Book Review: What have you changed your mind about? Edited by John Brockman

I push myself to write about the books I read for two reasons:

1. Being a very slow reader, I obsessively read, reread each sentence, understand and move to the next one all the while losing a lot of time. By the time I get to the end of the book, I may not remember very many things I read in the initial chapters of the book! So, writing a page or two about the whole book forces me to think through the contents of the entire book which in turn helps deposit the overall takeaways somewhere in my head. Without this process, I may not remember much of what I read after a week or two. Perhaps sad, but true! :-(

2. While most of my friends hit delete when they see my emails claiming TLDR :-), each book/topic tickles some subset of my friends, who then provide interesting additional pointers/follow ups. If I don't send out an email, I am sure I will never get those pointers. In a way sad, but that is the reality. :-)

This book called "What have you changed your mind about?" I just finished reading refuses to fold into any simple, easy takeaway making it interesting w.r.t. both of the points above. There is no simple summary for me to store & remember as it is a collection of short essays by several dozen experts in several different fields. Since it touches many different fields, this write up may not pique the curiosity of any one particular set of friends interested in a given field, obliterating the probability of receiving additional pointers. Hopefully I am wrong w.r.t. the second point and will get feedback related to such efforts online or in other books. :-)

You may know about Edge.org site that has been around since the mid-90's. In case, you didn't, you can read about it here. They had asked scientists, philosophers, academics, business people to write about ideas, opinions, concepts, notions they held earlier that they had changed later when new data or evidence proved them wrong. In this day and age, particularly in the arena of politics where being stubborn is considered a virtue and changing your mind on any issue gets you the sobriquet "flip-flopper", it is refreshing to read several respected experts writing about how they were wrong and were happy to change their long held views in their own field of expertise. Naturally you don't want to be fickle minded devoid of clear ideas in your field of interest, gullible enough to be swayed easily. But when new evidence/data that contradicts your ideas come to light, being able to switch your position is a mandatory requirement for scientists. It is certainly a characteristic that should be applauded and nurtured among the younger generation so that they don't feel ashamed to change views when warranted. So, I loved the premise of the book right away.

By design since each essay (not calling them chapters since each piece is just couple of pages long and there are more than 100 of them in a 400 page book) is written by a different person, it was a little difficult to read the book without settling into any one writing style and theme. Since there is no connection from one essay to the next, I did jump around initially to read the pieces written by people I knew. But later reverted to reading it from end-to-end so as not to miss any piece. While there were a few badly written pieces that didn't make much sense, there were a lot of good ones. Here are a few samples:

Freeman Dyson writes that based on the book Japan's Decision to Surrender by Robert Butow published in 1954, he believed that the two atomic bombs dropped on Japan brought world war II to the end. But based on new information summarized in a 2007 article, he has changed his mind since it is clear now that the surrender decision by the Japanese emperor didn't concern itself with the bombing but was based on other historical factors related to Soviet invasion of Manchuria! The Japanese military elite interviewed by Butow went with the "bomb brought an end to the war" narration since that saved face for them as the bomb is a result of a major scientific innovation where as the true reasons were related to lack of spiritual power and strategic errors.

Ray Kurzweil says that he has changed his mind about possible existence of other intelligent life forms in the universe and so rejects the SETI (Search for Extra Terrestrial Intelligence) attempts to find them.

Richard Dawkins discusses as to how The Handicap Principle proposed by zoologist Amotz Zahavi didn't make any sense to him for years and he was arguing against it. The principle basically says animals often carry serious handicaps as a way to display their superiority to the opposite sex. A good example is the plumage carried by peacock. It is unnecessary weight, and is inconvenient to carry around. So, peacocks without the plumage should have had an evolutionary advantage irrespective of the fact that the plumage may look pretty. But as per Zahavi, the underlying message is that the peacock is so strong and healthy that it can afford to carry the handicap and so should be preferred by the peahen in search of a mate. Verbal arguments discussing this notion can take you only so far. So, Dawkins looked for mathematical models that demonstrated Zahavi's idea is correct. Initial models & studies pushed the probability of Zahavi being right downwards. But eventually a scientist named Alan Grafen found an evolutionarily stable combination of male advertising and female credulity strategies that is indeed Zahavian. Having seen this proof, Dawkins had changed his mind.

While there are 130+ such changes that runs the gamut, what I found interesting was how years of analysis and additional evidence have moved researchers arguably in opposite directions as well! Just to give one example, Jesse Bering changed his mind to arrive at the notion that despite all the new understanding God still casts a long shadow on human beings for good reasons, while Clay Shirky has switched his belief coming to the conclusion that the Doctrine of Joint Belief (i.e. that science and religion can co-exist) is all nonsense and should be completely thrown out. :-)

Could be an interesting book to keep and pop open a random page to read a random article whenever you feel like it.

Please do me a favor. Send me a note or a short write up about how you have changed your mind about something over the years. It could be pertinent to anything in the world/our lives, not necessarily related to science & technology.

When you do, I will send you one notion that I used to hold that I no longer do due to contrary evidence.
-sundar.

A Better Replacement for Affordable Care Act (ACA)

Note: My wife Raji Srinivasan and I submitted this article to Medscape.com for a competition. It was selected as one of the top five winners out of 600+ submissions. A slightly edited version can be found at the Medscape site using this link. Our thanks to Medscape for encouraging such discussions.

Everyone agrees that US medical expenses are exorbitantly high for the quality of care we get. But getting consensus on how to fix it seems quite elusive. Since current alterations being considered were only tweaking a few things here and there due to political reality, the resulting system won't solve all the underlying issues. To resolve the source of the underlying problems, we need to implement a solution that resemble other businesses that are extremely successful in driving costs down consistently while making their products & services available to everyone as years go by.

To arrive at the solution we propose, we start with these assumptions/understanding:

• If we totally get rid of insurance systems, market forces will help contain the rising cost of healthcare. Basically this is what happens in societies/countries that do not have any health insurance policies and people pay for products & services from their own pockets when necessary. But in respectable/civilized societies, letting people die since they can't afford healthcare is inhumane. So, some form of healthcare support that is efficient is needed.
• A single payer system run by the Govt (as in UK or Canada) might be good from control perspective (no patchwork care, no incompatible systems, health history consistently available to care providers through a single database/access point, being able to control cost, etc.). But the amount of fraud that goes on with the US Medicare & Medicaid systems run by US Federal Govt is mind boggling. There are also large inefficiencies in the delivery. If we fail to address these concerns, the resulting system will not deliver care efficiently.

Keeping these points in mind, we propose the following framework:

1. Two percent of all income gets deducted and put in a personal account (similar to Health Savings Account currently in use in US). Since US median income is about $55,000 this will mean roughly $1100 per earning member.
2. No specific insurance company negotiated rates for any medical procedure/medicine/consultancy will be allowed. All providers must list the price for their products and services openly. Care providers will be allowed to revise these prices once a quarter.
3. When you need medical care/products/services, you can get it from whomever/wherever you like anywhere in the country. Expenses will be paid from the 2% account mentioned above until it is fully drained. At the end of the year, if it still has funds left, it is given back to the individuals. This will make sure people use coverage carefully and the providers who provide good quality services at low cost thrive.
4. Once that account is drained, the healthcare system will kick-in and pay for all additional coverage at 98% rate. The remaining 2% will still be paid by the individual user of the service. This will ensure that all needed coverage is available without bankrupting individuals while the 2% cost share by users will ensure that there is still a small cost (like co-pay) to restrict and discourage abuse.
5. Since one huge federal program administering healthcare for such a big nation will lead to fraud and abuse, we can do one of two things. Either setup a separate non-profit entity (like US post office) that handles healthcare. Or let the states manage it at the state level with block grants based on the size of the population so that smaller offices/budgets/geographical proximity can limit fraud/abuse. But the care/products/services are standardized nationwide so that states don't get to limit/deny coverage. Patients will still be allowed to get the care they need from anywhere in the country.
6. Allow anyone to buy pharmaceutical drugs from anywhere in the world. This may look like a dangerous proposition at first. Consumers may start to think that just like exploding batteries in devices imported from around the world, poor quality drugs may flood the market and obliterate the quality currently ensured in the US drug development & distribution system that is highly regulated. But this is a big myth. Even within US, there are poor quality compounding facilities that mix and pedal very poor quality medicine putting people's lives in danger. On the flip side, excellent quality drugs (same as the ones sold in US) are being sold by Canadian pharmacies for a fraction of the cost US users pay since the prices are regulated there. The simple act of opening up the market will make sure the prices remain real and not inflated due to regulation and middlemen. So, automatically drug prices in US will come down to the least possible value where the drug maker can still remain profitable. This is exactly how the tech industry makes extremely high quality products available at deflating rates as years go by. If products are faulty or of poor quality, the entities selling them will be punished severely by the market and can additionally be punished by regulatory agencies & courts.
7. Eliminate Medicare, Medicaid, and other individual Government run healthcare systems to save cost and improve efficiency, as this one model can serve everyone in the country.
8. Some of the details could be tweaked. For example, instead of 2%, it could be 1 or 3%; we can deposit a set dollar value into the accounts of those who may not be earning anything. But establishing these principles in a very simple, easy to understand system should be adequate to get things under control.

Though much more details could be added to this proposal, listed points highlight all the salient aspects of this plan. Despite what the healthcare industry may say, if true market forces are brought in, cost will come down irrespective of how high-tech provided care is or how different healthcare is compared to other products & services. For example, Lasik surgery is a high-tech procedure performed on such a precious organ as the human eye. But since it is not routinely covered by health insurance, the fee for that service is extremely competitive. It used to cost something like $10,000 when it was introduced about 20 years back. But it costs as low as $1000 now for a version that is much more improved! Same model goes for orthodontic procedures. Though it is not as high-tech as Lasik, price is competitive and continues to decline with improving quality. We can see advertisements for low, low prices in bill boards. We never see such competition, declaration of price for any procedure covered by insurance! 

Forcing the price for any product or service to become competitive and openly visible while providing the needed incentives for the users to choose the best possible option at the best possible price is the only principle needed to deliver excellent quality products & services at the right price in any field, including healthcare.

Book Review: On The Origin of Species by Charles Darwin

You might react to the title of this post with "Who the heck are you to review Origin of Species and aren't you a bit late to the party?!?" 

I should say that response is quite valid and this is more of an attempt to pay my homage rather than "review" the book. :-) 

More than 25 years back, during my grad school days, a friend of mine and I were walking by a strip mall where I saw an ice cream store. Just for fun I challenged my friend to say something amusing about ice cream. He promptly said, "I scream, you scream, we all scream for ice cream"! I thought it was brilliant and didn't realize for the next year or two that it was a popular slogan from an ice cream commercial on TV! Same thing happened with another friend who during a discussion on ethics and religion said, "For all we know, God could be a set of equations". Again I thought it was brilliant until I realized years later that he was restating a quote! Neither one of the friends actually tried to deceive me as they never took credit for those lines and probably presumed I knew that they were not being original. But I realized that they were quotes only years later.

Reading OoS put me through that ride multiple times. Several ideas I had read earlier in books by Richard Dawkins and other Biologists are all discussed in this one, while all along I was presuming that they were original ideas by those authors. Again they never claimed that they were but some how I don't explicitly remember reading that they are just elaborating/explaining Darwin's ideas further. Though it could be just my faulty memory, I can recall many examples. Will stop with just three:

1. The "Intelligent Design" (supposedly a more palatable euphemism for Creationism) crowd used to point to complex biological organs like eyes that have so many intricate components that need to come together for such organs to perform well as evidence that there must have been an Intelligent Creator who designed them as one complex piece at a time as they could not have evolved. Dawkins wrote a book called The Blind Watchmaker to present counter arguments. But Darwin has discussed this notion clearly explaining how a very primitive light sensing ability would have given a marine being a slight advantage over the others that didn't have any light sensing ability and how that sensitivity could have evolved into current level of sophistication we encounter in the human eye over the millions of years. Dawkins had only restated and elaborated Darwin's ideas. 

2. Ring species which describes slowly transforming/evolving populations that eventually diverge so much that the populations at the two ends of the ring can't interbreed. 

3. There are books like "Independent Birth of Organisms. A New Theory that Distinct Organisms Arose Independently from the Primordial Pond, Showing that Evolutionary Theories are Fundamentally Incorrect" with its author claiming he has come up with a fantastically original theory that proves Darwin wrong, while not supporting creationism. Upon closer inspection, I realized that the author says instead of just one life form created in the primordial pond that lead to all the variations in the living beings found in the universe, a small number of slightly different life forms could have arose originally that will allow for any incompatibility you find between organisms. Even 15 years back I was underwhelmed when I understood this detail since I thought it differed from Darwin's only marginally. This variation having been derived from computer models/simulations and DNA data sounded almost the same. But Darwin discusses even this same idea in this book even though DNA and genes were unknown in his days! He clearly says that there could have been more than one life form that came into existence as progenitors for all the life forms we see today but as long as we support small changes leading to variations in life forms that routinely get pruned out by the survival of the fittest notion, it doesn't matter whether the first life form was just one or a handful. . 

For a book that is more than 150 years old, it is not written in Greek or Shakespearean English and so is accessible. There are few notations like &c. (that means etc.) and terms that today's readers won't be familiar with. 

Interestingly, individual words Darwin uses to write his book are mostly at the high school level and so it looks like an easy read. But he continues to string them together in really long sentences, in stream of consciousness style writing that requires the reader to pay close attention to the thought process as it evolves. Here is a typical sentence: 

It is, no doubt, extremely difficult even to conjecture by what gradations many structures have been perfected, more especially amongst broken and failing groups of organic beings; but we see so many strange gradations in nature, as is proclaimed by the canon, `Natura non facit saltum,' that we ought to be extremely cautious in saying that any organ or instinct, or any whole being, could not have arrived at its present state by many graduated steps. 

You get the picture. :-)

Newer rewrites of the book using more contemporary writing style are available for purchase. I haven't read them. 

In general when we read a book, developments that have taken place after the book was published may not be that significant to what the book is trying to say. But since this book is 150 years old, I had to remind myself that Darwin didn't have any knowledge about the DNA, genomic structures and its contributions to shaping a life form, that is so relevant to this domain. He does wonder about how when an embryo starts to grow, somehow different parts of the growing embryo knows which part of the body it has to eventually become! These details are explained very well now by digital switches turning on and off on the genomic structure that he didn't know about. 

He talks a lot about the quality of fossilized records saying what we have should not be perceived as a perfectly well stocked museum but should be understood as a highly incomplete, record archive of questionable quality. He is correctly convinced that many of the questions he couldn't answer in his days related to how lifeforms morphed could have been answered well if only we have had a full collection of well preserved fossil records. 

Way back in the 1980's when I heard US President Reagan giving a speech to religious conservatives saying, "Theory of Evolution is just a theory", I was quite puzzled. As a teenager. I understood Biblical stories and the idea of creation were similar to Greek or Hindu mythologies. In school we have heard of those stories, took them as allegories and had no qualms moving on to the science class in the next hour to learn about the theory of evolution along the lines of learning physics or chemistry. We never thought what was taught in moral/religious classes need to be reconciled verbatim with what was taught in science class! Most of my friends receiving this email might be of similar persuasion irrespective of which continent they grew up in or living currently. But if you do have a different thought, please send them to me.

The volume of research Darwin has done to gather his data is stupendous. He has done studies like scrapping the dried mud off of the feat of migratory birds and then testing the seeds found buried in the mud for their capacity to germinate to assess the viability of seed dispersion across continents! During his famous voyage on board HMS Beagle from 1831 to 1835, he has gathered so many specimens, recorded tons of observations/notes. Many experiments of his were so slow and painstaking, that we can't help but stand up and salute! Only when we read the book end to end, we can appreciate the amount of thought he has put into it. He has analyzed in depth how certain features could have become atrophied due to disuse depending upon which part of the animal's life it would have been useful (i.e. when it was a baby or adult). Thus for example some teeth in calves that are present inside the gums but never come out to serve any purpose can be explained because when it was a baby it would have been of no use but in a progenitor animal in a different habitat, it could have been useful when it is an adult. Since the calf in the current habitat doesn't need it, the embryonic stage hasn't got the message to get rid of it fully yet. So, it is there inside the gum but doesn't grow out as it is not needed in its current species form and habitat! Similarly he presents arguments about continental shifts that could have moved a species from one part of the world to another though now it looks extraordinary. His ability to process so much of information spanning time, species and space to build his arguments is extremely humbling. 

Since the book is a fairly large one of about 600 pages, he not only takes the time to build his case but has delved into a lot of arguments he had come across in his days against the theory of evolution. Through slow and detailed arguments, he explains why he is convinced that his theory will stand the test of time and the naysayers will fall by the wayside, while simultaneously conceding that he is not able answer all the questions fully because evidence he needs in terms of fossil records or other scientific results are not yet available. 

His friend & colleague T.H.Huxley commented after the book was published as to how extremely stupid of us all not to have thought of this explanation. While it is a beautiful compliment to Darwin, I don't think ordinary human beings could have understood and explained this secret of nature looking at a tiny snapshot of time/space/species, until we evolve to be more intelligent beings in another million years. :-)

In case you haven't seen this documentary related to this topic, it will be worth your while:

https://www.youtube.com/watch?v=7HZzGXnYL5I

-sundar.