Status Quo Bias

From Machine, Platform, Crowd: Harnessing Our Digital Future by Andrew McAfee and Erik Brynjolfsson:

Research in many different fields points to the same conclusion: it’s exactly because incumbents are so proficient, knowledgeable, and caught up in the status quo that they are unable to see what’s coming, and the unrealized potential and likely evolution of the new technology.

This phenomenon has been described as the “curse of knowledge” and “status quo bias,” and it can affect even successful and well-managed companies.

There are a lot of bad actors in healthcare that I would love to see fall prey to the curse of knowledge.

When “value” became shorthand for “economic worth”

From Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist by Kate Raworth (emphasis mine):

Despite such misgivings from the twentieth century’s two most influential economists, the dominance of the economist’s perspective on the world has only spread, even into the language of public life. In hospitals and clinics worldwide, patients and doctors have been recast as customers and service-providers.

There may be no perfect frame waiting to be found, but, argues the cognitive linguist George Lakoff, it is absolutely essential to have a compelling alternative frame if the old one is ever to be debunked. Simply rebutting the dominant frame will, ironically, only serve to reinforce it. And without an alternative to offer, there is little chance of entering, let alone winning, the battle of ideas.

But when political economy was split up into political philosophy and economic science in the late nineteenth century, it opened up what the philosopher Michael Sandel has called a ‘moral vacancy’ at the heart of public policymaking. Today economists and politicians debate with confident ease in the name of economic efficiency, productivity and growth—as if those values were self-explanatory—while hesitating to speak of justice, fairness and rights. Talking about values and goals is a lost art waiting to be revived.

I love that.

And the example of healthcare I think is exactly right. Everything is a business–that’s unavoidable. It isn’t even a bad thing. Lose money and you won’t be in business very long. But not all businesses need to be organized with the primary purpose of optimizing productivity and growth.

Good patient care is inefficient. Talking to people–understanding their perspective and helping them become active participants in their health–takes time. A patient visit was never meant to be an assembly-line 15-minute med check.

It’s not that we should applaud or celebrate inefficiency. There is plenty of waste to trim in any enterprise. It’s that these ideas–efficiency, productivity, and growth–should be tools to achieve meaningful ends, not the primary endpoint. Measure what matters.

And if some of that extra “value” makes it to the actual workers? Much of our economy is predicated on individuals misallocating their income away from savings and away from optimizing their time:

As economist Tim Jackson deftly put it, we are ‘persuaded to spend money we don’t have on things we don’t need to make impressions that won’t last on people we don’t care about’.

ABR & Guessing the Cost of a Lawsuit

All non-profits have to file a Form 990 with the IRS detailing their finances. The ABR’s 990 says “THE BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.” I’ve already read and discussed the bylaws, but I thought I’d ask for the financial statements. Two emails went unanswered, but after I asked publically on Twitter I got a polite and professional email within a day.

Unfortunately, the statement I received was a broad profit and loss statement even less detailed than the 990. I’m not going to lie, I was really hoping they would send me something more granular that would further break down categories like travel to get a feel for how the ABR really operates. Travel expenses would likely include paying for coach airfare for volunteers to come together for question writing committees and the magical Angoff process, but they might also contain expenses related to annual getaways to Hawaii for the board. I don’t begrudge a working vacation, but big categories undeniably make it difficult to evaluate financial stewardship. Trolls on the internet talk a lot of smack about the ABR’s supposed largesse, but all we’ve really seen is a generous chief executive salary, a large pile of money in reserve, and some broad expense categories that I’d love to drill down. Large boxes hide their contents.

But since we can’t break down the big boxes, we may never know details the radiology community is interested in seeing. One recent example would be, how much is the ABR paying to fight off that class-action lawsuit?

The best we can do is a wild guess because all “legal” expenses are a single category in the ABR’s publically available tax documents (most recent filings are available on Guidestar).

Legal fees according to ABR Form 990:
2011: $57,280
2012: $70,811
2013: $78,271
2014: $114,563
2015: $44,776
2016: $48,703
2017: $45,439
2018: $25,294
2019: $119,445

We can see that earlier in the last decade, the fees were all over the place but mostly in the high five figures with exception of 2014. We then had several years in a row of lower numbers, primarily in the $40k range.

The initial complaint in the class action ABR lawsuit was filed on February 26, 2019, and the case is still ongoing.

The reported legal fees in 2019 were $119,445.

The average of the preceding 4 years prior to 2019 was $41,051.

If the costs of the lawsuit were responsible for the difference, that would be approximately $80k to fight the lawsuit in 2019 over 10 months. Is all that excess actually the lawsuit? Who knows; I don’t think they were sued in 2014 and that was a pricey year as well. Some likely additional one-time fees that I can think of like trying to deal with the legalese debacle of the ABR agreement earlier this year won’t appear until the 2020 Form 990 that will be filed next year. But we definitely have an upper bound.

The ABR’s legal counsel has filed three motions dated 6/27/2019 (54 pages), 03/13/20 (54 pages), and 07/21/20 (26 pages). It would seem likely that the overall cost will be at least double the 2019 amount if not substantially more. Just extrapolating on page count would put the estimate at $200k so far (though I would venture the research for the initial motion to dismiss would have taken longer and cost more).

While the case seems destined for dismissal, certainly an actual trial would increase costs exponentially. These lawyers presumably don’t charge for value like radiologists; they charge for time.

In 2019, there were (according to the ABR) approximately 31,200 diplomates paying for MOC (the very thing the lawsuit is about). Our very broad completely unscientific estimate would therefore suggest that each MOC-compliant radiologist, through their annual fee, paid about $2.50 in 2019 against their own interests (depending on whose side you take), which is less than 1% of their dues and which is, if we’re being honest, a trivial sum.

If the judge dismisses the current amended complaint and the case is subsequently dropped without further back and forth, then a non-grandfathered MOC-radiologist might expect to have contributed the equivalent of a beverage of indeterminate size and composition to support the ABR’s hegemony.

Anger and Outrage: Features, Not Bugs

From Cal Newport’s Digital Minimalism: Choosing a Focused Life in a Noisy World:

The techno-philosopher Jaron Lanier convincingly argues that the primacy of anger and outrage online is, in some sense, an unavoidable feature of the medium: In an open marketplace for attention, darker emotions attract more eyeballs than positive and constructive thoughts. For heavy internet users, repeated interaction with this darkness can become a source of draining negativity—a steep price that many don’t even realize they’re paying to support their compulsive connectivity.

Encountering this distressing collection of concerns—from the exhausting and addictive overuse of these tools, to their ability to reduce autonomy, decrease happiness, stoke darker instincts, and distract from more valuable activities—opened my eyes to the fraught relationship so many now maintain with the technologies that dominate our culture. It provided me, in other words, a much better understanding of what Andrew Sullivan meant when he lamented: “I used to be a human being.”

Doomscrolling is so insidiously toxic.

I am not a heavy social media user. I mainly use Twitter to make sure I interact with readers who use that medium and to share my newest articles. Since 2009, my main use of Twitter has been to publish other people’s tiny stories in Nanoism, an admittedly bizarre hobby and a largely one-way broadcast (@nanoism). I actively dislike Facebook.

And yet.

Sometimes I find myself scrolling and scrolling, clicking on a shared link to another depressing rantorial and then reading the awful comments from strangers on the internet who didn’t read the actual article acting out their respective caricatures. It all makes me wonder if humans are actually the creatures of morality and reason as argued by some philosophers. For most internet platforms, anger and outrage are features. Yelling at strangers on the internet is gold for companies that serve you targeted ads and profit from your attention. Everything is tailored for engagement.

One app I desperately needed when I was a student is Freedom, a service that allows you to block certain activities either on-demand or on a schedule. It would have saved me from a lot of my old internet demons. I should probably even turn it on more now, but I’m usually in a better place these days. Having young kids to soak up my time and attention has helped me hone my focus.

But Newport takes it a step further, and I think he’s right. It’s not enough to try to limit the damage of new technology or platforms on your life:

I’ve become convinced that what you need instead is a full-fledged philosophy of technology use, rooted in your deep values, that provides clear answers to the questions of what tools you should use and how you should use them and, equally important, enables you to confidently ignore everything else.

Many finance gurus talk about the need for all of us to have “Investor Policy Statements” or a “Written Financial Plan.” The reason being that if you don’t articulate a specific position, you may react inappropriately to the vagaries of life in a way that is counter to your goals. The plan keeps you honest and helps you deal with anxiety.

It makes sense to plot out “use criteria” so that you know if you should be incorporating the newest social media service that comes along and not just reactively picking something up because it’s popular.

Likewise, it makes even more sense to look critically at your use and see where the utility lies. You may not want to delete your Facebook profile or remove Instagram from your phone. Fine, right? But what–specifically–about using those services makes you happy, and what makes you angry, hurt, or jealous? And, knowing that, how can you structure some rules for engagement that can help you get what you want from the platform instead of letting it became just another automatic behavior?


Good ideas need to outlive the old guard

Nobel-prize winning physicist Max Planck argued in his autobiography that change takes time because good ideas need enough staying power to outlive their detractors:

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it…An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarized with the ideas from the beginning: another instance of the fact that the future lies with the youth.

Clearly not always true, but it’s so broadly applicable a principle that it’s worth adding to your library of mental models.