The Rational Optimist, Matt Ridley

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Chris Hibbert

Matt Ridley's The Rational Optimist is a very well written ode to the value of trade and how it contributes to a rational confidence that things will continue to improve for humanity as they have since we first appeared in the world.

Ridley's previous books have mostly been on evolution (though that includes the evolution of cooperation and virtue). Here he's focusing on how trade enriches us all, and how far back trading goes. He uncovers new evidence for the richness of trading in antiquity. One example is Oetzi, the mummified ice age hunter revealed by a receding glacier in the alps in 1991:

[He] was carrying as much equipment on him as the hikers who found him. He had tools made of copper, flint, bone and six kinds of wood: ash, viburnum, lime, dogwood, yew and birch. He wore clothes made of woven grass, tree bark, sinew and four kinds of leather: bearskin, deer hide, goat hide and calf skin. He carried two species of fungus, one as medicine, and other as part of a tinder kit that included a dozen plants and pyrite for making sparks.

Ridley's point is that Oetzi couldn't have collected, sewn, tanned, woven, smelted and sharpened everything he carried himself. The only way he could have accumulated so much useful equipment was through trade. I'm used to arguments for the early emergence of trade that show that quantities of obsidian or sea shells was found hundreds or thousands of miles from where it would have been regularly collected, but Ridley goes to great lengths to display evidence that trade was pervasive and that early people everywhere relied on it extensively for many items in their daily repertoire. It wasn't just an occasional trade for a high-value item, it was a part of routine life, and part of what people ate, wore, and used for healing, hunting, and food storage.

Ridley also carefully lays out the case for Ricardo's point that trade makes us all richer. Expanding the extent of trade increases the size of the market; with more people in your trading community, you can draw on the efforts of specialists who multiply the overall productivity you can take advantage of. Ridley argues that the increasing returns from trade taught our ancestors the value of trust and led to to more virtuous interactions, and better ethical instincts among our ancestors.

The underlying point of much of this is that increasing communication, increasing interaction leads to more and better ideas as we recombine the ideas in new ways, and this leads to the production of more wealth. Around the time of Malthus, it was still possible to argue that increasing production of wealth just made it possible for populations to increase, and didn't really make anyone better off. But sometime in the last two hundred years that started to change, and the recent demographic transition has made that position completely untenable. But pessimism is still more widely respected, and Ridley wants us to understand that a reasonable understanding of the sweep of history and of our evolutionary origins makes optimism a much better fit with our circumstances. Things have been getting better for hundreds of years, and while we can imaging things that might change that, none of them seems particularly likely.

More people are moving to cities where they are more productive and have fewer children. They live wealthier lives than before, and insist on and can afford a cleaner environment and healthier lifestyle. Government restrictions could prevent progress, or trap people outside the cities, or make it harder for them to buy the lifestyle and environmental values they will want, but the smart money goes with the trends. Ridley thinks that the pressure for progress will be sufficient to move governments out of the way, and that spontaneous order will enable people to get what they want. Technology will enhance our healthspan, and our ability to travel and communicate will continue to grow. We'll spend less time working and more on other things. China and Brazil will lead the way if politics in the West grows too stifling.

The Long Tomorrow, Michael Rose

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Chris Hibbert

Michael Rose's book The Long Tomorrow discusses aging in the context of evolution. The book has something of the feel of a memoir— Rose writes about how he happened into this field, who helped and encouraged him, who was right and wrong, and what he was working on along the way.

Rose has spent most of his career single-mindedly breeding long-lived fruit flies (Drosophilia Melanogaster). This approach to achieving longevity has important implications for understanding the mechanisms of evolution and how they impact lifespan. Because the mechanism itself (selective culling and breeding) isn't applicable to humans, the implications for human longevity are indirect, even though they may turn out to be very important for us.

Rose begins his tale at a symposium he spoke at for the Templeton Fund, where eminent scientists and ethicists spoke against any attempt to pursue human longevity as respectively impossible and immoral. Christian theologians joined that chorus, but were opposed by a Jewish scholar, and by Rose himself, already pursuing longer-lived flies. This serves as a nice backdrop and introduction to the issues which allows him to refer back to the controversy and the parties later when he talks about his own views.

In the mid-70s, when Rose was trying to get started in biology, Crick & Watson's theories had been accepted, but the implications weren't yet clear. Scientists were starting to investigate the molecular mechanisms for all kinds of biological effects, both to see how they interacted with evolution and to find the cellular mechanisms that made life function. Hayflick's proposal on the impact of cell division problems on lifespan was getting publicity, but there were few posited mechanisms based on evolutionary reasoning. The Hayflick limit was an observed and accepted fact, but so far without much theoretical context. Thirty years earlier, J. B. S. Haldane had suggested that Huntington's disease (which waits until carriers of the causative genetic defect are in their 30's or 40's to attack) was a consequence of selection's pressure: genes that debilitate before the carriers reproduce will be weeded out, but diseases that crop up later can survive more easily in the population. Peter Medowar expanded on these ideas, but got the evolutionary causality wrong. George C. Williams straightened out a few clues and pointed out that processes that are helpful in the young, and therefore reinforced by evolutionary pressures, might be costly for mature animals but they wouldn't necessarily be corrected because reaching maturity is so much more important evolutionarily than surviving it. Finally, in 1966, William Hamilton put the pieces together and provided an argument based on evolutionary principles that explained why aging would arise. Once Rose studied the history, it was clear that there was some evolution-based theory, but no significant experimental results validating the evolutionary basis of aging. He thought he'd be able to make a mark on this new field fairly quickly.

Brian Charlesworth was Rose's mentor and supervisor when he started the research. Charlesworth had worked out the math for how much selective pressures should fall as a creature aged. Since selection pressures are strongest on the young, you'd expect to see less weeding out of deleterious mutations that affect the mature and the aged than of those that affect the young. Charlesworth proposed that Rose look for an experimental demonstration of that difference in drosophilia, by showing that the fall in fecundity of female flies followed his formulas. Rose spent more than a year in the laboratory, and counted more than a million eggs before analyzing his results. The results showed that Charlesworth's predictions were wrong.

But Rose had started a parallel experiment about half-way through the first one, based on a paper by J. M. Wattiaux (published in 1968) which showed that offspring of older parents lived longer than those born to younger parents. Wattiaux had been unable to demonstrate what he expected to be environmental causes of the difference, but when Rose read the paper, he realized that age of reproduction was the crucial variable that evolution could select on. If only eggs produced from older parents were allowed to reproduce, then the selective pressure (acting on potential parents) would be towards flies that stayed healthy long enough to meet the delayed date. A year after sharing the results of the first experiment, Rose showed that the new procedure (delaying breeding) produced flies that were already living about 10% longer than under standard fly care.

From that point, Rose (and later his students) studied the interactions between longevity, stress resistance (starvation and desiccation), diet and diet restriction, and body fat and other energy storage. They established a positive correlation between long life and all kinds of stress resistance, and showed that body fat and other energy stored in the flies' bodies increased stress resistance. Diet restriction seems to work because it encourages retention of more energy reserves. But all of these mechanisms (except diet restriction) work over evolutionary time scales. Rose wanted to find treatments that can lengthen the lives of those already alive. So he started to investigate molecular mechanisms to see if we can tell what's different within the cells of those predisposed to longer life when compared to their counterparts.

A later series of experiments demonstrated that the death rate, which increases with age, only actually increases from the start of reproduction to its cessation. What this means is that the death rate is strongly controlled by evolutionary pressures. For any species, evolution acts to reduce the death rate as much as possible before the onset of sexual maturity. After that point, it allows the death rate (from natural causes, primarily) to increase relatively smoothly. Once sexual reproduction ends (or possibly a bit later if individuals are still contributing significantly to the life success of their offspring) evolution stops being able to apply selective pressure. This means that the rate at which individuals die (in deaths per capita per annum) stops increasing. For most populations the rate is pretty high by this mature age, and the number of individuals reaching each later age is small, so it's hard to see that the rate isn't changing. But separate experiments done by Rose, Charlesworth, and Larry Mueller show that manipulating the age of last reproduction in populations of drosophilia directly effects the death rates of the resulting populations in only a few generations.

In humans, Rose says that 95 is the age at which mortality rates stop increasing. From 15 to 90, there is exponentially increasing mortality, but after 95, the rates stop increasing. This has two interesting implications for humans. First, many more people are going to make it to their 90s in coming decades, just because we're living so much more healthily and robustly than we used to. That means that there will be much larger cohorts which will see their mortality rates stop increasing, so we should see gradually rising maximum ages, even if nothing else changes.

The other implication is that mortality rates don't increase to 100%. There is always a chance of surviving another year if you aren't hit by a bus. And if Aubrey de Grey is right, our first step is just to clean up our constitutions so that we keep the mortality profile of a 40-something, and we'll vastly improve life-spans. As Rose says:

Aging is not an infinitely high wall of mortality, rising faster and faster as we get older, until everybody is dead. It is a ramp that takes us from a phase of low childhood mortality to a much later phase of high, but relatively stable, mortality. Postponing, retarding, or otherwise mitigating aging does not require pushing back a wall of death of infinite height. It requires smoothing out a ramp of mortality, and possibly lowering the height of the top of the ramp.

At this point, Rose seems to get serious about the implications of his research for human longevity. At the prodding of New Scientist, in 1984, he wrote a lead article proposing that a major, government-backed program to produce long-lived "methuselah" mice would be valuable. He pushed the idea with potential funders from government and the private sector, but never found anyone willing to actually underwrite the proposal. Rose never mentions Aubrey de Grey's Methuselah Mouse project, which I've talked about before. de Grey found private funders to endow a prize, rather than attempting to organize a single Manhattan project-style (Rose's own description) effort.

Having failed at his own efforts to start a project to find ways to apply his research to humans, Rose continues to be upbeat at the prospects that someone will succeed. He finishes the book by offering lots of advice and suggestions on which scientific paths are likely and unlikely to bear fruit, and what modes of organization are worth trying, particularly by people with different skills than his.

My own postscript involves pointing out that Rose didn't talk about what happened to his fruit flies in the end. He was a co-founder of the company Genescient, which uses modern gene assay techniques to look for nutraceuticals that can reproduce the cellular effects present in the Methuselah flies. Rose's name doesn't appear on Genescient's site, so there appears to have been some sort of split. Genescient has spun out Life Code, which markets Stem Cell 100, a nutraceutical based on this research. I haven't started taking it yet, but I do continue to investigate.

Darkship Thieves, Sarah A. Hoyt

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Chris Hibbert

Sarah Hoyt's Darkship Thieves is a fun read, with a reasonably freedom-oriented bent. I think it's the strongest of this year's finalists for the Prometheus award. Athena Sinistra is the daughter of a wealthy tycoon who is kidnapped from her father's space yacht, and rescued by Christopher "Kit" Klaavil, an apparent ne'er-do-well from Eden, a colony founded by genetically enhanced humans in hiding from Earth. Eden seems to survive by siphoning off energy from Earth's orbiting power collectors.

Athena's and Kit's adventures together provide an opportunity for a look behind the scenes at how the society on Eden works. Athena can't be returned to Earth without revealing Eden's location, so she has to figure out how to earn a living on her own. The people are receptive and friendly, but insist that everyone find a way to support themselves. Athena has some skills, and finds a way to apply them, even though she's more used to people expecting her to take advantage of her father's wealth and position. It's a peaceful and progressive society and she earns people's respect, but wants to return home to Earth.

When they get back to Earth, Athena learns that the circumstances of her kidnapping weren't what she thought. Kit and Athena end up rescuing one another a few times, and they end up puzzling out some interesting mysteries about both their ancestries.

Hoyt throws in some plot twists involving cloning, brain transplants, and genetic enhancement.

Gawande on Cowboys and Doctors

Atul Gawande gave a commencement address at Harvard last week, and focused on the subjects he covered so well in his book The Checklist Manifesto. Given the setting, he adds a charge to the graduating class to enact the reforms he argued for. The line in his speech that caught my attention and makes me hopeful that the health care system may be moving in the direction he promotes was this:

Two years ago, the Institute for Healthcare Improvement started its Open School, offering free online courses in systems skills such as outcome measurement, quality improvement, implementation, and leadership. They hoped a few hundred medical students would enroll. Forty-five thousand did. You’ve recognized faster than any of us that the way we train, practice, and innovate has to change.

If the next generation of doctors understands and is buying into the idea that we need more systemic approaches to managing health care, there may be a chance that the system will gradually (or we can at least hope, rapidly) reform into something more sustainable, and directed at effective care.

The Last Trumpet Project, Kevin MacArdry

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Chris Hibbert

Kevin MacArdry's The Last Trumpet Project covers the consequences of a slightly future world in which realistic virtual realities and uploading of people's consciousnesses into software are becoming commonplace. The government and organized religion are both violently opposed to these developments (for different reasons) and work together to suppress the technology and the people promoting it. Since the technology is the result of decentralized processes, rather than a single company or organization, the efforts to suppress don't do much more than slow the tide.

The story is generally well-told, with plenty of excitement, intrigue, and reasonable character development. The one place where MacArdry comes up short is in his depictions of the bad guys. They are caricatures of venal politicians and religious leaders, and may turn off (politically) mainstream readers. Their explicit drives and goals are for personal power, and they verbally admit that they don't care who gets hurt as long as they don't have to relinquish control.

MacArdry presents a plausible economic story about the development of the technology (the ability to view past events necessary for uploading dead people notwithstanding). As the fidelity of the VR improves, and there are more things to do and places to go there, more people spend more time there. The eventual consequence is that their real world activities and sources of income become harder to trace, which squeezes the tax authorities. This is the root of much of the governmental opposition. The religious opposition is stirred up based on the project to resurrect the dead into the artificial worlds.

As befits a technology that people rely on so heavily (the resurrected can't exist without it), the software has actual security (not described) that enables owners to prevent bad actors from getting access to sensitive locations. Of course the weak spot is physical access to the servers hosting the system, and the enemy forces eventually figure that out, though they have a hard time connecting particular servers to particular virtual locations.

The Last Trumpet Project is a finalist for the Prometheus Award, and it has a reasonable chance. It may not be the best written candidate of this year's finalists, but it's one of the best at presenting a clear conflict between freedom and government repression.

Simple Explanation of Prices

One of the podcasts I listen to is Russ Roberts' "Econtalk". In a recent podcast on Hayek, he was talking with Bruce Caldwell about the price mechanism and how markets adjust when circumstances change. They referred to Hayek's article "The use of knowledge in Society", a classic article I've heard of many times. This is the place where Hayek conclusively settled the Socialist Calculation Debate, which had raged for a couple of decades to that point. It's remarkably readable.

The podcast also referenced Roberts' own short article "How Markets use Knowledge". This article gives a concrete example of how markets adapt to changing circumstances, using a simple intersection of supply and demand curves. As circumstances change, suppliers and consumers adapt, by changing the amount they produce or consume, and the changing price gives each all the cues they need to choose a new course of action. Roberts shows how their adaptations respond to the context and the information they each have so different economic actors make different choices in differing circumstances. It's simple and elegant.

War and Peace and War, Peter Turchin

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Chris Hibbert

Peter Turchin's War and Peace and War contains some fascinating details about a period in European history that isn't often covered in order to justify a relatively comprehensive theory about what drives the rise and fall of empires. Since I only have Turchin's view of the events, I don't feel confident in judging the theory, but it does hang together fairly well. Turchin's argument is that societies in which diverse cultures mix and which have frequent contact and conflict with very different groups, usually develop strong asabiya (social capital, Fukuyama's Trust), which leads to a strong culture and government, and historically led to empire (which he defines as a large multiethnic territorial state with a complex power structure.) The mixing which he says is crucial happens most often at the boundaries between empires, so as an empire grows the boundaries grow more distant, and the asabiya is undercut, followed by collapse and the rise of a new empire at the edges of the old.

The heart of the book is a presentation on European history before and after the Roman Empire, focusing on the interactions between the central areas and their Germanic, Frankish, Russian, and Arabian neighbors. There is a lot of detail about the various tribes and societies, and how they interacted, fought, and traded superiority over time. This was quite interesting, but since it was mostly new to me, and presented in support of Turchin's thesis, it was hard to tell how much selective bias there might have been. Turchin covers interactions between Russians and both Tatars and Mongols. The Russians apparently don't have any natural barriers to the east or south, allowing invaders to attack repeatedly. According to the thesis, northern Italy, which had more interaction with divergent neighbors than southern Italy, developed stronger social cohesiveness, which is completely consistent with the argument in Trust.

Turchin is less convincing when he talks about what drives the disintegration of social cohesion. This may be because he relies less on historical evidence and more on colloquial argument. He puts most of the weight of his argument on the "Matthew Principal" ('The Rich get Richer and the Poor get Poorer'.) He argues it's a cyclic process that occurs between and within classes. This sounds like social mobility to me, but he seems to believe that it's more accordian-like, compacting and stretching out the classes, and he argues that social capital eventually dissipates because of the disparities. In his view, the rich have advantages that allow them to amass more and more, so inequality rises, which leads to a decay of asabiya, ending in the fall of another empire. But it's clear from his description that some of the upper classes are rising and others are falling, and the same thing happens to the middle and lower classes at the same time. He even gives examples of some of the wealthy spending their money foolishly and ending up poor, and of the middle and lower classes saving their money and making it into higher strata.

In the final chapter, Turchin acknowledges that the Internet and the spread of the cell phone have changed the dynamics. He suggests a couple of possible directions that things might go, and some ways in which his theory might continue to be useful, but admits that societies don't have much of the stratification or immobiilty that drove the dynamics in prior eras.

Zendegi, Greg Egan

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Chris Hibbert

Greg Egan's Zendegi is another novel nominated for this year's Prometheus Award that features social media being used by an underground movement to topple a government. But this is Greg Egan, so there must be something about silicon consciousness or artificial life involved, right? Well, yes there is, but the political plot works out to be more interesting this time around. Egan's focal characters are Martin Seymour, an ex-pat American journalist living in Iran and Nasim Golestani, an Iranian scientist who worked in the US but has now returned. At the beginning of the story Golestani is working on the Human Connectome project, which gives her a background in mapping the brain to software. Seymour gets involved when cell-phone pictures help topple the Iranian religious dictatorship.

In the second half of the novel, Golestani works on improving the AI for a virtual reality game company that is struggling to keep up with its competition, while Seymour runs a bookstore in Tehran. Golestani starts incorporating data and software from the Connectome project into the NPCs, which raises the ire of fundamentalists. Seymour, meanwhile, has contracted a fatal disease, and wants to find a way to ensure that someone he trusts will continue to provide guidance to his son, and hits on the idea of getting Golestani to build an artificial mind for him.

Egan's depiction in Diaspora of the development of consciousness in artificial minds was ground-breaking, but nothing of similar scope happens here. There are many scenes in virtual reality, but the story-telling emphasis is on Seymour's attention to influencing his son's maturation. The descriptions of the development of the artificial consciousnesses focused on brain mapping rather than awareness. In the end, the characters decide that the simulacrum of Seymour isn't up to the task of mentoring his son, which renders many of the interesting conflicts and questions moot. The protesters against enslaving artificial being can be pacified with a promise to keep them below the level of a simple automaton, and Golestani doesn't have to grapple with her own moral sensibilities about just how conscious they might become. It feels like Egan really side-stepped the issue here. And his solution doesn't do anything to prevent other developers from taking the same step later.

It's especially bad because Egan has previously made it clear that understands these issues. His Diasporah, and Permutation City directly address issues related to artificial consciousness. In the latter work, his characters explore a large variety of different scenarios of partial experience, and directly discuss the issues concerning how real they are as persons, and what rights a partially aware entity should have.

While the story is well-written, topical, and engaging, the liberty-related themes are sparse and limited. The populace revolts against a corrupt dictatorship, but that's more celebration than presentation of issues. Artificial creatures are developed, but never get advanced enough for their rights to be a serious question. It's neither a strong contender for this year's Prometheus, nor as much as I would have expected from Egan.

Directive 51, John Barnes

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Chris Hibbert

John Barnes's Directive 51 is a fast-paced action story that covers a dystopian apocalypse and the struggle over presidential succession in a suddenly low-tech society which suffered huge losses. It's hard to call it libertarian, since the focus is on how the government will help people pull the country together again, but it does realistically show that the struggle for power trumps many other considerations, even when most of the survivors are fighting just to find food and shelter in an emergency.

The situation is that "Daybreak", a leaderless underground movement, has piggybacked on the Internet (there's a lot of that going around in SF this year, isn't there?) to put together a coordinated attack plan to destroy modern civilization. The participants all have different reasons and different objectives, but they agree that "the system" is broken, and we'd all be better off without it. Most of them haven't thought any deeper than that, and don't realize just how much they'd lose. Some of the movement's participants have invented bacteria that eat plastic and "nanoswarm" that gunks up powered machinery. Others have devised plans to ensure that these destructive agents are spread far and wide (worldwide, though the story's focus is on the US) on the appointed day. All this, of course results in the collapse of civilization, 100s of millions of deaths, and nearly everyone else being reduced to fleeing refugees trying to get out of the major metropolitan areas.

All of that serves as background to the story that Barnes really wants to tell. Directive 51 is (truthfully) the latest in a sequence of Presidential Directives laying out the process for maintaining constitutional government in the aftermath of a calamity that removes the bulk of the leadership of the federal government. In this depiction, the consequences are a deadly struggle for power that seems to supersede the attention that should be paid just to getting people back on their feet.

In order to justify one faction's claims that the nation is still under attack, the book has to enable Daybreak to conduct a continuing series of hydrogen bomb attacks after the devastation has occurred. This is both out-of-character with the rest of Daybreak, and hard to believe technically. Nearly everything else has broken down, but the bombs keep falling.

The book has been nominated for the Prometheus Award, and while it's an exciting story, and well-told, and it shows how power can corrupt even in a paramount emergency, I was disappointed that the focus of discussion of the recovery was largely on the government's efforts. It's clear that behind the scenes, individuals are doing most of the work independent of the government, but we're mostly watching federal efforts to ensure that the government continues to function. You might find that outweighed by the fact that people, acting on their own are the primary source of recovered food, the primary hope for growing more, as well as the drivers of a multitude of new inventions that provide some technologies that can continue to function in the face of the proliferating nanoswarm.

For the Win, Cory Doctorow

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Chris Hibbert

Cory Doctorow's For the Win is very much of the moment, covering an Internet-driven global uprising. In Doctorow's case, though it's a union organizing outbreak among Internet workers (gold farmers, mechanical turks, etc.). Not surprisingly, real-world union busting tactics are used to fight back. Doctorow, as usual, has a firm grasp on the zeitgeist, and has written another story just a few months into his own future. Published last year, it must have been written even earlier. The introduction on his webbed version of the story (linked above) talks up the relevance to the recent financial crisis.

There are a couple of fascinating ideas on display in the book: the parallels to current events in the Middle East of course, the discussions of on-line role-playing games and their various denizens, and the story itself and the characters and events that drive it.

The action centers around the Far East: mostly China and Viet Nam, though Cambodia, Indonesia, and India show up, too. Several groups of gold farmers are the focal characters. They're each controlled and abused by a relatively wealthy investor, who underwrites their access to the net, and resells the gold and treasures they earn on-line. In exchange, they're paid enough to keep them alive, and they get to play games all day. Rather than mindlessly wandering the games or doing the obvious quests, their modus operandi is to play the games and look for exploitable weaknesses—monsters that are easy to kill relative to the treasure they give, places that are unusually likely to spawn a good treasure, or actual bugs in the implementation that let players turn straw into gold with less than the usual effort. Since what they do is fun and exciting, and a lot like playing games, there are always plenty more players available, so individuals don't have a lot of leverage with their employers. In this kind of circumstance, it's not surprising that the situation occasionally turns more explicitly abusive, and that's the context that leads some of the characters to approach union organizers. Once they're gotten in contact, the support goes both ways: the on-line workers provide communication and publicity to traditional union workers, and the organizers provide manpower and experience in dealing with violent tactics.

The book was nominated for the Prometheus Award, but it's hard to identify explicitly libertarian aspects of the story. Most of the conflict is between (abusive) owners and workers, with governments not getting very involved. I found the context intriguing, and Doctorow tells a great story, but the closest I can get to a libertarian angle is to try to describe it as a struggle against authority—but it's only a struggle against power, which isn't quite the same thing.

For the Win is a fun read. Doctorow excels at depicting action crossing back and forth between virtual worlds and the real world, and at giving a feel for a future that's only a little advanced over our own. There's a fair amount of violence in this story, even though Doctorow presents it as a young adult novel. In the anti-union violence there's a fair amount of head-bashing, though eventually it's countered with ghandian non-violence. Definitely worth the read.

The Checklist Manifesto, by Atul Gawande

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Chris Hibbert

Atul Gawande has been writing on medical practice, provocatively and informatively, for the New Yorker for several years. His comments on price differences and what drives disparities between different areas garnered a lot of attention, but that area hasn't been his main focus. His recent book, The Checklist Manifesto, is closer to the main line of his writings. In this short book, Gawande presents his argument that medicine as currently practiced is far from a rigorous, science-driven field. He shows how aviation and construction are at least as complex and time-constrained as medicine, and that both have benefited from the use of checklists to help practitioners get the details right when performing complex operations.

Individual errors and mistakes of coordination are far more common in medicine than in other modern highly-technical fields. If medicine followed the standards of professional practice common in other areas, there would be a dramatic improvement in our overall health. Gawande discusses how checklists are constructed and used in aviation, another field where routine work is occasionally suddenly interrupted by situation requiring split second decision making at a rapid pace in a distracting environment with enormous consequences. Safety experts in aviation have learned how to put together checklists that can be found quickly, and that enable professionals to correctly address situations that arise in one flight in a million.

The safety record in aviation world-wide is amazingly good. I've long ascribed that difference between aviation and medicine to the fact that accidents in aviation are scrutinized thoroughly, and every mistake drives new corrective processes that quickly make it less likely that the same thing will happen again anywhere in the world. Every airframe manufacturer ensures that all of its vehicles are quickly updated with the most up-to-date procedures. In medicine, individual hospitals sometimes conduct reviews, but any knowledge gained is used sporadically and locally. There is also no standard for how to conduct these inquiries, so some investigations are derailed by politics, infighting, or a desire to deflect blame (which is exacerbated by medical malpractice risks.) The inquiries conducted in aviation have been designed to find correctable causes, and not to place blame. Focusing on the checklists that result from these inquiries would be a big improvement on what we have in medicine now. It's even plausible that a coordinated process for producing checklists would drive an improvement in the checklists based on measured effectiveness.

The book is very readable. The main story is about how Gawande led a task force for WHO testing out some simple checklists for a few common surgical procedures with high rates of routine errors. The results were spectacular, leading to a 36 percent reduction in complications and 47 percent drop in deaths from a variety of hospitals in rich and poor communities all over the world. Getting doctors and hospitals to actually adopt this simple improvement is a far harder task than getting a pilot program demonstrating its effectiveness. The side trips Gawande makes into aviation and construction to show how checklists work there and how they're constructed are engaging.

Going Inside, John McCrone

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Chris Hibbert

John McCrone's Going Inside provides a lot of insightful observations about how the brain works, but fails to tie them together into a cohesive picture. McCrone focuses on recent findings from new brain scanning technologies, and is particularly fascinated by timing studies that give details on how long it takes us to process incoming information, the specific times at which decisions are made, and how our subjective experience of when choices happen comport with the underlying brain circuitry. In particular, the studies show that it takes a half second to react to new information, even when we're expecting it, but our subjective experience is that the decision is made instantaneously at the end of that period. The experiments that show this are ingenious: by cutting off or distracting the process at various points, we can compare the reported subjective feel about the decision state that was reached with the brain scanner's details of how far into the process the brain actually got. All this works experimentally, because repeated sessions show that there's a lot of consistency in the information processing, so the scientists can pinpoint when the incoming information started being processed, and how long it would have taken to reach a choice.

The problem with the presentation is that McCrone doesn't provide an overview of the whole picture until the closing chapter, so as a reader, I had no framework onto which to attach all the facts as he presented them so as to build up a cohesive picture. I was left with the feeling that he'd presented good evidence that seemed to bear on the issue he was investigating, but I didn't know how it fit as I encountered it, so each tidbit vanished as I encountered the next one. I'm not sure things would be much improved on a re-reading. With a familiarity with the whole story, I could figure out how most of the pieces buttress the argument, but I'd have to make up my own argument structure for why his is the best explanation for the workings of the entire system.

McCrone also flubs up on the evolutionary explanation. At various points, he attempts to show why evolution would have produced just the structures and relationships that he has revealed, but his descriptions are unconvincing--he sometimes speaks as if evolutionary pressures are pushing toward a known result, rather than explaining why some abilities would have been selectively favored and why random mutations could have produced the effects. I think the correctly formed arguments could have been constructed, but McCrone's failed attempts were distracting.

One of McCrone's goals is to show how quickly brain scanning technologies advanced over the last few decades. The best tools for peering into the deepest details of timing and interaction in the brain have only recently been developed, so the insights that are most crucial to the book's argument aren't presented until a third of the way into the book, when he has set the historical context. Benjamin Libet did a series of experiments on patients (who were getting brain surgery already) that showed that direct electrical stimulation of the brain wasn't noticed unless it continued for a full half-second. If the stimulation was cut off earlier the patient wouldn't notice anything; if it continued for longer, the subject would report that they had been aware of it from the beginning. Later experiments showed that a second stimulus could mask the first one, as much as a third of a second later. This is pretty convincing evidence that processing inputs takes us up to half a second, and our experience of the present is cobbled together after the fact. Explaining "Libet's half-second" and figuring out what it implies about consciousness occupies the bulk of the book.

Libet did other studies later in which subjects were asked to notice the position of a rotating second hand at the moment they made a decision to lift a hand or take a similar action. With these and other similar experiments by other researchers it became clear that there isn't a precise moment at which decisions are made. The state of the brain changes somewhat continuously over a period from a half second to a full second, and subjects report somewhat arbitrary times as "the moment" of decision.

I would have to re-read the whole book (I've re-skimmed about the first half) in order to provide a detailed synopsis of it. I did feel like McCrone brought quite a few fascinating and important insights to light that would clarify an understanding of brain mechanisms, but the organization makes it hard to put them together on first reading. Maybe someone else will (or has) pull the material together in a better order, and that will be a more worthwhile book.