By Jennifer (Jennie) Latson

This article originally appeared in the New York Times as "Migraines and Me: A Love Story?" 

I’m kind of a big deal on the migraine clinical trial circuit. Researchers love me, if only for the prodigious number of migraines I get: 10 to 12 a month on average.

“This is fantastic,” the coordinator of my latest drug trial said when I showed him the headache diary I’ve been dutifully keeping for years. “This is great data.”

“Great for you,” I said. For me, it represents roughly a third of my life spent in the grip of migraines, including three or so days a month when I am bedridden with crippling pain and intense nausea.

I’ve tried more than a dozen existing migraine prevention medications and participated in a number of clinical trials for new ones. None of these drugs have helped; some have really hurt. All were designed to treat other maladies and then repurposed for migraines after patients taking them for hypertension or seizures or bipolar disorder reported a coincidental improvement in their headaches.

This trial, which I started in August, is the first time I’ve taken a drug designed specifically for migraines. It targets calcitonin gene-related peptide, a neurochemical that makes blood vessels swell, which people with migraines apparently produce too much of.

For the first time in my life, a drug seems to be helping. And the worst side effect so far has been extreme hopefulness — though this hope has come with unexpected complications. After years of experimenting with migraine drugs, I no longer worry that a new medication won’t work; that’s what always happens. What I noticed this time was a new worry: What if this one does?

I had my first migraine when I was 12 — then another, then another. At first, I didn’t know what they were. My parents thought I was just unusually susceptible to the flu, a condition they hoped, and I assumed, I’d outgrow. As a driven, overachieving teenager, I believed that all doors were open to me, career-wise. Astronaut. Surgeon. First female president.

It wasn’t until my freshman year at Yale that my migraines were diagnosed, and it dawned on me that I wasn’t going to outgrow them. Doors began to close. Having to lie down for days at a time seemed to rule out a job in which people’s lives depended on my showing up to work — so surgery was off the table. I also suspected that chronic migraines would undermine a presidential candidate long before Michele Bachmann’s headaches made headlines. I became a journalist instead.

For more than 20 years now, migraines have played a central, if unwelcome, role in my life, like the obnoxious sibling I never had. They’ve also helped shape me into who I am. They gave me my high pain tolerance and made me a pro at projectile vomiting — a talent that earned me the family nickname Barferina. And now that I’m facing the tantalizing prospect of getting rid of them forever, I’m starting to realize that I can’t even picture my life without them. Who would I be, after all, if not Barferina, stoically doing the best I can in spite of my migraines?

The emergence of a wonder drug would be bittersweet for multiple reasons. It would mean that had it come along earlier, I could have been an astronaut. And if the solution is really this simple — your body makes too much of this peptide, so here’s a drug that inhibits it — I’d struggle to understand why it took so long to develop.

But a cure would also be a new burden. Saying I’ve done my best “in spite of my migraines” lets me off the hook for anything I haven’t done, like becoming the first female president. If this migraine drug works, nothing will be stopping me from doing great things — which will also take away my excuse for not doing them.

Then again, what if the migraines actually helped me achieve what I have so far? Scott Sonenshein, a professor at Rice University’s Jones Graduate School of Business, argues that we can accomplish more when our resources (in my case, health) are scarce than when they’re unlimited. “Constraints can motivate us to be resourceful, act in more creative ways, and solve problems better,” he writes in his book Stretch.

It’s true that migraines have taught me valuable skills. I’ve learned to get my work done well ahead of deadlines, lest a migraine derail me at the last minute. I’ve learned how to push through pain when I have to — and to be kinder to myself the rest of the time. I’ve learned how to ask for help when I need it. Will a headache-free me be less responsible, less diligent? Or will I push myself harder, knowing that I’ll no longer end up in disabling pain from overexertion? I have so many questions for this possible future version of myself. (And one for NASA: How old is too old for astronaut training?)

Of course, if an identity crisis is the price I have to pay to end the debilitating brain pain, I’ll gladly pay it. I’ve spent decades dreaming of a cure, often while lying in a dark room with a bag of frozen peas pressed to my face. The surprise is that I’d feel any nostalgia for those days at all. But I realize now that if Barferina goes, part of me will miss her.

Jennifer Latson is a staff writer and editor at Rice Business and the author of The Boy Who Loved Too Much.

Based on research by Douglas A. Schuler and Kathleen Rehbein

• A company’s experience and expertise don’t play much of a role in gaining entry to the halls of power.
• Whether a company would be significantly impacted by a proposed policy had little bearing on whether they’d be invited to testify about it.
• Perhaps unsurprisingly, the best predictors of political influence are lobbying and money.

Beneath the dome of the U.S. Capitol stand statues of some of most influential figures in American history: George Washington, Abraham Lincoln, Ronald Reagan, Susan B. Anthony and Martin Luther King Jr. Tourists who stroll through the rotunda, understandably, can feel a bit overwhelmed. 

These figures made a mark on history in part because they were able to push for sustained legislative initiatives. In short: They had political muscle. Rice Business Professor Douglas A. Schuler and Kathleen Rehbein of Marquette University recently sought to bring the lessons of these historical influencers into the present, to better understand how businesses can exert a similar kind of political power. 

Schuler and Rehbein’s approach was to develop a series of snapshots that could provide insights into what kinds of lobbying worked best. To do this, they examined the political influence of 1,266 publically traded companies between 1991 and 1994, focusing on congressional testimony about two critical trade issues: the ratification of NAFTA and the Uruguay Round of multilateral trade negotiations during the General Agreement on Tariffs and Trade summit.

Studying the companies’ foreign market expertise, political relationships, and lobbying strategies, among other factors, Schuler and Rehbein investigated which elements played key roles in gaining access to Washington policymakers. That is to say, their goal was to understand how these companies most effectively wielded influence. If the companies managed to testify before Congress or join the ranks of trade policy advisory boards, they’d achieved noteworthy political access.

Which factors were the most critical to making such political inroads? The results were somewhat counterintuitive. First, the researchers found that experience didn’t guarantee access. There was little to suggest that a firm’s foreign experience would translate into appearing at a congressional hearing. Nor was experience with foreign sales a precursor to membership on advisory panels or trade policy organizations.

It was less clear whether the volume of a company’s export business played a role. Members of Congress tended to invite firms from industries with a high proportion of foreign sales to testify. But there was no clear indication that it mattered whether the firm competed significantly with import traffic.

You’d also expect that firms with a long history of holding sway in Washington would be more likely to be invited to testify at hearings or join trade associations. Turns out, that’s not quite the case. Past experience with trade policymaking bodies did not seem to affect congressional behavior regarding hearings.

What about the degree to which a given policy would affect a particular firm? Surely the companies with the most to gain or lose from a trade deal or tariff plan would be the stakeholders Congress would want to hear from? Not necessarily, Schuler and Rehbein found: The impact a policy would have on a company was statistically unimportant in predicting invitations to hearings.

So what does it take to wield influence in Washington? High-profile lobbyists, the researchers found. Companies that used lobbyists were significantly more likely to appear before Congress or to be a member of an important trade advisory institution.

Perhaps least surprisingly, one of the most influential factors in gaining political access is good old-fashioned cash. Firms that contributed to the Political Action Committees (PACs) of trade subcommittee members were significantly more likely to testify in hearings. Likewise, the firms that contributed PAC money to subcommittee members were more likely to be included on one of the trade advisory committees.

It’s a lesson that has stood the test of time when it comes to government influence: If you want to play, you have to pay. Think of that the next time you enter the Capitol rotunda.

Douglas Schuler is an associate professor of business and public policy at the Jones Graduate School of Business at Rice University.

To learn more, please see: Schuler, D., & Rehbein, K. (2011). Determinants of Access to Legislative and Executive Branch Officials: Business Firms and Trade Policymaking in the U.S. Business and Politics, 13(3), 1-30.

By Joe Mathews   

This article was written for Zócalo Public Square and originally posted as "The Healthiest Californians Are the Ones Who Are Healthy Together"

Immigrants bring cultural practices that could improve our health systems and the health of all Californians — if we do more to understand and deploy the advantages of cultural diversity, said a panel of experts on health and immigration at a Zócalo/The California Wellness Foundation event.

Those panelists — including top researchers and journalists — offered multiple examples of ideas that originated in immigrant communities that have made us healthier — from diet to exercise to an emphasis on family and social relationships. But they all pointed to one overarching conclusion: Immigrants often approach health together, with the participation of relatives and neighbors, instead of alone, as too many native-born Americans do.

In the foreign cultures, “there’s this continuity and connectedness that’s fundamental to your being. You are never alone,” said UCLA medical anthropologist Marjorie Kagawa-Singer. “We’ve lost that here” in the U.S.

The moderator, CALmatters health and welfare reporter Elizabeth Aguilera, began the event, held in the library at the Mechanics’ Institute in San Francisco, by asking what has been learned and adopted from immigrant cultures.

Journalist Claudia Kolker, author of The Immigrant Advantage, answered by citing a host of ideas. She said immigrants had taught Americans about the importance of post-partum care (which has been a higher priority in other cultures than in the U.S., where pre-natal health gets more emphasis), better ways of eating (she noted that Vietnamese culture makes meat a condiment, not the main course) and about seeing loneliness as a threat to health. “These are now medical ideas,” she said.

Asked by Aguilera how we might change our approaches to health from the lessons of immigrants, Kolker pointed to two. First, she suggested thinking bigger and having bigger life goals, as many immigrants do, which may help explain why immigrant groups in the U.S. have measurably better mental health. Second, referring to research from Rice University professor Utpal Dholakia, she suggested that thinking of your life as less of a highway and more as circle contributes to better planning and even more saving of money, which in turns aids health.

Kolker also said that living with grandparents, which is common in immigrant families, has cognitive benefits for children. And she said that understanding the importance of human touch is vital now, since Americans “as a society are touching each other less and less.” Many elderly patients are not touched at all, she said, even though we know from research and from other cultures that touch is good for our health.

Dr. David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA School of Medicine, argued that more attention must be given to the health advantages of immigrants and Latinos. He talked extensively about what he called the “Latino epidemiological paradox” — that even though Latinos often have less access to care than other Americans at the same income level, Latinos have fewer heart attacks, fewer cancers, drink less and smoke less, and live 3 and a half years longer. “If everyone in the United States had the same profile” as Latinos, “250,000 lives would be saved,” he said.

Hayes-Bautista has been investigating myriad possible reasons why Latinos do better — social networks, family, community support, diet, and even dance, music and spirituality. But, he cautions, instead of doing more to understand these advantages so they might be applied to medical care and training, the medical establishment has largely ignored diversity issues.

Medical training, he said, is based on “a bunch of stereotypes” about immigrants or Latinos as unhealthy, rather than as sources for ideas about health. And public health programs often exclude undocumented immigrants and recent immigrants, even though their participation in the health system might make us all healthier.

Kagawa-Singer, the UCLA medical anthropologist, said modern medicine doesn’t encourage doctors to listen to people from different cultures. And the U.S. system ends up dividing mental health and physical health, even though the experience of other cultures teaches us that mental and physical health are closely tied together.

“Modern medicine,” Kagawa-Singer said, offers “a very mechanistic view of the body isolated from the spirit, the family, and the community… And if there’s an immediate infection, biomedicine is great. But if you’re talking about chronic issues and mental illness, you have got to put the whole person back together again.”

During a wide-ranging question-and-answer session, audience members posed queries about the history of immigrant health and whether immigrants might bring a more open attitude and less costly interventions to medical care at life’s end. Panelists also suggested that the experience of immigrants who come from countries with universal health care might inspire the embrace of “Medicare for all,” especially in California, where political leaders have supported the idea.

In response to one query, panelists noted that immigrants may be healthier because people willing to leave their countries may be more adventurous and robust.

“There is evidence that families make the decision about who is the smartest and who is the least prone to being sick” when they decide who might immigrate first, Kolker said, “because he’s the person who is going to take care of us. So we get these extraordinary people coming here.”

Joe Mathews is the California and Innovation editor at Zócalo Public Square.

Based on research by Vikas Mittal, Yan Anthea Zhang and Kyuhong Han

• Most firms stoke strategic advantages with innovations based on research and development or by managing customers using marketing and advertisement.
• Each of these approaches in turn affects stock market risk.
• When such companies emphasize research and development, rather than marketing, they’re more exposed to risk when demand drops.

Consider for a moment the race to build the next super computer. Google, Alibaba and other U.S. and China companies are racing to build a machine — called quantum computing — far more powerful than anything the world has ever seen. In this race, China reportedly has the lead.

Given that this kind of technology can protect trillions of dollars in corporate and even national secrets, why do American companies lag behind? If such research and development represents an unknown and is a potential business risk, should U.S. companies be interested in assuming such a task? Rice Business professors Vikas Mittal, Yan Anthea Zhang and a Rice Business Ph.D. student Kyuhong Han, may have answers.

They researched the various ways companies create strategic advantages for themselves. What is the relationship between these strategies and the risks involved? Companies create value through innovation-based activities such as research and development or else via branding and advertisement. As there’s no set formula for success, each company has its own approach — which could affect the risk associated with the company’s stock price (called idiosyncratic risk).

Typically, the two strategic pillars are examined separately, rather than jointly. But when they compared the two approaches, they found that one presented far more risk than the other.

To reach their conclusions, the Rice team looked at a data set of 13,880 firm-year observations that included 2,403 firms operating in 59 industries over 15 years (2000–2014). The data sets were from the firms’ annual operational and financial information from Standard & Poor’s Compustat, the University of Chicago’s Center for Research in Security Prices and from the Kenneth French Data Library. What the data revealed was the stock price of companies that placed a higher strategic emphasis on marketing and branding (called value appropriation) than companies that focused research and development (called value creation).

If it is less risky for a firm to emphasize branding and marketing over research and development it stands to reason that firms would want to exercise caution in big new research and development efforts. What’s the payoff for making a quantum computer or even Space X, after all, if the research and development risks associated with the endeavor are extraordinarily high? In some instances, it may be much safer to rebrand and market. Closer to home, many companies in the oil and gas industry bet big on innovative ventures — costly product features, digitization initiatives and so on that may only increase the risk to their stock price than meet customer needs.

The researchers found that firms that plunge big efforts into research and development have more to worry about than whether their innovations will work. They have to weather the fluctuations of industry demand. When industry demand is volatile, the downside of excessive research and development, at the cost of customer-relevant strategies is even worse.

For the Rice Business researchers, the lessons for managers are clear. The return on investment is intimately linked not only with optimizing potential profits but also minimizing potential risks. Research and development heavy endeavors like Space X and quantum computers may be flashy, but in the event of an unexpected drop in demand, they’re also more likely to plummet to earth, creating stock-price volatility.

Managers need to think about the elements that create risk — like demand instability. The more companies create a stable and predictable client base, the less risk that they have to face in the stock market. There is still a tendency among many firms to see advertising and research and development as preceding and guiding customer perceptions, preferences and behaviors. But perhaps the relationship is just the opposite.

Vikas Mittal is the J. Hugh Liedtke Professor of Marketing and Management at the Jones Graduate School of Business at Rice University. 

Yan Anthea Zhang is a Fayez Sarofim Vanguard Professor of Management in Strategic Management at the Jesse H. Jones Graduate School of Business at Rice University. 

Kyuhong Han is a marketing Ph.D. student at the Jones Graduate School of Business at Rice University. 

To learn more, please see: Han, K., Mittal, V., & Zhang, Y. A. (2017). Relative Strategic Emphasis and Firm-Idiosyncratic Risk: The Moderating Role of Relative Performance and Demand Instability. Journal of Marketing, 81(4), 25-44.