I’m writing about the slow and uneven adoption of Standard Procedure Flying (SPF) during World War 2. SPF is superior, especially for newer pilots (which was who fought the war from 1943 onward, after the experienced ones were killed). So why didn’t everyone use it?? Analogy: free throw percentages in basketball are higher with underhand throws; but nobody uses it! Rick Barry is a legend who used it; but not even his sons followed him.Barry makes free throws into a “standard procedure.”
On Sunday I gave a capstone talk at the Production & Operations Society meeting in Denver. I oriented my talk toward a comparison of health care now, with aviation’s transition to Standard Procedure Flying in the 1940s and 50s. BOHN POMS Standard procedure flying 2013e
As in medicine now, experienced expert flyers who did not use standard procedures were still better than newly trained pilots who did. And there was resistance to the changes. But aviation had a couple of advantages in making the transition: New pilots who did not learn SPF died quickly, usually in accidents. And the old experts got rotated out of combat positions (United States Army Air Force), or eventually got shot down no matter how good they were. (Germany)
The first example is cancer research. … The genomic approach helps establish the right treatments today, and will likely lead to new and better drugs in the next few years. ….” this is something that will be useful 200 years from now. This is a landmark that will stand the test of time.”
Sorry, Andy, we have been getting hype about contributions of computers to biotech, and biotech to cancer, for 20+ years. It’s past time to be highly skeptical that medical breakthroughs are “around the corner… just give us another $X billion for research…” Although the research results have been fascinating, the practical impacts have been modest. I think one reason is that the Big Pharma/Big Academia model of R&D is inefficient and ineffective. Everyone hoards their data, and pursues their own stove pipe. There’s little collaboration or interchange among computer modelers, in-vitro, animal models, epidemiologists, etc. This is not something that better technology can solve – it’s a problem with business incentives and the academic promotion system.
Case in point: According to a friend, there have been no Randomized Clinical Trials on the relationship between crystalline salt and kidney disease. Everyone assumes there is a relationship, but what is the exact causal link? What’s the magnitude? What are the mediators of the effect (e.g. different diets, different climates). And what effects do intervention at different points (diet versus medications) have? This is not cancer research, but same principles hold.
Other benefits of technology: sure. Cultural and scientific and business. Mapping Inca ruins: awesome. Effect of Facebook on daily lives: large,and not captured in GDP statistics. So your basic thesis is good; just don’t use medical promises as cases in point!
A nice blog post by Laura McLay on a few of the paradoxes of cancer screening, and the human reactions to it. Everyone should read this weekend’s NYT article on breast cancer screening, by Peggy Orenstein. Title is Our Feel-Good War on Breast Cancer. One of my reactions to Peggy Orenstein being the author: age really does bring wisdom!
My extended family went through a scare caused by over-testing a few years ago. Nobody was at fault, but different family members have very different responses to uncertainty.
Here is the abstract to the article Laura mentions on prostate screening.
Debate regarding the prostate-specific antigen (PSA) screening test centers around test reliability and whether screening reduces mortality.1- 3 We consider yet another potential downside to the widespread use of unreliable screening tests: the downstream effect of receiving inconclusive or ambiguous results. When receiving information from screening tests, we usually want to know whether the result is a “yes” or a “no.” Receiving an inconclusive result amounts to a “don’t know”; this situation should have a level of uncertainty regarding the diagnosis similar to that of not conducting the test at all. Yet, we propose that the psychological uncertainty experienced after an inconclusive test result can lead to investigation momentum: additional, and potentially excessive, diagnostic testing. In contrast, not conducting the unreliable test would result in no further action. To investigate this, we evaluated whether receiving an inconclusive result from an unreliable test (the PSA screening), compared with undergoing no test, motivated more individuals to undertake an additional, more invasive and costly, test (a prostate biopsy).
At high tide, rock falls can be fatal. Rare risks, engaged often enough, add up to unreasonable levels. I’ve never seen anyone hit at Black’s, but I’ve seen lots of boulders sitting 20 feet from the base of the cliff, … Continue reading
An interesting concept: create a lottery which is really a disguised form of savings. That’s not quite what this proposal does, but it could be modified very easily.
From what I read, accumulating savings is a big problem for many poor people. Some nonetheless play the lottery. Create a lottery-squared, which takes in tickets from participants, accumulates most of it in an account for the payer, and puts a fraction in a true lottery. Then the ticket-buyer can “win” a small amount according to some rule. The rule may be hidden from them, as in the original proposal, or could be partially under their control.
Lots of legal problems with this, to say the least. The middleman is acting like a bank, with all the issues that brings. The record-keeping and security could be a problem. And so forth. This is more of a problem in some countries than others.
By the way, this is similar to what “Christmas club accounts” in banks did in the 1950s, apparently. Customers would put $5 into the account each week, and get it all back in December.
This blog challenges the “drowning in big data” cliche. He explains that most organizations don’t have useful access to most of their raw data – it sits somewhere in the IT department, but it’s not accessible, it has quality problems, and so forth.
But I think that is precisely where the “drowning” comes in. The psychological weight of all that unused data presses down and causes a sensation of “drowning.” The part of the data that is actually indexed, described, readily accessible and so forth is the data that we surf instead of drown under.
This applies on a personal level as well…. I drown under the weight of my “to read” pile; I surf the few things I actually sit and study.