Boys to STEM occupation, girls to people-oriented occ.: Women's empowerment is associated with relatively high levels of national wealth & this wealth allows more students to aspire to occupations they are intrinsically interested in

Stoet, Gijsbert, and David C. Geary. 2021. “Sex Differences in Adolescents’ Occupational Aspirations: Variations Across Time and Place.” PsyArXiv. October 20. doi:10.31234/osf.io/zhvre

Abstract: We investigated sex differences in 473,260 adolescents’ aspirations to work in things-oriented (e.g., mechanic), people-oriented (e.g., nurse), and STEM (e.g., mathematician) careers across 80 countries and economic regions using the 2018 Programme for International Student Assessment (PISA). We analyzed student career aspirations in combination with student achievement in mathematics, reading, and science, as well as parental occupations and family wealth. In each country and region, more boys than girls aspired to a things-oriented or STEM occupation and more girls than boys to a people-oriented occupation. These sex differences were larger in countries with a higher level of women's empowerment. We explain this counter-intuitive finding through the indirect effect of wealth. Women's empowerment is associated with relatively high levels of national wealth and this wealth allows more students to aspire to occupations they are intrinsically interested in. Implications for better understanding the sources of sex differences in career aspirations and associated policy are discussed.

There was no evidence whatsoever that older adults of today have more favorable views on how they age than older adults did two decades ago

Wahl, H.-W., Drewelies, J., Duezel, S., Lachman, M. E., Smith, J., Eibich, P., Steinhagen-Thiessen, E., Demuth, I., Lindenberger, U., Wagner, G. G., Ram, N., & Gerstorf, D. (2021). Subjective age and attitudes toward own aging across two decades of historical time. Psychology and Aging, Oct 2021. https://doi.org/10.1037/pag0000649

Abstract: A large body of empirical evidence has accumulated showing that the experience of old age is “younger,” more “agentic,” and “happier” than ever before. However, it is not yet known whether historical improvements in well-being, control beliefs, cognitive functioning, and other outcomes generalize to individuals’ views on their own aging process. To examine historical changes in such views on aging, we compared matched cohorts of older adults within two independent studies that assessed differences across a two-decade interval, the Berlin Aging Studies (BASE; 1990/1993 vs. 2017/2018, each n = 256, Mage = 77) and the Midlife in the United States Study (MIDUS; 1995/1996 vs. 2013/14, each n = 848, Mage = 67). Consistent across four different dimensions of individuals’ subjective views on aging (age felt, age appeared, desired age, and attitudes toward own aging) in the BASE and corroborated with subjective age felt and subjective age desired in the MIDUS, there was no evidence whatsoever that older adults of today have more favorable views on how they age than older adults did two decades ago. Further, heterogeneity in views on aging increased across two decades in the MIDUS but decreased in BASE. Also consistent across studies, associations of views on aging with sociodemographic, health, cognitive, and psychosocial correlates did not change across historical times. We discuss possible reasons for our findings, including the possibility that individual age views may have become increasingly decoupled from societal age views.

Physically strong men were consistently perceived as more conservative; inferences from strength cues were moderated neither by type of conservatism (i.e., fiscal versus social) nor presence of wealth cues

Brown, Mitch, Donald F. Sacco, and Aaron Lukaszewski. 2021. “Physical Strength as a Heuristic Cue of Political Conservatism.” PsyArXiv. October 26. doi:10.31234/osf.io/g5f87

Abstract: Social bargaining models posit physically formidable men tend to pursue strategies for acquiring resources and status through direct competition and promoting hierarchical social organization. Previous research indicates that formidable men espouse more conservative political viewpoints, as a means of advancing social policies favoring use of aggressive bargaining and hierarchy-maintenance strategies. If the mind is designed to utilize probabilistic cues of behavioral strategies, physical strength may function as a heuristic cue of political conservatism. Participants in three studies inferred conservatism of physically strong and weak men. Physically strong men were consistently perceived as more conservative (Studies 1 and 2). Inferences from strength cues were moderated neither by type of conservatism (i.e., fiscal versus social) nor presence of wealth cues. Inferences further extended to tradition-based and libertarian moral foundations domains (Study 3). We frame results using an affordance management framework, suggesting individuals utilize cues to formidability as heuristics to infer political attitudes.

Opium Wars' impact on China’s economy during the 19th century: They brought down local interest rates, & regions under Western influence exhibited both higher rates of industry growth and technology adoption

The Economic Consequences of the Opium War. Wolfgang Keller & Carol H. Shiue. NBER Working Paper 29404, Oct 2021. https://www.nber.org/papers/w29404

Abstract: This paper studies the economic consequences of the West’s foray into China after the Opium War (1839-42), when Western colonial influence was introduced in dozens of so-called treaty ports. We document a turnaround during the 19th century in the nature of China’s capital markets. Whereas before the Opium War, coastal cities were of relatively minor importance, the treaty port system of the West transformed China into an economy focused on coastal areas and on international trade that aligned with the trading interests of the West. We show, first, that the West had a positive impact on China’s economy during the 19th century. It brought down local interest rates, and regions under Western influence exhibited both higher rates of industry growth and technology adoption. Second, the geographic scope of influence went far beyond the ports, impacting most of China. Interest rates fell by more than a quarter in the immediate vicinity of the ports and still by almost ten percent at distances of 450 kilometers from treaty ports. The development of China was not simply propelled by its own pre-1800 history, or by post-1978 reforms. The nearly 100 years of semi-colonization have shaped China’s economy today as one focused on the coastal areas. 

Six-year-olds appear to more flexibly use multiple sources of information than younger children & adults; in their development, children are able to weigh information before they are too biased toward individuating information

Gualtieri, S., & Denison, S. (2021). Developmental change in the use of base-rates and individuating information. Journal of Experimental Psychology: General. Oct 2021. https://doi.org/10.1037/xge0001121

Abstract: Adults tend to make biased inferences when they are given base-rates (i.e., prior probabilities) that conflict with individuating information (i.e., a personality description), relying heavily on individuating information. Recent work has shown that six-year-olds do the same, whereas four-year-olds rely more on prior probabilities. In the present article, we revisit the argument that producing responses that align closely with base-rates should necessarily be seen as normative. We instead posit that rational inferences should be sensitive to all relevant information and should depend on its strength. In three experiments, we explored four-year-olds’, six-year-olds’ (N = 200), and adults’ (N = 196) information use by manipulating the strength of individuating and base-rate information. Across base-rate manipulations, adults showed a bias for individuating information regardless of its strength. In contrast, six-year-olds appeared to use each type of information flexibly, depending on which was more informative. Four-year-olds’ performance was less clear: Although they relied on base-rates when they were informative, they struggled to use the individuating information in their inferences and did not appreciate the manipulation of the strength of individuating information. Thus, six-year-olds appear to more flexibly use multiple sources of information than both younger children and adults, suggesting a period in development where children are able to weigh information before they are too biased toward individuating information.

Analyzing language on Reddit, we tracked people’s social, cognitive, and emotional lives as they dealt with the breakup of a close intimate relationship; impending relationship breakups can be detected up to 3 months before they occur

Language left behind on social media exposes the emotional and cognitive costs of a romantic breakup. Sarah Seraj,  Kate G. Blackburn, James W. Pennebaker. Proceedings of the National Academy of Sciences, February 16, 2021 118 (7) e2017154118; https://doi.org/10.1073/pnas.2017154118

Significance: By analyzing language on the social media platform Reddit, we tracked people’s social, cognitive, and emotional lives as they dealt with the breakup of a close intimate relationship. Language markers can detect impending relationship breakups up to 3 mo before they occur, with continued psychological aftereffects lasting 6 mo after the breakup. Because the language shifts are also apparent in subreddits (forums) unrelated to relationships, the research points to the pervasive impact personal upheavals have across people’s social worlds. Comparable cognitive and social effects are apparent among people undergoing divorce or dealing with major life secrets. The analysis of subtle shifts in pronouns, articles, and other almost-invisible words can reveal the psychological effects of life experiences.

Abstract: Using archived social media data, the language signatures of people going through breakups were mapped. Text analyses were conducted on 1,027,541 posts from 6,803 Reddit users who had posted about their breakups. The posts include users’ Reddit history in the 2 y surrounding their breakups across the various domains of their life, not just posts pertaining to their relationship. Language markers of an impending breakup were evident 3 mo before the event, peaking on the week of the breakup and returning to baseline 6 mo later. Signs included an increase in I-words, we-words, and cognitive processing words (characteristic of depression, collective focus, and the meaning-making process, respectively) and drops in analytic thinking (indicating more personal and informal language). The patterns held even when people were posting to groups unrelated to breakups and other relationship topics. People who posted about their breakup for longer time periods were less well-adjusted a year after their breakup compared to short-term posters. The language patterns seen for breakups replicated for users going through divorce (n = 5,144; 1,109,867 posts) or other types of upheavals (n = 51,357; 11,081,882 posts). The cognitive underpinnings of emotional upheavals are discussed using language as a lens.

Discussion

Breaking up is a complicated social and cognitive process that can last many months. The results suggest a natural evolution in the language people use before, during, and after a breakup.

Before the breakup, we see people’s natural thinking patterns on display, but the breakup disrupts this cognitive equilibrium. In fact, even before the actual breakup, analytic thinking drops as people talk about their relationship in a personal and informal manner. One explanation may be that people can sense the end of the relationship. This prebreakup phase reveals a disruption to people’s normal thinking patterns starting almost 3 mo before the breakup.

A second cognitive process is activated when the breakup occurs. As people make decisions about their new lives, their language spikes in the use of cognitive processing words. Finally, as the story becomes more developed and organized, analytic thinking increases again. The fluctuation in analytic and cognitive processing words reveals two dynamic cognitive mechanisms that unfold over the course of a breakup. Indeed, in many ways, these two cognitive processes may be tied to the way we encode experiences and map them into memories. We can see people’s thought process through their word use before a breakup even takes place. Additionally, tracking what happens during the moment of the breakup gives access to the ways people are trying to explain to themselves and others why the breakup occurred.

As seen in the post hoc analyses, those who write about their breakups more frequently are slower to return to their prebreakup language patterns. One explanation is simply that people who need to write continually may have experienced more disruptive or traumatic breakups. Alternatively, writing about the same events repeatedly may be a form of rumination whereby people are reliving the same distressing events over and over. In fact, expressive writing studies have found that people who write about emotional upheavals in similar ways on multiple occasions often do not show as many health benefits compared to those who update their narrative over time (47). By repeatedly recalling the same experience over several months, those who continue to relive the same painful memories might benefit from an alternative coping strategy, such as seeking clinical intervention.

Using language analysis tools, social scientists can now track social shifts in human connections in near-real time. Within hours of people revealing their broken hearts, it is possible to detect how they are communicating with other parts of their social networks about their hobbies, jobs, or religion. Communities such as Reddit provide a laboratory for researchers to measure how different coping strategies can potentially work. One contribution of the current research is that it points to the power of analyzing social media data to understand the unfolding dynamics of interpersonal processes.

The social construction of birthdays: There are many fewer modern U.S. births than would be expected on Christmas Day; in addition, modern parents appear to use birth medicalization to avoid undesirable birthdays (Friday the 13th)

Identity Selection and the Social Construction of Birthdays. Brett W. Pelham et al. Front. Psychol., October 26 2021. https://doi.org/10.3389/fpsyg.2021.693776

Abstract: We argue that rather than being a wholly random event, birthdays are sometimes selected by parents. We further argue that such effects have changed over time and are the result of important psychological processes. Long ago, U.S. American parents greatly overclaimed holidays as their children's birthdays. These effects were larger for more important holidays, and they grew smaller as births moved to hospitals and became officially documented. These effects were exaggerated for ethnic groups that deeply valued specific holidays. Parents also overclaimed well-liked calendar days and avoided disliked calendar days as their children's birthdays. However, after birthday selection effects virtually disappeared in the 1950s and 1960s, they reappeared after the emergence of labor induction and planned cesarean birth. For example, there are many fewer modern U.S. births than would be expected on Christmas Day. In addition, modern parents appear to use birth medicalization to avoid undesirable birthdays (Friday the 13th). We argue that basking in reflect glory, ethnic identity processes, and superstitions such as magical thinking all play a role in birthday selection effects. Discussion focuses on the power of social identity in day-to-day judgment and decision-making.

General Discussion

The studies in this report attest to the powerful role intuitive beliefs play in people's preferences for their children's birthdays. They suggest, for example, that basking in reflected glory, superstitious thinking, and the pragmatic goals of health care providers all influence preferences for a real-world outcome, namely a child's date of birth. The finding that birthday selection effects are larger than usual for more important holidays suggests that parents long ago engaged in motivated social cognition or even outright fabrication when recalling their children's dates of birth. This finding, combined with the aversions we have found here and elsewhere for undesirable birthdates, suggests that birthday selection is not simply a matter of memorial accessibility. For example, modern parents clearly avoided giving birth on the 13th of the month. These were actual birthdays rather than remembered birthdays. These findings strongly suggest that parents themselves play at least some role in birthday selection effects. The aversions to certain dates we have observed here and elsewhere suggest that there is much more to birthday selection than simple memorial accessibility.

The naming patterns observed in Study 1 strongly suggest that at least some parents try to help their children bask in the reflected glory of famous people—rather than simply misremembering salient dates as their children's dates of birth. Future research should try to dissect impression management processes and magical thinking processes as separate explanations for the effects document here. Given how robust birthday selection effects are, it would be surprising if a single mechanism were responsible for all cases of birth date selection. Many social preferences are overdetermined.

Limitations of this Research

Many of the studies in this report are open to more than one interpretation. For example, even showing that some parents gave their children names such as “George Washington Johnson” does not guarantee that all parents who chose this birthday for their children were trying to bask in reflected glory. Likewise, most of these studies cannot tell us exactly which parents falsely claimed desirable birthdays and which ones reported birthdays accurately. Further, we assume that more than one psychological mechanism is likely to be at the root of the preferences documented here. Along similar lines, we did not present any evidence that magical thinking played a role in any of these preferences. To address this concern, Pelham and von Hippel (2021) directly asked both parents and college students whether they endorsed “magical” beliefs about birthdays and holidays. These preliminary studies show that people clearly believe that others expect children to possess the traits associated with certain holidays. For example, people report that they believe most Americans think that a child born on Christmas Day will be perceived as “holy” and “generous” —whereas a child born on September 11th will be perceived as “evil” and “Anti-American.” Respondents even concede that they themselves endorse such beliefs—although to a weaker extent than they think such beliefs are endorsed by others. Magical thinking appears to be at least part of the reason for the preferences documented here. But this reinforces the fact that the present studies could not definitively identify the exact mechanisms responsible for the birthday selection effect.

Future research might also assess whether birthday selection in our older data is grounded in (a) motivated memory biases (ranging from self-deception to “judgment calls” that happen when children are born in very close proximity to midnight), or (b) consciously calculated fabrications. Illusory beliefs that portray us and those we love in a favorable light appear to be both more satisfying and more convincing to others when we truly believe them ourselves (Murray et al., 1996; Von Hippel and Trivers, 2011). But it is surely reasonable to assume that some of these parents consciously claimed a desirable birthday for their children. And if some of these parents lied about their children's birth dates, one must ask why they did so. Our findings suggest that at least some of these parents may have felt their children would benefit from basking in the reflected glory of a famous person or event. It is less clear that an obvious fabrication of a child's birth date could allow parents themselves to conclude that their child was especially holy. Magical thinking probably works best among people who personally buy into the relevant association. However, as Von Hippel and Trivers (2011) have argued, the line between self- and other deception is much fuzzier than most people assume. People who are able to convince themselves that a fabrication is true may well have an easier than average time convincing others.

Do our results reflect “cherry picking”? When researchers are able to study entire populations rather than convenience samples, and when they are able to examine every possible operationalization of a variable (as one can do with U.S. holidays but not with variables such as “self-esteem” or “cognitive dissonance”), concerns about “cherry picking” and “researcher degrees of freedom” are largely ruled out. Of course, one can always open the conceptual net—by examining the cross-cultural generality of an effect, for example. This is exactly what some members of this research team are currently doing. Whatever one's perspective, the findings reported here pave the way for critics who might wish to disconfirm our hypotheses. For example, the Social Security Death records examined here are freely available at ancestry.com. Thus, it would be possible to see how robust any one of these holiday biases is across the 50 U.S. states—or to see if these biases vary with cultural variables such as collectivism (see Vandello and Cohen, 1999). Our initial analyses suggest that cultural variables do matter. Both the pro-Christmas bias of yesteryear and the preference for July 4th birthdays were stronger than average in more collectivistic U.S. states. The Christmas Day preference was also much stronger than average in more religious U.S. states. As a final example, researchers could manipulate well-studied self-concept motives in the lab (e.g., using self-affirmation vs. self-concept threat manipulations) to examine the effects of such manipulations on the birthday preferences examined here.

One surprising aspect of our findings in Study 4 is that birthday number effects (e.g., the 11th vs. the 12th of the month) were so large in the 1890–1910 window that they introduced some noise into the assessment of some of the 10 specific holidays we examined in Study 1. In principle, one could ipsatize (i.e., proportionalize) the 31 days of the month during a given historical period to reduce noise when creating effect sizes for the holidays in the same exact window. Of course, these ipsatized scores would need to be calculated separately for different temporal windows, making this task a bit more complex than it would be otherwise. Having said all this, our supplemental analyses (e.g., those comparing claimed birthdays on the 25th of December vs. the 25th of other months) do make it very clear that holiday effects are not merely calendar day effects—or day of the week effects—in disguise. It is also possible that different psychological mechanisms underly the subtle preferences for certain calendar days and the preferences for specific holidays. It is not clear, for example, whether any parents would ever expect their children to bask in the glow of the likable number 14.

Of course, arguments such as these rest on the assumption that a person's birthday can be a part of a person's identity. Is this true? Research suggests so. Most people strongly like their birthday numbers (Kitayama and Karasawa, 1997). Further, many researchers have incorporated liking for one's birthday numbers into measures of implicit self-esteem (DeHart et al., 2006). In principle, any letter, number, or symbol that is associated with a person can become a part of a person's identity. Former professional athletes Reggie Jackson and Wayne Gretsky even incorporated their uniform numbers into their signatures (Armstrong, 1986). Of course, fans of famous athletes often advertise their psychological connection to such athletes—and to the teams for which the athletes play—by wearing copies of the jerseys of famous athletes. Symbols and events that are connected to us and to the groups to which we belong truly become a part of us. Finally, even if most people were not highly invested in their birthdays, those who believe that their birthday is special—because it doubles as a widely adored holiday—might be expected to identify more strongly than average with their birthdates.

These findings attest to the power and pervasiveness of both identity and magical thinking. We have long known that human beings care deeply about their identities (James, 1890; Cooley, 1902; Mead, 1934), including the ethnic, religious, and cultural groups to which they belong. The present findings suggest that parents are keenly aware of the subtle ways in which people can derive a sense of value or worth by merely sharing a birthday with a person who is deeply valued or respected by most others. Likewise, taken together, these studies strongly suggest that magical thinking is alive and well in the distortion and creation of children's dates of birth. For well over a century, U.S. parents have apparently gone to great lengths to create happy birthdays for their children.

Our understanding of why applications of deep learning networks are so effective is lacking; the empirical results should not be possible according to sample complexity in statistics and nonconvex optimization theory

The unreasonable effectiveness of deep learning in artificial intelligence. Terrence J. Sejnowski. Proceedings of the National Academy of Sciences, December 1, 2020 117 (48) 30033-30038; https://doi.org/10.1073/pnas.1907373117

Abstract: Deep learning networks have been trained to recognize speech, caption photographs, and translate text between languages at high levels of performance. Although applications of deep learning networks to real-world problems have become ubiquitous, our understanding of why they are so effective is lacking. These empirical results should not be possible according to sample complexity in statistics and nonconvex optimization theory. However, paradoxes in the training and effectiveness of deep learning networks are being investigated and insights are being found in the geometry of high-dimensional spaces. A mathematical theory of deep learning would illuminate how they function, allow us to assess the strengths and weaknesses of different network architectures, and lead to major improvements. Deep learning has provided natural ways for humans to communicate with digital devices and is foundational for building artificial general intelligence. Deep learning was inspired by the architecture of the cerebral cortex and insights into autonomy and general intelligence may be found in other brain regions that are essential for planning and survival, but major breakthroughs will be needed to achieve these goals.

Keywords: deep learningartificial intelligenceneural networks

Lost in Parameter Space

The network models in the 1980s rarely had more than one layer of hidden units between the inputs and outputs, but they were already highly overparameterized by the standards of statistical learning. Empirical studies uncovered a number of paradoxes that could not be explained at the time. Even though the networks were tiny by today’s standards, they had orders of magnitude more parameters than traditional statistical models. According to bounds from theorems in statistics, generalization should not be possible with the relatively small training sets that were available. However, even simple methods for regularization, such as weight decay, led to models with surprisingly good generalization.

Even more surprising, stochastic gradient descent of nonconvex loss functions was rarely trapped in local minima. There were long plateaus on the way down when the error hardly changed, followed by sharp drops. Something about these network models and the geometry of their high-dimensional parameter spaces allowed them to navigate efficiently to solutions and achieve good generalization, contrary to the failures predicted by conventional intuition.

Network models are high-dimensional dynamical systems that learn how to map input spaces into output spaces. These functions have special mathematical properties that we are just beginning to understand. Local minima during learning are rare because in the high-dimensional parameter space most critical points are saddle points (11). Another reason why good solutions can be found so easily by stochastic gradient descent is that, unlike low-dimensional models where a unique solution is sought, different networks with good performance converge from random starting points in parameter space. Because of overparameterization (12), the degeneracy of solutions changes the nature of the problem from finding a needle in a haystack to a haystack of needles.

Many questions are left unanswered. Why is it possible to generalize from so few examples and so many parameters? Why is stochastic gradient descent so effective at finding useful functions compared to other optimization methods? How large is the set of all good solutions to a problem? Are good solutions related to each other in some way? What are the relationships between architectural features and inductive bias that can improve generalization? The answers to these questions will help us design better network architectures and more efficient learning algorithms.

[...]

In his essay “The Unreasonable Effectiveness of Mathematics in the Natural Sciences,” Eugene Wigner marveled that the mathematical structure of a physical theory often reveals deep insights into that theory that lead to empirical predictions (38).

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Not only in AI...

38  E. P. Wigner, The unreasonable effectiveness of mathematics in the natural sciences. Richard Courant lecture in mathematical sciences delivered at New York University, May 11, 1959. Commun. Pure Appl. Math. 13, 1–14 (1960):

The first example is the oft quoted one of planetary motion. The laws of falling bodies became rather well established as a result of experiments carried out principally in Italy. These experiments could not be very accurate in the sense in which we understand accuracy today partly because of the effect of air resistance and partly because of the impossibility, at that time, to measure short time intervals. Nevertheless, it is not surprising that as a result of their studies, the Italian natural scientists acquired a familiarity with the ways in which objects travel through the atmosphere. It was Newton who then brought the law of freely falling objects into relation with the motion of the moon, noted that the parabola of the thrown rock’s path on the earth, and the circle of the moon’s path in the sky, are particular cases of the same mathematical object of an ellipse and postulated the universal law of gravitation, on the basis of a single, and at that time very approximate, numerical coincidence. Philosophically, the law of gravitation as formulated by Newton was repugnant to his time and to himself. Empirically, it was based on very scanty observations. The mathematical language in which it was formulated contained the concept of a second derivative and those of us who have tried to draw an osculating circle to a curve know that the second derivative is not a very immediate concept. The law of gravity which Newton reluctantly established and which he could verify with an accuracy of about 4 % has proved to be accurate to less than a ten thousandth of a per cent and became so closely associated with the idea of absolute accuracy that only recently did physicists become again bold enough to inquire into the limitations of its accuracy.[...] Certainly, the example of Newton’s law, quoted over and over again, must be mentioned first as a monumental example of a law, formulated in terms which appear simple to the mathematician, which has proved accurate beyond all reasonable expectation. Let us just recapitulate our thesis on this example: first, the law, particularly since a second derivative appears in it, is simple only to the mathematician, not to common sense or to non-mathematically-minded freshmen; second, it is a conditional law of very limited scope. It explains nothing about the earth which attracts Galileo’s rocks, or about the circular form of the moon’s orbit, or about the planets of the sun. The explanation of these initial conditions is left to the geologist and the astronomer, and they have a hard time with them.

The second example is that of ordinary, elementary quantum mechanics. This originated when Max Born noticed that some rules of computation, given by Heisenberg, were formally identical with the rules of computation with matrices, established a Iong time before by mathematicians. Born, Jordan and Heisenberg then proposed to replace by matrices the position and momentum variables of the equations of classical mechanics [S]. They applied the rules of matrix mechanics to a few highly idealized problems and the results were quite satisfactory. However, there was, at that time, no rational evidence that their matrix mechanics would prove correct under more realistic conditions. Indeed, they say “if the mechanics as here proposed should already be correct in its essential traits”. As a matter of fact, the first application of their mechanics to a realistic problem, that of the hydrogen atom, was given several months later, by Pauli. This application gave results in agreement with experience. This was satisfactory but still understandable because Heisenberg’s rules of calculation were abstracted from problems which included the old theory of the hydrogen atom. The miracle occurred only when matrix mechanics, or a mathematically equivalent theory, was applied to problems for which Heisenberg’s calculating rules were meaningless. Heisenberg’s rules presupposed that the classical equations of motion had solutions with certain periodicity properties; and the equations of motion of the two electrons of the helium atom, or of the even greater number of electrons of heavier atoms, simply do not have these properties, so that Heisenberg’s rules cannot be applied to these cases. Nevertheless, the calculation of the lowest energy level of helium, as carried out a few months ago by Kinoshita at Cornell and by Bazley at the Bureau of Standards, agree with the experimental data within the accuracy of the observations, which is one part in ten millions. Surely in this case we “got something out” of the equations that we did not put in.

[...]

Considered from this point of view, the fact that some of the theories which we know to be false give such amazingly accurake results, is an adverse factor. Had we somewhat less knowledge, the group of phenomena which these “false” theories explain, would appear to us to be large enough to "prove" these theories. However, these theories are considered to be “false” by us just for the reason that they are, in ultimate analysis, incompatible with more encompassing pictures and, if sufficiently many such false theories are discovered, they are bound to prove also to be in conflict with each other. Similarly, it is possible that the theories, which we consider to be “proved” by a number of numerical agreements which appears to be large enough for us, are false because they are in conflict with a possible more encompassing theory which is beyond our means of discovery. If this were true, we would have to expect conflicts between our theories as soon as their number grows beyond a certain point and as soon as they cover a sufficiently large number of groups of phenomena. In contrast to the article of faith of the theoretical physicist mentioned before, this is the nightmare of the theorist.

Moral outrage at injustices afforded highly justice-sensitive individuals a stronger sense of meaningfulness of their own life

Meaningful outrage: Anger at injustice bolsters meaning for justice sensitive individuals. Zachary K. Rothschild, Lucas A. Keefer. European Journal of Social Psychology, October 24 2021. https://doi.org/10.1002/ejsp.2820

Abstract: Individuals are frequently exposed to media describing salient moral violations, often eliciting negative reactions. Three studies examined whether the outrage engendered by such news may serve as a source of personal meaning for justice sensitive individuals. Using an experience sampling method, Study 1 found that among high (but not low) justice sensitive individuals, outrage (but not sadness) at unethical/unjust news content predicted greater personal meaning. Employing an experimental paradigm, Study 2 found that the opportunity to express outrage at third-party harm-doing attenuated a threat-induced reduction in personal meaning among high (but not low) justice sensitive participants. Study 3 found that giving justice sensitive participants the opportunity to affirm the meaningfulness of their own life (vs. another person's life or no affirmation) reduced expressions of outrage at third-party harm-doing. Results suggest outrage may uniquely serve a meaning-maintenance function for those who view upholding justice as a central value.

Consumption imagery increases food desire & suggest that this impact is due to induced feelings of deprivation; this increased desire explains a higher willingness to pay for and consumption volumes of the imagined food

Does a single consumption imagery event increase food desire? Evelynn Devos, Mario Pandelaere, Anneleen Van Kerckhove. Appetite, October 24 2021, 105773. https://doi.org/10.1016/j.appet.2021.105773

Abstract: Food desire is an intense motivational state a consumer experiences toward food that accounts for much of consumption. While extant research has shown that experiencing desire elicits consumption imagery, it remains unclear whether consumption imagery alone instigates desire. Even though this directional relationship has been often speculated upon, little empirical study has considered it. This paper empirically identifies imagined consumption as an antecedent of food desire. Six studies show that consumption imagery increases food desire and suggest that this impact is due to induced feelings of deprivation. Our findings also show that increased desire explains previously researched outcomes of imagery, such as a higher willingness to pay for and consumption volumes of the imagined food.

Keywords: DesireConsumption imageryFood deprivationConsumptionFood

Asexual participants scored significantly lower on approach (but not avoidance) social motivation than both heterosexual & LGB participants, indicating they are less motivated to enhance positive experiences & behavior in their social relationships

Asexual Identity, Personality, and Social Motivations in a New Zealand National Sample. Lara M. Greaves, Samantha Stronge, Chris G. Sibley & Fiona Kate Barlow. Archives of Sexual Behavior, Oct 20 2021. https://link.springer.com/article/10.1007%2Fs10508-021-02038-0

Abstract: Growing research interest in asexuality has led to several notable findings around the differences between asexual people and those with other sexual orientations. These findings have recently extended to personality, but questions remain around differences in personality between asexual people and others. Furthermore, qualitative and quantitative research disagrees about whether asexual people are less interested in close relationships than others. This paper used data from a nationally representative sample of self-identified asexual participants (Analysis 1: nwomen = 216, nmen = 54, ngender diverse = 13; Analysis 2: nwomen = 53, nmen = 19, ngender diverse = 3) and matched samples of heterosexual and lesbian, gay, and bisexual/plurisexual (LGB) participants (N’s = 75–283) drawn from the New Zealand Attitudes and Values Study (Ns = 19,396–54,183) to explore personality (Analysis 1) and approach and avoidance social motivations (Analysis 2). Compared to heterosexuals, asexual participants reported significantly lower extraversion, agreeableness, and conscientiousness, and higher emotionality, openness, and honesty-humility. Compared to those who identified as LGB, asexual participants reported significantly lower extraversion and agreeableness and higher honesty-humility. In addition, asexual participants scored significantly lower on approach (but not avoidance) social motivation than both heterosexual and LGB participants, indicating that they are less motivated to enhance positive experiences and behavior in their social relationships. These results help to clarify how personality and social motivations covary with sexual identity.

Brain imaging before and after COVID-19 in UK Biobank

Brain imaging before and after COVID-19 in UK Biobank. Gwenaëlle Douaud et al. medRxiv Aug 18 2021. https://doi.org/10.1101/2021.06.11.21258690

Abstract: There is strong evidence for brain-related pathologies in COVID-19, some of which could be a consequence of viral neurotropism, or of neuroinflammation following viral infection. Most brain imaging studies have focused on qualitative, gross pathology in moderate to severe cases, most typically carried out on hospitalised patients. It remains unknown however whether the impact of SARS-CoV-2 infection can be detected in milder cases, in a quantitative and automated manner, and whether this can reveal possible mechanisms for the spread of the disease. UK Biobank scanned over 40,000 participants before the start of the COVID-19 pandemic, making it possible in 2021 to invite back hundreds of previously-imaged participants for a second imaging visit. Here, we studied the possible brain changes associated with the coronavirus infection using multimodal MRI data from 785 adult participants (aged 51–81) from the UK Biobank COVID-19 re-imaging study, including 401 adult participants who tested positive for SARS-CoV-2 infection between their two scans. We used structural, diffusion and functional brain scans from before and after infection, to compare longitudinal changes between these 401 SARS-CoV-2 cases and 384 controls who had either tested negative to rapid antibody testing or had no COVID-19 medical and public health record, and who were matched to the cases for age, sex, ethnicity and interval between scans. The controls and cases did not differ in blood pressure, body mass index, diabetes diagnosis, smoking, alcohol consumption, or socio-economic status. Using both hypothesis-driven and exploratory approaches, with false discovery rate multiple comparison correction, we identified respectively 68 and 67 significant longitudinal effects associated with SARS-CoV-2 infection in the brain, including, on average: (i) a more pronounced reduction in grey matter thickness and contrast in the lateral orbitofrontal cortex (min P=1.7×10-4, r=-0.14) and parahippocampal gyrus (min P=2.7×10-4, r=-0.13), (ii) a relative increase of diffusion indices, a marker of tissue damage, in the regions of the brain functionally-connected to the piriform cortex, anterior olfactory nucleus and olfactory tubercle (min P=2.2×10-5, r=0.16), and (iii) greater reduction in global measures of brain size and increase in cerebrospinal fluid volume suggesting an additional diffuse atrophy in the infected participants (min P=4.0×10-6, r=-0.17). When looking over the entire cortical surface, these grey matter thickness results covered the parahippocampal gyrus and the lateral orbitofrontal cortex, and extended to the anterior insula and anterior cingulate cortex, supramarginal gyrus and temporal pole. The increase of a diffusion index (mean diffusivity) meanwhile could be seen voxel-wise mainly in the medial and lateral orbitofrontal cortex, the anterior insula, the anterior cingulate cortex and the amygdala. These results were not altered after excluding cases who had been hospitalised. We further compared hospitalised (n=15) and non-hospitalised (n=386) infected participants, resulting in similar findings to the larger cases vs control group comparison, with, in addition, a marked reduction of grey matter thickness in fronto-parietal and temporal regions (all FDR-significant, min P=4.0×10-6). The 401 SARS-CoV-2 infected participants also showed larger cognitive decline between the two timepoints in the Trail Making Test compared with the controls (both FDR-significant, min P=1.0×10-4, r=0.17; and still FDR-significant after excluding the hospitalised patients: min P=1.0×10-4, r=0.17), with the duration taken to complete the alphanumeric trail correlating post hoc with the cognitive and olfactory-related crus II of the cerebellum (FDR-significant, P=2.0×10-3, r=-0.19), which was also found significantly atrophic in the SARS-CoV-2 participants (FDR-significant, P=6.1×10-5, r=-0.14). Our findings thus relate to longitudinal abnormalities in limbic cortical areas with direct neuronal connectivity to the primary olfactory system. Unlike in post hoc cross-sectional studies, the availability of pre- infection imaging data mitigates to some extent the issue of pre-existing risk factors or clinical conditions being misinterpreted as disease effects. We were therefore able to demonstrate that the regions of the brain that showed longitudinal differences post-infection did not already show any difference between (future) cases and controls in their initial, pre-infection scans. These brain imaging results may be the in vivo hallmarks of a degenerative spread of the disease — or of the virus itself — via olfactory pathways (a possible entry point of the virus to the central nervous system being via the olfactory mucosa), or of neuroinflammatory events due to the infection, or of the loss of sensory input due to anosmia. Whether this deleterious impact can be partially reversed, for instance after improvement of the hyposmic symptoms, or whether these are effects that will persist in the long term, remains to be investigated with additional follow up.

Men are more likely to seek help with their relationships online, are more expressive of their emotions (e.g., discussing the topic of “heartache”), & show language patterns generally consistent with more secure attachment

Dirty laundry: The nature and substance of seeking relationship help from strangers online. Charlotte Entwistle et al. Journal of Social and Personal Relationships, October 23, 2021. https://doi.org/10.1177/02654075211046635

Abstract: Interpersonal relationships are vital to our well-being. In recent years, it has become increasingly common to seek relationship help through anonymous online platforms. Accordingly, we conducted a large-scale analysis of real-world relationship help-seeking to create a descriptive overview of the nature and substance of online relationship help-seeking. By analyzing the demographic characteristics and language of relationship help-seekers on Reddit (N = 184,631), we establish the first-ever big data analysis of relationship help-seeking and relationship problems in situ among the general population. Our analyses highlight real-world relationship struggles found in the general population, extending beyond past work that is typically limited to counseling/intervention settings. We find that relationship problem estimates from our sample are closer to those found in the general population, providing a more generalized insight into the distribution and prevalence of relationship problems as compared with past work. Further, we find several meaningful associations between relationship help-seeking behavior, gender, and attachment. Notably, numerous gender differences in help-seeking and romantic attachment emerged. Our findings suggest that, contrary to more traditional contexts, men are more likely to seek help with their relationships online, are more expressive of their emotions (e.g., discussing the topic of “heartache”), and show language patterns generally consistent with more secure attachment. Our analyses highlight pathways for further exploration, providing even deeper insights into the timing, lifecycle, and moderating factors that influence who, what, why, and how people seek help for their interpersonal relationships.

Keywords: Relationship help-seeking, natural language analysis, relationship problems, attachment, social media

Discussion

In the present study, we provide novel insights into the nature and substance of relationship problems—based on a sample of Reddit users—using natural language analysis methods. To our knowledge, this is the first study that has provided a large-scale, high-resolution, naturalistic view of relationship problems and relationship help-seeking in situ within the general population.

The first aim of the present study was to describe the demographic composition of online relationship help-seekers relative to those who typically seek help in more traditional/professional contexts. We examined the age and gender of individuals seeking relationship help online via the r/relationships subreddit, finding a greater percentage of men soliciting relationship help than women. Interestingly, this differs from traditional, professional contexts, where women are typically more willing and active in seeking help for their relationship problems compared to male partners (Stewart et al., 2016). This discrepancy in findings supports our notion that men may find anonymous, online relationship help settings preferable to in-person contexts, likely due to stigma attached to help-seeking behavior in men (Hammer et al., 2013; Vogel et al., 2011). As mentioned above, these results could also be interpreted as an over-representation of help-seeking by female users relative to the baseline demographic composition of our sample (Duggan & Smith, 2013). Given that we do not have access to the demographics of passive users who do not post to the subreddit, we suggest that our conclusions on the contribution of gender toward the propensity to seek relationship help online be interpreted tentatively.

Those posting to the r/relationships platform were found to be considerably younger (average age 24 years) than people who typically seek relationship help in more traditional contexts (average age range 38–41 years; Duncan et al., 2020; Schofield et al., 2015), with the majority of r/relationships users falling in the 18–24 age bracket. This finding suggests that the anonymous, convenient, and broadly accessible nature of the online help-seeking space enables those who traditionally under-represented or less likely to seek help (e.g., young men) by overcoming barriers related to stigma or resource availability. These results complement the wider support-seeking literature highlighting that online spaces provide greater opportunities for support-seeking through the erosion of barriers associated with traditional contexts (DeAndrea, 2015; Vitak & Ellison, 2013). Notably, given that online relationship help-seeking is particularly common among younger age groups, it could be inferred that the informality of the online help-seeking environment is providing means for people to seek help and advice for more casual and early-stage relationships (e.g., at the “dating stage”) compared to the stage at which people more commonly seek professional relationship help (i.e., after several years of marriage).

Our topic modeling approach revealed 25 themes that help to illuminate the topography of relationship problems in the general public. Analysis of the distribution of themes revealed that the most commonly discussed topic on the r/relationships platform was “heartache,” supporting the notion that romantic dissolution and breakups are particularly distressing life events (LeFebvre et al., 2015). Moreover, the frequent discussion of feeling heartache is interesting given that this is not a specific relationship problem being discussed. Rather, people appear to simply be using the online platform to express their distress and seek general emotional support from others, suggesting that the emotional pain experienced following relationship problems or dissolution is perhaps the strongest motivator of reaching out for social support—more so than seeking to resolve any particular problem in and of itself.

What is particularly revealing from our analyses is that the main motivators identified for relationship help-seeking in the digital space were generally consistent with the main reasons for seeking relationships help identified from previous research in more traditional, professional contexts. Specifically, in line with previous research highlighting communication difficulty as the most common motivator for seeking professional relationship help (Doss et al., 2004; Duncan et al., 2020; Roddy et al., 2019), as well as being the leading cause for romantic breakups (Morris et al., 2015), communication was also found to be the most-discussed relationship problem within our sample (discounting the general topic of heartache). Other core themes captured from the r/relationships discussions are also consistent with the main reasons for professional relationship help-seeking, such as issues relating to intimacy, trust, finances, and housework. This consistency in relationship help-seeking motivators between anonymous, online contexts and more traditional, professional contexts strengthens the idea that many relationship problems are common and ubiquitous.

Critically, we find that in many cases, our results reflect more realistic real-world prevalences of relationship problems outside of therapeutic contexts. For example, the WHO reports that around 13% of surveyed women report some form of intimate partner abuse in the previous 12 months (World Health Organization, 2021); our analyses found that 12.14% of submissions contained a non-negligible reference to the “abuse” MEM theme, strongly contrasting with only 1.3% in intervention contexts (Roddy et al., 2019). Similarly, other relationship problems, such as communication difficulties and conflict, may be over-represented in traditional contexts (e.g., 27.2% in Roddy et al., 2019; our sample: 18%). Other themes showed strong convergence with past work. For example, we found highly similar rates of family/parenting problems being raised as reported in past work (7.12% in our sample; 6.6% in Roddy et al., 2019).

Our analysis of relationship problems revealed small, consistent gender differences. Among the more pronounced gender differences, men more commonly discussed themes of school (the largest gender difference), heartache, dating, partying, personal qualities, and language; women more commonly discussed themes related to finances, abuse, physical distance, and housework. Notably, the fact that the heartache theme was more commonly discussed by men emphasizes how men are at least as equally as affected by relationship problems as women and feel comfortable to express and seek support for their distress in online, anonymous settings. We therefore re-emphasize that existing gender differences identified within traditional contexts may at least partially be a result of stigmatization and pressure to conform to stereotypes. However, our finding that women discussed things like abuse, finances, and housework more than men instead indicates some continuation of gender norms “spilling over” into the online platform. Rather than eliminating or reversing gender norms, the anonymous online platform instead appears to provide a space where gender norms and stereotypes are relaxed, particularly those that carry strong stigma (e.g., expression of emotional distress by men).

Last, we explored the use of online relationship help-seeking as a digital trace for generating novel insights into the relationship between gender and romantic attachment. We examined gender differences in romantic attachment through the analysis of pre-selected linguistic markers of attachment states-of-mind, building on limited previous work in this domain. Overall, the general patterns of language used by men and women discussing their relationships on the r/relationships platform appears to suggest that women may be more prone to preoccupied attachment states, whereas men may be more inclined toward secure attachment states. These findings align, in part, with those from previous research suggesting that women are more prone to preoccupied attachment (Haydon et al., 2014)—and, importantly, extends them into everyday life in the real world. However, our findings run counter to previous research indicating that men are more prone to dismissive attachment (Haydon et al., 2014). While several explanations for such patterns are possible, we suggest that modern, online help-seeking platforms may allow men to behave in ways that contradict the dismissive stereotype, again highlighting the powerful role of stereotypes in in-person relationship help-seeking behavior (as similarly shown when considering cross-cultural differences; (Schmitt, 2003). Nevertheless, it is important to emphasize that we did not possess established measures of attachment style in our study. Moreover, we do not know the extent to which various attachment styles self-selected into the r/relationships platform, potentially skewing the representativeness of our sample.

Limitations and future directions

While the current study comprises a large, real-world sample, it is not a globally representative sample. Given that our data were collected from a single website—albeit one of the most visited websites in the world (Alexa, 2020)—our sample may be biased in ways consistent with its user base, both demographically (e.g., younger, male, American) and psychosocially. It is therefore possible, for example, that the skew toward men and younger people within our sample could simply be a product of the demographic composition of Reddit. Despite such limitations, our sample is large, diverse, and highly international, creating a strong starting and comparison point for future research in this domain.

We also note the tentative nature of our findings pending further exploration in samples with more varied measures. For instance, within our sample, we cannot say whether gender differences were confounded with the current “stage” of relationship problems people were experiencing. Indeed, the choice to seek help online versus professionally is likely shaped by complex interactions between characteristics of the individual, such as gender and age, and characteristics of the relationships, including specific relationship problems and stage of relationship, and the language that partners use to convey and make sense of those problems. While such intricacies are beyond the scope of the current study, future research should aspire to disentangle such complexities.

Regarding our findings involving various gender differences, it is possible that women are more likely to seek relationship help once their relationship problems are at a more severe stage (see, e.g., Ansara & Hindin, 2010), whereas men may be more likely to seek relationship help at a much earlier, less severe stage, for example. Indeed, gender differences in the themes discussed do seem to suggest that men may in fact be seeking support for relatively more casual, early-stage relationship problems compared to women. For example, men more commonly discussed lighter topics stereotypically associated with youth and greater immaturity, such as dating and partying, whereas women spent more time discussing more serious topics, such as abuse and finances. Were there gender differences in the stage of relationship problems for which people were soliciting help, it is possible that this may have at least partially driven our associations found between gender and attachment state. We are unable to determine the presence or absence of such effects within our current sample.

Last, although the present findings provide novel insights into relationship help-seeking in online anonymous contexts, the quality of the help and advice given within these contexts remains unaddressed. Although the anonymous and effortless nature of the online space indeed provides numerous benefits to help-seekers, we do not know whether the advice provided in such settings is of sufficient quality to facilitate healthier relationships. If the advice provided is of poor quality, relationship problems may be exacerbated, contributing to further interpersonal problems. We anticipate further analyses of anonymous, online relationship discussion platforms to determine the quality and subsequent implications of such advice.

Administrative Simplification and the Potential for Saving a Quarter-Trillion Dollars in Health Care

Administrative Simplification and the Potential for Saving a Quarter-Trillion Dollars in Health Care. Nikhil R. Sahni et al. JAMAOctober 20, 2021. doi:10.1001/jama.2021.17315

Nearly every industry in the US has experienced substantial improvements in productivity over the last 50 years, with 1 major exception: health care. In 2019, the US spent an estimated $3.8 trillion on health care, including an estimated $950 billion on nonclinical, administrative functions, and that number has increased despite major technological enhancements.1,2 This Viewpoint considers several specific steps that can be taken to simplify administration in health care and boost overall productivity in the economy.

To run any organization, a base of administration is necessary. A typical US services industry (for example, legal services, education, and securities and commodities) has approximately 0.85 administrative workers for each person in a specialized role (lawyers, teachers, and financial agents). In US health care, however, there are twice as many administrative staff as physicians and nurses, with an estimated 5.4 million administrative employees in 2017, including more than 1 million who have been added since 2001.3

The administrative complexity of health care is profound. There are multiple transaction nodes, including more than 6000 hospitals, 11 000 nonemployed physician groups (defined as hospital-affiliated and independent practices with 5 or more physicians),4 and 900 private payers; regulatory complexity (compliance requirements such as the Health Insurance Portability and Accountability Act and regulated markets such as Medicare Advantage); and contrasting incentives, for example, market-driven checks and balances, such as prior authorization.4 The sheer complexity associated with so many entities makes administrative simplification difficult.

A new report provides an extensive evaluation of administrative spending to determine which parts are necessary and which could be simplified.2 The analysis dissected profit and loss statements of individual health care organizations, estimated spending on specific processes, and compared administrative spending in health care with that of other industries. The conclusion of the report is that an estimated $265 billion, or approximately 28% of annual administrative spending, could be saved without compromising quality or access by implementing about 30 interventions that could be carried out in the next 3 years.2 This set of interventions works within the structure of today’s US health care system in order to preserve its market nature (eg, multipayer, multiclinician, multi–health care center) and the associated benefits (eg, world-leading innovation in care delivery).

The starting point is 5 functional areas that account for approximately 94% of administrative spending (see eTable in the Supplement). The largest of these is industry-agnostic corporate functions: general administration, human resources, nonclinical information technology, general sales and marketing, and finance. This functional area accounts for an estimated $375 billion of spending annually. The second-largest category is the financial transactions ecosystem, which includes claims processing, revenue cycle management, and prior authorization, accounting for an estimated $200 billion annually. The rest is made up of industry-specific operational functions, such as insurance underwriting (an estimated $135 billion annually), administrative clinical support operations such as case management (an estimated $105 billion annually), and customer and patient services such as call centers (an estimated $80 billion annually).

For each of these functional focus areas, known interventions that could reduce spending without harming patient care were considered. This meant using a financial and operational perspective for the analysis, but also acknowledging that these interventions could and likely will have broader benefits on other outcomes, such as access, quality, patient experience, physician satisfaction, and equity.

“Within” and “Between” Interventions at the Organizational Level

The individual organization level was used as the starting point, by looking at “within” interventions, those that can be controlled and implemented by individual organizations, and “between” interventions, those that require agreement to act between organizations but not broader, industry-wide change. This spending is amenable to interventions that address highly manual, inefficient workflows, such as patient admission and discharge planning in case management; poor data management and lack of standardization, such as nonstandardized submission processes for prior authorization forms; and disconnected tools and systems, for example, the lack of interoperability between the claims systems of payers and hospitals.

Organizations could potentially save an estimated $210 billion annually by addressing these issues.2 The majority of those savings reside in industry-agnostic corporate functions such as finance or human resources. Interventions that affect these functions include automating repetitive work such as generation of standard invoices and financial reports; using analytical tools for human resources departments to better predict and address temporary labor shortages; integrating a suite of tools and solutions to coordinate staffing for nurse managers; and building strategic communications platforms between payers and hospitals to send unified messages. These interventions have been adopted in the marketplace by some payers, hospitals, and physician groups, with a positive return on investment using current technology and nominal investment (that is, once the interventions are fully rolled out, the cost of implementation is generally paid off in about a year by the recurring savings). Research has shown that organizations that aggressively pursue industry-leading productivity programs are twice as likely to be in the top quintile of their peers as measured by economic profit.5

Since many of these interventions are relatively standard, the question that arises is why they have not been implemented to date. A common set of barriers to implementation currently exists, including high levels of complexity and overlapping compliance rules such as privacy guidelines and requirements on how and where data can be stored; the need to manage labor displacement in an industry that is a driver of workforce growth; contrasting incentives for payers, hospitals, and physician groups in a primarily fee-for-service reimbursement model; and lack of prioritization from industry leaders on administrative simplification. Successful organizations often have common lessons for implementation including prioritizing administrative simplification as a top strategic initiative; committing to transformational change vs incremental steps; engaging the broader partnership ecosystem for the right capabilities and investments; and disproportionally investing in the underlying drivers of productivity, such as technology and talent.

“Seismic” Interventions at the Industry Level

Some of the inertia at the organizational level reflects market failures that require industry-level intervention, including the necessary decision-makers and influencers from both the public and private sectors for a given intervention. For example, individual organizations alone cannot change the systemic lack of interoperability in the US health care system. A set of “seismic” interventions were identified that require broad, structural collaboration across the health care industry.2 These include new technology platforms such as the use of a centralized, automated claims clearinghouse; operational alignment such as standardizing medical policies across payers, for example, requiring the same set of diagnostics and clinical data before agreeing to cover a more complicated procedure or drug therapy; and payment design such as globally capitated payment models for segments of the care delivery system. These are meant to be examples of what is possible and are based on analogs from other industries that have undergone this type of change. If currently identified seismic interventions were undertaken, an estimated $105 billion of savings could occur annually.2 These savings would largely occur in the financial transactions ecosystem and industry-specific operational functions such as clinician credentialing and medical records management.

Launching these seismic interventions could be considerably more difficult than the within and between interventions. A framework that focuses on how to promote innovation in the public sector was applied to isolate the mechanism required to enable action for each seismic intervention.6 For example, individual organizations do not experience the financial pressure today that would bring them together to create a centralized automated clearinghouse (which is what happened in banking). Financial incentives could help overcome this inertia.

A set of common actions is necessary to galvanize this change. These actions include using interoperability frameworks to support high-value use cases such as the assembly of longitudinal patient records; creating public-private partnerships such as piloting a complete Health Information Exchange in 1 or more states; and selecting third parties, such as foundations, to research facts to galvanize movement (for example, a foundation-backed randomized trial of administrative interventions to validate the conditions for success).

Why Now?

Across the 3 types of interventions, the analyses suggest that simplifying administration could save the US health care system an estimated $265 billion annually after accounting for $50 billion of overlap between organizational and industry-level interventions.2 These savings, if realized, would be more than 3 times the combined 2019 budgets of the National Institutes of Health ($39 billion), the Health Resources and Services Administration ($12 billion), the Substance Abuse and Mental Health Services Administration ($6 billion), and the Centers for Disease Control and Prevention ($12 billon).7 In per capita terms, $265 billion is approximately $1300 for each adult in the US.

Economic downturn often leads to health system change. With COVID-19 creating enormous disruption to the health care system, a known opportunity to capture more than a quarter-trillion dollars in the next few years without compromising the US health care system’s ability to deliver care could be quite attractive. The sooner health care administration is simplified, the easier it will be for all to engage the US health care system.

2. Sahni  NR, Mishra  P, Carrus  B, Cutler  DM. Administrative Simplification: How to Save a Quarter-Trillion Dollars in US Healthcare. McKinsey & Company. October 20, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/administrative-simplification-how-to-save-a-quarter-trillion-dollars-in-US-healthcare

3. Sahni  NR, Kumar  P, Levine  E, Singhal  S. The Productivity Imperative for Healthcare Delivery in the United States. McKinsey & Company. February 27, 2019. Accessed September 17, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-productivity-imperative-for-healthcare-delivery-in-the-united-states