The Science of Detergents

For an episode in the latest season of Revisionist History, Malcolm Gladwell travelled to Cincinnati to meet the product development teams at Proctor and Gamble behind their laundry and dish detergents. Gladwell was floored by the amount of science and research put into every element of detergents. It turns out there is a lot of effort that goes into developing the perfect soap, and there is good reason for it too. Good detergents allow for cold water washing, which drastically reduces the energy and carbon emissions associated with running a dishwasher or washing machine. Good detergents make things more efficient, which we need if we want to address the climate crisis. P&G has rows of washing machines and dishwashers all testing different formulas of detergents, to examine performance, wear and tear on the machines and clothes/dishes, and how their products perform relative to competitors.
I was reminded of Galdwell’s podcast when I looked back at a line from Mary Roach’s book Gulp. She writes, “Higher-end detergents contain at least three digestive enzymes: amylase to break down starchy stains, protease for proteins, and lipase for greasy stains (not just edible fats but body oils like sebum). Laundry detergent is essentially a digestive tract in a box. Ditto dishwashing detergent: protease and lipase eat the food your dinner guests didn’t.”
The two authors both highlight the surprising amount of effort in terms of science and research that goes into something most of us overlook. Detergents contain digestive enzymes that we may have in our bodies to make them more effective. Real scientific application and study has gone into giving us something so mundane, but it can still have a real impact on how our world moves forward while addressing climate change. Its comical to think of detergents as a digestive tract in a box, but it really is an important and scientifically interesting field of study.
Visual Versus Olfactory

Visual Versus Olfactory

I like to remind myself that I don’t experience the world around me the same way that my dog experiences the world. One of the biggest differences for us is that as a human I primarily experience the world by picking up on visual cues, whereas my dog primarily experiences the world through olfactory cues. My smelling ability isn’t very good, but my vision is pretty great. My dog’s vision isn’t very good, but her smelling is phenomenal. “Humans are better equipped for sight than for smell,” writes Mary Roach in Gulp: Adventures on the Alimentary Canal, “We process visual input ten times faster than olfactory.”
While we can smell, hear, and sense pressure changes on our skin, it is primarily our eyesight that helps us perceive and move about our world. We gain more information from looking at something than we do from smelling, tasting, and even feeling that same thing. That is why so much of our art is visual, why we paint our homes and cars, and why movies and videogames are able to keep our attention so well. Our brains pick up on and process visual stimuli much quicker than other stimuli.
In the human brain, a huge amount of space is dedicated to visual processing. Much more of our brains matter is dedicated to visual processing than olfactory processing, as Roach’s quote above indicates. This is why our brains are so much quicker at decoding and deciphering visual stimuli. In other animals, such as my dog, the part of the brain dedicated to visual processing is not as large relative to other brain regions. My dog has more brain space dedicated to olfactory processing than visual processing, relative to my brain, and thus perceives the world acting on different primary stimuli.
In the book The WEIRDest People in the World, Joseph Henrich shares research which suggests that certain visual activities, like reading, change the structure of the brain. In the case of reading, the brain space dedicated to processing visual symbols grows as one reads more and the brain tends to give up space related to facial recognition. We get better at reading quickly, but worse at remembering faces.¬† In Gulp, Roach explains that this kind of process is likely taking place very early on in childhood development. She quotes a scientist who she interviewed that explains that parents of infants go out of their way to label and identify objects that can be visually observed, but parents do not go out of their way to label sounds, smells, or other stimuli. We can spend hours identifying and labeling the tiny differences that we can observe in everything from different species of bugs to 1000 piece puzzles, but we don’t often spend a lot of time differentiating between all the aromas in the smell of coffee, all the different flavors in a slice of chocolate cake, or all the different sounds in an orchestra. In these instances, we take all the different components and experience them as one, unless we train to identify all the different components.
Our visual processing is truly impressive, but it is worth recognizing how much we rely on what we can see, and why. The world is a lot bigger than just what our minds can process from the visual information that we take in. Remembering how much of our brain is dedicated to visual processing can hep us better contextualize our experiences of the world and recognize when we are being overly biased toward visual information. Malcolm Gladwell’s final podcast of his most recent season, all about the power and potential of dogs’ olfactory processing, is a great reminder of why we shouldn’t be too biased toward what we can see.
Homelessness and Health

Homelessness and Health

When I was completing an MPA I took a couple of classes out of the MPH (Public Health) program. In one of the classes our professor assigned a group of us to a project focused on ways in which public agencies can access Medicaid funding for housing assistance programs for homeless individuals. The basic idea was that homeless individuals utilize healthcare resources and are unable to pay for any services they receive. The government, usually the local city or state government, ends up covering the cost of care provided to homeless individuals. The alternative would be that homeless individuals cannot access healthcare, and that they become more likely to spread communicable diseases or to die from preventable causes wherever they manage to find shelter.
This means that local governments end up paying a lot for the healthcare needs of their homeless (Malcolm Gladwell once wrote a story about “Million Dollar Murray” who happened to live in my hometown of Reno). Our project was to see what was permissible under Medicaid guidelines to allow hospitals and local public health entities to access Medicaid funding to provide housing for individuals who would otherwise drive huge healthcare costs. Accessing Medicaid funding would shift part of the costs to the federal government and bring in more federal funding to allow more individuals in the area to receive support. The ultimate goal was to get people established with basic housing and in the long run cut down on the number of emergency room visits and medical services that people would need.
Being homeless can drive up healthcare costs by driving people into worse health states. This is something that is often overlooked when we think about the homeless. As Elliot Liebow wrote in Tell Them Who I Am, “In many cases, the very conditions of homelessness produced poor health care as well as poor health. On the one hand, the women sometimes failed to tell the doctor that they were homeless; on the other hand, even when doctors knew their patients were homeless, they often failed to appreciate the significance of that fact.”
As my small team of fellow graduate students completed our project, we focused a lot of thought on housing individuals with diabetes or asthma. If you are homeless and have either condition, managing your health becomes dramatically more challenging. Doctors have to spend additional time with homeless individuals to help ensure they know how to use their medications and have secure and temperature controlled places for them. But as Liebow’s quote notes, this doesn’t always happen, even if a doctor knows the patient is homeless. A person without a fridge may not have a place to store insulin without it going bad. They may not then be able to access insulin when needed, and may end up in the ER for an emergency that would never happen if we had simply ensured they had a place to live and keep their medicine. Homeless individuals with asthma may find themselves sleeping in a car in a parking lot, or under a freeway overpass. This means they are in a place where they are exposed to more car exhaust and dust, potentially triggering a severe asthma attack and necessitating another entirely preventable ER visit. In both cases if the had been given a place to live that wasn’t densely inundated with vehicle pollution or had a way to safely store their medication, they wouldn’t have had to go to an ER. Society could have have paid the cost of their housing, but instead we chose to let them be homeless and pay for thousands of dollars in medical costs after they had a problem.
The question our team looked at is how many ER visits does it take to offset the costs of simply providing a house first? And what types of services will Medicaid allow to be billed that help secure and individual in the housing they are provided? As it turns out, Medicaid does offer assistance for housing search, coaching on how to be a successful tenant, and other basic services to help ensure someone can live within any housing they are provided. It doesn’t, however, allow any reimbursement for rent or direct housing costs. Nevertheless some hospitals and some local governments are beginning to invest in housing first strategies. Any efforts that keep people out of the ER will save money in the long term, even if it is more expensive up front to provide someone with a place to live. The returns and benefits to a persons health ultimately outweigh the costs of providing housing as fewer healthcare services are needed.
First Impressions Matter

First Impressions Matter

In Thinking Fast and Slow, Daniel Kahneman describes a research study that shows the power of the halo effect. The halo effect is the phenomenon where positive traits in a person outshines the negative traits or characteristics of the individual, or cause us to project additional positive traits onto them. For example, think of your favorite celebrity. You know they are good looking, talented at whatever they do, and you most likely also ascribe a number of positive traits to them that you don’t really have evidence for. You probably believe they have the same political beliefs as you, that they probably pay their taxes and don’t litter. If you discovered they did one of these things, your brain would want to discredit that information, or you might face some cognitive dissonance as you square the negative characteristic with the fact that the person looks good and is talented.

 

The study Kahneman references shows the power of the halo effect by giving people 6 descriptions of a fictitious person. Some people were shown 3 positive characteristics followed by 3 negative traits. Another group of people were shown a different fictitious person, with the same 6 traits, but listed in reverse, with the negative traits first followed by the positive. Kahneman writes, “The sequence in which we observe characteristics of a person is often determined by chance. Sequence matters, however, because the halo effect increases the weight of first impressions, sometimes to the point that subsequent information is mostly wasted.”

 

The study shows that first impressions matter a lot, even when we are not actually meeting someone in person. When the first thing we learn about a person is something positive, it can be easy to overlook negative traits that we discover later, and this is true in reverse. This idea is part of what drove Malcolm Gladwell to write his new book Talking to Strangers. I have not read Gladwell’s book, but I have listened to him talk about it on several podcasts. He discusses the death of Sandra Bland, and the interaction she had with law enforcement that led to her arrest and subsequent suicide. First impressions matter, and the first impression she made on the police officer who pulled her over was negative, shaping the entire interaction between Sandra and the officer, and ultimately causing her arrest. Gladwell would also argue, I believe, that first impressions can be formed before you have even met someone, simply¬† by absorbing racial or other stereotypes.

 

Gladwell also discusses Bernie Madoff in his book. A savvy conman who relied on the halo effect to swindle millions. He charmed people and seemed successful, so people who trusted him with investments had trouble seeing through the lies. They wanted to believe the positive traits they first observed from him, and any hints of fraud were easily missed or ignored.

 

The best we can hope for is awareness of the halo effect, and remembering how much our very first impressions can matter. How we put ourselves forward can shape the interactions we have with others. But we can remember to give people a break, and give people second chances when our first impressions of them are not great. Remember to look beyond the first observed trait to see the whole picture of other people in your life, and try to set up situations so that you don’t judge people immediately on their appearance, and can look further to know and understand them a little better.
The Cost of Outliers

The Cost of Outliers

Malcolm Gladwell is well known for his book Outliers, about people who become extremely successful thanks to intense practice, good luck, and supportive situations that enable their early practice and skill development. If you have read his book, you probably have at least a little exposure to the idea that some people are unique and can have a surprising influence on the world. But one area you probably haven’t considered with the impact of outliers, unless you study healthcare economics, is in medical spending.

 

In his book The Opioid Crisis Wake-Up Call, Dave Chase explains the issues with outliers in our system. “Six to eight percent of plan members are spending 80 percent of the plan dollars,” Chase writes.

 

We probably imagine that our healthcare costs are so expensive because so many American’s don’t eat well and don’t exercise. I have argued in the past that we don’t support a universal healthcare system in our country because many people think the problem is that others are not taking responsibility for themselves and are simply fat and lazy, costing more for the rest of us. The reality is that a huge amount of our total healthcare spending, as much as 80% according to Chase, is from a tiny percent of the population. Our outliers are driving the cost of healthcare up at an alarming rate, and it is not simply because these outliers are fat and lazy.

 

The people who spend the most on healthcare mostly have rare diseases, congenital conditions, or need extreme emergency acute care. Chase writes, “They tend to have complex health problems, usually with multiple comorbidities.” Because we don’t recognize that most of our spending goes toward outliers, and because we are biased against a vision of fat and lazy people, we adopt policies that bankrupt these outliers who often were simply born with bad luck when it comes to health.

 

What is really detrimental to our system is that these outliers are often misdiagnosed. Chase writes, “In any given year, about 20 percent of the outlier group is completely misdiagnosed. This means that about 16 percent of plan dollars each year are being wasted on treatments for diseases the patients don’t have.” It will always be difficult to treat outliers. They are not typical patients, and have multiple health issues that interact in complex ways. But because we don’t make their care easy and because healthcare in the United States has so many barriers, we end up failing this population, and the errors and failures mean that we waste a huge amount of money and resources in their care. It doesn’t just cost the individual, but everyone on the healthcare plan.