Adonis Diaries

Archive for the ‘medicine/medical treatment’ Category

Is it the less information the better in critical split-second decision cases?

ER of Cook County Hospital (Chicago) on West Harriston Street, close to downtown, was built at the turn of last century.

I was home of the world’s first blood bank, cobalt-beam therapy, surgeons attaching severed fingers, famous trauma center for gangs’ gunshot wounds and injuries…and most famous for the TV series ER, and George Clooney

In the mid 90’s. the ER welcomed 250,000 patients a year, mostly homeless and health non-insured patients…

Smart patients would come the first thing in the morning to the ER and pack a lunch and a dinner.  Long lines crowded the walls of the cavernous corridors…

There were no air-conditioners: During the summer heat waves, the heat index inside the hospital reached 120 degrees. 

An administrator didn’t last 8 seconds in the middle of one of the wards.

There were no private rooms and patients were separated by plywood dividers.

There were no cafeteria or private phones: The single public phone was at the end of the hall.

One bathroom served all that crowd of patients.

There was a single light switch: You wanted to light a room and the entire hospital had to light up…

The big air fans, the radios and TV that patients brought with them (to keep company), the nurses’ bell buzzing non-stop and no free nurses around… rendered the ER a crazy place to treat emergency cases

Asthma cases were numerous: Chicago was the world worst in patients suffering from asthma…

Protocols had to be created to efficiently treat asthma cases, chest pain cases, homeless patients…

About 30 patients a day converged to the ER complaining of chest pains (potential heart attack worries) and there were only 20 beds in two wards for these cases.

It cost $2,000 a night per bed for serious intensive care, and about $1,000 for the lesser care (nurses instead of cardiologists tending to the chest pain patient…)

A third ward was created as observation unit for half a day patients.  

Was there any rational protocol to decide in which ward the chest-pain patient should be allocated to?

It was the attending physician call, and most of the decisions were wrong, except for the most obvious heart attack cases…

In the 70’s, cardiologist Lee Goldman borrowed the statistical rules of a group of mathematicians for telling apart subatomic particles. Goldman fed a computer data of hundreds of files of heart attack cases and crunched the numbers into a “predictive equation” or model.

Four key risk factors emerged as the most critical telltale of a real heart attack case:

1. ECG (the ancient electrocardiogram graph) showing acute ischemia

2. unstable angina pain

3, fluid in the lungs

4. systolic blood pressure under 100…

decision tree was fine-tuned to decide on serious cases. For example:

1. ECG is normal but at least two key risk factors are positive

2. ECG is abnormal with at leat one risk factor positive…

These kinds of decision trees… (The early artificial programs)

The trouble was that physicians insisted on letting discriminating factors muddle their decisions. For example, statistics had shown that “normally” females do not suffer heart attack until old age, and thus a young female might be sent home (and die the same night) more often than middle-aged black or older white males patients…

Brendan Reilly, chairman of the hospital department of Medicine, decided to try Goldman decision tree.  Physicians were to try the tree and their own instincts for a period.  The results were overwhelmingly in favor of the Goldman algorithm…

It turned out that, if the physician was not bombarded with dozens of pieces of intelligence and just followed the decision tree, he was better off in the allocation to ward process…

For example, a nurse should record all the necessary information of the patients (smoker, age, gender, overweight, job stress, physical activities, high blood pressure, blood sugar content, family history for heart attacks, sweating tendencies, prior heart surgeries,…), but the attending physician must receive quickly the results of the 4 key risk factors to decide on…

Basically, the physician could allocate the patient to the proper ward without even seeing the individual and be influenced by extraneous pieces of intelligence that are not serious today, but could be potential hazards later on or even tomorrow…

Mind you that in order to save on medical malpractice suits, physicians and nurses treating a patient must Not send the patient any signals that can be captured as “contempt”, like feeling invisible and insignificant

Many factors are potential predictors for heart attack cases, but they are minor today, for quick decisions…

No need to overwhelm with irrelevant information at critical time.  Analytic reasoning and snap judgment are neither good or bad: Either method is bad at the inappropriate circumstances.

In the “battle field” the less the information coming in, the less the communication streams and the better the rapid cognition decisions of field commanders…

All you need to know is the “forecast” and not the numbers of temperature, wind speed, barometric pressure…

Note: post inspired from a chapter in “Blink” by Malcolm Gladwell

10 – Eye Exercises – Increase The Power of Your Optic Muscles

From allaboutcf.  July 29, 2020

The eyes contain lots of small muscles, and there is no doubt that eye workouts can do little damage to your eyes, but can they really be of benefit?

Dr William Bates, developed a series of eye exercises at the beginning of the century to enhance vision without turning to lenses or surgery.

Dr Bates felt that many eye problems had their origin in stress, stress and laziness of the eye and he thought that because of these causes, the eyes could be treated without correction such as lenses, eyeglasses or perhaps surgical treatment.

Dr Bates’ theory focused on the concept that the muscles of the eye became fixed on a scene triggering stress to the eyes. Dr Bates felt that the eyes could be re-trained to relax and improve the link between the optic nerves and the brain.

Many people around the globe have claimed enhancements simply put sight, long sight, astigmatism, squints and lazy eyes utilizing these techniques.

Even children are able to practice the workouts and individuals with normal vision might improve concentration, reading abilities and co-ordination by following the regimens suggested by Dr Bates.

In essence, you can expect to perform some basic exercises for about half an hour a day

These can include a few of the following:-.

To rest and relax your eyes, sit easily in front of a table, resting your elbows on a stack of cushions high enough to bring your palms quickly to your eyes without stooping forward or looking up. Close your eyes and cover them with your cupped palms to omit light, avoiding pressure on the sockets.

– ‘Swinging.’.
Unwind and keep the eyes mobile. Blinking cleans and lubricates the eyes, which is especially important if you invest a lot of time in front of a computer.

Select a colour and look out for it throughout the day. When you see it, be conscious of the colour rather than the kind.

See Plainly Approach.

The See Plainly Method is another popular series of exercises and training to help with vision correction. To the Bates’ technique, you are required to do 30 minutes of eye works out a day to enhance and boost the flexibility of the eye’s muscles.

This would usually involve making the eye change it’s focus from near to far. One easy method of doing this would be to hold a little item in your hand and slowly move it away from your face, making sure that your eye follows the things and maintains focus upon it.

One exercise which is referred to as “tromboning” has you hold a small object again, starting at arm’s length. Then you need to breath in and move the object slowly more detailed to your face, until it touches your nose. You are then required to breath out, taking a look at the item as you again move it away from your face.

Hence the idea of “Tromboning”.

The See Clearly Method also utilizes a variety of methods which are targeted at speeding up progress or enhancement.

There is a technique referred to as the “blur reading” technique, which asks you to turn a magazine upside-down at a range where the words are not distinct. Then, you are expected to choose one word and focus your attention around it, to see if you can determine any of the letters.

Skeptics? Not in relation to physical fact. Circumcision Not cutting it?

Circumcision has endured because of tradition, not because of rationale nor medical benefit.

Nor has it ever been successful as an anti-masturbatory measure, which is why it gained prominence in the West 150 years ago.

When a custom remains after its original intent has vanished, it has morphed into a ritual.

And ritual is one of the kinder words to describe removing highly-innervated tissue from the most vulnerable members of our species, without any benefit in return.

The relic rests in the same vein as coming-of-age rituals and other practices that involve cutting, slicing, burning, and flogging.

According to the American Academy of Pediatrics, one in 500 boys experience acute complications from circumcision. Even a 0.2% risk is Not acceptable when there is no chance of reward.

Still it endures because, to most Westerners, that’s the way it’s always been. But the appeal to tradition is a logical fallacy that, were it rigidly adhered to, would have us still with slavery and without women’s suffrage. 

Imagine if circumcision had never been practiced and someone proposed we begin fondling and mutilating the infant genitals. The collective response would be revulsion.  Yet the practice continues today because, well, just because.

Reasons include ensuring the infant conform to religious norms or so that they will look like their father.

But faith should be a personal choice and if a father was missing three fingers, no one would suggest lopping off the digits to ensure familial uniformity.

A third reason proponents give is because they think it looks unappealing. But that’s only because they are used to seeing circumcised penises.  Were every male intact, proponents would see circumcised members as the freaky outcasts. 

Parents deciding to circumcise their sons is distinct from having them vaccinated or given Vitamin K boosters, as these have identifiable benefits.

Chopping off someone else’s body part would mean prison time under any other circumstance, but exception made for the most vulnerable victim.

In a depressing display of bipartisanship, the practice remains prevalent among persons of all political leanings.

Conservatives still go for the religion and tradition angles, which is to be expected.

Harder to comprehend is the tepid response from liberals, who should be demanding bodily autonomy over the most defenseless of our species.

It has been pointed out that  we should never make Junior hug an aunt just because she’s visiting for Christmas if the child doesn’t wish too. Yet, somehow this mindset does not extend to control over the most private part.

With no medical benefit, circumcision is a solution in need of a problem.  Proponents sometimes cite hygiene, but this is no more logical that lopping off our ears to prevent dirt from accumulating within.

One seemingly more valid reason is the chance of reducing HIV infection.

But this is an untruth and based on studies that make such basic mistakes as assuming all transmission was due to heterosexual sex. Also, if the studies were correct, and the practice provided STD protection, there would be a wide difference in infection rates between the circumcised and intact. 

Note: I can speak from personal experience.

I decided for circumcision when I was 26 after a painful unachieved sexual encounter. I had never masturbated and was still physically a “virgin”.

When I checked with a female physician, she transferred me to a male physician, and for a good reason. The physician “recovered” my swollen penis and taught me how to retract and recover. I was to get it down by doing this exercise 3 times a day. And I reasoned that getting circumcised would same me from this tedious exercise.

Sure I suffered for 2 weeks of pain and inconvenience, but I am glad for taking this decision

And I am wondering: If I were circumcised, would I have masturbated much early on?

If were circumcised, wouldn’t I be bold enough to try sexual encounter much earlier?

And I feel circumcision is actually necessary for a normal growing up of males, and more hygienic too.

Many children had to be circumcised because they lacked the necessary training to clean their penis when taking showers.

How can a layperson differentiate between Alzheimer and other more confusing loss of memories?

Maybe it is Not Alzheimer, but the memory confusion maybe worse to everyone concerned

Are you afraid of having Alzheimer’s?

Or Someone close to be afflicted with Alzheimer?

Those who really suffer from a memory disease, like in Alzheimer, they do Not realize what is happening or that they forgot to do something or forgot a name…

Probably your perception of memory loss is Not due to Alzheimer’s?

If anyone is aware of his memory problems, he doesn’t have Alzheimer’s.

It often happens in people aged 60 and over that they complain that their memory is lacking: Like the information is still in the brain, but it is the ” Processor ” that is missing., or failing to function properly.. It is labeled “temporary oblivion“.

My memory difficulties with names of persons and objects and fruits and vegetables… is worrying me.

The instances that I am excited and talkative, I feel that I can be a stand up comic and all words are fluent and coming quickly.

My mother condition is much worse: She cannot form an entire sentence and she get terribly frustrated and start to cry.

Yes, mother is aware of the deteriorating condition of her memory.

Lately, the TV has become a live and living scenes: People on TV are actually talking to her, and any procession on TV is converging to her house. And she get busy arranging coffee cups… waiting for the arrival of the visitors.

Mother confuses names: her own daughter receives the name of her late oldest sister. Many times she calls me Georges, the name of my late father.

 Elie Bashour posted this following article on July 27, 2018 and I am re-editing it.

”There are times when I speak, I can stop and don’t know what I was talking about…
I was afraid it was a start of Alzheimer’s… but today, reading this article, I’m reassured.”

In the following analysis, French Professor Bruno Dubois Director of the institute of memory and Alzheimer’s disease (Imma) at mercy-Salpêtrière – Paris Hospitals / addresses the subject in a rather reassuring way:

”If anyone is aware of his memory problems, he doesn’t have Alzheimer’s. ” “

1. I forget family names…
2. I don’t remember where I tidied up some things…

Half of the people aged 60 and over present some symptoms that are rather due to age than to disease.

The most common cases are:
– Oblivion of a person’s name,
– the fact that we went to a room in the house and never remember why we were going…
– a white memory for a movie title or an actor, an actress,
– a waste of time looking where we left his glasses or keys…

After 60 years most people have such difficulty.

This indicates that this is not a disease but rather a characteristic due to the passage of the years…

Many people are concerned about these omissions and the importance of the following statement:

” those who are aware of these omissions have no serious problem of memory.

Professor Bruno Dubois, director of Imma, reassures the majority of people concerned by their omissions:

” the more you complain about memory loss, the less likely it is you suffer from a memory disease. ” ”

– Now a little neurological test.
Only use your eyes!

1-find the c in the table below!


2-if you already found the c, then find the 6 in the table below.


3-now find the n in the table below. Careful, it’s a little harder!


If you pass these three tests without problems:

– you can cancel your annual visit to the neurologist.
– your brain is in perfect shape!
– you’re far from having any relationship with Alzheimer’s.

So, circulate. Be reassure…

And why am I not reassured?

The consequences are as bad. Better Not know what’s going around me.

Are these the Covid-19 recommendations from Maryland University?

Most probably, we are set to live with the Covid-19 for a long time.

We have got to learn and train our daily habits to survive this pandemics without major health degradation.

Wear a mask made of 3 layers of different fabrics in enclosed environment

Frequently wash your hands with soap and Not with bacteria disinfectant liquids, as you touch objects

Learn to keep the distance of 2 meters, even inside your home

Frequently enjoy clean air outside spaces and let your system be contact with all kinds of outside bacteria to increase your immune system.

Fortifying your immune system is Not a cure for catching this virus

No, the visus does Not attach to your shoes, but learn to walk barefoot inside your home

Your skin is the best defense against all kinds of viruses and bacterias

بيان من عيادة الأمراض المعدية في جامعة ميريلاند الأمريكية:

1. قد نضطر إلى العيش مع C19 لشهور أو سنوات، دعونا لا ننكره أو نذعر، دعونا نتعلم كيف نتعايش مع هذه الحقيقة.

2. لا يمكنك تدمير فيروسات C19 التي اخترقت جدران الخلايا، حتى لو شربت غالونات من الماء الساخن؛ فقط ستذهب إلى الحمام كثيرا.

3. غسل اليدين والمحافظة على مسافة جسدية بطول مترين ( 2 m) هي أفضل طريقة لحمايتك.

4. إذا لم يكن لديك مريض C19 في المنزل ، فلا حاجة لتطهير الأسطح في منزلك.

5. البضائع المعبأة ومضخات الغاز وعربات التسوق وأجهزة الصراف الآلي لا تسبب العدوى، فقط اغسل يديك، وعش حياتك كالمعتاد.

6. إن C19 ليست عدوى غذائية، تترافق مع قطرات من العدوى مثل الانفلونزا، لا يوجد خطر واضح لانتقال C19 عن طريق طلب الطعام.

7. يمكن أن تفقد حاسة الشم مع الكثير من الحساسية والالتهابات الفيروسية، هذه ليست دائما أعراض تدل على إصابة بفيروس C19.

8. بمجرد أن تكون في المنزل لا تحتاج إلى تغيير ملابسك على وجه السرعة والاستحمام، الطهارة فضيلة، ولكن هوس الخوف ليس كذلك!

9. فيروس C19 لا يعلق في الهواء. هذه عدوى تنفسية تتطلب اتصالًا وثيقًا.

10. الهواء نظيف يمكنك المشي في الحدائق (فقط حافظ على مسافة الحماية المناسبة).

11. يكفي استخدام الصابون العادي ضد C19 ، وليس الصابون المضاد للبكتيريا.

12. لا داعي للقلق بشأن طلبات الطعام الخاصة بك، ولكن يمكنك تسخينها في الميكروويف، إذا كنت ترغب في ذلك.

13. فرصة إحضار C19 إلى المنزل مع أحذيتك غير صحيحة. أنا أعمل ضد الفيروسات منذُ 20 عامًا – فالعدوى لا تنتشر بهذه الطريقة!

14. لا يمكنك القضاء على الفيروس بأخذ الخل وعصير قصب السكر والزنجبيل! هذه لرفع مستوى الحصانة وليست علاجا.

15. ارتداء الكمامة لفترات طويلة يتعارض مع مستويات التنفس والأكسجين. ارتديه فقط في الأماكن المزدحمة.

16. ارتداء القفازات هو أيضا فكرة سيئة. يمكن أن يتراكم الفيروس في القفاز وينتقل بسهولة إذا لمست وجهك. الأفضل أن تغسل يديك بانتظام.

17- المناعة تضعف إلى حد كبير من خلال البقاء دائماً في بيئة معقمة. حتى إذا كنت تأكل أطعمة تعزز المناعة ،

يرجى الخروج من منزلك بانتظام إلى أي حديقة / شاطئ، فالمناعة تزيد من خلال التعرض للأمراض، وليس عن طريق الجلوس في المنزل وتناول الأطعمة المقلية / الحارة / والسكريات.

The right to end your terminally miserable life out of constant pains?

Feasting on Gore (Written in 1999)

1.   X-rays don’t hurt: no pain.

Chemo is different: You lose your mane.

Cancer, hospital appointment, hospital confinement, terminal.

Convicted criminal, prison, delayed execution, terminus.

2.   Dressed in apron, back naked, abandoned, and forgotten;

Robbed of your money, robbed of dignity, and robbed of life.

A case study you are, for all to learn from experiments.

The more cases the better the knowledge.

3.   You lived; lived enough.

Let others learn and live, a while longer.

The “right to live folks” need to hang the Kevorkian’s,

Every single one of them:

Those who aid the terminally ill to die with his own choice.

4.   Pain, constant pains, no end in sight, no cure.

Wait till the healthy, spineless soul of the “right to live” maniacs

Needs a Kevorkian,

But will be surrounded with pale faces feasting on gore.

5.   I have the power to predict the end.  I know the odds:

You either die instantly or you live,

In the mind of all you know,

half-man. Abandoned.

6.   You may listen to the pillars of moral characters,

You may nod to the Talking Heads:  They talk well.

I have decided on my destiny.

It shall be quick.

Drug Research Contracts: Keeping Pharmaceutical companies out of reach from procsecution?

An article published in the NYT in November 29, 2004

“Of the 12 studies for (the church of Pfizer), all 5 of the reports claiming positive results, meaning the drug worked without worrisome side effects, that were submitted for possible regulatory approval were published.

The 7 other studies were inconclusive or negative, which can mean that the drug failed to work or that the test failed because of its design.

(Two of the studies were never submitted to the Food and Drug Administration to support an application for the drug’s approval.)”

“In her Zoloft study, Dr. Wagner acknowledged that she had received “research support” over the years from several drug manufacturers including Pfizer, which paid $80,000 to the Galveston center in connection with the Zoloft test.

But she did not state that she also received sizable payments from the company for work she did related to the study.”

Dr. Karen Dineen Wagner of the University of Texas Medical Branch at Galveston Published in November 29, 2004 under “Contracts Keep Drug Research Out of Reach”

(Page 3 of 5)

Dr. Wagner, vice chairwoman of the department of psychiatry and behavioral sciences at the Galveston center, declined to be interviewed for this article but did reply to some questions in writing. Officials of the Galveston center insisted that the industry money she received did not affect her work.

A Researcher’s Role

It was hardly surprising that many manufacturers of popular antidepressants already approved for use in adults would turn to an established researcher like Dr. Wagner to test them in young patients.

In the late 1990’s, she was one of a small number of researchers with experience in testing drugs intended to treat children with problems like attention deficit disorder and bipolar disorder.

Over the last decade, Dr. Wagner has led or worked on some 20 studies published in medical journals, and the government has financed some of her work.

She has also attracted a large number of including those aimed at testing whether antidepressants approved for use in adults were safe and effective in children and adolescents.

Dr. Wagner’s role varied in 12 industry-sponsored trials in which antidepressants were tested against placebos for depression or other problems. On three of them, including a Zoloft trial, she was a lead investigator, working with company researchers to plan, analyze and write results up for publication.

On the others, her duties were limited to overseeing test patients at her clinic.

Of the 12 studies, all five of the reports claiming positive results, meaning the drug worked without worrisome side effects, that were submitted for possible regulatory approval were published. The seven other studies were inconclusive or negative, which can mean that the drug failed to work or that the test failed because of its design. (Two of them were never submitted to the Food and Drug Administration to support an application for the drug’s approval.)

Because many of the antidepressant studies were unpublished, many doctors never heard about the results.

Their findings were typically disclosed in limited settings, like talks at meetings of medical specialists or on a poster displayed in a room with dozens of other posters, which is a typical way of disseminating research results at professional conferences.

Several researchers who worked on the pediatric antidepressant trials said that in many cases they had little incentive to submit ambiguous or failed trials to medical journals because they thought the papers would be rejected by journal editors.

One of those researchers, Dr. Neal Ryan, a professor of psychiatry at the University of Pittsburgh, said there has typically been little publishing interest in studies with inconclusive findings or those that failed to work because of study design, a type sometimes referred to as a negative study.

“No one gets famous from publishing negative studies,” Dr. Ryan said.

In response to a question, Dr. Wagner wrote that in all the cases where she was the lead investigator, test results had been or would soon be published or presented at medical meetings.

It was her study of Zoloft for childhood depression, financed by Pfizer, that attracted the most attention and criticism. Results were published last summer in The Journal of the American Medical Association as the debate on pediatric antidepressant use was rising; the study concluded that the drug effectively treated depression.

The finding received widespread publicity in newspapers, including The New York Times.

“This study is both clinically and statistically significant,” Dr. Wagner said last year. “The medication was effective.”

But some academic researchers said that the difference in improvement that the study found between young depressed patients taking Zoloft and similar patients who received a placebo – 10 percentage points – was not substantial.

Asked about complaints about the trial, Dr. Wagner referred to a statement in The Journal of the American Medical Association in which she responded last year to critical letters.

In that statement, Dr. Wagner said she believed that the 10 percentage point difference was “clinically meaningful.”

A Possible Conflict (of interest?)

In her Zoloft study, Dr. Wagner acknowledged that she had received “research support” over the years from several drug manufacturers including Pfizer, which paid $80,000 to the Galveston center in connection with the Zoloft test. But she did not state that she also received sizable payments from the company for work she did related to the study.

Note: Dr. Karen Dineen Wagner participated in more than a dozen industry-financed pediatric trials of antidepressants and other types of drugs from 1998 to 2001.

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Environmental management practices in the Lebanese pharmaceutical industries

187(3):4290. doi: 10.1007/s10661-015-4290-3. Epub 2015 Feb 12.

Implementation strategies and challenges.

Author information

  • 1Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon,


This research attempts to provide an understanding of the Lebanese pharmaceutical industries’ environmental management strategies, priorities, and perceptions as well as drivers, barriers, and incentives regarding the implementation of the voluntary ISO 14001 Environmental Management System.

Accordingly, a semistructured in-depth interview was conducted with the pharmaceutical industries.

The findings revealed a significant lack of knowledge about the standard among the industries.

The main perceived drivers for adopting the ISO 14001 are improving the companies’ image and overcoming international trade.

The main perceived barriers for acquiring the standard are the lack of government support and the fact that ISO 14001 is not being legally required or enforced by the government.

Results revealed that adopting the ISO 14001 standard is not perceived as a priority for the Lebanese pharmaceutical industries. Although the cost of certification was not considered as a barrier for the implementation of ISO 14001, the majority of the pharmaceutical industries are neither interested nor willing to adopt the Standard if they are not exposed to any regulatory pressure or external demand.

They are more concerned with quality and safety issues with the most adopted international standard among the industries being the ISO 9001 quality management system.

This study highlights the aspect that financial barriers are not always the hurdles for implementing environmental management strategies in developing countries and underscores the need for regulatory frameworks and enforcement.

[PubMed – in process]
Investment in Medicine for virility and augmentation of breast:
5 times that of Alzheimer?
Drauzio Varella, Brazil Nobel laureate for medicine, said:
Currently, 5 times more are invested in Medicine for virility and augmentation of breast than on Alzheimer.
Within a few years, we will end up with a whole bunch of elder people with big breasts and rigid penis, and they will have no idea what they are for, and what they used them for…
La phrase qui tue !!!!....

Are making mistakes that essential?

“You show me a successful complex system, and I will show you a system that has evolved through trial and error.” (Mostly?)

God complex.  Almost all professionals in all disciplines believes he is absolutely certain in his convictions

Economics writer Tim Harford studies complex systems — and finds a surprising link among the successful ones: they were built through trial and error. In this sparkling talk from TEDGlobal 2011, he asks us to embrace our randomness and start making better mistakes

Tim Harford. Economist, journalist and broadcaster. His writings reveal the economic ideas behind everyday experiences. Full bio

Speech on July 2011

It’s the Second World War. A German prison camp. And this man, Archie Cochrane, is a prisoner of war and a doctor, and he has a problem. The problem is that the men under his care are suffering from an excruciating and debilitating condition that Archie doesn’t really understand. The symptoms are this horrible swelling up of fluids under the skin.

But he doesn’t know whether it’s an infection, whether it’s to do with malnutrition. He doesn’t know how to cure it.

And he’s operating in a hostile environment. And people do terrible things in wars.

The German camp guards, they’ve got bored. They’ve taken to just firing into the prison camp at random for fun. On one particular occasion, one of the guards threw a grenade into the prisoners’ lavatory while it was full of prisoners. He said he heard suspicious laughter.

And Archie Cochrane, as the camp doctor, was one of the first men in to clear up the mess. And one more thing: Archie was suffering from this illness himself.

1:23 So the situation seemed pretty desperate.  Archie Cochrane was a resourceful person. He’d already smuggled vitamin C into the camp, and now he managed to get hold of supplies of marmite (marmalade?)on the black market.

Some of you will be wondering what marmite is. Marmite is a breakfast spread beloved of the British. It looks like crude oil. It tastes zesty. And importantly, it’s a rich source of vitamin B12. So Archie splits the men under his care as best he can into two equal groups.

He gives half of them vitamin C. He gives half of them vitamin B12. He very carefully and meticulously notes his results in an exercise book. And after just a few days, it becomes clear that whatever is causing this illness, marmite is the cure (lack of vitamin B12. But this is No trial and error. It is an experiment designed to find the cause of the ailment)|By Tim Harford

So Cochrane then goes to the Germans who are running the prison camp. Now you’ve got to imagine at the moment — forget this photo, imagine this guy with this long ginger beard and this shock of red hair. He hasn’t been able to shave — a sort of Billy Connolly figure.

Cochrane starts ranting at these Germans in this Scottish accent — in fluent German, by the way, but in a Scottish accent — and explains to them how German culture was the culture that gave Schiller and Goethe to the world. And he can’t understand how this barbarism can be tolerated, and he vents his frustrations.

And then he goes back to his quarters, breaks down and weeps because he’s convinced that the situation is hopeless. But a young German doctor picks up Archie Cochrane’s exercise book and says to his colleagues, “This evidence is incontrovertible. If we don’t supply vitamins to the prisoners, it’s a war crime.” And the next morning, supplies of vitamin B12 are delivered to the camp, and the prisoners begin to recover.

I’m not telling you this story because I think Archie Cochrane is a dude, although Archie Cochrane is a dude. I’m not even telling you the story because I think we should be running more carefully controlled randomized trials in all aspects of public policy, although I think that would also be completely awesome.

I’m telling you this story because Archie Cochrane, all his life, fought against a terrible affliction, and he realized it was debilitating to individuals and it was corrosive to societies. And he had a name for it. He called it the God complex.

I can describe the symptoms of the God complex very easily. So the symptoms of the complex are, no matter how complicated the problem, you have an absolutely overwhelming belief that you are infallibly right in your solution.

Archie was a doctor, so he hung around with doctors a lot. And doctors suffer from the God complex a lot.

I’m an economist, I’m not a doctor, but I see the God complex around me all the time in my fellow economists.

I see it in our business leaders. I see it in the politicians we vote for — people who, in the face of an incredibly complicated world, are nevertheless absolutely convinced that they understand the way that the world works.

with the future billions that we’ve been hearing about, the world is simply far too complex to understand in that way.

 let me give you an example. Imagine for a moment that, instead of Tim Harford in front of you, there was Hans Rosling presenting his graphs. You know Hans: the Mick Jagger of TED. (Laughter) And he’d be showing you these amazing statistics, these amazing animations. And they are brilliant; it’s wonderful work.

But a typical Hans Rosling graph: think for a moment, not what it shows, but think instead about what it leaves out. So it’ll show you GDP per capita, population, longevity, that’s about it. So three pieces of data for each country — three pieces of data. Three pieces of data is nothing. I mean, have a look at this graph.

This is produced by the physicist Cesar Hidalgo. He’s at MIT. Now you won’t be able to understand a word of it, but this is what it looks like. Cesar has trolled the database of over 5,000 different products, and he’s used techniques of network analysis to interrogate this database and to graph relationships between the different products. And it’s wonderful, wonderful work.

You show all these interconnections, all these interrelations. And I think it’ll be profoundly useful in understanding how it is that economies grow. Brilliant work. Cesar and I tried to write a piece for The New York Times Magazine explaining how this works. And what we learned is Cesar’s work is far too good to explain in The New York Times Magazine.  (Explaining meta data analysis of various experiments that have Not much common ground in the designs)

Five thousand products — that’s still nothing. Five thousand products — imagine counting every product category in Cesar Hidalgo’s data. Imagine you had one second per product category. In about the length of this session, you would have counted all 5,000. Now imagine doing the same thing for every different type of product on sale in Walmart. There are 100,000 there.

It would take you all day. Now imagine trying to count every different specific product and service on sale in a major economy such as Tokyo, London or New York. It’s even more difficult in Edinburgh because you have to count all the whisky and the tartan. If you wanted to count every product and service on offer in New York — there are 10 billion of them it would take you 317 years.

This is how complex the economy we’ve created is. And I’m just counting toasters here. I’m not trying to solve the Middle East problem. The complexity here is unbelievable. And just a piece of context — the societies in which our brains evolved had about 300 products and services. You could count them in five minutes.

So this is the complexity of the world that surrounds us. This perhaps is why we find the God complex so tempting. We tend to retreat and say, “We can draw a picture, we can post some graphs, we get it, we understand how this works.” And we don’t. We never do.

 I’m not trying to deliver a nihilistic message here. I’m not trying to say we can’t solve complicated problems in a complicated world. We clearly can. But the way we solve them is with humility — to abandon the God complex and to actually use a problem-solving technique that works. And we have a problem-solving technique that works. Now you show me a successful complex system, and I will show you a system that has evolved through trial and error.

Here’s an example. This baby was produced through trial and error. I realize that’s an ambiguous statement. Maybe I should clarify it. This baby is a human body: it evolved. What is evolution? Over millions of years, variation and selection, variation and selection — trial and error, trial and error. And it’s not just biological systems that produce miracles through trial and error. You could use it in an industrial context.

 let’s say you wanted to make detergent. Let’s say you’re Unilever and you want to make detergent in a factory near Liverpool. How do you do it? Well you have this great big tank full of liquid detergent. You pump it at a high pressure through a nozzle. You create a spray of detergent. Then the spray dries. It turns into powder. It falls to the floor. You scoop it up. You put it in cardboard boxes. You sell it at a supermarket. You make lots of money.

How do you design that nozzle? It turns out to be very important. Now if you ascribe to the God complex, what you do is you find yourself a little God. You find yourself a mathematician; you find yourself a physicist — somebody who understands the dynamics of this fluid. And he will, or she will, calculate the optimal design of the nozzle. Now Unilever did this and it didn’t work — too complicated. Even this problem, too complicated.

But the geneticist Professor Steve Jones describes how Unilever actually did solve this problem — trial and error, variation and selection. You take a nozzle and you create 10 random variations on the nozzle. You try out all 10; you keep the one that works best. You create 10 variations on that one. You try out all 10. You keep the one that works best. You try out 10 variations on that one. You see how this works, right?

And after 45 generations, you have this incredible nozzle. It looks a bit like a chess piece — functions absolutely brilliantly. We have no idea why it works, no idea at all. And the moment you step back from the God complex — let’s just try to have a bunch of stuff; let’s have a systematic way of determining what’s working and what’s not — you can solve your problem.

 this process of trial and error is actually far more common in successful institutions than we care to recognize. And we’ve heard a lot about how economies function. The U.S. economy is still the world’s greatest economy. How did it become the world’s greatest economy?

I could give you all kinds of facts and figures about the U.S. economy, but I think the most salient one is this: 10% of American businesses disappear every year (No shame in taking risks and going bankrupt). That is a huge failure rate. It’s far higher than the failure rate of, say, Americans.

Ten percent of Americans don’t disappear every year. Which leads us to conclude American businesses fail faster than Americans, and therefore American businesses are evolving faster than Americans. And eventually, they’ll have evolved to such a high peak of perfection that they will make us all their pets — (Laughter) if, of course, they haven’t already done so.

I sometimes wonder. But it’s this process of trial and error that explains this great divergence, this incredible performance of Western economies. It didn’t come because you put some incredibly smart person in charge. It’s come through trial and error.

I’ve been sort of banging on about this for the last couple of months, and people sometimes say to me, “Well Tim, it’s kind of obvious. Obviously trial and error is very important. Obviously experimentation is very important. Now why are you just wandering around saying this obvious thing?”

So I say, okay, fine. You think it’s obvious? I will admit it’s obvious when schools start teaching children that there are some problems that don’t have a correct answer. Stop giving them lists of questions every single one of which has an answer.

And there’s an authority figure in the corner behind the teacher’s desk who knows all the answers. And if you can’t find the answers, you must be lazy or stupid. When schools stop doing that all the time, I will admit that, yes, it’s obvious that trial and error is a good thing.

When a politician stands up campaigning for elected office and says, “I want to fix our health system. I want to fix our education system. I have no idea how to do it. I have half a dozen ideas. We’re going to test them out. They’ll probably all fail. Then we’ll test some other ideas out. We’ll find some that work. We’ll build on those. We’ll get rid of the ones that don’t.” — when a politician campaigns on that platform, and more importantly, when voters like you and me are willing to vote for that kind of politician, then I will admit that it is obvious that trial and error works.

Until then, I’m going to keep banging on about trial and error and why we should abandon the God complex. Because it’s so hard to admit our own fallibility. It’s so uncomfortable. And Archie Cochrane understood this as well as anybody. There’s this one trial he ran many years after World War II. He wanted to test out the question of, where is it that patients should recover from heart attacks?

Should they recover in a specialized cardiac unit in hospital, or should they recover at home? All the cardiac doctors tried to shut him down. They had the God complex in spades. They knew that their hospitals were the right place for patients, and they knew it was very unethical to run any kind of trial or experiment.

Nevertheless, Archie managed to get permission to do this. He ran his trial. And after the trial had been running for a little while, he gathered together all his colleagues around his table, and he said, “Well, gentlemen, we have some preliminary results. They’re not statistically significant. But we have something. And it turns out that you’re right and I’m wrong. It is dangerous for patients to recover from heart attacks at home. They should be in hospital.”

And there’s this uproar, and all the doctors start pounding the table and saying, “We always said you were unethical, Archie. You’re killing people with your clinical trials. You need to shut it down now. Shut it down at once.” And there’s this huge hubbub.

Archie lets it die down. And then he says, “Well that’s very interesting, gentlemen, because when I gave you the table of results, I swapped the two columns around. It turns out your hospitals are killing people, and they should be at home. Would you like to close down the trial now, or should we wait until we have robust results?” Tumbleweed rolls through the meeting room.

Cochrane would do that kind of thing. And the reason he would do that kind of thing is because he understood it feels so much better to stand there and say, “Here in my own little world, I am a god, I understand everything. I do not want to have my opinions challenged. I do not want to have my conclusions tested.”

It feels so much more comfortable simply to lay down the law. Cochrane understood that uncertainty, that fallibility, that being challenged, they hurt. And you sometimes need to be shocked out of that. Now I’m not going to pretend that this is easy. It isn’t easy. It’s incredibly painful.

16:21 And since I started talking about this subject and researching this subject, I’ve been really haunted by something a Japanese mathematician said on the subject. So shortly after the war, this young man, Yutaka Taniyama, developed this amazing conjecture called the Taniyama-Shimura Conjecture.

It turned out to be absolutely instrumental many decades later in proving Fermat’s Last Theorem. In fact, it turns out it’s equivalent to proving Fermat’s Last Theorem. You prove one, you prove the other. But it was always a conjecture.

Taniyama tried and tried and tried and he could never prove that it was true. And shortly before his 30th birthday in 1958, Yutaka Taniyama killed himself. His friend, Goro Shimura — who worked on the mathematics with him — many decades later, reflected on Taniyama’s life. He said, “He was not a very careful person as a mathematician. He made a lot of mistakes. But he made mistakes in a good direction. I tried to emulate him, but I realized it is very difficult to make good mistakes.”




March 2021

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