Tim Harford The Undercover Economist

Articles published in March, 2020

How not to lose your mind in the Covid-19 age

here are as many responses to the Covid-19 pandemic as there are people to respond. Some have of us have children to home-school. Some of us have elderly relatives to worry about; some of us are the elderly relatives in question. Some of us have never been busier; others have already lost their jobs.

One experience is common, however: wherever the virus has started to spread, life is changing radically for almost everyone. It’s a strange and anxious time, and some of the anxiety is inevitable. For many people, however, much of the stress can be soothed with – if you will pardon the phrase – one weird trick.

First, a diagnosis. Most of us, consciously or not, have a long list of things to do. As the virus and the lockdowns have spread, many of the items on the to-do list have simply evaporated. At the same time, a swarm of new tasks have appeared, multiplying by the day: everything from the small-yet-unfamiliar (“get toilet paper” and “claim refund on cancelled holiday”) to the huge-and-intimidating (“organise an inspiring home-school curriculum” or “find a new job”).

The change is so fast and comprehensive that for most of us it is unprecedented. Even a divorce or an international relocation is more gradual. The death of a spouse might be the only experience that comes close. No wonder that even those of us who are safe and well and feel loved and financially secure find ourselves reeling at the scale of it all.

To the extent that the problem is that the to-do list is unrecognisable, the solution is oddly simple: get the to-list back in order. Here’s how.

Get a piece of paper. Make a list of all the projects that are on your mind. David Allen, author of the cult productivity manual Getting Things Done, defines a project as “any multistep outcome that can be completed within a year”. So, yes: anything from trying to source your weekly groceries to publishing a book.

That list should have three kinds of projects on it.

First, there are the old projects that make no sense in the new world. For those that can be mothballed until next year, write them down and file them away. Others will disappear forever. Say your goodbyes. Some part of your subconscious may have been clinging on, and I’m going to guess that ten seconds of acknowledging that the project has been obliterated will save on a vague sense of unease in the long run.

Second, there are the existing projects, some of which have become more complicated in the mid-pandemic world. Things that you might previously have done on automatic may now require a little thought. Again, a few moments with a pen and paper will often tell you all you need to know: what’s changed? What do I now need to do? What, specifically, is my next action? Write it down.

Third, there are brand new projects. For me, for example, I need to rewrite the introduction to my forthcoming book (‘How To Make The World Add Up, since you were wondering). It’s going to seem mighty strange without coronavirus references in it. Many of us need to devote more than a little attention to the sudden appearance of our children at home. Some of us need to hunt for new work; others, for a better home-office set-up. Many of us are now volunteering to look after vulnerable neighbours.  In each case, the drill is the same: sketch out the project, ask yourself what the very next step is, and write it down.

Occasionally, you may encounter something that’s on your mind – the fate of western civilisation, for example, or the fact that the health service desperately needs more ventilators and more protective equipment. For my family, it’s an elderly relative, suffering from dementia, in a locked-down nursing home. We can’t visit him. He can’t communicate on the phone or comprehend a video chat. There is, for now, literally nothing we can do but wait and hope. Acknowledging that fact – that there is no action to be taken – is itself a useful step.

I won’t pretend that in this frightening time, working through your to do list in a systematic way will resolve all anxieties. It won’t. But you may be surprised at how much mental energy it saves – and at the feeling of relief as all these confusing and barely-acknowledged new responsibilities take shape and feel more under your control.

Or so it seems to me. Good luck, and keep safe.


Oh – and in case it wasn’t obvious, this week’s Book of the Week is David Allen’s superb Getting Things Done.

My NEW book The Next Fifty Things That Made the Modern Economy is out in the UK in May and available to pre-order; please consider doing so online or at your local bookshop – pre-orders help other people find the book and are a huge help.

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29th of March, 2020MarginaliaOther WritingResourcesComments off

Why the crisis is a test of our capacity to adapt

“It’s really quiet,” said the proprietor of Oxford’s best falafel stall when I popped over to buy lunch on Monday. It is even quieter now. Meanwhile, my wife emailed friends to ask if we could help: both of them are doctors and they have three children and a parent undergoing treatment for cancer. “Thanks We will be in touch,” came the reply. No time for more. It may be quiet for the falafel man, but not for them.

There, in miniature, is the economic problem that the coronavirus pandemic has caused, even in its early stages. For everyone who is overworked, someone else has little to do but wait. The supermarkets have struggled to meet a rush of demand for some goods, but that should pass. “We are not going to run out of food, so chill,” Yossi Sheffi tells me. He’s an MIT professor and an authority on supply chains.

While the pressure on the supermarkets may ease, the strain on the healthcare system will not. It is already intense and will get much worse. Yet while clinicians are overstretched, others wonder when the next job is coming from. From the falafel seller to the celebrity chef, the hotel porter to the millionaire motivational speaker, many tens of millions of people around the world are fit and eager to work, yet unable to.

This is a test of flexibility and imagination. Gourmet restaurants are shifting to takeaway service; conference speakers are building portable studios. Best of all is when we find ways to turn idle resources into weapons in the fight against the virus. It is hard not to cheer when reading tales of distillers turning their stills to the task of producing hand sanitiser, or hoteliers offering their empty rooms to doctors and nurses.

But it is a much tougher task, for example, to make more urgently needed ventilators. In the mid-20th century, William Morris, a man who made his fortune manufacturing British cars, turned his workshops to the task of producing “iron lungs” for people paralysed by polio. It’s an inspiring precedent for his successors at Meggitt, McLaren and Nissan scrambling to emulate him by building ventilators to use in the current crisis, but it took time.

Prof Sheffi reckons that it would be straightforward for, say, an automobile parts supplier to retool in a matter of months, and having many thousands of extra ventilators by the autumn would certainly be better than nothing. But to produce complex equipment from scratch in weeks, perhaps using 3D printing, would be a miraculous achievement even if regulations are loosened, as they should be.

Yet harder is to find more nurses and doctors; intensive care units do not operate themselves. And even for less specialist staff, the task is larger than it might seem because of what the late Thomas Schelling, a Nobel laureate economist, called “the acceleration principle”. Let’s say that Europe has 10m hospital orderlies, with an annual turnover of 30 per cent. That means 3m need to be trained each year, 1m at a time on a four-month training course.

Now let us aim to expand gently to 11m over the next four months. It doesn’t sound much — just a 10 per cent increase. Yet the training programme must double in scale to accommodate it, because now 2m rather than 1m orderlies are enrolled in the same four-month window. The same logic applies to anything we need more of, from the personal protective equipment that is in desperately short supply in our hospitals, to the internet bandwidth that we will all be using more of, while working from home.

The task, then, is immense. But we must try. Under any conceivable scenario, we would not regret trying to expand emergency medical care several times over. If it is impossible, so be it. But if it is merely expensive and difficult, such costs are trivial compared to the costs of suspending everyday life for weeks or months.

And there is some hope: efforts are already under way to persuade doctors and nurses who have retired or switched careers to return, and to put medical students to work at once. We could quickly train new medical support staff to perform focused and limited roles. I can only imagine the breadth of the skills needed to be an intensive care nurse, but if we cannot have more experienced nurses with complex skills, let us at least support them with people who can quickly be trained to change an oxygen tank or turn a patient in bed.

Even those apparently ill-suited to intensive care duty — the 75-year-old retired doctor, the community volunteer with first aid training, or even furloughed airline crews — could indirectly support health systems. While medical professionals staff the wards, I would gladly pay taxes to fund online advice from a retired doctor, a virus test administered by an air steward, or stitches and bandages from a St John Ambulance volunteer.

Killing two birds with one stone never sounded easy to me. But there is no excuse now not to be radical. This crisis is a test of many things. Not least among them is our capacity to adapt.


Written for and first published in the Financial Times on 20 March 2020.

My NEW book The Next Fifty Things That Made the Modern Economy is out in the UK in May and available to pre-order; please consider doing so online or at your local bookshop – pre-orders help other people find the book and are a huge help.

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Book of the Week 12: The Misinformation Age by Cailin O’Connor and James Owen Weatherall

The Misinformation Age is a good read, although not quite what I expected. Not much on the psychology of misinformation – the backfire effect and confirmation bias, for example, are mentioned only briefly. But that’s fine: such topics are covered very well elsewhere. Instead, the book has two stylistically quite different components: some strong storytelling (and often the stories were unfamiliar to me); and a network-based analysis of the spread of information or misinformation through a nodes-and-edges graph.

O’Connor and Weatherall are interested, then, in the structure of networks that propagate information and misinformation, and spend at least as much time on expert networks (for example, networks of research scientists) as they do on muppets like you and me. The graph-analysis is used to study how pseudo-scientific propaganda (such as tobacco-cancer denial and climate denial) can influence experts. I learned a lot, and was delighted to see that an idea I proposed way back in “Adapt” actually exists in the scientific literature: it’s called the Zollman Effect. (The Zollman Effect describes a situation in which scientists can improve their beliefs by failing to communicate. Too much communication, too early, leads to a convergence of beliefs that might be premature. Pockets of heterodox thought gather data on alternative approaches, which will sometimes prove to be correct.)

The stories are good, too. Some come from the excellent Merchants of Doubt, but no harm in that. There was some very interesting detail on the initial research into the ozone hole, and I loved the opening tale about the Vegetable Lamb of Tartary, a piece of fake news that emerged around 1350 CE and persisted for centuries. Bravo.

UK: Blackwell’sAmazon

US: Powell’sAmazon

My NEW book The Next Fifty Things That Made the Modern Economy is out in the UK in May and available to pre-order; please consider doing so online or at your local bookshop – pre-orders help other people find the book and are a huge help.

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23rd of March, 2020MarginaliaComments off

Will economists ever be as good at forecasting as meteorologists?

The UK’s national weather service, the Met Office, is to get a £1.2bn computer to help with its forecasting activities. That is a lot of silicon. My instinctive response was: when do we economists get one?

People may grumble about the weather forecast, but in many places we take its accuracy for granted. When we ask our phones about tomorrow’s weather, we act as though we are gazing through a window into the future. Nobody treats the latest forecasts from the Bank of England or the IMF as a window into anything.

That is partly because politics gets in the way. On the issue of Brexit, for example, extreme forecasts from partisans attracted attention, while independent mainstream forecasters have proved to be pretty much on the money. Few people stopped to praise the economic bean-counters.

Economists might also protest that nobody asks them to forecast economic activity tomorrow or even next week; they are asked to describe the prospects for the next year or so. True, some almanacs offer long-range weather forecasts based on methods that are secret, arcane, or both — but the professionals regard such attempts as laughable.

Enough excuses; economists deserve few prizes for prediction. Prakash Loungani of the IMF has conducted several reviews of mainstream forecasts, finding them dismally likely to miss recessions. Economists are not very good at seeing into the future — to the extent that most argue forecasting is simply none of their business. The weather forecasters are good, and getting better all the time. Could we economists do as well with a couple of billion dollars’ worth of kit, or is something else lacking?

The question seemed worth exploring to me, so I picked up Andrew Blum’s recent book, The Weather Machine, to understand what meteorologists actually do and how they do it. I realised quickly that a weather forecast is intimately connected to a map in a way that an economic forecast is not.

Without wishing to oversimplify the remarkable science of meteorology, one part of the game is straightforward: if it’s raining to the west of you and the wind is blowing from the west, you can expect rain soon. Weather forecasts begin with weather observations: the more observations, the better.

In the 1850s, the Smithsonian Institution in Washington DC used reports from telegraph operators to patch together local downpours into a national weather map. More than a century and a half later, economists still lack high-definition, high-frequency maps of the economic weather, although we are starting to see how they might be possible, tapping into data from satellites and digital payments. An example is an attempt — published in 2012 — by a large team of economists to build a simulation of the Washington DC housing market as a complex system. It seems a long way from a full understanding of the economy, but then the Smithsonian’s paper map was a long way from a proper weather forecast, too.

Weather forecasters could argue that they have a better theory of atmospheric conditions than economists have of the economy. It was all sketched out in 1904 by the Norwegian mathematician Vilhelm Bjerknes, who published “The problem of weather prediction”, an academic paper describing the circulation of masses of air. If you knew the density, pressure, temperature, humidity and the velocity of the air in three dimensions, and plugged the results into Bjerknes’s formulas, you would be on the way to a respectable weather forecast — if only you could solve those computationally-demanding equations. The processing power to do so was to arrive many decades later.

The missing pieces, then: much better, more detailed and more frequent data. Better theory too, perhaps — although it is striking that many critiques of the economic mainstream seem to have little interest in high-resolution, high frequency data. Instead, they propose replacing one broad theory with another broad theory: the latest one I have seen emphasises “the energy cost of energy”. I am not sure that is the path to progress.

The weather forecasters have another advantage: a habit of relentless improvement in the face of frequent feedback. Every morning’s forecast is a hypothesis to be tested. Every evening that hypothesis has been confirmed or refuted. If the economy offered similar daily lessons, economists might be quicker to learn. All these elements are linked. If we had more detailed data we might formulate more detailed theories, building an economic map from the bottom up rather than from the top down. And if we had more frequent feedback, we could test theories more often, making economics more empirical and less ideological.

And yet — does anyone really want to spend a billion pounds on an economic simulation that will accurately predict the economic weather next week? Perhaps the limitations of economic forecasting reflect the limitations of the economics profession. Or perhaps the problem really is intractable.

Written for and first published in the Financial Times on 21 February 2020.

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Book of the week 11: Uncharted by Margaret Heffernan

“The sagacious businessman is constantly forecasting,” said the great economist Irving Fisher, a man thoroughly convinced of the power of data to make the future legible. Fisher transformed economics and made millions as an entrepreneur, but died in penury. He is now best remembered as the tragic figure who, shortly before the cataclysmic Wall Street crash of 1929, informed the nation: “Stocks have reached what looks like a permanently high plateau.”

Poor Professor Fisher appears early on in Uncharted. Margaret Heffernan’s book is less a smackdown of failed forecasts than an engaging ramble across our attempts to predict, control, explore or embrace an uncertain future. Heffernan is admired for books that question the received wisdom of how management works; she is a business guru who brings the stern discipline of good sense to the business book genre. In this book, she turns her attention to a topic that absorbs most business leaders — and the rest of us too: how to think about what the future holds. Gazing into the future is not fruitless, she argues, but it is unnerving and hard work. Lazy and fearful, we are far too quick to reach for overblown gurus, or misleading data or other useless guides. Even a good tool, such as GPS, can dull our senses.

“What matters most isn’t the predictions themselves but how we respond to them, and whether we respond to them at all,” she writes. “The forecast that stupefies isn’t helpful, but the one that provides fresh thinking can be.”

And fresh thinking is what Heffernan wishes to provoke, mostly through storytelling, occasionally through rhetoric. Are we trapped by history? Only if we let our own narratives confine us. Can parents use an app to “predict life outcomes and . . . maximise the life-long potential of your child”? No. She finds the idea appalling.

Better, she suggests, to explore, empower, experiment. Whether you’re running a multinational, pondering a career change or being a parent, the same wisdom applies: sometimes things go wrong, or go right, and we don’t know why. Keep your eyes open. Stay engaged. Listen to others. Don’t be afraid to change course. Contribute to your community, and make connections before trouble strikes: “Don’t exchange business cards in a crisis.”

At times, Uncharted resembles a collection of secular sermons illustrated with a story. Heffernan stands in the pulpit quietly admonishing us to be a little wiser, reflect a little more, to do the things that deep down we already know we should be doing.

Moments of counterintuitive astonishment are scarce, but the book is probably better for that. And it largely avoids the usual suspects: Apple, Google, 3M, the US military. Instead, we find ourselves in the shoes of a disillusioned Catholic priest, realising he has fallen in love and getting no help from the Church. Or in a room with a diverse group of Mexicans, from mobsters to senators, as they try to explore the future with a scenario-planning exercise. Or with the management of Nokia, wondering if there is life after cell phones. These are subtle tales of struggle and compromise.

The storytelling is not without its flaws. Physicist Marzio Nessi morphs into a Mr Messi, who is surely a different kind of genius. A discussion of fresh ideas in healthcare required multiple re-readings to sort out who was doing what, where, and whether these were diverse experiments across the nation. More than once I checked the index because I assumed I’d missed something. These are small things, but in a book that tries to flow so freely across so many stories, they are barnacles that produce a drag.

That said, Heffernan is generally a deft storyteller and the book’s reliance on such stories is a strength. Bad “smart thinking” books offer 2×2 matrices and jargon; good ones offer theory and evidence. Heffernan steps outside the category entirely. She wants us to engage with the particularities of people, places and the problems they faced — to empathise with them, reflect on our own lives and our own careers, and to draw our own conclusions.

Uncharted is not a book to skim in the business class lounge. Heffernan’s approach is more like a music lover trying to broaden the appreciation of a patient friend. “Here’s an example; listen to this; here’s another. Compare, contrast. Now do you see what I’m getting at?” It is messy, and occasionally frustrating, but wise and appealingly human.

UK: AmazonBlackwell’s

US: Amazon – Powell’s (Publishes Sep 2020)
Written for and first published in the Financial Times on 19 February 2020.

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16th of March, 2020MarginaliaOther WritingComments off

Why moonshots matter

Tim Bradshaw, head of the Russell Group of leading UK universities, has a curious tale to tell about failure. A few years ago he visited the Cambridge office of an admired Japanese company to find them fretting about the success rate of their research and development. At 70 per cent, it was far too high: the research teams had been risk-averse, pursuing easy wins at the expense of more radical and risky long-shots.

The late Marty Sklar, a Disney veteran, once told me a similar tale — if his colleagues weren’t failing at half of their endeavours, they weren’t being brave or creative enough. My boss at the World Bank 15 years ago had the same worry that too many projects were succeeding.

When the same concern arises in such wildly different contexts, we may be worrying about a common problem: a systematic preference for marginal gains over long shots. It’s not hard to see why. It is much more pleasant to experience a steady trickle of small successes than a long drought while waiting for a flood that may never come.

While marginal gains add up, they need to be refreshed by the occasional long-shot breakthrough. Major innovations such as the electric motor, the photo­voltaic cell or the mobile phone open up new territories that the marginal-gains innovators can then explore.

With this in mind, it’s hard not to sympathise with the UK Conservative party’s promise to establish “a new agency for high-risk, high-pay-off research, at arm’s length from government” — a British version of the much-admired US Defense Advanced Projects Research Agency.

Originally known as Arpa, now Darpa, it is most famous for creating Arpanet, the precursor to the internet. It also supported early research into satellite navigation and the windows-and-mouse system for operating a computer. And it helped to catalyse interest in self-driving cars. With successes like that, nobody seems to mind that Arpa’s failure rate is often said to be around 85 per cent. High-risk, high-pay-off indeed.

A collection of essays published recently by the think-tank Policy Exchange concurs that we need an Arpa for the UK. I’ve long argued for the importance of long-shots — the subtitle of one of my books is “why success always starts with failure” — so I can’t help but agree. Yet if this was easy, the UK would have an Arpa already.

At the casino it is easy to double the rewards by doubling the risk, but in the world of research, the trade-off is not so straightforward. While a low failure rate may indeed signal a lack of originality and ambition, we cannot simply decide to fail more often in the hope that originality will follow.

Arpa itself has approached this problem by hiring high-quality scientists for short stints — often two or three years — and giving them control over a programme budget to commission research from any source they wish.

Meanwhile, the Howard Hughes Medical Institute, a foundation, deliberately looks for projects with an unusual or untried approach, but a large potential pay-off. One study suggested that HHMI gets what it pays for — more failures, but larger successes, compared with other grant-makers funding researchers of a similar calibre.

Another large obstacle looms: how long will politicians find failure to be a sign of boldness and originality? Eventually, they will simply call it failure. Now that Arpa has a 62-year record, it is easy to forget that the agency was initially written off by some critics.

A new UK agency will face pressure to deliver. That sits uneasily with the desire to support risk-taking. Consider Arpa’s younger sibling, Arpa-E, created in 2009 to fund new energy projects. As of this week, the section of the Wikipedia entry on Arpa-E entitled “Accomplishments” is empty. Ouch.

The problem is more acute for a UK Arpa, because it is likely to have less funding — perhaps £200m a year. Is that enough? When Arpa’s head Charles Herzfeld heard the initial pitch for the proto-internet, in 1965, he responded, “Great idea . . . Get it going. You’ve got a million dollars more in your budget right now. Go.”

That is $10m-$30m in today’s money — depending on how one adjusts for spending power. It is hard to imagine a modern-day Herzfeld blowing a tenth of the UK-Arpa’s budget after a 20-minute meeting. We are on the Triceratops-horns of a trilemma. Be cautious, or fund lots of risky but tiny projects, or fund a few big, risky projects from a modest budget and accept that every single one may flop.

Keeping this new agency “at arm’s-length from government” is essential. Indeed, Safi Bahcall — the author of Loonshots — persuasively argues that such agencies need to be at arm’s length not just from government but from everybody. Yet somehow they must focus on real, practical, front-line problems. Not too close, not too distant. Not too many successes, but not too many failures, either. It’s quite a balancing act. Still, I’d pay for a ticket to this circus. Let’s give it a try.

Written for and first published in the Financial Times on 14 February 2020.

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Book of the Week 10: The Rules of Contagion by Adam Kucharski

All authors need a little bit of luck, and Kucharski has it with his suddenly-topical book, The Rules of Contagion.

I enjoyed this one a lot (or, strictly, am enjoying it a lot, since I’ve not finished but I wanted my review to be as timely as the book). Kucharski is a young epidemiologist with first-hand experience of the Zika outbreak, as well as a summer working in finance in the middle of the financial crisis, so is well-placed to write a lively book about contagion both of biological illnesses and of other things such as ideas.

The book is well written, plenty of nerdy ideas (Erdos-Renyi networks, for example) leavened both with practical examples and with nice pen-portraits of the scientists involved, such as Robert May, Hilda Hudson, Paul Erdos and Ronald Ross.

I’m learning fast and having a good time. A welcome distraction from the excitable news.

UK: AmazonBlackwell’s

US: Amazon

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9th of March, 2020MarginaliaComments off

The statistics behind the spread of ideas

Everyone loves a good idea. It’s even better when the idea becomes a tangible innovation, a better mousetrap that anyone can use and every mouse should fear. The awkward truth, however, is that even in a polished form, good ideas can be slow to spread.

Anaesthetic and antiseptic offer an instructive contrast. Both were developed in the mid-1800s. Anaesthetic spread faster than a hula-hooping craze. Atul Gawande explained in the New Yorker, “within seven years, virtually every hospital in America and Britain had adopted the new discovery”. Antiseptic, in contrast, took a generation to catch on.

“The puzzle is why,” noted Dr Gawande, before conceding that it is not a puzzle at all. Anaesthetic solves an immediate problem: a patient screaming and writhing in agony. Antiseptic is a defence against an invisible killer, infection, that acts only with a delay.

Unfortunately, many innovations are more like antiseptic than anaesthetic: they solve problems that can only be seen through a statistical lens. People are slow to embrace what they cannot see. A few years ago, researchers at the OECD looking at the diffusion of global productivity gains concluded that there was a growing gap between productive companies and the laggards. The gulf was huge — typically a fivefold productivity gap per worker, even after adjusting for differences in the equipment available.

Whether the innovation is a hardier variety of seed, a safer pharmaceutical compound or a more reliable manufacturing process, the benefits will rarely be as obvious as slumbering through surgery. Such ideas often spread all too slowly.

There are other barriers to the diffusion of innovation. If people feel they can’t adapt a new idea to their own purposes, or try it out on a small scale, they will resist. One major obstacle is social: evangelists for innovation are often rather different kinds of people from their audience. Agronomists are not farmers; pharmaceutical sales representatives are not general practice doctors; inventors are different from the rest of us. We will gladly imitate our peers, although that still raises the question of who will go first. One influential early study of hybrid corn in Iowa between 1926 and 1941 found that a few farmers would experiment with the new seed in small quantities to see how things worked out. Even the early adopters took things cautiously, while others watched. Farmers would then eventually copy their neighbours.

It is tempting to shrug and conclude that this is simply a tough problem. But there is no need to despair. Late last year, the British Medical Journal published a study that caught my attention, in part because of the cross-disciplinary team of authors: Alex Walker and Ben Goldacre (epidemiologists), Felix Pretis (an economist) and Anna Powell-Smith (a data scientist) — but also because those authors were looking at the diffusion of innovation in an innovative way.

The study examined how quickly National Health Service general practice clinics in England caught up with best practice in prescribing two types of drug. In one case, the birth-control pill Cerazette came off patent in 2012, at which point patients should generally have been prescribed cheaper generic versions of the drug, desogestrel. In the other, national guidelines were changed to recommend a different antibiotic for urinary tract infections.

NHS England publishes anonymised data, every month, describing the drugs being prescribed by GPs across 8,000 clinics. If you have time, you can noodle around on OpenPrescribing.net — a platform developed by Ms Powell-Smith and Dr Goldacre — looking for patterns.

And since that sounds like hard work, the BMJ study uses a statistical tool to spot whenever a clinic seems to have changed its clinical practice, and whether they did so promptly or gradually, or suddenly but after a delay, or not at all. The patterns are clear to the naked eye once pulled out of the mass of data: here’s a clinic that swiftly and sharply switched to the cheaper generic drug; here’s a clinic that never read the email. A follow-up study performs a similar analysis for statins.

What’s remarkable about all this is how unremarkable it really is. The diffusion of innovation could once only be studied in small settings and by taking considerable pains. But this is the 21st century: the NHS has made the data available to allow us to watch a good idea spreading across the nation, or not, almost in real time.

This is, of course, an atypical situation. It is unusual to be able to collect such a large set of high-quality data, showing who has or has not embraced a new idea. And it is unusual to have such sharply defined innovations: either the doctor prescribes the new drug to patient X or she does not. Still, being able to observe leaders and laggards in the NHS is no small thing. It should be straightforward to prod the laggards — and to ask the leaders how they do it. And Dr Goldacre’s group have published their statistical tools. Hopefully, it won’t take too long for the idea of using them to spread.


Written for and first published in the Financial Times on 7 February 2020.

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Book of the Week 9: Loonshots by Safi Bahcall

Loonshots is a book about “how to nurture the crazy ideas that win wars, cure diseases and transform industries” – and I should admit right off the bat that I haven’t had a chance to finish it yet, despite wanting to.

The book has a lot of strengths – some really nice accounts of the development of radar during the war, the creation of Arpa, Pixar, etc. These are case studies that you might have encountered before but the stories feel crisp and lively. Well worth reading for the potted histories alone, in fact.

I wish Bahcall had been less keen to coin new labels: P-type loonshots,  S-type loonshots, the “invisible axe” and the “Moses trap”. A few are fine, but as I skimmed ahead to the chapter about Arpa (which was excellent) I was surrounded by these new terms that I didn’t understand. By the way, P-type loonshots are bold product innovations. S-type loonshots are bold strategy innovations. Not sure why we don’t call them “product loonshots” and “strategy loonshots”.

Also still chewing over the effort to tie everything to phase transition (ice melting, water freezing). Bahcall is pointing to the fact that different organisations behave in different ways: a small start-up has a different culture to a large company; a military research outfit doesn’t act like an infantry regiment. But to get innovative ideas to work, you need both, and you need to manage the transfer of ideas between small and large, or blue-sky and front-line. As a metaphor, fine; but Bahcall seemed to feel it was more than a mere metaphor. Perhaps when I’ve had a chance to think about it some more, I’ll understand.

I wouldn’t be writing this review if I didn’t like the book, I should say. Despite the frustrations, there’s so much interesting material in it that I’m going to need to try again, cover to cover this time.

UK: Blackwell’sAmazon

US: Powell’s Amazon

Catch up on the first season of my podcast “Cautionary Tales” [Apple] [Spotify] [Stitcher]

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2nd of March, 2020MarginaliaComments off


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