Indiana just passed right-to-work legislation. The standard labor argument (against Mitch Daniels) is that all workers benefit from the actions of a worker's union, so they should all contribute. I'm not sure if that is true. There are some cases of overlap I'm sure, but one of the most important benefits of being in a union is protection from being laid off "unfairly". If a worker declined to pay union fees and didn't join the union, they face that risk. It's a calculation that any individual would need to make - but clearly, if the benefits of unionization are so great, theres no need for a law that forces a worker to join. I am always for greater individual freedom, so I definitely side with Mitch Daniels on this issue. Workers have the right to organize and join unions, but unions shouldn't have the right to force workers to join.
On a somewhat related note, consider what the essence of unionization is: it is undeserved economic influence; economic power at above-market rates. In a union, a collection of individuals organize within the framework of a larger group such that, by virtue of that organization, they become more influential than the sum of their parts. They increase their economic power not by increasing productivity, but by pressing political advantage into economic gain. Obviously, this leads to less efficient labor markets - and many others are hurt in consequence, including non-unionized workers.
Now stop and consider the entrenched financial and corporate elite in this country. The "1%" generally is a very productive group, and in a genuinely free market they would be compensated handsomely for their efforts. However, by virtue of their connections to politicians and their virtual ownership of government in general, the financial and corporate elite have been able to press their advantage. They have built a system from the inside that favors them unfairly. They are no different than factory workers who unionize and demand outrageous or unearned pay.
Wall Street and many entrenched corporations have economic power beyond that which their productivity deserves. Tax-payer bailouts and implicit government backing of too-big-to-fail institutions. A tax code, written by armies of lawyers and voted into being by bought politicians, which is insanely complex and riddled with loopholes that benefit the authors. Entrenched corporations (think: unionized workers) with their lobbyists buy themselves government subsidies and tax breaks; these are advantages that their smaller or newer competitors (think: non-unionized labor) don't enjoy. The power of the financial and corporate elite, like unionized workers in a factory, is greater than the sum of their parts. This is the Union of the 1%.
While Democrats are funded by traditional middle-class unions, Republicans are backed by the union on Wall Street - and as the financial crash in 2007 showed, the latter is more detrimental to the economy. So: want to do some union busting, and make our economy more competitive? Fine. Lets not stop with the middle class unions. We need to end corporate welfare. Simplify the tax code. Break up any company or bank that is implicitly backed by the taxpayers because it is too big to fail. Stop government subsidies and tax breaks to entrenched corporations. End attempts at regulating the internet. Re-write our ridiculous patent laws which have been woven into place by entrenched companies to keep out the competition. THAT is how you revitalize the American economy.
This is what Occupy Wall Street is all about. Americans have gone along with the de-unionization of the middle classes for decades, and the promised gains in living standards have absolutely failed to be realized. Now its time to end the union of Wall Street, of the entrenched interests, of the elites who own Washington.
Monday, February 06, 2012
Sunday, February 05, 2012
Catholic Bishops and the Laws of Men
Imagine a couple has been in a monogamous marriage for over two decades. They have raised four children. They do not wish to have more. They could be worried about having enough money for retirement,
and can't afford to raise more children. In addition, because the couple is getting older, they are worried that they will lack the energy to raise another child. Finally, they worry about the health of the mother and potential child in such a late pregnancy. This couple wishes to remain intimate, and so use contraceptives to prevent another pregnancy.
The vast majority of Catholics agree that the use of contraception, such as in the case described above, is completely reasonable. In 2005, a poll showed that over 90% of Catholics thought using contraception in some circumstances was not a sin. Also important is the central role that contraception plays in preventing great sins: a sure-fire way to prevent abortion is to prevent unwanted pregnancies.
Catholic Bishops stand in stark contrast to their flock. They believe that anyone who uses condoms is a sinner, no matter what. Not content to merely pass their antiquated judgments, the Bishops are now demanding the power to deprive American Catholics the right to purchase condoms & other family planning products with their health insurance.
Growing up a Catholic, I remember a church that tried to serve as a guide. The church gave recommendations and advice to its flock, but never dictats. The recent change is really bizarre to me. What does it say about the Bishops' mindset that they would even try to use legal means, to use man's laws, to restrict the freedoms of their flock? At any rate, the Vatican should not have the right to impose their religious laws on Americans from Europe. Americans have economic freedom, religious freedom, and behavioral freedom that should not be infringed upon by anyone, even Catholic Bishops. I am glad that President Obama stood up for the freedom of Americans in this case and told the Bishops that they can preach, but they cannot rule. Any Catholic who believes that family planning is smart, and that abortion is terrible and should be avoided, should call their Bishop and tell them as much.
and can't afford to raise more children. In addition, because the couple is getting older, they are worried that they will lack the energy to raise another child. Finally, they worry about the health of the mother and potential child in such a late pregnancy. This couple wishes to remain intimate, and so use contraceptives to prevent another pregnancy.
The vast majority of Catholics agree that the use of contraception, such as in the case described above, is completely reasonable. In 2005, a poll showed that over 90% of Catholics thought using contraception in some circumstances was not a sin. Also important is the central role that contraception plays in preventing great sins: a sure-fire way to prevent abortion is to prevent unwanted pregnancies.
Catholic Bishops stand in stark contrast to their flock. They believe that anyone who uses condoms is a sinner, no matter what. Not content to merely pass their antiquated judgments, the Bishops are now demanding the power to deprive American Catholics the right to purchase condoms & other family planning products with their health insurance.
Growing up a Catholic, I remember a church that tried to serve as a guide. The church gave recommendations and advice to its flock, but never dictats. The recent change is really bizarre to me. What does it say about the Bishops' mindset that they would even try to use legal means, to use man's laws, to restrict the freedoms of their flock? At any rate, the Vatican should not have the right to impose their religious laws on Americans from Europe. Americans have economic freedom, religious freedom, and behavioral freedom that should not be infringed upon by anyone, even Catholic Bishops. I am glad that President Obama stood up for the freedom of Americans in this case and told the Bishops that they can preach, but they cannot rule. Any Catholic who believes that family planning is smart, and that abortion is terrible and should be avoided, should call their Bishop and tell them as much.
Friday, February 03, 2012
The Tragedy of the Komen Foundation
Public health has taken another blow. They say these things come in threes. We have leading conservative presidential candidates telling people that vaccines cause autism. A conservative senator in Tennessee just told his constituents that it is "virtually impossible" to spread HIV through heterosexual contact. And now, we are politicizing the screening and treatment of breast cancer. I can't stop thinking about the cultural damage here. Has anyone else considered what we just lost as a nation? We disagree on just about everything these days. The notion that breast cancer is a disease worth fighting is one of the few remaining things everybody could agree on. That has now been destroyed; and for what? At the end of the day, this was over $700,000 dollars. To destroy such a cherished and unitary cultural icon for such a petty trifle, for such a cheap political victory. It must take an exceptionally vindictive person to want to make that trade.
At any rate, this was an unforced error of staggering proportions on the part of the Komen Foundation itself. Before this story broke, I suspect that very few people knew that Komen gave money to Planned Parenthood. Even if people knew Komen was providing breast cancer care at Planned Parenthood clinics, what kind of person would possibly care? One would think self-interest alone would have led Komen to stay out of this debate. Now that they have taken sides, its probably too late. If they stand firm and abandon low-income women, they will alienate at least the 75% of Americans who support abortion rights in some form or another. Arguably they will lose more than that, since obviously not everyone who is anti-choice thinks depriving poor women of breast cancer screening is worth a political point. Alternatively, Komen could do the right thing and reverse course. In doing so they would become a perpetual target for religious bullies who are always looking for another battle to fight. Either way, what used to be a non-controversial, unitary force, the fight against breast cancer, will be reduced into another yearly battle in our incessant culture wars.
I do think there is a way out. Komen needs to stand with low-income women and support breast cancer services, and provide concrete data that show that donors' money is being used only for breast services. Conservative women should stand with them when they do - because they should recognize that this isn't worth it, and that there are better and less destructive venues in which to have the abortion fight. People should remember why they supported the Komen Foundation in the first place and leave politics aside for once.
At any rate, this was an unforced error of staggering proportions on the part of the Komen Foundation itself. Before this story broke, I suspect that very few people knew that Komen gave money to Planned Parenthood. Even if people knew Komen was providing breast cancer care at Planned Parenthood clinics, what kind of person would possibly care? One would think self-interest alone would have led Komen to stay out of this debate. Now that they have taken sides, its probably too late. If they stand firm and abandon low-income women, they will alienate at least the 75% of Americans who support abortion rights in some form or another. Arguably they will lose more than that, since obviously not everyone who is anti-choice thinks depriving poor women of breast cancer screening is worth a political point. Alternatively, Komen could do the right thing and reverse course. In doing so they would become a perpetual target for religious bullies who are always looking for another battle to fight. Either way, what used to be a non-controversial, unitary force, the fight against breast cancer, will be reduced into another yearly battle in our incessant culture wars.
I do think there is a way out. Komen needs to stand with low-income women and support breast cancer services, and provide concrete data that show that donors' money is being used only for breast services. Conservative women should stand with them when they do - because they should recognize that this isn't worth it, and that there are better and less destructive venues in which to have the abortion fight. People should remember why they supported the Komen Foundation in the first place and leave politics aside for once.
Thursday, February 02, 2012
top 5 regrets of the dying
Interesting article from a palliative care nurse:
http://www.guardian.co.uk/lifeandstyle/2012/feb/01/top-five-regrets-of-the-dying
I anticipate that I will regret not having drank more beer. So I will
pre-emptively fix this problem tonight.
Sunday, January 22, 2012
Why do turtles travel across the ocean? And what of the recurrent laryngeal nerve?
A really magnificant description of an ancient behavior:
"I was told some years ago that the reason why some species of sea turtles migrate all the way across the South Atlantic to lay their eggs on the east coast of South America after mating on the west coast of Africa is that when the behavior started, Gondwanaland was just beginning to break apart (that would be between 130 and 110 million years ago), and these turtles were just swimming across the narrow strait to lay their eggs. Each year the swim was a little longer—maybe an inch or so—but who could notice that? Eventually they were crossing the ocean to lay their eggs, having no idea, of course, why they would do such an extravagant thing.
What is delicious about this example is that it vividly illustrates several important evolutionary themes: the staggering power over millions of years of change so gradual it is essentially unnoticeable, the cluelessness of much animal behavior, even when it is adaptive, and of course the eye-opening perspective that evolution by natural selection can offer to the imagination of the curious naturalist." -Daniel Dennett
In mamillian anatomy there is a similar such detour that seems absurd in the absence of evolution: the recurrent laryngeal nerve. Watch a video about it here:
Sunday, January 08, 2012
The Decline of Islamic Civilization
An exerpt from "Why the Arabic World Turned Away from Science". When reading about anti-rationalism, its impossible for me to not think about contemporary America.
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Just as there is no simple explanation for the success of Arabic science, there is no simple explanation for its gradual — not sudden, as al-Afghani claims — demise. The most significant factor was physical and geopolitical. As early as the tenth or eleventh century, the Abbasid empire began to factionalize and fragment due to increased provincial autonomy and frequent uprisings. By 1258, the little that was left of the Abbasid state was swept away by the Mongol invasion. And in Spain, Christians reconquered Córdoba in 1236 and Seville in 1248. But the Islamic turn away from scholarship actually preceded the civilization's geopolitical decline — it can be traced back to the rise of the anti-philosophical Ash'arism school among Sunni Muslims, who comprise the vast majority of the Muslim world.
To understand this anti-rationalist movement, we once again turn our gaze back to the time of the Abbasid caliph al-Mamun. Al-Mamun picked up the pro-science torch lit by the second caliph, al-Mansur, and ran with it. He responded to a crisis of legitimacy by attempting to undermine traditionalist religious scholars while actively sponsoring a doctrine called Mu'tazilism that was deeply influenced by Greek rationalism, particularly Aristotelianism. To this end, he imposed an inquisition, under which those who refused to profess their allegiance to Mu'tazilism were punished by flogging, imprisonment,or beheading. But the caliphs who followed al-Mamun upheld the doctrine with less fervor, and within a few decades, adherence to it became a punishable offense. The backlash against Mu'tazilism was tremendously successful: by 885, a half century after al-Mamun's death, it even became a crime to copy books of philosophy. The beginning of the de-Hellenization of Arabic high culture was underway. By the twelfth or thirteenth century, the influence of Mu'tazilism was nearly completely marginalized. In its place arose the anti-rationalist Ash'ari school whose increasing dominance is linked to the decline of Arabic science.
With the rise of the Ash'arites, the ethos in the Islamic world was increasingly opposed to
original scholarship and any scientific inquiry that did not directly aid in religious regulation of private and public life. While the Mu'tazilites had contended that the Koran was created and so God's purpose for man must be interpreted through reason, the Ash'arites believed the Koran to be coeval with God — and therefore unchallengeable. At the heart of Ash'ari metaphysics is the idea of occasionalism, a doctrine that denies natural causality. Put simply, it suggests natural necessity cannot exist because God's will is completely free. Ash'arites believed that God is the only cause, so that the world is a series of discrete physical events each willed by God. As Maimonides described it in The Guide for the Perplexed, this view sees natural things that appear to be permanent as merely following habit. Heat follows fire and hunger follows lack of food as a matter of habit, not necessity, "just as the king generally rides on horseback through the streets of the city, and is never found departing from this habit; but reason does not find it impossible that he should walk on foot through the place." According to the occasionalist view, tomorrow coldness might follow fire, and satiety might follow lack of food. God wills every single atomic event and God's will is not bound up with reason. This amounts to a denial of the coherence and comprehensibility of the natural world. In his controversial 2006 University of Regensburg address, Pope Benedict XVI described this idea by quoting the philosopher Ibn Hazm (died 1064) as saying, "Were it God's will, we would even have to practice idolatry." It is not difficult to see how this doctrine could lead to dogma and eventually to the end of free inquiry in science and philosophy. The greatest and most influential voice of the Ash'arites was the medieval theologian Abu Hamid al-Ghazali (also known as Algazel; died 1111). In his book
The Incoherence of the Philosophers, al-Ghazali vigorously attacked philosophy and philosophers — both the Greek philosophers themselves and their followers in the Muslim world (such as al-Farabi and Avicenna). Al-Ghazali was worried that when people become favorably influenced by philosophical arguments, they will also come to trust the philosophers on matters of religion, thus making Muslims less pious. Reason, because it teaches us to discover, question, and innovate, was the enemy; al-Ghazali argued that in assuming necessity in nature, philosophy was incompatible with Islamic teaching, which recognizes that nature is entirely subject to God's will: "Nothing in nature," he wrote, "can act spontaneously and apart from God." While al-Ghazali did defend logic, he did so only to the extent that it could be used to ask theological questions and wielded as a tool to undermine philosophy. Sunnis embraced al-Ghazali as the winner of the debate with the Hellenistic rationalists, and opposition to philosophy gradually ossified, even to the extent that independent inquiry became a tainted enterprise, sometimes to the point of criminality. It is an exaggeration to say, as Steven Weinberg claimed in the Times of London, that after al-Ghazali "there was no more science worth mentioning in Islamic countries"; in some places, especially Central Asia, Arabic work in science continued for some time, and philosophy was still studied somewhat under Shi'ite rule. (In the Sunni world, philosophy turned into mysticism.) But the fact is, Arab contributions to science became increasingly sporadic as the anti-rationalism sank in.The Ash'ari view has endured to this day. Its most extreme form can be seen in some sects of Islamists. For example, Mohammed Yusuf, the late leader of a group called the Nigerian Taliban, explained why "Western education is a sin" by explaining its view on rain: "We believe it is a creation of God rather than an evaporation caused by the sun that condenses and becomes rain." The Ash'ari view is also evident when Islamic leaders attribute natural disasters to God's vengeance, as they did when they said that the 2010 eruption of Iceland's Eyjafjallajökull volcano was the result of God's anger at immodestly dressed women in Europe. Such inferences sound crazy to Western ears, but given their frequency in the Muslim world, they must sound at least a little less crazy to Muslims. As Robert R. Reilly argues in
The Closing of the Muslim Mind (2010), "the fatal disconnect between the creator and the mind of his creature is the source of Sunni Islam's most profound woes."Friday, December 23, 2011
Stopping Keystone XL is the Best Policy for Energy Security.
Like a crazed heroin addict suffering through withdrawal, America is frantically tapping on its antecubital vein in eager anticipation of the next fix. Of course, Keystone XL hasn't been presented in this way. They say it's a bid for energy security, and that it will reduce our dependence on Venezuelan or Iranian oil. Lets just call it what it really is: giving more heroin to the addict. Building Keystone XL will be proof that America isn't ready to find help to get over its oil addiction, and it will be proof that we don't care about energy security, nor do we care about future generations.
Oil is traded on a global market, so any suggestion that Keystone XL is going to stick it to the Saudis by allowing America to import Canadian oil instead is absolutely ridiculous. In fact, the only way that Keystone XL will impact OPEC at all is if it significantly increased the global supply for oil - which it won't. The pipeline will bring in another 900,000 barrels per day. Considering that global production is about 85 MILLION barrels per day, excuse me, but whoop-de-fucking-do.
In fact, if I was OPEC I would WANT the Keystone XL project to come on-line. OPEC produces 30 million barrels per day and they are under intense international pressure to keep up unsustainable levels of production. They are using methods of oil extraction, because they are in such a rush, that will cause their wells to dry up more rapidly than they would if they could take things out a bit slower. Keystone XL will take the pressure off of OPEC. OPEC can just drop its own production by 900,000 barrels per day, global supply remains the same, the price doesn't budge, and OPEC sacrifices a tiny bit of income now for higher-endurance production in the future.
American politicians always harp about two things: energy security, and watching after our children. What could be more secure than leaving a giant untapped oil field in North America? What would be a better gift to leave our children? The truth is, global oil production right now is quite stable, and our economy is starting to turn around. We don't NEED the oil that Keystone XL would deliver right now, but it would allow us to continue our addiction. What if someday there is a world war of a geologic catastrophe? What if oil flies over 300 dollar per barrel, threatening even access to our military and basic civilian functions? Having a giant reserve in Canada waiting for us is the ULTIMATE energy security. It is a giant piggy-bank that our children could break in a dire emergency.
Even if Keystone XL went straight to American oil markets (it won't), and even if it could all be used for any purpose (it can't), it would only satiate 4.5% of American demand for oil. Another way to achieve energy security, which would be exactly equivalent to making Keystone XL, is to DECREASE our oil consumption by 4.5%. We can (actually, will be forced to whether we like it or not) build an economy that is less reliant on oil. Currently our development is a model of inefficiency. Our cities sprawl ever outward, fueled by cheap gasoline. Government continues to subsidize roads and highways, to connect every random distant suburb to its nearby strip-mall. Why not encourage more dense urban development? Why not push our cities to rely more on the foot, the bike, light rail, or trains - and away from the car? Why not encourage Americans to carpool more?
Well the real answer is this: we don't need to encourage any of these things because the market will do it for us. As long as oil prices remain high, we will begin to shift to a post-petroleum economy. Again, this is an inevitable transition. It makes no sense to me to delay that shift when world oil production is so stable right now. It makes no sense to raid a secure deposit of resources that our children may have a vital need for in the future because we want low-hanging fruit now.
Oil is traded on a global market, so any suggestion that Keystone XL is going to stick it to the Saudis by allowing America to import Canadian oil instead is absolutely ridiculous. In fact, the only way that Keystone XL will impact OPEC at all is if it significantly increased the global supply for oil - which it won't. The pipeline will bring in another 900,000 barrels per day. Considering that global production is about 85 MILLION barrels per day, excuse me, but whoop-de-fucking-do.
In fact, if I was OPEC I would WANT the Keystone XL project to come on-line. OPEC produces 30 million barrels per day and they are under intense international pressure to keep up unsustainable levels of production. They are using methods of oil extraction, because they are in such a rush, that will cause their wells to dry up more rapidly than they would if they could take things out a bit slower. Keystone XL will take the pressure off of OPEC. OPEC can just drop its own production by 900,000 barrels per day, global supply remains the same, the price doesn't budge, and OPEC sacrifices a tiny bit of income now for higher-endurance production in the future.
American politicians always harp about two things: energy security, and watching after our children. What could be more secure than leaving a giant untapped oil field in North America? What would be a better gift to leave our children? The truth is, global oil production right now is quite stable, and our economy is starting to turn around. We don't NEED the oil that Keystone XL would deliver right now, but it would allow us to continue our addiction. What if someday there is a world war of a geologic catastrophe? What if oil flies over 300 dollar per barrel, threatening even access to our military and basic civilian functions? Having a giant reserve in Canada waiting for us is the ULTIMATE energy security. It is a giant piggy-bank that our children could break in a dire emergency.
Even if Keystone XL went straight to American oil markets (it won't), and even if it could all be used for any purpose (it can't), it would only satiate 4.5% of American demand for oil. Another way to achieve energy security, which would be exactly equivalent to making Keystone XL, is to DECREASE our oil consumption by 4.5%. We can (actually, will be forced to whether we like it or not) build an economy that is less reliant on oil. Currently our development is a model of inefficiency. Our cities sprawl ever outward, fueled by cheap gasoline. Government continues to subsidize roads and highways, to connect every random distant suburb to its nearby strip-mall. Why not encourage more dense urban development? Why not push our cities to rely more on the foot, the bike, light rail, or trains - and away from the car? Why not encourage Americans to carpool more?
Well the real answer is this: we don't need to encourage any of these things because the market will do it for us. As long as oil prices remain high, we will begin to shift to a post-petroleum economy. Again, this is an inevitable transition. It makes no sense to me to delay that shift when world oil production is so stable right now. It makes no sense to raid a secure deposit of resources that our children may have a vital need for in the future because we want low-hanging fruit now.
On Traveling, Surgery Residency, and the Intensity of Experience
In his recent book "Thinking, Fast and Slow", Daniel Kahneman expands upon an interesting concept. He describes two ways that human beings perceive reality: the experience of the present and the remembrance of the past. He calls them our "experiencing selves" and "remembering selves" and shows that they often fail to come to a consensus, as illustrated by a beautiful experiment with absurd results:
Participants are subjected to two forms of torture. In one form, the participant's hand is immersed in painfully cold water for 60 seconds. In the other, the hand is immersed in the same painfully cold water also for 60 seconds, at which point the water is warmed 1 degree Celsius and the participant must now endure 30 more seconds of slightly less painfully cold water, for a total of 90 seconds.
If I was going through this torture, at the end of 60 seconds I would obviously prefer to just take my hand out of the water instead of endure another 30 seconds of still very cold water! And most people, if given that option at the time, would do the same. Remarkably, if the participants are later asked which form of torture they prefer, they actually choose the 60 + 30 instead of just the 60. They are voluntarily willing to subject themselves needlessly to an additional 30 seconds of pain!
Why does this happen? Kahneman explains that while the duration and aggregate of an experience might matter to our experiencing selves, those details are easily glossed over by our remembering selves. In fact, our remembering selves focus disproportionately on the beginning, end, lows, and highs of an experience. Another question is posed by Kahneman: would you bother to go somewhere on a vacation if you would have complete amnesia of the entire trip? I'm not sure I would. At that point, relaxation is the only thing that matters (and maybe sun exposure). I might opt for Florida instead of the Bahamas or somewhere more exotic, if I was going to go anywhere at all.
The conflict between our experiencing and remembering selves was an interesting subject for me to read, because it neatly explains a paradoxical trend I had noticed: I remember some situations as being better than I know they actually were at the time (if I am thinking of the sum of the entire experience in aggregate). For example, one of my favorite semesters as an undergraduate was the spring of my junior year, but I also know with certainty that I was insanely busy, studied harder than I ever had, and went out very infrequently. I remember my social life being significantly better than average that semester, which I know empirically is not actually true (I even went to bed early on my 21st birthday because I had a physics test the next week, to the chagrin of my roommates at the time).
In light of Kahneman's book, it makes perfect sense. I didn't go out as frequently, but when I did, it was a much more intense experience. Going out after two weeks studying is just a different feeling than going out for the fourth night in a row. In fact, I remember having significantly MORE fun in medical school than I did in undergrad. Frequency matters less than intensity of experience.
I've noticed this paradox about traveling as well. Traveling is by definition not a relaxing experience (that would be vacationing). Right before medical school I went on a 6 week trip through Europe with some friends. It was a mad rush, to fit in as much as possible, stopping at places sometimes for only 1-2 days before moving on. The trip was exhausting, I remember thinking on more than one occasion. Yet, my remembering self recalls more easily the positive experiences - which were many, and noteworthy, and easily forgets the baseline exhaustion of the grind of intense traveling. This phenomenon can be explained graphically, with the spikes representing the intensity of experiences while the baseline is the quality of life day-to-day. When traveling, there is an obvious sacrifice of short term conveniences, habits, and luxuries for the opportunity to have heightened experiences:
I chose to go into surgery, which as a career has a reputation of being brutal. The long hours and the daily grind mean that I know my experiencing (present) self is, while maybe not completely miserable, certainly wishing I had chosen a more relaxing life. There is a conflict, because when my remembering self recalls the last six months, it think it has been one of the best times of my life. My experiencing self thinks surgery residency is tough and often painful, but my remembering self thinks its great and not so bad. I remember the interesting surgical cases, complex patients, and funny stories - not the long hours.
Like is the case when traveling, I've sacrificed my experiencing self for the sake of the remembering self, in this instance the sacrifice being ample sleep, free time, etc. I am compensated by doing really neat things on occasion. Finally, recall the anecdote from my junior year in undergrad: in residency, when I do get time off, its much more high impact. The fact that I only get every other weekend off on average is more than compensated by the fact that each weekend has 2-3 times the impact that they used to.
I suppose this is something to think about, whether traveling or choosing a career path. Perhaps the difference maker for me is that I am too willing to make decisions based on the preferences of my remembering self. Still, for a person choosing whether or not go to into medical school, or whether or not to go into surgery, "long hours" is something I am glad I never put too much weight on (because hours are essentially forgotten by the remembering self). Like a person who subject themselves to 30 seconds of needless pain in Kahneman's torture experiment, I would choose surgery residency all over again, even if my experiencing self would prefer a more laid back profession. Absurd results, indeed.
Participants are subjected to two forms of torture. In one form, the participant's hand is immersed in painfully cold water for 60 seconds. In the other, the hand is immersed in the same painfully cold water also for 60 seconds, at which point the water is warmed 1 degree Celsius and the participant must now endure 30 more seconds of slightly less painfully cold water, for a total of 90 seconds.
If I was going through this torture, at the end of 60 seconds I would obviously prefer to just take my hand out of the water instead of endure another 30 seconds of still very cold water! And most people, if given that option at the time, would do the same. Remarkably, if the participants are later asked which form of torture they prefer, they actually choose the 60 + 30 instead of just the 60. They are voluntarily willing to subject themselves needlessly to an additional 30 seconds of pain!
Why does this happen? Kahneman explains that while the duration and aggregate of an experience might matter to our experiencing selves, those details are easily glossed over by our remembering selves. In fact, our remembering selves focus disproportionately on the beginning, end, lows, and highs of an experience. Another question is posed by Kahneman: would you bother to go somewhere on a vacation if you would have complete amnesia of the entire trip? I'm not sure I would. At that point, relaxation is the only thing that matters (and maybe sun exposure). I might opt for Florida instead of the Bahamas or somewhere more exotic, if I was going to go anywhere at all.
The conflict between our experiencing and remembering selves was an interesting subject for me to read, because it neatly explains a paradoxical trend I had noticed: I remember some situations as being better than I know they actually were at the time (if I am thinking of the sum of the entire experience in aggregate). For example, one of my favorite semesters as an undergraduate was the spring of my junior year, but I also know with certainty that I was insanely busy, studied harder than I ever had, and went out very infrequently. I remember my social life being significantly better than average that semester, which I know empirically is not actually true (I even went to bed early on my 21st birthday because I had a physics test the next week, to the chagrin of my roommates at the time).
In light of Kahneman's book, it makes perfect sense. I didn't go out as frequently, but when I did, it was a much more intense experience. Going out after two weeks studying is just a different feeling than going out for the fourth night in a row. In fact, I remember having significantly MORE fun in medical school than I did in undergrad. Frequency matters less than intensity of experience.
I've noticed this paradox about traveling as well. Traveling is by definition not a relaxing experience (that would be vacationing). Right before medical school I went on a 6 week trip through Europe with some friends. It was a mad rush, to fit in as much as possible, stopping at places sometimes for only 1-2 days before moving on. The trip was exhausting, I remember thinking on more than one occasion. Yet, my remembering self recalls more easily the positive experiences - which were many, and noteworthy, and easily forgets the baseline exhaustion of the grind of intense traveling. This phenomenon can be explained graphically, with the spikes representing the intensity of experiences while the baseline is the quality of life day-to-day. When traveling, there is an obvious sacrifice of short term conveniences, habits, and luxuries for the opportunity to have heightened experiences:
I chose to go into surgery, which as a career has a reputation of being brutal. The long hours and the daily grind mean that I know my experiencing (present) self is, while maybe not completely miserable, certainly wishing I had chosen a more relaxing life. There is a conflict, because when my remembering self recalls the last six months, it think it has been one of the best times of my life. My experiencing self thinks surgery residency is tough and often painful, but my remembering self thinks its great and not so bad. I remember the interesting surgical cases, complex patients, and funny stories - not the long hours.
Like is the case when traveling, I've sacrificed my experiencing self for the sake of the remembering self, in this instance the sacrifice being ample sleep, free time, etc. I am compensated by doing really neat things on occasion. Finally, recall the anecdote from my junior year in undergrad: in residency, when I do get time off, its much more high impact. The fact that I only get every other weekend off on average is more than compensated by the fact that each weekend has 2-3 times the impact that they used to.
I suppose this is something to think about, whether traveling or choosing a career path. Perhaps the difference maker for me is that I am too willing to make decisions based on the preferences of my remembering self. Still, for a person choosing whether or not go to into medical school, or whether or not to go into surgery, "long hours" is something I am glad I never put too much weight on (because hours are essentially forgotten by the remembering self). Like a person who subject themselves to 30 seconds of needless pain in Kahneman's torture experiment, I would choose surgery residency all over again, even if my experiencing self would prefer a more laid back profession. Absurd results, indeed.
Tuesday, December 06, 2011
How Doctors Die
Loved this.
Its a shame that Sarah Palin so completely poisoned the well with her "death panel" comments. A conversation about how we should approach patients at the end of life is something that this nation badly needs.
Its a shame that Sarah Palin so completely poisoned the well with her "death panel" comments. A conversation about how we should approach patients at the end of life is something that this nation badly needs.
Saturday, November 26, 2011
Sunday, November 06, 2011
The rebirth of my contempt for the left
The Nation writes a sob-story about some idiot who went $ 35,000 in debt in order to secure a degree in puppetry. This apparently is to highlight the injustice that Occupy Wall Street is fighting again, and no, they aren't joking.
One of the consequences of electing a somewhat moderate, consensus-building Democrat like Obama is that the fringe elements on the left have taken a backseat in the last several years. The only visible extremists in the national discourse have been on the right, but I think this will change a lot in the coming months with OWS.
Hat-tip to Tyler Cowen. He has another great post on the problem with American graduates. Yes, more people are attending college. The numbers of students graduating w/ degrees in math, science, computing, and engineering has not budged one iota since 1985.
One of the consequences of electing a somewhat moderate, consensus-building Democrat like Obama is that the fringe elements on the left have taken a backseat in the last several years. The only visible extremists in the national discourse have been on the right, but I think this will change a lot in the coming months with OWS.
Hat-tip to Tyler Cowen. He has another great post on the problem with American graduates. Yes, more people are attending college. The numbers of students graduating w/ degrees in math, science, computing, and engineering has not budged one iota since 1985.
Tuesday, October 25, 2011
Why I am bullish on America in one simple picture
Its demography, the X-factor that everyone always seems to forget when looking at the past and the future:
France was a dominant world power in part because it used to be the third most populous nation on earth (after China and India). Its population growth stagnated in the 19th and 20th centuries and it was overtaken by Germany, among others. Europe as a whole used to count for 20%+ of the world population, now they are barely 5%. Fears in 1989 were that Japan would overtake America economically. But the Japanese population growth stopped, and reversed, while Americas steamed ahead (we've added another 50 million people, IE, the entirety of England, while Japan has added essentially none). Or think of historical antagonists. In 1900 Britain had 40 million people to Iran's 7 million. Today, Britain has 60 million to Iran's 70.
Anyone who thinks China is destined to overtake America has not learned the lessons of demography. We Americans right now are haggling over debts and austerity, but at the end of the day, we're going to add another 150 million people by the year 2050, which is almost a 50% increase. China is going to start shrinking in population. Their ratio of workers to retirees will dramatically worsen, while ours will stay about the same (hence the oft repeated phrase that "China will get old before it gets rich").
If it was up to me we would encourage this even more, instead of turning into a xenophobic cocoon. A huge advantage that we still have is that most people would rather immigrate to the United States instead of China. Why not open our doors to skilled or driven foreigners from around the world? Every immigrant is a taxpayer. Immigrants are hard workers. They start business, and since they often have big families, they buy houses. Every immigrant is another ambassador to their home country, increasing the soft power of America around the world.
To an America with 500 million people, the debts of today are entirely manageable (assuming we can slow the growth of the debt to some extent). In contrast, the crushing burden of supporting retirees with the waning of the demographic dividend that China is now experiencing is a recipe for stagnation or worse.
America will probably be the second largest economy in the world by mid century. Rather than China that overtakes us, my bet is that it will be India. By 2050 demographers are projecting population growth of another 400 million people on the subcontinent.
France was a dominant world power in part because it used to be the third most populous nation on earth (after China and India). Its population growth stagnated in the 19th and 20th centuries and it was overtaken by Germany, among others. Europe as a whole used to count for 20%+ of the world population, now they are barely 5%. Fears in 1989 were that Japan would overtake America economically. But the Japanese population growth stopped, and reversed, while Americas steamed ahead (we've added another 50 million people, IE, the entirety of England, while Japan has added essentially none). Or think of historical antagonists. In 1900 Britain had 40 million people to Iran's 7 million. Today, Britain has 60 million to Iran's 70.
Anyone who thinks China is destined to overtake America has not learned the lessons of demography. We Americans right now are haggling over debts and austerity, but at the end of the day, we're going to add another 150 million people by the year 2050, which is almost a 50% increase. China is going to start shrinking in population. Their ratio of workers to retirees will dramatically worsen, while ours will stay about the same (hence the oft repeated phrase that "China will get old before it gets rich").
If it was up to me we would encourage this even more, instead of turning into a xenophobic cocoon. A huge advantage that we still have is that most people would rather immigrate to the United States instead of China. Why not open our doors to skilled or driven foreigners from around the world? Every immigrant is a taxpayer. Immigrants are hard workers. They start business, and since they often have big families, they buy houses. Every immigrant is another ambassador to their home country, increasing the soft power of America around the world.
To an America with 500 million people, the debts of today are entirely manageable (assuming we can slow the growth of the debt to some extent). In contrast, the crushing burden of supporting retirees with the waning of the demographic dividend that China is now experiencing is a recipe for stagnation or worse.
America will probably be the second largest economy in the world by mid century. Rather than China that overtakes us, my bet is that it will be India. By 2050 demographers are projecting population growth of another 400 million people on the subcontinent.
Tuesday, October 11, 2011
on PSA screening
The US Preventive Service Task Force (USPSTF) recently recommended that primary care physicians not screen men for prostate cancer. The question I have is, why were primary care physicians ever screening for prostate cancer with PSA levels in the first place if it hasn't been proven to be effective at reducing mortality?
And what of the contentious debate? I don't think anybody is saying don't screen for prostate cancer. There is an appropriate context in which to do it: a randomized, controlled clinical trial. Outside of research, it is ethically and economically* inappropriate to advocate for treatments that have no proven benefit. Am I missing something?
*I suspect that economics will increasingly play a major role in our clinical decision making. We might as well embrace it now and do the leg work early. We need to stop doing things that don't help so there is money to keep doing the things that do help. Physicians have the ability to trim the excess fat from our health care system with a scalpel. If we wait for the government to do it for us, its going to be with a guillotine.
And what of the contentious debate? I don't think anybody is saying don't screen for prostate cancer. There is an appropriate context in which to do it: a randomized, controlled clinical trial. Outside of research, it is ethically and economically* inappropriate to advocate for treatments that have no proven benefit. Am I missing something?
*I suspect that economics will increasingly play a major role in our clinical decision making. We might as well embrace it now and do the leg work early. We need to stop doing things that don't help so there is money to keep doing the things that do help. Physicians have the ability to trim the excess fat from our health care system with a scalpel. If we wait for the government to do it for us, its going to be with a guillotine.
Monday, October 10, 2011
Djerejian on Occupy Wall Street
Christmas for me only comes a few times per year. I found the insights into the behind-the-scenes strategy and tactics of the parties in play to be particularly interesting.
Friday, October 07, 2011
What's wrong with this picture?
This patient has situs inversus. It is a mistake in embryogenesis where the major organs in the body end up in a mirror-image position from where they should be.
On medical images, the right is on the left and the left is on the right. So what you see in this chest x-ray is a heart that extends to the patient's right side. It is normally the opposite, of course.
Tuesday, October 04, 2011
Little America.
Just when I started to think we bottomed out in the "reprehensible reactionary regressive politiking" department: a new immigration law in Alabama:
"School superintendents and principals across the state confirm that attendance of Hispanic children has dropped noticeably since the word went out that school officials are now required to check the immigration status of newly enrolled students and their parents."
So small.
Monday, October 03, 2011
Republicans and taxes: winning the battle, losing the war.
From one of my favorite economists:
http://www.nytimes.com/2011/10/02/business/economy/antitax-ideas-could-have-unintended-results.html?_r=1
I've said this before: the problem with the sort of scorched-earth policy that the GOP has been operating with is that in absence of reform, big government wins by default. The current crop of GOP leaders took power and could have cut all sorts of deals to drastically reduce the size of the government. They've taken advantage of precisely zero of those opportunities (its already obvious that the debt ceiling deal won't result in any actual spending cuts).
http://www.nytimes.com/2011/10/02/business/economy/antitax-ideas-could-have-unintended-results.html?_r=1
I've said this before: the problem with the sort of scorched-earth policy that the GOP has been operating with is that in absence of reform, big government wins by default. The current crop of GOP leaders took power and could have cut all sorts of deals to drastically reduce the size of the government. They've taken advantage of precisely zero of those opportunities (its already obvious that the debt ceiling deal won't result in any actual spending cuts).
Sunday, October 02, 2011
The Economist on Palestinian Statehood
"In truth, Israel will be safer when a proper Palestinian state has been consolidated. That is a point that too few Israelis and their American supporters appreciate. This newspaper has argued steadfastly for the right of Israel to exist. We abhor the creeping delegitimisation and demonisation of Israel. But we also believe that the Palestinians deserve a state of their own. These two beliefs are entirely compatible. By his intransigence, Mr Netanyahu has played into the hands of those who would destroy Israel. In blocking any Palestinian aspirations at the UN, America is helping extremists on both sides."
Apparently all it takes to be a NYT Columnist is a poorly considered opinion
This was such a weak article:
NYT: Is junk food really cheaper?
The column starts off with an argument that fast food is actually more expensive than natural food. As proof, the author picks an anecdote completely out of thin air. In his hypothetical case, for a family of four, fast food is more expensive than healthy food. Take that, statisticians! He goes on to make the really insightful point that there are lots of things people could do to live cheaper - like drink water instead of soft drinks. He then goes on to talk a lot about how the problem here is really cultural: people are lazy, and don't like to cook. His solutions include changing said culture. The column ends with a complete 180, culminating in vague references to statist political solutions to curb consumption of processed food.
The only useful thing he does is bring up the analogy with the anti-smoking campaign. Consider for a second: what would you say if, instead of taxing cigarettes to $ 8.00 per pack where they are now, the government was subsidizing them to $ 1.50 per pack? And then imagine some jackass wrote a NYT column about how we just have a crisis of culture and that the OBVIOUS solution was for people to just get some willpower and quit smoking. Never mind stopping government hand-outs to tobacco companies (in this hypothetical case).
This is the reality of the nation that we live in: the government essentially pays people to eat fast food and drink soda. That is the 100% truth. We can talk about culture, paternalism, and lots of other things but it really comes down to incentives. Whether or not fast food is cheaper than natural food is really irrelevant - thanks to subsidies, fast food is cheaper than it would otherwise be. Period. People would consume less processed food it it was appropriately priced. Food industry subsidies are an example of big-government corporate socialism at its worst.
Once we all agree that we shouldn't be paying people to eat unhealthy food, we can wade into the area of whether or not we should tax unhealthy food. I think reasonable people can BEGIN to disagree on that point. That being said, taxes have to come from somewhere. Why not tax things that we shouldn't be doing (smoking, eating unhealthy food) instead of taxing things that we should be doing (working hard / income taxation)? Especially when people expect the government to pay for their health care at the end of life, its not unreasonable for that government to try to discourage the most unhealthy behaviors. Whatever; like I said, taxing fast food is an issue we can debate; that we subsidize fast food is not a point for debate - its a travesty.
NYT: Is junk food really cheaper?
The column starts off with an argument that fast food is actually more expensive than natural food. As proof, the author picks an anecdote completely out of thin air. In his hypothetical case, for a family of four, fast food is more expensive than healthy food. Take that, statisticians! He goes on to make the really insightful point that there are lots of things people could do to live cheaper - like drink water instead of soft drinks. He then goes on to talk a lot about how the problem here is really cultural: people are lazy, and don't like to cook. His solutions include changing said culture. The column ends with a complete 180, culminating in vague references to statist political solutions to curb consumption of processed food.
The only useful thing he does is bring up the analogy with the anti-smoking campaign. Consider for a second: what would you say if, instead of taxing cigarettes to $ 8.00 per pack where they are now, the government was subsidizing them to $ 1.50 per pack? And then imagine some jackass wrote a NYT column about how we just have a crisis of culture and that the OBVIOUS solution was for people to just get some willpower and quit smoking. Never mind stopping government hand-outs to tobacco companies (in this hypothetical case).
This is the reality of the nation that we live in: the government essentially pays people to eat fast food and drink soda. That is the 100% truth. We can talk about culture, paternalism, and lots of other things but it really comes down to incentives. Whether or not fast food is cheaper than natural food is really irrelevant - thanks to subsidies, fast food is cheaper than it would otherwise be. Period. People would consume less processed food it it was appropriately priced. Food industry subsidies are an example of big-government corporate socialism at its worst.
Once we all agree that we shouldn't be paying people to eat unhealthy food, we can wade into the area of whether or not we should tax unhealthy food. I think reasonable people can BEGIN to disagree on that point. That being said, taxes have to come from somewhere. Why not tax things that we shouldn't be doing (smoking, eating unhealthy food) instead of taxing things that we should be doing (working hard / income taxation)? Especially when people expect the government to pay for their health care at the end of life, its not unreasonable for that government to try to discourage the most unhealthy behaviors. Whatever; like I said, taxing fast food is an issue we can debate; that we subsidize fast food is not a point for debate - its a travesty.
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