McKinsey & Company would like to claim the credit for coining the term MECE (pronounced as mee-see). However, this abbreviation of "Mutually Exclusive and Collectively Exhaustive" is almost as old as statistics. I recall this is how we used to define statistical events when I was studying mathematics as an undergraduate. You can find a lot more about mutually exclusive and collectively exhaustive events on Wikipedia.
Let us discuss how do we apply this "MECE" principle to the preparation of presentations and documents. I'm sure that you have heard about death by PowerPoint. This refers to the death of ideas that were killed because of a badly prepared presentation. Your ideas are important. There are three simple ways to avoid high mortality rate of ideas:
1. Each slide must be "mutually exclusive"
2. Presentation as a whole must be "collectively exhaustive"
3. Make your presentations less verbose, more pictorial
How does mutual exclusion apply to slides? It is important that thoughts presented on each slide are non-overlapping and please don't repeat yourself (DRY). A DRY presentation keeps the viewers interested. Overlapping slides represent confused thinking. If the thoughts that you plan to present have to be grouped under categories, make sure that the categories are non-overlapping and that each thought is grouped under one and only one category.
The second point refers to the importance of exhaustively dealing with all the possibilities and outcomes related to the topic of your presentation. Leave no stone unturned. One way of validating collectively exhaustive property is to look for all the inputs, outputs, processes and risks and analyze alternative scenarios. This will be some real hard work. Who said ideas are cheap!
Last point is unrelated to MECE but important to remember that a story is best told through pictures.
By the way, this is not a "collectively exhaustive" blog about improving your presentations. I was just discussing about "MECE". So you still need to follow other rules of a good presentation, for instance, understand your audience, present facts and use emotional appeal, follow the rules of writing a good story, et cetera.
Saturday, October 31, 2009
Monday, October 26, 2009
Systems Don't have Costs, Strategies Have
As a strategic IT consultant for some time, I've seen several cycles of system selection and implementation. Most of the organizations adopt a common sense approach to system selection. Invariably, system selection process is driven by the IT department. This common sense system selection process follows a standard route in IT departments. A process is defined and the requirements are collected by business analysts. These requirements provide a basis for creation of an RFP document. After receiving RFP responses, system features are reviewed, compared and a list of candidate systems is prepared. Next round features intense discussions with business teams to narrow down system selection to two systems. In the final round a financial analysis is carried out that compares total cost of ownership (TCO) of candidate systems and projects an estimated return on investment.
This common sense approach is just as accurate as the common sense perception that makes a full moon look closer and five time larger when it is on the horizon. It is a waste of time to calculate total cost of ownership (TCO) of systems. Systems don't have total cost of ownership, strategies have. Systems should be selected based on their "fit" with a given business strategy. This strategic fit means consistency within the system of activities so that there are no conflicts among activities that generate valued business results. Each activity supports and enhances other activities within this configuration of activities. The competitive advantage emerging from such an optimized system of activities is sustainable, since it is hard to copy an entire system of activities.
In such a scenario a chosen system is just a part of an overall strategy. The right way to evaluate each strategy is to do an economic value-added analysis (EVA) that includes a comprehensive analysis of changes in cost structure, growth and revenue opportunities. EVA take opportunity cost into consideration too. Based on this approach, one can prepare projected financial statements of the entire business under each strategy scenario and measure creation of shareholder value. This provides a holistic way of evaluating performance of different business strategies and their impact on business as a whole. System selection is just a by-product of strategy selection.
This common sense approach is just as accurate as the common sense perception that makes a full moon look closer and five time larger when it is on the horizon. It is a waste of time to calculate total cost of ownership (TCO) of systems. Systems don't have total cost of ownership, strategies have. Systems should be selected based on their "fit" with a given business strategy. This strategic fit means consistency within the system of activities so that there are no conflicts among activities that generate valued business results. Each activity supports and enhances other activities within this configuration of activities. The competitive advantage emerging from such an optimized system of activities is sustainable, since it is hard to copy an entire system of activities.
In such a scenario a chosen system is just a part of an overall strategy. The right way to evaluate each strategy is to do an economic value-added analysis (EVA) that includes a comprehensive analysis of changes in cost structure, growth and revenue opportunities. EVA take opportunity cost into consideration too. Based on this approach, one can prepare projected financial statements of the entire business under each strategy scenario and measure creation of shareholder value. This provides a holistic way of evaluating performance of different business strategies and their impact on business as a whole. System selection is just a by-product of strategy selection.
The Saga of AIG: Objectivism vs. Existentialism
I just finished reading another headline news on NY Times web. This was titled "Ex-AIG Chief is Back, Luring Talent from Rescued Firm". Now I know as much about objectivism and existentialism as Mary Williams Walsh knows about me. OK, may be a little more but not much. Somehow New York Times continues to find a way of getting on my nerves. The One Trillion Dollar Stimulus bill crowd is back in action. This time lambasting Maurice Greenberg, ex-CEO of AIG, for having this incredible chutzpah to start another firm, C.V. Starr & Co., and trying to make that successful by competing against the government run AIG. Mary Williams Walsh is an expert in adding subtle innuendos in her articles without suffering the burden of having to provide any evidence.
In the beginning this "economic stimulus" and bailout crowd wanted the treasury to throw tons of US tax payers' money at insolvent institutions, like AIG, to save them from bankruptcy. Once bankruptcy was avoided with billions of tax payers dollars to pay off liabilities, this same stimulus crowd is working overtime to bankrupt AIG by capping executive salaries. Unfortunately, now US government owned AIG has to compete with Maurice Greenberg's C.V. Starr & Co. When did legitimate competition and existential "freedom of choice" turn into "siphoning off" of business?
Is it a surprise that now AIG's executive talent has a major incentive to join Maurice Greenberg's C.V. Starr & Co. with better salaries and working environment than government run AIG. Mary Williams Walsh was quite worried about legitimate bonuses to AIG executives. Now she is worried about executives leaving AIG and joining Maurice Greenberg. She would like government to put some restrictions on AIG executives so that they are unable to leave AIG even after their salaries and bonuses have been drastically reduced. Since this country is not eastern Europe or China, it is hard for the government to force AIG executives to work at lower salaries. Of course, she does not say it but after reading her language, which is riddled with loaded terms like "raiding", "poaching", "siphoning off" and "success at the expense of tax payers", one is hard pressed not to have the notion that she is questioning the legitimacy of capital markets and our incentives-based economic system.
Is existentialism a leftist philosophy? That should explain it. If existence is essentially meaningless and a pure coincidence, then rationality is irrational. In that case, I would rather stay with objectivism.
In the beginning this "economic stimulus" and bailout crowd wanted the treasury to throw tons of US tax payers' money at insolvent institutions, like AIG, to save them from bankruptcy. Once bankruptcy was avoided with billions of tax payers dollars to pay off liabilities, this same stimulus crowd is working overtime to bankrupt AIG by capping executive salaries. Unfortunately, now US government owned AIG has to compete with Maurice Greenberg's C.V. Starr & Co. When did legitimate competition and existential "freedom of choice" turn into "siphoning off" of business?
Is it a surprise that now AIG's executive talent has a major incentive to join Maurice Greenberg's C.V. Starr & Co. with better salaries and working environment than government run AIG. Mary Williams Walsh was quite worried about legitimate bonuses to AIG executives. Now she is worried about executives leaving AIG and joining Maurice Greenberg. She would like government to put some restrictions on AIG executives so that they are unable to leave AIG even after their salaries and bonuses have been drastically reduced. Since this country is not eastern Europe or China, it is hard for the government to force AIG executives to work at lower salaries. Of course, she does not say it but after reading her language, which is riddled with loaded terms like "raiding", "poaching", "siphoning off" and "success at the expense of tax payers", one is hard pressed not to have the notion that she is questioning the legitimacy of capital markets and our incentives-based economic system.
Is existentialism a leftist philosophy? That should explain it. If existence is essentially meaningless and a pure coincidence, then rationality is irrational. In that case, I would rather stay with objectivism.
Sunday, October 18, 2009
Personal Insult: Is it a distraction?
Peter said (Here I go again!) that organizations were bodies in motion and politeness was the lubricant that kept the organizations working smoothly.
At one of my previous organizations, we had a meeting with the executives of another business unit to review a chargeback issue. There was a problem with the design of chargeback mechanism. The result was that IT did not have enough dollars to meet business needs. During the meeting, one of the IT executives got frustrated and said that if the issue was not resolved then he would have the appropriate chargeback amount directly deducted from the budget of the business unit. The debate got a little heated and there was an exchange of insults couched in satirical language. The resulting distraction delayed IT investment and business results by at least three to four months at huge loss to the organization.
Should a savvy executive allow a personal insult get in the way of organizational or professional goals?
...
At one of my previous organizations, we had a meeting with the executives of another business unit to review a chargeback issue. There was a problem with the design of chargeback mechanism. The result was that IT did not have enough dollars to meet business needs. During the meeting, one of the IT executives got frustrated and said that if the issue was not resolved then he would have the appropriate chargeback amount directly deducted from the budget of the business unit. The debate got a little heated and there was an exchange of insults couched in satirical language. The resulting distraction delayed IT investment and business results by at least three to four months at huge loss to the organization.
Should a savvy executive allow a personal insult get in the way of organizational or professional goals?
...
Friday, October 9, 2009
Business Problem Solving Approach of IT
Information Technology (IT) is generally considered to be a solution provider. The problem is that if IT puts too much focus on solutions it runs the risk of becoming a problem creator. Most of the time I notice more solutions in and out of IT than there are problems. Everyone one with an opinion has a solution. It does not matter if the problem is well understood or not.
I think if IT has to become a real solution provider, the focus must shift from finding solutions to understanding problems. A solution provider is a first and foremost a business problem solver. Therefore, first IT has to understand the problem. Now once you understand the problem, you may find out that the problem you have just understood may just be a symptom and not a root cause. Therefore, you will want to focus on solving the root cause instead of the initial problem. In some other cases, you may find out that solving the problem will not provide the desired results and there may be another related problem that will provide better business results. The key point to note is that once the problem is better understood, you may realize that you don't really want to solve that problem. Best solution may be no solution.
This requires a defined problem solving methodology. Though IT shops have the best and brightest people and some of them individually follow an excellent approach to problem-solving, organizationally, I've yet to come across an IT department that has built an effective problem solving approach. IT is business and IT must become an expert in business problem solving. From this point of view, it is okay to quickly arrive at an initial solution after a quick understanding of the problem. However, this initial solution should remain just that--an initial solution or an initial hypothesis. Once an intial hypothesis is defined, facts can be gathered to solve the problem. If initial hypothesis turns out to be invalid, an alternative hypothesis can be created and tested. This deductive method constitutes the core of problem-solving.
What I see most often is that a solution is found through a gut reaction before the problem is understood. This solution is communicated as the final solution. In the second iteration, facts are selectively searched to confirm the solution. If a selective search of facts does not confirm the solution, then facts can always be twisted to fit the solution with the help of IT consultants. Through psychology of escalation of commitment, good people bet their careers on getting those solutions implemented. After spending millions of dollars if a business is lucky, then from somewhere a sage emerges to point out that the king is naked and the project is finally abandoned. If the business is not lucky enough to have that sage, then the solution gets implemented and eventually dies out of existence due to lack of business results. Its no wonder that ROI on IT-driven business projects continues to be abysmally low.
I think if IT has to become a real solution provider, the focus must shift from finding solutions to understanding problems. A solution provider is a first and foremost a business problem solver. Therefore, first IT has to understand the problem. Now once you understand the problem, you may find out that the problem you have just understood may just be a symptom and not a root cause. Therefore, you will want to focus on solving the root cause instead of the initial problem. In some other cases, you may find out that solving the problem will not provide the desired results and there may be another related problem that will provide better business results. The key point to note is that once the problem is better understood, you may realize that you don't really want to solve that problem. Best solution may be no solution.
This requires a defined problem solving methodology. Though IT shops have the best and brightest people and some of them individually follow an excellent approach to problem-solving, organizationally, I've yet to come across an IT department that has built an effective problem solving approach. IT is business and IT must become an expert in business problem solving. From this point of view, it is okay to quickly arrive at an initial solution after a quick understanding of the problem. However, this initial solution should remain just that--an initial solution or an initial hypothesis. Once an intial hypothesis is defined, facts can be gathered to solve the problem. If initial hypothesis turns out to be invalid, an alternative hypothesis can be created and tested. This deductive method constitutes the core of problem-solving.
What I see most often is that a solution is found through a gut reaction before the problem is understood. This solution is communicated as the final solution. In the second iteration, facts are selectively searched to confirm the solution. If a selective search of facts does not confirm the solution, then facts can always be twisted to fit the solution with the help of IT consultants. Through psychology of escalation of commitment, good people bet their careers on getting those solutions implemented. After spending millions of dollars if a business is lucky, then from somewhere a sage emerges to point out that the king is naked and the project is finally abandoned. If the business is not lucky enough to have that sage, then the solution gets implemented and eventually dies out of existence due to lack of business results. Its no wonder that ROI on IT-driven business projects continues to be abysmally low.
Saturday, October 3, 2009
Peter Drucker and Marvin Bower
I learnt more from Peter Drucker during my years at Claremont than from anyone else except my father. Peter was my teacher, mentor and guide. At the age of 90 he used to speak non-stop for two to three hours and at that ripe age his memory was sharper than mine. In one of his lectures he mentioned reverently about Marvin Bower, who established the profession of management consulting. Peter and Marvin had worked closely. Peter had been a foremost management consultant and Marvin was the de facto founder and builder of McKinsey & Company. Peter had helped Marvin in setting up management practices at McKinsey.
Working with Marvin, Peter had noted that one of the key reasons of business failure was not wrong answers to right questions but right answers to wrong questions and Peter drilled that into us through myriad examples from his long career in management consulting. Problem formulation was more important than finding the right solution. Problem could only be formulated if there was an acute emphasis on collection of facts. Facts could never be collected accurately if information within a business was distorted by deference to hierarchy. Peter and Marvin had seen that frontline employees were scared to present the facts to their bosses, when those facts were in contradiction with what their bosses wanted to hear. This was one of the reasons Peter and Marvin encouraged flattening of the organizations, candor, informality and broad understanding of reality from multiple perspectives. Both of them put the interest of the client above their own personal interests and exhorted others to do the same. This required that the goals of a business could not be financial. Financial success was an outcome of the client success. They believed that business success and sustainability was based on organization's competence in regenerating leadership internally. Therefore, continuous investment in people was one of their core beliefs. Two of the firms most influenced by their thoughts, viz., McKinsey and GE are leadership factories today. Peter and Marvin understood that maintaining success was hard, since success created its own hubris and what caused success in the past might not be what would create success in future. Therefore, there was a need to develop an aversion to complacency within organization, which could be developed when there was openness and lack of defensiveness.
I listened to Peter for four years at Claremont Graduate University. His voice and the sentences that he uttered still ring in my years. In my own career I have seen validation of Peter's teachings umpteen times. These are the words that have helped me practice the discipline that Peter so diligently taught.
Working with Marvin, Peter had noted that one of the key reasons of business failure was not wrong answers to right questions but right answers to wrong questions and Peter drilled that into us through myriad examples from his long career in management consulting. Problem formulation was more important than finding the right solution. Problem could only be formulated if there was an acute emphasis on collection of facts. Facts could never be collected accurately if information within a business was distorted by deference to hierarchy. Peter and Marvin had seen that frontline employees were scared to present the facts to their bosses, when those facts were in contradiction with what their bosses wanted to hear. This was one of the reasons Peter and Marvin encouraged flattening of the organizations, candor, informality and broad understanding of reality from multiple perspectives. Both of them put the interest of the client above their own personal interests and exhorted others to do the same. This required that the goals of a business could not be financial. Financial success was an outcome of the client success. They believed that business success and sustainability was based on organization's competence in regenerating leadership internally. Therefore, continuous investment in people was one of their core beliefs. Two of the firms most influenced by their thoughts, viz., McKinsey and GE are leadership factories today. Peter and Marvin understood that maintaining success was hard, since success created its own hubris and what caused success in the past might not be what would create success in future. Therefore, there was a need to develop an aversion to complacency within organization, which could be developed when there was openness and lack of defensiveness.
I listened to Peter for four years at Claremont Graduate University. His voice and the sentences that he uttered still ring in my years. In my own career I have seen validation of Peter's teachings umpteen times. These are the words that have helped me practice the discipline that Peter so diligently taught.
Friday, October 2, 2009
Papa's Battle with Cancer
Papa passed away in 2005 in the ICU of SGPGI in Lucknow, India. My mom and sister were outside and my brother and I had gone to buy a medicine. Two days earlier I had landed in USA from India only to turn back and catch another flight back to India after getting a call from my sister. It took me a long time to come to terms with his death from multiple myeloma, a form of cancer. I learnt so much from him. When I was a kid, I told papa that I was not interested in learning English, since that was the language of former colonialists of India. Papa told me that a language did not belong to any nationality or race, it belonged to one who knew it. If you learn it, it will be yours. That irrefutable logic quickly sank in my twelve year old mind.
After his death, whenever I dreamt about him, it was a sad dream. In each one of my dreams I knew that he had cancer and he was not going to live for too long. I cried in my dreams. His cancer was detected in 1997. The harrowing news had totally devastated all of us. After that I had spent several days crying and researching about multiple myeloma, its diagnosis, causes and treatments. I discussed his case with the top cancer specialists at UCLA. I looked into bisphosponates like Pamidronate (Aredia) that had just been proven to reduce the incidence of fractures in myloma patients. I became a member of the Myeloma Foundation and tried to learn as much about it as I could. Aredia was not available in India then, therefore I got it shipped to India. Aredia and later zoledronate certainly helped papa. His treatment using melphalan was successful and around 1999, his cancer went into remission. I felt like we had won a major battle. In 2001, papa and mummy visited USA to live with us for three months. We went around lots of site seeing and we loved it from the depths of our hearts. I was happy like a child. This was one of the most memorable periods of my life. Papa was healthy and in good spirits.
Papa thought that his cancer was cured. Either he was in denial after going through some intense and deeply aggravating chemotherapy or he just did not know much about the disease. You can read all about painful side effects of chemotherapy but only those who have gone through it can really empathize. I knew that the monster was in remission but I had no courage to tell him that. But I was getting ready for the relapse. I had read that thalidomide was proving effective in the treatment of myeloma, Velcade had just been approved in USA by FDA and there was a lot of buzz on the Internet about the efficacy of Trisenox in the treatment of myeloma. Thalidomide was used in the sixties for treatment of morning sickness among pregnant women, which resulted in babies born with deformities of limbs. These babies were called Thalidomide Babies. After that the drug was banned all over the world. After tests had proven its effectiveness in myeloma, FDA approved it on a limited basis and Geraldine Ferraro was one of the first famous people to be treated with it.
A year after papa had returned to India, I came to know that he was not keeping well. He had pain in joints and intermittent fever. Those were all tell tale signs of a relapse. I was certain about the relapse but I lacked the courage to confront the denial or lack of understanding of my parents. I stand guilty of that. Eventually, my sister and I spoke and decided that enough was enough and papa had to go through a very painful bone marrow biopsy. Papa was reluctant but finally agreed. For cancer patients the choices are very hard. Cancer and its treatment, both are more than enough to make their remaining lives extremely miserable. If cancer doesn't kill you, then treatment will.
Papa's treatment started with thalidomide and dexamethasone. Dexa was really hard on him and when he mentioned this to his oncologist, she petulantly stopped dexa right away but continued with thalidomide. This was shocking since thalidomide's effectiveness without dexamethasone is limited. His treatment using thalidomide continued for about three months with no results. Whether his treatment started late or drug regimen was not correct or it was God's will, his blood test now showed that cancerous cells had moved from bone marrow into his blood stream. At this stage survival is a month or two at most. He lived for eight months after that and at one time we felt that he had a second remission. He was treated with Trisenox and then with Velcade. Velcade was a newly approved drug for myeloma and it was not available in India. I called everyone at Johnson and Johnson but they were not ready to start selling it in India. Finally, I bought it in USA and carried it to India with me. It was really too late by that time.
Regarding his treatment with Trisenox, after his death I came to know that that off-label use of Trisenox for multiple myeloma was really an Internet hype created through unethical and illegal marketing efforts of Cell Therapeutics, Inc. (CTI). In 2008 a federal judge awarded whistleblower James Marchese $1.6 million for tipping off federal prosecutors to a scheme by CTI to illegally promote unapproved uses of Trisenox.
I still feel that if I had convinced papa to go for treatment as soon as he had started complaining about joint pain and fever and put him straight on treatment using Velcade, the chances of his achieving a second remission would have been quite high. That guilt will perhaps stay with me for the rest of my life.
Just about two weeks before papa passed away he had an episode of shingles (herpes zoster) on his forehead. Shingles is common among multiple myeloma patients. Papa was in extreme pain. My sister had asked me to come fast to meet with him. I bought a ticket from LAX to Hongkong and boarded the flight. From Hongkong, I flew to Bangkok and from Bangkok to Bombay and from there to Lucknow. That took me more than 36 hours to reach home. It was late evening, when I got home. When papa saw me standing by his bed, he smiled at me and said that I was late, since he had been expecting me to reach in the morning. That was my last conversation with papa. My aunt told me that that was the first time she had seen him smile in several days.
Papa was in pain but he did not want to go to hospital. Against his will, we took him to hospital, where he breathed his last. I'm never going to meet him again but if I could do it all over again perhaps I'd have stayed with him at home and I'd have requested the doctor to put him on some strong pain killers. While I did everything to provide all the treatment options that were available at that time, I could not do much to improve the quality of his life towards the end. That pain will stay with me forever.
The last lesson that papa gave me through his battle with cancer was that discovery of truth was not enough. Truth has to be told, whether it is expedient or not. Ultimately, we have to face reality. Facts can never be covered for too long and must never be covered. Denial cannot withstand the storm of facts. Discovery of truth requires that you always ask for evidence even from those who are respected in their profession and scrutinize the evidence carefully to ensure that the results can be applied to a given situation. Finding a solution and then searching for evidence that supports the solution will positively lead you in the wrong direction. I owe my candor to papa. His lessons are deeply embedded in my personality. Today when I state facts, which may be inconvenient to me or my team or when I ask for empirical evidence, its not a job. Its a tribute to papa from deeply embedded intergenerational learning that has become part of my DNA.
After his death, whenever I dreamt about him, it was a sad dream. In each one of my dreams I knew that he had cancer and he was not going to live for too long. I cried in my dreams. His cancer was detected in 1997. The harrowing news had totally devastated all of us. After that I had spent several days crying and researching about multiple myeloma, its diagnosis, causes and treatments. I discussed his case with the top cancer specialists at UCLA. I looked into bisphosponates like Pamidronate (Aredia) that had just been proven to reduce the incidence of fractures in myloma patients. I became a member of the Myeloma Foundation and tried to learn as much about it as I could. Aredia was not available in India then, therefore I got it shipped to India. Aredia and later zoledronate certainly helped papa. His treatment using melphalan was successful and around 1999, his cancer went into remission. I felt like we had won a major battle. In 2001, papa and mummy visited USA to live with us for three months. We went around lots of site seeing and we loved it from the depths of our hearts. I was happy like a child. This was one of the most memorable periods of my life. Papa was healthy and in good spirits.
Papa thought that his cancer was cured. Either he was in denial after going through some intense and deeply aggravating chemotherapy or he just did not know much about the disease. You can read all about painful side effects of chemotherapy but only those who have gone through it can really empathize. I knew that the monster was in remission but I had no courage to tell him that. But I was getting ready for the relapse. I had read that thalidomide was proving effective in the treatment of myeloma, Velcade had just been approved in USA by FDA and there was a lot of buzz on the Internet about the efficacy of Trisenox in the treatment of myeloma. Thalidomide was used in the sixties for treatment of morning sickness among pregnant women, which resulted in babies born with deformities of limbs. These babies were called Thalidomide Babies. After that the drug was banned all over the world. After tests had proven its effectiveness in myeloma, FDA approved it on a limited basis and Geraldine Ferraro was one of the first famous people to be treated with it.
A year after papa had returned to India, I came to know that he was not keeping well. He had pain in joints and intermittent fever. Those were all tell tale signs of a relapse. I was certain about the relapse but I lacked the courage to confront the denial or lack of understanding of my parents. I stand guilty of that. Eventually, my sister and I spoke and decided that enough was enough and papa had to go through a very painful bone marrow biopsy. Papa was reluctant but finally agreed. For cancer patients the choices are very hard. Cancer and its treatment, both are more than enough to make their remaining lives extremely miserable. If cancer doesn't kill you, then treatment will.
Papa's treatment started with thalidomide and dexamethasone. Dexa was really hard on him and when he mentioned this to his oncologist, she petulantly stopped dexa right away but continued with thalidomide. This was shocking since thalidomide's effectiveness without dexamethasone is limited. His treatment using thalidomide continued for about three months with no results. Whether his treatment started late or drug regimen was not correct or it was God's will, his blood test now showed that cancerous cells had moved from bone marrow into his blood stream. At this stage survival is a month or two at most. He lived for eight months after that and at one time we felt that he had a second remission. He was treated with Trisenox and then with Velcade. Velcade was a newly approved drug for myeloma and it was not available in India. I called everyone at Johnson and Johnson but they were not ready to start selling it in India. Finally, I bought it in USA and carried it to India with me. It was really too late by that time.
Regarding his treatment with Trisenox, after his death I came to know that that off-label use of Trisenox for multiple myeloma was really an Internet hype created through unethical and illegal marketing efforts of Cell Therapeutics, Inc. (CTI). In 2008 a federal judge awarded whistleblower James Marchese $1.6 million for tipping off federal prosecutors to a scheme by CTI to illegally promote unapproved uses of Trisenox.
I still feel that if I had convinced papa to go for treatment as soon as he had started complaining about joint pain and fever and put him straight on treatment using Velcade, the chances of his achieving a second remission would have been quite high. That guilt will perhaps stay with me for the rest of my life.
Just about two weeks before papa passed away he had an episode of shingles (herpes zoster) on his forehead. Shingles is common among multiple myeloma patients. Papa was in extreme pain. My sister had asked me to come fast to meet with him. I bought a ticket from LAX to Hongkong and boarded the flight. From Hongkong, I flew to Bangkok and from Bangkok to Bombay and from there to Lucknow. That took me more than 36 hours to reach home. It was late evening, when I got home. When papa saw me standing by his bed, he smiled at me and said that I was late, since he had been expecting me to reach in the morning. That was my last conversation with papa. My aunt told me that that was the first time she had seen him smile in several days.
Papa was in pain but he did not want to go to hospital. Against his will, we took him to hospital, where he breathed his last. I'm never going to meet him again but if I could do it all over again perhaps I'd have stayed with him at home and I'd have requested the doctor to put him on some strong pain killers. While I did everything to provide all the treatment options that were available at that time, I could not do much to improve the quality of his life towards the end. That pain will stay with me forever.
The last lesson that papa gave me through his battle with cancer was that discovery of truth was not enough. Truth has to be told, whether it is expedient or not. Ultimately, we have to face reality. Facts can never be covered for too long and must never be covered. Denial cannot withstand the storm of facts. Discovery of truth requires that you always ask for evidence even from those who are respected in their profession and scrutinize the evidence carefully to ensure that the results can be applied to a given situation. Finding a solution and then searching for evidence that supports the solution will positively lead you in the wrong direction. I owe my candor to papa. His lessons are deeply embedded in my personality. Today when I state facts, which may be inconvenient to me or my team or when I ask for empirical evidence, its not a job. Its a tribute to papa from deeply embedded intergenerational learning that has become part of my DNA.
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