Geniuses and Hard Work

“Success is a lousy teacher. It seduces smart people into thinking they can’t lose.” -Bill Gates

“You’re Going to Lose More Often Than You Win”

In a recent New York Times op-ed, Ashley Merryman, co-author of NurtureShock: New Thinking About Children and Top Dog: The Science of Winning and Losing, rails against the use of “participation awards”. That is, awards which are given out to all children simply for showing up, regardless of performance. (I’ve got a bunch of participation awards strewn around my basement from my early Tae-Kwon Do years.) It turns out that the science is on her side; Ms. Merryman cites research that shows:

• Nonstop praise can cause students to collapse at the first sign of difficulty
• Praising a student for having innate talent can lead them to fixate more on their mistakes
• Excessive praise can create an expectation of success without real effort

In life, “you’re going to lose more often than you win, even if you’re good at something,” says Jean Twenge, author of Generation Me. “You’ve got to get used to that to keep going.”

True Grit

Incidentally, the reason this article caught my eye was because that same day, the MacArthur Foundation announced its 2013 MacArthur Fellows (journalists love calling them the “Genius Grants“, although the Foundation is loath to do so for reasons that will soon become clear). Among them was Dr. Angela Duckworth, Associate Professor of Psychology at the University of Pennsylvania, whose research focuses on grit: “sticking with things over the very long term until you master them.” Consider some of her lab’s findings:

• Among cadets at West Point, grit was a better predictor of performance in a rigorous summer training program than intelligence, leadership ability, or physical fitness.
• Among Scripps National Spelling Bee contestants, grit was a better predictor of advancing to the finals than intelligence.
• Among Penn students (the perennial test subjects of Penn researchers), grit was a better predictor of GPA than IQ. In fact, those with higher IQs actually had less grit than their peers with lower IQ.

This last point suggests an interesting phenomenon: innate talent–and the frequent early success that comes with it–may reduce the opportunities for an individual to develop his or her grit. This means two things. First, that grit is something that is malleable and can be developed over time (while theories abound over ways to maintain self-control in the short-term, evidence on ways to build grit over the long term has been much harder to find). And second: Bill Gates was right.

A Patient Grit Measure?

And of course, since I’m a health care nerd, I can’t close without connecting this all back to health care in some way. And what got me thinking was the “Grit Scale”, an 8-12 item questionnaire developed by Dr. Duckworth and colleagues that assesses your grit. It’s freely available, and you can take the 12-item version here. I haven’t heard of the Grit Scale being used in health care, but there are other questionnaires that are regularly used. The Patient Health Questionnaire (PHQ-2 and PHQ-9), for example, which has been validated for screening for depression in a primary care setting. Or the Patient Activation Measure (PAM), which gauges a patient’s knowledge, skills, and confidence in managing his or her own health.

I’m venturing into the realm of speculation, but I wonder if the Grit Scale–or some component of it incorporated into existing health questionnaires–can give us a useful measure of which patients are likely to succeed in sticking to a treatment regimen and which patients need extra support. Given that behavior change may be one of the most promising ways to address the coming chronic disease crisis, I think it’s certainly worth exploring.

In the closing minutes of her MacArthur Foundation video, Dr. Duckworth describes the next two areas of her research:

1. Exploring better ways to measure grit–in particular, “objective measures that don’t require people to measure questionnaires…but looking at their behavior.”
2. Evaluating interventions to improve grit.

I greatly look forward to seeing what her team finds.

Meanwhile, halfway down their FAQ page, the MacArthur Foundation explains its rationale for avoiding the term, “genius grant”:

“We avoid using the term ‘genius’ to describe MacArthur Fellows because it connotes a singular characteristic of intellectual prowess. The people we seek to support express many other important qualities: ability to transcend traditional boundaries, willingness to take risks, persistence in the face of personal and conceptual obstacles, capacity to synthesize disparate ideas and approaches.” (emphasis mine)

Maybe they should have called them “Grit Grants”.

Does Language Influence Our Propensity to Save?

Does my Chinese language subconsciously influence me to save more, avoid smoking, exercise more, and eat more healthily?

That seems to be the conclusion of economist Keith Chen of the Yale School of Management, in his recently published paper (and described in his much more viewer-friendly TED Talk).

Prof. Chen’s argument essentially runs as follows: certain languages, such as English and  Greek, oblige speakers to separate out present and future tense (“I will go to the store tomorrow”), while other languages, such as Chinese and German, prevent speakers from doing so (“我明天去商店”, or, “I go to the store tomorrow”). Could this linguistic separation of present and future in certain languages lead speakers of that language to discount the future, thus reducing their propensity to save and prepare for the future? Since this is certainly not a question that can be answered using a randomized controlled trial, Prof. Chen goes the big data route; pulling data from the largest data sets in the world and running regressions to parse out the effects of numerous possible confounding variables, so that he can compare the savings behavior of people born in the same country, living in the same country, of the same sex, age, income level, educational achievement, family structure, religion, etc. and differing only in the language they speak. What he found was a surprisingly rigorous correlation despite controlling for all of these other factors: “Futureless” language speakers are 30% more likely to report having saved in any given year, 20-24% less likely to smoke, 13-17% less likely to be obese by retirement, and 21% more likely to report having used a condom in their last sexual encounter.

Two Linguists Offer Their Criticisms

I listened to a recording of this TED talk while practicing my (apparently linguistically-driven) morning run yesterday, and slowly shifted from skepticism to mind-blown acceptance as Prof. Chen covered his statistical bases. But it’s easy to become a believer when you’re neither a professional linguist or economist. Upon arriving home, I did a quick search and sure enough, uncovered well-written criticisms from two linguistics professors:

Mark Liberman of the University of Pennsylvania highlights the dangers of running statistics on factors that may very well not be completely independent. He uses graphical depictions to show that as soon as you introduce the assumption that certain factors are correlated in their geographic diffusion (e.g. language and culture), it becomes quite easy to find highly statistically significant correlations between non-causally related phenomenon.

“If you torture the data long enough, it will confess.” -Economist Ronald Coase

Geoffrey K. Pullum of the University of Edinburgh has a slightly more piquant response (including taking a jab at Prof. Chen for being a “non-linguist”), challenging Prof. Chen’s categorization of languages into strong and weak “future time reference” languages. This underlied some of my initial skepticism as well (after all, I can easily say, “我明天会去商店”, or “I will go to the store tomorrow”). Perhaps most alarmingly, Osten Dahl–the same scholar whose work Prof. Chen relies upon to categorize his languages–shows up in the comments section to emphasize that he never created hard categorizations in the first place.

These posts touched off a series of additional conversations, which you can find outlined here. Not being an expert in either field, I’ll leave it to you if you want to continue down the rabbit hole of this very interesting debate. However, I did want to highlight one remark from Prof. Chen that I think we can all learn from.

Stepping Out of the Echo Chamber

Earlier in the week, I had listened to a TED Talk (maybe I’ve overdosing a bit here) by Margaret Heffernan, who recounted the story of Alice Stewart. Alice Stewart was an English physician and epidemiologist who in 1956 published a paper showing for the first time that children of women who received X-rays while pregnant were significantly more likely to die from childhood cancer. What’s most striking about this story is the fact that Alice had to fight entrenched interests for 25 years before the British and American medical authorities changed their practices, and how her working relationship with a statistician named George Kneale helped her persevere through the fight. As Ms. Heffernan explains, George saw it as his job to prove Dr. Stewart wrong. He crunched the numbers in different ways, explored possible confounding factors, and tried everything within his statistical power to poke holes in her conclusion.

“Because it was only by not being able to prove that she was wrong, that George could give Alice the confidence she needed to know that she was right.” -Margaret Heffernan

This brings me to a statement that Prof. Chen included in his response to Profs. Liberman and Pullum that jumped out at me:

“…all analyses I conduct are on publicly available data, and I’d love to talk more with readers interested in replicating, extending, or testing these results in ways I haven’t thought of.”

Too often we enclose ourselves in an echo chamber of like-minded thinkers, looking for the next killer argument to throw at “the other side”. Regardless of whether Prof. Chen’s hypothesis turns out to be valid or not, his openness to engaging in constructive conflict is something I think we should all strive to emulate.

Can Higher Wages Drive a Virtuous Cycle of Profit?

Suddenly faced with time for some free reading, I’ve decided to occasionally write a post on a topic outside of my usual focus. As such, I plan to structure these posts are shorter blurbs, offering more conjuncture than conclusion, and hoping to garner your thoughts and opinions. I hope these can lead to some interesting discussions.

Can Higher Wages Drive a Virtuous Cycle of Profit?

An article this week in The Atlantic makes the argument that companies like Costco, QuikTrip, and Trader Joe’s prospered through the recession because they viewed employees as assets and paid higher wages–in direct contrast to conventional business notions to cut costs (read: layoffs and lower wages) during a recession. It’s this philosophy, the author argues, that will allow companies to flourish in the future.

Perhaps. It’s certainly an enticingly paradoxical notion–that paying higher wages will actually lead to a virtuous cycle of more growth. I was drawn to the title precisely because of the beloved TJ’s located a block from my office, where staff seem constantly energetic, engaged, and all around happy to be there. But does it actually play out in practice? Three example companies make a very measly sample size (n=3), in a narrative that could easily confuse correlation for causation. Is there documented rigorous evidence that treating workers as assets (whatever that may mean in practice) actually leads to positive growth for companies?

It may turn out to hold true for the vast majority of companies, in which case we would be facing huge opportunities by changing companies’ ingrained sense of cost-cutting. I could also see it hold true only for certain types of companies–for example, ones that target a more socially conscious consumer willing to pay a premium for better service (TJ’s I’m looking at you!). “Treating workers as assets” is also a fairly vague term–does this mean higher wages, greater voice in sharing ideas, better benefit plans, or something else? I’m sure there’s already a growing management literature on this. The article quotes Dr. Zeynep Ton of MIT’s Sloan School of Management; that may be a good beginning place to look.

For Employee Health Benefits, “Cost Control” May be the Wrong Approach

This issue becomes most interesting for me when we look through the lens of health benefits. As the poorly portrayed CVS-demanding-workers’-weight story indicated, companies are becoming increasing interested in ways to manage their workers’ health through benefit plan design and wellness incentives. And the conventional wisdom is that when I write, “workers’ health”, I really mean “workers’ health costs”. Facing spiraling health care costs that parallel our nation’s terror over the future of Medicare, companies have been trying to find creative ways to rein in those costs, through euphemisms such as “consumer-driven health care” that make employees pay a greater share of health care costs to “get their skin in the game”.

The problem is, if the argument that better-treated employees contribute to increased productivity and a better bottom line, then offering employees skimpier health care benefits may paradoxically ruin productivity (greater absenteeism, less energy at the workplace, etc.) and hurt the bottom line. As employers increasingly recognize this, they may start looking beyond the health benefit price tag to see what plans, providers, and services can help increase worker productivity and well-being, even if they cost a little extra.

I have a hunch that research in this area is still a murky black box. How do we distinguish effective programs from trumpeted snake oils? What services actually translate into bottom line benefits? What metrics should we even look at to measure the “value” of a health benefit package?

What do you think?

2012 Olympic Taekwondo Fighters to Watch

I haven’t followed Olympic Taekwondo before, but with the games just 10 days away (Taekwondo is scheduled for Aug 8-11) and myself itching to get back into training, I decided to scour the internet for some previews. Here are some highlights of people and teams to watch:

Traditionally, Korea has dominated in the sport of their home country. Just scroll down and look little Korean flag icons on the medal tables for Olympic Taekwondo and the World Taekwondo Championships, the two major international Taekwondo competitions. They swept the 2008 Beijing Olympics by winning gold in all four events they competed in; however, their performance was disappointing during last year’s world championships on home turf, where they only tied for first with Iran. Their new team contains two returning champions (Cha Dong-min and Hwang Kyung-seon), and it will be interesting to see if they can regain their former glory.

Team USA, which ranks third in overall medal count at the Olympics, is a force to be reckoned with. Two members (Steven and Diana Lopez) and a coach (Jean Lopez) are all from the same family, and it would have almost been a full house had Terrence Jennings not defeated brother Mark Lopez at the Olympic trials. Two-time defending Olympic champion and four-time world champion Steven Lopez has a history of rigorous training twinged with just a little hubris, but it appears that one of his most prominent opponents Aaron Cook (who defeated him in Mexico) has already lost the battle–with the British Olympic Association.  Nevertheless, medal projections (which are shared on Sports Illustrated but appear to originate from China Daily, so you know how much they’ll favor the US) have Lopez coming in second to Azerbaijan’s Ramin Azizoz (You can watch a video of him getting knocked out here). In an insightful display of American brilliance, Lopez shares his winning strategy: “I want to land my foot on my opponent and not let him land his foot on me. Actually doing it may be a little trickier.”

Also sure to be politically rivalrous are two possible China-Taiwan line-ups: #2 ranked Hou Yuzhuo vs. #1 ranked Tseng Li Cheng (bonus points if you can tell by name which is which) for featherweight division, and China’s Wu Jingyu vs Taiwan’s Yang Shu-chun for flyweight division. For those of you with patience, here’s a video of Wu and Yang’s match during last year’s world championship, in which Wu won 6-2. (For those without patience, skip to 12:35 for a slow-mo view of the 3-point head kick that secured Wu’s victory.)

Finally, the underdog I’ll sure to be rooting for, Afghanistan’s Rohullah Nikpai. Four years ago he upset world champion Juan Antonio Ramos to bring his country the first Olympic medal (a bronze) and, to borrow a cheesy line, “emerged as a symbol of hope for a nation scarred by conflict.” Watch this video from 19:15 (unfortunately it won’t let me embed right to that point so you’ll have to let it load a bit), and you’ll be moved as well.

However, perhaps most interesting will be the fact that Taekwondo may be on the brink of being removed from the Olympics, after a number of controversies including scoring protests and a referee assault. The International Olympic Committee is poised to reduce the number of core sports from 26 to 25 next year, and Taekwondo may be on the cutting block.

Mobile Medic

I NEED to learn from this guy:

http://www.mad.asia/events2/annual-mad2/mad-2011/talks/social-innovation/221-mad-2011-talk-josh-nesbit-text-message-can-save-lives

目送（“To Watch One Leave”）

父亲、母亲…你们是不是今生今世不断地在目送我的背影？

An Antibiotic Alternative?

After weeks of searching, I finally found an excellent review that describes the patterns and mechanisms by which fatty acids affect gut bacteria.

Let me give some background to this unabashedly nerdy exclamation. Since summer of freshman year, I have been working on research on the effect of a mouse’s diet on the populations of bacteria that inhabit its gut. It doesn’t sound like the most exciting prospect until you pause to consider that (1) bacterial cells in/on the human body outnumber human cells 10:1, (2) bacterial genes outnumber human genes 100:1, and (3) the majority of these bacteria are concentrated in the gut. In one respect, we’re really more like clumps of bacteria walking around with some human cells mixed in.

Much research has lately been done on the effects of prebiotics (indigestible compounds that modulate levels of gut bacteria) and probiotics (living cultures of ingested bacteria—the most well-known being the Lactobacillus in our yogurt). But painfully little research has been done on the effect of fatty acids on gut bacteria populations. Frustrated by the hours of fruitless literature searches, I recently sent an email to a prominent researcher in the field, based in Belgium. He replied by relaying his belief that the reason little research has been done in this area was because very small amounts of fatty acids actually reach the colon, adding that if a fatty acid could be constructed in away so that it could reach the colon and offer beneficial effects…that would be a “breakthrough”.

It’s true that most fatty acids are absorbed in the small intestine. But that fails to explain the sweeping shifts in colon bacteria that labs such as the Gordon lab have observed in response to high-fat diets—in as little as 24 hours. Still unsatisfied, I hit PubMed once again and somehow tripped upon a fantastic paper I had previously missed.

Desbois and Smith (2009) summarize a number of studies on how different fatty acids kill bacteria in different ways. They then proceed to propose a number of possible mechanisms. Perhaps they insert themselves into the bacterial cell membrane to make it “leaky”. Perhaps they act like a detergent and dissolve it altogether. There’s also been scattered evidence that they shut down key bacterial enzymes, prevent uptake of nutrients, or cause damage with their reactive products.

Further along there’s a statement that catches my eye:

The increasing prevalence of drug-resistant bacteria as well as an enhanced appreciation for the mechanisms of drug resistance acquisition is necessitating the discovery and development of alternative anti-infectives to conventional antibiotics.

And that brings me back to freshman year, when I had borrowed a book from my research mentor (can’t remember the name of the book but it was purple) on the escalating war between bacteria and antibiotics. Humans spend years developing a new drug, only to see bacteria evolve resistance to it in a matter of days. It was a disconcerting thought to say the least, and at the time I thought that maybe the key to avoiding a losing race was to focus efforts on bolstering the natural human immune response to react to infections rather than targeting them with antibiotics.

But Desbois and Smith offer an alternative that may hold promise. Free fatty acids (FFA) have already been shown to be effective at killing pathogens on human skin, while topical antibiotics such as mupirocin are facing growing resistance. There is potential to develop creams to prevent the spread of STIs, growth of cavities, or development of acne. Fatty acids may even help us overcome the growing concern (and political nightmare) of feeding antibiotics to livestock, presenting a natural, less controversial alternative.

And the kicker? “[…] as FFAs are also active against methane-producing Archaea (methanogens) in the guts of ruminants, they could reduce emission of this important greenhouse gas.” By stopping cows from farting, fatty acids may bring us one step closer to solving the global warming problem.

http://www.zazzle.com/cure_cow_farts_cure_global_warming_2_tshirt-235700152907512082

Delivery

Only a third of Americans eat their recommended two servings of fruit a day, and only a quarter are eating their recommended three servings of vegetables. That’s according to a Science Friday podcast I’m listening to this morning.

There’s a big information challenge when it comes to healthy eating. Not one of the 5000-6000 ads an average child sees per year promotes fruits or vegetables. It’s painfully difficult to find consistent, trustworthy advice on how to eat healthy on the internet, and as the food pyramid fiasco showed, the government was not a much better information source. Finally, there’s the fact that families in some communities don’t know how to turn fresh foods into a healthy meal.

What’s more, it’s inconvenient. It’s hard to keep fresh. And it’s time-consuming to have to run to the supermarket and pick up. Almost every weekend I’m home my mom is making another run to Costco.

A caller calls in suggesting a return to home deliveries. “There’s more energy moving around for the delivery services…” the guest Dr. Willett mutters hesitantly. And then it hits me.

What if my mom literally ran to Costco every weekend?

Ok, it’s not exactly like that. But as I walk past the bike machines, watching people cycle in place, I think wistfully how efficient it would be to harness that energy to get fresh food to people’s doorsteps.

Imagine this: You sign up for a program to have fresh fruits and vegetables delivered to your door. You decide online what you want to order and how much you want to order. Every few days, a volunteer cyclist—perhaps a member of a local gym doing his regular routine—rides up to your door and delivers the goods. (You give him/her a little tip.) Your food comes fresh. You get perfect portions and reduce food waste. You save yourself a trip to the supermarket, not to mention the gas it takes to get you there, and avoid the risk of buying all the processed foods you have to pass to get to the vegetable isle. The cyclist gets a nice workout.

Even better, you tell your adolescent son to get off the sofa and go pick up the groceries. By bike.

(What do you think, viable idea or head-in-the-clouds thinking? Here are some other related posts showing how bicycle delivery is already being utilized for local restaurants, including a particularly interesting one on using bicycle trailers to deliver local foods.)

 

How about a Memory Enhancing Piece of Fish?

I’m browsing through one of my favorite blogs (when I really should be doing homework) and come across an article on Nestle plan to bring us “Nutrition, Health, and Wellness”. I’m intrigued at how a chocolate company plans to do that. I scroll down until a line catches my eye:

“How about a memory enhancing Kit Kat bar or Nescafé that fights hypertension?”

I blink a few times and read over it again. Maybe a memory enhancing Kit Kat bar is awhiles off. But how about a memory enhancing piece of fish? Or a piece of fruit that fights hypertension? Or–get this–a heart-enhancing, obesity-reducing, metabolism-boosting, muscle-building fruit and nut bar?

Wait a second, let me go grab one from my shelf.

The point here is that nowadays a lot of attention is paid to the negative effects of eating unhealthily. We get assaulted from every end with warnings of obesity and cardiovascular disease that it all starts to bounce off of us at some point, at which time we throw our hands up and exclaim “EVERYTHING CAUSES CANCER!” and then go munch on a candy bar to relieve the stress. But not nearly as much attention has been paid to the health-enhancing effects of healthy eating. Brug (2008) notes that some of the most effective ways to motivate people to eat healthy are an image of oneself as “healthy”, combined with the belief that changing one’s food choices can improve one’s health.

Sticking health-promoting labels on products is effective in getting people to choose those products. (In fact, “diet” and “low-fat” labels have been so effective that people actually end up consuming too much and gaining weight.) It’s not unreasonable to consider the opportunity costs of making an unhealthy choice–you not only damage your health direct, but you miss out on the opportunity to eat something beneficial to your health.

Healthy choices are all around us already (sorry Nestle, what you’re trying to do is admirable too). But to change people’s behavior, maybe we need a different approach than the doom-and-gloom attacks on unhealthy foods we’ve been engaging in. A vision-enhancing, bone-boosting bag of carrot sticks, anyone?

How I (Almost) Became a Vegetarian

My recent initiative to eat healthier, my work with healthy eating in Chester, and the realization that the incidence of almost every chronic disease can be reduced by (1) exercising and (2) eating well led me to some interesting statistics surrounding the consumption of meat.

According to the UN’s Food and Agriculture Organization, eliminating livestock production would eliminate nearly a fifth of the world’s greenhouse gases—more than that caused by transportation. An interesting comparison posed by Drs. Eshel (Bard Center) and Martin (U-Chicago) calculates that if we all reduced meat consumption, we would have each essentially switched from a standard sedan to an ultra-efficient Prius. According to Dr. Naylor at Stanford, if I abstained from eating one cow, the energy from the grain used to feed that cow could be used instead to feed people suffering from malnutrition—with a 10x multiplier effect. (If you want more, here’s the article)

But wait a minute, I tell myself before I get too caught up in this liberal mumbo jumbo. Let’s be rational. You can’t say that just because carbon emissions are bad for the environment, we should destroy our cars and let our roads fall into disrepair. You have to always balance the costs of something against the benefits that it brings you.

So then I considered what benefits eating meat were bringing me. Eating meat seems to be associated with an increased risk of coronary heart disease, hypertension, diabetes, obesity, and cancer. It’s also associated with a decreased life expectancy (Frazer, 2009). It is a great source of proteins—but then again, so are beans, nuts, soy, and whole grain (Harvard School of Public Health). It’s also a great source of saturated fat. After a few intense bouts of thinking, it seems that the only thing eating meat has going for it is simply…because it tastes good.

I suppose you could make an argument for the psychological strain that eating less meat would have on my poor mind. But psychology has something else intriguing to say as well: taste preferences can be learned and unlearned. The social factors surrounding coffee and beer can make teach us to enjoy the taste of bitter substances (Brug, 2008). I haven’t gone all-out vegetarian, but I’m certainly eating less meat and more vegetables/nuts than before, and strangely the knowledge that I’m putting something healthy into my body makes that previously-unappealing salad taste better than before.