Month: June 2015

How to Be an Effective Expert Witness

(p. B16) Dr. David Sackett, whose clinical trials proved the value of taking aspirin in preventing heart attacks and strokes, and who helped pioneer the use of exacting statistical data in treating patients, died on May 13 [2015] in Markdale, Ontario.
. . .
His colleagues also appreciated his sense of humor. He recalled that while he was testifying in a case as an expert witness, a lawyer handed him a research paper supposedly proving the safety of a drug that was in dispute. He read the paper and concluded that it was flawed.
“Well, I could take several more days and show you dozens more papers on this topic, but the jury would probably want to lynch me,” the lawyer insisted.
“I would welcome that,” Dr. Sackett said.
“Well, we could meet after the trial and go over these papers together,” the lawyer suggested.
To which Dr. Sackett replied, “No, I meant that I would welcome the lynching.”

For the full obituary, see:
SAM ROBERTS. “Dr. David Sackett, a Health Care Innovator, Dies at 80.” The New York Times (Thurs., May 21, 2015): B16.
(Note: ellipsis, and bracketed year, added.)
(Note: the date of the online version of the obituary is MAY 19, 2015, and has the title “Dr. David Sackett, Who Proved Aspirin Helps Prevent Heart Attacks, Dies at 80.”)

Common Sense “Rules” Often Contradict Each Other

(p. 43) The world we face is too complex and varied to be handled by rules, and wise people understand this. Yet there is a strange and troubling disconnect between the way we make our moral decisions and the way we talk about them.
From ethics textbooks to professional association codes to our everyday life, any discussion of moral choices is dominated by Rules Talk. If we’re asked to explain why we decided to tell the painful, unvarnished truth to a friend, we might say, “Honesty is the best policy.” But if we’re asked why we decided to shade the truth we might say, “If you can’t say anything nice, don’t say anything at all.” It’s clearly not a rule that is telling us what to do. Both maxims are good rules of thumb, but we don’t talk about why we picked one and not the other in any particular case. “Better safe than sorry.” But “He who hesitates is lost.” “A penny saved is a penny earned.” But “Don’t be penny wise and pound foolish.” When we hear the maxim, we nod. End of story. It’s as if stating the rule is sufficient to explain why we did what we did.

Source:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

The Bureaucratic Absurdities of Socialized Medicine

(p. 13) Reading “Do No Harm,” Henry Marsh’s frank and absorbing narrative of his life in neurosurgery, it was easy to imagine him at the table. The men, and increasingly women, who slice back the scalp, open the skull and enter the brain to extract tumors, clip aneurysms and liberate nerves, share a certain ego required for such work. They typically are bold and blunt, viewing themselves as emperors of the clinical world. Marsh adds irony to this characterization, made clear in the opening line of the book, “I often have to cut into the brain and it is something I hate doing.”
. . .
Britain’s National Health Service is a socialized system, and Marsh chafes at new rigid rules imposed by its administrators. He is particularly incensed by a mandatory dress code: Neurosurgeons are subject to disciplinary action for wearing a wristwatch. There is scant evidence that this item contributes to hospital infections, but he is shadowed on ward rounds by a bureaucrat who takes notes on his dress and behavior. The reign of the emperor is ending, but Marsh refuses to comply and serve as a myrmidon.
Clinical practice is becoming a theater of the absurd for patients as well. Hospital charts are filled with N.H.S. forms detailing irrelevant aspects of care. Searching for a patient’s operative note, Marsh finds documentation she passed a “Type 4 turd.” He shows her an elaborate stool chart “colored a somber and appropriate brown, each sheet with a graphically illustrated guide to the seven different types of turd. . . . She looked at the document with disbelief and burst out laughing.”

For the full review, see:
JEROME GROOPMAN. “Consider the Comma.” The New York Times Book Review (Sun., MAY 24, 2015): 13.
(Note: ellipsis between paragraphs, added; ellipsis within paragraph, in original.)
(Note: the online version of the review has the date MAY 21, 2015, and has the title “‘Do No Harm,’ by Henry Marsh.”)

(p. C6) Amid the life-or-death dramas of neurosurgery in this book are some blackly comic scenes recounting the absurdities of hospital bureaucracy in the National Health Service: not just chronic bed shortages (which mean long waits and frantic juggling of surgery schedules), but also what Dr. Marsh calls a “loss of regimental spirit” and ridiculous meetings, like a slide presentation from “a young man with a background in catering telling me I should develop empathy, keep focused and stay calm.”

For the full review, see:
MICHIKO KAKUTANI. “From a Surgeon, Exhilarations and Regrets.” The New York Times (Tues., MAY 19, 2015): C1 & C6.
(Note: the online version of the review has the date MAY 18, 2015, and has the title “Books of The Times; Review: In ‘Do No Harm,’ a Brain Surgeon Tells All.”)

The book under review, in both reviews, is:
Marsh, Henry. Do No Harm: Stories of Life, Death, and Brain Surgery. New York: Thomas Dunne Books/St. Martin’s Press, 2015.

Dogs Split from Wolves at Least 27,000 Years Ago

The evidence quoted below might increase the plausibility of the theory that dogs helped give Homo sapiens a survival advantage over Neanderthals.

(p. A8) The ancestors of modern wolves and dogs split into different evolutionary lineages 27,000 to 40,000 years ago, much earlier than some other research has suggested, scientists reported Thursday.

The new finding is based on a bone fragment found on the Taimyr Peninsula in Siberia several years ago. When scientists studied the bone and reconstructed its genome — the first time that had been done for an ancient wolf, or any kind of ancient carnivore — they found it was a new species that lived 35,000 years ago.
Based on the differences between the genome of the new species, called the Taimyr wolf, and the genomes of modern wolves and dogs, the researchers built a family tree that shows wolves and dogs splitting much earlier than the 11,000 to 16,000 years ago that a study in 2014 concluded.

For the full story, see:
JAMES GORMAN. “Dogs Split From Wolves Much Earlier Than Thought.” The New York Times (Fri., MAY 22, 2015): A8.
(Note: ellipses added.)
(Note: the date of the online version of the story is MAY 21, 2015, and has the title “Family Tree of Dogs and Wolves Is Found to Split Earlier Than Thought.”)
(Note: the online version says that the page on the New York edition was A10; my edition is the one that is sent to Omaha.)

Seven Seconds to See Whether Design Is Right or Wrong

(p. B14) Jacob Jensen, an industrial designer whose sleek minimalism exemplified the style known as Danish modern, most notably with the stereo systems and other audio products he created for the consumer electronics company Bang & Olufsen, died on May 15 [2015] at his home in Virksund, Denmark.
. . .
. . , Mr. Jensen wrote of his working method:
“In my view, constructing a fountain pen, writing a poem, producing a play or designing a locomotive, all demand the same components, the same ingredients: perspective, creativity, new ideas, understanding and first and foremost, the ability to rework, almost infinitely, over and over. That ‘over and over’ is for me the cruelest torture.
“The only way I can work,” he continued, “is to make 30-40 models before I find the right one. The question is, when do you find the right one? My method is, when I have reached a point where I think, O.K., that’s it, there it is, I put the model on a table in the living room, illuminate it, and otherwise spend the evening as usual, and go to bed. The next morning I go in and look at it, knowing with 100 percent certainty that I have 6-7 seconds to see and decide whether it’s right or wrong.
“If I look at it longer, I automatically compensate. ‘Oh, it’s not too high,’ and ‘It’s not so bad.’ There are only those 6-7 seconds; then I make some notes as to what’s wrong. Finished. After breakfast, I make the changes. That’s the only way I know.”

For the full obituary, see:
BRUCE WEBER. “Jacob Jensen, 89, Danish Designer, Dies.” The New York Times (Fri., May 22, 2015): B14.
(Note: ellipses, and bracketed year, added.)
(Note: the date of the online version of the obituary is MAY 21, 2015, and has the title “Jacob Jensen, Designer in Danish Modern Style, Dies at 89.”)

More Detailed Rules Reduce Ability to Improvise, and Result in More Deaths

(p. 41) How do wildland firefighters make decisions in life-threatening situations when, for instance, a fire explodes and threatens to engulf the crew? They are confronted with endless variables, the most intense, high-stakes atmosphere imaginable, and the need to make instant decisions. Psychologist Karl Weick found that traditionally, successful firefighters kept four simple survival guidelines in mind:
1. Build a backfire if you have time.
2. Get to the top of the ridge where the fuel is thinner, where there are stretches of rock and shale, and where winds usually fluctuate.
3. Turn into the fire and try to work through it by piecing together burned-out stretches.
4. Do not allow the fire to pick the spot where it hits you, because it will hit you where it is burning fiercest and fastest.
But starting in the mid-1950s, this short list of survival rules was gradually replaced by much longer and more detailed ones. The current lists, which came to exceed forty-eight items, were designed to specify in greater detail what to do to survive in each particular circumstance (e.g., fires at the urban-wildland interface).
Weick reports that teaching the firefighters these detailed lists was a factor in decreasing the survival rates. The original short list was a general guide. The firefighters could easily remember it, but they knew it needed to be interpreted, modified, and embellished based on (p. 42) circumstance. And they knew that experience would teach them how to do the modifying and embellishing. As a result, they were open to being taught by experience. The very shortness of the list gave the firefighters tacit permission– even encouragement– to improvise in the face of unexpected events. Weick found that the longer the checklists for the wildland firefighters became, the more improvisation was shut down. Rules are aids, allies, guides, and checks. But too much reliance on rules can squeeze out the judgment that is necessary to do our work well. When general principles morph into detailed instructions, formulas, unbending commands– wisdom substitutes– the important nuances of context are squeezed out. Better to minimize the number of rules, give up trying to cover every particular circumstance, and instead do more training to encourage skill at practical reasoning and intuition.

Source:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

Why I Will Never Write for the New Yorker

(p. 18) Norris is a master storyteller and serves up plenty of inside stuff. When Mark Singer wrote an article about the cost of going to the movies and buying refreshments, the editors cut his reference to Junior Mints. As one editor intoned, “A New Yorker writer should not be eating Junior Mints.”

For the full review, see:
PATRICIA T. O’CONNER. “Consider the Comma.” The New York Times Book Review (Sun., APRIL 19, 2015): 18.
(Note: ellipses added.)
(Note: the online version of the review has the date APRIL 14, 2015, and has the title “‘Between You & Me,’ by Mary Norris.”)

The book under review, is:
Norris, Mary. Between You & Me: Confessions of a Comma Queen. New York: W. W. Norton & Company, 2015.

“Brazen Federal Overreach” Blocks Wine Process Innovation

(p. A13) On May 27, our Napa Valley winery will pull eight cases of Cabernet Sauvignon out of Charleston Harbor in South Carolina. We placed them there six months ago, protected from the elements, following similar experiments in the past two years. The cold water and the tides seem to expedite the aging process, and we believe that our ocean-aged fine wine–which we’ve trademarked as Aquaoir–could revolutionize how vintners around the world think about winemaking. The only obstacle: the federal government.
For more than a year, our winery has been targeted by the Treasury Department, specifically, the Alcohol and Tobacco Tax and Trade Bureau. The agency believes our product is unfit for human consumption, despite an utter lack of evidence, and it has threatened to revoke our winemaking license. Washington doesn’t recognize this wine for what it is: the product of entrepreneurship and experimentation.
. . .
We don’t envision expanding into vast underwater wine-storage development. We simply want to try to understand the ocean-aging effects so that we can try to simulate them on dry land. It would be lamentable if brazen federal overreach blocked the potential for innovation in an industry that could be on the cusp of a true sea change. Only in Washington could you raise a glass to that.

For the full commentary, see:
JIM DYKE JR. “The Wine-Dark Sea of Regulation; We aged wine at the bottom of the ocean–then the feds threatened our license.” The Wall Street Journal (Thurs., May 21, 2015): A13.
(Note: ellipsis added.)
(Note: the date of the online version of the commentary is MAY 20, 2015.)

Nazi Urban Planners

(p. D5) Vienna
In May 1938, shortly after the Nazi annexation of Austria, Hitler made the following pronouncement: “In my eyes Vienna is a pearl to which I will give a proper setting.” That quote, with its ominous overtones, is the starting point of “Vienna: Pearl of the Reich. Planning for Hitler,” at the Architekturzentrum Wien, the National Architecture Museum of Austria, which is housed in Vienna’s MuseumsQuartier. This fascinating exhibition reveals the Third Reich’s plans for the Austrian capital. In this untold chapter of World War II, the perpetrators are not storm troopers or concentration camp Kommandants, but architects and urban planners.

For the full review, see:
A.J. GOLDMANN. “City Planning, Nazi Style.” The Wall Street Journal (Thurs., May 21, 2015): D5.
(Note: italics in original.)
(Note: the date of the online version of the review is MAY 20, 2015, and has the title “‘Vienna: Pearl of the Reich. Planning for Hitler’ Review.”)

Empathy for the Absent

In Practical Wisdom the authors argue for empathy and against rules. There is something to be said for their argument.
But we tend to empathize with those who are present and not those we do not see or even know.
For example in academic tenure and promotion decisions, slack is often cut for colleagues who already have their foot in the door. We know them, their troubles and challenges. So they are tenured and promoted and given salary increases and perks even though there are others outside the door who may have greater productivity and even greater troubles and challenges.
Charlie Munger in an interview at the University of Michigan spoke of how hard it is for physicians to hold their peers responsible when they are incompetent or negligent. They have empathy for their peers, knowing their troubles and challenges. And Munger also says few physicians are willing to suffer the long-lasting “ill will” from their peers who have been held accountable. They do not know so well the patients who suffer, and one way or another, the patients are soon out of sight.
Just as in academics we do not know so well the students who suffer; or the able scholars who suffer, standing outside the door.
Following rules seems unsympathetic and lacking in empathy. But it may be the best way to show empathy for the absent.

The book mentioned is:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

The interview with Munger is:
Quick, Rebecca (interviewer). “A Conversation with Charlie Munger.” University of Michigan Ross School of Business, Sept. 14, 2010.