Daniel Frank writes about agreements and disagreements:
There’s something to be said for the blissful ignorance of not knowing every opinion held by every person in our lives and for spending less time dwelling on divisive topics. If you got along well with your work colleague until you discovered their view on topic X, then maybe discussing topic X isn’t wise.
Right! That’s one way to avoid condemnation games.
In their excellent but unfortunately titled book Ending Medical Reversal, Adam Cifu Dr. Cifu talked to Russ Roberts recently, in one of the best episodes of EconTalk so far this year. Dr. Prasad’s interview with Russ was also quite good, though the topic was not my cup of tea. and Vinay Prasad note the practice of “medical reversals”, which is a tendency of medicine to reverse practice — or self-correct — once evidence suggests that something that was thought to work actually doesn’t. Typical examples are starting prophylactic anti-arrhythmics after a heart attack, using estrogen to treat symptoms of menopause and performing kyphoplasty to treat vertebral compression fractures. The RCTs that led to reversals are: CAST, Women’s Health Initiative and ACTRN12605000079640, and guess which one of these was done in New Zealand. For each of those, there was a randomized controlled trial that showed no benefit — or, even worse, more harm — of the intervention compared to placebo. And presto, medical reversal was official and doctors around the world stopped doing what they now knew was harmful.
Just kidding: it took years to stop those practices, and kyphoplasty/vertebroplasty is still being performed, in select cases, based on little to no evidence. There is a long tail of doctors who either don’t believe RCTs in general, or don’t know about some of those in particular, or what is most common know and believe in RCTs when they affect someone else’s practice but find a million faults in those that investigate their own bread and butter. These doctors perform what I’d like to call Zombie Medicine, a term inspired by Lisa Feldman Barret’s Zombie Ideas (↬Andrew Gelman): Incidentally, “Zombie Medicine” would have made a much better book title than “Ending Medical Reversal”. Add a subtitle (Zombie Medicine: How Doctors' Inertia and Bad Science Harm Patients and Waste Billions) and you have a best-seller. Maybe for the second edition?
Zombie ideas abound in our culture, nibbling away at the brains of their victims. The mistaken belief that vaccinations cause autism — a celebrated zombie idea — is responsible for rising rates of vaccine-preventable diseases. The belief that a person’s personality type, assessed by the Myers-Briggs Type Indicator (MBTI), predicts job performance is another zombie idea that continues to lure otherwise capable managers into making decisions that benefit neither employees nor their companies.
But inertia to a big, unexpected medical reversal isn’t even the most common type of zombie medicine. There are some undead concepts so ingrained that a million RCTs couldn’t reverse them: the belief that atelectasis (partial lung collapse, common after surgery due to immobility) causes fevers (high body temperature, common after surgery due to infection, transient bacteraemia, and general inflammation), that early cancer detection is an absolute good, that Vitamin C cures anything other than scurvy, that vitamin D prevents anything other than osteoporosis and rickets. And it’s insidious, for I bet every reader will have felt a pang for at least one of these concepts. (“Wait, why does he think this is zombie medicine when I know it’s true!?") That’s how zombie practices become undead: with a sliver of doubt, a shimmer of hope, a dollop of wishful thinking.
And on the very edge of zombification sit tempting ideas that have greater than 99% chance of being false, but that you know will never truly die: that mTOR inhibitors can prolong human life spans, that with enough sequencing we will find genetic causes of most diseases, that the gut microbiome influences anything other than gastrointestinal health and quality of stool. This kind of zombie medicine adds another item to the list of harms: opportunity cost in both money and time.
The first step in addressing a problem is to identify it, the second is to name it. Now comes the time to make lists.
The FBI arrested a DC council member yesterday for taking bribes. The same council member who made the news in 2018 for saying that “the Rothschilds controled the climate”. Here is a good heuristic: if someone sees corruption, manipulation and conspiracies everywhere, odds are that they are themselves corrupt, manipulative and conspiratorial. Pure projection.
📚 Forty books that comprise the Vague Tech Canon, per Patrick Collison:
Linked are those I wrote about, starred are the ones I’ve read, daggered are the ones already on my pile and double-daggered are the ones that got on it thanks to this list. There is a single ‡ entry — the list had too much navel gazing for my taste. (ᔥTyler Cowen)
🍿 The Hunger Games (2012) came out the same year as our first child was born, and now that the child is old enough to participate it was time to finally see it.
The West Virginia aesthetics of District 12 were fine, but the over-the-top style of the capitol city dwellers was jarring. So was the architecture, which looked like what DC would be if all of DC were one large L’Enfant Plaza. Yikes!
I don’t know how much money Jennifer Lawrence earned from being in this franchise, but it really should be all of it — she was the only reason it was watchable, dare I say even enjoyable.
Janan Ganesh published another banger of a column this week, Beware the professional ghetto. He quotes Taleb, and rightfully so, and puts out this fascinating bit of trivia:
Tim Walz is the first person on either the top or bottom half of a Democratic presidential ticket since 1980 who did not attend law school. That is 20 individuals across 10 elections over 40 years who pursued a JD or LLB. Not one of the four Republican presidents over the period had a legal background.
Fachidiocracy, anyone?
Attulus fasciger is a species of spider from the family Salticidae native to northern and western Asia. However, it has also been introduced to North America. The spider is brownish-black coloured, has 8 eyes, and is 3–4 millimetres (0.12–0.16 in) in size.
Shot with an iPhone 14 Pro Max. I should remember to take more close-ups!
🍿 Incredibles 2 (2018) made several questionable choices that resulted in something less than the original:
At least the soundtrack didn’t disappoint!
Hustling. That’s what some people do in all industries. Young people in tech. Slightly older people in medical careers. I always admire people who hustle, even though I often wonder what the point of their work is. One thing I know for sure is that no matter how stupid and low yield and pointless and futile ideas might be in silicon valley— and believe me I live here and know just how bad it can be— ideas in medical research are often even more stupid and low yield and pointless and futile and worse of all harmful to human beings.
He’s not wrong, sadly.
For the past few months I have been trying out both Tot and Bebop for quick note-taking, and Tot has a clear edge: the Mac app. The biggest loser is Drafts, which has become way too bloated for my needs. So it goes…