Fear is contagious. Natural selection has wired us to sense fear in our surroundings and make it our own. Zebras might not get ulcers from chronic stress but those that fail to activate their acute stress response when others around them are stressed are more likely to miss cues of threat and be consumed by a predator. Absorbing secondhand stress from others is a survival instinct—an adaptation shaped by prehistoric environments to promote evolutionary fitness.
However, our culture is evolving faster than our ability to biologically evolve. Too often, we helplessly rubberneck trainwreck events—often sensationalized by media for attracting attention and profit—despite their remote connection to our personal survival. For example, fear of the Ebola virus in recent weeks has become more viral than the virus itself. In the modern technology age where fear memes can spread around the globe near-instantly, our tendency to absorb secondhand stress from our ubiquitous, 24/7 media culture to activate our own stress response can produce maladaptive responses that are out of proportion to the actual threat.
Stewardship is defined as the responsibility to shepherd and safeguard the interests of others. Many of us are in positions of stewardship on behalf of others in public corporations, private enterprises, and charitable organizations. Warren Buffett, perhaps the most widely followed business leader of our time, speaks often of the importance of stewardship in business. It is striking, then, to see the dearth of courses discussing the concept of stewardship at top American business schools.
In the online course catalogs of the top five MBA programs in the America (as recently ranked by US News and World Report), “stewardship” is nowhere to be found in any course title. To put this into context, each of these schools offers at least five classes with the word “leadership” in the title. In the detailed descriptions of courses offered at Stanford’s Graduate School of Business, tied for #1 in the same report, the word “leadership” appears 108 times. The word “stewardship” is not mentioned once. The closest mention of the word appears in the context of how to steward yourself in a course entitled “Leading Your Life.”
Hiding In Plain Sight is a collection of essays that I have written on investing, healthcare, and life.
A Little Experiment
For the sake of experiment, read the next sentence once, while counting the number of “f”s that you see.
“Five-winged flies are the result of years of scientific study combined with the experience of many years.”
Most likely, you counted an “f” in each of the more vibrant words of the sentence: “five,” “flies” and “scientific.” Most people only see these three “f”s, when in fact there are six. The other “f”s are hidden in the unassuming preposition “of”. Your mind probably skipped over each “of” because it processed these words without absorbing the raw information of the letters that composed them.
Although heart disease is common today, it was likely a far less frequent cause of death than predatory assaults among our prehistoric ancestors. Anyone reading this article is the fortunate descendant of an unbroken lineage of organisms that escaped or survived predatory attacks before reproducing.
The responses that help us survive predatory attacks are collectively called the fight-or-flight system. This system drives three major vascular responses to injury: coagulation (to counter blood loss), vasoconstriction (also to counter blood loss), and inflammation (to combat microorganisms and to promote wound healing). Together they helped our predecessors survive a predator’s bite. These responses are called upon reflexively no matter what the source of injury.
Social mobility enabled by innovations in technology, communication, and transportation has dramatically increased the liquidity of our relationships. Some of the hard-wired social traits that we inherited from our tribally-minded ancestors may be maladaptive and not properly suited to handle modern relationship dynamics.
Our attraction to new social opportunities was shaped when such opportunities were far more limited than they are today. Not unlike our attraction to sweet, fat, and salty foods, little selection pressure existed in the old world for evolving upper limits on our attractions for new social opportunities. But does a tendency to be intrigued by new social opportunities make us happier people in a world where access to new opportunities is virtually limitless?
Evolutionary medicine (also referred to as Darwinian medicine) is the application of evolutionary theory to the understanding of human ailments.1 2 3 It explores evolutionary mechanisms of disease, offering a complementary framework to the proximate mechanistic explanations that prevail in medicine today. In this paper, we consider the application of evolutionary theory to the treatment of ailments.
A major contribution of evolutionary medicine is the framing of human diseases as maladaptations of our prehistoric factory settings. Our physiologic processes were shaped during prehistoric evolution to meet the needs of the era, but those same processes may behave maladaptively in the modern environment and produce disease. We take that notion one step further and propose an overarching therapeutic paradigm for human ailments based on evolutionary theory—the induction of adaptations in the body as a way to treat disease. It is the idea of creating somatic traits in the body that evolution might otherwise need to create over many generations through the sheer force of variation and natural selection. In the same way, that evolution has endowed us with traits that shield against biotic and abiotic stress to maintain homeostasis, we propose treating patients by endowing the body with buffers against ailments.
This year marks the 50th anniversary of “American Girl in Italy”, Ruth Orkin’s iconic photograph of men ogling Ninalee Craig as she walked down a street. Despite the cultural stigma now attached to its practice, the rubbernecking of young beautiful women is an everyday phenomenon. From an evolutionary perspective, prehistoric males who did not instinctively tune to visual cues of potential mates with beneficial traits and fecundity would face adverse natural selection pressure. Presumably, males living today have inherited the tendency to rubberneck nubile females because such proximate behaviors translated to improved ultimate fitness during natural selection.
In similar fashion, people driving by a car accident turn their heads to look. In nature, an organism that does not tune to signals of carnage is ignoring potential useful cues of threat in their vicinity and could be subject to elimination. Our tendency to rubberneck trauma, thus, is an adaptation inherited through evolution through the survivorship bias of those who attended to cues of stress that can improve our Darwinian fitness.
Children are trained to count linearly: one, two, three, four, five, etc. Long before mathematics was invented, however, a subjective process of estimation was used to quantify and make decisions. If the ability to appreciate quantities in linear terms confers fitness advantage, that edge appears to have eluded Darwinian selection. Studies of the Amazonian Mundurucu indigenous tribe and preschool American children all suggest that humans are innately wired to use a compressed scale to understand magnitude – not unlike those depicted by logarithmic, exponential, or power-law functions. A compressed scale is biased toward achieving higher resolution at the lower end of the spectrum where smaller numbers reside, where discriminating subtleties in degrees of scarcity can provide the greatest benefit. Psychophysical studies assessing the magnitude of subjective estimation of sensory inputs such as light intensity and sound intensity also reveal innate mapping of signals on compressed scales. From an adaptive perspective, a compressed scale of subjective estimation enables a wider dynamic range of sensory processing which is valuable in environmental signal interpretation. The hypothesis that selective pressures favored the cognitive adoption of a compressed scale for subjective estimation is consistent with the reality that natural phenomena generally unfold through iteration, yielding patterns of development that are best understood through the prism of compounding rather than the lens of linearity. Like an intellectual slide rule, modern mathematics reprograms children. It obligates them to abandon their natural cognitive tendencies, which rely on compressed scales and estimation and coerces them into adopting linear scales that provide uniform resolution along the entire scale. It resigns them to participate in a wholesale exercise of indiscriminate precision with respect to all things. This force-fed mental framework may help individuals thrive in the artificiality of our modern socio-cultural-economic landscape, replete with man-made straight lines and standardized tests. However, we believe that the conflict between our innate instinct to estimate on a compressed scale and our learned ability to quantify on a linear scale is a source of profound decision dysfunction in the modern world, particularly impairing the ability to assess the possibilities of outlier outcomes.
The concept of the importance of eating a balanced diet took on major cultural significance in this country when the U.S. Department of Agriculture released its first Dietary Guidelines for Americans in 1980 — a response to an increase in heart disease amongst Americans in the 1960’s. The Guidelines are updated every five years to incorporate the latest advances in medical and scientific research, based on the recommendations of the 11-member Dietary Guidelines Advisory Committee, a group of widely recognized nutrition and medical experts. The U.S. government directly or indirectly feeds approximately 54 million people daily according to these guidelines — including over 25 million school children. These numbers are not lost on those in the food, agriculture, and diet industries, who are all busy promoting their particular points of view. They work to install members to the committee whose support they can count on, ostensibly in order to ensure that the committee itself has a ‘balanced’ view of diet and nutrition. In such a politically charged environment, what do we end up with? A ‘balanced’ diet indeed, with a little something on everyone’s plate.
While the experts disagree on what constitutes a diet balanced for optimal health, most presume the need for ‘balance’, and the importance of consuming a wide variety of different foods. The guidelines have changed over time, with the recent addition of an emphasis on physical activity to offset caloric consumption. The debate remains largely centered, however, over which foods reside at the top and which languish at the bottom of the food pyramid, rather than the validity of the approach itself.
A doctor-turned-stockpicker says he’s bearish on stents.
By MARK VEVERKA
YOU DON’T HAVE TO BE A MEDICAL DOCTOR to pick healthcare and biotech stocks, but it doesn’t hurt.
Joon Yun has been managing money for only nine years, but his 12 years as a radiologist — mostly at Stanford University Medical Center — have served him well in his second career as a partner of Palo Alto Investors in Palo Alto, Calif., an 18-year-old hedge fund with about $1.5 billion under management, focused mostly on small-cap growth. “Radiology is sort of similar to investing,” he says. “You’re making decisions based on limited information and looking for patterns.”
The graduate of Harvard and of Duke Medical School hadn’t been looking to leave his day job. But when a colleague had to bail on an interview with Palo Alto, which was seeking a doctor to oversee healthcare investing, Yun filled in on a whim. The rest is history.
Since joining PAI, Yun has never had a down year. The three-year return of Palo Alto’s $250 million micro-cap fund, heavily weighted toward healthcare and biotech, is nearly 23%. Over five years, the return is close to 30%.