Andart

Decision Meta-Strategy

On CNE, I blog about the new european health strategy. The good: it understands that health is important, that individualized health is coming and that we need to benchmark it. The bad: it doesn't get the strategic benefits of life extension, it focuses on politically correct issues and wants to force inclusion of health concerns into *every* policy everywhere.

I wonder about that last part. In an ideal world every decision would take into account every kind of consequence - the environmental, social, spiritual and economical effects of every little playground or software utility ought to be considered. It is rational to try to get the best outcome, and at the very least we ought to state what outcomes we are aiming at. But clearly it is impossible to assess all possible aspects: there is not only merely 24 hours in a day, we also lack the knowledge of how 1) the policy will actually be implemented, 2) how this implementation actually affects the world and 3) how we in the future will judge these effects. So we have to use a bounded rationality approach, where we look at the most likely effects that have the biggest or most certain consequences. It is essentially a search tree situation with a probabilistic adversary ("nature").

Adding new areas that ought to be assessed is essentially demanding that the search tree branch more strongly. That means that we will have less resources to do depth searches and should use robust heuristics, or simply go for satisficing. But the current administrative vision is that we should all be optimizing and use as much information as possible. How can that be avoided?

One approach would be to have the administrators bear the costs of the information demands they make. If the Commission wants to add another dimension to every policy, they need to give every policymaker affected an increased budget. While this might be nice if you are a bureaucrat, it sounds like a recipe for balooning bureaucracy.

Another approach, which would also promote satisficing and finding better heuristics, is to make policymakers affected by the utility of their decisions. If it goes well, they get more money/resources, if they make stupid decisions they lose. Ideally, decisionmakers should be able to make a fortune (real money or political capital) from supporting a decision that turns out to be very good - and lose it if they also support bad or wasteful decisions. This would encourage rationality and accountability. To get it to work we need better follow-up, which is also good for transparency and as a basis for future decisionmaking. It may also be tricky to determine what constitutes a good result, and how to factor in external forces, as well as avoiding perverse incentives. But these issues can likely be solved; what we need from the start is the recognition that policymakers should get incentives to make better decisions, not just more decisions.

Loyal Bits

Pascal Meunier writes about Disloyal Software and mentions my essay about it. His main concern is the disloyalty and insecurity of web applications.

I wonder how a standard for loyal computing would look? Or maybe loyalty certification: "This application has been certified by the Internet Loyalty Center and found to act solely in the interest of its owner, not its creator or any third party".

Suicide as a Status Symbol?

This week on CNE I discuss an empirical study of slippery slopes in physician-assisted suicide. It is based on Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups by Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D Onwuteaka-Philipsen (Journal of Medical Ethics 2007;33:591-597).

They find no evidence that vulnerable groups like the elderly, women, uninsured, people with low educational status, poor, physically disabled or chronically ill, minors, people with psychiatric illnesses, or racial or ethnic minorities were making use of the suicide option. The exception were people with AIDS. They also found that the people who used assisted suicide were better off socially, economically, educationally and professionally.

Maybe higher socioeconomic status promotes more liberal views and more of a patient autonomy? I looked at the correlation between opinions about suicide and self-stated social status in the GSS dataset, but found no correlation. Self-stated political views appear to become more polarized at the higher and lower social ranks, but that could just be an effect of too few sampled people.

On the other hand there is a very strong link between the POLVIEWS scale ("do you think of yourself as liberal or conservative?") and views on suicide. In the case of incurable disease every group above "conservative" (including the slightly conservative) had a majority for suicide. In the case of other reasons (bancrupcy, dishonor, tired of life) there was a sharp transition at "moderate" where the minority opinion (in favor of suicide) became statistically significant. Overall, this somewhat dated data suggest that we cannot simply explain it as well-off people being more liberal about suicide.

A fun observation was that the HEALTh variable (how healthy people felt) had a strong link to views on suicide for health-related reasons: people in fair and poor health were against suicide, people in good and excellent health felt that it was a good idea.

I noticed that people who were not in the "homosexuality is always wrong" category were in favor of illness-related suicide. Looking loosely at civil liberties questions, it generally looked like people in favor of civil liberties are also liberal about suicide. So the reason more AIDS-victims were using physician-assisted suicide might simply be that they belong to a more liberal (in the civil and personal liberties) sense group, not that they are politically liberal or well-off.

Income had no effect on the views on suicide except at the very highest level (+$20000 family income) where there were a noticeable suicide-liberal majority. They were also noticeably more liberal towards homosexuality. This is interesting, because politically there is a shift towards political conservatism as income increases.

Nothing too surprising. But if suicide is seen as a status symbol or "upper class" it would likely be a more powerful liberalising argument than any ethical reason. As Sappho wrote in an early immortalist poem:

If death be good,
Why do the gods not die?
If life be ill,
Why do the gods still live?

If love be naught,
Why do the gods still love?
If love be all,
What should men do but love?

The Network is the Doctor

This week on CNE I blog about Microsoft's (and likely Google's) move into storing patient information. It is not surprising, and I think they might pull an iTunes on the electronic health record market - unless the incumbents can get governments to pass sufficiently cumbersome regulations to make new competition impossible.

Patient data control is tremendously important not just from a patient empowerment perspective (owning your own records and having them available enables easier move between providers) but also for the possibility of doing new kinds of epidemiology (what I call "wikiepidemiology, where people pool data for ad hoc surveys) which are likely to be important for developing both enhancements and finding the health issues for the lifeblogger generation. And of course, just imagine Google having not just your search queries and documents but also your health data and maybe your genome - the advertising possibilities are just staggering!

We need to get these regulations right. Too strict, and sharing of medical data will not be possible outside a few expensive centralized systems, and we will miss the chance for good e-medicine and patient empowerment. Too loose (or technologically un-savvy) and we will get spam based on our cancer risk.

Cured, or your money back

This week on CNE I blogged about refunding money for non-efficacious cures. Given the placebo effect of treatments this is probably always going to be good for business.

I'm Visually Complex

I have been honored by having one of my graphs, visualcomplexity.com | Road traffic between Swedish counties, being displayed on Visual complexity. This graph was developed as a quick illustration for an earlier blog post here (now sadly spammed).