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?

Random Stuff From This Week

Last weekend, I attended the California GOP Convention, where I mostly hung out with the Log Cabins (luau themed party with free piña coladas!). Yes, I know I've just outed myself as a Republican, but I consider this choice as largely strategic. My political passions constitute a giant matrix, but, given a de facto two party system, a tiny vector, once political polarity is superimposed. I work for this group.

I went on a mini-hike in Eaton Canyon with the husband (That's me above, taking a break). Roots sweatshirt- yeah, I'm half Canadian. Every year, I pit stop to visit my bubbe (yoy!)in Toronto (eh!), before heading to New York (bitch). Pictures of all the Eaton Canyon waterfalls are trapped my husband's camera at lab, so they'll be up later.

Today, I took the practice boards at my school. I'm kinda screwed- unless the Kaplan Fairy leaves, like $10,000 under my pillow.

I have a 5:45 a.m. AA meeting to attend, as part of my Clinical Medicine course, so I've made a searching and fearless moral inventory of myself, and decided that I'm justified in spending the night blogging and watching the entire season of Top Chef (although some spoiler already told me that the bald yid wins).

Narrative Medicine

Ms. Smith is a Caucasian 68-year-old morbidly obese (400+ pounds) woman being treated for congestive heart failure. She takes short, labored breaths, and has symmetrical pitting edema in her legs.

Ms. Smith cannot get up to move herself to sit on the bedside commode, so the petite Chinese nurse leaves to request additional help. As the nurse exits the room, Ms. Smith turns to me and says, "She can't do this by herself? What are they paying her for?"

Ms. Smith's father was an abusive alcohol addict. Ms. Smith divorced her husband about 30 years ago, after she discovered that he had cheated on her, the first clue being the gyn's diagnosis of chlamydia and gonorrhea. She had had a hysterectomy at age 28, due to a prolapsed uterus, following birth of twins. When she announced her intentions to divorce her husband, he said, "I wasn't going to stay with you, anyway. I wanted more kids, and you can't have any." Ms. Smith's ex-husband recently died of a stroke, following surgery for prostate cancer. Ms. Smith says "I am glad that G-d let me see him in such pain in my lifetime, the bastard deserved it."

Ms. Smith never leaves her house, but a kind neighbor drops off some groceries about twice a month. She has no relationship with her children or grandchildren, for reasons she did not specify. She has no plans to improve her life (her one pleasure is "spraying her sheets with perfume," which reminds her of the way her mom smelled, and provides an "aromatherapy" feeling). However, she does faithfully take her 13 medications every day.

I asked Ms. Smith what she had to lose by sending her grandkids Christmas or birthday cards. If she didn't have a relationship with them, the worst thing that can happen is that the situation remains the same. Ms. Smith, bitter during most of the conversation,lightened up during my blunt challenge. "Yes. That is true. What do I have to lose?" Then her smile faded. "I just don't think I'd be able to deal with the rejection."

In many ways, I'm privileged to work in a hospital; For better or worse, I get to witness and learn from other people's life mistakes. This is a woman who spends the overwhelming majority of her day watching TV in her bed. It would seem to an objective observer that a genuine attempt to live in any different way ought to be wholeheartedly embraced. Ms. B is not afraid of death ("I'm just waiting for God to take me, when he wants to take me"), but is utterly panicked about sending a Christmas card.

When I see situations like this, I realize just how irrational it is to be nervous about contacting an old friend or putting up an inarticulate blog post or do anything else, for which I might be judged. I see the ultimate futility of caring too much about what other people think.

I suggested an alternative for Ms. Smith- perhaps she can keep journals, which her granchildren could one day read. Ms. Smith started to ramble excitedly, "Yes. It could by my legacy to them. Something for them to know me by...It won't get my voice inflections...but I could still give them advice..make sure they don't make the same mistakes. I can tell them to always stay celibate. That is the only way to stay safe."
I've recently read about "Narrative Medicine," a movement pioneered by Rita Charon, in which patients, even (especially?) those in palliative care, write and reflect about their illnesses. To me, the narrative medicine is particularly seductive, as it provides opportunities for doctors to inculcate values in which they're often criticized for being remiss- empathy, consideration of the "whole" patient, and integration of other fields- all without sacrificing a commitment to evidence-based medicine.

The evidents suggests that narrative medicine may help mitigate pain, or even increase survivorship and longevity. Promoting science-based medicine is not in conflict with recognizing the bio-social-psychological model of medicine, nor realizing that the effects of, say, loneliness can discernible physiological consequences.

I had no major suggestions that were acceptable for Ms. Smith, on how she could perhaps improve her life (Therapy? No Nutrition Counseling? No). She will likely remain alone for the rest of her life. However, she might punctuate her TV-viewing with journal keeping. So, maybe I've my part to ensure Ms. Smith's lasting legacy.
I wonder when I'll start recommending to all the lonely seniors that they ought to start blogs.

Do Not Mess With Dana Stevens

A few days ago, I wrote a post admiring the writing skills of Dana Stevens, the culture critic at Slate. I then stumbled upon the following review of Stevens, which included such tidbits as,

"The result in Stevens has been some of the most comically overwrought prose this side of an undergraduate civics paper. Two posts by her in, and the Movie Club is the worse for wear....[after quoting Stevens] It’s January 3rd, folks, yet that may be the most inept attempt at a meaningful sentence I digest all year."

I will try (and often fail) to avoid forging ad hominem attacks. However, I am a big believer in defending people, even phantoms whom I've never met, the ones who live in copper wires and fiber optic cables. Thus, I do not draw my own "civility line" at presenting harsh critics in their own words. Therefore, here is more from Freddie DeBoer:
Title of Blog Post from last week:

"The Continuing Fraud of Mickey Kaus"

On Martin Peretz:

"His blog is linked to by mainstream blogs and online magazines. He is a firmly establishment figure. He is also a vulgar and hateful man....he's become a clownish figure..."

And then there are almost 400 earlier blog posts that I don't have the energy to wade through. This all may seem like trying to remove the whips from the sex shop; after all, the civility norms of the internet differ from the general tone of face-to-face conversation or academic journal critique.

However, what irks me is that the following is posted on Freddie De Boer's personal wikipedia page:

"I believe that the irrational anger, out of hand rejection, and defensive zeal with which people on Wikipedia reject postmodernism reveals the degree to which that rejection is the product of doubt and fear...I think nothing can be accomplished without an attempt at genuine dialogue, founded on mutual respect and a good faith understanding of the opponent's viewpoint [words bolded in original]."

As much as I try, I will not always write in a respectful tone. Please call me out on it, as this is something I try to avoid. We all have our bad days. However, if someone mocks people whom I admire, he will be called out on that, as well. We are left with differences of opinion concerning what is respectfully-conducted discourse, and upon whom forceful language is legitimitely proclaimed. Therefore, it's a good thing Freddie's a self-described "post-modernist."

What is Bill Maher's Religion?

Larry King interviews Bill Maher, February 14, 2009:

KING: From our blog, Chris writes, "Bill, what is your silver bullet for health care?"

MAHER: Well, eat right would be a good start. Stop eating that crap in the supermarket. I think most health problems are from lifestyle choices. This is something no politician ever talks about, because no politician is going to say, get off the couch; you're fat; you know, ask the doctor if getting off your ass is right for you. But that really is the key to it. People don't catch a cold, they hatch a cold by things they put in their body. We have way too much toxicity and too few nutrients.

KING: Do you get a flu shot?

MAHER: Never. Never.

KING: It's a vaccine against the flu?

MAHER: First of all, that's a huge scam. Even if it worked, and I don't believe it does, by the time the actual flu came around, it would have mutated from whatever they shot into you. That is a good example of the corruption --

KING: You eat nothing in a box or in a can?

MAHER: Things that are in boxes or cans generally are not good. But have some peanut butter tonight if you like, Larry.

Here Bill Maher manages to deny the pathogenic cause of disease, as well as blame victims for acquired viral infections, stating that people "hatch a cold." Does Maher feel the the same way about Dengue Fever? Polio?

This is an example of hyperbole gone wild. Is Maher correct that people with suppressed immune systems are more susceptible to suffer an illness? Yes. Do people develop weaker immune systems by eating unhealthy foods? Perhaps. But Bill Maher's misleading statements imply that dietary intake is the primary cause, or at least an extraordinarily significant cause, of developing viral rhinopharyngitis.

In fact, the extensive National Health and Nutrition Examination Survey suggests that, while obesity is responsible for numerous pathological phenomena, overweight and obesity seem to be protective from death via infections¹. (The researchers used a COX model to account for the fact that the obese tend to die earlier from other diseases, before getting a "chance" to die from infections). While one randomized controlled trial (RCT) in mice showed that genetically ob/ob obese rodents were more likely to die from influenza virus than "slim" rodents², another RCT demonstrated that ob/ob obese mice were more resistant to death from the malarian parasite, Plasmodium berghei³. Thus, the research relating to the link between obesity and infectious disease is insufficient to be considered conclusive, and additional studies should be performed on this topic. However, Maher's conjecture that acute coryza (common cold), or other infectious diseases, are largely "hatched" from dietary choices, is invalid.

Even if we were to discover a causal link between eating habits and symptomatic coryza infection,⁴how does Maher know that "toxins" are the culprits, rather than excess fat? Which specific toxins are responsible? Additionally, on what basis does Maher believe that "nutrients" inoculate people from the common cold?

Indeed, many Americans ought to lose weight for other reasons, so at least this embellishment likely has mild consequences.

But then Maher moves on to vaccines.

An estimated 20,000 Americans die from influenza every year. So, if Maher convinces people to avoid a efficacious inoculant, he is behaving very irresponsibly.

Several randomized controlled trials demonstrate the effectiveness of the flu vaccine in children and non-elderly adults, and no scientific study seems to have refuted this. For example, according to the CDC:

A 4-year randomized, placebo-controlled trial of children aged 1-15 years found vaccine effectiveness ranging from 77% to 91%, following only one dose of vaccine given to previously unvaccinated children³."

There is a bit of controversy regarding the efficacy of the flu vaccine in the elderly population. While most well-designed cohort studies have shown that the flu vaccines reduce incidence of influenza infection and death for this demographic ⁴, these data has been contested in a few other studies ⁵. However, let's say we did discontinue vaccination of the elderly. We should then employ even greater care to vaccinate children, in order to decrease the probability of elderly exposure to the virus. (The authors of the Canadian study that challenges the usefulness of vaccination for the elderly, indeed noted, "Placebo-controlled randomised trials show influenza vaccine is effective in younger adults.")

Even if Maher, for some wacky reason, does not recognize the validity of such studies, why does he believe that the findings published in these journals amount to a "huge scam," a fabrication intended to hoodwink the public, and an example of "corruption"? These articles all seem to me like the expected process that takes place to advance scientific knowledge, rather than some large conspiracy. In order to save lives, we rely on the best evidence we have, concerning the costs and benefits of every preventative measure and treatment.

We already know that Maher views religious people unfavorably, and that he maintains staunch views on a whole gamut of topics. However, if Maher distrusts both theological doctrine and scientific research, which Higher Authority does he rely on as his arbiter of truth?

1. Katherine M. Flegal and Barry Graubard, et. al. "Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity" JAMA. 2007;298(17):2028-2037. http://jama.ama-assn.org/cgi/content/full/298/17/2028

2.Alexia Smith, Patricia Sheridan, et. al. "Diet-Induced Obese Mice Have Increased Mortality and Altered Immune Responses When Infected with Influenza Virus." Nutritional Immunology137:1236-1243, May 2007
http://jn.nutrition.org/cgi/content/full/137/5/1236

3. Vincent Robert, Catherine Bourgouin, et. al. "Malaria and obesity: obese mice are resistant to cerebral malaria" Malaria Journal 2008, 7:81

4. Please note that infection with the Influenza virus is always the primary etiology. By "causal link" I mean that dietary habits might lead to increased rate of clinical disease from infection, or decreased ability to kill off the virus.

5. Kathleen Neuzil and William Dupont, et. al. "Efficacy of inactivated and cold-adapted vaccines against influenza A infection, 1985 to 1990: The Pediatric Experience." The Pediatric Infectious Disease Journal:Volume 20(8)August 2001pp 733-740
CDC link that review some of the evidence about flu vaccines is at http://www.cdc.gov/FLU/PROFESSIONALS/VACCINATION/effectivenessqa.htm

6. Most of the research in this area seems to have been

Peter A. Gross, Alicia W. Hermogenes, et. al. "The Efficacy of Influenza Vaccine in Elderly Persons: A Meta-Analysis and Review of the Literature." Annals of Internal Medicine. Volume 123 (7) October 1995 pp. 518-527
http://www.annals.org/cgi/content/full/123/7/518

See also a randomized controlled trial at http://jama.ama-assn.org/cgi/content/abstract/272/21/1661

One study involved a Swedish cohort study of 260,000 age 65 or older. The researchers state, "The relative risks of mortality among vaccinated versus unvaccinated individuals were estimated using Cox's proportional hazards regression adjusted for, and stratified by, demographic factors and comorbid conditions." They found that they needed to vaccinate 297 in 1998/1999, 158 in 1999/2000 and 743 in 2001/2002 (the vaccine was not so great that year) in order to prevent one vaccine related death among the group, let alone prevent incidence of developing an influenza infection.
a. Ortqvist, F. Granath. "Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area." Eur Respir J. 2007 Sep;30(3):407-8.

7. Lone Simonsen, Roberty Taylor, et. al. "Mortality benefits of influenza vaccination in elderly people: an ongoing controversy."
The Lancet Infectious Diseases, Volume 7, Issue 10, Pages 658 - 666, October 2007. http://www.annals.org/cgi/content/full/123/7/518.