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Emotions And Critical Thinking

My emotions are telling me something.

Let’s say you’re about to give an important speech to a large audience. You’re nervous and your palms start sweating. Which of the following statements is true?

  1. Your brain is nervous and communicates to your palms, telling them to sweat.
  2. Your body is nervous and uses sweaty palms to communicate to the brain, telling it to be prepared.

I never really thought about this before I started teaching critical thinking. However, if you had asked me, I would have guessed that the first statement is right. Over the past several years, I’ve switched my position. Today, I think that the second statement is much more likely to be correct.

Each time I teach critical thinking, some students tell me that they’ve seen the light. From now on, they will ignore their emotions and make decisions based solely on logic and critical thinking. They will emulate Mr. Spock on Star Trek. In my opinion, that’s the wrong thing to do.

Our emotions are a source of information. They tell us something. What they tell us is not always clear. Further, it’s not always correct. But they are worth listening to. In fact, I now think of intuition as the body communicating to the brain, through mechanisms like sweaty palms, shallow breathing, shortness of breath, and so on. Our bodies sense our surroundings and communicate information to the brain.

According to Susan David, a professor at Harvard, our emotions can help us clarify our values – but only if we listen to them. In a recent HBR Management Tip of The Day, she writes: “Our emotions are signals that can give us data about what is important to us, but only if we pay attention. Next time you feel emotional at work, take a step back and consider what it’s telling you.” (Literally taking a step back can help you see your options more clearly, too).

She then goes on to explain how emotions can help us understand our core priorities. She suggests that we can’t get to those core priorities solely by thinking – we need to tune in to our emotions. The Heath brothers, in their book, Decisive, also emphasize the need to identify core priorities and offer some tips on how to do it. Between David and the Heaths, you can identify your priorities and learn ways to focus on them.

I’d suggest that you treat your emotions as just another information source. Treat the information that comes through the “emotion channel” just the same as any other information. Evaluate it in the same way as any other piece of information, using the same go-to questions and evaluation processes. Your emotions may be right or they may be wrong. But they’re always worth listening to.

You can find Susan David’s tip of the day here. (The tip was published on February 9, 2017 – just scroll back to that date). You can also find her longer article in HBR here.

Luck, Skill, and Clembama

Go Clembama!

Go Clembama!

In last year’s NCAA football championship game, Alabama beat Clemson by a score of 45 to 40.

In this year’s NCAA football championship game, Clemson beat Alabama by a score of 35 to 31.

The aggregate score is 76 to 75 in favor of Alabama.

So, which team is more skilled?

To ponder the question, we need to return to Michael Mauboussin’s ideas* about skill and luck – and, especially, his concept of the paradox of skill.

Let’s start with definitions for skill and luck. For Mauboussin, a key question helps us identify skill: Can I lose on purpose? If the answer is yes, then some skill must be involved in the process, whether you’re shooting hoops or playing poker. If the answer is no, then the process is random – it’s a matter of luck.

Most processes – like NCAA football games – involve both skill and luck. How can we sort out the differences between the two? Was Alabama more skilled last year or just luckier? What about Clemson this year?

Mauboussin’s paradox of skill can help us sort this out. Simply put, the paradox states that: “In activities that involve some luck, the improvement of skill makes luck more important…” We have training programs that can improve skills in many competitive activities, including sports, business performance, combat, and perhaps, even investing. As more people take advantage of these programs and average skill levels improve, you might think that luck would become less important in determining outcomes.

Mauboussin says that exactly the opposite is true. The big issue is skill differential and distribution. If a given skill is unevenly distributed in a society, then skill likely determines the outcome. Luck doesn’t have a chance to worm its way in. On the other hand, if skill is broadly and evenly distributed, then even minor fluctuations in luck can change the outcome.

As an example, Mauboussin cites the difference between the winning time and the time for the 20th finisher in the men’s Olympic marathon. In 1932, the difference was 39 minutes. In 2012, it was 7.5 minutes. Clearly, the skill of marathon running has become more evenly distributed over the past 80 years. We have more people with greater skills more evenly distributed than we had in the past. As a result, the marathon has become much more competitive.

Paradoxically, as the marathon has become more competitive, luck plays a greater role. Let’s say that the 1932 winner had the bad luck of stepping in a pothole at Mile 22 and had to limp to the finish line. Because he had so much more skill than the other runners, he might still have won the race. If the 2012 winner stepped in the same pothole, chances are the other (highly skilled) runners would have caught and passed him. He would have lost because of bad luck.

The paradox of skill should teach us some humility and helps to illuminate the illusion of control. We may think we’re successful because we’re skilled and talented and can control the events around us. But oftentimes – especially when skill is evenly distributed – it’s nothing more than an illusion. It’s just plain luck.

And what about Clemson and Alabama? My interpretation is that both teams are perfectly balanced in terms of skills. So the outcome depends almost entirely on luck: a lucky bounce, a stray breeze, a bad call, a slippery turf, and so on. Let’s celebrate two great teams that have separated themselves from the pack but not from each other. Perhaps we should call them Clembama.

* I used several sources for Mauboussin’s ideas. His 2012 book, The Success Equation, is here. In 2012, he also gave a very succinct presentation to the CFA Institute. That paper is here. His HBR article from 2011 is here. In 2014, he gave a lecture as part of the Authors at Google series – you can find the video here. And David Hurst’s very enlightening review of Mauboussin’s book is here.

Will Corruption Skyrocket In Sweden?

No cash here!

No cash here!

Here’s a pair of questions raised by Dan Ariely in his book, Predictably Irrational:

Your school age daughter calls you at work and asks you to bring home a red pencil she needs for her homework.

Q1: You find a red pencil in your company’s supply closet. Would you take it home or would you consider that cheating?

Q2: You can’t find any red pencils in the office but you know you can buy one for a quarter at the office supply store around the corner. You don’t have a quarter but you can find one in the petty cash drawer by the coffee machine. Would you take a quarter and buy your daughter a red pencil or would you consider that cheating?

If you’re like Dan Ariely or me or most people, you think it’s OK to take a pencil from the supply closet but you would never take a quarter from the petty cash drawer.

The value involved is the same in both cases, so why do we think one scenario is OK and the other is not? According to Ariely, it’s about cash. We tend not to cheat when cash is involved. We know it’s wrong to take money. We can’t rationalize the action to ourselves.

The farther we get from cash, however, the easier it is to rationalize cheating. Most of us wouldn’t steal money from a stranger. But we might shade things a bit on our tax returns and we don’t feel too badly about inflating our losses on insurance claims. Ariely concludes that, “When we look at the world around us, much of the dishonesty we see involves cheating that is one step removed from cash.”

So does this mean that corruption is about to skyrocket in Sweden?

For the past several decades, Sweden has been moving toward a cashless society. Banks began charging for checks about 30 years ago. Rather than writing checks, people found it easier and less expensive to transfer money from one account to another, initially by fax, then online, and now by mobile devices like smartphones. ATMs are being phased out. By one estimate, only 900 of the 1,600 branch banks in the country even bother to keep cash on hand.

So how do Swedes pay for things? With blips and chips. You can pay the parking meter with your smart phone. You can transfer money from one account to another with an app called Swish. You can give money to a beggar by swiping a card or tapping a phone. Even Swedish churches use apps instead of collection plates.

The Swedish transition to a cashless society accelerated in September 2009, after the Västberga heist. Thieves in a stolen helicopter smashed through the skylight of a bank-processing center and made off with about $6.5 million in cash. The heist has been romanticized endlessly in Sweden. But its biggest impact was to erode trust in cash. If cash could be stolen so easily – and it was never recovered – why bother with cash? (I happened to walk by the Västberga center, on my way to work, about half an hour before the attack. Yikes!)

In addition to theft, cash is involved with a whole host of nefarious activities – ranging from drugs to weapons to prostitution to payments to illegal aliens. So why not do away with it? Dan Ariely’s data may give us pause – the farther we get from cash, the more likely we are to cheat.

So is Sweden growing more corrupt? At least one estimate suggests, “…cases of electronic fraud have more than doubled in the past decade….” Before giving up cash altogether, the Swedish government should take some baseline measures of corruption and cheating and then monitor them over time. It may turn out that going cashless is much more expensive than the occasional bank heist.

Your Commonplace Or Mine?

I told you this 2,000 years ago.

I told you this 2,000 years ago.

In persuasive presentations, we often appeal to commonplaces — opinions, attitudes, or perceptions that are widely held by a particular group. Like common sense, these attitudes are (supposedly) common to all members of a group. As persuaders, we can speak to a common point of view.  We’re on common ground and we can move forward together.

The problem, of course, is that commonplaces aren’t so common. Indeed, many commonplaces have equal and opposite commonplaces to counterbalance them. One commonplace advises us to look before we leap. Another reminds us that he who hesitates is lost. On the one hand, we root for the underdog. On the other hand, we admire the self-made man – who is anything but an underdog.

It seems that we can find a commonplace to suit almost any argument. Want to lower taxes? There’s a commonplace for that. (The government is inefficient. You earned it. You keep it. etc.) Want to raise taxes? There’s a commonplace for that. (We’re all in this together. We need to help each other. etc.) And “good” commonplaces can be twisted to support “bad” causes. As Shakespeare reminds us in The Merchant of Venice, “The devil can cite scripture for his own purpose.”

In my persuasion class, I ask students to write papers in which they argue a point. By and large, my students are quite adept at deploying commonplaces to support their arguments. I notice that they often deploy commonplaces that they believe in. To be persuasive, however, we need to consider the commonplaces that the audience believes in. I shouldn’t assume that you think like me. Rather, I should seek to understand what you think and use that as a starting point for building my argument.

The concept of using the audience’s commonplaces is as old as Greek rhetoric. It got a boost last year when the sociologists Robb Willer and Matthew Feinberg published their research on argumentation and moral values. Their basic finding: we are more persuasive when we frame arguments for a political position around “the target audience’s moral values.”

Feinberg and Willer point out that liberals and conservatives have different moral values (or commonplaces in our terminology). They write “…liberals tend to be more concerned with care and equality where conservatives are more concerned with … group loyalty, respect for authority and purity.”

They then tested how to persuade conservatives to take a liberal position or vice-versa. For instance, how would you persuade conservatives to support same-sex marriage? They found that conservatives are more likely to agree with an argument based on patriotism than one based on equality and fairness. Conservatives tended to agree with an argument that, ““same-sex couples are proud and patriotic Americans … [who] contribute to the American economy and society.” They were less likely to agree with an argument couched in terms of fairness and equality.

(Feinberg and Willer’s research article is here. A less technical summary is here).

Aristotle taught us that the best person to judge the quality of food is the one who eats it, not the one who prepares it. The same is true for arguments. You can’t judge how effective your argument is. Only the audience can. The moral of the story? Get over yourself. Learn what the audience is thinking.

Animal Fats and Multiple Sclerosis

Maybe not.

Maybe not.

As a person who has multiple sclerosis, I read with great interest “STAT”, an article by Maria Bustillos that appeared recently on the Longreads website. (Click here to access the article). Bustillos describes her very unpleasant experiences when her 24-year-old daughter was diagnosed with MS. She also advances the hypothesis that animal fats are an important and overlooked factor in the cause and progression of MS.

If Bustillos is right, then removing animal fats from your diet should alleviate – or even eliminate – many symptoms of MS. I hope she’s right. Controlling MS through diet would be much simpler and less costly than many other alternatives. However, I have my doubts and want to summarize them here.

By way of background, I am a sixty-something Caucasian male who was diagnosed with MS in 2008. I have the remitting-relapsing form of the disease and have not had a relapse for almost eight years. I am also an active volunteer for the National MS Society (NMSS). I participate in their fundraisers – Bike MS, Walk MS, etc. – and I currently serve on the Board of Trustees for the Colorado-Wyoming chapter. It’s worth noting that the opinions stated here are mine alone.

The Animal Fats Hypothesis

Bustillos proposes that animal fats are a significant factor in causing MS and/or exacerbating its symptoms. She writes, “Animal fats appear to play a significant role in making MS patients sicker; fish oils help keep them healthier.” Based on this analysis, Bustillos recommends a vegan-plus-fish diet to manage MS. Let’s call this the animal fats hypothesis or AF for short.

Other Hypotheses

While the AF hypothesis is useful, many other hypotheses about MS exist. One that I find especially intriguing is what I’ll call the clostridium hypothesis as proposed by Dr. Timothy Vartanian and his colleagues at the Weill Cornell Medical College.

The clostridium hypothesis derives from research conducted in the Faroe Islands, an isolated chain in the north Atlantic. Prior to World War II, the inhabitants of the Faroe Islands – the Faroese — had never recorded a case of MS. During World War II, the British established a naval resupply station in the islands and brought in scores of troops and pack animals, especially mules. The first recorded case of MS occurred in 1943 and heralded the beginning of an MS epidemic. Researchers have documented three successive epidemic waves since then. (Click here for more detail).

What changed in the Faroe Islands to enable the rise of MS? Dr. Vartanian and his colleagues suspect – but certainly haven’t proven – that the cause is a specialized subtype of the bacterium clostridium perfringens. The subtype produces the epsilon toxin, which can degrade the myelin sheath that protects the nervous system. Degraded myelin is a hallmark of MS.

Clostridium is associated with grazing animals and is often found in the soil where they feed. Vartanian’s team has found the epsilon-producing form of clostridium in soil samples from the Faroe Islands and also in stool samples of people who have MS – both in the Faroes and elsewhere. Dr. Vartanian and his team suspect that British pack animals introduced clostridium perfringens to the Faroe Islands and created an environmental trigger for MS. There’s no conclusive proof of this hypothesis but clostridium is certainly a bacterium of interest.

MS has traditionally been viewed as an autoimmune disease. For unknown reasons, the immune system attacks the body and degrades myelin. The clostridium hypothesis suggests that the immune system is reacting to a bacterial infection. It’s a very different model and potentially yields very different therapies.

Could a change in diet have caused the eruption of MS in the Faroe Islands? It’s possible but I haven’t found any evidence that the Faroese changed their diet substantially during or after World War II.

I’ve highlighted the clostridium hypothesis because I think it’s intriguing. But there are many other hypotheses as well. One, for instance, suggests that MS is related to a deficiency in Vitamin D. This is based on the observation that the incidence of MS is higher the farther one is from the equator. Presumably one gets less Vitamin D from the sun in far northern or southern latitudes. (Click here for more detail). My point is that there are many hypotheses and we shouldn’t consider the AF hypothesis in isolation. We can compare hypotheses to determine which one explains our observations best.

(Click here, here, here, here and here for more articles on the clostridium hypothesis).

Norway and Colorado

Bustillo’s argument relies heavily on a study of the incidence of MS in post-war Norway. The study, by the neurologist Roy Swank, was published in 1952 in The New England Journal of Medicine. As Bustillos writes, Swank found that “…the incidence of MS in remote, mountainous dairy-farming regions, where there was a high consumption of beef and dairy products, was eight times higher than on the coast, where the predominant diet was based on fish.”

Bustillos and Swank conclude that diet was the causal factor behind these differences. That’s certainly possible but I’m not convinced. The evidence I would point to comes from my home state of Colorado, which also has an unusually high incidence of MS. In Colorado, the incidence of MS is about 182 cases per 100,000 people. In the United States as a whole, the ratio is 135 cases per 100,000 people.

Why the difference? Perhaps it’s Colorado’s altitude. That would fit nicely with the Norwegian study, which found that highlanders contracted the disease more frequently than coastal dwellers. Or perhaps it’s the fact that Colorado is the center of a large livestock industry. We have millions of grazing animals and I suspect our soil is chockfull of clostridium. This would lend credence to the clostridium hypothesis and the Faroe Island experience.

I can’t think of any dietary differences between Colorado and the rest of the nation that would account for the differences. As far as I can tell, the Colorado example doesn’t support the animal fats hypothesis — but doesn’t refute it either.

As Bustillos points out, Swank did considerable research on the vegan-plus-fish diet. Indeed, it’s often referred to as the Swank diet and is promoted by the Swank MS Foundation. (Click here for more detail). Bustillos claims that the National MS Society does not provide information on this diet. That’s not quite right. Here’s an article from 2008 on the NMSS website that summarizes a variety of diets, including Swank’s.

Beef Consumption and MS

If the AF hypothesis is correct, one surmises that there should be a correlation between beef consumption and the prevalence of MS. But I can’t find such a correlation in the available data.

Here, for instance, are the top five countries in terms of beef consumption per capita.

Hong Kong                123.51 pounds per capita per year

Argentina                  96.95

Uruguay                    81.59

Brasil                        60.40

USA                          53.84

(Click here for the full table of 61 countries)

On average, the worldwide prevalence of MS is 30 cases per 100,000 people. Yet Argentina has only 18 cases per 100,000 people. Uruguay has 26. Brasil has 15. The USA has 135. (I couldn’t find data on MS in Hong Kong).

At the other end of the spectrum, Sweden and Norway don’t even rank in the top 61 countries in terms of beef consumption. Yet Norway has 160 MS cases per 100,000 people and Sweden has 189.

The data here and here support the Vitamin D hypothesis much more than the animal fats hypothesis.

Other Diets

Based on the animal fats hypothesis, Bustillos concludes that a vegan-plus-fish diet is a good way – perhaps the best way – to manage MS. Let’s remember that other diets have also been proposed to manage MS.

In a popular YouTube video, for instance, Dr. Terry Wahls attributes her success in managing her MS symptoms to a diet rich in leafy greens, colored fruits and vegetables, seaweed, meat from grass-fed animals, and organ meats. She also stresses the need to reduce sugar and gluten as well as the need to reduce stress. Dr. Wahls’ MS symptoms were severe enough that she could no longer walk and was chronically fatigued. When she switched to her new regimen, she regained her energy and her ability to walk.

What intrigues me about Dr. Wahl’s diet is that it includes meat. In fact, her diet is quite similar to the popular paleo diet. Numerous testimonials suggest the paleo diet can help manage MS. (See here, here, and here, for instance).

All of these diets include meat, which a vegan-plus-fish diet excludes. If the AF hypothesis is correct, it seems that the paleo diet should exacerbate MS symptoms rather than alleviate them. It seems that either the vegan-plus-fish diet or the paleo diet might work to alleviate MS symptoms. But I’m hard pressed to explain how both could work. But perhaps we’ll soon find out as the National MS Society recently announced new research into both the Wahls and Swank diets. In cooperation with the Univeristy of Iowa, NMSS is investing $1 million in a 36 week clinical trial to measure the effectiveness of “…a low saturated fat diet (Swank diet) or a modified paleolithic diet (Wahls diet)”. Stay tuned. (Click here for more information).

Evidence Based Medicine

Bustillos writes a long critique of evidence-based medicine or EBM. She clearly believes that we should not accept EBM as the be-all and end-all of medical research. I agree. So does the medical establishment.

For some years now, medical researchers have used a hierarchy of evidence that includes at least four levels. The most stringent level of evidence – Level I – involves randomized, double blind experiments that are replicated in multiple locations. This is the gold standard of evidence-based medicine.

The least stringent level of evidence – Level IV – includes testimony from a panel of experts. Ideally, the panel will include experts from multiple institutions and represent multiple disciplines. The panel reviews the existing evidence and presents it in a public forum where interested parties can question their findings.

Based on what Bustillos writes, it appears that the animal fats hypothesis does not yet rise to the Level IV standard of evidence. Perhaps a useful next step for AF proponents — while we await the results of the NMSS/Iowa study — would be to organize a panel of experts and present their findings in public.

(Click here for more detail on the four levels of evidence or here for an alternate version that includes five levels).

Character References

Bustillos offers sterling character references for researchers who agree with the AF hypothesis. She describes them as “distinguished”, “eminent”, “prominent”, and “highly qualified”.

I’m sure she’s right. I would similarly like to offer sterling character references for the neurologists, biologists, researchers, and clinicians that I have met in the MS community. Many of them have close personal connections to MS. Indeed, many of them have the disease themselves. On the whole, I find them to be highly professional, creative, and open-minded. They’re looking for answers and they’ll pursue any clue that seems promising.

I made my career in the computing industry and I recognize the Not Invented Here syndrome when I see it. I don’t see it in the MS community.

Medical Therapies

There are currently 14 FDA-approved disease modifying therapies (DMTs). None of these is a magic bullet that stops or reverses the course of the disease. However, the DMTs can slow the progression of the disease and produce useful outcomes in both the short term and long term.

Generally, the sooner one begins treatment with DMTs, the better off they are in the long run. Mark Freedman’s research, published in the journal Neurology (click here), suggests that, “…that early optimal treatment aimed at reducing disease activity can improve longer-term outcomes by delaying disease progression.”

My Case

Like Bustillos, I believe that good diet is essential to good health. I’m intrigued by the vegan-plus-fish diet. Yet, I’ve managed my MS symptoms successfully without it.

I eat a healthy diet but it’s not nearly as strict as vegan-plus-fish – or paleo for that matter. I follow the recommendations of various heath organizations like the American Heart Association. I don’t each much sugar but I don’t worry too much about gluten or dairy. I eat a lot of fish and vegetables but I also toss in a hamburger every now and then. Why? Because I believe that occasional pleasures are essential to good health as well.

I also do a lot of yoga. Perhaps that’s what makes the difference for me. Perhaps we should research yoga’s impact on MS more thoroughly. I think we could build a strong case for yoga – perhaps equally as strong as the case that Bustillos presents for the AF hypothesis.

The Newly Diagnosed Experience

Bustillos writes about her experiences in the immediate aftermath of her daughter’s diagnosis. By and large, she describes it as a nightmarish period in her life.

My own baptism into the MS world was more benign. The first thing my doctors told me was that there’s a lot that we don’t know. I accepted that and did a lot of research on my own. I discovered various therapies including the paleo diet, yoga, massage, and acupuncture. I adopted those that made most sense to me.

I’m sorry that Bustillos and her daughter had a negative experience. But I don’t think that’s relevant to whether we accept or reject the AF hypothesis. I think we should share as much information as we can about as many therapies as possible. But I don’t think we should promote the vegan-plus-fish diet as the one true solution. There’s just not enough evidence.

Where To?

I’m interested in the vegan-plus-fish diet but not yet ready to convert. I’m well versed in Pascal’s Wager and I don’t require Level I evidence to pursue a potential therapy. But I would like to see some evidence that’s at least at Level IV. I have an open mind here but I need to know more.

I hope that Bustillos — and others who are intrigued by dietary therapies – will also keep an open mind about disease modifying therapies. The evidence is quite clear that it’s better to start DMT therapies earlier rather than later. It’s Level I evidence and it’s quite convincing.

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