The Moral Arithmetic of Humble Bundle

Someone comments on yesterday’s Humble Bundle post:

 Hmmm, if I’ve pledged to donate 10% of my income to charity, and I select an effective charity (eg. Against Malaria Foundation) as the 100% recipient on my humble bundle, should I morally count that as part of my charitable donations?

It doesn’t count for taxes or company matching. And on a practical level, I think that if $12 is a high enough percentage of your donation budget it’s worth the accounting overhead, you are probably not in a donation season of your life. Focus on savings and investing in yourself.

But maybe the overhead is cheap for you, plus Someone specifically asked about morality. And that depends on what kind of morals you’re working with.

If you’re strictly utilitarian, I think you can count the sale price of the bundle as equivalent to a donation . The fact that you got something out of it is irrelevant to the good it does.

If you’re a virtue ethicist I think it doesn’t count, because you got something out of it besides bed nets.

I’m not a strict utilitarian or virtue ethicist. I think I have an obligation to give ~10% of my income because my ability to earn that income is in part based on things I didn’t earn, like being born in America with a high IQ to parents with money and a love of education. The “luck tax” framing is why I get to deduct the costs of being unlucky (e.g. medical bills) from the income used to calculate required donations. Under this framework I also don’t count Humble Bundle purchases as donations, because I’m getting something out of it.

But I only buy bundles I would happily buy without the charitable inducement. You could argue that the difference between what I’m willing to pay commercially and what I actually pay is a donation. This is relevant right now as the current bundle is attractive to me for the Crusader Kings 2 expansion, Stellaris, and maybe Cities in Motion 2* but not quite $12 attractive, especially because missing expansions for a game I own distresses me far out of proportion to the actual expected value of the expansion. However, “I totally wouldn’t have bought this except it goes to charity” seems like an easy rule to game.

There’s another moral issue though, which is paying the developers and Humble Bundle for their work. Paying the developers feels least pressing for cases where they’re using HB as a lure in an attempt to get you to buy more, but I think it’s important when people put complete games in a bundle. Humble Bundle itself has costs, and I think it’s only fair to cover those. You might think saving babies from malaria is obviously so much more important it doesn’t matter, but that’s an overfeeding from the commons that prevents us from having nice things if it spreads. I like having nice things.

I’d feel differently if HB or the developer chose the charity themselves; that’s paying them via an indirect route. But when you’re picking the charity, it doesn’t count towards paying the devs.

So I think on a moral level you get to count the difference between what the games are worth to you and what you actually pay (but don’t inflate your price to donate, that’s just dumb), unless you’re a utilitarian, in which case you can count the whole thing. But if it’s actually worth the mental overhead to you, probably focus on building a savings cushion and improving yourself rather than donating at all.

*I love the concept but found Cities in Motion 1 disappointing

Humble Paradox Bundle

Humble Bundle is a website that sells very cheap bundles of (mostly older) video games. And by cheap I mean “pay what you want”, although paying more does get you more games. You choose how much of the purchase price to distribute to a charity, the game developers, and Humble Bundle itself.

Paradox is a games publisher and developer that I am super glad exists. Their games are genuinely different. For example, Majesty is kind of an RTS, except you don’t control your units. All you can do is build buildings and set rewards, and then watch your idiot fragile wizards walk into a den of monsters over and over while your high level warriors sit around because no reward is high enough to interest them.  I have lost hours to this game.

Humble Bundle is currently hosting a Paradox Bundle (sponsored link). It includes the sequel to Majesty, which plays basically the same except dwarves are amazing. It also includes Crusader Kings 2, aka “the real Game of Thrones game.” It is kind of like an RTS, except you build power mainly through marriage alliances and politicking.  I sunk about 20 hours into this game before losing my tiny Irish Kingdom to a hard drive failure, and could never build up the heart to play again.

 

Paradox Games frequently make Extra Credit’s Games You Might Not Have Tried series, which by the way is an excellent series you should follow if you’re interested in seeing games evolve as an art form. My excitement after watching a game appear on GYMNHT is a very good predictor of how much I eventually enjoy a game, so I’m just going to link to the relevant episodes here.

Europa Universalis III and Hearts of Iron III

Crusader Kings II

Stellaris

A word of warning- Paradox games tend to have a *lot* of DLC, some real and some cosmetic. Some of these games are either old enough that that’s not an issue (Majesty 2) or are being sold with DLC (Europa Universalis III Complete, although if that turns out to mean “complete in 2014 but we’ve added 4 DLCs since then” I will not be surprised). You can be perfectly happy playing the main games without the DLC, but this bundle is obviously a loss leader trying to induce you to spend more. For example, the complete Crusader Kings 2 is $160 on HB right now ($100 cheaper than Steam, so I guess the humble store isn’t useless after all). I find this a little out of keeping with the spirit of Humble Bundles (me getting cheap games price discrimination). Simultaneously, it strikes me as quite reasonable; I already joke that HB isn’t me buying games, it’s me buying the chance to try games, and if I happen to enjoy it I get the game for free. Monetizing that second part is totally fair. $200 feels like it’s pushing it through.

While I’m shilling, Humble Bundle has a monthly bundle for which only one game is announced ahead of time. The game for February is Civilization 6, which is itself worth the $12 if you’re into that sort of thing.

The Tallest Pygmy Effect

Status: I thought this was a common economics term, but when I google it I get either unrelated or references using it the way I expect but not defining it. It’s a really useful term, so I’m going to attempt to make it a thing.

“Tallest Pygmy Effect” is when you benefit not from absolute skill or value at a thing, but by being better at it than anyone else.  For example, the US dollar is not that great a currency and the US economy is not that great an economy. However, the dollar is more stable than other currencies, so it becomes the currency of choice when you want stability. This high volume makes USD more stable and is in general good for the US economy (because e.g. US companies don’t have to take on currency risk when they borrow money).

Tallest pygmy effects are fragile, especially when they are reliant on self-fulfilling prophecies or network effects. If everyone suddenly thought the Euro was the most stable currency, the resulting switch would destabilize the dollar and hurt both its value and the US economy as a whole.

Epistemic Spot Check: The Tapping Solution (Nick Ortner)

This is part of a series called epistemic spot checks, in which I investigate claims a book makes to see if it’s worth paying attention to, without attempting to be comprehensive about it.

Introduction

This is a weird review to write.  I went into reading The Tapping Solution with two beliefs:

  1. The scientific claims would be far less supported than the author implies.  The best case scenario was “as terrible as your average therapy research.”
  2. The book’s prescriptions work for me anyway, in the sense that they make me calmer and happier and enable me to take better actions.

This book is about EFT, which stands for emotional freedom technique. I write that in a very small font in the hopes you won’t notice how stupid it sounds.  EFT is also known as tapping, because the primary action is tapping your fingers against your face.

I originally learned about EFT in a book that went full blown magic about it: you tap your fingers on your face, it changes energy currents in your body, and the universe magically gives you what you want.  There’s no point evaluating the science in books like that; they are what they are.   The Tapping Solution markets itself as the more studious cousin of that book.  It keeps the energy channels but backs off the magic gifts claim, offering the much more defensible explanation that tapping changes something in you that lets you create better outcomes.

The basic idea of EFT is you tap out a pattern on your body, mostly your face, while repeating a statement about something with a lot of negative emotional affect for you, especially ones that activate the sympathetic nervous system (fight/flight/freeze).  Repeat until you feel better.

[There’s a lot of different techniques claiming to be The Best EFT Script and, while I suspect there are individual variations in what works best for each person, I can’t possibly care about the intra-EFT wars.  Any script you use should just be a starting point for making your own anyway.]

Why would tapping improve your mood?  I have some guesses:

  • It makes anxiety et al. boring.  There are a lot of activities where people deliberately activate their SNS (sky diving, horror movies, drugs), so there must be something fun rewarding about being activated.    Plus, lots of the things that happen to you in response to anxiety are quite pleasant.  People cuddle you and bring you ice cream.  You put off doing the stressful thing.  I don’t think many people deliberately push themselves into hysterics for the attention, but I do think these benefits bias how people handle their stress.  Tapping does not offer those kinds of rewards; after two or three rounds of tapping, you are bored.  There are times I have gone and done the stressful thing because I would rather deal with it than have to do another round of tapping.  It’s nice to have my intolerance for boredom harnessed for good.
    • I suspect this is some of how cognitive behavioral therapy works as well.  Having taught myself both, EFT is less work and yet harder to develop an immunity too, although hybrid systems do better still.
  • A sense of control lowers stress.  Having A Thing You Can Do While Stressed that you think lowers your stress level is already lowering your stress level.  You can dismiss this as a self-fulfilling prophecy, but that’s only the point if you’re actually evaluating the concept of energy meridians.  If what you want is to calm down so you can respond to comments on your code review, it doesn’t matter if it’s a placebo.
  • Something something vagus nerve.  The vagus nerve is this weird nerve that skips the spinal cord and runs all over your body, including most major organs and a lot of your face.
    • Its tasks include:
      • Parasympathetic (relaxing) stimulation of all major organs except the adrenal glands.
      • Parasympathetic stimulation of muscles around the mouth and larynx.
      • Possibly reduces systemic inflammation
      • Sympathetic (fight/flight/freeze) stimulation of blood vessels.
      • A bunch of sensory stuff around the face.
    • Activity on your face is already known to affect your body via the vagus nerve.
      • Cold water on the face slows down your heart, and this is attributed mainly to the vagus nerve.
      •  Direct electrical stimulation of the nerve is touted as a cure for all kinds of stuff.  My sense is the science on that is… optimistic, but there is a reason it is being done to the vagus nerve and not something else.
    • There’s an alternate EFT script that involves tapping only on the hands.  I have fond this to be a calming distraction at best.  Hands are also pretty innervated, so this points to the effects being due to something specifically in the face, as opposed to sensitivity in general.
    • I yawn *a lot* while tapping.  Heart problems can cause yawning via the vagus nerve. I’m obviously not damaging my heart by tapping, I mention this just to show that the vagus nerve and yawning are related.
    • So I don’t know what’s going on, but I suspect the effect of tapping is mediated via the vagus nerve.
  • It’s a framework for breaking your problem into bite sized chunks, which is the ideal size for problems to be.  EFT practices vary in how much you work off a verbal script you’re given, vs introspect on your own issues and tap on what comes up.  I predict script-style work to be at best competitive with relaxation exercises, and only introspective EFT leads to actual improvements.
  • Who knows, maybe energetic meridians are a real thing, or at least a workable metaphor for a real thing.  Lots of things sound stupid until you know how they work.
    • In particular, if you mixed up the explanations for EFT and the much more legitimate EMDR (deliberate eye movements rewiring your brain), I’m not convinced anyone could tell which one was the Officially Sanctioned Therapy and which was the crackpot treatment.
    • Mark at meditationstuff.com argues that what gets sensed as energy flow is severe awareness of your own nervous system.  He provides no compelling evidence for this, but it is interesting.
    • Many Properly Credentialed Authorities believe things that are no weirder.

 

How I evaluated this book: usually when doing these checks I evaluate any statement I find interesting.  In this case, I’m sticking to the ones for which the author explicitly claims scientific backing.  For stuff that is essentially running on placebos and metaphors, I find a calm, confident, made up explanation is better than a hedged, hesitant, literally true one, so I’m not going to investigate the obviously exaggerated claims.  But if you’re going to claim scientific validity, I am going to check.

Claim: “The amygdala is the source of emotions and long term memories, and it’s where negative experiences are encoded (p4)”.

True.  Simplified, but obviously trying to explain how the amygdala was relevant to a particular concept, not give a comprehensive overview of our friend the amygdala.  The amygdala is in fact so good at emotional memory that it can be invoked by visual cues even in people blinded by brain damage.  This confused me at first, so let me note that the amygdala is not involved in fight/flight/freeze, but the longer, cortisol-driven chronic kind of stress.

Claim: Stimulating acupoints calms down the amygdala, and this is observable in fMRI and PET machines (p5).

Misleading, either bad faith or credulous.  Both studies cited were done with acupuncture, not acupressure or tapping.  I consider that relevant evidence for EFT, but dislike that he tried to make it even stronger evidence by hiding that both studies involved needles.  The effectiveness of acupuncture appears to have large if weak support; I very quickly pulled up many more studies demonstrating the exact same thing, all of which were tiny (the largest was 18), and used fMRIs, which are suspect.

In general, studies of acupuncture have shown that it kind of works, but Official Legitimate Chinese Medicine Points don’t do any better than a random spot, so this adds more legitimacy to randomly stabbing yourself than it does to meridian points.

Claim: Other studies show that pressure works just as well for stabbing, maybe even better for anxiety (p5).

Seems legit.  I didn’t find any citation for this but I’m willing to spot him that touching works better than stabbing for anxiety.

Claim: A study demonstrated that EFT reduces cortisol levels in the saliva (p5).

True, evidence weak but better than I guessed.  The study cited is real, and with some effort I even found a full PDF.  EFT did better than both a support group and no treatment on both a symptoms assessment and cortisol levels (24% decrease vs 14%).  The differences in symptoms between EFT and the other groups are small, and some were not statistically significant.  OTOH, every one of them goes in the same direction.  I find this pretty compelling, assuming they published every trait they recorded.  As usual, small study, vulnerable to p-hacking, etc.

Claim: This John Hopkins approved doctor agrees with us (p7).

Misleading, possibly very.  The named person (David Friedman) does exist, but he’s a doctor of psychology, not psychiatry.  The level that JHU approves of him is unclear.  On his CV (PDF) he lists himself as “research associate”, “instructor”, and “faculty.”  None of these words are “professor”, which makes me think he was an adjunct and certainly didn’t have tenure.

Claim: Competing systems telling you to never think about the negative are idiotic.  True things are true (p8).  In particular The Secret is bullshit.

Seems legit.  “Make bad things approachable”  just seems like a better tactic than wishing really hard. I also enjoy watching different alt modalities fight with each other.

Claim: Meridians have been scientifically validated, they’re called Bonghan channels (p10).

False.  The official name of Bonghan channels is the primo-vascular system, and there’s minimal evidence it exists.  Given that it’s pretty hard to prove that there’s a link between them and meridians in any scientific sense.  But it’s established fact within the meridian community, so it’s at least well sourced bullshit.

 

A few more notes on The Tapping Solution.

As expected, Tapping Solution has failed the RCT test.  What about the model test?

Well, it’s a fairly vague model, and energy meridians can be used to power anything.  On the other hand it avoids my biggest complaint about heal-yourself-with-the-placebo-effect books, and also religion, certain parts of medicine, and psychology, which is that the solution to failure is often do the same thing harder.  Tapping by and large avoids that trap.  For actual physical problems you’re encouraged to see a doctor first, then tap, and if that doesn’t work see a doctor again.  If a particular tap isn’t working you’re given alternate prompts to try.  Additionally, tapping claims that often it will work so well you’ll forget you will ever upset about something, and the solution is not to hand over money to the nice man to keep the good vibes flowing, it’s to keep track of how upset you are at the beginning of the session.  That level of empiricism shouldn’t make a book stand out, but it does.  Tapping Solution, although not every book on EFT, is also pretty clear that you’re not imposing your will on the universe, you’re calming down so you can take better actions.

I don’t want to write out instructions for tapping because I believe the process of reading a book adds a lot of value over a quick run through (the same way doing yoga is better for you than waving a magic wand and becoming more flexible).  But to help you decide if even starting the book is worth your time, here are some genres of problems I think tapping is most appropriate for:

  • Somaticizations, especially back pain.
  • Emotions you find too overwhelming to deal with, especially anxiety.
  • Legit life problems that are just too big to deal with all at once and need to be broken into bite size pieces.

Model

Simplicity: very low.  “Magical energy currents” sounds simple in that you can explain it quickly, but it takes a very long time to explain what things it can’t do and why.

Explanation quality: poor.  Merdians can power anything.

Explicit predictions: okay. You have to make your own explicit predictions, but the book very much encourages you to do so.

Acknowledging limitations: mixed.

Relative to other heal-yourself-with-the-placebo-effect systems, The Tapping Solution is modest in its claims about what your mind can do.  It goes out of its way to establish that the mind-body connection is in fact a connection, it doesn’t mean your body is a hallucination you can will into whatever form you want.

GemasAugust2015.png
Lesbian space rocks whose bodies are solid holograms  are not representative study subjects.

And then on the next page there’s a story of how a woman cured her lung cancer with EFT.  So it’s not amazing on this axis.

Measurability: extremely good.  This is where EFT really shines.  They claim it’s such a good technique you will forget you ever had a problem, and encourage you to keep track so you won’t forget.

 

Empirics

I’m deliberately not giving a lot of details on how to do it yourself, because I think there might be value to going through the book beyond the technique.

I taught this technique to five people, one of whom had a good response to it. Counting myself, that’s 1/3 successes, which is not great. But it’s cheap enough and has high enough potential I still recommend trying it.

 

Product Endorsement: Secret Stuff Chalk Cream

This is strictly for the climbers and other friction-ey athletes in the audience.

Chalk Cream is a lotion you rub on your hands, then air dry so that the alcohol evaporates and the chalk remains. I did not realize how amazing it was until I tried regular chalk. Regular chalk comes off in maybe three holds. Chalk Cream is still present at the top of very tall belaying routes. Yes, it is harder to reapply, but you need to do so so much less often.

I have no idea why this stuff hasn’t gone to fixation because it’s eons better and not that much more expensive than traditional chalk- possibly cheaper, if you go by dollar per time with chalk covered hands.

Epistemic Spot Check: Full Catastrophe Living (Jon Kabat-Zinn)

Full Catastrophe Living is a little weird, because between the first edition and the second a lot of science came out testing the thesis.  For this blog post, I’m reviewing the new, scienced-up edition of FCL.  However I have ordered the older edition of the book (thanks, Patreon supporters and half.com) and have dreams of reviewing that separately, with an eye towards identifying what could have predicted the experimental outcome.  E.g. if the experimental outcome is positive, was there something special about the model that we could recognize in other self-help books before rigorous science comes in?

I originally planned on fact checking two chapters, the scientific introduction and one of the explanatory chapters.  Doing the intro was exhausting and demonstrated a consistent pattern of “basically correct, from a small sample size, finding exaggerated”, so I skipped the second chapter of fact checking. I also skipped the latter two thirds of the book.

Overview

You’ve probably heard about mindfulness, but just in case: mindfulness is a meditation practice that involves being present and not holding on to thoughts, originally created within Buddhism.  Mindfulness Based Stress Reduction is a specific class created by the author of this book, Jon Kabat-Zinn.  The class has since spread across the country; he cites 720 programs in the introduction.   Full Catastrophe Living contains both a playbook for teaching the class to yourself, the science of why it works (I’m guessing this is new?), a section on stress, and followup information on how to integrate meditation into your life.

Introduction

Claim: Humans are happier when they focus on what they are doing than when they let their mind wander, which is 50% of the time.

Accurately cited, large effect size, possible confounding effects. (PDF).  The slope of the regression between mind wandering and mind not-wandering was 8.79 out of a 100 point scale, and the difference between unpleasant mind wandering and any mind not-wandering task was ~30 points.  Pleasant mind wandering was exactly as pleasant as focusing on the task at hand.  Focusing accounting for 17.7% of the between-person variation in happiness, compared to 3.2% from choice of task.

Some caveats:

  • People’s minds are more likely to wander when they’re doing something unpleasant, and when they are having trouble coping with that unpleasantness.   The study could be identifying a symptom rather than a cause.
  • The study population was extremely unrepresentative, consisting of people who chose to download an iPhone app.

Claim: Loss of telomeres is associated with stress and aging; meditation lengthens telomeres by reducing stress (location 404).

Research slightly more theoretical than is represented, but theoretical case is strong. (Source). First, let’s talk about telomeres.  Telomeres are caps on the ends of all of your chromosomes.  Because of the way DNA is copied, they will shorten a bit on every division.  There’s a special enzyme to re-lengthen them (telomerase), but leading thought right now is that stress inhibits it.  Short telomeres are associated with the diseases of aging (heart issues, type two diabetes) independent of chronological age.  This is hard to study because telomere length is a function of your entire life, not the last week, but is pretty established science at this point.

Mindfulness reduces stress, so it’s not implausible that it could lengthen telomeres and thus reduce aging.  The authors also present some evidence that negative mood reduces the activity of telomerase.  This is a very strong theoretical case, but is not quite proven.

Claim: Happiness research Dan Gilbert claims meditation is one of the keys to happiness, up there with sleep and exercise (location 461).

Confirmed that Gilbert is a happiness researcher and said the quote cited, although I can’t find where he personally researched this.

Claim: “Researchers at Massachusetts General Hospital and Harvard University have shown, using fMRI brain scanning technology, that eight weeks of MBSR training leads to thickening of a number of different regions of the brain associated with learning and memory, emotion regulation, the sense of self, and perspective taking. They also found that the amygdala, a region deep in the brain that is responsible for appraising and reacting to perceived threats, was thinner after MBSR, and that the degree of thinning was related to the degree of improvement on a perceived stress scale.” (location 502)

Accurate citation, but: small sample size (16/26), and for the first study the effect size was quite small (1%) for regions of a priori interest, and the second had quite wide error bands (source 1) (source 2).  However the book does refer to these findings as preliminary.

Claim: “They also show that functions vital to our well-being and quality of life, such as perspective taking, attention regulation, learning and memory, emotion regulation, and threat appraisal, can be positively influenced by training in MBSR.” (location 508).

Misleading.  These are really broad claims and no specific study is cited.  However, source 2 above has the following quote: “The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.”  This is a very carefully phrased statement indicating that mindfulness is in the right ballpark for affecting these things, but is not the same as demonstrating actual change.

Claim: “Researchers at the University of Toronto, also using fMRI, found that people who had completed an MBSR program showed increases in neuronal activity in a brain network associated with embodied present-moment experience, and decreases in another brain network associated with the self as experienced across time. […]  This study also showed that MBSR could unlink these two forms of self-referencing, which usually function in tandem.” (location 508).

Accurate citation, small sample size (36) that they made particularly hard to find (source).  I can’t decipher the true size of the effect.

Claim: Relative to another health class, MSBR participants had smaller blisters in response to a lab procedure, indicating lower inflammation (location 529).

True, but only because the other class *raised* inflammation (source). Also leaves out the fact that both groups had the same cortisol levels and self-reported stress.  So this looks less like MBSR helped, and more like the control program was actively counterproductive.

For the record, this is where I got frustrated.

Claim: “people who were meditating while receiving ultraviolet light therapy for their psoriasis healed at four times the rate of those receiving the light treatment by itself without meditating.” (location 534)

Accurate citation (of his own work), small sample size (pdf).

Claim: “we found that the electrical activity in certain areas of the brain known to be involved in the expression of emotions (within the prefrontal cerebral cortex) shifted in the MBSR participants in a direction (right-sided to left-sided) that suggested that the meditators were handling emotions such as anxiety and frustration more effectively. […]

This study also found that when the people in the study in both groups were given a flu vaccine at the end of the eight weeks of training, the MBSR group mounted a significantly stronger antibody response in their immune system”

Accurate citation (of his own work), slightly misleading, small sample size.  Once again, he’s strongly implying a behavioral effect when the only evidence is that MSBR touches an area of the brain. On the other hand, the original paper gets into why they make that assumption, so either it’s correct or we just learned something cool about the brain.

Claim: MSBR reduced loneliness and a particular inflammatory protein among the elderly (location 551).

Not statistically significant. (source)  More specifically; the loneliness finding was significant but uninteresting, since the treatment was “8 weeks with a regular social activity” and the control was “not.”  The inflammation finding had p = .075.  There’s nothing magic about p < .05 and I don’t want to worship it, but it’s not a strong result.

I also researched MBSR in general, and found it to have a surprisingly large effect on depression and anxiety.

The Model

To the extent Full Catastrophe Living has a model, it’s been integrated so fully into the cultural zeitgeist that I have a hard time articulating it. It could be summarized as “do these practices and some amount of good things from this list will happen to you.” Which kills my hypothesis that having a good model is necessary to getting good results.

 

You Might Like This Book If…

I don’t know. I found it a slog and only read the first third, but the empirical evidence is very much on mindfulness’s side and I don’t know what better thing to suggest.

 

 

 

Thanks to the internet for making it possible for me to do these kinds of investigations.

Thanks to Patreon supporters for giving me money.

 

 

The Parable of Ignac Semmelweiss

When I was a kid, my dad told me the parable of the first physician to realize you should maybe mothers would not suffer quite so many horrifying deaths if doctors washed their hands between autopsies and childbirth. Unfortunately this doctor was an asshole, so everyone ignored him. He eventually went crazy from the stress of knowing so many women were being killed by their doctors, and died in a mental hospital. And that is why we don’t dismiss ideas just because they come from crazy assholes, no matter how much we want to.

I really like this story, and tell it to myself sometimes when I want to dismiss someone for being crazy and/or an asshole. Recently I got curious how true it actually was, so I pulled a couple of books on the topic, of which I finished one, The Doctor’s Plague by Sherwin B. Nuland.

First: the story as told by my dad is way more accurate than a story half remembered 25 years later has any right to be. The doctor in question is Ignac Semmelweis. Like most such discoverers, Semmelweis’s genius was not an entirely unique idea, other people had noticed autopsies and childbed fever seemed to go together, but he was the one to invent handwashing. He got a little more support than my dad mentioned, but managed to alienate them by, as I was told, being an asshole. He refused to write up his results because he had already proven them to his satisfaction. He wrote angry letters attacking the most prominent doctors in Europe. He did not play well with the other children. And he did indeed die in a mental hospital. The only thing my dad got wrong was the cause of the insanity: it was probably Alzheimer’s, not frustrated genius.

But there was another part of the story I knew but hadn’t considered; the autopsies that were contaminating doctors were being done in pursuit of curing childbed fever. The infection was spread by examinations meant to teach students. The very things doctors were doing to cure women were hurting them. Over the medium term, everyone would have been better of if they’d stopped trying. I find this terrifying.