Category Archives: risk management

“One, Two, Many, Lots, and Whole Bunches!” – Life in a Base 100 World

I have always been told we use a base ten numbering system.  I maintain we are a base ten times ten when it comes to absorbing the meaning of numbers.
I have always been told we use a base ten numbering system. I maintain we are a base ten times ten when it comes to absorbing the meaning of numbers.

There seems to be a logical disconnect in our brains when it comes to very large numbers. We have ten fingers and ten toes. We are fine counting to ten. When it comes to counting to 100, we don’t have big problem either. However, I note that I can put myself to sleep counting down from 100 by “1’s” or “2.5’s.” One hundred seems a natural barrier, and because we are a tens based society, ten times our natural barrier is still comprehendible. However, as we go further from hundreds our understanding of scale diminishes. When we start counting in thousands, we may as well go back to the childhood counting, saying “One, two, many, lots, and whole bunches!”

We can intellectually go beyond a thousand, but I note that when we do, we group things so that we are counting the groups again, never going beyond the hundreds. For example, 530,253,063 is said “five hundred thiry million, two hundred fifty-three thousand, and sixty-three.” We have kept our counting to the hundreds of a group. That seems a natural cognitive limit of our intuitive understanding.

I think this inability to think beyond hundreds inhibits some of our intuitive understanding of scale. I see this all the time even amongst those of us dealing with numbers all the time. At my work, a group of us play the lottery when the winnings are big enough for all of us to retire. We call it the “stupid people’s tax” because we all know the expected return for our money is nothing and we pay anyway. The odds of one in hundreds of millions feels like one in hundreds with the millions only understood intellectually.

It is with this in mind that I read much of the news about the Syrian refugees. I see reports where countries take in thousands or even tens of thousands, and it feels impressive for some group to advocate increasing the number of refugees from one thousand to ten thousand. It feels like the group advocating for ten thousand is much more heroic. I submit this thinking is at least partially the result of our inability to comprehend the number of refugees is estimated at 10.8 million. Again, we focused on the wrong parts when thinking about the scale of the crisis. Like the examples above, we thought about the numbers I underlined instead of the description after them. It is very hard to get to 10.8 million (number of refugees) when we are dealing with them a thousand to maybe ten thousand at a time. When I think about the true scale of the problem, it feels like the responses are akin to trying to put out California forest fires with one spoon full of water at a time. Some may bring the teaspoon while others bring a ladle, but how effective are either?

Don’t take this wrong, our minds inability to grasp large numbers has advantages. I take a drug that has a chance to cause severe brain infections and possibly kill me. The published odds I get on that happening to me are changing all the time. My neurologist asks at every visit if I am concerned by the odds and want to switch medications. My most recent numbers were one in seven hundred, and I told him again I will be concerned when my odds worsen to below one in two hundred. Above that, my mind treats the risk like the odds of being struck by lightening or dying in a car crash on the way to work. These things happen all the time, but the odds are not worth worrying about because my mind puts them all in the remote risk category. My minds inability to internalize the risk helps me live my day to day life. I justify my thinking about taking Tysabri by noting my odds are still better than a Cancer patient taking Chemo which has a mortality rate of one in two hundred. I do not think about the large number that is my odds of getting the brain infection. Rather I think about it in comparison to something else.

The comparison method is the only way I think most of us truly attach meaning to large numbers. This is what I am doing when I compare the mortality rate taking Tysbari with the mortality rate of a cancer taking chemo. When we release data on the United States economy, most people care more about the direction of the change in numbers and how fast they are changing rather than how big the actual base number was. Most of us really cannot intuit the GDP reports talking about trillions of dollars.

When it comes to large numbers, we just need to be careful to be mindful of what the large numbers are for which we see differences and the differences in scale between different large numbers. If we can manage these two obstacles, we might avoid some of the common mistakes in our perceptions of the universe in which we live. Maybe then we can stop comparing “many” to “whole lots.”

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Hard Choices – When Does One Go All in on Adoption

Some times I think the most valuable thing MS has taken from me is any sense of expectations.  It has always seemed easy to play the odds with a sort of internal risk management style.  What could I lose versus what could I win ruled my thought process even if it wasn’t explicitly said or thought.

Along came MS. For the first few years, it was simply survival mode with every day seeming to bring new challenges with precious few bringing opportunities I recognized.  What a miserable couple of years. Heck, this blog suffered it’s first death for my lack of desire to remember the thoughts of the years.  When I think back on the first few years, it’s mostly memories of not being there because of hospital trips, puking, dropping everything, and shit in my pants at work.  Everyday brought a waking up and taking stock of what was working today.  I couldn’t predict what would go wrong next.

Then came Tysabri,and the choice to take a med with a small chance to kill me versus living like I was seemed a no brainer (bad pun).  Five years later, I have been stable for long enough to somewhat get back into a shape other than round and squishy.  However, I still find myself with symptoms progressing.  Pain is getting worse, and my mental mistakes are legion when tired.  Heck J doesn’t even want to take a break for a weekend because she fears I will make too many mistakes or just one bad one.  Who am I to second guess?

Add onto this guess work, uncertainty of what taking Tysabri for a decade or two will do to my body.  I have now had roughly 75 infusions.  There are no studies on people who have taken it for this long.  I am part of the test population who will be in the stats to tell future patients the effects it may have.   As if the uncertainty of MS wasn’t enough…

This all makes the choice we have of whether to adopt K even harder.  When asked, I have to admit I don’t know how much longer I will be able to work.  As I try to run scenarios in my head, the median answer I come to is about 15.  I want it to be another 25, and I fear it will be about 4 or 5.  So the expectation is 15.  What kind of position would that put our family?  How will J take care of all of us?  Is it fair to expect her to still have any sanity?

Still, there is a side of me which asks the questions, if not us then who?  At some point, one is given enough gifts to make a winning situation.  One has to then ask if not now, if not this, then for what is one working or waiting?  In poker terms, this would be the big blind special (another bad pun for a practically blind K).  We flopped our way into a full house of wonderful children over crazy parents.   If not for this, why do we keep trying.  There are some hands which seem so likely to come up short, but the possible rewards make throwing them in so unappealing.  When are odds not the best reasons to make decisions?  Of course one could argue risk management is also about the risk for things working out.  Not all risks are bad, and getting a proper feeling for what real odds are versus wishful thinking is very difficult.

I think that’s where we are now, trying to decide how best to live.  Maybe the life well lived has morphed.  When I first thought of the phrase it was how I would wish my biography to be titled.  Then it was a wish for my kids, but over time, it’s become a phrase I hope describes our life as a family.

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