right now, but had to change in order to compete against much larger companies. I hope that my book will encourage more companies to adopt a good jobs strategy. If I can observe some of these changes, I will be in a better position to offer suggestions for implementation.

ROBERTS It seems to me the underlying theme of your book is “Look, your employees have brains. The more you take advantage of those brains, the better off everyone — you, them, owners, customers — will be.” Is that a fair summary?

TON One could say that the book is about designing the work that employees do to leverage committed, motivated, and capable employees. It’s also about making smart operational choices that benefit employees, customers, and investors at the same time.

ROBERTS Do you have a theory — is there a theory — that ties your four suggestions (“operational choices”) together? Is there an underlying principle from which all four of them can be deduced?”

TON The four choices I observed are choices that operationally excellent companies have been making for decades and they could be traced to lean manufacturing. Overall, the good jobs strategy—the combination of the four choices and investment in people—is a blueprint for operational excellence.

ROBERTS Why has it been hard to learn to make the choices you describe?

TON Unfortunately, the dominant view in business is that paying employees as little as possible and treating them as a cost to be minimized is the best and perhaps only way to run a profitable business, especially in industries with low profit margins.

As I show in my book, that’s not the only way and that’s not even the best way.

But companies can make bad choices just like people can make bad choices. We know exercising is great for our health but regular exercise requires commitment, discipline, hard work and a long-term view. The good jobs strategy is good for companies’ health but that too requires commitment, discipline, hard work, and long-term view.

Excellence is always harder to achieve than mediocrity. And right now we have too many companies stuck in mediocrity.

ROBERTS You say “the dominant view in business is that paying employees as little as possible and treating them as a cost to be minimized is the best and perhaps only way to run a profitable business, especially in industries with low profit margins.” That is a common-sense view that Adam Smith might have expounded. Why has such a wrong view persisted so long? On the face of it, I would think that how to treat employees would be one of the central questions that business professors (and CEOs) try to answer and nobody would be satisfied with repeating ideas of several hundred years ago. It’s one thing for a third grade teacher to tell students “the earth is flat” — yes, it looks vaguely flat. But for sophisticated university professors and captains of industry to say “the earth is flat” for hundreds of years when there is a vast amount of money to be made from realizing it isn’t flat, that is puzzling.

TON But it’s not just ignorance. Perhaps I should have worded it differently. Following the good jobs strategy is not easy. You have to get many things right. It requires excellence.

POSTSCRIPT This is what Ton said in the book — that the good jobs strategy is difficult. I wasn’t persuaded. CEOs of major retailers have done many things that are not easy. Why has this difficult thing been out of reach?

I suspect an examination of why the 4 retailers Ton study broke from the pack and treated their employees differently would not find that the people in charge were more capable of excellence than the leaders of other companies. Maybe their personalities were different, maybe their cultures (internal company culture or external society culture) were different, I have no idea.

I am unsurprised that business profs had failed to figure out what Ton figured out (although her conclusions are supported by the work of other professors). Other disciplines have enormous blind spots — epidemiologists never study the immune system, for example. The more things you can take for granted, such as the idea that labor is a cost to be minimized, the easier it is to publish papers. In academia what is rewarded and selected for is not solving real problems, it is publishing papers in prestigious journals, which is quite different.