Here’s the transcript of my talk to Nudgestock which was held a few weeks ago. I was hoping to do it in London where it’s normally held, but in the world of COVID it migrated online and acquired for itself an enormous audience. I was told that 20,000 people watched my session and something like 130,000 tuned in for some period of the 12 hours. It was a very high standard of presentations. The video should start at my presentation, but if there’s any issue, it starts at 02:21:44
Sam: Right now I’m really excited to introduce Nicholas Gruen who’s the CEO of Latera Economics. Nicholas will be sharing how the coronavirus exposed the necessity for adaptive thinking for a focus on effectiveness and not just efficiency – often a pragmatic perspective of where the practical might be the best response until proven dangerous. Nicholas will lead us today on his keynote Thinking: Keep It Adaptive Stupid. This will be a great crescendo from Chiara to Jason to Nicholas Gruen. Welcome to Nudgestock, Nicholas.
Nicholas: Thanks very much, Sam. Let’s get straight to it. This slide emphasises something I think many people don’t appreciate: Although they might think that the expertise that they’ve learned at university is about 80% of their job and 20% of it is adapting it to circumstances and executing. I’d suggest it’s the other way around.
Here are some words from Nassim Nicholas Taleb and Yaneer Bar-Yam. You’re familiar, I expect with Taleb, the author of the Black Swan. Yaneer Bar-Yam is a pioneer of complexity science. I quote:
The government relied at all stages on epidemiological models that were designed to show us roughly what happens given pre-selected parameters and choices.
What could possibly be wrong with that? Something that was right about it was that it did enable some people with the mantle of science to say this is serious. We could have an awful lot of deaths from this coronavirus. We really need to start taking it more seriously.
But there’s something else going on that I want to draw your attention to. If you like you can think of this idea of a hierarchy of knowledge. There you’ve got a particular hierarchy of sciences: the harder they are, the less ambiguous they are, in some ways the less complex they are, the higher they are on the hierarchy.
The great temptation there is the temptation to what I call “the God’s eye view”. Here’s another God’s eye view from the Middle Ages. One of the things that happens here is that the higher on that hierarchy you get, the more status we give you. The more, that is, we treat you like God. But we are not gods. Here’s a non-God—I’m sure he’s a God in a film world, but here’s somebody, a human being, who’s trying to get a God’s eye view and sometimes you just end up looking ridiculous.
Here’s a hierarchy from epidemiology. This is where things start to go badly wrong because we get taught at university that randomized controlled trials are a certain kind of ‘gold standard’ of evidence and above that, there are systematic reviews of randomized trials and even meta-analyses of randomized trials and other methods. Well, what could be wrong with that?
What could be wrong with it is that that’s all wrong unless you add the magic words – “other things being equal”. And if you do add the magic words, then you come face to face with an uncomfortable fact. Other things are never equal. So, we leave people who have a lot of expertise in this difficult area where they’re being told that certain things are better than certain other things, but then we just leave it up to their common sense for them to work out how much it matters that other things are not equal.
There’s been a bit of a war on it in epidemiology about whether we can accept evidence if it hasn’t been peer-reviewed, if it doesn’t come out of a randomized controlled trials and so on. What the epidemiology—what the modelling should have focused on, wasn’t God’s eye view but our eye view and our eye view needs to focus on our choices, our knowledge, what knowledge we have, and our ignorance: The priorities we need embrace to work out what we need to know most that we don’t know.
And science isn’t everything, there’s another kind of knowledge, and that’s professional knowledge. Science is for knowing. And you’ll see on the slide a fancy Greek word to tell you that professions are not principally for knowing like science. They’re for doing. That Greek word phronesis means “practical wisdom”. Here we have the practical wisdom of the ancient Egyptians who knew that the bark of willow trees help to alleviate pain and fever. They didn’t know why, they didn’t know how, they just knew that it worked, and they knew that it was pretty safe and so they used it.
On this slide I’ve listed some professions that are for doing and in my opinion economics should be there, but it has pretensions to being a science. Now, of course, professions use scientific knowledge. No one suggesting that they use anything else. No one’s suggesting that they don’t try to meet the world where it is. But the purpose of that knowledge isn’t for God. It’s for us. It’s to enable us to prosecute human purposes. Often that gets missed in the public discussion.
So let’s take two examples. Here is a thermometer and here’s a face mask. Both are low tech, common-sensical things that would enable us to manage the virus better.
Now let’s look at how science and the professions of epidemiology and medicine dealt with that. It’s had hundreds of drug trials: 145 of hydroxychloroquine which is kind of ridiculous and it’s been done without connecting them up properly. It’s had scores of vaccine trials. I guess we give them a big tick for that – we all want a vaccine. But now look, there have been two trials of masks, none examining social distancing, none looking at the quarantining effect, and often one of the most fundamental things which this audience will certainly appreciate is getting people to do what we say we should get them to do. That’s a critical thing, but it’s not high status. That doesn’t get you a great academic career or even a professional career often.
Here’s a friend of mine is his name is Jeremy Howard, I got to know him when I was the first chair of a company called Kaggle which subsequently was bought by Google. He was the chief data scientist, an amazing guy. Jeremy’s a very smart guy but he’s not an epidemiologist. But common sense said to him “surely masks ought to be an important part of this” and he did some reading and he confirmed for himself that masks were indeed very important and he started the #Masks2All hashtag and has saved tens of thousands of lives with this global movement and its hashtag. Please hashtag, tweet it now. Do me a favour, if you would. And now I’m going to ask Peter to play a video which is an edited version of what you’ll find on the Masks4All website.
[02:30:28 – video starts]
We have an important message for all of you, especially if you live in a country that is right now facing the new coronavirus. The pandemic is growing exponentially in many countries.
But the Czech Republic is one of the few in Europe that has significantly slowed down the spread of the virus.
In this video, we would like to tell you what we did differently. And mainly we would like to help you to do the same.
We are following social distancing in the rule “stay at home”. But others do that, too.
We also have the strict hygienic procedures. Others do that as well.
But the main difference is, everyone who has to leave their house has to wear a face mask. Everyone.
I know, they may be told you that masks wouldn’t protect you but there are studies proving that even a homemade mask can be partially protective—partially. Any protection is essential today.
But now the more important thing. Masks fundamentally prevent the transmission from you to others by sneezing, coughing, but also breathing, and many people are the most contagious before they start showing symptoms.
So when we both have a face mask, I protect you – you protect me, and we are both safe.
Just a few days ago, people were laughing at those who were masks. But some people knew about this positive effect and started to share this information across social media.
The message grew fast through artists, influencers, and others.
I know—face masks aren’t in stores, right? But something incredible happened. People started making homemade masks and giving them to others for free.
Many companies, theatres, or even retirement houses change their buildings into sewing rooms and thousands of people started to sew masks at home. So we know that face masks work and it has been repeatedly confirmed by scientists. We know that it is possible in just three days to provide face masks for 10 million people in one country. And we know that here we have fundamentally repressed the infection.
Please share this knowledge and help us to change as many countries as possible. Take a picture with your face mask on and share it with the hashtag Masks4All.
It can really save lives. And remember: I protect you, you protect me.
[02:33:18 – video ends]
Nicholas: Okay, so there you could see a very different approach to thinking our way through and addressing the practical circumstances of the COVID crisis. I’ll put on the screen, you can look in the recording later, what is on the Mask4All website and just look at how different what is on that website to the scientific and medical stuff. For instance, cloth masks can be washed in soapy water and reused. A very different world of practical action on that website which has saved tens of thousands of lives.
Now I want to play a second shorter video of what’s going on in China. I can’t tell you whether the government mandates this, but it doesn’t matter because we could be improvising something like this. And how many of us are doing this when we open up schools. Please run the video.
[02:34:43 – 02:35:23 – video playing]
Nicholas: I want to finally now just take you through some of the conclusions I would like to suggest that you might draw from this: what can we do, what should we be doing differently? The first thing I want to say is a big thing, which is we should change the way we educate people. Expert training shouldn’t just be teaching people what experts know. It should be teaching people what experts don’t know.
We heard from Jason Collins earlier, something that Daniel Kahneman said some time ago, which didn’t stand the test of time. Something else that struck me when I was looking at a Daniel Kahneman’s work recently is that he said that all professionals suffer from overconfidence. Can I tell you that that’s not true? If we train professionals not to be overconfident, they’re not overconfident. If you train an engineer properly he or she can tell you exactly the tolerances that they’re building to. And, in the case of weather forecasters, every forecast is a forecast of what they know, 60% chance of rain and what they don’t know, a 40% chance that whatever they say is the highest probability is going to turn out to be wrong.
Another thing is we talk about what works and then we think that that can be worked out by people who don’t do what works. So, if we’ve got a what works centre for education then let’s find people, actual people who do things that do work. Let’s promote them rather than just turn up and try and suck the knowledge out of what they’ve done and presented as science because knowledge is embodied in practice.
Challenge systems with common sense, change rules into presumptions. One of the terrible things in most countries is that we should have been using masks all along. That’s what Jeremy Howard was arguing all along and now everyone has come around. Can you imagine how much less destructive this crisis would have been had we done that? But what happened was in one country after another, the Chief Medical Officer said, “Oh well the World Health Organisation (WHO) hasn’t recommended it,” so we won’t use our common sense.
Finally then, it would be easy to say this is adaptive thinking for the crisis – that it only applies to the crisis where we have to improvise because of how different things are. I want to tell you that we always need to keep it adaptive.
I want to tell you about my own experience which will (go) back over 20 years ago when I found blood in my urine. I rang the doctor and he indicated to me that I should have a cystoscopy for my bladder and an ultrasound for my kidneys to see if there was any cancer there. A cystoscopy is a quite invasive exercise. They put you under a general anaesthetic and it’s therefore not something to be done lightly. The ultrasound is extremely harmless. I could only get the ultrasound on Friday and I awaited my cystoscopy on the Tuesday.
At the ultrasound, I said to the guy, “I’ve been under a lot of stress lately. I’m rather worried. Would you mind after you check my kidneys, if you could look at my bladder?” He checked my bladder, he said, “You don’t have cancer.” I said to him “surely you mean I might have cancer but it doesn’t look like it”. He said, “No, I can be confident you don’t have cancer.”
The person you’re looking at on the screen on my last slide is a person who died of bladder cancer. I know what happened,. He’s my father. He was riding his motorbike on his farm and he fell off and there was blood in his urine and he and the doctor decided it probably wasn’t worth him at 75 having a cystoscopy. Four months later, he was diagnosed again from the same condition.
But what could have happened is we could have known what was going on four months earlier, if we just kept it adaptive stupid. Thank you.
Sam: Thanks so much, Nicholas. Insofar as being adaptive, it looks like you nailed that straight to time.
Nicholas: I did. I should have turned my buzzer off but there you are.
Sam: What a great discussion. I think changing rules into presumptions, just such powerful language and certainly as an organisation that looks to embrace some of the knowledge and theory that psychology gives us to be adaptive and creative with those solutions. I think the setup you provide of sort of, we tend to bring 80% knowledge and 20% adaptability should be flipped is an extremely powerful one can.
Nicholas: Can I just interrupt to say but we don’t want psychologists telling doctors to do that. We want doctors trained to be able to use their expertise with common sense rather than just a read-off list. Anyway, you go on with your questions.
Sam: No, no, but that’s what—I might skip question for a moment because there’s a nice question that’s popped up on the slide here. Essentially the question was regarding a lot of the behavioural interventions, like distancing and like wearing masks. It can be tough for epidemiologists to conduct RCTs beyond these sort of interventions. I was wondering, that feels like it’s a fact, wondering about the ways in which we can start to make ourselves feel comfortable in implementing these solutions…
Nicholas: There’s going to be a lot of thing that we’re going to do better next time. That’s cold comfort. But there’s going to be a lot of things we’re going to do better next time – that’s pretty obvious. Let’s hope it happens. It hasn’t really happened with economics much, but let’s hope that a chief medical officers have behavioural people around, have this broad practical knowledge to say—because do you remember how we were told that there would be lockdown fatigue? Well, people were just making that stuff up. That was just confirmation bias because various people were afraid of asking the population to lockdown for a long time. So, it is possible to do a lot more short-term experimentation scanning of similar situations and so on. I think that we will do better but we need to build it in rather than just build over a kind of behavioural layer, I think.
Sam: I think there’s a similar a question posed to Chiara earlier in the session around hard science and behavioural interventions and Chiara’s resounding response was it’s neither, it’s both, and embracing what we don’t know…
Nicholas: But it is science for purpose, it’s not the other way around. You can leave out that up to the astronomers, they can just have science for science’s sake, but it’s science for purpose for all this stuff. It’s science to be brought into a professional purposive context.
Sam: As you say, rules into presumptions, direction into hypotheses, and to be as focused on the 80% that we don’t know as the 20% that we think that we do. The last piece just on—you touched on this, but maybe the role of education and universities not teaching us what we don’t know.
Nicholas: Absolutely, they don’t. So, there are plenty of opportunities. I mean, for instance, you can take people through forecasting competitions. People can discover how much they don’t know, how little their expertise adds. I don’t need to mention Philip Tetlock’s name to this audience, I’m sure. Tetlock has a list of qualities of a super forecaster. They are ethical qualities. They are curiosity, respect for others, attempting not to be overconfident. So, we could think about some of that for our education as well. It’s not all technical.
Sam: Nicholas Gruen, thank you so much for joining us at Nudgestock 2020. It’s been a thrill to work with you on this.
Nicholas: Thanks very much, Sam.