Assorted Links

Thanks to Dave Lull.

Interview with Doron Weber, Author of Immortal Bird, About What He Learned From a Hospital Tragedy

Immortal Bird by Doron Weber, a program director at the Sloan Foundation, is about his son, Damon, who had a rare medical condition, and his son’s heart transplant operation (cost = $500,000) at New York Presbyterian/Columbia University Medical Center. Damon died after the operation. The post-operative care was so bad his father sued. “Three years into the lawsuit, the medical director [of the hospital] claimed Damon’s post-op records couldn’t be located,” said the New York Times.

How can such tragedies be prevented? To find out, I interviewed Doron Weber by email. Continue reading “Interview with Doron Weber, Author of Immortal Bird, About What He Learned From a Hospital Tragedy”

Best Books of 2012

In order of quality (best first):

1. The Dictator’s Handbook: Why Bad Behavior is Almost Always Good Politics (published 2011) by Bruce Bueno de Mesquita and Alastair Smith. The best book about political science I have read. A leader always needs supporters. The essential difference between dictatorships and democracies is how many. Full of data and examples that this view — the whole theory is a bit more complicated — explains. Econtalk interviews.

2. Antifragile: Things that Gain From Disorder by Nassim Taleb (copy sent me by author). Full of original ideas. It  may be unprecedented that a serious thinker so anti-establishment has so loud a voice. Much of the book is about a generalization of hormesis, the observation that a small amount of Treatment X can be beneficial even though a large amount of Treatment X is deadly. For example, a small amount of smoking is probably good for you. Taleb goes beyond this to say that in some things, the hormetic benefit (the benefit from small amounts) is much larger than in other similar things. You can fulfill the same function (governance, banking, science) with a system where the entities benefit a lot from small shocks (which Taleb calls “anti-fragile”) or a system where the entities benefit not at all from small shocks. Systems where small shocks cause benefits tend to suffer less when exposed to large shocks. In my personal science, I have benefited a lot from day-to-day changes in my life (e.g., it led me to discover that butter improves my brain function and flaxseed oil improves my balance). In large science, day-to-day variation is only harmful. The core idea is that hormesis-like dose-response functions exist outside of the drug/poison/mice/rat/health experiments in which they were discovered.

3. Confessions of a Microfinance Heretic: How Microlending Lost Its Way and Betrayed the Poor by Hugh Sinclair (copy sent me by publisher).  By “microfinance” he means microcredit. Sinclair convinced me that the belief that microcredit is a wonderful thing for poor people is one of the big delusions of our time. It is a wonderful thing only for the institutions that give it out (at exorbitant interest rates, usually). Sinclair sums it up like this (pp. 217-8): “Give a man a fish and he’ll eat for a day. Give a woman a microcredit loan to buy a fishing boat, and the CEOs of the MFI [microfinance institute] and the microfinance funds will eat for a lifetime.” Sinclair continues: “There is too much at stake [for the CEO’s] to allow any genuine scrutiny.”

Assorted Links

  • Experiments suggest flu shots reduce heart attacks and death. Huge reduction: 50%. The new report (a conference talk, not a paper) is a reanalysis of four earlier experiments. I was surprised to learn that the CDC uses heart attack outbreaks to locate flu outbreaks, implying that the new finding is not a fluke — there really is a strong connection. I already knew heart attacks are more common in the winter, which also supports a connection with flu.
  • Une histoire des haines d’écrivains by Boquel Anne and Kern Etienne. Published 2009. About literary feuds. One of my students was reading a Chinese translation.
  • Correspondences between sounds and tastes.
  • Report on fraudulent Dutch research. “The 108-page report says colleagues who worked with Stapel had not been sufficiently critical. This was not deliberate fraud but ‘academic carelessness’, the report said.” I doubt it. Based on my experience with Chandra, I believe Stapel’s colleagues had doubts but did nothing from some combination of careerism (doing something would have cost too much, for example  a lot of time, and gained them nothing), ignorance (not their field), and decency (they saw no great value in ruining someone).  I wonder if the report considered these other possible explanations (careerism, ignorance, decency).

Thanks to Tim Beneke.

How I Read

In a review of a book by Alice Munro, Charles McGrath, who edited her at The New Yorker, wrote:

Many of these stories are told in Munro’s now familiar and much remarked on style, in which chronology is upended and the narrative is apt to begin at the end and end in the middle. She has said that she personally prefers to read stories that way, dipping in at random instead of following along sequentially,

That’s what I do. Most books I find are improved if I start in the middle and hop around. Doing so adds difficulty and mystery, which otherwise they are deficient in. Same reason I usually like reality shows more than scripted shows, scripted shows lack that attractive raw edge. Spy magazine had an article about writing guidelines for a woman’s magazine. The guidelines said start in the middle: Talk about someone (“he” this, “he” that) before identifying them.

A few great writers (Vladimir Nabokov, Jane Jacobs, Tolstoy) I don’t do this with. Some true crime (The Stranger Beside Me by Ann Rule) I don’t do it with. But most books benefit.


Assorted Links

  • Olive oil and the Willat Effect. “You can read about great olive oils, and their vast superiority over bad oils, all you want. . . . But until you try first-rate olive oil for yourself – actually put the good stuff in your mouth, and compare that experience to the bad stuff you’ve eaten in the past – you won’t really get it. . . . . Once you taste fine olive oils and their low-class imitations [side by side], though, you start to care.”
  • Petraeus Affair: The journalism of what we don’t know.
  • Tucker Max on book publishing. Disruptive innovation for popular authors.
  • Animal self-medication. Sick animals eat differently than healthy animals.

Thanks to Alex Blackwood.

Assorted Links

Thanks to Anne Weiss and Dave Lull.

Assorted Links


Thanks to Anne Weiss and Dave Lull.

Assorted Links


Edward Jay Epstein Reviewed Movies For Vladimir Nabokov

Edward Jay Epstein attended college at Cornell. When he was a freshman, he took Vladimir Nabokov’s lecture course about European and Russian literature. Nabokov told his students that a great writer creates pictures in readers’ heads. One of the exam questions, about Anna Karenina, was Describe the train station where Anna met Vronsky.

Epstein hadn’t read the book. However, he had seen the movie, so he described in great detail the train station in the movie. After the exam, Nabokov asked to meet him. Epstein told him he hadn’t read the book. Nabokov said it didn’t matter, and gave him an A. He offered Epstein a job. Ithaca had four movie theaters. Movies were released on Wednesday, so every Wednesday each theater would have a new movie. Nabokov loved movies. He went on Friday. He wanted to know which movie to choose. Epstein’s job, for which he was paid, was to watch all four movies and report back.

Epstein did this conscientiously but in retrospect, he said, one of his comments was a mistake. The Queen of Spades (from Pushkin’s story) was one of the movies. Epstein told Nabokov it reminded him of Dead Souls. (They were reading Dead Souls in class.) This interested Nabokov. He looked at Vera, his wife, who was sitting at his desk facing him. He asked Epstein why The Queen of Spades reminded him of Dead Souls.

“They’re both Russian,” said Epstein.

More: Epstein tells the story himself.

The Cost of Hope by Amanda Bennett

I came away from The Cost of Hope by Amanda Bennett (copy sent me by publisher) full of admiration for two people the book barely mentions: Bennett’s parents. How did they raise her to be such a competent and resourceful person? The book isn’t about her. It is mainly about her husband’s fatal illness and their marriage. She never brags, but glimpses of staggering competence slip through. In 2006,

I am the only editor of a major newspaper in the United States [the Philadelphia Inquirer] to run the Danish cartoon of Mohammed wearing a bomb on his head instead of a turban–the cartoon that causes riots in Europe. By the following Monday, protesters are in front of our building carrying signs with my face and the face of Hitler. Joe Natoli, my publisher, and I plunge into the crowd, shaking hands, talking to families, listening to their stories. The crowd turns friendly. I emerge with several copies of the Koran.

She tells this story because her husband is proud of her, which means a lot to her:

The pride I see on Terence’s face . . . keeps me going, even when I am scared.

However, she was courageous before she met him. In 1983, she took a job in Beijing as a correspondent for the Wall Street Journal, which is where she met her husband. Their first encounters, she says, were a series of fights.

Most of the book is about what happened when her husband came down with a rare form of kidney cancer — especially how much the treatments cost. For $600,000 — paid mostly by insurance — they bought a few more years of life together. It was worth it, says Bennett, adding but did it have to cost so much? Her best insight comes when she notices the wildly different prices paid for exactly the same treatment (CAT scans) — exactly the same treatment, same machine, same operator. The “retail” rate is, let’s say, $20,000. One insurer pays $5,000, another pays $1,000. She wonders why. Her moment of insight comes when she is back in Beijing at a fakes market with her 10-year-old daughter. At such markets, tourists are told prices wildly above what the seller will accept. In one case a fake Chanel purse is offered for 2000 yuan ($300). A woman who pays 200 yuan walks away happy. “I got it for 200!” she tells her friends. Bennett’s (adopted Chinese) daughter pays 20 yuan. (Apparently Bennett has her parents’s parenting skills.) Wildly inflated retail prices for health care — so much more than what sellers will accept that they are almost meaningless — exist to take advantage of poor negotiators, Bennett realizes.

The Cost of Hope was a pleasure to read and, as I’ve said, Bennett is an astonishing person, but it omits an important point. Bennett, like most people who write about the high cost of American health care, fails to point out its central tenet:  First, let them get sick.  Bennett’s husband died young (early 60s). He was significantly overweight, how much we aren’t told. Apparently he had diabetes — again, few details are given. Obesity and diabetes are preventable. One of the first treatments her husband receives for his cancer is IL-2, meant to boost the immune system. What about boosting his immune system before he got sick? For example, by improving his sleep. This neglected approach might have prevented or delayed her husband’s cancer and extended his life much more cheaply and painlessly than what happened.  The biggest flaw of her book is her failure to ask — literally ask, such as ask the head of the National Institutes of Health — why prevention, especially cheap prevention, is ignored.

Trust Me I’m Lying: Confessions of a Media Manipulator by Ryan Holiday

When Clinton was President, Ryan Holiday writes in Trust Me I’m Lying (copy sent me by publisher, Ryan is a friend),

[Matt] Drudge accused prominent journalist and Clinton adviser Sidney  Blumenhthal of a shocking history of spousal abuse — and one covered up by the White House, no less. Except that none of it was true. . . . An anonymous Republican source had whispered into Drudge’s ear to settle a political score against Blumenthal. . . . [Drudge] refused to apologize for the pain caused by his recklessness.

In spite of knowing this, I still read Matt Drudge. I don’t have to. There are a zillion other things to read. That may or may not make me a horrible person but it illustrates the depth of the problem that Ryan writes about: Spreading lies pays.

A more mundane example is press releases. Bloggers love press releases, Ryan says (speaking from experience working at American Apparel). All the work is done for them. So what if press releases are profoundly dishonest in the way they present a half truth (positive stuff about the product) as if it is a whole truth? It’s an easy way to get a few thousand clicks. “I recall sending e-mails to Gawker and Jezebel on several occasions over matters of factual errors and not receiving a response,” writes Ryan. “My anonymous tips seem to arrive in their inboxes just fine — it’s the signed corrections that run into issues.” A car site published a rumor that turned out to be false. A friend of Ryan’s complained that the headline wasn’t fixed:

[Ryan’s friend:] Why keep the headline up since we now know it’s not true?
[Car site:] You guys are so funny.

Taking the headline down would generate fewer clicks than leaving it up. Shameless.

“That way lies madness,” I told a friend who worried about how much traffic his blog attracted. Bloggers who will do anything for a click do so, of course, because their salary depends on it, whereas my friend did not get significant income from his blog. Sure, paying bloggers by the click pushes them to write stuff that people want to read — which sounds good, aren’t snobs bad? — except what if people don’t care that much about the truth?

I think of science. Who do professional scientists more closely resemble? 1. Bloggers who will do anything for a click. 2. Disinterested seekers of truth. Well, it’s a job, not a hobby. Science and job are not a good fit (as I’ve written), just as factory food and health are not a good fit. We can see the consequences of the bad fit between factory food and health in the obesity epidemic (which I believe is caused by eating calorie-dense quickly-digested food that tastes exactly the same each time — factory food is much more standardized than food you make yourself) and the epidemic of digestive problems (caused by too-sterile food — factory food is more sterile than food you make yourself). We can see the consequences of the bad fit between science and job in the failure to find solutions to one growing problem after another (obesity, Crohn’s disease, autism, depression, poor sleep, etc.). Trust Me I’m Lying is about the consequences of the poor fit between being paid by the click and caring about the truth of what you write.



The Art of Fermentation by Sandor Katz

The Art of Fermentation by Sandor Katz was published two weeks and I got a copy from the publisher. It has a few conceptual chapters (“fermentation as a coevolutionary force”, health benefits, small business)  but most of it is DIY, how to ferment X, Y, and Z. Unlike a set of recipes, he includes background with each food so the result is a cross between an encyclopedia and a cookbook. There are also several pages of color photographs, cute marginal drawings, and excellent lists of references and sources. It covers lots of stuff I rarely see. For example, there is one page on fermenting eggs. When I’m in China, I eat lots of fermented eggs. The book doesn’t mention the controversy in China about heavy metals in the fermented eggs.

The author’s enthusiasm is contagious and I’m sure the book will encourage me to ferment more stuff. Nowadays I just make yogurt, kefir, and kombucha — not even sauerkraut. I once got a book called something like The Book of Yogurt that consisted of 30 different yogurt recipes — which differed from each other by only about 5%. Page after page the same with only minor differences. Talk about cut and paste! I got rid of it (“this is useless!”) but now I wish I had saved it because it was so funny.

Which is only to say that food writing is either incredibly difficult or incredibly awful. I used to subscribe to Saveur. Some of their recipes were very good. The writing was awful, however — like something from a tourist guide. Please, don’t tell me how beautiful the country, how friendly the cook, or how tasty the food! Katz does better than that, especially when he is describing what he has actually done. But about half of the book reminds me of my first piece of extended writing — a “state report” about Maine that I did when I was in fifth grade. I went to several encyclopedias and copied the interesting stuff. Katz has gone to quite a few books and copied the interesting stuff.

In at least one case, he has copied too much. I have made yogurt hundreds of times. Only in the beginning did I do something like what practically everyone in America, including Katz, advocates: heat the milk up, let it cool, put in the culture. Now I just take the milk from the refrigerator, put in a tiny amount of culture, surround the milk with hot water (using a Chinese yogurt-making machine that keeps the water warm), and wait. So much easier. The final product is better (smoother, thicker) than the old hard way, especially when I learned that tiny amounts of culture work better than large amounts. “In my experience, cultures from commercial yogurts never maintain their viability beyond a few generations,” Katz writes. My experience is different: I’ve never had a problem using them.

In contrast to Harold McGee’s On Food and Cooking, The Art of Fermentation is more personal, more hands-on, and less scientific, all of which are improvements, in my opinion. It is also more opinionated, which since the opinions are commonplace, is bad. “I too love the beer they are usually thinking of . . . However I define beer more broadly than the famous 1516 Bavarian beer purity law . . . I define beer as a fermented alcoholic beverage in which . . . ” At another point, to my surprise, he mentions Jane Jacobs and her theory that agriculture began in cities. “If Jacobs’s theory is correct, then fermentation practices must also have had urban roots,” writes Katz. This is not interesting. The small business chapter is interesting whenever Katz is telling the story of a small business and uninteresting the rest of the time (“Consistency is not necessarily important to the home experimentalist”).

Oh well. I am glad to have a book that will encourage me to ferment more stuff and from which I can learn a lot about fermentation. The book is obviously a labor of love and there are not many of those.

Assorted Links

Three Days in May: Sex, Surveillance, and DSK

Nicholas Sarkozy must be kicking himself. Sometimes a bird in the bush is worth more than a bird in the hand. If only I’d waited… He struck too soon. If only he’d waited until Dominique Strauss-Kahn (DSK) became his main opponent and then created a DSK scandal. The opposition would not have had time to regroup. DSK was careless, creating opportunities for his opponents. Edward Jay Epstein’s new book, Three Days in May: Sex, Surveillance, and DSK , makes clear that DSK was being monitored, presumably via his cell phones. A first-rate intelligence organization, says Epstein, can turn on your cell phone and listen to you. At one point a French journalist is given a transcript of a call that DSK made. How was this possible? the journalist asked. The answer given is that by freakish coincidence “DSK’s speaker phone was accidentally left on while his line was somehow connected to a French phone that was legally under surveillance.” Why the speaker phone should matter is not explained.

Such means of surveillance — available to those in power, but not to the rest of us — make those in power more powerful, harder to unseat. However, Epstein’s book also shows the effect of lower-tech new recording devices, especially CCTV recordings, cell phone records, and key-entry logs. They make it harder to lie. DSK’s accuser, Nafissatou Diallo, was lying, no doubt. The district attorney’s office got to “Version 3” of her story before giving up.  The discrepancies between what she said happened and the key-entry records reveal her lies beyond doubt. The new recording devices also pull two people into the story who otherwise might have remained out of it: a security guard and the head engineer at the hotel, who went into a private loading-dock area and did a kind of victory dance shortly after 911 was called. The 911 call made the matter public, which effectively destroyed DSK’s chance of elective office. They claim to not remember what they were celebrating. If it had nothing to do with the 911 call, it is exceedingly strange — another freakish coincidence — that it happened at exactly the same time.

Three Days in May is a new kind of investigative journalism in the sense that it is based on detailed electronic records (such as CCTV tapes and key-entry records) that weren’t available until recent years. Stories and movies are often set in remote locations or times to give the story a kind of freshness. Here freshness derives from the information being used. Epstein assembles hundreds or thousands of facts from these records into his story. I was interested to see a kind of power-law distribution of information value, the same thing I see in my self-experimentation: almost all of the facts tell us just a little, a very tiny fraction of them tell us a lot. Although electronic surveillance is usually considered a government tool (“Big Brother is Watching”) Epstein’s book makes a more subtle point.  These records make false accusations more difficult to sustain and conspiracies more difficult to carry out without detection — and who does that help? In any case, Three Days in May is a fascinating true crime story — and the criminal is not DSK.

The Hunger Games

I recently read The Hunger Games and liked it a lot. I finished it in a few hours — couldn’t stop reading. In contrast, I read a few pages of the first Harry Potter and stopped. When I was ten years old, I read The Hobbit, The Fellowship of the Ring (the first book of The Lord of the Rings trilogy), and stopped halfway through the second book. I never went back and have not seen the movies. I have never read a book by Stephen King, John Grisham, Robert Patterson, Anne Rice, Stephanie Meyer, and so on. None of them appealed to me. The Hunger Games is different than other books that have sold huge numbers of copies. When it came out, Stephen King reviewed it in Entertainment Weekly and gave it it a B. The second book in the trilogy, reviewed by someone else, got a C.

Sentence by sentence, even scene by scene, The Hunger Games is mediocre. It is not quotable. There is no vivid writing. The characters are barely interesting. It is not Jonathan Franzen, much less Vladimir Nabokov. But it does a wonderful job of supplying the four basic elements of a good story: a hero, a villain, making you care about the hero, and putting the hero in jeopardy.

Beneath the surface, also, is something I rarely find in novels: the author feels strongly about her subject matter. Collins, the author of The Hunger Games, has said she is writing for teenagers about war. Her father, who was in the Army, cared deeply about this and taught his children about it. “A family trip to a castle, which [the 13-year-old Collins] imagined would be “fairy-tale magical,” turned into a lesson on fortresses [given by her father],” says an article about Collins. Did Vladimir Nabokov know this much about child molesters (Lolita)? No, it was a literary device. Did Tolstoy or Flaubert have the events of Anna Karenina or Madame Bovary drilled into them in childhood? Unlikely. Both novels are built on basic novelistic subjects (actually, the same subject — infidelity). Somehow Collins’s deep connection comes through. I have no idea if you can write a good book simply because you love something. But you can definitely write a good book if you hate something: The Devil Wears Prada.


Gary Shteyngart is a Very Funny Guy

I heard Gary Shteyngart (latest book Super Sad True Love Story) at the Beijing Bookworm. No better job of authorial self-promotion have I seen. He was born in Leningrad in 1972, he grew up hearing jokes from his parents. For example: The 1980 Summer Olympics were in Moscow. At the time, Brezhnev was in charge. He was going senile. At an Olympic ceremony,  he gave a speech. His hands shook holding the text of his talk.

“Ohhhhhh…..” he read.

He paused.


He paused.


An apparatchik ran up to him. “Senior Comrade Brezhnev, those are the Olympic Rings!”

The moderator asked Shteyngart what he thought of Putin’s plan to require every Russian teenager to read a specified 100 great books by graduation. “These things never work,” said Shteyngart. “American cities have done this. Everyone’s supposed to read a certain book, usually To Kill a Mockingbird. Never tell someone what to read.” However, he said one of his favorite authors is Karen Russell. (For a New Yorker podcast, he read a story by Andrea Lee.)

I asked about his favorite TV shows. He mentioned The Sopranos, The Wire, and Breaking Bad. “Who would have guessed that TV would become a great art form?” He is writing a show for HBO about Brooklyn immigrants.

I learned that he was interviewed by a magazine called Modern Drunkard. The interviewer — not Shteyngart — mentions an Russian saying: “The church is near, but the road is icy. The bar is far away, but I will walk carefully.” How true.




Assorted Links

Thanks to Peter Spero and Allan Jackson.

Father Versus Surgeons and New York Presbyterian Hospital

I decided to read this book review because of a brief description (“A father describes, and rages at, the loss of his teenage son.) in an email. Then I found this:

Weber’s story becomes more spirited and urgent when Damon’s health begins to fail more seriously, and his father is forced to locate his true enemy: the received wisdom and arrogance of the American medical establishment.

Weber père . . .  admits he doesn’t trust “any single voice on Damon’s illness.” And he’s wise not to, as he discovers in short order that health care for his son is first and foremost a business, and that surgeons frequently talk out of their hats.

Heart transplants represent big money for hospitals: at half a million dollars each, 20 pediatric transplant operations a year make a significant contribution to the finances of New York-Presbyterian ­Hospital/Columbia University Medical Center, where Damon’s surgery is eventually performed. Hospitals compete to attract patients (every transplant center Weber speaks with wants to perform his son’s operation) and stringently guard their surgical outcome data, as Weber discovers when he tries to find out if the blithe assurances of the Columbia transplant team are scientifically valid. He quickly realizes “each hospital is a fiefdom.”

Worse still, the medical barons who run the fiefs care as much [i.e., as little] for protocol as they do for patients. Over Christmas of 2004, Damon is casually “listed” as a potential heart recipient — meaning he has to be ready to receive a new heart at a moment’s notice — without his father’s knowledge. His doctors then disappear for a week and more.

Before Weber can truly blow his stack, he discovers Damon’s doctors have also misclassified his son’s transplant status as less urgent than it is. Dad bulls [sic] them into fixing the problem, and 11 days later, a heart is found for Damon. The transplant in turn initiates a tragic cascade of doctor errors so egregious that Weber eventually sues both the medical director of pediatric heart transplants at New York-Presbyterian Columbia hospital and the hospital itself for malpractice. (Three years into the lawsuit, the medical director claimed Damon’s post-op records couldn’t be located.) All this happens at one of the country’s best heart transplant centers.

“Passively relying on the medical establishment and trusting them to manage my son’s care in his best interest is not . . . a luxury I have allowed myself,” Weber writes, with good reason.

Maybe I should start a series called “The Culture of Surgeons”. Entry 1: Eileen Consorti, a Berkeley surgeon who told me I should have surgery for a hernia I could not detect. Entry 2: Martin  Burton, an Oxford ear nose and throat surgeon whose Cochran Review about the pros and cons of tonsillectomy failed to consider that tonsils are part of the immune system.