“The Checklist Manifesto” by Atul Gawande

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.Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields–from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

The Checklist Manifesto chronicles Dr. Gawande’s quest to better understand the sources of the greatest stresses and failures in the practice of medicine. From an essay he read in college, he gathers that there are two kinds of failure: those of ignorance and ineptitude. “Failures of ignorance we can forgive,” he says, “If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.” To remind us to apply this knowledge correctly, he happens upon a simple solution—the checklist.

He emphasizes with our inherent resistance to such a simple fix. He understands that a checklist feels by its very nature robotic and ‘soulless’ but says that a well-designed one doesn’t have to squelch our heroism. Across industries, from aviation to construction, Dr. Gawande shows that a checklist can get the routine and known checked off so we can focus our full attention on the parts of our jobs that include uncertainty.

Our world is complicated, and any method of better organizing all of our knowledge and information is much needed. Mundane as they are, the checklist has been shown to save lives and money in just about any place it’s methodically used.

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Perverse Incentives in Media

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Read what I have to say about perverse incentives here.

With journalism, the internet has created a set of perverse incentives that makes all of our lives a bit more convenient but have had unforeseen political consequences.

Media outlets are paid by the click, and that which goes unclicked goes unseen. Before long, those types of stories are no longer being written. With the unbundling of the variety of stories in a newspaper comes the evisceration of a news team’s budget. Craigslist and Indeed have diverted the ‘Help Wanted’ and ‘Classifieds’ revenue away from newspapers. All of this leaves us more narrowly informed and much more partisan. Ever wonder why national politicians seems to be going crazy? This is a significant contributing factor.

With the incentive structure for online journalism and the unbundling of the subscription model comes the return of some of the worst aspects of Yellow Journalism. The tenants of yellow journalism as laid out by the media historian W.J. Cambell include:

  • Prominent headlines that screamed excitement about ultimately unimportant news
  • Lavish use of pictures (often of little relevance)
  • Impostors, frauds, and fake interviews
  • Ostentatious support for the underdog causes
  • Use of anonymous sources
  • Prominent coverage of high society events

All of those look familiar to me. These are the hallmarks of a media structure that is perversely incentivized to rewards transient sensationalism over farseeing rationality, and frivolous trivia over hard facts.

What is a Perverse Incentive?

The fundamental lesson of economics is that people respond to incentives, while the driving insight of psychology is that people respond to positive or negative reinforcement. The two conclusions are very similar in their implications, but economics is focused primarily on money while psychology places its emphasis on love and attachment. Both incentives and reinforcements depend on the logic of cause and effect. Do this and get that.

The desire for money, love, respect, and leisure are some of the most powerful drivers of behavior that any of us will ever experience.  No one would disagree that the need to avoid the opposites of these rewards, being death, neglect, scorn and thankless toil, is an equally powerful motivator. The incentives structure of positive and negative reinforcements drive our behavior in just about any situation we’ll find ourselves in.

Given the corollaries between incentives and reinforcements, it’s tempting to assume that a perverse incentive would be the same thing as a negative reinforcer. It’s a bit more complicated than that. With negative reinforcement, you deter a behavior by punishing it. A perverse incentive, on the other hand, is an incentive to do something that has an unintended result that is contrary to the interest of the person naming their terms.

If I reward you for doing something a lot, you will be incentivized to inflate that number at all cost, outcome be damned. Your incentive to do the right this is perverted by the incentive to do the expedient thing. In business, an unfortunate example of this is a CEO’s whose salary is tied to the stock price company initiating company-wide lay-offs in order to revive a faltering stock price. In history, an illustrative example took place in Hanoi, under French colonial rule, where a program that paid villagers a bounty for each rat tail handed in was intended to exterminate rats led instead to the farming of rats by those citizens.

Economics is particularly bad at teaching empathy, and that’s the attitude you need to avoid setting up a perverse incentive for someone. Before deciding how you’ll reward or punishing someone else’s behavior, it’s helpful to think about how you’d react to the given reinforcers if you were the person you’re incentivizing. Chances are, your needs aren’t that much different from theirs.

 

“Extreme Medicine” by Kevin Fong, M.D.

There is no evolutionary precedent for the limits of survival we are now probing. By the time we’re supporting multiple organ systems on an intensive-care unit in the wake of major trauma, we’ve left evolution far behind. Out of those extremes, we depend not on our physiology but upon state-of-the-art systems of life support and the speed with which they can be brought to bear. The idea that, in the event of major accident, a team might literally drop out of the sky, scoop you up from the road, and propel you within minutes to a hospital is a construct of modern medicine that has existed only in recent decades. The edge of life, in that respect, has never been more heavily invested in.

 

This book is about the limits of our bodies in extreme conditions. Tangled with the history of medicine is the history of overcoming war, deadly contagions and exploration. Technology has allowed us, mostly in the past 150 years, to explore the frozen wastelands of the poles, the deep sea, and space. Our physiology is such that we can only last short periods of time in these conditions without succumbing to the elements.

Each chapter covers an area of health and details the circumstances in which innovation took place. From Sir Walter Scott’s frigid death in Antarctica in 1912 to reviving a clinically dead skier in the Alps nearly a century later; to plastic surgery repairing critically burnt fighter pilots disfigured faces in the World Wars; to the prospect of open heart surgery (another innovation with its root in the World Wars); to deep sea diving safely without being crushed by the pressure; this is the story of humanity’s fight to extend life in the most extreme circumstances.

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“Square Peg: My Story and What It Means for Raising Innovators, Visionaries, & Out-of-the-Box Thinkers” by Todd Rose

1.) Variability is the rule: As humans, our ways of perceiving thr world and reacting to what we perceive are much more diverse and dynamic than we might ever have imagined.

2.) Emotions are serious stuff: Contrary to what we’ve long believed, modern neuroscience has shown that there is no such thing as purely rational thought or behavior. Parents and teachers need to learn to tune in to children’s emotional states to help them make the most of their education.

3.) Context is key: People often behave in dramatically different ways, depending on the circumstances . Among other things, this suggests that we unfairly prejudice children by labeling them with a disorder, when they’d be perfectly fine in a different environment.

4.) Feedback loops determine long-term success or failure: Remember those flapping butterfly wings, and keep in mind that small changes in your child’s life today can make an enormous difference tomorrow.

Listed above are Todd Rose’s rules for understanding the variables in all of our educations. Learning is, for each of us, a complex system with many factors at play. His thesis is that until this is acknowledged in the classroom ‘No Child Left Behind’ is a hollow sediment instead of a genuine call to action.

Square Peg is an autobiography of an education, a thoughtful memoir of the challenges involved in going from a high school dropout with a kid on the way to a Harvard-educated and employed education reformer.

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Art Appreciation: Katsushika Hokusai

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I have a stack of Economist magazines from last year that I never got around to reading. Today I went through a couple finally trying to catch up. It was interesting to read the world news of the moment a year removed; to see what they got wrong and what’s still important.

An article about an exhibit on the work of Japanese artist Katsushika Hokusai (1760-1849) caught my eye with a graphic of his work, “The Great Wave.” This painting is familiar to me for some reason, but only peripherally. Perhaps it decorates the interior of a restaurant I like. I had NO IDEA that it was painted in the 1830s, and that Hokusai’s work inspired the likes of Van Gogh (1853-1890).

“The Great Wave” is a woodblock print, meaning the work was easily reproducible and available to Hokusai’s patrons for about “the price of a big bowl of noodle soup.” This was humble art made for the people. Of the nearly 5,000 copies made in Hokusai’s lifetime very few remain, the ones around today being the survivors of natural disasters, world wars, and almost 200 years time.

Required Reading, Fourth Week of April 2016

Throughout the week, I read a LOT of online articles. What follows are the three I found most interesting:

The Next Conservative Movement,via The Wall Street Journal–The national representatives of the Republican Party seems to have completely lost the plot over the past few years. I liked this article’s summation of the party’s difficulties, as well as the suggestions it gives for bringing Conservatism into the 21st century:

 Liberals treasure the social liberation and growing cultural diversity of the past half-century but lament the economic dislocation, the loss of social solidarity and the rise in inequality. Conservatives celebrate the economic liberalization and dynamism but lament the social instability, moral disorder, cultural breakdown and weakening of fundamental institutions and traditions. Part of Mr. Trump’s appeal has been that he basically laments it all—and thus unites the anxieties of those who see no real upside for themselves in the evolution of modern America.

But a politics of angry lamentation, whatever visceral appeal it may have, cannot look forward. America cannot afford a competition of barren nostalgias. We need a politics that builds on our strengths to address our weaknesses.

 

The Global Glut of Stored Time ,via The Reformed Broker–this short article, as well as it’s companion piece ‘Abundance’,contains a number of interesting concepts for making sense of the times we live in. The author’s premise is that we live in a time of unparalleled abundance, and that we have too much money and entertainment for our own good. Sounds like a good problem to have, right? The problem is that it’s inefficient, and we have no clue what to do with it all. Also, a new way to think about money:

“People work in order to convert their time into a unit of account,” he said. “We call that money, and it’s an invention that allows us to store time.” Most people have stored little or none. So when they receive money, they quickly purchase necessities; food, shelter, health care. “People who are able to save money inevitably purchase real estate, stocks, bonds – all of which are alternative vehicles for storing time.” One share of Google stores 30 hours of work for the average American, or 30 minutes of copying-and-pasting formation documents for the average hedge fund attorney. “Bill Gates has stored enough time to fund a 1bln person army for 20 years.”

 

The Best is The Last,via Benedict Evans–I feel Benedict Evans’ insight about innovation, that a technology is at its finest iteration right before it gets superseded by something else, is enlightening. It explains why laptops and PCs are so amazing and cheap even though some would say that technology is passé and on the verge of becoming secondary to mobile,  among other things. This essay uses the examples of airplanes and sailing vessels:

The point of this excursion into tech history is that a technology often produces its best results just when it’s ready to be replaced – it’s the best it’s ever been, but it’s also the best it could ever be. There’s no room for more optimization – the technology has run its course and it’s time for something new, and any further attempts at optimization produce something that doesn’t make much sense.

Are Your Chances of Having a Baby Boy or Girl Really A 50/50 Split?

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This has to be a case of spending waaaay too much energy just to solve a simple problem.

Laying in bed the other morning unable to get back to sleep, I kept pondering the randomness of a baby’s gender. Is it really a random 50/50 possibility either way? After all,  the world population isn’t exactly even ( 3,477,829,638  men to 3,418,059,380  women in 2010, according to The Internet). And a lot of families with more than one child seem skewed to one gender or another, almost as if they couldn’t have children of the other gender if they tried.

So I used my parents large families as an example. On the liquid marker board on my wall, I plotted the older generation of each family vertically and connected each of their bubbles horizontally to the bubbles representing their children. Below, I redrew the bubbles and flipped a coin for each one and recorded each coin tosses’ outcome by coloring each bubble either red or blue. Viewed in the aggregate, the results look strikingly similar. (The only 50/50 split come from my cousins on my mom’s side. Out of three sisters, one had two girls, the other a boy and a girl, while my mom had two boys.)

This also reveals something about probability that has isn’t exactly obvious: that a 50/50 chance doesn’t necessarily yield an even distribution of outcome in real life.

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For more information, check out Wikipedia’s page on Human Sex Ratio.

Required Reading, Second Week of April 2016

Throughout the week, I read a LOT of online articles. What follows are the two I found most interesting:

Why Most People Don’t Learn From Their Mistakes, via Maneatingrobot–This blog post by Shane Snow is the shortcomings inherent in the cliche “That which doesn’t kill you makes you stronger.” As he says, “What doesn’t kill you doesn’t make you stronger if it puts you in a lifelong coma.”:

Researchers interviewed 500 prisoners about how they felt about their crimes, and then kept tabs on them after release to see whether they ended up re-committing similar crimes. The researchers catalogued the prisoners in two categories: those who felt guilt and those who felt shame. Guilt means that you feel badly for your actions. Shame means that you feel badly about who you are.

Though guilt and shame sound like similar emotions, they proved highly predictive of the ex-cons’ future behavior. Prisoners who felt guilty for what they’d done tended to do better post-parole; they focused on the actions they could do differently since it was their own actions that got them locked up in the first place. Prisoners who felt shame tended to blame their circumstances in order to preserve their self-esteem—both regarding their crimes and in their general lives—and so they didn’t actually learn from the mistakes and continued on to lives of crime later. Many in the “shame” category ended up back in the slammer.

 

The Voyeur’s Motel, via The New Yorker–Here is a long expose about a man who purchases a motel in Aurora, Colorado in order to fulfill a lifelong ambition: to be able to spy on the personal lives of strangers. Over the years, this man is witness to all shades of depravity and tedium and has finally gone public with his story. Perhaps, in a way, we’re all voyeurs:

A voyeur is motivated by anticipation; he invests endless hours in the hope of seeing what he wishes to see. Yet for every erotic episode he witnesses he is also privy to hundreds of mundane moments representing the ordinary daily human routine—people channel-surfing, snoring, urinating, primping, and doing other things too tediously real for reality television.