It takes way more time to cover this stuff in detail here than I’m willing to spend on it, but here are a few relevant links to stuff I’m working on/with at the moment:
iii. Kolmogorov–Smirnov test.
iv. Chow test.
vi. Education and health: Evaluating Theories and Evidence, by Cutler & Muney.
vii. Education, Health and Mortality: Evidence from a Social Experiment, by Meghir, Palme & Simeonova.
…Tales of the Unexpected and More Tales of the Unexpected, by Roald Dahl. It‘s a pretty damn good book; I gave it 4 stars (‘really liked it’) on goodreads (the average rating there is 4.16), but I seriously considered giving it 5 stars (‘it was amazing’). The reason why I didn’t was that it’s a collection of short stories, and whereas some of the stories on their own surely deserve 5 stars, I’m not sure the book as a whole does – not all stories are awesome, some are just ‘fine’.
Before I started out reading it yesterday I was under the impression that I hadn’t read Dahl before, but as I was reading the book I started feeling more and more certain I’d read some of the stories before – I’d imagine something like 15 years ago. I couldn’t remember the stories, so even though I’m reasonably sure I’ve read some of them before it felt like I was reading them for the first time.
It’s hard to illustrate how great this book is via quotes; most of them are great because of where you unexpectedly end up and because of how he manages to build up the tension during the stories, which are aspects you can’t really capture in quotes without giving too much away. But I’ll note that I thoroughly enjoyed reading it.
i. “Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong.” (H. L. Mencken)
ii. “if I let myself believe anything on insufficient evidence, there may be no great harm done by the mere belief; it may be true after all, or I may never have occasion to exhibit it in outward acts. But I cannot help doing this great wrong towards Man, that I make myself credulous. The danger to society is not merely that it should believe wrong things, though that is great enough; but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.” (William Kingdon Clifford, The Ethics of Belief – the full text is available here)
iii. “If you wish to be good, first believe that you are bad.” (Epictetus)
iv. “If you have assumed a character beyond your strength, you have both played a poor figure in that, and neglected one that is within your powers.” (-ll-)
v. “Let silence be your general rule; or say only what is necessary and in few words. […] Above all avoid speaking of persons, either in the way of praise or blame, or comparison. If you can, win over the conversation of your company to what it should be by your own. But if you should find yourself cut off without escape among strangers and aliens, be silent.” (-ll-)
vi. “Few people can be happy unless they hate some other person, nation, or creed.” (Bertrand Russell)
vii. “Science does not know its debt to imagination.” (Emerson)
viii. “Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life.” (Marcus Aurelius)
ix. “Remember that man lives only in the present, in this fleeting instant; all the rest of his life is either past and gone, or not yet revealed. Short, therefore, is man’s life, and narrow is the corner of the earth wherein he dwells.” (-ll-)
x. “To change your mind and to follow him who sets you right is to be nonetheless the free agent that you were before.” (-ll-)
xi. “A wrongdoer is often a man who has left something undone, not always one who has done something.” (-ll-)
xii. “People seldom improve when they have no other model but themselves to copy after.” (Oliver Goldsmith)
xiii. “That virtue which requires to be ever guarded is scarce worth the sentinel.” (-ll-)
xiv. “Men think they may justly do that for which they have a precedent.” (Cicero)
xv. “That is the true perfection of man to find out his imperfections.” (Augustine of Hippo)
xvi. “Why should we put ourselves out of our way to do anything for posterity; for what has posterity done for us?” (Boyle Roche)
xvii. “Reading is to the mind what exercise is to the body.” (Richard Steele)
xviii. “A favor well bestowed is almost as great an honor to him who confers it as to him who receives it.” (-ll-)
xix. “No man was ever so completely skilled in the conduct of life, as not to receive new information from age and experience…” (-ll-)
xx. “When men are easy in their circumstances, they are naturally enemies to innovations.” (Joseph Addison)
I decided that it might be a good idea to give a brief account of the ‘rejection process’ I went through today. I’d decided to give Thomas Attig’s How We Grieve a shot, but I quickly realized this was not a book I wanted to read. There are a few of those during any given year, but I rarely talk about them here. I prefer to say nothing when I don’t have a lot of nice things to say, but sometimes there’s a case for speaking up – and I think this is the case here. The book is written by a philosopher and the focus is on the stories of bereaved people (not on, say, data about grief responses) – the combination made me skeptical from the outset, but it was on a topic I figured might be interesting to read about, it was published by Oxford University Press, and it had a 4.8 rating on amazon – so I figured I should give it a try. The 4.8 rating is part of why I don’t want to stay silent. It had 3.5 on goodreads before I added a 1-star evaluation to the mix.
I didn’t get far – I thought the book was unreadable. Quotes and comments below:
“I have come to use a vocabulary of ego, soul, and spirit to flesh out my understanding of the nature of the self as it is embodied in a web of caring engagements in the world” (Margin note: This is bad. But…) (If I’d read this a few pages later, I’d probably not have read any more than that. But I’d read so little of the book’s introduction at that point that I didn’t think I could just reject the entire book out of hand because of problematic terminology like that, even though I was already seriously considering just throwing it away and reading something else.)
“If any single driving force motivated me to write the book, it is an abiding conviction that personal stories are ” the heart of the matter, ” both in responding to the bereaved and in developing thinking about grieving. […] The existentialist philosopher in me insists that the understanding needed for a compassionate and effective caregiving response is possible only when we hear the stories grieving persons have to tell. As we listen attentively and caringly, we must focus on the uniqueness of the individual story-teller, of the challenges of living meaningfully and with integrity in his or her particular life circumstances, and of his or her personal confrontations with finiteness in bereavement and grieving. […]
They [caregivers, grief counsellors, etc.] do not encounter or help general populations or abstract statistics but flesh and blood individuals who live in distinctive circumstances, develop irreplaceable relationships, and have unique experiences of loss and grief. Compassionate and effective caregiving is simply not possible without the courage to engage in heart to heart dialogue with those who are suffering about what they are experiencing, listening and responding in turn. […] I urged the importance of getting past the idea that only scientific findings, news reports, biographies, or documentaries convey truth. Like myths, works of fiction, including folk tales, fables, parables, novels, short stories, plays, and films can be true to life without being literally true. And they can teach us a great deal about themes and narrative lines to listen for as others share their real-life tales of suffering.” (Margin note: From bad to worse…)
“I am by no means opposed to scientific research about loss and grief when science is broadly construed to include qualitative research focused upon careful listening to personal stories of experiences after particular kinds of deaths, within specified populations, in different family or cultural contexts, in response to different caregiving efforts, and the like. Experiences of relearning, and the support offered while having them, vary a great deal, and there is so much more to be learned about these families of experience through qualitative study.
I am skeptical, however, about the statistical generalizations that issue from quantitative research in the field.” (Margin note: And it gets worse…) […] “The gap from generalization to application to individual cases is huge and difficult to bridge. Rarely do statistical findings provide useful insight for us individuals or our caregivers.” (Margin note: However this is likely true at least to some extent.)
“There are two areas where scientific explanation and prediction might be worth pursuing in grief research: First, it could be useful to validate or refine understanding of the causes of some of us becoming mired in grief reaction, not responding effectively or meaningfully to changes in the world of our experience and, in some instances, needing specialized professional help to relearn them. […] Second, it would be useful to do research to discover the causes of success or failure in approaches to caregiving, to evaluate which make things worse, which do no harm hut are ineffective, and which actually help to promote effective relearning (Margin note: So it’s not all bad – at least there’s some common ground…) […]
“When we attend to them, our emotions tell us about our brokenness, all we have taken for granted, and what we need for survival, reengaging in the world, and even thriving again. Emotions that arise from our ego tell us about our needs to be effective, desires to keep up appearances and reputation, and illusions of complete independence from others, invulnerability, and limitless control. What I choose to call emotions of soul tell us about our deep needs for roots, belonging, nurture, connection, care, and love. All of these enable us to make ourselves at home in the familiar. And what I choose to call emotions of spirit tell us about our deep needs for courage, hope, purpose, meaning, adventure, and joy. All of these enable us to reach beyond the familiar, grow, and soar in the extraordinary. When we grasp what our emotions are telling us, they loosen their grip on us and begin motivating tentative reengagement in the worlds of our experience.” (No margin note, but I’m (again) getting very close to putting the book away for good here.) […]
“I have come to believe that what I call “sorrowfriendly” practices can enable us to listen effectively to our not so inscrutable emotions, learn valuable lessons from them, and use the lessons as we reengage with the world. I view these practices as grieving responses inasmuch as they provide a means of actively engaging with grief reactions. I have in mind such practices as using ceremony and ritual, sharing and exploring sorrow with another, keeping a grief journal, meditating, attending to sorrow in our bodies, pondering our dreams, calling forth and engaging with unconscious images, seeking meaning in after-death encounters with our loved ones, experiencing or creating works of art, surrendering in silence to mystery, attending to breath and breathing into deep rhythms of life, leaning into faith, and opening our hearts in prayer. For many of us, this kind of grieving response as active engagement with our grief reactions proves invaluable in readying us for active reengagement in the world.” (This guy just kept adding way too much crap into way too few pages. Margin note: Okay, I’m out… So I closed the book and wrote this brief review.)
Sorry for the infrequent updates.
On goodreads I gave the book a 2 – corresponding to ‘it was ok’. It wasn’t a bad book, and it was closer to 3 (‘liked it’) than 1 (‘did not like it’). Do recall this as you read the post. The average rating on goodreads is 3.59, and the average amazon rating is 4.3, so a lot of people seem to have liked the book better than I did. Perhaps it has to do with the horrid quality of the alternatives out there? It may also have to do with the format of the book:
“I do […] place a good deal of stress on the obvious in this book, and that is quite deliberate. In logic, as in life, it is the obvious that most often bears emphasizing, because it so easily escapes our notice. […] This is neither a treatise in logical theory nor a textbook in logic […] My governing purpose was to write a practical guidebook, presenting the basic principles of logic in a way that is accessible to those who are encountering the subject for the first time. Being Logical seeks to produce practitioners, not theoreticians — people for whom knowing the principles of logic is in the service of being logical.”
Much of the stuff covered I’d seen before in other contexts, but there was some new stuff and some stuff I’d long forgotten; it wasn’t my first book on logic, but it was the first semi-decent book on the subject I’ve read in a while. I got somewhat annoyed along the line by the fact that many of the (evolutionary, biological, etc.) reasons why we behave illogically are not addressed in the book at all – he mentions once or twice in passing that being logical has a cost associated with it because it takes effort, but that’s it. A little bit about that stuff seems very important to me to include in a book like this, because otherwise the advice given can easily become disconnected from peoples’ experiences; telling someone not to be emotional when making arguments is fine, but when are you likely to be emotional, how can you tell, and how can you increase the costs associated with behaving emotionally and disregard logic in situations where it is particularly important to not do that? No stuff like that is included in the book. On the other hand this is probably just the format taking its toll; he intended it to be short and readable and he succeeded, although the format has some limitations. I immediately jumped to ‘what about quantum mechanics? – should the state of QM theory not make us reject that principle ‘on principle’?’ when reading about the law of excluded middle – and although it later turned out I’m not the only one thinking that way, this is probably not an important counterpoint to include in a book with a scope like this one. But on the other hand when the author includes stuff like this, you get annoyed if you’re me:
“Another trait of first principles—it follows from their being self-evident—is that they cannot be proven. This means that they are not conclusions that follow from premises; they are not truths dependent upon antecedent truths. This is because first principles represent truths that are absolutely fundamental. They are “first” in the strongest sense of the word.”
If we know that the world has some randomness in it that we can’t get rid of, if truth is in some fundamental sense best thought of as (irreducibly) probabilistic to some extent, then what does that tell you about the previously mentioned supposedly ‘absolutely fundamental first principle’? Metaphysicians are always one step ahead, but ‘materialists’ (or whatever you want to call them) tend to be right behind them and sometimes they will catch up with them. Language like this will make some people tend to think of the author as an ignorant and arrogant/self-important philosopher with a fundamentally simplistic worldview that doesn’t correctly map how the world works. ‘Something is either true or false’ was an ‘established fact’ before QM – but science marched on. There are other, more decision-relevant contexts where a (to me) similar implicit rejection of probabilistic reasoning takes place, and this is by far the biggest problem I have with this book. I’ll discuss these aspects in more details in a few of the comments below.
Anyway, some more quotes and comments:
“Being logical presupposes our having a sensitivity to language and a knack for its effective use, for logic and language are inseparable. It also presupposes our having a healthy respect for the firm factualness of the world in which we live, for logic is about reality. Finally, being logical presupposes a lively awareness of how the facts that are our ideas relate to the facts that are the objects in the world, for logic is about truth. […]
Our ideas are clear, and our understanding of them is clear, only to the extent that we keep constant tabs on the things to which they refer. The focus must always be on the originating sources of our ideas in the objective world. […] The more we focus on our ideas in a way that systematically ignores their objective origins, the more unreliable those ideas become. […] Bad ideas can be informative, not about the objective world—for they have ceased faithfully to reflect that world—but about the subjective state of the persons who nourish those ideas. Bad ideas do not just happen. We are responsible for them. They result from carelessness on our part, when we cease to pay sufficient attention to the relational quality of ideas, or, worse, are a product of the willful rejection of objective facts.” […]
“To be in a state of uncertainty concerning the truth is neither a pleasant nor a desirable state to be in, and we should always be striving to get out of such states as soon as possible.” (Note added in the margin: “Here I violently disagree. Probabilistic reasoning is much more useful than ‘categorical’ reasoning in terms of estimating the true state of the world – categorical reasoning is limited in a way probabilistic reasoning is not, and the added flexibility needn’t be a cost and will often prove beneficial. Admitting to uncertainties about the true state of the world should be considered a virtue. Adding probabilities to estimates increases accuracy and decreases (implicit) measurement error. Applied probabilistic reasoning also makes us more likely to update our beliefs over time.”)
“The principle of sufficient reason tells us that things don’t just happen. They are caused to happen. We do not know the causes of everything, but we know that everything has a cause. A good part of our energies as rational creatures is devoted to the search for causes. We want to know why things happen. The knowledge of causes, simply from a theoretical point of view, can be very satisfying, since to know the causes of things is to have a truly profound understanding of them.” (As has been noted elsewhere (the book was bad, but that point stands) applying causal models is not without costs – but the costs are not addressed in this book, only the benefits. As I bluntly put it in the margin: “The hunt for causes isn’t always a good thing; we tend to apply causal thinking to areas where they do us no good. Often the causes we come up with are wrong – often ‘shit happens’ is a truer statement than ‘X caused Y’. We should be aware of this.”)
“Everything I have said thus far has been said with argument in mind. Argument is the activity of logic, and any particular argument is a concrete manifestation of the reasoning process. The next step in the process will be to look more closely at the statement, more specifically, at the “categorical statement.” The most effective argument is one whose conclusion is a categorical statement. A categorical statement tells us that something definitely is the case. […] A categorical argument (one made up of categorical statements) is the most effective of arguments, then, because it provides us with certain knowledge.” (Note in the margin: “No it doesn’t. It just gives us the illusion of certain knowledge. Which is bad. Arguments involving categorical statements may be the “most effective” – but they are not necessarily the most true. Often statements involving likelihoods have much higher truth-correspondence. The application of categorical statements will often lead to faulty reasoning because uncertainty (which contains valuable information) is neglected.”)
“[The agnostic] claims ignorance as to the truth of a certain matter. Just as there is a place for skepticism in sound reasoning, so is there also a place for an honest agnosticism. We are being honestly agnostic when we simply admit to an ignorance that is really ours, here and now. If our knowledge of a particular thing is so limited that it does not allow us to take a confident position regarding it, we should refrain from committing ourselves. To do otherwise would be intellectually irresponsible. Evasive agnosticism is the attitude that attempts to pass off vincible ignorance as if it were invincible. It is one thing to say “I don’t know” after long and assiduous research into a subject. It is quite another to say “I don’t know” when you haven’t even bothered to look into the matter. The person who succumbs to evasive agnosticism uses ignorance as an excuse rather than a reason. Such ignorance is the result of indifference or laziness.” (Margin note: “But again it is necessary to ‘pick your battles’ because logical thinking is hard work – we can’t apply it all the time because it is costly. And we can’t do research on everything. Agnosticism will often, at least for utility function specifications implicitly argued for here where people care mainly about the truth of statements, be much preferable to a poorly reasoned position.)
“The more intense our emotional state, the more difficult it is to think clearly and behave temperately. […] we need to be constantly aware of the fact that if emotion gains the ascendancy in any situation, clear thinking is going to suffer. […] There is a simple rule of thumb to be followed here: Never appeal directly to people’s emotions.”
“In the ideal debate, the primary purpose of the debaters is not to triumph over each other, but rather by their combined efforts to ferret out the truth as it pertains to the issues being debated.” (not new, but nice that stuff like this is included in the book.)
This one was fun, as it was from the last part of the last chapter: “If we are tempted to call black white, or white black, it is because the complexities of life sometimes overwhelm us. But it is not a rational response to a complex reality to simplify it in such a way that grossly distorts it. The result of simplistic reasoning is always distortion.” (…fun considering how he feels about categorical reasoning. Categorical reasoning is just a simplified version of the more general form of probabilistic reasoning, admitting only a binary probability variable that will often grossly distort the truth by adding measurement errors to our estimates.)
“Compliance is the degree to which a patient is compliant with the instructions that are given by a healthcare professional and written on the medication label (for example, prescribed dose and time schedule).” (p.8 – I didn’t know that definition before reading the book so it made sense to me to start out with this quote, to make sure people are aware of what this book is about.)
It’s an interesting book with a lot of stuff I didn’t know and/or at the very least hadn’t thought about. A couple of the chapters were quite weak and I basically skipped most of chapter 6, which was written by a pharmaceutical marketing consultant who wrote about branding stuff which I couldn’t care less about – but most of the book was quite good. One of the chapters (chapter 8) very surprisingly included undocumented claims which were to some extent proven wrong in a previous chapter (chapter 3) – it seemed as if the authors of that chapter had not read the previous chapter in question. Here’s what they wrote at the very beginning of their chapter (chapter 8):
“Compliance is important. Better adherence to treatment regimes leads to less healthcare resource utilization overall, as fewer illness recurrence or medication errors leading to side-effects take place.” (p.109)
And here’s what Dr. Dyffrig Hughes told us in chapter 3:
From the studies evaluated, the direction and magnitude of the change in costs and consequences resulting from applying sensitivity analysis to the compliance rate was measured and taken as an indicator of the impact of non-compliance. There was consistency among studies, in that as compliance decreased (whatever the measure), the [health] benefits also decreased […] There is no consistency, however, in the direction of change in costs resulting from changes in compliance [my bold, US] […] Whilst some studies show that costs increase as compliance decreases, others showed the opposite trend. This difference did not appear to be related to the nature of the disease, the measure of non-compliance or the assumptions relating to the health benefits experienced by non-compliers.
And here’s even a figure illustrating this point:
A little more from chapter 3 on the same subject: “The economic evaluations described demonstrate that medical expenditures do not always increase because of poor compliance. However, the limitations in the methodology adopted in many of the studies would suggest that the reported changes in healthcare expenditure may not necessarily be observed in practice. It is difficult, therefore, to predict the true economic impact of non-compliance with drug therapy, particularly as evidence relating to discontinuers is often not reported. It is the case, however, that decisions on optimal treatments, based on economic criteria, are influenced by non-compliance […] Health economic evaluations often fail to include non-compliance with medications. As a significant proportion of evaluations are based on efficacy trials, attention should be given to how their findings might be generalized. In particular, as poor compliance is one of the most important elements responsible for the differences that may exist between the effectiveness and efficacy of an intervention, greater consideration should be given to compliance when generalizing from the results of a controlled clinical trial. An optimal cost-effective treatment strategy chosen on the basis of efficacy data may not be so attractive once real-world compliance figures are taken into account.”
I don’t consider this to be an unforgiveable error in a book like this with a lot of authors writing about different aspects of the problem, but it doesn’t help that the authors of chapter 8 repeat the claim that improved compliance will have cost-saving effects in their conclusion of the chapter as well, and at the very least it doesn’t make them look good to me (a more cautious and tentative approach in the introduction and the conclusion of the chapter would have suited me better). A good editor sh(/w)ould probably have caught something like this.
The efficacy/effectiveness difference he talks about relates to the fact that the results of randomized controlled trials (RCTs) could/should be considered estimates of the health effects related to something close to the ideal treatment scenario, whereas real world implementation (effectiveness) of the treatment in question will often provide patients a sometimes significantly lower health benefit in terms of average treatment effect (or similar metrics), because of differences in the composition of the two groups and the settings of the treatment protocols applied, among other things. RCTs often deliberately try to maximize compliance e.g. by excluding patients who are likely to be non-compliers, and that of course will lead to biased estimates if you apply such estimates to the total patient population. There are many variables affecting how big the potential difference between efficacy and effectiveness may be for a particular drug and they cover that stuff, as well as a lot of other stuff, in the book. Non-compliance rates are much bigger than I’d imagined, but there are a lot of reasons for this that I hadn’t considered. The fact that non-compliance is widespread can be inferred even from the definitions applied in clinical trials:
“ultimately it is the outcome that is important. This might not always require that all doses of a drug are taken. Indeed, in short-term efficacy clinical trials patients who take 80 per cent or more of their medication, based upon pill counts, are usually considered ‘compliant’.” (p.14)
You can fail to take one-fifth of the medicine and still be considered compliant. Indeed as Parkinson, Wei and McDonald put it in their chapter:
“As the reader of this chapter it might be informative to reflect on your own behaviour: can you honestly say that you have always complied fully with every tablet of every prescription and have always finished the course? A very few readers will say yes, with honesty. The reality is that nearly everyone is non-compliant; the variable is the degree of non-compliance.”
A few numbers from the book illustrating the extent of the problem:
“reports (for example, Sung et al., 1998) have suggested that only 37 percent of participants take greater than 90 per cent of all doses of statins over a two-year period. […]
[Astma:] When patients were aware of being monitored a majority (60 per cent) were fully compliant, but when unaware the majority had a compliance rate between 30 and 51 per cent (Yeung et al., 1994). […]
Significant levels of non-redemption [of prescriptions], as seen in this study, have subsequently been confirmed within the large UK general practice databases such as GPRD where there is only about 90 per cent concordance between the prescriptions issued by the GP and those recorded as being redeemed at a pharmacy by the UK Prescription Pricing Authority (Rodriguez et al., 2000). […]
Chapman et al. (2005) recently examined compliance with concomitant antihypertensive and lipid-lowering drug therapy in 8406 enrollees in a US-managed care plan […] Less than half of patients (44.7 per cent) were adherent with both therapies three months after medication initiation, a figure that decreased to 35.8 per cent at 12 months. […]
Despite international clinical guidelines recommending lipid-lowering treatment in patients with clinically evident atherosclerotic vascular disease, study after study has documented low treatment rates in this high-risk patient population, thereby creating a clinical practice and public health dilemma (Fonarow and Watson, 2003).
Only about 30 per cent of patients with established CVD and raised serum lipids, and fewer than 10 per cent of individuals eligible for primary prevention, receive lipidlowering therapy. Target total cholesterol concentrations are then achieved in fewer than 50 per cent of patients who do receive such treatment (Primatesta and Poulter, 2000).
Poor patient compliance to medication regimen is a major factor in the lack of success in treating hyperlipidaemia (Schedlbauer et al., 2004). All of the lipid-lowering drugs must be continued indefinitely; when they are stopped, plasma cholesterol concentrations generally return to pretreatment levels (Anon, 1998). […]
Up to half of the patients treated for hypertension drop out of care entirely within a year of diagnosis (ibid. [WHO, 2003b], Flack et al., 1996). […]
Non-compliance comes in many forms: depending on the disease area, as many as one in five patients fail to take the first step of collecting a prescription from the pharmacy. Many patients on short-term medications depart from recommended doses within a day or two of starting treatment. And many of those on longer-term medication may take a break from their medication or vary their dose depending on how they feel. A review of the evidence (Horne and Weinman, 1999) concluded that compliance overall is approximately 50 per cent but varies across different medication regimens, different illnesses and different treatment settings.”
A little more stuff from the book:
“Compliance depends on many factors, including the study population (better in educated compared to disadvantaged patients) type of intervention, duration of treatment, complexity of treatment, real or perceived side-effects and life circumstances (see Table 8.1). The reasons are often patient-specific, multifaceted and can change over time. Demographically, the very young, the very old, teenagers and those taking very complex treatment regimes are the least likely to comply. […]
asymptomatic and chronic diseases needing long-term treatment […] result in poorer compliance; and […] the longer the remission in chronic diseases, the lower the compliance (Blackwell, 1976). […] patient-controlled non-compliance was lower in treatment for diseases in which the relationship between non-compliance and recurrence is very clear, such as diabetes, compared to treatment for diseases in which this relationship is less clear […] Of course, cognitive deficit, helplessness, poor motivation and withdrawal all lead to forgetfulness and passive or structural noncompliance (Gitlin et al., 1989; Shaw, 1986). […] most non-compliance is intentional and results from conscious choices. […]
As a rule, patients cannot be simply classified as compliers or non-compliers. Rather, the level of compliance ranges from patients who take every prescribed dose precisely as directed to those who never do with the typical patient lying between these two extremes. The degree to which patients intend to comply with a regimen can be subdivided into patient-controlled and structural. Patient-controlled factors can be subdivided further into rational behaviour (as seen in patients with Parkinson’s disease who regulate their own dosing) and irrational behaviours (such as self-induced seizures). Structural factors are those beyond the patient’s control, such as impaired memory or difficulty accessing medication (Leppik, 1990). […]
Compliance and adherence to therapy are complex issues with no obvious ‘one size fits all’ solution available. It appears that actively involving patients in treatment decisions, empowering patients with access to medical information and providing ongoing monitoring all contribute to improved compliance and adherence rates. The challenge for health services, however, is to provide these enhanced levels of support cost-effectively.”
The book is a few years old and sometimes you can tell. I was curious along the way about how much things have changed in the meantime. I’m guessing less than would have been optimal.
I should point out lastly that I have made a goodreads profile. I haven’t added a lot of books to my profile yet, but I may decide to use that site actively in the future. At goodreads I gave the book 3 stars, corresponding to an ‘I liked it’ evalution.
I’m currently writing a topic on ‘the causal effect of education on health’, so this is a topic I’ve looked at a bit – consider this post a ‘workblog’-post, even though it’s only tangentially related to what I’m working on.
This kind of stuff – health disparities related to education and income – pops up in the public debate every now and then, see e.g. this recent article (in Danish), or this analysis by AE-rådet (also in Danish). This is ‘politics’ to some extent (see the previous post), but it’s also a question about what’s actually going on in the world, and the latter type of question is the type of question I tend to be interested in answering. I’d like to make some general points here which are sometimes overlooked:
i. People with lower education are fatter. And being fat is bad for your health.
ii. People with lower levels of education smoke more: “Well-documented declines in smoking prevalence over time have not occurred evenly throughout society (12, 13). They have been most substantial among the most educated. Thus, the least educated form increasing proportions of those who remain smokers.” Regarding alcohol the picture is more complicated (as I’ve talked about before), however it should be noted that if the variance of the quantity consumed by the highly educated is lower than for the lower educated groups, as they claim in the article I link to at the beginning of this paragraph, then it would make sense if the highly educated people who die from alcohol-related diseases die later and lose fewer years of their life to the alcohol than does the group with low education (‘the uneducated alcoholic loses 20 years, the educated alcoholic loses five…’). Either way alcohol matters much less than smoking, and the differences aren’t that big in the former case. Incidentally the causal pathways of the smoking link are still unclear: “The causal pathways between education and smoking are both complicated and contested in the literature.” (link)
iii. Lifestyle differences among different educational groups make up a big part of the difference in health outcomes: “the mediating effects of health behaviors – measured by smoking, drinking, exercising and the body mass index – account in the short run for 17% to 31% and in the long run for 23% to 45% of the entire effect of education on health, depending on gender.”
iv. An additional point related to point iii.: I haven’t looked for studies on this because it’s obvious, but the health gradient is more sensitive to stuff like income level and employment status in countries like the US than it is in Denmark. So international (non-Scandinavian?) estimates of the magnitude of educational effects and income effects on health outcomes are likely to be biased upwards, compared to what the magnitude would be in a country like Denmark where ability to pay for medical services problems are unlikely to have much influence on life expectancy at this point.
v. I’ll spell out this point even though it should be obvious by now: Many of the reasons why people with a low education on average die too soon relate to the fact that they on average make poorer choices when it comes to their health. And the stuff mentioned above is just a small part of what’s going on; you also have related stuff like information channels and compliance differences, on top of stuff like ‘likelihood of seeking proper medical attention conditional on you actually needing it, and ability to verbalize complaints so that the doctor makes the correct inferences’ (e.g. a lot of T2 diabetics don’t get diagnosed, and this lowers their life expectancy significantly).
vi. Note that whereas it’s true that some jobs are still more unhealthy than others (a traditional mechanism most people think of when they’re thinking about these things), if the connection between type of work and health risks is known people employed in such jobs would be expected to earn a risk premium – this is not super relevant when you look at education and health, but it is something to have in mind when analyzing health and income stuff.
vii. It should be noted that if you get better over time at treating people for stuff that isn’t lifestyle-related and so stop a lot of people from dying early on of other causes, then lifestyle-stuff is going to become a big driver of health disparities.
i. Econometric methods for causal evaluation of education policies and practices: a non-technical guide. This one is ‘work-related’; in one of my courses I’m writing a paper and this working paper is one (of many) of the sources I’m planning on using. Most of the papers I work with are unfortunately not freely available online, which is part of why I haven’t linked to them here on the blog.
I should note that there are no equations in this paper, so you should focus on the words ‘a non-technical guide’ rather than the words ‘econometric methods’ in the title – I think this is a very readable paper for the non-expert as well. I should of course also note that I have worked with most of these methods in a lot more detail, and that without the math it’s very hard to understand the details and really know what’s going on e.g. when applying such methods – or related methods such as IV methods on panel data, a topic which was covered in another class just a few weeks ago but which is not covered in this paper.
This is a place to start if you want to know something about applied econometric methods, particularly if you want to know how they’re used in the field of educational economics, and especially if you don’t have a strong background in stats or math. It should be noted that some of the methods covered see wide-spread use in other areas of economics as well; IV is widely used, and the difference-in-differences estimator have seen a lot of applications in health economics.
ii. Regulating the Way to Obesity: Unintended Consequences of Limiting Sugary Drink Sizes. The law of unintended consequences strikes again.
You could argue with some of the assumptions made here (e.g. that prices (/oz) remain constant) but I’m not sure the findings are that sensitive to that assumption, and without an explicit model of the pricing mechanism at work it’s mostly guesswork anyway.
iii. A discussion about the neurobiology of memory. Razib Khan posted a short part of the video recently, so I decided to watch it today. A few relevant wikipedia links: Memory, Dead reckoning, Hebbian theory, Caenorhabditis elegans. I’m skeptical, but I agree with one commenter who put it this way: “I know darn well I’m too ignorant to decide whether Randy is possibly right, or almost certainly wrong — yet I found this interesting all the way through.” I also agree with another commenter who mentioned that it’d have been useful for Gallistel to go into details about the differences between short term and long term memory and how these differences relate to the problem at hand.
“An extensive body of prior research indicates an association between emotion and moral judgment. In the present study, we characterized the predictive power of specific aspects of emotional processing (e.g., empathic concern versus personal distress) for different kinds of moral responders (e.g., utilitarian versus non-utilitarian). Across three large independent participant samples, using three distinct pairs of moral scenarios, we observed a highly specific and consistent pattern of effects. First, moral judgment was uniquely associated with a measure of empathy but unrelated to any of the demographic or cultural variables tested, including age, gender, education, as well as differences in “moral knowledge” and religiosity. Second, within the complex domain of empathy, utilitarian judgment was consistently predicted only by empathic concern, an emotional component of empathic responding. In particular, participants who consistently delivered utilitarian responses for both personal and impersonal dilemmas showed significantly reduced empathic concern, relative to participants who delivered non-utilitarian responses for one or both dilemmas. By contrast, participants who consistently delivered non-utilitarian responses on both dilemmas did not score especially high on empathic concern or any other aspect of empathic responding.”
In case you were wondering, the difference hasn’t got anything to do with a difference in the ability to ‘see things from the other guy’s point of view’: “the current study demonstrates that utilitarian responders may be as capable at perspective taking as non-utilitarian responders. As such, utilitarian moral judgment appears to be specifically associated with a diminished affective reactivity to the emotions of others (empathic concern) that is independent of one’s ability for perspective taking”.
On a small sidenote, I’m not really sure I get the authors at all – one of the questions they ask in the paper’s last part is whether ‘utilitarians are simply antisocial?’ This is such a stupid way to frame this I don’t even know how to begin to respond; I mean, utilitarians make better decisions that save more lives, and that’s consistent with them being antisocial? I should think the ‘social’ thing to do would be to save as many lives as possible. Dead people aren’t very social, and when your actions cause more people to die they also decrease the scope for future social interaction.
v. Lastly, some Khan Academy videos:
(This one may be very hard to understand if you haven’t covered this stuff before, but I figured I might as well post it here. If you don’t know e.g. what myosin and actin is you probably won’t get much out of this video. If you don’t watch it, this part of what’s covered is probably the most important part to take away from it.)
It’s been a long time since I checked out the Brit Cruise information theory playlist, and I was happy to learn that he’s updated it and added some more stuff. I like the way he combines historical stuff with a ‘how does it actually work, and how did people realize that’s how it works’ approach – learning how people figured out stuff is to me sometimes just as fascinating as learning what they figured out:
(Relevant wikipedia links: Leyden jar, Electrostatic generator, Semaphore line. Cruise’ play with the cat and the amber may look funny, but there’s a point to it: “The Greek word for amber is ηλεκτρον (“elektron”) and is the origin of the word “electricity”.” – from the first link).
The universe, our lives, all this stuff – it’s just so incredible it sometimes boggles my mind how we can just walk around, doing whatever it is that we’re doing, just taking all this stuff for granted, overlooking everything. There’s so much to see, to appreciate!
I’ll start here – with a picture of a rock:
It’s not just any rock though – it’s been through a lot. Almost too much to imagine. Allow me to demonstrate what I mean by that…
Now, before going any further I should start by noting that I think that timescales are funny things. I sometimes sort of feel like I don’t really understand them, how they work. I have similar problems with distances now and then, but we’ll get to that later. Of course it’s not that hard to imagine an hour passing by, or a day, or perhaps even a year. But a millenium? I don’t really have a good idea how much time a millenium is – it’s such a long time it boggles the mind. A million years? That’s just crazy. I have no way to conceptualize that kind of time-scale, my mind is much too small for that. So recently I tried to come up with a way to imagine how much time these big multiples of the numbers we usually use to denote time passing by actually represent. I decided to engage in a thought experiment where I’d be counting the years that have gone by and see where I’d end up, starting out where we are now. I pretend I’m able to count one year each second. That way 60 years will go by in just a minute – an entire life of a human being in just a minute. After an hour of counting I’d be close to the starting point of written history; we’d now be 3600 years into the past. We all sort of tell ourselves that we know roughly how long that is; the Jesus stuff is supposed to have happened 2000 years ago, and 3600 years isn’t that different from 2000 after all. But here’s a picture:
This is the Sicilian Temple of Juno Lacinia, and this is what 2400 years – just two thirds of the amount of time we’ve counted so far – looks like from a certain point of view.
Let’s count on: After a day of counting we’d be 86.000 years into the past – so what happened 86.000 years ago? We have little idea, it’s so very long ago. After a year of counting without rest, we’d be 31 million and 536 thousand years into the past – you can count one year each second every second without pause for an entire year of your life and you’re not even half-way to the dinosaurs!
If we assume you count every second of your entire life and you can expect to live 75 years, then the last number you’ll get to is the year that happened 2 billion, 365 million and 200 thousand years ago.
Here’s the kicker: The rock in the image above is much, much older than that.
I’ve been to Copenhagen a few times this year. My parents also went there not too long ago – they came to the city and went back home the same day, for reasons which are not important here. I’ll pretend the trip was 220 kilometres each way; it’s close enough.
200 km is actually a really big distance, once you start thinking about it. We usually don’t, because we have means of transportation that will bring us very fast from A to B. So I decided to think about what would happen if we didn’t have those things; what if they had had to walk to Copenhagen instead of going by car? Well, walking takes more time, but it’s also a lot harder. So I decided to say that it probably wasn’t realistic that they walked more than 12 hours per day, at 5 km/hour. Or 5000 meters per 60 minutes, if you’re of a different persuasion. How long would it have taken them to get back and forth? Well, 5 km/hour and 12 hours per day gives 60 km per day, or 420 km per week. 220 km each way adds up to 440 km in total. So they’d have had to walk for more than a week to get to Copenhagen and back. It would have taken them more than a month to walk to Paris (~900 km) and back.
The closest big thingy you can see at night when you look up into the sky is basically a big rock which reflects the light of a huge ball of fire which luckily is quite a bit farther away from us than the big rock is; a ball of fire which has been burning without stop for a much longer amount of time than you can count years during your life. We like to think the big light-reflecting rock up there is quite near us; some humans have even been up there, so it can’t be that far away, right? Actually it isn’t – from a certain point of view. It’s average distance to Earth is around 385.000 km. If you could ‘fly-walk’ at a very human speed of 5 km/hour, you’d be there in just 17,5 years or so. You could leave at the age of 15 and be back here again at the age of 50. If these kinds of things were possible, which of course they’re not.
Here’s a different way to conceptualize that distance: Let’s think in terms of human-scale magnitudes (one human = ~1,5-2 metres), so that the distance is now 385.000.000 metres, instead of all that cheating with metrics like kilometres. Let’s say an average human is close to 2 metres tall and let’s say we wanted to get up to the moon by standing on top of each other; in order to reach them moon, you’d need something like 200 million people. Let’s do the counting thing again: Count one person per second. It’d take you close to 7 years to count the people you’d need to make that happen. (Of course there are various reasons why that kind of thing wouldn’t work.)
I mentioned that ‘the average distance’ was 385.000. It’s an average because the Moon is moving very fast, just like the Earth, and it doesn’t move around in a perfectly spherical manner. But the Earth and Moon is – as people know these days, although it took a very long time to convince all those well-dressed monkeys that that was how it worked – moving around the Sun as well, and this is where it gets a bit more interesting. The movement around the Sun is, well, fast. The Sun is approximately (such a wonderful word, considering which kinds of distances and differences are actually hidden here) 150 million km away from us. We don’t have enough humans to do the same trick we did with the Moon, not even close. But let’s look a little closer at the speeds involved. The average distance to the Sun is of course not the distance that the Earth travels during a year – the latter number is quite a bit larger, and like many other things it involves the number pi. The Earth goes roughly one billion km/year (940 million km/year, assuming the orbit is circular), which is 108.000 km/hour! Or 30 km each second. It’s almost unbelievable that we don’t notice, that we don’t fall off – that everything just happen the way things do, without anyone sparing much thought as to how utterly insane this is. We don’t even notice.
There’s a lot more on stuff like distances and time frames at Khan Academy. If you want to appreciate just how tiny the distance between the Earth and the Sun really is ‘in the big picture’ but you don’t have the time to watch all those lectures, see also this post.
Now, a different thing you could wonder about is how you can even think the thoughts you’re thinking now. It’s incredibly hard to understand what’s going on there, and we don’t have a very detailed model of the brain as it is. So let’s be less ambitious – let’s just have a look at some of the cells you have hanging around in ‘your body’. Here are a few juxtaglomerular cells, the likes of which are now hanging out in your kidneys (doing useful stuff):
There are a lot of different types of cells in the human body, and the total number of cells in your body is much higher than the number of humans on Earth. So you probably shouldn’t try to count them, like we tried counting other stuff before – you won’t get very far. Obviously they’re not very big, given that we don’t seem to notice them in our day-to-day lives even though there are so many of them. Until a few hundred years ago we didn’t even know such things existed. Now we do, and each day we as a species learn more about the almost infinite number of awesome small living things hanging around everywhere here on Earth. There are so incredibly many of them that cooperate with each other to keep you alive. Even though some of the types of cells in your body live only for a few hours, the combined work of all of them keep ‘you’ going for years, decades. So many things could in theory go wrong – a few cells messing up and dividing the wrong way can end up killing you (yes, I know cancer is more complicated than that – but cancer is nothing special in that respect; things always turn out to be more complicated than you’d think, once you take a closer look..). Depriving the little ones of oxygen for a few minutes will also make many of them get very angry with you, and some of them and their friends ending up the wrong place, one way or the other, may actually quite quickly end the collaborative agreement you’ve had with them for a long time.. Yet somehow things very rarely go wrong, you stay alive, year after year, until one day the little ones have done all they can for ‘you’ and so start worrying more about themselves than about what made you you.
It’s an interesting thing to think about that these small things have been around about as long as the rock in the picture above has, and that you’re a direct descendant of one of those little organisms. If you want a story of how we got from A to B, this is a good book on that topic. If you take a closer look, you’ll also realize that in a very real sense you are those little organisms.
On top of all that… If you look even closer at the cells we talked about, you’ll see that they’re made up of tiny little atoms which are jiggling around all the time, everywhere, at insane speeds and in complex patterns we don’t always understand very well at all. Even though cells are really small, it takes a lot of atoms to make a cell – a lot of atoms which need to constantly ‘cooperate with-‘ and interact with each other to maintain the structure of the cell (and again, if for some reason they don’t cooperate…). We talked about how there were more cells in your body than there are humans on Earth; it turns out that the number of atoms in a cell is roughly the same as the number of cells in a human body – 1014, or 100 trillion. The little atoms get broken down and reassembled in all kinds of ways, all over the place, all the time. I sometimes find it very confusing how all these interactions, all these things can happen everywhere and all the time, right under our noses (and over it, and in it, and…) without us being any the wiser. We look at the world and our eyes interpret the light which is available to us in a manner which the organisms which came before us benefited from. The way our eyes work is part of why we’re alive, why we’re here today – they enabled our ancestors to spot other huge collections of atoms and cells in order to facilitate the most optimal types of interaction with all those other collections of cells and atoms. Oh yes, our eyes are immensely useful things, and if you go into a bit more detail about how they work they’re fascinating things in and of themselves – yes, but even so: Such a profoundly limited, such a coarse-grained view of the world they have given us, compared to what actually is going on!
Or you could talk about the waves, all the different kinds of waves moving around in our environment – sound, heat, light, … Many of them humans can’t even see or feel, and many humans have lived their entire lives without ever knowing they even existed. Just as many people don’t know what that rock at the beginning really looks like when you start to zoom in, and which factors have caused it to look the way it does now, so relatively unharmed by time. I’ve read some stuff about rocks, but I also don’t know that in any amount of detail. And that’s okay – there’s so much stuff to learn you can’t possibly ever get to the bottom of it all.
We’re smart (yet also incredibly stupid), well-dressed apes. Apes which interact with each other and with our environment. If you have a closer look at all that interaction stuff, it turns out that that stuff – all these interaction patterns that form our lives and shape our behaviours – well, that’s just incredibly complex as well.
And it gets worse, or better, depending on whom you ask – because there are trillions of other places out there without smart well-dressed apes; places so remote we can’t even imagine the distances involved, but at the same time also places where we don’t even need to go near to understand a lot of what is happening there. Because we through a combined effort as a species have gotten wonderfully good at understanding what’s going on in this remarkable universe we’re a part of. Ignorance is the default state. But it should not be a desired end state. The world gets so much bigger, so much more interesting, once you start to look closer at what’s going on.
So much stuff to learn, to understand, to appreciate. The world is an amazing place.
I’m sad Feynman died before I ever got to at least have a chance to meet him. He set a good example:
(The last one is a repost, but I love that one. If you like these, see also this abstrusegoose comic.)
There would be plenty of much worse stories to read to your child. Mind you, when the child is a bit older it might be a good idea to introduce him/her to the Blackadder version…
i. Victorian era. This is a fascinating article, with lots of stuff:
“The Victorian era of British history was the period of Queen Victoria‘s reign from 20 June 1837 until her death on 22 January 1901. It was a long period of peace, prosperity, refined sensibilities and national self-confidence for Britain. Some scholars date the beginning of the period in terms of sensibilities and political concerns to the passage of the Reform Act 1832.
The era was preceded by the Georgian period and followed by the Edwardian period. The latter half of the Victorian age roughly coincided with the first portion of the Belle Époque era of continental Europe and the Gilded Age of the United States.
Culturally there was a transition away from the rationalism of the Georgian period and toward romanticism and mysticism with regard to religion, social values, and the arts. In international relations the era was a long period of peace, known as the Pax Britannica, and economic, colonial, and industrial consolidation, temporarily disrupted by the Crimean War in 1854. The end of the period saw the Boer War. Domestically, the agenda was increasingly liberal with a number of shifts in the direction of gradual political reform, industrial reform and the widening of the voting franchise. […]
The population of England almost doubled from 16.8 million in 1851 to 30.5 million in 1901. Scotland’s population also rose rapidly, from 2.8 million in 1851 to 4.4 million in 1901. Ireland’s population decreased rapidly, from 8.2 million in 1841 to less than 4.5 million in 1901, mostly due to the Great Famine. At the same time, around 15 million emigrants left the United Kingdom in the Victorian era and settled mostly in the United States, Canada, and Australia. […]
The mortality rates in England changed greatly through the 19th century. There was no catastrophic epidemic or famine in England or Scotland in the 19th century – it was the first century in which a major epidemic did not occur throughout the whole country, with deaths per 1000 of population per year in England and Wales dropping from 21.9 from 1848–54 to 17 in 1901 (contrasting with, for instance, 5.4 in 1971). […]
The Victorian era became notorious for the employment of young children in factories and mines and as chimney sweeps. Child labour, often brought about by economic hardship, played an important role in the Industrial Revolution from its outset: Charles Dickens, for example, worked at the age of 12 in a blacking factory, with his family in a debtors’ prison. In 1840 only about 20 percent of the children in London had any schooling. By 1860 about half of the children between 5 and 15 were in school (including Sunday school).
The children of the poor were expected to help towards the family budget, often working long hours in dangerous jobs for low wages. Agile boys were employed by the chimney sweeps; small children were employed to scramble under machinery to retrieve cotton bobbins; and children were also employed to work in coal mines, crawling through tunnels too narrow and low for adults. Children also worked as errand boys, crossing sweepers, shoe blacks, or sold matches, flowers, and other cheap goods. Some children undertook work as apprentices to respectable trades, such as building, or as domestic servants (there were over 120,000 domestic servants in London in the mid 18th century). Working hours were long: builders might work 64 hours a week in summer and 52 in winter, while domestic servants worked 80 hour weeks. Many young people worked as prostitutes (the majority of prostitutes in London were between 15 and 22 years of age). […]
Children as young as four were put to work. In coal mines children began work at the age of 5 and generally died before the age of 25. Many children (and adults) worked 16 hour days. As early as 1802 and 1819, Factory Acts were passed to limit the working hours of workhouse children in factories and cotton mills to 12 hours per day. These acts were largely ineffective […]
Beginning in the late 1840s, major news organisations, clergymen, and single women became increasingly concerned about prostitution, which came to be known as “The Great Social Evil”. Estimates of the number of prostitutes in London in the 1850s vary widely (in his landmark study, Prostitution, William Acton reported that the police estimated there were 8,600 in London alone in 1857). When the United Kingdom Census 1851 publicly revealed a 4% demographic imbalance in favour of women (i.e., 4% more women than men), the problem of prostitution began to shift from a moral/religious cause to a socio-economic one. The 1851 census showed that the population of Great Britain was roughly 18 million; this meant that roughly 750,000 women would remain unmarried simply because there were not enough men. These women came to be referred to as “superfluous women” or “redundant women”, and many essays were published discussing what, precisely, ought to be done with them. […] Divorce legislation introduced in 1857 allowed for a man to divorce his wife for adultery, but a woman could only divorce if adultery were accompanied by cruelty. The anonymity of the city led to a large increase in prostitution and unsanctioned sexual relationships.”
An image from the article, displaying “working class life in Victorian Wetherby, West Yorkshire”:
ii. Landlocked country.
“A landlocked country is a country entirely enclosed by land, or whose only coastlines lie on closed seas. There are 48 landlocked countries in the world, including partially recognized states. No landlocked countries are found on North American, Australian, and inhospitable Antarctic continents. The general economic and other disadvantages experienced by landlocked countries makes the majority of these countries Landlocked Developing Countries (LLDCs). Nine of the twelve countries with the lowest HDI scores are landlocked. […] Historically, being landlocked was regarded as a disadvantageous position. It cuts the country off from sea resources such as fishing, but more importantly cuts off direct access to seaborne trade which makes up a large percentage of international trade. Coastal regions tended to be wealthier and more heavily populated than inland ones. […] Landlocked developing countries have significantly higher costs of international cargo transportation compared to coastal developing countries (in Asia the ratio is 3:1).”
Landlocked countries make out 11,4% of the total land area of Earth, and the countries make out an estimated 6,9% of the world population.
“A landlocked country surrounded only by other landlocked countries may be called a “doubly landlocked” country. A person in such a country has to cross at least two borders to reach a coastline.
There are currently two such countries in the world:
- Liechtenstein in Central Europe surrounded by Switzerland and Austria.
- Uzbekistan in Central Asia surrounded by Afghanistan, Kazakhstan, Kyrgyzstan, Tajikistan, and Turkmenistan.
“The 1842 Kabul Retreat (or Massacre of Elphinstone’s Army) was the entire loss of a combined force of British and Indian troops from the British East India Company and the deaths of thousands of civilians in Afghanistan between 6-13 January 1842. The massacre, which happened during the First Anglo-Afghan War, occurred when Major General Sir William Elphinstone attempted to lead a military and civilian column of Europeans and Indians from Kabul back to the British garrison at Jalalabad more than 90 miles (140 km) away. They were forced to leave because of an uprising led by Akbar Khan, the son of the deposed Afghan leader, Dost Mohammad Khan.
Afghan tribes launched numerous attacks against the column as it made slow progress through the winter snows of the Hindu Kush. In total the India Company army lost 4,500 troops, along with 12,000 civilian workers, family members and other camp-followers. The final stand was made just outside a village called Gandamak on 13 January.
Out of more than 16,000 people from the column commanded by Elphinstone, only one European, an Assistant Surgeon named William Brydon, and a few sepoys would eventually reach Jalalabad. The Afghanis subsequently released a number of British prisoners and civilian hostages. However many Indians were not handed back and were instead sold into slavery or killed.
Sir Willoughby Cotton was replaced as commander of the remaining British troops by the ageing and infirm Sir William Elphinstone. The 59-year-old Major General, who was initially unwilling to accept the appointment, had entered the British army in 1804. He was made a Companion of the Bath for leading the 33rd Regiment of Foot at the Battle of Waterloo. By 1825 he had been promoted to colonel and made a major-general in 1837. Although Elphinstone was a man of high birth and perfect manners, his colleague and contemporary General William Nott regarded him as “the most incompetent soldier who ever became general”. […]
Throughout the third day, the column laboured through the pass. Once the main body had moved through, the Afghans left their positions to massacre the stragglers and the wounded. By the evening of 9 January, the column had only moved 25 miles (40 km) but already 3,000 people had died. Most had been killed in the fighting, but some had frozen to death or even taken their own lives.
By the fourth day, a few hundred soldiers deserted and tried to return to Kabul but they were all killed. By now Elphinstone, who had ceased giving orders, sat silently on his horse. On the evening of 11 January, Lady Sale, along with the wives and children of both British and Indian officers, and their retinues, accepted Akbar Khan’s assurances of protection. Despite deep mistrust, the group was taken into the custody of Akbar’s men. However once they were hostages, all the Indian servants and sepoy wives were murdered. Akbar Khan’s envoys then returned and persuaded Elphinstone and his second in command, Brigadier Shelton, to become hostages, too. Both senior officers agreed to surrender, abandoning their men to their fate. Elphinstone died on 23 April as a captive. […] On 13 January, a British officer from the 16,000 strong column rode into Jalalabad on a wounded horse (a few sepoys, who had hidden in the mountains, followed in the coming weeks). The sole survivor of the 12-man cavalry group, assistant Surgeon William Brydon, was asked upon arrival what happened to the army, to which he answered “I am the army”. Although part of his skull had been sheared off by a sword, he ultimately survived because he had insulated his hat with a magazine which deflected the blow. […]
The annihilation of about 16,500 people left Britain and India in shock and the Governor General, Lord Auckland, suffered a stroke upon hearing the news. In the Autumn of 1842 an “Army of Retribution” led by Sir George Pollock, with William Nott and Robert Sale commanding divisions, levelled Kabul. Sale personally rescued his wife Lady Sale and some other hostages from the hands of Akbar Khan. However, the slaughter of an army by Afghan tribesmen was humiliating for the British authorities in India.
Of the British prisoners, 32 officers, over 50 soldiers, 21 children and 12 women survived to be released in September 1842. An unknown number of sepoys and other Indian prisoners were sold into slavery in Kabul or kept as captives in mountain villages. […]
The leadership of Elphinstone is seen as a notorious example of how the ineptitude and indecisiveness of a senior officer could compromise the morale and effectiveness of a whole army (though already much depleted). Elphinstone completely failed to lead his soldiers, but fatally exerted enough authority to prevent any of his officers from exercising proper command in his place.”
iv. Alcatraz Federal Penitentiary. (‘good article’)
“The Alcatraz Federal Penitentiary or United States Penitentiary, Alcatraz Island (often just referred to as Alcatraz) was a maximum high-security Federal prison on Alcatraz Island, 1.25 miles (2.01 km) off the coast of San Francisco, California, USA, which operated from 1934 to 1963. […]
Alcatraz was designed to hold prisoners who continuously caused trouble at other federal prisons. One of the world’s most notorious, and best known prisons over the years, Alcatraz housed some 1576 of America’s most ruthless criminals […] Faced with high running maintenance costs and a poor reputation, Alcatraz closed on March 21, 1963. […]
The prison cells typically measured 9 feet (2.7 m) by 5 feet (1.5 m) and 7 feet (2.1 m) high. The cells were primitive and lacked privacy, with a bed, a desk and a washbasin and toilet on the back wall and few furnishings except a blanket. Black people were segregated from the rest in cell designation due to racial abuse being prevalent. […]
By the 1950s, the prison conditions had improved and prisoners were gradually permitted more privileges such as the playing of musical instruments, watching movies at weekends, painting, and radio use; the strict code of silence became more relaxed and prisoners were permitted to talk quietly. However, the prison continued to be unpopular on the mainland into the 1950s; it was by far the most expensive prison institution in the United States and continued to be perceived by many as America’s most extreme jail. […] A 1959 report indicated that Alcatraz was more than three times more expensive to run than the average US prison; $10 per prisoner per day compared to $3 in most others prisons. The problem of Alcatraz was exacerbated by the fact that the prison had seriously deteriorated structurally in exposure to the salt air and wind and would need $5 million to deal with it. Major repairs began in 1958 but by 1961 the prison was evaluated by engineers to be a lost cause and Robert F. Kennedy submitted plans for a new maximum-security institution at Marion, Illinois. After the escape from Alcatraz in June 1962, the prison was the subject of heated investigations, and with the major structural problems and ongoing expense, the prison finally closed on 21 March 1963. […] Today the penitentiary is a museum and one of San Francisco’s major tourist attractions, attracting some 1.5 million visitors annually. […]
Security in the prison was very tight, with the constant checking of bars, doors, locks, electrical fixtures etc., to ensure that security hadn’t been broken. During a standard day the prisoners would be counted 13 times, and the ratio of prisoners to guards was the lowest of any American prison of the time. […]
The library, which utilized a closed-stack paging system, had a collection of 10,000 to 15,000 books […] The average prisoner read 75 to 100 books a year.”
Pathological science is the process by which “people are tricked into false results … by subjective effects, wishful thinking or threshold interactions”. The term was first used by Irving Langmuir, Nobel Prize-winning chemist, during a 1953 colloquium at the Knolls Research Laboratory. Langmuir said a pathological science is an area of research that simply will not “go away”—long after it was given up on as ‘false’ by the majority of scientists in the field. He called pathological science “the science of things that aren’t so”.
Bart Simon lists it among practices pretending to be science: “categories [.. such as ..] pseudoscience, amateur science, deviant or fraudulent science, bad science, junk science, and popular science [..] pathological science, cargo-cult science, and voodoo science ..”. Examples of pathological science may include homeopathy, Martian canals, N-rays, polywater, water memory, perpetual motion, and cold fusion. The theories and conclusions behind all of these examples are currently rejected or disregarded by the majority of scientists. […]
Pathological science, as defined by Langmuir, is a psychological process in which a scientist, originally conforming to the scientific method, unconsciously veers from that method, and begins a pathological process of wishful data interpretation (see the Observer-expectancy effect, and cognitive bias). Some characteristics of pathological science are:
- The maximum effect that is observed is produced by a causative agent of barely detectable intensity, and the magnitude of the effect is substantially independent of the intensity of the cause.
- The effect is of a magnitude that remains close to the limit of detectability, or many measurements are necessary because of the very low statistical significance of the results.
- There are claims of great accuracy.
- Fantastic theories contrary to experience are suggested.
- Criticisms are met by ad hoc excuses.
- The ratio of supporters to critics rises and then falls gradually to oblivion.
Langmuir never intended the term to be rigorously defined; it was simply the title of his talk on some examples of “weird science”.”
“Upwelling is an oceanographic phenomenon that involves wind-driven motion of dense, cooler, and usually nutrient-rich water towards the ocean surface, replacing the warmer, usually nutrient-depleted surface water. The nutrient-rich upwelled water stimulates the growth and reproduction of primary producers such as phytoplankton. Due to the biomass of phytoplankton and presence of cool water in these regions, upwelling zones can be identified by cool sea surface temperatures (SST) and high concentrations of chlorophyll-a.
The increased availability in upwelling regions results in high levels of primary productivity and thus fishery production. Approximately 25% of the total global marine fish catches come from five upwellings that occupy only 5% of the total ocean area.”
i. “Only those who will risk going too far can possibly find out how far one can go.” (T. S. Eliot)
ii. “They constantly try to escape
From the darkness outside and within
By dreaming of systems so perfect that no one will need to be good.
But the man that is shall shadow
The man that pretends to be.” (-ll-)
iii. “We die to each other daily.
What we know of other people
Is only our memory of the moments
During which we knew them. And they have changed since then.
To pretend that they and we are the same
Is a useful and convenient social convention
Which must sometimes broken. We must also remember
That at every meeting we are meeting a stranger.” (-ll-)
iv. “Half the harm that is done in this world
Is due to people who want to feel important.
They don’t mean to do harm — but the harm does not interest them.
Or they do not see it, or they justify it
Because they are absorbed in the endless struggle
To think well of themselves.” (-ll-)
v. “Your burden is not to clear your conscience
But to learn how to bear the burdens on your conscience.” (-ll-)
vi. “I have great faith in fools — self-confidence my friends will call it.” (Edgar Allan Poe)
vii. “Education begins the gentleman, but reading, good company, and reflection must finish him.” (John Locke)
viii. “Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them.” (Laurence Johnston Peter)
ix. “To have doubted one’s own first principles is the mark of a civilized man.” (Oliver Wendell Holmes)
x. “The history of Western science confirms the aphorism that the great menace to progress is not ignorance but the illusion of knowledge.” (Daniel J. Boorstin)
xi. “Education is learning what you didn’t even know you didn’t know.” (-ll-)
xii. “Some are born great, some achieve greatness, and some hire public relations officers.” (-ll-)
xiii. “Gallantry of mind consists in saying flattering things in an agreeable manner.” (Rochefoucauld)
xiv. “If our inward griefs were seen written on our brow, how many would be pitied who are now envied!” (Metastasio)
xv. “For the whole world, without a native home,
Is nothing but a prison of larger room.” (Abraham Cowley)
xvi. “No one can be so welcome a guest that he will not become an annoyance when he has stayed three continuous days in a friend’s house.” (Plautus)
xvii. “He is ungrateful who denies that he has received a kindness which has been bestowed upon him; he is ungrateful who conceals it; he is ungrateful who makes no return for it; most ungrateful of all is he who forgets it.” (Seneca)
xviii. “One ungrateful man does an injury to all who are in suffering.” (-ll-)
xix. “Ideas are like rabbits. You get a couple of them and learn how to handle them, and pretty soon you have a dozen.” (John Steinbeck)
xx. “We are lonesome animals. We spend all our life trying to be less lonesome.” (-ll-)
i. I had a doctor’s appointment today and got the results of my bloodwork back. My Hba1c was 48, or 6.5%. This is the lowest it’s been for as long as I can remember. I have had some trouble with hypoglycemic episodes now and then, but not significantly more than usual and I’ve had no major episodes. I believe the lowered Hba1c is probably mostly a result of lowered nocturnal blood glucose values. These have however at some points been uncomfortably low, so I’m not sure 6,5 is a realistic long-term goal and because of those uncomfortably low values I have made adjustments along the way which probably means that the Hba1c may be a bit higher next time if other things stay pretty much the same (which I know they won’t; for instance I’m planning on significantly increasing my running over the next four months). But even so I was very happy about this result, as I choose to believe that it means I’ll actually be able to obtain <7.0% results in the future without major adverse events if I’m careful and vigilant.
This recent post goes into more detail about the hypoglycemia risk and what it’s about. This Danish post has some data on the distribution of Hba1c results among Danish diabetics – the relevant figure is this one (with 6.5%, I’m in the 10% fractile).
ii. I’m now ‘officially’ a researcher. I have just become a member of Statistics Denmark’s research programme (-forskerordning), which means that I’ve obtained access to a specific data set which I’ll do work on during the next year. Danish registers contain a lot of good information compared to the registers of most other countries, so I may actually be able to look at stuff that a lot of researchers elsewhere are simply not able to analyze due to data issues – which is exciting. Unfortunately I’ll not be comfortable blogging anything about this stuff, as there are a huge number of restrictions on data access/sharing etc. – but I believe it’ll be interesting to work with this stuff and I’m looking forward to it.
iii. A couple of Khan Academy videos:
Abstract: “We analyzed one decade of data collected by the Programme for International Student Assessment (PISA), including the mathematics and reading performance of nearly 1.5 million 15 year olds in 75 countries. Across nations, boys scored higher than girls in mathematics, but lower than girls in reading. The sex difference in reading was three times as large as in mathematics. There was considerable variation in the extent of the sex differences between nations. There are countries without a sex difference in mathematics performance, and in some countries girls scored higher than boys. Boys scored lower in reading in all nations in all four PISA assessments (2000, 2003, 2006, 2009). Contrary to several previous studies, we found no evidence that the sex differences were related to nations’ gender equality indicators. Further, paradoxically, sex differences in mathematics were consistently and strongly inversely correlated with sex differences in reading: Countries with a smaller sex difference in mathematics had a larger sex difference in reading and vice versa. We demonstrate that this was not merely a between-nation, but also a within-nation effect. This effect is related to relative changes in these sex differences across the performance continuum: We did not find a sex difference in mathematics among the lowest performing students, but this is where the sex difference in reading was largest. In contrast, the sex difference in mathematics was largest among the higher performing students, and this is where the sex difference in reading was smallest. The implication is that if policy makers decide that changes in these sex differences are desired, different approaches will be needed to achieve this for reading and mathematics. Interventions that focus on high-achieving girls in mathematics and on low achieving boys in reading are likely to yield the strongest educational benefits.”
Abstract: “A cornerstone of modern biomedical research is the use of mouse models to explore basic pathophysiological mechanisms, evaluate new therapeutic approaches, and make go or no-go decisions to carry new drug candidates forward into clinical trials. Systematic studies evaluating how well murine models mimic human inflammatory diseases are non-existent. Here, we show that, although acute inflammatory stresses from different etiologies result in highly similar genomic responses in humans, the responses in corresponding mouse models correlate poorly with the human conditions and also, one another. Among genes changed significantly in humans, the murine orthologs are close to random in matching their human counterparts (e.g.,R^2 between 0.0 and 0.1). In addition to improvements in the current animal model systems, our study supports higher priority for translational medical research to focus on the more complex human conditions rather than relying on mouse models to study human inflammatory diseases.”
vi. Married men at the age of 40 can expect to live on average 7.1 years longer than unmarried men at the age of 40, and 6.6 years longer than divorced men at the age of 40. For women the life expectancy difference between the married and unmarried group is 4.8 years, and the difference between married women and divorced women is 4.3 years. The excess mortality for unmarried men in their forties (compared with married males) is around 250%, and for men in their fifties it’s still above 200%.
The data reported above is from a new publication by Statistics Denmark which you can read here. Here’s a related publication. Here is a recent publication on the education levels of Danish emigrants. All three publications are unfortunately in Danish.
vii. Nasa – The Tyranny of the Rocket Equation. This part was surprising to me, because I’d never really thought about this:
“If the radius of our planet were larger, there could be a point at which an Earth escaping rocket could not be built. Let us assume that building a rocket at 96% propellant (4% rocket), currently the limit for just the Shuttle External Tank, is the practical limit for launch vehicle engineering. Let us also choose hydrogen-oxygen, the most energetic chemical propellant known and currently capable of use in a human rated rocket engine. By plugging these numbers into the rocket equation, we can transform the calculated escape velocity into its equivalent planetary radius. That radius would be about 9680 kilometers (Earth is 6670 km). If our planet was 50% larger in diameter, we would not be able to venture into space, at least using rockets for transport.”
I’ve completed the book. The last part of the book wasn’t that bad, though I remain unconvinced of some of the findings in these chapters because of methodological issues I have with the way they do things (Here’s a link relevant to one of the issues I have: “Whether individual Likert items can be considered as interval-level data, or whether they should be treated as ordered-categorical data is the subject of considerable disagreement in the literature, with strong convictions on what are the most applicable methods. This disagreement can be traced back, in many respects, to the extent to which Likert items are interpreted as being ordinal data. […] Non-parametric tests should be preferred for statistical inferences […] While some commentators consider that parametric analysis is justified for a Likert scale using the Central Limit Theorem, this should be reserved for when the Likert scale has suitable symmetry and equidistance” (I’m far from sure these requirements are met). It was still interesting stuff, though I believe the chapters in the middle were the most interesting ones. I’d say that if your impression after reading some of the quotes I’ve posted is that ‘it’d be an interesting read’, you should probably read it. A few quotes from the last part of the book:
i. “until the late 1980s we had never conducted research on college students. When the NEO Personality Inventory was first published (Costa & McCrae, 1985), we heard from psychologists around the country who thought there was something wrong with our norms, because their student samples were far from average. Colleagues generously provided data from students at two West Coast universities, one East Coast, and one Southern university. A comparison of these data showed several striking effects: All the students differed substantially from our adult norms; all the subsamples showed very similar patterns; and men and women had parallel age trends (Costa & McCrae, 1989). The implication was that college students differed systematically from adults in the mean levels of many traits. […] We began our careers looking for signs of adult development and found mainly stability. Examining what might be expected to be the most volatile time of life, the teenage years, we now find—mostly stability. As Figure 9.7 shows, adolescence appears to occupy a plateau before the important changes of the next decade. But there is one extremely important difference between this plateau and that seen after age 30. As Roberts and DelVeccio (2000) show, the stability of individual differences is inversely related to age. Costa, Herbst et al. (2000) studied 40-year-olds over a 6- to 9-year interval and reported a median retest correlation of .83 across the five factors. Over the 4 years of college, Robins et al. (2001) reported a substantially lower median retest correlation of .60, and the median retest for gifted 12-yearolds was only .38 (Costa, Parker, & McCrae, 2000).
What these dramatically lower stability coefficients mean is that adolescence really is a turbulent time in which the personality traits of any given individual may change considerably. But across individuals, there is no uniform trend. Some teenagers become more agreeable—more courteous, generous, and modest—as they go through junior high and high school, but an equal number become more antagonistic, belligerent, and arrogant. Similarly, individuals’ shifts in N, E, and C appear to yield no net effect on mean levels at this age.
The exception is O, on which both boys and girls show systematic change in mean level. […] Social class certainly has marked effects on the life course, but there is little data on whether personality traits develop differently in different social groups. Physical health status in general has little effect on personality or its stability (Costa, Metter, & McCrae, 1994)” (from chapter 9)
“individuals were more compartmentalized when stress was high than when stress was low (t(13) = 2.71, p < .02). With the exception of the low vulnerability, minor events group, there was a tendency for all groups to be more compartmentalized when stress was high than when stress was low. […] among those who were experiencing high levels of stress, greater compartmentalization was associated with less negative mood.
Although these data are correlational and must be interpreted cautiously, they are consistent with the notion that increases in compartmentalization may be an effective response to stressful life events. Individuals who have the flexibility to change their type of self-organization may experience less negative mood when stressful events occur.” (from chapter 11)
“Interpersonal behavior […] involves the temporal coordination of behavior at divergent levels of analysis, from basic movements and utterances to broad action categories reflecting momentary goals and long-range plans. Even something as elemental as leaving a room, after all, requires that the room’s occupants coordinate their physical movements so as not to stumble over each other. As group action becomes more complex, the ability of group members to coordinate their activities in time becomes correspondingly more important.
To distinguish the dynamic aspects of coordination from its conventional interpretation, we employ the term synchronization. Synchronization refers to the fact that the actions, thoughts, and feelings of one person are temporally related to the actions, thoughts, and feelings of one or more other people. […] In its most basic form, synchronization refers to the coupling of behavior patterns […] Synchronization […] is likely to become more difficult as the action in question becomes more complex. It may be impossible, for example, for two unacquainted people to synchronize their efforts sufficiently to assemble a mechanical device or create a piece of art. The ability to synchronize in more complex modes requires at least some semblance of concordance in the requisite internal states of each person. […] The importance of similarity in facilitating synchronization is apparent with respect to stable characteristics such as attitudes, values, talents, temperament, and personality traits. Indeed, similarity with respect to such characteristics has been shown consistently to be among the strongest preconditions for interpersonal attraction (cf. Byrne, Clore, & Smeaton, 1986; Newcomb, 1961). By the same token, individuals avoid forming relationships with people who appear to be different from them in their personal characteristics (e.g., Rosenbaum, 1986). […]
Even if someone’s internal state is readily detectable, it may prove difficult to modify one’s own state to match it. It is hard to change one’s cognitive style or temperament, for example, regardless of how pragmatic it would be do so in preparing for an interaction with someone whose way of thinking and tempo of expression is markedly different from one’s own. There is evidence, for example, that differences in temperament can hinder effective emotional and behavioral coordination (e.g., Dunn & Plomin, 1990). In this sense, personality sets constraints on social interaction. People’s stable characteristics—traits, values, and the like—bias the choice of interaction partners and dictate the likely success of establishing relationships with those who are chosen.
But one can look at the process in reverse to ask how social interactions shape personality. Personality, after all, comes from somewhere. […] We propose that individual differences are shaped by the history of social interactions. […] In essence, the model envisions social interaction as a vehicle for coupling the dynamics of individuals. Each individual brings his or her personal dynamic tendencies to social interaction and attempts to synchronize these tendencies with his or her interaction partner. As a result of these attempts, social interaction revises the settings for each individual, or engraves entirely new settings, which then provide the foundation for subsequent social interactions. In principle, this reciprocal relation between settings of internal parameters and social interaction iterates continuously throughout social life. In reality, the engravings of some tendencies are likely to become particularly stable and thus resistant to modification in the ordinary course of social encounters. […]
With respect to modeling human dynamics, the dynamical variable (x) can be interpreted as behavior. Changes in x thus reflect variation in the intensity of behavior. The control parameter, r, corresponds to internal states (e.g., personality traits, moods, values, etc.) that shape the person’s pattern of behavior (i.e., changes in x over time). […] (α) corresponds to the strength of coupling and reflects the mutual interdependency of the relationship. When the fraction is 0, there is no coupling on the behavior level. When the fraction is 1, each person’s behavior is determined equally by his or her preceding behavior and the preceding behavior of the other person. […] The main results […of their simulations – US] were straightforward. In general, the degree of synchronization between partners’ behaviors increased both with α and similarity in r. This implies that similarity in internal states and interdependence can compensate for one another in achieving or maintaining a given level of synchronization. […] Modeling the direct synchronization of control parameters is relatively straightforward. One need only assume that on each simulation step, the value of each person’s control parameter drifts somewhat in the direction of the value of the partner’s control parameter. The rate of this drift and the size of the initial discrepancy between the values of the respective control parameters determine how quickly the control parameters begin to match. This mechanism assumes that both interaction partners can directly estimate the settings of one another’s control parameters. In many types of relationships, considerable effort may be focused on communicating or inferring these settings (cf. Jones & Davis, 1965; Kunda, 1999; Nisbett & Ross, 1980; Wegner & Vallacher, 1977). Even with such effort, however, the exact values of the relevant control parameters may be difficult or impossible to determine.
Control parameters can also become synchronized through behavioral coordination. Research concerning the facial feedback hypothesis, for instance, has established that when people are induced to mechanically adopt a specific facial configuration linked to a particular mood (e.g., disgust), they tend also to adopt the corresponding affective state (e.g., Strack, Martin, & Stepper, 1988). This matching of internal states to overt behavior is enhanced when the behavior is interpersonal in nature. Even role playing, in which a person simply follows a behavioral script in social interaction, often produces pronounced changes in attitudes and values on the part of the role player (e.g., Zimbardo, 1970). […]
Figure 12.1 shows the time course of synchronization as two maps progressively match each other’s control parameters […] This simulation was run for relatively weak coupling (α = 0.25). The x-axis corresponds to time in simulation steps, and the y-axis portrays the value of the difference between the two maps. The thin line corresponds to the difference in the dynamic variables, whereas the thicker line corresponds to the difference in r. Over time, the difference in the respective control parameters of the two maps decreases and the maps become perfectly synchronized in their behavior. This suggests that attempting behavioral synchronization with weak levels of influence and control over one another’s behavior will facilitate matching of one another’s internal states.
Figure 12.2 shows the results when the simulation was run with a stronger value of coupling (α = 0.7). Note that although coordination in behavior develops almost immediately, the control parameters fail to converge, even after 1,000 simulation steps. This is because strong coupling causes full synchronization of behavior, even for maps with quite different control parameters. Once the behavior is in full synchrony, the two maps do not have a clue that their control parameters are different. Hence, if the coupling were removed, the dynamics of the two respective maps would immediately diverge. This result suggests that using very strong influence to obtain coordination of behavior may effectively hinder synchronization at a deeper level. More generally, there is optimal level of influence and control over behavior in relationships. If influence is too weak, synchronization may fail to develop. Very strong influence, on the other hand, can prevent the development of a relationship based on mutual understanding and empathy. Although highly controlled partners may fully synchronize their behavior, they are unlikely to internalize the values of control parameters necessary to maintain such behavior in the absence of interpersonal influence. For such internalization to occur, intermediate levels of mutual influence would seem to be most effective.” (from the last chapter of the book)