Autonomous Cars and Doctors

Few people understand this, but the practice of medicine is almost entirely a matter of procedures and protocols. It's about memorizing flow charts, zillions of them, as well as the chemical, biological, structural, and anatomical basis for them. Med schools aren't tough to get into (and out of) in order to select particularly talented and resourceful hero/healers. On the contrary, admission is crazy selective in order to filter out the well-rounded and broad-minded. We want single-minded nerds who can memorize all that stuff and apply it without screwing up. That's the whole ballgame: not screwing up.

A very good doctor hardly ever screws up.
A fair doctor mostly doesn't screw up, at least on important stuff.
A lousy doctor screws up.
(and, needless to say, the nurse, pharmacist, and, most egregiously, you and me screw up prodigiously, regardless).

There's a popular notion that especially good doctors - the fancy expensive ones - put a personal spin on their treatment, wielding resourceful and unconventional moves to uniquely respond to their patients' unique health situations. If you ever find any such a doctor, run away fast.

The problem is that a single doctor operates from a few hundred data points, whereas medicine as a whole operates from millions of them. Protocols have been honed to the best of our ability, and while medical science may not have all the answers, it unquestionably has the most rigorously proven ones. So deviating from protocol out of intuition, creativity, or other fuzzy subtleties places patients in no-man's-land; an untested realm. Gambling. 

While as a chowhound I resist well-trodden pathways, as a patient I prefer to be placed smack in the bright center of the lane. Don't give me your extra-special best attention. Don't play out your hunches or untested regimens. Feed me into the machine and treat me exactly like the jillion who came before me. That's where my best odds are.

Unless, that is, your hunches and untested regimens are utterly harmless. I actually have some hunches and regimens of my own, some surprisingly effective (propolis, for example), but that's not where I seek when things get serious...except in scenarios where medicine has nothing viable to offer (the sole realm where a "God of the gaps" perspective, otherwise fallacious, might make itself practically useful).

Medicine will soon be dominated by algorithms and robots. They lack intuition and judgement, but in most cases, that's a feature, not a bug. What's most important is that they never screw up.

One seeming exception is diagnosis, which is considered something of an art in edge cases - e.g. when rare diseases are hard to distinguish from more common ones. One might hesitate to have computers handle this part, even though human doctors are notoriously prone to misdiagnosis. An innate fallacy makes humans feel most indispensable at their greatest failure points.

Same with driving. One might insist that human experience/intuition/higher-level judgement is invaluable to safe driving, but the overwhelming majority of traffic accidents are due not to inadequate subtlety of judgement, but to plain old stupid screw-ups.

I've got very good driving intuition. I can spot, for example, when a driver is growing aggravated by a slow car in front, and is impatiently pressurizing an impulse to spazzily dart into the passing lane. Similarly, I can tell when someone awkwardly inviting me to proceed is poised to step on the gas if I hesitate. Spazzy driving bursts are not difficult to anticipate (it's not telepathy, just a read of ongoing micro-actions - wheel direction and speed changes, general jerkiness, etc.). It will be a long time before autonomous cars match my street smarts.

But that ignores the salient point. If I were to honestly survey all the cat lives I've used up by committing blunders while no one happened to be in the way, dozens of potential calamities have strewn my 40 year driving career. However we absolve ourselves via amnesia, we're fortunate that our errors haven't killed multitudes. While an autonomous car would lack human wisdom, it wouldn't make the infrequent stupid blunders that kill people.


As AI powers more and more critical tasks, and we feel leery about the loss of human intuition and judgement in such systems, bear closely in mind that stupid blunders are what kill people.

The OxiClean Enigma

Can someone please help me?

I was watching this OxiClean commercial, thinking to myself that it's really well done, strikes all the right notes, and is remarkably persuasive re: the product. And then, at the very end, this weird, cheesy, 1980's dude comes out of nowhere to deliver the capper with an extremely weird vibe, like he'd stepped onto the set from another commercial.

Take a look:


I've been trying to suss out how this might have happened. Here's my best theory:

They'd planned to dress the guy in a referee's uniform, put a whistle around his neck, and have him deliver the capper like an official game call, with mock gravitas. Finding it didn't quite work - and they already had him on set, and desperately needed the tagline delivered somehow or other - they had the actor take off the ref's outfit and just deliver the line. They didn't know how to direct him because, having nixed the referee idea, there was no alternative rationale for someone to step in-camera at that moment to make that statement. So he went with the referee gravitas he'd rehearsed, and, to "really sell it", lubed it up with all the 80's charisma he could squeeze out of himself.

Any better ideas?

Solution: Big Scary Health Insurance Pitfall

There were two bright lights during my year of forced labor with CNET after they bought Chowhound. One was Max Mead (written about here), a brilliant business wiz who brought our site to his company's attention, and a human resources health insurance specialist who prefers anonymity and who had a gift for explaining complexity...plus a level of human kindness unusual in big corporations. Both these qualities would seem to be obviously necessary for an HR employee. Ha. Haha. Hahahahahaha.

This person has - no surprise - a smart comment to offer on my "Big Scary Health Insurance Pitfall", which apparently is no pitfall at all...if you take the proper steps. Great news!

I’m commenting on your article about in-network hospital care and unknowingly receiving treatment from an out-of-network provider.

New York has a law on that.

Insured are protected if this situation happens; the insurance company pays as if the provider was in-network and the out-of-network provider has to accept the payment.

I haven’t seen it work in practice, but in the link there are instructions on what to do. It might be helpful to discuss with your insurance company.

Other states have enacted similar laws, although New York posts the information more clearly than other states.

Note that this all started out with my posting about Psyching Out Health Insurance.

How to Polymath

Here's part of a recent New Yorker article, "Garry Kasparov Says We Are Living in Chaos, But Remains an Incorrigible Optimist: The chess grandmaster and political activist on Putin, Trump, and how we are living again through the eighteen-fifties" by the great Masha Gessen:

Kasparov: I realize that I can’t compete with the leading chess players today.

Gessen: How does the greatest chess player in history feel being unable to win?

Kasparov: You can’t really maintain the level of concentration. I can play a strong chunk of a game, or I can win one game in a beautiful way. But, on the whole, that’s not my life anymore. You can’t come from a different life at fifty-five and beat a thirty-year-old, or even a forty-year-old who does nothing but chess. I’m an amateur, and I feel comfortable with that.

Welcome to my world. As I've lamented, I will never be the musician I was in my 20s and 30s, back when I lived and breathed music.

Nor will I ever be in the physical condition I was in in 2009, nor be the manager I was from 1997-2004, nor the hatha yogi I was from 2002-2011, nor the social butterfly I was in the early 1990s, nor the rapier-like insult comic I was in high school, nor the voracious reader I was in the late 1980s, nor will I likely ever experience another freaky, multi-year food discovery Streak, etc. etc..

I've had a half dozen careers, several dozen all-consuming hobbies, and been a slew of different people under an uncommonly diverse set of circumstances. But I can't simultaneously keep all skills sharp or be all of those people (I use procrastination, i.e. compartmentalization, as my process for channel flipping, but it's a primitive, glitchy trick that only goes so far).

But let me make an important distinction. With a couple months work, I could play trombone well enough to get satisfaction, and to please audiences (so long as I stay within a narrow comfort zone, rather than try to be the uber-versatile chameleon I once was). I could also get back into at least some semblance of shape (I can no longer lift heavy weights due to my stent; a serious limitation). I could be a respectable dilettante in nearly every field in which I'd previously been an expert, given sufficient time (and tolerance of the zero-summing that ensures that some other part of my life disintegrates as I pivot my attention).

The problem is that it's difficult, and humiliating, and depressing to find yourself a dilettante in fields in which you were once expert. And I hadn't planned for this! I'd always imagined myself exuberantly riding the various bulls til the bitter end!

Perhaps the smarter way to have done it would have been to choose two main fortes, and stick with them all the way, channeling fickle curiosity into much broader dilettantism, rather than the spotty Swiss cheese I allowed myself to become (anyone who knows me well can attest that I'm really bad at everything I'm not really good at).

Either that, or do it my way, chalking up a gaggle of fields where you've invested 10,000 hours...but be better prepared than I was to amiably watch plate after spinning plate crash down over the years.

Hardly one thought from this Slog could have sprung out of my mind prior to 2004 or so. In fact, I've used this vehicle to answer nearly all the questions I've spent my life eagerly curious about. So I sometimes hear my younger self shrieking at me to stop regretting what's missing (I may never entirely learn)...and to recognize that what I'm engaged in is at least as worthy, if not more so. In fact, I’m the envy of my younger self!

The problem is that I perennially undervalue my immersion-du-jour, even if I register quality when I infrequently step back to appraise. Current engagements usually feel as pedestrian to me as an earthworm's view of its process - i.e. consuming dirt and shitting out slightly improved dirt. Earthworms don't take victory laps.

I'm obviously no Einstein, but I have similar self-framing aberrations to the ones I imagine he had....and that we all have (which is why it's important to tell people what they are).

Big Scary Health Insurance Pitfall

Friend-of-the-Slog Paul Trapani points out a little-known health insurance pitfall contradicting my assurance in yesterday's posting that a plan's maximum out-of-pocket "is the point where your insurer shuts up and pays. Forget coinsurance, copays, deductibles, etc.; the health care system opens up and saves your ass from potentially infinite expense."

First, one note: not one of the Affordable Care Act plans in NY state include any provision for out-of-network treatment.

There’s a potential gotcha with “out of network”. I don’t think the maximum out-of-pocket applies there. You can obviously choose in-network when it comes to your personal physician and specialists, etc., but you may find yourself at an in-network hospital, being operated on by an in-network doctor and they call in an out-of-network anesthesiologist or other out-of-network-specialist. People have been hit with high bills because of it.

This can be extremely expensive, because out-of-network doctors never agreed to your insurance company's negotiated rates and can charge whatever they want.

In the event this happens to you, you have two plays:

1. Apparently insurance companies sometimes relent and pay.

2. You can negotiate a payment plan with the out-of-network provider, even if it’s a minimal figure like $20/month. They are willing to work with you out of fear that you'll declare bankruptcy, leaving them completely unpaid. Not ideal of course, but it’s something....

But wait! Read this!

Psyching Out Health Insurance

After staring at Affordable Care Act plan choices for hours, and taking lots of time to parse wording and seek foothold on the actual decision points, I believe I've found the gist and uncovered the game.

This is deliberately confusing. It buries the actual decision point. Consider:

Deductible is 5500, and max out-of-pocket is 6550. This means "50% coinsurance after deductible" (e.g. emergency and hospital services) only applies between 5500 and 6550 in expenses. Up until 5500, you're paying in full. Past 6550, you don't pay a cent. So virtually all terms of the plan apply to the very narrow terrain between those points. So it's all misdirection.

Upshot: you'll pay some, one way or another, for all your standard health care stuff like doctor visits and prescription costs. You can't get around this. You might find a hugely expensive plan taking care of most of that stuff (there are no such plans in NY state under Obamacare), but premiums would be so high that you'll still lose in the end. It's like Vegas: you will absolutely lose in the end, so strategy, insofar as it exists, is entirely about setting hard limits.

Fortunately, Obamacare makes this aspect super clear, via "maximum out-of-pocket". That's the point where your insurer shuts up and pays. Forget coinsurance, copays, deductibles, etc.; the health care system opens up and saves your ass from potentially infinite expense. [UPDATE: Hmmm...maybe not. Definitely read this.)

And god bless Obama for making it so they can't cut you off for previous conditions or if your totals do get scary high. That's not a scenario most of us will experience, but it's extraordinarily relieving not to have to worry about it. Also: the exchanges are highly regulated, so the cheapest plan will keep you just as alive as the most expensive one. That's not clear at first glance, either. A lot of the goodness is baked in and not explicitly touted.

So...

Typical doctor visits and prescription charges are more or less set costs (a tad higher or lower from plan to plan, though you will never ever find one mis-priced to give you a break). Above/beyond that overhead you'll be highly vulnerable (in case of health surprises) up to the max out-of-pocket. All variability between ACA plans occurs in the subtle shadings within that vulnerability window. Which is to say, they don't really matter! What matters is your maximum out-of-pocket. So keep your eye squarely on that number. I did, and chose a cheap bronze plan from Oscar.

I'm shaving complexity here, but by no means implying that you shouldn't still study and compare coverage. For example, one important variable for me is the "gatekeeper" requirement. Oscar doesn't make you go to your primary care physician for specialist referrals (a huge pain).

Video Driving Games and Trump Scandal Hobbyism

When I was first learning to drive, I was also playing driving video arcade games. And one day while doing the latter, I realized something that made me gulp: since I was crashing frequently in the game, doesn't that mean driving's super dangerous?

The next time I got behind the wheel of a car, I shifted my frame of perspective, and imagined myself inserted into a driving video game. And I instantly realized: real world driving is really, really, really slow. Crazy slow! That's why people only rarely crash.

Driving normally doesn't seem slow. After all, it's ten times the speed of walking. And there are tens of thousands of annual fatalities. But cars aren't poised to kill you at every given moment, and that's because they're really, really, really slow.

I've been flashing to this memory throughout the progression of the Mueller investigation. It's seemed like a relentlessly intense roil of activity; so many revelations, so many puzzle pieces endlessly being filled in. The Friday night news dumps. The indictments. The talking heads and their hot takes. I know people who've hardly taken their eyes off their iphones and TVs. They feel exhausted and aged by the speed of it all.

But it's an illusion. It's all been happening really, really, really slowly. All the fantastic reporting from WaPo, NYT and Daily Beast has been so minutely incremental that one has scarcely needed to read beyond the headline. A vanishing drizzle felt like a hurricane. You could spend all day watching cable news or digesting newspapers without aggregating much more useful new data than you could via a fast rake through a few smart Twitter feeds. The daily movement of the progress thermometer could easily be encapsulated within a few 140-character Tweets.

Take a James Fallows article that came out this morning: "Serving Trump Revealed Who John Kelly Always Was". I haven't selected some turkey to shoot at; it's a good article, well-conceived and well-written. But there's no new news, no fresh theory, and nothing not entirely understood by virtually everyone. The article could be boiled down to a single hashtag: "ETTD", the signature acronym of Rick Wilson, author of the bestselling "Everything Trump Touches Dies", from whence the acronym draws.

We've become so meme oriented that we endlessly re-wield the same bag of memes and feel expressive...and we endlessly re-consume those same memes and feel full. We keep sweeping the same pile around the floor. Very little's actually happening but we're plumb exhausted not by the speed or the complexity but from the sheer density of our own collective repetition. We're perpetually crashing from memey sugar highs augmented by the starchy ingestion of mountains of padding. It feels like the bracing rush of a car race though the car's actually been just barely inching along.

Some try to rectify the contradictory sensations by diving into minutiae. I know people who can name all the relevant Russian oligarchs; who've mapped the corporate spider web of Cambridge Analytica and mastered the time line of the Trump Tower meeting and its foreshadowings and after-tremors. These Trump Scandal hobbyists are even more frazzled - but hardly more clued-in, generally - than the rest of us.

The solution, I think, is to do precisely what weighty folks rail against: skate. Grab the minuscule daily bait in the form of headlines or tweets, swallow quickly, and move on to other life stuff. In so doing, you'll know 95% as much as the hobbyists, and what's missed can easily be filled in later when our First (Crime) Family is in orange jumpsuits and the networks produce slick retrospective overviews (which will have the added benefit of being accurate and thorough).


I made some of these same points 1-1/2 years ago, including links to the Twitter Feeds I find helpful.

Ricky Jay

I've been thinking a lot about Ricky Jay, who died last month. If you don't know about Jay, you absolutely need to. Start with the documentary about him, "Deceptive Practices" (free on Amazon Prime), move on to the New Yorker profile, and from there you have a world of books, films and videos to explore (as well as Jay's own web site).

You don't need my two cents about Ricky Jay. It would be ridiculous to try to sketch - to capture and circumscribe - a man who'd made an exquisite art form out of startled surprise. Lightning resists bottling. However, I will relate the most Ricky Jay-ish experience of my life. If I'd ever met Jay - alas, I did not - I'd have told him this story, and I'm certain he'd have loved it.


There was a "bookstore" in the East Village in the 80s called Harris Books. I use quotation marks because it was not, in fact, a bookstore. It was just this dude's apartment. His name was Harris, and he lived a couple floors above Kiev Restaurant on Second Avenue with his hippy British girlfriend and an autistic (or maybe I should say 'especially autistic') cat. If you rang the "Harris Books" buzzer, and he was at home, you could come up and hang out, and perhaps buy a book or two from his large-ish collection.

Harris looked a bit like Zonker, the character from the Doonesbury cartoon strip, and he was a real character. Once, I mentioned that I'd been hunting for a certain extremely obscure book. I was mostly just making conversation. The title was much too arcane to be found even in a gigantic bookstore. But as soon as its name left my mouth, he broke in and said "Look straight down." I did, and there it was. The very book.

I tallied the miracles. First, that he had the book. Second, that I was standing right in front of it. Third, that he knew that I was standing in front of it. And fourth (and perhaps most unsettlingly), while there were hundreds of volumes within my line of sight peering downward, something about his unequivocal command to "look down" made my eye lock straight onto that specific book.

Next visit, I mentioned another obscure book (different topic), whose title I'd forgotten. He asked me to describe it, I offered a vague few words, and damned if he didn't pull it straight off a shelf and hand it to me.

On the following visit, I'd planned to ask about yet another book in yet another topic, but when I arrived the title once again escaped me. "What's it about?" Harris asked. That, too, had suddenly slipped my mind. As I stood, sheepishly mute and struggling to recall, Harris walked to a shelf, pulled out a volume, and it was, somehow, that very book.


This was one of only a precious few times I've experienced a sense of heart-stopping wonder akin to the Max Malini ice block trick.

"Cornered Rat" Report #29

It's been a while since the last "Cornered Rat" report, back in October, when the phrase "cornered rat" found 123,000 Google search results.

It's now up to 144,000, a gain of 17%.

All "Cornered Rat" postings in reverse chronological order

Bagel Postscript

If you've heard the term "hand-rolled bagel" and wondered what that meant, the bottom photo on my previous posting is a great example. You can clearly see where the ends were joined together. A machine-punched bagel has no end (trippy....but also less delicious).

What the hell; I'll re-publish the photo for your convenience: