The power of dyads

Maybe love is a feature not a bug, and they came to the ark in pairs for a reason.


Lately I've been spending a lot of time reading books on how to make groups of people better able to do the work that "meetings" are supposed to help with.   


People, as individuals,  have a lot of problems when viewed as "problem solving" units or agents.  We have terrible and selective memory,  flawed perceptions,  are easily biased and swayed in ways that are invisible to us, etc.     Sometimes, using the power of collective intelligence and social wisdom, we can come together and actually have a dialog and collaborate and consult, and overcome those flaws, at least partly, and make better decisions together than any of us could have made as separate individuals. 


Still,  when we assemble all that into larger units,  such as corporations and mega-corporations and governments,  the process seems to break down and revert to being dominated by the ego and psychological flaws of individuals all over again. Sadly, this time the individuals are armed with not rolling pins and sticks, but armies and nuclear weapons so the costs of these character flaws become much higher.


What to do?     Humanity has experimented with all kinds of mix and match ways to organize ourselves,  with assemblies and parliaments and elected "representatives" and houses and senates and committees and subcommittees -- but the results we were hoping for -- a central honest competent decision-making process -- remains elusive. On a business sense,  we seem able to put together close to a  million people to make a company, like General Motors, that is surprised by the fact that people seek more efficient cars when the price of gasoline goes up.    We have, in fact, made a collection that appears to be dumber than the average Joe on the street.

We've even tried "group work" and "collaboration",  which sometimes works better than "competition", but still has yet to demonstrate the robust power of a true solution.


I just noticed, however, that one thing we have always been doing is using individuals as the building blocks.

So, maybe we should consider using dyads (pairs, couples) as the building blocks instead, and see what we can make in the way of larger complex structures composed of pairs-of-people-working-as-one.


Of course, we are biased against this by being taught in school that  1 + 1 = 2.   We come to believe this, and it colors all our thinking.


In reality, however,   we also have the option of this math:

1 + 1 = 1

In other words,  a small one plus a small one can add up to a larger ONE.   Some couples can make this work,  generally assisted by a combination of "love" and a great deal of relationship-sustaining plain hard work and sacrifice.

I've discussed in prior posts the idea of "pair programming" and the power of working on a computing task as a pair with one computer and two people, intimately consulting on each step.   This is known to be very effective. It's also a lot more fun than working in isolation, and it overcomes the terrible trade-off our business structures force us to make -- between being social and "working". 


Why should the two be mutually exclusive? This is so strange.


Maybe,  the concept needs to be extended to all our business structures, and every slot for a "person" should be a candidate for being filled with a person-dyad instead, a pair of people.


Actually, our legal system recently made it clear that corporations are legally "persons" and have First Amendment Rights, etc.  So,  certainly a pair of people could legally incorporate and become a meta-person then, and hold one job between them.


Imagine if we allowed this to occur, and could consider for our elected official persons,   not just "individuals" but also "dyads".  Typically, suppose, that rather than choosing between a male and a female President, say,    we could elect a married couple as our meta-person to fill that slot.


This is a fascinating thing to consider.    Suppose we restrict the playing field to those couples that have been married for, say, 10 years or more.  Hey, we restrict it to people who have been alive for 35 years or more. so same deal here -- we're just looking for a meta-person, a PERSON, who has been alive at least 10 years.


By so doing, we will actually be selecting for a demonstrated ability of each of these individual people to overcome their own egos and work with at least ONE other human being over a period of time, where every step has consequences they are going to have to face.   


Maybe, that would be a good trait to select for in our elected leadership.   And, it might allow our leaders to have the option of being in two places at once,when needed.   More on this later.

We seem as a society to have somewhat abandoned the idea that two people,  with a male and female viewpoint, would come together for the purpose (or accepted side-effect) of managing a household and family.


I don't think that was such a bad idea.   The fact that the rest of our social and religious structures and culture undermined that construct didn't make it a bad idea, just one that has been increasingly difficult to accomplish.


Still,  if we selected for leadership couples who have managed to pull that off and accomplish it,  wouldn't they, as a pair,  have the type of insights and attitudes that we actually always wanted our leadership (in loco parentis) to have?


In any case, it would be one way to cope with the fact that we have more people than jobs these days -- start filling one job-slot with a pair of people, a legally-incorporated meta-person,  instead of with a single person.     Especially if the pairs are mixed genders, both male and female viewpoints can be reflected in their work.


Yes, it would be a challenge.  It would suggest some rather dramatic changes in our entire educational K-12 and college programs,  to be oriented around training dyads instead of training individuals on the one hand and "teams" on the other.


Still, since nothing else we've tried has been very successful,  I put this on the table for consideration.

Electronic Health Records not so great -- Rand Corp.

WASHINGTON – Hospitals' use of electronic health records has had just a limited effect on improving the quality of medical care nationwide, according to a study by the nonprofit RAND Corporation.
The study, published online by the American Journal of Managed Care, is part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care.

[snip]

However, quality scores improved no faster at hospitals that had newly adopted a basic electronic health record than in hospitals that did not adopt the technology. In addition, at hospitals with newly adopted advanced electronic health records, quality scores for heart attack and heart failure improved significantly less than at hospitals that did not have electronic health records. EHRs had no impact on the quality of care for patients treated for pneumonia.

[snip]

"The lurking question has been whether we are examining the right measures to truly test the effectiveness of health information technology," said Spencer S. Jones, the study's lead author and an information scientist at RAND. "Our existing tools are probably not the ones we need going forward to adequately track the nation's investment in health information technology."

  [snip]

Support for the study was provided by RAND COMPARE (Comprehensive Assessment of Reform Efforts). RAND developed COMPARE to provide objective facts and analysis to inform the dialogue about health policy options. COMPARE is funded by a consortium of individuals, corporations, corporate foundations, private foundations and health system stakeholders.

Other authors of the study are John L. Adams, Eric C. Schneider, Jeanne S. Ringel and Elizabeth A. McGlynn.

Then a miracle happens

Miracles do occur!

My wife and I went to the annual Baha'i conference on Social and Economic Development in Orlando earlier this week.  The session on dealing with how to design and run development projects in fragile post-conflict countries, such as Iraq or Afghanistan was particularly enlightening.

Here's a picture of my summary of the recommended strategy:

In words the steps are:

1. Invest in project
2. Crash and burn
3. repeat

So, I know there are skeptics among you, who will be comparing this strategy to the company president who was asked how he could price his products below cost, and replied "Sure, we lose money on every sale, but we make it up on volume!"

Yeh,  right.

ON THE OTHER HAND, consider the following body-building strategy:

In words, the steps are

1. Go to gym
2. destroy muscles by exercise
3. repeat

So,  at first glance,   the skeptics again might ask how on earth you can possibly "build up" your muscles by going to the gym and exercising so much that you destroy them.

Here's the thing though -- that turns out to be the only way to build up muscles -- you have to destroy them in order to build them up. 

The reason is that there is something else going on, that was left off the diagram.  So, maybe the diagrams should look more like this, and match the cartoon this posting started with:

We now have these steps in our success formula:

1. go to Gym
2. Destroy muscles by exercise
3. Then a miracle occurs
4. (repeat)

The point is, it's not really "a miracle", although it certainly is amazing.   WE put out some effort to constructively use-up our muscles, and then WE take a break.    While we are taking a break,  something truly amazing happens, and our muscles are rebuilt for us, including a little bit of overbuilding, so we end up with more muscles than we had before we started.

WE, thank God,  don't need to understand molecular biochemistry, or structural engineering,  or biological pathways and the Krebs Cycle, or all that stuff.  All that stuff is done FOR US.   We just need to recognize that a process is already in place that we can simply tap into and utilize.

The whole point of the SED conference,  in my mind, the summary of it all, is that the following diagram is ALSO true, and is really just the exact same process on a larger scale:

So the steps are

1. Invest in project
2. crash and burn
3. then a miracle occurs
4. (repeat)

Again, this really only looks like a miracle, and it certainly would be a miracle if WE had to understand all the details and plan them out.  Fortunately, just like the muscle-building strategy,  WE don't need to know the details.

In particular, the point is that the local people, the indigenous population,   need to be the ones doing the investing in their own self-help project.   AND, they need to realize that this project is very similar to muscle building, or learning how to shoot baskets at the gym -- the way you "succeed" is by repeatedly failing and going back for more.

There is no other pathway.  There are no shortcuts.   There are no pills to take. There is no way to "import" infrastructure,  and simply assemble the pieces in place, like some sort of prefabricated building.

But,  despite all that,  we are correct to place our hope, and our project planning dollars,  in the fact that "then a miracle occurs."

Comment -- This insight actually has a rather profound impact on how donors and funding agencies should assess whether a project is a "success" or a "failure".  

Zen and college admission webform flaws

So, it seems the widely-used on-line college admission form has a substantial flaw.  I think the real flaw is a little further upstream.    Today's New York Times describes the situation.   (picture is from the "demotivational" web site.
========

With Common Application, Many Find a Technical Difficulty in Common, Too

By JACQUES STEINBERG   (Dec 22, 2010)

The Common Application, the admission form accepted by more than 400 colleges and universities, was created in part to ease the burden on high school seniors. No longer must applicants fill out a dozen different forms to apply to a dozen schools, including the nation’s most selective.

So it was frustrating for Max Ladow, 17, a senior at the Riverdale Country School in the Bronx, to discover this fall that he could not get his short essay answers to fit in the allotted 150 words on the electronic version of the application, even when he was certain he was under the limit.
When he would follow the program’s instructions to execute a “print preview” of his answers — which would show him the actual version that an admissions officer would see, as opposed to the raw work-in-progress on his screen — his responses were invariably cut off at the margin, in midsentence or even midword.

This technical glitch in the Common Application has vexed an untold number of college applicants, not to mention their parents, at a moment in their lives already freighted with tension.
Considering the stakes, Max said he was left with two head-scratchers: Why can’t the Common Application be better, technologically, given the caliber of the institutions involved? And, at the very least, why can’t the nonprofit association of colleges that produces the form fix this particular problem?

========
I wrote this comment:

 >> Asked why the problem had not been fixed, Mr. Killion said, “Believe me, if there’s a way to do it, we’d do it. Maybe there’s a way out there we don’t know about.” And this has been going on a decade?

Wow. What a metaphor for what ails the USA today.  How many employees, faculty, or students, doctors, nurses, etc.  have questioned some absurdity and been told, basically,  to shut up, there's nothing that can be done about it?

First, of course there's a way to make a web-based application that doesn't have this problem.   In fact, most don't have it, which is why the students are so unprepared for it.

Second, it's trivial to find out what's wrong and find a dozen different ways to fix it or even get  volunteers to write working software for zero cost -- publish the source code and describe the problem on the web and ask for solutions.  SourceForge would be an excellent place to start looking at examples of  "open source" software that is superb.

Third, maybe students should take note that their own educations and lives will be similarly filled with absurd flaws if they don't learn successful ways to seek and obtain help when they run into a problem.

Fourth,  maybe students should note that  their own generation has already found web-based social media ways to deal with such trivial problems that are still viewed as "unsolvable" by their parents and institutional decision-makers who come from the old generation.

Fifth,  welcome to the world, students can learn that "adult" institutions are quite ready to "teach" lessons but almost incapable of being taught themselves, or turning into learning institutions.  

Essentially every person in the country will be affected by this class of problem, as so called Electronic Health Records are pushed into every health care provider's face,   despite every such system having many problems exactly like the glitch the admissions system has -- which doctors and nurses are told to put up with, because they're impossible to fix.

Enough with the "impossible to fix" song, people.  You people have a combination of institutional clinical depression and very poor self-improvement skills.

Time to move over a bit and let youth show you how it's done.

Bill and Mellinda Gates Foundation looks at education - MET

Classes exist, not just classrooms. This is important!

I'm reviewing the press release on the Bill and Melinda Gates Foundation's Measure of Effective Teaching MET program (Educational measures) and a glimpse into what characteristics of teachers, perceivable by students, correlate with successful outcomes.   Many of the quoted characteristics overlap with characteristics of successful facilitators of meetings.  ( See, for example, Sam Kaners: Facilitator's Guide to Participatory Decision-Making).

Also, in the last decade, the Institute of Medicine has reviewed factors that improve health care in the USA, and a central finding is that the behavior of "microsystems",  small teams of individuals working together, is both correlated with success and is the best intervention point for improving success.

 I recall that, at least back in '70's a study of Chinese school systems by Urie Bronfenbrenner showed that they routinely had the more advanced students assisting the less advanced ones -- that is,they turned every student into a potential teacher's aide.

And several years ago I went to a conference of "Self-Determination of Health Behaviors" sponsored by the Knight Foundation on what it was that got people to do what was good for them regarding health.  What was startling was that every presenter in this area, the world's experts,  talked about how social interventions were more effective than individual interventions.  It had more clout to pay a woman's children ten dollars for every pound she lost than to pay her, for one example.   At the end of the conference, there was a panel, and I asked whether I was imagining it, or hadn't every single one of them said that social interventions were the more effective than individual interventions?   They discussed and agreed.  So, I pursued, why did not a single paper they had written include this finding?  They conferred again and said it was because they didn't know how to measure social interventions and collaborations, SO THEY LEFT THAT PART OUT OF THEIR PUBLISHED WORK.     Basically, they did't know how to compute a "P-value".      Despite that, their semisecret findings are intensely relevant to education.

What I am hoping is that the MET program can at least LOOK AT the area of small groups,  teams,  group cohesion,  and in particular "competition versus collaboration" in the environment.   In terms of Karl Weick or Harvard's Amy Edmondson's work on "safety culture"  -- is the classroom "psychologically safe" for a student to raise her hand and say "I don't understand?"  without ridicule and with support?

All of the work I refer to above focuses on the target of the intervention on the TEAM, not on the individual per se.   In the real world, TEAMS are what fly airplanes and make business decisions. 

It looks to me like the preliminary results released so far support the idea that the best teachers build community in their classrooms, psychologically safe environments to be open within,  mutually supportive environments (peer to peer) not just teacher-to-student.

Basically,  the published results treat the situation no differently than if a teacher was really simply surrounded by 30 computer consoles, and was multiplexing his or her time tutoring the students at the other end of the computer connection -- the entire social structure of a "classroom", and more precisely, NOT the room, NOT the fixtures, NOT the books, but the OTHER STUDENTS has been left out of the model. 

Unless the other students are unruly or disruptive.  The other students are viewed simply as a competition on the teacher's time,  a drain on resources, something we'd do best if we could simply LIMIT the number of students per classroom and per teacher.

I am strongly suggesting that the best teachers in fact turn their liabilities into assets,  turn students into resources, and turn the entire class-worth of social support and approval into an engine that can help each student in that CLASS (and that classroom) learn new material and debug gaps in understanding of prior material.

The measures stated so far are essentially blind to that dimension.    I feel this is akin to the disastrous search pulsars, which are strobe-like sources of energy in the sky,   second in brightness only to the sun -- but they were totally missed by radio astronomers for decades because everyone knew such things didn't exist, so they short-circuited any data that might reveal them.

Yes there is a teacher, and a student (times N) and a classROOM.  But there is also a "class" - a living, breathing,  multiperson social composite organism in that space. That is both something to be reckoned with, and a resource, and a potential intervention point.

On secrecy and surprise

After the mathematician turned jungle explorer had an affair with the chief's beautiful daughter, the chief pondered a suitable punishment.  "You will be executed at dawn some day in the next week such that it will be a surprise," he declared, and the explorer was put in jail on Sunday evening to contemplate his fate.  

The chief was known to be a man of his word, so the logic engines began to whir. Maybe there was a way out of this mess after all.  He figured that he couldn't be killed on the final day,  next Sunday at dawn, because if he had made it that far, it would no longer be a surprise.  That ruled out Sunday.  Well, how about Saturday?  Since Sunday was out of the question, if he survived till Saturday, THAT would no longer be a surprise. So Saturday was out of the question as well.   Curiously,  so therefore was Friday, Thursday, Wednesday, Tuesday, and even Monday.   In fact,  no day would be a surpise!

At dawn on Monday he smiled, knowing he was safe, and, as the Chief's men arrived and proceeded to execute him, he was indeed surprised.

There are many situations in which secrecy is not required in order to achieve "surprise".

In any contest in which your opponent is simply unable to believe that you are doing something, call it "X", you can simply continue to do that and your opponent will suffer the damages caused by your use of "surprise".  If you subscribe to Liddell Hart's rules of strategy, and you believe the element of surprise is a key component, this does not mean automatically, as has been assumed, that therefore you require secrecy of operations.

I say this looking at the current furor over WikiLeaks.  While most policy gurus are fighting over how and where to apply pressure to stop the leaks, I'd like to step back a few more steps and consider the case where we adopt a strategy that is immune to leaks -- not because there aren't any, but because they don't matter.

It seems to be taken as an unquestioned tenet of action that the optimum behaviors occur in the darkest dark,  with maximum security and secrecy surrounding them.    Let me challenge that head on, and say, frankly, hogwash.

Let me propose instead an alternative tenet and rule of operations, which says that the optimum behaviors occur in the brightest sunlight, and have no need for secrecy -- which is good, because secrecy is increasingly impossible to obtain.   The very nature of secrecy requires compartmentalization and the creation of silos of knowledge and action, which are directly in the way of any kind of large scale coherence of thought or action.

Now, the idea of abandoning secrecy strikes one like the idea of "open-source" software -- our first reaction is that such a thing is patently absurd and couldn't possibly work.    But,  we are increasingly aware that open source software not only works, but works better and more reliably than software developed in tight corporate secrecy.   Something is apparently wrong with our mental lenses and insights, because this comes as a surprise to us.

And,  despite being front-page news,  every time we see it it comes as a surprise.   It is itself an example of something that can hide in plain sight because our mental model's blind spot falls directly on top of it, shielding it from our sight.

There's more of that going around than you would think.  In fact, as Thomas Kuhn (Structure of Scientific Revolutions) would agree, anything that goes against the prevailing paradigm ( effectively, the current narrative, story, or myth) is, de facto, invisible.  It is either not seen at all, or when it is forced upon our consciousness, it evaporates quickly leaving no trace or change in our model of the world.

There is these days a transition in management thinking from McGregor's Theory X ( people are disruptive idiots who need a strong whip hand and know zilch and don't care) to Theory Y (people are caring allies who know a lot and if left to their own devices will help out.)    There is much evidence that open-management models work better for many kinds of tasks,    because facts known by the "lower" levels of the organization are no longer kept secret from the top level of the organization.   More to the point, those "in power" are more willing to listen, and once they listen, are no longer surprised by actual intelligence from below.

Some threads come together here when we try to take these facts and apply them to pondering what national policy should be regarding secrecy of operations.

First - if secrecy is abandoned as a policy,  then we have a chance that the left hand will know what the right hand is doing.    I'd affirm that as a requirement for success, and not an easy one to achieve in these days of leaky on-line systems that we attempt to surround with expensive and intricate layers of nested security that only have one sure property -- they are a pain in the ass in terms of doing one's job.

Second,  if we continually are honest and open about what we are doing and why,  after a while this can serve as a basis for trust,  which, as writers in social capital have noted, will lower the transaction costs for every event.We are far more likely to find willing allies if they actually believed, based on observation, that we were being honest and sincere and open and capable of doing what we said we'd do.

But, a contrary thought goes, wouldn't that mean we would lose all the benefits of deception and surprise?

As to surprise,as I mentioned above, it is possible to maintain perfect surprise in plain sight, if your behavior is contrary to what your opponent believes it must surely be. If our opponents believe we are liars and thieves, then any action we take which is honest and fair will come as a surprise to them.    We do not lose the strategic and tactical benefit of "surprise" by being completely open.

How about deception.  Isn't it true that the best outcomes of negotiations or diplomacy arise through use of clever bluffs and lies and deceptions?

Actually, the latest word on negotiations is that  where interests are admitted and facts are not hidden, open negotiations can lead to and often do lead to far better outcomes for both parties than negotiations based on bad faith. 

But surely diplomacy depends on lies or at least silence that preserves a lie, doesn't it?

Let's look at an example. When your girlfriend asks if you like her haircut or recipe for stew, and you can't stand it, aren't you better off lying about it?  What about the impact of facing that new haircut and that stew for supper every week from then on  -- is that going to strengthen and  improve the relationship?

It is no longer obvious, at least to me,  that diplomacy requires lies in order to function.  Diplomacy doesn't require lies unless your entire behavior and being is one huge lie, and you are terrified of being "found out".  It is possible to disagree with someone "diplomatically". The diplomacy per se is in how the response is delivered, the human context surrounding it,  not in the content of the response.

It is possible to say "I don't like the haircut but, listen, it doesn't really matter because I really love YOU so much and I'm just blown away by the effort you put into getting it to make me happy."  That can work.  That is what diplomacy can still be about -- knowing how to disagree without it being disruptive.

This is hardly a comprehensive analysis of this subject, but I put it on the discussion table anyway.  Maybe,  expending our treasure to protect our shield of lies and deceptions is not the most effective strategy available to us.

Maybe, long term, we'd be better served, both internally and externally, by taking down the massive shield of secrecy and putting our energies into being worthy and reliable allies.

Comments welcome, public or private.

Kindle is to book as Electronic Health Record is to ... what?

Dan Newman writes in todays WSJ on why he does NOT want a Kindle for Christmas, and it's worth a read. Excerpts below:
(A Kindle for Christmas? Spare me!)

I should be the perfect candidate for an e-reader: I own thousands of books, lack space for more and often schlep several heavy volumes in my bag. So when I begged my family to refrain from getting me a Kindle for Christmas, they were confounded.
[snip] 

While a search function is useful, it also points to a flaw in the Kindle: All the pages are alike, to the extent that there are pages at all. 


I remember passages by where they are in my books—this or that detail is two-thirds of the way through, on the bottom left. That physical memory runs deep.

... I've seen her set down a dozen stiff-backed Little Golden Books before a group of adults. They chatted with delight as they held old copies of ..  childhood favorites. "The physical book holds meaning," says Ms. Kroupa. "If I were to bring a modern edition of 'Dumbo,' it wouldn't elicit nearly the same response."

Print editions enable shared experiences in ways unavailable to electronic versions. I'm no snoop, but one of the first things I do when I enter a home is scan the bookshelves. As often as not, that sparks conversation about the interests of my hosts and about what they've read and hope to read. They invariably pull out other books, some inscribed, and hold them in their hands while we talk.

That experience simply can't happen crouching over a hard-drive. Imagine entering a living room and saying: "Hey! Mind if I scroll through your Kindle?"

A book is more than a shell for words: It's a box whose magic starts at its real-world dimensions. No other common item so lacks a standardized size, and that makes individual books memorable. ... Maybe I'm a Luddite because I feel sorry for children who read "Goodnight Moon" on a phone. And perhaps I'm a softie for hoarding my torn copy of "Huck Finn," a gift from my grandfather, with an inscription that still makes my eyes water.

I could tell you what it says. But it's best to read with the book held in your own hands.

Mr. Newman is a writer at work on his first novel.

I'm with Dan.   I have all my old class textbooks, heavily annotated, and know where to find a passage or equation by where it is on the page, and about where in the book that is. And the book is this big and blue and this tall and here it is and .... here's the passage I wanted to show you....  etc.

Given my focus on Electronic Health Records (EHR) , and trying to articulate what is is that's so subtle and at the same time so blatantly wrong with them,   I noted his description above.

... a flaw in the Kindle: All the pages are alike, to the extent that there are pages at all. 

It is, of course, a "given" that the pages of an EHR look alike.   In fact, the pages of every patient look alike. In fact, if designed "correctly" according to modern theory of User Interface design,  the pages will also look pretty much like your email, your word-processor, your spreadsheet, and other familiar paradigms, so it is "easy to use".

It is this "feature" which in my mind is a "bug" -- it makes the chart and the structure in it extremely easy for a computer to read and process, being as it is all "machine readable" -- but it makes it all merge into a single huge identical "chart" for a human doctor or nurse, and therefore any given patient's story becomes exquisitely forgettable.

When I pick up a book, by the time I have it open the nature of the book has brought back to mind all of the contents, that were filed,  (technically "hashed"),  based on the color, size, weight, smell, font, margins, and other distinguishing characteristics of that specific book.  This makes it easy for me to store and recall it as a single associated unit.   The question is, when a doctor opens the EHR "chart" on a patient,  is what he or she sees sufficiently distinctive that it instantly brings back to mind the contents of the patient's story?  Almost certainly not.

Does it mattter?  I think so, for the same reason that memorizing sacred writings or poetry or songs is a very different thing than looking them up.   Memorized stuff goes into a state where other things are continually compared against it, and it against them,  sometimes adding to them.    A fully-internalized patient story will go where, weeks later in the shower, something will go "click" and it will pop back into consciousness with an answer to your unspoken suspicion that there is something else going on, something wrong with the glib initial diagnosis, but you couldn't put your finger on it. That kind of error can get fixed, in other words.

The EHR stands a risk of the equivalent of being so busy taking pictures of your vacation or birthday party that you forgot to HAVE a vacation or birthday party.    Yes, you end up with pictures.  Yes, they probably are "more accurate" than your memory.  But they are not the same thing as a memory, at all.

Designers go to great lengths to put the name and 9 or ten digit patient identifier on every "screen", so that there is no confusion as to who this data pertains to.       Names, and 10 digit identifiers are not processed in the same part of the brain as, say, a photograph of the patient.

Maybe, at a minimum, a photograph of the patient should accompany every screen, so that the other part of our brain, that associates facts and builds a narrative,  is fed instead of being starved by the system.  Then when we see the patient walk in the room, we don't have to ask for their story -- it leaps to mind full-blown already.   We've associated it with something that is unique for human beings (a photo) instead of with something that all looks alike to human beings (a ten-digit ID).


RWS
Ann Arbor

Math education, discipline, and catching up to Shanghai

This is a much shorter version of a recent post on math education. I'd like to challenge a basic assumption behind the solutions presented to teaching math and physics.

I was a physics and astrophysics undergraduate major in college. I love math and physics, couldn't get enough of it.    On one exam, as a senior, we were allowed to bring in a 3x5 inch notecard with laws of physics on it.   We didn't need the entire card.   Physics is almost entirely approaches and derivations, generally using math,  from very few basic laws.

After conceptually isolating and extracting a subset of the world as a model, the math involves labeling the parts of the model, symbolically manipulating the model into a new state, and then reasoning from the new state back to the real world to see if what you just derived actually works in practice.   The math, to me, makes much more sense in a context where it is connected to reality at each end than where it is simply floating in space as something to learn on its own.  Also, its quite relevant to realize that the process of model building and dissecting a model out of context is a crucial step to this actually being useful in the real world,  can easily be done wrong,  and is a part where system dynamics experience could be helpful.

Regardless,   the math involved is primarily an activity of manipulating strings of symbols.   This is not required by mathematics, but is typically what is used.

And therein lies the problem.  If our practices had grown up after the development of image processing hardware, it's possible we would go about this a different way, and that battle rages in artificial intelligence today.  Here's why:  images are robust against noise, and symbol strings are not.

I can take a picture of George Washington on a $1 bill and randomly change half the pixels to black or white, and a human can still see George there.  Images are, for the most part, quite forgiving of point-wise errors.  They are also quite dense in information, or can be.  ("One picture is worth 1000 words", etc.).

Symbol-string manipulation on the other hand is exquisitely sensitive to point-noise.  If I randomly change one symbol in the middle of a derivation to something else,  the entire derivation becomes instantly worthless.  It is not even "mostly right" -- it is simply wrong.

So, in order to use symbol-string manipulation successfully, a huge amount of self-discipline, structure, and orderly behavior is required.  This is not negotiable.

For whatever reasons and whatever you think of it,  students in the USA today are not, in general,  capable of such self-discipline.  The culture as a whole not only does not support it, but is actively hostile to such behavior,  unlike in Shanghai, to pick an example from the news.   A long discussion of psychosocial determinants of "self-discipline" is out of place here, but I'll simply assert that much current thinking puts the determinants "outside the box"  and outside the "student" and says that,  in the absence of a strong cultural support system,  an "individual" is simply not capable of intense self-control.   

The point is, however, that there is no way that students, lacking self-control, can ever possibly utilize mathematical techniques of symbol string processing and get correct results,  or get any kind of encouraging feedback.    It won't work. It can't work.  It can't be made to work.  "Close" doesn't cut it.

In short,  due to the nature of symbol-processing,  "self-discipline" is a necessary pre-requisite for math, which is a pre-requisite for physics and other hard sciences.  The discussion about HOW to teach math is therefore effectively irrelevant, to all except a few lucky teachers in classes with students who are, in fact, psychosocially and culturally prepared for the subject.

I pursue this line of thought somewhat further here:
http://newbricks.blogspot.com/2010/12/rails-across-swamp-why-math-education.html

In short, I conclude there that nationally we are not likely to solve the self-discipline problem in the next generation, at the rate we are going, and if we wish to "catch up" with the Chinese we need to either figure out a new mathematics using image processing or some other technique that is, in fact, robust under noise,   or we need to start working as small clusters or teams of individuals structured so that the team is noise-resistant, despite the error-proclivity of each member.  Again that is a total shift in the focus of education, to see the intended "learner" is a team, not an individual.  

Of course, teams have far more places to "put" learning than do individuals.   The Institute of Medicine,  interestingly enough, recently concluded that changes in health care practices should be focused on changing the behavior of "Microsystems" -- small teams of people who work as one to accomplish tasks -- not on trying to change individuals,  based on increasing evidence that changing individuals doesn't really work.    In safety engineering,  we find results showing that, say, 74% of commercial aircraft "accidents" occur on the very first day that that TEAM of individuals attempted to work as a TEAM,  despite their individual professional expertise.  (Source:Bryan Sexton, Johns Hopkins).

The real social leap would be letting a team, with a corporate identity, take over the slot called a "job" which we currently allocate only to "individuals".   This may be facilitated by having the team teleworking, so that additional desks are not required.  Massive social change is required for this to be implemented, although less, I think, than that required to restore a culture that supports discipline to two generations that reject it out of hand as a life-style to be admired.

Unless this problem,  separable from "physics" and "math" is addressed, it seems purely academic to argue about how to teach "math" in the abstract.   Students will continue to blame physics or math for being "hard" subjects conceptually, when in point of fact they are failing at a different point in the system.   Physics, per se, is actually quite easy, if one is already fluent in math.  And math, I'm asserting, is conceptually not that difficult either, in context,  but is in practice essentially impossible due to lack of the required self-discipline.

Wade Schuette
Ann Arbor, MI

Rails across a swamp - why math education is a waste of time in America

We've had a fascinating discussion of what constitutes core competencies and concepts in math, and now physics education.   I myself had benefit of one of the USA's top-10 high-schools,   and was an undergraduate Physics major, and just love math and physics.   I've also struggled to teach this skill and love to people I've tutored or taught.

On reflecting on the struggle,  and how to overcome it,  I think it might be worth pondering together whether we can separate out practices from concepts, and address them separately.

My own sense is that the concepts in physics and math are not that impenetrable or alien to children.  As college seniors we were allowed to bring a 3x5 notecard to an open-book exam once,  and it was not that difficult to put ALL college physics onto that card.  There's not that many equations or concepts -- almost everything is implications and derivations from them.  It's not nearly as full of separate islands of disconnected concepts and "facts" as history or biology or chemistry.  And, what concepts there are can be demonstrated in videos and experienced in person or on-line in a simulated experimental world.

To me, it's way way easier than "What did Hemmingway really mean when he used the image of the fisherman?"  or "Please disentangle the things Islam and Christianity agree on and those they disagree on."

So, why is it so "hard" then?

I submit that the problem is actually subtle, but also staring us in the face, so that, once seen, it becomes easy to continue seeing.

First, let me slightly oversimplify physics and math by modeling the activity as follows:    We know some things about the world, and there is something else we are now curious about.   It's hard, expensive, and possibly dangerous to simply go look or try stuff, so we want something easier, cheaper and safer.

So we circumscribe and transform what we're sure of in the real-world into a simplified abstract model, consisting of "facts" and "symbols" and "equations" and "rules".    Then, we can use some process to do two things, in an order that depends on our sophistication -- one is to "fit" the model's parameters to the real world, and the other is to "extend" the model, or play it out, or transform it so that it reaches to the part of the world we are curious about.    Either way, once the abstract model now is extended to that part of space,  we then can un-abstract it back into real stuff and see how well we did,  or build the thing, or look for the effect, or whatever our goal was.

For the part of life we have, for sociological and psychological reasons called "the hard sciences",  this process is relatively easy.   We CAN disentangle a part of the world from context,   build a model for it,  transform the model, fit one end to reality and read out the other end as our new insight about what "should be true" if our model is valid and no new physical laws have swung into play.  We conclude that "If we build the wing shaped like this, or the bridge shaped like that, it should work" and try it and it does and life is good.

The hard part of this has to do with the nature of the representation of facts and relationships as strings of symbols.  Right there we should stop and consider what we're doing, and historically we have not done that.

Let me oversimplify a huge controversy in the artificial intelligence community by saying that there are two ways to represent stuff:   as symbols and as images.    Each representation has some processes and these days,  hardware which can do the heavy lifting for you.

Images... I love images.   You can take a picture of George Washington on a dollar bill, say,  and randomly change half the pixels to white, or black, and you can still recognize Georgie boy.   We can say images are both packed with information ( a "thousand words") and robust against some types of "noise".   Images are, in that sense, "forgiving".    We can, in many ways, be sloppy about our collection process and our transformation process and still come out with the correct answer.

Symbols and symbol strings,such as equations.  This is a different story.  This type of representation and processing is exquisitely sensitive to noise or what one might call "error".     A single point-wise error in even one symbol can, and almost always will, make the remaining 5 pages of work totally useless.

I would submit for consideration that this is the crux of the "problem", the shoals upon which our students are smashing their conceptual boats and sinking.

It has nothing to do with the concepts of physics.  It has, in the end, very little to do even with the concepts of mathematics.  It has, however, a very great deal to do with the error-sensitivity of modeling and symbol processing.

The reason this is a problem is that our students today have no basis in the rest of their lives for being the type of compulsively neat quadruple-checking each and every step detail-obsessive workers that symbol-processing demands in order to work at all.

We are trying to lay precise rail-road tracks across a thinly-encrusted swamp of sloppy behavior, and, frankly,  that simply does not work, and cannot be made to work.   Unlike image processing, symbol processing does not allow a "close enough" attack to "mostly work".

It is a whole other discussion of what psychosocial context and cultural factors,  habits, training, experience, group memberships, expectations, value systems, sports experience,  and other things come into play in making it possible, or likely, or almost certain that a person can impose on an activity a high degree of neatness and structure.

What is clear, I submit, is that such capacity is an absolute, non-negotiable requirement for "doing math and science", at least mediated through symbol processing.

So, the policy and practice implications of that strong assertion are enormous. Either we bite the bullet and figure out what it takes to accomplish "self-discipline", or we should abandon all pretense that we can "teach math and science".

At this point,  self-discipline can probably be taught only by a continuous series of successful experiences using it to solve problems, which means we need to go way back before calculus, before stats, before algebra and get things mastery-learned to a higher degree of certainty starting with addition.

Put it a different way -- if the closest tolerance your machine-shop can give you is plus-or-minus ten percent on the dimensions you specify for parts,  you should abandon the idea that you are going to build a jet engine.

This is a problem that is completely distinct from questions of what shape the parts should be,  or engine design,  or propulsion, etc.

Either we should figure out processes that will work despite sloppy parts, (maybe a variant of image processing?) -- a sort of Loc-blocks of the mind that makes straight what we sort of get roughly straight,  or we should stop wasting all this time and energy on a pointless task.

There is no point trying to teach concepts to students who don't have sufficient self-control to keep a column of numbers straight on a page.   It may in fact be possible to teach the concepts, but it won't by itself result in them being able to "do" math or science.

If my analysis is correct, then we need to have wide-spread specialized remedial courses in whatever works to teach habits of structured work and self-discipline.   It's absurd to expect our math and science teachers to have to do that on top of teaching math and science. 

Shanghai

So, in other related news, yesterday the results of the world-wide OECD PISA test of 15 year olds were release, showing the USA near the very bottom of the industrialized countries, and Shanghai, the city of 20 million,   scoring at the very top.

See:

Shanghai students ranked best in the world at maths and science

Schoolchildren in Shanghai have been ranked the best in the world at mathematics, science and reading by the leading global study of secondary school performance. 

The counter-narrative told in the USA is that China scores so well because they are basically robots who are into mindless drill and obedience,  at odds with the innovative and creative spirit that has made this country great -- or some such thing.  Every Chinese version of a new car, plane, train, computer, etc is met with the comment that it is a "copy" or "clone" of creative work done elsewhere, most likely here.

Curiously,  they must have one heckuva copy machine, because their "clones" often work 20% faster, more reliably,  less expensively,  or otherwise seem to actually be an "improvement" over the prior version.

There is a mistake being made that confuses "rigor" with "rigidity" and freedom of action with anarchy.  By the "freedom" argument,   anyone trying to run the marathon, or play great basketball or football is hampered by the fact that their bones are "rigid" and they would be much better if only their bones were creatively flexible and not so darned rigid.

The reality is that what they would be if their bones were flexible is ... jellyfish.

For fluidity of graceful and powerful motion, some things should be rigid. 

To not damage Johnny's weak self-esteem,  we keep telling him in school that 85% is "just fine" until he manages to get out in the job market, which is now international in scope,  and discovers that "85% good" doesn't even make it into the "C" pile of candidates, let alone the "A" pile, let alone land a job, let alone allow him to do the job.

In mathematics,  the passing score for any concept should be 100% - -the only exceptions being questions that were poorly designed or ambiguously phrased. "Sort of knowing" something will not cut it.  Getting "most of the equation right" except for that one term there will not get most of the answer right.

This seems to come as a surprise to people, students and teachers alike.   You cannot build a high quality car or plane or computer-program out of parts that are 85% correct, or 95% correct, or 99% correct -- although 99.995% correct might work for machine parts for some things.

However, for mathematical equations and symbol processing systems,  even that is not sufficient. Each symbol, each step, each transformation, each equation must be 100% correct,  or the answer at the bottom of the page is pure rubbish.   Your satellite to Mars will attempt to land 200 feet below the surface, instead of on the surface, which is "pretty close", given the distance to Mars .... but not "close enough."

Either you go with "mastery learning" or you are wasting your time poking at mathematics skills that will never be useful to anyone.   Assuming we want to compete with China,   we need to go for "mastery learning."

And, to put it mildly, we are coming from behind on this issue these days.   Our students are behind. Their teachers were not taught well and are behind, overall, with some clear exceptions.   Given the rate of progress we've seen recently, and the total inability of those in Congress to reason together about, well ... frankly, anything,  it is arguing uphill to think we can get that turned around in less than a generation -- time we simply do not have.

But most of all our concepts of discipline,  structure,  order,  routine, rigorousness are the weak spot with the approach we've been using of "national collective power through individual genius capacity."

OK.  Then let's be creative about this level of the problem.

Working separately, as competing individuals,   we are very unlikely to win or even catch up and break even with the Chinese.  The arguments are above. They look solid to me.

So ... maybe we should put the "image processing" analogy on the table and look long and hard about it. 

Why is it that "image processing" is so strong and immune to damage from "noise" or point-wise error,  unlike the mathematical tools of "symbol processing" ? 

Isn't there ANY way to build a reliable system out of kind-of-reliable parts?

Yes, is the answer.   Creative redundancy.   There is a whole engineering discipline of making reliable "systems" out of unreliable and flaky components.

If we cannot make our INDIVIDUALS reliable,   that doesn't mean we are unable to make COMBINATIONS OF INDIVIDUALS reliable.     Individuals are like symbols;   teams are like images.

If we're going  to go that direction, then the dollars, priorities, and emphasis in education needs to change from attempting to maximize INDIVIDUAL skills and reliability to maximizing COMBINED skills and reliability of small TEAMS of people working on problems together.

I'll argue that it is obvious ("without proof" ) that two people, working together,  and cross-checking each other's work,  should be able to produce a math homework paper that has fewer errors on it than one person working alone.

From the point of view of "business" or "commerce",    the only thing that is needed in a particular "slot" or "job" is some person,   OR TEAM OF PEOPLE WORKING AS ONE,  who can take a problem and solve it in the time available. 

Already we see this in the concept "pair programming", where two people sit side by side at one computer, and together attempt to solve programming problems.    It turns out, if done correctly, this is something like 5 to 10 times more effective at generating workable programs than "dividing up the work" and having each person work in isolation on "their own piece of it."

So, here's the trade off.  To catch up to the Chinese in productivity in problem solving in math or science in the REAL WORLD,  which has, in fact, no constraint of "do your own work separately",     we have two possible approaches: 

(1) We could try to back-fill remedial high-quality self-discipline into our students and culture PLUS "learn math". ,  or

(2)  We could try to remove the "do your own work separately" constraint and start tackling problems as pairs of somewhat-sloppy but cooperating individuals. 

Neither of these is trivial or a cake-walk, but, of the two, the second seems more likely to succeed than the first.  At a mimimum, since we're that kind of place, we should explore some of each, have some schools try to go for structure, and others go for true-pairwork.

Both of these require a cultural shift to support them.

At the current time discipline is not popular.   On the other hand "groupwork" is a dreaded four-letter work in academia as well, as in "Oh God, ... I just found out this course requires group-work. I wonder if it's too late to drop it!"

My point is, if we want to be sloppy about our personal work habits, and we appear to take that as a cultural norm,  and we HAVE to be concerned about product reliability, which is demanded by the mission or a competitive marketplace,  then we have no choice that I have seen so far besides figuring out how to be less sloppy (in terms of errors in the work) when working together than when working separately.

And,  we need to start trying to figure out how to treat a work-dyad as an acceptable filler for a "job" that currently is intended for a work-singlet. (a.k.a. employee.)

How do you pay a dyad? What about health care? Do both people always have to show up for work or can only one show up on a given day? Who cares?   If they both work "from home" does anyone even need to know it's a dyad not a singlet? If we gave the dyad a "name" and a "social security number" would that help?

That's where the problems rotate into with the dyad approach.  

Again, I didn't say it was easy -- I suggested it was EASIER THAN THE ALTERNATIVE, given where we're starting. 

The dyad needs a name, and a resume, just like a singlet-employee.    Presumably, the dyad needs a single paycheck.   Desk space is a problem unless the dyad works "at home."

While we're at it, let's say the dyad IS allowed to "cheat" and have permanent full-time access to the internet during any portion of training, education, examination, or activity during the actual job. That's realistic these days.

So NOW the question is,  can  dyads of Americans,  with access to the world wide web, working just with each other and learning over time how to operate as a team,  trained as a team,  operating as a team,  outperform Chinese singlets working with what they learned and stuffed in their heads, without access to web?

My thought is,  yes.  

So,  we should redefine the OECD PISA test to reflect, not what we have assumed all along is the style of education and learning, but what is the 21st century style of operating.

We should allow small-units,  teams,   squads of  2 or more people, working together in the web-context, connected to each other and their friends on the web,   to compete with Chinese individuals working alone, and see who comes out better on THAT test.

That would more likely work if the teams, like SEAL teams in the US Navy,  or cockpit crews in commercial aviation,  trained AS TEAMS.

This is a whole new ballpark of opportunities and pitfalls, but the only ballpark so far that I've seen that has any chance of catching up with the Chinese -- already in motion and already beyond us.

Of course, it's sort of ironic that the Chinese, with a strongly stated national culture of collective action,  turns out to be succeeding best in the area of competitive individual action,   while the USA, by my analysis,  with a strongly stated national culture of competitive individual action,  may turn out to succeed best in the area of collaborative team performance.

I guess, when you're coming from behind, "whatever works" is a good philosophy.  We have a lot of sports where doubling-up on your opponent is a winning strategy, don't we? If they're allowed to use our tactic of "competition" we should be allowed to use their tactic of ganging up on someone, shouldn't we?

Especially if it would even the odds here and give us a "level playing field."

Besides .. it sure beats having to learn algebra for real.

Anyway, it IS "American as apple pie and baseball."   Baseball is a game where players learn how to collaborate with each other so that their TEAM can "cover the bases" and "compete".

Yeah -- Bill Gates, are you listening?  We need an international competition on CONNECTED-TEAM-ENTRIES into things like the OECD Exam.

You pick your team size,  you are allowed to be connected to the web, it's open book, open notes, open cell-phone,  ok to consult with each other.   Then we can see who can field a better "team".

And you know why that would be better? Because that's EXACTLY what international business competition is about.   You get to pick your size.  You get to pick your structure.  You get to pick your hardware.  You get to network.  NOW, let's see who can solve a real world business problem and take advantage of a real world opportunity faster and more effectively.

So, isn't that what our "schooling" should be preparing us for by running us through it over and over?

It's Christmas!

T'is the time of gift giving! Yay!  Time for all good Christians to go shopping!  Or is it?

I was raised in a somewhat Christian family and, much to the surprise of my parents, spent a lot of time reading by Bible.   I had been given one of those "red letter" editions at age 8 or so, with the words of Jesus in red, so, naturally,  thinking that was the point, I spent a lot of time reading primarily those words and reflecting upon what they meant.

Not too surprisingly,  I ran into trouble.  My young mind read things like "Thou shalt not kill"  (or more precisely the Sermon on the Mount) and thought, you know, it meant that people should not kill each other, even when they really, really wanted to and good cause to do so.

This "interpretation" of the words of Jesus socially seemed to differ.  "Onward Christian Soldiers" was taught as a hymn.   There were Christian ministers and priests blessing the guns and soldiers we were sending off to kill very large numbers of people we felt we had good cause to kill.    Oh.

So, there seemed to me to be a lot of cherry-picking and choosing of just which words of Jesus we were going to respect and which we were going to "reinterpret" to the point of reversing entirely so we could keep on doing what we wanted to do originally.

So, in this Christmas season, with fair warning that I may be going outside the comfort zone,  I want to take a minute to look at the idea of "gift giving".  Specifically, did Jesus have anything to say on the subject?

Yep. Matthew 5 has this section (From the New International Bible):

Murder

21“You have heard that it was said to the people long ago, ‘Do not murder,^a and anyone who murders will be subject to judgment.’

22But I tell you that anyone who is angry with his brother^b will be subject to judgment. Again, anyone who says to his brother, ‘Raca,^c’ is answerable to the Sanhedrin. But anyone who says, ‘You fool!’ will be in danger of the fire of hell.

23“Therefore, if you are offering your gift at the altar and there remember that your brother has something against you,

24leave your gift there in front of the altar. First go and be reconciled to your brother; then come and offer your gift.

Jesus Christ, and Christianity,  had a great deal of focus on the concept of "forgiveness" and specifically, this idea of removing anger from your heart for past sins of others,  real or imagined.

This is a long way from "An eye for an eye and a tooth for a tooth."   It is a long way from "getting even". It is a long way from "never forgive, never forget."   It is way more along the lines of  "Get over it. You haven't exactly been a perfect role model yourself, dude."

And, actually, Jesus said:  "Let he who is without sin cast the first stone." ( John 8:2-11 KJV)

I thought as a child that the message was pretty clear.   I still think it's pretty clear.   Before you go around giving presents to your friends,  or to God,  you need to start by clearing the anger out of your own heart for past transgressions of others on your turf, real or imagined, of any degree of seriousness.

He did not say you needed to be a wimp or a sacrificial victim. He did not say you needed to forget. But he did say you needed to forgive, and in particular,  not feel so self-justified about your own anger while being, frankly, so blind to your own past behavior and transgressions.

Are there people or peoples we still hold grudges against this Christmas season, that we are using as the basis for personal and international policy?  

Jesus said:  "Let he who is without sin cast the first stone." ( John 8:2-11 KJV)

And there was all that stuff about "Forgive us our sins as we forgive others."

I suspect, from reading the papers, that we have not individually or collectively, followed that advice.

Carrying venom around in your own heart tends to result in poisoning yourself.  If we as a nation are going to kill other humans, we should at least feel bad about it,  not vindictive and smug and jubilant and self-satisfied and self-righteous.   It is a bad policy overall, a bad habit, a bad way of dealing with conflicting interests, that tends to become self-perpetuating, sucking those doing the killing into the same pit, the same framework, and ultimately the same behaviors as those they are focusing on killing.

Jesus told us not go get suckered into that approach.   It's a good time of year to imagine listening to that advice.  Or we will simply become like unto those we take such delight in hating.

And how are we feeling today?

The string of leaks damaging credibility of the establishment continues -- although I'm talking about newsflashes that show patients have as much impact on their own health as do, gasp, doctors or hospitals.  Just shocking. 

Fortunately,  most of these news flashes occur one at a time, so there is a chance for spin-control to counter-balance, neutralize, and finally remove all the punch entirely from them, so that the legacy model of doctors as small gods can continue sucking the nations coffers dry, without delivering much in the way of, you know, actual health improvement in the population.

And, again,  it is mostly at the institutional level that these myths are propagated.   Solo doctors,  the 60% who are not in the American Medical Association, and particularly those few who dare to practice primary care and family medicine, are as much suppressed and oppressed by hospitals and the Megamyth of high-tech care as patients.    Those are the ones as well who can't see the benefit to their patients or their own practice in making their patient records into e-records,  "machine readable",  visible to the universe.

Anyway, the latest news is that color and sound, untouched by doctors, can affect healing rates in hospitals.  I quote from a November 22 piece in  Advance for Nurses titled The Arts in Healthcare

Healthcare is connecting people with the power of the arts and their therapeutic effects. Painting a canvas with bright primary colors or listening to music while under medical treatment has a notable positive impact on patient outcomes.

The benefits are many, but art therapy is impacting physical, mental and emotional recovery, including relieving anxiety and decreasing the perception of pain. On the other side, research promoted by the Society for the Arts in Healthcare out of Washington, D.C. shows that the arts can reduce patients' use of medication and length of stay in the hospital, and improve compliance with recommended treatments-offering substantial savings in healthcare costs.

I didn't instantly find a description of the research papers themselves that describe said research, but I'm willing to believe it's true.

In fact,   even doctors officially recognize the fact that they may be able to set bones or prescribe drugs or cut out bad parts from people,  but the subsequent healing that takes place is a mysterious process that is simply unblocked by that "treatment", and the healing of the bones, say,  is the doing of the patient's human body itself.    So, the doctor takes an hour and sets a bone, and the patient takes 6 weeks and heals the bone, and the doctor gets all the credit for "fixing the arm."   Yeah, sounds familiar.

In point of fact, the "placebo effect" is well known to have a healing potency quite close to most prescription drugs.   Notice how the actor has been removed from the common description -- as if  this effect sort of comes out of thin air, as opposed to giving credit to the human body of the patient for being able to heal itself,  under the right conditions and correct thinking.

The narrative, the story, the Megamyth, is that Doctors And Hospitals do healing and curing of "patients", who are passive objects, like lawn mowers who complain,  coming in to the healing center to "be fixed".  This narrative is important because it makes it really hard to see or believe anything contrary to it that is going on.

So, let's actually take it as given for a few moments that the most powerful medicine, or most powerful healing force or actor in the hospital, or at work, or at home is, in fact the patient's own body.   (A few moments is all you get, until the Megamyth will come along, see such improper thinking, and erase it, by the way.)

While we have a minute to ponder before that happens,  let's leap to an observation: If your body is in fact a powerful healer, then it stands to reason that your body can tell how it is doing with the healing process.

That is,  the most powerful diagnostic tool, or vital-signs capture device on the scene is something you already own and carry with you -- your own body.

You don't need to purchase it, or rent it from a medical-services company.  You already have one.

This fact is contrary to the Megamyth  - that only what doctors or hospitals or high-tech equipment or drugs do, in the way of "billable events"  matters.  Therefore, it is not taken advantage of in a hospital or health-care setting, which, in my mind, is not only stupid, it's criminally negligent.

Here's an example -- one of the the largest and best carried out "longitudinal studies" (over the lifetime) ever done is something called the Framingham Heart Study.  People were followed for 50 years to see what happened in their lives in the way of heart attacks, etc., and what factors in their lives might have been responsible or led to seeing what was coming.

One of the principal investigators of that study came to talk to us when I worked at Parke-Davis pharmaceutical research,  and he discussed some less well-known results of the study. One was this: among all the lab tests, doctor's examinations,  and other methods of predicting what was going on with a patient, there was a single factor that stood head-and-shoulders above the rest.   There was one way to predict, with very high accuracy, the future trajectory of the patient's health.

That one way was to ask the patient:  "How much longer do you expect to live?"

Yes - campers,  amazingly,  people knew the answer to this question. Better than every lab test and doctor's examination in the world, people already knew the answer.

This makes perfect sense, if you are in that brief period of sanity,  briefly out of the grips of the MegaMyth, in which you can accept that the patient's body is the best and most competent healing agent on the scene. Of course, in that framework, it would also be the most competent predictive observer of how things are going and how much longer it can hold out and hold on and compensate for everything else that's going wrong.

So, again, in this brief moment of sanity unpolluted by the Megamyth,   you could immediately see two things:

• 1)  Even in a hospital setting, surrounded by high-tech equipment,  "vital signs monitors", and laboratory tests,  the best observer of "how the patient is doing" or "current status" and "prognosis" would be, ta da,  the patient's own body.    The body can, of course, put all the current signs into context,  and know what these signs mean FOR THIS PATIENT,   versus what they might mean for a generalized average patient, on average. The body has decades of experience with this patient.   
• 2)  At a home or work setting, outside the hospital,  even in the total absence of high-tech "telemetry" equipment and expensive "tele-health" fancy gadgets,   the best observer of the same person's health and vital signs and status would be, ta da,  their own body.

If the Megamyth hasn't blanked out your mental screen for improper thoughts,  you might then ask yourself, well, if that is true, how come no one is USING these facts to inform health care?  How come doctors and nurses sort of worship lab tests and vital signs traces and EEG's and EKG's and put their best decade of medical experience to bear on taking all those data points and synthesizing a single construct of what all that means, for this particular patient?

How come the doctors and nurses at the same time  more or less ignore the patient's and don't just ask "How are you doing?" with any deep degree of attention to the answer?

How come, when a 65 year old woman calls from home and says "I think somethings wrong" or "This drug isn't helping me" their comments are mostly considered "anecdotal" and totally ignored?

This is not a small question. This is a BIG QUESTION.

As a nation, as a health care system, we have some evidence (Framingham study, etc.) that patients are capable of being more in touch with their own medical status and prognosis than the best the high-tech health care system can do.  Yet we basically demean, dismiss, and ignore this as "anecdotal".

Maybe we need a cool sounding name for it, like "deep sensing patient analytics" for it to be taken seriously.

Or, given the de facto and unpleasant fact that only things that make a lot of money for someone (else) are taken seriously,    (e.g., we totally ignore the "placebo effect" since it cannot be patented or sold),   then, in all cynical honesty,   maybe what we need is not only a cool sounding name, but a piece of technology that captures, amplifies and cleans up the presentation of this "deep body internal sensing" so that is becomes as credible as the stupid so-called "vital signs monitor" next to it.

I suspect the reason anecdotal evidence is so bad, aside from the tremendous bias and skewing caused by the Megamyth,   is that patients themselves have not learned how to listen to their own bodies.  They (we) have been persuaded by the Megamyth that we are not competent observers of ourselves.

And here, we get to what at first looks like a picky nuance of language, but is a critically profound distinction.  There are TWO OF US in here.   For the purpose of this discussion, I'm assuming that our internal BODY control system is astoundingly good, far far better than doctors or hospitals or high-tech equipment, capable not only of diagnosis and predictions, but of actually managing the healing process itself.  That's one "agent" on the scene. That agent, however, is 100% NON-VERBAL.     This agent is highly competent, or we'd all be dead already.   You have no idea how much work it is just to keep you alive on a day to day basis. This agent is far more powerful and far less visible in the megamyth than even NURSES!

The OTHER agent on the scene is our conscious self, our internal dialog and voice, which IS VERBAL, and which is very heavily skewed and biased by the Megamyth, by what we just saw on television,  and by a billion other things.    This self is quite prone to error, and generally very out of touch with the BODY.  For the last two thousand years, it was more or less assumed there wasn't even ANY connection between this spirit / conscious self and the BODY -- the body was just sort a kind of vehicle the spirit rode around in. The spirit was lucky to understand where the ignition key and light switch was, let alone have any grasp of how the internal combustion engine's carburetor was functioning.   Perhaps as very intentional design, or perhaps as the result of seeing when it was NOT true,    the BODY and the SPIRIT are pretty much isolated from each other. The mind can go off on imagining itself in Tahiti while the body is sitting in New York.  It would be best if the BODY did not react to the mind's imagining, in general -- or you get a bad LSD trip or sleepwalking.

So, to the point.  Improving health care significantly on a national scale at an affordable cost.

We are not taking advantage of the best resource available,the body's own diagnostic system, let alone the body's healing-management system.   Even skipping the healing management part, for now,  let's just focus on the diagnostic system.

QUESTION:  Is it conceivable that a device or process or system MIGHT be developed so that people COULD let their body have a voice that was as credible, even to doctors,  as the typical vital-signs monitor? Maybe, even, so that they themselves, the "patients" could hear, first hand, the BODY's response to eating this versus that, or doing this versus that,  or taking this drug versus that drug, or this dosage of that drug versu the other dosage,  and use this at least as much as we use "Better HERE? or HERE?" in getting a new prescription for eye-glasses?

I'd say, yes, it's conceivable.  It's even likely.   The system is not totally submerged, if it can lead to a highly-accurate clinical impression and prognosis in the Framingham Heart study.   It it's even partly visible,  there are clever ways to amplify it and isolate it and clean up the signal and make it control colored lights or a strip-chart recorder or sound an alarm when things are "heading out of control". For most care a simple "better HERE?" or "Warmer or colder?" or "Yes/no" functionality would be sufficient to get this non-verbal entity to communicate with the totally verbal health-care systems.

OK,  I've presented an argument that a cost-effective highly-available diagnostic and prognostic system could be developed to assist both patient self-care and doctor-guided care and hospital care.    We simply need to shove the damn megamyth out of the way long enough to say -- no, there IS a signal right here, already, that we just need to tap into, and do it.

My God -- imagine the value of a simple device that could reveal the body's inner response and tell us whether any given intervention was actually helping or not.  NOW we're talking "evidence-based medicine" and "patient-centered care". 

Let me stress that the whole concept here is not yet some new way of instrumenting the body in order to "measure it".    The body is capable of measuring the ten thousand complex things it has to manage already on its own, as proven by the fact that it manages to keep us alive day after day. 

The concept here is learning how to simply ASK the body, in non-language that it understand (being non-verbal) to REVEAL  the answer to the question "how are you doing?" or "better here?" And generate (gasp) an answer translated into verbal words that WE are used to that is a "yes" or "no" or "down to about 2 hours left before I run out of ability to compensate." or "getting better at last" or "getting worse now." or "getting really unstable, call someone fast."

We are not talking about measuring. We are talking about communication. We are talking about learning how to listen, or, perhaps, how to give a non-verbal but extremely bright agent inside our body a channel, a pathway, a pencil or crayon or anything it can control so that it can find its voice and talk to us in terms we understand -- and then, we are talking about changing our captivity to the Megamyth enough that we are willing to listen to the answer and take it seriously.

For any given person, there would be a training curve, a period in which this feedback pathway would need to be tuned, calibrated, and validated.   OK, we can pay someone for the device and services to do that.  Now it's valid "medicine".  

But then,  everything else doctors or self-care or food-choices or activity-choices or hospitals or nurses did could reveal immediately the impact on our internal health, and if we also learn to listen to our own bodies,  how could this NOT improve the outcomes?

Doctors lord it over nurses, at least the AMA does,  jumping up and down over the "years" of training and thousands of hours with patients.    Well, dudes,  the human body internal control system can play that game too, by your rules.  It has a million years demonstrated experience keeping bodies functioning under all sorts of conditions, and an entire lifetime experience with this particular patient, this particular body, as opposed to "bodies in general".


If nurses are supposed to yield to doctor's superior judgment due to these kinds of numbers, then, by the AMA's own arguments,  doctors should yield to the Body's judgment.


We just need to solve some very straight-forward communication problems here, not deep theoretical problems.   There is a signal, it's non-verbal, get over it.   How do we communicate with a silent non-verbal agent, trapped inside our body and say "Hey, we're ready to listen to you now!" and give it a non-verbal Quija board or whatever it needs to "talk to us" and find its voice?


I'm affirming that THAT problem is WAY more approachable and amenable to research than trying to figure out the massive tangle of health-care-insurance-policies or electronic-health-record-systems we are turning to in our desperation for reducing costs and improving the visibly deteriorating health of the American public and work-force.

Again, because I know this is a sticking point. This is not something we can "measure".  There is no signal for us to measure, in that sense. If we go looking we will not find it.   The signal will not "come" until we build a receiver capable of  responding to such a signal,  and start listening hard, and start responding to what we hear.    After a while, hopefully not too long,  the body will realize that we are listening, and THEN start broadcasting on that channel, as we are now something control-ABLE that it can seek to take control OF, which it's good at because it is a "control system".

It is, in other words, something you have to believe to see.

It is something that requires humility, because we are asking, which is a submissive pose, not strapping to a chair and "measuring", which is a dominating pose.

It is, in that sense, I suppose, a lot like the process of prayer and "listening to God's voice" at least as described in serious practical religious literature -- until you are ready to respond to what you hear, don't expect to hear much. 

We are JUST on the verge of getting to wifi systems for our laptops that won't waste any energy at all broadcasting UNTIL we indicate we are present and ready to listen, and then they will wake up and start a communication link.    This is finally a concept we can relate to.    There is no signal to measure until we are ready to listen to it, and then there is a signal.  We must have an active-receiver that closes the communication AND CONTROL loop, before the contents of the signal will be broadcast.

So don't go sticking probes in people looking for "the signal" so you can "study" it.  It is probably not interested in being studied.  It is interested in taking control.  That's what it does.  That's the language it speaks.   This is an important distinction.  This is how come you can report in good faith that "we went to look for it but didn't see it."  Nope. You wouldn't. Not that way.

Oh yeah, one last note. If this thing strikes you as "true" or "important" -- take an action right now to do something about it.  Tomorrow will be too late. By tomorrow, the Megamyth will have detected this improper thinking, and erased it from your mind. It will be at best a note that no longer seems important.