The Safety Mindset

In the startup world there is the extensive use of the word "Disrupted" when it comes to describing your company. It's hard to be heard unless it's somewhere in your pitch, and there are even books on startups using it for their title. "Disrupting" implies shaking up the status-quo, bringing the white heat of technology to an old inefficient market and turning it upside down, reaping huge financial rewards in doing so. A good example of this is Amazon.com, starting as an online seller of books disrupting the traditional book selling market, and within 20 years of founding is now both a bigger retailer than Walmart, and the world's largest supplier of cloud computing. It really has disrupted multiple industries, and created entirely new ones as it has done so.

Another disrupter is Uber - the "ride sharing" service that tries to pretend it's everything but what it actually is, a taxi service. Taxis in most US cities are heavily regulated, with medallions (licenses) sold by the city for sometimes exorbitant sums - a New York city medallion used to fetch $1,320,000, but is now dropping to $750,000 and below with no end in sight thanks to Uber - and when money like that is to be made, it's tightly controlled. This high medallion price, however, was no guarantee of good service and in most locations in the US taxis were regarded as transport of last choice. Uber bypasses the purchase of a medallion, and introduced a simple to use phone app that worked for calling the taxi, seeing its location when en-route, and seamless paying regardless of what city you were in. Suddenly, a taxi was actually reliable, clean, and affordable, and this was a fantastic thing. Offer customers a service they want at a price they are willing to pay, and you grow quickly, and Uber have grown to a near $63 billion valuation in just 7 years.

But let's be clear - they did this by breaking the law. Calling it "ride sharing" or any other term is just marketing, and it's a taxi service that bypasses all local taxi laws. There are legal battles all over the US, and other parts of the world, with Uber spending huge amounts of money in trying to overturn local taxi laws, and seeming to win more than they lose. The taxi services in the US really needed disrupting, and most people cheer them on because they provide a service we want, and we all know that the whole "medallion" system was just about rich people charging rent for them and not really about public safety. Personally, I love Uber as a service, and love that they are breaking up the old taxi business, but I do have concerns over their ethics and concern for privacy, the dangers of the "gig economy", and ignoring other laws such as those for the disabled, but equally importantly for the example it is setting to other companies regarding "break the law and fix it later" mentality.

Companies in the new tech area tend to be a little lax when it comes to doing things carefully - Mark Zuckerberg, founder and CEO of Facebook, tells us all to "Move fast and break things", which I have to agree is a great way to innovate and learn when your product does nothing of actual importance at all. It doesn't matter if you don't get your silly cat videos, or can't post pictures of your holidays, because your business payroll doesn't run on it, your medication isn't delivered by it, nor is your aircraft navigation based on it. Real consequences of a Facebook blackout are near zero.

Much of the software boom of the last few years has been in companies like Pinterest, Snapchat, Twitter, LinkedIn, WhatsApp, and Facebook which have concentrated on connecting people, creating communities, sharing pictures and text, but nothing truly vital to health or financial well-being. There is a mentality of "minimum viable product" (which to repeat is a good approach in such unimportant areas) that has taken hold and has been rewarded. The incentives have been to companies that released quickly and did their alpha testing on customers, those who took the time to get it right before release sank into obscurity.

So is it any wonder that eventually a company like Theranos would appear, promising to disrupt the boring world of blood testing by using only a finger prick and small "nanotainers" for a battery of tests, yet releasing a minimum viable product quickly and doing testing on the patients? After all, it's just a blood test, that can't have consequences! Except it does, and when around 1.6 million test results are recalled, that has real effects on people's lives - treatments they had that were unnecessary, or necessary treatment that was never performed. I'm sure we'll be hearing in the coming months, through the various civil and criminal lawsuits Theranos will face, about the employees who tried to raise the alarm and were ignored, intimidated, silenced, by those who had the "move fast and break things" mentality and faced no consequences to a lack of care about safety and efficacy. That thinking has been so heavily rewarded, for so many years, that it seems now to be the default, even in industries that should put safety first.

It's been bizarre for me to see this thinking grow, particularly in the last 5 or so years as I worked in and consulted with a number of new tech companies, and heard stories from friends and colleagues of similar. My engineering background had at first been in manufacturing and heavy electrical motors and generators, where there was real danger of physical injury, chemical exposure, and electrocution, and the emphasis on your personal safety and those of your coworkers was intense and was an important lesson in the mentality of safety that has stuck with me throughout my career. Following that, I was heavily involved in medical ultrasound, where there are stringent tests and validation required before it's even to be allowed to be used on a small number of test subjects. (I did also work in some tech companies whose founders and staff had a history in healthcare and similar, and the difference was noticeable in the care they took, and how pro-active they were in working to ensure safety and security.)

In both these industries the mentality was "we must make sure this is safe" and the idea of reducing or skipping safety is never considered, but I do not see the same thinking in many of these tech companies. I have literally heard "what's the minimum we have to do?", "we don't have proof it's a risk", "that sounds time-consuming and expensive. We should do <pointless but fast/cheap thing> instead", and "well if it goes to court our lawyers say they have good arguments". The people running many tech companies have simply never operated in a safety conscious, or heavily regulated, environment. The consequences of their lack of care is not a coworker losing fingers in a press or being electrocuted in front of them, but is remote in both time and space, easy to put out of mind.

The safety rules in factories we enjoy now came only after horrific accidents from the time of the industrial revolution on. Medical treatments and drugs were previously unregulated, but even though regulation is not perfect, are now much safer than they once were. These improvements came at a great cost to many people's health and lives, as we developed laws and regulations, but a way of thinking that put safety first was developed. That thinking does not exist in many of the companies that used to send funny home movies over your phone, but are now accessing your healthcare data, your bank account, and the online webcams monitoring your children. 

Safety is not a set of checkboxes, it is a mindset, and until there are significant consequences for those that ignore safety there will continue to be more and more Theranos-like stories.