Seth's Blog

A few years ago, Gawande wrote two articles in The New Yorker about medical innovation: The Score (about Apgar scores) and The Checklist. Since then, he has done actual research promoting the use of checklists and this book (which I got free from the publisher) is mostly the story of his contribution, with sidebars about the origin of checklists in aviation and their use in building construction. The word checklist suggests that it is all about making sure certain things get done but Gawande takes pains to say that is only half of it. The other half is helping people who don’t know each other work together — by having them introduce themselves and by making sure everyone is heard.

Use of checklists, judging by the results, is a big advance and for that reason alone this would be a solid book — the story of one person’s part in an important innovation. I am sorry he didn’t tell parts of the story that reflect badly on others — such as the Office of Human Research Protections decision that Johns Hopkins research must be stopped immediately because introducing checklists and tracking their effectiveness was dangerous. (Doctors might be embarassed by the results!) I wouldn’t expect a Harvard Med School prof to get nauseous with rage, the way Richard Harris, an earlier New Yorker writer, appropriately did in A Sacred Trust (how the AMA tried to block Medicare), but every story needs a villain. And there are plenty of villains in American medicine.

The book’s website, including Steve Levitt’s review.

1. You don’t need a starter culture (often called a scoby). You can make one from store-bought kombucha. I let a cup of Rejuvenation kombucha sit in a wide-mouth jar at room temperature, covered with a paper towel. After two weeks, a thin film had formed on the surface, easily transfered to a tea-sugar mixture. More This didn’t work! The culture grew poorly. It might have worked to just pour the Rejuvenation kombucha into the tea-sugar mixture.

2. My friend Carl Willat has used empty Synergy kombucha bottles to bottle kombucha he makes himself. By bottling your kombucha, and leaving it at room temperature for a few days, you get carbonation.

Jonah Lehrer writes:

We travel . . . because distance and difference are the secret tonic of creativity. When we get home, home is still the same. But something in our mind has been changed.

He’s wrong about animal fat (“the taste for saturated fat, one of those instincts we should have left behind in the Pleistocene epoch”) but he’s right about that. A trip to Amsterdam is why I have a scooter. It’s so much better than a bike or a car. Only after visiting Amsterdam did I figure this out. The Shangri-La Diet came out of a trip to Paris. Living in Beijing half the year is somewhere between emigration and travel but whatever you call it it has opened up a whole new world. (Whether this will make me more scientifically creative remains to be seen. It certainly makes blogging easier.) My study of the faces/mood effect showed that travel changes something in the brain in a bad way: The light-sensitive oscillator involved takes about three weeks to fully recover from a big change in time zones. The effect takes three weeks to regain full strength, which is longer than it takes sleep to appear normal.

I liked David Owen’s new book, Green Metropolis (free copy from publisher), as much as I thought I would. Owen critidizes a large fraction of the environmental movement for missing the point that big cities like New York are the greenest communities in America. To make a community green you need two things: high density and great public transportation. They go together: high density makes great public transportation possible. In large chunks of New York, unlike most big American cities, it’s easy to not have a car.

The book has plenty of villains. Bill McKibben has written many books: one about global warming, one about cutting back on consumerism, one about having only one child (to save the earth from overpopulation), one called Hope, Human and Wild about environmentalism — yet he lives in a small town in upstate New York, which requires him to use a lot of energy for heating and travel that he wouldn’t have to use if he lived in New York City. (McKibben is my example, not Owen’s.) A great many environmentalists, Owen says, have causes or goals that have little to do with reducing energy use. They tend to see themselves as preserving the past rather than shaping the future — an excellent point. That’s something Jane Jacobs might have said and if the book has a hero, it’s her. “Jacobs’s focus was on the vibrancy of city life but the same urban qualities she identified as enhancing human interaction also greatly reduce energy consumption and waste,” Owen writes.

Owen sees himself almost as deluded as the average environmentalist. He and his family moved from Manhattan to rural New England when their daughter was one year old. How she will love the country, thought Owen. She didn’t. Walking through the country bored her far more than walking through the city. “And it [a country walk] usually has the same effect on me, although I hate to admit it,” he writes.

Why did my self-experimentation discover a lot? Because a lot remained to be discovered. The discoveries I made weren’t made by the experts who should have made them (e.g., sleep experts)  because they were too busy doing research whose main goal was to impress other people. Rather than do science that worked, they did science that looked good. It’s the same with environmentalists. Rather than do projects that work (save energy), they do projects that feel good. “Sitting indoors playing video games is easier on the environment than any number of (formerly) popular outdoor recreational activities, including most of the ones that the most committed environmentalists tend to favor for themselves,” says Owen, neatly summing up the problem.

Beijing has far more hot pot restaurants than you’d ever guess from Chinese restaurants in America. There are about ten restaurants on the Tsinghua campus; one of them is a hot pot restaurant. Judging from this passage in an article about Beijing hot pot restaurants, some aspects of restaurant reviews (“don’t forget”, semi-humorous derogatory comparisons) are universal:

And don’t forget the wan or spheres of hashed protein, often how fish and seafood find their way to the table.Wise up in cheaper establishments and be warned that some meatballs [i.e., fishballs] can have a texture as if they bounced off the courts of Wimbledon, so avoid them unless you’re in a reputable safe house.