### Plain old conceit

On Monday I was required to monitor at the Tokyo University undergraduate entrance exams. I shepherded 60 terrified 17 year olds through a 2.5 hour Japanese language test and then a 100 minute maths test. These tests were part of a two day examination process for those want to enter the humanities faculty of Tokyo University. About the Japanese test I can say nothing, but the maths test interested me, and can be found online (in Japanese) at the Mainichi Shinbun newspaper. In order, based on my feeble attempts at translating the exam, the four questions were:

• A straightforward but nasty calculation of the properties of a line intersecting with a cubic function, including elucidation of all minima and maxima of the products of the lengths of two line segments
• A geometry question with two proofs
• A constrained linear programming problem
• A simple Markov model with a slight twist

The students had 100 minutes, and to their credit quite a few of the students managed all four, though a lot also stumbled and didn’t get past two. I would say that for a well-trained student with good maths skills, these four questions can all be done inside their allotted 25 minutes, but it’s a pretty risky process – even a small error at the start, or misconception of how to do the problem, and you have basically lost the whole question because you only have time to attack the problem once. And these problems are probably about the same level of difficulty as the questions on a standard year 12 maths exam in Australia – where usually we would have three hours.

But these questions were for the Humanities Faculty of this university. If you want to study Japanese literature at Tokyo University, you first have to get through that 100 minutes of high level mathematics. It says something, I think, about the attitude of Japanese people towards mathematics, and towards education in general, that they would even set a mathematics test for access to a Humanities Faculty; and it says even more about the national aptitude for maths that the students could tackle this exam.

At about the same time as these exams were being held, the Guardian and the Sydney Morning Herald released articles slamming the mathematical and science abilities of the average student in the UK and Australia, respectively. The Guardian reported on a new study that found English star students were two years behind their Asian counterparts in mathematics, with 16 year old English students at the same level as 14 year old Chinese. The study also found that

The research also found England’s most able youngsters make less progress generally than those of similar abilities across the 12 other countries studied. The other countries studied were Singapore, Hong Kong, Taiwan, Japan, Australia, Slovenia, Norway, Scotland, the US, Italy, Lithuania and Russia.

Meanwhile, the Sydney Morning Herald reported on a new study showing that the proportion of students doing mathematics is falling fast, with apparently only 19% of students studying maths, science or technology in their final year of school, and a rapid fall in mathematics enrollments amongst girls especially. The corresponding figure in Japan in 2002 was 64%.

So is this a problem, why is it common to the English speaking world and viewed so differently in Asia, and what can be done about it? Obviously as a statistician I think this is woeful[1], and it certainly is my personal opinion that understanding mathematics is a good thing, but is it bad for a society as a whole to neglect mathematics education? I don’t know if that’s objectively verifiable. So let’s skip that question, assume for now that improving the number of people taking mathematics is good, and just jump onto the question of why it is unpopular in Australia, and why the British are so bad at it.

First, I would like to dispute the possible explanation provided in the Guardian article by “the researchers”:

In east Asian cultures education has historically been highly valued. This can be seen not only in teachers’ high salaries, but also in the heavy investment of families in private tutoring services

While it may be true that “social and cultural factors” affect maths achievement, the idea that Asians are better at maths because they value education more highly is a very weak one. If this were the case, would it not also be the case that Japanese would universally be better at foreign languages than the British or Australians? Japanese get a long exposure to English teaching but are generally woeful at it, despite all the money they sink into private tutoring services. No, there’s something else going on here, something about the Asian approach to maths and the way it is taught that is important.

It is certainly the case that private tutoring services need to be considered in the mix. When comparing a 16 year old English student to a 14 year old Japanese student, for example, you are comparing someone who does a 9 – 5 study day with very long winter and summer holidays against someone who does an 8 – 8 study day with two-week holidays, and who gets 2-on-1 or small group tutoring in key subjects for up to 3 hours a day, and on weekends. This process starts at age 10 and really ramps up at about age 15-16, just when the linked article finds the biggest gap between English and Asian students. It’s also the kind of process that benefits the “brightest” students most, and would explain the gap very nicely.

It may be that if the UK wants to compete with the sleeping giants of Asia on basic educational outcomes, it’s just going to have to face up to a simple fact: British students need to study harder. A lot harder.

There are some more nebulous cultural factors that come into play, however, and I am going to go out on a limb here and name a few factors in Japanese society (the part of Asia I am familiar with) that I believe make Japanese so much better at maths than their western counterparts.

• It isn’t about native talent: A pet hate of mine about western approaches to mathematics is the idea that some people are talented at it, and most people aren’t. I don’t think this is true at all, and I think it’s not something that Japanese believe very strongly. The reality is that getting good at maths is a long, hard slog that involves a huge amount of repetition of basic skills (things like completing the square, substitution, differentiation, interpreting graphs, sign diagrams, etc.) – just like learning a language. Sure, solving maths problems requires creativity and intuition, but these are only of any value if you know the tools you can apply them to, and are familiar enough with those tools to recognize when and how to use them. Mathematics – and especially high school mathematics – is a process of drilling, drilling, drilling, and I think that Japanese recognize this. In Japan the default assumption is that if you pay attention at school and do your homework, you will be good at maths. Sure, they recognize that advanced maths requires extra commitment and talent, but there is a fundamental assumption here that the broad body of maths (up to and including differentiation, integration, limits, and basic probability theory) are things that anyone can learn.
• The teacher is important: the flip side of the idea that education is important is an increased stress on the value of the teacher, and their role as a guide. The role of the guide is also viewed very differently if they are teaching something that they believe anyone can do, compared to if they are teaching a subject that everyone believes is impossible for most mortals to comprehend. Find me a westerner under the age of 30 who is “terrible at maths” and I will show you someone who was humiliated by an arrogant maths teacher at a crucial time in high school, usually around when they were 14. I was in the bottom class in mathematics when I was 14, expecting to drop out as soon as possible, until a good teacher put some time into teaching me, and I found that I really loved it. In Japan, teachers can be bullies and they can be cold and hard, but I would also argue that they have a much greater burden of personal care and responsibility placed on them compared to western teachers, and the failure of their students is treated more like a professional failure (rather than due to the student’s personal talents) than it is in the west. I think this is especially important with mathematics, because when you don’t get it it really hurts – like a kind of itching in the back of your brain – and the failures pile up rapidly. Just a single year between 12 and 14 in which you give up on maths is enough to make all the subsequent years ever more challenging, meaning the damage and the attendant confidence failures compound.
• Being nerdy is cool: In Japan, it’s okay to be a nerd, and being good at mathematics is admired and respected. It’s virtually unheard of to find someone here who looks down on a man who can do maths, or thinks that it is beyond the female brain, or thinks that being interested in mathematics is weird. Furthermore, the nerd world in Japan is much more gender neutral than in the west, so there’s nothing unusual about girls doing maths. Good mathematics skill – up to and including being able to rearrange equations or solve systems of equations, for example – is not seen as a weird foible, but as an admirable sign that you are a rounded human being.
• There is a social expectation of mathematical skill: In addition to nerdiness being much more acceptable, the range of mathematical abilities that qualify you as a nerd in Japan is much more esoteric and advanced than in the west. There is a general expectation that ordinary people can solve maths problems, that they understand the basic language of mathematics so that even if they can’t solve a problem they know roughly what it is and where it sits in the pantheon. Parents assume that their kids will learn mathematics, and don’t dismiss it as the too hard subject that only the special or the weird get ahead in. Whereas in Australia having a kid who is good at maths is unusual, in Japan it is unusual (and embarrassing!) to have a kid who is not good at maths.

I think these properties add up to a society in which mathematical achievement is encouraged and widespread. I think that Australia and the UK need to change some cultural factors so that the intellectual and educational landscape is closer to that in Asia if they want to keep up on mathematics and technology achievement – especially since China’s education system is maturing, and other Asian nations like Vietnam, Singapore and India are getting wealthier, with all the educational gains that implies. So what should Australia do?

• Ditch the nerd-baiting: there’s something really wrong with the way the English-speaking world treats people who do nerdy things. I’m sure it’s mellowed a lot since I was a kid but it’s still there, the kind of ugly-four-eyes assumption about anyone who is interested in anything that isn’t sport or fashion. Until this weird attitude dissipates – and until the nerd world becomes more gender-balanced, to boot – it’s going to be hard to encourage the kind of cultural changes needed to make maths achievement standard across the board
• Less intuition and initiative, more drills: I think it’s very sweet that maths teachers want to encourage their charges to think about the broader world of maths, about creative problem-solving, about applying maths to the real world, etc. But I think those are natural talents all humans possess, that cannot be unlocked without a robust background in the basic skills that make mathematics work. So leave the creativity for people who need it, and stuff kids’ heads full of “useless” rote learning of techniques and drills. It’s boring, but it’s essential to the bigger stuff. If you aren’t able to immediately see when and how to complete a square, then any problem which requires this basic technique is going to be beyond you, no matter how intuitive you are. Maths, possibly more than any other discipline, is built from the ground up, tiny block by tiny block, and all those blocks are essential. So ram them down every kid’s throat, and make every kid think that knowing the quadratic formula is not a test of some kind of obscure talent, but a basic expectation of every 12 year old
• Force mathematics at higher school levels: When I finished school our balance of subjects had to include at least one science/technology subject, but it didn’t have to include maths. This is wrong, and part of the reason that so many students in Japan do mathematics is that you can’t get into a good university if you take this approach: every one of the better universities includes mathematics in its entrance exam. My personal belief is that completion of higher school certificates should require one foreign language, mathematics, and English. That leaves two other subjects to choose from, and guarantees that you have to do some kind of mathematics to the end of school. Not only will this very quickly lead to a society where entire generations of people are generally familiar with mathematics, it will also put a real focus on the quality of teaching at the earlier years, since any student who is doing badly in years 8 – 10 is going to fail their higher school certificate. [Probably this suggestion for a national curriculum is completely unreasonable, but at the very least students could be forced to do mathematics up until year 11, for example].
• Make school more robust: The Japanese school system is about to shift to a “tougher” system that will include Saturday morning classes, because the previous system was considered “relaxed” compared to earlier years. This is, frankly, ridiculous, but so is the attitude towards education of most of the English-speaking world. Summer holidays are way too long and relaxed, there is a real lack of extension classes and tutoring, and expectations are altogether too low. Education isn’t valued enough, and until this changes anyone who wants their child to do better is going to be swimming against a strong current. Educational achievement is partly supported through the shared goals of a whole society, not just through the targets of individual families, and the expectations we hold for education are primarily set through the school system. So toughen it up – not in the sense of making teachers scarier or bringing back outdated “three Rs” educational styles, but by increasing the amount of time students spend at school, setting tougher standards for graduation and university entrance, making schools compete with each other (as Japanese schools partly do) and forcing parents to take greater responsibility for and involvement in their children’s education. This change isn’t specific to mathematics, but it would certainly help.

I don’t think there’s anything special about Asian students, or about Asian culture, that we can’t adopt. Asians’ mathematics achievements aren’t some kind of native or racial talent. It’s just a collection of attitudes towards education, mathematics and nerdiness that we can adopt if we want. Obviously there will be (potentially challenging) institutional changes required as well, and many people may judge it not worth the effort, but I personally think a world where everyone is good at mathematics is a better world, and we should be aiming for it. With these cultural changes maybe one day everyone will know the obvious thrill of being able to complete a challenging mathematics exam … and enjoying it!

fn1: Though obviously, the less people doing maths, the longer I will remain competitive in the marketplace …

Do any of these dickheads look virtual to you?

A couple of days ago Australia’s prime minister (PM) Julia Gillard found herself in the unprecedented position of having to host an extended news conference to hose down allegations of corruption from 17 years ago. A slightly abridged version of the news conference is available here, and it’s a barn-storming performance by Ms. Gillard that shows some of her finer qualities. My reader(s) from countries with a more timid political climate might like to feast their eyes on it as an example of how politicians should handle the idiots from the press.

At the same time the Observer is running another of the seemingly endless run of journalistic pleadings about whether the blogosphere is responsible for the modern atmosphere of political hysteria. It cites some of the now famous research that claims the blogosphere fragments rather than facilitates political debate, and calls on some (imo) fairly trite stereotypes of the internet generation as self-serving and individualistic. But is blogging, and internet debate more widely, really the cause of this modern hysteria? Can journalists really stand above the fray and pretend to be offering a better, more reasoned or more “balanced” form of public debate? Or is this all smoke-and-mirrors aimed at hiding journalism’s corruption, and subsequent loss of control of the space of cultural and political discourse?

Returning to Gillard’s press conference, I can’t say I’m convinced that the problems she faces would just go away if a couple of vile and sexist websites were to disappear, and judging by her tone when she deals with a journalist called “Sid” from the Australian newspaper, she doesn’t think so either. Although the allegations she was confronting have been floating around for years, they were largely unknown to the wider public until 2007 – when the Australian published a defamatory version of them. And then 2010 – when the Australian published a defamatory version of them. And then last weekend, when the Australian published a defamatory version of them. Are we seeing a pattern here? On every occasion that it has chosen to move these allegations from the fringe blogosphere into public debate, the Australian has had to apologize and publish a retraction, and in 2010 it sacked the journalist who wrote the story. This newspaper – Australia’s only national newspaper – is on record as having declared a plan to destroy Australia’s environmental party, The Greens; its editor in 2003, Paul Kelly, traveled the country openly drumming up support for the Iraq war and calling anyone who opposed it cowards. The Australian is owned by News International – on the same weekend as the Observer was blathering about standards on the blogosphere, News International’s the Sun was publishing pictures of Prince Harry’s naked arse, presumably in the interests of free speech. This is the same News International that probably used illegal means to obtain and then broadcast a recording of Prince Charles telling his girlfriend he wished he was her tampon; the same News International that hacked a dead girl’s cellphone and deleted some messages, giving her parents false hope that she was still alive. The same News International – an American company, incidentally, run by an Australian – that probably also hacked the phone of the UK prime minister, and the families of a couple of soldiers who died in Iraq.

So is Gillard’s problem really with the blogosphere alone? As she observes in the press conference, in a world with more and more information people will tend to put more weight on the opinions of trustworthy mainstream sources; but when these mainstream sources simply regurgitate the opinions of “the nutjobs and misogynists on the internet” then the issue becomes bigger than just the opinions of some lonely wanker with a PC – the bigger issue is the judgment and respectability of the employees of a newspaper company that thinks hacking dead girls’ cellphones is a justifiable act. The reality is that journalists are cheap and easily bought, and they were running down the respectability of their own profession long before the internet made it possible for lonely misogynists to pile on.

But looking a little wider, beyond the issue of what journalists choose to confer legitimacy on, is the increasing nastiness of public debate really the fault of arseholes on the internet at all? The picture at the top of this page is from a rally against Australia’s carbon price. The poster at the back refers to Ms. Gillard, and is suggesting in quite a vile and sexist way that she is the sexual toy of the leader of Australia’s environmentalist party, Bob Brown. The man standing under that banner at the front, with the microphone, telling the demonstrators he agrees with them, is Tony Abbott, the leader of Australia’s opposition liberal party and Australia’s potential future PM. The woman next to him is Bronwyn Bishop, a senior and respected politician from that same party. One might call it merely an error of judgment, but it’s hard to say that they’re doing much to keep debate above board and polite when they choose these kinds of banners as their backdrop. Where are the bloggers in this picture? It wasn’t a lonely wierdo on the internet who called a feminist activist in America a “slut” for wanting contraception to be covered by health insurance – that was Rush Limbaugh, a major media figure. It was a Republican who decided to invoke the 10th Century fiction of “legitimate rape” in defending his anti-choice views; it was a politician, not a blogger, who put rifle cross hairs over pictures of American democrats (or was it their offices?); and there are more than a few birthers in the Republican party (indeed, in congress).

So is the problem really with the blogosphere and the increasing fragmentation of political debate on the internet, or is that a symptom of a wider unhinging, that is being driven by powerful forces in politics and the media? Indeed, even though he’s completely wrong and definitely not honest or well-meaning, there’s not really anything wrong with what Anthony Watts does, in principle, in his little denialist fantasy land. There’s also lots of debate and engagement between the two sides of the AGW “debate” on the internet – if anything, the question is whether there should be less, not more, given how wrong and mendacious the denialists can be. And the role of the media here, too, is questionable since the average journalist’s understanding of the concept of “balance” doesn’t extend past “giving a nutjob a voice on national tv.” The notion that balance is best obtained through calm and rational presentation of facts and getting it right doesn’t seem to have stuck with modern journalists, who constantly trot the likes of “Lord” Monkton out to defend the indefensible – and in fact as the science gets more settled and the denialist population shrinks to a smaller and crazier rump, the journalist notion of “balance” just leads to crazier and crazier people being put on national tv to represent the “opposing view.” Again, is this the blogosphere’s fault? Sure some of those bloggers love to feed the fires, but everyone is craving the legitimacy of the mainstream public eye, and it’s journalists who offer that legitimacy, not blogs with too many colours and 30% of the words in block letters. If AGW was a fiction conjured up by powerful voices in the mainstream, then Watts’s work would be honourable rather than misguided, and he would be justified in both using harsh language, and allowing insulting and rude language on the part of his commenters. And even though some of the stuff he does there – particularly the shenanigans with publishing private correspondence that just happens to be embarrassing – is scummy and low and something he should be ashamed of, that kind of stuff is par for the course with national media and has been for a very long time.

I guess there’s a fine line between being an arsehole and being a hero – a lot of politicians seem not to like the Watergate journalists, or Assange, and I guess from their perspective the work of these people is more than just an inconvenience. But there’s more than enough arseholes in politics and the media, and they’ve been around long enough and doing dirty enough work, that one hardly needs to look to the internet for the cause of the increasingly strident and aggressive nature of modern political debate. The Palins and Limbaughs and Abbotts and Murdochs of the world have pretty much cornered the market on being nasty in public, and given how often journalists offer them the fig-leaf of legitimacy through unquestioning regurgitation of their crap, acceptance of the “legitimate questions” they raise, or straight-out editorializing in their favour, I think it’s fair to say that when journalists start pointing the finger at new media they’re either trying to shift the blame, or warn each other that their time is up. They certainly aren’t trying to improve the quality of public debate, because they and their political masters managed to debase that years ago.

It’s come to my attention recently that I’ve never actually written a comments policy, or stated what my privacy policy is on this blog. Even though very few people visit this tiny part of the internet, it may surprise both of you to discover that I have actually had to enact an element of my privacy policy before, and this makes me think that I probably ought to specify what it is for those of you who comment here. So here’s my privacy policy in (more than) three easy dot points:

1. I don’t demand real names or identification of any kind, though you’re welcome to use your real name and of course I encourage interesting screen names. Furthermore, I don’t demand that you provide a valid email address (one of my friends posts here with a pathetically obvious fake email address, that he should be ashamed of)
2. I will never reveal your identity publicly on the blog or privately, and no matter how much I disagree with your loathsome political views (let’s face it, you’re all worms) I won’t be cashing them in to your boss/wife/mistress/dog, because that kind of behavior is complete shit. If some neo-nazi gobshite turns up on my blog and gives the email address “[insert obviously real name]@metropolitanpolice.gov.uk”, that gobshite can rest assured that I won’t be telling the cops that they’re a nazi gobshite (though admittedly, giving that email address would be profoundly stupid – but if you weren’t profoundly stupid, you wouldn’t be a neo-nazi gobshite, would you?]
3. I’m a curious and kind of voyeuristic guy, so I might do a whois inquiry or google you or something, but I won’t reveal that information to others on the blog or privately. Furthermore, I discourage commenters from referring to people using details that haven’t been revealed online. If you know that commenter neonazigobshite is a woman because you shagged her at the last End Apathy! gig (you poor bastard!), that doesn’t mean you should reveal her gender here if she is trying to keep it ambiguous (some chicks do that). I’m also not going to get pissed with anyone for obvious stuff-ups in this regard (let’s face it, you guys are pretty stupid)
4. I see search terms that link to my blog, and if I find that someone is trying to identify you on google, or they have your identity and are trying to find out something about e.g. your political opinions or your online activity, I will do my best to tell you (I did this for someone once before)
5. If you are looking for a job/partner/friend/drinking buddy and you are worried about them googling you and finding out that you wrote something stupid on my blog (because, let’s face it, you did), then contact me and I will do my best to delete it and/or everything you ever wrote (your choice). I’m pretty lazy, though, so if you wrote a lot your chances of scoring a clean record are pretty low, plus there’s the wayback machine (but anyone who is small-minded enough to google you is probably not clued up to that stuff). Also note in this regard that if I discover someone hunting you out on google and I’m worried that what you’ve said here might endanger your job chances, I may unilaterally delete you from the internet. You can thank me later!
6. None of these considerations apply if you reveal that you have committed serious crimes, especially involving children. I’m not a priest!

Of course, a lot of this stuff is irrelevant because if you say anything really horrible I’ll just apply my comments policy, which is essentially: you’re free to say whatever you like, but I’m going to delete anything really nasty. I think if you review the comment threads on my Tolkien and Nazism or Tolkien and Fascism stuff you’ll see I’m pretty relaxed in my definition of “nasty.” I’ve never deleted a comment here before, but I’m sure one day I’ll have to.

I think it should be fairly obvious that this comments policy means I’m in favour of internet anonymity. I’m aware that this anonymity encourages rudeness but I have also seen a few situations where people online got into a lot of real life trouble – including losing jobs – because of the shitty behavior of other commenters and/or blog owners, and I don’t think that encourages decent debate (plus it’s really not very nice is it?). I don’t hide my identity, but I don’t flaunt it either, and that’s because I like to use this blog for exploratory or speculative thinking about topics related to my work, that I can’t do at work. I don’t want people thinking that what I say here represents either my fully-formed professional ideas (which are generally quite conservative) or my employer’s opinion of the same topics, and I also don’t want to make any claims to authority in what I present here. I think it’s better if people view me in terms of my nickname and treat my comments here with all the seriousness the nickname deserves (i.e. none). Also, a lot of what I talk about here blends sci-fi and politics and real life, and it’s easy for people googling someone to confuse that kind of speculative thinking with real opinions. I don’t want that to happen to me or you, so I’m happy to preserve your anonymity.

I know a lot of people on the internet think that anonymity is not one of its better qualities, but I disagree. I think debate can be enhanced by genuine anonymity, because people can say what they think without fear of work/loved ones/dogs discovering that they’re secretly an idiot. In general it hasn’t degraded the quality of debate here, there’s very little rudeness here and everything seems to be working out, but I certainly think that some of my commenters would be less inclined to, shall we say, engage in robust disagreement with me (you wankers) if they had to put their real names on the comments. So I’m going to preserve your anonymity. Although if the CIA come calling I’ll sell you down the river in a second – no one’s waterboarding me!

Oh, and on that note, I’m sure there are hundreds of people out there with great things to contribute who’ve been scared to on account of not knowing my privacy policy. So please, lurkers, delurk now! You are guaranteed anonymity! But not freedom from ridicule…

Gruumsh not think R help much like poetry. Gruumsh need use R to crush human foe. Gruumsh not like read help, but sometimes have to. Here help for round function, Gruumsh quote verbatim:

Note that for rounding off a 5, the IEC 60559 standard is expected to be used, ‘go to the even digit’. Therefore round(0.5) is 0 and round(-1.5) is -2. However, this is dependent on OS services and on representation error (since e.g. 0.15 is not represented exactly, the rounding rule applies to the represented number and not to the printed number, and so round(0.15, 1) could be either 0.1 or 0.2).

Gruumsh not trained statistician, but Gruumsh think this is big pile of steaming Ogre shit. Gruumsh check with Stata oracle. Stata rounds 0.5 to 1, not 0. Stata sensible god of numbers. Gruumsh not mathematician, but when Gruumsh round 0.15, Gruumsh expect 0.2. Gruumsh want to smash idiot that made IEC 60559 standard. Stupid jobsworth die slow nasty death under Gruumsh-club.

Today, doing a little task in R, I had cause to look up the following “warning” that appeared after compiling a script:

Warning message:
In readLines(file) : incomplete final line found

I couldn’t figure out what this warning meant, because the script ran fine, so I did a web search and I came across this exemplary example of why working with R really sucks: the help files are completely useless, the warning messages are cryptic and meaningless, the inbuilt editor is broken, there is no standardization of externally-developed editors, and the people who provide help online are some of the rudest people you will ever meet in computer science. This simple warning shows it all at once. I’ve complained about the dangers of R’s cryptic and meaningless warning messages again, but this example should really serve to show how they also cry wolf in a really unhelpful way.

The linked page is a message board of some kind (I think a reproduction of the “official” R boards on a another site) where a person called Xiaobo.Gu has posted up a request for help in decoding the above warning message. The request is polite enough though not voluminous, asking “Can you help with this?” but the first response (from someone with 7328 posts on this board!) consists entirely of the following:

Help with what? You got a warning. And it had information that should
tell you how to edit the file if the warning bothers you.

What is the point of a reply this rude and dismissive? This person actually took the time to reply to a post, in order simply to say “I won’t help you.” On a message board explicitly intended to help resolve problems with R. In addition to being rude it’s arrogant: there is no information abou thow to edit the file, just a pointer to the final line. We will shortly see the cause of the error, and it should be clear that no one in their right mind would consider the warning to have provided “information” of any form.

The next reply admonishes the original poster for failing to follow the posting rules (though doesn’t say how they were breached – so is essentially another contentless reply!) and then includes a little sneering aside about the way Windows encodes ASCII text that makes me think the developers of R have an elitist refusal to engage with Windows’s flaws. It then reveals that the warning is harmless and only appears in R version 2.14.0 (unpatched).

Why bother putting such a warning into a program? Whose idea was it to put a harmless warning in a single version of R, and why and how can a warning be a warning and also be harmless? Either something risky is going on, or it’s not. If it’s not, don’t waste my time with red text.

Finally another person comes along to sneeringly answer the question and provide actual information:

A warning message such as this could not be clearer.
It means that the last line of the file does not end with a <newline> sequence ==> the final line of the file is incomplete.

In an editor go to the end of that line and press <Enter> or <Return>
And save.

Alternatively configure your editor to always terminate the last line of a file with  a <newline> sequence.

This is a sparkling gem of passive-aggressive “help.” I can see a simple way in which the warning could be “clearer:” It could say “you did not press enter or return.” Then, it would be clearer. As it is, there is no information about what is missing in the final line: it just says it is “incomplete.” How can anyone claim that a warning such as this could not be clearer?

But then, just to top it off, this commenter has suggested that the poster configure their editor to “always terminate the last line of a file with a <newline> sequence.” This might seem to be reasonable advice, except that I get this warning in every script I write and I am using the built-in editor! This means that some muppet at C-RAN shipped a version of R with an editor configured to write scripts in such a way that they would trigger a warning. By default. Then, the very first patch they released got rid of the warning. wtf!? Is this what passes for quality control at C-RAN?

This is why wherever possible I use Stata for my work. I need software I can trust to produce the same results every time I run it, that isn’t going to waste my time with meaningless warnings and threats in glaring red, that isn’t configured to do things wrong by default, and that performs all calculations correctly. In order to trust that my stats software will perform all calculations correctly, I really need to know that the designers have some degree of basic quality control. When I see stuff like this – simple programmatic failings in things like the default settings of the script editor – I find it really hard to believe that the correct attention has been paid to, say, the way that the program performs adaptive Gaussian quadrature.

I also expect that the people who design this stuff will be polite when answering questions. I don’t need some passive-aggressive guy on the internet telling me off for failing to understand an extremely vague warning message that is only troubling me because C-RAN don’t have adequate quality control. The replies on that thread should have been polite requests for more information followed by an apology and a promise to fix this problem – or, if these people aren’t directly involved in C-RAN (and we know one of them is … one of R’s designers is on that thread) then a suggestion about how to alert the developers to the problem. Sneering and bullying – no thanks. I don’t get that when I contact Mathworks for help with Matlab, no matter how stupid my request.

This is why when I teach my students about stats packages I tell them a) you can’t trust R and b) it has a nasty community. I teach them its value for automation and experimental stats, and warn them away from using it for anything that has to be published in serious journals.

I think R is just another example of how dangerous it is to run your business on open source software, though I’m sure there are times when it’s safe. And I think it would be fascinating to see a detailed textual analysis comparing the message boards of an open source community (linux, R, latex) with a proprietary product like Stata, because in my experience there’s a world of difference between the two communities. Why  that difference exists would not only be a fascinating anthropological study, but would no doubt be of relevance to the scientific study of neckbeard behavior, because I have a strong suspicion that neckbeards are the dominant species in the open source world. Will an anthropologist somewhere take on the task?

Having criticized the approach the UK government is taking to reforming the NHS, it seems only fair that I should make a few suggestions of my own. Unburdened as I am by the responsibility to be serious or to come up with a proposal that actually works, I’m going to write up a few perhaps crazy suggestions this week and next. For my reform ideas, I’ve decided to set the following arbitrary constraints:

• The basic remit of the NHS must not change: that is, any reform plan must preserve the ability of the NHS to provide quality care accessible to all and free at the point of delivery
• The patient experience must not be changed, so that if a reform plan were enacted wholesale today, a patient attempting to use the health system tomorrow would not notice any practical effect on their lives or patient experience[1]
• As much as possible, red tape and administrative barriers to healthcare access should be reduced at the level of the patient, so e.g. we should try to abolish lists and restrictions on hospital attendance
• The system should allow cost containment
• Where possible, the system should reduce inequality, or at least not make the current system worse

I will of course add extra rules wherever possible.

The four ideas I have so far are:

• Radical privatization, which looks too good to be true and probably is (this is essentially a radical shift to a Japanese-style marketplace but with no private up-front payments)
• Minimal privatization, in which minor changes are made to the hospital system to allow new entrants and private investment (essentially the Australian model hospital system tacked onto the British GP system)
• A license system, with trade in licenses slowly opened up to allow increased privatization and resource reallocation (this is completely new but probably just a mechanism to achieve a mixture of the other three ideas)
• Reform of the GP market only, to significantly improve the function of the primary care system while leaving the tertiary care system unchanged (essentially, the Australian model)

I hope these ideas will show that it’s possible to radically change the structure of the NHS without changing its essential relationship between patient and system, its fundamental funding arrangements or its main outcomes. I don’t claim that any of my ideas will work, of course, nor do they have to since I’m writing on a blog. But I suspect that even the most minimalist of them would be politically unpalatable in the UK now (and even more so when the Tories stuff up their current round of reforms).

Any other ideas in comments would be appreciated, and I’ll try and write them up too!

fn1: This rules out care budgets and vouchers and some of the crazier ideas floating around in the UK and USA, that require patients to become active participants in health service planning

Saturday night was boxing’s equivalent of a neckbeard giving a naked reading of Carcosa on Sesame Street. It was the chavtastic moment when the final nail was hammered into the coffin containing heavyweight boxing’s credibility. The first hint of the sport’s rapid decline was evident when Tyson returned from prison to “knock out”  a series of patsies; it looked beyond salvation when that same man turned cannibal; but briefly under the rein of the Klitschkos we could all pretend that it had regained some life. But on Saturday night, surely, the sporting public gave up on the farce that is the “sport” of heavyweight boxing, as two classic representatives of everything that is wrong with modern Britain re-enacted a classic Friday night in Guildford, while the only civilized representatives of the sport looked on in horror and barely-disguised scorn.

Of course, the brawl was just the sad end of a sorry series of events, any one of which would have seen the end of a man’s career if perpetrated in a less forgiving, more reality-based sport. The scene was the face-off between the 40 year old Vitali Klitschko (46 fights, 44 wins, 40 KOs), “Dr. Ironfist,” from the Ukraine fighting out of Germany; and 28 year old Dereck Chisora (18 fights, 15 wins, 10 KOs), whose win record is lower than Klitschko’s knockout rate. Klitschko is one of a pair – between him and his younger brother Wladimir they own all the titles in heavyweight boxing – and the talent is so thin on the ground that they have to stoop to beating up men like David Haye, the third leg in Saturday night’s sad showdown. Chisora, perhaps hoping to psyche out the un-psychable Ukrainian machine, Chisora engaged in a series of pre-fight antics that would embarrass anyone with any taste: first he slapped Vitali Klitschko at the weigh-in; then, he spat water in Wladimir Klitschko’s face during the pre-fight introductions. In between this, he refused to allow Wladimir to witness his hand-wrapping, which required some sensitive negotiations and led to a delay in the fight. The Klitschko’s response to this behavior was typically level and measured: after the slap, Vitali was heard to say “You’re fucked now Dereck, you really are fucked,” but otherwise didn’t do much (and revealed in the post-fight press conference that he wasn’t able to knock Chisora out because his right hand was injured). The video of the water-spitting incident shows Wladimir (59 fights, 56 wins, 49 KOs) licking his lips and giving a tight little smile, but no other response – this man is his brother’s prize, and there’s a lot of money at stake, so he restrains himself from taking revenge on a man who is so clearly beneath his regard.

Really, these are not men you want to anger. And it’s a sad indictment of the management of the sport that Chisora even tried: had he engaged in either of those antics before a rugby match, he would certainly not have been allowed to play, and would most likely have been banned for life. The press is talking about 6 months for Chisora, and only because of what happened at the post-fight press conference.

It was at the post-fight conference that we really saw how much British boxing has lost of the dignity it built up under Bruno, Hollyfield and Lewis. Klitschko’s promoter was asked if he would bother with any more British contenders, given the behavior of Chisora and Wladimir’s previous opponent, David Haye, who famously promised to “hospitalise” Wladimir and taunted him continuously in the weeks leading up to the fight, but then put in a terrible performance on the night, that he blamed on a broken toe. The promoter said he would look elsewhere, but was interrupted by the infamous (now retired) Haye himself, from the back of the conference, demanding a fight with Vitali. The promoter’s response, in perfect English: “You don’t get to fight anyone. Chisora showed his face, you just showed your toe.” Chisora’s promoter then suggested a face-off between Chisora and Haye, with the winner to face “a Klitschko” (like a penitent at the altar of boxing …) Haye’s response: Chisora had already lost 3 fights in a row, so why should Haye bother? Chisora took offence to this and walked up to Haye, demanding that Haye “say it to his face.” And so the schoolboy brawl commenced, and ended with Haye swinging a camera tripod around and nearly braining his own trainer. In the video you can see, while all this is happening, Klitschko standing on the podium like some gentle giant, sneering down at his defeated British opponents as they brawl with each other over their own failings, like spoilt children.

This is British boxing in the new millenium: being sneered at by civilized, educated boxers from Europe. There is no talent left in Britain that the Klitschkos will deign to face, and even if there were, on reputation alone the British are best left well outside the ring, brawling in car parks where they belong. Britain has always been one of the top two countries for heavyweights, and British heavyweights have carried the sport with a certain dignity and poise, but in just 10 years the division has been dragged into the gutter by its reprehensible promoters and fighters.

The problem for those of us who enjoy a fighting art mirrors, in many ways, the problems role-playing faced in the 80s through accusations of satanism and addiction. Those of us who enjoy boxing and understand it know that it is a thing of beauty when done properly, but for those looking in from the outside it clearly resembles nothing more than a sanctioned brawl, in which barely-civilized men pound the crap out of each other for excessive amounts of money. We ask them to trust us that this sport is more than mere barbarism, and we point to its elements of discipline, courage and respect – which we like to hope are more than just a silly myth – as evidence that it is worthy of a little more respect than mere brawling. We also want people to think it’s not a particularly dangerous sport – which compared to Rugby it probably isn’t – and we point to the strict adherence to rules of combat as evidence of this. But it’s kind of hard for the general public to believe us when they see the sports peak performers bashing each other with camera tripods and threatening “I’ll fucking shoot him.” It’s the Carcosa problem, in essence, only being played out in front of the cameras on national TV. And it has a spillover effect: as UFC is gaining popularity and professionalism, its more popular cousin, boxing, is making fighting arts look like uncivilized brawling. How is UFC going to make headway then? And how will we be able to, for example, over turn bans on women fighting (often justified on the basis that it’s “uncivilized”) when the men at the top of the art are doing their best to encourage a ban on anyone fighting?

Some promoters have clung onto another great stereotype of the sport that I think has been used to gain it respect it probably never deserves: the “rescuing urban yoof” myth, that boxing offers working class and poor kids “a way out” and offers youth involved in gangs and crime a way to reform and learn to respect themselves and others. Watching the behavior of Haye and Chisora, and comparing it with PhD-endowed Vitali Klitschko, the conclusion is obvious: education makes men better, boxing makes criminals more dangerous. Society might consider itself well-served in asking: perhaps instead of sanctioning these poor kids’ efforts to beat each other up in the ring, we should ban men like Chisora’s trainer from being allowed to teach poor kids from deprived neighbourhoods any skills that might in any way resemble what we see on display in that video? Because it doesn’t appear to have improved their respect for themselves or others, or their wit: it’s just made them bigger and nastier. Perhaps they might be better off staying away from the boxing gym and doing their homework …?

With this sad display, boxing joins the long list of activities that Britain invented or codified, but lost out on to the rest of the world through indiscipline, inequality and poor education. Other notable activities that went this way are:

• Naval warfare (to the Japanese and then the Americans)
• Cricket (to Australia)
• Rugby (to the Antipodes, but increasingly, just about anywhere)
• Soccer (to everywhere else)
• Statistics (to India, and then the rest of the Commonwealth, and the USA)
• The English language (to the Commonwealth)
• Heavy Industry (to Germany, Japan and the USA, and now China)

I guess so long as they have the Falklands, the British can still lay claim to being the masters of colonialism. It’s important to be good at something, after all! But it’s a long and sad decline that Britain has gone through since the end of the war, and boxing, though hardly likely to be the thing British society will most miss, has now sadly been outsourced to Mexico and the Ukraine. What have the British got left to lose?

Everything she can do, he can do better

I’ve started reading John Carter of Mars, by Edgar Rice Burroughs, in anticipation of what looks like a very fun movie, but I have to say that even though the story is interesting the writing is absolutely appalling. It’s classic Mary Sue, with a character who is just better than everyone else at everything and obviously already knows his way through the plot, as if he were in fact the writer of the story himself. It also uses the classic “tell, don’t show” error of teenage fanfiction. Reading it is a tedious exercise in admiration of a two-dimensional hero.

The basic story is simple: John Carter, ex-slave owner and “Southern Gentleman,” finds himself accidentally on Mars, where he is thrown into the middle of the ongoing conflict between two races who have been reduced to hard scrabble in a failing environment. Mars (or “Barsoom,” as the locals call it), used to be the home of a great race of human-like peoples, who slowly fell into decay as the environment of Mars failed. Another race appears to have decided to live communally on the land and, as commies are wont to do, degenerated into barbarism and cruelty. The descendants of the great race – red skinned humanoids – have great technology and are trying to save the planet, while the savages – weird buggish freaks – run around being cruel and nasty. John Carter lands amongst the savages, but immediately impresses them with his prowess at everything, and though a captive of these savages manages to get himself appointed a chieftain (through combat, of course) and is given wardenship of one of their prisoners, who of course is an extremely important member of the red-skinned people. He is also given a couple of women to look after him, and one of these just happens to be the only kind and thoughtful savage on Barsoom.

So, having accidentally disappeared from his own world, with its rich 19th century culture of slave-holding and subjugated women, where he is a much-admired and respected man, Carter finds himself on a completely alien world with different culture and language, but within a couple of seconds finds himself much-admired and respected, and lording it over a small collection of women – purely by dint of his talents, of course.

This could be a fun read, I suppose, like a kind of sexless version of Gor, but for the fact that John Carter is a tedious, insufferable braggart who is good at everything and never makes an error. And oh, how we are constantly reminded of his talents. For example:

To be held paralzyed … seems to me the last word in fearsome predicaments for a man who had ever been used to fighting for his life with all the energy of a powerful physique

or:

I do not believe that I am made of the stuff which constitutes heroes, because, in all of the hundreds of instances that my voluntary acts have placed me face to face with death, I cannot recall a single one where any alternative step to that I took occurred to me until many hours later … I have never regretted that cowardice is not optional with me

and following this up:

Fear is a relative term … but I can say without shame that if the sensations I endured during the next few minutes were fear, then may God help the coward, for cowardice is of a surety its own punishment

In case you hadn’t noticed, John Carter is a robust fighter who never feels fear and acts automatically out of a sense of duty. These quotes are from the first few chapters but Burroughs isn’t tardy about letting us all know that John Carter is the best, y’all: his manifold perfections are outlined in a foreword. But just in case you thought Carter might just be the 19th century equivalent of a great sportsman, we are also reminded that he is a consummate warrior, and a genius to boot. In training with the savages weapons, we find:

I was not yet proficient with all the weapons, but my great familiarity with similar earthly weapons made me an unusually apt pupil, and I progressed in a very satisfactory manner

Oh! The modesty! Also, within a few days of joining the savages, John Carter has befriended his watchdog in a way that no martian has ever done before, and has taught the martians better ways of managing their own mounts, and mounted combat, so that they are both better able to manage their mounts and better able to fight en masse. This despite the fact that he is unfamiliar with martian gravity and doesn’t speak their language. Not that the latter bothers him much:

in a week I could make all my wants known and understand nearly everything that was said to me. Likewise, under Sola’s tutelage, I developed my telepathic powers so that I shortly could sense practically everything that went on around me.

This, incidentally, is the entirety of the coverage that the existence of telepathy gets in this work for the first 8 or so chapters. We’ve had more sentences devoted to the production of the milk Carter drinks than to the telepathy he learns. It’s not, however, the last time that Carter gets a chance to remind us that he is a genius:

I nearly drove Sola distracted by my importunities to hasten on my education and within a few more days I had mastered the Martian tongue sufficiently well to enable me to carry on a passable conversation and to fully understand practically all that I heard

Here is an example of a conversation he could understand “within a few more days”:

In our day we have progressed to a point where such sentiments mark weakness and atavism. It will not be well for you to permit Tars Tarkas that you hold such degenerate sentiments, as I doubt that he would care to entrust such as you with the grave responsibilities of maternity

So, one week to learn how to say “I need to take a leak,” another few more days to get to the point of understanding an overheard conversation about “atavism.” Also, telepathy in one sentence. And nowhere in this time period is there a hint, even a single hint, of homesickness, or any kind of emotional trauma at having teleported out of a cave in Arizona to a field on Mars. Do you feel small yet? Or are you, more likely, bored stiff with this character who can do everything and anything?

In addition to being a robust Southern Gentleman who can learn martian in a day, Carter also seems to have remarkable luck to take exactly the right path in any situation. He hears someone behind him, so instead of attacking, he jumps, which impressed his attackers rather than getting him killed; he gives his horse its head in the darkness, which is just as well because it leads him up just the right path to escape the Indians; he makes a guess about the best way to impress the natives and – lo! – it was the right guess. Within about a chapter of the start of the adventure it has been well-impressed upon the reader that, no matter what, Carter is not at risk of significant injury, failure or death. As the reader, you have nothing invested in the story at all – it’s not like Carter is going to ever have to overcome a failing or character flaw (he has none), there’s no sense in which his plight is the same as yours would be if you ended up on Mars, and there’s never a feeling that he will make a bad choice, even by accident.

This apathy is further entrenched by the narrative flow, in which Burroughs tells us everything we need to know about the society, environment and structure of Mars long before Carter himself finds out the details. Rather than discovering the mysteries of Mars in the flow of the adventure, we’re told everything about a setting, person, circumstance or technology as soon as we encounter it. The phrase “As I later learned,” or “as I was to discover,” appears constantly in the text – maybe a couple of times every chapter, and always expounds on things we could quite happily find out ourselves with a bit of time. Thus, we only know we are somewhere mysterious because we are told we are on Mars: from the very moment of his arrival there, Carter’s narrative breaks the mystery of the planet with constant references to things that neither he nor the reader know. We even get a lesson in Martian demographics in the second chapter of his encounter with the savages, something that really could have waited to be revealed to us later in a conversation with someone.

This kind of adventure writing is so tedious as to be almost unbearable. The plot itself is interesting – I want to find out about Mars and the society Burroughs has created, and I want to see where the story goes. It’s a really good idea that, in the hands of a decent writer, would make a really cool story. I’m guessing, then, that the movie is going to be good. But the book – thoroughly forgettable so far. It reminds me of John Wyndham’s pompous academic Mary Sues, who always take a young woman under their wing and teach her the harsh realities of the world, while she constantly thanks them in breathless wonder at their wisdom; or the later books of Dune, after whats-his-face becomes a god and surmounts every challenge by simply being himself. No challenge, no threat, no sympathy with a human character, no need for character development and no sense that the character will ever grow as a person through adversity. Of course, this may change later, but at the moment it’s looking like the writing is going to be drier than the surface of Mars.

So, unless you’re feeling really patient, I can’t recommend John Carter of Mars. Is the rest of Burroughs’s work this badly written?

Today I am celebrating my first publication in my new job, and since it’s about a topic I’ll probably be coming back to a lot in the next year, I thought I’d cover it here. It’s not much of a publication – just a letter in the journal Addiction – but it covers what I think is an interesting topic, and it shows some of the complexity of modern health policy analysis. The article, entitled Equity Considerations in the Calculation of Cost-Effectiveness in Substance Use Disorder Populations[1], can be found here[2]. It’s only 400 words, but I thought I’d give an explanation in more detail here, and explain what I’m trying to say in more detail. The background I’m presenting here may be useful for some future material I’m hoping to post up here. I’ll give a brief overview of the “cost effectiveness” concept, explain what the problem is that I’m addressing in this paper, and then give a (slightly) mathematical example in extremis to show where cost-effectiveness analysis might lead us. I’ll also add some final thoughts about cost-effectiveness analysis (CEA) in fantasy populations, with perhaps a final justification for genocide. Or at least an argument for why Elves should always consider it purely on cost-effectiveness grounds.

Cost-Effectiveness Analysis, QALYs and the IDU Weight

Traditional epidemiological analysis of interventions is pretty simple: cholera, for example, kills X people, so let’s prevent it. However, we run into problems when we have limited resources and need to compare two different interventions (e.g. turning off a pump vs. handing out disinfectant pills). In this situation we need to compare which intervention is more effective, and we do this by assessing the cost per life saved under each intervention – if turning off the pump is cheaper and saves more lives, then it’s better. This is usually represented mathematically as the ratio of the cost difference between the intervention and some control (the incremental cost) and the effect difference (the incremental effects). The ratio of the two is the incremental cost effectiveness ratio (ICER). This is what I used in assessing clerical interventions to prevent infant mortality. However, when we are dealing with chronic diseases the incremental effects become harder to measure, because a lot of interventions for chronic illness don’t actually save lives: they extend life, or they improve the quality of life a person experiences before they die. In this case we use Quality-Adjusted Life Years (QALYs). These are usually defined by conducting a study in which people are asked how they would weight a year of their life under some condition relative to fully healthy – or, more usually, relative to their health as it is now. For example, blindness in one eye might be rated a QALY of 0.9 relative to being fully-sighted. There is some interesting debate about whether these ratings should be assessed by those who have the condition or the community as a whole; the logic here can be perverse and complex and is best avoided[4].

So in essence, you rate one year of life as having the value of 1 when fully healthy, and then other states are rated lower. We can use the issue of Voluntary Testing and Counselling as an HIV intervention to see how this works.

Example: Voluntary Testing and Counselling

It’s fairly well-established that good post-test counselling can successfully reduce a person’s risk behavior, so if you can get people at high risk of HIV (e.g. men who have sex with men (MSM)) to undergo voluntary testing, you can catch their HIV disease at an early stage and get them to change their behavior. In theory, doing this fast enough and effectively will reduce the rate at which HIV spreads. Furthermore, catching HIV earlier means initiating treatment earlier (before it becomes symptomatic), and early treatment with anti-retroviral drugs leads to longer survival[5]. However, discovering one is HIV positive is not a pleasant experience and knowing you are HIV positive lowers your overall quality of life, even if the disease is asymptomatic. So if the survival benefits of early testing don’t outweigh the loss of utility, then it’s not worth it. So 10 years ago, when treatment extended your life by perhaps 10%, but testing reduced your remaining QALYs from 1 to 0.9, then the benefits might not outweigh the costs. Additionally, treatment is expensive, and it might be more cost effective on a population level to run health promotion campaigns that reduce risk behavior: reduced risk behavior means less infections, means less QALYs lost to HIV.

In essence, it’s a kind of rigorous implementation of the old bar room logic: sure I’d live longer if I didn’t drink, but why would I want to?

Recently, however, some analysts have introduced a sneaky new concept, in which they apply a weight to all QALY calculations involving injecting drug users (IDUs). The underlying logic for this is that IDU is a mental illness, and people with a mental illness have a lower utility than people without. This weight is applied to all QALY calculations: so a year of life as a “healthy” IDU is assigned a value of, e.g. 0.9, and all other HIV states (for example) are given a value of 0.9 times the equivalent values for a non-IDU.

What is Wrong with the IDU Weight

This has serious ramifications for cost-effectiveness and, as I observe in my article, fucks up any attempt to get a cost-effectiveness analysis past the British NICE, since it breaks their equity rule (for good reason). In addition to its fundamentally discriminative nature, it’s also technically a bit wonky, and in my opinion it clouds cost effectiveness analysis (“which treatment for disease X provides better value for money?”) with cost-benefit analysis (“who should we spend our money on?”). It’s cool to do the latter vs. the former, but to cloud them together implicitly is very dangerous.

Technical Wonkiness

Suppose you have a population of IDUs with a weight of 0.9, and you need to compare two interventions to prevent the spread of HIV. One possible intervention you could use is methadone maintenance treatment (MMT), which is very good at reducing the rate at which IDUs take injecting risks. You want to compare this with some other, broader-based intervention (e.g. voluntary testing and treatment, VTT, which also affects MSM and low-risk people).  Then the average QALY for an MSM with asymptomatic HIV is about 0.9 (to pick a common value). Because you’ve applied the weight to IDUs but not to (e.g.) MSM, the average QALY for an IDU with asymptomatic HIV is 0.9*0.9=0.81. Now suppose that you implement MMT: this intervention reduces the risk of transmission of HIV, but it also treats IDU’s mental illness, so the weight for all the successfully-treated IDUs drops away and you gain 0.09 QALYs per IDU you treat; but then you gain 0.1 additional QALYs for every case of HIV prevented by the MMT intervention. This means that VTT has to be almost twice as effective as MMT to be considered cost effective, if they cost roughly the same amount. That is, in this case the cost-effectiveness of MMT is exaggerated relative to VTT by dint of your weighting decision – even though half of the benefits gained don’t actually have anything to do with reducing the spread of HIV (which implies you can prevent half as much HIV for the same QALY gains). On the other hand, if you implement an intervention that doesn’t treat IDU but does prevent HIV in IDU (such as needle exchange), its effectiveness will be under-estimated due to the IDU weight. In both cases, introducing the cost-benefit element to the analysis has confused your outcome.

Opening Pandora’s Box

The real problem with this IDU weight, though, is if we decided to extend the logic to all cost-effectiveness analysis where identifiable groups exist. For example, we could probably argue that very old people have lower QALYs than younger people, and any intervention which affects older people would gain less benefit than one which affects young people. An obvious example of this is anything to do with road accidents: consider, for example, mandatory eye testing vs. raising the minimum driving age. Both would result in lower rates of injury (and thus gain QALYs) but the former would primarily affect older people, and so would be assigned lower effectiveness, even if it prevented a hugely greater number of injuries[6]. When we start considering these issues, we find we’ve opened Pandora’s box, and particularly we’ve taken ourselves to a place that no modern health system is willing to contemplate: placing a lower value on the lives of the old, infirm, or mentally ill. As is often the case with social problems, the marginalized and desperate (in this case, IDUs) are the canaries in the coalmine for a bigger problem. I don’t think any health system is interested in going down the pathway of assigning utility weights to otherwise healthy old people (or MSM, or people with depression, or…)

An Example in Extremis

Let’s consider an obscene example of this situation. Suppose we apply a weight, let’s call it beta, to some group of recognizable people, who we call “the betamaxes.” Now imagine that these people are the “carriers” for a disease that doesn’t afflict them at all (i.e doesn’t change their quality of life) but on average reduces the quality of life of those who catch it to a value alpha. Suppose the following conditions (for mathematical simplicity):

• The people who catch the disease are on average the same age as the betamaxes (this assumption makes comparison of life years easier; breaking it simply applies some ratio effects to our calculation)
• The disease is chronic and incurable, so once a member of the population gets the disease their future quality of life is permanently reduced by a factor of alpha
• One betamax causes one case of disease in his or her life
• Preventing the disease is possible through health promotion efforts, but costs (e.g.) \$10000 per disease prevented
• Betamaxes are easily identifiable, and identifying and killing a betamax costs \$10000

I think we can all see where I’m going here. Basically, under these (rather preposterous) conditions, identifying and killing betamaxes is a more cost-effective option than the health promotion campaign whenever alpha>1-beta. Obviously permanent quarantine (i.e. institutionalization) could also be cost-effective.

This may seem like a preposterous example (it is), but there’s something cruel about these calculations that makes me think this weighting process is far from benign. Imagine, for example, the relative QALY weights of people with dementia and their carers; schizophrenia and the injuries caused by violence related to mental health problems; or paedophilia. I think this is exactly why health systems avoid applying such weights to old people or the mentally ill. So why apply them to IDUs?

Cost-Effectiveness Analysis in Fantasy Communities

There’s an obvious situation where this CEA process breaks down horribly: if you have to apply it to elves. Elves live forever, so theoretically every elf is worth an infinite amount of QALYs. This means that if a chronic disease is best cured by drinking a potion made of ground up human babies, it’s always cost-effective for elves to do it, no matter how concentrated the baby souls have to be. If a human being should ever kill an elf due to some mental health problem, then it’s entirely reasonable for the elven community to consider exterminating the entire human community just in case[7]. Conversely, any comparison of medical interventions for chronic disease amongst elves on cost-effectiveness grounds is impossible, because all treatments will ultimately produce an infinite gain in QALYs: this means that spending the entire community’s money on preventing a single case of HIV has an incremental cost effectiveness of 0 (it costs a shitload of money, but saves an infinite number of QALYs). But so does spending the entire community’s money to prevent a single case of diabetes. How to compare?

Similar mathematical problems arise for Dwarves, who have very long lives: you’d have to give them a weight of 0.25 (for being beardy bastards) or less to avoid the same problems vis a vis the use of humans in medicinal treatment that arise with elves.

This might explain why these communities have never gone for post-scarcity fantasy. When you have an infinite lifespan, no intervention of any kind to improve quality of life is cost-effective. You might as well just live in squalor and ignorance, because doing anything about it is a complete waste of money.

Cost Effectiveness Analysis as a Justification for Goblin Genocide

Furthermore, we can probably build a mathematical model of QALYs in an AD&D world: some people have better stats than others, so they probably have better quality of life. We could construct a function in terms of the 6 primary stats, and obviously goblins come out of this equation looking pretty, ah, heavily downward weighted. Given that they lead short and brutish lives, and are prone to kill humans when the two communities interact, the obvious effect of weighting their QALYs from this mathematical model is pretty simple: kill the fuckers. The QALY gains from this (and the low cost, given the ready availability and cheap rates of modern adventurers) makes it a guaranteed investment. In fact, compared to spending money paying clerics to prevent infant mortality, it could even be cost-effective.

Conclusion

Cost-effectiveness analysis needs to be applied very carefully to avoid producing perverse outcomes, and the logical consequences of applying weights to particular groups on the basis of their health state are not pretty. We should never weight people “objectively” to reflect their poor health in dimensions other than that under direct consideration in the cost-effectiveness analysis, in order to avoid the risk of applying a cost-benefit analysis to a cost-effectiveness situation. Furthermore, even if we are comfortable with a “discriminatory” weight, of the “oh come on! they’re just junkies!” sort, it can still have perverse outcomes, leading to over-estimates of the cost-effectiveness of treatments for the mental illness compared to other interventions. Furthermore, we should never ever ever allow this concept to become popular amongst elven scholars.

I’ll be coming back to this topic over the next few months, I think, in a way I hope is quite entertaining for my reader(s). Stay tuned…

fn1: The slightly cumbersome title arose because the journal now doesn’t like to refer to “substance abuse” or “substance abusing populations” so I had to change it to the un-verbable “Substance Use Disorder”

fn3: Which is a contradiction in terms, surely?

fn4: For a full explanation of this and other matters you can refer to the famous text by Drummond, which is surprisingly accessible

fn5: In fact we are now looking at very long survival times for HIV – up towards 30 years, I think – provided that we initiate good quality treatment early, and so it is no longer necessarily a death sentence, if one assumes a cure will be available within the next 30 years

fn6: This applies even if you ignore deaths and focus only on short-term minor injuries, and thus avoid the implicit bias in comparing old people with young people (interventions that save life-years in old people will always be less “effective” than those that save life years in young people, unless the effect of the intervention is very short-lived, because old people have less years of life to save).

fn7: In fact you can go further than this. All you need is for an elven propagandist to argue that there is a non-zero probability that a single crazy human will kill a single elf at any point in the future, and the expected value of QALYs lost will always be greater than the QALY cost of killing all humans on earth, no matter how small the probability that the human would do this

I am reading the Warlord Chronicles by Bernard Cornwell at the moment. I’m really enjoying it and will have more to say when I’m done, but as an initial thought I would like to mention that I am struck by how much like a Daily Mail reader Merlin is. He wants to purge all foreigners from Britain, thinks their religions are savage and weak even though his own is pretty debauched, appears to be pretty fast and loose with his own faith when it suits him, and enjoys shagging women much younger than himself. Sure, the Saxons are actually a violent and bloodthirsty race but I’ve yet to see any sign of anything except moral equivalence in the story. The only thing they’ve done worse than the Britons so far is to paint their shields with blood. And in any case, when did the facts about foreigners sway a Daily Mail reader’s views?

Arthur, on the other hand, is clearly a Guardian reader. He accepts all religions and wants peace, and won’t do anything barbaric himself, but is too much the moral relativist to do anything about the terrible behavior of his fellow tribesmen, and obviously has a wide streak of viciousness himself when push comes to shove. Polly Toynbee with a sword, that is. Also, he likes to think he’s all about peace and justice but you’ll never catch him genuinely doing anything radical to overthrow the accepted order of things.

I guess that means Nimue reads the Sun, and Lancelot – like Elle McPherson – has never read anything he didn’t write himself. The rest of them don’t seem to be able to read at all, or maybe they only buy the Daily Mail for the crossword, so I suppose nothing’s really changed in 1500 years. You were a failure, Arthur, face it!

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