Seth’s blog

Fugu is a puffer fish prized by Japanese fish connoisseurs. Its liver is poisonous, thus only specially-trained chefs can serve it. A episode of The Simpsons featured Homer poisoned by fugu.

Recently, however, researchers determined that fugu liver is poisonous because fugu eat poisonous food. When fugu is farmed, and given non-poisonous food, its liver is harmless, and the fish tastes almost as good. No more need for special processing. Unsurprisingly, the National Fugu Association wants to preserve the status quo. But you can now buy fugu liver in the town of Useki.

Masataka Kinashi, the head of the tourism association in Usuki and a fugu dealer himself, suddenly stared down at his desk when asked about the widespread sale of fugu liver.

“Officially, you can never eat it here,” Mr. Kinashi said. “Well, it’s not that you can’t eat it, but, no, you can’t eat it. That’s the only answer I can give you.”

The other shoe drops. A year ago Atul Gawande wrote in The New Yorker about the Apgar score, a low-tech measurement of newborn viability that led to vast improvements in obstetrics. That’s the “how to improve?” side of things. Now Gawande has written about something equally simple and powerful on the “here’s how to improve” side of medicine: the use of checklists to improve ICU treatment. The first article was called “The Score”; this one is called “The Checklist”.

Checklists are the idea of Peter Pronovost, an ICU doctor at Johns Hopkins Hospital. His first checklist, in 2001, was designed to prevent infections on tubes inserted into patients. Nurses made sure that doctors followed the checklist. It’s like the Ten Commandments: the top and bottom getting together to improve the behavior of people in the middle. Checklists involved the empowerment of nurses (bottom) by hospital administrators (top) to improve the performance of doctors (middle). No coincidence, I’m sure, that the Apgar score also involved female empowerment: Virginia Apgar was one of the first powerful women in medicine.

Pronovost told Gawande:

The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.

Not to mention a sick person’s perspective. I completely agree. Several years ago I heard an industrial designer give a talk to an interface design group. He said that new high-tech products go through three stages: (a) used only by gadgeteers and professional engineers (e.g., the first home computers); (b) used by experts (e.g., billing software for lawyers); and (c) mass market (e.g., cell phones). The discipline of engineering, he said, was good at designing for the first two stages but not the third.

The similarities suggest a common explanation. I think one reason goes back to Veblen: It is low status to do useful work. It may also have to do with male dominance of medical research and engineering. When balancing status versus usefulness, men may weigh status more highly.

More innovation in the delivery of medicine: house calls. No kidding. More about Peter Pronovost.

Ian Ayres’ interesting new book, Super Crunchers, has a chapter about expert prediction versus predictions from math models. Almost always, the math models do better than the experts. I learned about this in graduate school when I read stuff by Paul Meehl, a psychology professor who compared the predictions of clinicians and regression equations in the 1950s. The idea has gathered strength since then and now the persons in some jobs — such as loan officers — are required to follow an algorithm for making decisions. Their expertise is ignored. Obviously they no longer derive as much self-worth from their job, Ayres points out.

It’s like the beginning of agriculture. Lots has been written about the physical problems caused by the change to agriculture. Stature decreased, tooth decay increased, and so on. I’ve never read about the mental problems it must have caused. I can only speculate, of course, but here’s an possible example: Hunters derived self-worth from bringing meat to their families. Taking that away caused problems. (Watching Once Were Warriors, a terrific movie, should make this more plausible.)

I have never read anything about how to reintroduce into everyday jobs crucial mental elements that hunting had and farming lacked. Nutrition education, vitamin supplements, dietary fortification, and other nutrition programs push us toward a pre-agricultural diet, which was far more diverse and better balanced. There is no similar set of things that move us closer to pre-agricultural ways of making a living. My self-experimental research is all about the value stuff that ancient life had but modern life lacks — such as seeing lots of faces in the morning — but I have never figured out how to simulate elements of hunting, beyond being on one’s feet a lot.

Philip Weiss has written an excellent (as usual) article about Matt Drudge.

“Matt Drudge is just about the most powerful journalist in America,” said Pat Buchanan.

And he’s self-employed. He started way down:

This is an incredibly lonely kid, [said a friend]. He doesn’t have a sister, his mother is in and out of hospitals [diagnosed with schizophrenia], the father was beside himself. In high school they treated him like shit. He was starting to lose his hair in high school; think what that does to a kid.

According to Publisher’s Weekly, a new program at amazon.com called

Amazon Vine rewards the site’s elite reviewers by giving them access to advance copies. According to a representative at Amazon, invitations have gone out to the site’s “top reviewers,” deemed so by their review rankings, to become Vine Voices.

I once read about a Los Angeles catering business that wasn’t doing so well until they doubled their prices. This is the opposite of that.

From Seth Godin:

When the Times switched from 10 books on the Hardcover [Best Sellers] list, they created a list of 15 Hardcover [Best Sellers] and a list of 5 Advice, How To and Miscellaneous [Best Sellers]. I wrote in and asked the editor why they only had 5 titles on this list and 15 on the others. She wrote back and said,

“Because we don’t want people to read those books.”

Pride goeth before a fall.