The latest Edward Tufte book: Seeing with Fresh Eyes

by philg

From the world’s leading expert on how information presentation affects decision making, a new book: Seeing with Fresh Eyes.

A new book on information design is either extremely timely, if you believe that humans are making data-driven decisions regarding coronaplague, or mostly for post-vaccine reading, if you believe that humans are using “science” and data to confirm already-held beliefs regarding what should be done.

As with previous books by Professor Tufte, the teachings are via positive and negative examples. The reader can dip into the book at any point and if you don’t get something that you can use from one example, you might from the next.

Pages 48-53 provide interesting demonstrations of the dramatic impact of breaking up a continuous paragraph with newlines.

Page 66 looks at a word tree from a book by Galileo and also “stacklists”, a way of formatting words that would be tough to replicate in HTML and certainly isn’t supported by WYSIWYG editors.

A healthy (so to speak) fraction of the book deals with data in medical contexts. Sample:

Screening tests produce many false alarms, terrifying millions of healthy people. False alarms cascade into more tests. Mass screenings are now regarded as dubious–because of false alarms, harms, and failure to reduce all-cause mortality. … Since survival time = time from diagnosis to death, early diagnosis can create statistical illusions of improved survival times. And false alarms, if their falsity is not detected, lead to treatments of patients for a disease they don’t have.

(The latter point is the true magic of screening tests. The annual mammogram that Americans eagerly adopted circa 1990 resulted in improved five-year survival statistics… because people who didn’t have breast cancer and who nonetheless received treatment for breast cancer were unlikely to be dead from breast cancer five years later.)

On page 94, Professor Tufte provides what I think is the best example of survivorship bias: “Most medieval castles were made of wood. We think most were made of stone because of survivor bias.”

As the author of the world’s first web-based electronic medical record system, Tufte’s lambasting of the EHR is a little painful to read, but I’ve written some similar stuff here! (see, for example, Doctors willing to say that the electronic medical record emperors have no clothes)

Page 108 provides “a short list of medical reversals,” many of which were due to misinterpretation of data.

Faith that government experts and regulators will save us from coronavirus? Page 112:

Every single oxycodone pill was approved by the U.S. Food and Drug Administration, and was made by licensed drug companies, prescribed by licensed doctors, sold by licensed pharmacists. All 72,000,000,000 pills (500 pills/U.S. household) were tracked to the exact place/time/amount of sale by the Drug Enforcement Agency.

(See Who funded America’s opiate epidemic? You did.)

The above paragraph subtly shows a Tufte principle by placing the 72 billion pills in context with “500 pills/U.S. household.”

Readers know how passionate and frustrated I am about dishwashers. Page 18 singles out a particularly bizarre Bosch owner’s manual page. A similar one from our latest Bosch:

Who back in Germany thought that there was someone in the U.S. who was going to follow this plan? (Or that this was an effective way to communicate it?)

Computer programmers will appreciate page 14, pointing out the importance of spacing and formatting for source code.

Some of the last pages relate what Tufte has learned from teaching 930 one-day courses to 320,000 students and are worth reading for anyone who wants to give effective presentations. (The one-day course is now offered in an online video version that includes a complete set of the hardcopy books.)

The organization and formatting makes this more challenging than some of Professor Tufte’s earlier works, but it should reward study. A great Christmas gift for anyone who has the preceding four books!

Related (read these first if you’re new to Tufte):

And, what do we think of this U.S. map in which every state, except Hawaii, is presented in the same color? (from www.covidexitstrategy.org, which Maskachusetts officialdom uses to decide whether or not to fine residents $7,000 or not if they choose to travel)

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The ideal Christmas gift: 29 hours of Barack Obama

by philg

From a recent Costco excursion, a 29-hour 28-CD audiobook by Barack Obama:

It is impossible to imagine a better Christmas gift for your friends, who can wrap themselves in 29 hours of bliss and comfort every time something upsetting is said by Donald Trump or those Republicans who remain unkilled by COVID-19.

(What if you have neglected to defriend all Republicans? This is an even better gift for a Deplorable because Deplorables need to hear these healing messages more than the righteous.)

Separately, in terms of page count, this is the same length as Homer’s Iliad and Odyssey combined. Homer’s epics were almost the sole basis for education for centuries. Perhaps we could design a public school curriculum where A Promised Land was the only book studied from K through 12?

An Amazon review:

Obama’s autobiography is very wordy, slow and much of it boring. And I like the guy and loved his first book. There is no real news in this autobiography which is mostly about politics and how moderate he was as president. Too long, too. Too much about his time in the Illinois legislature and the U.S Senate. The book should have been edited down. Volume One is 752 pages and ends with the killing of Osama bin Laden. Volume Two likely will be equally long.

Hallelujah! There will be four Iliads worth of content soon enough.

Related:

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God loves Florida?

by philg

Maskachusetts is the 3rd most restricted state in the U.S. (WalletHub ranking). Florida is ranked #11 for freedom. Yet the latest map from covidexitstrategy.org, which our state officials use to decide cleanliness/godliness for travel order purposes, shows that no-mask-order Florida has 427 new cases of COVID-19 per million residents while fully-masked-since-May Massachusetts has 704 new cases per million (slightly lower positivity rate, but that could simply be due to the fact that universities here are constantly testing the rich white locked-in students and thus pumping up the denominator).

If the God of Shutdown is a just god, and the people of Florida have been flouting the church dogma of shutdown+masks, aren’t we forced to conclude that the God of Shutdown has a special love for Floridians?

Related:

  • On the third hand, “No Excess Deaths In Massachusetts Over the Past Six Months” (from our state’s boards of health): This means that for any one currently living in Massachusetts that the probability of dying from any cause has been equal to or lower than during the previous seven years. Does this sound like a strange statistic given all that you have heard about the increased death rates due to COVID-19 during the past six months? Given this fact, why are so many individuals more afraid of dying from COVID-19 than any other cause? The answer is that numbers reported without proper adjustments, missing critical denominators or taken out of context altogether lend themselves to false interpretation. [This page has some stats and you can adjust to see different states; Florida has roughly the number of expected deaths from all causes currently.]
  • Optimum COVID-19 American lifestyle: Florida in winter; Maine in summer?
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Celebrate guys such as Chuck Yeager while displacing them from corporate boards?

by philg

A variety of Facebook friends today posted their respect for Chuck Yeager, who died yesterday at age 97. Some had been in meetings with General Yeager when he was serving in various high management roles and talked about the pointed intelligent questions that he asked.

What about on days when a hero such as Yeager did not die? The same folks post approvingly of rules to forbid the assignment of high management roles to Americans such as Yeager who identify as straight white males. For example, “Nasdaq to Corporate America: Make your boards more diverse or get out” (CNN):

Nasdaq is proposing a rule that would require at least some measure of diversity on the boards of directors of companies listed on the exchange.

The rule, which needs the approval of the Securities and Exchange Commission to take effect, would require companies to have at least two diverse directors, including one woman and one member of an “underrepresented” minority group, including Black people, Latinos or members of the LGBTQ+ community. Smaller companies and foreign companies on the exchange could comply with two woman directors.

(separately, how do the money nerds at Nasdaq evaluate whether someone is a “member of the LGBTQ+ community”? Will it be like the gay evaluation scenes in the Kevin Kline movie In & Out, e.g., a quiz on the titles of Barbra Streisand‘s recorded oeuvre? Does a person meet the B victimhood designation within LGBTQIA+ if he/she/ze/they merely finds people in multiple gender ID categories attractive, but doesn’t act on this attraction by having sex with those people? Similarly, what constitutes “Black people” as far as a Wall Streeter is concerned? Will Nasdaq start looking at Quadroons and Hexadecaroons and decided how many of them are required to add up to the business wisdom of a single “Black” individual?)

(Also, what about Elliot Page? We are informed that a man who was born with XX chromosomes is no different than a man who was born with XY chromosomes. Mr. Page identifies as a man currently. Mr. Page may also identify as white. If are going to give maximum respect to transgenderism, shouldn’t Elliot Page therefore be excluded from boards due to being a white male?)

From the National Air and Space Museum, an X-15 points at Yeager’s old X-1:

(Both the downtown D.C. Museum and the Dulles Airport annex that celebrate Americans willing to risk their lives in the air are currently closed due to coronavirus fears.)

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The $70 billion travel sports industry (rich whites and Asians getting their kids into college)

by philg

Playing to Win, a short Michael Lewis book that is free to listen to for Audible subscribers, is a fascinating look into a strange corner of the U.S. economy: the $70 billion/year travel sports industry.

The primary motivation for kids’ travel sports is the parental desire for their children to get into elite colleges, which may reserve 25-33 percent of their spots for recruited athletes. (I.e., white privilege permeates America, but it is available only to whites with degrees from elite universities). The statistics that we see for selective university admissions lump together athletes and non-athletes. The chance of a white or Asian child getting into without an athletic coach’s recommendation is actually worse than the statistics suggest.

What does it cost? Lewis describes the typical athlete starting at age 11 or 12 and the parents spend $20,000 to $30,000 per year (plus a huge amount of time driving, flying, and spectating). In other words, at least $150,000 of which a small percentage might be recouped via an athletic scholarship. These costs mean that only one sport remains open to the half of Americans whose families are below the median income: football. This is because football is the only sport in which the good teams remain associated with public high schools. Travel sports is how upper-middle-class and rich whites/Asians compensate in a world where college admissions starts with a sort-by-skin-color and victimhood status.

Can individuals tap into this river of cash? Oh yes! The best is volleyball. Lewis describes a volleyball coach who organized a weekend tournament and made $1 million renting a convention center and filling it with nets. Sports for “girls” (however that term might be defined) are better than sports for athletes who identify as “boys” because the parents of the “girls” are less likely to allow the “girls” to travel unsupervised. At least one parent comes along with the athlete and books an additional hotel room then buys a ticket to the event. From the leagueapps.com web site, a presumably typical document requiring participants to book their hotels through the event organizer:

(LeagueApps says that they have processed more than $1 billion in payments.)

Lewis’s own daughter gets into the liberal arts college of her choice after a softball coach watches her play. What is a stressful admissions process for her classmates is a brief conversation with the coach in the spring of her junior year of high school.

Recommended.

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Experience with One Medical?

by philg

As Toucan Sam likes to remind us, Barack Obama said “If you like your doctor, you can keep your doctor,” but our new insurance company apparently did not get the Presidential memo.

It is thus time for me to shop for a new physician. The new insurer assigned me to a doctor, but after a couple of hours on hold with the big clinic where he works, I learned that (a) he isn’t accepting new patients, and (b) he is mostly retired.

One Medical has a couple of offices here in Boston and claims to be patient-centric rather than insurance-company-centric. Does anyone have experience with this concierge-lite primary care system? (it is $200/year, which is a lot better than waiting on hold for hours!)

Update… part of the sign-up form:

(I decided to sign up based on positive reviews from people here and also a friend who drives 30 minutes from the Boston suburbs to continue his treatment at One Medical. As readers can no doubt imagine, it was tough for me to resist entering a long essay into the Gender Information box. And, then, of course, I had to de-subscribe from One Medical after it turned out that they accept Tufts insurance, yes, but not the particular flavor of Tufts “Platinum” that we have.)

Related:

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How does HIPAA interact with state governors’ demands for COVID-19 test results?

by philg

Today is National Pearl Harbor Remembrance Day, marking 79 years since we entered World War II in order to fight Totalitarianism.

Here in Massachusetts, as part of our governor’s more-than-50 orders, we are required to tell the government, via a web form, about any travels that we might have undertaken. And “Quarantine for 14 days or produce a negative COVID-19 test result that has been administered up to 72-hours prior to your arrival in Massachusetts.”

From mass.gov:

72-hour Testing Rule: The individual can produce, upon request, proof of a negative test result for COVID-19 from a test administered on a sample taken no longer than 72 hours before your arrival in Massachusetts.

So we’ve spent hundreds of $billions (software, time spent with forms) for our medical records to be protected by HIPAA (federal law), but the state can demand a portion of our record via a “request” (fine of $7,000 if one fails to comply with the “request”; see the governor’s 45th order).

Plainly the Shutdown Karens can say that this is quite reasonable. The governor has declared an emergency so the state government should have access to whatever is necessary to deal more effectively with that emergency (never mind that test and trace immediately fell apart, so this information is useless, or that the typical person is not contagious by the time a test has been scheduled and result received (NYT)). But, on the other hand, a governor can declare additional “emergencies” any time that he/she/ze/they wants to. Obesity kills far more Americans than COVID-19. Couldn’t a governor declare an obesity crisis and demand that people submit medical records related to obesity and diabetes? We’re already in an opioid crisis, right? Why shouldn’t the state have the right to “request” your prescription records to make sure that you haven’t been getting too many OxyContin pills? (and fine you $7,000 if you fail to comply with the request)

Very loosely related, a conversation with a 5-year-old after putting a e-collar on our golden retriever to prevent her from scratching at a scab:

  • Me: Mindy doesn’t like wearing this collar.
  • Child: Why not?
  • Me: Even a dog can tell when her liberty is taken away.
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Health care workers in Aruba plead with you to stay home and avoid travel

by philg

“Health Care Workers Plead With Americans To Take Pandemic More Seriously” (NPR):

Health workers and hospitals already strained by the pandemic are increasingly making direct appeals to the public with open letters, asking people to mask up and stay at home this holiday season.

I was chatting this evening with our stealth author of Medical School 2020. He’s working 12-hour shifts at a hospital where roughly 8 percent of the beds are occupied by COVID-19 patients. “Remember that if someone comes in with appendicitis and happens to test positive, they become a ‘COVID-19 patient’ in our census,” he said.

How seriously do frontline health care workers take the pandemic? Our mole in the system described a doc and nurse couple electing to take a mid-November vacation in Aruba. They got on a flight that was 100-percent full, thus voluntarily spending hours sharing a narrow cylinder of air with 150+ other humans. When they got off the plane, they were subjected to screening questions by the Aruban authorities. Instead of admitting that they worked in a hospital every day, they said that they “worked in biochem.” On reaching the (packed) resort, they said “The majority of the other guests were health care workers” (i.e., there were additional hundreds of doctors, nurses, etc. who had chosen to take the risk of contracting COVID-19 at the jammed airports or on the full flights).

(Separately, should COVID-19 patients be in the hospital to begin with? It is not like having a heart attack or getting into a car accident where the doctors have effective treatments to offer. Why aren’t they at home with an oxygen bottle and a CPAP machine or high-flow nasal cannula? A med school professor friend:

Many things could be done from home cheaper and safer but we don’t have the infrastructure or culture. Home model kills the rationale for the hospital cash cow.

Our Medical School 2020 author:

I agree that outside of severe Covid, most of the interventions can be done at home — we send patients home with up to 5 L O2 for bad COPD. It somewhat reminds me of the slow transition from inpatient to outpatient management for other conditions, e.g., deep ventous thromobosis (“blood clots in the legs”) that now is managed with oral blood thinners at home instead of in the hospital. … There are really only a few interventions that we do for covid19 — low and high flow oxygen supplementation, noninvasive (think CPAP) or invasive mechanical ventilation, steroids (actually a good intervention for mechanically ventilated patients — 30 vs 40 percent 1-month mortality) and remdesivir (only benefit shown in low O2 patients with decrease in hospital stay of 10 vs 15 days in small study). … I agree that the only difference for non-severe covid infections between home versus inpatient is just getting telemetry monitoring and daily labs in the hope of catching worsening pulmonary function or prognostication of the weird complications of covid (e.g., heart attacks, blood clots). Unsure of our prognostic ability to guess who will worsen versus who will improve early on in the course (uptodate states the shortness of breath from covid19 occurs up to 8 days after symptom onset). Perhaps utilizing some Apple Watches and Fitbits over those 8 days might save some hospital beds.

See “A Covid-19 Lesson: Some Seriously Ill Patients Can Be Treated at Home” (NYT, July 18) for a story about a hospital that innovated.)

Is #StayHomeSaveLives the new #TakeTheBusSaveThePlanet? Classically, everyone agrees that it would be a good idea if other people took the bus or the subway, thus reducing traffic congestion and pollution.

From the official Aruba tourism site:

(I would love to go right now, but despite my reputation for skepticism regarding coronapanic, I would not voluntarily get on a commercial airline with all seats full.)

Related:

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Why not heated furniture to fight coronaplague?

by philg

In their righteous muscular efforts to “control” coronavirus, some state governors and city mayors have ordered restaurants shut down, except for outdoor dining. In response, restaurants have built four-sided tents filled with CO2-emitting propane heaters. It is unclear why this is different from being indoors, other than the lack of a real HVAC system. The tent sides are necessary, though, because otherwise the propane heat will blow away.

Why not heat the customers instead of the air?

Back in 2010, I wrote Heated Furniture to Save Energy?

A lot of cars have heated seats. When the seat heater is on, most drivers will set the interior temperature 3-7 degrees lower than with the seat heater off. Why not apply the same technology to houses?

Imagine being at home in a 65-degree house. Even in a T-shirt and jeans, it would probably be comfortable to walk around, stir a pot on the stove, carry laundry, scrub and clean, walk on a treadmill while typing on a computer (as I’m doing now!). However, if one were to sit down and read a book, it would begin to seem cold. Why not install heat in all of the seats and beds of the house? And sensors to turn the heat on and off automatically? In a lot of ways, this would be more comfortable than a current house because the air temperature would be set for actively moving around while the seat temperature would be set for sedentary activities.

There is a fine line between brilliant and stupid, of course, but could it be that coronaplague has pushed this idea over the line?

A Dutch company, sit & heat, seems to have thought of this: heated cushions that can fit into a standard frame. Serta makes a chair-shaped electric quilt (could not survive outdoors) for only $64. A plastic chair with a built-in 750-watt heater is $900 (Galanter & Jones; they have sofas too at roughly $6,000 and claim they are “cast stone”).

If heated chairs were mass-produced in Asia, presumably the cost per chair would be only about $100 more than a regular outdoor chair. That should be affordable for a restaurant.

Related:

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Does disinfectant theater contribute to coronaplague?

by philg

Text message exchange with a couple of 24-year-olds:

  • Me: We can come over now.
  • Them: We are at the gym!
  • Me: You’re always there. I am amazed you haven’t gotten coronaplague yet!
  • Them: Hahaha I know! The gym we go to is super clean.

Surface contamination has been ruled out as a significant source of coronavirus infection, right? (see below, however, for how cleaning can cut flu risk by 2 percent) Everyone agrees that it is now mostly about aerosols and therefore a gym is a perfect environment for spreading, yes? (People breathing hard and relying on non-N95 masks and/or bandanas as PPE.)

Masks make people complacent and prone to ignoring instructions to keep a 6′ distance. I wonder if the sight of workers with spray bottles and paper towels has the same effect. These 24-year-olds feel that they are significantly less likely to get infected because they’ve seen every surface being wiped, despite the fact that wiped surfaces are irrelevant when faced with an aerosol enemy.

Related:

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