Mind In The Cloud

“Technology changes ”how“ not ”what.“ Expands in space, compresses in time. The results are sometimes breathtaking.”

Notebooks as Extended Mind

In 1998, Andy Clark and David Chalmers made the radical suggestion that the mind might not stop at the borders of the brain. In their paper, The Extended Mind, they suggested that the activity of the brain that we experience as consciousness is dependent not only on brain but also on input from the rest of the world. Clark’s later book, Supersizing the Mind clarifies and expands on the idea. Taken to its logical conclusion, this extended mind hypothesis locates mind in the interactions between the brain and the external world. The physical basis of consciousness includes the brain, the body and nearby office products.

I mean to say that your mind is, in part, in your notebook. In the original paper, Clark and Chalmers use the hypothetical case of Otto. Otto has Alzheimer’s Disease and compensates for his memory deficit by carrying a notebook around with him at all times. They argue for externalism- that Otto’s new memories are in the notebook, not in his brain. The system that constitutes Otto’s mind, his cognitive activities depends not only on his brain, but on the the notebook. If he were to lose the notebook those memories would disappear just as if removed from his brain by psychosurgery. It should make no difference whether memory is stored as physical traces in neuronal circuitry or as ink marks on paper since the use is the same in the end.

The paper actually opens with more extreme cases like neural implants that blur completely whether information is coming from the brain or outside. We have brain mechanisms to separate what is internally generated and what is external. The point is that these external aids are extensions. In medical school I learned to use index cards and a pocket notebook reference, commonly referred to as one’s “peripheral brain”. Those of us who think well but remember poorly succeed only with these kinds of external knowledge systems.

In 1998, when The Extended Mind was published, we used mostly paper notebooks and computer screens. The Apple Newton was launched August, 1993. The first Palm Pilot device, which I think was the first ubiquitous pocket computing device , in March, 1997.

The Organized Extended Mind

When David Allen published Getting Things Done in 2001, index cards and paper notebooks were rapidly being left behind as the world accelerated toward our current age of email and internet. I’ll always think of Getting Things Done system as a PDA system because of the lists I created my system that lived on mobile devices. First it was the Palm, then Blackberry and most recently, iPhone. @Actions, @WaitingFor, @Projects were edited on the PC and synced to a device that needed daily connection to the computer. I had a nice collection of reference files, particularly for travel called “When in London”, “When in Paris”, etc.

My information flow moved to the PC as it became connected to the global network. Two communication functions really: conversations and read/write publishing. Email and message boards provided two way interaction that was generally one to one or among a small community. Wider publishing was to the web. Both of these migrated seamlessly to hand held devices that replicated email apps or the browser on the PC. Eventually the mobile device became combined with phone. Even though capabilities have grown with faster data rates, touch interfaces, bigger screens and large amounts of solid state data storage, The first iPhones and iPads showed their PDA roots as a tethered PC device in the way they backed up and synced information. That world is rapidly fading as the internet becomes a ubiquitous wireless connection.

Access to email and internet through smartphones has served to further “expand time”“ and ”compress space" as Dave put it. I adopted a text file based approach so that I could switch at will between my iPhone, iPad and MacBook Air and have my external thoughts available. The synced plain text files seems transformational, but feels like my old Palm set of lists.

The age of the cloud is one of information flakes. Much of what we know is now latent and external requiring reference to a small device. Is it any wonder that our streets and cafes are filled with people peering down into a screen rather than out into the world?

It was a rapid transition. One that continues to evolve and that demands frequent reconsideration of the means and methods for constructing the extended mind.

A Mind Released

The SimpleNote and Notational Velocity and DropBox ecosystem was the enabling technology for me. Suddenly there was seamless syncing between the iPad or iPhone and the Mac. The rapid adoption of Dropbox as the defacto file system for iOS broke the game wide open so that standard formats could be edited anywhere- Mac, Windows, iPhone, iPad, Unix shell. This was a stable fast data store available whenever a network was available.

Editing data on a server is also not a new idea. Shell accounts used for editing text with vi or Emacs on a remote machine from anywhere is as old as computer networking. I started this website in late 1999 on Dave Winer’s Edit This Page service where a text editor in the browser allowed simple website publishing for the first time.

Incremental searching of text files eliminates the need for databases or hierarchical structure. Text editors like Notational Velocity, nvAlt, SimpleNote or Notesy make searching multiple files as effortless as brain recall from long term memory. Just start typing associations or, for wider browsing, tags embedded in metadata, and unorganized large collections become useful. Just like brain free recall of red objects or words that begin with the letter F. Incremental searching itself is not a new idea for text editors. What’s new is that we’re not seeing just a line of text, but rather multiline previews and instant access to each file found. But together incremental searching with ubiquitous access and the extended mind is enabled across time and space.

What seems to have happened is that the data recorded as external memory has finally broken free from its home in notebooks or on the PC and is resident on the net where it can be accessed by many devices. My pocket notebook and set of GTD text lists is now a set of text files in the cloud. Instantly usable across platforms , small text files have once again become the unit of knowledge. Instant access to personal notebook knowledge via sync and search.

Why Enrichment Designs Don’t Work in Clinical Trials

Last week I was discussing a clinical trial design with colleagues. This particular trial used an enrichment design. A few years ago I did some simulation work to show that you can’t pick patients to enroll in a clinical trial in order to improve the results.

People are probabilistic too.

The idea of and enrichment design is to winnow the overall patient group down to those individuals who are likely to respond to therapy. One way is to give all of the candidates a placebo and eliminate placebo responders. Another strategy is to give a test dose of drug and keep only those who respond. Either way, the patients that pass the screening test get to go on to a double blind test of active drug versus placebo.

Sounds like a great idea, but it doesn’t really work most of the time in practice. While this idea of screening out patients, it turns out that it mostly just excludes patients who are varying in their complaints over time. You can’t really  tell who are going to be better patients during the screening test. It turns out that most patients look different at one time point compared to any other.

The mistake that we make is in thinking that people can be categorized by simple inspection. We think of patients as responders or non-responders, an intrinsic characteristic they have or don’t have. Trying to screen out patients we don’t want falls into the trap of thinking that a single set of tests can successfully discriminate between classes.

The way I think of it is that we need relatively large clinical trials to prove the value of a modestly effective drug. So it seems odd to think that one could easily categorize patients themselves when tested. You can see this by looking at how well a test dose of a drug looking for drug responders would be able to enrich a patient population. Variability over time makes this impossible.

Let’s walk through an example. An imaginary trial of a drug to treat migraine attacks.

Lets say we know the truth and this candidate is in reality a pretty good treatment for a migraine attack. But the patient varies in headache severity and responsiveness to treatment.

Some headaches are mild and will resolve without treatment. That mild attack will act no differently whether the active drug or placebo was administered. Some headaches are very bad and even a really effective drug might not touch that kind of headache. So again the attack will be the same whether placebo or treatment is given.

And what about the headaches that are in between and could respond? Well if a drug worked half the time, then out of every two of those attacks, the active drug would show an effect where the placebo did not. The other half the time, it would look just like placebo again.

Add up these cases, there are four of them. For only one atttack did the active drug work where the placebo would fail. One out of 4 times, a 25% overall response rate. All just because in the same patient the headache and its response to drug changes. So if I did a test treatment to see if I had a responder, I would eliminate half of the responders because either they had a headache that was the the one too severe to respond or the one that happened not to respond that time.

Of course you’d eliminate some of the non-repsonders. But we know that even non-responders may have 1 in 4 headaches that are mild enough that they don’t need the treatment anyway. So you eliminate 75% of the non-responders with a test dose which is better than the 50% of responders that were eliminated. You’ve done better. How much better depends on the ratio of responders to non-responders in the population, a ratio that is completely unknown.

What’s nice is that while you can see the logic by reading the story I’ve told, a mental simulation, one can create an explicit mathematical model of the clinical trial and simulate running the trial hundreds of times. It turns out that there very few conditions where this kind of enrichment really works. I turns out its simpler and just as informative to see whether or not the drug is effective in the overall population without trying to prejudge who is a responder or not with a test dose.

The irony? This is exactly the opposite of clinical practice. In the real clinic, each patient is their own individual clinical trial, an “N of 1” as we say. N is the symbol for the number in a population. An individual is a population of one. N of 1. We treat the patient and over time judge whether or not they respond in a personal clinical trial. Not to see whether the drug works but whether the patient is a responder.  If they don’t, therapy is adjusted or changed. But in our migraine example, multiple headaches of various intensity would have to be treated so see the benefit.

Perhaps variability across a population is easily grasped. People are tall or short, have dark or light hair color. Variability within an individual over time is perhaps more subtle but just as important for over time.

Trust is Simplifying

The outrage directed toward the TSA reflects a breakdown in trust.

With terrorists trying to bring down planes, we don’t trust our fellow passengers. Every fresh attempt, even when not successful lowers that trust even further. The government and its TSA becomes the vehicle to demonstrate that lack of trust. As trust declines, surveillance increases. In a decade it’s gone from identity and magnetometer checks to direct body searches, either by technology or direct physical contact.

As discussed in the NYT today, there’s also a lack of trust between the government and the citizenry. We feel angry that government is being so intrusive and body searches seems to cross a personal limit for us. And the TSA doesn’t trust is to just go along and let them do their job.

The loss of trust in air travel creates hassle and uncertainty. Everything being carried onto a plane must be checked. Every person must be checked. No one is trusted in this system. Calls for more targeted surveillance are really calls for more trust of at least some individuals. After all, I know they can trust me. Its those suspicious looking young men I’m worried about. That would remove lots of hassle. Actually all of my hassle if they would trust me somehow.

Trust is a great simplifying principle. I trust my bank to keep my accounts private and secure. I trust other drivers on the road to stay in their lanes. As trust goes down, complexity goes way up. I have to worry about more and more because so much more could go wrong in so many unexpected ways.

I was introduced to the importance of trust in Francis Fukuyama’s book“Trust” In it he looks across different cultures and describes the  structure of trust in each one and how it affects politics, economics and quality of life. Not surprisingly, the higher the level of trust, the better off people are. And one of his theses is that the U.S. with its frontier driven communitarianism, is one of the highest trust societies in the world.

Most simply, trust transform an uncertain potentially hazardous environment into a safe, reliable socially driven model. Its such a powerful simplifying principle that the desire to cooperate in a fair way is a deeply felt human quality, wired into our brains it seems.

Since I’m currently exploring ideas about extended cognition, lets turn the view 180 degrees. Usually we think of trusting in the external environment, looking for predictability. I think there’s an important aspect of self-trust that contributes to simplicity. If I can rely on myself to remember how to do something complex, I approach it with confidence.

That sense of mastery and self-confidence dispels fear just as trust in the world does.

On Packing Better

There is a difference between reducing complexity by deciding better and just artificially reducing choice through enforced “simplicity”. It is better, from a decision theory point of view, to have three shirts to choose from than to own only one shirt and lack choice.

With choice comes the chance for a better outcome. But don’t make the mistake of preserving choice instead of making choices.

I always think of packing as a great example of this. Better to decide well what to pack and travel light than to postpone choice and drag around too much for just in case scenarios. I see think is project planning. There are situations that call for robust plans with low failure probability and times for fast flexible plans that may need a trip back to the drawing board.

In the spirit of minimalism, I support the use of Folios

OTC Recommends: The Leather Document Folio | Off the Cuff: “”

True, folios have limited space and can never really compete with the functionality of a messenger bag or roomy elegance of a soft sided brief bag. You always have to hold it, or tuck it under your arm, and often there is no outside slash pocket for a paper or metro pass. But such limitations are to me a big part of their charm.

By necessity I am forced to shed most of the stuff I habitually carry around but never really use. It is simplification by requirement.

Part of the charm of the folio is enforcing the discipline to decide better. When appropriate.

IPad Inspirations

For reasons I only partly understand, I bought the latest version of Tinderbox from Eastgate. It’s been over 4 years since I last worked on the Decision Tools blog. I found the relevant files and templates to update the home page at least.

The iPad is serving as catalyst here. Somehow the eBook format of the iPad suggests to me that is worth weaving together all of the threads contained in my philosophical investigations.

Al Is Back

What a pleasant way to transition out of winter. Alwin Hawkins has started his weblog back up again:

code:theWebSocket;: Arisen from the ashes…: “”

(Via .)

It’s a nostalgic day. I’m reading David Allen’s new book, “Making It All Work”. I had settled into a comfortable routine of capturing information and processing it, but reading his Getting Things Done roadmap has me thinking about kicking it up a notch again.

I don’t have a laptop tool for tracking projects like I had for my last job. Now I work on a shorter cycle time and projects are generally managed for me. My role is more reactive these days.

So I started up Tinderbox for the first time in years, finding that I was at version 3.5 and Mark Bernstein had moved all the way up to 4.6. I’ve downloaded the new version and will decide whether to pony up for the upgrade.

On Deciding . . . Better : Imagination as Simulation

On one monitor tonight I’m watching Garry Winogrand’s New School interview via 2point8. His work was just taking pictures. He transformed the ordinary by capturing it.

On my other monitor, Dave Rogers reminded me just how long we’ve been at this. The Edit This Page group is now going on 9 years of online writing.

Groundhog Day: “Tomorrow will mark the ninth anniversary of my effort in this thing called ‘blogging,’ or, as I tend to think of it, ‘ranting into the void to no discernible effect.’ Not sure if longevity counts for anything, but there it is. Been here longer than Scoble. Go me.”

I think Dave can safely assume his writing has been toward some end, as we have all moved to occupy different spaces than we did 9 years ago. We’ve gotten somewhere, but not where we imagined back then. I still enjoy reading Dave’s work on figuring out exactly how that works.

Since my original weblog is now lost to time and the discontinuation of the ETP servers, I go to the Internet Archive every once in a while to read what I wrote back then. From Dec 5, 1999:

On Deciding . . . Better : Imagination as Simulation: “Simple solutions to complex problems are usually wrong. Complex problems usually require complex solutions. In a complex situation it can be hard to know which variables are important. We tend to act from simple biases based on simple analogies once complexity becomes too great.

When decisions involve uncertainty, multiple goals and multiple effects technology can help amplify imagination. In my own life, I’ve been exploring how this technology can help me clarify my goals, understand my assumptions and help me act in a way that is most consistant with what I believe.”

My set of concerns are very different now and my approach to this complexity is also very different. My decisions are now much smaller and short term. They are less focused on getting someplace, less focused on defining path. More taken with what to do rather than which to do.

The problems are no less complex and the uncertainty is just as great. Yet rather than looking at the pieces analytically, I’ve moved to a wider view in which emergence of choice dominates analysis of options.

iPhone Europe

I used my iPhone pretty extensively in Europe during the last trip. The reaction was interesting.It’s viewed as a great phone, but the limitation to high priced, long term contracts is a huge barrier to everyone I talked to. These folks are used to buying unlocked phones and switching plans or carriers as needed. Avoiding the iPhone seems more of a protest against changing the current adventageous system than a real economic decision for them.Here in the US, we’re used to carrier lock-in and contracts. 

On Deciding . . . Better 2.0 Is Off the Air

After 6 months of regular writing here, I took down my previous weblog. Because of it’s long life, decidingbetter.com had better page ranking than this weblog on Google. I’m redirecting the domain here for now and plan to hold on to it.

I looked over the referer log for the last 6 months and found that there was only one theme that was getting regular searches, which was some posts on chromogenic C41 process black and white film. That should be replaced, since I don’t think there’s a great deal of information on this alternative on the net.

But the site was ugly, was probably leading to occasional attacks on my home network and wasn’t where I wanted searchers looking for my net writing. For now then, I’ve consolidated here.