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What’s the difference between a physician and a surgeon?
If you were sick in the Middle Ages you had three options: the church, the local healer, and the physician. A physician was the most expensive and least effective. If you had a migraine, for example, he would cut you open and bleed you. The local healer would give you an amulet to wear on your head and an herbal tincture made from walnuts. You were better off with her because she did not bleed you - same with the church. Sadly, this was the state of affairs for most of human history. As the medieval scholar James Hannam notes, “the history of medicine until the 19th century… is a history of failure.”
Surgeons are a different story. They made great advancements starting with the ancient Greeks. By the Middle Ages they could provide stiches, set bones, remove tumors and perform successful amputations. Why? Surgeons had access to something physicians did not: clear feedback. Physicians struggled because they didn’t know that they were getting it wrong - the source of an illness and the effectiveness of a treatment were obscure. When surgeons operated it was clear – sometimes fatally clear – when something did not work.
Improving human judgment and decision-making is challenging because, like a physician before the modern era, it’s difficult to know when you’ve screwed up. Here’s the problem: awareness doesn’t seem to help (no one ever became more rational after reading a few decision-making books). Some research shows that we can overcome some biases in the short term. But we always return to our default state, in which we are ignorant of our ignorance. The question is: if awareness doesn’t work, what does?
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Let’s return to medicine.
In 1847 Ignaz Semmelweis was working in the Maternity Department in a Vienna hospital when he noticed something: women in a ward run by doctors were contracting puerperal fever (or childbed fever) and dying at a rate nine times higher than women in a ward run by midwives. What caused the asymmetry? Semmelweis acquired a vital clue when his colleague Jakob Kolletschka, a doctor, cut his finger while conducting an autopsy and died of puerperal fever a few days later. Midwives did not preform autopsies, Semmelweis reasoned, so doctors must be transferring the fever from the corpses to the mothers. He was right. The solution? Hand washing.
Despite Semmelweis’ research, every year in the United States about 2 million people every year contract an infection they did not have before entering the hospital. Worse, hundreds of thousands of patients die in hospitals each year from avoidable mistakes. Many of these mistakes, just like the microbes that cause puerperal fever, are invisible.
Consider the following real story. A patient was undergoing an operation to remove a tumor from his stomach when his heart stopped. The cause was a mystery. The patient was not losing blood, his lungs were receiving oxygen, and the doctors were not detecting any abnormalities. That’s when the anesthesiologist remembered that the patient had a low potassium level and that he accidently gave him a dose one hundred times more than what was expected. It was a lethal amount. When the team realized this they administered appropriate drugs to counteract the potassium. The patient’s heart started again and he pulled through.
This story and others like it come from Atul Gawande’s bestseller The Checklist Manifesto. Drawing from strategies used in the aviation and engineering industry, Gawande suggests that surgical teams adopt checklists. The purpose of the checklist is not instructional but to prevent trivial mistakes by forcing surgical teams to avoid “errors of ineptitude” (mistakes we commit because we don’t make proper use of our knowledge). It works. In 2012 Gawande reports that in eight hospitals that adopted the checklist strategy complication rates feel 35 percent and death rates feel 47 percent.
In other words, knowledge isn’t the problem – we can fix nearly every illness today. It’s human error, and a checklist is an easy solution. In this way, Semmelweis identified the problem and Gawande showed us how to avoid it.
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This brings me back to human rationality. Research on judgment and decision-making has its Semmelweis (Kahneman and Tversky) but it lacks a Gawande.
Last week I finished Francesca Gino’s Sidetracked: Why Our Decisions Get Derailed, and How We Can Stick to the Plan. Like most pop decision making books, it uses the Story-Study-Lesson format to highlight human error for a lay audience. It’s good but we’ve heard it before: systematic biases distort our decisions. Now we need to know what to do about it. Awareness is not enough.
One solution comes from Decisive: How to Make Better Choices in Life and Work by Chip and Dan Heath. The Heath brothers propose a four step strategy summed up by the acronym WRAP: Widen Your Options (to avoid narrow framing), Reality-Test Your Assumptions (to avoid confirmation bias), Attain Distance Before Deciding (to avoid short-term emotion), Prepare To Be Wrong (to avoid overconfidence). The beauty of WRAP is that it is a checklist. Its effectiveness is unclear, but I think it’s the right idea.
People unfamiliar with decision-making research are like physicians before Semmelweis: without clear feedback they don’t know that they are screwing up. Research from Kahneman and Tversky and books like Sidetracked highlight our mistakes. But the nature of biases means that’s not enough. We need tools to compensate for them, just like medical professionals needed Gawande’s checklist. Improving decision-making does not mean studying biases. We need to figure out how to use our knowledge of our ignorance.
Image via Robert Kneschke/Shuttershock
Your body’s full of stuff you no longer need. Here's a list.
Evolution doesn't clean up after itself very well.
- An evolutionary biologist got people swapping ideas about our lingering vestigia.
- Basically, this is the stuff that served some evolutionary purpose at some point, but now is kind of, well, extra.
- Here are the six traits that inaugurated the fun.
The plica semilunaris
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgwMS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY3NDg5NTg1NX0.kdBYMvaEzvCiJjcLEPgnjII_KVtT9RMEwJFuXB68D8Q/img.png?width=980" id="59914" width="429" height="350" data-rm-shortcode-id="b11e4be64c5e1f58bf4417d8548bedc7" data-rm-shortcode-name="rebelmouse-image" />The human eye in alarming detail. Image source: Henry Gray / Wikimedia commons
<p>At the inner corner of our eyes, closest to the nasal ridge, is that little pink thing, which is probably what most of us call it, called the caruncula. Next to it is the plica semilunairs, and it's what's left of a third eyelid that used to — ready for this? — blink horizontally. It's supposed to have offered protection for our eyes, and some birds, reptiles, and fish have such a thing.</p>Palmaris longus
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgwNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzQ1NjUwMn0.dVor41tO_NeLkGY9Tx46SwqhSVaA8HZQmQAp532xLxA/img.jpg?width=980" id="879be" width="1920" height="2560" data-rm-shortcode-id="4089a32ea9fbb1a0281db14332583ccd" data-rm-shortcode-name="rebelmouse-image" />Palmaris longus muscle. Image source: Wikimedia commons
<p> We don't have much need these days, at least most of us, to navigate from tree branch to tree branch. Still, about 86 percent of us still have the wrist muscle that used to help us do it. To see if you have it, place the back of you hand on a flat surface and touch your thumb to your pinkie. If you have a muscle that becomes visible in your wrist, that's the palmaris longus. If you don't, consider yourself more evolved (just joking).</p>Darwin's tubercle
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgxMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0ODUyNjA1MX0.8RuU-OSRf92wQpaPPJtvFreOVvicEwn39_jnbegiUOk/img.jpg?width=980" id="687a0" width="819" height="1072" data-rm-shortcode-id="ff5edf0a698e0681d11efde1d7872958" data-rm-shortcode-name="rebelmouse-image" />Darwin's tubercle. Image source: Wikimedia commons
<p> Yes, maybe the shell of you ear does feel like a dried apricot. Maybe not. But there's a ridge in that swirly structure that's a muscle which allowed us, at one point, to move our ears in the direction of interesting sounds. These days, we just turn our heads, but there it is.</p>Goosebumps
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMxNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNzEyNTc2Nn0.aVMa5fsKgiabW5vkr7BOvm2pmNKbLJF_50bwvd4aRo4/img.jpg?width=980" id="d8420" width="1440" height="960" data-rm-shortcode-id="8827e55511c8c3aed8c36d21b6541dbd" data-rm-shortcode-name="rebelmouse-image" />Goosebumps. Photo credit: Tyler Olson via Shutterstock
<p>It's not entirely clear what purpose made goosebumps worth retaining evolutionarily, but there are two circumstances in which they appear: fear and cold. For fear, they may have been a way of making body hair stand up so we'd appear larger to predators, much the way a cat's tail puffs up — numerous creatures exaggerate their size when threatened. In the cold, they may have trapped additional heat for warmth.</p>Tailbone
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMxNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3MzQwMjc3N30.nBGAfc_O9sgyK_lOUo_MHzP1vK-9kJpohLlj9ax1P8s/img.jpg?width=980" id="9a2f6" width="1440" height="1440" data-rm-shortcode-id="4fe28368d2ed6a91a4c928d4254cc02a" data-rm-shortcode-name="rebelmouse-image" />Coccyx.
Image source: Decade3d-anatomy online via Shutterstock
<p>Way back, we had tails that probably helped us balance upright, and was useful moving through trees. We still have the stump of one when we're embryos, from 4–6 weeks, and then the body mostly dissolves it during Weeks 6–8. What's left is the coccyx.</p>The palmar grasp reflex
<img class="rm-lazyloadable-image rm-shortcode" type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMyMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjY0MDY5NX0.OSwReKLmNZkbAS12-AvRaxgCM7zyukjQUaG4vmhxTtM/img.jpg?width=980" id="8804c" width="1440" height="960" data-rm-shortcode-id="67542ee1c5a85807b0a7e63399e44575" data-rm-shortcode-name="rebelmouse-image" />Palmar reflex activated! Photo credit: Raul Luna on Flickr
<p> You've probably seen how non-human primate babies grab onto their parents' hands to be carried around. We used to do this, too. So still, if you touch your finger to a baby's palm, or if you touch the sole of their foot, the palmar grasp reflex will cause the hand or foot to try and close around your finger.</p>Other people's suggestions
<p>Amir's followers dove right in, offering both cool and questionable additions to her list. </p>Fangs?
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Lower mouth plate behind your teeth. Some have protruding bone under the skin which is a throw back to large fangs. Almost like an upsidedown Sabre Tooth.</p>— neil crud (@neilcrud66) <a href="https://twitter.com/neilcrud66/status/1085606005000601600?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Hiccups
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Sure: <a href="https://t.co/DjMZB1XidG">https://t.co/DjMZB1XidG</a></p>— Stephen Roughley (@SteBobRoughley) <a href="https://twitter.com/SteBobRoughley/status/1085529239556968448?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Hypnic jerk as you fall asleep
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">What about when you “jump” just as you’re drifting off to sleep, I heard that was a reflex to prevent falling from heights.</p>— Bann face (@thebanns) <a href="https://twitter.com/thebanns/status/1085554171879788545?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script> <p> This thing, often called the "alpha jerk" as you drop into alpha sleep, is properly called the hypnic jerk,. It may actually be a carryover from our arboreal days. The <a href="https://www.livescience.com/39225-why-people-twitch-falling-asleep.html" target="_blank" data-vivaldi-spatnav-clickable="1">hypothesis</a> is that you suddenly jerk awake to avoid falling out of your tree.</p>Nails screeching on a blackboard response?
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Everyone hate the sound of fingernails on a blackboard. It's _speculated_ that this is a vestigial wiring in our head, because the sound is similar to the shrill warning call of a chimp. <a href="https://t.co/ReyZBy6XNN">https://t.co/ReyZBy6XNN</a></p>— Pet Rock (@eclogiter) <a href="https://twitter.com/eclogiter/status/1085587006258888706?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Ear hair
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Ok what is Hair in the ears for? I think cuz as we get older it filters out the BS.</p>— Sarah21 (@mimix3) <a href="https://twitter.com/mimix3/status/1085684393593561088?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Nervous laughter
<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">You may be onto something. Tooth-bearing with the jaw clenched is generally recognized as a signal of submission or non-threatening in primates. Involuntary smiling or laughing in tense situations might have signaled that you weren’t a threat.</p>— Jager Tusk (@JagerTusk) <a href="https://twitter.com/JagerTusk/status/1085316201104912384?ref_src=twsrc%5Etfw">January 15, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Um, yipes.
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Sometimes it feels like my big toe should be on the side of my foot, was that ever a thing?</p>— B033? K@($ (@whimbrel17) <a href="https://twitter.com/whimbrel17/status/1085559016011563009?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>The COVID-19 pandemic has introduced a number of new behaviours into daily routines, like physical distancing, mask-wearing and hand sanitizing. Meanwhile, many old behaviours such as attending events, eating out and seeing friends have been put on hold.
VR experiments manipulate how people feel about coffee
A new study looks at how images of coffee's origins affect the perception of its premiumness and quality.
Expert drinking coffee while wearing a VR headset.
Is empathy always good?
Research has shown how important empathy is to relationships, but there are limits to its power.
