Weekly Thoughts


Salt, Sugar, and Water

Our first job after college was as a macro research analyst.  This involved trying to make sense of (and predictions for) complex ideas with a lot of moving, unpredictable pieces.  It was possible to do boundless reports on any given idea, along with the nuances, caveats, and justifications for our assumptions.  It is an area where it’s very possible to lose the forest through the trees.  

We are eternally thankful that our first boss was adamant that all ideas be presented to him as three key (one sentence) bullet points.  We could attach whatever report we wanted, but he believed that if we couldn’t distill an opportunity down to three key points, we didn’t understand it.  Lesson learned. 

When forced to summarize an idea into three key points, we often had to go back to basics and think from a first principles perspective.  What, actually, was the problem in the Brazilian housing industry?  What was driving European CDS spreads?  How would the Swiss Franc move in pro-nationalist EU elections?  It was wonderful and invaluable training. 

We learned that when working with complex issues, the simplest explanation is often closest to the truth.  We were reminded of this universal truth when reading a Harvard Magazine article about solving the spread of cholera (and dehydration) in Pakistan in the 1970s.  Back then, there was no accessible cure, and patients would have to travel to urban hospitals to receive IV infusions.  According to Ashish Jha, Professor of Global Health at the Harvard Chan School, while diarrhea still kills about 500,000 people annually, that number is down ~80% since 1980.  Prior to 1980, the standard of care was to treat diarrhea with intravenous (IV) fluids, which was “really expensive, often dangerous, and often not available.” 

Richard Cash, a National Institutes of Health (“NIH”) employee who worked at the Pakistan-SEATO Cholera Research Laboratory, saw the problem of cholera dehydration first-hand and was moved to provide a solution.  From Harvard Magazine: 

“After some tinkering, [Cash] and his colleagues began the first successful clinical trial of an oral rehydration therapy (ORT). Their mix of salt, sugar, and water helped patients return to their normal hydrated state almost as quickly as they had sickened – and reduced the use of IV fluids, reserving that more complicated treatment for unconscious patients.”

And hence, the invention of electrolyte packages.  However, the initial (packet-based) iteration was too expensive to distribute to rural areas.  As a result, the research team continued to tinker: 

“The research group adjusted the formula; a three-finger pinch of salt, a fistful of unprocessed sugar, and a half liter of water. Health educators traveled from town to town teaching women about the therapy and scratching pots at the half-liter mark. Five decades later, ORT has saved an estimated 50 million-plus lives worldwide. The story of ORT, Cash believes, can inspire researchers today. Among its lessons are, first, to think simply: [the innovations] most responsible for reducing diarrheal deaths… are inexpensive and uncomplicated. The second was the importance of helping the target community ensure effective implementation. ‘A solution that can’t be applied,’ he says, ‘is really no solution at all.’” 

One thing we love about the small business world is that most operators have a practical, no-nonsense approach.  That said, sometimes we all get stuck in the weeds when analyzing a particular problem and create ever-more complex solutions on behalf of our constituents.  We forget to return to first principles and simplify any given problem. 

The ORT story is incredible and we’ll never look at our morning electrolyte drink quite the same.  It’s also a good reminder that even when faced with life-and-death situations, simple solutions often create tremendous impact.  As Cash noted to students at the Harvard School of Public Health in 2018“Simple doesn’t mean second-class.”  Although people often think fancy technology must be used to deal with difficult problems, “it really is harder to make something simple than to make it complicated.”  It’s a great reminder that sometimes, all you need is some salt, sugar, and a half liter of water.

Have a great week,

Your Chenmark Team

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