Tag: CoVid19

Outlive (book review)

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What’s the point of reading this book?

Peter Attia’s Outlive starts with the medicine: biology, physiology, chemistry and so on. There’s an excellent explanation on arterial plaque. I did not know that cardiovascular diseases were caused by the body trying to heal itself from within, dealing with LDL cholesterol as best it can. There’s also good explanations about our synapses and cancers.

But what’s the point?

Information does not change action.

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Attia’s book is about the four modern horsemen of human mortality: cancer, heart disease, type two diabetes, and neurodegenerative diseases.

Like other areas of discovery, medicine follows the pattern: identification, react, ‘proact’. The Ghost Map tells the story of choleras identification in 1854. Covid-19’s cadence meanwhile was within a year: sequence, treatment, and bundled with the flu shot.

According to Attia, there is a lot more room to proactively address the four horsemen.

Channeling Michael Pollan, switching from hundreds of pages to a few words that address the action, the advice might be:

Get stronger. Eat your best foods. Sleep well.

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The book is thick. Parts are dense. Even now, days later, I can’t explain parts.

But that’s okay.

The main point of the book is to be intentional. Like the vegetarian experiment and as good bayesians we should tinker. Attia is rarely absolute: Do this but not that! Instead it’s about you getting to this point of heart rate or insulin sensitivity or sleep.

One takeaway from Covid-19 was our heterogeneity (see: The End of Average). Outlive fits in this line of thinking. It’s your healthspan, it’s your lifespan, it’s your choice.

So get stronger, eat your best foods, and sleep well.

QR IQ

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This is part of the made up start up series.

My mother-in-law has a problem when she goes out to eat. The problem is a combination of information, imagination, and conceptualization. The problem is: my mother-in-law doesn’t know what to order.

But she’s 70 years old. She has solutions. Is it familiar? Is there a picture? Is it recommended? Everything she orders falls into those three buckets. And thanks to Covid19 all that can change.

Part of the (uneven) Covid19 strategy are QR menus. These codes mostly link to a pdf version of the old menu. Consequently, these menus mostly suck. PDF or HTML menus take all of the worst parts of ordering food and make them more difficult to see. But things don’t have to be this way. QR codes for menus are the perfect opportunity for this peripheral technology to become a main course.

Here’s the pitch: a startup that builds interactive menus.

This is a hard problem. Restaurants are hectic, restaurant retention is tough, and there’s not a lot of excess capital for investment, but QR code menus may be a wise pairing thanks to framing.

Restaurant menus are terrible at framing. A paper menu is static and the only form of framing is the relative price framing. I’m not buying the most expensive or cheapest so this middle item seems fine. A digital menu can be dynamic. The options for choice architecture are abundant.

  • Guests who liked this also liked this.
  • The chef recommends this with that.
  • Add in this appetizer for only $3 more.
  • This item has been ordered 1,000 times this month.

All this startup needs is a few salespeople, a copy of Cialdini’s Influence, and an AWS account!

Restaurants are hired for multiple jobs: food, atmosphere, social status, signaling, and so on. Restaurants are also hired to make things easier: I don’t have to cook, clean, plan, or shoulder the burden of honey-what-is-for-dinner-tonight? A well built menu can reduce the diner’s decision demand.

This startup isn’t obvious because customers won’t articulate why they had a nice time at Dariano’s Diner but they will have a nice time because it’s a better experience which begins with the menu.

Yes, there are many restaurants to sell to – but this startup is competing with non-consumption. This isn’t a better reservation system (though it could be) or a better procurement provider (it could be that too), it only has to be better than a PDF or webpage.

So join me in raising funds for some QR IQ, a business that will build on human psychology to create a better dining experience.

March 3, 2022 update: This works! At least for automotive. The full video is here but according to one ex-industry person the digital signing of documents can increase (via framing I’d wager!!) back-end profits by 25%.

Energy for change

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This post is part of our thinking about ease and its counterpart design.

Football in Florida in February

John List begins his book, The Voltage Effect, with the example of Nancy Reagan’s D.A.R.E. program. That program, failed, List notes because it was based on a false positive. “It was a pretty large scale study in Honolulu,” List said, “the problem was it was only one study, it was never replicated, and it was never the truth.” Part of the reason D.A.R.E. is a case of something is always happening is the social incentive. It felt good to have a solution. It felt good to align with Nancy Reagan or local law enforcement or your child’s school.

A modern parallel is Michelle Obama’s Let’s Move! program. My year of AmeriCorp was in this heyday and it felt good to align with a political party or athletes or your child’s school.

Contrast Obama’s and Reagan’s initiatives with what I witnessed the first week of February: Florida football. This park was swarming with kids. Every NFL team was represented (and what a rollercoaster the kids on the Bengals team went through) and the parents were into it.

There’s no lack of football in Florida. If the current First Lady wanted a win, she should create a program that further promoted football in Florida. And the reason why is the ease. There’s not friction for Florida football. The weather is good to great (though dangerously hot) all year long. The culture welcomes football. There’s lots of people already doing it, so doing more of it wouldn’t be too much. Contrast Florida football with ‘Just Say No!’ or ‘Let’s Move!’. All the things in favor of Florida football are missing for the former First Ladies.

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How to vaccinate the world: Hire the smartest, most attractive, and persuasive medical students (doctors and nurses) to go door-to-door across the country. Or along the football theme, get the best recruiters. Have them sit on the couch, look the person in the eye, and sell them on vaccination. That would work. But like ‘Just Say No!’ and ‘Let’s Move!’ it takes too much energy. But football in Florida? No energy needed.

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There’s a gap between things I would like this person to do and things this person does. Energy closes the gap. Wordle wonderfully demonstrates energy. It’s easy to learn, easy to share, easy to play, easy to habituate. But Wordle will fade because it struck kindling. Unlike football in Florida there’s not a lot of factors working in its favor like with Facebook or automotive culture or take-out-pizza.

Energy, ease, friction, design – they’re all ways to address the same idea, how to change.

Just the first day of camp

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Stand up comedy is the fruit fly of the comedy world. Comedians can think of an idea in the morning, expand it in the afternoon, and perform it that night. Nothing is above the laugh and the feedback is fast and firm. Jokes work or they don’t.

Covid, no laughing matter, has been similar. Though not as fast or firm, the cycle between idea, test, and results has been pretty good. Though clear-ish now, vaccines, hand washing, masks, social distancing, lockdowns, etc. etc. etc. have been a figure-it-out-as-we-go kind of thing. There’s a lot we didn’t know, and still don’t know.

Another area where we know more is our sense of costs and benefits. For instance:

“Send your kid to camp the first day. When they come home they won’t have Covid, because they didn’t get Covid on the first day of camp and they will be like, ‘Wow, camp was amazing.’ The normalcy makes the other pieces vivid.” – Emily Oster, September 2021

What Oster does nicely here is frame the Covid camp trade off for people who overweight the risk from Covid for kids and underweight the reward from camp. During ’20 & ’21 Covid has been all we think about, and we need a reminder about this other stuff. A small step – the first day – is a good approach for highlighting this balance.

We haven’t always known that kids are mostly okay. We haven’t always known that camp is mostly ok (maybe up to 20,000 people?). We’ve learned that being younger is better. We’ve learned that local conditions matter – a lot! We’ve learned a lot.

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Framing information one way rather than another is one of my favorite themes.

Show the way or in the way

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One common mistake in our understanding of “how the world works” is to think that lack of action is due to a lack of information. If people just knew how important X was they would definitely do it.

One form is seen in the social media question: What would you add to the high school curriculum? Answers tend to hover around statistics instead of calculus, personal finance, or decision making.

Those are well intentioned suggestions, and on net, students would be better off if we could download a stats module in place of the first derivative. But information is not action.

Orlando Marriott hand washing sign

Geez. We’ve looked at hand washing (twice!) and there’s probably a well designed study that notes signs like that, in bathrooms such as this, change a proxy for health in some-such-way.

But, there’s a better example. It’s a real life example. It’s been tested on thousands. It’s also in Orlando. Arrange hand sanitizers to be avoided. To hijack Ryan Holiday: the obstacle is the way. But after two days people watching in the theme parks it’s very clear, this works.

And the reason for signs showing the way and not sanitizer stations in the way is incentives.

Back to Twitter. Some schools offer personal finance. From Kris’s nephew.

“I have this assignment for school where I have to invest $1,000 into a company’s stock. And I know you’re a stocks person so I was wondering if you know a good company i should invest in. Because the winner gets a prize of who makes the most money.”

Just give every twelfth grader $200. But there’s no action in that. There’s no standards or benchmarks or assessments about net learning in the second quarter of the school year. So in a way, Kris’s nephew is getting exactly what the system incentivized.

This is the system. In education it’s hard to measure “financial literacy”. In public health it’s hard to measure “healthy place”. In these systems optics are rewarded. Theme parks are in the optics business too, but for them results like: Person Gets Sick at World Famous Theme Park matter more. It’s important to know the rules if we want to play the game.

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In finance there’s paper returns and there’s “moolah in the coola”, that’s another analogy. Paper returns are optics. Money in the pocket is an outcome.

Being better than Superman

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Maxim four from Richard Zeckhauser is: “When trying to understand a complex real-world situation, think of an everyday analogue”.

Alex Tabarrok has been using this strategy to communicate about vaccines.

“To me the vaccines are like a superpower. Superman is immune to bullets and I tell people: ‘Wouldn’t you like to be immune to bullets? The virus has killed many more people this year than bullets have, and the vaccine makes you immune to the virus, it’s better than being immune to bullets!'” – Alex Tabarrok, July 2021

In Dan Levy’s book about Richard Zeckhauser he includes a section from Gary Orren who used the everyday analogy strategy to describe the AmeriCorps service program. AmeriCorps, Orren told legislators, is like a Swiss Army knife, it does many things well though it’s never the perfect tool. A few weeks after addressing the governmental staff Orren returned to their offices. “Oh yeah, I remember you. Swiss Army knife.”

This strategy helped, Orren explained, because it focused his thinking and the audience’s understanding. A lot of times our thinking is FAST and analogies shift complex concepts into simpler situations.

Simplification isn’t the end though. Extremes, like questioning the Ohio vaccine lotto, are not the final answers but a first foothold. If we can understand an issue’s basic components first, it can be easier to build up to the rubber-meets-the-road challenges of IRL.

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My year of AmeriCorps was health based, and I remember many vision screenings .

Hurdling past covid

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One way to think about “adoption” is as series of hurdles. If something is “adopted” it has succeeded by crossing the set of hurdles. There are few food bacteria “adoptions” because of hurdle technology: hot, cold, salt, and acid all make the process harder for food bacteria to survive.

Another metaphor for this approach is Swiss cheese: one layer has multiple holes but if the layers are independent, then stacking one on top of another removes the holes.

Part of the problem with studying, treating, and living with Covid is that it’s hard to figure out what works. There are models, but we’re still kinda guessing. As of August 2021, more than one-fifth of all FDA approved drugs were tried as off label treatment for Covid. Ironically, there’s not enough Covid to study it.

“What should give us reason to be hopeful is that there’s this cumulative effect that if you give the right drug at the right time along the way…there are these 15-30% reductions at each step so if you are someone that gets a monoclonal antibody early on, if you get fluvoxamine, you get remdesivir on admission, you get dexamethasone once you are on oxygen. We should model out where this puts you at.” – David Fajgenbaum, Wharton Moneyball, August 2021

Ah not so fast, Eric Bradlow follows up. How independent are these? Is this like a piece of Swiss cheese? “It’s shocking,” says Fajgenbaum, “they all seem to hit it from a different angle.” That angle appears to be time. Vaccines are like sunscreen, David explains, and that’s the pre-infection prevention. Then it’s one drug to stimulate the body’s immune response, then it’s another to slow that response way down.

Abraham Lincoln is attributed as saying, give me an hour to chop down a tree and I will spend the first fifty minutes sharpening an axe. Rather than trees and axes we can ask: Is our situation a hurdle condition? With Mr. Lincoln and the suggestion of Charlie Munger to invert, always invert (!), we can come up with a simple situational:

For deceleration, we want to create a series of independent hurdles an agent must cross. In the case of covid this might mean that a place mandates masks, vaccines, and social distancing — or maybe just be outside.

For acceleration, we want to create fewer hurdles for an agent. If not possible, we want homogenous hurdles. Smartphones did this for ride sharing: the who (payments), where (location), and when (on-demand) were all integrated into an app. Another way to consolidate hurdles is find the JTBD.

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Even 17 months into it still feels early to say these are the treatments. While they may not be this approach still feels okay.

Apples to apples in Iceland

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The basic base rate question is: what should I expect in situations like this? Most often we have looked at base rates through the lens of projects. We have an optimistic tendency to think, “yeah but…”. Sometimes it is! Sometimes it’s not.

but it might work for us

The general advice for using base rates has been to start with them, rather than our impressions, and then adapt from there.

Another way to think about base rates is as sampling. It’s important to get the “situations like this” part right, right? This is tricky, and this came up during the summer of 2021 as more and more covid vaccinated people became infected with the covid virus. At one point 67% of Iceland’s cases were among the vaccinated.

“When you look at Iceland and graph out (cases) by who is vaccinated, who is not, and where the cases are, you can see that there are more cases in the vaccinated group than the unvaccinated group.” – Dr. Kat, NPR Planet Money, August 2021

That sounds like the vaccine doesn’t work, or doesn’t work as well, or never-worked?! Maybe, but maybe our conclusions are muddied by an initial assumption that’s wrong.

Rather than jump right to Iceland, let’s pull a Zeckhauser and simplify everything. Imagine in Indiana there is a group of 100 people, half are vaccinated and half are not. In the vaccinated group there are five infections and in the unvaccinated group there are five infections. Putting aside “long-infection”, hospitalization, and death, it-looks-like, in-this-case, that the vaccine is meh.

Okay, now in Nevada there is another group of 100 people. This time there are 90 which are vaccinated and 10 are not. In the vaccinated group there are five infections and in the unvaccinated group there are five infections. Putting aside the same other-factors, in this case the vaccine is doing a lot of work! This was the case in Iceland too. Six of every thousand vaccinated people caught covid while fifteen of every thousand unvaccinated people caught covid. And all of the other-factors were much worse for the unvaccinated group. Vaccination reduced someone’s risk by more than half.

This idea is known as the “base rate fallacy” but really it’s comparing apples to apples which will make the idea stick better anyway(another bit of Zeckhauser advice is to keep explanations simple). BRF is good for talking with economists and behavioral scientists but for implementing this idea it’s an apple-to-apples question a day that will keep the bad decisions at bay.

A confusing life expectancy calculation

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“Statisticians are sometimes dismissed as bean counters. The sneering term is misleading as well as unfair. Most of the concepts that matter in policy are not like beans; they are not merely difficult to count, but difficult to define…the truth is more subtle yet in some ways easier: our confusion often lies less in numbers than in words.” – Tim Harford, The Data Detective, 2021

One of Harford’s goals is to help people understand the world more as it is and less as they wish it. Harford kindly covers ideas like base rates, sampling bias, and algorithm associations.

That last one has some quite funny anecdotes. For instance, one AI system was trained to distinguish healthy skin from cancerous skin. Crunching and comparing over and over are two things computers do really well, so this seemed a good fit. And it was! The AI categorized correctly. But computer code is like a mango slicer – it has a singular use. In the case of the skin cancer, what the AI “learned” was that if a ruler was present it was cancer.

That’s funny.

But also not. One economic principle that’s going to affect (is affect_ing_) work is the idea that as something gets cheaper it’s used more. LEDs and cameras are two recent examples, name an electronic product that does not have one of those. Data too, is going to be part of our lives more, and Harford wants us to think about the numbers a bit more. For instance, what does “life expectancy” mean?

“They take the relative risk at every age and they integrate it. They ask, if the relative risk this year stayed constant forever, how long would someone born today live? That’s where we lost a year, but that’s assuming Covid stays and the year we just had gets repeated .” – Adi Wyner, Wharton Moneyball, July 2021

This isn’t the only way to calculate life expectancy, but it was the way that lead to headlines like, “US Life Expectancy in 2020 Saw Biggest Drop Since WWII, With Virus Mostly to Blame”. That’s true, but is that how most people understood it?

Most of what happens, and Harford starts his book on this idea, is that we think fast. “Biggest drop”, “WWII”, and “Virus” are all oh-boy-this-is-bad bits of information. But we dig in to what the words really mean and things look a little better.

Our tendency to think fast doesn’t have to be a hinderance. We can use this tendency to be more numerate. Books like Harford’s bump up (be Bayesian baby) these ideas. Riddles like: most British men live past the average age help too. A steady dose of numeracy uses the availability heuristic for our own good.

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Not into the book thing? Harford has great podcast that cover these ideas. Wharton Moneyball is another with more of a sport’s bent. Gambling podcasts too cover these ideas. As Tyler Cowen said, it’s not that these things are VERY IMPORTANT but that if we see them more we update our mental toolboxes so they are marginally more important.

Ohio’s Vaccine Lotto

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On May 12, 2021 Governor Mike DeWine of Ohio announced a one million dollar vaccination lottery. Teens were eligible for a college scholarship. Two days after the announcement Ohio doubled its vaccinations-per-day figure to thirty-three thousand people. Success!

Maybe. “States with lottery programs,” noted the Boston Globe “are not doing any better compared to states without such initiatives.”

And.

But, there are at least two reasons Ohio’s strategy was a good one. The first is the testing of new approaches. One of the beautiful things about the United States of America is the differences in states. When states do different things academics call this “heterogeneity” and “natural experiments”. While not perfect, these opportunities and observations lead to novel lessons. Part-of-the-reason there won’t be another 2020 are these learnings.

The second reason Ohio’s vaccine lottery was a good idea is an idea from Maxims for Analytical Thinking, a Michael Mauboussin recommendation:

MfAT is a book of thinking tools by Dan Levy who focuses on the ideas, information, and influence of Richard Zeckhauser. Maxim 1 is When you are having trouble getting your thinking straight, go to an extreme case. Using this lens, was the Ohio Lotto a good idea?

Imagine it this way. What if there were a Hypo-Ohio, where thanks to the industriousness, intelligence, and ingenuity of the individuals, a vaccine holiday was declared on February first. Employers gave employees the day off. Starbucks and Subway donated their stores for stick sites. Netflix was free for Ohio ISPs. Everyone that was willing and able to get a vaccine got vaccinated.

Ohio Vax

If that happened, like poker chips slid across a table, the May blip and March wave would be compressed into an early February explosion. This would have been awesome. We know from the vaccine friendship paradox that all social networks have a super-spreader. At the extreme, pulling the demand forward would be a good thing.

But what was the effect size? Here I’m over my skis. But that’s actually okay. The techniques I learned in my Ohio high school still work: remove the bad answers first. Like the 15y or 30y mortgage question, I’m looking for choosing from only the good options. At the extreme, pulling demand forward is a fantastic idea. How much effect, I don’t know, but I’m glad they tried.

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Bias Warning: I thought the Ohio Lotto was a good idea from the start.