Productive Knowledge – Amar Bhidé

The “fact” of rain

Amar Bhidé — Sat, 02 Apr 2022 14:19:10 +0000

Social Agreement v. objective facts/information

“Facts are independently testable and verifiable, with truth independent of one’s own opinions or beliefs. It is raining at this place and this time is a testable statement, provably true or false. An opinion is not a fact. “I think it is raining” is an opinion; it may or may not be accurate. Fact-based persuasion is convincing someone else it is raining using clear, verifiable evidence that it is, in fact, raining; demagoguery is not. Social consensus is a widely held perspective, best supported by history and evidence.”

Yet, and I’m not making this up: As I’m planning to head out I often ask a Google home device that sits on my dining table abutting a window, “OK Google: Is it raining?” She tells me it is. But when I look out, through the window I don’t see raindrops. I ask again. Google again tells me it’s raining but again I see no raindrops. I stand up. The road is wet. But an earlier shower could have made it wet.

If I go outside, I will feel raindrops on my face – or not. But do they establish the “fact” of rain? What privileges tactile sensation over visual observation? And what is the “fact” of rain anyhow? There is always some moisture in the air. It’s a linguistic and thereby social convention to call moisture that takes the form of distinct droplets subject to the laws of gravity that we can both feel and see “rain.” Fog which we can see but not feel isn’t rain. But what if we can just feel the drops but can’t see them?

‘Tis done!

Amar Bhidé — Fri, 23 Apr 2021 10:46:27 +0000

Done with my LTMA course. Good or bad, is for my students to say in their evaluations but it was like nothing I have ever taught or taken.
I said at the end of the last class that teaching my entrepreneurship course is like being a tour guide at Disneyland. I know every ride, there are no surprises, virtually ever.
Teaching this was like being a rookie whitewater rafting guide in class 4 or class 5 rapids: Thrilling, but at any moment could end in disaster.
And you have to make it up, moment by moment.
The final class was no exception. The case was on Cicely Saunders’s founding of the modern hospice movement, as told by her brother, Christopher. (He’s an HBS MBA 1950 who has been a friend for several decades now.)
Christopher, now 94, attended class via Zoom as did his daughter, Kate. Kate is Chair of Trustees at the Arthur Rank Hospice in Cambridgeshire.
Christopher was tired — or the connection was bad perhaps. But his daughter filled in splendidly.
The Big Surprise was my HBS ’79 classmate, Tom Dickerson. Tom used to be a health care VC and more importantly, as he told me on a walk on Sunday, his wife had died in a hospice. So, I had invited Tom to class. As always, he was eloquent and engaging. (He is a 3 H after all).
Of course, that meant completely changing my teaching plan on the fly.
I think it – and the course — worked. But my taste isn’t everyone’s taste. Most curious what the students will say.

Shorter Simplified version

Amar Bhidé — Sat, 10 Apr 2021 10:02:54 +0000

Shorter and possibly more accessible version of Making Economics More Useful. (originally published, under CC in Applied Economics) Fair warning: contains commercial for my Productive Knowledge obsession/agenda.

May or may not help, but can’t hurt.

Amar Bhidé — Sun, 21 Feb 2021 08:31:07 +0000

Long ago, when I had a persistent cold, my father had taught me the yogic practice of ‘jala neti.’ So when I began to read stories about the prophylactic effects of nasal sprays I googled. And sure enough someone has looked into it. (I have already been, out of an abundance of caution, gargling whenever I return from the outdoors)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528968/?report=classic

Do saline water gargling and nasal irrigation confer protection against COVID-19?

Prashanth Panta,^a,^⁎ Kiranam Chatti,^b and Archana Andhavarapu^c

Author information Copyright and License information Disclaimer

Abstract

This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.

1. Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease-2019 (COVID-19), has spread to more than 200 countries, attaining pandemic status. Although many researchers are pursuing key directions for therapy and/or prevention, no acceptable therapy has been found to confer protection. A simple, economical, practically feasible, and globally implementable strategy with therapeutic and prophylactic value is the need of the hour.

1.1. SARS-CoV-2: Infection transmission and localization

SARS-CoV-2 is known to transmit through airborne spread via respiratory droplets and contact transmission via fomites. When a patient coughs out a sufficient number of SARS-CoV-2 viral particles in proximity to a recipient, the emitted particles are likely to gain access to the lower portions of the respiratory epithelia; when fewer particles are coughed out over considerably larger distances, the viruses mainly settle at a location like the throat mucosa.¹ In the upper portions of the respiratory epithelium, nasal cilia may trap and eliminate such pathogens via the muco-ciliary response and other cellular defense pathways. In contrast, the clearance of viruses lodged directly in deeper portions of the respiratory epithelium is challenging due to a lack of competent local defense.¹

The coronaviruses that cause influenza are mainly localized to the upper respiratory epithelium, but severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) involve the lower respiratory epithelium. On the other hand, SARS-CoV-2 shows a comparatively higher binding capacity to human cells and has acquired the ability to settle in both upper and lower portions, the two important hotspots.¹ Therefore, a differential set of symptoms are observed in COVID-19 patients. Patients with infection localized to the upper respiratory epithelium may experience subtler presentations ranging from alterations in olfaction (anosmia/hyposmia) and taste perception (ageusia/dysgeusia),^2.^,^3.^,^4. and patients with infection typically localized to the lower respiratory epithelium suffer from disease features like that of pneumonia, necessitating ventilation efforts. Throat mucosa is an important epicenter of viral replication,¹ a feature common to several upper respiratory viruses. Patients either develop cough and/or low-grade fever, or if appropriate immune responses cannot be deployed, may develop pneumonia with or without an intermediate throat stage.¹

Early clinical evidence by Zou et al. showed that nasal swabs contain a higher viral load of SARS-CoV-2 compared to throat swabs.⁵ This pattern is similar to influenza but markedly different from MERS-CoV, which showed higher viral load from throat swabs.⁵ ^, ⁶ Recent reverse genetics efforts by Hou et al. using pulmonary epithelial cultures also confirmed a higher distribution of SARS-CoV-2 in proximal portions of the respiratory epithelium.⁷ Because the nasal epithelium and nasopharyngeal mucosa are key portals of entry, attachment, localization, and replication of SARS-CoV-2, approaches like saltwater gargling and saline nasal irrigation are likely to have practical value.

Because previous coronavirus infections caused by SARS-CoV or MERS-CoV mainly involved the lower respiratory epithelium and frequently resulted in severe pulmonary complications like pneumonia with a high fatality rate, they were considered medical emergencies, and complementary approaches like saline water gargling and nasal irrigation were not explored. Because the current pandemic is characterized by milder clinical presentations (in ~80–85% cases) with sufficient localization to the upper respiratory epithelium,⁷ ^, ⁸ more focus on such easily implementable options is needed.

1.2. Beneficial role of saline water gargling and nasal irrigation

Saltwater gargling is a simple, well-known method that explicitly targets pathogens of the pharyngeal mucosa.⁹ The practice of saline nasal irrigation, a popular cleansing technique adapted from traditional Yoga, is more effective against pathogens harbored in the nasal mucosa. In Yogic parlance, saline nasal irrigation is referred to as ‘Jala-neti’.

In woodworkers, who face significant challenges due to the dust accumulated within nasal passages, the use of isotonic saline nasal irrigation resulted in a decreased incidence in sore throats and cold, besides being an effective cleansing practice.¹⁰ ^, ¹¹ Nasal irrigation using normal saline (0.9%) and seawater spray (2.3%) were useful in preventing upper respiratory infections in children.¹² ^, ¹³ Saline water gargling and saline nasal irrigation at hypertonic concentrations (1.5–3%) showed protection against the common cold.¹⁴ There is also evidence on the beneficial effect of saline irrigation in chronic inflammatory conditions like rhino-sinusitis,¹⁵ ^, ¹⁶ which is characterized by the blockage of sinuses. Irrigation may therefore facilitate the clearance of inflammatory exudate.

In vitro evidence by Ramalingam et al. demonstrated that sodium chloride (NaCl) results in a dose-dependent inhibition of replication of a range of DNA and RNA viruses, including the human coronavirus 229E (HCoV-229E).¹⁷ This antiviral effect is mediated through the formation of hypochlorous acid (HOCl).¹⁷ HOCl not only accumulates within neutrophils and macrophages but also accumulates within non-myeloid epithelial cells.¹⁷ An interesting observation concerning the antiviral effect of NaCl is found in shrimp, which becomes more susceptible to white spot syndrome when water salinity decreases.¹⁸ Another interesting observation comes from human cancer literature; women who possess a GG polymorphism in the promoter of the MPO gene (that results in elevated myeloperoxidase production) were shown to have lower cervical cancer incidence, indicative of the innate immune response of cervix epithelial cells against some high-risk strains of human papillomavirus.¹⁹

Post-hoc analysis²⁰ of the Edinburgh and Lothians Viral Intervention Study (ELVIS)¹⁴ also confirmed the direct beneficial role of hypertonic saline against alpha and beta coronaviruses. This work²⁰ can be considered the most relevant clinical study suggesting the beneficial effect of gargling and irrigation against SARS-CoV-2 infection. The primary outcome of this study was a reduction in the duration of illness.²⁰ Recent in vitro evidence by Rafael et al. showed that 1.5% NaCl causes 100% inhibition of replication of the SARS-CoV-2 virus,²¹ another vital piece of evidence favoring hypertonic saline use.

A study has also shown that even plain water gargling is competent in preventing upper respiratory tract infection, indicating mechanical detachment of viruses as a possible effect of gargling.²² From a practice point-of-view and logically speaking, the whirling forces caused by gargling movements can undoubtedly contribute to this detachment, thus compromising viral entry. Interestingly, the work of Satomura et al. has shown the additional potential of plain water over povidone-iodine.²² Although povidone-iodine is an antiseptic with known virucidal properties, it may not be well tolerated as a gargle due to its strong and irritant taste. Also, povidone-iodine may injure pharyngeal mucosa due to its cytotoxic effects, altering microbial flora dynamics thereby, enabling the settling, entry, and invasion of bacterial pathogens and viruses. Therefore, saline water is preferable in contributing to additional infection control over plain water due to the dislodging effect of gargling forces and virucidal effects of NaCl. The fact that gargling is a suitable sampling method for diagnosing mild COVID-19 cases²⁰ further supports the notion that saline gargling may be beneficial. While few reports in the sinusitis literature doubt the potential of hypertonic saline,²³ ^, ²⁴ several pieces of evidence¹⁴ ^, ²⁰ ^, ²¹ indicate the reliability of saline gargling and nasal irrigation (preferably at hypertonic concentration) as effective cleansing practices and antiviral strategies.

Managing community transmission is crucial at this time, but there is currently a lack of potential interventions. Elevated SARS-CoV-2 viral load in saliva and nasal secretions¹ ^, ⁸ is strongly connected with community transmission. Because the virus anchors to the upper respiratory epithelium (nasal epithelium and/or throat mucosa),⁷ replicates in the throat,¹ and exhibits a broad shedding pattern (before infection and after seroconversion⁸), saline water gargling and nasal irrigation may limit its community spread. In general, these maintenance approaches serve as gatekeepers for oral and nasal portals/passages primarily due to NaCl’s broad antiviral effects and cleansing activity associated with gargling and nasal irrigation. Therefore, based on examination of several related pieces of evidence, judicious use of hypertonic saline may reduce SARS-CoV-2 viral load in recovered patients and contribute to breaking the chain of transmission.

1.3. Possible limitations and practice suggestions

Gargling may carry a small risk of swallowing low volumes of hypertonic saline water, and saline nasal irrigation may lead to aspiration. Another possibility during saline nasal irrigation is accidental injury to mucosa due to hot water use. Possible downward displacement of the virus from the upper respiratory to lower respiratory passages, while theoretically possible, is highly unlikely due to the broad-spectrum antiviral effects of NaCl. Disinfection of the irrigation vessel/pot is also vital because unclean vessels may enable lodging of particulate matter that may become a nidus for bacterial infection. However, these limitations are only speculative, and long-term studies have not shown the emergence of any such issues.^10.^,^11.^,^12.^,^13.^,^14. For some beginners, saline nasal irrigation may appear slightly difficult than gargling, but studies have shown this to be a well-tolerated approach.¹⁰ ^, ¹¹

We note that studies by Ramalingam et al. employed an irrigation cup.¹⁴ ^, ²⁰ In the traditional practice of nasal irrigation, a vessel with an angulated spout, referred to as the neti-pot, is used, and the practitioner must assume the appropriate head position to allow free passage of water (Fig. 1 ). Although the above clinical trials¹⁴ ^, ²⁰ have shed new light concerning these practices, we firmly believe that using a neti-pot (in place of an irrigation cup) could further improve the antiviral activity. The neti-pot facilitates smooth passage of saline water as a thick column and can significantly contribute to the wetting of nasal passages, increasing the likelihood of toxin clearance and antiviral activity. As the angulated spout of the neti-pot is brought near the nostril-to form a seal with it, a continuum is established, giving the individual a sense of control on the water column.

Fig. 1

Saline nasal irrigation or Jala-neti using an appropriate water pot. The neti-pot is a vessel with an angulated spout (panel a) and can contain a sufficient quantity of water for both nostrils. Before initiating the practice, the spout is gently brought close to the nostril to make a perfect seal. A downward and sideward inclination of the head facilitates the easy passage of saline water through the nasal passages due to gravity (panel b). A few moments before the practice, the individual must shift their breathing to the mouth. Following this practice, a lying posture or forward bending postures can be opted to facilitate the evacuation of retained water (Dr. PP is the demonstrator).

On the other hand, the turbulent flow of water from an irrigation cup may result in dispensing of higher quantities of water into the nostril due to a lack of control, raising the possibility of aspiration. Although this is not of significant concern because only low volumes may be aspirated in any instance, the use of a vessel with a design closer to a neti-pot, in our opinion, can improve tolerance and commitment among new users. If a neti-pot or a similar vessel is not accessible, an irrigation cup with a chipped spout is reliable.

2. Concluding remarks

While there is limited clinical evidence concerning the curative or preventive role of saline water gargling and nasal irrigation against SARS-CoV-2 infection, all the previous studies outlined above provide compelling support to their applicability in the current crisis. Additionally, considering risks and benefits, these are undoubtedly harmless approaches and can be attempted fairly easily by most individuals; they do not require new knowledge or training. They can be easily implemented by individuals with mild symptoms, those facing obstacles to physician visits, and especially by those in home quarantine.⁵ It must be borne in mind that some individuals often confuse simple influenza for COVID-19 because these tend to be indistinguishable in some cases.⁴ ^, ⁵ Negative opinions of saltwater gargling and nasal irrigation²⁵ prevents use of these measures in the context of an actual viral infection; however, appropriate consideration of these complementary therapies may minimize infection, improve the overall course of the disease, and in the broader context, may even de-link the chain of community transmission. In our opinion, these are suitable options worth considering in the current crisis. We note that due to the lack of conclusive evidence, specific clinical studies are warranted.

References

1. Cyranoski D. Profile of a killer: the complex biology powering the coronavirus pandemic. Nature. 2020;581:22–26. [PubMed] [Google Scholar]

2. Vaira L.A. Anosmia and Ageusia: common findings in COVID-19 Patients. Laryngoscope. 2020;130:1787. [PMC free article] [PubMed] [Google Scholar]

3. Lovato A. Upper airway symptoms in coronavirus disease 2019 (COVID-19) Am J Otolaryngol. 2020;41 [PMC free article] [PubMed] [Google Scholar]

4. Yan C.H. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol. 2020 Apr 12 doi: 10.1002/alr.22579. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

5. Zou L. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382:1177–1179. [PMC free article] [PubMed] [Google Scholar]

6. Al-Tawfiq J.A. Viral loads of SARS-CoV, MERS-CoV and SARS-CoV-2 in respiratory specimens: what have we learned? Travel Med Infect Dis. 2020;34 [PMC free article] [PubMed] [Google Scholar]

7. Hou Y.J. SARS-CoV-2 Reverse genetics reveals a variable infection gradient in the respiratory tract. Cell. 2020 S0092-8674(20)30675-9. [PMC free article] [PubMed] [Google Scholar]

8. Liu W.D. Prolonged virus shedding even after seroconversion in a patient with COVID-19. J Infect. 2020 S0163-4453(20)30190-0. [PMC free article] [PubMed] [Google Scholar]

9. Panta P. Amazon Kindle Direct Publishing; 2020. Health & Well-being during Pandemics. [Google Scholar]

10. Rabone S.J., Saraswati S B. Acceptance and effects of nasal lavage in volunteer woodworkers. Occup Med (Lond) 1999;49:365–369. [PubMed] [Google Scholar]

11. Holmström M. Effect of nasal lavage on nasal symptoms and physiology in wood industry workers. Rhinology. 1997;35:108–112. [PubMed] [Google Scholar]

12. Köksal T. Comparison between the use of saline and seawater for nasal obstruction in children under 2 years of age with acute upper respiratory infection. Turk J Med Sci. 2016;46:1004–1013. [PubMed] [Google Scholar]

13. Slapak I. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008;134:67–74. [PubMed] [Google Scholar]

14. Ramalingam S. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep. 2019;9:1015. http://www.elvisstudy.com/nasal-irrigation-and-gargling.html [PMC free article] [PubMed] [Google Scholar]

15. Chong L.Y. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4 [PubMed] [Google Scholar]

16. Harvey R. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;(3) [PubMed] [Google Scholar]

17. Ramalingam S. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci Rep. 2018;8:13630. [PMC free article] [PubMed] [Google Scholar]

18. Van Thuong K. Effects of acute change in salinity and moulting on the infection of white leg shrimp (Penaeus vannamei) with white spot syndrome virus upon immersion challenge. J Fish Dis. 2016;39:1403–1412. [PubMed] [Google Scholar]

19. Castelão C. Association of myeloperoxidase polymorphism (G463A) with cervix cancer. Mol Cell Biochem. 2015;404:1–4. [PubMed] [Google Scholar]

20. Ramalingam S. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 2020;10 [PMC free article] [PubMed] [Google Scholar]

21. Rafael R.G., et al. Hypertonic saline solution inhibits SARS-CoV-2 in vitro assays. bioRxiv. 2020; 2020.08.04.235549; doi: 10.1101/2020.08.04.235549. [CrossRef]

22. Satomura K. Prevention of upper respiratory tract infections by gargling: a randomized trial. Am J Prev Med. 2005;29:302–307. [PubMed] [Google Scholar]

23. Pinto J.M. Effects of saline sprays on symptoms after endoscopic sinus surgery. Am J Rhinol. 2006;20:191–196. [PubMed] [Google Scholar]

24. Nikakhlagh S. A comparison between the effects of nasal lavage with hypertonic, isotonic and hypotonic saline solutions for the treatment of chronic sinusitis. J Glob Pharma Technol. 2016;8:68–73. [Google Scholar]

25. World Health Organization: Coronavirus disease (COVID-19) advice for the public: myth busters (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters#saline)

Productive Knowledge and the Social Sciences — Some Pragmatic Ruminations

Amar Bhidé — Sat, 23 Jan 2021 10:36:34 +0000

A monthly Hayek seminar at the London School of Economics on risk and uncertainty sets a reliably high standard for intellectual stimulation, with quite the diverse constellation of luminaries (and just a few stragglers like me).
Most regard themselves as social scientists; I don’t see myself as a scientist, in the modern sense: I like to study social phenomena from a pragmatic perspective (in the William James sense, of what’s useful rather than what’s “true.”)
This week’s session further clarified what these two perspectives mean for thinking about economic models.
The ‘classical’ economic scientist’s approach, going back to J.S. Mill, was to start with axioms, and deduce what “tendencies” followed. Mill for instance defined economics as the deductive science of inferring tendencies that result from seeking wealth. He emphatically did not assume that wealth seeking was the only – or even dominant or uniformly distributed — motivation. Therefore, the tendencies deduced might not actually be observed in specific instances or even in the aggregate.
We have of course come a long way since then, both in the sophistication of deductions and efforts for empirical validation. This has prompted new deductive models — and backward induction from observation. This effort would include behavioral and evolutionary economists (of various stripes), the Santa Fe complexity folk, and George Soros’s ‘reflexivity.’
For all that, I think it’s fair to say that the gap between models and observations remains vast and most everything – as far as I can tell — is over determined (with many plausible explanations for the same thing).
The most that ‘scientific consensus’ can realistically expect is some kind of ‘abductive’ generalization: the “best” explanation for the widest possible phenomena. And I’m skeptical that without some kind of intellectual bullying such a consensus is possible.
The alternative ‘pragmatic’ enterprise (in the William James sense) looks for whats useful rather than what’s universally true — and thus (as John Kay and Mervyn Kay argue in Radical Uncertainty) to ‘situational’ abduction: the best possible inference about a particular circumstance. They further argue that such abduction requires a kind of “plumber’s tool kit” of models. Charlie Munger (of Berkshire Hathaway fame) says this as well in arguing for a diverse ‘latticework’ of models.
This prompts the further pragmatic question: which tools, used under which circumstances? Plumbers learn this in trade school, through apprenticeships, learning by doing, learning by watching (again to borrow from Mervyn King) etc. Yet Knightian uncertainty (perhaps short of ‘radical’) about tool selection and use seems unavoidable.
I think social scientists have something to bring to the pragmatist’s table: more suggestive tools and heuristics for their selection and use. It would be a pity if this were lost in a dogmatic striving for the “best” model and approach.

The Plague in Pepys’s London

Amar Bhidé — Wed, 23 Dec 2020 09:59:48 +0000

Email from a distinguished, very thoughtful, and classically educated, pillar of the UK establishment concludes:

“Meanwhile I send you our warmest wishes for a better 2021 than this Plague Year. I’m reading Pepys’s Journal and although the disease killed perhaps a quarter of the population of London, they seem to have remained rather more cheerful than their modern counterparts.”

To which I responded:

“On Pepys’s London: a morbid thought, but we really do seem to have lost our acceptance of death, making our societies psychologically brittle and tormented.”

Another friend pointed me (on Facebook) to C.S. Lewis’s famous “Living in an Atomic Age” essay from 1948 – which seems very on point more than 70 years later.

“In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”

“In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.”

“This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.

To what end Heterodoxy? (Hayek Seminar at LSE)

Amar Bhidé — Thu, 19 Nov 2020 07:40:42 +0000

I’m privileged to participate in a seminar (with far more distinguished scholars than I) with diverse views and research agendas but joined by a common skepticism about the mainstream model for decision making under uncertainty. After the first session presented by John Kay (based on a chapter with his book with Mervyn King) I posted the following reaction on the seminar’s bulletin board:
“(A). The question of alternatives to the standard model came up a few times. Gert brought it up explicitly, I think. To me, this raises the issue of to what end — how does it matter? To use William James’s possibly crass pragmatic formulation, what is the “cash value” of alternatives that we are looking for?
For my two cents/pennies worth, I’d make a distinction between alternatives for making ‘abductive’ assessments to inform specific decisions where something meaningful is at stake versus alternatives for deriving and defending propositions about recurring, universal phenomena. (The latter to include general propositions about abductive assessments and choices.)
This takes me (it would, wouldn’t it!) to the distinction between engineering and science and their respective methodologies). And this is not at all intended as a put down: the overall orientation of the group seems towards general (albeit) heterodox propositions that are ‘better” than what the mainstream has to offer.
(B). On the issue of “correctness” — the individual forecasts of the probability of rain that can never be wrong. This is a problem both in the scientific and practical domain since counterfactuals are often difficult to come by and abduction is almost inevitably a just so story telling process.
I would propose replacing the sharp falsifiability standard of science to a variant of Dewey’s (again pragmatic) formulation of truth as a “warrantable assertion.” This would lead me to the following tests:

Is the inverse plausible? In business management at least one encounters lots of vacuous propositions whose inverses cannot be defined or that are pima facie implausible.

and (assuming the first test in met)

How strong are the warrants for the claim (and its competing inverses) in this particular situation?

Overview slides of Practical Knowledge Seminar (hopefully encourages downloads of the syllabus!)

Amar Bhidé — Fri, 10 Apr 2020 09:52:49 +0000

Conflating Convenience with Correctness

Amar Bhidé — Mon, 23 Mar 2020 09:42:07 +0000

My email and facebook feed is filled with pictures and videos of exponential growth functions.

The flood originates, I believe, in epidemiological hubris, namely that:

1. The form of equation governing infection growth is known and unchanging; and,

2. That the parameters of the equation — the now infamous R0 — also don’t change, and therefore can be reliably estimated from the data.

Yes, you can “fit” the initial *recorded* covid infections to an exponential curve — as you could “eyeballs” in the early phases of the 1999 internet bubble. But as Herbert Stein famously observed “if something cannot go on forever it will stop”; very likely, I might add tailing off before it stops for many phenomena. The reasons will of course vary from case to case.

The conflation of the convenience of a mathematical model with is correctness is common in economics (eg Cobb-douglas production functions) and financial risk models (normally distributed price changes). Sometimes, as in 2008, with disastrous consequences.

How reliable does a test need to be in order to be used for screening?

Amar Bhidé — Wed, 18 Mar 2020 12:26:50 +0000

A pro-screening friend posed this question — in response to my strong objections to mass screening.
To which I replied:
“It depends on the purpose, costs and the consequences.
Testing witches by tying weights to suspects’ feet and tossing them into ponds was a terrible idea. Yet at the time, many authorities decided it was a conclusive test — real witches didnt drown — and crucial to containing the scourge of witchcraft.
If I could offer some serious personal examples: When I was twelve, a servant in the house (yes that was common in India) was diagnosed with leprosy. Everyone in the family was immediately tested (with relatively crude, indirect tests) in a public hospital. I tested positive and was prescribed — and immediately started taking — a drug that would cure the disease but would eventually seriously damage my liver.
My mother, a cancer researcher not a medical doctor, wasn’t persuaded by the diagnosis. About a year later, after reading whatever she could find on the top, she took me to a specialized leprosy hospital. They redid the crude test and this time I tested negative. But since there was a prior diagnosis — and there was some abnormal scaling of skin — they performed a much more invasive, accurate test. They took out a large chunk of skin (about 5 mm deep) which they tested in a culture. After several weeks the culture showed there were no leprae bacteria. The drugs were immediately discontinued and later, when it was discovered I had developed an allergy to nylon socks, the scaling went away.
Accuracy here was crucial.
But what if the better test wasn’t available? Would I urge using the crude test to screen the population for leprosy. Absolutely not. But for people who had symptoms or circumstances that indicated the possibility of leprosy, yes. Even if misdiagnoses needlessly harmed their livers.
Another example: I am a sucker for all kinds of testing even when I know the accuracy of the test has not been tested (and is probably low). I have several gadgets to test blood oxygen saturation levels in my sleep (as an indication for apnea). Im sure they are extremely dodgy. But they are harmless. Likewise, I know the 23andme genetic tests have no medical value to me. Yet I did them for sport — and got the “risk factors” for a thousand of my genes which I know are utterly unreliable.
The CDC has sensible criteria for testing for the flu (generally it recommends against). In my judgement those are pretty good ones for the corona virus as well.
And if you are really interested in the general issue of testing methods and tradeoffs look up the readings on that topic in my practical knowledge syllabus“

Productive Knowledge – ​Amar Bhidé