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Health Insurance Test for Green-Card Applicants Could Sharply Cut Future U.S. Legal Immigration

A new Trump administration action requiring intending immigrants to prove they can purchase eligible health insurance within 30 days of arrival has the potential to block fully 65 percent of those who apply for a green card from abroad, MPI estimates.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar MPI experts discuss their estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They also discuss the broader consequences of the public-charge rule implemented in February 2020, through its "chilling effects" and imposition of a wealth test aimed at assessing whether green-card applicants ever would be likely to use a public benefit in the future. 




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The Public-Charge Rule: Broad Impacts, But Few Will Be Denied Green Cards Based on Actual Benefits Use

While the Trump administration public-charge rule is likely to vastly reshape legal immigration based on its test to assess if a person might ever use public benefits in the future, the universe of noncitizens who could be denied a green card based on current benefits use is quite small. That's because very few benefit programs are open to noncitizens who do not hold a green card. This commentary offers estimates of who might be affected.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar, MPI experts discussed the public-charge rule and released estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They examined the far larger consequences of the rule, through its "chilling effects" and imposition of a test aimed at assessing whether green-card applicants are likely to ever use a public benefit in the future. And they discussed how the latter holds the potential to reshape legal immigration to the United States. 




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As U.S. Health-Care System Buckles under Pandemic, Immigrant & Refugee Professionals Could Represent a Critical Resource

In a time of critical shortages of U.S. health-care workers during the COVID-19 pandemic, retired doctors are being called back to work and medical students are graduating on a fast track. There is another important pool that could be tapped: Immigrants and refugees who have college degrees in health fields but are working in low-skilled jobs or out of work. MPI estimates 263,000 immigrants are experiencing skill underutilization and could be a valuable resource.




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The Digital Transformation Playbook: Rethink Your Business for the Digital Age

Every business begun before the Internet now faces the same challenge: How to transform to compete in a digital economy? This is the leadership challenge examined by BRITE founder and Columbia Business School faculty member David Rogers in his newest book, The Digital Transformation Playbook (April 5, 2016; Columbia Business School Publishing). In the book, […]




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Can a Company be pro-regulation and pro-commerce? Gregg Renfrew from Beautycounter thinks so

It’s the middle of an election year and, according to the Pew Research Center, the country hasn’t been this polarized since the Civil War. In such a climate, it would seem to be an oxymoron for a company to push for both financial growth and tighter regulations. Gregg Renfrew, CEO & Founder of Beautycounter, wouldn’t […]




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Reflections on Business, Leadership, and Branding: Shelly Lazarus ’70

Much has changed in the world of advertising from the picture painted by Mad Men. Shelly Lazarus ’70, Chairman Emeritus, Ogilvy & Mather, was one of the women helping pioneer these changes. Making the journey from ‘the only woman in the room’ to CEO and Chairman of Ogilvy gives Lazarus a lot to reflect on […]




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Algorhythms for Marketing Transformation

We all understand that digital media, data, and analytics are driving transformations in society and business. Most marketers are now armed with case studies of what can be done differently, but many are still challenged with how to truly develop new ideas and execute new strategies to grow their business. Mitch Joel, President of Mirum […]




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Musculoskeletal Complications of Diabetes Mellitus

Rachel Peterson Kim
Jul 1, 2001; 19:
Practical Pointers




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Evaluating the Effect of U-500 Insulin Therapy on Glycemic Control in Veterans With Type 2 Diabetes

Joseph A. Granata
Jan 1, 2015; 33:14-19
Feature Articles




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Cutaneous Manifestations of Diabetes Mellitus

Michelle Duff
Jan 1, 2015; 33:40-48
Practical Pointers




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Gestational Diabetes in High-Risk Populations

Wilfred Fujimoto
Apr 1, 2013; 31:90-94
Diabetes Advocacy




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The Diabetes Attitudes, Wishes and Needs Second Study

Martha M. Funnell
Jan 1, 2015; 33:32-36
Translating Research to Practice




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Case Study: Potential Pitfalls of Using Hemoglobin A1c as the Sole Measure of Glycemic Control

Huy A. Tran
Jul 1, 2004; 22:141-143
Case Studies




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Effects of Glycemic Control on Diabetes Complications and on the Prevention of Diabetes

Jay S. Skyler
Oct 1, 2004; 22:162-166
Feature Articles




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Diabetes and Periodontal Infection: Making the Connection

Janet H. Southerland
Oct 1, 2005; 23:171-178
Feature Articles




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Medical Nutrition Therapy: A Key to Diabetes Management and Prevention

Sara F. Morris
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Feature Articles




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Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain

Lorenzo Rinaldo
Jul 1, 2017; 35:126-131
Feature Articles




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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Margaret A. Powers
Apr 1, 2016; 34:70-80
Position Statements




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Integration of Clinical Psychology in the Comprehensive Diabetes Care Team

Steven B. Leichter
Jul 1, 2004; 22:129-131
The Business of Diabetes




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Gestational Diabetes Mellitus

Tracy L. Setji
Jan 1, 2005; 23:17-24
Feature Articles




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Diapression: An Integrated Model for Understanding the Experience of Individuals With Co-Occurring Diabetes and Depression

Paul Ciechanowski
Apr 1, 2011; 29:43-49
Feature Articles




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SGLT-2 Inhibitors: A New Mechanism for Glycemic Control

Edward C. Chao
Jan 1, 2014; 32:4-11
Feature Articles




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Self-Monitoring of Blood Glucose: The Basics

Evan M. Benjamin
Jan 1, 2002; 20:
Practical Pointers




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PROactive: A Sad Tale of Inappropriate Analysis and Unjustified Interpretation

Jay S. Skyler
Apr 1, 2006; 24:63-65
Commentary




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Persistence of Continuous Glucose Monitoring Use in a Community Setting 1 Year After Purchase

James Chamberlain
Jul 1, 2013; 31:106-109
Feature Articles




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Opportunities and Challenges for Biosimilars: What's on the Horizon in the Global Insulin Market?

Lisa S. Rotenstein
Oct 1, 2012; 30:138-150
Features




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Diabetes Management Issues for Patients With Chronic Kidney Disease

Kerri L. Cavanaugh
Jul 1, 2007; 25:90-97
Feature Articles




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Health Care Transition in Adolescents and Young Adults With Diabetes

Michael E. Bowen
Jun 1, 2010; 28:99-106
Feature Articles




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Building Therapeutic Relationships: Choosing Words That Put People First

Jane K. Dickinson
Jan 1, 2017; 35:51-54
Commentary




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Application of Adult-Learning Principles to Patient Instructions: A Usability Study for an Exenatide Once-Weekly Injection Device

Gayle Lorenzi
Sep 1, 2010; 28:157-162
Bridges to Excellence




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Engaging Patients in Education for Self-Management in an Accountable Care Environment

Christine A. Beebe
Jul 1, 2011; 29:123-126
Practical Pointers




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Helping Patients Make and Sustain Healthy Changes: A Brief Introduction to Motivational Interviewing in Clinical Diabetes Care

Michele Heisler
Oct 1, 2008; 26:161-165
Practical Pointers




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Cardiac Manifestations of Congenital Generalized Lipodystrophy

Vani P. Sanon
Oct 1, 2016; 34:181-186
Feature Articles




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Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment

Jennifer M. Perkins
Apr 1, 2007; 25:57-62
Feature Articles




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The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations

Edward A. Chow
Jul 1, 2012; 30:130-133
Diabetes Advocacy




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Microvascular and Macrovascular Complications of Diabetes

Michael J. Fowler
Apr 1, 2008; 26:77-82
Diabetes Foundation




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Heroic Consciousness: What it is and How to Acquire it

By Scott T. Allison This blog post is excerpted from: Allison, S. T. (2019). Heroic consciousness. Heroism Science, 4, 1-43.   The philosopher Yuval Noah Harari (2018) recently described consciousness as “the greatest mystery in the universe”. What exactly is heroic consciousness? It is a way of seeing the world, perceiving reality, and making decisions … Continue reading Heroic Consciousness: What it is and How to Acquire it




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The Innovation Dilemma

"If it ain't broken, don't fix it."Sound advice, but limited to situations where "fixing it" only entails restoring past performance. In contrast, innovations entail substantive improvements over the past. Innovations are not just corrections of past mistakes, but progress towards a better future.

However, innovations often present a challenging dilemma to decision makers. Many decisions require choosing between options, one of which is both potentially better in the outcome but markedly more uncertain. In these situations the decision maker faces an "innovation dilemma."

The innovation dilemma arises in many contexts. Here are a few examples.

Technology. New and innovative technologies are often advocated because of their purported improvements on existing products or methods. However, what is new is usually less well-known and less widely tested than what is old. The range of possible adverse (or favorable) surprises of an innovative technology may exceed the range of surprise for a tried-and-true technology. The analyst who must choose between innovation and convention faces an innovation dilemma.

Investment. The economic investor faces an innovation dilemma when choosing between investing in a promising but unknown new start-up and investing in a well-known existing firm.

Auction. "Nothing ventured, nothing gained" is the motto of the risk-taker, while the risk-avoider responds: "Nothing ventured, nothing lost". The innovation dilemma is embedded in the choice between these two strategies. Consider for example the "winner's curse" in auction theory. You can make a financial bid for a valuable piece of property, which will be sold to the highest bidder. You have limited information about the other bidders and about the true value of the property. If you bid high you might win the auction but you might also pay more than the property is worth. Not bidding is risk-free because it avoids the purchase. The choice between a high bid and no bid is an innovation dilemma.

Employer decision. An employer must decide whether or not to replace a current satisfactory employee with a new candidate whose score on a standardized test was high. A high score reflects great ability. However, the score also contains a random element, so a high score may result from chance, and not reflect true ability. The innovation dilemma is embedded in the employer's choice between the current adequate employee and a high-scoring new candidate.

Natural resource exploitation. Permitting the extraction of offshore petroleum resources may be productive in terms of petroleum yield but may also present officials with significant uncertainty about environmental consequences.

Public health. Implementation of a large-scale immunization program may present policy officials with worries about uncertain side effects.

Agricultural policy. New technologies promise improved production efficiency or new consumer choices, but with uncertain benefits and costs and potential unanticipated adverse effects resulting from use of manufactured inputs such as fertilizers, pesticides, and machinery, and, more recently, genetically engineered seed varieties and information technology. (I am indebted to L. Joe Moffitt and Craig Osteen for these examples in natural resources, public health and agriculture.)

An essay like this one should - according to custom - end with a practical prescription: What to do about the innovation dilemma? You need to make a decision - a choice between options - and you face an innovation dilemma. How to choose? All I'll say is that the first step is to identify what you need to achieve from this decision. Recognizing the vast uncertainties which accompany the decision, choose the option which achieves the required outcome over the largest range of uncertain contingencies.

If you want more of an answer than that, consult your favorite decision theory (like info-gap theory, for instance).

I will conclude by drawing a parallel between the innovation dilemma and one of the oldest quandaries in political philosophy. In The Evolution of Political Thought C. Northcote Parkinson explains the historically recurring tension between freedom and equality.

Freedom. People have widely varying interests and aptitudes. Hence a society that offers broad freedom for individuals to exploit their abilities, will also develop a wide spread of wealth, accomplishment, and status. Freedom enables individuals to explore, invent, discover, and create. Freedom is the recipe for innovation. Freedom induces both uncertainty and inequality.

Equality. People have widely varying interests and aptitudes. Hence a society that strives for equality among its members can achieve this by enforcing conformity and by transferring wealth from rich to poor. The promise of a measure of equality is a guarantee of a measure of security, a personal and social safety net. Equality reduces both uncertainty and freedom.

The dilemma is that a life without freedom is hardly human, but freedom without security is the jungle. And life in the jungle, as Hobbs explained, in "solitary, poor, nasty, brutish and short".




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No-Failure Design and Disaster Recovery: Lessons from Fukushima

One of the striking aspects of the early stages of the nuclear accident at Fukushima-Daiichi last March was the nearly total absence of disaster recovery capability. For instance, while Japan is a super-power of robotic technology, the nuclear authorities had to import robots from France for probing the damaged nuclear plants. Fukushima can teach us an important lesson about technology.

The failure of critical technologies can be disastrous. The crash of a civilian airliner can cause hundreds of deaths. The meltdown of a nuclear reactor can release highly toxic isotopes. Failure of flood protection systems can result in vast death and damage. Society therefore insists that critical technologies be designed, operated and maintained to extremely high levels of reliability. We benefit from technology, but we also insist that the designers and operators "do their best" to protect us from their dangers.

Industries and government agencies who provide critical technologies almost invariably act in good faith for a range of reasons. Morality dictates responsible behavior, liability legislation establishes sanctions for irresponsible behavior, and economic or political self-interest makes continuous safe operation desirable.

The language of performance-optimization  not only doing our best, but also achieving the best  may tend to undermine the successful management of technological danger. A probability of severe failure of one in a million per device per year is exceedingly  and very reassuringly  small. When we honestly believe that we have designed and implemented a technology to have vanishingly small probability of catastrophe, we can honestly ignore the need for disaster recovery.

Or can we?

Let's contrast this with an ethos that is consistent with a thorough awareness of the potential for adverse surprise. We now acknowledge that our predictions are uncertain, perhaps highly uncertain on some specific points. We attempt to achieve very demanding outcomes  for instance vanishingly small probabilities of catastrophe  but we recognize that our ability to reliably calculate such small probabilities is compromised by the deficiency of our knowledge and understanding. We robustify ourselves against those deficiencies by choosing a design which would be acceptable over a wide range of deviations from our current best understanding. (This is called "robust-satisficing".) Not only does "vanishingly small probability of failure" still entail the possibility of failure, but our predictions of that probability may err.

Acknowledging the need for disaster recovery capability (DRC) is awkward and uncomfortable for designers and advocates of a technology. We would much rather believe that DRC is not needed, that we have in fact made catastrophe negligible. But let's not conflate good-faith attempts to deal with complex uncertainties, with guaranteed outcomes based on full knowledge. Our best models are in part wrong, so we robustify against the designer's bounded rationality. But robustness cannot guarantee success. The design and implementation of DRC is a necessary part of the design of any critical technology, and is consistent with the strategy of robust satisficing.

One final point: moral hazard and its dilemma. The design of any critical technology entails two distinct and essential elements: failure prevention and disaster recovery. What economists call a `moral hazard' exists since the failure prevention team might rely on the disaster-recovery team, and vice versa. Each team might, at least implicitly, depend on the capabilities of the other team, and thereby relinquish some of its own responsibility. Institutional provisions are needed to manage this conflict.

The alleviation of this moral hazard entails a dilemma. Considerations of failure prevention and disaster recovery must be combined in the design process. The design teams must be aware of each other, and even collaborate, because a single coherent system must emerge. But we don't want either team to relinquish any responsibility. On the one hand we want the failure prevention team to work as though there is no disaster recovery, and the disaster recovery team should presume that failures will occur. On the other hand, we want these teams to collaborate on the design.

This moral hazard and its dilemma do not obviate the need for both elements of the design. Fukushima has taught us an important lesson by highlighting the special challenge of high-risk critical technologies: design so failure cannot occur, and prepare to respond to the unanticipated.




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Beware the Rareness Illusion When Exploring the Unknown

Here's a great vacation idea. Spend the summer roaming the world in search of the 10 lost tribes of Israel, exiled from Samaria by the Assyrians 2700 years ago (2 Kings 17:6). Or perhaps you'd like to search for Prester John, the virtuous ruler of a kingdom lost in the Orient? Or would you rather trace the gold-laden kingdom of Ophir (1 Kings 9:28)? Or do you prefer the excitement of tracking the Amazons, that nation of female warriors? Or perhaps the naval power mentioned by Plato, operating from the island of Atlantis? Or how about unicorns, or the fountain of eternal youth? The Unknown is so vast that the possibilities are endless.

Maybe you don't believe in unicorns. But Plato evidently "knew" about the island of Atlantis. The conquest of Israel is known from Assyrian archeology and from the Bible. That you've never seen a Reubenite or a Naphtalite (or a unicorn) means that they don't exist?

It is true that when something really does not exist, one might spend a long time futilely looking for it. Many people have spent enormous energy searching for lost tribes, lost gold, and lost kingdoms. Why is it so difficult to decide that what you're looking for really isn't there? The answer, ironically, is that the world has endless possibilities for discovery and surprise.

Let's skip vacation plans and consider some real-life searches. How long should you (or the Libyans) look for Muammar Qaddafi? If he's not in the town of Surt, maybe he's Bani Walid, or Algeria, or Timbuktu? How do you decide he cannot be found? Maybe he was pulverized by a NATO bomb. It's urgent to find the suicide bomber in the crowded bus station before it's too late - if he's really there. You'd like to discover a cure for AIDS, or a method to halt the rising global temperature, or a golden investment opportunity in an emerging market, or a proof of the parallel postulate of Euclidean geometry.

Let's focus our question. Suppose you are looking for something, and so far you have only "negative" evidence: it's not here, it's not there, it's not anywhere you've looked. Why is it so difficult to decide, conclusively and confidently, that it simply does not exist?

This question is linked to a different question: how to make the decision that "it" (whatever it is) does not exist. We will focus on the "why" question, and leave the "how" question to students of decision theories such as statistics, fuzzy logic, possibility theory, Dempster-Shafer theory and info-gap theory. (If you're interested in an info-gap application to statistics, here is an example.)

Answers to the "why" question can be found in several domains.

Psychology provides some answers. People can be very goal oriented, stubborn, and persistent. Marco Polo didn't get to China on a 10-hour plane flight. The round trip took him 24 years, and he didn't travel business class.

Ideology is a very strong motivator. When people believe something strongly, it is easy for them to ignore evidence to the contrary. Furthermore, for some people, the search itself is valued more than the putative goal.

The answer to the "why" question that I will focus on is found by contemplating The Endless Unknown. It is so vast, so unstructured, so, well ..., unknown, that we cannot calibrate our negative evidence to decide that whatever we're looking for just ain't there.

I'll tell a true story.

I was born in the US and my wife was born in Israel, but our life-paths crossed, so to speak, before we were born. She had a friend whose father was from Europe and lived for a while - before the friend was born - with a cousin of his in my home town. This cousin was - years later - my 3rd grade teacher. My school teacher was my future wife's friend's father's cousin.

Amazing coincidence. This convoluted sequence of events is certainly rare. How many of you can tell the very same story? But wait a minute. This convoluted string of events could have evolved in many many different ways, each of which would have been an equally amazing coincidence. The number of similar possible paths is namelessly enormous, uncountably humongous. In other words, potential "rare" events are very numerous. Now that sounds like a contradiction (we're getting close to some of Zeno's paradoxes, and Aristotle thought Zeno was crazy). It is not a contradiction; it is only a "rareness illusion" (something like an optical illusion). The specific event sequence in my story is unique, which is the ultimate rarity. We view this sequence as an amazing coincidence because we cannot assess the number of similar sequences. Surprising strings of events occur not infrequently because the number of possible surprising strings is so unimaginably vast. The rareness illusion is the impression of rareness arising from our necessary ignorance of the vast unknown. "Necessary" because, by definition, we cannot know what is unknown. "Vast" because the world is so rich in possibilities.

The rareness illusion is a false impression, a mistake. For instance, it leads people to wrongly goggle at strings of events - rare in themselves - even though "rare events" are numerous and "amazing coincidences" occur all the time. An appreciation of the richness and boundlessness of the Unknown is an antidote for the rareness illusion.

Recognition of the rareness illusion is the key to understanding why it is so difficult to confidently decide, based on negative evidence, that what you're looking for simply does not exist.

One might be inclined to reason as follows. If you're looking for something, then look very thoroughly, and if you don't find it, then it's not there. That is usually sound and sensible advice, and often "looking thoroughly" will lead to discovery.

However, the number of ways that we could overlook something that really is there is enormous. It is thus very difficult to confidently conclude that the search was thorough and that the object cannot be found. Take the case of your missing house keys. They dropped from your pocket in the car, or on the sidewalk and somebody picked them up, or you left them in the lock when you left the house, or or or .... Familiarity with the rareness illusion makes it very difficult to decide that you have searched thoroughly. If you think that the only contingencies not yet explored are too exotic to be relevant (a raven snatched them while you were daydreaming about that enchanting new employee), then think again, because you've been blinded by a rareness illusion. The number of such possibilities is so vastly unfathomable that you cannot confidently say that all of them are collectively negligible. Recognition of the rareness illusion prevents you from confidently concluding that what you are seeking simply does not exist.

Many quantitative tools grapple with the rareness illusion. We mentioned some decision theories earlier. But because the rareness illusion derives from our necessary ignorance of the vast unknown, one must always beware.

Looking for an exciting vacation? The Endless Unknown is the place to go. 




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Squirrels and Stock Brokers, Or: Innovation Dilemmas, Robustness and Probability

Decisions are made in order to achieve desirable outcomes. An innovation dilemma arises when a seemingly more attractive option is also more uncertain than other options. In this essay we explore the relation between the innovation dilemma and the robustness of a decision, and the relation between robustness and probability. A decision is robust to uncertainty if it achieves required outcomes despite adverse surprises. A robust decision may differ from the seemingly best option. Furthermore, robust decisions are not based on knowledge of probabilities, but can still be the most likely to succeed.

Squirrels, Stock-Brokers and Their Dilemmas




Decision problems.
Imagine a squirrel nibbling acorns under an oak tree. They're pretty good acorns, though a bit dry. The good ones have already been taken. Over in the distance is a large stand of fine oaks. The acorns there are probably better. But then, other squirrels can also see those trees, and predators can too. The squirrel doesn't need to get fat, but a critical caloric intake is necessary before moving on to other activities. How long should the squirrel forage at this patch before moving to the more promising patch, if at all?

Imagine a hedge fund manager investing in South African diamonds, Australian Uranium, Norwegian Kroners and Singapore semi-conductors. The returns have been steady and good, but not very exciting. A new hi-tech start-up venture has just turned up. It looks promising, has solid backing, and could be very interesting. The manager doesn't need to earn boundless returns, but it is necessary to earn at least a tad more than the competition (who are also prowling around). How long should the manager hold the current portfolio before changing at least some of its components?

These are decision problems, and like many other examples, they share three traits: critical needs must be met; the current situation may or may not be adequate; other alternatives look much better but are much more uncertain. To change, or not to change? What strategy to use in making a decision? What choice is the best bet? Betting is a surprising concept, as we have seen before; can we bet without knowing probabilities?

Solution strategies.
The decision is easy in either of two extreme situations, and their analysis will reveal general conclusions.

One extreme is that the status quo is clearly insufficient. For the squirrel this means that these crinkled rotten acorns won't fill anybody's belly even if one nibbled here all day long. Survival requires trying the other patch regardless of the fact that there may be many other squirrels already there and predators just waiting to swoop down. Similarly, for the hedge fund manager, if other funds are making fantastic profits, then something has to change or the competition will attract all the business.

The other extreme is that the status quo is just fine, thank you. For the squirrel, just a little more nibbling and these acorns will get us through the night, so why run over to unfamiliar oak trees? For the hedge fund manager, profits are better than those of any credible competitor, so uncertain change is not called for.

From these two extremes we draw an important general conclusion: the right answer depends on what you need. To change, or not to change, depends on what is critical for survival. There is no universal answer, like, "Always try to improve" or "If it's working, don't fix it". This is a very general property of decisions under uncertainty, and we will call it preference reversal. The agent's preference between alternatives depends on what the agent needs in order to "survive".

The decision strategy that we have described is attuned to the needs of the agent. The strategy attempts to satisfy the agent's critical requirements. If the status quo would reliably do that, then stay put; if not, then move. Following the work of Nobel Laureate Herbert Simon, we will call this a satisficing decision strategy: one which satisfies a critical requirement.

"Prediction is always difficult, especially of the future." - Robert Storm Petersen

Now let's consider a different decision strategy that squirrels and hedge fund managers might be tempted to use. The agent has obtained information about the two alternatives by signals from the environment. (The squirrel sees grand verdant oaks in the distance, the fund manager hears of a new start up.) Given this information, a prediction can be made (though the squirrel may make this prediction based on instincts and without being aware of making it). Given the best available information, the agent predicts which alternative would yield the better outcome. Using this prediction, the decision strategy is to choose the alternative whose predicted outcome is best. We will call this decision strategy best-model optimization. Note that this decision strategy yields a single universal answer to the question facing the agent. This strategy uses the best information to find the choice that - if that information is correct - will yield the best outcome. Best-model optimization (usually) gives a single "best" decision, unlike the satisficing strategy that returns different answers depending on the agent's needs.

There is an attractive logic - and even perhaps a moral imperative - to use the best information to make the best choice. One should always try to do one's best. But the catch in the argument for best-model optimization is that the best information may actually be grievously wrong. Those fine oak trees might be swarming with insects who've devoured the acorns. Best-model optimization ignores the agent's central dilemma: stay with the relatively well known but modest alternative, or go for the more promising but more uncertain alternative.

"Tsk, tsk, tsk" says our hedge fund manager. "My information already accounts for the uncertainty. I have used a probabilistic asset pricing model to predict the likelihood that my profits will beat the competition for each of the two alternatives."

Probabilistic asset pricing models are good to have. And the squirrel similarly has evolved instincts that reflect likelihoods. But a best-probabilistic-model optimization is simply one type of best-model optimization, and is subject to the same vulnerability to error. The world is full of surprises. The probability functions that are used are quite likely wrong, especially in predicting the rare events that the manager is most concerned to avoid.

Robustness and Probability

Now we come to the truly amazing part of the story. The satisficing strategy does not use any probabilistic information. Nonetheless, in many situations, the satisficing strategy is actually a better bet (or at least not a worse bet), probabilistically speaking, than any other strategy, including best-probabilistic-model optimization. We have no probabilistic information in these situations, but we can still maximize the probability of success (though we won't know the value of this maximum).

When the satisficing decision strategy is the best bet, this is, in part, because it is more robust to uncertainty than another other strategy. A decision is robust to uncertainty if it achieves required outcomes even if adverse surprises occur. In many important situations (though not invariably), more robustness to uncertainty is equivalent to being more likely to succeed or survive. When this is true we say that robustness is a proxy for probability.

A thorough analysis of the proxy property is rather technical. However, we can understand the gist of the idea by considering a simple special case.

Let's continue with the squirrel and hedge fund examples. Suppose we are completely confident about the future value (in calories or dollars) of not making any change (staying put). In contrast, the future value of moving is apparently better though uncertain. If staying put would satisfy our critical requirement, then we are absolutely certain of survival if we do not change. Staying put is completely robust to surprises so the probability of success equals 1 if we stay put, regardless of what happens with the other option. Likewise, if staying put would not satisfy our critical requirement, then we are absolutely certain of failure if we do not change; the probability of success equals 0 if we stay, and moving cannot be worse. Regardless of what probability distribution describes future outcomes if we move, we can always choose the option whose likelihood of success is greater (or at least not worse). This is because staying put is either sure to succeed or sure to fail, and we know which.

This argument can be extended to the more realistic case where the outcome of staying put is uncertain and the outcome of moving, while seemingly better than staying, is much more uncertain. The agent can know which option is more robust to uncertainty, without having to know probability distributions. This implies, in many situations, that the agent can choose the option that is a better bet for survival.

Wrapping Up

The skillful decision maker not only knows a lot, but is also able to deal with conflicting information. We have discussed the innovation dilemma: When choosing between two alternatives, the seemingly better one is also more uncertain.

Animals, people, organizations and societies have developed mechanisms for dealing with the innovation dilemma. The response hinges on tuning the decision to the agent's needs, and robustifying the choice against uncertainty. This choice may or may not coincide with the putative best choice. But what seems best depends on the available - though uncertain - information.

The commendable tendency to do one's best - and to demand the same of others - can lead to putatively optimal decisions that may be more vulnerable to surprise than other decisions that would have been satisfactory. In contrast, the strategy of robustly satisfying critical needs can be a better bet for survival. Consider the design of critical infrastructure: flood protection, nuclear power, communication networks, and so on. The design of such systems is based on vast knowledge and understanding, but also confronts bewildering uncertainties and endless surprises. We must continue to improve our knowledge and understanding, while also improving our ability to manage the uncertainties resulting from the expanding horizon of our efforts. We must identify the critical goals and seek responses that are immune to surprise. 




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Mind or Stomach? Imagination or Necessity?

"An army marches on its stomach" said Napoleon, who is also credited with saying "Imagination rules the world". Is history driven by raw necessity and elementary needs? Or is history hewn by people from their imagination, dreams and ideas?

The answer is simple: 'Both'. The challenge is to untangle imagination from necessity. Consider these examples:

An ancient Jewish saying is "Without flour, there is no Torah. Without Torah there is no flour." (Avot 3:17) Scholars don't eat much, but they do need to eat. And if you feed them, they produce wonders.

Give a typewriter to a monkey and he might eventually tap out Shakespeare's sonnets, but it's not very likely. Give that monkey an inventive mind and he will produce poetry, a vaccine against polio, and the atom bomb. Why the bomb? He needed it.

Necessity is the mother of invention, they say, but it's actually a two-way street. For instance, human inventiveness includes dreams of cosmic domination, leading to war. Hence the need for that bomb. Satisfying a need, like the need for flour, induces inventiveness. And this inventiveness, like the discovery of genetically modified organisms, creates new needs. Necessity induces inventiveness, and inventiveness creates new dangers, challenges and needs. This cycle is endless because the realm of imagination is boundless, far greater than prosaic reality, as we discussed elsewhere.

Imagination and necessity are intertwined, but still are quite different. Necessity focusses primarily on what we know, while imagination focusses on the unknown.

We know from experience that we need food, shelter, warmth, love, and so on. These requirements force themselves on our awareness. Even the need for protection against surprise is known, though the surprise is not.

Imagination operates in the realm of the unknown. We seek the new, the interesting, or the frightful. Imagination feeds our fears of the unknown and nurtures our hopes for the unimaginable. We explore the bounds of the possible and try breaking through to the impossible.

Mind or stomach? Imagination or necessity? Every 'known' has an 'unknown' lurking behind it, and every 'unknown' may some day be discovered or dreamed into existence. Every mind has a stomach, and a stomach with no mind is not human.




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The Age of Imagination


This is not only the Age of Information, this is also the Age of Imagination. Information, at any point in time, is bounded, while imagination is always unbounded. We are overwhelmed more by the potential for new ideas than by the admittedly vast existing knowledge. We are drunk with the excitement of the unknown. Drunks are sometimes not a pretty sight; Isaiah (28:8) is very graphic.

It is true that topical specialization occurs, in part, due to what we proudly call the explosion of knowledge. There is so much to know that one must ignore huge tracts of knowledge. But that is only half the story. The other half is that we have begun to discover the unknown, and its lure is irresistible. Like the scientific and global explorers of the early modern period - The Discoverers as Boorstin calls them - we are intoxicated by the potential "out there", beyond the horizon, beyond the known. That intoxication can distort our vision and judgment.

Consider Reuven's comment, from long experience, that "Engineers use formulas and various equations without being aware of the theories behind them." A pithier version was said to me by an acquisitions editor at Oxford University Press: "Engineers don't read books." She should know.

Engineers are imaginative and curious. They are seekers, and they find wonderful things. But they are too engrossed in inventing and building The New, to be much engaged with The Old. "Scholarship", wrote Thorstein Veblen is "an intimate and systematic familiarity with past cultural achievements." Engineers - even research engineers and professors of engineering - spend very little time with past masters. How many computer scientists scour the works of Charles Babbage? How often do thermal engineers study the writings of Lord Kelvin? A distinguished professor of engineering, himself a member of the US National Academy of Engineering, once told me that there is little use for journal articles more than a few years old.

Fragmentation of knowledge results from the endless potential for new knowledge. Seekers - engineers and the scientists of nature, society and humanity - move inexorably apart from one another. But nonetheless it's all connected; consilient. Technology alters how we live. Science alters what we think. How can we keep track of it all? How can we have some at least vague and preliminary sense of where we are heading and whether we value the prospect?

The first prescription is to be aware of the problem, and I greatly fear that many movers and shakers of the modern age are unaware. The second prescription is to identify who should take the lead in nurturing this awareness. That's easy: teachers, scholars, novelists, intellectuals of all sorts.

Isaiah struggled with this long ago. "Priest and prophet erred with liquor, were swallowed by wine."(Isaiah, 28:7) We are drunk with the excitement of the unknown. Who can show the way?




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Accidental Education


"He had to take that life as he best could, 
with such accidental education as luck had given him". 

I am a university professor. Universities facilitate efficient and systematic learning, so I teach classes, design courses, and develop curricula. Universities have tremendously benefitted technology, the economy, health, cultural richness and awareness, and many other "goods".

Nonetheless, some important lessons are learned strictly by accident. Moreover, without accidental surprises, education would be a bit dry, sometimes even sterile. As Adams wrote: "The chief wonder of education is that it does not ruin everybody concerned in it, teachers and taught."

An example. I chose my undergraduate college because of their program in anthropology. When I got there I took a chemistry course in my first semester. I was enchanted, by the prof as much as by the subject. I majored in chemistry and never went near the anthro department. If that prof had been on sabbatical I might have ended up an anthropologist.

Universities promote lifelong learning. College is little more than a six-pack of knowledge, a smattering of understanding and a wisp of wisdom. But lifelong learning doesn't only mean "come back to grad school". It means perceiving those rarities and strangenesses that others don't notice. Apples must have fallen on lots of peoples' heads before some clever fellow said "Hmmm, what's going on here?".

Accidental education is much more than keeping your eyes and mind open (though that is essential). To understand the deepest importance of accidental education we need to enlist two concepts: the boundlessness of the unknown, and human free will. We will then understand that accidental education feeds the potential for uniqueness of the individual.

As we have explained elsewhere, in discussing grand unified theories and imagination, the unknown is richer and stranger - and more contradictory - than the single physical reality that we actually face. The unknown is the realm of all possible as well as impossible worlds. It is the domain in which our dreams and speculations wander. It may be frightening or heartening, but taken as a whole it is incoherent, contradictory and endlessly amazing, variable and stimulating.

We learn about the unknown in part by speculating, wondering, and dreaming (awake and asleep). Imagining the impossible is very educational. For instance, most things are impossible for children (from tying their shoes to running the country), but they must be encouraged to imagine that they can or will be able to do them. Adults also can re-make themselves in line with their dreams. We are free and able to imagine ourselves and the world in endless new and different ways. Newton's apple brought to his mind a picture of the universe unlike any that had been imagined before. Surprises, like dreams, can free us from the mundane. Cynics sometimes sneer at personal or collective myths and musings, but the ability to re-invent ourselves is the essence of humanity. The children of Israel imagined at Sinai that the covenant was given directly to them all - men, women and children equally - with no royal or priestly intermediary. This launched the concept and the possibility of political equality.

The Israelites had no map of the desert because the promised land that they sought was first of all an idea. Only after re-inventing themselves as a free people created equal in the image of God, and not slaves, only after finding a collective identity and mission, only then could they enter the land of Canaan. Theirs wanderings were random and their discoveries were accidental, but their formative value is with us to this day. No map or curriculum can organize one's wandering in the land of imagination. Unexpected events happen in the real world, but they stimulate our imagination of the infinity of other possible worlds. Our most important education is the accidental stumbling on new thoughts that feed our potential for innovation and uniqueness. For the receptive mind, accidental education can be the most sublime.




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Alone


[S]ince there is an infinity of possible worlds, there is also an infinity of possible laws, some proper to one world, others proper to another, and each possible individual of a world includes the laws of its world in its notion. Gottfried Wilhelm Leibniz

On simple matters we can agree. Water freezes and wood burns. People can agree on social or political issues, though often more from self interest than from reasoned argument.

Agreement is rare or flitting on what is good or bad, worthy or worthless, humane or heartless. Are we simply not wise or intelligent or patient or convincing enough to find consensus?

Agreement is rare because the realm of possibilities is boundless. Every thought or vision carries a cosmos of variations and extensions. A good idea is one that spawns new good ideas, on and on. We are told that God the creator created man and woman in his image: as creators, to be fruitful and to multiply children, and ideas, and worlds.

At first we think that we are the entire world. Then we discover other worlds - things and people - and we think that they are the same as us. Then we discover that they have minds that, like ours, create their own worlds. We learn to communicate with those minds out there. We think that our meanings are their meanings, and this is true for many things, and even for many thoughts. But not for all of them. Then we discover that our deepest feelings are ours alone, and that we have created a continent whose shores are only lapped by waves from distant lands. 




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Habit: A Response to the Unknown


David Hume explained that we believe by habit that logs will burn, stones will fall, and endless other past patterns will recur. No experiment can prove the future recurrence of past events. An experiment belongs to the future only until it is implemented; once completed, it becomes part of the past. In order for past experiments to prove something about the future, we must assume that the past will recur in the future. That's as circular as it gets.

But without the habit of believing that past patterns will recur, we would be incapacitated and ineffectual (and probably reduced to moping and sobbing). Who would dare climb stairs or fly planes or eat bread and drink wine, without the belief that, like in the past, the stairs will bear our weight, the wings will carry us aloft, and the bread and wine will nourish our body and soul. Without such habits we would become a jittering jelly of indecision in the face of the unknown.

But you can't just pull a habit out of a hat. We spend great effort instilling good habits in our children: to brush their teeth, tell the truth, and not pick on their little sister even if she deserves it.

As we get older, and I mean really older, we begin to worry that our habits become frozen, stodgy, closed-minded and constraining. Younger folks smile at our rigid ways, and try to loosen us up to the new wonders of the world: technological, culinary or musical. Changing your habits, or staying young when you aren't, isn't always easy. Without habits we're lost in an unknowable world.

And yet, openness to new ideas, tastes, sounds and other experiences of many sorts can itself be a habit, and perhaps a good one. It is the habit of testing the unknown, of acknowledging the great gap between what we do know and what we can know. That gap is an invitation to growth and awe, as well as to fear and danger.

The habit of openness to change is not a contradiction. It is simply a recognition that habits are a response to the unknown. Not everything changes all the time (or so we're in the habit of thinking), and some things are new under the sun (as newspapers and Nobel prize committees periodically remind us).

Habits, including the habit of open-mindedness, are a good thing precisely because we can never know for sure how good or bad they really are.