"Unlike dry spells in innovation, quality defects and mistakes made in entering new markets, many of the problems that midsized companies must deal with are not obvious. These problems grow out-of-sight in the dark recesses of the midsized organization, unrecognized by management in their daily routines until they emerge as full-blown crises that can threaten the present and future of the business. I refer to these special afflictions of midsized companies—seven in all—as silent growth killers. These silent growth killers sneak up on leaders at midsized companies just as high blood pressure and high cholesterol can creep up on us, often unnoticed, and later cause massive complications. Just as those medical conditions, untreated, can lead to an early demise, executives who fail to prevent or address these silent growth killers may see their businesses collapse in a dysfunctional heap."