When you apply skepticism and care in equal amounts, you get bliss.

Author: akshay

Decommissioning Technology Centered Theories of Change
If you look closely, many theories of change in public health where technology is involved has, at its heart, the following idea:

Adopting Technology -> leads to -> Better Health

This is a meaningless assumption guided by the hype around what technology can accomplish and the wishful thinking on solving large problems.

Firstly, technology is a large, amorphous, heterogenous categorization of human innovations. There are thousand different kinds of technology. One could say anything that human beings have made is technology.

Wikipedia says: “Technology is the sum of any techniques, skills, methods, and processes used in the production of goods or services or in the accomplishment of objectives”

Oxford dictionary says: “scientific knowledge used in practical ways in industry, for example in designing new machines”

Here is a list of things. Pick the ones you think are technology:
- MRI machine
- Stethoscope
- Instant messaging app like WhatsApp
- A paper tea cup
- Polio vaccine
- Mobile phone
- Solar panel
- Wallet
- Pen
- Clothes
- Fishes
- Scissors
- Fan
- Ubuntu linux
- Paracetamol
- Breast milk
Generalizations like “adopting technology will improve universal health coverage” are as useful as saying “human innovations will improve universal health coverage”.

The second problem with the unquestioning acceptance of technology is that technology isn’t always positive, or even value neutral.
- Nuclear bomb
- Pegasus spyware
- Deepfake
- Fake news bots
- Addictive apps
- Fossil fuel
- Heroin
Now if you are a tech-bhakt, your primary reaction to the above list is “Oh, but you know, these are just harmful uses of an otherwise good/neutral technology. It is a human problem, not the technology’s problem.” But please read on carefully.

The world we live in is populated by an increasing number of human beings. And human beings interact with technology in many ways. Some are predictable, some are unpredictable. The effect that a technology has on anything cannot be assumed to be “universally positive”. That effect has to be studied and understood.

That is not an argument against developing technology. It is an argument only against how technology is advertised and incorporated into human life. Technology should not be pushed into systems without weighing the potential advantages and potential harmful effects it can have. Such push can be counter productive if the real harms outweigh the real benefits.

Any use of technology will lie in a spectrum that ranges from extremely beneficial to extremely harmful. It takes discretion to identify where on the spectrum it lies. That human discretion, rationality, and scientific temper is what we need to develop in theories of change surrounding technology in public health.

***

Now that we have accomplished that technology in public health needs to be evaluated on an intervention-by-intervention basis, we can look at some specific examples.

Digital (enabled) delivery of healthcare

This vague concept is a slice of the “technology” concept we discussed above. Digitally enabled healthcare delivery can mean anything. Is it digitally enabled if I use a digital thermometer or a digital blood pressure device? Is it digital delivery if I’m doing a consultation over WhatsApp video call?

Let’s take a plausible example. A hospital information management system with electronic medical records and teleconsultation. This probably is something that many people have in mind when they’re talking about things like “medical and diagnostic connectivity throughout life course for every individual” or “sophisticated early warning systems leading to better preventative care”.

That example brings up a lot of questions. Which hospital are we talking about? Where is it located? Who are the beneficiaries and users of these? What kind of skills are we talking about? What kind of resources are available in these settings? What costs in terms of attention, time, effort, fatigue, etc are involved in utilizing these systems? What kind of software is available? How practical are the benefits? What are the challenges in taking data out of an EMR system and building early warning systems out of it? What foundational technologies are we lacking to build such systems? How will data from EMRs be analyzed? Who will do the analysis? What are the political processes occurring in India which could be connected to these? What are the incentives given to private sector in this? What are the protections required for patients? What are the support structures required for healthcare workers? Who is this intervention aimed to benefit? How does it affect health equity? Is it solving a problem that has been expressed by the community that it is being incorporated in?

These and countless other questions have to be answered before considering whether an intervention like above will lead to the impact that it is assumed to produce. Now, as is evident from these questions, the answers will vary widely depending on the settings. It might (or might not) produce an overwhelmingly positive impact in a super-specialty hospital in Koramangala for a software developer working with Infosys. It might not produce a similar impact in a PHC in Koppal for a NREGA dependent person. Unfortunately a lot of Indians are of the latter kind.

Techno-legal regulations

Here is another vague slice. Of course technology has to be regulated. Technology has always been regulated. It is just some newer technologies which are only slowly getting regulated. Things like databases and software platforms. The concern that regulations try to address in here are “Citizen rights, privacy and dignity”, “reducing technological inequities, algorithmic bias”, etc.

But “regulations”, like “technology” are not a sure-shot solution to anything. A lot of regulations stifle technology but doesn’t help fulfill the purpose it was meant to be either. Take the telemedicine guidelines released in March 2020, for example. In an attempt to enable telemedicine, it restricted the kind of diagnoses and prescriptions that can be made over telemedicine.

Getting regulations right is super hard. In the case of software based technology, even when regulations are right and tight, people tend to find loopholes rather quickly. Because software can quickly be adapted, it is possible to follow regulation and still continue doing bad stuff. Take how after GDPR came into place requiring consent for cookie use, so did dark patterns in cookie consent pop-ups.

India has a government which went to the Supreme Court to argue that privacy is not a fundamental right. When the government itself is involved in treating human beings as citizens to be controlled through surveillance, what insulation can regulations provide to human rights like privacy?

In other words, “equitable, people-centered and quality health services” and “improved accountability and transparency in the health system” cannot come through techno-legal solutions when the democracy does not have those in its priority list. Surely, technology and law can be instruments of social transformation. But only in the right hands.

There is no question of equity and people-centeredness emerging out of a process that does not have representation of people in it. What about quality? There are already some frameworks for quality in healthcare service. NHSRC, NABH, etc have various accreditation policies for hospitals. It takes a lot of work to build a culture of quality in a complex organism like a hospital, let alone health system. Culture is not something technology can fix.

Technology can be omnipresent. But a human cannot yell at a machine to get justice. That technology can lead to better accountability is a dream. The game where technology rapidly adapts to regulations and finds loopholes – human beings are 10 times better than machines in that game. Any accountability system based on technology will be gamed by human beings.

To see how technology and law affects transparency, one just has to look at what is happening to Right To Information act in our country today. No matter how “sophisticated” our technology gets, human beings are going to remain human beings.

***

And that is where “trust in the health system” comes in. How should human beings trust a system that doesn’t listen to them, negates their experiences, puts barriers in front of them in accessing healthcare, reduces health to the singular dimension of curative services (or recently vaccinations), treats them as undeserving, and regularly intrudes and violates their right to life and bodily integrity? What app should they install to download some trust?

Discussions on technology in public health need to wait till we discuss who our health systems are for. And once we have an answer on that, we should invite those people to the table. And when they state the problems that they face in leading a healthy life, those are the problems to be solved. Work backwards from there and you’ll realize that a lot of what we have are problems that don’t require technology to command citizens, but instead require human beings to listen to human beings.
March 9, 2022
Finding Direction When Being Pragmatic

You remember how I embraced pragmatism and started chasing power? There was one problem. When you start chasing power with the idea of wielding it for social justice, when and where do you stop chasing power and start wielding it?

Take Praveen’s comment for example

One possible answer can be that you start wielding power while you start chasing power – and you chase less and wield more as you go forward.

But going by this, today I should spend lesser effort in chasing power than I spent yesterday. And tomorrow, even lesser than today. That doesn’t quite fit with the idea of chasing power first. Perhaps there is a threshold of power which I should reach before I start using power. Perhaps the graph is more like:

Perhaps that threshold is what is called “the line”. The line that determines when you stop (or decrease effort in) chasing power and start using that power to reach ideals. Drawing the line becomes important once again.

Let us then try drawing that line.

How much power is enough power? Is a PhD enough academic power? Is a 20 person company that operates in profit enough entrepreneurial power?

Read my poem (?) about career advice. Any goal you accomplish will be dwarfed by a bigger goal. No matter how much power you gain, there will be someone more powerful than you.

Which means that there is no clear way to draw the line on when to stop chasing power.

But there maybe an alternative that requires us to not draw a line. One in which we can chase power and use power simultaneously with the same effort. That alternative requires us to reconcile pragmatism and idealism.

You find a hack to chase power through your ideals.

That is extremely slow though. Slow and excruciatingly boring.

Which is why it has to be extremely personal. You have to be very selfish in what you are doing and craft the journey to your likes and desires. Only that can sustain the boredom of that chase.

(It was Varsha who told me first about entrepreneurship being a very personal journey. This maps on to that. Life is a very personal journey.)

That also solves a long-running question in my mind. How do you find what direction to go in when you are being pragmatic? What’s the principle with which you make pragmatic decisions?

The answer is to listen to yourself. To do what feels the most right to you. I know that sounds like profound bullshit (something that internet gurus would say). But it is based on neuroscience and philosophy of knowledge.

The brain is a rather complicated organ. We can process many more signals than we are conscious about. Even when we think we make decisions rationally, we make decisions based on very many things that we haven’t consciously considered. Read Scott Young’s Unraveling the Enigma of Reason to read more about how our reasons are always post-facto rationalizations.

And this is tied in the external world to intersectionality. There is no decision on earth that lies on a single dimension. Everything affects everything else and nothing is clear-cut.

And thankfully these are complementary. It is only a decision making machine vastly complicated like our brain that can consider all the thousand factors that intersect on a decision in the human world. (I express similar thoughts in the earlier post on living with opposition)

It also means it is difficult to rationalize some of these decisions and generalize them into principles. Pragmatism is the acceptance of this fundamental difficulty and the decision to live within that framework of uncertainty.

Of course, one has to be widely reading and learning to offset the risks of trusting an uninformed brain. One must be open to unlearning and relearning, criticisms, etc as well. These are the things that will protect the pragmatic person from going in the wrong directions.

tl;dr? Trust your gut.

March 8, 2022
Scraping the Bottom of the Pyramid in Indian Healthcare
At least 300 million people in India live below poverty line. And that line is drawn somewhere around an income of ₹1000-1500 per month. If we draw the line double that, the number of poor also doubles.

That’s the bottom of the bottomless pyramid.

Half a billion people who earn less than ₹3000 a month.

If you earned that much, what would your priorities be? Food? Shelter? Financial security? Education for a child?

What about your own health?

Imagine you have diabetes too. The cheapest food you have all around you is rice or wheat based. If you want to decrease carbohydrates and not go hungry, how much can you spend on food? And if your sugars are not under control, would you spend more on a combination of multiple oral hypoglycemic agents that might cost about ₹500 per month?

   ***

Scraping the bottom of the pyramid works beautifully in consumer goods. You build something dirt cheap for the poor. Take a ₹2 shampoo sachet. You can cut down the size of the sachet to make it even cheaper.

You can’t sell half a metformin tablet to a poor diabetic.

You can’t prescribe a 1 day course of antibiotic.

You can’t cure pain with an injection.

But you can. Indeed that’s the kind of healthcare that those at the bottom of the pyramid currently receive. Sub-standard, inappropriate, and incomplete.

Because healthcare, unlike consumer goods, doesn’t become cheaper at the bottom of the pyramid. It actually becomes more expensive due to the intersection of vulnerabilities.

   ***

There is simply nothing to scrape at the bottom of the pyramid for healthcare.

Someone else has to pay.

A third party.

Could be the government. Could be charity. Could be grants.

But hey! If someone is paying, does it matter whether it is the beneficiary or a third party?

   ***

That’s the logic with which most NGOs in health and government facilities work.

Say you’re a doctor in a PHC. The government pays you. You deliver healthcare to the poor. Simple economics.

Where does the government get money? It raises money through taxes, etc.

What if you’re a non-governmental organization? You get donations/grants in what is called “fund-raising”.

(There’s of course a cross-subsidization model which may look different superficially, but isn’t very different in the larger scheme of things)

Is this any different from first party payment?

Very different!

   ***

The first issue is that of accountability. Accountability lies where money flows from. If my healthcare is paid for by someone else, my healthcare provider isn’t accountable to me.

Public health facilities are not accountable to the poor that it serves healthcare to. They are only accountable to the hierarchy above them.

NGOs are not accountable to the poor that they serve healthcare to either. They are only accountable to funders. (Typically NGOs which are able to diversify their funding source is able to decrease the power that funders have to some extent by dividing the funders into many).

Why, though? Because accountability without control doesn’t work.

If you want to hold someone accountable, you have to be able to control them in some way.

   ***

When there is no accountability, the next issue is that of quality.

In first party payment, quality assessment is decentralized. Every individual makes their own assessment about the quality of care they receive. And this instantly translates to payment, recurring visits, etc.

In third party payment, quality assessment is different. It uses “metrics”. And metrics are difficult. Funders typically look at fancy metrics like “decrease in maternal mortality rate”. The problem with such “key” metrics are that they capture very little nuance and sometimes no meaning.

To government, for example, where the whole hierarchy is just supplying metrics to someone else, it becomes a complete number game. (Recommended reading: Chasing Numbers, Betraying People)

To NGO funders who have a bit more involved staffing structure it goes beyond numbers to also include “reports” filled with presentation-worthy photographs.

It no longer matters whether the individual receives quality healthcare as long as the metrics and reports are looking good.

   ***

Now let us look at something totally different. The CSR sector spent about 2600 crore rupees in health in 2020-21 FY. That’s about 1% of India’s national health budget. As per national health accounts 2017-18, the combined contribution of NGOs, corporates, foreign aid, etc to India’s health expenditures is less than 10%.

By all means, the government is the single largest provider and payer of healthcare for the bottom half of India’s pyramid.

   ***

If you read all of this together, there are certain insights to be gained about why certain things are the way they are.

Why do NGOs build/research “models”? Because the kind of money it takes to deliver care to a population larger than what “model”s serve is hard for NGOs to come by.

Why does everyone want to build software? Because software can (theoretically) “scale” to large populations without a lot of money.

Why do NGOs focus on showcasing “reach”? Because numbers mean impact for funders. And creating the impression of quality is more important than quality.

Why does public health system get away with delivering poor quality healthcare? Because there’s no real way citizens can hold health system accountable. The constitutionally mandated way they can do so has been hijacked by issues like religion, party, and war.

   ***

What to do about all this?
1. Look deeper than numbers – everywhere. In fact, don’t look at numbers, at all. Numbers are meant to hide and deceive.
2. Think critically. Especially on stories around impact. Reach isn’t impact. Touch-points aren’t healthcare. Technology can’t solve problems that technology can’t solve. Innovation is a buzzword unless and until innovation leads to inclusion.
3. Be political. In thoughts, actions, and choices.
4. Be aware, call out, and discuss things like above with raw honesty. Reality is shaped by what we accept silently.
February 18, 2022
Why I am Back on WhatsApp

Long time readers of this blog knows that I have a very strained relationship with WhatsApp. When I deleted my WhatsApp account a couple of years ago, I was at a place where personal productivity was the most important to me. For example, I wrote this:

Thirdly, and most importantly, people are unable to work on hard
problems with their mind into it because that requires focus and
peaceful mind. I have a very big hunch that this is the biggest reason
why economies world over are failing – because people simply aren’t
productive any more.

I am in a very different space now. Embracing pragmatism has come to mean more important than sticking to ideals. And gathering useful power is also a priority. All of this helps in bringing action to words.

In that context, in the space of primary healthcare, WhatsApp is a very useful communication tool.

It allows me to collaborate with a very diverse group of people. It allows quick and effective communication especially in socially tricky situations. Just today I could effectively use WhatsApp to organize two meetings. The most important feature, perhaps, is the ability to forward messages quickly.

In all, I still value productivity. But productivity, now, for me is not just about me, but about the teams that I lead or am part of. Like in the case of shaving beard, WhatsApp has become important to me now.

And that’s why I am back on WhatsApp.

November 21, 2021
Asking For Help
Many days ago, in a discussion with some of my colleagues, I realized two things. I trust less on others (compared to how much I trust on me – even in things I have no clue about) and I rarely ask for help. It probably is also true that the latter is because of the former.

I had made a resolution that I would start asking people for help thereby building trust in the process of trusting others.

Life sent me a reminder in the form of a tweet.

A lawyer friend taught me how to network and cold email people. Another friend who is a financial consultant reads most of my emails before I hit ‘send’. Another friend taught me that your network grows by sharing.

— Umme H. Faisal (@stethospeaks) November 4, 2021

I had to do something. I did make a start this week.

DM me if you want to apprentice with me in the space between health, education, and technology.

You get to do some or all of
– writing
– grassroot organizing (internet based)
– video editing
– website building
– software building

— Akshay S Dinesh (@asdofindia) November 7, 2021

Okay, maybe it doesn’t really count as “asking for help” because I’ve still framed it in a way where I am in control. Nevertheless, I believe it is a good start.

I got four people responding to that. I got on a phone call with three of them. One of them helped me finish a project that was pending for 9 months and I could also connect them to two other opportunities. Another person has very many shared interests and we’re looking at several academic collaborations.

One of the myths I had in my mind was that I am selfless and everyone else is selfish. That people won’t respond to my call for help – unless I can give them something of great monetary value.

There are many things wrong with those thoughts. One, people are inclined to help rather than reject requests for help. It’s in human nature to help others in need. Two, many people find many things other than money valuable.

Note to self: I should give the world a chance before judging the world.

Considering I know very little about the subject of using help to advance causes, I decided to get a bit more scientific about this. I did a YouTube search for “entrepreneurship”. The second video was this wonderful talk by a person named Ankur Warikoo.

The 3 rules of life Warikoo mentions are:
1. Spend time with people who are nothing like you
2. Don’t feel entitled at any moment of your life
3. Don’t get comfortable
I understand all 3 of them. I think I’m good at #2. I’m trying to make a difference in #1. I suck at #3.

And that’s where “asking for help” comes in.

Asking for help is uncomfortable for me at the moment. It helps me break out of comfort zone, and it also increases my chances of finding new people with different stories and experience (“diversity” as RK Prasad puts it).

I went ahead and started listening to Warikoo’s podcast. He puts immense stress on “cold emails”. Connecting to people and asking for help is very powerful indeed, even if the person whom you’re asking help from does not know you. In one of the episodes titled “How May I Help You” he talks about how information, advice, and help are three different things. I highly recommend you listen to that episode.

It is a similar aspect of asking for help that Derek Sivers pointed out which makes it such a powerful instrument. When you ask for help, you are forced to think clearly. You put an effort into finding what exactly it is that you need. Sometimes, all you need is information and you’re able to find it on your own. At other times, the act of asking for help advances your thinking to a large extent. And often, you end up receiving help which is useful on its own too.

Help will always be given ~~at Hogwarts~~ on this planet to those who ask for it.

PS: I track the project opportunities that people can engage with in the opportunities gitlab repository. If you feel particularly kind, feel free to check out some of those ideas and offer help. (I know, this doesn’t count as asking for help)
November 9, 2021
Objective Assessment of Primary Healthcare Leadership
In our primary healthcare leadership fellowship that’s been running for 2 years now, we’ve only used self-assessment by fellows as a measure of impact till now.

While self-assessment is the easiest to perform and also gives a good sense of subjective measures like confidence and readiness, bringing objectivity to the measurement of impact is important for academic rigor.

The subject of measurement here is leadership. How do we objectively measure leadership and/or growth in leadership?

For that, it becomes necessary to define leadership in some way. Fortunately, there’s an article that RK keeps showing everyone which details 6 roles of a family physician.

The roles are
- Care provider
- Consultant
- Capacity builder
- Clinical trainer
- Clinical governance leader
- Champion of community orientated primary care
We can define primary healthcare leadership as excellence in all these roles. It is easier to develop objective measures for some of these at least.

Here are some examples:

Capacity builder – How many practitioners are being or have been mentored/supported by the practitioner?

Clinical trainer – How many workplace trainings have the practitioner conducted in the past 3 months?

Champion of community orientated services – Has the practitioner worked with the community to develop/promote any community based service?

It is important to evaluate these at the baseline, incorporate growth in these dimensions as an expectation during the onboarding process, and re-evaluate these at the end of the fellowship to get an objective metric of leadership growth.
October 31, 2021
Be Irreplaceable Workers And Replaceable Leaders

A good worker is someone who produces so much value that they become irreplaceable.

As Cal Newport writes in the book “So Good They Can’t Ignore You” knowledge workers who have the most satisfying careers don’t just “follow their passion”. Instead, they build rare and valuable skills that they leverage to negotiate better career positions.

If you want a satisfying career, become so good at what you do that they cannot ignore you and they cannot replace you. Become irreplaceable.

But when you are a leader, you need to think differently. Leaders do whatever it takes to achieve their vision and make an impact. And one of the things that they have to necessarily do is to make more leaders and make themselves replaceable. If a movement has a single leader – a single point of failure, a bus factor of 1 – that movement is poised to fail when that leader falls. And like all humans, leaders fall.

Good leaders don’t wait for their own end to think about replacing themselves. Good leaders think about replacing themselves from day 1. Because that’s the most sustainable way forward. That’s the way things scale out of control.

If you want a successful movement, become replaceable and replace yourself as soon as you can.

PS: I’ve deliberately not talked about the intersection between leaders and workers. I believe good leaders have to necessarily be good workers. That’s an implementation detail I will cover in a future blog post.

October 27, 2021
Why I Shaved Beard

Well kempt, clean shaven man dressed in a coat, pant, shoes, and a tie. That’s the typical figure of leadership. Anarchists hate that. Feminists hate that. Why should leadership look a certain way and act a certain way? Who is excluded from the ideal image of a leader?

In medical school, for example, it was me against the white coat. I hate white coat for it is a symbol of power. For those who think there are practical advantages of white coat, I am talking about the white coat that doctors wear in out-patient consultation rooms, for photo-ops, and even for doing theory lectures. Why should doctors use this uniform of power in such situations?

They are building on stereotypes. The white coat has certain stereotypes associated with it. That built by generations of doctors who have lived earlier. By wearing a white coat they’re saying – “I am a part of this legacy. The respect you have for this legacy, give me that.”

But stereotypes (biases) are the reason why the world is full of problems. Sexism, casteism, racism, colonialism – everything is built on stereotypes.

How do you tap into the benefits of stereotypes on one hand (reinforcing those stereotypes while doing so) and yet fight these large issues on the other hand? It is a contradictory position. Which is why activists (anarchists, feminists) make political statements with their body. Women cut hair, men grow long hair. Those who can grow beard, grow it long. They wear chappals. They wear Burka. They show up in places where they are not expected. They show up in ways that break stereotypes. Because breaking stereotypes is a political tool.

I too found the logic that a doctor should present themselves as “smart” (by shaving clean, etc) unreasonable. Why should doctors care about the biases of the patient? More importantly, if that’s the direction we go, then what about patients who are biased against women doctors, or black doctors, or Dalit doctors?

One of the biggest arguments against this all-or-nothing fight against biases is that there are things one can control and things one can’t – I can’t change which family I was born into, but I can shave my facial hair – and that only the biases against things one can’t change need to be removed from society; that it is fair to be biased against things that are in one’s control.

Fat shaming is a grey area then. Some people can’t grow thin and it is out of their control. For some it might be possible, but how do we know it is possible?

What about clothing? Is it in one’s control? Does everyone have access to all kinds of clothing? That’s when some people say that dressing smart is not about wearing expensive clothes, but about wearing clothes smartly. They are thinking about leaders who wear cotton kurtas or saris.

Nevertheless surely, everyone can afford a shaving blade, a mirror, and some water, right? So it is in one’s control? What about those who have religious beliefs against shaving?

Suffice to say, I’m not completely convinced by the separation between biases based on controllable features and uncontrollable features. For one, biases aren’t always nuanced. A bias doesn’t take into account the background of the person whom you’re biased against/for. A bias is difficult to reason with.

To me, this is sufficient reason to fight against all biases.

But that’s where pragmatism entered my life. Sure, we should fight against all biases. But, is personally breaking stereotypes the most effective form of fighting biases? Also should we only do bias-fighting? Aren’t there other battles too?

When one looks at this larger picture, the problem becomes more about what our goals are and what the most ethical and effective ways to reach our goals are.

And therein I have to measure on a balance the pros and cons of using individual attributes to harvest biases vs the pros and cons of breaking stereotypes using body politics.

That’s how I decided to shave beard.

PS: See also the clothing choices of BR Ambedkar and MK Gandhi

October 19, 2021
How To Live With Opposition

There are enough number of people in the world who will tell you that the world is becoming “increasingly polarized”, that respectful political debate is “a thing of the past”, that people talk past each other “all the time”.

You will also be forced to pick a side. “You’re either with us or against us.”

These ideas come from a binary understanding of the world. By looking at things from a single dimension. Even in that dimension, the middle ground is stripped and only the two extremes remain as options.

How do I know? Because I’ve straddled that path, found it unlivable, and found a better alternative.

I must thank Adam Grant for the book “Think Again” which helped me with timely insights while I was going through this journey. And I would recommend it to you (along with Eugenia Cheng’s x + y).

So, what’s the answer?

The short answer is that you shouldn’t worry a lot.

The long answer is fairly complicated. Let’s first go through some axioms.

The human world is complex and chaotic

Chaos meaning nothing is predictable. And complex meaning we don’t yet know what to make of things. Economists, sociologists, stock market analysts – people who work very closely with the human world – are the most successful if they embrace this complexity and chaos. Adam Grant gives the example of the election forecaster who predicted that Donald Trump would become President of the United States much before anyone else did. The reason?

“The single most important driver of forecasters’ success was how often they updated their beliefs. The best forecasters went through more rethinking cycles. They had the confident humility to doubt their judgments and the curiosity to discover new information that led them to revise their predictions.”

This is so because the world is very chaotic and unpredictable. At best we can predict things just before things are going to happen – only if we are constantly holding our beliefs to scrutiny.

It is not that nothing can be predicted. There are several things which will follow patterns – but in controlled settings, where all the confounding variables have been controlled. And we can’t isolate all confounding variables in the real world.

This is the reason smart people in public health research use tools like realist evaluation framework.

This is why it is useful to think of the world in terms of complex adaptive systems.

Simple, pure points are rarely correct

Even if Twitter didn’t have character limits, people would choose simple straightforward “pure” intellectual positions. These are easier to articulate, easier to think about, and easier to argue for/against.

But if a point is being made about the real world and it doesn’t capture the nuance of the chaos and complexity then chances are high that the point is incorrect or at least incomplete.

Almost all perspectives are correct

This doesn’t contradict the previous point. Different people look at things from different perspectives. The human brain is amazingly capable in that it sums up all the experiences it has had in the past when looking at an issue – and it does this automatically. Each perspective that a human brings to any conversation is a summary of that person’s entire life experience – even if they aren’t conscious of it.

The secret is in finding the convergence of differing viewpoints. Before we discuss that, we will discuss the reason why there seem to be irreconcilable differences.

Brain’s ability to reason and articulate such reasons is far too limited

Our brain produces incredible insights through “gut feeling”. But when it comes to explaining these or articulating the exact feeling, it falters. This is based in neurobiology. Reasoning is a brain function that is different from the decision making function. Therefore, while our brain maybe excellent in making certain decisions, it could be very poor in articulating the reason for those decisions. This is not just a deficiency of language. It is also a symptom of how nuanced our brain’s responses are – and how it summarizes one’s life experiences. It is much easier to do things than to explain why. Even if one beautifully explains why, the explanation would probably not have captured the complete picture.

Disagreements result from lack of nuance

When different perspectives are seemingly irreconcilable, the reason is that they’re articulated in simple, pure ways which conceal the underlying (reconcilable) shared values. If people are able to pour their insides out, they’ll find that everyone is looking forward to achieving essentially the same things. One perspective might consider an “obtuse point” as “checks and balance”, while another perspective considers those checks as the “main thing”.

Also, everyone doesn’t have the same set of life experiences. Therefore, one person’s nuance will be missing in another person’s nuance. It is often helpful to figure out the life experiences that someone brings in which leads them to a particular nuance. Because when you put several different experiences together (and experience those, even second hand), you get to produce better nuanced positions.

What to do with these axioms?

Think like a scientist. Adam Grant uses these exact words. But that’s also what MK Gandhi used to do. Think like you’re perpetually seeking the truth. Look for answers everywhere. Take every perspective as an empirical observation. And expand your theory to fit those observations (bring nuance). Everyone has theories about the world (that’s how our brain works). Make your theory all encompassing. That way, you won’t have opponents at all – you’ll only have a theory that accounts for nuances. Don’t be scared to get into debates. But get into debates with an intention to expand your view. (Of course, social conventions apply.) Watch other people argue and while you grab popcorn, also grab your microscope to analyze why different people are saying different things. Ask clarifying questions. Make it not about you or them, make it about the “truth”. And remember that the truth is probably more nuanced than anyone can ever understand.

PS: This view of nuance unsettles a lot of people with strong opinions. They get scared that such “pragmatism” means a corruption of morals and politics. But, what I’ve experienced is that it is possible to fight a stronger fight when you’re able to find flaws in your own political positions – and address them proactively. It also helps in building bridges with “opposition” – because you would not have a large number in the opposition anyhow. It is also severely practical. It accomplishes a lot more than a purist politics.

I’m sure you have something to add. Comments are welcome. I will add the nuance you bring into my theory 😀

October 11, 2021
On Leadership

One can be a leader only when one desires something to happen in the world. This something can be called “change”. Leaders want to change the world (or a part of it) in some way.

The change that a leader wants to see in the world – the impact they want to make – that is their vision.

Having a random vision isn’t very helpful. A successful leader has a vision that is borne out of the needs and wants of the humans around them. A vision that is rooted in humanity. One that benefits the human kind.

A leader effectively communicates this vision to others, in an attempt to inspire others to work towards the same vision. The quantity of how much a leader is able to inspire action could be the measure of someone’s leadership.

Such communication can occur in many ways – through talking (sometimes even story-telling), writing, or through setting examples. When a vision is completely new, leaders are forced to communicate more verbally. But when the vision has already been articulated (by other leaders, for example), leaders can inspire by setting examples through their own work.

Change requires work (often hard work). One person can only do so much work. Leaders create coalitions with people to get more work done towards their vision. These coalitions can look like organizations, companies, networks, groups, actual coalitions, etc. We could call them movements. Leaders lead movements.

Movements may have strategies, planning, coordination, structure. And these keep evolving with time, based on the real world position of the movement.

At this point, one may ask, is leadership hierarchical? Should there be one leader (or a hierarchy of leaders) for one movement?

Before we answer that we will have to answer a related question – Is everyone a leader?

The romantic answer to this question is that everyone is a leader. But that’s similar to saying all human beings are equal. Everyone can be a leader given the right circumstances. And everyone should be a leader. But everyone is not a leader. One becomes a leader only when one is able to accomplish a vision through leadership as stated before.

When one looks at leadership with such raw sincerity, we will see that the stronger leaders automatically are able to get more work done and a hierarchy is inevitable no matter how hard we try to avoid it. Saying this hierarchy doesn’t exist is like erasing caste/race/class from our society.

A slightly more romantic way to look at it is by imaging every individual as a leader of their own movement – where movements overlap with each other significantly. Each individual can be thought of as a celestial body with their mass (leadership capacity) determining how much gravitational pull they exert towards their vision on the people around them. The most massive leader will have the strongest pull.

Consequently, if everyone are equal leaders, there would be no hierarchies and vice versa.

There are social, economic, and political determinants for any individual’s leadership mass. Someone born with privileges – of caste, gender, sexuality, class, race, disability, and others – might find that their leadership mass is already greater than someone without those privileges. In many situations, for example, money speaks. And someone with money – or access to money – might have it easier to “lead” others. Social capital is another example.

Leadership mass can increase (and decrease) over time. This can happen through education, scholarship, credentials, affiliations, positions, jobs, work, association, mobilization, agitation, talking, writing, creativity, relationships, etc. Even gaining a follower base on Twitter can increase someone’s leadership mass (through psychology of mass appeal).

This leadership mass is called “power” in the formal language. While vision determines the direction a leader pulls people in, power determines how strong the pull will be. It is impossible to be a leader without power (of some or the other kind).

This is where things get intensely human and psychological. Power works through human emotions. Fear, love, hatred, joy, laziness, anger, sorrow, confidence, trust, aggression, etc. But not every human has the same emotion when confronted with the same stimulus. An anti-establishmentarian will look at you with scorn when you tell them that you’re from the ministry (of whatever) whereas someone who is awed by such positions will be psychologically receptive to what you want to say. It is safe to say that most people will be pulled by mainstream sources of power (because majority acceptance is what makes these sources mainstream).

Effective leadership thereby also becomes a performance. Like doctors need to be chameleons and be the doctor that each patient needs, leaders will have to be the leader that each individual needs. If someone is motivated by solving complex challenges, the leader can get them excited by presenting their vision as a complex challenge. If someone is interested in creative expression, leader can find avenues for creative expression that advances their vision.

At this point, the conscientious reader will ask whether leadership is emotional manipulation.

Manipulation has negative connotations. Perhaps “emotional guidance” captures the nuance of what leadership does with emotions. Leadership is about emotionally guiding people. There can be effective leaders with selfish motives and they can turn this into manipulation and abuse. But you can’t blame any individual for being too sincere towards their own vision, albeit a bad one.

Also, the human mind is trapped such that it can never be free of influences. Everything that happens, every interaction, every thought, every idea – everything changes the mind. And therefore, the only way someone can never “manipulate” your thoughts is by never coming in contact with you.

The same reader will also ask whether this view of leadership considers people (followers) as lacking agency (autonomy).

In this world, nobody has complete agency. Every human is delicately dependent on other human beings in this society. Complete independence is not possible for any human. And therefore, a transactional view of individual relationships where every relationship is that of giving and taking models the society in a better way.

Considering the sensitive nature of the relationship that a leader has with others, it is very important that leaders are empathetic and emotionally intelligent. Leaders must be quick to identify an emotion, to label it, and to address it. That includes self-awareness and awareness of one’s own emotions. They need to think of things from the perspective of multiple others and bring those perspectives together in their vision.

This empathy also gives leaders humility. That they do not know all the answers, and that their answers have to include all the perspectives from people around them. That if the answers did not entrench empathy this way, they wouldn’t be able to achieve their vision. That it is unlikely that one human being’s vision is greater than everyone else’s.

An intense desire to create more and more powerful leaders around them arises in leaders from this humility. They see that the world is better served by a multitude of visions and that for each vision to succeed there must be leaders taking those visions forward. They strive to turn people around them into leaders who can pull weight. That’s how the best leadership is scalable – by being infectious.

When enough leaders pull weight in the same direction, no vision is too far to achieve.

Why does the world need leaders to pull though? Can’t well articulated vision statements automatically attract people?

Inertia is the problem. Human beings are resistant to change – individually and as a society. It might be explained by evolutionary psychology. Human beings have evolved past the stage where they need to be held hostage by biology, yet we are biological beings. And we are not rational beings by design.

If we were rational we wouldn’t have problems like global warming, poverty, and war in our world.

Leaders appeal to both the irrational and the rational sides of human beings at once. That’s how they pull people out of their inertia. Once people are moving, systems move too. Especially if you pull the heavier people.

Leaders, hence, are balancing-artists. They have to handle conflicts all the time and find balance. There is strategy, but there is vision. There is rationality and irrationality. There is movement and there is stasis. There are tensions and counter-tensions. There is pressure to lead and pressure to follow. Leaders make judgement calls all the time. They can go wrong many times. And over time the number of right calls decide whether they become effective leaders or not.

Is leadership a teachable/learnable skill?

Leadership requires a lot of practice. But it is also important to know what to practice. That is where the learning/teaching part of leadership lies. There are plenty of books written about leadership. Plenty of stories to read and learn from. Concepts like “ownership”, “thinking big”, “delivering”. Almost every major (successful) organization has leadership principles which have been documented. Exposure to leadership philosophies can accelerate someone’s growth as a leader. Consuming content about leadership helps think in different ways and gain new perspectives.

What now?

Think about whether you have a vision for the world. Think about how effective you are as a leader in taking the world towards that vision. Talk to people around you about leadership. Read. Find avenues for your own growth as a leader. Find people with similar values and vision. Grow each other. Grow yourself. And change the world.

October 10, 2021