dw2

15 April 2012

Hope for healing healthcare

Filed under: books, change, Economics, healthcare, market failure, medicine, passion — David Wood @ 12:45 am

Within the space of the first few pages of his book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care“, T.R. Reid had me chuckling at some of his descriptions of healthcare systems around the world. Within these same few pages, he also triggered in me a wave of anger and disbelief. He’s a veteran foreign correspondent for the Washington Post, and his writing skills shine throughout his book. Marshaling personal anecdotes from his experiences during visits to healthcare facilities in ten different countries, with historical accounts of how these healthcare systems came to have their current form, his writing addressed both my head and my heart.

Given the title of the book, it’s no spoiler for me to reveal that the episode in the first few pages that triggered my feeling of anger and disbelief was located in the USA. NY Times journalist Nicholas D. Kristof also read T.R. Reid’s book and had the same reaction as me. He retells the story in his article “The Body Count at Home“:

Nikki White was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.

In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable…

As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.

Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.

“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”

By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”...

Alas, the case of Nikki White is very far from being an exception. Kristof notes the estimates that “18,000 Die a Year for Lack of Insurance” each year in the US. (And numerous online responses to his blog post give other sad personal experiences.)

But here’s what I found really stomach-churning in the opening pages of T.R. Reid’s book:

Many Americans intensely dislike the idea that we might learn useful policy ideas from other countries, particularly in medicine. The leaders of the healthcare industry and the medical profession, not to mention the political establishment, have a single, all-purpose response they fall back on whenever someone suggests that the United States might usefully study foreign healthcare systems: “But it’s socialized medicine!”

This is supposed to end the argument. The contention is that the United States, with its commitment to free markets and low taxes, could never rely on big-government socialism the way other countries do. Americans have learned in school that the private sector can handle things better and more efficiently than government ever could.

In US policy debates, the term “socialized medicine” has been a powerful political weapon…  The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national healthcare system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to healthcare must be a communist. And the phrase has retained its political power for six decades…

I was reminded of the remarkable claims at the beginning of this year by would-be President Rick Santorum that the “NHS devastated Britain” and caused “the collapse of the British Empire”.

T.R. Reid had been bureau chief for the Washington Post in both London and Tokyo, and had lived in each of these cities for several years with his family. That gave him considerable first-hand experience of the healthcare systems in these two countries. The book arose from a wider set of visits, including France, Germany, Canada, India, Nepal, Switzerland, and Taiwan. He had two reasons for all these visits:

  1. To inquire about possible treatments for a shoulder injury he had sustained many years previously, but which had recently flared up again, becoming increasingly painful and hard to move. As he explained, “I could no longer swing a golf club. I could barely reach up to replace a lightbulb overhead or get the wine-glasses from the top shelf. Yearning for surcease from sorrow, I took that bum shoulder to doctors and clinics… in countries around the world”
  2. To seek, more generally, for “a solution to a much bigger medical problem… a prescription to fix the seriously ailing healthcare system” of the US.

He retells his diverse experiences with good humour and great insight. Along the way, he lists and punctures “Five Myths About Health Care in the Rest of the World” – myths that are widely believed in some parts of the US, but which have limited basis in actual practice:

  1. It’s all socialized medicine out there
  2. Overseas, care is rationed through limited choices or long lines
  3. Foreign health-care systems are inefficient, bloated bureaucracies
  4. Cost controls stifle innovation
  5. Health insurance has to be cruel

For example, on whether cost controls stifle innovation, he notes the following:

The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who’s had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

And the facts and figures throughout the book are relentless and comprehensive:

  • Average life expectancy at birth in the United States is 77.85 years. “That means the world’s richest country ranks forty-seventh, just ahead of Cyprus and a little behind Bosnia and Herzegovina, in terms of longevity. The United States is among the worst of the industrialized nations on this score; for that matter, the average American can expect a shorter life than people in relatively poor countries like Jordan”
  • “For those Americans who are uninsured or under-insured, any bout with illness can be terrifying on two levels. In addition to the risk of disability or death due to the disease, there’s the risk of financial ruin due to the medical and pharmaceutical bills. This is a uniquely American problem. When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally, the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry’s parking lot last week. How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000”
  • “The one area where the United States unquestionably leads the world is in spending. Even countries with considerably older populations, with more need for medical attention, spend much less than we do. Japan has the oldest population in the world, and the Japanese go to the doctor more than anybody – about fourteen office visits per year, compared with five for the average American. And yet Japan spends about $3,000 per person on health care each year; we burn through $7,000 per person”
  • “When a Harvard Medical School professor working at the World Health Organisation developed a complicated formula to rate the quality and fairness of national healthcare systems around the world, the richest nation on earth ranked thirty-seventh… just behind Dominica and Costa Rica, and just ahead of Slovenia and Cuba…”

(For more about the WHO comparative rankings of healthcare systems, see e.g. Wikipedia’s coverage. T.R. Reid addresses various criticisms of the methodology in an Appendix to his book.)

Rising above the facts and figures, and the various anecdotes, the book provides a handy framework for making sense of the different systems deployed around the world:

“Fortunately, for all the local variations, health care systems tend to follow general patterns. In some models, government is both the provider of health care and the payer. In others, doctors and hospitals are in the private sector but government pays the bills. In still other countries, both the providers and the payers are private.”

There are four basic models:

  1. The Bismarck Model: “Both health care providers and payers are private entities. The model uses private health insurance plans, usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. health insurance industry, though, Bismarck-type plans are basically charities: They cover everybody, and they don’t make a profit”
  2. The Beveridge Model: “Health care is provided and financed by the government, through tax payments. There are no medical bills; rather, medical treatment is a public service, like the fire department or the public library. In Beveridge systems, many (sometimes all) hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge”
  3. The National Health Insurance Model: “The providers of health care are private, but the payer is a government-run insurance program that every citizens pays into. The national, or provincial, insurance plan collects monthly premiums and pays medical bills. Since there’s no need for marketing, no expensive underwriting offices to deny claims, and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style private insurance. As a single payer covering everybody, the national insurance plan tends to have considerable market power to negotiate for lower prices. NHI countries also control costs by limiting the medical services they will pay for or by making patients wait to be treated.”
  4. The Out-of-pocket model: “Most medical care is paid for by the patient, out of pocket, with no insurance or government plan to help”.

Which all these systems apply in the US? The answer, surprisingly, is: All of the above – but not done in an efficient way.

Chapter by chapter, the book highlights ways in which the various medical systems keep costs lower (e.g. through having simpler administration) and deliver generally higher quality than applies in the US.

But two examples are even more important than any mentioned so far. These are the examples of Switzerland and Taiwan. Both of these are countries where significant reforms in the healthcare system have recently taken place – putting the lie to any viewpoint that complicated healthcare systems are incapable of major improvement:

Neither of these countries looks much like the United States of America… Still, both countries have important parallels to the United States. Both are vigorous democracies marked by fierce competition between political parties that look a lot like our Republicans and Democrats. Both have finance and insurance industries that are rich and politically influential. Both are ferociously capitalist places, and both have jumped aboard the digital revolution to build advanced, high-tech economies. Most important, both Taiwan and Switzerland had fragmented and expensive health care, similar to the American system – until they launched their reform campaigns.

In both countries, payment for medical care was dominated by health insurance plans tied to employment; in both significant numbers of people were left with no coverage at all. Even with large numbers of people uninsured, both countries were pouring considerable amounts of money into health care. In both Taiwan and Switzerland, as in the United States…, a growing chorus of voices began demanding universal coverage, arguing that every sick person should have access to a doctor…

In both cases, the results of the reforms have been very positive. To take the case of Taiwan:

Almost overnight, some 11 million Taiwanese who had no medical insurance suddenly had access to doctors and hospitals, with the Bureau of National Health Insurance paying most of the bill. This created a flood of new demand for medical services. The market responded with a flood of new supply: Clinics, hospitals, dentists, optometrists, labs, hostels, and acupuncture centers sprang up everywhere…

The most striking result of Taiwan’s new system is a healthier population with a longer healthy life expectancy and much higher recovery rates from major diseases. This is particularly evident in rural areas, where it was difficult or impossible to see a doctor before the new system took place…

As a system started from scratch, with uniform rules and procedures for every doctor and patient and state-of-the-art paperless record-keeping, Taiwan’s new health insurance system is the most efficient in the world. The 1994 law seemed hopelessly optimistic when it set a limit of 3.5% for administrative costs; in fact, the system has done much better than that, with paperwork, etc. accounting for only 2% of costs most years (and sometimes less). That’s about… one-tenth as high as the administrative burden for America’s private health insurers. As a result, even with explosive growth in the consumption of medical services, national health spending in Taiwan remains at about 6% of gross domestic product (as opposed to about 17% of GDP in the United States). This has kept costs low for patients…

As for the healthcare reforms in the US, under President Obama, T.R. Reid points out that they miss various elements of the reforms undertaken in both Taiwan and Switzerland:

  • Even with the reform in place, there will still be around 23 million Americans without healthcare insurance in 2019
  • American health insurance companies will still be able to get away with various practices (for denying payments to patients) that are banned in every other rich democracy
  • Much of the argumentation in favour of the reform has emphasised economics (not a bad thing in itself), but the moral and ethical drivers which were at the forefront in the debates in Taiwan and Switzerland have had a much lower profile in the US.

The final passage in the main body of the book puts it like this:

The sad truth is that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable healthcare system of any developed nation. The new law won’t get to the destination all other industrialized democracies have reached: universal healthcare coverage at reasonable cost. To achieve that goal, the United States will still have to take some lessons from the other national healthcare systems described in this book.

I’ll touch on four points in my own conclusion:

1. The moral argument for healthcare reform

The time I’ve spent recently reading Jonathan Haidt’s “The Righteous Mind” and watching him speak at a couple of events in London, has made me more sensitive to the fact that different people have different moral “tastes”, and can assign different priorities to six major dimensions of moral sensibility:

  • care vs. harm
  • fairness vs. cheating
  • liberty vs. oppression
  • loyalty vs. betrayal
  • authority vs.subversion
  • sanctity vs. degradation.

Failure to appreciate this fact leads of lots of bewilderment, as summarised in William Saletan’s New York Times review “Why won’t they listen?” of Haidt’s book. As T.R. Reid highlights, the current US healthcare system may well fail important moral tests on grounds of care vs. harm, and by being “unfair”. However, the arguments of people like Rick Santorum against the reform act build on different moral dimensions – e.g. liberty vs. oppression. These arguments find it particularly objectionable that, under these reforms, many people will be obliged (“oppressed”) into purchasing healthcare insurance. That’s seen as a fundamental denial of liberty.

Another insight from Haidt is that, in these circumstances of conflicting moral intuitions, reasoning often fails. One of his key summary points is as follows:

Moral intuitions come first, strategic reasoning comes second, to justify the intuitions we have already reached.

That’s not to say further discussion is pointless. As William Saletan puts it:

Haidt believes in the power of reason, but the reasoning has to be interactive. It has to be other people’s reason engaging yours. We’re lousy at challenging our own beliefs, but we’re good at challenging each other’s. Haidt compares us to neurons in a giant brain, capable of “producing good reasoning as an emergent property of the social system.”

Our task, then, is to organize society so that reason and intuition interact in healthy ways. Haidt’s research suggests several broad guidelines. First, we need to help citizens develop sympathetic relationships so that they seek to understand one another instead of using reason to parry opposing views. Second, we need to create time for contemplation. Research shows that two minutes of reflection on a good argument can change a person’s mind. Third, we need to break up our ideological segregation. From 1976 to 2008, the proportion of Americans living in highly partisan counties increased from 27% to 48%. The Internet exacerbates this problem by helping each user find evidence that supports his views…

2. A surprisingly effective example of lower-cost healthcare

So, what happened to T.R. Reid’s shoulder? Out of the all the recommendations from different doctors around the world, which was the best?

Doctors in several countries – including the US – recommended expensive, invasive, reconstructive surgery – even though all these doctors noted that there was no guarantee the surgery would be successful.

But the advice T.R. Reid ultimately found most useful involved a very different kind of technology, with roots going far back into time. That treatment was in India, and was based on Ayurdveda – which, like yoga, is derived from ancient Hindu scripture. It included

  • Eating only bland food (lentils and rice, primarily) during the course of the treatment, on the theory that the body should be under minimal strain during treatment
  • Daily massages involving hot oils and powerful hand movements (“to smooth the bodily routes that the prana needs to follow”)
  • Six times each day, imbibing “a vile assortment of herbal medicines, most of which tasted like spoiled greens or aging mud”
  • Attending a temple within the hospital grounds, “to perform poojah, or reverence, tot he Hindu god of healing”
  • Undertaking various yogic exercises
  • Accepting advice to “relax, and to forget whatever stresses and worries”
  • Reading one of the key Hindu scriptures, the Bhagavad Gita.

After several weeks of this treatment, the results were unmistakable. The shoulder had a much greater range of movement than before, and the pains were much reduced:

To this day, I don’t know why it happened. Was it the massage, the medication, the meditation…? In any case, the timing was definitely propitious. Ayurveda worked for me. I didn’t have a miracle cure; my shoulder was not completely healed. But my pain decreased, my range of motion increased, and I was definitely better – and all without the trouble or cost of a total shoulder arthoplasty…

Note that the book also describes some alternative medical treatments that were not successful – including other herbal medicines in Nepal, and acupuncture in Taiwan. And as mentioned, the Ayurveda did not provide “complete” healing. What’s more, Ayurvedic clinics increasingly incorporate x-ray machines, stethoscopes, and other western tools. But this section of the book was an intriguing reminder to me that I’d love to dig more deeply into material such as William Broad’s “The science of yoga: the risks and the rewards“.

3. Every healthcare system is under increasing financial strain

Despite the many successes of healthcare systems covered in the book, T.R. Reid was clear that all these systems are under increasing financial stress. He quotes the (somewhat tongue-in-cheek) “Universal Laws of Healthcare Systems” as articulated by economist Tsung-Mei Cheng:

  1. No matter how good the health care in a particular country, people will complain about it.
  2. No matter how much money is spent on health care, the doctors and hospitals will argue it is not enough.
  3. The last reform always failed.

As the author states,

All national health systems, even those that do their job well, are fighting a desperate battle these days against rising costs.

We live in a technological age, and technology – in the form of new miracle drugs, new medical devices (e.g. man-made shoulders) and new procedures – plays a huge role in modern medicine. This is unquestionably a good thing… but it is also an expensive thing.

But good technology, wisely applied, can reduce healthcare costs, rather than simply make them more expensive. For example, as T.R. Reid points out, suitable early tests can do wonders in preventive medicine. One place I’ve covered this topic before is in “Smartphone technology, super-convergence, and the great inflection of medicine“.

4. The good news in American medicine

Lest it be thought that T.R. Reid, the author of “The healing of America”, is unduly negative about America, or unpatriotic, let me draw attention to a 53 minute PBS documentary he has recently released: “The good news in American medicine“.

Whereas “The healing of America” gathers inspiring examples of best practice from around the globe, “The good news in American medicine” gathers inspiring examples of best practice from around the US – and draws out some important economic and moral principles along the way. (Quote: “A whole lot of this is about doing the right thing“.) Just as I recommend the book, I also recommend the video.

28 December 2010

Some suggested books for year-end reading

Looking for suggestions on books to read, perhaps over the year-end period of reflection and resolution for renewal?

Here are my comments on five books I’ve finished over the last few months, each of which has given me a lot to think about.

Switch: How to change things when change is hard – by Chip & Dan Heath

I had two reasons for expecting I would like this book:

I was not disappointed.  The book is full of advice that seems highly practical – advice that can be used to overcome all kinds of obstacles that people encounter when trying to change something for the better.  The book helpfully lists some of these obstacles in a summary chapter near its end.  They include:

  • “People here don’t see the need for change”
  • “People resist my idea because they say, ‘We’ve never done it like that before'”
  • “We should do doing something, but we’re getting bogged down in analysis”
  • “The environment has shifted, and we need to overcome our old patterns of behaviour”
  • “People here simply aren’t motivated to change”
  • “People here keep saying ‘It will never work'”
  • “I know what I should be doing, but I’m not doing it”
  • “I’ll change tomorrow”…

Each chapter has profound insights.  I particularly liked the insight that, from the right perspective, the steps to create a solution are often easier than the problem itself.  This is a pleasant antidote to the oft-repeated assertion that solutions need to be more profound, more complex, or more sophisticated, that the problems they address.  On the contrary, change efforts frequently fail because the change effort is focussing on the wrong part of the big picture.  You can try to influence either the “rider”, the “elephant”, or the “path” down which the elephant moves.  Spend your time trying to influence the wrong part of this combo, and you can waste a great deal of energy.  But get the analysis right, and even people who appear to hate change can embrace a significant transformation.  It all depends on the circumstance.

The book offers nine practical steps – three each for the three different parts of this model:

  • Direct the rider: Find the bright spots; Script the critical moves; Point to the destination
  • Motivate the elephant: Find the feeling; Shrink the change; Grow your people
  • Shape the path: Tweak the environment; Build habits; Rally the herd.

These steps may sound trite, but these simple words summarise, in each case, a series of inspirational examples of real-world change.

The happiness advantage: The seven principles of positive psychology that fuel success and performance at work – by Shawn Achor

“The happiness advantage” shares with “Switch” the fact that it is rooted in the important emerging discipline of positive psychology.  But whereas “Switch” addresses the particular area of change management, “The happiness advantage” has a broader sweep.  It seeks to show how a range of recent findings from positive psychology can be usefully applied in a work setting, to boost productivity and performance.  The author, Shawn Achor, describes many of these findings in the context of the 10 years he spent at Harvard.  These findings include:

  • Rather than the model in which people work hard and then achieve success and then become happy, the causation goes the other way round: people with a happy outlook are more creative, more resilient, and more productive, are able to work both harder and smarter, and are therefore more likely to achieve success in their work (Achor compares this reversal of causation to the “Copernican revolution” which saw the sun as the centre of the solar system, rather than the earth)
  • Our character (including our degree of predisposition to a happy outlook) is not fixed, but can be changed by activity – this is an example of neural plasticity
  • “The Tetris effect”: once you train your brain to spot positive developments (things that merit genuine praise), that attitude increasingly becomes second nature, with lots of attendant benefits
  • Rather than a vibrant social support network being a distraction from our core activities, it can provide us with the enthusiasm and the community to make greater progress
  • “Falling up”: the right mental attitude can gain lots of advantage from creative responses to situations of short-term failure
  • “The Zorro circle”: rather than focussing on large changes, which could take a long time to accomplish, there’s great merit in restricting attention to a short period of time (perhaps one hour, or perhaps just five minutes), and to a small incremental improvement on the status quo.  Small improvements can accumulate a momentum of their own, and lead on to big wins!
  • Will power is limited – and is easily drained.  So, follow the “20 second rule”: take the time to rearrange your environment – such as your desk, or your office – so that the behaviour you’d like to happen is the easiest (“the default”).  When you’re running on auto-pilot, anything that requires a detour of more than 20 seconds is much less likely to happen.  (Achor gives the example of taking the batteries out of his TV remote control, to make it less likely he would sink into his sofa on returning home and inadvertently watch TV, rather than practice the guitar as he planned.  And – you guessed it – he made sure the guitar was within easy reach.)

You might worry that this is “just another book about the power of positive thinking”.  However, I see it as a definite step beyond that genre.  This is not a book that seeks to paint on a happy face, or to pretend that problems don’t exist.  As Achor says, “Happiness is not the belief that we don’t need to change.  It is the realization that we can”.

Nonsense on stilts: how to tell science from bunk – by Massimo Pigliucci

Many daft, dangerous ideas are couched in language that sounds scientific.  Being able to distinguish good science from “pseudoscience” is sometimes called the search for a “demarcation principle“.

The author of this book, evolutionary biologist Massimo Pigliucci, has strong views about the importance of distinguishing science from pseudoscience.  To set the scene, he gives disturbing examples such as people who use scientific-sounding language to deny the connection between HIV and AIDS (and who often advocate horrific, bizarre treatments for AIDS), or who frighten parents away from vaccinating their children by quoting spurious statistics about links between vaccination and autism.  This makes it clear that the subject is far from being an academic one, just for armchair philosophising.  On the other hand, attempts by philosophers of science such as Karl Popper to identify a clear, watertight demarcation principle all seem to fail.  Science is too varied an enterprise to be capable of a simple definition.  As a result, it can take lots of effort to distinguish good science from bad science.  Nevertheless, this effort is worth it.  And this book provides a sweeping, up-to-date survey of the issues that arise.

The book brought me back to my own postgraduate studies from 1982-1986.  My research at that time covered the philosophy of mind, the characterisation of pseudo-science, creationism vs. Darwinism, and the shocking implications of quantum mechanics.  All four of these areas were covered in this book – and more besides.

It’s a book with many opinions.  I think it gets them about 85% right.  I particularly liked:

  • His careful analysis of why “Intelligent Design” is bad science
  • His emphasis on how pseudoscience produces no new predictions, but is intellectually infertile
  • His explanation of the problems of parapsychology (studies of extrasensory perception)
  • The challenges he lays down to various fields which appear grounded in mainstream science, but which are risking divergence away from scientific principles – fields such as superstring theory and SETI (the search for extraterrestrial intelligence).

Along the way, Pigliucci shares lots of fascinating anecdotes about the history of science, and about the history of philosophy of science.  He’s a great story-teller.

The master switch: the rise and fall of information empires – by Tim Wu

Whereas “Nonsense on stilts” surveys the history of science, and draws out lessons about the most productive ways to continue to find out deeper truths about the world, “The master switch” surveys many aspects of the modern history of business, and draws out lessons about the most productive ways to organise society so that information can be shared in the most effective way.

The author, Tim Wu, is a professor at Columbia Law School, and (if anything) is an even better story-teller than Pigliucci.  He gives rivetting accounts of many of the key episodes in various information businesses, such as those based on the telephone, radio, TV, cinema, cable TV, the personal computer, and the Internet.  Lots of larger-than-life figures stride across the pages.  The accounts fit together as constituents of an over-arching narrative:

  • Control over information technologies is particularly important for the well-being of society
  • There are many arguments in favour of centralised control, which avoids wasteful inefficiencies of competition
  • Equally, there are many arguments in favour of decentralised control, with open access to the various parts of the system
  • Many information industries went through one (or more phases) of decentralised control, with numerous innovators working independently, before centralisation took place (or re-emerged)
  • Government regulation sometimes works to protect centralised infrastructure, and sometimes to ensure that adequate competition takes place
  • Opening up an industry to greater competition often introduces a period of relative chaos and increased prices for consumers, before the greater benefits of richer innovation have a chance to emerge (often in unexpected ways)
  • The Internet is by no means the first information industry for which commentators had high, idealistic hopes: similar near-utopian visions also accompanied the emergence of broadcast radio and of cable television
  • A major drawback of centralised control is that too much power is vested in just one place – in what can be called a “master switch” – allowing vested interests to drastically interfere with the flow of information.

AT&T – the company founded by Bell – features prominently in this book, both as a hero, and as a villain.  Wu describes how AT&T suppressed various breakthrough technologies (including magnetic disk recording, usable in answering machines) for many years, out of a fear that they would damage the company’s main business.  Similarly, RCA suppressed FM radio for many years, and also delayed the adoption of electronic television.  Legal delays were often a primary means to delay and frustrate competitors, whose finances lacked such deep pockets.

Wu often highlights ways in which business history could have taken different directions.  The outcome that actually transpired was often a close-run thing, compared to what seemed more likely at the time.  This emphasises the contingent nature of much of history, rather than events being inevitable.  (I know this from my own experiences at Symbian.  Recent articles in The Register emphasise how Symbian nearly died at birth, well before powering more than a quarter of a billion smartphones.  Other stories, as yet untold, could emphasise how the eventual relative decline of Symbian was by no means a foretold conclusion either.)

But the biggest implications Wu highlights are when the stories come up to date, in what he sees as a huge conflict between powers that want to control modern information technology resources, and those that prefer greater degrees of openness.  As Wu clarifies, it’s a complex landscape, but Apple’s iPhone approach aims at greater centralised design control, whereas Google’s Android approach aims at enabling a much wider number of connections – connections where many benefits arise, without the need to negotiate and maintain formal partnerships.

Compared to previous information technologies, the Internet has greater elements of decentralisation built into it.  However, the lessons of the previous chapters in “The master switch” are that even this decentralisation is vulnerable to powerful interests seizing control and changing its nature.  That gives greater poignancy to present-day debates over “network neutrality” – a term that was coined by Wu in a paper he wrote in 2002.

Sex at dawn: the prehistoric origins of modern sexuality – by Christopher Ryan and Cacilda Jetha

(Sensitive readers should probably stop reading now…)

In terms of historical sweep, this last book outdoes all the others on my list.  It traces the origins of several modern human characteristics far into prehistory – to the time before agriculture, when humans existed as nomadic hunter-gatherers, with little sense of personal exclusive ownership.

This book reminds me of this oft-told story:

It is said that when the theory of evolution was first announced it was received by the wife of the Canon of Worcester Cathedral with the remark, “Descended from the apes! My dear, we will hope it is not true. But if it is, let us pray that it may not become generally known.”

I’ve read a lot on evolution over the years, and I think the evidence husband and wife authors Christopher Ryan and Cacilda Jetha accumulate chapter after chapter, in “Sex at dawn”, is reasonably convincing – even though elements of present day “polite society” may well prefer this evidence not to become “generally known”.  The authors tell a story with many jaw-dropping episodes.

Among other things, the book systematically challenges the famous phrase from Thomas Hobbes in Leviathan that, absent a government, people would lead lives that were “solitary, poor, nasty, brutish, and short”.  On the contrary, the book marshals evidence, direct and indirect, that pre-agricultural people could enjoy relatively long lives, with ample food, and a strong sense of community.  Key to this mode of existence was “fierce sharing”, in which everyone felt a strong obligation to share food within the group … and not only food.  The X-rated claim in the book is that the sharing extended to “parallel multi-male, multi-female sexual relationships”, which bolstered powerful community identities.  Monogamy is, therefore, far from being exclusively “natural”.  Evidence in support of this conclusion includes:

  • Comparisons to behaviour in bonobos and chimps – the apes which are our closest evolutionary cousins
  • The practice in several contemporary nomadic tribes, in which children are viewed as having many fathers
  • Various human anatomical features, copulatory behaviour, aspects of sperm wars, etc.

In this analysis, human sexual nature developed under one set of circumstances for several million years, until dramatic changes in relatively recent times with the advent of agriculture, cities, and widespread exclusive ownership.  Social philosophies (including religions) have sought to change the norms of behaviour, with mixed success.

I’ll leave the last words to Ryan and Jetha, from their online FAQ:

We’re not recommending anything other than knowledge, introspection, and honesty. In fact, as we say in the book, we’re not really sure what to do with this information ourselves.

9 May 2010

Chapter completed: Crises and opportunities

Filed under: alienation, change, climate change, Economics, H+ Agenda, recession, risks, terrorism — David Wood @ 12:16 am

I’ve taken the plunge.  I’ve started writing another book, and I’ve finished the first complete draft of the first chapter.

The title I have in mind for the book is:

The Humanity+ Agenda: the vital priorities for the coming decade

The book is an extended version of the 10 minute opening presentation I gave a couple of weeks ago, at the Humanity+ UK 2010 event.  My reasons for writing this book are spelt out here.  The book will re-use and refine a lot of the material I’ve tried out from time to time in earlier posts on this blog, so you may find parts of it familiar.

I’ve had a few false starts, but I’m now happy with both the framework for the book (9 chapters in all) and a planned editing/review process.

Chapter 1 is called “Crises and opportunities”.  There’s a copy of the current draft below.

I’ll keep the latest drafts of all the chapters in the “Pages” section of this blog – accessible from the box on the right hand side.  From time to time – as in this posting – I’ll copy snapshots of the latest material into regular blogposts.

It’s my hope that the book will benefit from feedback and suggestions from readers.  Comments can be made, either to regular blogposts, or to the “pages”.  I’m also open to receiving emailed comments or contributions.  Unless someone tells me otherwise, I’ll assume that anything posted in response is intended as a potential contribution to the book.

(I’ll acknowledge, in the acknowledgements section of the book, all contributions that I use.)

========

1. Crises and opportunities

<Snapshot of material whose master copy is kept here>

The decade 2010-2019 will be a decade of crises for humanity:

  • As hundreds of millions of people worldwide significantly change their lifestyles, consuming ever more energy and generating ever more waste, the planet Earth faces increasingly great strains. “More of the same” is not an acceptable response.
  • Alongside the risk of environmental disaster, another risks looms: that of economic meltdown. The massive shocks to the global finance system at the end of the previous decade bear witness to powerful underlying tensions and problems with the operation of market economies.
  • The rapid rate of change causes widespread personal frustration and societal angst, driving a significant minority of people into the arms of beguiling ideologies such as fundamentalist Islam and the militant pursuit of terrorism. Relatively easy access to potential weapons of mass destruction – whether nuclear, biological, or chemical – transforms the threat of terrorism from an issue of national security into an issue of global survival.

In aggregation, these threats are truly fearsome.

To improve humanity’s chances of surviving, in good shape, to 2020 and beyond, we need new solutions.

I believe that these new solutions are emerging in part from improved technology, and in part from an important change in attitude towards technology. This book explains the basis for these beliefs.  This chapter summarises the crises, and the remaining chapters summarise the proposed solutions.

In the phrase “Humanity+”, the plus sign after the word “Humanity” emphasises that solutions to our present situation cannot be achieved by people continuing to do the same as before. Instead, a credible vision of wise application of new technologies can bring humans – both individually and collectively – to operate in dramatically enhanced ways:

  • Humans will be able, in stages, to break further free from the crippling constraints and debilitations of our evolutionary background and our historical experiences;
  • We will, individually and collectively, become smarter, wiser, stronger, kinder, healthier, calmer, brighter, more peaceful, and more fulfilled;
  • Instead of fruitless divisions and conflicts, we’ll find much better ways to cooperate, and build social systems for mutual benefit.

This is the vision of humanity fulfilling its true potential.

But there are many obstacles on the path to this fulfilment.  These obstacles could easily drive Humanity to “Humanity-” (humanity minus), or even worse (human annihilation), rather than Humanity+.  There’s nothing inevitable about the outcome.  As a reminder of the scale of the obstacles, let’s briefly review five interrelated pending crises.

1.1 The environmental crisis

Potential shortages of clean drinking water.  Rapid reductions in the available stocks of buried energy sources, such as coal, gas, and oil.  Crippling impacts on our environment from the waste products of our lifestyles.  These – and more – represent the oncoming environmental crisis.

With good reason, the aspect of the environmental crisis that is most widely discussed is the potential threat of runaway climate change.  Our accelerating usage of fossil fuels means that carbon dioxide (CO2) in the atmosphere has reached levels unprecedented in human history.  This magnifies the greenhouse effect of the atmosphere, tending to push the average global temperature higher.  This relationship is complex.  Forget simple ideas about increases in factor A invariably being the cause of increases in factor B.  Think instead about a dance of different factors that each influence the other, in different ways at different times.  (That’s a theme that you’ll notice throughout this book.)

In the case of climate change, the players in the dance include:

  • Variation in the amount of sunlight striking earth landmasses, due to changes over geological timescales in the axis of the earth, the eccentricity of the earth’s orbit, and the distribution of landmass over different latitudes;
  • Variation in the slow-paced transfer of heat between different parts of the ocean;
  • Variation in the speed of build-up or collapse of huge polar ice sheets;
  • Variation in numerous items in the atmosphere, including aerosols (which tend to lower average temperature) and greenhouse gases (which tend to raise it again);
  • Variation in the amounts of greenhouse gases, such as methane, being suddenly released into the atmosphere from buried frozen stores (for example, from tundra);
  • Variation in the sensitivity of the planet to the various “climate forcing agents” – sometimes a small change in one will lead to just small changes in the climate, but at other times the consequences are more severe.

What makes this dance potentially deadly is the twin risk of latent momentum and strong positive feedback:

  • More CO2 in the atmosphere raises the average temperature, which means there’s more H2O (water vapour) in the atmosphere too, raising the average temperature yet further;
  • Icesheets over the Antarctic and Greenland take a long time to start to disintegrate, but once the process gets under way, it can become essentially irreversible;
  • Less ice on the planet means less incoming sunlight is reflected to space; instead, larger areas of water absorb more of the sunlight, increasing ocean temperature further;
  • Rises in sea temperatures can trigger the sudden release of huge amounts of greenhouse gases from methane clathrate compounds buried in seabeds and permafrost – another example of rapid positive feedback.

Indeed, there is significant evidence that runaway methane clathrate breakdown may have caused drastic alteration of the ocean environment and the atmosphere of earth a number of times in the past, most notably in connection with the Permian extinction event, when 96% of all marine species became extinct about 250 million years ago.

Of course, predicting the future of the environment is hard.  There are three sorts of fogs of climate change uncertainty:

  1. Many of the technical interactions are still unknown, or are far from being fully understood.  We are continuing to learn more;
  2. Even where we believe we do understand the technical interactions, many of the detailed interactions are unpredictable.  Just as it’s hard to predict the weather itself, one month (say) into the future, it’s hard to predict the exact effect of ongoing climate forcing agents.  The effect that “a butterfly flapping its wings unpredictably causes a hurricane on the other side of the planet” applies for the chaos of climate as much as for the chaos of weather;
  3. There are huge numbers of vested interests, who (consciously or sub-consciously) twist and distort aspects of the argument over climate change.

The vested interests include:

  • Both anti-nuclear and pro-nuclear campaigners;
  • Both anti-oil and pro-oil campaigners, and anti-coal and pro-coal campaigners;
  • Both “small is beautiful” and “big is beautiful” campaigners;
  • Both “back to nature” and “pro-technology” campaigners;
  • Scientists and authors who have long supported particular theories, and who are loath to change their viewpoints;
  • Hardened political campaigners who look to extract maximum concessions, for the region or country they represent, before agreeing a point of negotiation.

Not only is it psychologically hard for individuals to objectively review data or theories that conflicts with their favoured opinions.  It is economically hard for companies (such as energy companies) to accept viewpoints that, if true, would cause major hurdles for their current lines of business, and significant loss of jobs.  On the other hand, just because researcher R has strong psychological reason P and/or strong economic incentive E in favour of advocating viewpoint V, it does not mean that viewpoint V is wrong.  The viewpoint could be correct, even though some of the support advanced in its favour is non-logical.  As I said, there’s lots of fog to navigate!

Despite all this uncertainty, I offer the following conclusions:

  • There is a wide range of possible outcomes, for the climate in the next few decades;
  • The probability of runaway global warming – with disastrous effects on sea levels, drought, agriculture, storms, species and ecosystem displacement, travel, business, and so on – is at least 20%, and likely higher;
  • Global warming won’t just make the temperature higher; it will make the weather more extreme – due to increased global temperature gradients, increased atmospheric water vapour, and higher sea temperatures that stir up more vicious storms.

A risk of at least 20% of a global environmental disaster deserves urgent attention and further analysis.  Who among us would enter an airplane with family and friends, if we believed there was a 20% probability of that airplane plummeting headlong out of the sky to the ground?

1.2 The economic crisis

The controversies and uncertainties over the potential threat of runaway climate change find parallels in discussions over a possible catastrophic implosion of the world economic system.  These discussions likewise abound with technical disagrements and vested interests.

Are governments, legislators, banks, and markets generally wise enough and capable to oversee the pressures of financial trading, and keep the systems afloat?  Was the recent series of domino-like collapses of famous banks around the world a “once in a lifetime” abnormality, that is most unlikely to repeat?  Or should we expect a recurrence of fundamental financial instability?  What is the risk of a larger financial crisis striking?  Indeed, what is the risk of adverse follow-on effects from the “tail end” of the 2008-2009 crisis, generating a so-called “double dip” in which the second dip is more drastic than the first?  On all these questions, opinions vary widely.

Despite the wide variation in opinions, some elements seem common.  All commentators are fearful of some potential causes of major disruption to global economics.  Depending on the commentator, these perceived potential causes include:

  • Clumsy regulation of financial markets;
  • Bankers who are able to take catastrophic risks in the pursuit of ever greater financial rewards;
  • The emergence of enormous monopoly powers that eliminate the benefits of marketplace competition;
  • Institutions that become “too big to fail” and therefore derail the appropriate workings of the market system;
  • Sky-high accumulation of debts, with individuals and countries living far beyond their means, for too long;
  • Austerity programmes that attempt to reduce debts quickly, but which could provoke spiraling industrial disputes and crippling strikes;
  • Bubbles that grow because “it’s temporarily rational for everyone to be irrational in their expectations” and then burst with tremendous damage.

We must avoid a feeling of overconfidence arising from the fact that previous financial crises were, in the end, survived, without the world of banking coming to an end.  First, these previous financial crises caused numerous local calamities – and the causes of major wars can be traced (in part) to these crises.  Second, there are reasons why future financial problems could have more drastic effects than previous ones:

  • There are numerous hidden interconnections between different parts of the global  economy, which accelerate negative feedback when individual parts fail;
  • The complexity of new financial products far outstrips the ability of senior managers and regulators to understand and appreciate the risks involved;
  • In an age of instant electronic connections, the speed of cascading events can catch us all flat-footed.

For these reasons, I tentatively suggest we assign a ballpark risk factor of about 20% to the probability of a major global financial meltdown during the 2010s.  (Yes, this is the same numeric figure as I picked for the environmental crisis too.)

Note some parallels between the two crises I’ve already discussed:

  • In each case, the devil is in the mix of weakly-understood powerful feedback systems;
  • Again in each case, our ability to discern what’s really happening is clouded by powerful non-rational factors and vested interests;
  • Again in each case, the probabilities of major disaster cannot be calculated in any precise way, but the risk appears large enough to warrant very serious investigation of solutions;
  • Again in each case, there is deep disagreement about the best solutions to deploy.

Worse, these two looming crises are themselves interconnected.  Shortage of resources such as clean energy could trigger large price hikes which throw national economies into tailspins.  Countries or regions which formerly cooperated could end up at devastating loggerheads, if an “abundance spirit” is replaced by a “scarcity spirit”.

1.3 The extreme terrorist crisis

What drives people to use bombs to inflict serious damage?  Depending on the cirumstance, it’s a combination of:

  • Positive belief, in support of some country, region, ideology, or religion;
  • Negative belief, in which a group of people (“the enemy”) are seen as despicable, inferior, or somehow deserving of destruction or punishment;
  • Peer pressure, where people feel constrained by those around them to follow through on a commitment (to become, for example, a suicide bomber);
  • Personal rage, such as a desire for revenge and humiliation;
  • Aspiration for personal glory and reward, in either the present life, or a presumed afterlife;
  • Failure of countervailing “pro-cooperation” and “pro-peace” instincts or systems.

Nothing here is new for the 2010s.  What is new is the increased ease of access, by would-be inflictors of damage, to so-called weapons of mass destruction.  There is a fair probability that the terrorists who piloted passenger jet airlines into the Twin Towers and the Pentagon would have willingly caused even larger amounts of turmoil and damage, if they could have put their hands on suitable weapons.

Technology itself is neutral.  A hammer which can be used to drive a nail into a piece of wood can equally be used to knock a fellow human unconscious.  Electricity can light up houses or fry someone in an electric chair.  Explosives can clear obstacles during construction projects or can obliterate critical infrastructure assets of so-called enemies.  Biochemical manipulation can yield wonderfully nutritious new food compounds or deadly new diseases.  Nuclear engineering can provide sufficient energy to free humanity from dependency on carbon-laden fossil fuels, or suitcase-sized portable weapons capable of tearing the heart out of major cities.

As technology becomes more widely accessible – via improved education worldwide, via cheaper raw materials, and via easy access to online information – the potential grows, both for good uses and for bad uses.  A saying attributed to Eliezer Yudkowsky gives us pause for thought:

The minimum IQ required to destroy the world drops by one point every 18 months.

(This saying is sometimes called “Moore’s Law of mad scientists“.)  The statement was probably not intended to be interpreted mathematically exactly, but we can agree that, over the course of a decade, the number of people capable of putting together a dreadful weapon of mass destruction will grow significantly.  The required brainpower will move from the rarified tails of the bell curve of intelligence distribution, in the direction of the more fully populated central region.

We can imagine similar “laws” of increasing likelihood of destructive capability:

The minimum IQ required to devise and deploy a weapon that wipes out the heart of a major city drops by one point every 18 months;

The minimum IQ required to poison the water table for a region drops by one point every 18 months;

The minimum IQ required to unleash a devastating plague drops by one point every 18 months…

Of course, the threat of nuclear annihilation has been with the world for half a century.  During my student days at Cambridge University, I participated in countless discussions about how best to avoid the risk of unintentional nuclear war.  Despite the forebodings of some of my contemporaries at the time, we reached the end of the 20th century unscathed.  Governments of nuclear-capable countries, regardless of their political hues and ideological positions, found good reason to avoid steps that could trigger any nuclear escalation.  What’s different with at least some fundamentalist terrorists is that they operate in a mental universe that is considerably more extreme:

  • They live for a life beyond the grave, rather than before it;
  • They believe that divine providence will take care of the outcome – any “innocents” caught up in the destruction will receive their own rewards in the afterlife, courtesy of an all-seeing, all-knowing deity;
  • They are nourished and inspired by apocalyptic writing that glorifies a vision of almighty destruction;
  • They operate with moral certainty: they seem to harbour no doubts or questions about the rightness of their course of action.

Mix this extreme mindset with sufficient raw brainpower and with weapons-grade materials that can be begged, bought, or stolen, and the stage is set for a terrorist outrage that will put 9/11 far into the shade.  In turn, the world’s reaction to that incident is likely to put the reaction to 9/11 far into its own shade.

It’s true, would-be terrorists are often incompetent.  Their explosives sometimes fail to detonate.  But that must give us no ground for complacency.  The same “incompetence” can sometimes result in unforeseen consequences that are even more destructive than those intended.

1.4 The sense of profound personal alienation

Environmental crisis.  Economic crisis.  Extreme terrorist crisis.  Added together, we might be facing a risk of around 50% that, sometime during the 2010s, we’ll collectively look back with enormous regret and say to ourselves:

That’s the worst thing that’s happened in our lifetime.  Why oh why didn’t we act to stop it happening?  But it’s too late to make amends now.  If only we could re-run history, and take wiser choices…

But there’s more.  Here’s a probability that I’ll estimate at 100%, rather than 50%.  It’s the probability that huge numbers of individuals will look at their lives with bitter regret, and say to themselves:

This outcome was very far from the best it could have been.  This human life has missed, by miles, the richness and quality of experience that was potentially available.  Why oh why did it turn out like this?  If only I could re-run my life, and take wiser choices, or benefit from improved circumstances…

The first three crises are global crises.  This fourth one is a personal crisis.  The first three are highly visible.  The fourth might just be an internal heartache.  It’s the realisation that:

  • Life provides, at least for some people, on at least some occasions, intense feelings of vitality, creativity, flow, rapport, ecstacy, and accomplishment;
  • These “peak experiences” are generally rare, or just glimpsed;
  • The majority of human experience is at a much lower level of quality than is conceivable.

The pervasive video broadcast communications of the modern age make it all the more obvious, to increasing numbers of people, that the quality of their lives fall short of what could be imagined and desired.  These same communications also strongly hint that technology is advancing to the point where it could soon free people from the limitations of their current existence, and enable levels of experience previously only imagined for deities.  Just around the corner lies the potential of lives that are much extended, expanded, and enhanced.  How frustrating to miss out on this potential!  It brings to mind the lamentations of a venerable French noblewoman from 1783, as noted in Lewis Lapham’s 2003 Commencement speech at St. John’s College Annapolis:

[A] French noblewoman, a duchess in her eighties, …, on seeing the first ascent of Montgolfier’s balloon from the palace of the Tuilleries in 1783, fell back upon the cushions of her carriage and wept. “Oh yes,” she said, “Now it’s certain. One day they’ll learn how to keep people alive forever, but I shall already be dead.”

Acts of gross destruction are often motivated by deep feelings of dissatisfaction or frustration: the world is perceived as containing significant wrongs, that need righting.  So there’s a connection between the crisis of profound personal alienation and the crisis of extreme terrorism.  Thankfully, people who experience dissatisfaction or frustration don’t all react in the same way.  But even if the reaction is only (as I suggested earlier) an internal heartache, the shortcoming between potential and reality is nonetheless profound.  Life could, and should, be so much better.

We can re-state the four crises as four huge opportunities:

  1. The opportunity to nurture an amazingly pleasant, refreshing, and intriguing environment;
  2. The opportunity to guide global economic development to sustainably create sufficient resources for everyone’s needs;
  3. The opportunity to utilise personal passions for constructive projects;
  4. The opportunity to enable individuals to persistently experience qualities of human life far, far higher than at present.

I see Humanity+ as addressing all four of these opportunities.  And it does so with an eye on one more crisis, which is the most uncertain one of the lot.

1.5 The existential crisis of accelerating change and deepening complexity

Time and again, changes have consequences that are unforeseen and unintended.  The more complex the system, the greater the likelihood of changes leading to unintended consequences.

However, human society is becoming more complex all the time:

  • Multiple different cultures and sub-cultures overlap, co-exist, and influence each other;
  • Worldwide travel is nowadays commonplace;
  • Increasing numbers of channels exist for communication and influence ;
  • Society is underpinned by a rich infrastructure of multi-layered technology.

Moreover, the rate of change is increasing:

  • New products sweep around the world in ever shorter amounts of time;
  • Larger numbers of people are being educated to levels never seen before, and are entering the worlds of research, development, manufacturing, and business;
  • Online collaboration mechanisms, including social networks, wikis, and open source software, mean it is easier for innovation in one part of the world to quickly influence and benefit subsequent innovation elsewhere;
  • The transformation of more industries from “matter-dominated” to “information-dominated” means that the rapid improvement cycle of semiconductors transforms the speed of progress.

These changes bring many benefits.  They also bring drawbacks, and – due to the law of unintended consequences – they bring lots of unknowns and surprises.  The risk is that we’ll waken up one morning and realise that we deeply regret one of the unforeseen side-effects.  For example, there are risks:

  • That some newly created microscopic-scale material will turn out to have deleterious effects on human life, akin (but faster acting) to the problems arising to exposure from asbestos;
  • That some newly engineered biochemical organism will escape into the wild and turn out to have an effect like that of a plague;
  • That well-intentioned attempts at climate “geo-engineering”, to counter the risk of global warming, will trigger unexpected fast-moving geological phenomenon;
  • That state-of-the-art high-energy physics experiments will somehow create unanticipated exotic new particles that destroy all nearby space and time;
  • That software defects will spread throughout part of the computing infrastructure of modern life, rendering it useless.

Here’s another example, from history.  On 1st March 1954, the US military performed their first test of a dry fuel hydrogen bomb, at the Bikini Atoll in the Marshall Islands.  The explosive yield was expected to be from 4 to 6 Megatons.  But when the device was exploded, the yield was 15 Megatons, two and a half times the expected maximum.  As the Wikipedia article on this test explosion explains:

The cause of the high yield was a laboratory error made by designers of the device at Los Alamos National Laboratory.  They considered only the lithium-6 isotope in the lithium deuteride secondary to be reactive; the lithium-7 isotope, accounting for 60% of the lithium content, was assumed to be inert…

Contrary to expectations, when the lithium-7 isotope is bombarded with high-energy neutrons, it absorbs a neutron then decomposes to form an alpha particle, another neutron, and a tritium nucleus.  This means that much more tritium was produced than expected, and the extra tritium in fusion with deuterium (as well as the extra neutron from lithium-7 decomposition) produced many more neutrons than expected, causing far more fissioning of the uranium tamper, thus increasing yield.

This resultant extra fuel (both lithium-6 and lithium-7) contributed greatly to the fusion reactions and neutron production and in this manner greatly increased the device’s explosive output.

Sadly, this calculation error resulted in much more radioactive fallout than anticipated.  Many of the crew in a nearby Japanese fishing boat, the Lucky Dragon No. 5, became ill in the wake of direct contact with the fallout.  One of the crew subsequently died from the illness – the first human casualty from thermonuclear weapons.

Suppose the error in calculation had been significantly worse – perhaps by an order of thousands rather than by a factor of 2.5.  This might seem unlikely, but when we deal with powerful unknowns, we cannot rule out powerful unforeseen consequences.  Imagine if extreme human activity somehow interfered with the incompletely understood mechanisms governing supervolcanoes – such as the one that exploded around 73,000 years ago at Lake Toba (Sumatra, Indonesia) and which is thought to have reduced the worldwide human population at the time to perhaps as few as one thousand breeding pairs.

It’s not just gargantuan explosions that we need fear.  As indicated above, the list of so-called “existential risks” includes highly contagious diseases, poisonous nano-particles, and catastrophic failures of the electronics infrastructure that underpins modern human society.  Add to these “known unknowns” the risk of “unknown unknowns” – the factors which we currently don’t even know that we should be considering.

The more quickly things change, the harder it is to foresee and monitor all the consequences.  There’s a great deal that deserves our attention.  How should we respond?

>> Next chapter >>

28 December 2009

Wired’s top 7 mobile disruptions of 2009

Filed under: change, disruption, futurist — David Wood @ 9:00 pm

Wired.com today provide their list of the “top 7 disruptions” for mobile in 2009:

  1. Google Stack
  2. Mobile App Stores
  3. HTML5
  4. A New FCC
  5. Streaming Music
  6. The Real-Time Web
  7. Augmented Reality

You can read the details on Wired.com.  It’s a pretty good list: all the items included are important.

To nitpick, it’s not clear that they all count as “disruptive” rather than “evolutionary”.  And it seems at least some of the items are on the list because of what they’ll accomplish in 2010 rather than in 2009.   Never mind.

Wired asks: “What did we miss?”

With the same two provisos as before, I offer four additional candidates for inclusion:

1.) Mobile maps

Mobile maps seem to be getting better and better, and to be used more and more widely.  With 3D as well as 2D, with improved routing, and with plug-in integration from numerous third party apps and services, this trend is likely to continue.

2.) Mobile payments

From the perspective of the so-called developed world, use of mobile phones in payment transactions still seems relatively unexciting.  But from the perspective of the developing world – in countries where bank accounts and credit cards are comparatively scarce – mobile payments are already making a decisive difference.

3.) User Experience

For a while, technologists could tell themselves that good user experience (UX) was an optional extra, necessary for some mobile products but not for all.  This view is fading fast.  It’s now clear that users have become aware that good UX is possible on mobile – even for complex services – and they have an increasingly dim view of any mobile product that score weakly on UX.

4.) Open Source

It’s still early days for people to see the benefits of applying open source methods to creating mobile tools, applications, services, middleware, and (last but far from least) to improve the underlying platform.  But the transformational potential is enormous  – both in the improvements that end users will notice, and in the skillsets best suited to take advantage of the new innovation engine.  For further discussion of these points, see my recent presentation “Open ecosystems: a good thing?” (PDF) to the Cambridge Wireless network.

29 October 2009

Bridging the knowing doing gap

Filed under: books, change, complacency, leadership — David Wood @ 12:50 pm

A May 2000 Fast Company article Why Can’t We Get Anything Done? poses a very good question:

These days, people know a lot. Thousands of business books are published around the world each year. U.S. organizations alone spend more than $60 billion a year on training — mostly on management training. Companies spend billions of dollars a year on consulting. Meanwhile, more than 80,000 MBAs graduate each year from U.S. business schools. These students presumably have been taught the skills that they need to improve the way that companies do business.

But all of that state-of-the-art knowledge leaves us with a nagging question: Why can’t we get anything done? It’s a mystery worthy of a business-school case study. If we’re so well trained and so well informed, then why aren’t we a lot more effective? Or, as Stanford professors Jeffrey Pfeffer and Robert I. Sutton ask in their useful book, The Knowing-Doing Gap: How Smart Companies Turn Knowledge Into Action (Harvard Business School Press, 2000), “Why is it that, at the end of so many books and seminars, leaders report being enlightened and wiser, but not much happens in their organizations?”

Pfeffer and Sutton’s book “The Knowing Doing Gap” made a big impact on me when I read it.

The book recounts a story of a company paying consultants to come in and give them advice on particular strategy issues.  The consultants eventually found that previous consultants had already been engaged and produced reports that matched what they themselves were going to recommend.  The company had already received the advice which the consultants thought was best – but had failed to be able to act on that advice.

It’s a familiar story.  Companies bring in external advisors who say things that management agree make sense, but … nothing changes.

My own takeaway from the book was the following set of five characteristics of companies that can successfully bridge this vicious “Knowing Doing Gap”:

  1. They have leaders with a profound hands-on knowledge of the work domain;
  2. They have a bias for plain language and simple concepts;
  3. They encourage solutions rather than inaction, by framing questions asking “how”, not just “why”;
  4. They have strong mechanisms that close the loop – ensuring that actions are completed (rather than being forgotten, or excuses being accepted);
  5. They are not afraid to “learn by doing”, and thereby avoid analysis paralysis.

If you don’t have time to read the whole book, there’s a 38 minute long download “The smart talk trap” from Audible that covers much of the same ground.  It’s the audio version of a 1999 Harvard Business Review article by Pfeffer and Sutton:

The key to success in business is action. But in most companies, people are rewarded for talking – and the longer, louder, and more confusingly, the better. The good news is, there are 5 strategies that can help you avoid the trap.

Footnote: There’s one other angle that deserves a mention on this topic.  It’s the angle of why change programs frequently fail.  John Kotter has shed much light on this question.  I wrote about this previously, in “Why good people fail to change bad things“.

25 December 2008

Why good people fail to change bad things

Filed under: books, change, complacency, leadership, urgency — David Wood @ 3:22 pm

2008 has been a year of great change in the Symbian world. Important change initiatives that were kicked off in previous years have gathered speed.

2008 has also seen change and trauma at many other levels, throughout the mobile industry and beyond. And the need for widespread change still remains. Daily – perhaps hourly – we encounter items that lead us to wonder: Why isn’t someone getting this changed? Why isn’t someone taking proper care of such-and-such a personal issue, family issue, social issue, organisational issue, political issue, educational issue, environmental issue, operating system issue, ecosystem management issue, usability issue, and so on?

I’ve attended quite a few “change facilitation workshops” and similar over the last 24 months. One thinker who has impressed me greatly, with his analysis of the causes of failure of change initiatives – even when good people are involved in these initiatives – is Harvard Business School Professor John Kotter. Kotter describes a series of eight steps which he recommends all significant change initiatives to follow:

  1. Build a sense of urgency
  2. Establish an effective guiding coalition
  3. Create a clear, appealing vision
  4. Communicate, communicate, communicate
  5. Remove obstacles (“empower”)
  6. Celebrate small wins
  7. Follow through with wave after wave of change
  8. Embed the change at the cultural level.

Lots of other writers and speakers have their own different ways of describing the processes of successful change initiatives, but I find Kotter’s analysis to be the most insightful and inspiring.

The main book that covers this eight stage process is “Leading Change” – a book that must rank high in the list of the most valuable business books ever written.

Subsequently, Kotter used the mechanism of an easily-read “cartoon book”, “Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions“, in order to provide a gentle but compelling introduction to his ideas. It’s a fable about penguins. But it’s a fable with real depth. (I noticed it and purchased a copy in the Inverness airport bookshop one day, and had finished reading it by the time my plane south landed at Gatwick. I was already resolved to find my copy of “Leading Change” and re-read it.)

As Kotter emphasises, the steps in the eight-stage change leadership process have mirror images which are the main eight reasons why change initiatives stumble:

  1. Lack of a sufficient sense of urgency;
  2. Lack of an effective guiding coalition for the change (an aligned team with the ability to make things happen);
  3. Lack of a clear appealing vision of the outcome of the change (otherwise it may seem too vague, having too many unanswered questions);
  4. Lack of communication for buy-in, keeping the change in people’s mind (otherwise people will be distracted back to other issues);
  5. Lack of empowerment of the people who can implement the change (lack of skills, wrong organisational structure, wrong incentives, cumbersome bureaucracy);
  6. Lack of celebration of small early wins (failure to establish momentum);
  7. Lack of follow through (it may need wave after wave of change to stick);
  8. Lack of embedding the change at the cultural level (otherwise the next round of management changes can unravel the progress made).

A few months ago, Kotter released yet another book on the subject of change initiatives that go wrong. Like “Our Iceberg Is Melting”, this is another slim book – only having 128 pages, and with large typeface, making it another very quick read. But, again, the ideas have real merit. This book is called “A sense of urgency“.

As the name implies, this book focuses more fully on the first stage of change initiatives. The biggest reason why significant change initiatives fail, in Kotter’s considered view, is because of a lack of:

a real sense of urgency – a distinctive attitude and gut-level feeling that lead people to grab opportunities and avoid hazards, to make something important happen today, and constantly shed low-priority activities to move faster and smarter, now.

Instead, most organisations (and most people) become stuck in a combination of complacency and what Kotter describes as “false urgency”:

  • Complacency is frequently fuelled by past successes and time-proven strengths – that may, however, prevent organisations from being fully aware of changes in circumstances, technologies, and markets;
  • False urgency involves more activity than productivity: “It is frenetic. It is more mindless running to protect themselves or attack others, than purposive focus on critical problems and opportunities. Run-run, meet-meet, talk-talk, defend-defend, and go home exhausted.”

Kotter provides a helpful list of questions to help organisations realise if they are suffering from over-complacency and/or false urgency:

  • Are critical issues delegated to consultants or task forces with little involvement of key people?
  • Do people have trouble scheduling meetings on important initiatives (“Because, well, my agenda is so full”)?
  • Is candour lacking in confronting the bureaucracy and politics that are slowing down important initiatives?
  • Do meetings on key issues end with no decisions about what must happen immediately (except the scheduling of another meeting)?
  • Are discussions very inwardly focused and not about markets, emerging technologies, competitors, and the like? …
  • Do people run from meeting to meeting, exhausting themselves and rarely if ever focusing on the most critical hazards or opportunities? …
  • Do people regularly blame others for any significant problems, instead of taking responsibility and changing? …

The centrepiece of “A sense of urgency” is a set of four tactics to increase a true sense of urgency:

  1. Bring the outside in. Reconnect internal reality with external opportunities and hazards. Bring in emotionally compelling data, people, video, sights, and sounds.
  2. Behave with urgency every day. Never act content, anxious, or angry. Demonstrate your own sense of urgency always in meetings, one-on-one interactions, memos, and email, and do so as visibly as possible to as many people as possible.
  3. Find opportunity in crises. Always be alert to see if crises can be a friend, not just a dreadful enemy, in order to destroy complaceny. But proceed with caution, and never be naive, since crises can be deadly.
  4. Deal with the NoNos. Remove or neutralise all the relentless urgency-killers: people who are not skeptics but who are determined to keep a group complacent or, if needed, to create destructive urgency.

The rest of the book fleshes out these tactics with examples (taken from Kotter’s extensive consulting and research experience) and additional checklists. To my mind, there’s a great deal to learn from here.

Footnote: Kotter’s emphasis on the topic of “real urgency” may seem to fly in opposition to one of the most celebrated messages of the literature on effectiveness, namely the principle that people should focus on matters that are important rather than matters that are merely urgent. In the renowned “first things first” language of Stephen Covey, people ought to prioritise “Quadrant two” (activities which are important but not urgent) over “Quadrant three” (activities with are urgent but not important).

To my mind, both Kotter and Covey are correct. We do need to start out by figuring what are the most important activities. And then we have to ensure that we keep giving sufficient attention to these activities. Kotter’s insight is that organisations and people can address this latter task by means of the generation of a sufficient sense of urgency around these activities. In other words, we should drive certain key targets out of Quadrant two into Quadrant one. That way, we’ll be more likely to succeed with our key change initiatives.

« Newer Posts

Blog at WordPress.com.