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kottke.org posts about James Hamblin

The Paradox of Preparation

Coronavirus, social distancing, exponential growth, flatten the curve, pandemic, immunocompromised โ€” those are just some of the concepts related to COVID-19 we have had to come up to speed on over the last few weeks. We should add the “paradox of preparation” to that list.

The paradox of preparation refers to how preventative measures can intuitively seem like a waste of time both before and after the fact. Most of us don’t stop brushing our teeth because the dentist didn’t find any cavities at our most recent checkup, but with larger events that have effects more difficult to gauge (like COVID-19, climate change, and Y2K), it can be hard to spur people to action. From Chris Hayes:

A doctor I spoke to today called this the “paradox of preparation” and it’s the key dynamic in all this. The only way to get ahead of the curve is to take actions that *at the time* seem like overreactions, eg: Japan closing all schools for a month with very few confirmed cases.

That was in response to Dr. James Hamblin:

The thing is if shutdowns and social distancing work perfectly and are extremely effective it will seem in retrospect like they were totally unnecessary overreactions.

Epidemiologist Mari Armstrong-Hough made a similar point earlier on Twitter:

You won’t ever know if what you did personally helped. That’s the nature of public health. When the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction.

Preparation, prevention, regulations, and safeguards prevent catastrophes all the time, but we seldom think or hear about it because “world continues to function” is not interesting news. We have to rely on statistical analysis and the expert opinions of planners and officials in order to evaluate both crucial next steps and the effectiveness of preparatory measures after the fact, and that can be challenging for us to pay attention to. So we tend to forget that preparation & prevention is necessary and discount it the next time around.

The good news is that while unchecked epidemics grow exponentially, another thing that can also spreads exponentially is behavioral norms. The basic expert advice on how we can slow the spread of COVID-19 in our communities is pretty unambiguous โ€” wash your hands, don’t touch your face, maintain social distance, self-quarantine, etc. โ€” and so is the huge potential impact of those precautions on the number of people who will get infected and die. To help overcome the paradox of preparation, let’s continue to spread the word about what the experts are urging us to do. Because if we don’t, there might be a lot fewer of us around in a month or two.

Update: In the same vein, Vaughn Tan writes:

This means that any effective actions taken against coronavirus in the few days before the epidemic curve shoots upward in any country will always look unreasonable and disproportionate.

By the time those actions look reasonable and appropriate, they will be too late.

And Now Is the Time to Overreact Ian Bogost in the Atlantic:

The idea that an extreme reaction, such as closing schools and canceling events, might prove to be an overreaction that would look silly or wasteful later outweighs any other concern. It can also feel imprudent; just staying home isn’t so easy for workers who depend on weekly paychecks, and closing is a hard decision for local companies running on thin margins. But experts are saying that Americans can’t really over-prepare right now. Overreaction is good!

It’s hard to square that directive with the associations we’ve built up around overreactions. Ultimately, overreaction is a matter of knowledge-an epistemological problem. Unlike viruses or even zombies, the concept lives inside your skull rather than out in the world. The sooner we can understand how that knowledge works, and retool our action in relation to its limits, the better we’ll be able to handle the unfolding crisis.

Michael Specter writing about America’s weakened public-health system for the New Yorker:

Few people have trouble understanding the purpose of public education or public housing: they are tangible programs that, at least in theory, are designed to improve our lives. Public-health accomplishments, however, are measured in an entirely different way: success is defined by what is prevented, not by what is produced. This creates an odd psychological dynamic.

When public-health programs are successful, they are invisible, and what is invisible is almost always taken for granted. Nobody cheers when they remain untouched by a disease that they hardly knew existed. That makes it easy for shortsighted politicians to deny long-term realities. And that is what they almost always do.


If Our Bodies Could Talk, a FAQ for human bodies

If Our Bodies Could Talk

James Hamblin, the dishy brainiac doctor who does those entertaining and informative videos for The Atlantic, is coming out with a book in December called If Our Bodies Could Talk. He calls it “a FAQ about human bodies”.

Now, in this original and entertaining book, Hamblin explores the stories behind health questions that never seem to go away โ€” and which tend to be mischaracterized and oversimplified by marketing and news media. He covers topics such as sleep, aging, diet, and much more:

Can I “boost” my immune system?
Does caffeine make me live longer?
Do we still not know if cell phones cause cancer?
How much sleep do I actually need?
Is there any harm in taking a multivitamin?
Is life long enough?


Don’t Let Kids Play Football

Today, the NY Times is running an editorial by Dr. Bennet Omalu called Don’t Let Kids Play Football. Omalu was the first to publish research on CTE in football players.

If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name Chronic Traumatic Encephalopathy, or C.T.E., a disease that I first diagnosed in 2002.

Depending on the severity of the condition, the child now has a risk of manifesting symptoms of C.T.E. like major depression, memory loss, suicidal thought and actions, loss of intelligence as well as dementia later in life. C.T.E. has also been linked to drug and alcohol abuse as the child enters his 20s, 30s and 40s.

The story of Omalu, his research, and its suppression by the NFL is the subject of Concussion, a movie starring Will Smith that comes out on Christmas Day, as well as a book version written by Jeanne Marie Laskas.

Update: Dr. James Hamblin shares the findings of a new paper on how repeated head trauma can affect the brains of kids as young as 8.

In the journal Radiology today, an imaging study shows that players ages 8 to 13 who have had no concussion symptoms still show changes associated with traumatic brain injury.

Christopher Whitlow, chief of neuroradiology at Wake Forest School of Medicine, wanted to see how head impact affects developing brains. His team studied male football players between ages 8 and 13 over the course of a season, recording “head impact data” using a Head Impact Telemetry System to measure force, which was correlated with video of games and practices.