How to Get Into Medical School

Once in a while, I interview pre-med applicants to my school. While the medical students' evaluations are probably influential as only a low-NPV serial-killer screening test, I still very much enjoy doing them. This is because, if the applicants are eventually admitted, I get profuse thank-yous and friendly hellos for the entire subsequent year. Other than this experience, I have no knowledge whatever on the inner workings of the admissions chambers, so my insights are based on some post-call Gladwellian blinks.

Please note that Numbers 1 and 4 should not actually be followed by anyone, and are akin to obtaining a Golden Ticket by serially eating thousands of candy bars, or harassing hundreds of factory employees to unwrap them. It's just not worth it.

1) Take Physics for Poets.
And Literature for Actuaries. PE for Hobbits. Enroll in the easiest courses that fulfill pre-med requirements, and for which you almost certainly can earn an A- or above. The caveat here would be that you'd have to choose a somewhat traditional-sounding major, so it cannot be Fashion Merchandising, Liberal Studies, or Communications. Slightly newer, but still well-respected (and sometimes difficult, depending on your school- be careful!) majors, such as Women's Studies, as well as many interdisciplinary majors (i.e. Latin-American Studies) are considered fine.

My reasoning here is that, when it comes to course-work, admissions committees care mostly (though not exclusively) about Overall and Science GPAs, as well as a notable absence of Cs. A B- in "Physics for Future Nobel Laureates" is worth less than an A- in your standard Calc-based Mechanics course. Don't take any high-stakes gambles.

(For those now tuning in: Do NOT actually follow this advice. Take 4 years of Russian, a Combinatorics class, and a seminar on James Joyce. Keep your life joyous and a bit irrationally exuberant.)

2) Do your Undergrad at State School.
State school makes sense in general, and especially so if you are pre-med. It's generally easier to get an A in the science classes there. I know this statement may draw some contrarian personal testimonies from people who attended The University of Somewhere. The thing is, I know that many of the kids there are just as smart as the ones in Someone University, and that the teacher quality is likely the exact same. But the same student can often be in the top 10% of his Orgo class in a public school (also improving his chances for getting an excellent recommendation), rather than in the middling middle of an equivalent Ivy course.

3)Sign up for at least one test prep program, but not for any live classes.
Study by simply doing as many sample test questions as possible, starting on day one. Then go over the explanations and the reading material for anything you get wrong. You may get many or most questions wrong in the beginning. Still, do not waste time reading through the review books before you start taking practice tests. Take your MCATs in April, not August. Try to get at least a 30, unless you funded your school's infectious diseases institute (Treating Burmese children suffering from infectious diseases is not an acceptable substitute).

4) If Short on Time, Don't Dedicate a Huge Amount of Time to Clinical Experiences
While you should have some shadowing or hospital volunteering experiences, you do not actually need much of it. An EMT who has transported five patients looks roughly the same on an application as an EMT who has worked since age 16, has delivered a hundred babies, and can already interpret EKGs. The AMCAS does ask you how many hours per week you spend on each activity, but 5 hours vs. 10 hours per week probably doesn't get noticed. If stressed and cynical, think of marginal benefits.

(Repeated disclaimer: This advice is about what gets you into medical school, not about what you should do. To become a good doctor, take advantage of every opportunity you can to gain clinical experience. Some people cut corners without any one else ever noticing, but don't allow your values and ambitions to conform to this strategy).

5)Be Specific in your Essays.
When answering questions for your secondary applications, do not write "I am passionate about..." Have a strong, unique opening, even for those one paragraph answers. When addressing why you want to attend a particular school, refer to specific professors or programs. Don't use generic phrases like "Exceptional academics," "Excellent location," or "Outstanding research." Instead, say that you've always admired the [Insert Name] Free Clinic that Dr. [Insert Name] started, and you would like to volunteer there because he sees a lot of patients with [Insert medical condition], which is a disease you may want to specialize in.

(Don't lie. No one will ever know whether or not you are truly interested in that clinic, but to maintain your dignity, try to identify specific features of a school that you do actually care about.)

I know my take on medical school admissions is a bit cynical. However, even the most caring and mission-minded committee members must focus one eye on the US News rankings. The subsequent diplopia means that the theoretically best choices for pre-meds are not necessarily those that insure a successful application. If you find yourself sacrificing too many opportunities, I'd recommend dropping pre-med, enrolling in PA school, keeping your specialty of choice, and becoming a happy, dedicated, and productive clinician.

Psych Consult

Mr. A is a 40-year old male. After checking in his items with the clerk, and obtaining a full evaluation from the ER doc, the psychiatrist and students begin the interview.

Mr. A: You have to check me into the psychiatric unit. Otherwise, I'm going to hurt somebody! And I'm going to kill myself!

Student: Mr. A., Which do you plan to do first, hurt someone else or kill yourself? [Yes, I know it's a weird question, but we use it to assess the viability of the plan. Some patients take the bait].

Mr. A: Hurt someone else first!

Student: Who do want to hurt?

Mr. A: Anyone who pisses me off! I was already going to hurt at least 5 people today, before I checked in.

Student: How do you plan to harm someone else?

Mr. A.: I'm gonna stab them with a fork!

[After full assessment]

Physician: Mr. A, we're going to admit you into the psychiatric unit of the hospital... students can you please bring over Mr. A's belongings?

Student: Clerk, can you tell us which one's Mr. A's locker?

Clerk: Yeah, it's over here. But he only brought one item with him. I think it was a fork.

The Epistemology of Paranoid Schizophrenia

Note: All details, including names, ages, and specific descriptions of conversations with staff or patients have been considerably changed. Sorry, I know that reality blogging is more fun than fake medical encounters. Additionally, the discussion exclusively concerns people with relatively mild or well-controlled schizophrenic symptoms, with whom I can easily engage in conversation.

When the psychiatry resident asked for an update on Tracy, I glibly responded, "Still very delusional. Thinks the CIA is after her."

"She's not delusional!" the doctor corrected. "The CIA or the FBI or whatever agency really is after her. Tracy used to threaten killing former President Bush numerous times. During her last hospitalization, I had to argue with the authorities for hours, to convince them that she's safe for discharge." Thus, my near-designation on my patient's record as possessing this delusion, or a "fixed, false belief," that is not "widely held within the context of the individual's cultural or religious group" was in error. Tracy's paranoia was based on truth.

The interesting part, however, of working with schizophrenic patients is generally not figuring out what is false; Patients have spoken of receiving commands from their televisions to overthrow the "vitamin pill industry," and of obtaining classified information that their true parents are Liza Minnelli and Bobby Fisher. Many patients insist that a doctor or nurse can gain remote access to the contents of their brains, via some transhumanistic, genetic link-protocol of sorts. False belief, check.

Determining what falls under cultural norms can be a bit trickier. One patient, David, believes that he and fellow schizophrenics have powers in the "sixth dimension," on an "etherical, astral, plane," a belief that I'd brand as delusional, if I 1) Knew what it meant, curvilinear coordinates not being my forte and 2) The International Headquarters of the Theosophy Society weren't right in my hometown, flagging this as a possible local cultural or religious belief.

The main challenge in assessing delusions, however, lies mainly in determining which are considered "fixed," or intransigent to reason and the passage of time. A binary "yes" or "no" to describe the "fixedness" of a belief is inadequate. Many patients come to the hospital voluntarily, desperate to rid themselves of fearsome beliefs or voices that they know, at least in part, aren't true. Thus, they demand anti-psychotics that deny the pleasure of dopamine, and beg for mood-stabilizing drugs that inhibit norepinephrine-fueled arousal. And those are just some of the intended effects. Side effects include dystonia, neuroepileptic malignant syndrome, the frog-tongued gestures of tardive dyskinesia, and the rabbit-mouthed oscillations of EPS. Patients are often desperate to "unlearn" their beliefs, and hope to foster distrust of the voices in their head, which so distrust everyone around them.

Tom, one of my fellow medical students, asks patients an interesting question: "What do you think is the percent probability that your belief is true, and what is the percent probability that it isn't true?" Lillian, who's convinced that President Obama promised her $1 million, so long as she refrains from eating, (the Cult of the Presidency is the only thing both alive and well in the psych ward) said "About 5% of me thinks it's true, and 95% of me thinks it's not true." Five percent is not terribly much. I'm sure there are plenty of beliefs I maintain with a similar level of certainty that would confer me with at least an Axis II diagnosis, if someone could scan my brain for the latest Bayesian updates. Which leads me to wonder if percentages and predictions can adequately capture the credos that serve as the foundation for diagnosing paranoid schizophrenia.

For those of us with homo economicus pretensions, such stated probabilities may even persuade us that schizophrenic biases are simply standard deviants from very irrational mean population thought content. Indeed, critics of psychiatry often insist that people are deemed psychotic, simply because their delusions don't conform to what all the cool kids are fabricating this season. In this view, once norms change (like they did when the medical professions stopped labeling homosexuality as a disease), many schizophrenics will be considered as peers among the unhinged masses, with all our opioidic (agonistic and antagonistic both), nonsensical beliefs unleashed.

Perhaps we can focus on a more qualitative approach to evaluating "fixedness." After all, numbers don't seem to work with a patient named Mark, who contemplates (at least after he's taken his meds) of the instructions he "receives" from the devil via rap songs on the radio, "they're sometimes real...I don't know... it's so hard to separate in my head." Perhaps, we can ask an Isaac Levi-inspired series of questions, checking off what David considers "serious possibilities," out of a "potential corpora of knowledge and evidence." I can ask David, "Do you think that it's physically possible for you to hear the devil speaking to you, and only you, from the radio? Logically possible? Technologically possible? Psychologically possible?

Defenders of psychiatric designations counter their critics by noting that virtually every DSM-IV diagnosis, including schizophrenia, must involve significant impairment in occupational or social functioning. Apparently, in 2003, 20% of Americans affirmed to pollsters that an HIV vaccine already exists, but is being kept a secret. And yet, I don't see many people staging the proper revolt that such a conspiracy, if actually true, would merit. Aberrant thought content alone is not the rate-limiting-step to being diagnosed as schizophrenic. Many people have negative thoughts about the vitamin pill industry, but only Sally (who has Schizoaffective Disorder, Bipolar Type) embraced her mission by roaming in the streets, "recruiting" fellow revolutionaries (i.e. passing cars), and propelling Los Angelenos into traffic-induced hysterics.

So for paranoid schizophrenics who maintain only 5% certainty about their delusions, perhaps they simply act upon this glimmer of confidence more often than others, like the "Deal or No Deal" folks who, knowing basic math, still reject the banker's actuarially outlandish offer, because, what if the million is in my box? According to polls, many Americans claim that our current president is a foreigner, and is thus ineligible for his elected position, according to our country's most sacred national document. Then we go off to do our laundry and water our lawns. However, there are always those few that can't eat, sleep, or tweet, while harboring such persistent ideations of conspiracy.

A behaviorist might say that, Bayesian self-reports not-withstanding, patients' actions exclusively measure their convictions. Skinnerians will believe our stated fidelity to untruth when they see it! All the rest perhaps just falls under the purview of "symbolic belief." In other words, you may take pride in widely professing that Obama is an alien, but watch your shame when a behaviorist calls you out on your pretense! My humble suggestion: To stay out of the psych ward, you're better off holding certain beliefs as insincerely as possible.

Palliative Care Grand Rounds is Up!

Thaddeus Pope at the Medical Futility blog does a beautiful job hosting the latest Palliative Care Grand Rounds. For my contribution, I describe an experience working with the family of a 28-year-old patient who died of breast cancer.

Med-staffing Coachella

Coachella is like a giant exhibition of Roomba vacuum cleaners, where restless young beings motor along toward one end of the giant field, bump into someone or something at the other end, and then head in a different direction, continuously for three days straight. Occasionally, one might stop to check out a band, buy a tofu naan sandwich, or take a puff of something. But mostly you just kind of amble around, smiling with kinship at each person whom you passed by a couple of hours earlier.

This seemingly underwhelming activity is actually quite joyful, and I do plan to one day attend as an actual ticket-holder. This year, I served as a med-student-helper-outer-to-the-EMTs, (but not officially as an EMT, as my license expired a few years back). The Company (not HIPAA) forbids us from speaking even generally about the cases we saw, but I'd say that the biggest progress made involved my riding of an awesome John Deere Gator everywhere. Thus, the lingering childhood resentment over my lack of Power Wheels (Miskeena!) is now officially resolved, sans therapy.

Grand Rounds is Up Again!

Brought to you by Dr. Guzmán at Pharmamotion. My submission addresses the pressing issue of med student apparel.
Guzmán has a very Canadian post about Gp IIa/IIIb inhibitors (a class of anti-platelet function drugs) over here. I mention this because tonight is the magical night where the fairy godmother comes and I transform into a Canadian at the stroke of midnight. So I'm channeling all my Kafkaesque energies into becoming the pharm video narrator with the pleasant voice, rather than this guy.

Weird Medical Etymology of the Day

Fornication comes from the word fornix, which means "arch." In Roman times, customers used to identify the brothels by a prominent archway at the entrance. (Coincidentally, we refer to the anterior, posterior, and lateral fornices as components of the uterus, but we also have a fornix in the brain, so interpret that as you will).

HT: My Gross Anatomy Prof

Disclaimer: I take no responsibility for the possibility that this is all urban legend.

Doctors and Speeding

“The officer proceeded to pull out his gun, point it at my face, and told me to lay face down on the ground, which I did. At this point, my ID card dropped on the floor and I remember him stepping on me, probably putting his knee on my back, and then cuffed me.”

This is how a Dr. Ziworitin of UMC describes his encounter with a cop, after the physician was stopped for speeding, while rushing to hospital for an emergency.
Radley Balko writes, "Even if the cop doubted this guy was a doctor, the cuffs, gunpoint, and a boot in the back all seem more than a little excessive, no?"

The shear theater and spectacle of the violent assertion of power certainly makes ones bristle. However, the outrage over this incident, as well as the outcome of the DPD PR disaster, both make me a bit uncomfortable. Certainly, cops ought to exhibit some common sense. However, people should know that one's emergency does not confer an implicit right to put other people's lives in danger. If we express only populist outrage, (which is distinct from genuine sympathy for the driver's misfortune), we may forget to communicate that it is perfectly reasonable for a cop to stop a car, and tell the driver to slow down (pulling out the gun is...unnecessary).

I don't know how things work here in the U.S., but when I worked as an EMT for the Red Star of David in Israel, we were explicitly forbidden from going beyond a particular speed, even if the patient was in cardiac arrest. So if people facing tragedy deserve to not be harassed and threatened by the cops, the police, in turn, deserve increased public awareness that sensible traffic rules aren't conditional to one's personal, or even tragic, circumstances.

Medical Research Fraud

Because of "Scrotumgate,", my favorite medical resource, The Thackery T Lambshead Pocket Guide to Eccentric & Discredited Diseases, requires an update.
HT: My Pharm Prof

Grand Rounds is Up!

Leslie at "Getting Closer to Myself" did a fantastic job of organizing all the posts submitted by a motley crew of medical bloggers. The theme is "Reflections on the way life used to be."
And I got a star next to my name! If I still got stars for doing good work, I'd be on dean's list.

In other world wide web-related news, I have a post up about medical licensure at the "Students for Liberty" blog. It features a sweet parking spot (these things matter to L.A. girls).

The Banality of Marijuana in Medical Education

In one of our GI lectures, among the interminable pharmacology powerpoint slides that address anti-emetic drugs, the following information appeared:
If an alien guest to our planet perused a pocket pharmacopeia, and had to guess which drug would be "fetishized" over all others, I doubt he'd pick marijuana. Mind you, I'm not convinced that there are many positive benefits for healthy people to take marijuana (and smoking a combustion product is more carcinogenic than using a vaporizer). Yet cannaboids strike me as just another class of drugs with certain indications and side effects, some known, some perhaps unknown. Another anti-vomiting drug, metoclopramide, can lead to tardive dyskinesia (Parkinsonism). Scopalamine, yet another, features a whole slew of anti-cholinergic (antagonistic to the parasympathetic nervous system) effects, and can cause delirium in overdose.

However, when patients with cancer obtain the latter two drugs, we praise modern medicine's ability to provide some alleviation to the horrible side effects of chemotherapy. When patients happen to select the former, we convict their state-law-compliant medical dispensers of crimes punishable by up to 100 years in prison.

Taleb and Pre-test Probabilities

Arnold Kling comments about Russ Roberts' conversation with economist Nassim Taleb:

I was most interested in the latter third of the conversation, where Taleb talks about his radical empiricism. For example, he argues that medicine makes more progress with trial-and-error than with knowledge of biological processes.

Trial and error would require taking a drug already known to be ineffective, adding a methyl group, testing the new molecule on a statistically significant number of patients, and then methylating again, until we've tested infinite permutations of "little-value-added" functional groups. We'd be bored sick.

One of the reasons why many empiricists object to all the funding that goes into certain alternative medicine projects, such as magnet therapy or reiki, is that, based on our understanding of physiological or biochemical principles, the pre-test probability of such treatments being effective is pretty low. An extreme Popperian would object, insisting that we can't truly know if anything works, before testing it, (and once experiment concludes, we still couldn't be sure). Such agents of uncertainty would be technically correct.

However, science does not mean claiming omniscience nor capitulating to any smidgen of doubt. Science involves taking the information that lies before us, determining what phenomenon is most likely, and using these findings to develop a testable hypothesis. We are occasionally lucky enough to discover a drug whose mechanism of action we do not fully understand (such as in the case of Topirimate for epilepsy, or the prevalent use of beta-blockers of hypertension, long before we knew how it worked). Yet relying on lucky breaks, or "trial and error," rather than "hot on the trail" paths gleaned from discoveries in biology, is like searching for a bank robber by starting with the As in the phone book. Or like seeking out a black swan, by beginning the expedition at a local Los Angeles lake.

Med Students Lobby Congress for Tuition Breaks

People, I know that we aspiring physicians are all in major debt, but some Americans can't afford the rent for their trailer homes. Let's leave the welfare-for-the-well-to-do-groveling to the AIG execs.

Ross Douthat is Trying to Murder Michael Kinsley! (Or Some other Distortion of Douthat's Views)

Brad Delong links to "The Daily Beast" and writes:

Michael Kinsley confronts the fact that Ross Douthat doesn't care more than a smidgeon about whether Kinsley lives or dies from Parkinson's disease.

If Kinsley were facing imminent death, and the only guaranteed antidote was a destroyed embryonic stem cell, I'm sure Douthat would fly over in a crimson-colored-cape and perform the destruction necessary to save the day. The fact that Douthat opposes federal funding for promising basic science research, that may one day be used treat PD, is far removed from the notion that Douthat doesn't care whether Kinsley lives or dies. If all of us were certain that could automatically save a life by sponsoring a certain magnitude of stem cell research, most of us would wire donations overnight. We don't do this, and thus admit that Kinsley's life is not immediately and urgently dependent on it. Reducing the situation to two variables (Kinsley's life versus stem cell funding), as well as admitting no degree of uncertainty about the potential effects of both the research and its related public policies, is innacurately simplistic.

Ok, I stood up for the social conservative.

Now, let's get the pluripotent blastocyst-derived inner cell mass differentiation party started!

Update: Before writing this post, I had written the first paragraph, as a comment in Brad Delong's blog (it did not include the more bellicose title of this post). It was taken down, after a few hours. Brad Delong has the right to do whatever he wants on his blog. However, I am disappointed by an academic who is unwilling to tolerate reasonably polite critique.

Who Lives?

Mr. Smith is a 58-year-old African-American male, who appears at least a decade older than his stated age. He is about 6’0, slim, and features a neatly-trimmed mustache. He sits stooped forward, and relies on a cane to get around. Mr. Smith has a pleasant affect, and even offers to get me a cup of water. His legs show moderate edema, and his eyes feature notable scleral icterus. Mr. Smith is on the list.
Mr. Smith inquires to whether I’m “also on dialysis,” and if I voted for Obama. I told him that I’m attending as a medical student, and that I don’t share my political views in public. Mr. Smith believes that Obama will bring us “back to nature” and will stop “sending jobs overseas.” I smile and tell Mr. Smith that I hope the president helps solve the economic crisis. This is no occasion for pessimism.

Mr. Smith expounds on his dating woes. His last girlfriend was “too needy,” and wanted something more permanent than Mr. Smith was able to provide. Mr. Smith implies that his misgivings were more due to his lack of emotional readiness, rather than the fact that his remaining days are contingent on a fluctuating number on a table, and that, like many of the 101,236 current Americans waiting for an organ, he may die before receiving a much-needed kidney transplant.

I met Mr. Smith, because I happened to sit next to him this past Sunday in a downtown Los Angeles theater, to view “Who Lives?,” a play Sponsored by the Renal Support Network. The production takes place in early 1960s Seattle, and explores the moral anguish afflicting a committee dedicated to choosing the lucky few who will test a curious, but experimentally promising machine, which “removes your blood, cleans it out, and then returns it to your body.”

The panel consists of a devout priest (“God has chosen us for this very important purpose”), an overwhelmed homemaker (“Father, there isn’t anything spiritual about this!”), a blue-collar craftsman (“The workers are always getting a raw deal, so what’s so wrong…”), a pedantic, neophyte doctor (“Disease is just the gross exaggeration of aging”), a pushy Jewish lawyer (“F-ck doctors”), a beautiful, liberated grad student, and some un-endearing blonde guy, who instinctually rejects Black applicants, and focuses the rest of his attention on seducing the grad-student. The group’s task involves ranking people, not merely based on medical criteria, but also each applicant’s presumed “value” to society. Thus, the committee debates the relative "significance" of musicians versus businessmen. The wealthy versus the poor versus the “rags to riches” success stories. Women versus men. Women with children versus men. Fertile women versus infertile women versus men. Blacks versus whites.

Today, such technocratic management of life and death strikes one as pretty abhorrent. Unfortunately, however, I find no solace in our contemporary method of organ allocation. Indeed, while we, as a society, have come to recognize the human infallibility inherent in prioritizing human lives, we now do something far worse, by creating an artificial shortage of life-saving organs, and banning individuals, charities, and the government from paying people for their kidneys.

We invoke all kinds of moral arguments to dissect messy commerce and greed from the prim and genteel art of uprooting a meat-sized slab of tissue, hitching it to various tubes and plumbing out a urine stream. To defend the volunteer-only status of organ donation, liberals and conservatives alike manufacture arguments that they would never entertain, when concerning other topics: “The poor will be the first to give up their organs, and this is harmful!!” (Cs: Should we prevent the needy from obtaining payday loans or eating at McDonald’s? Ls: Ought we to restrict women from obtaining abortion or birth control, even if it posed her some risk?) “It will be racist!” (Check out the demographic makeup of the waiting list.) “It will cheapen the ideal of giving from the goodness of one’s heart! “ (Ls: Do you ascribe the same logic to food stamps? More ceremoniously- “Would you like to sign up today and volunteer to save a life?! Low risk and high 'goodness of heart' satisfaction! No? I, shamefully, haven't signed up either...”) “Legalization will increase violence and coercion!” (Organ prohibition, meet drug prohibition), “Only rich people will be able afford them!” (Rich medical tourists and insurance-holders are generally the only ones who can afford obtaining organ transplants. If legalized, there may still be a disparity between the rich and poor in organ procurement, just as there is in all aspects of medicine, but this does not call for a ban on all medical procedures. However, we can legalize organ sales, and then- depending on whether you favor Heritage or TAP- accept a certain degree of inequality, or fiddle with our health care system, so that the poor can afford organs, as well).

My feeling is that most people oppose economic exchange of organs simply because the whole idea seems very, very unpleasant (yes, to me, too!). But good public policy is not constructed to convenience such a persnickety relic of natural selection as our sense of disgust. We ought to focus solely on whether we are actually helping people like Mr. Smith, who needs additional time to find the fellow freewheeling partner of his dreams.

In “Who Lives?,” while the committee pores over endless piles of pallid folders, the delicate housewife cries out, “We shouldn’t even have the power to make this decision!” However, she and her colleagues at least brave the clearly-understood ramifications of crafting countless letters featuring the dreaded words, “We regret to inform you...” Today, meanwhile, we largely avoid such formalities, by revering our high-minded legal dictates, and remaining casually inattentive to the tragic reality of thousands of end-stage kidneys.

Judging Others

At Overcoming Bias, Robin Hanson states:

When evaluating someone intellectually, I tend to downplay their degrees, publications, affiliations, etc. and focus on how they handle themselves in intellectual conversation. But most academics have more prudish norms, and consider it rude to challenge prestigious visitors to thoughtfully discuss topics beyond their prepared speech. Thank goodness my favorite lunch partners share my imprudish tastes. :)

I wonder if his method of evaluating intellectual ability may introduce more bias than does checking out the speaker's degrees.

If someone has a fancy education or job, she demonstrates that she was at least able to accomplish something minimally substantial over time (except in rare cases). If you judge someone based on a single conversation, well- What if he was nervous? Sick that day? Expresses himself better through writing than via speech?

I'm still working out my general approach to judging others. Which is the most fair (and possible) strategy: Matthew 7:1 , Pirkei Avot 1:6, or regularly scheduled Bayesian Updates?

Show Your (Well, Other People's) Work!

Olivia Judson's fabulous blog for the New York Times leads me to wonder:
Why aren't all journalists required to cite their references?

Just Deserts

I just viewed a Bloggingheads video, which featured Will Wilkinson, of the Cato Institute, and Lew Daly, scholar at Demos, and author of the book, "Unjust Deserts." Daly asserts that, because, capitalism's winners' can attribute much of their success to the intellectual contributions of past innovators, the wealthy Johnny-come-latelies owe some sort of "royalties," to the rest of society.

Robert Nozick once made a similar, "Hey, Those rich guys weren't all that back then," argument, but only to armchair-psychoanalyze the jealousies of the anti-free market intellectual class. He believed their views stem from the sudden weaning of these approval-junky scholars from their teachers' sweet, selective praise:

"Schooled in the lesson that they were most valuable, the most deserving of reward, the most entitled to reward, how could the intellectuals, by and large, fail to resent the capitalist society which deprived them of the just deserts to which their superiority "entitled" them?"

I'm having technical issues using the bloggingheads site (image only appears in the corner), so I will embed my next queued video over here:

Moore's Paradox

In second grade, I received a poor evaluation on a particular homework assignment. We were given a worksheet, which featured sentences such as:

A) It is raining outside
B) "I like chocolate."
C) "That girl is beautiful."

The teacher told us to ignore whether or not the statements were true, but to focus on whether or not each fell into the purview of fact or opinion. I sincerely believed that A and B were facts, and that C was an opinion. (B was apparently an opinion).

I'm still a bit stubborn about that answer. Can't a lie detector determine, within a certain margin of error, whether or not the anonymous kid indeed enjoys chocolate cake? I suppose this semantic confusion can be avoided with clearer instructions about which aspect of the sentence to evaluate, or with a less hopelessly literal third grader (The girl in the sentence is stating her opinion. Get over it, kid).

In his new communal blog, Less Wrong, Eliezer Yudkowsky mulls over Moore's paradox, Wittgenstein's favorite reflection on assertion versus belief: "It's raining outside but I don't believe that it is." Yudkowsky expounds on this contradiction to differentiate between belief and endorsement. He says,

"It's not as if people are trained to recognize when they believe something. It's not like they're ever taught in high school: "What it feels like to actually believe something - to have that statement in your belief pool - is that it just seems like the way the world is. You should recognize this feeling, which is actual (unquoted) belief, and distinguish it from having good feelings about a belief that you recognize as a belief (which means that it's in quote marks)."

I think that the mix-up largely stems from failing to juxtapose the concepts of truth/falsehood with fact (be it true or false)/opinion . Beauty is neither truth nor falsehood. It's just opinion- until we are given a more specific, working definition (i.e. "Beauty is the democratic consensus").

As Yudkowsky mentions, we use the word "believe" to express a lot of different concepts. For example, we say,

1) "I believe she is beautiful"- If we ignore the fussiness of my third-grade self, we'll call this an opinion, neither true nor false. Perhaps in need of clearer criteria, but certainly not irrational.

2) "I believe it is raining" -A statement concerning fact, which can be proven as true or false", and

3) "I believe in life after death"- A statement concerning fact, which cannot, however, be reasonably proved or disproved.

We also use the word "believe" ways that are difficult to categorize- say, "I believe in liberal/conservative political policy."
Is this statement purely an endorsement that requires no need for evidence (Example 1)?, Or, given clear-cut, agreed-upon goals, can evidence show that one ideology is likely superior (Example 2)? Or is this divide, with its necessary "whole world as laboratory" scientific design so hopelessly flawed and impossible that it is akin to attempting to prove "life after death."(Example 3)?
2 plus? 3 minus?

Is the term "belief" better used to make assertions regarding facts, or is the word better spared for expressions of mere opinion? My problem is that, despite having passed third grade, I'm still not always sure about the category in which my pronouncements belong.

Hal Incandenza on Doctors

It will start in the E.R., at the intake desk . . . or in the green-tiled room after the room with the invasive-digital machines; or, given this special M.D.-supplied ambulance, maybe on the ride itself: some blue-jawed M.D. scrubbed to an antiseptic glow with his name sewn in cursive on his white coat’s breast pocket and a quality desk-set pen, wanting gurneyside Q&A, etiology and diagnosis by Socratic method, ordered and point-by-point. There are, by the O.E.D. VI’s count, nineteen nonarchaic synonyms for unresponsive, of which nine are Latinate and four Saxonic. . . . It will be someone blue-collar and unlicensed, though, inevitably—a nurse’s aide with quick-bit nails, a hospital security guy, a tired Cuban orderly who addresses me as jou—who will, looking down in the middle of some kind of bustled task, catch what he sees as my eye and ask So yo then man what’s your story?