Hospital, Heal Thyself

The lights blink, the bells ring. It seems like there are hundreds of things wrong with this patient. Your best team is working. The result of test after test comes in. But what is the diagnosis? You have no theory. So far, you’re just treating the symptoms.

That is the state of health of the typical hospital today. HHS collects hundreds of measurements of hospital health, but most of them catch the symptoms of broken processes. How many expensive tests do we have to run to find out that our processes are broken? How many of these tests are actually cost effective in driving change?

On the other hand, very few tests measure the overall health of the hospital — which ultimately shows up in how much healthier it makes its patients. Better would be to measure some the actual outcomes patients achieve: if someone replaces their hip so they can walk up the stairs without pain, can they walk up the stairs without pain after a year?

Then, for those outcomes that are poor, actually diagnose the problem in the processes, not just the symptoms. For this we need to measure the change in symptoms given intervenions. We need longitudinal data that correlates with operations: who was on duty, what sorts of patients were present, etc. when certain types of results or failures occurred. We need robust analytics and personel who get direct feedback and can think about the data themselves, at every level.

Apps vs Media

People who know me know that I sometimes don’t explain myself sufficiently. So it was the other day, when I asked Kamil to clean up a mockup…. To my surprise, Kamil put in a navigation bar at the top, and rearranged the display to simplify it. When I asked him why, he asked me — do you want a web app or a web site? I’ve just standardized the web site interface, so that users know what they are doing.

I told him it was supposed to be a web app, and that the prominent nav bar would be distracting. He asked me to define what I meant by a web app, vs. a web site. As this was a chat conversation, I took a few moments to search … someone else must have posted a handy definition, that I could refer to.

To my surprise, a good definition didn’t pop up. It would seem that web apps are taken to mean sites that had lots of javascript. But obviously this isn’t what Kamil was asking me to get at.

Here is my take: a web app has a state that the user takes a hand in creating, whereas on a web site, state can be mapped to “position”, in which the user explores. A site, or other media, is “there” independent of the user, whereas in an app, what is there depends on the user.

Obviously these categories are made to be subverted. Interactive stories try to allow the user to “co-create” the flow of the plot, and huge numbers of sites allow the user to create some content, if only a post or a profile. But I think these poles are useful: app — intensional, site — extensional.

Against Dawkins on God

I think most of my friends are atheists. Also, most people online are inundated with more material than they can absorb. Information is proportional to surprise. I’ll inaugurate my blog in a manner I hope will be surprising.

Dawkins has argued that God is a delusion. In the following I argue that God exists: science answers questions about how, but insofar as it answers questions about purpose (“why”), it can only do so relatively: one thing is good for another. Such judgements are very useful, but they presuppose that we know that some things are good from some other source.

I should note that Dawkins sees himself as a partisan of science in a struggle with religion. He constructs a theory about how humans could have come to make ethical distinctions, which he claims obviates the need for such an entity as God. In the main his arguments are aimed not at God per se but at religion, which I don’t wish to argue about at all. After all, if God does exist, then God is not dependent on people who believe in God — rather the reverse.

Dawkins takes God to be a hypothesis about how things happen, which has been or should have been superseded by the better theories of science. I see the situation a bit differently: God has been a hypothesis about how and why things happen. Science has found beautiful explanations for how things happen, but has rather undermined the reasons that people used to believe about the purposes of things. Indeed, much of that undermining is salutary: the purpose of a planet is not to influence the lives of mortals. But some things must have a purpose. Whence?

Quickly, Dawkins might respond: we give things purpose. But who or what gives us purpose? An atheist may say: nothing, and claim to be satisfied — but most would admit in all honesty that they are only satisfied because there is no other alternative. And yet, strangely enough, many scientific atheists are willing to admit one transcendent thing. Let me call attention to one argument of Dawkins:

God who is capable of sending intelligible signals to millions of people simultaneously, and of receiving messages from all of them simultaneously, cannot be, whatever else he might be, simple. Such bandwidth! God may not have a brain made of neurones, or a CPU made of silicon, but if he has the powers attributed to him he must have something far more elaborately and non-randomly constructed than the largest brain or the largest computer we know. [Dawkins, Richard (2008-01-16). The God Delusion (Kindle Locations 2564-2567). Houghton Mifflin Harcourt. Kindle Edition.]

This is a perfectly good argument against a physical God. But note the argument might also seem to apply to the Law of Nature (which I put in the singular here as I am following Dawkins in avoiding complicating the discussion with polytheism). Particles collide all over the universe — how do they know how to interact? One could say, well the particles themselves know. But think of all the bits of instructions each particle has to have to have its own copy of the Law!

In fact, scientists are usually happy to believe in the Law as something not in itself physical. Although a hard-core anti-realist would say that even this exists only in peoples heads, more common would be to say: yes — the Law is an exception. We are willing to admit its existence because of its extraordinary explanatory power.

But is the Law only about physics? The nub of the question is this: does the Law pertain directly to conscious persons? Can an act or decision be Right or Wrong, irrespective of the society or even in principle the species of the actor? Or, contrariwise, are all judgements about an individual only valid in a particular social or evolutionary context? The former is tantamount to the existence of God.

Dawkins makes the case that morality evolved. Indeed Pinker recently argued that it is still evolving. I am convinced by these arguments. However, just because the morality of human societies evolves, doesn’t mean that we don’t need to have recourse to some external standard to judge one set of mores better or worse than another.

Consider the Romans: the Pax Romana was a justification for genocide. Despite the other benefits the Roman order brought, we will probably feel, as even many Romans did, that the ruthlessness of the empire was wrong. But are we really just making a comparative statement with our own beliefs, who’s basis is an accident of evolution? Are we perhaps arguing that evolution naturally proceed probabilistically to more sophisticated lifeforms, and so therefore we can assert with some probability that our morality is more adaptive than theirs was.

But the rejoinder is clear: why is adaptive better? If you say, well that’s just the survival meme… nothing is really “better” absolutely, but I can be self-consistent and say that I believe it, however unjustifiably. But now you’ve come to Vaihinger’s “als ob”. Is it really confortable there? Why not have the courage of your convictions? Nothing stands in your way to say it is better. Indeed, Dawkins’ work is suffused with the conviction that it is right to believe in science: the Law is on his side. In fact, maybe Dawkins believes in God, and just doesn’t want to admit it!

Just keep in mind: you can be right, and all those other people with whom you disagree with and who believe in God can still be wrong, even if God does exist.