I originally intendedThe Tale of the Dueling Neurosurgeons for epistemic spot checking, but it didn’t end up feeling necessary. I know just enough neurobiology and psychology to recognize some of its statements as true without looking them up, and more were consistent enough with what I knew and what good science and good science writing looks like; interrogating the book didn’t seem worth the trouble. I jumped straight to learning from it, and do not regret this choice. The first thing I actually looked up came 20% of the way into the book, when the author claimed the facial injuries of WWI soldiers inspired the look of the Splicers from BioShock.*
[*This is true. He used the word generic mutant, not the game-specific term Splicer, but I count that under “acceptable simplifications for the masses”. Also, he is quicker to point out that he is simplifying than any book I can remember.]
At this point it may be obvious why I think fans of this blog will really enjoy this book, beyond the fact that I enjoyed it. It has a me-like mix of history (historical color, “how we learned this fact”, and “here’s this obviously stupid alternate explanation and why it looked just as plausible if not more so at the time”*), actual science at just the right level of depth, and fun asides like “a lot of data we’ve been talking in this chapter on phantom limbs about comes from the Civil War. Would you like to know why there were so many lost limbs in the Civil War? You would? Well here’s two pages on the physics of rifles and bullets.”**
[*For example, the idea that the brain was at all differentiated was initially dismissed as phrenology 2.0.
**I’m just going to assume you want the answer: before casings were invented, rifles had a trade off between accuracy and ease of use. Bullets that precisely fit the barrel are very hard to load, bullets smaller than the barrel can’t be aimed with any accuracy. Some guy resolved this by creating bullets that expanded when shot. But that required a softer metal, so when the bullet hit it splattered. This does more damage and is much harder to remove.]
I am more and more convinced that at least through high school, teaching science independent of history of science is actively damaging, because it teaches scientific facts, and treating things as known facts damages the scientific mindset. “Here is the Correct Thing please regurgitate it” is the opposite of science. What I would really love to see in science classes is essentially historical reenactments. For very young kids, give them the facts as we knew them in 18XX, a few competing explanations, and experiments with which to judge them (biased towards practical ones you know will give them informative results), but let them come to their own conclusions. As they get older, abandon them earlier and earlier in the process; first let them create their own experiments, then their own hypotheses, and eventually their own topics. Before you know it they’re in grad school.
The Dueling Neurosurgeons would be a terrible textbook for the lab portion of that class because school districts are really touchy about inducing brain damage. But scientists had a lot of difficulty getting good data on the brain for the exact same reason, and Dueling Neurosurgeons is an excellent representation of that difficulty. How do we learn when the subject is immensely complex and experiments are straightjacketed? I also really enjoyed the exploration of the entanglement between what we know and how we know it. I walked away from high school science feeling those were separable, but they’re not.
You might like this book if you:
like the style of this blog. In particular, entertaining asides that are related to the story but not the point. (These are mostly in footnotes so if you don’t like them you can ignore them).
are interested in neurology or neuropsychology at a layman’s level.
share my fascination with history of science.
appreciate authors who go out of their way to call out simplifications, without drowning the text in technicalities.
You probably won’t like this book if you:
need to learn something specific in a hurry.
are squeamish about graphic descriptions of traumatic brain damage.
are actually hoping to see neurosurgeons duel. That takes up like half a chapter, and by the standards of scientists arguing it’s not very impressive.
The tail end of the book is either less interesting or more familiar to me, so if you find your interest flagging it’s safe to let go.
I have a very vivid memory of reading Cryptonomicon, where a character explains that the Allies won World War 2 because they worshiped Athena (technology, strategy), and the Germans worshipped Ares (Brute Strength, physical and moral).
[Some of you may be thinking “But German craftsmanship was better, right? It took 5/10 American tanks to take down 1 German Tank?” I thought so too, but apparently no. To the extent it was true, it was craftsmanship, not technology.]
The Axis did do better in encryption originally, but by the end we were reading much more of their mail than they were reading of ours. Although it’s important to give credit to this to Polish Intelligence, who broke the Enigma code early on, enabling them to keep up as Germany increased its complexity. If they hadn’t sent their results to Britain just as Germany invaded, Alan Turing et al. may never have been able to crack it. That was some high leverage work there.
Anyways, I’m reading The Alchemy of Air (Thomas Hager) now, which is about the history of nitrogen chemistry, which played a much larger role in World War 1 than I would have guessed. Fritz Haber’s invention of a way to transform atmospheric nitrogen into a usable form, something previously only accomplished by lightning and a handful of bacteria, is estimated to have prolonged the war by at least one year, possibly two. We’ll get into why in a later post. That’s Athena. According to the book, a lot of what the Allies wanted in reparations was not actually money, but German technology, especially chemistry.
[I do not entirely trust Hager on the relative important of chemistry and money here. He’s spent the entire book waxing lyrical about the importance and beauty of nitrogen. The internet was not terrible helpful; I’ve confirmed that dyes and pharmaceuticals were among goods taken as reparations, but not the amounts. Some guy on Quora says the US, Britain, and Germany were equally competitive in technology in 1914.]
Even if Alchemy is overestimating German dominance in chemistry, I think it’s safe to say that technology was a major force behind German military power in World War 1. And by World War 2, it wasn’t. They made some advances and would have done worse without them, but no one ended the war thinking “man, getting access to this German technology will save us 20 years in research”. But 60 years later, Germany is again a leader in technology, and has one of the more functional economies in the world.
This was going to be a “me wondering about a mystery” post, but once I thought about it the answer to “what changed?” is obvious. Germany exiled or killed 25% of their scientists. Fritz Haber, the guy who added years to the war with one invention and went on to pioneer chemical warfare? Jewish “Germany hurt itself while killing several million people” is not exactly news, but I think it’s important to note individual stories of how.
Although this puts me in the weird position of honoring the guy who more-or-less created chemical warfare. But that’s maybe okay, because the same process that made Germany gun powder is also feeding half the world right now. Utilitarian morality is complicated.
I was worried my epistemic spot checking project was doomed before it began. The well regarded Sapiens dismissed a link between cultural and genetic evolution, and Last Ape Standing made two explosively wrong errors in the first chapter. Neither related to human evolution (one was about modern extreme poverty and the other about cetacean evolution), but I just couldn’t let them go. I worried that every book was terrible if you actually fact checked it, or maybe just every book on the emergence of homonids?
And then I started A Brief History of the Human Race. Two chapters in, I cannot find a flaw in it. There are a few simplifications, and some broad statements he later walks back, but nothing I can point to and say “that is miseducating people.” Meanwhile there are a lot of things I can point to and say “that is right”, even things I initially thought were wrong. So I think A Brief History… might be the one.
Here’s a list of statements I checked and their results. Normally I sort claims into true and untrue sections, but that proved unnecessary in this case because it is a beautiful rigorous snowflake of a book.
Claim: The holocene era has had unusual climactic stability, and is warmer than typical for the planet (page 6).
This checks out, but it’s a little weird that his graph doesn’t label the temperature axes, and it’s a graph of oxygen ratios from a single glacier rather than the wider variety of evidence available.
Cook further claims that this warmth and stability is what let farming, and thus history, start. There’s some counter evidence to the claim of the holocene as the absolute start of agriculture. but it certainly seems legitimate to say that’s when it really took off.
Claim: there exists art “well over 20,000 years old” (page 9)
I was very surprised by this but if anything he’s underselling it; there’s claims of 50,000 year old art
Claim: most human DNA is junk DNA that serves no purpose, and mutations have no effect (page 11):
He’s a little behind the times on junk DNA. Even when A Brief History… was published (2003) we knew it that while lots of DNA didn’t encode any proteins, much of it does seem to serve some purpose and mutations in it are significant. At a minimum noncoding DNA definitely plays a role in the regulation of DNA transcription, the structural cohesion of the chromosome, and protecting coding DNA from degradation. This is the closest thing to a falsehood I found in the first two chapters. At the level of genetics this book is discussing I think it’s a forgivable simplification, although an addendum noting the real world was more complicated would have been appreciated.
Claim: humans are inbred (page 12)
Page 13: AFAIK this explanation of multiorigin vs out of Africa human evolution hypotheses is correct, and he’s picked the correct winner.
Claim: evidence of human tool use half a million years ago (page 16)
me: there is no way there were tools that long ago.
Claim: early hominid and chimp tool use are both culturally transmitted (page 17)
I’m pretty sure this is correct, and I appreciate the distinction he is making
Claim: it was hard for nomadic hominids to combine their tools in novel ways, because they had so little room. There are exceptions, but they might have been better off sticking with lower technology (page 20).
I am extremely happy to see this guy acknowledge that hunter gatherers had a pretty kick ass life and farming sucked.
Claim: iron is more abundant than copper because of something about supernovas (page 29).
Not only is A Brief History… not saying wrong things, it is throwing out tangential facts at about the right rate. I was never going to look up which molecules supernovas produced. But now I have a general idea of the concept of “primary elements” and how this affected human history, which makes me happy.
Verdict: A Brief History of the Human Race has passed the epistemic spot check with flying colors, and is enjoyable to read.
I am in the middle of a post on Dreamland (Sam Quinones) and how it is so wrong, but honestly I don’t think I can wait that long so here’s an easily encapsulated teaser.
On page 39 Quinones says “Most drugs are easily reduced to water-soluble glucose…Alone in nature, the morphine molecule rebelled.” I am reasonably certain that is horseshit. Glucose contains three kinds of atoms- carbon, oxygen, and hydrogen. The big three of organic chemicals. Your body is incapable of atomic fusion, so the atoms it starts with are the atoms it ends up with, it can only rearrange them into different molecules. Morphine is carbon, oxygen, hydrogen, and nitrogen, and that nitrogen has to go somewhere, so I guess technically you can’t reform it into just sugar. But lots of other medications have non-big-3 atoms too (although, full disclosure, when I spot checked there was a lot less variety than I expected).
This valorization of morphine as the indigestible molecule is equally bizarre. Morphine has a half-life of 2-3 hours (meaning that if you have N morphine in your body to start with, 2-3 hours later you will have N/2). In fact that’s one of the things that makes it so addictive- you get a large spike, tied tightly it with the act of ingestion, and then it goes away quickly, without giving your body time to adjust. Persistence is the opposite of morphine’s problem.
This is so unbelievably wrong I would normally assume the author meant something entirely different and I was misreading. I’d love to check this, but the book cites no sources, and the online bibliography doesn’t discuss this particular factoid. I am also angry at the book for being terrible in general, so it gets no charity here.
I really love physics puzzle video games. The general pattern for physics puzzlers is that you have a fairly small set of tools that alter some fundamental law, like gravity, and you use them to get to the other side of the room. The puzzles are quite separate from each other, and there is no metapuzzle. You walk into a chamber, you solve the puzzle, you walk out. None of this wondering if you’re did the puzzle wrong or it’s just a tree you walked in to, no metagame (I’m looking at you, The Witness. Either be a book of mazes or have a story, doing neither is annoying), just a puzzle to solve with a little reward pellet when you’re done. I have enough things in my day where it’s not even clear if I’m solving the correct problem, I don’t need that from my leisure activities.
The example you’re most likely to be familiar with is Portal.
Thomas Was Alone uses a couple of my favorite themes, including disparate people (rectangles) bonding together to solve a problem, and entwined moral and practical leveling up. The puzzle solving of using different rectangles to get them all where they need to go becomes a metaphor for social cooperation in really impressive ways. It is the first game I ever went through to get the collectibles not because I wanted the reward pellet from getting 100% completion, but just because I wanted to spend more time in the world. So you can imagine my excitement when I found out the creator, Tom Bithell, had a new game coming out, and by coming out I mean came out a year and a half ago and was in a Humble Bundle, because I am not super up on my video game releases.
Story wise, Volume is no Thomas Was Alone, and I think that’s true even accounting for the facts that I was playing during a truly awful week, and Thomas was Alone‘s story couldn’t have targeted me better if it tried. If you removed the story from both Volume is clearly the better the game, but part of what made Thomas Was Alone work was the superb integration between story and mechanics, so that’s not really fair.
But Volume‘s gameplay is excellent. You play a thief playing a AI-driven simulation of stealing (but are also actually stealing? To be honest I wasn’t paying attention. Oh, apparently you’re simulating it to show other people how to steal and then they do? That explains the moralizing at the end) from people who totally deserve it. If you filmed the results it would look a lot like a wireframe of a Bugs Bunny Cartoons. Guards can only see in a very prescribed area, so often the best thing to do walk directly behind them. If you enter their line of sight they will chase you, but if you leave it for long enough they will give up, which led to a couple of really entertaining chases where I ran around columns perfectly opposite them until they gave up. The game pokes fun at the simplifications it made- “I didn’t have the money to illustrate a bunch of objects so just pretend each of these identical gems is something different”, “Yes, transporters are impossible, but stairs are hard to code please just go with it.”
You’re given a variety of tools to manipulate the guards, like a bugle to create sound far away from you, and a way to generate a ghost of you running away so the guards will chase it (this one is a mixed blessing because it makes the guards more vigilant). The tools vary dramatically in entertainment value: I found the stun gun was no fun at all, because it removed the need for planning. Encounter a problem? Shoot it. It doesn’t even take that long to recharge. But the stunning tripwire was fantastic. Figuring out where to place it so you have as much time to run past the guard to your goal as possible and then lure them to it without getting shot is hard.
Like Thomas Was Alone and unlike every other puzzle game I’ve ever played, I completed Volume without once looking at a walkthrough. For Thomas this was pretty clearly because the puzzles were easy; for Volume I think it’s at least partly really excellent design. I didn’t know how to solve everything right away, but I always had more ideas of things to try. None of this staring at a brick wall wondering what the hell I’m supposed to do (I’m looking at you Fez).
If I had one complaint about Volume that wasn’t about the lack of the magic of friendship, it would be that you don’t get enough time with any one mechanic. I wish the game had had more confidence that the puzzles were fun and it didn’t need to keep feeding me novelty. Luckily there is an ecosystem of user-made levels that I can only assume solves this exact problem.
So I heartily recommend Volume. While I’m at it, if you like this type of game you’ll probably love Swapper, which might be more fun mechanically than even Portal and has narrative/mechanic integration to rival Thomas Was Alone, although this time the narrative is about watching your body die horribly over and over again, which is somewhat easier to represent in gameplay. And for people like me who will enjoy even mid-tier representatives of the genre, Q.U.B.E is totally adequate.
Mountains Beyond Mountains is a biography of Paul Farmer, an American doctor who founded a small clinic in Haiti and ended up saving hundreds of thousands of lives, possibly millions. But that’s at the end. The beginning is spent with him doing obviously suboptimal things like spending $5000/year per patient treating AIDS patients in a country where people were constantly dying of malnutrition and diarrhea (average cost to treat: <$30), while baiting me by bragging about how cost ineffective it was. I was very angry at him for a while, until it dawned on me that getting angry at a man for distributing lifesaving drugs probably said more negative things about me than it did about him. Plus he did maybe avert a worldwide epidemic of untreatable tuberculosis, so perhaps I should stop yelling at the CD player and figure out what his thinking was.
Let’s take tuberculosis. At some point in the story (it’s frustratingly vague on years), Farmer’s friend brings him to Peru, which had what was widely considered the world’s best TB containment system (called DOTS). The WHO held it up as what the rest of the world should aspire to. DOTS did many things right, like ensuring a continuous supply of antibiotics to patients and monitoring them to ensure compliance (intermittent treatment breeds resistance). On the other hand, the prescribed response to someone failing to get better on drugs (indicating their infection was resistant to them) was “give them all the same, plus one more.” This is exactly the right thing to do, if what you want is to make sure the bacteria evolve resistance to the new drug without losing its existing resistance. The protocol specifically banned testing to see which drugs a particular patient’s infection was susceptible to, because that is expensive and potentially difficult in the 3rd world.
The WHO ignored the possibility of drug resistant TB because it was considered an evolutionary dead end. Resistance had to evolve anew in each patient, and rendered the infection noncontagious. I don’t know what evidence they based this on, but at best it was a case of incorrectly valuing evidence over reason. At worst, it indicates a giant sentient TB cell has infiltrated the WHO and is writing policy.
If your evidence says a contagious disease spontaneously becomes completely noncontagious at a convenient moment, your first thought should be “who do I fire?” because obviously something went wrong in the study design or implementation. If you check everything out and it genuinely is noncontagious, your next thought should be “wow, we really lucked out having all this extra time to prepare before it inevitably becomes contagious again.” At no point should it be “sweet, cross that off the list”, because while you are not looking it will redevelop virulence and everyone will die.
Farmer’s response to the ban on treating multiple drug resistant TB was to steal >$100,000 worth of medicine and tests from an American hospital to treat a handful of patients. When caught, a donor bailed him out.
Or take cancer. A young child with weird symptoms shows up at his clinic. He drops a few thousand dollars on tests to determine the child had a rare form of cancer. 60-70% survival rate in the US, no chance in Haiti. He convinced an American hospital to donate the care, but when the child becomes too ill to travel commercially he spends $20,000+ on medical transport.
Both of these went against standard measures of cost effectiveness, as did Farmer’s pioneering work treating AIDS patients in the 3rd world. But let’s look at his results:
The WHO’s “yeah, it’s probably fine” approach to drug resistant TB worked as well as you would think. Farmer proves it is contagious, is treatable, and drives down the price of treatment (to the point it is $/DALY competitive with standard health interventions). He goes on to change the international standard for TB treatment and lead the effort in several countries. Book gives no numbers but I estimate 142,000 lives and counting, plus avoiding an epidemic that could cost 2 million lives/year.*
Kid’s cancer is inoperable, he dies in the US. American hospital agrees to take a few more cases each year.
In retrospect his actions in the TB case seem pretty damn effective. But he didn’t set out to change the world. He stole those drugs for the exact reason he flew that boy to the US: someone was dying in front of him and it made him sad. It’s possible you couldn’t correct his answer in the cancer case without also “correcting” his answer in the TB case. And while someone more math driven could have launched the world changing anti-MDR TB campaign, they didn’t. Farmer did, and we need to respect that.
Lots of people in the philanthropic space, including Farmer and most EAs, say that it’s unreasonable to expect perfect altruism from everyone. People need to spend money on themselves to keep themselves happy and productive, and constant bean counting about “do the morale effects of name brand toilet paper make up for the kids I won’t be able to deworm?” is counterproductive. You put aside money for charity, and you put aside money for you to enjoy life, and you make your choices. What if we view Farmer’s need to save the life in front of him as a morale booster that enables our preferred work (averting world wide incurable TB pandemic), rather than the work itself? By that measure, $150,000 on a single kid’s cancer and 7 hours doing a house call for one patient in Haiti is a steal. Given that I pay my cats more (in food and vet care) than what 1/6 of the world survives on, I do not have a lot of room to judge Paul Farmer’s “saving children from cancer” hobby.
Farmer himself raises this point, in a way. It turns out that effective altruism did not invent the phrase “that’s not cost effective.” Lots of people with a lot of power (e.g. the WHO) have been saying it for a long time. From Farmer’s perspective, it seems to be used a lot more to justify not spending money, rather than spending it on a different thing. He also rejects the framing of the comparison: cancer treatment may save fewer lives per dollar than diarrhea treatment but it saves way more per dollar than a doctor’s beach house, so how come it only gets compared to the former? Those are fair points.
It’s not clear he could have redirected the money even if he wanted to. Most of the care for the cancer patient was donated in kind; there was no cash he could redirect to a better cause (although that’s not true for the cost of the medivac). No one gave him $100,000 to spend on TB treatment, he stole drugs and got bailed out. It’s not clear the donor would have been as moved to rescue him if he stole $100,000 worth of cheap antibiotics.
In essence, I’m postulating that Farmer operated under the following constraints.
Evaluating cost effectiveness is emotionally costly even in the face of very good information.
Low quality information on effectiveness
Financial discipline was emotionally costly
Some money was available for treatments of less relative effectiveness but could not be moved to the most effective thing. But the money was not clearly labeled “the best thing” and “for warm fuzzies only”, he had to guess in the face of low information.
Under those things, evaluating cost effectiveness could easily be actively harmful. Judging by the results, I think he did better following his heart.
Doing The Most Effective Thing is great, and I think the EA movement is pushing the status quo in the right direction. But what Farmer is doing is working and I don’t want to mess with it. At the same time, his statement that “saying you shouldn’t treat one person for cancer because you could treat 10 people for dysentery is valuing one life over another.” (paraphrased) is dangerously close to Heifer International’s “we can’t check how our programs compare to others, that would be experimenting on them and that would be wrong.” (paraphrased), which is dangerously close to Play Pump’s “fuck it, this seems right.” (paraphrased) as they rip out functional water pumps and replace them with junk. So while Farmer is a strong argument against Effective Altruism as “the last social movement we will ever need” (because some people do the most good when they don’t compare what they’re doing to the counter-factuals), he’s not an argument against EA’s existence. Someone has to run the numbers and shame Play Pump until they stop attacking Africans’ access to water.
And just like you couldn’t improve Farmer by forcing to him do accounting, you can’t necessarily improve a given EA by making them sadder at the tragedy immediately in front of them. EA is full of people who didn’t care about philanthropy until it had math and charts attached, or who find doing The Best Thing motivating. We’re doing good work too. I understand why people fear doing the math on human suffering will make them less human, but that isn’t my experience. I cry more now at heroism and sacrifice than I ever did as a child.
Ironically the one thing I was still angry at Farmer for at the end of the book was his most effective choice: neglecting his children in favor of treating patients and global health politics. I could forgive it if he felt called to an emergency after the children were born, but he had kids knowing he would choose his work over them. For me, no amount of lives saved can redeem that choice. Maybe that is what he feels about letting that Haitian child die of cancer.
*This paper (PDF) estimates 142,000 deaths averted 2006-2015 by the program Farmer pioneered, and the program is still scaling up. I estimate a drug resistant TB epidemic would cost a minimum 2.3 million lives/year (math below), although how likely that is to occur is a matter of opinion. That’s ignoring his clinical work in Haiti, the long term effects of his pioneering HIV treatment in the 3rd world,the long term effects of his pioneering community-based interventions that increased treatment effectiveness, infrastructure building in multiple countries, and refugee care. I would love to give you numbers for those but neither Paul Farmer nor PIH believe in numbers, so the WHO evaluation of the TB program was the best I could do.
TB rates have been dropping since ~2002, but that’s due to aggressive
treatment. New infection rate held steady at ~150 people/100,000
from 1990-2002, so let’s use that as our baseline. With 7.3 billion people, that’s 11 million cases/year. 11 million * .7 chance of death = 7.7 million deaths. Per year. 25% of those are patients with AIDS who arguably wouldn’t live very long anyway, so conservatively we have ~5.7 million deaths. If I’m really generous and assume complete worldwide distribution of the TB vaccine (efficacy: 60%), that’s down to 2.3 million deaths. Per year.
For comparison, malaria causes about 0.5 million deaths/year.
Let me begin by describing something The Hot Seat does not do. A while ago I read Never Say Die, about how society talks about old age. Sometimes I would want to argue with its factual statements (“old women have no access to sex”), but feel immediately aversive. Eventually I realized that this was because Never Say Die spent a long time deriding anyone who believed anything good about old-old age as delusional or mean. I didn’t want to be delusional or mean, so even in the privacy of my own head I resisted arguing. This is a bad tactic for finding out the truth. You don’t win arguments by deriding people who oppose you, you win them with facts. And the facts are that old people in nursing homes get a lot of STDs.*
A lot of business books do this too. “Other people will tell all a company needs is a website and a mascot, but we’re not like that. We think you should have a product.” It’s not quite argument from bravery– more like argument against stupidity. It often follows statements like “we won’t sugarcoat this” and “fancy new economy idiots/stodgy old economy losers believe…”. The effect is to discourage critical thought about what they are telling you.
The Hot Seat does not do this, at all. It gives you information- both legal rules and the unspoken ones, from funding to people management. I think it would be useful for someone planning on starting their own company, but that wasn’t my use case. I want to be an early employee at a start up, and want to be able to tell good start ups from bad. Hot Seat isn’t a complete book for that, but it is a very strong foundation that will make it easier to assess if I’m getting good advice from other books. It is also extraordinarily readable, to the point I would read it for fun.**
*When I went to look up the numbers I saw that they counted everyone above age 65 or even 50. The book’s main thesis is that people take happy statements about the (upper class) young old and inappropriately apply them to the old old (80+). So the author may not have even been wrong, but I don’t like the way she proved her point.