Friday, April 27, 2012

Against All Odds


     I was going to call this piece “A Plea For Math Literacy” but thought few titles could better guarantee no one would read it. For most of us, math is our first academic experience of being plain wrong. An incorrect answer in math is never “interesting” the way a response in English or even History class might be. No math teacher ever admiringly uttered the phrase, “Now that’s an different perspective.” I’ll never forget the math teacher who called my answer “not even wrong”. No one likes being wrong, but we turn our backs on math at a cost.

     Math literacy may seem to mix two different systems, the world of numbers and the world of words. Traditionally literacy related to the ability to read and write. But it has grown to encompass the capacity to understand all forms of communication including body language, imagery, or any symbol system relevant to a particular culture.

     We live in a culture where the art of estimation is essential if we hope to understand the wide range of magnitudes and time frames that are tossed around in every day discourse. Whether considering the national debt or your mortgage rate, the population of China or the daily loss of brain cells, an earthquake of 4 or 6 on the Richter scale, the date of the Industrial Revolution or the origin of the universe, you’re lost without some basic math smarts that provide a sense of proportion. 

      Now more than ever, we are flooded with data that could inform our decisions. This is particularly true when it comes to our health. Doctors no longer dictate treatments. In the age of “informed consent” we are presented with the odds of this procedure or medication having “x” benefits and “y” risks. We are expected to make our own decision. (And the complexity of patient decision-making will increase dramatically as the human genome is deciphered.) Yet we rarely use the pertinent data when we make our choices.

     Why do we play the odds rather than calculate them?

     On a fundamental level we seem hard-wired for bad decision-making. We like to presume that we have control over what happens to us. We believe that if we stick to a plan the desired result should occur. If we take "good" care of ourselves (or if we are "good") we will grow old and prosper. But any 10 year high school reunion demolishes these naive assumptions.

     Daily life provides shedloads of examples of just how bad we are at understanding the odds; the popularity of the lottery, casinos, junk food, and cigarettes. Like disagreeable information of any kind, when we don't like the odds we remove them from consciousness. And when we fail to bury disturbing odds we unwittingly seek data that will bind our anxiety. The newspaper we read, the TV shows we follow, the people with whom we socialize, are all chosen to confirm our view of the world, that we're doing the right thing, that we know, that we are secure.

     We are masterful at avoiding the discordant experience of learning something that contradicts our beliefs. And we are equally disturbed when others respond to new information and change their stance. In politics it's pejoratively labeled flip-flopping, a career ender.

     Certainty is seductive. But the reality is that we live in a sea of uncertainty. And yet we are raised (and raise our children) to believe the opposite. Can this change? I think so. While the complexity of the kaleidoscopic forces that drive our choices is overwhelming, there are things we can do in order to encourage better decision-making. And math may be one of the most powerful antidotes to emotionally-based judgements.

     Here's a short list of ideas that could be applied at any stage of development, from kindergarten to think tanks.

     Encourage suspicion of experts and the accepted verities.

     Explore who profits from one set of data versus another.

     Introduce children to probability calculation early in a real-world accessible form using something they find interesting like a favorite player's batting average, or the chances of winning at tic-tac-toe, or the relative risk of getting a filling with and without brushing your teeth.

     Most importantly, we must attempt to get more comfortable with the messy business of ambiguity, complexity and not knowing. If we could delay even briefly that reflexive leap to embrace social or intellectual ready-made conceptions, it could have enormous impact. Like fast-food, these packaged ideas allow some immediate soothing, but provide nothing that nourishes.  In the end they make us sick because in adopting beliefs that are not our own we blind ourselves to what we really think and feel. And without such knowledge, making the right choice is against all odds.

Saturday, April 21, 2012

Balancing Acts

     The concept of balance is considered a fundamental quality for the good life. We believe that only a balanced approach can provide the reasonable stance, whether we’re talking about eating, religion, work, sleep, sex or money. Our language reflects this view through such expressions as “an unbalanced individual”,  “a chemical imbalance”, “a balanced economy”.  The unbalanced desire of addiction has spawned every conceivable form from chocoholic to workaholic or shopaholic. And yet for all the lip service balance receives as the prudent path, we worship excess.

     Should we aspire to balanced lives? Certainly not when it comes to love. The very expression “falling in love” speaks to the need for a loss of balance. It is hard to imagine what balanced love looks like, if it looks like love at all.  Don’t we want to believe we would die for someone or some thing? Can we say what amount of love or grief or belief is excessive?

     The notion of balance implies an awareness of what is too little and what is too much. But one can only identify excess by knowing what is enough, something we struggle with (“enough is enough” is as close as we’ve come). We seem much better at identifying excess in others, and we are mesmerized by it.  The righteous indignation and moral superiority that comes with labeling someone else’s excess is made all the more pleasurable for its reassurance. It implicitly suggests that we know our limits, how much is enough and appropriate, that we are in control of our desires.

   We all have some form of excess that feeds our favorite rant, drug addicts, alcoholics, suicide bombers, narcissists, fat people, anorexics, CEO salaries, celebrity orgies, serial killers, faith, atheism.  But the one we find most outrageous or offensive or unreasonable or fascinating, tells us something important.  Show me which excess you can’t abide and I’ll show you who you are.

     How can we understand our relationship with excess? How do we continue to believe that more money or cars or shoes or food or sex will make us happy? Why are we the only animal that can be made ill by our appetites?

     It is precisely because money or cars or shoes or food or sex is not quite what we want that we find ourselves thinking that perhaps more would be satisfying. When we have too much, it is because we have too little of what we need.


Saturday, April 7, 2012

Sitting Ducks


          “Those who think they have not time for bodily exercise will sooner or later have to find time for illness.”
                    Edward Stanley, Earl of Derby 1873

     We continue to deny this idea despite more than a century of data. In the latest contribution to this argument, an Australian group put another nail in the coffin of the couch potato. They demonstrated that the amount of time we spend sitting correlates with all-cause mortality. For those who haven’t been living under a rock, this is not news. However, what puts this study on the map is the finding that the negative effect of prolonged sitting was not significantly reversed by physical activity.

     The fact that modern humans spend so little time out of a chair has given birth to a vital new field, sedentary behavior research. Investigation has revealed that the adverse consequences of prolonged sitting (surely this will become a familiar acronym in the literature – PS, so let’s coin it now) stem from a web of causes including; reduced metabolic function, increased triglycerides and decreased HDL-cholesterol (the good one), decreased insulin sensitivity, and impaired carbohydrate metabolism. These are the usual suspects in any discussion of cardiovascular disease, diabetes or obesity.

     But now the data suggests two important things. First, it seems that physical activity and sedentary behavior act independently through different mechanisms. This would explain why the damage of PS (sitting for 10 hours a day) is not undone by 30 minutes of daily exercise. Secondly, they have found that normal weight is not protective against the  ravishes of PS and in no way means you’re healthy.

     The pioneering work on this issue was done in the early 1950’s by a British researcher, Jeremiah Morris, the man responsible for connecting physical exertion and health. In seeking to determine whether there was an association between the type of work people do and heart disease, he stumbled upon groundbreaking data. Morris combed through the health records of 31,000 bus drivers and conductors in London. The conductors had significantly less heart disease than the drivers. The only variable that consistently distinguished one group from the other was activity level.

     So if this link was appreciated more than 50 years ago, why has so little been done, allowing heart disease to remain the number one killer? The answer is simple. Medicine addresses disease not health. Until you are sick, the medical system has had nothing to offer. We’ve gotten better at treating heart disease but have just begun to seriously consider preventing it. Until people stop thinking about health in terms of doctors and medicines, things will not change. 

     The “progress” afforded by the Industrial Revolution has provided a natural experiment demonstrating the catastrophic effects of sedentary life. If one considers our genetic wiring, perfected over hundreds of thousands of generations, this all makes perfect sense. We were made to move. And our genome has not adapted to this relatively new lifestyle. It turns out we need more than exercise.

      So don’t just sit there. Get up and get well.