Author: James Vornov

What really makes us smart is not our ability to pull facts from documents or decipher statistical patterns in arrays of data. It’s our ability to make sense of things, to weave the knowledge we draw from observation and experience, from living, into a rich and fluid understanding of the world that we can then apply to any task or challenge.
The Glass Cage: Automation and Us    Nicholas Carr

What is this human intelligence that enables man to make complex decisions based on intuition and feelings without any formal consideration of options, probabilities or relative desirability of outcomes? Are we incredibly sophisticated, rule-based decision making machines? Is it even possible to get better at decision making or has evolution done all of the work already?

These fundamental questions continue to drive my interest in decision making. It’s a practical matter for me, since drug development requires making plans, spending money, and making innumerable decisions on the path of turning a chemical into a new medicine for clinical use all with near total ignorance of the chances of success.

To further On Deciding, Better, I’m delving into the origins of Decision Theory for the first time. I learned the concepts of making decisions under conditions of uncertainty from consultants and practitioners in the field. The tools of decision trees and simulation were presented as simple consequences of statistical principles. I worked through a basic textbook, Robert Clemens’ Making Hard Decisions: An Introduction to Decision Analysis and began writing about making decisions here at ODB.

After become expert, I realized that no one outside of the world of management consultanting and corporate strategy offices really used these tools. Eventually I came to a fundamental reimagining of decision making based on belief models and my training in Neuroscience. The tools of decision analysis, mathematical models, and simulation seemed to best characterized as tools to augment human imagination and understanding. They were useful fictions to guide thinking, merely simple representations of the complex world.

Working through the subject more deeply now, I realize there were similar lines of argument throughout the original works in the field. In Statistical Rethinking, the book I’m working through to learn Bayesian statistical methods, Richard McElreath provides a wonderful introduction to the Bayesian interpretation of probability. Decision theory is predicated on a specific interpretation of probability. Probability is seen as the subjective likelihood of a particular future event, whether it’s the outcome of a coin flip or the choice of nominee by a political party. These things happen only once, so probability is prediction.

There has been a decades long discussion about whether the probability of heads in a coin flip and the probability of a complex event in the real world can really be the same kind of probability. McElreath presents the formulation of Jimmy Savage, one of the foundational thinkers in the field. Savage proposed that there is a difference between the “small world” of the coin flip which can be accurately reduced to a simple mathematical model and the “large world”, where simple models don’t necessarily hold.

Where does the subjective judgement of probability made by the human brain fit into this scheme? The brain itself clearly is an unpredictable large world, but can contain within it small world models, both explicit and implicit, used for decision making. The brain can easily imagine the mechanics of the Bernoulli distribution. But the brain can also contain the mental model of neurological disease and the potential effect of a new medicine. Perhaps machine and other algorithmic, mathematical “small world” systems can never match the “large world” human decision making brain. If I had to guess why, I’d say it’s because the brain itself is part of the even larger real world.

I have a hard time combining reading with taking notes. Reading is a focused activity in itself while taking notes requires a different state of mind. How can you notes and maintain focus while reading?

Cal Newport points in Deep Work, not only is doing the work the path to sucess in the 21st century, it is meaningful, satisfying, and fulfilling. Reading to learn with purpose is one of those joyous activities that increases appetite for a full life. Cal identifies this pleasurable state as flow, described famously by Csikszentmihalyi, arguing that Deep Work is not only valuable and rare, it is also meaningful. Flow is that state of “optimal experience” where time dissolves in the face of completely focused, single minded immersion in doing.

Reading often is a state of flow, making switching to writing notes a problem. Flow is not simply about enjoyment and challenge, it involves continuity. It’s interesting that one of the highest rated experiences is actually driving a car. Sadly, pathological gambling is also a state of deep immersion leading to gamblers fainting at the slot machines, failing to eat or drink. Perhaps Csikszentmihalyi was being a bit too much of a positivist when he wrote so glowingly about entering the mental state of flow. But reading is an easily accessable route to a positive, valuable flow state.

Becoming good at entering a state of flow makes it easier to do Deep Work at the highest level for signicant periods of time. Practicing entering that state of mental performance makes it easier and easier to sit down at a desk and do the work. That work will be of higher quality when the barrier between inside and outside models dissolves- mental energy is not needed to support all kinds of extraneous hypotheticals when the mind is in the world, not in the head. This is an extended or expanded consciousness. When driving a car or, better, a motocycle, down an interesting rural two-lane, the internal mental state becomes the perfect mirror of the process of moving down the road.

I struggle with maintaining the state of flow in taking notes when reading, so have reached something of an accomodation over the years. I was helped a few years ago by the wonderous and appropriatedly titled How to Read a Book by Mortimer Adler and Charles Van Doren who actually break down the process.

“Reading a book analytically is chewing and digesting it”

Once you realize that reading is an activity- or really a group of related activities, then reading can fit into the overall plan of doing the work. On the one hand, there’s the great advice to always be reading by having books at hand and deep pipeline of reading ready to go. But on the other hand, one needs to capture knowledge deliberately.

I’ve found it works best for me to read deeply over a chapter or section of text and avoid taking notes unless the thought that’s occurred to me is so signficant and pressing that I’m compelled to get a notebook and paper to avoid the possible loss of the idea. Making notes while reading is distracting. I’ll read to get the book’s content first, then later review and create notes in conversation with the author. That’s a different, more active frame of mind, the chewing and digesting. Of course some books are spit out and not worth the work.

This kind of note taking is very different from taking notes during a lecture or meeting where the talk pulls you back and wont wait for long interruption of writing. Lectures and meetings proceed more slowly than thought most of the time and there’s plenty of time for notes in the pauses and other mental spaces.

Reading has to become work at some point; thoughts need to processed into notes and the notes have to be further processed into summaries and analyses. Something I happen to have been doing here, writing this post. Thanks for your help.

I’ve long been a reader of Cal Newport‘s blog, Study Hacks. Cal has been writing and blogging as he’s moved from college to graduate school to academic faculty, as he puts it, “decoding patterns of success.” His first books were not of great interest to me, focusing as they did on school, studying and early career, but I’ve read a few and recommended them over the years.

Now Cal is trying to figure out how to succeed as junior faculty in the Georgetown University Computer Science Department. Deep Work: Rules for Focused Success in a Distracted World is the first book length expression of what he’s learned.

Deep Work is a very academic view of the world – it focuses on gaining world class levels of technical expertise. Cal has to admit that some shallow workers are successful, but he makes the point well that, in general, success in our economy is based on technical expertise. Let’s say this book is aimed at that slice of the new cognitive elite, who read, study and write, not those who work primarily in a world of human relationships as opposed to knowledge. I’ll include myself in this group as an MD, PhD Neurologist who now makes his living providing guidance to companies and teams developing novel therapies in pain, neurological disease and psychiatry. It’s now purely my deep and wide knowledge across medicine, neurobiology and regulations that makes me valuable.

I could have used this book along the way, although most successful professionals figure it out on their own. Time have changed and doing the work is more and more of a challenge in our world of digital distraction. Cal spends about half the book explaining what deep work is and then spends the second half providing some rules of engagement with nice examples drawn from publically available stories and interviews he’s conducted. While useful, it’s important to remember that this is a small slice of the world and Cal is an academic in a certain discipline. But I recall how I too over identified highly successful individuals over the years and worked to reverse-engineer their methods of success.

In essence, the process of deep work is planning the time for uninterrupted periods of deep concentration at hard taks. I enjoy this kind of work and have tried to find jobs where I not only have an opportunity to do it but it’s also a major value driver to my employer.

But out in the world of work, the culture of responsiveness cruelly pulls one away, particularly if one’s surrounded by coworkers who don’t appreciate the value of deep work. They’re scheduling meetings and trying to look busy while you try to analyze data. It’s easier to spend all day farming the inbox and having meetings than to research an unfamilar technical area and synthesize a new business case. But in some companies, answering emails or sitting in meetings to coordinate and manage is the job, or at least most of it. Newport correctly identifies the problem in these coporate cultures, that when being busy is the measure of success then there must be no real work to do anyway. Can such a culture be successful for long?

My own call to “doing the work” is a simpler plea to focus on production. Learning is not productive in itself, real artists ship. Academics are actually scored based on number of publications and the impact ratings of the journals in which the papers appear. My H Score on Google scholar is 21. Not bad for 20 years out of academia. They’ve tried to make keeping score easy. But that’s not been the focus of my career, I’ve been on the business side where being uniquely qualified to help on a project is the goal.

A documentary pursues “reality” while fiction’s goal is the “truth” .
A documentary accumulates facts and let’s them tell the story,
While a work of fiction creates an imaginary world.
We filmmakers hide truths within these imaginary worlds.
– Shoichiro Sasaki, Film director: “What Is a Story?”

In Liberty of Conscience, Martha Nussbaum presents her view of the constitutional protection of religion based on the writings of Roger Williams, an early American theologian who left the Massachusetts colony and founded what would become Rhode Island. By tracing a thread from Williams through the drafting of the constitution and Supreme Court decisions, she presents a coherent view of separation of church and state.

I approach these questions as a scholar of constitutional law, but also, and more fundamentally, as a philosopher. Philosophical ideas were important to the Founding, and thinking about some of the philosophical texts that formed its backdrop helps to clarify the underlying issues. I take an independent interest in these philosophical ideas as good ideas to think with, not just ideas that had a certain historical and political influence. But I will also be arguing that the constitutional tradition is best read as embodying at least some of these ideas, in some form.
-Martha Nussbaum
Philosopher/Scholar of Constitutional Law
“Liberty of Conscience”

A Historical Approach to Philosophy?

This historical approach to philosophy uses story understand where we are now. We seek pattern and coherence in the world- it’s the way people are. You might think that history is fixed and unchangable. But if history is viewed as the story we tell to explain what we see now, it makes sense that history will change as the world now changes or as the motivations and knowledge of the storyteller changes.

While the founders didn’t explicitly follow the ideas of Roger Williams, they were familiar with them. As it turns out, it’s useful to see his idea of “Liberty of Conscience” providing the basis for the First Amendment’s two clauses, the Free Exercise Clause and the Establishment Clause. As I learned, it’s not “separation of church and state”; that’s a much more modern concept and one that probably reflects the fact that lack of religion has grown so much in recent decades. In Nussbaum’s view, the First Amendment is aimed at preventing any citizens from being favored, ensuring that all citizens could follow their own way in matters of conscience. And that might include any truth seeking endeavor, whether it involves the God, many gods, or no god at all.

Nussbaum writes further:

People aren’t always content to live with others on terms of mutual respect. So the story of the tradition is also a story of the attacks upon it, as different groups jockey for superiority. What has kept the tradition alive and healthy is continual vigilance against these attacks, which in each new era take a different concrete form.

If deciding better depends primarily on improving the brain’s mapping of the world, then we need the freedom to study and act according to religion and more broadly conscience, philosophy.

I remember a time when there was a just a few sources for news. When I was growing up there was the local newspaper, three television networks and magazines like Time (read in waiting rooms). Even after we got cable while I was in High School, CNN was nothing more than expanded, 24 hour a day news channel much like the news on regular TV or from the newspaper. Journalists tried to provide information that was at least confirmed and had been filtered through the prevailing notions of the time. Even if the reporting wasn’t always completely accurate and even it was somewhat biased by political or financial considerations, it was a received truth that created a common world view for citizens. If ther was a single point of view at least it was everyone’s.

In their book Blur: How to Know What’s True in the Age of Information Overload, Bill Kovach and Tom Rosenstiel present the case that individuals now have to take on that role for themselves. With more and more primary information available, understanding an issue now involves searching out multiple sources on the net, synthesizing a personal view. This may be as simple as avoiding the trap of one sided presentation of a situation and searching out other reports to verify or perhaps present a more nuanced picture.

The presidential campaigns have raised fundamental questions about the US, its role in the world and its future. I’m finding much of the conversation to be unconvincing from all sides. Some of the changes to tax policy, trade pacts and immigration are quite radical with potentially far-reaching unintended consequences. Of course, in line with the ideas described in Blur, I’ve been reading multiple sources, opinion across the spectrum and fact checking if possible.

Some of the questions I have are pushing me towards reading some political science, economics and history a bit more in depth order to understand context. For example, I just finished Martha Nussbaum’s Liberty of Conscience: In Defense of America’s Tradition of Religious Equality. Why is political economy relevant to Deciding Better? It’s an example of a complex system. The constitution provides a framework and set of rules. The actor within create an ecology of ideas that govern real events. Even constitutional rights are fluid and changeable. These ideas of tolerance and free exercise have changed over time with fear being a major driver of minority rights being infringed.

Besides my work with the (M Monochrome)[https://decidingbetter.com/?p=783], I’ve shot and developed 10 rolls of film this year. I’ll probably get one or two more developed before the end of the calendar year.

It’s fair to ask why I chose to shoot film side by side with digital. I think if you look through my (Flickr Photostream)[https://www.flickr.com/photos/jamesvornov/] you’d be hard pressed to pick out film from digital in the images. I treat them as equivalent except for the incredible low light sensitivity you can now get with digital capture that ASA 400 Tri-X can’t match. Once film is scanned, I treat it similarly in the workflow, so film just has a few extra steps compared to digital. Price is not a consideration when buying bricks of Tri-X and doing the developing and scanning at home.

So why film? Authenticity in the photographic process, I think. At this point, once an image is in the digital realm, the tools we have to alter the image are so powerful that the digital file is a starting point, not the object itself. With the techniques I’ve learned over the years, I can infuse light into a flat image, creating a subjective reality for the viewer that is only suggested by the original scene.

Film provides me with an opportunity to let the chemical photographic process do that manipulation of light to image in its time honored way, providing a starting point that is much closer to the end product. My relationship to a scanned film image is different. I adjust brightness and contrast, sharpen the image back up to what its lost in the scanning process and present it more or less as I found it.

The image above was captured on a gray winter day. I scheduled myself to spend a few hours capturing images on film and came home with two rolls exposed, unimpressed by what I had seen. Shooting film, I lacked the feedback provided by the camera LCD, so its a matter of looking, composing and capturing. This image reminds me how much a scene is transformed by its capture to film. This for me is the authentic experience of the photographic process and its linked to the magic of the chemical emulsion and wonders that D-76 works on Tri-X.

Recognize that we don’t live in a clockwork universe. The future cannot be known based on the current state of the system. Uncertainty is fundemental.

Complexity . . . occurs when the number of interactions between components increases dramatically . . . The density of interactions means that even a relatively small number of elements can quickly defy prediction.
Stanley McChrystal, Team of Teams: New Rules of Engagement for a Complex World

On one of the Sunday morning news shows, Hugh Hewitt proclaimed that Team of Teams was “transformative”. Hewitt interviewed McChrystal about the book and how fighting a new type of enemy in Iraq, one that was decentralized and adaptable, caused him to question traditional military thinking. It turns out that McChrystal has been deeply influenced by systems thinking and complexity theory, just as I have over the years. He uses Emergence by Steven Johnson as reference point which was one my introductions to the field. I’d recommend Steven Strogatz’ Sync: How Order Emerges From Chaos In the Universe, Nature, and Daily Life as another good way to get into the ideas of how higher order structure can be created by independent working parts.

I agree with Hewitt that Team of Teams is a great introdruction to chaos and complexity theory. Written by a man of some accomplishment, it provides a real view as to why complexity matters in the world and how to deal with uncertainty in getting the work done.

The book outlines the shift in McChrystal’s thinking and management style from top down command structure to distributed team work. One might argue that this merely mirrors broad shifts in how we work across many industries. In drug development, as in software development, small focused teams have become the norm. The value in Team of Teams is the somewhat scholarly background into history and theory, from Taylor to Lorenz to Kahneman.

In my review of 168 Hours I focused on the idea of taking stock of how one spends the weekly gift of 168 new hours. But how do you choose how to spend those hours once time like sleep and work are budgeted? If that time is going to as rewarding as possible, somehow you must find your passion and distinguish between activities that bring fulfillment and those that are of no value.

All decisions are emotional. Deciding how to spend time is no less personal and subjective. What is a joy for one person is a bore for another. Even within the same sphere of activity, the same work might be trivial for the experienced practitioner but impossible for the novice.

As a guide to “what”, Vanderkam suggests looking backward as to what activities had that magnetic attraction over the years. What do you find draws you back over and over? In fact, according to Vanderkam, we usually start in childhood. The child who loved to perform may find joy in an audience as an adult, whether it’s in community theater or in front of a class teaching. The childhood mud pie maker will be happiest with dirty hands their whole life whether as an artist, knitter or programmer deep in code.

I love the idea of adults as grownup versions of the children we once were, seeking the same basic satisfaction throughout life. It’s consonant with my observation that over the years people don’t change at their core. Over many years we are at our happiest engaged in the work of our souls.

Me? I’m a student. Mentally, I never graduated. After a BA it was an MD and PhD. Then Neurology training followed by another 10 years on a medical school faculty: still in school, learning more than I ever produced as a researcher. Even now after almost 20 years of working for a living as a drug developer, I’m in it for what I can learn. My writing here? Just another mode of learning for me.

One of my discoveries this year was Coursera as a resource for learning. During the year, I completed the full Data Science Specialization which was created by faculty at Hopkin’s own Bloomberg School of Public Health. Coursera does it right. These are courses with quizzes, projects, and deadlines. Once a course started, I had to be committed, sometimes spending many, many hours on a course project. The result? I’m now reasonably proficient in the statistical programming language R, many of its add on packages and the IDE, R Studio.

Understanding how to manipulate, display and analyze data is a useful skill set for me, of course. That’s why I’m learning about data science, not physics. But the joy for me is in the learning, the mastery of a body of knowledge. I’m continuing to look at my 168 hours each week and budget a nice chunk to exploring data analysis and statistics in a curriculum I’m designing myself.

It’s worthwhile to step, see where the time goes and try to set some of it aside for doing what you truly love.

My photography has taken a major turn back toward black and white. Like others of my generation, I started with film in the 1980’s, developing and printing in the darkroom of the lab where I did my PhD. At some point in the digital Photoshop-enabled era, my images became saturated color depictions of the suburban landscape. I’ve gone back to embrace my roots in formal, somewhat abstract black and white images. Still of course depicting light with the techniques I learned from Vincent Versace in his Welcome to Oz books.

While my earliest art photography influence was Ansel Adams, my earliest love of images was the macro photographs in My Weekly Reader. The transformation of objects by the process of photography has stuck with me. I’m now exploring just how far I can go with the idea.

Black and white photography provides maximum abstraction. I’d been meaning to shoot black and white film for a long time. I finally bought a tank and chemicals, loading the film at night in a closet with the room lights off. Once again I was greeted with the magic of light transformed to physical image. I’m trading off between film and digital, but mostly staying with a 50mm lens which I find helps isolate and abstract scenes.

Get it here: 168 Hours: You Have More Time Than You Think

Laura Vanderkam has written a great book encouraging us to think deeply about how we spend our time. As Vanderkam points out, everyone gets the same 168 hours in their week. We’re gifted with a new week 52 times a year, each with the same number of hours. Looking at the week as a bucket with a fixed number of hours, each hour, its value, is brought into sharp focus. In general, 56 hours are spent sleeping, leaving a full 112 hours available. When I was working at an office, I had 40 hours committed office time plus about 5 hours of commuting. This leaves a full 67 hours for family, fitness, spiritual, artistic and intellectual pursuits. But you can spend those 67 on valued activities only if you refrain from squandering those riches.

In January of this year I returned to work with a Contract Research Organization on the service side of drug development after a two year stint as Chief Medical Officer at a biotech. Personally, this meant going back to a home office where I manage my own activities most of the time. There’s a wider variety of projects now and much more unstructured time outside of a more formal office setting. That flexibility has allowed me to pursue some projects biostatistics and neuroscience in addition to regular work responsibility.

Without feedback, there is no learning. I’m an pragmatist and the world is a data source, life an ongoing experiment. I’ve used many systems over the years, trying to refine the tracking process to suit current activities. Sometimes tracking needs to be granular, other times it’s the timely progress to big events like completing a clinical trial. I think it always comes down to choosing a unit of time and looking both back over what did and did not happen and forward to what can be done in the next unit of time. I generally operate at the level of quarters (3 months), weeks, and days. This book really helped me up my game in the area of time commitment.

168 Hours is a book with a big idea, lots of illustrations, examples, and anecdotes, but also an action plan. Just like a food diary is the best way to loose weight and a budget is the best way to save money, time tracking is the best way to gain control of how those hours are spent. I’ve refined my time tracking, but more with an eye toward focusing on the work that inspires.

Highly Recommended