Friday, August 26, 2011

The Role of Anecdotal Information in a Modern Health Care System

Some argue only scientifically proven methods should be used for treating patients. FDA style double blind studies to prove efficacy before patients get the treatment. Therefore anecdotes such as a patient saying some weird unstudied thing that helped them should be discarded as useless information - unscientific.
But where do ideas for new treatment studies start?
Weird anecodotal stories.
For example I was reading some comment forum on a documentary about autism. The vaccine anecdotes came up - a few parents saying soon after vaccination there was a fever, then they noticed the symptoms of autism appearing. It's easy for a health professional to discount this as parents looking very hard for someone to sue to recover the horrible costs and burdens of caring for an autistic child deep into adulthood. Lets call that the law-suit hypothesis. One parent said her son was sick a few years later with a fever, and behaviour returned to near normal, briefly. Now that's a weird annecdote, and doesn't seem to be tied to the law suit hypothesis.
If I'm a university researcher looking for something to research, I might pick away at that annecdote, by forming hypotheses:
H0: lawsuit hypothesis
H1: parent imagining things
H2: real symptom mitigation but unrelated to fever
H3: real symptom mitigation and related to fever:
H3a) something about the metabolism of the brain being reset lower during a (ie vaccine induced) fever during a critical brain growth period, and another fever brings the brain metabolism back to normal
To test H3a I might run a properly controlled studied (double blind, placebo control group) where I give some medication that increases metabolism of internal organs including the brain -I think thyroid hormone will do that- and if that makes a difference then I'll do more studies to try and isolate brain metabolism

A treatment may or may not result. The point is the annecdotes are very useful starting points for investigation. That's how a lot of discoveries are made in many fields. An accidental weird data or annecdote, further investigation and bingo. And annecdotes can come from outside of the research community. Inbreeding of ideas within a scientific discipline can result in stagnation, and annecdotes from non-scientific sources are a great way to open up new investigations.

Annecdote -> hypotheses formation -> scientific research -> dead end / new insight / treatment

But if I'm a researcher, or a health practitioner, or a health insurer or health system developer is there a way to systematically gather and mine annecdotes, since they can be so valuable? I think that's the next step in the evolution of modern health care systems.

Thursday, August 18, 2011

Good and Bad Peaceful Protesting

Stanley cup and London riots recently have put the spotlight on social dynamics of protesting, and in particular, what happens when a peaceful protest turns ugly.
In many democratic countries, we have a right to peacefully protest. Lets say I excercise my democratic right to peaceful protest, and plaquard in hand, I join the street crowd to march in protest. So far I'm a good Peaceful Protestor.
Now lets say the guy beside me pulls a scarf over his face, flips a hood over his head, pulls out a brick, and throws it through a window. He's a Violent Protestor. I'm still a Peaceful Protestor. But here's an opportunity to be a good or bad peaceful protestor. If I'm a Bad Peaceful Protestor, I'll watch the guy, cheer him on, and let him duck behind me away from surveillance cameras. If I'm a Good Peaceful Protestor, I'll quickly put several dozen paces between me and the Violent Protestor, exposing him to police and surveillance cameras, and giving riot police a clear shot at corralling/teargassing/rubber-bulleting just the Violent Protestors.
Should there be a law against Bad Peaceful Protesting? What if I don't see the Violent Protestor throw the brick or mask his face? It might be too much to make that a criminal offence, and probably the average Peaceful Protestor isn't analyzing the situation in detail, so wouldn't have read up on the fine print of Peaceful Protesting. So more people would be charged, but with little change to the tenor of protests.
Tactically and practically though, if I want to avoid teargas, batons and rubber bullets, the several dozen paces rule of thumb seems like common sense. So police should be ready with teargas and let it fly when the window breaks. A right to peaceful protest and a right to be teargassed for sheltering a violent protestor should go together as twin rights.

Saturday, February 26, 2011

Missing and Hidden Nodes - and what it means for you

"Aha!" I quipped as the new word 'infoGuardian' popped to my conscious left brain hemisphere. I had been pondering what seemed to be a complex situation in bureaucracies: Someone sits in a cubical, holding expert knowledge and views of data someone might need. A knowledge worker. But a cost in large corporations and governments at all levels. IBM's WATSON #ibmwatson computer won a few rounds of TV's Jeopardy! and one of the contestants mentioned after the game he was the first knowledge worker whose job just became obsolete. So how could WATSON-like computers help in making bureaucracies more efficient I pondered? One idea: as a central hub -or node- and then refactor / reorganize staff so that there are two kinds of employees: those that are training WATSON on new knowledge, and those that are using WATSON in their everyday jobs. That would elliminate a kind of knowledge worker - the infoGuardian.

The last paragraph may seem rambling, confusing and complex. Let me simplify it by introducing a new concept:

The Hidden or Missing Node

Lets say you have 6 people named A,B,C,D,E and F who must communicate among themselves. A communicates with B,C,D,E and F. B communicates with A (already mentioned as A communicating with B), C,D,E,F. C communicates with (besides A, and B already mentioned) D, E and F. A few more lines like this and you get the idea there are 5 + 4 + 3 + 2 + 1 = 15 paths of communication in what I'll call a complex network of communication channels. There's a math formula for it: (N-1)! (that's N-1 factorial). As the number of partcipants grow, (N-1)! gets exponentially bigger, and the communications more complex.
Now lets say I introduce one more person G and give G a new role: communication hub. And I say to the others to communicate only with G. Now A talks to G. B talks to G, as does C,D,E and F. A total of 6 communication channels. Math formula: N-1. No factorial, and no exponential growth in complexity.
What I just did was add a communications node. From my perspective the node should have been there and was missing. I call that a missing node. This is the role WATSON would play in my bureaucracy cure: a new node that simplifies communications and triggers a reworking of roles and relationships.

The concept of a Hidden or Missing Node helps me. I can look for them. If something seems complex, I can sniff for a hidden or missing node. Concepts in general help simplify our knowledge. If you're facing what appears to you to be a complex topic of knowledge, the complexity usually comes from what appears to be several concepts that are all related to each other. Like the communications network, it seems (N-1)! exponentially complex. So a good strategy is to learn more concepts in the topic. Each concept is like a node in a network of concepts. Experts have gone before you and sorted out the complexity, usually by introducing new concepts that help simply the relationships between the concepts. If it's a new topic, and it's your job to sort it out, a good strategy is to identify Hidden Nodes in the knowledge network, and give them an name. Like I did with InfoGuardian. Or borrow a name or concept - like I did by using WATSON as a placeholder for the more general concept of a knowledge hub. (KnowledgeHub - I just made that up).

So we've seen a bit of the use for identifying hidden nodes or creating new nodes to simplify communications and knowledge concept networks. But do they have any other practical use?

Business / commercial supply chains often organize themselves as network-simplifying nodes. If you're incubating some business ideas, and wondering what are some good filters or tests of the ideas, you may have heard terms like "differentiate or die" or "disruptive technology." Introducing the hidden or missing node concept here, if your idea causes the supply chain to reorganize around new relationships that are simpler, that would indicate you've identified a missing node. Or if you're wondering where to look for a new idea, you can look for complex supply chain relationships, and try to design a simplifying node business model.

Or if you're an author / blogger, you can look for missing-node topics that would simplify and illuminate human life, and write about them. Like I just did here.

Sunday, January 23, 2011

Democratic Reforms > Who Speaks for Future Generations?

Q. who should speak for future generations?

Up till now it's voters: we're in a democracy and generally free market economy. Usually what's good for this generation is also good for the next generation - intergenerational interests are generally aligned. And if there's a mother or grandfather that's worried about the next generation they can cast their vote accordingly.

But if I could interpret my past voting logic under the microscope of generation-centric selfishness it would sound something like this: “I’ll vote for you if you borrow money (federal debt) and give it to me (low taxes, program spending) - leaving a future generation to pay the interest.” and “I’ll vote for you if you allow me to plunder the environment for my own economic gain - leaving a future generation to pay for adaptation.”

If that sounds weird, the case of Greece -and a few others like her- should serve as a wakeup call.

I spent some time in Greece back in the 1990s, and back then there was a culture of tax evaders. No receipts for anything. Underground economy. Oddly, that included value added tax even though it was flow through like the GST.
One fellow I was in daily contact with had tax auditors audit him and assess him more. He said he was honest and declared all his income but the auditors said he must be hiding much, much more because greeks don't normally declare honestly in full. Bottom line: there was no incentive to be honest in a sea of cheaters.
And we see the results today, with Greece needing bailout after their balance sheet was exposed.

We're in relatively good shape here in Canada. But with demographic shifts (aging) and entitlement program spending a function of demographics -health care, retirement, reduced income and taxes per capita - there are dark clouds on the horizon. How we handle these challenges will determine if some future generation ends up like Greece or fares better.

What I'm looking for: sustainable democracy, which I see as an antecendent to sustainable development: both environment and economy. 


SUSTAINABLE DEMOCRACY - AN OXYMORON?
I used to think more democracy was the cure to all problems. For example if there was something like a TV channel changer, and all citizens would vote on each issue daily by pressing its buttons, I used to think that would fix some of the 'inefficiencies' in the system and bring us closer to utopia. Or if information was disseminated better so voters could see the whole issue in detail, that would result in better voting and utopia.

But I know myself a bit better as a voter now. I voted for lowering the GST. That cut budgetary surplus, and during the recession we ran up government debt, which -if we don't restore taxes or tax revenue- will mean some future generation will be paying interest on debts I ran up.

And I voted for caution/slowness on the kyoto/carbon-tax/cap&trade issue. Even though I read "Limits to Growth" back in the 1970s, which had a chapter on CO2 and global warming.

If I could interpret my voting logic it would sound something like this: “I’ll vote for you if you borrow money and give it to me - leaving a future generation to pay the interest.” and “I’ll vote for you if you allow me to plunder the environment for my own economic gain - leaving a future generation to pay for adaptation.”

Economists like what Adam Smith had to say about free enterprise: "Two parties, each acting in their own self interest, are better off..." And economists also pointed out the flaws with that - the reason we need laws:
- Externalities - a 3rd party not part of the deal is made worse off
- Tragedy of the Commons - like overfishing - each party is better off by taking more than their fair share and doing it as fast as possible - even especially knowing it's all going to run out

So I see my voting as containing some combination of the problems of 'Generational Externalities' and Tragedy of the Commons. If the Commons will be depleted well within my lifetime - in a few years lets say - then of course I'm all for regulations to preserve it, make it sustainable and stop others from prematurely exhausting it. But when the Commons lifespan spans generations, and only runs out in some future generation, I'm likely to not want sustainable regulation. Because being selfish, I'll want to get as much as I can in my lifetime and I don't care if it runs out in some future generation. Both the environment and government debt are resources or Commons I selfishly want to deplete in my lifetime, and I don't care if some future generation has to pay the tab.

Or at least, that seems to be how I'm voting.

Information isn't the problem. I know about government debt. I know about the GHG and global warming, and its impacts. Selfishness relative to future generations is the problem. So giving me more information won't help future generations, or giving me a more democratic 'direct line' to government decision making won't help future generations. Democracy in it's purest utopian form won't help.

I see democracy as part of the problem for future generations. And I see a need for 'sustainable democracy' as an antecedent to sustainable economics and sustainable environment.

I suspect I'm not alone in my suspicions about democracy.
http://dambisamoyo.com/category/blog/ MOYO -an economist- says:
"""
It is pretty clear that, politicians are, for the most part, driven by attaining and retaining political power. The problem is that over time and across the world, there has emerged a myopic political culture where politicians (and the decisions they make) are rewarded for focussing on shorter term (more tactical issues), rather than critical longer-term (more structural issues).
Worse still, the desire to win votes at regular elections provides negative incentives and inducements that encourage policymakers to enact dismal policies. This is not to say that democratic elections are a bad thing. It is to say that economic policy has increasingly become beholden to political machinations, with the most detrimental economic consequences for growth and poverty.
"""
http://www.lomborg.com/cool_it/ LOMBORG -also an economist and self-described post-Al-Gorian says (me paraphrasing from his CNN interview) 'forget about mitigation (of CO2), it's much cheaper to spend the same money on adaptation, and on cheap research'. The idea behind cheap research is what I'll call Lomborgian Innovation: to reduce the cost of mitigation so that the current generation doesn't feel like it's sacrificing anything for some future generation. To convert it from a zero-sum game between generations into a non-zero-sum game.

But democracy has been working well for centuries now. What's changed? The size of the impacts on future generations. A hundred years ago if I wanted to screw the planet or bankrupt a country I couldn't have because the technology and mechanisms didn't exist back then. But today bonds can be auctioned in 30 seconds -enough to bankrupt a country- and it's happening in Europe. And -no surprise- we've already screwed the planet.
http://sync.sympatico.ca/news/new_study_suggests_climate_change_would_continue_even_without_greenhouse_gases/d7937043

SUSTAINABLE DEMOCRACY
I don't know how to achieve it. But here's how I would measure it: when it's a zero-sum game between the current generation and some future generations, the future generations' needs are weighted in as fairly as you would weight between two parties in the current generation.

Once you have some way to do that, then sustainable economy and sustainable environment are easy to achieve with or without perfect information or perfect voting mechanisms or perfect politicians or perfect parties. So I see sustainable democracy as an antecedent to sustainable development/economy/environment.

Q. how to weight the needs of some future generation?
Sometimes what seems to be a direct zero-sum tradeoff between generations isn't. If we deplete a mineral -mine it out and use it up- some future generation may invent a substitute that's cheaper and better, or may not have the same use for the mineral anyway. So what we value in this generation, some future generation might not value.

If future generations could time travel, and show up at an auction to bid against this generation for resources, who would outbid whom for what? A future generation might say "you can have it at that price, because by the time we need it, we'll have invented some other way to do it."

And let's say I selfishly run up government debt in this generation. What do I do with that money? Maybe I build infrastructure which some future generation will want anyway. In other words, it's not wasted. Perhaps the increased efficiency from that infrastructure in this generation means some future generation will inherit a larger more robust economy. So being selfish in this generation isn't necessarily in conflict with the interests of a future generation - my interests and theirs can be aligned.
http://www.nonzero.org/

But that infrastructure may not be needed like I'm assuming. If it was road infrastructure, what if future generations don't use roads, except for hauling food and building materials. Perhaps various forms of virtual travel / telepresence / telerobotics, along with high speed trains, will largely obsolete the use of roads.

I struggle to find an example of a certain clear-cut zero-sum tradeoff between generations. But just because it's very hard to calculate and speak for future generations' needs doesn't mean we should not try.

SOME HALF-BAKED IDEAS FOR MAKING DEMOCRACY MORE SUSTAINABLE
1. give vote to children
2. make vote weighted, and weighted inversely with age
3. give vote to future generations (but how to know what they would vote for)
4. invite other countries/outside interests to vote on behalf of our future generations and vice versa, so interests aren't in direct conflict
5. do a lot of cheap research to invent new things that solve this generation's money and evironmental impacts in ways that don't seem like a sacrifice (so called Lomborgian Innovation)
6. generational philanthropists: keep the future impacts of todays selfishness top of mind during elections with non-partisan media campaigns which do the hard sell so politicians don't have to, and try to calculate -net of shared benefits- what part is a zero-sum game
7. let democracy run its course, ruin itself and the earth if that's its destiny, and see what evolves from the ashes
8. elect children to the Senate
9. adaptation set-aside regulation insofar as current generations will vote for it

The idea about giving more weight to youth in a democracy may not be quite what I'm thinking. As a youth I was often impulsive and short sighted. But the general idea is that youth can internalize more of those generational externalities: they'll be around to feel the impacts.

In the interim, I can try to remind myself of impacts on future generations as I cast my democratic vote. And if there are voices to help me with that so much the better.