How Medical “Research” Can Harm Individual Health

This morning, KQED public radio’s Forum program aired a piece about tooth flossing:  Episode airs August 3, 2016 at 9:00 AM

Screen Shot 2016-08-03 at 9.48.50 AMThe tag line reads: “Since 1979, the federal government has recommended flossing daily to help prevent gum disease and cavities. But according to a new report by the Associated Press,  there’s little scientific evidence to support that advice. We’ll drill down into the data, and we want to hear from you: Will the news affect your oral hygiene routine?”

The problem with this discussion hinges on the difference between statistical and individual results. I, personally, am a good example of this. I have two gaps between molars that have enlarged as I’ve gotten older. When I chew meat little bits lodge in these gaps and the gum there becomes inflamed within 24 hours if I don’t remove the debris with floss (or a toothpick). For me, flossing is critical. My individual experience may not have any perceptible effect on statistical results but it is critical to my personal health. No “scientific” (read statistical) study can tell me what will benefit me. I’ve had several occasions when doctors tell me a behavior or treatment is not worth doing because there are no scientific studies that support it. Unfortunately, it is not possible to determine whether you or I fall within the large number of individuals who populate the high point on the statistical curve or are part of the long tails on either side of the statistical norm.

Screen Shot 2016-08-03 at 9.46.02 AMWhen dealing with personal health, paying attention to statistical probability tells us only how likely it is that a medication or treatment will help us but tells us nothing about how any one person will respond. The bottom line, on flossing or any other medical recommendation, is to look for a personal solution. The fact that a treatment doesn’t work for 99 out of 100 people does not prove it will not work for you or me.

Attention to medical research results, research results in any field for that matter, should not be limited to reports of statistically significant outcomes. The gap between what is statistically likely or probable and what actually happens in any given situation is unpredictable. Research that uncovers rare phenomenon is just as important as that which shows us the commonplace.

The medical profession, the government and the media can actually harm individual health by focusing public trust on statistically probable to the exclusion of exploratory research outcomes. Doctors hesitate to try unusual treatments when more common solutions fail. The FDA limits access to drugs that are effective for small numbers of people and encourages everyone to consume foods that may be harmful to some. The media often touts studies that just barely cross the threshold of statical credibility but excite an uninformed audience.

I applaud KQED for opening up this discussion about federal recommendations and personal practice. Let’s go further and address how to interpret the discoveries, meanings and messages of scientific research.

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Another Encounter with Artificial Stupidity

This morning I was researching “learning analytics” and my search led, after many, many clicks, to this web page:

Screen Shot 2016-07-02 at 10.33.57 AM

Note the purple chat window pop-up that appeared in the lower lefthand corner of my active window. Great, I thought, someone wants to know why I’m reading this page.

Here’s the ensuing dialog:


pastedGraphic.png   Nadia Dennis

Nadia Dennis

10:26 am   Hi, sorry to disturb 🙂
Can I ask which school you
represent?

Visitor

10:27 am   I have a nonprofit research organization called LO*OP Center, Inc. LO*OP stands for Learning Options*Open Portal.

Nadia Dennis

10:27 am   I’ll be glad to help, could I have your name please?

Visitor

10:27 am   Liza

Nadia Dennis

10:27 am   Nice to meet you Liza!  To know how I could properly address your concern, would just like to clarify if I am chatting with a student, a teacher or a parent?

Visitor

10:28 am   There are other designations. I’m an educational researcher. I also identify as a student, teacher and parent.

Nadia Dennis

10:29 am   Can we verify if you currently have Compass Learning in your school?

Visitor

10:29 am   If you want to have a meaningful conversation you’ll have to free yourself from your script. It’s not a school.

10:30 am   I’m not going to buy anything from Compass. Do you really want to chat with me?

Nadia Dennis

10:30 am   You may call us at 866.586.7387 or email successteam@compasslearning.com

Visitor

10:31 am   This chat is a fine example of ARTIFICIAL STUPIDITY. It does nothing to encourage me to contact Compass Learning again.

Read

Nadia Dennis

10:31 am   If there is nothing else, I’ll close this chat window. If you need anything else, feel free to reopen chat. Thanks for visiting.


Poor Nadia Dennis. She flunked the Turing Test. I could not distinguish her from a robot — a particularly unsophisticated robot at that.

Increasingly I am encountering Artificial not-so Intelligent voices and typists when I telephone an organization or use “live” chat on the internet. Even when I can determine that the voice is that of a living human being that person is often reduced to serving as a computer peripheral. By this I mean that the person is constrained to read responses from a preprogrammed script and has no personal skills with which to address my topic or problem.

I have to admit to becoming verbally abusive when I find myself in either situation. Since the AI has no feelings (no matter how often it claims to experience  “gladness” or “sorrow”) my emotional venting has no consequence. However, no live operator deserves my expressions of wrath.

There are two significant personal consequences and two societal outcomes that I ask my  readers to consider and comment on.

  1. Personally, I am usually angry by the time I work though the artificial stupidity and finally contact a human being who may be able to help me. I invariably look back on the whole interaction with sadness and regret. My day is diminished.
  2. As an already somewhat isolated senior citizen I leave these interactions even more lonely for meaningful human contact. I am beginning to dread asking for help via phone or  computer. I have little hope that this situation will improve as I grow more frail.
  3. i-hate-attFrom a societal perspective, it’s probably not a good idea for businesses to piss off their customers. If you do a web search using keywords ‘hate’ and ‘AT&T’ you’ll find plenty of evidence supporting the growing dissatisfaction with the customer service provided by this large corporation. Such frustration is not unique to AT&T. It begins when consumers try to contact the company and must thread their way through a maze of automated options and recorded voices professing delight, sorrow and desire to please. It often ends with a meaningless survey.
  4. Perhaps the most dire consequence of our increasing reliance on simulated human-to-human interaction is what it does to employees. First it deskills a large number of them – – the human-as-peripheral effect I mentioned earlier. Second, it decimates the job opportunities for semi-skilled workers. Companies claim that they must automate to remain competitive and/or profitable. A follow-up effect of shrinking employment is the separation of the worker from money – the means of obtaining the goods and services their former employers must sell to remain in business. Third, it spawns a generation of young people who feel helpless. They are taught in school that academic success is the path to economic prosperity. But only the best and brightest are able to compete with well-designed AIs and robots.

Don’t get me wrong. I’m not a luddite battling against all forms of automation techniques. I am strongly opposed to two things: Bad Design and attempts to pass off or disguise machines as human. Poor design exposes us to one form of ‘artificial stupidity’ that wastes our time and fails to solve our problems or provide us with usable information. Clouding the distinction between the human and the machine demeans both types of entity.

So where is the light at the end of this dark tunnel? A clean, carefully-designed, clearly demarked human-machine symbiosis. Humans need to be being creative, non-routine, emotive, person-to-person. Machines should continue to be employed to augment human productivity and enhance human life and planetary sustainability. To reach these goals we humans must evolve new socioeconomic institutions that permit the wealth we are generating with our machines to be distributed broadly throughout the people of the planet. Education is one important key to such evolution. So now, having ranted at length, I’ll return to my search for tools to enhance human learning and teaching.

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Premier responses to the future of work

My grandson will inherit the future.

My grandson will inherit the future.

I keep searching for out-of-the-box thinkers who are addressing what I believe is a looming catastrophe around the future of work as we know it. Here’s my response to a recent discussion of the issue by Yi-huah Jiang, the former premier of the Republic of China, Taiwan and currently a research fellow at the Center for Advanced Study in the Behavioral Sciences at Stanford University. Who am I to question someone with such sterling credentials? Well, somebody has to do it. I can’t see sitting around and waiting for Armageddon.

 

 

https://www.psmag.com/business-economics/the-future-of-work-what-politicians-should-know

I applaud the courage shown by Dr. YI-HUAH JIANG in addressing the Future of Work. Yi-huah JiangHowever I’m afraid his approach does not go far enough in challenging underlying cultural assumptions about the role of work and employment in a world that anticipates ubiquitous automation and AI.

 

 

“The combination of business commitment and social ideal attracts many young people. Its challenge lies in the ambiguity of its positioning and the lack of necessary game rules.”

This is more than a game. The very fabric of industrialized society is woven from merit derived from work and the specific reciprocity of market economics. At present we have no mechanisms for distribution of the wealth we are capable of producing outside of a monetary system and we are seeing a rapid rise in populations with little access to money. If we continue to focus our thinking on business, jobs and work as we have known them, I fear we are failing to notice that the proverbial train has already left the station.

“Will job opportunities become better or worse with the advance of an innovation-driven economy and freelancing?”

Worse. Freelancers do not have jobs in the sense of employment. They have gigs — short-term and highly competitive, punctuated by increasing periods of searching for new clients during which they have ongoing expenses but no income. Today I spoke with the Executive Director of an organization that deploys resources for disaster recovery. He mentioned that he has a surfeit of volunteers and not enough money. Those highly-skilled volunteers come from the ranks of the underemployed. The money is sitting in the hands of the very wealthy who cannot consume enough to keep our current economic engine running and, correctly, don’t believe philanthropy is an adequate vehicle to solve the world’s distribution problems. We’ve got to think outside the box of paid work.

IT worker“Not everyone can adapt to jobs that demand a higher level of technology knowhow.”

 

 

 

fisherpeople

 

You said it. Human beings evolved first as hunter-gatherers and then farmers.

 

 

 

 

Even craftspeople, artisans and traders can begin their practice around age 12 and become experts by their 20s. Actually, it’s not “technology” (which means “knowhow”) that is the problem because there is knowhow associated with every occupation. It’s the high levels of creative innovation and intellectual problem solving to which “average” minds have difficulty adapting. Most of us are creatures of repetition and habit. With robots and artificial intelligence programs doing the routine work, only the exceptional humans are employable. What does this mean for the masses in a world where self-esteem is intimately connected with having a job?

“The crisis of mid-career unemployment will therefore grow, and can be only temporarily alleviated by a decrease in population due to the global trend of falling birth rates, especially among advanced economies.”

Uh huh.

“To face a changing world of work, all the components of a society need to prepare, be it family, school, corporation, labor union, or social enterprise.”

150383-cathedralTo face a changing world, perhaps all these components need to find meaning in human activity that goes beyond “work” as we define today. In medieval times large quantities of society’s wealth went into building cathedrals, conspicuous consumption by royals and nobles and waging local wars. We’re already recreating the wars. Is Burning Man the new cathedral?

“The government should take the initiative to envision reasonable working conditions.”

No. Governments need to envision and support new ways of distributing real wealth before the masses, in their frustration over being kept from that wealth, revolt and tear down their governments with no idea what to put in their place.

burning-man1

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A Person-to-Person Disaster Response Online Infrastructure

You may find this blog repeats my comments from the previous two on the Valley Fire. Sorry, but each time I try to capture my ideas in text it comes out a little differently. My hope is that you will respond to these published essays by telling me what you think will work, what doesn’t make sense and how we can work together to implement any ideas that resonate with you. So…

More on how we might improve response to local disasters such as the still-burning Valley Fire in Lake County, CA.

Much of effective, sustained response to local disasters is a supply chain problem.  Uber and AirBNB have solved it. So can we. Underlying these “sharing economy” services is a rapidly responding database accessed through a user-friendly web site. If you need something you can go to the site and post a request. If you have something you can post your offer. The computer software matches need with offer and puts the parties in contact so that they can negotiate a deal. No middleman. No visible bureaucracy. Scalable solution that does not get overwhelmed.
Every local disaster — fire, flood, hurricane, tornado, earthquake, explosion, terrorist attack — has four major phases:
1) the outbreak, where getting people to safety is paramount;
2) second response, where people are sheltered, fed, treated medically and stabilized;
3) the interim, during which initial shock gives way to planning for a short-term future and assessing of resources;
4) rebuilding, when resources are sought and deployed to regain long-term housing, employment, educational goals and as much “normalcy” as possible. This is the perspective of both disaster victims and first responders such as police, fire departments and Red Cross.
From the perspective of well-meaning neighbors who are not endangered by the disaster the view is quite different. For most the beginning phases are:
  1. shock and emotional outpouring of sympathy;
  2. questioning how to help and assessment of resources available to offer;
  3. search for pathways to get offered resources to victims.
At this point the would-be givers are likely to have two very different experiences. Some will be successful at getting their offered donation to the individuals they wish to help. For example, someone with a horse trailer and pasture may succeed in picking up a stray pony, locating the owner and providing care for the animal for months until the owner is in a position to bring the beloved pet home again. Someone else may feel fulfilled by simply dropping off a bag of groceries at a designated shelter. These are positive outcomes for both donor and recipient. For them the 4th phase is
  1. Help delivered, donor feels virtuous.
A different donor experience results when first responders are overwhelmed on one side by the number of victims who need their immediate attention and, on the other side, the logistics of handling offers from a concerned and generous surrounding community. In this case the scene plays out thusly:
  1. Channels for delivering physical goods or services are blocked and donors are turned away
  2. Relief agencies begin appealing for cash instead of personal involvement
  3. Donors, feeling frustrated and angry, lose interest in the cause as soon as headlines fade
  4. Victims, having been steered to overwhelmed, understaffed and underfunded agencies are left without adequate support during their Interim and Rebuilding phases.
The Valley Fire broke out on Sept 12, 2015 about 60 miles east of my home. I learned about it the following morning, before the enormity of this catastrophe had penetrated the airways, and watched as the phases I’ve described unfolded. Among the onlookers on social media, shock and awe from sensational pictures were quickly followed by “how can I help?” This is when a supply chain infrastructure — one that does not require the attention of first responders — should be activated so that initial outpouring of desire to contribute can be channeled constructively and sustained over time. Here are a few of the features we need to build into an online, disaster action template.
 
  1. Mostly empty database-with-web-interface that can be activated immediately by a local community as soon as the disaster strikes.
  2. Publicity so that
    1. first responders are aware that activation can be done within seconds simply by going to the central site and naming the crisis.
    2. news sites will point people to this site
    3. social media participants will use a single site instead of creating competing sites on Facebook and other platforms (of course, not everyone will cooperate)
  3. Instant features (1st phase) should include:
    1. Call for rescue section
    2. Missing person – ‘I’m here’ section
    3. Pet Lost and Found section (publicize in advance to animal shelters)
    4. Emergency Shelters requests and offers section
  4. 24 hour features (person to person, not agency moderated)
    1. Short-term temporary housing match (to move people out of shelters and tents)
    2. Pet foster match
    3. Special goods match (for medical supplies, dietary needs, etc.)
  5. 24 hour agency support
    1. agency needs match (specifically for volunteers and warehouse space)
    2. money appeals
  6. Interim Phase
    1. Skills bank (offers of free labor, skills, consulting, counseling and temporary employment)
    2. Medium-term temporary housing match
    3. Vehicle and RV loan program (needs detailed planning)
    4. General goods and services match
  7. Rebuilding Phase
    1. Continue skills bank
    2. Continue warehouse program
    3. Continue skills bank
Each local disaster site should remain available as long as there are unsettled disaster victims.
Implementing this program can probably be done by a staff of 4 to 10 people:
  1. Database programmer
  2. Web UX designer
  3. Emergency response consultant
  4. Publicist
  5. Manager/Coordinator/Executive Director
  6. Supply chain/resource allocation consultant
  7. Legal consultant
  8. Site host/manager/webmaster/maintainer
It could be funded by a combination of grants and in-kind labor.
I wrote this idea up (again) after listening to KQED Radio’s Forum program on Thursday, Sept. 24, 2015. One of the guests was Kyle Sherman from the Center for High Impact Philanthropy at University of Pennsylvania. This essay is now in their hands (on their disk) and we’ll just have to wait and see how they respond. — No, don’t wait. You can respond regardless of what they do. You know, it takes a village…

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Hoping to Help – Improving local response to disasters such as California’s Valley Fire

Burned out carport and car from Valley Fire

“Interim” period of life begins, between before and after the Valley Fire

It has been 10 days now since the Valley Fire erupted in Lake County, California. I’ve been watching social media and have seen the outpouring of concern for afflicted “neighbors” from miles around the burn area. How do we help? Who do we notify to let the “authorities” know we have resources, money and personal energy to offer? I have a spare room in my dog-friendly home, an extra car, unused clothing, extra office supplies, a patient ear and a kind word or two. Who do I tell?

In the early chaos of evacuations, pet rescues and emergency feeding and sheltering I thought I would just be in the way so I have sat quietly by and held on to my urge to help. Indeed, within the first 48 hours of the fire’s outbreak on Sept. 12, Red Cross shelters were so overwhelmed with truckloads of food and piles of clothing that the request went out to stop bringing “things” and just send money. Many people tried to use Facebook and Twitter to get or give information. The instant response was heartwarming and many, many fire victims, both human and animal were helped. Today, evacuees are sifting through the ashes and trying to organize an interim period in their disrupted lives.

Volunteers at Community Market in Sebastopol pack donated food for delivery to Valley Fire shelters

Volunteers at Community Market in Sebastopol pack donated food for delivery to Valley Fire shelters

We’ve seen other disasters and we know that there will be delays in insurance payments and relief assistance, bureaucratic snafus, denied and disputed claims, uncountable frustrated tempers flaring in uncoordinated relief offices across the state and even the country for months to come. It has been 10 years since Hurricane Katrina devastated New Orleans and some families are still living “interim” lives. Now that the dramatic photos of flaming houses, crying children and singed, bewildered animals have been replaced by images of drowning Syrian refugees, much of the initial outpouring of public compassion may have drained away. Many would-be helpers are feeling relieved that the benevolent, authoritative hands of government and large-scale relief agencies such as the Red Cross are caring for those we wanted to rush in and support just a fortnight ago. Local agencies such as Lake County Local Assistance Center are making a valiant effort but they were not evident to outsiders a week ago and it took me days to find them. Perhaps, in the aftermath of dramatic disasters such as the Valley Fire, private, sustained, coordinated contribution is needed as much, if not more, than it was 10 days ago.

With this thought in mind (and my extra room still unoccupied) I again sallied into cyberspace to try to connect with a few individuals whose burdens might be lightened by my modest resource sharing. To cut to the chase, I fear I’ve failed. I did find one voice at the end of a phone line who took down my name, phone number and offer of a room. FYI, this was Shelter Care Hotline: 707-262-1090. Perhaps my information will find a circuitous route to a person and a dog who need it. With luck it will reach someone with whom I can stand to cohabit for more than a day or two while he or she traverses that interim between former and future settled existence.

While I wait for a response I’ll continue to share my ideas are about how we might create a more effective, efficient local disaster response infrastructure — via this blog in several more posts. This is a resource distribution problem and all the tools for an immediately deployable, just-in-time supply chain utility are available in both business and the military. We need to use these technologies to create a public/private collaboration, ready to be activated when the next inevitable, local emergency strikes. This way, when that emotional punch-in-the-stomach hits me – when I see my neighbor in trouble and automatically reach out saying “how can I help?” – there will be an answer. Send canned goods here. Show up to volunteer there.

Found terrier seeks fire displaced owner

Found terrier seeks fire displaced owner

Describe the skills you’re offering on this list. Post a picture of the frantic dog you are feeding and where to find him at this URL. Enter your temporary housing opportunity here. Throw your unique ideas into the bin over there. The time to get organized is before the disaster, not during it. And no, I couldn’t find such a response infrastructure at the Red Cross. If it exists it’s a very well-kept secret. Whether we find a workable utility someone else has built and simply publicize it, or build a new one, this is a task society needs done — now. We’re talking one, central, web site with several empty databases to be replicated for specific incident use, that can be filled with local resources when needed. It won’t take a lot of people to build it but it will take everyone in “the crowd” to spread the word once we have the prototype. Information technology can’t solve all of humanity’s problem but this is one that we can nail. I want it in place very, very soon. After all, the next fire, flood or explosion may happen on my street!

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LOGO Programming: It’s fascinating but does it change lives? – A 40 year question

New video on Jamaican girls using LOGO

The comment by Artemis Papert in this video (at minute 3:40) is key. These girls are learning how to approach a problem and segment it into solvable chunks. Bravo! But we are still making major educational decisions on the basis of anecdotal evidence. We have now been using LOGO with kids for over 40 years. Where are the longitudinal studies to tell us what the outcomes have been in these children’s lives? It’s not enough just to notice that kids enjoy the activity, can generate artistic displays or to claim that it “works”. We need evidence of whether learning to code in this way correlates with changes in future education, work and leisure activities. The studies must be “goal free”. In other words, the research design cannot be biased so that negative findings are suppressed. Although I am a strong advocate for everyone to learn the rudiments of programming, I still want evidence that indicates that the proposition “there is no relationship between exposure to programming in LOGO and desired educational outcomes” is false.

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Networked Passivity – We sit by and watch California burn

I’m sitting in my house next to a tinder-dry forest staring in horror at my computer screen, watching the Valley Fire devastate the communities of Cobb and Middletown less than an hour’s drive away. In vain I tweet: What should I be doing to help my neighbors?

A piece of bread

Where should I take food, blankets, tents? Does a family need a place to stay? Do you need in-person volunteers? But, with all this wonderful interactive media, all I’m getting back are more sensational pictures narrated by ernest newscasters bent on causing my heart to race while my muscles remain limp.

We’re missing an important opportunity here. We have the technology to communicate about local emergencies within minutes of a fire, explosion or other catastrophic event. All of us can contribute either physical labor, intellectual problem solving, or money — but we shouldn’t descend, en masse, on a chaotic scene and demand to be told how to help. Instead we should have buckets ready to receive donated goods to be deployed to the disaster location. (Yes, there’s always the Red Cross but did you hear about their fiasco over funds given for Haiti relief?) We could have a “job bank” set up, ready to be activated immediately to direct volunteers to places where their skills can be best used. And any organization that wants to funnel money for relief should have its nonprofit status and FRFUpdate-791x1024other bona fides in place and available so people can give money with confidence that it will actually reach the intended beneficiaries. These conduits for good deeds need to be in place before the devastating event, not after when authorities are overwhelmed protecting life and limb.

Maybe the disaster relief infrastructure I’m looking for already exists but it certainly isn’t easy to find on this sunny, Sunday afternoon. And if it does exist, why isn’t the media telling me about it? I don’t need a gazillion photographs of burning buildings, Facebook posts about praying for victims, or frantic tweets asking whether a particular house is still standing. I need a constructive channel for my energy and my sympathy. It’s a resource allocation problem. If Uber and AirBNB can mobilize the “sharing economy” we can use the same technology to help our neighbors in distress.

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