The Expanding Classroom

Answer by James Fisher:

Short answer: create and keep customers (a phrase I stole from Peter Drucker).

(Slightly) longer answer: Marketing managers manage demand. This typically involve a mix of strategic and tactical roles and responsibilities.

At the strategy level, the key responsibilities have to do with market selection and product policy (including, for example, new product development). Market selection requires skills typically have to do with market analysis, marketing research, market segmentation and forecasting. The matching of market needs with the firm's offerings and how those offerings are positioned in the marketplace with respect to the customers' preferences and the competitors' own positional advantages and disadvantages is the arbiter of success and a more-or-less on-going challenge.

Tactical considerations involve translating the more conceptual elements of strategy in more concrete expressions that will typically involve people, programs and money. Thus successful marketing managers often have good people skills, but are also capable of careful and effective planning, programming and budgeting.

Marketing managers typically have their feet in two worlds — the firm and the more external operating environment. The strategic maneuvers require imagination as well as critical-analysis, which get expressed as good positioning strategies and compelling value proposition. Extra credit for clarity, simplicity and impact. Tactical determinations require strong executional skills: motivating, communicating and monitoring.

Tactics are often summarized as the four (4) P's: product, price, promotion and place. Strategy is focused on the imperative of growth as it relates to sales and profitability.

What are the roles and responsibilities for a marketing manager?

An op-ed I wrote on the occasion of George Washington’s Birthday in 2015. I shopped it at the St. Louis Post-Dispatch, but, alas, they did not pick it up.

It should be noted that in Parson Weems’ account of the boy’s unflinching truth-telling – “I cannot tell a lie, Pa” – the circumstances were hardly conducive to any evasion of responsibility. A new hatchet in his possession combined with the felled cherry sapling near the family home provided all the circumstantial evidence necessary to indict the young George Washington.

Let us brush aside for the moment any concerns that the little vignette is itself apocryphal. (The account did not make its way into Weems’ best-selling The Life and Memorable Actions of George Washington until the fifth edition.) The story still works and at more than one level. The virtue of courageous truth-telling also seems to presage the political wisdom of letting the story out, the better to manage its damaging consequences. And, indeed, in Weems’ spinning of the tale the elder Washington is deeply moved by his son’s honesty and all is forgiven.

Washington’s birthday might serve as a useful occasion to reflect on the value of honesty, but also to reconsider the persistent human tendency to shade the truth, if not obscure it outright. I was disappointed to learn recently that Jack Webb in his portrayal of Detective Sergeant Joe Friday on the Dragnet series never really insisted on “just the facts, ma’am.” But maybe it’s just as well, because who among us really wants to let the facts speak for themselves. And so we gild the lily. We take the unvarnished truth and, well, varnish it. Or at least some do, though the coat may be sparingly applied.

There is more than a little social science to support this contention, and it’s buttressed by clever experimental manipulations to measure how much pressure we apply to the boundaries of honesty or how far our transgressions will take us when and if we cross the line.

Dan Ariely, a professor of psychology, and his academic colleagues report several studies in which the occasion for telling falsehoods about one’s accomplishment is altered in ways that make the risks and rewards of dishonesty vary with experimental conditions.

In the lab, these social scientists give you wide berth to lie more or less or not at all. The risk of detection can be dialed up or dialed down or virtually eliminated. Even proxies for moral moments have their role in these series of experiments. The run-up to the moment of truth or its erosion can be “primed” with reminders of religious strictures or ethical codes.

The empirical findings are themselves rich and nuanced. They deserve a close reading, and Ariely’s findings have been popularized in his best-selling Predictably Irrational and his TED talks that have similarly found a huge audience online. But here’s his own pithy summary: “So we learned that people cheat when they have a chance to do so, but they don’t cheat as much as they could. Moreover, once they begin thinking about honesty – whether by recalling the Ten Commandments or by signing a simple statement – they stop cheating completely.”

A marvelous balance is on display here. Context obviously matters. Circumstances can nudge us toward higher ethical standards or tempt us play a little lose with the facts. I emphasize the diminutive here because, as Ariely would have it, we don’t cheat as much as we could. This seems, on balance, a good thing. Character counts, but so does our delicate self-image. We don’t tell the big lie in part because it would be inconsistent with our conviction, renewed every morning, that the face we see in the mirror is that of a fundamentally honest person.

My fellow social scientists continue to report intriguing empirical studies on what can erode your propensity to tell the truth. A recent research letter[1] in the prestigious journal Nature focused on how one’s professional role might explain our decisions, at the margin, to be more or less honest. Alain Cohn and his colleagues from the University of Zurich, in a serious of experiments similar to the ones conceived by Ariely, provide suggestive evidence that “the prevailing culture in the banking industry weakens and undermines the honesty norm” – a finding that will no doubt lead some cynics to conclude that academicians do indeed have a complete grasp of the obvious.

The recent episode with NBC news anchor Brian Williams seems illustrative of just how wobbly human agency can be when measured against high standards for honesty. Memory and motive comingle so that details of the story change and accounts vary. How well should we in St. Louis know this?

Perhaps as details in William’s story have changed in small ways in his retelling of it, a new and fundamentally false one emerged. In the same way, the tensions inherent in his professional role of news anchor also became his undoing. There seems little doubt that those in front of the camera now command their multi-million dollar contracts as much for their star power as for their journalistic talents. The sober newscaster collided with the charismatic storyteller and truth was one of the casualties. To paraphrase the late Daniel Moynihan, we are all entitled to our own stories, but not our own facts.

[1] Cohn, Alain, Ernst Fehr and Andre Marechal, “Business culture and dishonesty in the banking industry, Nature, Volume 516, December 2014, pp. 86-88.

Answer by James Fisher:

The nexus of real-life events depicted in The Exorcist was indeed Saint Louis University (SLU), a Jesuit school, where I happen to be a professor. I've traded on my SLU connections to run down some of the elements in this story.

Yes, it was a boy, who was "possessed." He was a 13-year-old kid from Maryland and not the 12-year-old girl depicted by Linda Blair in the movie.

The train of events evidently got underway with some urgency in January of 1949. The family reported disturbing events surrounding their youngster: scratching sounds emanating from the walls, dripping water, the unexplained movement of objects, including the boy's mattress. A hypothesis emerges: the boy is plagued by the spirit of a recently deceased aunt, who according to family lore introduced the boy to the Ouija board.

It turns out that the boy and his family are not Catholics, so they hie themselves to a Lutheran minister with something of a reputation for things paranormal. The Reverend Luther Miles Schulze doesn't mince words, delivering an earnest piece of advice: "Go to a Catholic priest; the Catholics know about this kind of thing."

The family follows this advice and go to a local (still in the Maryland area) priest, who offers them some holy water and candles, but little else on this first visit. The priest, E. Albert Hughes, subsequently asks the archbishop of Washington, D.C., for permission to perform an exorcism on the boy. It's unsuccessful.

Things get weirder. Unexplained scratches appear on the boy's body, culminating with the word "LOUIS" emerging in relief along his rib cage. The family interpret this as a sign to take the boy to St. Louis, where they have relative attending, yes, you guessed it, Saint Louis University.

Enter the Jesuits. Several of them. The SLU student contacts her professor Father Bishop, who brings in his friend, another Jebbie and World War II combat veteran, William Bowdern, S.J, who also happens to be the pastor of St. Francis Xavier College Church. Paul Reinert, another Jesuit and then President of SLU gets consulted, as does St. Louis Archbishop Joseph Ritter. An exorcism it will be. According to the Roman Ritual. And Father Bowdern will do it. Other priests are enlisted, as are the Alexian Brothers.

Here's an account from a SLU publication, Universitas:

The process ended up taking more than a month, during which Bowdern fasted…[F]amily members participated in or witnessed the rite, which always began in the evening.

"The pattern was that the boy would act normally during the day, and then he would put on his pajamas and go to bed, and go into a trance and start screaming and yelling and acting wild," said [Thomas B.] Allen [author of Possessed: The True Story of an Exorcism]….

The exorcism continued on almost a nightly basis, even though the boy seemed to be getting worse. The priest asked his family for permission to teach him about Catholicism and convert him as a way to strengthen the fight against the supposed demonic possession. As he got closer to conversion and making his first holy Communion, his episodes become increasingly violent.

On April 18, the day after Easter Sunday, the exorcism appeared to have succeeded. An entry from Bishop's diary reads: "Since Monday at 11 p.m. there have been no indications of the devil."

The boy, whose precise identity is not public knowledge, left St. Louis and never experienced anything like demonic possession again. He married in 1970 and has raised a family.

More about this story is available in Allen's book, cited above, and in Saint Louis University's Universitas, Spring 2014 issue: Saint Louis University : SLU

What elements in William Peter Blatty's The Exorcist are rooted in the real-life exorcism performed in and around Saint Louis University?

#healthcare #EHR

Answer by James Fisher:

The questioner asks us Where will they go? And this is the angle I want to explore, because I think the patient portal is taking us down the road to a personal-controlled electronic medical record and this, more generally, to a veritable explosion of personal health care data. This will be, I believe, one of the most important and far-reaching trends in the 21st century.

A Closer Look
To illustrate let me begin with an unlikely source, namely, Simon Cowell. This is from his Rolling Stone interview, April 6, 2006:

INTERVIEWER: What do you want more than anything else in the world?

COWELL: Money. As much money as I can get my hands on. It’s as simple as that.

INTERVIEWER: I read that you’re worth something like $90 million. Not enough?


INTERVIEWER: If you could perform one miracle, what would that miracle be?

COWELL: That tricky. Do suit others of do I suit myself? If I’m being honest with you, I’d probably be to have 1 billion pounds put in my bank account, and then I’d ask the bank statement to magically appear on my desk so I could stare at it from all angles.

INTERVIEWER: Do you think you’re shallow?

COWELL: Yes, I do.

The thing that captures my fascination with this conversation is the evocation of Simon’s gaze, intently focusing on bank balance “from all angles.” Because, really, what’s more interesting than information about ourselves? Maybe financial information now, but one day—very soon—it will be personal health data.

Finance as Analogy
The patient portal is roughly analogous to the electronic financial portal we have into our primary financial institution. You interested at all in that? Check it often? From different devices? Maybe even from all angles?

Of course this financial portal is convenient, and now with more capabilities being introduced (e.g., paying bills, cashing checks, moving money) it’s becoming increasingly useful. But as a full picture of, say, our financial health, it’s incomplete, a myopic or one-dimensional view. Maybe we relate to other financial institution, maybe we have a brokerage account, a retirement fund, credit cards, loans, assets, etc.

Enter a data integration application like Mint or one of its competitors and you start to get a fuller picture: a view of you assets and liabilities, your overall cash position, maybe a summary of your spending and your budget variances. But wait, there’s more: Mint will alert you to upcoming bills, maybe advise you to consider a financial product suited to your lifestyle and its corresponding habit. Maybe it will suggest you consider re-financing your house or a college fund for the kids. You get the picture. Data are aggregated, presented in an accessible and pleasing UI/UX; these same data are analyzed and interpreted and then delivered in the form of financial prescriptions that could, quite possibly, improve your economic well-being.

This integration layer and the overall information sophistication of financial services are pretty decent. The healthcare industry, by contrast, is a much earlier stage of evolution. The patient portal is an important, albeit partial, step.

Patient Portals Are Not all the Same
At present, patient portals are essentially online applications that allow patient to interact, transact and communicate with their healthcare providers. Thus the core functionality (potential benefit) delivered by the patient portal is to enable patients to interact with their medical information via electronic means. Additionally, as functionality gets established and use cases extend, these patient portals will potentially yield an impressive array of services, but we’re nowhere close to that now.

In fact, there is a great deal of variation among patient portal at present (2013).  Some patient portal applications exist as stand-alone websites. Some of these stand-alone websites may be linked to or otherwise affiliated with a sponsor, for example, an employer or a wellness program.

Further distinctions get made about the connectedness or control of these portals. Some may be entirely or largely under the patient or individual’s direct control and considered, therefore, to be untethered. Other patient portals are integrated into the existing website of a healthcare provider, say, a physician or practice group or hospital. These are typically considered tethered.

In a similar vein, some patient portals exist as an add-on module to an existing electronic medical record. And some vendors, like Epic, will offer both a patient portal module to its EHR (MyChart) as well as a personal health record (Lucy).

Though patient portals are frequently conceived of as a module to the EHR (as illustrated in the previous example with Epic), it is just as valid and useful to conceptualize patient portals along the dimension of functionality. Some have this function, some have that; some have more, some have less.

Patient Portals and Healthcare Apps
These facts on the grounds would seem to auger the rapid development and widespread availability of health care apps (available on the Web and on mobile devices) that focus on a specific use or on a more narrow range of uses.

Development strategies may, therefore, bifurcate between organizations (e.g., hospital systems, medical practices, pop-up clinics, employers, wellness programs, insurers) that offers a range of what it anticipates will be popular or useful functions and use cases and the development community that focuses of very specific and targeted applications that the health care providers and consumers qua patients would select from an app store.

With all these distinctions to be made, it is not surprisingly that the meaningful differences among portals, applications, electronic medical records, personal health records and even health information exchanges are starting to blur or otherwise cause confusion.

At same time, each stakeholder in the healthcare system (e.g., patients, physicians, practices, hospitals, insurers) relies on the portal effectively serving the needs of other stakeholders. Better health outcomes—sought by insurers and healthcare providers—are unlikely to be forthcoming without patient engagement and utilization of the portal. Personal control sought by patients similarly depends on access to relevant data (and data originating from a variety of sources) and participation by those in the larger health ecosystem if the locus of control is to be sufficiently broad and meaningful.

Whither Patient Portals?
So these musing provide the basis for some preliminary conclusions about the patient portal and its future:

  1. Data richness is a key driver of the ultimate utility derived from of a patient portal. So, too, is access to the data and the capacity to add or write appropriately to it.
  2. Context counts. Utility of patient portals will also be shaped by their functionality and the context in which they are used. This utility can be captured in different ways by different stakeholders at different stages in the healthcare delivery process.
  3. User interface and user experience will separate the winners from the losers. Delivery of best experience yields a host of advantages, including patient engagement, utilization rates and improved outcomes,

The Big Picture
So the patient portal really opens the door to a world in which personal health data gets big, gets shared and applied and then, ultimately, gets results.

More specifically, I think we will see a proliferation of medical devices—most of them miniature or otherwise unobtrusive—and these will start to contribute or write to our medical records.  Just think how much more utility this personalized health data will have as we start to get real-time data instead of the static measures that get taken at the doctor’s office or at the patient’s bedside. Devices like FitBit and Nike’s Fuelband are now getting dramatic uptake in the fitness market.  I wouldn’t be surprised to see these devices or ones like them starting to attach or to write to personalized health records—perhaps through the patient portal.

So personal health data will get big and get big fast. As it does it will get tapped in valuable ways. Build these data, make them accessible and the developers will come. Patients—maybe we should just call them consumers—will become empowered as they capture the data and find novel ways to apply it. Data will be shared more widely. Privacy concerns notwithstanding, personal healthcare data will get exchanged much faster, more productively within the healthcare system and beyond. The fitness and personal training market will gain deeper insights and greater relevance as they assume more data-driven approaches. Social media will similarly have its role in this data-enriched environment, connecting people to valuable resources, keeping them on track with their respective health agenda and gamifying efforts to get fit and stay well. Personal health will be less a medical monopoly as a wider network gets applied. Algorithms and artificial intelligence will have a role in screening populations, alerting people at risk and preventing potential health crises.

The patient portal is a catalyst for much of this, an organizing principle for both the collection of data and the dissemination of information services and, most certainly, behavioral modification. At present, patient portals are fairly sterile conduits of limited medical information and thus probably not attracting many eyeballs, but as the data are enriched, as the UI/UX experience gets elevated, and as the data get shared and applied in engaging and helpful ways they will draw users seeking a host of benefits and, who knows, wanting to stare at it from all angles.

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As a young graduate student (well, relatively speaking) I became interested in social class and its measurement. I revisited the topic on Quora by showcasing one of the more interesting and robust social class yardsticks: The Living Room Scale. Was interested to see that it has been revised a couple times: once by Paul Fussell and then more recently by fellow St. Louis academician, Robert Keel.

Answer by James Fisher:

If you must know, then apply the highly reliable and largely valid Living Room Scale.

Take up a position in your living room and start your tally with 100 points. Add or subtract accordingly:

Hardwood floor, add 4

Parquet floor, add 8

Stone floor, add 4

Vinyl floor, subtract 6

Wall-to-wall-carpet, add 2

Working fireplace, add 4

New oriental rug or carpet, subtract 2 (each)

Worn oriental rug or carpet, add 5 (each)

Threadbare rug or carpet, add 8 (each)

Ceiling ten feet high, or higher, add 6

Original paintings by internationally recognized practitioners, add 8 (each)

Original drawings, prints, or lithographs by internationally recognized practitioners, add 5 (each)

Reproductions of any Picasso painting, print or anything, subtract 2 (each)

Original paintings, drawings, or prints by family members, subtract 4 (each)

Windows curtained, rods, and draw cords, add 5

Windows curtained, no rods or draw cord, add 2

Genuine Tiffany lamp, add 3

Reproduction Tiffany lamp, subtract 4

Any work of art depicting cowboys, subtract 3

Transparent plastic covers on furniture, subtract 6

Furniture upholstered with any metallic threads, subtract 3

Cellophane on any lampshade, subtract 4

No ashtrays, subtract 2

Refrigerator, washing machine, or clothes dryer in living room, subtract 6

Motorcycle kept in living room, subtract 10

Periodicals visible, laid out flat:
  National Enquirer, subtract 6
  Popular Mechanics, subtract 5
  Reader’s Digest, subtract 3
  National Geographic, subtract 2
  Smithsonian, subtract 1
  Scientific American, subtract 1
  New Yorker, add 1
  Town and Country, add 2
  New York Review of Books, add 5
  Times Literary Supplement (London), add 5
  Paris Match, add 6
  Hudson Review, add 8

Each family photograph (black-and-white), subtract 2

Each family photograph (color), subtract 3

Each family photograph (black-and-white or color) in sterling-silver frame, add 3

Potted citrus tree with midget fruit growing, add 8

Potted palm tree, add 5

Bowling-ball-carrier, subtract 6

Fishbowl or aquarium, subtract 4

Fringe on any upholstered furniture, subtract 4

Identifiable Naugahyde aping anything customarily made of leather, subtract 3

Any item exhibiting words in an ancient or modern foreign language, add 7

Wooden venetian blinds, subtract 2

Tabletop obelisk of marble, glass, etc., add 9

No periodicals visible, subtract 5

Fewer than five pictures on walls, subtract 5

Each piece of furniture over 50 years old, add 2

Bookcase(s) full of books, add 7

Any leather bindings more than 75 years old, add 6

Bookcases(s) partially full of books, add 5

Overflow books stacked on floor, chairs, etc., add 6

Hutch bookcase ("wall system") displaying plates, pots, porcelain figurines, etc., but no books, subtract 4

Wall unit with built-in TV, stereo, etc., subtract 4

On coffee table, container of matchbooks from funny or anomalous places, add 1

Works of sculpture (original, and not made by householder or any family member), add 4 (each)

Works of sculpture made by householder or any family member, subtract 5 (each)

Each framed certificate, diploma, or testimonial, subtract 2

Each "laminated" ditto, subtract 3

Each item with a ‘tortoiseshell’ finish, if only made of Formica, add 1

Each “Eames chair”, subtract 2

Anything displaying the name or initials of anyone in the household, subtract 4

Curved moldings visible anywhere in the room, add 5

245 and above: upper class
185 to 245: upper middle class
100 to 185: middle class
50 to 100: higher proletariat
Below 50: lower proletariat
The Living Room Scale originated with sociologist F. Stuart Chapin over 75 years ago in his book Contemporary American Institutions (1935). The version provided here is a revision by the late cultural historian, Paul Fussell, in his book Class (1983). My fellow St.Louisan, Robert Keel, himself a sociologist, updated the scale in 1999. You will find it at THE LIVING (

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Answer by James Fisher:

The seeds of the sixties are largely located the swirl of social currents that precipitated shifting social attitudes and sweeping social change. Values, lifestyles and institutions all received special scrutiny and challenge at different times and from different quarters.

Theodore Roszak in his The Making of a Counter Culture (1969) alludes to the historical antecedent of the sixties:

Why and how this generation lost control of the institutions that hold sway over its life is more than we can go into here.  The remembered background of economic collapse in the thirties, the grand distraction and fatigue of the war, the pathetic if understandable search for security and relaxation afterwards, the bedazzlement of the new prosperity (pp. 22-23). 

Thus the so-called Generation Gap was one of the root causes. The hippies gave the movement a distinctly anti-establishment character, rejecting certain values they labeled materialistic, business interests they characterized as rapacious and politics they lampooned while protesting and attacking its leaders and practitioners as bellicose and lacking moral authority. In this regard the signal issues of the day–the Vietnam War and civil rights–gave credence to certain aspects of the Hippie indictment of society's institutions. And perhaps those flash-points broadened the appeal of the Hippie movement while also giving it a moral dimension if not exactly depth.

Hippies were non-conformist in their intention and anarchist in their practice, a heady mix of  idealism and rebellion. Clothing, hair and personal hygiene were all outward expressions of an internal and seemingly abrupt about-face on the current establishment. Timothy Leary’s famous advice to turn-on, tune-in and drop-out was but a psychedelic variant of a lifestyle exploration that, for many, combined an inward search with a outward release of pretense. 

Though emphatically non-materialistic, the idealized lifestyle was unabashedly hedonistic:“if it feels good, do it!” was one of the more common mantras of
the sixties and the hippies that embodied so much of its spirit.

I remember. I was there.

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Super Bowl XLVI kicks off today. It’s a quintessential American spectacle, blending competition and commerce seamlessly.

Just yesterday, I taught a marketing class that featured a case on advertising, so we took some time before our case discussion to consider the larger significance of the Super Bowl as a widely observed ritual here in the United State—one that’s increasingly reaching a global audience. It’s a celebration embedded deeply in our culture, having been joined securely at the hip to the institution of advertising.

The Super Bowl is one of a handful of really big shows that can command a truly national audience. With the proliferation of cable, on-demand entertainment and DVRs there are few, if any, occasions for an advertiser to draw anywhere near the audience that a Super Bowl commands. This year well over one hundred million viewers will tune in. I have seen estimates that perhaps half of all Americans will view some part of the Super Bowl. What will you be doing?

The bonanza for advertisers is that many, many viewers are just as interested in the advertising that accompanies the Super Bowl as they are in the action on the field. This interest spills over into the following days as discussions about the Super Bowl ads enliven water-cooler conversations, media accounts and Internet chatter. For a brief respite the advertising mavens escape their subordinate, supporting role as the subsidizers of commercial media. Advertisers take a holiday from their so-called interruption model on Super Sunday. For many, it’s the main event.

So how might advertisers want to take advantage of this special opportunity? Let me count the ways:

1. Get on the consumer’s radar: Awareness is the coin of the realm in mass communications. It’s hard to find a large audience and then when you do it’s often difficult to make an impression. So advertising on the Super Bowl will be enlisted to announce what’s new: new TV shows, new products, new styles and fashions. Over-the-top executions will drive home the impression.

2. Keep a brand’s forward momentum: Strong advertising campaigns can reassert their dominance with a strong Super Bowl presence. So this year, watch for the E*Trade baby, back for something like his fifth year. You’ll recognize other familiar campaigns, icons and, of course, the usual cast of animals: chimps, dogs, Clydesdales, polar bears, etc.

3. Update the viewer: Have you driven a Ford lately? If not, then the Super Bowl is excellent venue to suggest as much. So watch for marketers to tell you what’s new and improved. If an image needs polished or re-positioned then no better stage than the super bowl to do so. Dannon Oikos Greek Yogut is a good example of the stratagem this year.

4. Cement customer loyalty: People always pay closest attention to advertisements for products they already own. So as you eat your Doritos and swill your Bud Light you can likely depend on the corresponding ads to reinforce your behavior.

5. Demonstrate your advertising chops: You go-pro on the Super Bowl. For an up and coming ad agency, this worldwide stage showcases your work like nothing else. Creative, break-through advertising get announced to the gatekeepers and influencers that keep watch over the ad industry. And, of course, potential clients are watching as well.

Kick-off is at 6:30 pm ET. But advertisers will have put points on the board even before the coin toss.


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