You Can’t Spell Numbers Without Numb?
A Guide to Excelling at People-Person Math

Do you consider yourself a numbers-person?

Probably not.

No, odds are you are proudly a people-person.

Still, virtually everyone who reads this is surrounded at their work by numbers and probably judged by them: vaccination rates, disease statistics and oh, yeah, budgets. And those numbers influence more immediate numerical concerns, like performance ratings and compensation. Yes, we are living in a material world – count on it.

And that’s why I took the advice of Dr. Scott Hamstra, STChealth Medical Advisor and big brain, and picked up the book Making Numbers Count by Stanford B-school prof Chip Heath and science writer Karla Starr.  The point of the book is to get better at using numbers by using fewer of them. Indeed, the book includes this surprising advice: “AVOID NUMBERS.”

The logic of this is that our brains aren’t built for numbers, but rather for visuals, and by visuals, let’s hope nobody wants more flow charts; no, what we seek are mental photographs. We’ve all heard “one picture is worth a thousand words.” But, so too, one picture is worth a thousand numbers… no, wait, hold on… that’s more numbers.  So, it’s tricky. Even so, as the book declares early on, “Math is no one’s native tongue. At best, it’s a second language picked up in school through formal teaching. The more you can relay your message in the native song of your people – without math – the better.”

This means, the authors suggest, translating numbers into visuals. The book offers many examples, including some useful health-related ones. For instance, they show a chart translating the size of a tumor from centimeters to familiar food items:

1 cm = pea

2 cm = peanut

3 cm = grape

And so on, up to

10 cm = grapefruit

And then there are the translations of social distancing during Covid, where health departments found lively ways to express “about six feet,” often using local objects for comparison:

Canada: One hockey stick

Florida: One adult gator

San Diego: One surfboard

Montana: One fishing rod

Hoping to find a nice visual of one of these, I came across this eccentric one from the BBC, for some reason upping the ante on memorability by adding a naked man brush off…

Another of the author’s translation tricks is humanizing and/or personalizing the data. For instance, when trying to describe an animal’s ability, it becomes a mental picture like converting the jump of a frog to a basketball player:  Instead of, “A frog can leap several times its own body size,”; you’d say, “If you could leap like a frog, you would be able to dunk the ball from the 3-point line… actually from the 3-point line around your opponent’s basket.”

Often, however, the numbers you’re avoiding aren’t merely expressing a distance or size, and thus are not so readily translating into a visual. There’s the one “translation” that has come back to me multiple times since reading the book: the difference between a million and a billion. Here the authors describe teaching number translation to grade school kids:

We’ve seen sixth-graders (11 year-olds) get excited about knowing the difference between a million seconds and a billion seconds. A million seconds is 12 days from now, the next pizza day in the cafeteria. A billion seconds is 32 years, unfathomably far off in the future (the 11 year-old will be 43!), past high school and college and first jobs and over the horizon into the boring years of chauffeuring kids and heart attacks.”

I don’t know about you, but “billions” are so commonplace that, for me, they’ve started to lose any proportion – hey, million/billion/schillion. But, the translation that excited sixth graders snapped me back to the reality of size.

And here’s another one that stuck with me:  The authors turn this sad-but-not-surprising fact, “A very small percentage of Fortune 500 CEOs are women,” into this eye-opener: “Among Fortune 500 CEOs, there are more men named James than there are women.”

Or, remember when everyone was talking about “Six Sigma” as the goal for reducing defects/errors? Here’s how the authors humanized that one..

Instead of merely defining Six Sigma as “3.4 defects per million objects,” they offer this alternative: “To achieve Six Sigma as a baker, imagine baking a batch of two dozen chocolate chip cookies every night. You could do that for 37 years before baking a cookie that is burned, raw, or doesn’t have the  perfect number of chips.”

THE POINT

There are countless examples, but here’s the point: The authors, Heath and Starr, created a book that, while having a schillion numbers, does not have a single visual printed on its pages; yet, it contained dozens of memorable mental pictures. So the book serves as a challenge: when reporting results, take the time to attempt to translate your numbers into pictures. Can that number be concretized, humanized, personalized, foodified, sportified, geographified or otherwise turned into something that might charm the mind’s eye? Do that and even people-persons will pay attention to your numbers.

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STATS OF THE MONTH

Community Immunization Stimulants?

By Bill Davenhall, Geomedicine Analyst

Rural America seems to face stronger immunization headwinds then their urban counterparts, and some of that has to do with the site location of primary care physicians (PCPs). CDC studies suggest that rural America has significantly lower immunization rates and when a PCP physician shows up in a rural community, immunization rates increase. Uneven physician distribution would suggest that PCP site location is a top determinant in impacting immunization rates and, subsequently, the overall  success in getting both children and adults immunized in many rural parts of the US. The contextual data would also suggest that other non-medical factors begin to impinge on that choice of location.

Two factors loom large in any rural community – and represent major challenges to the immunization ecosystem.

#1. Attraction and Retention of PCP’s in the rural community (however geographically defined). Attracting and retaining a PCP is not an easy task for any rural community, and many communities don’t have a variety of incentives to attract physicians. Site location decisions are also impacted by educational loan repayment incentives that may only solve a temporary community PCP shortage.

#2. Competition of Urban Environments.  Some non-medical issues can be difficult to negotiate: an array of family employment opportunities, availability of  lifestyle amenities, educational choices for children, and many other non-negotiable “needs” of a family.

(One example: I currently reside in what I would call a “transitional” medical geography – halfway between rural areas  and dense urban areas – but many PCPs  in my community commute daily an hour or more to get to my more rural community and are not usually around my community on weekends.)

The chart below gives you a hint where PCPs are not in the right geographical location, statistically. (The data are according to HRSA, the United States Health Resources Services Administration, and Kaiser Family Foundation). HRSA reports that, as of end of the year 2024, there were approximately 13,000  PCPs that are needed in a different geographical location. If you want to give your immunization rates a better chance of increasing, you’d recruit additional PCPs (and their families) into your rural communities.  Keep in mind that the PCPs’ decisions as to where to “practice” starts long before they exit medical school — there are studies that report that physicians don’t move too far away from their birth place, where they went to high school, where they sought medical training or residency programs, or where they may have developed close friendships and met future spouses. This should signal to any reader that getting any (or perhaps additional) PCPs into your rural communities will require a lot of work ahead of time on the many non-medical  “delighters” that will  bolster  your communities health-seeking future and immunization rates.

If you live in a PCP shortage area, please let us know what your community does to get or retain your PCPs — we would appreciate hearing more about what works!

As always I appreciate 2^nd opinions.

Primary Care Unmet Needs

December 31. 2024

How Worried Should We Be?
Facing up to the Outbreak of Vax Doubters

Anyone who works with immunizations is used to keeping a wary eye for outbreaks, and this time it’s an epidemic of doubters. It might seem as if vaccinations themselves are in terrible danger… or are they? We sat down with Dr. Scott Hamstra, infectious disease expert and veteran of many vaccination crises, and asked him questions that amounted to this: HOW WORRIED SHOULD WE BE?

Dr. Hamstra suggested that we start with perspective. He used a headline from a recent “American Academy of Pediatrics News” story as an example of the old “glass half-empty” choice…

“Is the headline misleading?” Dr. Hamstra asked us, then answered, “Yes and no. Yes, the kindergarten MMR rate decreased from 92.7% to 92.5% and the exemption increased from 3.3% to 3.6%. But, you could instead frame the findings positively: The vast majority of kindergarteners continue to get MMR, and few choose exemptions, not even 1 in 25 kindergarteners!”

He went on to say, “We get all wigged out when the report says we went down from 93% to 92%. ‘Oh, my gosh the sky is falling!’ Hold on a second, are you kidding me? It’s still over 90%! Sure we want 95%, yet we would give our eye teeth for that level of success in adult vaccines, where we’re struggling at 40-to-60%. We have such high standards that we’re like the “A” student who doesn’t want to get an A-minus –‘Oh no, the world will fall apart if I get an A-minus.’”

So, the sky isn’t falling. The glass isn’t just half-full, it’s over 90% full. STILL, we wonder, if we now have vaccine skeptics in leadership positions, doesn’t that threaten to undermine the vaccine infrastructure?

“Yes, we are all afraid that the new regime will blow up the whole infrastructure and leave us scrambling,” Dr. Hamstra responded. “But let’s look at what has happened so far…

“First, they make a big deal out of thimerosal. Well, guess what? We already took that out of routine childhood vaccines decades ago. Thimerosal preservative only persists in about 5% of multi-dose vials of flu vaccines.

“Second,  they said don’t give toddlers MMRV together. Well, guess what? 85% are already getting those two as separate doses. So we’re talking about 15%. Hardly a game changer.

“Finally, with COVID, they shifted from ‘recommended’ to ‘shared decision’!  Personally, I have problems with the notion of ‘shared decision’, since in my view ALL vaccines are shared decisions. It’s always: ‘Here’s my recommendation, my advice, why it’s the smart thing to do; but is it always YOUR CHOICE, you don’t have to do it.’”

So how would you sum up what’s gone on?

Dr. Hamstra: “These are all little tweaks; they’re not rocking the foundation.”

SIDEBAR

Dr. Scott Hamstra, Captain (retired), pediatrician, served Arizona Native American communities as a US Public Health Service Officer for 24 years before retiring from Active Duty in 2014. Since then, as Medical Advisor to the STChealth, he shifted focus to expanding the impact of vaccination to the USA and world. Living in Tucson, he continues to offer medical expertise to Native Americans.

END SIDEBAR

Beyond these “tweaks” coming from ACIP, there are other potential worries — insurance companies, funding and the political climate. How do you see the environment for vaccinations changing?

“Thankfully, insurance companies understand this: Preventing disease saves them money. That means the money side is weighing in, along with the science. For three decades now, half of American children fall under the Vaccines For Children program. It’s been enormously helpful to eliminate the cost barrier to vaccines, super helpful with Native Americans. This VFC program is  a bigger worry. If they eliminated that funding, that would not doubt cause major headaches. However, we’ve got some senators and leaders pushing back. After all, Mitch McConnell had polio as a kid, and he’s like, ‘Wait, the polio vaccine is good!’ Congress is more likely to question making drastic changes. There’s the wisdom in leaders saying, let’s think this through. So, hopefully, we’ll see continued VFC funding as well as Medicaid for childhood medical care.

“So far, the professional organizations, the medical ones, and the insurance ones, are all stepping up; and, it looks like some state leaders and some congressional leaders are stepping up, too.”

Okay, that’s all reassuring. You’re making us feel better, so thank you.

“There’s one more thing to keep in mind about the future of immunizations: If we forget why we need vaccines, the diseases will remind us. I’m thinking here of the folks in Texas, the area where the MMR rate was lower and then saw the measles outbreak. Almost overnight, the MMR vaccination rates doubled tripled or quadrupled from the previous year! Why? Because they were playing catch up! I saw this same phenomenon in my career: in September-October, it was often challenging to get people to come in for flu shots, then one child got hospitalized or died from flu and the hypothetical “risk” became real, and everybody and their brother shows up clamoring for flu vaccine. We are victims of our own success, creating a safer world, and a different challenge because people lose their fear of these pathogens.  They are still out there, and as vaccine rates drop, more kids get sick. We humans are not great at understanding risk. In the past, pathogens were the best educators, and sadly they may need to re-educate us once again”

Yikes. That’s a dark thought on which to end. Anything more uplifting you’d like to add?

“Sure, let’s back up and think about what’s going on at the highest levels of vaccination policy. ACIP was made up of lots of professionals (pediatricians, physicians, epidemiologists, public health, pharmacists) all kinds of science experts. The pros came together to review the data and give us a single unified voice. That voice has been so strong, so highly valued for so long that many forget all the professionals and organizations behind this unified front.

“What happens if you destroy that unified front? Well, all those professionals are still out there. They’re still doing the same things. If your leader disappears, the team is still going to play. If the coach goes down, another coach takes over, or the players step up to keeping playing the game. The reality is that most parents and most professionals are going to continue to do what they are doing because it’s the right stuff to do. I sometimes think people believe leaders have more influence than they really do. The professionals with years of training and experience are going to keep doing the right things, and the team is going to keep winning.”

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STATS OF THE MONTH

How Many Immunizations Will the US Population Require in 2030?

By Bill Davenhall, Geomedicine Analyst

Question: How many immunizations will the US population require in 2030?

Answer: About 500-550 million, according to the artificial intelligence (AI) source Grok

Most health experts and researchers would answer that “how many immunizations” question with “it depends,” and then proceed to qualify that response with various expert studies, detailed numbers, and hopefully peer-reviewed studies. How would you proceed to find a reasonable answer? How long would it take you to arrive at an fairly accurate estimate for every county or zip code in the US? I purposely used AI to try to see what it would deliver to me in light of my decades of research in health service demand forecasting by small geographies, and it encouraged my curiosity about how useful the early days of AI in a field like immunization would be.

I would encourage readers of this column to try out an AI tool. I believe it will cause you to pause and reconsider how you ask questions and at the same time have you marvel at AI’s ability to do conduct a “world factorial” or a deep dive on any healthcare subject within seconds. I have discovered that an AI’s value to me as a researcher is in its ability to listen carefully to what I asked and then guide my “deeper dive” at my own pace and in directions that I have some familiarity with.

So rather than bore you with more “facts” as I usually do, I turned to Grok’s AI to understand my questions, scour the planet to find data that would help answer my question, and then for me to then evaluate what I got returned. While getting a reasonable, believable and accurate answer, I was also interested in the path(s) that it followed to arrive at that answer so quickly (seconds).

Here is my short list of learnings or as I like to call it “testing the truth serum” for quality.  Here is what I suggest you do as you move into the use of any AI.

• Get better at framing your question:  increasingly making it more complex or nuanced (i.e. time frames and geographical interests) from your own perspective.
• Judge the information you receive in terms of how accurate it is in content and coverage. You are the best judge in the areas of your own expertise and knowledge. 
• Tell the AI what it missed or got wrong and see if it learns and finds additional  sources.

I would expect you will quickly become the judge of AI’s usefulness to your work and interests, and it will certainly force you into re-thinking how you approach learning about a subject, or how you search for innovations or solutions. It has already encouraged me to  change  the way I go about conducting research and identifying “best practices” (without it taking excessive amounts of time to  discover new learnings).

I would appreciate knowing of your experience with “early AI” and your evaluation regarding the summarization “answer” by Grok in the enclosed box below. Grok used 7 seconds to listen and reflect on my question and provided this answer. How close might this answer be? Let me know what your AI is telling you.

As always I appreciate 2^nd opinions.