Strong Horse is a series of conversations, observations and recollections of the author’s experiences in the Middle East over the last decade … focusing on Cairo, Beirut, Israel and Damascus. Living in Brooklyn, Smith took the events of 9/11 as a personal challenge to study in the region. That led him to discussing the political and social culture of the Arab world with individuals as varied as Sufi scholars, Koranic recitators, Lebanese Druze warlords, and Cairo doormen … engaging as well with more famous names such as Naguib Mahfouz (Egyptian Nobel Laureate in Literature), Edward Said, Omar Sharif, and Natan Sharansky.

As the title of the book suggests, Smith feels the conflicts of the Middle East are largely an internal clash of Arab civilizations and involve the “captive” peoples (Copts, Druze, Christians, Jews, Sufis, Shia, etc.) who must somehow survive with Sunni majorities and governments in the region. The spillover of violence into the West, while constant, is therefore largely a secondary effect. The key question, the author believes, is over “who’s the real Muslim?” Since that bloody debate, by definition, doesn’t extend to the infidels, violence in the non-Muslim world is usually some form of manipulation in benefit of domestic agendas. The evidence of the last decade suggests the Arabs reserve the lion’s share of their bile and violence for each other. Though they provide unrelenting warnings about the dangers of inciting further violence by Muslims (through American actions in Iraq and Afghanistan), such concerns never seem to translate into a lighter hand by authorities within the region. It is this observation which leads Smith to propose that “strong horse” politics was, is, and will be, a enduring principle in the Middle East … and widely supported by Arabs of every persuasion.

For Smith, Arab antagonism to Americans and Westerners is fundamental, being as they are neither Muslim nor, more importantly, Arab. The various Arab tribes and sects who feud endlessly amongst themselves do not permit any profound reconciliation with the Other, either across the religious and ethnic boundaries or within them. Muslim willingness to leverage Western allies against other Muslim powers is built right into Islamic history, as outlined with methodical effort in Efraim Karsh’s Islamic Imperialism: A History, reviewed earlier on chicagoboyz here.

The author’s conclusion after his travels and conversations over the last decade is that “overthrow, domination, and eventual collapse” is a political pattern long established amongst the Arab tribes, largely reinforced (not introduced) by Islam, recognized for over half a millennium by Arab historians, and it shows little or no sign of change in the 21st century. The strong horse is the model for successful political change in the region. It was not chosen as a metaphor by Osama Bin Laden on a whim. And it resonates deeply within Arab culture. It is the aspiration of all participants in the political process in the Middle East, in Smith’s belief … and any discussion of peace (as opposed to interim truce) is a form of cultural betrayal. And punished accordingly. Despite the fact that this cultural habit reiterates destructive cycles without end, it cannot be relinquished without giving up a fundamental cultural narrative. The toxic results are self-evident to modern Arabs but if Smith is to be believed, they are caught in a situation where all they can do is “double down” on the model of political change that has served them very poorly in the past. Struggling to cope with the impact of two centuries of Western technology and culture, the Arab hope is that an Arab Strong Horse will arise. The reality is that it is the United States, and inadvertently Israel, that have found themselves in the role of Strong Horse in the Middle East. The burden of the role is that all parties in the region look to gain favor and/or manipulate the destruction of their domestic and regional competitors by playing games with the Strong Horse. As Smith quotes in passing, Arabs are better at feuding than warring. At the point at which they are able to escalate conflict to war, inevitably it is their culture and self-regard that pays the price. What was true of Napoleon in Egypt is now true of America in the Middle East.

Apart from giving the reader the interesting opportunity to listen directly to ordinary Arabs from many walks of life describe their world to Smith, Strong Horse does a fine job of introducing the history of the theme of “renewal” that has been developed by Arabs since Napoleon’s invasion of Egypt in the early 19th century. That invasion was to shine a light on the backwardness of Arab technology and power that’s reverberated through the centuries. Like Bernard Lewis before him, Smith notes that the Arab world’s failures in the military and technology realm are not merely political failures. Because Islam is the newcomer amongst the People of the Book, a failure to dominate Christians and Jews, and suppress the various “heresies” within Islam itself, casts doubt on Muhammad’s authenticity as Prophet and the essence of his message. Apostasy is a major concern in the Muslim world. The response of the “liberal” strain in Arab culture to the shocks of the Industrial Revolution and European dominance was not to begin a process of Koranic hermaneutics (a process, as noted here, fraught with danger to this day), but rather a house-cleaning of Islamic hadiths or commentaries, and an attempt to return to the time when Islam was unsullied by Sunni-Shia splits, by Caliphate collapse, by Mongol disruption and Turkish hegemony. The good old days, in other words. And a very tall order for any political philosophy.

Smith interweaves his conversations with modern Arabs with the history of Arab political thought, especially the pan-Arab movements that sought to respond to European occupation, and more latterly (post-Nasser), the 20th century rise of Islamic “purification” as a political solution to Arab woes. To kick things off, the author turns to the Arab world’s most widely-known medieval historian. Ibn Khaldun identified the Arab pattern of “rise and fall” some six hundred years ago. Even then it was seen as a very old tradition. Ironically, Khaldun’s own scholarly efforts, greatly admired in the West, were to subject him to abuse and imprisonment by the authorities of the day. For me, as a reader with a passing familiarity with the scientific and cultural history of the region, this detail of the great historian’s biography jumps out. As Smith notes, and other authors such as Toby Huff (The Rise of Early Modern Science: Islam, China and the West) and Christopher Beckwith (Empires of the Silk Road: A History of Central Eurasia from the Bronze Age to the Present) substantiate in great detail, intellectual innovation in the Arab World is often rewarded with torture, assassination, and death. Often the innovators are outsiders (Ibn Khaldun a Tunisian, for example, Ibn Rushd (Averroes) a Spanish Muslim) and their lives are often spent back-pedaling from insights and commentaries of their youth. A golden age of scholarship and organized education appeared to be in collapse by the early 12th century, with the writings of Al-Ghazali bringing the Arab enhancement of Hellenistic philosophy to a permanent end.

Smith, however, focuses not on the time when the Arab world gave up its lead (and its interest) in natural philosophy but on the the liberalizing and modernizing trends of the 19th and 20th century as they appeared in the Middle East. Ironically, and as noted in Michael Oren’s book Power, Faith, and Fantasy: America in the Middle East: 1776 to the Present (reviewed here on cb), so much of American involvement in the Middle East began as an accommodation to the limits of Christian proselytization in the Ottoman Empire. It was through medicine and education (the “American University in …” system) that American missionaries came to influence the region. And indeed, they were the “good guys” (in contrast to the British and French) for much of the 19th and 20th centuries. The intellectual discussions amongst Arabs of the way forward eventually generated a movement of “return to Islamic basics.” This approach fully accepts the West’s technology but rejects its political and cultural values. The process of suppressing dissent (weeding out heretical or fantastical hadiths), and promoting intellectual agendas through violence, is often undertaken by the individuals in society (e.g. doctors, engineers) who are notably apolitical in our own world. Just as the natural philosophers of an earlier Arab era found themselves under attack, the political/religious philosophers of this later era contend with their national authorities. In their appetite to become the Strong Horse, they set up a cycle of violence which often consumes them personally.

Smith works his way through the history of the last two centuries in the region and identifies the intellectuals of the period that came up with the approaches we now know as Wahhabist or Salafist, and the eventual evolution of organizations such as the Muslim Brotherhood. The guiding lights of the modern Arab rationale for worldwide jihad are all there:

Muhummad ibn ‘Abd Al-Wahhab 1703-1792 (casting a baleful eye largely on other Muslims)
Jamal-al-Din Afghani 1838-1897
Muhammad Abduh 1849-1905
Rashid Rida 1865-1935
Sati’ Al Husri (1882-1967)
Hassan al-Banna 1906-1949 (formed Muslim Brotherhood 1928)
Sayyid Qutb 1906-1966

The story of how Arab intellectuals responded to the Western world … casting hither and yon for a solution to their inability to fulfill their religious destiny and assume their correct role over dhimmis and heretics … meeting failure at every turn … is solemn reading. No bad idea appears to have been left untried. Domestic politics in many Middle Eastern countries appear to outsiders to consist of a fearsome police state riding herd on a bubbling stew of various ethnic, religious, and sectarian divisions. Every new technological innovation, from firearms, to explosives, to television, and cell phones opens up a new front for argument, then oppression and violence.

The Arab ability to generate and maintain antagonism within their own world appears inexhaustible when presented in this light and Smith looks to explain this. Israel, to the author’s mind, is a convenient bogeyman in the region which now performs the role of designated Strong Horse. Street cred comes from resisting that Horse. The reality is that the Arabs and the many minorities undermine each other’s national and economic aspirations. The security services of the Middle East are demonstrably capable of working with nominal enemies to destabilize (or, better yet, threaten the destabilization) of their next door neighbors. Every Arab man’s hand apparently against the other. With mutual assured destruction for whatever clans are at the top of the Arab nation-states should they stray from the ancient habits. Ironically, it is now Israel that acts as buffer and guarantor for the Sunni states against a resurgent Persian Shia state, and Arab Shia populations throughout the region.

Cultural habits seem to work against forming a consensus that would actually create the pan-Arabism that was so urgently longed for in the middle of the 20th century. All, however, are apparently certain that the Jews and Americans are the cause of all their suffering to a minute degree. Washington, in this worldview, watches every Arab nation and power group with a close eye. All through this book, Smith is a conscientious and generous rapporteur of these viewpoints. The reality, as those of us in the West know all too well, is that the citizens of the G8 are industriously indifferent to the Arab world except when absolutely compelled to be otherwise. In some ways, I suppose this is the more grievous insult. To be despised is one thing. To be ignored, entirely another. Does this mean more generations of Arabs “acting out” in order to gain status, or favor, or assistance? That’s a sobering thought but I think this book goes some way to making that case.

With such a conclusion, I believe it can be safely said that Smith falls within the “school of skepticism” about Arab democracy but he is certainly more sympathetic to the culture and the people than some earlier authors who feel that Arab and Islamic culture is irredeemably toxic to itself and its non-Muslim neighbors. Smith is not so pessimistic as to write off the Middle East indefinitely, but he’s at best neutral about the potential for true liberal belief and behavior in the region any time soon. Tying modern antagonisms to ancient habits (which long predate European, let alone American intervention), he’s certainly not optimistic for the Arab world’s abandonment of terror and violence as an accepted method of governance, and dynastic succession. The architecture of Cairo itself gives him a perfect way to illustrate the shifting tides of Muslim belief as caliphate and Mameluke, Sunni and Shia, each build mosques in the city proclaiming their enduring authority and Islamic authenticity. Each, in turn, is overturned violently. To Smith, modern Egyptian political structure, irrespective of its European veneer and American subsidies, is entirely within the flow of Arab tradition of the past millennium. The momentary fluorescence of a Westernized model of Arabic culture in the 20th century, as illustrated by authors like Mahfouz or actors like Sharif, seem largely lost.

Latter parts of Strong Horse spend time in discussing the realities of Lebanon, Syria, and Israel … and the momentum created by Iran to use Syria and Hezbollah as their proxies in establishing Shia prestige in the Middle East. As noted above, ironically Israel becomes the region’s Strong Horse, providing indirect protection and stability for Sunni majorities west of the Euphrates by counterbalancing Iran’s military force. It’s hard to imagine that this state of affairs gives Arabs much comfort. Though Iran can bluster and threaten its Jewish and Sunni neighbors, it must (at least for now) work through proxies in order to make good on its threats. As for George Bush’s legacy of the last decade, Smith believes the events in Iraq and Afghanistan may well turn out to be the most momentous in Arabic history since the Mongols took Baghdad in 1258. In setting the Shia above the Sunni in Iraq, an Arab (rather than Persian) Shia power has been established. America, for better or worse, now has the power to intimidate all parties in the region whether it goes or stays. The natural zig-zagging of democratic America in forming foreign policy can only create heartburn in a region that must broker status with the current Strong Horse to compete with its domestic antagonists and regional competitors. What seems like transitory dithering in America translates to life and death in the Middle East. The US is in the position of arbiter and guarantor of a multitude of unofficial agreements which prop up the Arab world … whether freedom of the seas, access to oil, or military/technological subsidization. From Smith’s point of view, then, the US is cast in the role of strong horse whether wanted or not, and as such, people in the Middle East will see it both as tyrant and benefactor simultaneously, and indefinitely. That means complaints and begging aren’t likely to end any time soon. And idealistic American foreign policy, untempered by the application of real power, will perpetuate bloodshed.

Conclusion

Strong Horse is a fascinating, if unsettling, read because Smith lets the Arabs speak for themselves, across their various economic situations, locations and denominational differences. Arab dreams of the last fifty years have been largely dashed. A dread of the future is widespread. Yet it is matched with a world-view that still seems largely fantastical to a Western reader, and inevitably blood-soaked. The author’s conversations do seem to reflect a deep trust by the people who spoke openly to him. Where he asks follow-up questions, they are probing, if respectful.

This book is an excellent complement to more rosy assessments of political change in the Middle East. People with a long-standing interest in the region will find it a quick and somewhat contrarian view, by someone without a professional axe to grind. It’s a relief to hear about the region from someone who doesn’t have an academic, diplomatic, or journalistic career to advance. Strong Horse will also be of interest to those fascinated by the question of European, English and/or American exceptionalism. Does culture matter? Smith’s book would suggest that it does, and it will. For Israelis and Americans who find credence in Smith’s assessment, the book has rather ominous implications. Both countries will be co-opted into the ancient Arab political tradition of unquenchable grievance, of “Resistance to Illegitimate Power” … of people alternately vilifying and passively suffering the Arab governments of the day. America may yet be honest broker, bogeyman, and benefactor for generations of Arabs wedded to violence as their only tool for change.

Strong Horse is written well, and written for the general reader. It’s a quick read but for those with limited time or interest, you’re in luck. Radio talk show host Hugh Hewitt gave the book a careful and thoughtful reading, and then invited Lee Smith on his program for an extended interview. The transcript of their conversation here is a tribute to Hugh Hewitt’s intelligence. I wish my review could have given Mr. Smith’s book half as credible a summary. To Hewitt’s great credit, his interview manages to cover all the central points of a book while engaging the author in a deeper conversation about Smith’s views on the future of the region. For additional commentary by Lee Smith, check out his recent article in Slate on the Obama Administration’s treatment of the Israelis. Realpolitik at its grimmest.

I’ve been to more than my fair share of art galleries but I’ve never seen any artsy photo that has packed as much pathos as this one.

I mean, we’ve all been there, at least metaphorically and isn’t that what great art is all about?

Also, it is possible to discern a slight relationship between the woman called “Jihad Jane,” an American accused of terrorist activities, and Koestler’s protagonist Hydie Anderson. But as I noted in the post

today’s Hydies are unlikely to share the educational and religious depth of the woman Koestler imagined

To put it mildly, judging from appearances in this case. Looks like I called that one right!

(Once-through cooling, which has been used since the days of James Watt, means simply that water is used to condense steam and is thence returned to the source from whence it came. The cooling water is not polluted, but is warmed up a bit. IIRC, the returned cooling water is somewhere in the range of 85-90 degrees F, i.e., less than the temperature of the typical hot tub.)

The state of California has taken other actions which make it difficult for the capacity of these 19 plants to be replaced. California has a moratorium on new nuclear power plants and coal plants. New natural gas plants, which are less polluting than coal plants (and emit less CO2, for those who care about this issue) are also banned in much of California.

A project to build large-scale solar plants in the Mojave Desert is encountering opposition from environmentalists who object to the construction of transmission lines to carry the power to San Diego. And California Senator Dianne Feinstein is apparently also opposed to this solar project on grounds that it threatens a species of turtle. There is also environmentalist objection to wind turbines because of the danger they pose to birds and bats.

If you live in California, expect your electricity bills to rise significantly. If you run an energy-intensive business located in that state, you probably need to think about alternative locations.

Although unfortunately, these California polities are merely the currently-most-extreme version of the policies that the Democratic Party, in its war on energy, wants to impose on the country as a whole.

The only possibility we as a nation have to overcome our very serious debt problems and to restore anything like full employment is to grow our way out of the problem. The Democrats’ war on energy is one of the primary threats to such growth.

The relevant lines are:

His friends assembled at the wake
And Mrs. Finnegan called for lunch,
First they brought in tea and cake
Then pipes, tobacco and whiskey punch.
Biddy O’Brien began to cry
“Such a nice clean corpse, did you ever see?
“Arrah, Tim, mavourneen, why did you die?”
“Ah, shut your gob” said Paddy McGee!
Then Maggy O’Connor took up the job
“O Biddy,” says she, “You’re wrong, I’m sure”:
Biddy gave her a belt in the gob
And left her sprawlin’ on the floor.
And then the war did soon engage
‘Twas woman to woman and man to man,
Shillelagh law was all the rage
And the row and the ruction soon began.

Is Biddy O’Brien saying that Finnegan doesn’t look dead and Paddy McGee takes offense at the raising of false hope? (Back in the day, it wasn’t always evident that people were dead. Typhoid in particular produced a paralysis that could be mistaken for death.)

Does Biddy O’Brien punch Maggy O’Connor just because O’Connor gainsaid her or is there some subtle insult implied?

I know we Irish are quick to fight but I think there is more to the story. Anybody know?

No matter how much they steal, no matter if it is irreplaceable family heirlooms, the criminal walks. They get “community punishment”, which I suppose is the same as “community service” is here in the United States.

And we know that the felons will show up to fulfill their obligation to society because they are such stand up guys. Hardly like criminals at all. Right?

My favorite part…

“The recommendations to let burglars walk free come as, for the first time in several years, burglaries are increasing.”

So refusing to lock the burglars up where they can’t ply their vile trade will cause the number of break-ins to decline?

I keep rereading the news report, and I just can’t believe it. It slides off of my comprehension like claws on glass.

Is this some sort of April Fools joke done early?

In the spirit of full disclosure, there was a similar problem in the United States dating from the late 1980’s through the 1990’s. Space in our prisons was at a premium, the crowding so severe that courts were ordering a certain percentage to be released early to thin out the press.

Eventually the money was found and more prisons were built. And, please note, the felons got at least some jail time.

(Cross posted in a similar form over at Hell in a Handbasket.)

For an hour I was in a small blind bird watching. There was no light inside the blind so we could see out but (supposedly) the birds couldn’t see inside. However, I am sure that the Atlantic Puffins knew we were there because they kept walking right up to the rocks in front of the blind just a foot or two away and eyeballing us, which was great.

I had a camcorder and while I am no great shakes as a photographer or as the video equivalent it was hard to make a bad movie with the Atlantic Puffins (and Razorbills) literally a couple of feet away. I had a web site for this briefly but because the movies take up a lot of bandwidth it was a pain to maintain and setup so I abandoned it. Recently I set up a You Tube channel (owned by Google like Blogger here) and started putting my movies up there, a couple a day, so that everyone can see them.

If you want a laugh or have kids I definitely recommend checking out the “Puffin Movies” channel over at you tube. The URL is http://www.youtube.com/puffinmovies and it is over on the LITGM side bar. Turn UP the sound because you can actually hear the little tick-tick-tick of the Atlantic Puffin feet as they walk on the rocks in front of you and the sound of their wings as they fluff and then fly off (they are really fast and I read that they fly up to 50 mph).

Cross Posted at LITGM

Many CB readers likely have read the above article, which does a nice job challenging certain aspects of the intellectual and policy “group-think” at the heart of ObamaCare. But never fear – I’m sure the same political class that sends its children to private schools in D.C. will cheerfully take its place in line with the rest of us should the “reform” fail to live up to expectation.

Update: Ezra Klein interviews Rep. Paul Ryan.

This book is several years old but deals with timeless subject matter that might be of interest to cb readers. In the past decade or two, a major initiative called evidence-based medicine (EBM) has tried to improve how medical research is conducted and how it is used in everyday clinical practice. It’s the application of the scientific method (with all its strengths and weaknesses) to confirming how we know what we know about medical practice. Some examples of such efforts “organized improvement” were covered in a book I reviewed earlier on cb called Better: A Surgeon’s Notes on Performance by Atul Gawande. Like Dr. Gawande, Dr. Groopman writes extensively for the New Yorker. The resulting quality and clarity of his writing in How Doctors Think stands out. Either he or his editors are very good.

In How Doctors Think, the author looks at a very different avenue of medical improvement. Deductive, evidence-based, medicine necessarily involves many patients and the careful collection of information about how a treatment works for large numbers of people. This is the foundation for proving the efficacy of particular treatments for particular populations, and winnowing out cases where doctors are “fooling themselves” about their treatment. Not fooling ourselves, as physicist Richard Feynman once pointed out, is one of the great challenges of science. The folks doing EBM research always give themselves a good laugh by evaluating the mathematical and statistical skills of the average GP. Interpreting the scientific medical literature is a real skill. One that needs to be taught and reinforced. As a baseline, we can aspire for a medical profession that can dependably read, critique, and interpret its own research.

The inductive process of forming a diagnosis and executing treatment with a specific patient benefits mightily from the disciplined research of EBM, but it by no means replaces the services of skilled physicians. Checklists or AI applications in medicine can reduce egregious errors, but human judgment, matched with experience and rigorous thinking, are necessary components of health care. And that’s the focus of Groopman’s book.

Humans present with a bewildering array of symptoms. Which ones are important? People (especially kids) may have limited language and vocabulary skills. They may have limited understanding of their own bodies. And be embarrassed by what they do know. Diagnostic tests are subject to a range of problems that can lead to “false-positive” or “false-negative” results. How much re-testing is warranted? Indeed, as I discussed in an earlier review of a book by Greg Easterbrook, diagnostic medicine is becoming inherently more complex, feeding more and more information back to the physician rather than less. For example, the recent fad for full-body CT scans can identify a wealth of physical anomalies or sub-clinical problems in any individual. Such variations from the mythical norm may, however, have little or no health impact. But when matched with mysterious symptoms or illness, the information overload created by the latest generation of non-invasive tests is guaranteed. So how does the physician separate the important from the trivial, hundreds of times a day?

We don’t really have a handy rubric to describe this face-to-face process. “Medical decision-making” is a handy term but it masks a great deal of subtlety. Psychologists (primarily from the social and cognitive branches of the discipline) have recently been looking more closely at exactly how doctors make their clinical decisions (from diagnoses through treatment). Groopman’s book is about their most notable discoveries, and whether these new insights about how doctors make decisions can be used to alter the education and work habits of modern medical practitioners.

A moment’s reflection by any lay person might come up with their favorite list of physician shortcomings …

• too fatigued,
• too busy to listen more than a few seconds,
• jumping to wrong conclusions,
• just plain incompetence,
• too constrained by insurance rules
• or legal demands
• or subtle economic self-interest.

Dr. Groopman touches upon all these issues in his book but because he’s a practicing doctor at a prestigious teaching hospital, he’s in a position to look at a much wider range of errors and biases in physician thinking … both from his position as practitioner and teacher, and from his experiences as a patient and the parent of a sick child. The author combines interviews with senior physicians with digestible summaries of the scientific research on how choices are identified and made in particular patient cases. The fascination in reading his book comes both from the human interest, a standard component of every medical TV show, and from the candid discussions between practicing physicians about where they’ve gone wrong and what they do, mentally, to avoid those errors in the future.

The result of the author’s efforts is an excellent, though sobering, look at the multitude of ways that human cognitive errors are expressed in the practice of medicine. While we wait for the medical academics to translate their work into the nuts-and-bolts of medical education, and from there, one hopes, to better tools for physicians to moderate their cognitive biases, the general reader can turn to How Doctors Think.

The book is organized into a series of case studies (some involving the author) but most engaging Groopman’s medical colleagues in different parts of North America. While each chapter could stand along as an interesting New Yorker vignette, the cumulative effect of these anecdotes and professional conversations on how doctors think introduces the reader to a number of themes in human cognition.

While EBM tries to train doctors to use the probabilistic results of medical research on thousands of people to select effective treatment for their particular patients, the cognitive scientists try to help doctors avoid jumping to conclusions and ignoring the cues that a patient’s body or conversation might be offering. “When you hear hoof beats, think horses, not zebras.” That’s a common rule of thumb in clinical practice, notes Groopman. Nonetheless, zebras do exist. We don’t want our doctors focused on horses to the exclusion of zebras. Correctly identifying them … one time in a hundred, or one time in a thousand … requires a particular mental discipline for busy physicians. Not unlike that of an athlete who must face every contest with fresh perspective to respond to the unanticipated.

In no particular order, here are some cognitive errors which Dr. Groopman discusses:

Mis-diagnosis by groupthink A set of symptoms with no clear diagnosis sets off a round of different diagnoses. Each new specialist offers a new or variant diagnosis that fits their own body of expertise. The patient’s deteriorating health leads to physician frustration and intimations that the patient is malingering, psychologically disturbed, or not complying with medication and treatment. An ever-expanding case file may create an unwarranted set of assumptions for each attending physician. Confirmation bias, search satisfaction and diagnosis momentum are cognitive errors, well identified by psychology, that can herd a group of physicians into making a premature diagnosis in a case and sticking with it despite contrary facts. There’s never a good or inexpensive time for a doctor to start with a blank piece of paper, re-interview a patient and ask for a brand-new round of diagnostic tests. Nonetheless, it is through such “blank sheet” reviews that errors inherent in diagnoses (both human and technological) are often caught. Recall the brief discussion during my mini-review of Easterbrook’s Sonic Boom about cost controls and medicine. To spot the zebras amongst the hoof beats, more time, more careful attention, and more money must be spent. As medical science is becoming constantly more complex, and the treatment alternatives proliferate … good, better, and best medicine may well correlate with the resources available to nail down the “possible but less likely” explanations for illness.

Question cogently, listen carefully, observe keenly This epigram, introduced by the author, is an inadvertent introduction to the scientific literature on human attention. Attention which narrows so much as to eliminate the things in front of our nose. Attention which is so distracted by clinical pace that details are missed. Attention which is so overwhelmed by fatigue, emotion, rapid-fire pace, and information overload that the zebras all but disappear. For the physician, how does one maintain an open mind for each patient, neither over- nor under- valuing the information presented by patients.

Two doctors, three opinions A great deal of clinical practice is learned during the course of rounds and internship. As Groopman notes, follow-up research suggests that much of this practice may reflect hospital or senior practitioner “tradition” rather than a method of diagnosis or a course of treatment that has any careful study behind it. Conflicting results, when patients seek a second opinion may reflect the fact that there is a lack of thoughtful consensus in the medical community. Not much help to a patient! Individual doctors, in the face of unknowns in a particular case, may resort to “wild-ass guessing” based on the last article they read, the last patient they successfully treated, or the last conference they attended. The psychological literature has a lot to say on how people deal with uncertainty and conflicting information.

Last bad experience Conversely, a physician’s last bad experience with a particular ailment, medication or therapeutic action may color their actions in the next similar case that they face. The vividness of recent events is a function of human being’s short-term and long-term memory. Again, this subject of “attention” in medical decision-making has a large body of science attached to it.

Bad diseases, bad patients Physicians form opinions about prognoses for particular diseases or conditions. They also form opinions about their patients — their likability, pliability, and curability. Some diseases, and some patients who don’t seem to improve, may receive a physician’s “second-best” effort in paying close attention to reported symptoms. Doctors need accurate feedback. Patients may come to feel that “no one’s listening.” A mute, suffering patient may be subtly resented by a doctor. All these factors … leading to how the doctor feels about their own competence and “agency” in a clinical situation, may influence the practitioner’s willingness to re-evaluate their initial assumptions about a case, about a treatment regime, about a particular medication.

Feeling good about your doctor vs. feeling good Some cognitive biases in the doctor-patient relationship can lead the physician way off track. The desire to be seen as competent and successful can steer a physician to make decisions that will impress or satisfy their patient but have less and less to do with treating a condition. Groopman talks about a cadre of physicians in his region who have wonderful social skills and are well-liked by their patients (often across generations of patients) but whose clinical skills are deficient. In some cases, they assist their patients more by referral than by direct diagnosis or treatment. Medicine is a big tent. Its practitioners can leverage all their skills and attributes … whether a cheerful disposition, vast reservoirs of physical energy, a capacious memory, a brilliant intellect, or a manipulative psychology … to attain career success. Groopman wants to outline all the different ways that physicians can go off track in providing medical care for the patients.

The examples highlighted above are just a sample but they give a sense of the narratives that the author discusses in his book.

Why I Found This Book Particularly Compelling

As someone who switched from prehistoric archaeology to medical anthropology twenty-five years ago, and went back to school to pick up credentials in health care and medical writing, I’m quite impressed with How Doctors Think. It covers the subject of physician-patient relationships humanely, broadly, and with a great deal of insight. As someone who’s further spent the last ten years grinding through the generic literature on decision-making (the work in behavioral economics is most well-known), How Doctors Think is a particularly welcome addition. Finally something compelling, written for the general public.

Some years ago, inspired by how important the subject is, I joined the Society for Medical Decision Making. In retrospect, my membership has been more “charitable donation” than intellectual satisfaction because the scientific (or social science) literature on this topic is very advanced. It bears all the advantages and burdens of modern scientific research … arcane statistical analyses that are de rigueur, the burdens and logistical challenges of conducting studies and getting adequate case numbers, and the narrow and/or tentative applicability of any results. It seems like a discipline that creeps forward at great expense and struggles to convert its results into everyday clinical practice that an ordinary lay person might experience.

For me as an anthropologist, however, after years of watching practitioners inside and outside mainstream medicine, it was interesting to contrast Groopman’s comments with my own observations of how much traditional medicines control the physician-patient encounter. The timing of interviews, the uncertainties of symptoms and results, the environment of the clinic, the emotions of all concerned — medicine and health care are fraught with circumstances that can lead treatment astray. While the efficacy of “alternative medicine” will never be subjected to the rigor of evidence-based analysis, it seems to me that the cognitive and social gamesmanship used by various shamans, healers, and ancillary practitioners nonetheless explain a great deal of their popularity. “Feeling better” counts for something … even if it’s not “getting better.” The nebulous obligations of “alternative healers” to the State, the insurance companies, and the legal profession, often means that they benefit from superior psychological conditions for helping others to those available to a beleaguered medical doctor.

How to give the ordinary medical doctor a leg up on the “competition” is a subject that Groopman doesn’t cover. The obligation to avoid cognitive errors in medical decision-making can be proclaimed. The long list of cognitive biases which may trip up a doctor can be listed (and matched to those everyone makes in daily life). Nonetheless, a rigorous training and environmental regime by which such physician errors can be avoided seems a long way away. Some obvious solutions, like limiting physician work hours, evaluating physician personality traits, extending patient interviews, or self-conscious training in methods for reducing cognitive error seem very unlikely to be introduced to medical education or practice. And yet, I’ve seen such solutions applied in the least convincing alternative medical practices one could imagine. The cognitive psychologists, at least, would approve.

There’s an irony there.

Conclusion

How Doctors Think is a well-written treatment of the subject of medical decision-making on the front lines. It does suffer, I think, from a lack of tighter integration with the scientific literature on decision-making as a whole. I struggled to match the chapter themes to the specific phrases from psychology that science uses to discuss cognitive biases that we all are prey to in ordinary life. A table or summary or illustration organizing the pattern of cognitive biases in medical decision-making would have been very welcome in this book. It’s hard to tell if this was an author’s preference, an author’s oversight, or editorial opinion that general readers wouldn’t want such graphic material in How Doctors Think. Nonetheless, I think the use of graphics would have provided complementary information to the scientific articles cited in the End Notes. Especially for readers with a motivation to go further.

Understandably, Dr. Groopman’s conclusions about “how doctors think” are less easily translated into how we, as patients, can ensure that we get doctors that are swayed by as few cognitive biases as possible. As a result, the book seems to limp across home plate. Perhaps a second book will appear, turning knowledge into action. In a sense, we’re asking doctors to perform like mental athletes … responding reflexively with the benefit, but not hindrances, of experience. In the absence of all but the most coarse-grained “quality assurance” that now exists in the medical profession, it’s hard to know how an ordinary physician could be evaluated and make improvements on their own. For the moment then, Dr. Groopman’s discussions with his senior colleagues that he has shared in his book seem like the only uncertain (if informal) way forward. Disappointing but understandable.

As individuals, we may be more comfortable with authoritative physicians who brook little discussion, let alone skepticism. Or we may prefer a doctor who will review all the details of our case and outline how they come to a conclusion. Our choice. Not everyone wants the “agency” and responsibility to confront disease as a patient. While we might like a calm, well-rested, well-trained, focused physician with wide experience and the time to listen to us for as long as we have something to say, modern health care (short of the Mayo Clinic or platinum-care options) means that we sometimes take “pot luck,” even with a physician we know and trust. This book gives us a sense of how much randomness is in the system.

This book is highly recommended as a gift for college students in psychology, medicine, or the health care industry. Most general readers would find Dr. Groopman’s anecdotes, case studies, and discussions very thought-provoking. I do think that readers who’ve had bad experiences with the medical profession in the past would NOT enjoy this book. Doctors are human. And humans are prey to many mistakes in thinking. This book highlights the ways that medical diagnoses and treatment can go astray, up close and personal. Once you know how sausage is made, you never look at sausage quite the same way again. And second-guessing one’s treatment can lead to a lot of enduring anxiety. Barring such a caveat though, How Doctors Think is a great read.

The reason as I see it for this strange move, which is almost certainly going to very slightly erode the special relationship that the United States enjoys with the UK without gaining anything in return, is due to Obama’s overall foreign policy vision.

It would seem that he is pursuing a Jeffersonian strategy, where commitments beyond our borders are seen as messy and dangerous. An added bonus to divesting the US of allies is that military spending can be cut in favor of domestic budgets, as there will be few reasons to project power across the globe if we don’t have any friends.

Two items that Glenn linked to yesterday support my conclusions.

The first is a rather plaintive op-ed from The Times UK. The author asks “Does Barack Obama give a damn about us?”, and then goes on to answer the question with a resounding “No”.

But something particularly significant is buried eight paragraphs down.

“When the Washington Post columnist Jackson Diehl asked White House officials to name a foreign leader with whom Obama had forged a personal relationship, there was “a lot of hemming and hawing”, he said. To his astonishment, no one mentioned Gordon Brown. Instead the name proffered was Dmitry Medvedev, the Russian president.”

Traditional allies are snubbed and ignored, while the President makes nice with countries that have been historically opposed to us. The former is a cynical move designed to undermine and sabotage alliances, while the latter is an equally cynical move to provide weight to the claim that America doesn’t need a globe spanning military because we don’t need to face down the bad guys anymore.

In private conversations I have had about this, many people have pointed out that Pres. Obama has a personal mad on when it comes to Old Blighty. It seems that, in one of the two books he penned, he mentions how his grandfather was beaten by British troops in colonial Kenya. It is all family history and private prejudices.

And yet, there is nothing in his memoirs about how anyone from Israel beat up someone related to the President.

This might seem like a non sequitur, but please note how the current administration is following the same strategy with the tiny state of Israel that it has chosen to follow concerning Great Britain. Those regimes which are opposed to both the US and our traditional allies are pursued with ardor, while the countries and people which have proven to be our greatest friends are subjected to contempt and disdain.

It could very well be that I am misreading the situation. Perhaps our current President simply has little knowledge and less interest of how our strategic and diplomatic relationships have served the US in the past. It could be that what I discussed above is simply hubris and miscalculation, and not the opening moves to align our foreign policy towards isolationism. But I don’t think so.

A deliberate manipulation of world wide opinion, or simply a stunning naivete of foreign affairs? I’m not sure which one would be worse.

Erin O’Connor on California’s universities and their role in the state’s economic debacle.

Climategate: it was an academic disaster waiting to happen. Interesting and contrarian thoughts about the role of peer review.

Richard Fernandez wonders if World War III has already started…without many people even noticing. (via Isegoria)

Solar arbitrage in Germany. (via Maggie’s Farm) It’s hard to believe he will really get away with this, but still pretty funny. See also this related post from Evolving Excellence: Better Call the Waaaahmulance!

AnoukAnge writes about ambition. (One of the great literary works that deals with this subject is Goethe’s Faust…memo to self: a blog post on the treatment of ambition within Faust could be very interesting)

AnoukAnge also has a nice photographic essay on color…including the psychological connotations and cultural-symbolic meanings of various colors.

Speaking of color, this year’s winning images have been chosen for GE’s In Cell Analyzer photography contest. The In Cell system used used by scientists for better understanding disease processes and for drug development; as it happens, it also produces images which are appealing and even beautiful, in a psychedelic sort of way. There’s a nice video, with music, at the bottom of GE’s post about the contest.

One more photography-related link: British industry in the 1950s and 1960s. (via Brian Gongol)

A Reynolds’ reader points out the cross isn’t appropriate for the leader of the most powerful nation on earth; he’s more a Herod/Caeser/Pilate. And perhaps Lent isn’t a great time to blaspheme. But, then, does the Times even know the meaning that gives power to the symbols they manipulate? They swim through a world whose history is rich with such symbols, but they don’t understand the richness within an image. Of course, they do cherish that frisson of edgy sentiment. And they know enough to know that they lose power if the images are of chocolates and the Easter Bunny. (Unless, of course, like the New Yorker, they crucify the bunny.) The Times doesn’t seem campy – over-the-top, perhaps, but not ironic.

But I’m not so easily seduced – indeed, something else strikes me. This picture doesn’t have American heroism, doesn’t have the power of the great American archetypes. American history is of humility linked with grandeur: our presidents are large not because the White House is in their shadow, but rather because they are in its. Neither larger than the office nor wiser than the Constitution, their heroism comes because they reverence those ideas, losing their selves in them. Enlarged by the White House, they are well aware of the distinction between their private selves and the public office they hold but for a term or two.

Our presidents have needed a sureness of touch, a confidence that orders men into battle. But they also needed humility. George Washington handing over his sword, George Washington handing over his office – these are symbols of heroism. Many a man has been a general; few have had the self-respect, the pride in country and history (minimal as that history was for that early, role-defining president), the humility before not the founders but the founders’ ideas. Such humility gives backbone; it comes from a large, simple and even ego-less pride.

We haven’t been seeing much humility lately. But that is what moves us; it structures the archetypes Americans catch their breath over, indeed, the ones that mist our eyes.

Recently I saw a comedy special by Nick Swardson, who played “Terry” the roller-skating gay prostitute on the sadly canceled Reno 911! show. In this unlikeliest of places I heard something that made me think… the comedian was talking about how blase we are today, about the special effects for a movie like “Transformers”. He said that if people from the 1950’s saw that movie their heads would explode while today in the 21st century we just take it for granted.

As I watched the effects and sound on the Muse show I thought about how much the sound quality, visual effects and stage quality (the stage components rose and fell independently in synch with all the laser and light effects) and how they would just blow away anything from the 60’s – 80’s. If you brought in the top shows from those years the artists and fans would just stand there, mouth agape as they watched something like Muse, with their integrated lights / effects / and sounds.

As some people (generally baby boomers) talk about how rock music was better in different eras they obviously aren’t considering how much vastly improved the concert experience has been made by modern technology, when properly done. Not only are the visual effects better, but the performers have better microphones and monitors and supporting technicians on hand. The effects in those eras probably only were effective if you provided your own chemicals in the brain as enhancements.

Cross posted at LITGM

Anyway, judge the quality of the interview for yourselves. Here are a few choice excerpts from the transcript at Real Clear Politics:

Pelosi: “People are more optimistic outside of Washington D.C. than they are inside of Washington. They want to — they want to be sure that we stick to our path which is to take us out of this economic challenge and not be afraid to do so” – What?

Pelosi: “When the president began and he said that he called for swift, bold action now. And the public responded to it in a very positive way. And he said in a very shall we say professorial way, but also inspirational way, we will harness the sun and the wind and the soil to fuel our cars and run our factories, and we’ll invest in science, have better healthcare innovation and schools for the 21st century.” – What?

Pelosi: “Universal healthcare. It’s a place where we are recognizing the damage to our planet by decision that said we have made that we need to reverse. It’s a place where we have to go — we had the industrial revolution, we have the technological revolution. Now we have to have a green revolution.” – What?

Pelosi: “I think there is a realization among all people that all the things we want to do, we need to think in public private — public, public, all different kinds of different combinations on how we get them done, so we can leverage our dollars in a safe way, but leverage our dollars so we get more than just the appropriate dollars.” – What does that even mean?

I could go on and on. What do you suppose she’s saying?

SUPER-DUPER MASSIVE AND IMPORTANT UPDATE: I screwed up – the link is to the 2010 Rose interview that I recently watched, while the excerpts are from the 2009 interview. I honestly did not pick up on that while reading the transcript, obviously. In my defense, here’s an excerpt from the correct transcript:

“It’s so historic. It’s so exhilarating to be part of
history that each one of us in the Congress is on the brink of making
history. This is Social Security, Medicare, health care for all Americans.
So it is its own — it has its own encouragement to it. ”

“It has its own encouragment to it.” Well, there you go. Make fun of me and my faulty memory, and her statement, in the comments. Or just me. Whatever.

The above-market prices, called feed-in tariffs because panel owners feed power into the grid at premium prices guaranteed for decades, are high enough in Italy to generate average revenue of 35 euros ($48) a day for a 100-square-meter (1,076-square-foot) roof, according to Bloomberg calculations.
 
“The feed-in tariff drives our business plan and profitability,” said de Vergnies, whose plans include two photovoltaic plants in southern Italy that will generate enough electricity for 25,000 homes.

The gist:

The solar industry is “built on subsidies,” said James Britland, an alternative energy analyst at Allianz RCM in London. “This is a non-competitive industry that has to be subsidized.”

The investment capital that’s diverted by taxes into subsidies for politically-correct tech fads, and by investors themselves in response to the distorted incentives created by such subsidies, is capital that doesn’t get invested in productive ventures in biotech, medical devices, etc., etc. Keep this fact in mind the next time you or someone you know needs advanced medical treatment. Those chemotherapy agents and other wonder drugs don’t invent themselves. Fewer of them get invented to the extent we allow our reckless political class to divert precious capital to unproductive solar-energy schemes and other financial sinkholes.

This is myth. Booms and busts represent two equal and necessary phases of technological development. A bust looks ugly but so does the birth of child. The busts are every bit as necessary as the booms and every bit as good for the general society and economy.

I am a student of technological history and the dot-com boom/bust followed a pattern that has reoccurred since at the least the beginning of the Industrial Revolution.

(1) When a new technology reaches a certain level of development, it becomes universally recognized as a game changer (e.g., trains circa 1850, cars circa 1920, aircraft circa 1930, plastics circa 1955, computers circa 1985, the Internet circa 1998).

(2) A boom happens as venture capitalists and established businesses pile into the new technology like the Three Stooges trying to get through a door at the same time. In the great aircraft boom of the late-1920s to 1939, everyone from shipwrights to car makers to furniture makers tried their hands at building aircraft. Ford was the largest single producer of aircraft in America till the end of WWII.

(3) This period results in an explosion of diverse variations on the central technology. The majority of them are in hindsight just plain silly. Look at a Byte Magazine circa 1984 and just see how many hundreds of computer hardware platforms there were. Now we have two with a few variations.

(4) After the boom there comes a bust. The bust is caused by the results of market selection winnowing down all the variations to a handful of optimal forms. Most of the companies in the market go out of business or are absorbed by larger and more successful companies.

(5) We all get treated to endless moralizing by everyone from ministers to economists about how the bust demonstrates human folly and how we all need either God or the government to save us from ourselves.

(6) While the moralizing goes on, the supposedly busted technology sector becomes a dominant economic player of such magnitude that no one can image the world without it.

(7) Some new tech comes along and the cycle repeats itself. Right now, I would say we’re just at the Three Stooges-versus-the-door stage of the mobile computing device boom.

Far from being a moralistic tale of human greed and economic hubris, the boom and bust of new technologies is part of creative evolution. As much as it pains our egos to admit it, the only way that we even know is something will work or not is to try it and see. Technology booms are the economic version of the scientific method. We should no more sneer at failed investors, businessmen and inventors than we sneer at scientists who test and destroy their own hypotheses.

Most dot-coms failed because they were experimental and most experiments will fail. If they didn’t, we wouldn’t call them experiments, we would call them, let’s-do-that-thing-we-already-knows-works-iments.

We should venerate all those idiots at Pets.com, Flooze.com, Koop.com et al as the sacred fools of an empirical market economy. Thanks to them, we know what does and does not work.

No boom, no bust, no progress.

Selfish as always
I’ve started missing you now
Want to say so
Don’t know how
Want to hug you
Don’t know if I should
Hope you understand
I’d take your place if I could

In 1942, at the age of 22, Leo Marks joined the secret British agency known as Special Operations Executive, and soon became the organization’s Codemaster, responsible for the security of communications with SOE’s resistance and sabotage agents in occupied Europe. He usually briefed these agents…soon-to-be-legendary individuals like Violette Szabo and Forest Yeo-Thomas…before their departures and they all left indelible impressions on him. His memoir is a very emotional book: frequently heartbreaking, sometimes very funny. There is a lot about the technical aspects of cryptography, but these sections can be skipped or skimmed by those who are primarily interested in the powerful human story. Poetry, much of it written by Marks himself, played an important part in SOE’s cryptographic operations and hence plays an important role in this book.

When Marks joined SOE, communication with agents was accomplished using a poem code. Each agent chose a poem and memorized it precisely: a copy was retained at SOE headquarters. When the agent wished to send a message–a very hazardous operation, as the Germans maintained a large network of radio direction finders–he or she would mathematically combine the letters of the message with the successive letters of the poem. The process would be reversed at the other end, yielding–if all went right–the clear text. But if the agent made a single mistake in the encoding, the message would probably be un-decipherable, and the agent would be required, at great personal risk, to retransmit it. Marks found this to be disturbing and unreasonable:

If (a wireless operator in occupied territory), surrounded by direction-finding cars which were after him like sniffer dogs, who lacked electric light to code by or squared paper to code on–if that agent hadn’t the right to make mistakes in his coding without being ordered to do the whole job again at the risk of his life, then we hadn’t the right to call ourselves a coding department.

His resolution to do something about this problem became definitive after he briefed “my first frightened agent.”

When Paul and I shook hands they needed galoshes…He suddenly asked what would happen if he made ‘a bit of a mistake’ and sent us a message we couldn’t decode.

I was careful to keep looking at the code-card. There was nothing more that I could say to him. But there was one thing that I could do.

Marks went to the Grendon wireless station to meet the girls who worked as code clerks and to begin the task of training them for the much more difficult work of breaking indecipherable messages. It was only two days later that he received a message on the teleprinter:

WE HAVE BROKEN OUR FIRST INDECIPHERABLE MESSAGE. THE CODERS OF GRENDON

Another huge problem with the poem-code was that it was potentially very insecure: if the Germans could guess the poem being used, they could readily decode the message…with adequate resources, they could try hundreds of poems against each message until they found the key that fit the lock. Marks reasoned that if poems that had never been published anywhere could be used instead of the old standards, the task of the enemy could be made much more difficult. He began writing poems when the inspiration struck him (the poem quoted at the beginning of the post is one example of his work) and encouraged the coders of Grendon (known as FANYs because they were members of a paramilitary organization called the Field Auxiliary Nursing Yeomanry) to do the same. One day the female brigadier who supervised the FANYs walked into a room where a dozen of her charges were quietly and totally absorbed in “the ladylike pursuit of composing poems.” Unfortunately, she picked up an example of their work, which began:

Is de Gaulle’s prick
Twelve inches think

When the brigadier’s complaint reached Marks, he responded that the poem was excellent: the imagery was unusual, the words easy to memorize, and the content not at all what the enemy would be expecting.

Shortly before an agent departed for enemy-held territory, Marks met with him/her to review the selected poem and the coding procedures. He was well aware that many of these agents would not be coming home. Each agent was given the option to carry a lethal pill (the “cyanide” in the title of the book) to be taken–if there was time–in the event of capture. Some of these agents were…

Noor Inayat Khan, the Indian-American daughter of a leading Sufi mystic and a writer, particularly of children’s books. (One of her books is still in print.) She had abandoned the pacifist principles taught by her father in order to join the fight against Naziism. Marks describes his first meeting with her:

I longed to be able to walk into a briefing room and switch on the detached receptivity with which an analyst treats his patients…But as soon as I glimpsed the slender figure seated at a desk in the Orchard Court briefing room I knew that the only thing likely to be detached was one (if not both) of my eyeballs. No one had mentioned Noor’s extraordinary beauty.

After the briefing, Noor departed for France by light plane. After serving the Resistance as a radio operator and evading capture several times, she was eventually caught by the Gestapo and killed.

Francis Yeo-Thomas, who before the war had been general manager of the Molyneux fashion house in Paris. One of SOE’s leading agents, “Tommy” made many trips back and forth to Occupied France, and he and Marks became well acquainted. The much-younger Leo Marks asked for Tommy’s advice often, and admired him unreservedly. “I had never met anyone I trusted so completely or whose trust I valued more.” Marks remembers Tommy congratulating him on his promotion and putting his hand “firmly on my shoulder.” Writing 50 years later, Marks adds “It’s still there, Tommy. Hope you know it.”

Marks recalls a strange and disturbing dream in which Tommy appeared, along with Churchill, Tommy’s girlfriend Barbara, and two kinds of codes known as WOKs and LOPs:

I dreamed that Churchill was in danger of dying, and that Tommy was stating his case to God. Tommy offered the Lord a WOK, and then a LOP, and then himself, if Churchill could be spared. Christ and Moses were present as members of the Executive Council. Barbara was taking notes, and I was holding a copy of the FFI code-book in case Jehovah wanted that too. “No,” said Barbara, “Tommy’s life will be enough,” and a tear fell on her notebook. A heavenly choir began chanting “Hosanna” in Morse.

Violette Szabo, who struck Marks as “a dark-haired slip of mischief” on their first meeting. She had problems remembering the French nursery rhyme she had been given as a code poem, and Marks suggested as an alternative a poem he had written himself…although he never told her that he was the author. The poem, “The Life That I Have,” later became well-known after its inclusion in the movie which was made about Violette in 1958.

She carried out two missions into France…on the first one, she celebrated her success by treating herself to a shopping expedition in Paris. On the second mission, she twisted her ankle while running from German troops, and held the enemy off with her submachine gun while her partner made his escape. She was captured and executed: her George Cross award for bravery was presented by the King to her daughter Tania.

Francis Cammaerts, like Noor a pacifist who had reconsidered his views. Marks found Cammaerts to be a very frustrating student of coding methods: he finally realized that his pupil was constitutionally unable to mechanically conduct a series of operations for which he did not understand the underlying reasons–once Marks explained the theory behind the coding to him, Cammaerts did just fine. Which was fortunate, because Cammaerts became one of SOE’s most important and successful agents, organizing resistance activities in the south of France on a large scale.

I met Mr Cammaerts in the summer of 2001, and in a future post will have much more to say about this interesting and noble man.

Despite the improvements brought about by the unique poems and the growing cadre of girls dedicated to breaking “indecipherable” messages, Marks remained frustrated with the poem-code approach. He lobbied for an approach based on a one-time pad: a code to be inscribed on a piece of silk and with each element used only once. Such a code was theoretically unbreakable by cryptographic means: moreover, it could not be memorized (being a random string of letters) and hence could not be tortured out of a captured agent. Why silk? For one thing, it burns very quickly. Much of the book deals with the political maneuvering that was necessary to get the silk codes adopted and the necessary materials produced in large quantity. The poem-codes were still retained as a backup, for cases where the silk was lost. The SOE poem-code project continued throughout the war. Here’s another Marks creation that I like:

Have you never known
A glass-bottomed day
When your minutes can be seen
Flowing beneath you
In every direction
But the one you mean?

And mother’s pride
Is safe inside
An envelope of ice
And doesn’t even hear
A cock crow thrice?

Marks was often inspired to commit poetry when meeting a new colleague…especially if the colleague was someone he instinctively disliked. After meeting a Signals administrator named Miss Saunders, he wrote:

A long line of lips
The eyes an eclipse
Arteries hardened
Nobody pardoned
Who holds the key
To that self-locking face
Who stole your grace?

(Despite this inauspicious start, Marks and Miss Saunders soon became friends.)

Marks often enjoys laughing at his younger self. He observed that even the girls who were the best, most consistent coders occasionally went through times when their error rates increased substantially. Analyzing the data, he “sensed a pattern to the lapses which I couldn’t define.” He asked for help from Captain Henderson, an attractive Canadian woman who was personnel officer for the FANYs. Marks described the error problem, and Captain Henderson suggested that it might have something to do with periods. After realizing that the naive Mr Marks had no idea what she was talking about, she directed her secretary to hold all calls for the next half hour while she educated the Codemaster in the basic facts of female biology.

Though the book is leavened with much humor, the heartbreak is never very far away. Just about the time of the German surrender, Marks noticed “an old man watching me from the doorway” of his office. He was about to ask the man if he an appointment, but then he realized…

It was Tommy. He had been in Buchenwald.

After the European war ended, SOE was quickly disbanded. Marks wandered through the empty offices, and on the wall he wrote one last poem:

We listen round the clock
For a code called peacetime
But will it ever come
And shall we know it when it does
And break it once it’s here
This code called peacetime

Signalmaster, Signalmaster
Whose Commandments were in clear
Must you speak to us in code
Once peacetime is here?

I cannot recommend this book highly enough.

Some related links:

My post about Noor Inayat Khan
My post about Violette Szabo
Tania Szabo’s web site
The women of SOE

The author was shocked (shocked!) to find out that the tuna she has been using wasn’t from Italy, even though it has a vaguely Italian-sounding name. In fact, the tuna is caught in the middle of the ocean, and packaged by an American company.

So what does she do? The author swears off that particular brand of tuna! It was perfectly good when she thought it was from Italy, but it isn’t worthy enough to pass her lips now that she knows that a company based in the US is involved. Only tuna caught in the waters off Sicily, and packaged in that country, will be used from now on.

Most of the comments at the post accuse the author of being a snob, which certainly seems to be obvious. But I think it shows a much darker and vile tendency than simple snobbery. Isn’t the author exhibiting blatant racism?

Turn it around. If someone refused to use perfectly acceptable tuna from Sicily, just because it came from Sicily, they would be accused of being racist. How could they not? There isn’t anything wrong with the product, after all. They just can’t stomach the idea that those people touched the food.

So isn’t it racist to do the same thing, just because the tuna is sold by an American company?

As of this writing, the author hasn’t bothered to respond to the criticism. I doubt she will. Racists usually have a lack of backbone, after all.