The One-Eyed Man Is King

My first real job was a software developer in a start-up that built massively-parallel supercomputers; the machines had up to 16K processors and handled very large datasets. While the company was staffed with seasoned hardware types, many of us software developers were relatively inexperienced. Not wanting to admit our greenness, we usually tried to solve problems on our own rather than asking the more senior staff.

One newbie was a little more experienced than the rest and, when bestowing his opinion on us, would invariably exclaim:

In regione caecorum rex est luscus

If you’re not classically trained in Latin, this phrase roughly translates to “in the land of the blind, the one-eyed man is king.”  While he barely knew more than we did, the knowledge made him king.

The quote comes from the Adagia (III, IV, 96), an annotated collection of proverbs compiled by Desiderius Erasmus Roterodamus during the Renaissance. By his death in 1536, Erasmus had documented nearly 5,000 proverbs including many colorful ones that are still used in English today:

  • Never look a gift horse in the mouth
  • The grass is always greener on the other side of the fence
  • Can’t teach an old dog new tricks
  • Between a rock and a hard place
  • To call a spade a spade
  • There’s many a slip ‘twixt cup and lip

Erasmus was a prolific writer, even though most of his output didn’t happen until he mastered Latin late in life. Beyond the Adagia, his best-known work is “The Praise of Folly”, a satire of popular superstitions and the Catholic Church. Erasmus is also responsible for the first published Greek translation of the New Testament which was later used as the primary source material for the Church of England’s authoritative King James Version of the Bible. Neither endeared him to the Catholic Church but his writings were extraordinary popular. According to some accounts, Erasmus accounted for 10-20% of all book sales in the 1530’s.

It’s unlikely that any modern day author could ever reach that level but, for all of you struggling writers out there, don’t worry. As Erasmus himself might have said, every dog has its day.

The Nocebo Effect is Serious Medicine

noceboA decade ago I read an intriguing article entitled “The Nocebo Effect: Placebo’s Evil Twin” which argued a patient’s pessimistic attitude could have negative consequences on their health. Research showed that patients who were warned of gastrointestinal side effects from repeated use of aspirin were almost three times as likely to exhibit the side effects as those who were not warned. In the intervening years, I’ve seen other scattered reports that a patient’s anxiety around a disease can lead to a hastened death, even when medicine suggests the patient should recover.

The term nocebo, which is Latin for “I will harm”, was allegedly chosen by Walter Kennedy in 1961 as a reaction to the then recently-coined term placebo.  According to Irving Kirsch, a psychologist at the University of Connecticut,

nocebos often cause a physical effect, but it’s not a physically produced effect.  In many cases [the cause] is an unanswered question.

For obvious reasons, the nocebo effect has not been well-studied: it’s unethical to encourage illness in patients who are not sick.

Science might now be closer to an answer of how to treat the nocebo effect. A recent Oxford University study demonstrates that nocebo pain is detectable in an MRI scanner. This suggests patients are responding to actual pain at a neurological level. A University of Turin study goes one step further by identifying a neurochemical called cholecystokinin which appears to be responsible for this effect. When scientists use drugs to block cholecystokinin, patients do not feel the nocebo pain.

The realness of the nocebo effect makes me to wonder about its impact on doctor-patient relationships. To avoid being sued, doctors might be tempted to emphasize drug side effects to their patients but the mere act of highlighting these side effects might make them more likely to happen. On the other hand, patients who do not completely trust their doctor’s prescriptions might reduce the efficacy of their own treatments. This is the ultimate Catch-22.

While it might seem easy to laugh off, the nocebo effect is clearly real and important to consider in treating patient health. The nocebo effect could even explain how anxiety can cause patients to become worried sick or literally scared to death.

Is Whole Foods Brandwashing Us?

whole foodsWhat’s with all of the ice?

The question bothered me after a recent trip to Whole Foods Market, an upscale market near my home. The container of hummus I bought hadn’t been refrigerated; it was displayed in a large barrel of ice.

In fact, lots of other food and drinks items were stored in ice barrels all around the store. The items needed to be kept cold but it certainly would have used less space if they had been placed on normal cooled shelves. What was Whole Foods thinking?

I found a plausible – and fascinating – answer in a Fast Company article entitled “How Whole Foods Primes You To Shop”. The author suggests that ice is a symbol of freshness; it provides the unconscious suggestion what you’re looking at is ready-made or straight from the farm. It doesn’t matter whether the ice is strictly needed as long as it reinforces Whole Foods’ brand promise.

Using ice to denote freshness is only a more sophisticated version of a subliminal tactic supermarkets have been using for years:

…supermarkets have been sprinkling vegetables with regular drops of water – a trend that began in Denmark. Why? Like ice displays, those sprinkled drops serve as a symbol, albeit a bogus one, of freshness and purity. Ironically, that same dewy mist makes the vegetables rot more quickly than they would otherwise. So much for perception versus reality.

Lindstrom claims that Whole Foods is a master at the art of consumer seduction. Most grocery stores have non-perishable items at their entrances: cash registers, snacks, and movie rentals. In contrast, Whole Foods places fresh flowers at the front entrances to prime us into thinking of freshness from the moment we enter the store. We carry that subliminal message around with us for the rest of our visit.

This brand promise is reinforced everywhere in the store, from the fruit spilling out of cardboard boxes to the hand-drawn prices in chalk on slate. The boxes and slate evoke the image of a traditional outdoor European market.

It’s as if the farmer pulled up in front of Whole Foods just this morning, unloaded his produce, then hopped back in his flatbed truck to drive back upstate to his country farm.

The chalk scrawl also suggests the prices are set locally and change daily depending on supply. In fact, the prices are fixed at the Texas corporate headquarters and the signs are mass-produced in a factory. Even the multiple randomly-stacked boxes are actually a single-sided display case designed to look like individual boxes.

News flash: Whole Foods isn’t a country store. We’ve been Brandwashed.

Are you diversifying your choices?

Halloween PumpkinWe are creatures of habit.
Variety is the spice of life.

Both are commonly held beliefs which seemingly contradict each other. Which is it? Do we always choose our favorite food/toy/song or do we opt for less-desirable alternatives so we don’t get bored?

The answer is yes.

When faced with multiple simultaneous options, people diversify their choices, even if they end up with less-desirable alternatives. However, if the same options are presented sequentially over time, people will stick with their preferred choice. Carnegie Mellon University researchers used a Halloween-night experiment to vividly depict this so-called diversification bias.

In the experiment two sets of trick-or-treaters visited two houses. The first set of children had to choose between taking either a single Three Musketeers or a Milky Way bar. The other set of kids were told to ‘choose whichever two candy bars you like’. There were large piles of both candies available to ensure the kids didn’t think it was rude to take two of the same.

More than half of the kids in the first set (the sequential choice condition) picked the identical candy at both houses, presumably the one they preferred. However, nearly every child in the second set selected one of each candy at both houses, demonstrating the diversification bias. Since the candy is typically consumed much later, this result is even more striking. It is end-of-the-evening portfolio that matters, not the portfolio selected at each house.

It’s not just kids and candy that are susceptable to the diversification bias. When employees are simultaneously offered n funds to choose from when signing up for a retirement plan, researchers found they are likely to divide the money evenly among the funds offered. If the fund options are presented over time, employees concentrate their money into a smaller number of funds. The researchers use the term 1/n heuristic to describe this extreme version of the diversification bias.

A plan administrator can greatly influence investments by the number and order of funds that are presented. In a plan with one stock fund and one bond fund, the average allocation would be 50% stocks. However, if another stock fund were added, the stock allocation would be 66%. In fact, the  researchers analyzed a large  sample of pension plans and found strong evidence to support this prediction.

I have no way of knowing if plan administrators are  using this knowledge to influence investments but it certainly would be the ultimate trick-or-treat.

Tabulating Taboos

What percentage of people wash their hands after going to the restroom?

This is a difficult question to answer accurately. Surveys are unreliable because people are not likely to be truthful about behavior that is considered socially unacceptable. Surveys under-report the true percentage.

Even if it is difficult, estimating the percentage of people who engage in a specific illegal or frowned-upon behavior is critical as it has important uses in policy-making and enforcement.  Research studies have shown some improvement in accuracy by asking participants to estimate the percentage themselves. People are more likely to be open about what others are doing than they are about themselves. Obviously this works best for populations that are well-known by the participants, such as employees in a company.

Survey researchers have come up with a randomized response technique (RRT) that encourages participants to be more open. The experimental design is as follows:

  • Before answering a question, the participant throws a single dice which the researcher cannot see.
  • The participants answers ‘yes’ if a 1 comes up and ‘no’ if it is a 6, regardless of the actual answer to the question.
  • For all other numbers, the participant answers the question truthfully.

Because a ‘yes’ response does not necessarily mean the person actually engaged in the undesirable behavior, people are more honest.  Admittedly, the forced yes and no means at least of 1/6 of the answers are incorrect but, despite introducing this statistical noise, the overall results give better answers.

Introducing error to increase accuracy seems counterintuitive but it works in multiple domains. As an example, comparing RRT results to drug screening on hair samples shows that it is 30% better than traditional techniques.

Now go wash your hands. I bet you forgot.