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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

By clinical.diabetesjournals.org
Published On :: 2016-04-01

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

By clinical.diabetesjournals.org
Published On :: 2004-07-01

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


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The Death of the "1800-Calorie ADA Diet"

By clinical.diabetesjournals.org
Published On :: 2002-04-01

Irl B. Hirsch
Apr 1, 2002; 20:
Editorials


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The Potential of Group Visits in Diabetes Care

By clinical.diabetesjournals.org
Published On :: 2008-04-01

Andrew M. Davis
Apr 1, 2008; 26:58-62
Feature Articles


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Clarifying the Role of Insulin in Type 2 Diabetes Management

By clinical.diabetesjournals.org
Published On :: 2003-01-01

John R. White
Jan 1, 2003; 21:
Feature Articles


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Gestational Diabetes Mellitus

By clinical.diabetesjournals.org
Published On :: 2005-01-01

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


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Therapeutic Inertia is a Problem for All of Us

By clinical.diabetesjournals.org
Published On :: 2019-04-01

Stephen Brunton
Apr 1, 2019; 37:105-106
Editorials


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

By clinical.diabetesjournals.org
Published On :: 2011-04-01

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


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SGLT-2 Inhibitors: A New Mechanism for Glycemic Control

By clinical.diabetesjournals.org
Published On :: 2014-01-01

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


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Self-Monitoring of Blood Glucose: The Basics

By clinical.diabetesjournals.org
Published On :: 2002-01-01

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


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PROactive: A Sad Tale of Inappropriate Analysis and Unjustified Interpretation

By clinical.diabetesjournals.org
Published On :: 2006-04-01

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

By clinical.diabetesjournals.org
Published On :: 2013-07-01

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


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Interdisciplinary Team Care for Diabetic Patients by Primary Care Physicians, Advanced Practice Nurses, and Clinical Pharmacists

By clinical.diabetesjournals.org
Published On :: 2011-04-01

David Willens
Apr 1, 2011; 29:60-68
Feature Articles


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Insulin Strategies for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2002-01-01

Karen L. Herbst
Jan 1, 2002; 20:
Feature Articles


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

By clinical.diabetesjournals.org
Published On :: 2012-10-01

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


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Diabetes Management Issues for Patients With Chronic Kidney Disease

By clinical.diabetesjournals.org
Published On :: 2007-07-01

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

By clinical.diabetesjournals.org
Published On :: 2010-06-01

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


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Stigma in People With Type 1 or Type 2 Diabetes

By clinical.diabetesjournals.org
Published On :: 2017-01-01

Nancy F. Liu
Jan 1, 2017; 35:27-34
Feature Articles


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Management of Diabetic Peripheral Neuropathy

By clinical.diabetesjournals.org
Published On :: 2005-01-01

Andrew J.M. Boulton
Jan 1, 2005; 23:9-15
Feature Articles


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Building Therapeutic Relationships: Choosing Words That Put People First

By clinical.diabetesjournals.org
Published On :: 2017-01-01

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

By clinical.diabetesjournals.org
Published On :: 2010-09-01

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

By clinical.diabetesjournals.org
Published On :: 2011-07-01

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

By clinical.diabetesjournals.org
Published On :: 2008-10-01

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


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Hospital Management of Hyperglycemia

By clinical.diabetesjournals.org
Published On :: 2004-04-01

Kristen B. Campbell
Apr 1, 2004; 22:81-88
Practical Pointers


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Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

By clinical.diabetesjournals.org
Published On :: 2008-01-01

Daren Anderson
Jan 1, 2008; 26:22-27
Bridges to Excellence


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Cardiac Manifestations of Congenital Generalized Lipodystrophy

By clinical.diabetesjournals.org
Published On :: 2016-10-01

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


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Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology, and Management

By clinical.diabetesjournals.org
Published On :: 2006-07-01

Vanessa J. Briscoe
Jul 1, 2006; 24:115-121
Feature Articles


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Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2019-01-01

American Diabetes Association
Jan 1, 2019; 37:11-34
Position Statements


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

By clinical.diabetesjournals.org
Published On :: 2007-04-01

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


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Amylin Replacement With Pramlintide in Type 1 and Type 2 Diabetes: A Physiological Approach to Overcome Barriers With Insulin Therapy

By clinical.diabetesjournals.org
Published On :: 2002-07-01

John B. Buse
Jul 1, 2002; 20:
Feature Articles


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The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations

By clinical.diabetesjournals.org
Published On :: 2012-07-01

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


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Standards of Medical Care in Diabetes--2016 Abridged for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2016-01-01

American Diabetes Association
Jan 1, 2016; 34:3-21
Position Statements


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What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 Diabetes

By clinical.diabetesjournals.org
Published On :: 2004-07-01

William H. Polonsky
Jul 1, 2004; 22:147-150
Practical Pointers


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A Real-World Approach to Insulin Therapy in Primary Care Practice

By clinical.diabetesjournals.org
Published On :: 2005-04-01

Irl B. Hirsch
Apr 1, 2005; 23:78-86
Practical Pointers


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Improving Patient Adherence

By clinical.diabetesjournals.org
Published On :: 2006-04-01

Alan M. Delamater
Apr 1, 2006; 24:71-77
Feature Articles


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Standards of Medical Care in Diabetes--2018 Abridged for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2018-01-01

American Diabetes Association
Jan 1, 2018; 36:14-37
Position Statements


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Standards of Medical Care in Diabetes--2017 Abridged for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2017-01-01

American Diabetes Association
Jan 1, 2017; 35:5-26
Position Statements


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Standards of Medical Care in Diabetes--2015 Abridged for Primary Care Providers

By clinical.diabetesjournals.org
Published On :: 2015-04-01

American Diabetes Association
Apr 1, 2015; 33:97-111
Position Statements


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Empowerment and Self-Management of Diabetes

By clinical.diabetesjournals.org
Published On :: 2004-07-01

Martha M. Funnell
Jul 1, 2004; 22:123-127
Feature Articles


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Microvascular and Macrovascular Complications of Diabetes

By clinical.diabetesjournals.org
Published On :: 2008-04-01

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 blog.richmond.edu
Published On :: Thu, 23 Jan 2020 13:03:26 +0000

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 Heroic Leadership Imperative

By blog.richmond.edu
Published On :: Fri, 06 Mar 2020 15:34:27 +0000

Allison, S. T. & Goethals, G. R. (2020). The heroic leadership imperative: How leaders inspire and mobilize change. West Yorkshire: Emerald. Our next book describes a new principle that we call the heroic leadership imperative. We show how leaders who fulfill the imperative will inspire followers and initiate social change.   The imperative consists of … Continue reading The Heroic Leadership Imperative →


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COVID-19 Pandemic Turns Heroism Upside-Down

By blog.richmond.edu
Published On :: Sat, 04 Apr 2020 03:12:21 +0000

By Scott T. Allison William James, who authored the first psychology texbook, was taken and moved by the quiet heroism in everyday working people. He noticed “the great fields of heroism lying round about” him. He was mesmerized by small, seemingly inconsequential everyday acts that, in effect, exemplified unsung heroism in everyone. Before the COVID-19 … Continue reading COVID-19 Pandemic Turns Heroism Upside-Down →


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  • Commentary and Analysis
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10 Examples of Heroism Arising From the COVID-19 Pandemic

By blog.richmond.edu
Published On :: Sat, 04 Apr 2020 20:26:56 +0000

By Scott T. Allison In any tragedy or crisis, you will see many people standing out and stepping up to save lives and make the world a better place. These heroic individuals can range from leaders of nations to ordinary citizens who rise to the occasion to help others in need. During this COVID-19 pandemic, … Continue reading 10 Examples of Heroism Arising From the COVID-19 Pandemic →


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The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy

By blog.richmond.edu
Published On :: Mon, 20 Apr 2020 13:06:15 +0000

By Scott T. Allison Devs is the ideal TV mini-series for people to sink their teeth into, for many reasons: (1) It’s both science and science-fiction; (2) it’s brilliant mix of psychology, philosophy, religion, and technology; (3) it tantalizes us with the mysteries of love, life, death, time, and space; and (4) it features a … Continue reading The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy →


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  • Commentary and Analysis
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Heroism Science: Call for Papers, Special Issue: The Heroism of Whistleblowers

By blog.richmond.edu
Published On :: Tue, 21 Apr 2020 17:11:14 +0000

Heroism Science: Call for Papers, Special Issue The Heroism of Whistleblowers Edited by Ari Kohen, Brian Riches, and Matt Langdon Whistleblowers speak up with “concerns or information about wrongdoing inside organizations and institutions.” As such, whistleblowing “can be one of the most important and difficult forms of heroism in modern society” (Brown, 2016 p. 1). … Continue reading Heroism Science: Call for Papers, Special Issue: The Heroism of Whistleblowers →


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The Innovation Dilemma

By decisions-and-info-gaps.blogspot.com
Published On :: Tue, 09 Aug 2011 10:09:00 +0000

"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

By decisions-and-info-gaps.blogspot.com
Published On :: Tue, 09 Aug 2011 10:21:00 +0000

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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(Even) God is a Satisficer

By decisions-and-info-gaps.blogspot.com
Published On :: Fri, 12 Aug 2011 11:44:00 +0000

To 'satisfice' means "To decide on and pursue a course of action that will satisfy the minimum requirements necessary to achieve a particular goal." (Oxford English Dictionary). Herbert Simon (1978 Nobel Prize in Economics) was the first to use the term in this technical sense, which is an old alteration of the ordinary English word "satisfy". Simon wrote (Psychological Review, 63(2), 129-138 (1956)) "Evidently, organisms adapt well enough to 'satisfice'; they do not, in general, 'optimize'." Agents satisfice, according to Simon, due to limitation of their information, understanding, and cognitive or computational ability. These limitations, which Simon called "bounded rationality", force agents to look for solutions which are good enough, though not necessarily optimal. The optimum may exist but it cannot be known by the resource- and information-limited agent.

There is a deep psychological motivation for satisficing, as Barry Schwartz discusses in Paradox of Choice: Why More Is Less. "When people have no choice, life is almost unbearable." But as the number and variety of choices grows, the challenge of deciding "no longer liberates, but debilitates. It might even be said to tyrannize." (p.2) "It is maximizers who suffer most in a culture that provides too many choices" (p.225) because their expectations cannot be met, they regret missed opportunities, worry about social comparison, and so on. Maximizers may acquire or achieve more than satisficers, but satisficers will tend to be happier.

Psychology is not the only realm in which satisficing finds its roots. Satisficing - as a decision strategy - has systemic or structural advantages that suggest its prevalence even in situations where the complexity of the human psyche is irrelevant. We will discuss an example from the behavior of animals.

Several years ago an ecological colleague of mine at the Technion, Prof. Yohay Carmel, posed the following question: Why do foraging animals move from one feeding site to another later than would seem to be suggested by strategies aimed at maximizing caloric intake? Of course, animals have many goals in addition to foraging. They must keep warm (or cool), evade predators, rest, reproduce, and so on. Many mathematical models of foraging by animals attempt to predict "patch residence times" (PRTs): how long the animal stays at one feeding patch before moving to the next one. A common conclusion is that patch residence times are under-predicted when the model assumes that the animal tries to maximize caloric intake. Models do exist which "patch up" the PRT paradox, but the quandary still exists.

Yohay and I wrote a paper in which we explored a satisficing - rather than maximizing - model for patch residence time. Here's the idea. The animal needs a critical amount of energy to survive until the next foraging session. More food might be nice, but it's not necessary for survival. The animal's foraging strategy must maximize the confidence in achieving the critical caloric intake. So maximization is taking place, but not maximization of the substantive "good" (calories) but rather maximization of the confidence (or reliability, or likelihood, but these are more technical terms) of meeting the survival requirement. We developed a very simple foraging model based on info-gap theory. The model predicts that PRTs for a large number of species - including invertebrates, birds and mammals - tended to be longer (and thus more realistic) than predicted by energy-maximizing models.

This conclusion - that satisficing predicts observed foraging times better than maximizing - is tentative and preliminary (like most scientific conclusions). Nonetheless, it seems to hold a grain of truth, and it suggests an interesting idea. Consider the following syllogism.

1. Evolution selects those traits that enhance the chance of survival.

2. Animals seem to have evolved strategies for foraging which satisfice (rather than maximize) the energy intake.

3. Hence satisficing seems to be competitively advantageous. Satisficing seems to be a better bet than maximizing.

Unlike my psychologist colleague Barry Schwartz, we are not talking about happiness or emotional satisfaction. We're talking about survival of dung flies or blue jays. It seems that aiming to do good enough, but not necessarily the best possible, is the way the world is made.

And this brings me to the suggestion that (even) God is a satisficer. The word "good" appears quite early in the Bible: in the 4th verse of the 1st chapter of Genesis, the very first book: "And God saw the light [that had just been created] that it was good...". At this point, when the world is just emerging out of tohu v'vohu (chaos), we should probably understand the word "good" as a binary category, as distinct from "bad" or "chaos". The meaning of "good" is subsequently refined through examples in the coming verses. God creates dry land and oceans and sees that it is good (1:10). Grass and fruit trees are seen to be good (1:12). The sun and moon are good (1:16-18). Swarming sea creatures, birds, and beasts are good (1:20-21, 25).

And now comes a real innovation. God reviews the entire creation and sees that it is very good (1:31). It turns out that goodness comes in degrees; it's not simply binary: good or bad. "Good" requires judgment; ethics is born. But what particularly interests me here is that God's handiwork isn't excellent. Shouldn't we expect the very best? I'll leave this question to the theologians, but it seems to me that God is a satisficer.


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Baseball and Linguistic Uncertainty

By decisions-and-info-gaps.blogspot.com
Published On :: Sun, 21 Aug 2011 14:00:00 +0000

In my youth I played an inordinate amount of baseball, collected baseball cards, and idolized baseball players. I've outgrown all that but when I'm in the States during baseball season I do enjoy watching a few innings on the TV.

So I was watching a baseball game recently and the commentator was talking about the art of pitching. Throwing a baseball, he said, is like shooting a shotgun. You get a spray. As a pitcher, you have to know your spray. You learn to control it, but you know that it is there. The ball won't always go where you want it. And furthermore, where you want the ball depends on the batter's style and strategy, which vary from pitch to pitch for every batter.

That's baseball talk, but it stuck in my mind. Baseball pitchers must manage uncertainty! And it is not enough to reduce it and hope for the best. Suppose you want to throw a strike. It's not a good strategy to aim directly at, say, the lower outside corner of the strike zone, because of the spray of the ball's path and because the batter's stance can shift. Especially if the spray is skewed down and out, you'll want to move up and in a bit.

This is all very similar to the ambiguity of human speech when we pitch words at each other. Words don't have precise meanings; meanings spread out like the pitcher's spray. If we want to communicate precisely we need to be aware of this uncertainty, and manage it, taking account of the listener's propensities.

Take the word "liberal" as it is used in political discussion.

For many decades, "liberals" have tended to support high taxes to provide generous welfare, public medical insurance, and low-cost housing. They advocate liberal (meaning magnanimous or abundant) government involvement for the citizens' benefit.

A "liberal" might also be someone who is open-minded and tolerant, who is not strict in applying rules to other people, or even to him or herself. Such a person might be called "liberal" (meaning advocating individual rights) for opposing extensive government involvement in private decisions. For instance, liberals (in this second sense) might oppose high taxes since they reduce individuals' ability to make independent choices. As another example, John Stuart Mill opposed laws which restricted the rights of women to work (at night, for instance), even though these laws were intended to promote the welfare of women. Women, insisted Mill, are intelligent adults and can judge for themselves what is good for them.

Returning to the first meaning of "liberal" mentioned above, people of that strain may support restrictions of trade to countries which ignore the health and safety of workers. The other type of "liberal" might tend to support unrestricted trade.

Sending out words and pitching baseballs are both like shooting a shotgun: meanings (and baseballs) spray out. You must know what meaning you wish to convey, and what other meanings the word can have. The choice of the word, and the crafting of its context, must manage the uncertainty of where the word will land in the listener's mind.


Let's go back to baseball again.

If there were no uncertainty in the pitcher's pitch and the batter's swing, then baseball would be a dreadfully boring game. If the batter knows exactly where and when the ball will arrive, and can completely control the bat, then every swing will be a homer. Or conversely, if the pitcher always knows exactly how the batter will swing, and if each throw is perfectly controlled, then every batter will strike out. But which is it? Whose certainty dominates? The batter's or the pitcher's? It can't be both. There is some deep philosophical problem here. Clearly there cannot be complete certainty in a world which has some element of free will, or surprise, or discovery. This is not just a tautology, a necessary result of what we mean by "uncertainty" and "surprise". It is an implication of limited human knowledge. Uncertainty - which makes baseball and life interesting - is inevitable in the human world.

How does this carry over to human speech?

It is said of the Wright brothers that they thought so synergistically that one brother could finish an idea or sentence begun by the other. If there is no uncertainty in what I am going to say, then you will be bored with my conversation, or at least, you won't learn anything from me. It is because you don't know what I mean by, for instance, "robustness", that my speech on this topic is enlightening (and maybe interesting). And it is because you disagree with me about what robustness means (and you tell me so), that I can perhaps extend my own understanding.

So, uncertainty is inevitable in a world that is rich enough to have surprise or free will. Furthermore, this uncertainty leads to a process - through speech - of discovery and new understanding. Uncertainty, and the use of language, leads to discovery.

Isn't baseball an interesting game?


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