12/31/17: THE PROBABILITY OF THE IMPROBABLE: Capitalizing and Counting on the Unexpected; Thoughts for the New Year



My late father, who was a rational person, a man of science, had an unusual philosophy that guided his scientific research and, in part, actions in his life. He called it the Probability of the Improbable.

The way I see it, he explained, you don’t go around figuring everything that’s probable. You have to count on something being improbable. Once you factor in improbability, you can capitalize on it.

I always liked the phrase, Probability of the Improbable, with caps. It sounds contradictory or circular, but it’s not. It’s another way of saying improbable things happen, and you have to be alert to their occurrence. If you just assume the obvious, the probable, the anticipated, and/or the expected, you may miss out. You may limit yourself and your discoveries because you’re limiting your critical thinking.

Once engaged in the process of medical-scientific experimentation, my father said, “things start to pop.” Sometimes the pop is the end-result, but more often, it is a lead that the researcher must pursue and parlay into the next. When the next step is not readily apparent, it sometimes takes contrary thinking—examining data with an eye toward disbelief and improbabilities, not easy conclusions—before research can continue.

The Probability of the Improbable has to do with being able to see Significance, with a capital “S,” when something is important and when it’s not. It’s a matter of being able to perceive and then extrapolate from it, of recognizing the unexpected and knowing how to take advantage of it.

In part, the improbable is the same as following your research leads, because research is never a straight line. It’s only a straight line if you’re doing something like screening for something, and then you hit what you started out to hit.

Not everyone can zig and zag and both recognize the unexpected and when the unexpected is significant. Many people don’t feel comfortable veering from a safe, predictable, and straight line of thinking that others share and can reinforce. It feels “counter-intuitive” to them to do otherwise.

As you turn the calendar page on another year, I offer the Probability of the Improbable as a hopeful way to view life. If you open your mind up to all possibilities and think beyond what you expect and are used to—assumptions are often wrong—you may find a zig to go with your zag. You might perceive realities and make connections that you never knew existed.



The Probability of the Improbable appeals to what I sometimes refer to as the lawyer “side” of me. Upon encountering any problematic situation, my lawyer mindset quickly assesses the “what ifs” and the “why nots,” all possible scenarios and the probability of their occurrence, and then takes this assessment into account to form my actions.

My father’s intellectual imprint is upon me.

Notably, I apply the Probability of the Improbable in my patient advocacy, about which I’ve written, so I can be prepared for whatever happens and respond rationally, not emotionally. In a crisis, I’m even-keeled and incisive. I don’t choke up or panic. If I’m going to be thrown for a loop, it will be later when I’m processing what happened, not while I’m in the moment and need to be decisive.

As I discovered in 2002, in a life-and-death crisis with my mother, who was then 78, physicians are disinclined to venture into diagnostic improbabilities. They rely upon what is known as pattern recognition, which is a nonanalytical approach to arriving at a diagnosis. You might say they think within the box. As I write in my book, “Our Parents in Crisis”:

“Pattern recognition is reasoning by case analogy or similarity, by [the physician’s] experience. The patient’s clinical data coalesce into a pattern that the doctor identifies as a specific disease or condition: In other words, the doctor has seen the clinical problem before.

“Pattern diagnoses are fast, automatic, and, because of disease prevalence, largely accurate. . . .

“‘Doctors are machines of pattern recognition,’ said Dr. Peter Rabins, [then-]director of the Johns Hopkins Division of Geriatric Psychiatry and Neuropsychiatry.”

While pattern recognition may serve most of the diagnoses most of the time, it also may transform a patient’s unique narrative into a doctor’s preconceived, and erroneous, illness script. In 2002, one doctor diagnosed my mother’s rare tick-borne disease, ehrlichiosis, as a urinary tract infection; many others diagnosed it as a bacterial meningitis. Laboratory signs and physical symptoms were there, but they all missed their significance.

The apparent human tendency to see patterns everywhere is what I believe accounts for so many false assumptions that people make about others. In my experience, people tend to assume that others have lived as they have, have the same values, and desire the same social norms. This observation is grist for another column, and so I’ll leave it at that.

The sports world is guilty of patternization in the form of statistics. Whenever I hear a football game announcer say something like “The New England Patriots have never lost a game when they’ve been leading by 14 points at the end of the first quarter,” I think, “So what?” Today, now, in this game, in these moments, under these conditions, with this opponent, etc., etc., they just might.

These days, I apply the Probability of the Improbable to my homebound 93-year-old mother’s daily care. Mom lives on her own a half-mile away from my house. I’ll never be caught out of town, without a caregiver available to stay with my mother because the caregiver I scheduled is sick, has been in a car crash, has been arrested, or has died! Or because her car has broken down, or the bridge onto the Outer Banks is closed for some reason!

All of these “improbabilities” have occurred in the past four years, and they dismayed, but they didn’t surprise me.

I suppose an “Act of God”—unfortunate shorthand for a natural disaster—could defeat my preparation, but it won’t be a hurricane. I draw the line at Chicken Little, though. I’m willing to take the risk that the sky will fall.



This past week, I watched an old movie adaptation of Agatha Christie’s novel, “A Caribbean Mystery,” starring the great British actress Joan Hickson.

In explaining how foolish she had been in reasoning through the facts of three murders, Christie’s busy-body spinster detective, Miss Marple, scolds herself for forgetting to factor in the “impossibilities,” which is to say the improbabilities. As soon as she does, the resolution becomes clear to her.

Detective-fiction writers seize upon improbabilities in their plots in order to lead their pattern-thinking readers astray and then sneak up behind them to yell: “Gotcha!”

But if you’re a mystery and puzzle solver like me, you’re hip to concealed entry doors, locked rooms, murderers in disguise, identical twins switching identities, gunshots being fired after the murder victim is already dead, all manner of plot contrivances and twists, some of which are so common in the detective-fiction genre that they are considered subgenres.

I’ve just finished reading Ruth Ware’s “The Woman in Cabin 10.” Ho-hum. This snore is what passes for a New York Times bestseller these days. Ware is no Agatha Christie.

Detective fiction appeals to the analytical mind, the same mind that physicians employ in diagnostics after pattern recognition has failed them. By then, if you’re the patient, you’ve seen multiple specialists who have engaged in confirmation bias, premature closure, or search satisfaction, all of which translate to: The doctor stopped looking, and, therefore, stopped thinking.

The analytical mind is an open one, but it is not so open as to be seduced by superstitious or paranormal beliefs that underlie “meant to be.”

I believe in the infinite incapacity of the human mind, by which I do not mean mindfulness, which is more about being aware in the moment. I refer instead to the mind’s infinite power to reason, perceive, and make things happen.

Improbability is not merely chance or randomness, two concepts I leave primarily to mathematicians and statisticians.



You could assign the word, “hunch,” to my father’s improbability theory. Indeed, its practical application is easily explained and understood in a gambling context, where bettors routinely play hunches, hoping for windfall results. A gambler, my father could transfer it readily to shooting craps, which was one of his great passions:

Hey, I’ve been at the craps table and seen the “11”—which is only a one-in-eighteen chance—come up twice in a row. Or a “10.” You know, with the 10, there are only three ways out of thirty-six—five and five, six and four, and four and six—that it can come up. But I’ve seen that damn 10 show three or four times within a few rolls. . . . When you’re shooting craps, you have to figure in this improbability. You have to count on it happening sometimes. And if you’re riding on that 10, wow, you know, it pays two to one.  . . .

I never knew him to lose at craps. He had rules that he followed, and he never broke them.

Dad also had a wonderful story about being at the racetrack and witnessing a dead heat between two horses, one of which was partially owned by a good friend of his.

Improbably, Dreadnought, his friend Tom’s horse, crossed the line at the exact moment as his chief competitor, More Fudge. The 1-minute-12 3/5-second race culminated in a photo finish that could not distinguish a winner.

On the drive down to Churchill Downs the day of the Dreadnought-More Fudge contest, Dad had told Tom about the Probability of the Improbable. As he recalled:

They both had their noses on the wire. Tom’s horse and the other guy’s horse. In line. No difference. Two winners. So they had to make another cup. . . . I remember Tom walking into the clubhouse, all big smiles, holding the championship cup high over his head, and calling out to me, “Hey, Al, the Probability of the Improbable!” Everybody applauded. . . . What can you say? It happens.

The improbable can be shocking and distressing, as it was with the thalidomide catastrophe (see my July 2017 blog posts), but it also can be enlightening and liberating, as it was so often in my father’s high-rolling clinical-research career.



Just days before my father died in 2014, he read a newspaper review of a new book titled “The Improbability Principle: Why Coincidence, Miracles, and Rare Events Happen Every Day.” He called me excitedly about it and asked if I would print copies of the review for my siblings and contact the author!

Dad’s heart was missing beats, but his mind wasn’t.

The author, British mathematician and statistician David J. Hand, apparently argued in his book that extraordinarily rare events are actually quite commonplace, and that we should all expect to experience a “miracle” roughly once every month. Hand, an emeritus math professor at Imperial College London, based his rational conclusions on laws of logic and mathematics, including the laws of probability and inevitability.

The British professor was clearly operating in a different realm of reality—except for the gambling—than my physician-scientist father had, but they could claim to be kindred spirits. Unfortunately, Dad never got the chance to read Hand’s book, and I haven’t had the heart or inclination to read it. While I may not always be at peace with uncertainty in my life—I’m a planner and list-maker—I do embrace the improbable in my critical thinking and do not need statistics to convince me.

Tonight, if you are out and about partying, keep in mind the improbable that can harm you, rather than lift you up. Do not assume you will get home safely. Brainstorm all worst-case scenarios and take precautions.

Ditto, don’t assume that strangers you meet at a party or club have your best interests at heart. Worst-case scenario . . . precautions. You’re being rational, not paranoid.

Tomorrow, as you embark on the first day of a new and unknown year, allow yourself to contemplate that the improbable may bring you joy and pleasure, if you just take notice. Let your mind wander toward the unexpected. If you perceive the significance, you just might capitalize on it.

Happy New Year, everyone. I toast to your health.

Ann, 12/31/17


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