Should the FDA regulate tobacco?

According to the New York Times today, "Report Seeks FDA regulation of Tobacco",

A report from the Institute of Medicine, part of the National Academy of Sciences, urged Congress and the president to give the Food and Drug administration the authority to regulate tobacco.

Use of tobacco is recognized in Public Health as the second largest cause of premature death in the world today. The World Health Organization estimates that half of the smokers will be eventually killed by that habit, with the death toll 5 million people per year now, and rising.

So, this is a surprising thing. The USA launches a whole occupation army and spent over a trillion dollars because 3000 people were killed. But the same country sits by and watches the tobacco industry kill 5 million people a year, every year, and that's no big deal.

We really need to pause and make sense of these observed facts, and what they can teach us about ourselves.

There is a very long history of attempts to regulate tobacco, which has a specific exemption put in place by our very own Congress, specifically to prevent such regulation. Any consideration of that kind of regulation also has to look at the dismal results when the US tried to regulate the sale of alcohol during "prohibition" with a constitutional amendment.

The Times story continues:

The report said cigarettes contained carcinogens and other dangerous toxins and would be banned if federal laws did not exempt tobacco. A bill before Congress would give the F.D.A. regulatory authority, but the agency’s commissioner, Dr. Andrew C. von Eschenbach, expressed skepticism, saying that if nicotine levels were reduced, smokers would change their habits to maintain current levels. The report also called for higher tobacco taxes and a national ban on indoor smoking.

The Johns Hopkins Institute for Tobacco Control estimates that 1 billion people will die prematurely, in the 21st century, from use of tobacco. According to that site, "The Institute for Global Tobacco Control works to prevent death and disease from tobacco use through research, education and policy development."

Apparently, "research, education, and policy development" have not been very successful and solving this problem.

In fact, while non-smoking areas are now commonplace in places wealthy Americans hang out, the companies have only moved operations abroad and expanded them tremendously. The death toll is expected by WHO to double in by 2020, to 10,000,000 people - a year, each year.

I would like to suggest that "research, education, and policy development", while helpful locally, will never solve this problem.

There are two reasons I think that, related to the whole theme of this weblog.

First, our ability to reason about such things is poor. The fixation on numbers in much of Science, and explicit belief by many that only numeric results are meaningful, has short-circuited our ability, as a society, to reason correctly about things that cannot be measured with numbers. Even for things that can be measured with numbers, the fixation on linear statistical models has short-circuited our exploration of feedback models.

In the perverse way of complex systems, our biggest problem is now of our own making. Like the blades of a helicopter, we must travel in our own wake. The very success of the mechanical view of the universe, of Science and technology, and of linear statistical models have made it almost impossible to now move forward from there. These techniques have, effectively, become religions, defended with blind religious zeal against perceived enemies at the gates.

So, when we are confronted with a problem which shimmers and changes with the size and scale of the observer, we are effectively paralyzed. Do tobacco companies kill people? On the scale of populations, the cause and effect is clear and unambiguous, and satisfies all the requirements of causality, except one we'll get to. Raised marketing efforts by tobacco companies precede and have a dose-response relation to the number of people smoking and the number of people dying. Etc. The problem is that if we shift lenses, on the scale of individual humans, this relationship is no longer "causal." Individuals have free will. Any particular individual may or may not respond to marketing efforts by the tobacco industry. The solidity dissolves.

It's not that there is no solidity to the causal argument - it's that the solidity depends on scale, which is a concept that is not yet recognized as pervasive and important.

I go on about this at great length in some other posts. ( Search "scale" or "causal" in the search window above to find them. ) See "Ten most important lessons from physics" for a discussion of how even water pipes have this property. From a human scale, there are entities called pipes, and water towers, and faucets and there are measurable factors like pressure and volume and flow-rates. These seem very solid. But if you drill down to the molecular level, this solidity dissolves. Molecules don't think, or act, or respond to any of that. Those words are meaningless to molecules. Molecules just respond to their local environment, and their neighboring molecules. A given molecule may linger at the pipe wall forever, it doesn't matter.

A few more such examples are given in my post: Amazing devices to impress your friends.
These include hollow tubes that cause air to separate into boiling hot air and air so cold it creates frost, pumps that pump water uphill with no power source and essentially no moving parts, hollow spaces that convert battery power to microwaves in one step with no moving parts, etc. These are all commercial, off-the-shelf devices, not my imagination gone wild.
They also all have the property of being globally causal and locally non-causal. Like the photo of Marilyn Monroe or Einstein, depending on how far back you stand from your monitor, they are both at once and fall into a space we are not taught about in school.

The second reason that "research, education, and policy development" have not been very successful and solving this problem of tobacco-related deaths is that this is a spiritual problem, and it will never yield to technology.

As T. S. Eliot noted, in Choruses from The Rock (1934):

They constantly try to escape
From the darkness outside and within
By dreaming of systems so perfect that no one will need to be good.
But the man that is shall shadow
The man that pretends to be.

Or, more precisely, the society that is shall shadow the society that pretends to be. Any individual effort to change the situation with respect to tobacco use will fail on two fronts.
First, the industry will fight back, and that is a cross-scale fight that pits corporations against individuals and guess who will win. Second, human weakness will fight back against our best intentions for our own behavior, and we will give in, as we did with alcohol. The latter is what the FDA Commissioner was referring to, in that regulations limiting tobacco per cigarette would only increase the number of cigarettes smoked until the same physiological hit was obtained, making the industry even richer.

In the contest between an individual and a multi-billion dollar corporate marketing campaign, it is not likely the individual will win.

There are exceptions. For instance, the population of Latter Day Saints (Mormons) in Utah has a well-documented life expectancy ten years longer than the average for the US, and one reason is that they prohibit smoking and drinking.

Look what is going on here. It is not the individuals that are fighting off the temptation to smoke or drink, but the larger scale entity, the, gasp, organized religion, that has succeeded where
"research, education, and policy development" have all failed.

One of the youth in our community asked one day "Why do we need organized religion? Why can't we all just worship God on our own?" The answer is visible in Utah -- larger scale entities can do things that smaller scale entities cannot possibly ever, ever, ever do on their own.

This is not a "cognitive" thing. Yielding to temptation and losing ability to deliver on one's own intentions is a function of being disconnected from a larger entity that helps shape and define and support you, and provides you what structural engineers call "active strength." The simple fact is that human beings are heavily influenced by peer pressure, whether they like it or not, or believe it or not, or have IQ's of 200 or 20.

It's not so much a question of which entity to belong to. Pick one that looks good. What matters is belonging to something larger that supports the values you desire your "self" to have.

Life is too complex to go it alone. We've seen to that. The one church that does not work, and will never work, is "rugged individualism." Whether you believe in God or not, or evolution or not, the math is the same - no individual will ever be as strong as a strong group. In the end, strong groups will win. Multi-celluarism always wins out, in the end - it's just a better solution. The fact that you're reading this shows that multi-cellular architecture can work, because that's exactly the operating principle your body uses to orchestrate a trillion cells and get one body. We're swimming in examples of this working.

Wrapping up the social thought - tobacco deaths continue because we accept them. If we, as a society, collectively, decided we didn't want our companies killing 5 million people a year, we could stop that cold. Such an action requires moral conviction and group solidarity of a type that will not come from "research, education, and policy development".

Such an action requires a change of heart.

Change everyone's heart, and the "problem" will dissolve. Suddenly, "we" will be at the same scale as "the problem", and the "problem" will simply evaporate.

So, I'd suggest that focus as the most likely to succeed. It demands that we come to grips with larger questions of society, morality, religion, science, and our own nature. It's not a simple thing to do, but, from the reasoning above, it looks to me like the easiest thing to do that has a chance of working, based on fundamental principles of what's going on here and the evidence at hand of what works and what doesn't.

Religion, like gasoline, is volatile. It releases tremendous energy in people, for good or bad. It can be misused, and it can kill. It can also power our lives with non-polluting ability to cope.

We don't need to throw out religion. We need to understand, when it works, why it works. There is no shorter path to the solution to the problems we've now made for ourselves, and no path that doesn't involve these questions.

Man on the roof

A story was going around of a person in a flood, who climbed up on the roof of his house. A rowboat came by and asked if he needed assistance, and he said, "No, my God will save me!"

As the water rose, another boat came by and asked the same question and again, he said "No, my God will save me!" As the water neared the top of the roof a third boat came by and asked again, and he gave the same answer. Finally, the water swept him away and he perished.

Arriving in Heaven, he confronted God at the gate and said "I thought you were going to help me! Why didn't you save me?"

And God replied "I sent three boats."
.
.
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We're all right. Did your finish your homework?

Maybe I can stay closer to everyday experience and illustrate how it is possible that we can agree and yet disagree. If we imagine humanity sent 3 different scouts to glimpes the sphinx of Egypt, and they came back with 3 "completely different" pictures, as shown here.

We can imagine intense sectarian violence over the issue of whether the pyramid goes "up to the right", or "down to the right" or has a large side that is "completely level".

The problem is that all three pictures show exactly the same physical world, but the observer's camera was held at a different angle when the picture was taken.

The picture is not the reality.

Our pictures seem to disagree, but once you correct for the difference in position of the camera, the pictures agree entirely.

Every human, every time, every culture will have a different "camera position" or "reference frame", and there is no such thing as "a right one" or a "wrong one" - they are all equivalent. We shouldn't argue over that aspect of the picture, but only about the contents of the picture that don't depend on who's holding the camera. These are entirely different levels of "difference".

For petty, earth-based experience, we may have an unstated preference, and could feel that there is a "right" way to view the pyramid and sphinx, that none of those images exactly captures. Actually, they all capture the right way if you bend your neck a little when you look.

But for "heavenly" experience, arguing over which way is "up" may be totally meaningless. Here's a last picture, of our neighboring galaxy in space - a trillion stars. It doesn't even make sense to argue which picture is "right" and which is "upside down". There is no "up", only "outward" in space. Earth-bound meanings of "up" don't apply to that universe.




We need to get over arguing about the camera, so we can focus our attention on the contents of the image. That is the point. We should stop killing each other over details that vary with the camera so we can move on to realizing our common humanity and that we're looking at the same image, regardless. We're killing our own brothers, our own kin, over nothing.

This is something that "science" can teach us about "religion" - or at least about how the limitations of our own experience can cloud our ability to see where we should be agreeing with each other, and moving on with the shared and exciting discussion of what it all means.

At the extreme, I recall one extended discussion in a list-server group about a person who was hung up for over a year, and couldn't proceed with investigating a religion until he had resolved the question of whether the word "satan" should be capitalized or not.

These kind of "hang-ups" are tremendously convenient at avoiding getting to the issues that actually might call your own behavior into question, such as whether you are, or are not, taking the care of your brother or neighbor or employees or the poor that your religion has told you is your duty.

All of the world's major religions agree entirely that it is our personal responsibility to be concerned for and taking care of our family and our neighbors and our community and our educational system and our children. There is no excuse in avoiding that responsibility because we are bickering over what words were used to give us that message and when it came.

First, get that much accomplished. Then, we can come back and get on with killing each other's children over whether the exactly right word was used for our next assignment.

M31 galaxy image by John Lanoue.

One Common Faith

The booklet title One Common Faith , prepared under the supervision of the Baha'i central administrative body (The Universal House of Justice, 2005) has been recommended for group study. The starting point is this:

Ancient sectarian conflicts ... have re-emerged with a virulence as great as anything known before... A world... is warned that it is in the grip of civilizations whose defining character is irreconcilable religious antipathies. (page 7)

I want to bring some concepts from science to the discussion, and show how they fit with the theological and sociological arguments that are in the booklet. In some ways, this is a translation, as best I can, at first pass, of the document into "scientific" terms. It will be imperfect and I'm hoping that, with comments from you, dear reader, it can be improved. Hopefully, the discussion will not cause any additional hostility. ("First of all, do no harm!")

To that end, let me state that I'm going to look at some apparently depressing facts, but the end of the story will be optimistic, hopeful, and action oriented. My take on life is that, despite all the gloom and doom, some aspects of the global community have never been better, and, with the use of the web and instant global communications, we have an opportunity to improve the process that no generation in history has ever had before. This by itself is astounding, and means the past cannot be used to predict the future.

Part of the reason for the resurgence of religion is described in the booklet as the "bankruptcy of the materialist enterprise itself" -- the failure of various efforts whether secular, humanitarian,
social and economic development, modernization, globalization to make good on their promise to improve life for most of us. The promise of "freedom from want [and] fulfilment for the human spirit" has not been met.

I'd note that not only is the gap growing between rich and poor, as has been well document elsewhere, but even within the USA, as I described yesterday, the "economic miracle" seems to be sinking. Gasoline hit $3.59 a gallon in my town yesterday. Housing foreclosures are at record levels. Layoffs abound. Personal savings has gone negative and hit a rate not seen since 1933 in the "Great Depression". Obesity, depression, diabetes, asthma are rising rapidly. And so on while people seem, individually and collectively, numbed into a type of helpless-hopeless passive despair, as I described in "A Patient Dies in Los Angeles" , occasionally breaking out into extreme violence, and resurgences of anger, blame, hate crimes, and racism, individually and collectively. Why isn't this economic model working?


The answer given in One Common Faith, to paraphrase, is that we have "thrown out the baby with the bathwater." Observing the abuses and downside of religious thinking and warfare, our society attempted to break free of those problems by discarding religion and God and adopting a "scientific" and materialistic model where "competition" and "free-markets", it was argued, will produce the best possible social outcomes. Exactly how and why that was supposed to work was vaguely described as "The invisible hand of Adam Smith" or some version of "survival of the fittest", although I can't recall ever seeing a simulation model showing that individual unbridled local self-interest produced the maximum benefit for all and a stable society. (If you know of one, please comment.) And, regardless what any model might show, the actual outcome was described yesterday, and looks more like economic and social ruin than "The Great Society."

On page 12 it is argued that "global integration" has only perpetuated and intensified gross inequities, resulting in

a questioning of all established authority, no longer merely that of religion and morality, but also of government, academia, commerce, the media, and, increasingly, scientific opinion. (p12)

and

Loss of faith in the certainties of materialism and the progressive globalizing of human experience reinforce one another int he longing they inspire for understanding about the purpose of existence. Basic values are challenged; parochial attachments are surrendered; one unthinkable demands are accepted. (para 16)

Despite the tremendous accomplishments of religiously inspired actions in the past, the question is raised as to why people are not turning to that spiritual literature for guidance today - or, if they are turning to it, not finding relevant guidance.

The problem is, of course, twofold. The rational soul does not merely occupy a private sphere, but is an active participant in a social order. Although the received truths of the great faiths remain valid the daily experience of the individual in the twenty-first century is unimaginably removed from the one that he or she would have known in any of those ages when this guidance was revealed. ... In large part therefore, loss of faith in traditional religion has been an inevitable consequence of failure to discover in it the guidance required to live with modernity successfully and with assurance.

A second barrier to a re-emergence of inherited systems of belief as the answer to humanities spiritual yearnings is the effects already mentioned of global integration. Throughout the planet, people raised in a given religious frame of reference find themselves abruptly thrown in close association with others whose beliefs and practices appear at first glance irreconciably different from their own. ...

Each one of what the world regards as independent religions is set in the mould created by its authoritative scripture and its history. As it cannot refashion its system of belief in a manner to derive legitimacy from the authoritative words of its Founder, it likewise cannot adequately answer the multitude of questions posed by social and intellectual evolution. Distressing as this may appear to many, it is no more than an inherent feature of the evolutionary process. ...

The dilemma is both artificial and self-inflicted.
(para 21 and 22)

There are several familiar threads in this section I'd like to


highlight, and bring the experiences of some other fields to bear on. The concepts I'd focus on are these:

1. The idea that "truth" depends on context.
2. The idea that context changes over time.
3. The question of how what should change over time so as to preserve "truth".
4. The question of sliding the respective "truths" of different religious founders across time and comparing them to see how much they agree, after correcting for the distortions produced by context shifts.

I focus on those because those are actually the core issues that are pondered and completely solved in the entirely "scientific" area of "General Relativity" - which is the study, basically, of how to make measurements and think and operate in a world in which context (space-time) and content (matter and energy) interact bidirectionally and affect each other, producing many "fictitious forces" that are artifacts of the accidental details of each careful observer's reference frame in which they are inextricably and invisibly embedded. (See my earlier post on Context versus Content, Silos and the Electronic Health Record. )

In other words, I'm saying that the concepts necessary to understand what is happening to religious truth over time have already been developed in science, but never been brought to bear on the problem in theology.

This is not surprising, because the concepts have an aura of "complexity" that "only Einstein" would be able to understand, because they are so "alien and unfamiliar".

Well, I've scouted out that territory, taken a good, solid graduate-level course in General Relativity, solved those equations, and can report back that this material is not at all that scary if you hide the math in the calculator and just use the results.

Furthermore, it is not at all "alien." In fact, we are born being comfortable with these ideas -- such as the fact that, in general, the volume of a liquid depends on its shape -- and then, as Piaget showed, we have these beaten out of us by "education" and finally "learn" that volume doesn't depend on shape, and that the tall, skinny glass of juice has the same amount as the short, wide glass it was just poured from. The problem is that, THEN, when these students reach grad school, trying to teach them that volume does, in fact, in general, depend on shape except on small, cold, rocky places like the Earth, they find the idea that was native and "came with the unit" to now be "unthinkable."

I have to wrap this up for the day and will continue working my way through "One Common Faith" in the next few days, tying it into the related scientific concepts that help understand it.

Let me close by at least pointing out that the idea that things change shape as they are slid through space or time is captured in the concept from General Relativity (or Hilbert Space mathematics) called "parallel displacement" or "vector transplantation."

In "curved" spaces, which are common on cosmological scales, the way things change as you slide them across space and time can be exactly computed, and therefore it can be "backed out" of the equations and corrected for. Seemingly inconsistent observations, such as two observers each seeing the other's clock run more slowly than their own" can be completely explained, predicted, and corrected for, revealing the beauty of an underlying, absolute reality, the perception of which was distorted by each observer's invisibly distorted reference frame,
and the attempt to measure straight lines with curved rulers.

Fascinatingly, the key concept comes down to what paths light travels, or "geodesics", as light's path pretty much defines "straight." That should be of particular interest to Baha'is, as the word itself means "light of God."

What is really fascinating is to imagine taking all the great religious prophets of time, assuming that they are all saying the same thing (plus noise in the reporting), and computing whether a single consistent curvature of space-time could be applied to bring them all into perfect alignment. Or, if not perfectly aligned, the "transported versions" of them could be tweaked slightly to fit the shared truth great grand estimate, then the process reversed and the "tweaks" transported back to the original context, and assessed to see if those would in fact be legitimate and acceptable small changes in concept of the source religious doctrine or not.

I'm not exactly sure how to do it, but the very fact that science does say that such a thing is conceptually possible is really important to grasp - that there are techniques to figure out what properties transport over time as "constants" and which ones transport over time as "invariants" and which as "covariants" and what properties will be preserved regardless and which ones will appear to change, due to the change in context.

If we don't even use that basic level of mathematics to compare two religions it's hard to know how we expect to tell whether, at the core, they agree with each other or not. We will be overwhelmed with accidental changes due to reference frame changes that look like they matter, but that, in the final analysis, add up to exactly zero difference.

It's time to cross-breed these scientific and religious issues. Quoting from my old textbook,
Introduction to General Relativity (Adler, Bazin, and Schiffer, McGraw-Hill, 1965), on page 16,

In order to make these general and rather abstract considerations more specific, we shall have to develop an elegant notation and proper mathematical tools which are provided by the theory of tensor analysis. The basic problem of tensor analysis is the determination of those constructs and concepts which are independent of the accidental choice of the coordinate system employed.

This, in my mind, is exactly the same problem that is involved in showing that all the world's major religions have, at their core, exactly the same constructs and concepts, underneath the apparent differences due to the "accidental choice" of reference frame in which those constructs had to be expressed at that time and place by the religion's Founder.

Science and Religion are on the same quest, trying to look through the surface complexity and noise, and see the constant Beauty behind and under it all. Science is starting at local details and working upwards, Religion is working at the global scale and working downwards, and, when they meet in the middle, if we've done our sums correctly, the two large pieces should mesh perfectly and the larger picture be revealed.

How neat is that!

Tomorrow (I hope) I'll expand on the phrase quoted above "The rational soul does not merely occupy a private sphere, but is an active participant in a social order" and explore what the current evidence in public health and social epidiology teach us about changing concepts of the nature of "an individual" and why we need a larger concept to explain the very solid biomedical data from the majority of studies that show that "connectivity" of an individual to society is the major predictor of biomedical outcomes - disease, poverty, death, heart-attacks, obesity, violence, suicide - you name it. This whole area of very robust and solid scientific data from public health forces us to change the way we think about what it means to be a "person" and "an individual" in "society."

See: The hierarchy of life
and Key Findings from Public Health
for more information on what the data actually show about how "separate" we are from each other.

Photos of the "same" Earth from various viewpoints and times are from NASA.

How does that help me? - Average American

"They complained in the East,
They are paying too high.
They say that your ore ain't worth digging.
That it's much cheaper down
In the South American towns
Where the miners work almost for nothing...

"The summer is gone,
The ground's turning cold,
The stores one by one they're a-foldin'.
My children will go
As soon as they grow.
Well, there ain't nothing here now to hold them."

North Country Blues (1963)
Bob Dylan

( photo credit: spoon )

So, The New York Times had a story "Couple learn the high price of credit" by John Leland about a typical family in Ypsilanti, Michigan, and a graph of the personal savings rate of the average American. Like most of the other economic indicators, the back broke in about 1982 and it's just been plummeting ever since. The big news is that 2 years ago the rate crossed zero, and now we have a graph where the "average savings rate" of Americans is negative. I asked in economics once what that meant, and the professor said it was "dissavings." I asked again, what if the family has no savings left? Then what does it represent? He stared at me blankly, as if this concept was absurd, and went on.

The last time the personal savings rate was negative was in 1933. (Source EBRI Databook, US Department of Commerce.) The blue line on the chart is the personal savings rate, as a percentage of disposable income. The chart goes from 1930 to 2007. It is clear that whatever is going on is structural, a consistent pattern over 75 years, not just some blip that will turn around next year.



The dismal point this graph makes is that the economic pain, and the mental, medical, and social problems that this pain brings, is not going to go away anytime soon and, in fact, will probably get worse over the forseeable future.

For a serious structural trend, we'd expect to see this not just in personal data, but in national level data. What's that look like?

A similar story is in "Measuring the Moment - Innovation, National Security, and Economic Competitiveness" (Nov 2006).

US Trade Deficit (From BEA, quoted at invisibleheart. "Does the Trade Deficit Destroy American Jobs, Russell Roberts, George Mason University, Nov 2006.)



The left scale goes from +100 million per year to -900 million per year and the time from 1960 to 2005. Again, the whole picture changed about 1982, and the overall trend is accelerating downward into debt as a whole nation.

As a whole nation, we're buying way more than we can afford to pay for, and it's not getting better - in fact, it seems to be getting worse.


This raises an hypothesis that doesn't seem to be discussed much in public health - that the reason the US health care bill is skyrocketing is not only because the charges per unit of care are going up, but because we are, frankly, as a nation, getting sicker.

That is a crucial distinction, because it means that the major problem we have is not really getting more insurance to pay for damage repair, or lowering the cost per repair job.

The real problem facing public health, as we trek upstream to see where this problem is coming from, is "Why are the American people getting sicker and how can we prevent that and reverse that trend, on a personal, local, state, regional, and national level, simultaneously?" Blaming doctors or hospitals or drug companies won't fix this. Pitting individuals against corporations won't fix this. Blaming China or Japan won't fix this. It's deeper.

Part of the problem, in my model, is that so many people in corporations think that the problem is one of dividing the pie between "consumers" and "corporations", or between managment and labor, or between the rich and the poor. I don't think that's the problem at all, although it certainly is a source of conflict.

The problem is that the pie is shrinking, in any real measure. The wind has gone out of the sails of the American dream. We've lost a positive direction and now are on the decline curve instead. Squabbling over who gets the remaining food in the cupboard won't address the larger question, which I want to look at.

The key question is where does the pie come from in the first place. What creates wealth, and why isn't it working any more?

I'd say the universe (or Universe) clearly supports a wonderful overall design, whether accidental or intentional, for the hierarchy of life to evolve in ever more ways, at least on large scales and long timeframes -- but something seems to be interfering with out ability to ride that tide right now, on every level.

Surrounded by opportunity, we are failing to thrive. Surrounded by water, we are dying of thirst. With more computing power on our desktop than the entire planet had 50 years ago, we are unable to solve even basic problems of getting along and making things work. So, maybe, more technology is not the answer. We don't use 1% of what we have now.

I'm not sure where "the tracks" are, but I am pretty sure that our train has left them.

We have a "failure to thrive" problem here, a global depression that has gripped us on multiple levels simultaneously, causing despair and self-destructive behaviors on all scales.
By all our models and insights, what we're doing "should" work, but it clearly doesn't. That suggests that one of our basic, cherished assumptions is wrong.

And, it's not only wrong, but it's blinded us to a reality that is all around us, but we're incapable of perceiving it -- the myth is so strong that it squelches out all contrary evidence. The myth, after all, in my model, is itself alive and seeking to survive, and doing a good job of it.

Which myth? Which assumption?

Well, my model suggests that our concept of "individuality" is seriously wrong. We do not exist independently of the world around us, but are actually dependent on the world around us to survive and, in fact, we are an inseparable part of the world around us.

This is one of those ideas that varies by what size the observer is.

Darwin and others observed that individuals battled and the fittest survived, and perceived that as a global truth and a model for how humans, corporations, and nations should treat each other, basically saying "It's us or them, Jake, and there ain't room on this planet for both of us!"

However, that's poor observing, because the competition is really only local. On a larger scale, the wolf species and the deer species get along just fine. The wolves kill off the weakest deer, which, net, strengthens the deer herd. On the scale of many years and the size of species, deer and wolves cooperate and get along and help form a stable ecosystem.

That's the part of the model that seems to have gotten lost, as we try to make both corporate America and international America a one-horse show, take no prisoners. I think most CEO"s spend more time building alliances than they do attacking enemies, and many of them would rather get along and play golf than compete fiercely in a winner-take-all contest.

It may be hard to grasp at the corporate level, but the survival of corporations depends on the survival of the people who make them up. And, judging from the charts and graphs above, the people are getting very near running out of steam here.

It's not Al Qaida that's destroying us, it's our concept that the only way to structure life is as a competition, between nations, between cultures, between corporations, and between corporations and the people who make them up, unaffectionately known as "labor."

Because of the interlocking feedback loops and distant effects, there are indeed two choices - there's "win-win" and "lose-lose." Corporations, individuals, and public health can figure out how to co-exist and thrive together, which is a thought starting to emerge at the Ross School of Management, or they can go on fighting with the results shown above., and the population dying of obesity, diabetes, asthma, stress, and rampant infections.

Competition is not an "invariant". A single counter example can prove that, and here it is: The cells in our body do not spend all day with each one trying to be the "king cell" that rules all the others. They manage to cooperate, and thrive.

It's a good model. We should consider it. It's a model that does scale up, and then no one has to lose -- except the purveyors of the old myth that someone has to lose.

"Economic competitiveness" is the wrong term touse. "Ability to thrive while allowing others to thrive as well" or "jointly thriving" are better terms. Failure to thrive is a problem of the spirit, of our interest in and willingness to work together to ride the available tide of innovation, growth, and life that is all around us.

I'm unabashedly a Baha'i, and the Baha'i's believe in "spiritual solutions to economic problems"
which that link can explain better. This means, in my mind, more that the answer is in greater willingness to stop fighting and cooperate than in simply praying that things should get better while continuing our daily habits that make them worse.

A strong dose of humility can get thrown in as well, which doesn't mean walking around glum, but does mean not thinking we know it all without at least checking around first for contrary evidence, for any sign that maybe our model is wrong. As Karl Weick has pointed out in secular high-reliability organization literature, that kind of "mindfulness" doesn't come easy, but brings great rewards when it can be achieved.

Here's a tiny look at how drenched we are in this concept. People laugh at guys who would drive around for hours rather than stop and ask for directions -- although if it's a pilot and not asking directions results in using the wrong runway, this is no longer funny. Today, many families, like the one described by the Times article, are in deep debt and at risk of losing their house. Yet, if I were to suggest to them that maybe two familes could live in one house and share the mortgage costs, they'd think I was crazy.

Why is that, exactly? People would rather get lost than ask for directions? People would rather lose their home than share it with others, who, apparently, they think they would surely hate?
I'm glad I don't like ice cream because, if I liked it, I might eat it, and I hate it?

This idea that each family should have their own home and car has co-evolved with the idea that the purpose of money is so we don't have to learn how to get along with each other.

Now that the money has gone away, maybe we should revisit the idea of getting along with each other, instead of losing our homes. THAT's what I mean a "spiritual" solution - one that simply requires a change in heart, and suddenly, a new door opens where there was just disaster before.

When little things matter

This post is a very simple lesson that can give us a profound deeper insight into how things work and why so much around us doesn't.

This arose from a very simple question I asked yesterday, to my daughter who is learning how to teach the concepts of physics to 4th graders. No number-crunching is involved. Relax.

Here's the situation. Some people, who work at the Daily News in New York, between sightings of Elvis, argue that the Earth is a hollow shell, like a tennis ball, and there is a whole world inside it, illustrated by my clever picture #1. Oh, yes, and they would add, there are holes at the poles where the flying saucers go in and out, which of course the military knows about but keeps secret from us all. The aliens from the UFO, shown here as "little green men" live on the inside as shown in the picture.

My question is, "Do you think that would work?" or paraphrased, "What's wrong with this picture?" Of course, there are many things wrong with the picture, but the one I wanted to focus on has to do with gravity. If you could make a hollow earth-sized space ship, unless it was spinning really, really fast, the problem is that the little green men wouldn't be able to stand up as shown. In fact, they would fall "up", towards the center of the earth.

See picture #2 for why that would happen.



So, here's the deal. In your mind, break up the earth into "billions and billions" of basketball sized pieces.

Some of these, "under" the alien's feet, would be close, and would pull on them with a lot of force.

Some of these, "above" the alien's head, would be far away, and would pull on them with just a little force.

So, you think, the close ones will win and the pull will be towards the local "ground".

The problem is that there are way more chunks of earth far away than there are close up. And even a little pull, multipled by billions and billions, adds up to a lot more than a huge pull, multipled by a small number.

As a result, the alien would fall towards the majority of the earth, which is over its head, instead of towards the little bit of earth beneath its feet. "Down" is still towards the center, even if you are inside the hollow shell, for the same reason "down" is towards the center if you are outside the hollow shell.

But, some one would ask, if the earth were spinning at a thousand miles an hour at the equator, which it is, wouldn't the centrigual force hold the aliens "down" onto the shell, just like in the movies of spinning circular spaceships? Yes, Timmy, it would - but, if the earth spun that fast, then the people, rocks, and buildings on the outside of the earth would also be going that fast, and we'd all be flung "upwards" and fly off the earth. We don't need any more math, just logic - because we aren't thrown "upwards", the earth isn't spinning fast enough to hold aliens "upwards" either.

What's the point? The point is that most people think that the first picture is right, and that local effects dominate the world. It's not true in this case - distant effects dominate the world, even though they are tiny, because there are just so many of them.

The conceptual mistake that "big" local things determine the outcome is carried over into our thinking of much of human society and our decisions about what things will "work" and what things won't work. Unfortunately, many of our social decisions, like picture #1, look fine at first glance, and seem fine, and "feel right", but they turn out to be wrong in the same way. That is, we throw the "tiny" effects out of the calculations before we have multiplied by how many places they occur, instead of afterwards. That gives us the wrong answer.

To decide whether an effect is "tiny" or "negligible" or not, we can't just compare it to some other effect locally. We have to multiply it out first, or compound it if there is feedback, and then decide which effect is "tiny" and which one is "big" - and whether our alien will fall "down" or "up".

Many of our social structures, like the alien, are built on the wrong model - and they keep trying to fall apart, and it's baffling to us why that is happening. It "should" work. If that is happening in your world, many the same thing is true there. Maybe, many tiny effects that you think "go away" actually turn out to dominate the answer.

This is true ten times over if there is one of those "feedback loops" I keep going on about. If an effect is "compounded", like interest on your credit card, it turns out to be way more powerful on the outcome than you would think at first glance.

These "feedback" systems that are used to control everything from elevators to airplanes, and the engineers who analyze them use a different lens than an inexperienced person would use, to account for this effect, before they do their calculations. They apply something called "The Laplace Transform", named after some guy who lived a long time ago whose name was "Laplace." That "operator" does two nifty things at once. First, it corrects everything for what it will add up to after you take "compounding" into effect. And second, it changes the loop into a straight line, so all our favorite statistics can be used on it again, but this time, giving us the right answer. (Warning -- If you look it up, don't mistake this for the "Laplace Operator", which is a whole different thing, named after the same guy!)

The math behind the Laplace Transform looks scary, but, just like the rest of statistics, that all gets hidden inside the calculator and all you need to do is push the correct button to use this, so it's not a big deal.

Actually, there's a third effect, but it's distant and subtle - the Laplace Transform means that this concept will not put biostatisticans out of a job, so they can stop the torch and pitchfork parade up to the castle to kill the idea. Without some way, like the Laplacian, to counter that distant and subtle effect, we'd expect the small resistance put up by a large number of established researchers to dominate the scene, and squash this idea from being taken seriously.

Anyway, now you have a better idea what I'm talking about when I say such things.

References & further reading
======================
A description of the Laplace Transform, and what it does, in something approaching English,
can be found in any "control system engineering" introductory textbook. I prefer the explanation in this one.

For anyone who enjoys the idea of big things and little things switching roles, stay tuned for a discussion of "Olber's Paradox", or the very serious question of why the sky is dark at night.
Any idiot knows that's because the sun has set. Olber, howerver, raised the point that the sun, where you can see it, will be the same brightness per area, regardless how far away from it you are. If you imagine holding up your thumb and first finger in a circle, and looking at the sun from close, you'd see a small portion of it, and that portion would be very bright. If you were twice as far away, you'd see more of it through that circle of your thumb and finger, but it would be farther away and less bright. Well, it turns out those two effects exactly cancel out.
The amount you see goes up as the square of the distance, and the brightness goes down by the square of the distance, so the total amout of light coming through that circle remains constant.

Sooner or later, you get far enough away that the sun doesn't fill the circle. But, no matter, because if there are an infinite number of stars scattered evenly around the universe, sooner or later any line you draw will run into one. And the little section of sky that one covers will also be as bright as the sun.

Which means, the entire sky should be as bright as the sun, and we should all be cooked.

The math, it turns out is correct. Which means, one of our other assumptions about what's out there is wrong. Fascinating...

A Patient dies in Los Angeles - Systems Views

The LA Times reconstructed the scene today from the videotape and interviews.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference....

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

How Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing.

Questions are being asked of "How could this happen?"

Rodriguez's son, Edmundo, 25, said he still couldn't understand why his mother died. "It's more than negligence. I can't even think of the word."

And blame is being focused on the last person in what always proves to be a very long chain of contributing events:

David Janssen, the county's chief administrative officer,... said that the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

But, while legal issues of blame proceed, from the bleachers we can start an analysis of the "system factors" that all came together in this tragic result. And, as with many previous studies in errors, odds are very high that there are many more distant factors that were are work here. It is important to delve into the always-surpising world of "How could this happen?"

You can read the Times article, and start with as much information as I have, but I'll try to put it into a "systems thinking framework."

First, though, let's abandon the idea that the nurse is "to blame." Yes, she may have made an error in judgement - but that's a type of problem humans have that is fully predictable, and the collection of other people around her should have caught that and reversed that error before harm occurred. So, remove the nurse entirely from your mental picture of the scene, and just look at what else was going on, as we change the "zoom" setting on the lens and back out to larger and larger contexts.

First, an entire room of other people, patients and staff, was apparently paralyzed. We need to ask how that sort of thing happens. This brings to mind the Kitty Genovese stabbing and slow death in New York City, where hundreds of people watched from their apartments and did nothing, not even call 911. It brings to mind Stanley Milgram's famous experiments, where subjects, told by a person in a white coat to deliver electric shocks to another person, continued to do so far past the point where the other person screamed and finally went silent. It brings to mind not only "It's not my job" but also "... and the last time I intervened I was punished and told if I did it again, I'd be fired."

It seems that everyone in the room, staff and patients, had been conditioned to observe an unfolding tragedy, and sit passively by and do nothing. Hmm. Sounds like the sort of operant conditioning and behavior modification that 20 years of watching television might create.

Actually, it also sounds like a lot of people were in a burned out, depressed, helpless, hopeless state and maybe had given up trying to change the world around them, and this was just one of a hundred things around them daily that was going wrong.

It appears that the patient was Latina, overweight, and had no health insurance or regular family doctor. We might investigate bias, bias, and an entire nation that seems to stand by indifferently while 50 million residents of the US with no "coverage" try to get adequate primary medical care by swamping emergency departments. This problem is very well publicized, but the American public is too busy with other problems right now to focus on that.

On a mid-range scale, it seems that California or Los Angeles is standing by, not helping, while another hospital that attempts to help the poor sinks into debt and finally drowns.
The LA Times article points out:

The incident has brought renewed attention to King-Harbor, a long-troubled hospital formerly known as King/Drew....Over the last 3 1/2 years, King-Harbor has reeled from crisis to crisis.

Based on serious patient-care lapses, it has lost its national accreditation and federal funding. Hundreds of staff members have been disciplined and services cut.

Janssen said he was concerned that the incident would divert attention from preparing the hospital for a crucial review in six weeks that is to determine whether it can regain federal funding.

If the hospital fails, it could be forced to close.

Then what? Then what will the people in this neighborhood do for primary and emergency medical care? Drive 45 minutes to Beverly Hills? The same problem of inner city hospitals closing is visible across the US. They want to move out to the rich suburbs and focus on care for rich people with great health "coverage." Or, they have no choice, because of the perverse "unintended side effects" of demanding that they must provide emergency services to anyone who shows up, whether they can pay or not - and a national health care system that means 50 million people can't pay. The public hospitals and all the caring staff in them are being burned out, gutted, and deleted.

One of the roles of the field of "Public Health" is to hold up such uncomfortable mirrors, stop focusing entirely on how to repair gunshot wounds in the Emergency Room, or how to get faster ambulance dispatch, and start asking why so many people are getting shot in the first place.

Yes, in this case a nurse resigned. But, in many ways, it appears that she was a victim too, and likely a person who went into nursing because she really wanted to help, and tried to help, and just finally ran out of the ability to cope with the job that society had created for her. Day after day, night after night, social tragedies that could at best be patched and sent back out into the world to be damaged again and return again. I doubt that she started as a mean or uncaring person. How many hours had she been on duty? How was she coping with the fact that even this job looked like it would evaporate soon? What else was going on that she needed to attend to?

No, I don't think that removing this single person will "fix" this problem and stop such things from ever happening again in this hospital or in Los Angeles or in the USA.

How can people just look the other way? It's baffling.

But, now that we've all seen this larger issue squirming in pain on the floor, and feel helpless to do anything about it, it must be time to shake our heads in disbelief at "those people", and go see what else is on TV.

I'm not trying to be mean - only to illustrate that this problem of being overwhelmed with other people's problems is not some local thing that only happens in this hospital ER in LA. That doesn't make it less of a problem - it makes it more of a problem.

When a whole nation says "there's nothing we can do..." it's right, but it's wrong.


Article: Tale of last 90 minutes of Woman's Life,
By Charles Ornstein
Los Angeles Times
May 20, 2007

The Future of Emergency Care in the US Health System
Institute of Medicine, June 2006

Crisis Seen in Nation's ER Care
The Washington Post (registration required)
June 15, 2006

Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner

Emergency Medical System in Crisis, USA
Medical News Today

Emergency Care - A system in crisis
Journal Watch

Kellerman AL. Crisis in the emergency department. N Engl J Med 2006 Sep 28; 355:1300-3.

Photo credit: In the Emergency Room by ebilflindas

Systems Thinking and the emergence of new Life

T.S. Eliot, in the Four Quartets , said

We shall not cease from exploration
And the end of our exploring
Will be to arrive where we started
And know the place for the first time.

I'd like to suggest, as others have, that the process of exploration is more a spiral or helix than a circle, and we, individually and collectively, may go through multiple cycles of coming back to where we were, except that now it's "different" than the last time we were "here."

There is a motion, very much akin to an actual mechanical screw, in which we apply a rotational force or motion, but the result is a much harder to achieve motion in a wholly different direction.

As I sometimes do, I was rereading Practical Challenges of Systems Thinking and Modeling in Public Health this morning, seeing if the article had changed in meaning since I last read it [ Trochim WM, Calebra DA, Milstein B, Gallagher RS, Leischow SJ, American Journal of Public Health, March 2006, V96, No. 3]. Most of those people are at Cornell, in fact, in my old stomping ground, MVR Hall. Bobby Milstein is at the CDC, and Scott Leischow at NCI.

As one of my favorite philosophers, Charles Schulz's dog Snoopy, noted one day:

Did you ever notice
that if you think about a problem at 2 AM
and then again at noon the next day
you get two different answers?

Anyway, I got a different answer I wanted to share.

Still reverberating from my post on the Ten Lessons from Physics yesterday, I realized there is another candidate for important lessons in reducing complexity to a manageable level from physics that may be relevant to "Systems Thinking."

I already described yesterday how immensely complex interactions at one level, such as gas molecules, can get reduced to a few very simple but aggregate-scale concepts on the next level, such as "pressure, volume, and temperature", that are meaningless words on the individual molecule's level. In between those scales there was a forbidden zone, computationally intractable from either end.

Near the first easy end, only a few things only occasionally interacting, we have some room to actually compute the motions of several planets or billiard balls - much to the dismay of students of introductory physics.

What I can bring home from my foray into physics, however, is the news that there is also an easy zone at the other end - the end of immense numbers and immense interaction.

There is a continuum actually, and a sort of "continuous paradigm shift" as you go from the first easy end (few things, little interaction) to the other easy end (huge number of things and interactions) and that is in "what goes away."

At the lower easy end, the interactions go away, and we think in terms of "objects", mostly, that have properties, such as position and velocity.

At the upper easy end, it is the objects that go away, and we think in terms of persistent interactions that have self-energy and properties. This "regime" is the one that most of the visible universe inhabits, except for some relatively cold rocks (planets). It is the world of plasma, of high-energy physics, of stars, of the huge interactions at the centers of galaxies.

This is akin to the near-field, mid-field, and far-field of a radiating antenna - the math is relatively easy at either very near the antenna, or very far from the antenna - it's only at intermediate distances away that things become totally strange and slippery. I discussed that issue before.

In any case, we have here a two-dimensional entity, not a one-dimensional one, so it is now capable of being non-transitive and forming what Hofsteader called "a strange loop", akin to M.C. Escher's waterfalls or staircases. As the number of actors and intensity of interactions increases, one dimension, objects, diminishes in importance, the other dimension, interactions, increase in importance, until we reach the limit point, mathematically, and physically, where the initial objects simply drop out of the equation entirely and we are left only with the persistent interactions - which, voila, close the loop, the snake bites its tail, and these persistent interactions become the "objects" for the next level of existence and we start our next turn
around the greater helix of Life.

It's a smooth transition, easily modeled, not a "leap". It only looks like a leap if we go across the screw threads, not along them.

So, the meaning of "an entity" is really only locally defined, in an asymptotic way.. well below its level, the concept or entity is too large to be perceived, as "temperature" is to a molecule or "admission to Harvard" is to one of our body's cells. Then, as we think about sliding up to larger and larger scales, this concept has very strong meaning and dominates the local equations in the local time frame at the local scale, and then, as we keep on going, it goes away again forever, as does our problem starting our car on January 12th in terms of international relations.

OK, nice metaphor, but how is it useful? Do we have a name for these "persistent interactions"?

Aha! In physics, one type of persistent interaction is a "soliton". I'll skip the details, but these are waves that don't die out as they travel, but just keep on going. Fascinating.

What I do want to suggest for these persistent interactions is, at one scale, the idea of self-aware regulatory feedback loops. This concept is applicable at any scale, size, or time-frame and seems to be invariant and a core building block of life. Cells do it. The endocrine system does it. People do it. Corporations do it. Nations do it. Ecosystems do it. Policy makes and lawyers actively work on "regulations" that are, one realizes, actually supposed to be part of an on-going dance and regulatory feedback loop. Hospitals and doctors and the Centers for Medicare and Medicaid do this dance. The fact that there is a dance is the constant, and it's a very specific kind of dance that Control System Engineers know very well, and have tools to deal with.

I've gone on at great length in my recent MPH Capstone presentation at Johns Hopkins about these loops, and the fact that a closed, regulatory feedback loop is a qualitatively different animal than a "network" of interactions or a "web" of interactions or some Systems Dynamics Causal Loop Diagram. The loop has several properties that are very distinct from what is sloppily called "feedback":

• The loop persists over time.
• The loop is self-aware and can tell "itself" from "other" and do repairs, that is it has some kind of rudimentary immune system and damage repair system.
• To accomplish stability in a changing world, and overcome the problems Godel pointed out, the loop probably has formed alliances with other loops, either horizontally (peer loops) or vertically (management loops) where "you tell me if I'm losing it without realizing it and I'll do the same for you."
• The goal of the regulatory process has to include stability and survival, yes, but on top of that there is some goal, or direction, or "intent", and that goal may, in fact, be set by other loops (management) or peers (norms) or the surrounding context (tissue), or distant context (the pituitary gland).

Such loops will consequently differentially survive and persist, and end up dominating the landscape. They will tend to survive and persist best, if they are compatible with the larger scale activity that is going on, of course - if they are "aligned" with larger and larger contexts - but in Life this is a bidirectional game and the larger context goals may still be in flux and controllable by the lower level actors - until we get "phase lock" in that vertical dimension, the image finds a home and latches into place, and the whole entity is now stable on multiple levels at once. A solution has been found. Life, at a whole new level, has emerged.

Such loops are also exquisitely powerful in a computational sense. It's a long story, but closed feedback loops are IIR and open feedback loops are FIR, and IIR is infinitely more powerful than FIR. I'll get back to that tomorrow. In any case, no Control System Engineer would even imaging using an "open-loop" system if a "closed-loop regulatory feedback control system" were available. You get much better performance, stability, cost, robustness, response-time, tunability, etc. with closed-loop systems.

So, where's that get us? It's time to head off to my day job. Let's lash this down.

Of all the possible, N-factorial loops on causal loop diagrams, or in physical reality of the whole hierarchy of self-organizing Life, which includes people and corporations and nations, the winners will be the relatively persistent closed feedback loops. These will form, in many real senses, meta-life, or actors in their own rights with their own agendas and local worlds and local reference frames in which they are important and most of the rest of life is reduced to "an environment" in which they swim.

This "meta-life" will emerge at ever higher and higher organizational levels.

If you want to tweak, or tune, or improve the behavior and outcomes of any of these local entities (cells, the pancreas, the endocrine system, a person, a team, a corporation, the tobacco industy, the auto industry, a whole culture or nation or broken nation or proto-nation), then this model suggests focusing on finding a way to nudge it towards this stable and viable condition. "Nudge" means find existing proto-regulatory feedback loops that are almost closed, and close them. This pushes the whole "holon" (Ken Wilber's word) towards a stable attractor, a hold-fast, a sort of resonant notch or Lagrange point, where it can exist consistently with Life above and Life below it efficiently and effectively.

This is consistent with the focus on "microsystems" of the Institute of Medicine's Crossing the Quality Chasm, but goes beyond that and suggests a type of completion or stabilization of an actual meta-life process is the key variable to a sustainable intervention. It suggests what to look for, what to measure, and how to tweak it, and a fundamental principle of physics that supports that type of intervention as being principle-based.

It's also consistent with Senge's Presence and Stephen Covey's "8th habit" and focuses on the use of local feedback processes to bring about a change in a person or small team or an entire corporation that needs "restructuring" to return to an innovative, agile, productive state.

And it's consistent with my previous posts that Public Health, by its own logic, has to embrace improving the performance of corporations as well as populations of people, because both types of meta-life interact strongly, and, as many people in southeast Michigan are aware, if the corporate health is not well, the employee lives will not be well either. These do not need to be in conflict, and should be totally consistent objectives from both sides.

Neat. We should try simulating this and see how it behaves. We need to know how to measure such things, how to parametrize them, how to reverse engineer the underlying simple model from observable features, and how to nudge the various mathematical poles in the control-world towards the correct quadrant and tell (with p<0.01) whether our intervention is working or not - or, more precisely, we need to navigate and steer the intervention, in a minute-by-minute short-scale piloting fashion, around the rocks and to completion and need this compass to recover our direction after each swerve to avoid some obstacle or seize some favorable wind.

Ten most important lessons from physics

Please don't run screaming from the room - no math will be used in this post!

My daughter is learning how to teach concepts from physics to elementary school students in the US. So, physics was my major in college, and Carl Sagan was my advisor in grad school for a while, so I should have learned something. I'm trying to evaluate what concepts have survived the test of time and actually are still helpful to me, many years later.

Anyway, here's my list of what I learned from physics:
The most important thing in solving a problem is figuring out where to stand to look at it. Once you figure out the right perspective, the rest is easy.

There is an elegant simplicity underneath much apparent complexity. Very simple rules can generate very complex outcomes. All the rules of physics fit on a 3x5 card -- the rest is implications.

You don't need to compute the details to be able to make strong statements about the outcome. Almost all of the internal complexity "drops out" of the equations if you stand back another few steps.

Paul Dirac, developer of quantum mechanics amid a very hostile field, said, paraphrasing: Life is intrisically beautiful. If an idea is beautiful, stick with it, even if the data argue against it, and even if you can't figure out the details yet -- you will. ( A dangerous rule to know when to apply.)

You can't decide whether something is beautiful or interesting based on whether your teaching assistant perceives either. Most of the time, "helpful" introductions to a field just get in the way. It's much easier to read Dirac's original work than it is to read someone else's interpretation and "simplification" of what it is Dirac was saying.

The mountain will not come to you - you need to go to the mountain. Physical problems have an intrinsic level of detail, beyond which they cannot be simplified. All efforts to wish the problems to be simpler, so you can avoid having to learn the relevant tools, are a waste of time. Bite the bullet, accept the delay, and go learn the right tool, then come back and ask that question again and it will be easy.

The worship of computational math is way over-rated. Techniques of thinking in terms of "symmetry", or rigorous qualitative logic are much more powerful than they are given credit for. (see item #3)

Knowing how to design something doesn't tell you whether you should actually build it or not. We live in a social world. "Technical" things have social ramifications that cannot be separated from them. This is true for bombs. It's also true for surprising things, like whether it would be a good idea to deliver cheap energy or abundant water to a society. ( The primary role of water is to flush your toxins into someone else's back yard, which ultimate turns out to be your own front yard, so you don't see the costs and just get the benefits ... for a while. Then when the bill arrives, it all looks different and you wish you hadn't done that.)

Things add up in surprising ways, and sometimes even very diute very distant stuff adds up to more than very strong local stuff, because there's just so much of the universe at a distance to multiply that small factor by. In the short run, electromagnetism is strong and gravity is weak. In the larger world, gravity wins in the end, and electromagnetism "goes away" in terms of determining outcomes. In the short run, "rock" beats "water" -- in the long run, "water" beats "rock". You can't assume how things add up by what's "obvious" locally.

and #10 -Quoting my favorite T.S. Eliot poem, Choruses from the Rock,

And the wind shall say: Here were decent godless people:
Their only monument the asphalt road
and a thousand lost golf balls.

We build in vain unless the Lord build with us.
Can you keep the City that the Lord keeps not with you?
A thousand policemen directing the traffic
Cannot tell you why you come or where you go

The basic concept in #10, even for those who do not believe in some version of "God", is that the structure of the whole is not determined by the nature of the parts, but by the relationship between the parts. This is probably a restatement of the fundamental teaching of "systems thinking." As with my favorite M.C. Escher picture of the waterfall, getting the parts right doesn't mean the whole picture adds up to anything that's even sane, let alone valuable.

And, if the whole picture doesn't add up to something meaningful, it's a waste of time to "perfect" the pieces. The problem probably isn't with the pieces, but with the meaning, which needs to be addressed on its own level.

Images, health, wealth, success -- all are deeply nested fractal quantities, all vary with your planning horizon or prespective in space, time, and scale. (Ken Wilber would describe them as "holons".)

Getting things "right" in your local part of space, time, and scale tells you nothing, zero, zip about whether it is "right" in all those other worlds. Getting things right locally doesn't tell you anything about whether you have it right globally, or are just wasting your time. Both are important, but if you have to make a trade off, getting the global right is more important than getting local details right.

Details can be fixed later -- after you move the car off the train tracks.

More directly, because the global level(s) float on, but are largely independent of the lower local level(s), there is no reason to wait until you have one level perfectly understood before looking at the next higher level. Even perfect knowledge of atomic structure will tell you nothing at all about who will win the next election. You really can't reach "up" by going "down". Not even an infinite amount of work on one scale level will reveal to you what is going on at the next level up, or the one above that, etc.

But that is not to say that the next level up is even harder than infinity, but to say that the next level up is extremely simple again, but, well, um ... at a whole new level. So we stop trying to understand where every molecule goes, and just start looking at global properties, such as "pressure" and "temperature" that don't even have a meaning at the single molecule level.
It's not that it's hard to express, it's that it's impossible to express, but you don't need to.

So, when I open the faucet, why does water come out? This is a very deep question we can learn a huge amount by pondering. On a macro scale, we draw a picture of a distant water tank, higher than my house, and a half mile of pipes, and pressure gradients, and feel pleased that we have "explained" it. On a micro-scale, the molecules that were just inside the pipe nearest my faucet have no knowledge of "water tank" or "pipe" or "pressure". They only know "impact by this idiot molecule next to me" and "looks like more empty space over there."
Or that molecule may end up just sitting next to the pipe wall for the next 3 years, and some
other molecule comes out into my glass. On a local level, there is no "causality". On a global level, there is very clear "causality." In between lies madness, but we don't need to go there.
We can leap over the middle, skip the supercomputer figuring each molecules motion, which it turns out is not deterministic anyway. No computer can even conceptually ever tell us which
molecules will end up coming out of that pipe later today. But we don't care. We can leap
over the hard spot in the middle and just start doing reasoning at the next level up, in terms of "Pressure" and "temperature" and other new concepts that have zero, zip, absolutely no meaning to an individual molecule.

So, in a great many ways and senses, observers are embedded in their own world, and will never be able to directly perceive, or measure, whether they are measuring straight lines with straight rules, or crooked lines with crooked rulers. Everyone is right in his own eyes. So, some humility and trading of notes is a good idea before locking down your world model based upon your own observations, regardless how solid they appear to you.

As Karl Weick would say, you need to be "mindful", and look for contrary information, and be prepared to be surprised and discover that one of your favorite assumptions isn't actually true -- then, you may be able to find the simple and beautiful truth under all the clutter.

To me, that's what physics said.

Doctors who wield the Pen to Heal the Profession

There's an interesting article titled Doctors who wield the Pen to Heal the Professoin, on the type of books doctors are writing these days, in today's New York Times. It's written by Abigail Zuger, M.D.

Books mentioned:

JOHN E. CASTALDO AND LAWRENCE P. LEVITT "The Man With the Iron Tattoo and Other True Tales of Uncommon Wisdom: What Our Patients Have Taught Us About Love, Faith and Healing" (Benbella Books, $20).

ATUL GAWANDE "Better: A Surgeon's Notes on Performance" (Metropolitan, $24).

JOHN GEYMAN "The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy?" (Common Courage Press, $17.95).

JEROME GROOPMAN "How Doctors Think" (Houghton Mifflin, $26).

BERTON ROUECHÉ "The Medical Detectives" (Plume, $16) and "The Man Who Grew Two Breasts" (Plume, $10.95).

SHANI STEIN-RATZKER "M.D.: A Four-Year Journey Through Medical School" (iUniverse Inc., $13.95).

GERALD WEISSMANN "Galileo's Gout: Science in an Age of Endarkenment" (Bellevue Literary Press, $25).

I should note that Berton Roueche's book should probably be classified more properly as the epidemiology field of public health , versus "medicine". His book The Medical Detectives is a great read, and describes work done by local health department workers and the Epidemiology Intelligence Service of the Centers for Disease Control (CDC). The stories are more fascinating than CSI, and all true.

Did you know, by the way, that the Public Health Service Commisioned Corps is the 7th uniformed service of the United States? Boasting rights for anyone who can name the other six. I'll start you off with "Army, Navy, Air Force ..."