physicians, patients, and intellectual triage

Please, please read this fascinating essay by Maria Bustillos about her daughter’s diagnosis of MS — and how doctors can become blind to some highly promising forms of treatment. The problem? The belief, drilled into doctors and scientists at every stage of their education, that double-blind randomized tests are not just the gold standard for scientific evidence but the only evidence worth consulting. One of the consequences of that belief: that diet-based treatments never get serious considerations, because they can’t be tested blindly. People always know what they’re eating.

See this passage, which refers to Carmen’s doctor as “Dr. F.”:

In any case, the question of absolute “proof” is of no interest to me. We are in no position to wait for absolute anything. We need help now. And incontrovertibly, there is evidence — not proof, but real evidence, published in a score of leading academic journals — that animal fat makes MS patients worse. It is very clearly something to avoid. In my view, which is the view of a highly motivated layperson whose livelihood is, coincidentally, based in doing careful research, there is not the remotest question that impaired lipid metabolism plays a significant role in the progression of MS. Nobody understands exactly how it works, just yet, but if I were a neurologist myself, I would certainly be telling my patients, listen, you! — just in case, now. Please stick to a vegan plus fish diet, given that the cost-benefit ratio is so incredibly lopsided in your favor. There’s no risk to you. The potential benefit is that you stay well.

But Dr. F, who is a scientist, and moreover one charged with looking after people with MS, is advising not only against dieting, but is literally telling someone (Carmen!) who has MS, yes, if you like butter, you should “enjoy” it, even though there is real live evidence that it might permanently harm you, but not proof, you know.

In this way, Dr. F. illustrates exactly what has gone wrong with so much of American medicine, and indeed with American society in general. I know that sounds ridiculous, like hyperbole, but I mean it quite literally. Dr. F. made no attempt to learn about or explain how, if saturated fat is not harmful, Swank, and now Jelinek, could have arrived at their conclusions, though she cannot prove that saturated fat isn’t harmful to someone with MS. The deficiency in Dr. F.’s reasoning is not scientific: it’s more like a rhetorical deficiency, of trading a degraded notion of “proof” for meaning, with potentially catastrophic results. Dr. F. may be a good scientist, but she is a terrible logician.

I might say, rather than “terrible logician,” Dr. F. is someone who is a poor reasoner — who has made herself a poor reasoner by dividing the world into things that are proven and all other things, and then assuming that there’s no way to distinguish among all those “other things.”

You can see how this happens: the field of medicine is moving so quickly, with new papers coming out every day (and being retracted every other day), that Dr. F. is just doing intellectual triage. The firehose of information becomes manageable if you just stick to things that are proven. But as Bustillos says, people like Carmen don’t have that luxury.

What an odd situation. We have never had such powerful medicine; and yet it has never been more necessary for sick people to learn to manage their own treatment.

all the news that’s fit to read

In the past year or so, as more and more websites — of all kinds — have acquired Twitter feeds, my daily newsreading habits have shifted: whereas I once began the day by going through a large collection of RSS feeds, now I start with Twitter. And as I have added Twitter feeds, I’ve noticed a good deal of redundancy: sites giving me links to their new posts through RSS and Twitter alike. I responded to this phenomenon by purging my RSS feeds, ultimately leaving in my RSS reader only those sites that don’t have Twitter feeds, and making Twitter my chief portal for news as well as conversation with friends.

And you know what? This doesn’t work so well. Twitter doesn’t handle news as well as RSS, largely because of the 140-character limit. Given so little information, I often can’t tell whether a story is worth reading or not, so — because I don’t want to miss out on something awesome! — I often end up clicking through to stories that prove to be that interesting or informative. RSS, by contrast, typically gives me either a complete story or a full first paragraph, so it’s a much more efficient conduit, leading to fewer unnecessary click-throughs.
Also, while for conversations I might want Twitter to refresh frequently, for news that’s not necessary — unless it’s breaking news, in which case what you want is not your regular stream but searches by relevant hashtag. Setting the RSS reader to refresh every hour at most, the Twitter client to refresh more frequently, is the way to go. For me anyway.
Fortunately, before I started trimming my RSS feeds I made and stored a copy, as an OPML file, of my list when it was at its largest. So I’m restoring that, and cutting back my Twitter feed largely to friends. Twitter is great for conversations; RSS is better for the daily news.

decision time

Here’s a fascinating little essay by Cory Doctorow on . . . well, it’s complicated. He’s explaining why he’s happy with his decision to self-publish his new collection of stories, but he’s using that situation to explore the problem — or the “problem” — of having too much information and too many options:

I’m not sorry I decided to become a publisher. For one thing, it’s been incredibly lucrative thus far: I’ve made more in two days’ worth of the experiment than I made off both of my previous short story collections’ entire commercial lives (full profit/loss statements will appear as monthly appendices in the book). And I’m learning things about readers’ relationship to writers in the 21st century.

But more than ever, I’m realising that the old problem of overcoming constraints to action has been replaced by the new problem of deciding what to do when the constraints fall away. The former world demanded relentless fixity of purpose and quick-handed snatching at opportunity; the new world demands the kind of self-knowledge that comes from quiet, mindful introspection.

That last sentence is great, and worthy of much reflection. When opportunities for acquiring and disseminating knowledge were fewer, we had to act quickly to seize them: who know when another would come by? But now, with so much we can know and so many ways to get our ideas out into the world, we need to seek time and space to filter through the options. We need, as never before, the virtues of discernment.

There’s something to think about in the holiday season. I’ll be back in a few days. In the meantime, a Merry Christmas to all, and God bless us every one!

the problem of abundance

The Quintessence of Ham:

Roger Chartier identifies eighteenth-century concerns about scarcity and abundance which closely parallel the challenges faced by digitial humanists. For example, he notes that the “fear of obliteration obsessed the societies of early modern Europe.” According to Chartier the eighteenth century compounded the problem of scarcity with unexpected abundance. He describes the scenario as one of “uncontrollable textual proliferation, of a discourse without order or limits. The excess of writing piled up useless texts and stifled thought beneath the weight of accumulating discourse, creating a peril no less ominous than the threat of disappearance.” Anyone who has studied printed materials during the late seventeenth and early eighteenth century is acutely aware of the explosion of new titles and reeditions that transformed the literary landscape of early modern Europe. This revolution in supply was matched by equally transformative growth in demand, with literacy rates spiking and growing especially fast among women. In France, for example, the percentage of women who could read doubled, and the overall rate among men and women rose from about 1/3 to 1/2 of the population. Authors developed new strategies to differentiate their works, and readers had to develop new filters to determine what was worth reading.The eighteenth century was thus a time when people grappled, often uneasily, with the problem of abundance. One response was the Enlightenment fascination with taxonomy and system-building. The eighteenth century gave us enduring systems for ordering living things (Linnaeus) and physical matter (Lavoisier), but it also attempted to systematize more or less the entire material world with a spate of projects tackling language, arts, cooking, hair styles, whatever. All were designed not only to impose order but also to solve the problem of abundance.

Courtesy @tcarmody.

only connect!

Shreeharsh Kelkar has emailed with some questions that I thought it might be interesting to answer here. Here are the first two:

1) Just briefly, how do you decide if something is worthwhile (“clippable”) while browsing the web? Obviously, the easiest is when it relates to a particular project you’re doing. But what about the others which you think may be useful some day but can’t really say? How often do you end up going back to them? Or even better, using them in a project?2) Finally, do you “clip” anything that you think will be relevant at some point in the future or are you more discriminating?

Over the last couple of years I have developed, gradually and not altogether intentionally, a three-stage method of organizing and responding to what I read online. It works like this:1) If I see something long enough and complex enough that I need to read it with care, but don’t have time to read at the moment, I send it to Instapaper. And by the way, Instapaper’s “mobilizer” — its built-in tool for extracting the text from a webpage — provides the ideal way to read anything on the iPhone. It’s now built in to Tweetie — um, Twitter for iPhone, so clicking on links in tweets takes me to the mobilized version rather than the original web page, which means that it loads fast and is easy to read. Brilliant.2) If, having read something, I think I might want to come back to it later, I clip an excerpt and send it to Pinboard. I used to use Delicious for this, and Delicious is still a fine tool, and free, but Pinboard is more elegant. I then use Pinboard’s tag cloud to browse the relevant clippings when I’m working on a particular project.3) But if I know (or think I know) that a particular article or story or blog post is going to be important for something I’m doing, and I can’t take the chance on it disappearing behind a paywall or just plain disappearing, then I convert it to a PDF and send it to my preferred Everything Bucket, Together.By the way, it has become clear to me that I save too much, both to Pinboard and to Together. I go through and purge from time to time, but I would like to develop habits that make me more thoughtfully selective at the point of reading.Here’s a funny thing: in general, I dislike having more apps open at once than absolutely necessary — I like to streamline my workflow, and will even at times use a second-best tool in order to keep things simple. And yet, even though I could bypass Pinboard and keep all my clippings in Together, I don’t. Similarly, I could gather everything in Zotero, but I can’t stand the way Firefox looks. I’m weird that way.Similarly, I could keep all my notes and jottings in Together, but I don’t: I use the brilliant Notational Velocity instead. I am not sure why I violate my own principles here, but I think it’s because I’m keeping tasks that make different cognitive demands on me in different environments: note-jotting in one place, articles that need skimming in another, articles that require serious attention in a third.Here is Shreeharsh’s third question:

3) I use Evernote to make notes while I browse the web and one of the things I find is that while I do clip extracts from web-pages there, when the time comes for me to go back to the article, I often just google the article rather than searching for it on Endnote (I usually remember some keywords from the article). Does this happen to you too?

It does! — and that’s interesting, no? It’s often faster to Google something that to look through the materials I have so painstakingly filed (especially when I’m not sure whether I’ve put something in Pinboard or Together). “Search, don’t sort” is the Gmail motto, and it seems to work here too. But I don’t always remember what I need to remember to do a good Google search; and the sorting and filing itself is cognitively useful, I think — it helps me to organize my thoughts and keep them in good marching order, even when I don’t go back to the materials I’ve collected later.

email and other gluts

Nick Bilton’s “10 Proposals for Fixing the E-mail Glut” is mostly silly — limit emails to 140 characters? — but has one legitimately interesting idea:

Clay Shirky, author of the book “Here Comes Everybody: The Power of Organizing Without Organizations,” believes that “we don’t have information overload; we have filter failure.” I completely agree with this, but creating filters can become a chore too. My solution would add a single-click button called Auto Filter. Once pressed, it would do its best to analyze the message and create a new filter, and then file future messages into this new category.

Presumably the filters would only need to be new when you first started using the feature: after a short time the app would start adding new messages to already existing filters. (Otherwise you’d have a new filter for every message.) Another possibility would be to set up some filters manually at the beginning, and ask the app to try to fit new messages into one of the existing filters, only creating a new one if it can’t find any plausible matches.

This is one step beyond Gmail’s already excellent filtering system, which works only on the basis of criteria you explicitly set up. (The “smart folders” used in Mac OS X’s Mail application, and elsewhere in the system, are exactly the same thing: saved searches.) All that said, this is the kind of thing that should only be used by people who get email in enormous volume, because it’s a recipe for shunting messages into folders that you never look at.

I expect Gmail to offer something like this before too long. A number of desktop apps do this kind of automatic sorting already: my “everything Bucket,” Together offers the option to auto-tag new files based on existing tags — though in my experience it doesn’t do this very well — and many people are devoted to DEVONthink because of its “Artificial Intelligence,” that is, its ability to sort and auto-classify large numbers of documents. I think addressing “filter failure” will be a major goal of many kinds of software in the coming years, and I expect Google to lead the way in this endeavor.

One more thing: How long will people be worrying about an “email glut”? Already many people use email only for business purposes, having redirected their personal communications to Facebook and Twitter. My teenage son, for instance, gets and sends absolutely zero personal emails. When email is a place for business and business only, some important filtering has been done.