Category: Jane Jacobs

Evidence-Based Medicine Versus Innovation

Seth Roberts6 Comments

In this interview, a doctor who does research on biofilms named Randall Wolcott makes the same point I made about Testing Treatments — that evidence-based medicine, as now practiced, suppresses innovation:

I take it you [meaning the interviewer] are familiar with evidence-based medicine? It’s the increasingly accepted approach for making clinical decisions about how to treat a patient. Basically, doctors are trained to make a decision based on the most current evidence derived from research. But what such thinking boils down to [in practice — theory is different] is that I am supposed to do the same thing that has always been done – to treat my patient in the conventional manner – just because it’s become the most popular approach. However, when it comes to chronic wound biofilms, we are in the midst of a crisis – what has been done and is accepted as the standard treatment doesn’t work and doesn’t meet the needs of the patient.

Thus, evidence-based medicine totally regulates against innovation. Essentially doctors suffer if they step away from mainstream thinking. Sure, there are charlatans out there who are trying to sell us treatments that don’t work, but there are many good therapies that are not used because they are unconventional. It is only by considering new treatment options that we can progress.

Right on. He goes on to say that he is unwilling to do a double-blind clinical trial in which some patients do not receive his new therapy because “we know we’ve got the methods to save most of their limbs” from amputation.

Almost all scientific and intellectual history (and much serious journalism) is about how things begin. How ideas began and spread, how inventions are invented. If you write about Steve Jobs, for example, that’s your real subject. How things fail to begin — how good ideas are killed off — is at least as important, but much harder to write about. This is why Tyler Cowen’s The Great Stagnation is such an important book. It says nothing about the killing-off processes, but at least it describes the stagnation they have caused. Stagnation should scare us. As Jane Jacobs often said, if it lasts long enough, it causes collapse.

Thanks to Heidi.

Assorted Links

Seth Roberts11 Comments
  • Scientific heresy, a lecture by Matt Ridley mostly about climate change. “Jim Hansen of NASA told us in 1988 to expect 2-4 degrees [of warming] in 25 years. We are experiencing about one-tenth of that.”
  • The continuing influence of Jane Jacobs. “Rouse spoke first, recalling the words of Daniel Burnham, “Make no little plans, for they have no magic to stir men’s blood,” he said. Jacobs followed and began, “Funny, big plans never stirred women’s blood. Women have always been willing to consider little plans.””
  • A self-experimental study of lactose intolerance. ” I came across an article that pointed out that levels of [lactase, the enzyme that digests lactose] peak in the morning and evening hours. So I experimented with having either ricotta products or a half cup of milk with my supper. It worked like a charm, and sure enough, if I tried having any between 11 AM and about 4 PM, I would get sick.”
  • A rather dramatic Google bug. Google the phrase “first let them get sick”. You will be told there are hundreds of thousands of results — perhaps 250,000. Look through them and you will see the correct number is much less (recently, 47).
  • Lorrie Moore reads one of my favorite short stories, “Day-Old Baby Rats” by Julie Hayden. “[In a confessional:] ‘I have missed Mass.’ ‘How many times?’ ‘Every time.’”

Thanks to Dave Lull and Nile McAdams.

Assorted Links

Seth Roberts1 Comment

Thanks to Bryan Castañeda, Lemniscate, Dave Lull and Reihan Salam.

Assorted Links

Seth Roberts3 Comments
  • Reclamations. Essays by University of California students about the harm done by student loans. Via Boing Boing. Being taught “how to think” (as many college professors claim they do because the details of their class are obviously useless) is fine when it’s a choice. (I support the study of esoteric seemingly-useless stuff — when it’s a choice.) When it’s required (to get a decent job) and very expensive (due to tuition), there’s a problem.
  • The Cobblestone Conservative: How Jane Jacobs saved New York City’s soul.
  • Robin Hanson surveys his students. “[Their] opinions [about “random policy questions”] strongly tend to support the status quo – mostly whatever is, is assumed good.” Same thing at Berkeley. Most of my students, for better or worse, were very conformist. My conclusion, which I imagine Robin agrees with, is that the reasons we give for our beliefs have roughly zero correlation with the actual reasons and shouldn’t be taken seriously (e.g., argued with). Professors who claim to teach their students “how to think” (e.g., lines of argument) are shutting their eyes to what Robin shows is right in front of them: the lack of importance of “thinking” in the determination of belief.
  • Edward Jay Epstein on Michael Milken. Great journalism.

Thanks to Ryan Holiday. If you send me a link that I post I am happy to link to your blog or website.

Jane Jacobs and Amazon.com

Seth RobertsLeave a comment

How did air-breathing evolve? In The Nature of Economies (p. 87), Jane Jacobs uses it to illustrate the developmental pattern she calls “bifurcation” (air-breathing isn’t a refinement of water-breathing). She speculates on how it started:

Lungfish had both gills and a primitive lung, suggesting that their habitat was swampland. The earliest to take to dry land may have inhabited swamps subject to severe droughts or perhaps they were escaping fearsomely-jawed predators who couldn’t follow them to dry land.

According to Steve Yegge’s already-famous “psst, Googlers” memo, something much like this was why Amazon started selling web computing services, which wasn’t a refinement of their earlier business (selling books, toys, etc.):

Amazon was a product company too, so it took an out-of-band force to make Bezos understand the need for a platform. That force was their evaporating margins; he was cornered and had to think of a way out. But all he had was a bunch of engineers and all these computers… if only they could be monetized somehow… you can see how he arrived at AWS [Amazon Web Services], in hindsight.

People say necessity is the mother of invention. That isn’t even close to true. Trial and error is the mother of true, profound invention. The Bezos story, and Jacobs’s generalization of it, suggest what is actually true: necessity is the mother of development. Necessity pushes people to use, and thereby develop, inventions they had ignored.

Chapter 1 of The Nature of Economies.

Assorted Links

Seth Roberts4 Comments
  • The Shangri-La Diet: still too good to be true. It was my dream — and maybe every scientist’s dream — to discover something (a) useful and (b) counter-intuitive, the more surprising the better. It did not occur to me that (a) and (b) conflict. I think that more surprising discoveries are eventually more useful (as logic suggests), but it takes much longer.
  • Marisa Tomei wants to play Jane Jacobs. “I love that she saved Greenwich Village.” When she does, perhaps Robert Caro will post the unpublished Jane Jacobs chapter of The Power Broker.
  • Symposium on The Death and Life of Great American Cities by Jane Jacobs.
  • Did you know that Mindy Kaling’s amusing article in this week’s New Yorker is an excerpt from a forthcoming book? Neither did I. Likewise, the recent Murakami story Town of Cats was from a forthcoming book. The New Yorker, unlike other magazines, never identifies book excerpts. This is unfortunate because doing so would help both writers (sell books) and readers (find books to read). For more criticism of The New Yorker, see the great book Gone: The Last Days of The New Yorker by Renata Adler.

Thanks to Dave Lull.

First, Let Them Get Sick

Seth Roberts18 Comments

In Cities and the Wealth of Nations, Jane Jacobs tells how, in the 1920s, one of her aunts moved to an isolated North Carolina village to, among other things, have a church built. The aunt suggested to the villagers that the church be built out of the large stones in a nearby river. The villagers scoffed: Impossible. They had not just forgotten how to build with stone, they had forgotten it was possible.

A similar forgetting has taken place among influential Western intellectuals — the people whose words you read every day. Recently I wrote about why health care is so expensive. One reason is that the central principle of our health care is not the meaningless advertising slogan promoted by doctors (“first, do no harm”) but rather the entirely nasty first, let them get sick. Let people get sick. Then we (doctors, etc.) can make money from them. This is actually how the system works.

It is no surprise that doctors and others within the health care system take the first, let them get sick approach. It is wholly in their self-interest. It is how they get paid. If nobody got Disease X, specialists in Disease X would go out of business. What is interesting is that outsiders take the first, let them get sick attitude for granted. It is not at all in their self-interest, just as it was not at all in the self-interest of the Carolina villagers to think building with stones impossible.

An example of an outsider taking first, let them get sick for granted is a recent article in the London Review of Books by John Meeks, an excellent writer (except for this blind spot). The article is about the commercialization of the National Health System. Much of it is about hip replacements. How modern hip replacements were invented. Their inventor, John Charnley. How a hospital that specialized in hip replacements (the Cheshire and Merseyside NHS Treatment Centre) went out of business. And so on. Nothing, not one word, is said about the possibility of prevention. About figuring out why people come to need hip replacements and how they might change their lives so that they don’t. Sure, a surgeon (John Charnley) is unlikely to think or say or do anything about prevention. That’s not his job. But John Meeks, the author of the article, is outside the system. He is perfectly capable of grasping the possibility of prevention and the parasitic nature of a system that ignores it. Long ago, people understood that prevention was possible. As Weston Price documents, for example, isolated Swiss villagers knew they needed small amounts of seafood to stay healthy. But Meeks — and those whom he listens to and reads — have forgotten.

Assorted Links

Seth Roberts1 Comment
  • Jason Epstein on Jane Jacobs. He edited most of her books.
  • How former Emory psychiatrist Charles “Disgraced” Nemeroff found a home at the University of Miami. A comment on the article put it well: “I am even more concerned as to the scientific truth and validity of the studies, drugs, treatments etc they [= Nemeroff and his supporters] have been involved in.” At the same time her university was hiring Nemeroff, the president of the University, Donna Shalala, sent out a letter boasting how the University of Miami was increasing the “integrity” of their medical school by improving policies related to conflicts of interest! “There is no room for compromise in this area,” wrote Shalala.
  • More about Jane Jacobs

Thanks to Dave Lull, Paul Sas and Alex Chernavsky.

Tucker Max on Writing and the Importance of Understanding How You Differ

Seth Roberts24 Comments

I recently heard Tucker Max speak about writing books. He said he had succeeded because he told the truth about himself — including the unpleasant stuff. Most people don’t. That, plus an ability to make it entertaining, was what he could do that other people couldn’t. He was saying that “being yourself” — more precisely, building on how you are different — was the only good place to start. Imitating other people is not a good place to start. Jane Jacobs said the same thing about how cities should develop. She said it was pointless to try to imitate other cities — to imitate them by building a stadium or convention center, for example. Each city should figure out what its unique strengths are — what makes Springfield Springfield — and build on them. Amplify them.

I was pleased to hear Tucker’s remarks because I never hear such stuff said publicly (or privately), except from Jane Jacobs. When I was at Berkeley, now and then I’d tell other professors: It’s a mistake to treat all students in a class the same (by giving them the same assignments, the same tests, etc.). They’re not all the same. They differ greatly. A lot is lost by treating them all alike — a lot of self-esteem, for instance. My colleagues didn’t like hearing this. It was convenient to treat all students the same. And it was status-boosting. My fellow professors worked in a system where the dimension used to gauge success was something they were good at. The notion that there were many other useful ways to excel was undermining. If there is only one measure of success and I am #1 on that measure, I am #1 period. If there are thirty measures of success, all equally valid, and I am #1 on only one of them, my superiority is less clear.

Tucker’s presence at the Ancestral Health Symposium was criticized. Here is an email that the organizers (who include me) received:

One thing neither I nor my attendee friends can explain: Tucker Max as a speaker? Really? His claim to fame is having rough sex with drunk girls and then writing about it. I’m pretty sure the majority of his speaking gigs take place at bars and frat houses. From his own website:

“I get excessively drunk at inappropriate times, disregard social norms, indulge every whim, ignore the consequences of my actions, mock idiots and posers, sleep with more women than is safe or reasonable, and just generally act like a raging dickhead.”

If you have a chance, could someone please explain this choice of speaker? I’d love to support this conference in the future, and I’m all for challenging social norms, but not those that have to do with basic respect for other people.

I replied:

I wanted Tucker Max to come and went so far as to give up half my presentation time to allow him to speak.

Why did I want him to speak? Because he is a big supporter of paleo, because he had something fresh to say, because he would say it well (and he did), and because he is deeply respected by an audience it is crucial to reach — college students. Sure, some things he writes offend some people. I don’t think that means he doesn’t have something helpful to say.

I don’t think college students respect him so much because he writes about getting raging drunk, etc. I think they respect him because he speaks the truth about subjects where most people don’t speak the truth.

The connection between “being yourself” and speaking the truth about difficult subjects is simple: Being yourself inevitably involves being different and being different inevitably involves some people scorning you. As Tucker said things that caused people to scorn him. As some people scorn my self-experimentation. In a society where being yourself isn’t valued enough, the fear of scorn wins, people self-censor, and, as in the above email, they censor others. Everyone’s loss.

The effect of an educational lifetime of being treated the same — from kindergarten thru college — is that the notion that you are different and have something unique to add becomes less and less plausible to you. Because it becomes implausible, that possibility doesn’t enter into your calculations about what to do with your life — in particular, what job to choose. You begin to think that success = imitation of successful people, when that is misleading. Imitate successful people like you, yes, but most people aren’t like you. I chatted with Tucker after his talk. He said it isn’t enough to be different, you have to act on it, become better and better at exercising your unique talent. I agree. In a better world, you would do this starting young, like 10, and slowly become better so that by the time you needed to make a living you would have substantial skill. But our educational system, by treating everyone the same, or nearly the same, discourages this.

 

Phone Hacking and Jane Jacobs (Roberts/Jacobs emails: 3 of 3)

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After I posted on the relation between Jane Jacobs’s ideas and the British phone-hacking scandal, Jim Jacobs, one of her sons, wrote to me. The first back-and-forth emails in our discussion are here and here. Finally, I wrote:

Thanks for more explanation. You’re quite right that exposure of the truth is at the heart of journalism and is utterly counter to what governments want. In this sense good journalism and governments are opposites — or rather opponents. In this sense, also, journalism is inherently populist whereas governments rarely are. Businesses are inherently populist.

On the other hand, journalism is not a standard commercial enterprise. This is why at many publications there is strict separation between advertising (devoted to raising money) and “editorial” (which spends it). They don’t want what they print to be affected by commercial considerations. That is utterly different than a conventional business. Powerful newspapers, such as the NY Times, see themselves (rightly) as far more than mere commercial enterprises — which is one reason the NY Times has lost so much money lately. It is one reason the NY Times took so long to get a sports section and why they barely have a gossip column. I have seen too many “undercover investigations” and “hidden camera” interviews to believe that journalists find anything wrong with deceiving for the sake of the task. They usually identify themselves, true, but so do police officers.

Exclusivity varies with organizational needs. Journalists do mix with everyone to get stories but that’s because of what they do; it couldn’t be otherwise. Some religions (which are far more guardian than commercial) make a big deal out of missionary work — again, the details of their enterprise demand it. Along the same lines, some businesses try to appear exclusive — the nature of their brand (luxury) demands it.

I agree that journalists trade information and favors with powerful sources. (But think it bad form to pay for interviews.) Whether this is different than governments forming alliances and signing treaties I don’t know.

Because journalism is actually a business, there are necessarily some commercial values, such as avoiding waste, being efficient, and so on.

In contrast to trading and rulers, which have been around for many thousands of years, powerful newspapers and powerful journalists are no more than a few hundred years old, if that. So there has been less time to clarify values. But there’s a reason they’re called the “fourth estate” — two of the other estates being religion and government.

And you’ve heard the phrase “the pen is mightier than the sword” — implying that the pen and the sword are on the same playing field. I can’t imagine anyone saying “the jacket is mightier than the sword” or “the carton of milk is mightier than the sword”.

To which Jim replied:

As I mentioned before, Jane had real trouble finding good names for the two syndromes. You can see it in the part of Chapter 2 where she talks about names – first A & B, then heroic is rejected, etc. and finally she ended up with commercial & guardian. She later regretted the choice because these names can be quite misleading. Activities using the commercial syndrome don’t need to make money or be ‘commercial’ – most good science, for example. Activities using the guardian syndrome don’t need to be guarding anything – classical music, for example. Writing can be either, depending on its use. Advertising shares much with propaganda writing – deception, ostentation, fortitude, etc. No wonder advertising and journalism need to be kept apart! Too much charitable work will ruin any business’ profitability, but it isn’t inherently at odds with the moral syndrome. Nor are stupid business decisions.

I agree that journalists do use unscrupulous means to get their information – like hacking phones. It works. It’s effective. But it isn’t right, and in the end, like all unethical behavior, there’ll be a comeuppance. But what’s wrong for a journalist is right for a police detective, as Jane explains.

Religions are guardian activities, as you say, and missionary work can be either charity or largesse, or a mix. It’s not an aberration that missionaries were traditionally expected to remain aloof from their flocks, just as religious leaders were. Although a luxury goods dealer may sell its goods to royalty, it should itself operate ‘commercially’, being non-exclusive in its dealings with suppliers, rich foreigners, etc. Journalists get much of their material from government, and to government the selling of information is treason. Don’t expect government to give such activity any blessing! Unlike the breaking of a contract, the breaking of a treaty between governments is considered ‘strategic’ (the Hitler/Stalin pact, for example). Between governments the aberration is a contract (Alaska purchase, for example).

Journalism may be older than one would guess. Sometimes it’s hard to tell after ages of editing and translation. Homer probably wrote propaganda, but Herodotus and Thucydides, although usually thought of as historians, seem much like journalists to me – their values certainly align with those of journalists.
And just as the sword and shield can be used to make dinner (paella may have originated as a soldier’s meal, prepared on a shield) so may the pen be made to serve both commercial and guardian work – and be mighty in either role.

And there you have it.