Catch-Cold 22: Placebo Paradox

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Catch-Cold 22 Placebo Pic

In the name of full disclosure, I work in marketing. So I’m technically obliged to say that marketing is great.

And it is, of course. Sort of in the sense that God or a charismatic dictator is great… infinitely powerful, manically crazy, and for the most part, outright terrifying. It changes your cognition and neural responses in ways to which even the most seasoned behavioral researcher is not immune.

It’s safe to say that there’s enough going on in the world of advertising and marketing today to make any reasonable human squirm. So much so that some of the more reasonable amongst us have, in fact, been squirming their way into class action lawsuits for improper tracking online. Dig below the surface a bit, and you’ll find the seedy underbelly of a digital society where your behavioral data is collected and sold freely to the highest bidders. Like an old piece of gum spat out by a celebrity that sells for thousands of dollars on eBay, your discarded bits of data debris are helping pay some enterprising seller’s beer money, and then some. The end result is nothing short of unsettling. Those ads in your browser or in your junk mail? They often know your preferences better than your loved ones do.

But marketing is a funny thing; for all of its dubious tactics, it works. Fantastically well. It can exuberantly overwrite your existing memories and surreptitiously plant false ones. If plain sugar water can make the brain’s pleasure circuitry flicker like a promotional LED keychain, then sugar water with just the right logo on it can make it light up like the goddamn Vegas strip (hookers and cocaine controlled for as confounding variables). Good marketing propagates a consumerist placebo effect, disproportionately increasing our pleasure and subjective experience of the goods we interact with. So, what if we applied more of this black magic to the things that matter most? Like our health? If marketing and labeling can trick the pleasure centers of our brain into thinking dirty swill wine is a fine vintage worthy of a candle-lit dinner, then why can’t we leverage it to “lifehack” our tangible ills? To make us feel better when sick? To make us both subjectively and physiologically more well?

Well, we can. The only problem is that — like a classic tragedy of the commons — it would eventually erode the very foundation of medicine that we stand upon. In the process of increasing short-term placebo outcomes for the individual via false advertising and false medical advice, we would inevitably crash the faith in treatment that allows the effect to exist.

Someone call Hippocrates, because his oath has encountered a moral hazard.

The thing is, the placebo effect is real, and it works. Like, actually works. In some ways, similar to how a real pharmaceutical substance would work. It engages in heavy underground construction to modulate the loop of neurological, biological, and hormonal interactions that we experience up above as the subjective psychological experience of feeling better. And while not all people are equally susceptible to the effect, it’s overwhelmingly confirmed to exist. But there’s an inherent Catch-22: using more placebos in clinical practice could certainly help the average individual, giving them the instant benefit of feeling better without overuse of medication. But by increasing the prevalence of placebo use in general medicine, we would eventually alter the average expectations of the public at large. In a bad way.

Expectancy, after all, is one of the core perpetrators of the placebo effect… as well as the foundation for enhanced positive benefits in real drugs. If you really trust and expect something to work, it often does, regardless of its true pharmacological impact. But there’s a flip side: if you go to a doctor knowing there’s a 50/50 chance that the pill you’re prescribed is a dirty sham, you’re that much less likely to be expectant of a positive effect. Expectancy goes down, placebo effects are deadened, and over time, you’re left with a healthcare dystopia where there’s little faith or trust in the efficacy of medical intervention. Sometimes a sugar pill is just a sugar pill, especially if you foment a cultural expectation that doctors may be lying, or that the treatment is likely a fake. In fact, patient distrust and skepticism are likely to summon the placebo effect’s nefarious fraternal twin: the nocebo.

Medical practice constantly has to adjust to new technology and advances, balancing like a high-wire walker teetering between the desire to assure the best possible outcomes for patients and the critical need to maintain their trust and cooperation. Since the majority of people seeking medical counsel are in no position to fully understand the science behind their conditions and treatments, the physician becomes a default source of ultimate truth. So it’s a doctor’s duty to not lie to patients, right? Not necessarily. Medical ethics are fraught with the delicate struggle between keeping spirits up and being realistically direct. And it’s a two-way psychological street to treatment: both the patient’s expectations and the physician’s emotional sensitivity are linked to patient satisfaction and actual medical outcomes.

Trust is essential for patients’ prognoses, and is fundamental to the placebo effect. So it’s a shame that the placebo effect itself relies on lies. By design, such a triangular relationship cannot go on forever.

That’s all fine and well, but it’s just a thought experiment, no? So far, medical practice seems to hum along at a steady clip with the placebo effect as an incidental and positive byproduct of the system. How can this be? It’s because most placebos in clinical practice are NOT fraudulent little capsules, but rather much more complex and contextual in nature. “Pure” placebos, in the form of a biologically inert dose, are relatively rare: only about 12% of general practitioners admit to ever administering one in their entire career. Generic clinical placebo effects, on the other hand, are much more common and tend to have more than one source. Most are unintentional. Verbal communication from the doctor, patient mood and expectations, past experiences, conditioning, and even depictions of medicine in the media can all converge to create placebo effects on the individual level. My placebo effect may have very different causative influences than yours. And just because you ask a patient to pee into a cup doesn’t mean that there’s an ethical pissing match at hand. Most doctors are truly dedicated to long-term patient outcomes, dodging any blatant deception. Everyone benefits, getting to have their placebo and eat it too.

However, there IS already an excellent example of how a very specific and defined placebo use is currently undermining global health: they’re called antibiotics. Curious things begin to happen when the patients themselves start begging to be actively misled.

Unbeknownst to the majority of patients themselves, unwitting demands for placebo effects are helping accelerate the overuse of antibiotics, which in turn spawns more resistant strains of bacteria such as MRSA and the hilariously-nicknamed “ThunderClap.” Needless to say, antibiotics themselves aren’t inherently placebos. The problem is partially ours: we’ve justifiably extolled antibiotics as saviors of humanity. They just so happen to take on the role of placebos when they’re prescribed to treat illnesses that aren’t bacterial. If antibiotics’ biological mechanisms were simply limited to wishful thinking, the bubonic plague wouldn’t be just an occasional sensationalist story, and Hawaii’s Kalaupapa National Historical Park would probably still be called “Kalaupapa National Leper Colony.” Antibiotics positively changed the course of history: you’d be pretty hard-pressed to find a dissenting opinion. However, an antibiotic used against a virus is essentially a sugar pill.

Nevertheless, people go to the doctor to get better, and they don’t particularly care whether the malady making them miserable is bacterial or viral. They feel cheated by medical science’s glorious advances when they walk away with nothing but the suggestion of “plenty of rest and fluids.” Ergo, they press on like the script of a bad porno, asking, “Oh but doctor, isn’t there ANYTHING you can do for me?” And boom: antibiotics. They’re cheap, they’re pervasive, and they’re marginally more ethical than sexing up a patient right then and there on the exam table. Add in the fact that the most common ones generally have tame side effects to the individual, and you have a recipe for overuse. A medicine handed out by someone in a white coat inspires more credibility than Nanna’s chicken soup. Besides, at the end of the day, medical practitioners are people too, subject to the same ego depletion that drives us to eat terribly when stressed during finals. After a long day and compounded late appointments, they are subject to the same psychological drive to take the route of least resistance. Unfortunately, in their case, the course of least resistance is often simultaneously the course of most resistance… at least for the bacteria involved.

But wait, there’s more. Incentives can wreak havoc on behavior in unexpected ways, and doctors have no special immunity to the ills of human nature. One of the most powerful of these incentives is the looming threat of a malpractice suit; despite most physicians’ having professional insurance, a malpractice case is a messy nuisance at best. People are, by nature, loss-averse: a potential loss always looms larger than an equally-sized potential gain, contorting behavior accordingly. Even for doctors in low-risk specialties, the chance of facing a suit over the course of a professional lifetime is an overwhelming 75%. For overachieving colleagues in high-risk fields, it’s 99%. Add in the fact that that live cultures can take several days to confirm a bacterial infection, and there is always the portentous uncertainty that even the best medical professionals can make an incorrect diagnosis.

The psychological soothing of prescribing an antibiotic can provide gap-coverage insurance for covering one’s own ass in the context of malpractice. For however certain the doctor is that someone has a standard-issue flu, those little pills can help account for the (statistically improbable) chance that it wasn’t. The patient gets to walk away from the clinic with a placebo-driven spring in her step, while the doctor sleeps more soundly that night. At the individual level, it’s a net gain. But in the case of bacterial resistance, everyone eventually sinks into the red: the toll is paid gradually and cumulatively, borne collectively by the vast expanse of humanity at large.

However complex the causes of antibiotic overuse may be, one thing is clear: it needs to stop. The rising chorus of patient antibiotic requests for inappropriate conditions has become so cacophonous that the CDC has enacted an entire ad campaign to preempt the abusive relationship that contributes to bacterial resistance. By stepping in with consumer advertising tactics, authoritative bodies are hoping to intervene as a neutral third-party to circumnavigate the turbulent waters and psychological malaise that would result from unnecessarily blunt doctor-patient discussions. It’s not entirely a demographic issue, either. Lest you assume that the misunderstanding of antibiotic mechanisms is confined to select socioenomic strata, it’s clearly not. The emotional disquiet that rises in physical duress has tendency to bring equal but opposite quiescence to logical reasoning. Pain represents the ultimate cross-cutting cleavage, uniting all in its path. But market segmentation marches on, deeply rooted in business and non-profit psyche, with the keenly-accumulated knowledge that individuals respond most acutely when they feel connected to those of the same in-group affiliation.

The medical marketing materials have responded accordingly. There’s a CDC ad For African Americans. For savvy, Spanish-fluent caretakers. For parents of ugly babies. For aficionados of turtleneck couture. And, of course, for the ubiquitous white Millennial drama queens who “just can’t EVEN” handle this case of the sniffles. Collective marketing has had the power to instill a faith so unassailable in the omnipotence of antibiotics that patients now demand them when they are useless. So now, the CDC will damned well do its best to reverse this belief via yet more marketing. Perhaps it’s about time. What the marketer have giveth, the marketer hath taketh away.

So why not then, as a logical next step, use aggressive advertising to purposely mislead consumers, thereby extracting more placebo effects for the mutual benefit of all? If we get people to believe that a certain “medication” can alleviate their cold and flu much better than an antibiotic, it doesn’t really matter if it’s inert, since they were simply seeking a placebo effect to begin with. They will flock to the new substance, getting the same perceived benefits as before without the cumulative damage of overuse, since there’s nothing biologically-based to be overused. Unfortunately, to do so via advertising would erode the fragile, marketing-based foundation that allows pharmaceutical placebos to exist in the first place. In fact, it’s the very restrictions on medical marketing that subsequently help it earn credibility in the public eye, elevating the buyer-seller relationship to more of a doctor-patient one.

The FDA has much to do with all of this. To put it succinctly, they’re a buzzkill. And they should be, because it’s their goddamn job. For every tantalizing buzz that they make available to the collective reach of the public, they are tasked with defending against its abuse and preventing pharmaceutical companies from claiming to offer more bang for their buck than they actually provide. Pharma research and development is notoriously expensive, making it all the more tempting to use dubious claims in order to gain the upper hand over competing companies with similar products. So the FDA steps in as a referee, ensuring that there are standards sufficient to ensure that consumers have relative confidence in the accuracy and scientific rigor of the information being relayed to them.

FDA advertising regulations are undoubtedly a circus, at least for those with the wherewithal and tolerance for the sort of rambling legalese that I’ve extensively discussed before. For the brave few seeking reference (or masochistic punishment), you can find them all here. But for everyone else, they’re a boorish bore. There’s simply too much to detail involved to nest that discussion within the context of another topic. Writing about all of them here would be akin to paying for an extended vacation to Disney World, and then spending the entirety of you week-long stay cloistered within a Library of Congress replica in the US corner of Epcot. Missing the point. So I’ll save you the trouble, and perhaps stash their wild and wacky world for a later time. The regulations are sprawling, specific, and place immense constraints on the normally fluid word of advertising creativity… by enumerating guidelines on everything from font size to acceptable age of cited research. The result is an acceptably consistent (albeit boring) advertising sphere that garners relative trust from the public.

So here we are, stuck with listening to comically-exhaustive ramblings of potential side effects for allergy drugs, and seeing couples sitting in separate bathtubs to euphemistically depict middle-age boning. No one said being honest is mutually exclusive to being weird.

The point is, current regulations do not permit blatantly deceptive claims within pharmaceutical ads. And ironically, it’s the faith and trust that heavy regulation instills in the public that actually allows the placebo effect to run rampant in the way that it does. Patients are accustomed to knowing that they won’t be outright lied to — even by consumer pharmaceutical advertising — and that feeling of trust amplifies their experience of the placebo effect. But then again, they also don’t fully understand most of the information being relayed to them.

As a result, modern medicine often attains a quasi-religious aura, and the extensive use of abstruse terminology and listing of complicated side effects serve to further underscore the perception that the substances being sold are immensely, incomprehensibly powerful. The masses don’t fully grasp the exact chemical and biological interactions that help them feel better, and thus the experienced effects become evangelical in nature. Commitment to traditional religion may be declining, but we’ve replaced it with another type of blind trust. Loosely imply that your non-FDA regulated supplement has been “scientifically tested” and people swoon with belief, whether deserved or not. Vague allusions to science are used as a heuristic for truth. Entire industries thrive upon it, using placebo effects as a primary source of income. Thus, placebo effects continue to frolic everywhere, happily intermingling and piggybacking off of the tangible and biologically-vetted mechanisms that real medicine has to offer.

Trying to “lifehack” the placebo effect on a mass scale might extinguish the mechanisms that allow it to flourish. It’s a perilously delicate balance. For the time being, it’s probably a good thing that both regulated standards and generally-accepted ethics do not permit the rampant application of our Latin-rooted friend to “please” us too much.

Ah, yes, but you still feel sick? At least you can always grab some Airborne® and get better the proven way… or maybe not.

Tragedy of the Commas

Posted on by Standard 1

LegaleseA fittingly long-winded post is afoot for a notoriously long-winded subject. It doesn’t take the due diligence of a top-10 law firm to conclude that just about everyone and their mother hates legalese.

Now don’t get me wrong. The desire to feel competent is an innately human part of mental wellbeing, and language plays a significant role in that aspirational endeavor. There’s a significant grounding in the notion that vocabulary isn’t simply a marker of intelligence, but rather a means of acquiring intelligence as well. Nuanced vocabulary provides a tool for grasping and differentiating the increasingly nuanced concepts seen in complex topics. Besides, I get my rocks off from erudite jargon as much as the next person when it just so happens to suit my fancy and expertise. Ooh baby, nothing potentiates my action potential quite like the perfusion of knowledge that comes from a good peer-reviewed publication. Patch clamps? Kinky.

But abstruse, field-specific language is usually just that: constrained to a certain academic or professional specialty, and not extrapolated to apply to the public at large. Legal wording is perhaps unique in this regard. Encountered on a near-daily basis whether we realize it or not, it’s not only perplexing to the majority of people that it applies to but also binding in ways that the most recent manuscript from Cell is not. If you don’t fully absorb the nuanced ANCOVA variable interactions of a longitudinal cohort study, it probably isn’t going to ruin your day. However, if you failed to fully digest the Terms of Service outlined meticulously by AT&T, your next iPhone upgrade might just become an iHeadache replete with surcharges you didn’t even know existed. Data roaming abroad? Good thing you read the fine print (you did, didn’t you?) because it could set you back $6000… or even more.

The Sparknotes summary is that the florid language endemic to legalese is somewhat warranted by the intricate subject matter that it entails. However, more often than not, it is generally resented, misunderstood, and largely ignored by those that are affected most by its endless chains of commas, footnotes, subordinate clauses, and abstruse terminology. Contracts written between equal business parties are fair game, but for consumer-facing agreements, there’s significantly unequal footing. Why must we “promulgate” policies when we could simply “declare” them or “officially make them known?” Quite the curious oxymoron we have on our hands, given that “legalese” sounds so much like “legal ease.” Too bad the scholars of the world beat me to that punchline.

So the majority of people hate legalese. I know I hate it, or at least grow weary of it. This guy, who is currently both a judge and a Columbia Law professor, hates it. Antonin Scalia has his own doubts about it, and you might just recognize him as a muthafuggin’ US Supreme Court Justice. But more importantly, your own brain hates it.

Why?

Vocabulary is only the very tip of a frigid and unloving legal iceberg: it’s the easiest to pinpoint, but there’s much more shifting beneath the surface to rock our cognitive boats. Everything from the price tag of the products we sign terms of service for, to length of the documents themselves, all the way to the general readability and even the typographic conventions of legal prose tend to stack the attention span and cognitive processing capacity of the individual against their own interests.

So let’s start with an easy one: time. Fully reading — or even skimming — the legal documents we encounter on a regular basis takes a TON of time. There was a bit of stir over the past year when researchers published a study that pegged the average time for consumers to fully read all of the legal material they encounter at 250 hours per year, which totals 31.5 work days for those of you keeping score at home. If you are employed in the US, you might notice that that is about twice as much as the average paid vacation days per year in the private sector, or infinitely percent more time than is required by law (none, the answer is none). Hope you’re ready for a sabbatical.

Reading speed for the averaged adult population is generally considered between 250 to 300 words per minute (the former being used for the research analysis), and that doesn’t even assume 100% comprehension. Given the inherent complexity of legal document content and low intrinsic interest most people have regarding their Flappy Birds download rights, it’s not a stretch to say that those 250 hours might require several dozen more to achieve a decent level of understanding.

Perhaps you think you’ll improve your lot by taking up speed reading? Not so fast, Eyestrain McLightning. While there are currently apps that are doing a dandy job of leveraging technology to assist faster reading techniques via reduction in time spent on lateral eye movement (visual saccade), their potential doesn’t shine as brightly as the smartphone screens on which they reside. The general consensus about speed reading is that with increased speed comes inevitable reduced comprehension of content. A noteworthy pitfall for legal reading, thick with its recursion and subordinate clauses tangled as mangrove roots, which already has a low general comprehension. At normal speeds.

Besides, the public at large rarely finds legal content engrossing. Individual interest and rapt attention can make anything easier to read, at any speed. But terms of service aren’t exactly the gripping type of content that readers consume ravenously for pleasure. No one is going to try to argue that contracts are on par with 50 Shades of Grey; that is, unless your idea of BDSM is getting hog-tied, whipped, and screwed by your cable company. Hot.

I’m not here to judge you or break Rule 34 of the Internet.

Just what is it that makes the 50 Shades trilogy more “readable” than the average terms and conditions? For one, many of the legal agreements that average consumers now frequently encounter on a daily basis are for free services. Fiction we purchase and read is a paid service unto itself, something we exchange money for and expect pleasure from accordingly. We’re invested. With an economy that is becoming ever more data-centric, free shit is a common tactic to get people to unwittingly sign away personal data.

And for humans, FREE is a very peculiar thing. It’s not just college students creeping about the descending margins of twilight, grabbing pizza from club meetings they don’t belong to or fighting sweaty hordes to snag one of the remaining XXL t-shirts their own mother would be embarrassed to sleep in. For anyone who’s ever been to a tech trade show or convention, it’s easy to become inured to the absurdity of grown men and women, dressed in business finery, grabbing up free tchotchkies with the free bags and free totes that they were given specifically to collect their free crap with. And once back home, they overwhelmingly come to their senses, tossing most of it in the trash, to become “free” once again from the unintended clutter of their busy lives.

In short, we’re irrational. Our perception of value does NOT have a purely linear relationship with price. Let’s say we’re selling two items, side-by-side, in which one item is clearly higher quality and more desirable. Assuming that the respective prices offered are discounted below their standing market norms, most individuals will choose the higher-quality product, realizing they are getting a relative luxury for an unusual bargain. However, once prices are linearly shifted down so that the lower-quality item is free, the “purchase” pattern is flipped. Suddenly people are disproportionately gobbling up the free item, more or less blind to fact that the higher quality item is still a better “deal” in the classical economics sense. Put a $2.99 high-quality app next to a related $0.99 one, and many will choose the more expensive option for reasons of performance. Now shift the prices to $1.99 vs. $0.00, and it’s like the more expensive option doesn’t even exist. Amidst our trappings of a free app culture, the lack of monetary investment makes the item more desirable whilst simultaneously decreasing our cognitive commitment to it.

We don’t believe we have as much at stake when we read the legal documents for Gmail as we do when we read the lease for a new car. Thus, we click “I Agree” and move on with our lives, ravenously searching for the next free app to tickle our fancy.

Complexity in writing is another factor, albeit a contentious one. For the most part, we are still abjectly terrible at quantifying our own communicative means, despite the algorithmic nature of society’s most celebrated advancements. However, basic metrics do exist. The most commonly used stat, the Flesch-Kinkaid readability test, was originally developed by the US Navy as a way to classify and standardize readability levels for manuals and training materials. It’s still used widely by the Department of Defense, and also has applications in education. It all boils down to number of words per sentence and number of syllables per word; in a nutshell, lower scores indicate harder reading material. A score of 30 or lower is best understood by a university graduate upward, and publications like Time usually have a score around 50. And if you want to feel perpetually demoralized by your own lack of writing prowess, there’s even a simple way to set up scoring in Word documents. Sure, it’s basic, but a starting benchmark.

Here’s where the fun starts. Most people would assume legal documents would tank on this test in terms of readability score, and most people would be undeniably right. Pennsylvania was the first state to mandate that many insurance policies had to be written to the ninth grade level, or roughly a score in the 60s range. Hilariously, the “Insurance Plain Language Act” itself has a score of 36.8 and grade level of 12.8, but perhaps we’re nitpicking since it isn’t a consumer-facing document. What about other legal items?

I grabbed a business partner contract from a certain litigious “big” and “blue” technology company that I had lying around, and plugged it in. Score of 34.1 with a grade level of 14. Fair enough, given that it’s a business agreement between business parties which are assumed to have business-y legal teams replete with educational trajectories that didn’t fall flat at sophomore year of college. But what about some consumer agreements?

Hmmm.

Again, Flesch-Kincaid scoring is basic, and for the most part, it assumes that big words are overall harder to understand. Not groundbreaking, exactly. But it also has a sort of implied assumption that the reader has the innate capability of understanding the general topics being addressed, with a missed vocabulary word as a minor hiccup. In the legal arena, though, is quite a stretch. One missed word might mean an entirely missed broad and recurring concept. While a grade 12 level reader might have a clear understanding of the five-syllable juggernaut “liability” in general usage, they might still be far from understanding its specific usage and ramifications in a legal context. Most terms and agreements on the worldwide webernets also rely heavily on hyperlinking to connect to more policies and explanations, resulting in an “expanded” content that could equal hundreds of pages were one to attempt tackling it all. Bad enough if it’s in your native language, yes. On the other hand, some tech giants have gotten in trouble recently for sending users to content that wasn’t in the same language as the original terms. Ruh-roh.

Indeed, the jury’s still out — so to speak — on what an appropriate readability metric would be for legal material. Some researchers have recently taken task with finding one, and quickly realized that traditional grade-level scoring metrics did little to predict actual readability of legislation. By using machine learning to compare linguistic characteristics of a balanced corpus of all English writing versus a sprawling sample of legalese, they discovered what everyone knew all along: it really IS harder to understand, with sentence structure highly divergent from other written English conventions.

Well that’s no fun. An online machine-learning assessment for legal readability isn’t yet available to the public, and if it were, it would likely entail downloading yet another app with yet another terms and conditions agreement to slog through. You want a tool now. Hence, I provide a tentative formula — research pending — of my own: (n + 6 = G). Insert the the original Flesch-Kincaid grade level of the document as “n,” and add six years for adjusted grade level “G…” three for the time it takes to complete law school, and three more for the time and patience to thoroughly read the document and all off its attendant hyperlinks.

But let’s go out on a limb and assume you’ve decided to give that gnarly contract the ol’ college try. The battle’s not over yet. You’ve gotten fairly deep into the text, doing your best to remain attentive, but just as you get to the most important and binding parts, something seems amiss. You feel uncomfortable, disoriented, squirming ever so slightly in your chair. And then it dawns on you:

“WHY IS MY LEGAL DOCUMENT YELLING AT ME?!?”

Typographic trickery is at hand. Full capitalization of words isn’t just confined to the shady underworld of internet trolls, but rather is used in legal writing to fulfill the requirement of “conspicuousness” of important clauses. To be fair, it exists for the common good: it makes it harder to bury critical information in monolithic blocks of normal-looking paragraphs, such that a reasonable person would not miss the information. However, the Uniform Commercial Code, which dictates the conspicuousness requirement, only mentions capitalization as one of many options for fulfilling this need (see #10). But hey, color ink is expensive, so full capitalization has become a go-to standard for making important legal junk stand out. But it makes your brain hurt.

No good deed goes unpunished. Paradoxically, the legal community has settled on the fulfillment of “conspicuousness” that most reduces the average reader’s ability to comprehend the very same material being made conspicuous.

All-caps writing is quite well known to decrease readability, to the extent that there is very little current research is even available on the subject. It’s more or less considered a closed case, although interest in the subject has undergone a renaissance within the user experience and user interface (UX/UI) development industry. Much of the work on readability and typography was pioneered by Miles Tinker beginning in the late 1920s, and because we still read and write with many of the same conventions even in the digital world, his findings have remained the authority on what makes some type more readable than others. In some of Tinker’s original research, he noted that all-caps writing, on average, resulted in a nearly 12% reduction in reading speed for adults.

Over the years, there have been several theories on how humans recognize and process words; the faster you can recognize a word as a unit with its associated meaning, the faster you can comprehend text. And for a long time, word shape was implicated as a major factor: with recognition of a particular word’s outline aiding in quicker recognition of the word and its subsequent definition. Even though that simplistic explanation has fallen out of favor (we actually recognize letters and familiar letter sequences within the word unit), the argument against full capitalization still has wind in its sails. Using all capital letters fills space much more homogeneously and creates a clean rectangular edge along the top and bottom of the word, which can incidentally make it harder to recognize those familiar letter combinations that act as heuristic “cheats” for quicker cognition. Less recognition causes more frequent fixations of the eye and more stilted progression of visual saccades, resulting in a slower pace.

Many now acknowledge that the reduced readability of all-caps text is due to a practice effect, being that the average person simply has less experience reading fully-capitalized material. Speed and comprehension can be increased for all manner of bizarre text presentations, including mirror-images, and full capitalization is no exception. If we want legal document capitalization to not slow us down, we ought to simply practice reading it on a regular basis. Perhaps include it in curriculum… hell, in standardized testing. Let us print eBooks and tabloids and textbooks and job applications in all-caps! Let us shout ALL-CAPS from purple mountains’ majesty to echo across fruited plains! Let every caps-lock button be broken and sticky, not for April Fools’ revelry, but for all eternity!

Surely, more exposure and practice would negate the effect of slower comprehension seen with all-caps in a legal context. Too bad familiarity and desensitization would also negate the entire legal reason that it exists: to be objectively jarring and “conspicuous.”

But maybe we’re dissecting legalese from an unfairly Anglocentric perspective. Lest we forget, there are a very limited number of native languages which don’t have recursion, or even cardinal numbers, which so seamlessly permit all those marathon run-on sentences and infinite enumerated clauses. Needless to say, those wireless contracts would likely be easier to understand, given the statistically naught chance that you are fluent in Pirahán or that you get 4G coverage in the remote Amazon.

So, yes. Most legal language is out to screw you in one way or another. And many of the cognitive tricks it employs to do so are incidental rather than purely malicious. It’s up to you to decide exactly what you’re willing to exchange for that next shiny thing. Skim those terms a little closer next time, and just be careful out there.

Wait… you’re not reading this on a free RSS app, are you? Jesus.

Why Do We… Hesitate?

Posted on by Standard Reply

HesitationIt took me forever to write this.

Months, picking away at shreds of ideas, spitting out the bits I found unsavory not unlike like a vulture that fancies itself a fairer creature. Procrastination nipped at the heels of every sentence like a lethargic cattle dog. Hesitation, at it would seem, is the bane of accomplishment. We undulate our thoughts like polished river stones in a restless palm, yet grapple with the commitment to release one skipping across the rippling surface of reality. And the longer we hesitate, the more those smooth stones seem to distort into chunks of broken glass.

For anyone who has ever had work to get done, even in the most pressing of circumstances, hesitation tends to rear its ugly head when most expected and least desired. Anticipated, unsurprising, and yet universally despised, it often slows our ability to execute to a grinding halt. Paradoxically, the higher the stakes, the harder it is to build the mental inertia we need to dive in. But what causes it?

Perhaps this isn’t so much an exploration of hesitation as a mental state, but rather the factors that go into perpetuating its existence. And much to the chagrin of anyone with anything to do, there are many.

Hesitation as a discrete topic of research appears to be nothing but a small blip on the vast radar of scientific exploration. Most published biomedical and psychological literature refers to hesitation as an aspect of stuttering and speech pathology, or as simply a rhetorical device to be used in a manuscript title. After all, if “Our Hesitation Waltz” sweeps up so elegantly across the ballroom of peer-review approval, why would we ever want to stop dancing?

Indeed, most research about hesitation can’t be found by searching the simple term itself. Rather, the components that go into hesitation as a state of being must be inferred and then disassembled. Attention span, fear, procrastination, and the inherent cognitive struggle between them are all at play.

Sustained attention, or rather the lack thereof, seems to be a key culprit. Modern society and digital obsession are practically engineered to capitalize on our cognitive weaknesses in ability to concentrate. For every nascent inkling of a concept that might be acted upon, there is an equal and opposite reaction of distraction. The well-meaning foray into the depths of Wikipedia to confirm a simple fact about common gourd cultivars leads to a depraved intellectual binge that lands you reading about phallic architecture and explaining a very strange browsing history to your employer. It happens to the best of us. It also happens to me.

But distraction is very much a real and perplexing ill of the human condition, one that we all struggle with and bemoan ever more loudly in the progression of the digital age. Like your brain’s version of wrestling with a circus bear, it’s a highly entertaining venture which inevitably leads to the mauling of any productive pursuits. Or does it?

Its ubiquity would suggest that distraction, at its very core, offers an evolutionary benefit to those that can balance the awareness of surroundings that it proffers with the ability to filter out the non-important elements. It’s a fine balance, to say the least. Distraction is the reason that we find sudden motion more salient and easier to detect in a landscape than, say, the gradual change in hue of the afternoon sky. It’s adaptive because noticing a snake move on the ground in front of you – and immediately directing your attention to it — is much more beneficial than ignoring it and stepping on it. Recent research has even suggested that a gene associated with ADHD and reduced dopamine function is also associated with longevity. Distraction saved the lives of our evolving forebearers, and may even help us live longer today. But try telling that to your boss.

Today, the world is filled with more available distraction than ever before, most of which offers no immediate threat or relevance to our physical existence. The internet has built a towering empire built on the industry of distracted clicks. Much like many other first world ailments such as poor diets and sedentary lifestyles, our mental immersion in little screens and distracting pleasantries reflect the defeat and contortion of the environment in which our bodies originally evolved to function. Many have even likened our current obsession with checking emails, social media alerts, texts, etc. to variable ratio reinforcement, in which a certain behavior sometimes results in a certain reward… but what changes is HOW MANY times that behavior may have to occur before the reward is received. Sometimes you win after one pull at the slot machine, other times it may take 100 to pay out the exact same sum. Guessing games allow us to delude ourselves into thinking the next pull/click/press will be “the one.” There’s little wonder that variable ratio reinforcement is so highly associated with addictive behavior.

So the little spurt of dopamine we get from anticipating a potential reward keeps us clicking at those little red notifications, like a rat pressing a lever in hope of cocaine. And just like our junkie rodent friend, the unpredictable rate of success doesn’t deter us, but rather keeps us coming back aggressively for more. Sure, distractions may not be the entirety of hesitation. They do, however, play a significant and arguably more relevant role in today’s life.

Fear, of course, also plays a role. One can hardly argue that it’s not adaptive: anyone who has frozen in pause before bungee jumping or plunging into a cold swimming pool knows that the amygdala raises hell when confronted with situations that would guarantee harm if not for recent technology. Sometimes, it’s still clear-cut. Even today, this primal fear continues to be a major factor in the rise of medication non-compliance, with patients hesitant to take their prescribed drugs due to fear of adverse side effects. But in general, modern society dictates that the cold waters of the pool are muddier, our possible fears more esoteric. The fear of falling to death is more immediate and tangible than the fear of falling short on an exam, which may not have demonstrable impact until several multi-faceted steps down the road. In a world where the average person must look at an entire forest of potential outcomes rather than the single trees of action, this hesitation to act is all too often manifested in procrastination. After all, we don’t have to face negative results of a decision so long as we can put that decision off.

Fear of failure is an unbroken steed we ride cantering aimlessly though the fields of procrastination. The inability to tame it takes us places we don’t necessarily want to be, and far from where we wanted to end up. Fear and the urge to postpone action are often well-meaning, and driven by the desire to perform our best; though tragically, it often has the opposite effect. In a Western world where young generations have oft been sheltered from disappointment and coached that success is the only acceptable outcome, we neglect to accept failure as a valuable part of learning. Students that face difficult tasks without the reassurance of failure’s role in improvement tend to perform worse on subsequent tasks of working memory… convinced that their poor performance was an infallible marker of incompetence. And those who perceive themselves to have low competence to begin with procrastinate even more. Perceived incompetence begets actual incompetence, so instead of finishing that problem set, we decide that we “really should check our email” and then promptly direct our browser to Reddit.

Long story short, hesitation is a funny thing to pin down. It’s complicated. Dictionary definitions do little to distill its inherent complexity, and maybe that’s because we have but a tenuous grasp of the hard-wired factors that prompt and perpetuate it to begin with.

Will we ever fully understand hesitation? Not so easily, it seems. But personally, I’ll try.

…well, maybe tomorrow.