When a patient says "no thanks" to surgery

The Journal of the American Medical Association Internal Medicine has a really interesting essay they've published in full online. It's written by Anna Petroni, a 77-year-old California woman who recently decided against undergoing surgery on her ankles and knees to correct recurrent foot abscesses and arthritis. It's a short, simple piece — just Petroni recounting the story about why she made the decision she made — but serves as a jumping-off point, I think, for several different important discussions about the way we do medicine and the way we make medical decisions.

A couple of things particularly stood out to me. First is the relationships we have with doctors, especially specialists whom we see once or twice and who don't know us very well. Petroni's story suggests that bedside manner is about more than just making somebody feel nice — it can also affect their overall health if the doctor makes decisions related only to their specialty without taking into account the patient's whole story. The second thing I think is really important here is the idea of there often not really being one right answer when it comes to medical decisions. Doctors can say, "we can do this" or "we can fix that", but there's a responsibility on the patient (one we're not usually prepared for or coached through) to decide whether the trade-offs of intervention outweigh the side-effects. And those decisions can vary widely from patient to patient.

I guess I was so shocked when the orthopedist told me I needed to have 4 surgical procedures, I didn't even think about the fact that he did not ask about my cardiac history.

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Where Anonymous actions come from

Quinn Norton reports in depth on Wired with a careful, important account of where Anonymous's actions come from -- how coordinated activity (political, lulzy, legal and illegal) can emerge from noise, randomness, bombast and joking. This is the best description of how decision-making works in decentralized movements, and has important implications for the future of activism, governance, politics, crime and security:

But it’s a mistake to identify Anonymous entirely with these arrestees, some of whom were blackhats and others who were guilty of just using the LOIC. The hacks draw their power from the support of the wider collective, not the other way around. The majority of Anonymous operations are conceived and planned in a chaotic and open fashion. At any given time, a few thousand people are congregating on the Anonymous IRC channels, figuring out for themselves what it means to be an anon. And together they embody whatever Anonymous is going to be that day.

Most of the time, in most of the channels, there’s little more than conversation; sometimes a whole channel will consist of lurkers, with no one contributing a thing. But when some offense to the net is detected, anons will converge on one or more of these “chans,” with hundreds or thousands arriving within hours—many of them new to Anonymous and yet all primed and eager to respond. What looks in one moment like a sad, empty chat room can quickly become the staging ground for a major multipronged assault.

Consider OpBART, which flared up in August 2011 and dealt with an unlikely issue for Anonymous: the messy offline world of race relations and police violence.

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Tempo: transformative, difficult look at advanced decision-making theory

As I've noted here before, Venkatesh Rao is a thought-provoking, profound thinker, and I always welcome his long, fascinating blog posts. When he sent me a copy of his slim book, Tempo, I was very excited to see it turn up in my mailbox.

Tempo is Rao's attempt to formalize many years of study into human decision-making. Rao spent two years as a Cornell post-doc doing USAF-funded research on "mixed-initiative command and control models," part of the research on decision-making that includes such classics as Chet Richards's Certain to Win. Rao taught a course on decision-making theory at Cornell that included many of his theories, metaphors and advancements on the subject, and he reports that students found the course entertaining, but disjointed -- a "grab bag" of ideas. Tempo is meant to turn that grab-bag into an orderly, systematic argument explaining Rao's overall view of how and why we decide stuff, how we can change the way others behave, and how to look at the history and future of humanity's individual and collective decisions. Heavy stuff, in other words.

Rao does not entirely succeed in making an orderly argument out of his grab bag. My relationship with Tempo was tumultuous. It's heavy going, abstract, and makes difficult (for me) to follow leaps from one subject to the next. I would normally read 150 pages of academic text in a day or two, but after two days with Tempo, I was still only 40 or so pages in. Read the rest