Thinking, Fast and Slow – by Dr. Daniel Kahneman
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We all try to make the best decisions we can with the information available… Don’t we?
Yet, somehow, a survival chance of 90% seems better than a mortality rate of 10%, and as it turns out, we as fallible humans are prey to all manner of dubious heuristics.
Nobel Prize winner Dr. Daniel Kahneman lays out for us two sytems of thought process:
- Fast, intuitive, emotional
- Slow, deliberate, logical
He makes the case for how and why we do need both, but often end up using the wrong one. He notes how the first is required for efficiency, or we would spend all day deciding what socks to wear… The second, meanwhile, is required for high-stakes decisions, but is lazy by nature, and often we don’t engage it when we ought to.
Over the course of many diverse examples, Dr. Kahneman shows how again and again, the second system is slowly cogitating at the back of the class, while the first system is bouncing up and down with its hand in the air saying “I know! I know!”, even when, in fact, it does not know.
For a book largely founded in economics (it’s a massive takedown of the notion of the rational consumer), it is not at all dry, and is very readable in style. It’s engaging throughout, and readers far removed from Wall Street will find plenty of ways it relates to our everyday lives.
Bottom line: if you’d like to avoid making many mistakes in what you’d assumed to be rational decisions, this book is critical reading.
Click here to check out “Thinking, Fast And Slow”, and enjoy the results of better decisions!
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International Women’s Day (and what it can mean for you, really)
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How to not just #EmbraceEquity, but actually grow it, this International Women’s Day!
It’s International Women’s Day, and there’s a lot going on beyond the hashtagging! So, what’s happening, and how could you get involved in more than a “token” way in your workplace, business, or general life?
Well, that depends on your own environment and circumstances, but for example…
A feminist policy for productivity in the food sector?
We tend to think that in this modern world, we all have equal standing when it comes to productivity, food, and health. And yet…
❝If women do 70 per cent of the work in agriculture worldwide, but the land is mainly owned by men, then we don’t have equity yet. If in Germany, only one-tenth of female farmers manage the farm on which they work on, while they also manage the household, then there is no equity yet❞
~ Lea Leimann, Germany
What to do about it, though? It turns out there’s a worldwide organization dedicated to fixing this! It’s called Slow Food.
Their mission is to make food…
- GOOD: quality, flavorsome and healthy food
- CLEAN: production that does not harm the environment
- FAIR: accessible prices for consumers and fair conditions and pay for producers
…and yes, that explicitly includes feminism-attentive food policy:
Read all about it: Slow Food women forge change in the food system
Do you work in the food system?
If so, you can have an impact. Your knee-jerk reaction might be “I don’t”, but there are a LOT of steps from farm-to-table, so, are you sure?
Story time: me, I’m a writer (you’d never have guessed, right?) and wouldn’t immediately think of myself as working “in the food system”.
But! Not long back I (a woman) was contracted by a marketing agent (a woman) to write marketing materials for a small business (owned by a woman) selling pickles and chutneys across the Australian market, based on the recipes she learned from her mother, in India. The result?
I made an impact in the food chain the other side of the planet from me, without leaving my desk.
Furthermore, the way I went about my work empowered—at the very least—myself and the end client (the lady making and selling the pickles and chutneys).
Sometimes we can’t change the world by ourselves… but we don’t have to.
If we all just nudge things in the right direction, we’ll end up with a healthier, better-fed, more productive system for all!
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Staying Healthy and Active After 60
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: How to be your best self after 60: Self motivation / Avoiding or limiting salt, sugar & alcohol: Alternatives / Ways to sneak in more movements/exercise
…and, from a different subscriber…
Q: Inflammation & over 60 weight loss. Thanks!
Here are some of our greatest hits on those topics:
- Where Nutrition Meets Habits ← focusing on food that’s all three of: healthy + easy + cheap
- How To Keep On Keeping On ← exercise tips for when the motivation wanes
- Keep Inflammation At Bay ← science-based tips and advice
Also, while we’ve recommended a couple of books on stopping (or reducing) drinking, we’ve not done a main feature on that, so we definitely will one of these days!
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Having dense breasts is linked to cancer. But advice about breast density can depend on where you live
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Having dense breasts is a clear risk factor for breast cancer. It can also make cancers hard to spot on mammograms.
Yet you might not be aware you have dense breasts, even after mammographic screening.
In Australia, advice for women with dense breasts and their health-care professionals can be inconsistent and confusing.
This is because there’s not currently consensus on whether women who have dense breasts, but no symptoms, benefit from further imaging such as ultrasounds. Concerns include potential cost of these tests and the risk they can produce false positives.
Gorodenkoff/Shutterstock What is breast density?
Breasts are made up of fatty tissue and fibroglandular tissue (including glands that make milk, held together by fibrous tissue).
On a mammogram – an x-ray of the breast – fibroglandular tissue appears white and fatty tissue appears dark. The white areas are referred to as breast density.
Fibroglandular tissue shows up white on a mammogram. Nata Sokhrannova/Shutterstock A higher proportion of fibroglandular tissue means your breasts are dense.
There are four categories to classify breast density:
- A: almost entirely fatty
- B: scattered areas of fibroglandular density
- C: heterogeneously or consistently dense
- D: extremely dense.
Breast density is very common. Around 40% of women aged 40–74 are estimated to have “dense breasts”, meaning they fall in category C or D.
What’s the link to cancer?
Breast density is associated with the risk of breast cancer in two ways.
First, breast density usually decreases with age. But if a woman has high breast density for her age, it increases her likelihood of breast cancer.
One study looked at the risk of breast cancer over the age of 50. It found there was a 6.2% risk for the one-third of women with the lowest density. For the 5% with the highest density, the risk was 14.7%.
Second, breast density “masks” cancers if they develop. Both cancers and breast density appear white on a mammogram, making cancers very hard to see.
Breast cancer screening saves lives through early detection and improved treatment options. But we don’t yet know if telling women about their breast density leads to earlier cancer detection, or lives saved.
In Australia, screening mammography is free for all women* aged 40 and older. This is run through BreastScreen Australia, a joint national, state and territory initiative. Those aged 50-74 are invited to have a mammogram, but it’s available for free without a referral from age 40.
However, the messages Australian women currently receive about breast density – and whether it’s recorded – depends on where they live.
What does the advice say?
In 2023, the Royal Australian and New Zealand College of Radiologists updated its position statement to recommend breast density is recorded during screening and diagnostic tests in Australia and New Zealand.
Meanwhile BreastScreen Australia says it “should not routinely record breast density or provide supplemental testing for women with dense breasts”. However this position statement is from 2020 and is currently under review.
Some state and territory BreastScreen programs, including in Western Australia, South Australia and soon Victoria, notify women if they have dense breasts. Victoria is currently at an early stage of its roll-out.
While the messaging regarding breast density differs by state, none currently recommend further imaging for women with dense breasts without speaking to a doctor about individual risk.
What are the issues?
Providing recommendations for women with dense breasts is difficult.
The European Society of Breast Imaging recommends women with extremely dense breasts aged 50–70 receive an MRI every two to four years, in addition to screening mammography. This is based on a large randomised controlled trial from the Netherlands.
But the Royal Australian and New Zealand College of Radiologists describes this recommendation as “aspirational”, acknowledging cost, staffing and accessibility as challenges.
That is, it is not feasible to provide a supplemental MRI for everyone in the screening population in category D with extremely dense breasts (around 10%).
Further, there is no consensus on appropriate screening recommendations for women in the category C (heterogeneous density).
We need a national approach to breast density reporting in Australia and to do better at identifying who is most likely to benefit from further testing.
BreastScreen Australia is currently undergoing a review of its policy and funding.
One of its goals is to enable a nationally consistent approach to breast screening practices. Hopefully breast density reporting, including funding to support national implementation, will be a priority.
*This includes those recorded female at birth and who are gender diverse.
Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Other Alzheimer’s Risk Factor
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The usually-listed 7 known risk factors of dementia (in general, not just Alzheimer’s) do not include today’s item. For a recap, those were:
The 7 Known Risk Factors For Dementia
The bonus risk factor
This idea is not completely novel; it’s been known for a while that traumatic brain injury (TBI) can increase the risk of dementia, but it has generally been chalked up to “if you damage an organ, then that organ does not function so well afterwards”.
However, in the case of Alzheimer’s, it seems there’s something deeper at play. Specifically, a study that found…
❝…traumatic brain injury alters the small vessels in the brain, resulting in an accumulation of amyloid beta—a hallmark of Alzheimer’s disease.
The findings suggest that vascular dysfunction could be an early driver in neurodegenerative disorders rather than being caused by neuronal damage.❞
This association held true even in quite young patients!
The study from Sweden looked at brain tissue from TBI patients (who had had to have brain tissue removed for medical reasons due to bleeding and swelling), and found that the (traumatic) changes to the vascular smooth muscle cells were associated with increased aggregation of amyloid-β.
In terms of establishing cause and effect: since it could be safely concluded the amyloid-β had not caused the TBI (which all had external explanations such as “car crash” or such), it can be deduced that almost* certainly the TBI caused the amyloid-β aggregation.
*because little to nothing in science is every truly certain. As in life in general, really; the difference is that scientists admit it!
You may be wondering: what was the control? It would be a very generous group of citizens indeed who would volunteer bits of their brains that hadn’t needed removing. However, the answer is that the control brain bits came from a biobank, and were from uninjured patients with no history of TBI or neurodegenerative disorders, and who had died from systemic, unrelated causes. Having been dead for a matter of hours, and the fixation time for the brain bits from the living people taking long enough that everybody’s brain bits had been out of their respective living bodies for a similar length of time, this was deemed an acceptable, if imperfect, control.
You can read the study in its entirety here; it is fascinating:
The practical take-away
The practical take-away, of course, is: look after your brain
Not just in the sense of eat fiber, get healthy fats, move more, get good sleep, stay intellectually stimulated, etc*, but also in the sense of “keep your brain physically safe”.
Now, you may think that you already try not to get into car crashes, and perhaps you do not compete in contact sports, but do be aware that one of the leading causes of TBI in older people is, ignominiously, falling down.
And if you think “that only happens to older/other people”, then be aware: there’s a first time for everything and you are not immune. With that in mind, do check out:
Fall Special! ← the seasonal title notwithstanding, this is about not falling down in the first place, and being less injurable if you do fall down
*This was a modest and vague list for brevity’s sake, so for much more detail, enjoy:
How To Reduce Your Alzheimer’s Risk ← this is rather more comprehensive
Want to know more?
Here you can read about the largest study of its kind into lifestyle factors and Alzheimer’s disease:
Alzheimer’s Causative Factors To Avoid ← the methods and conclusions of Dr. David Snowdon’s famous “Nun Study”
Take care!
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Health Shots − by Toby Amidor
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First a quick note on qualifications: while not a doctor, she’s a RD, CDN, FAND, and as such, this is a very nutrition-focused book.
As a general rule of thumb, juices are unhealthy because of being largely liquid sugar and no fiber, but in this case:
- even the juice-based tonics are very small portions, so even if some have a high glycemic index, they’ll still have a low glycemic load, which means that having one is unlikely to spike blood glucose and thus insulin
- many of the tonics have fiber in any case, due to how they are made.
The tonics are divided into sections per what one wants to focus on, e.g. anti-inflammatory, brain health, sleep, gut health, skin/nails/hair, etc.
That said, some of the recipes are a little optimistic about how much effect the dosage present will have. For example, we calculate an an average of 0.03mg of resveratrol in her grape-based shot boasting resveratrol benefits. For contrast, resveratrol supplements range from 500mg to 200mg. So, to get the equivalent of the least generous supplement, you’d need to drink 16,667 shots.
Bottom line: some of the the health claims in this book are overstated, but by and large, it’s hard to go wrong consuming more plants, and these “health shots” are not a bad way to get a good dose of phytonutrients without hitting glycemic problems.
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Bird Flu Is Bad for Poultry and Dairy Cows. It’s Not a Dire Threat for Most of Us — Yet.
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Headlines are flying after the Department of Agriculture confirmed that the H5N1 bird flu virus has infected dairy cows around the country. Tests have detected the virus among cattle in nine states, mainly in Texas and New Mexico, and most recently in Colorado, said Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention, at a May 1 event held by the Council on Foreign Relations.
A menagerie of other animals have been infected by H5N1, and at least one person in Texas. But what scientists fear most is if the virus were to spread efficiently from person to person. That hasn’t happened and might not. Shah said the CDC considers the H5N1 outbreak “a low risk to the general public at this time.”
Viruses evolve and outbreaks can shift quickly. “As with any major outbreak, this is moving at the speed of a bullet train,” Shah said. “What we’ll be talking about is a snapshot of that fast-moving train.” What he means is that what’s known about the H5N1 bird flu today will undoubtedly change.
With that in mind, KFF Health News explains what you need to know now.
Q: Who gets the bird flu?
Mainly birds. Over the past few years, however, the H5N1 bird flu virus has increasingly jumped from birds into mammals around the world. The growing list of more than 50 species includes seals, goats, skunks, cats, and wild bush dogs at a zoo in the United Kingdom. At least 24,000 sea lions died in outbreaks of H5N1 bird flu in South America last year.
What makes the current outbreak in cattle unusual is that it’s spreading rapidly from cow to cow, whereas the other cases — except for the sea lion infections — appear limited. Researchers know this because genetic sequences of the H5N1 viruses drawn from cattle this year were nearly identical to one another.
The cattle outbreak is also concerning because the country has been caught off guard. Researchers examining the virus’s genomes suggest it originally spilled over from birds into cows late last year in Texas, and has since spread among many more cows than have been tested. “Our analyses show this has been circulating in cows for four months or so, under our noses,” said Michael Worobey, an evolutionary biologist at the University of Arizona in Tucson.
Q: Is this the start of the next pandemic?
Not yet. But it’s a thought worth considering because a bird flu pandemic would be a nightmare. More than half of people infected by older strains of H5N1 bird flu viruses from 2003 to 2016 died. Even if death rates turn out to be less severe for the H5N1 strain currently circulating in cattle, repercussions could involve loads of sick people and hospitals too overwhelmed to handle other medical emergencies.
Although at least one person has been infected with H5N1 this year, the virus can’t lead to a pandemic in its current state. To achieve that horrible status, a pathogen needs to sicken many people on multiple continents. And to do that, the H5N1 virus would need to infect a ton of people. That won’t happen through occasional spillovers of the virus from farm animals into people. Rather, the virus must acquire mutations for it to spread from person to person, like the seasonal flu, as a respiratory infection transmitted largely through the air as people cough, sneeze, and breathe. As we learned in the depths of covid-19, airborne viruses are hard to stop.
That hasn’t happened yet. However, H5N1 viruses now have plenty of chances to evolve as they replicate within thousands of cows. Like all viruses, they mutate as they replicate, and mutations that improve the virus’s survival are passed to the next generation. And because cows are mammals, the viruses could be getting better at thriving within cells that are closer to ours than birds’.
The evolution of a pandemic-ready bird flu virus could be aided by a sort of superpower possessed by many viruses. Namely, they sometimes swap their genes with other strains in a process called reassortment. In a study published in 2009, Worobey and other researchers traced the origin of the H1N1 “swine flu” pandemic to events in which different viruses causing the swine flu, bird flu, and human flu mixed and matched their genes within pigs that they were simultaneously infecting. Pigs need not be involved this time around, Worobey warned.
Q: Will a pandemic start if a person drinks virus-contaminated milk?
Not yet. Cow’s milk, as well as powdered milk and infant formula, sold in stores is considered safe because the law requires all milk sold commercially to be pasteurized. That process of heating milk at high temperatures kills bacteria, viruses, and other teeny organisms. Tests have identified fragments of H5N1 viruses in milk from grocery stores but confirm that the virus bits are dead and, therefore, harmless.
Unpasteurized “raw” milk, however, has been shown to contain living H5N1 viruses, which is why the FDA and other health authorities strongly advise people not to drink it. Doing so could cause a person to become seriously ill or worse. But even then, a pandemic is unlikely to be sparked because the virus — in its current form — does not spread efficiently from person to person, as the seasonal flu does.
Q: What should be done?
A lot! Because of a lack of surveillance, the U.S. Department of Agriculture and other agencies have allowed the H5N1 bird flu to spread under the radar in cattle. To get a handle on the situation, the USDA recently ordered all lactating dairy cattle to be tested before farmers move them to other states, and the outcomes of the tests to be reported.
But just as restricting covid tests to international travelers in early 2020 allowed the coronavirus to spread undetected, testing only cows that move across state lines would miss plenty of cases.
Such limited testing won’t reveal how the virus is spreading among cattle — information desperately needed so farmers can stop it. A leading hypothesis is that viruses are being transferred from one cow to the next through the machines used to milk them.
To boost testing, Fred Gingrich, executive director of a nonprofit organization for farm veterinarians, the American Association of Bovine Practitioners, said the government should offer funds to cattle farmers who report cases so that they have an incentive to test. Barring that, he said, reporting just adds reputational damage atop financial loss.
“These outbreaks have a significant economic impact,” Gingrich said. “Farmers lose about 20% of their milk production in an outbreak because animals quit eating, produce less milk, and some of that milk is abnormal and then can’t be sold.”
The government has made the H5N1 tests free for farmers, Gingrich added, but they haven’t budgeted money for veterinarians who must sample the cows, transport samples, and file paperwork. “Tests are the least expensive part,” he said.
If testing on farms remains elusive, evolutionary virologists can still learn a lot by analyzing genomic sequences from H5N1 viruses sampled from cattle. The differences between sequences tell a story about where and when the current outbreak began, the path it travels, and whether the viruses are acquiring mutations that pose a threat to people. Yet this vital research has been hampered by the USDA’s slow and incomplete posting of genetic data, Worobey said.
The government should also help poultry farmers prevent H5N1 outbreaks since those kill many birds and pose a constant threat of spillover, said Maurice Pitesky, an avian disease specialist at the University of California-Davis.
Waterfowl like ducks and geese are the usual sources of outbreaks on poultry farms, and researchers can detect their proximity using remote sensing and other technologies. By zeroing in on zones of potential spillover, farmers can target their attention. That can mean routine surveillance to detect early signs of infections in poultry, using water cannons to shoo away migrating flocks, relocating farm animals, or temporarily ushering them into barns. “We should be spending on prevention,” Pitesky said.
Q: OK it’s not a pandemic, but what could happen to people who get this year’s H5N1 bird flu?
No one really knows. Only one person in Texas has been diagnosed with the disease this year, in April. This person worked closely with dairy cows, and had a mild case with an eye infection. The CDC found out about them because of its surveillance process. Clinics are supposed to alert state health departments when they diagnose farmworkers with the flu, using tests that detect influenza viruses, broadly. State health departments then confirm the test, and if it’s positive, they send a person’s sample to a CDC laboratory, where it is checked for the H5N1 virus, specifically. “Thus far we have received 23,” Shah said. “All but one of those was negative.”
State health department officials are also monitoring around 150 people, he said, who have spent time around cattle. They’re checking in with these farmworkers via phone calls, text messages, or in-person visits to see if they develop symptoms. And if that happens, they’ll be tested.
Another way to assess farmworkers would be to check their blood for antibodies against the H5N1 bird flu virus; a positive result would indicate they might have been unknowingly infected. But Shah said health officials are not yet doing this work.
“The fact that we’re four months in and haven’t done this isn’t a good sign,” Worobey said. “I’m not super worried about a pandemic at the moment, but we should start acting like we don’t want it to happen.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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