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’.

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?


Attention is a Gift

From the highly readable Nobody Wants to Read Your Sh*t by Steven Pressfield:

You begin to understand that writing/reading is, above all, a transaction. The reader donates his time and attention, which are supremely valuable commodities. In return, you the writer must give him something worthy of his gift to you. When you understand that nobody wants to read your shit, you develop empathy.

Dear reader, I feel for you. Thanks as always.

Regarding persuasive nonfiction:

Here’s the wrong way:
1) Introduce the thesis (first three chapters).
2) Cite examples supporting the thesis (next hundred chapters).
3) Recap and sum up what you’ve presented so far (last five chapters).

In other words, “Tell ‘em what you’re gonna tell ‘em, tell ‘em, then tell ‘em what you’ve just told ‘em.”

This is salient advice, and it perfectly explains why every time I read self-help or one of these pop-psych “here’s how things really work” books it feels like the whole thing should have been a blog post or two.


Sociopaths need data too

I just finished John Carreyrou’s Bad Blood: Secrets and Lies in a Silicon Valley Startup, about the fall of Elizabeth Holmes and Theranos, the Silicon Valley Unicorn that pretended to be a pioneer in laboratory testing but was really just a purveyor of bloated promises and outright lies.

A sociopath is often described as someone with little or no conscience. I’ll leave it to the psychologists to decide whether Holmes fits the clinical profile, but there’s no question that her moral compass was badly askew. I’m fairly certain she didn’t initially set out to defraud investors and put patients in harm’s way when she dropped out of Stanford fifteen years ago. By all accounts, she had a vision that she genuinely believed in and threw herself into realizing. But in her all-consuming quest to be the second coming of Steve Jobs amid the gold rush of the “unicorn” boom, there came a point when she stopped listening to sound advice and began to cut corners. Her ambition was voracious and it brooked no interference.

A 19-year-old with a couple of semesters of chemistry under her belt suddenly knows enough science and engineering to demolish the scientific state of the art and maybe even the laws of physics when it comes to fluid dynamics. Even the products themselves kept pivoting as her original ideas were clearly impossible with the current state of technology and the people she brought in to do the actual work rotated through.

It’s bonkers, and it’s so telling that almost everyone investing was a tech billionaire or silicon valley VC with no understanding of science. A cult of personality has no business in healthcare without data. This was Holmes describing the Theranos lab process:

A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.

If you heard this in a pitch meeting, would you think future of medicine or middle school book report?

I remember the news when Theranos imploded and I think a lot of people fully embraced the schadenfreude. But reading the detailed story was just so depressing. You shouldn’t be able to run a science company while hiding all the research and data. You know, all the sciency stuff. That’s literally not how science works.

How many thousands upon thousands of hours of smart folks’ time was wasted trying to duct tape vaporware when they could have been making a substantive contribution to their fields. How much money was flushed for someone’s ambition?

What I Read in 2019

Continuing my tradition of posting my annual book diet, this year wasn’t nearly as good of a reading year as 2018. 2019 was (extremely?) busy with the birth of our baby daughter, the continued raising of our four-year-old son, my wife starting a solo private practice (that’s another post), and my first full year as an attending (and winning teacher of the year to boot!).

  1. Get Jiro! by Anthony Bourdain (weird)
  2. How to Talk So Little Kids Will Listen by Joanna Faber and Julie King (kids are ruthless)
  3. War of the Blink by Michael Nicoll and Yahgulanaas
  4. Anthem: The Graphic Novel by Ayn Rand
  5. Voice Lessons for Parents by Wendy Mogel
  6. Power Moves by Adam Grant
  7. Replay: The History of Videogames by Tristan Donovan (very interesting, at least if you’re me)
  8. Meet the Frugalwoods by Elizabeth Willard Thames
  9. Contact by Carl Sagan (classic)
  10. Heart: A History by Sandeep Jauhar (no Emperor of All Maladies, but pretty good)
  11. Junk by Les Bohem
  12. Company of One by Paul Jarvis (synopsis: there’s more to business than growth; something hospitals and academic centers would do well to remember)
  13. The Dispatcher by John Scalzi
  14. Black Crow, White Snow by Michael Livingston
  15. The Rule of One by Ashley and Leslie Saunders (near-future dystopia, but the twist is that the main characters are twins [and the authors are twins!]. The protagonists aren’t awesome athletes or killers, but it’s also not as good as [the first two books] of The Hunger Games or the [first two books] of Divergent.)
  16. The Rule of Many by Ashley and Leslie Saunders (the conclusion)
  17. Skyward by Brandon Sanderson (he’s better at fantasy, but still highly enjoyable YA light-sci-fi.)
  18. The Physician Philosopher’s Guide to Personal Finance by James Turner (reviewed here)
  19. Educated by Tara Westover (excellent memoir)
  20. The Yiddish Policemen’s Union by Michael Chabon (Chabon is my Jewish writer spirit animal.)
  21. The Vexed Generation by Scott Meyer (Magic 2.0 #6) (meh)
  22. Everything is F-cked by Mark Manson (though neither really treads new ground, his first book was much better and genuinely enjoyable. This one suffers from sequelitis.)
  23. Digital Minimalism by Cal Newport (Be thoughtful in how you use technology. Hint: Less is more. The weakest of his books, but still has enough meat to have warranted several blog posts.)
  24. Fall by Neal Stephenson (Long, good. What happens when people figure out how to live as digital avatars after death?)
  25. Chop Wood, Carry Water by Joshua Medcalf
  26. Space Force by Jeremy Robinson (hilarious, page-turning shoot ’em up thriller. I don’t laugh out loud very often, but I did a lot with this one. What happens if we create Trump’s Space Force,  everyone realizes how dumb it is, we cancel the program, and then immediately experience an alien invasion?)
  27. The Mage Fire War by L.E. Modesitt, Jr. (Sage of Recluce #21[!])
  28. Level Five by William Ledbetter
  29. Keep Going by Austin Kleon
  30. Bushido Online: War Games (#3) by Nikita Thorn (I’d never heard of let alone read a “LitRPG” book before this series, and I’ll probably never read another one. But I like this series! Yes, it’s silly. And yet.)
  31. Small Fry by Lisa Brennan-Jobs (A really good memoir; also, Jobs seems like a pretty not nice guy.)
  32. Make it Stick by Peter C. Brown (Probably the definitive book on modern learning science)
  33. The Toll by Neal Shusterman (Arc of a Scythe #3)
  34. The Others by Jeremy Robinson
  35. Indistractable by Nir Eyal (meh)
  36. Ultralearning by Scott Young (more anecdotal than #31)
  37. Strange Planet by Nathan W. Pyle (hands-down best thing on Instagram)

I think 2020 is going to be a good year. I already know what my first book is going to be.