Pressure

A couple of items that caught my attention this week:

In Japan, a growing number of young people (predominantly male) have been retreating to their rooms and not coming out for years. They are called hikikomori (meaning withdrawal in Japanese), and they represent a syndrome specific to Japan and neighboring nations (Korea & Taiwan)--a product of the way Asian societies are structured, the way anorexia is a largely Western phenomenon. Excerpts from the article I read in this week's NYTimes Magazine ("Shutting Themselves In" by Maggie Jones):

"A leading psychiatrist claims that one million Japanese are hikikomori, which, if true, translates into roughly 1 percent of the population. Even other experts' more conservative estimates, ranging between 100,000 and 320,000 sufferers, are alarming, given how dire the consequences may be. As a hikikomori ages, the odds that he'll re-enter the world decline. Indeed, some experts predict that most hikikomori who are withdrawn for a year or more may never fully recover. That means that even if they emerge from their rooms, they either won't get a full-time job or won't be involved in a long-term relationship. And some will never leave home. In many cases, their parents are now approaching retirement, and once they die, the fate of the shut-ins - whose social and work skills, if they ever existed, will have atrophied - is an open question. ...

Saito, who has treated more than 1,000 hikikomori patients, views the problem as largely a family and social disease, caused in part by the interdependence of Japanese parents and children and the pressure on boys, eldest sons in particular, to excel in academics and the corporate world. Hikikomori often describe years of rote classroom learning followed by afternoons and evenings of intense cram school to prepare them for high-school or university entrance exams. Today's parents are more demanding because Japan's declining birth rate means they have fewer children on whom to push their hopes, says Mariko Fujiwara, director of research at the Hakuhodo Institute of Life and Living in Tokyo. If a kid doesn't follow a set path to an elite university and a top corporation, many parents - and by extension their children - view it as a failure. ...

Many hikikomori also describe miserable school years when they didn't, or couldn't, conform to the norm. They were bullied for being too fat or too shy or even for being better than everyone else at sports or music. As the Japanese saying goes, 'The nail that sticks out gets hammered in.' One hikikomori was a victim of bullying in fifth grade because he excelled in baseball without having played as long as his teammates. ... Fujiwara says that urban Japanese parents lead increasingly isolated lives - removed from the extended family and tight-knit communities of previous generations - and simply don't know how to teach their children to communicate and negotiate relationships with peers.

In other societies the response from many youths would be different. If they didn't fit into the mainstream, they might join a gang or become a Goth or be part of some other subculture. But in Japan, where uniformity is still prized and reputations and outward appearances are paramount, rebellion comes in muted forms, like hikikomori. Any urge a hikikomori might have to venture into the world to have a romantic relationship or sex, for instance, is overridden by his self-loathing and the need to shut his door so that his failures, real or perceived, will be cloaked from the world. 'Japanese young people are considered the safest in the world because the crime rate is so low,' Saito said. 'But I think it's related to the emotional state of people. In every country, young people have adjustment disorders. In Western culture, people are homeless or drug addicts. In Japan, it's apathy problems like hikikomori.'"

Genentech, which is owned by my company, was named #1 in Fortune's Best Companies To Work For this year. Excerpts from the Fortune article:

"Domagoj Vucic didn't come to Genentech for the rich stock options or the free cappuccino or the made-to-order sushi or the parties every Friday night. He came from the University of Georgia seven years ago because he believed Genentech could help him answer a burning question: What is it that keeps caterpillars infected with baculovirus alive for an entire seven days before they explode into a gooey puddle? Figuring that one out could, believe it or not, be a big step toward curing cancer. Doctor-scientist Napoleone Ferrara didn't come for the perks either. He joined Genentech in 1988 because the company would allow him to pursue an obsession: the study of the formation of blood vessels that feed, say, a tumor, and the search for an antibody to disrupt the process. ...

Genentech pours tremendous energy into hiring people with that kind of passion. In fact, it can take five or six visits and 20 interviews to snag a job. The process is meant partly to screen out the free agents -- people preoccupied with salary, title, and personal advancement. If candidates ask too many such questions, 'Boom, wrong profile,' says [CEO] Levinson.

The gantlet is also designed to let job candidates know exactly what they're getting themselves into. 'We're extremely nonhierarchical,' Levinson says. 'We're not wearing ties. People don't call us doctor. We don't have special dining rooms.' (They aren't even assigned parking spaces, and it's hell in the morning to find a spot.) ...

True innovation takes guts. Industry-wide, new drugs on average cost about $800 million and take up to 12 years to develop. More than 90 percent of the drugs in clinical development never reach the market, including half of those that make it to late-stage clinical trials. That's why so many big drug companies are running out of new drugs. For a long time it was easier and lucrative enough to pursue what Vishva Dixit, vice president of research, calls the "detergent" strategy -- creating me-too drugs in big established markets as if they were laundry soap, and then spending big bucks on marketing to steal share from rival pharmas.

At Genentech, using market data or return-on-investment analysis to drive the science is strictly taboo. 'At the end of the day, we want to make drugs that really matter,' says Levinson. 'That's the transcendent issue.' Not that this company considers itself a philanthropy. By decade's end, it aims to be the leading U.S. oncology company in terms of sales and a leader in both immunology and tissue-growth disorders, setting ambitious new product goals in each of those categories. It has a salesforce of fewer than 1,000 and licenses with Roche and others to sell its products overseas. Levinson really believes that if the company does the right thing, sales will follow. The strategy: Fund enough basic research in targeted areas of interest, and the results will yield multiple drugs -- or drugs that can be used in multiple ways.

That makes Genentech an especially rewarding place to work for a scientist like Ferrara, whose 17-year obsession -- launched with a breakthrough made on discretionary time -- led him to discover VEGF, a key to blood-vessel formation, which in turn enabled Genentech to develop an antibody that can choke off the blood supply to certain tumors. Those discoveries laid the groundwork for two of Genentech's newest drugs, Avastin, approved to treat colorectal cancer, and Lucentis, which is awaiting FDA approval for treatment of age-related blindness. Avastin might have died a premature death when it failed clinical trials three years ago, causing the company's share price to plunge nearly 10 percent overnight (to a split-adjusted $14.45 a share). But because Levinson and his lieutenants were so deep into the science, they knew better than to give up. Avastin, approved in February 2004, had sales of $774 million in the first nine months of 2005. ...

When Levinson sees signs of culture atrophy, he pounces, as he did in an e-mail to senior managers in December about 'the spread of unintelligible, gibberish-laden PowerPoint presentations.... I have recently sat through several presentations that were simply incomprehensible -- mind-numbing, bloated discourses that were full of buzzwords and otherwise devoid of meaningful content. This is a serious problem, and the worst part is that it's spreading like the disease it is.' ...

In case the memo alone doesn't do the trick, Levinson invented a game called gBuzz Bingo. Here's how to play: From the company intranet, download a bingo card featuring terms like 'actionable,' 'traction,' 'value-added,' and 'winwin.' Take the card to any meeting where you expect the worst. Check off boxes as the words are uttered. First to complete a line wins, which of course requires that you shout out: 'gBuzz!'

The winner receives the smug satisfaction of silencing the b.s. And DNA by the Bay, as Genentechers call their company, keeps its magic -- for one more meeting, at least."

Finally, my illustrious sister was recently named a finalist in the annual competition for the Paul & Daisy Soros Fellowship for New Americans. (Wish her luck -- her interview for the fellowship is next Tuesday!) Here is an example sketch of a winner from the 2004 competition. (I actually knew this girl when I was in school -- she was a friend of a friend).

"Sunita Puri is a student in the University of California at Berkeley/University of California at San Francisco Joint Medical Program. She recently finished pursuing an MSc program in comparative social policy, at St. Antony’s College, Oxford where she was a Rhodes Scholar. In 2002, she received a BA with distinction in cultural anthropology from Yale University, where she established a discussion forum entitled 'Creating a Queer-Friendly Asian America' and a South Asian women’s group, and won prizes from Medical Anthropology Quarterly and the departments of Women's Studies and Ethnic Studies for her research. Sunita has worked as a counselor and victim advocate for battered South Asian women and minority freshman, published work on domestic violence among South Asian immigrants, and served as an HIV peer educator. In the UK, Sunita worked for both the Oxford Rape Crisis Center and the Asian Women's Helpline. Sunita is also a classical pianist and harmonium player, and is currently working on two screenplays. Sunita was born in 1976 in Kentucky and is the daughter of naturalized citizens from Punjab state, India. Her family now lives in Los Angeles. Sunita plans a career combining anthropological research on South Asia, grassroots activism, and the practice of medicine with a focus on immigrants and women."

The common thread running through these 3 stories is success, and I think they illustrate very nicely the different definitions of that ever-elusive goal, and the ways people go about achieving it across cultures. In Japan's hikikomori, we see the fallout from the impossibly high expectations imposed on young people from the outside --from parents, teachers, peers, and society as a whole. Because (as moiji has so kindly pointed out to me) Japan is such a non-confrontational society, the only way these kids can escape the pressure is to retreat inside themselves.

On the other hand, intrinsic motivation and passion seem to fuel the success of individuals and organizations in the U.S. Case in point: at Genentech, the careful selection of only those applicants who really want to be there for the love of the job.

In either case, there is a hidden cost to the single-minded pursuit of success. It's the increasing isolation from the communities that connect people to each other. Parents don't know how to talk to their kids. Companies can provide a sense of community for their employees when business is booming - and that's all well and good - but if business should take a turn for the worse, it's still going to be every man for himself (as my family saw all too well in recent years). In order to win prestigious awards these days, it's necessary for young people to demonstrate "leadership" in some way, and what better way than to start your own club or organization? If everyone's starting a club, though, it becomes a case of "too many chiefs." Who's going to be in your club and make sure there's continuity when you're gone?

In our efforts to catapult ourselves onto the world stage -- to say, "Here I am, World! Take notice!" -- I think it's all to easy to lose sight of what's truly important. And what is truly important? There was an exercise in a recent issue of Time magazine that posed 3 questions to the reader:

1. What would you buy if you won the lottery?
2. If you found out you only had 6 months left to live, what would you do?
3. If you found out you only had one day left, what would you do?

The first 2 questions are supposed to illustrate those things and goals that you consider important but are ultimately temporary. The answer to the last question reveals what is, truly, important.

Food for thought.