This statement leaves the unfortunate impression that decisions based on theoretical models are somehow suspect and of little value.  The better, but less soundbite-friendly, question should have been whether the model adequately predicts the risk. To make useful predictions, a model needs to do two things:

• account for all key factors that influence the outcome
• quantify how each factor influences the outcome.

To the frustration of passengers, airlines and businesses around the world, the eruption of the Eyjafjallajokull volcano in Iceland presented several challenges for modelers.  Some of the key factors playing a role here include:

• Ash composition: how damaging is it?
• Extent of the cloud: how high, how far and where?
• Aircraft capability: how much ash exposure can airplanes handle?
• The costs of staying grounded vs. the costs of catastrophic failure

These four bullets of course represent just the tip of the ice berg: each of them summarizes a long list of related factors.  For example, while current data is unavailable, scientists have to rely on past experience when estimating the size and weight of ash particles, their chemical make-up and the density of the ash.  To confound matters, predictions regarding wind speed, direction and turbulence need to be considered as well.

So the real question needs to be: how well does the model represent the current situation? How well do we understand what the actual key factors are?  How well can we measure them?  Are we relying purely on past insight or can we refine our knowledge with data from the current situation?  To what extent can current satellite images, air samples and meteorological measurements improve our ability to predict the risk to life and well-being of people and property?

This interactive map on the BBC we site shows one example of how output from such modeling looks by mapping the extent of the plume over several days along with normal flight routes across the Atlantic.  This post in Business Week sheds some light on our spotty knowledge regarding the real risks of volcanic ash.

The other critical question revolves around acceptable risk.  Risk not only originates from ash clouds. It also comes from “playing it safe.”  Billions of dollars in lost revenues and productivity put the livelihood of hundreds of thousands of people at risk.  Every day we accept the risks of driving our car – so at what point do ash clouds represent a higher risk than driving a car?  Even if we could come up with an exact numeric value for these risks, how does the value of human life fit into these equations?

Therein lies the apparent disconnect between statistical models and real life: intangible values sometimes outweigh what can be measured.  The decisions we make depend on how we actually perceive the risk.  Yet, in order to put our perceptions into perspective, we need to have good numbers to guide us – and getting good numbers requires a good model of reality.

So, before we start talking about law suits, we need to accept that risk is inherent to anything we do.  Blaming people for doing the best they can to balance public safety with economic considerations wastes resources that would be better spent on improving our ability to assess and manage risks.  We send unmanned drones to gather combat intelligence, why not modify them to collect air samples?  Why not fund research to create better models for volcanic plumes? Especially if history should repeat itself and Eyjafjallajokull continues to sputter for the next year or two.

Additional Reading

From Eruptions, a blog dedicated to volcanism:

Airlines lobby to reopen European airspace closed by Eyjafjallajökull
Posted on: April 18, 2010 2:30 PM, by Erik Klemetti

http://scienceblogs.com/eruptions/2010/04/airlines_lobby_to_reopen_europ.php

Eyjafjallajökull flight cancellations: How the right decision is being made to look wrong

Posted on: April 22, 2010 9:40 AM, by Erik Klemetti

http://scienceblogs.com/eruptions/2010/04/eyjafjallajokull_flight_cancel.php

Research Gap Left Airlines Exposed to Volcano’s Blast (Update1)

April 22, 2010, 9:05 AM EDT

http://www.businessweek.com/news/2010-04-22/research-gap-left-airlines-vulnerable-to-volcano-s-fire-and-ice.html

Is driving more dangerous than flying through ash?

Page last updated at 10:51 GMT, Wednesday, 21 April 2010 11:51 UK

http://news.bbc.co.uk/2/hi/uk_news/magazine/8633484.stm

Could aircraft dodge the volcanic ash cloud?

Page last updated at 14:06 GMT, Tuesday, 20 April 2010 15:06 UK

By Stephen Mulvey

BBC News

http://news.bbc.co.uk/2/hi/in_depth/8632583.stm

Recriminations erupt in ash-fueled aviation crisis

AP 4/21/2010

By Arthur Max, Associated Press Writer

http://news.yahoo.com/s/ap/eu_iceland_volcano

How volcanic ash could ground your next flight

By Larry Dignan | Apr 15, 2010

http://www.smartplanet.com/business/blog/smart-takes/how-volcanic-ash-could-ground-your-next-flight/5989/?tag=content;col1

How Volcanic Ash Can Kill An Airplane

Apr 15, 2010 09:00 AM

Ray Wert

Story & pictures of KLM Flight 867

http://jalopnik.com/5517775/how-volcanic-ash-can-kill-an-airplane

Iceland Volcano Vs Mt. St. Helens And Airspace

Pilot’s discussion forum

http://www.airliners.net/aviation-forums/general_aviation/read.main/4783270/

Volcanic Ash Contingency Plan

ICAO (International Civil Aviation Organization)

http://www.paris.icao.int/documents_open/files.php?subcategory_id=63

http://www.paris.icao.int/documents_open/show_file.php?id=274

• How does one differentiate between the “voice of the customer” and the “noise of the customer?”

VOC or “Voice of the Customer” is a key concept in Six Sigma, the quality methodology used by Toyota and many other companies.  Needless to say that with millions of customers, there are millions of opportunities for feedback – hence the potential for noise.

Wordplay aside, any communication from a customer contains some useful information, but not all feedback carries the same weight.  For example, a broken radio most likely has less impact on car safety than a stuck gas pedal – but we can’t be sure until we have more information: the broken radio may be a symptom of an electrical problem that also affects the accelerator.

Therein lies the problem: how do we assign the “appropriate” value to the information we receive?  How much effort and money do we put into researching the (hypothetical) “radio problem” versus other problems?  How can we quickly assess whether the “radio problem” can turn into a “safety problem” that requires thorough attention?  With the myriad of active and passive ways in which we can listen to customers, we need a good triaging system to help us separate critical information from information clutter.

While everyone can agree that data needs to be used “appropriately,” it is much more difficult to agree on what “appropriate use” actually means.  Assuming for the moment that we can collect accurate data, what do we need to know in order to elevate an incident from “routine” to “requires immediate attention?” Here are several key factors that influence appropriate use:

• The ability to recognize the potential for significant harm
• The ability to draw a correlation between the incident and significant harm
• The ability to develop a solution to the problem
• The ability to implement a solution to the problem
• The ability to make that solution pay off in the long run

Each of these bullet points shares two characteristics: to accomplish them, we need good information as well as sound judgment – neither of which comes easily.  This applies to all types of corporate decisions – whether we are dealing with product safety issues or the most profitable allocation of sales and marketing resources.  The major differences between types of decisions typically revolve around their scale and the level of detail required to make a decision.

It is impractical to go through all the possible ways in which we can identify “appropriate” information.  Instead, here are a few guidelines:

• Assess the potential harm
• Identify actionable information
• Prioritize timeliness, accuracy and budget
• Identify who needs to know what and when
• Incorporate the means to review requirements from time to time

Keeping these bullets in mind goes a long way toward selecting the tools and resources needed to supply appropriate information.

Additional Reading

Toyota knew of accelerator pedal problem in UK a year ago
From The Times
February 2, 2010

http://business.timesonline.co.uk/tol/business/industry_sectors/transport/article7011671.ece

Unintended Acceleration: Toyota Addresses the Issues
November 06, 2009 by Irv Miller

http://pressroom.toyota.com/pr/tms/our-point-of-view-post.aspx?id=2234

Wikipedia entry for Six Sigma, the quality control methodology used by Toyota and many other companies.  Voice of the Customer (VOC) is a key concept of the Six Sigma methodology.

While point-and-click is much easier than writing code, it still requires computer users to become familiar with what the computer can do and how to accomplish various tasks.  It also requires standards about where to click and what should happen when certain actions are taken.  All this knowledge and these standards had to develop over time and often through trial and error.

In some ways we have reached a similar stage for data analysis: visual analytics provides a new language through which non-analysts can explore and answer business questions.  It frees the non-technical user from the analytic equivalent of writing code, that is, it frees them from the need to learn how to create graphics that – until now – required significant technical knowledge to generate.

As with any new technology, some mayhem ensues: we have to gain experience and learn through practice.  We need to become fluent in the appropriate use of less familiar – yet oddly intuitive – graphing techniques like sparklines, heatmaps or small multiples.  In short, we must develop a visual vocabulary beyond the bar charts and line graphs we know from Excel or PowerPoint.

And this brings me back to the Xerox-GUI-Macintosh comment from the beginning: as in those early days of learning the language of icons and point-and-click, we have now reached the point where more powerful ways of encoding data in a visual format is available to the lay person.  Just as with the graphical user interface, we will some day look back and say “I can’t imagine a world without seeing data in pictures.”  For at least a little while, those of us in the analyst professions need to act as interpreters and guides to those who are learning this new language.   Sooner rather than later we will all get there.

• As the largest private employer, Wal-Mart has the kind of clout that no other private US employer has: 1.4 million employees is a large pool over which to spread risk. It would be interesting to know to what extend this pool includes young and healthy employees vs. older employees with more extensive healthcare needs.  It may also be interesting to know to what extent Wal-Mart employees fit the stereotypical health profile of low wage earners.  According to a Wal-Mart sourced graph in the WSJ, only 52% of its employees get their insurance through Wal-Mart.  This begs the question “why do the other 48% go elsewhere?”   Does it have to do with coverage being better elsewhere?  This is a real question – I am not trying to imply anything here.
• With roughly 700,000 lives to cover (50% of 1.4 million), Wal-Mart can offer some efficiencies to insurers that they would not have if all these policies had to be managed within the Individual Market: one standard policy for hundreds of thousands of people, without the need for an underwriter to talk to each one of them.  Does this make an argument in favor of “single payor” and “coverage for everyone?”  After all, the law of large numbers implies that the bigger the pool, the more likely we can determine the “true average” of medical costs.
• Given its size, Wal-Mart is in a unique position to negotiate price breaks – whether they are for insurance coverage or employee health services (think preventive screening, health education, etc.). Small businesses can’t keep up with that, yet they employ the majority of employees in this country and are at greater risk for increased healthcare costs due to their smaller “pool” of employees.  If small companies are eventually exempted from a mandate, what have we really gained by requiring employers to pay for health insurance?

Philosophical Meanderings

The crux of our healthcare debate lies in the fact that we have a very desirable product, but not enough resources to provide the full extent of this product to everyone.  Doctors have the knowledge and expertise to cure many more diseases and they can extend the lives of many more patients than in the past.  That comes at a cost. By default we are currently rationing access to this product based on who has access to health insurance or who can pay for it through other means.  There has to be a better way.

So, what can we do? First of all, let’s cut through the rhetoric of ideology and political posturing.  As with so many things in life, the real answer falls somewhere between “market forces” and “socialized medicine.” Everyone needs to give a little and everyone needs to take a little more responsibility. By “everyone” I truly mean everybody – because to some extent we are all involved in this debate, regardless of whether we are a taxpayer, patient, provider, insurer or someone engaged in the many industries that support or deal with health care.

Many of us have already started down this path.  I notice more and more discussion about appropriate end-of-life care, whether the expense of a treatment is justified by the expected outcome, whether it is necessary to see a doctor for a particular ailment, how individuals can make healthier life style choices, what role primary care doctors should play in healthcare, and on and on.  Some examples that have recently caught my attention can be found in the “Additional Reading” section at the end.

Looking at all these discussions it seems that the “market forces” are grappling with the “socialized medicine forces” to come up with a blended solution.  That sounds like a promising deal to me – as long as we actually get there.

Additional Reading

Quality of Death: End of Life Care in America

WBUR
Posted by CommonHealth
Sunday, April 26th, 2009

http://commonhealth.wbur.org/wbur-posts-and-stories/2009/04/quality-of-death-end-of-life-care-in-america/

Candidates Aplenty for Spending on Comparative Effectiveness

June 30, 2009, 4:04 PM ET

WSJ Health Blog

http://blogs.wsj.com/health/2009/06/30/candidates-aplenty-for-fed-spending-on-comparative-effectiveness/

An Open Letter to Dr. David Blumenthal

By RICK WEINHAUS, MD
June 26, 2009
The Health Care Blog

http://www.thehealthcareblog.com/the_health_care_blog/2009/06/an-open-letter-to-dr-david-blumenthal.html#more

an article pleading for more user-friendly EHR software (EHR: electronic healthcare record) and related discussion

One Reporter’s Painful Decision

by Richard Knox
June 15, 2009
NPR Health Blog

http://www.npr.org/blogs/health/2009/06/by_richard_knox_i_broke.html – deciding when (not) to see a doctor

Advance Directives, Living Wills, and End-of-Life Issues
Up to Date
KCUR Radio
April 16, 2009

Podcast Link: http://archive.kcur.org/kcurViewDirect.asp?PlayListID=6484

Link Source: http://www.practicalbioethics.org/cpb.aspx?pgID=1080

“Guest host Stephen Steigman talks with Center for Practical Bioethics senior fellow Bill Colby and Dr. Karin Porter-Williamson, an assistant professor, section head and Medical Director for Palliative Care services at the KU Medical Center about advance directives and living wills: what we need to have ready, who needs to know it and how to ensure our wishes and those of our loved ones are carried out.”

Basically, the VT Attorney General argued that keeping prescriber data from sales reps makes their sales efforts less effective and thus keeps doctors from prescribing newer (i.e. riskier) and more expensive branded drugs – while saving Vermont a significant amount of taxpayer money.  The counter argument, of course, states that prescriber data allows sales reps to be more efficient and thus helps reduce the cost of drugs.

The fall-out from major drug failures and headlines questioning the legitimacy of drug prices makes it easy to see why the VT legislature saw it fit to pass the law at issue here.  On the other hand, the majority of drugs on the market are not blockbuster material and are not the ones driving current headlines.  Smaller companies do benefit from prescriber data that allows them to allocate their more limited resources to areas where their drugs are more likely to be needed.

Increased conflict of interest controls, lackluster product pipelines, the move toward so-called personalized medicine, cost constraints and other industry developments already are changing the way in which drugs are marketed and sold.  It will be interesting to see how the legal details continue to play out, but by the time the final rulings are made, the industry may have moved on.

Further Reading

PDF file of the 4/23/2009 ruling by the US District Court for the District of Vermont
http://www.prescriptionproject.org/tools/solutions_resources/files/0040.pdf

In a nutshell, officials and business leaders to have to

• Decide when to act: developing vaccines, producing them and getting them to where they can do the most good takes significant money, time and human resources
• Figure out what to do: doing too little could lead to a major health crises while doing too much could result in wasted resources at a time when our means are already stretched thin
• Find the best time to act: if they act too soon, the wrong vaccine may be developed, significant resources may be wasted and lives may be lost – if action is delayed for too long the proper vaccine may not be ready in time to prevent major loss of live or productivity
• Weigh the relative impact of each decision: regardless of which choices are made, each will have significant effects on people and business – the trick lies in finding choices with the least negative impact.

Regardless of the ultimate outcome, this situation underscores the critical value of accurate, timely and appropriate information.  While scientists work around the clock to fully understand this new virus, vaccine manufacturers still have to look at some hard facts – after all, they can only produce vaccines as long as they can stay in business.  Some of the critical pieces of information to be gathered include:

• Does this virus present a serious enough threat to warrant the production of a vaccine?
• How many people are really at risk?
• How many doses will actually be needed?
• How long will it take to produce them?
• What are the costs of speeding up production or increasing capacity should this become necessary?

While it may sound inappropriate to worry about bottom lines when people’s lives are potentially at stake, it would be reckless to rush ahead with producing a product that may never be needed.

Further reading:

Officials Face a Tough Decision Over Ordering Vaccine
By JEANNE WHALEN and GAUTAM NAIK
Wall Street Journal (4/30/2009)
http://online.wsj.com/article/SB124105096668271115.html

Swine flu: How serious is the global threat?
James M. Steckelberg, M.D.; The Mayo Clinic
http://www.mayoclinic.com/health/swine-flu/AN02000