This year, Yale honored Constance L. Royster ’72, the second Black woman to receive the Yale Medal (as far as I can tell), the university’s highest alumni honor. Ms. Royster was celebrated for her extraordinary contributions to Yale—her dedication, her advocacy, and her unwavering commitment to building a stronger, more inclusive community.
On my trip to the Royal Observatory in Greenwich, I learned about how important time was for navigation. In the 1700s, sailors had no reliable way to determine their exact position at sea, which often led to ships being lost and many lives being endangered. The primary challenge was determining longitude, as latitude could be measured with relative ease using the stars.
In his book The Language Hoax, John McWhorter writes about one of the longstanding myths in linguistics: Language influences and defines the way that people things. Like his other books, McWhorter writes about how focusing too much on the differences in language is an excuse for the elite to look down upon others.
When most people hear the word ‘hacking,’ their minds go to a scary place of spies trying to break into computers and steal their credit cards. However, in A Hacker’s Mind, security expert Bruce Schneier points out that hacking is really something else. He defines hacking as “Something that a system allows but which is unintended and unanticipated by its designers.” Using this definition, Schneier looks at hacking as a method of creative problem-solving and critical thinking, challenging how one can extend a system’s capabilities beyond its designers’ original expectations.
Do you remember the legend of John Henry? John Henry was a steel driller in West Virginia or somewhere thereabouts in the late 1800s. He was the best there ever was. Then one day the railroad bought a big steam drill that they said could drill faster than any man. Henry, secure in his abilities (and trying to avoid the unemployment line) challenged the drill (and the company) to a famous battle of “man against machine.” Using two 10-pound hammers, one in each hand, he pounded the drill so fast and so hard that he drilled a 14-foot hole into the rock. The drill, unable to clean off the bits of rock, got stuck nine feet in. But John Henry couldn’t celebrate for long, dying quickly of exhaustion. (1)Here’s Johnny Cash’s The Legend of John Henry’s Hammer.
I’m in the middle of the modern-day battle of John Henry and the steam engine. I’m a product manager. It’s my job to find out what customers want and what technology can deliver. Then I figure out how to get the computers to do the job that people need. So you’d think I was on the side of the steam engine, trying to make computers more intelligent so that they can just do everyone’s jobs.
Making computers smarter so they can do things like people is called Artificial Intelligence.(2)Artificial Intelligence is actually more complicated but humor me. A lot of people get very excited about Artificial Intelligence but it’s not as important as you’d think. While there are some things that computers can do better than humans (e.g., recommending movies, finding the quickest route), there’s a far larger and more important set of things that computers aren’t great at—at least by themselves.
In his book Deep Thinking, Gary Kasparov details his battle with Deep Blue and how computer chess, like many other forms of AI, go from laughably bad to incredibly good in just a few years. Kasparov lost to Deep Blue in 1997. He outlines a whole host of reasons including getting flustered in game 2 and IBM hiring a Russian speaker to spy on him. But he concedes that it was only a matter of time before computers were going to beat him.
Footnotes
| ↑1 | Here’s Johnny Cash’s The Legend of John Henry’s Hammer. |
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| ↑2 | Artificial Intelligence is actually more complicated but humor me. |
Growing up, I remember hearing the term “Writing the Great American Novel” and not quite knowing what it was. I thought that it was a quest to write the best book ever written. But I later learned that The Great American Novel isn’t about writing the best book ever, it’s about creating a book that captures a point in American history so crisply and clearly that you can freeze-dry it, put it in a time capsule, and take it out fifty or a hundred years later to examine.
Many of these books are the classics we read in school like The Great Gatsby or Catcher in the Rye. But something strange happened in the 1960s and 70s. The Great American Novel was replaced by the great American non-fiction book. In his essay Why They Aren’t Writing the Great American Novel Anymore, Tom Wolfe writes about how novelists at the time were trying to write “important” and “thoughtful” books that were too removed from real life. This created an opening for Wolfe and his fellow writers to write non-fiction books to fill that void.
This is a book about trying to find your place in the world. Lulu Miller was always looking for a tried and true path through life, and She had a hard time as a kid. Her father was a scientist who had very strong beliefs about his atheism and the beauty and value of science. Though he thought that there was nothing special or holy about other people, he said that you still had to pretend like there was and treat other people well.
Lulu was looking for a template to base her life on. She became enamored with the story of David Starr Jordan, the original president of Stanford University. She tried to figure out how this nerdy taxonomist was able to conquer the world. He was a man who categorized things. He was the world expert on categorizing fish who somehow became a university president. Even when the San Francisco earthquake destroyed his entire collection, he didn’t let that get him down. He just sewed the labels on to as many fish as he could find(1)Sewing the labels onto the fish would make sure they didn’t come off again! and built an even greater collection.
Footnotes
| ↑1 | Sewing the labels onto the fish would make sure they didn’t come off again! |
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Imagine a world where nothing is real. A world where you plug yourself into a simulated environment and you can have everything you’ve ever wanted. Once you plug in, you’ll be able to eat the most fantastic foods, travel everywhere, and do everything you’ve ever wanted. This is the world of Ready Player Two.
Note: You can watch the speech I gave based on this material here.
I remember the first time it happened to me. It was the first year of business school and we were working on an economics problem set. My friend Yugin had just arrived from Korea and she was correcting an answer for her economics homework.
She asked me “What’s the English word for after you erase something?”
I thought this was a philosophical question like, “What’s left of an image after you remove it?” Something like the way Robert Rauschenberg erased a drawing by William de Kooning to push the boundaries of art.
So I answered, “When you erase something there’s nothing left. You’ve erased it.”
“No, that’s not what I’m asking. Those little pink things that come off the eraser. What do you call that?”
“Hmmm … eraser shavings maybe. We don’t have a word for that in English.”
“Huh,” she said, “that’s odd. We have a word for that in Korean.”
i·at·ro·gen·ic /īˌatrəˈjenik/ Relating to illness caused by medical examination or treatment. — Google Definitions
I learned about the word iatrogenic when reading the book Writing to Learn by William Zinsser. The book, written in 1984, used the following passage as an example of medical writing. It talks about the link between medical prescriptions and opium addiction:
The medical profession has a long record of treating patients with useless or harmful relatives, often in clinical settings of complete mutual confidence. Iatrogenic diseases, complications and injury have been, in fact, common in the history of medicine. Only look upon addiction to certain dispensed drugs as one variation among the occasional effects of drug therapy.
I thought, “What an interesting new word!” as did Zinsser who also had to look it up. Then I came across Nicholas Nassim Taleb’s book Antifragile and found that he also fell in love with the word and expanded the idea into a class of issues that he called iatrogenics that went beyond medicine.
Iatrogenics are different from malpractice. Malpractice is doing an operation wrong. Iatrogenics is about doing a treatment correctly but it still having harmful side effects. When doctors ignore these side effects, they are far more likely to use all the tools at their disposal, like drugs or surgery, whether or not it’s a good idea in the long term.(1)The story of homeopathy is particularly interesting in the story of iatrogenics. Homeopathy involves a dilution of a substance until all you’re left with is water. It’s currently viewed as a pseudoscience but at one point, it was good medicine. When homeopathy was in its heyday, it was far more effective than the iatrogenic alternatives of the day, like bloodletting. The relative success of homeopathy actually forged a path to science based medicine.
Let’s look at a recent example. The New York Times recently published Heart Stents Are Useless for Most Stable Patients. They’re Still Widely Used. While they have no medical benefit, putting in a stent makes both doctors and patients feel like they are doing something — that they are in control. And, from both points of view, “they seem to work,” even though they don’t work any better than a placebo.
So what’s the harm in that? Everyone’s happy aren’t they? Well no, they’re not. Doctors are performing an operation that does no better than a placebo so there’s no upside. However, there’s a significant downside in the complications from the operation.
Or take another example from a cruise I went on. Cruises offer Wi-Fi on the ship with tiny data limits (50MB for the whole trip). This is so small that just opening my phone will go over this limit. So a cruise director offered, “Give me your phone and I’ll make it work on the boat.” So I gave him the phone and he starting turning off these data hogging applications. A few months later I realized that one of the things he turned off was my iCloud backup. So the decision that the cruise director made, without telling me, was to give me very limited internet functionality on the boat while turning off my critical backup capability.
Another way of looking at iatrogenics is overvaluing of short term gains vs. long term risks. Take the example of Thalidomide, the poster child for drug overuse. Thalidomide was a sedative that was prescribed around 1960. While it helped women with morning sickness (a relatively minor problem) it caused tens of thousands of serious birth defects.
Indulge me with one more example. When George Washington had left the presidency he’d taken ill. His treatment was the standard for the day — bleeding. However, taking 5 to 7 pounds of blood from Washington’s body is now widely believed to accelerate his death. Bleeding stayed around for a while after that. It was still recommended by leading doctors as late as 1909.
Taleb tells one story of how this problem goes beyond medicine and into finance:
One day in 2003, Alex Berenson, a New York Times journalist, came into my office with the secret risk reports of Fannie Mae, given to him by a defector. It was the kind of report getting into the guts of the methodology for risk calculation that only an insider can see—Fannie Mae made its own risk calculations and disclosed what it wanted to whomever it wanted, the public or someone else. But only a defector could show us the guts to see how the risk was calculated.
We looked at the report: simply, a move upward in an economic variable led to massive losses, a move downward (in the opposite direction), to small profits. Further moves upward led to even larger additional losses and further moves downward to even smaller profits.
At its core, this was what caused the financial crisis. It was people adding more and more risk for smaller and smaller gains. They failed to look at the downside risks which kept growing larger and larger because they couldn’t imagine that they would occur.
Oddly enough, people don’t get in trouble for doing this. There’s a general sense that the people causing the problems were doing the best they could. The idea of “this is the best modern medicine (or modern finance) has — even if it doesn’t work” is well accepted. This is true even when the procedure is successful but the patient died or the economy collapsed.
A lot of this happens because the people making the decisions don’t have skin in the game. They get the upside benefits without being exposed to the downside risk. Taleb mentions that when Roman engineers built a bridge, they were required to sleep under it. Then, if the bridge fell down, the engineers would feel the pain (or death in this case) of the people who were hurt by the bridge.
So what can you do about all this? Try to get your doctor to put a little skin in the game. The next time you have an important medical decision to make, don’t ask your doctor for her medical opinion, ask her what she would do if she were in your place. This changes her mindset from a “disinterested professional” to someone with a personal stake in the game. You might get a very different answer.
Read this along with my story on back pain.
Footnotes
| ↑1 | The story of homeopathy is particularly interesting in the story of iatrogenics. Homeopathy involves a dilution of a substance until all you’re left with is water. It’s currently viewed as a pseudoscience but at one point, it was good medicine. When homeopathy was in its heyday, it was far more effective than the iatrogenic alternatives of the day, like bloodletting. The relative success of homeopathy actually forged a path to science based medicine. |
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