Prescribing the Big Pill
Willful self-injury
Peace Corps volunteers returning from parts of West Africa are given the Liver Bomb, and strict instruction: continue malaria prevention, abstain from alcohol completely for weeks, and follow the protocol exactly. This potentially harmful medication is administered presumptively, without any presenting symptoms.
Why?
- The risk is high: these volunteers spend years in rural areas with limited sanitation, facing near-certain exposure to parasites.
- The threats are severe: from potentially fatal (and certainly miserable) malaria to permanently damaging conditions like river blindness and schistosomiasis.
- The alternatives aren’t viable: Waiting for symptoms is a non-starter, since these tropical diseases are often misdiagnosed or missed entirely in Western healthcare settings until serious damage occurs. And less aggressive treatments aren’t effective enough.
The Liver Bomb–the Big Pill–gets prescribed presumptively, despite lack of symptoms, and despite it potentially causing some minor harm, because it mitigates a much greater harm that has a fair chance of actually happening.
What’s your Big Pill?
This is a newsletter about tech leadership, not tropical medicine (though permit me some nostalgia). So why am I telling you about this?
Sometimes, we need to consider and accept team and organizational “injuries” to prevent greater harms.
Some technical examples:
- code freezes before major releases or known high-traffic dates, or
- the continued high friction of zero-trust infrastructure, or
- strictly curtailing access to your production data.
Or, at an organizational level:
- you might deliberately have redundant staffing, or
- devolve power and decisionmaking across multiple centers that compete for resources, or
- you might need to remove a poor-fit employee or even branch without a clear succession path, or even
- push for industry-wide regulation that you’d be subject to.
The key is to thoughtfully consider the context–the levels of risk and severity, and cost of the mitigating actions. A five-person startup probably doesn’t need to worry about devolving authority, and a sticker seller on Shopify is unlikely to need Kubernetes. But identifying your team’s and organization’s “Big Pills” – and when to take them – is crucial for their long-term health.
