Archive for the ‘technology’ Category

The Politics of Politics

February 16, 2011

You’ve probably noticed the phenomenon yourself. Any discussion can be completely derailed, any subject can be avoided. All you have to do is say “Well, that’s just politics.” End of discussion. On to the weather and organized sports. Amazingly enough, even elected representatives can blacken one another’s reputations simply by accusing each other of “playing politics” with some important issue. Politics is a dirty word among Americans. Calling someone a politician borders on libel.

It was not always thus. Aristotle said politics is the main thing that distinguishes human beings from lower animals. (Which tells you how little Aristotle knew about cats, for instance. But I digress.) Politics, after all, is the way people make collective decisions, usually about our various visions of The Good, or about distributing scarce resources, without resorting to violence. In most other cultures, politics (a/k/a public service) is still an honored profession. In Central Europe, post-communist politics has achieved a new birth of respectability. What makes American attitudes about politics different?

Politics has been defined as the “manipulation of power,” and as “war by other means.” Usually, when we talk about “playing politics”, we are referring to something else, to what we call “party politics” and James Madison would have called “faction”–putting the success of one’s own group ahead of the merits of the issue in question. It is this sense of the word which we usually have in mind when we talk about certain things being “above politics”–for instance, that “politics stops at the water’s edge,” i.e. that foreign and military policy are “above politics.” Similarly, we appoint government functionaries through civil service, and appoint federal judges for life, to keep them “above politics”–that is, not beholden to or under the control of any particular “faction.”

But, like Madison, we tend to think “faction” is a bad thing because we see it as based on nothing but personal or group advantage. “Viva Yo,” as the Spanish put it. If a faction takes an ideological position of any substance at all, we assume that position is somehow conducive to the personal advantage of faction members, or they wouldn’t be adopting it. There is some basis for this, of course. Very few people who do any serious thinking about public policy issues arrive at positions that are likely to work against their personal advantage and survival. Most of us figure that what’s good for me is also good for just about everybody else, everybody who matters, anyway. But the real purpose of politics is not merely to allow factions to compete for advantage, but to allow divergent visions of The Good to compete for public support and power.

The other aspect of politics which most disturbs ordinary Americans is the necessity of compromise, splitting the difference, making sure everybody leaves the table still a bit hungry. To decide any issue this way, we think, is to start by presuming it can’t be very important. If it were, we would fight to the last drop of blood. Once a question transcends politics in this sense, war cannot be very far away. Once slavery stopped being a normal part of life, like breathing air, and became a moral issue for both sides, politics failed and war became inevitable.

Which puts an entirely different slant on placing anything “above politics.” That which is above politics is also beyond civil dispute. If “politics stops at the water’s edge,” then foreign and military policy lie outside the operation of democracy. Somebody–who may or may not have been popularly elected–decides what that policy should be, and our elected representatives then buckle down to supporting and implementing it. Even if circumstances change, so that a workable policy become unworkable, or a morally neutral policy becomes an abomination, the people and their representatives must continue to implement it to the bitter end. Any attempt to call a halt, for instance by cutting financial support, would be “playing politics” with national security, or so the supporters of the status quo insist.

Similarly, to say that education, or the environment, or other matters of public policy, are “outside politics” is to say either that we are prepared to “go to the mattresses” for them, or that we have unanimous agreement on The Good in those areas. No doubt there have been periods in our history when the latter was true. But, more often than not, this is simply wishful thinking among partisans of one or another vision who desperately want everybody to stop all this arguing and let them get on with their work. Merely wishing, however passionately, will not make it so.

We have to accept the fact that most communities and nations–and particularly ours–are host to numerous factions competing both for material advantage and for their visions of The Good. If we downplay the political realm as a place to play out this competition, we do not thereby eliminate competition. We merely force it to happen in other arenas and by other means. The most common alternatives are violence and money. If you cannot get a hearing for your vision of The Good within the political forum, you can always assassinate one of the more legitimate contenders, or buy off his supporters. Both of these alternatives to politics are popular in Third World countries, and both have achieved some currency even in the U.S. and industrialized Europe as well. The political realm, because its participants can so easily (and often deservedly) be accused of using public funds and facilities for personal advantage, has a hard time protecting itself against infringement by money or violence, and an even harder time distinguishing, in practice and in theory, between personal advantage and ideology.

In countries where, as here, the political realm still exists in a more or less healthy condition, it needs a few things to insure its preservation:
(1) better mechanisms for drawing more people into political dispute, especially people whose opinions are not normally solicited or listened to;
(2) a clear message that dispute is legitimate, and nothing is “above politics,” including ongoing military conflict, national security, and data and principles agreed on by scientifically-educated people; and
(3) mechanisms for public education about issues currently under public dispute, in structures accessible to any interested citizen, and encouragement of a strong ethos requiring those who take part in public debate to educate themselves first. What the “public square” did in a rather rudimentary but thoroughly personalized way in ancient Athens or revolutionary Philadelphia, the Internet is equipped to do in a somewhat shallower but far broader way. For the first time ever, we are technologically equipped to exercise democracy in cities larger than the Aristotelian fifty thousand families.

The questions that so far have been adjudged to “transcend politics” are all, of course, “controversial,” which is what we call any topic when we don’t want to discuss it. What the word actually means is that people disagree about it, and feel strongly about their opinions on all sides, but cannot imagine allowing their minds to be changed by rational argument.

So far, the U.S. has managed to form and preserve a relatively healthy political forum by keeping the really hot “controversial” topics out of it, or allowing discussion within the political realm only by properly licensed “special interest groups.” Such groups are likely to explore an issue more thoroughly and extensively, but they are not necessarily more knowledgeable than the average person on the street. On the contrary, they may just be better organized and more enthusiastic in spreading ignorance and misinformation (and sometimes even disinformation.) Which would be okay if all sides had an equal chance to be heard. But that kind of opportunity depends on all kinds of often unpredictable variables. Money helps a lot. Enough of it can guarantee a hearing. Being perceived as controlling a lot of votes or a lot of publicity is the next best thing. Absent these advantages, the best an interest group can do is try to get a lot of money or a lot of votes, and then parley them into access. Merely having strong, well-researched, carefully-thought-out, well-expressed opinions will not do the job. Maybe we need a more open political realm where it would.

Part of our problem is not merely that we distrust politicians (although, heaven knows, we do!) but that we distrust the political art, even (perhaps especially) when practiced by sincere advocates who are not pursuing their own material advantage. “Rhetoric”, which originally meant the art of persuasion, is now a synonym for the barnyard epithet. Most of us resent anyone who merely states a position without prefacing it modestly with “It’s only my opinion, but…” Anybody who has the nerve to try to change other people’s opinions–except, of course, in the mode of commercial advertising–is somehow infringing on our right to believe whatever we want. The converted are now the only people it is acceptable to preach to. Indeed, most advocacy activity these days is specifically directed only toward inactive sympathizers, and its purpose is not to change their opinions, but to persuade them to act on the opinions they already hold. The only non-sympathizers who can legitimately be confronted with one’s opinion are legislators and other public officials. The purpose of such confrontation is still not to change their opinions, but to change their official actions. We don’t really expect politicians to have opinions of their own, but only to weigh the vote-power behind the opinions of their constituents and act accordingly.

The blogosphere itself, the virtual ground on which we here confront one another, is one of the political arenas with the most potential for civil discourse among widely divergent constituencies. It can easily break down into either a commercial forum for sale to the biggest advertiser or a batch of mutually inaudible echo chambers for the narrowest possible ideologies. But the fact that nobody is paying us to be here, and that we have so far managed to refrain from both real and symbolic threats against each other, is a good augury. This may be the ground on which the American polity revitalizes itself, and we—with all our flaws, crochets, and ideosyncrasies—may be among those who can make it happen.


Abuses of WikiPlumbing

December 19, 2010

The Wired Family is somewhat confused about the WikiLeaks revelations and the various reactions to them. Mr. Wired thinks they were a really bad idea, and Julian Assange should be punished to the fullest extent of the law. But the sisters are all uncomfortable with this proposal. Red, predictably enough, considers Julian to be a hero. She looks forward to the end of official secrecy in the Western world. Jane, on the other hand, misses diplomatic discretion, which did some useful things in its day. Cyn is most concerned, not about the breaches of governmental secrecy, but about the measures being taken to discourage repeat performances.

First, Cyn, being the lawyer in the family, is discomfited by repeated proclamations that the US government (and probably others as well) is trying to figure out how to rewrite the Espionage Act to cover the behavior of Assange and his sources. Umm, guys, that’s behavior that has already happened. Which means any law enacted or amended now to punish it is an ex post facto law. And Article One of the US Constitution specifically prohibits the enactment of such laws. Okay, maybe the government just wants to close the barn door before the next batch of horses is stolen. That’s not what it sounds like.

Secondly, Cyn finds the behavior of private agencies against Assange and his buddies really scary. Closing down his server and his domain; shutting down credit card donations to his website; arresting him for utterly unrelated criminal charges in Sweden, which may or may not have any factual basis, and in either case may or may not be the sort of thing the Swedish courts normally prosecute—try to imagine, gentle reader, how easily you could be the target of such sanctions, if some government took a dislike to you. Note that most of these sanctions were implemented by private organizations, such as MasterCard, Amazon, Bank of America, PayPal, Visa and Swiss bank PostFinance. Suppose your bank decided to stop accepting deposits to your account. No more direct deposit of your paycheck or your pension. Suppose your website, or blogsite, or email, got cut off by your server. If you have not had the foresight to put a substantial portion of your money into your mattress, you may discover yourself homeless and broke, and unable to communicate your plight to most of your friends and family. Writers of speculative fiction have played with this scenario for several decades now—most notably Whitley Strieber in Nature’s End and John Brunner’s The Shockwave Rider, but the list is a lot longer. We have all entrusted our lives, our fortunes, and our sacred honor to a bunch of faceless non-governmental strangers who can all too easily be co-opted against us by an irritated government (or even an irritated corporation.) After all, under US law, MasterCard, Amazon, and their other buddies, as non-governmental actors, are not bound by the Equal Protection and Due Process mandates of the Constitution.

Assange, of course, is far from friendless. His supporters are retaliating against the above-mentioned malefactors with Denial of Service attacks far beyond my poor power to add or detract. But how many of us have access to such support? Maybe while governments are tinkering with the machineries of censorship to fend off the next batch of leaks, the rest of us should be organizing a vigilante support mechanism to protect ourselves from the vengeance of the international bankers and servers.

Maybe Assange deserves it. I haven’t read most of the leaked documents, or even read a synopsis of them. The ones I do know anything about seem more embarrassing than dangerous. Red, as previously indicated, likes to see politicians embarrassed. It may help keep them honest. But even if he had put the formula for the Universal Solvent on the front page of the New York Times, or done something else that really deserved punishment and needed deterrence, so far nobody except maybe the Swedes are even trying to follow the law in sanctioning him.

There are a few other background questions that need exploration. Like: how many of these leaked documents were originally created with the specific intention of being leaked, as unofficial and unauthorized but plausibly deniable and highly useful communications? Or in the alternative, is there any likelihood that some or more of the documents were falsified or redacted by WikiLeaks to say things they never originally meant to say? And if so, how does that change their legal status (compare: the guy who knowingly sells oregano claiming it is marijuana—what crime, if any, has he committed? Or suppose he sells it with the explicit disclaimer that it is oregano, but wink-wink-nudge-nudge we all know better don’t we?)

Consider the bizarre fate of Leonard Lewin’s Report from Iron Mountain ( The_Report_from_ Iron_ Mountain), a kind of fictionalized predecessor of the very real Pentagon Papers. It was published in 1967 as a satire purporting to be a report on military-industrial policy prepared by several government officials and think tankers. But 30 years later, a right-wing nutcase printed excerpts from it in his propaganda screeds, and defended himself (unsuccessfully) against Lewin’s copyright suit by claiming it was a government document and therefore in the public domain. What if the WikiLeaks papers turn out to be another Report from Iron Mountain? Or, as the Italians say, Si non e vero, e

Ben Trovato *

*A friend of the Wired Family, and director of the Iron Mountain Office of Creative Publicity and Quasi-Factual Information.

Risk Aversion

November 26, 2010

We are, no doubt, doomed to go on hearing about how extraordinarily risk-averse we foolish ordinary Americans are, until the end of this year’s holiday flying season. We will also, no doubt, get to hear from all the usual “expert” risk assessors, who just can’t understand why we ordinary mopes worry more about flying than about driving, more about nuclear power than about peanut butter.

The answer, which most of the “experts” can’t be bothered to consider, lies in the variable most ordinary people consider most important–they worry less about voluntarily assumed risks than about those imposed by circumstance.

Of course, one of the reasons people prefer chosen risks to those imposed from outside is that freedom of choice is a traditional, well-nigh sanctified American value. But in addition, a person who chooses to smoke cigarettes or live in L.A. or eat peanut butter or drive a car, has already at some level done his or her own risk-benefit calculation, and has decided that the benefit, in terms of what s/he personally values, is greater than the risk of loss in the same terms.

Where the risk is imposed from outside, on the other hand, the social risk-benefit equation may actually look a lot better–but the ordinary person on the street is being asked to assume some proportion of the risk while not necessarily being personally offered what s/he would consider enough benefit to compensate. For instance, living next door to a toxic waste dump may create less risk than smoking cigarettes–but what benefit can I derive from my poisonous neighbor? Quite aside from the health risk, it probably reduces the resale value of my home. The same goes for nuclear power, which offers very little in the way of benefits to anyone, except the people who sell it. The cheaper electric power we consumers were originally promised (“too cheap to meter”) has not materialized. On the contrary, Illinois, the most highly nuclearized state in the Union, also has some of the highest electricity rates in the country. I’m not sure any risk, however small, is justified by higher light bills. Smoking, on the other hand, to those who do it (especially these days, in the light of all those warnings on cigarette packs), has already passed the risk-benefit test; smokers honestly believe they get more out of it than they stand to lose, in terms of what they personally value.

So if we ordinary mopes don’t know enough to accept the experts’ risk-benefit calculations, merely because they often involve our taking the risks while someone else, often someone already much better off than we are, gets most of the benefits, too bad for the experts. Of necessity, our vision may be narrow–but it is not as clouded as the folks on the mountaintop like to think.

Red Emma

A Climate of Controversy

November 8, 2010

Why does the Right—religious and otherwise—so strongly oppose the scientific theory of global warming? Everybody seems to just accept this as a given, apparently without noticing how odd it is. I can certainly understand why the Right, especially the Religious Right, would oppose theories about human overpopulation of the planet and its essential harmfulness. Such theories have obvious implications for the proper organization of sex and marriage and the family, about which the Religious Right has strong convictions. Similarly, I can understand their problems with evolution, which casts doubt on the human race being God’s favorite children. If they re-started the controversy about the geocentric vs. heliocentric vs. randomly organized universe, I could understand that too, though I would marvel at their ability to ignore evidence.

But global warming? Are they opposing the theory just because the Left (such as it is in this country) supports it? Yes, the science behind it is not yet rock-solid. I can remember back in the early 1980s reading some very persuasive scientific articles about the impending Ice Age, a theory that seems to have evaporated of its own accord in the intervening decades. (Although there is a perfectly respectable scientific scenario that involves global warming resulting in an Ice Age, at least in Europe, by way of shutting down the Gulfstream.)

One possibility is that the Right, Religious and otherwise, is in the pocket of the global oil industry, and opposes anything that could result in reducing the use of petroleum products and the profits to be derived therefrom. For individual politicians, this may be a sufficient explanation. The fact that the petroleum industry itself seems to be rolling quite well with the scientific punches and is now establishing multiple beachheads in alternative energy technologies casts doubt on it, however. The Left does seem to be underestimating the flexibility of global capitalism (which is probably quite prepared to market numerous consumer-attractive varieties of marijuana if it becomes legal, especially if tobacco also becomes illegal) but apparently the Right does too.

With some hesitation, I find myself returning to my gut-level realization that my fondest dream is somebody else’s worst nightmare. Let’s take that a step further. There are people out there for whom my fondest dream is their worst nightmare precisely because it is my fondest dream. If I (secularist feminist socialist that I am) can dream fondly of a future in which every household provides its own power from solar cells or whatever, why shouldn’t Ayn Rand, given her fondness for smokestacks and their emissions, be horrified by that dream? Certainly I read Rand’s utopian screeds with less than impartial skepticism, precisely because they are Rand’s and not, say, Marge Piercy’s. “I do not like thee, Doctor Fell,” after a while, becomes its own rationale, capable of justifying almost anything.

Some thinkers on the Right seem to honestly believe that the Leftist Conspiracy has concocted the theory of global warming as a great hoax upon both the economy and the body politic. They spend a lot of time attempting to demonstrate that the theory is not scientifically valid, or has even been fabricated from whole cloth by a bunch of mad scientists. But they never (so far as I know) bother to explain just why the scientists, or even their sinister political supporters, would go to all that trouble. Cui (the late congressman Sonny’s adopted Vietnamese daughter) bono? No doubt there are “green entrepreneurs” who could make money off it. If they’re any good at their job, they could perfectly well make money off of some other less speculative technology. Why bother with this one?

Other than the Doctor Fell theory, I have no answer, and have seen no plausible answer either from the Left or the Right. What am I missing? In the words of Our Leader, is this anything?


Dumb Drivers Need Smart Cars

January 4, 2010

Last Friday, our sovereign state made it illegal to text while driving. Despite a lot of public discussion of the subject, our lawmakers did not deal with conversing (by phone or in person), eating, drinking (other than alcohol), personal grooming, smoking, or reading while driving. The AAA says that “distracted driving” (which covers all of these issues and then some) causes between 4,000 and 8,000 car crashes per day, and that roughly half of all car crashes are caused by distracted driving. The NHTSA says distracted driving kills roughly 6,000 people a year. (That’s twice the number of people who died in the World Trade Center on 9/11.)

Illinois is far from the only state paying legislative attention to this issue. There are roughly 200 bills pending in various jurisdictions. In addition, many major employers have no-texting rules for their employees who drive on company business. Being a member of the last generation to grow up without cell phones, I can’t see anything remarkable about this surge of anti-texting, except that it doesn’t cover other forms of vehicular multitasking. But apparently there are people out there who have to take serious efforts to admit their powerlessness over texting on the road, and to curb their insatiable need to do it (usually by keeping their cell phones in some place inaccessible to the driver’s seat.)

I can kind of understand eating and drinking while driving (i.e., I do it myself sometimes.) I have occasionally talked on my cell phone while on the road, though I now don’t do it except in traffic jams where what I am doing doesn’t really count as driving, since the car isn’t in motion. Even that is probably a bad idea, and I intend to cut it out this year.

But texting? If you can write something down, isn’t that proof positive that it isn’t urgent, and can wait till you have a chance to email? And reading? Oy.

There are three conflicting technological presumptions going on here, at least among the younger generations. One is that any task can be multitasked, that any time spent doing only one thing is “down time,” or even wasted time. Another is that one must be in constant communication with one’s friends, clients, and colleagues at all times, whether or not one is face to face with them. And the third is that Real People get from point A to point B by driving whenever possible. Anybody who uses any other mode of transportation is just not serious about time management.

Even back when gas cost four dollars a gallon, most of us kept on driving pretty much the same amount. The very young might have taken up the bicycle, and the somewhat older might have opted for public transportation more often (especially when, as in Chicago, it is free for seniors.) But the rest of us just keep looking down that long lonesome road. Apparently we also try to make it less lonesome by reaching out and touching people on the way. Or we insist on doing business from the highway.

Something has to give. We’ve already fiddled around with trying to get people out of their cars, or off of their cell phones. But now that we’ve built an entire culture that depends on both cars and cells, backtracking is not really workable. So why don’t we get realistic? We’re already working on various fuel-efficient cars, which require rethinking the internal combustion engine and the petroleum fuel supply network. While we’re at it, why don’t we build smart cars, cars that can be driven (if that’s the right word) by people who either have to devote their attention elsewhere, or are too old, too young, or too disabled to drive properly?

To keep the American driving public happy, such a vehicle would still have to be solidly built, individually owned, and individually controlled as to choice of destination. Ideally, the “driver” would simply program in a destination and leave the actual driving to the computer, while tending to her children, her manicure, his sports page, their lunch, or their texting. Or even taking a much-needed nap. It would be the cyber-equivalent of a chauffeur.

While the introduction of the first generation would be pretty pricey, long-term savings could be substantial. A “smart” car could be programmed to drive around the block with no driver at all, rather than have to be parked (now that parking has become so expensive.) It could be set up as a mobile office, with all the associated tax advantages, so that the “driver” need not waste a minute of waking time. “Smart” trucks could even be “driven” by people who could sleep their regulation 8 hours while on the road.

Computer glitches could easily result in moving violations, of course. But on the other hand, DUI need no longer be an issue, as long as a designated non-drinker programs in the destination. The productivity of working adults could be increased enormously, nce parents no longer have to spend their afternoons chauffeuring their children from one activity to another and people with elderly relatives do not have to drive them to the doctor. The “smart” car could be set up with “parental controls” to keep teenagers from driving like—well, like teenagers.

We already have much of the technology needed to make this happen, and the rest of it is certainly within our capability. As long as the US government owns General Motors, why not take advantage of the crisis? Drivers of the world, unite. You have nothing to lose but your responsibility, and you’re already giving up on that.


Shop Class as Soulcraft: a Book Report, Sort Of

December 8, 2009

That Other Blog Over There piqued my interest in Matthew Crawford’s SCAS some months back, but apparently someone or something did the same for many other Chicago readers, with the result that the public library didn’t have a copy available until last week. Sometimes that kind of situation makes me desperate enough to actually go out and buy the book, without even waiting until it comes out in paperback (which usually happens at roughly the same time that the Chicago Public Library acquires it.) Fortunately, this time, my current difficult finances enabled/required me to hold out a bit longer and finally read the library’s copy. I don’t mean to sound curmudgeonly, because SCAS was a reasonably good read. But it was not the wellspring of original thought that That Other Blogger led me to expect. It was, in fact, warmed-over Paul Goodman and David Riesman, without a single attribution to either of them.

Well, okay. See: The More Things Change… for more grousing about the same thing, and for a mode of reconciling oneself to it. Those who have not read Goodman and Riesman, as Santayana might have said, may have to rewrite it. With, admittedly, an interesting overlay of speculation about the financial crisis of the last couple of years, drawing a nice parallel between the alienation of labor and the commoditization of mortgages. These are still worthwhile ideas, and if books by Goodman and Riesman have become hard to find, Crawford is no doubt entitled to reintroduce their thinking to this generation, which probably needs it more than mine did.

And, like Goodman and Riesman, Crawford talks almost entirely about how our alienation from the world of physical work affects men. Which is a serious batch of issues, well worth discussing. But how about the way that alienation affects women, if in fact it does so at all, or even as much as it affects men? I think women are in better touch with the physical world, and physical work, than men, these days. We still, by and large, do the cooking and the cleaning and the housework. Admittedly, the portion of it that men agree to do is usually the least alienated and most interesting part of it, such as fancy cooking. But women do the day-to-day plain cooking, and take as many shortcuts in the process as they can afford, since they are under the same time pressures from the paid workplace as their menfolk. As a result, there are probably a lot fewer women around than in my mother’s generation who can tell you how to make a good non-lumpy gravy without buying it in a jar. Last night, for the first time in a couple of years, I made such a gravy. It took maybe ten minutes longer than the kind that comes in a jar, and that ten minutes was already tied up with various other tasks involving preparation of a pair of turkey drumsticks, so the total process didn’t take any longer. It felt like an accomplishment, even though nobody except Mr. Wired would ever have noticed.

Also, the other night, while working on a blog about the effect of third-party payment on the economy, I got so absorbed in this mind work that I forgot about the very material teakettle under which I had lighted the burner, until I discovered that the water had boiled away and the kettle had been ruined. Or rather (from Crawford’s point of view) its ruin, initiated by an inadequately performing whistle, was completed. So much for intellectual work versus physical work.

Generally, every night, I clean up the kitchen (having made the momentous discovery that the Elves will not do it for me, no matter how long I leave it, and that it really does feel nicer to make breakfast in a clean kitchen) and find the task quite satisfying. I proofread and copyedit my text as I type, and take pride in producing final text with minimal numbers of typos and fluffs. (It took me a while to understand that most people do not proofread their emails before hitting send, and that it is considered rude to call their attention to typos.) I don’t like messy text going out over any of my signatures. All of these activities are interactions with the physical world that lack the homespun glamor of Crawford’s conduit-bending and motorcycle repair work. So they lack even the narrow “public” of such predominantly male activities. They are mostly what industrial psychologist Frederick Herzberg calls “hygienic factors”—things, the presence of which does not noticeably please the person who benefits from them, but the absence of which seriously displeases him/her. A lot of women’s work fits into this category.

The other thing Crawford ignores, perhaps because he is a white male, is that the kinds of material immediate-feedback work he finds least alienated are also the kinds that attract many really intelligent “minority” workers and women. Rosabeth Moss Kanter discusses this phenomenon at some length. She feels that choosing “staff” rather then “line” positions within the corporation limits the upward mobility of women and minority workers, and generally advises against it. But “staff”—such as engineers, computer analysts, medics, and janitors—perform work that can be quickly evaluated, with little room for the evaluator’s prejudice. A good engineer builds bridges that don’t fall down, even if her boss doesn’t like her because she is “too shrill” or “too quiet,” or even if he is Jewish or Asian or Hispanic and doesn’t quite “fit in” in the lunchroom. Crawford draws on Dilbert and “The Office” to ridicule personality-based evaluations, but it seems not to occur to him that this style of evaluation encourages not only groupthink and stupidity, but discrimination. And Kanter does not, evidently, realize that taking a staff position may limit one’s upward mobility, but also limits the likelihood of suffering discrimination for not being the “right sort of person.” (For a lot more information on this phenomenon in the history of the American legal profession, see Jerold Auerbach’s Unequal Justice.)

So anyway, read SCAS, but don’t buy it unless you have never read Paul Goodman or David Riesman and can’t get hold of any of their stuff now. And while reading them, listen for the bloody teakettle. Or just heat the water for your tea in a self-limiting microwave (something Crawford would no doubt appreciate.)


Living in an Immaterial World

September 12, 2009

A few weeks ago, did something that rocked the whole system of private property. And all most of us did about it was kvetch. We saw it as a mere inconvenience. You buy a copy of 1984 for your Kindle, and some days later, you log back on and discover 1984 isn’t there. Since then, Amazon has explained, and apologized, and most recently cleared up the legalities between Amazon and George Orwell’s estate or whatever owns the rights to 1984, and most of those who bought it have had it restored. Most of us regard it as a mere pothole on the road of life. It’s patched now, all’s well that ends well and so on.

Given that most people buy books before reading them, rather than after, can we then conclude that those inconvenienced bibliophiles are only now reading 1984 for the first time, and only now realizing that Orwell pretty much predicted what has happened to his book? George Winston, after all, was in the business of making, and remaking, history, in the most basic sense, de-happening events that had now become inconvenient for Big Brother’s current ideology. Those of us who read the book before Amazon put it onto Kindle™, or at least some of us, are bloody spooked. Anybody who can make a book disappear from your library without any kind of notice, much less permission, can just as easily change the content of the book so that (for instance) Big Brother turns out to be the hero, and poor George Winston is just a pathetic dupe. Or rewrite the history of the Civil War to make slavery a noble cause. Or rewrite the JFK assassination to make Lee Harvey Oswald a Wahhabi Muslim and Marina Oswald a femiNazi.

How do you know that when you Google™ a news story from 2005, you won’t see George W. Bush filling sandbags and pitching in to reinforce the levees in New Orleans? Or Silvio Berlusconi inventing a new and vastly improved version of linguini bolognese? Or Governor Sanford entering a monastery?

Back in “the Sixties,” when Mr. Wired and I were active in all kinds of countercultural religion and politics, I took to clipping the papers regularly, to preserve stuff that I felt the next generation would never believe if I couldn’t produce it. (In the Talmud, BTW, you run across all sorts of weird stories to which the Rabbis themselves add a little note: “If it were not written, it would be impossible to believe this.”) I filled up most of a 4-drawer filing cabinet with high-acid-content paper (that was the flaw in my reasoning), which I only recently went through and mostly discarded, since it has mostly turned into stiff yellow snowflakes of indecipherable memory and I needed the drawer space for client files. Now, like most other people, I am at the mercy of the Mass Media and what little paper documentation the librarians have managed to preserve.

The Buddhists (with whom I have been hanging out occasionally of late) would not be seriously distressed by these developments. Nor would a client of mine from thirty-odd years ago who was trying to get discharged from the Navy as a conscientious objector because, while on maneuvers in Hawaii, he sat on a beach for an evening and became Enlightened. My usual approach to these cases is to refer the client to a psychiatrist who firmly believes military service is bad for most people’s mental health, especially that of people who think killing people is wrong, and encourage Uncle Sam to discharge the client for reasons of emotional stability. It’s usually faster and cheaper than using the official regulations for Conscientious Objector discharge. This client objected to the tactic. He wasn’t crazy, he explained. The Navy was crazy. They still believed in the reality of the material universe. The real universe is an eternally-flowing mesh of causes and consequences, assumptions and reactions.

Now, causality can reach backward as easily as forward. If we need the Reconstruction to have been a Bad Thing in order to accomplish some current political goal, we can revise it without even recalling and re-publishing the encyclopedias and textbooks that will shape the next generation’s understanding of history.

Which assumes, of course, that the next generation will have an understanding of history. Yesterday, a paralegal in our office, a smart and reasonably well-educated young woman, asked me who was on the other side in World War II. While Big Brother’s right hand is busy rewriting history, his left hand has managed to make the whole idea of history irrelevant to those who would ordinarily be expected to create its next chapter. When Seward, mourning the just-deceased Lincoln, said “Now he belongs to the ages,” he meant that Lincoln would always be part of what shaped America and the world. These days, when somebody says that a particular person or thing is “history,” they mean it’s gone, disappeared, never to be seen again. Even the History Channel is mostly taken up with the exploits of ice road truckers in Alaska and myopic analyses of the DaVinci Code pitting the Freemasons against the Bavarian Illuminati.

We are just now realizing that all the gee-whiz forensic technology that lies at the foundation of any criminal prosecution in which the State has somehow not managed to persuade the defendant to plead guilty, is highly fallible, precisely because it contains nothing so physical as a smoking gun, just a bunch of digital impressions on “a media” [sic] that the next generation of forensic “scientists” won’t even be able to read.

Friends of mine with libraries as extensive as the one in the Wired residence are contemplating selling them, or donating them to schools in the Third World, or recycling them for pulp, now that the best that has been thought and said is available in digitized format through Google or whoever, on “a media” the size of a good Cuban cigar. But a good cigar is, at least, a smoke. The best that has been thought and said can be rendered unreadable through a simple electromagnetic hiccup or an “updated” digitizing format.

We have already allowed ourselves to become accustomed to the best music and drama that has been composed and performed being recorded onto one short-lived medium after another. Those of us who really cared about such stuff now have more than six generations of it in our “media rooms,” accumulated over only a mere half-century. More reasonable people just throw out the last generation when the new one reaches an affordable price. The newest generation, of course, doesn’t exactly accumulate at all. Like the Kindle books, it merely takes up residence on our current “media” until we get bored with it, and then makes way for the next batch of stuff. We never own any of it.

I think (maybe I’ve been hanging out with Buddhists too long?) that this might be okay if the generations of ideas and songs and plays that wander into and out of our minds originated among real thinkers and artists, and not just the minions of media conglomerates who “own” most of what gets “created” these days. I’ve been through distributing the books and records and pictures of my deceased parents and friends, and part of me doesn’t want to put anybody through the same process again for my stuff. But if the alternative is to let Sony, Bertelsman, and Gulf Western do my thinking and my enjoying for me while I live, and leave no thoughts or music of my own to those who come after me, then, thanks, I’ll stay in the material world a while longer, even if it means stumbling over my accumulated books and music while I live and burdening my friends and family with them afterward.

Jane Grey

Health Care: the Reform Before the Reform

August 21, 2009

We’re hearing a bunch of different messages about what “health care reform” involves. Obama is now saying it means “health insurance reform,” which many of us have trouble with.  I have a very good auto insurance policy. It neither drives nor maintains my car.  But we all seem pretty clear that we want to cover everybody (or nearly everybody), and that we want to reduce the cost of both health care and health insurance. Whether these various goals are mutually compatible is a whole other question.

But there are things that we can perfectly well do before getting into the details of who is to be covered for what, and perhaps one of the most important is to solve the medical data problem.  Right now, your medical records are paper full of illegible doctor longhand, plus some transcribed and typed notes, plus X-ray films plus images from scans, EEGs, and EKGs.  Depending on your age and state of health, those records may fill a single folder, or, like Mr.Wired’s, be the thickness of the entire New York City phone directory. Furthermore, those records may be taking up space in the office of several different offices and facilities, because Doctor #3 wants to know what Doctors #1 and 2 found when they checked you out for hallux valgus, how they treated it, and whether the treatment worked, before she takes up where they left off. So she has had you send for all of the records from Doctors #1 and 2, and, when necessary, pay for the copying and shipping.  Copying, meaning the originals stay where they started out.  Most health care facilities have at least one room devoted entirely to record storage, sometimes a lot more.

Sometimes, not unreasonably, patients decide they want to keep a set of their own medical records.  This requires another set of copying fees, and another quantum of storage space.  In addition, it requires the patient to find someplace to store X-ray films (which are, essentially, photographic negatives with all their attendant storage problems, and furthermore are roughly four times the size of most paper documents and places to store them.)

BTW, in many other countries (Chile is the one I know best), the medical records are considered the property of the patient, who keeps his/her own set of copies and takes them from doctor to doctor as needed.  I don’t know whether the doctors in question make and store their own set of copies. Considering that doctors do retire, move away, and die, this approach has a lot to recommend it.  Indeed, these days, doctors move around a lot more than they used to, and tracking down one’s records after a few years can be really difficult.

So anyway, creating, maintaining, storing, and transmitting paper medical records is expensive.  Regardless of what happens with the more global aspects of health care reform this year, we could cut medical costs a lot by digitizing the records.  Many practitioners do that now.  My orthopedist puts my X-rays on his computer monitor, where he can zoom in on areas of particular interest and show me utterly cool and fascinating things about them.  He can also email them to anybody who wants them. But his software may or may not be compatible with that of my physical therapist.  That’s where the Reform Before the Reform comes in.
We not only need to digitize medical records, we need a standard system for doing so, so that this information can be readily transmitted to anybody with a bona fide need to see it.  We could, of course, just wait till Microsoft crams their version (which they are undoubtedly working on in some cellar in Seattle) down everybody’s throat.  And in the meantime, health care providers who have committed their resources to some other system will of course be out of luck.  VCR vs Beta, anybody?

Health care is more important than home movies.  It’s important enough for the government to play a role in deciding on a digitization standard.  Presumably the National Institutes of Health would be the place to start.  But obviously the real world of private medicine has to be involved as well.  AMA?  There may be some professional organization of medical IT specialists with contributions to make as well.  Ideally, the private side should be getting together to formulate its standard, which the NIH boffins can then examine for obvious and not-so-obvious glitches.  Mr. Wired suggests that unless the glitches are deal-breakers from the point of view of NIH, their critique should be kept out of the process, or a very minimal amount of tweaking done to produce a workable product.  That product, with recommendations from the private sector and NIH, should then be forwarded to the Surgeon General for his rubber stamp.  Probably the resulting system should be open code and licenseable to everybody who wants it. After a reasonable period of time (5 years or so), all government agencies that deal with individual medical records can legitimately require that they be digitized in the Standard Format, whatever it may be, and then, probably, everybody else will follow suit.

Within ten years, the system will have eliminated at least half the paper storage space (I’m assuming that the original originals will continue to be kept on paper, as a backup), and most of the costs of transmission and copying.  As an additional benefit, that digitized information can be made available almost instantly on demand for emergency responders.

Obviously, such highly personal records will need to be kept under varying levels of security.  One level for emergency responders, another for primary care providers, maybe another level for insurers, and so on.  Which is a lot easier to do (and where necessary, undo) digitally than on paper.  A person’s entire medical record could be kept on a single memory stick, and the emergency provider portion of it, probably, on a chip the size of the one embedded in my cat’s back to identify her if she goes astray.

No matter what else happens to the health care system over the next decade, this single advance can cut costs and improve care by significant amounts.  I don’t offhand know whether any other country has done this yet.  I know that various providers are doing it locally. The Veterans Administration is working on it.  But universality is more important here than anywhere else.  I welcome comments from the docs here, and anybody else with specialized knowledge to contribute.


It All Started With the Witch Doctor

August 9, 2009

Since our Fearless Leader wants more stuff on health care, I’m contributing an abbreviated version of my first lecture in a course I occasionally teach, called “Professional Standards for Mental Health Workers.”  It has a heavily historical/anthropological slant, since my students, though highly competent and hard-working, generally have a lousy background in history, which I feel puts them at a serious disadvantage.

Let’s start with the premise that all professions are priesthoods, and all originate with healing the sick.  Terms like “witch doctor” and “medicine man” point clearly in this direction.”  “Medicine”, in Native American religious tradition is a synonym for “religious ritual/power.”  Like most pre-industrial medical traditions, it is based on the assumption that “sickness” can arise from or affect the body, the intellect, the emotions, and the spirit, in varying combinations.  Among the Navaho, for instance, many illnesses are believed to result from “sleeping with kinfolk,” contamination from proximity to corpses, or witchcraft–that is, the improper behavior of the patient or somebody else.

So the “medicine man” has to know things about the patient that the patient would  never want to become public knowledge. The patient will submit to treatment (and pay the doctor) only if the confidentiality of that information can be guaranteed.

Arthur C. Clarke, the science fiction writer, says that any technology we don’t understand is for all practical purposes magic. Healing the sick has always been one of the major attributes of divinities and their priests/shamans—a much more useful form of miracle than making water flow uphill or rods flower or whatever.  The ability to heal implies POWER, which is scary to those who lack it.  It implies, specifically, four kinds of power:
 power to heal
 power to withhold healing (“I don’t like you, or your brother killed my brother, so I won’t set your broken leg, nyah nyah nyah”)
 power to kill (anybody familiar with herbs knows poisons and abortifacients as   well as healing herbs)
 power derived from knowledge (about the natural world and about the patient–unavoidable access to confidential info) (imagine a delirious patient raving about a passionate interlude with a person to whom s/he is not married, for starters.)

So most cultures generate some kind of code for their priests and healers, to restrain this power and keep it channeled in paths likely to be useful for the culture as a whole. In this lecture, I assign the students to ask any professional or skilled craft person they meet during the week about the professional ethics of that craft, and get written documentation if possible.  I have gotten some fascinating samples: taxi drivers, sexual surrogates, veterinarians, child care workers, chefs—a long way from the Hippocratic Oath, which I generally see as the Ur-Document of its kind.  But they all have pretty much the same restrictions in common:
 Restrictions on use of knowledge and information
 first, do no harm:  for instance
 no poisons;
 in some cultures, no abortifacients
 no exposure of patients’ secrets (no blackmail)
 No favoritism in use of skills and knowledge, which must be made available to all, regardless of personality, affiliation, or resources
 No “overreaching”–using rare and necessary skills to extort undue recompense (pecuniary, or, for instance, sexual favors) (The course, naturally, has a whole lecture devoted exclusively to the issue of sex with patients/clients, which seems to be a problem for every profession with the possible exception of accountants, engineers, and veterinarians.  We’ve been blogging about Fountainhead lately, so you know it’s an issue for architects.)

The lecture then goes into a wildly condensed and popularized history of medicine, which I figure the various docs here are perfectly capable of providing us far beyond my poor amateurish power to add or detract.  The point of it, however, is not what technology and information has become available at various points in our history, but how we use it. Thus, it’s important to keep in mind that there is a big difference between:
(1) what we can conceive  of doing
(2) what we can actually do
(3) what we are  actually doing
(4) what most people actually have done.

These days we pretty much presume that we can develop any technology we decide we want to develop. The areas of cosmetic medicine, infertility treatment  and organ transplantation seem to be where we have actually decided we want to develop technology.  Economics is probably the driving force behind these choices.  Doing things people want is almost always more profitable than doing things people need.  It took medicine a while to come up with serious work in the former area, but now medical science has clearly taken that ball and run with it.  More about this later.
At the same time, mental health issues, which seem to be more and more salient as a source of real social problems, are being offered less and less attention from everybody except the drug companies.  This is probably economically driven too.  Drug companies can make lots of money in large gobs, while the more labor-intensive methods of treating mental illness dribble out the money in tiny drips to lots of people. .  The things psychotherapy can do–usually over long periods with close attention–are miles away from what most psychiatric patients actually get.
All of the chapters of the history of medicine exist in the US today, side by side, like the rings on a tree.  There is a ring in which sickness is still believed to result from the patient’s improper behavior (these days, we have given up on policing health in the bedroom, and taken up jackbooted thuggery in the dining room instead, but the results are the same.)  There is another ring in which the most drastic intervention is the most highly regarded (especially in the treatment  of cancer, where chemotherapy does a lot of the same thing that purges and bleeding used to do–the Ben Tre “destroy the village to save it” theory of medicine.)   There is a ring in which the doctor’s job is to keep the patient comfortable until nature takes its course (that’s what hospice care is all about.)  There is a ring in which medicine actually works, like a well-run car repair shop.  And finally, the local “wise woman” is still around (herbal shops and healers in Chinatown, Hispanic neighborhoods, and New Age enclaves, etc.)

The economics of medicine work differently in each of these rings.  Undoubtedly, whatever finally comes out of Congress (if anything) will not be fine-tuned to these distinctions.  Probably we should be looking for a minimalist and mostly-preventive approach: make sure everybody, regardless of ability to pay, gets vaccinations, wellness counseling, treatment for infectious diseases, mental health care, and palliative end-of-life care, and let the Almighty Free Market do everything else. Mental health care, BTW, should be required to include some treatment for whatever DSM-V calls the compulsion to scream and shout disruptively at public meetings.  Without it, our democracy cannot survive.


Do Americans Watch Too Many Hospital Shows?

July 31, 2009

Watching Marcus Welby may have led Americans of a Certain Age to expect house calls and long conversations with their doctors.  Watching ER may have led younger Americans to expect a lot of noisy rapid action.  Watching Grey’s Anatomy or General Hospital may have led many of us to sneak a peek into supposedly empty hospital rooms in hope of catching younger medical personnel in flagrante delicto.  Popular culture undoubtedly shapes our expectations of the health care system, for better and for worse.

Age, class, and gender play their part, too.  Younger males, especially blue-collar men, want as little contact with the health care system as possible.  Real men don’t go to doctors and don’t take meds.  Real blue-collar men watch ESPN, which rarely deals with medical issues other than the ingestion of illegal substances by professional athletes. Naturally, this tends to make doctors, when seen at all, the bad guys.

Women generally get stuck functioning as the designated interface with the health care system on behalf of everybody else in the family until they are old enough to need somebody else to handle those duties on their own behalf.

Middle-class, educated, white-collar Americans have higher expectations, because in addition to watching Private Practice and Hawthorne, they read Scientific American and the Health section of the daily paper.  Which leads them into the same trap we collectively fall into:  losing track of the distinction between what we can imagine being able to do, what science has worked out the how-tos for but not implemented yet, what elite medical care can provide if paid enough for it, what is actually being done in the majority of American facilities, and what poor people can get if they’re really lucky.  The popular culture culprit here may not be a hospital show at all, but CSI and other purveyors of gee-whiz technology.  In an earlier generation, we didn’t have so much trouble realizing that Dr. McCoy’s scanner was a couple of centuries away. Today, we rarely think about the fact that the various non-invasive technologies for imaging and surgery  that we really do have available now are EXPENSIVE.  ER was pretty good about discussing the financial facts of medical life where they were relevant to the plotline, but of course, in an emergency room, the law requires every bona fide emergency patient to be treated regardless of ability to pay, so the issue didn’t necessarily come up until much later, usually long after the show was over.

Quite possibly what popular culture and the health care system should be working on together is a medical version of Car Talk.  You know, that Public Radio show on which, every Saturday morning, two Italian-American mechanics (both MIT-educated, and one of whom has a PhD, so much for blue-collar credentials) take questions from listeners nationwide about the foibles and failings of cars and mechanics.  They have a pretty healthy and realistic attitude toward both.  Cars are mortal.  All cars eventually disintegrate and die.  Mechanics are fallible and sometimes greedy.  Car dealers and their repair and maintenance facilities are not necessarily much better.  But most of us can keep our cars running for well over 100,000 miles by paying attention to telltale noises (Car Talk makes me wonder if good hearing and possibly even perfect pitch are Bona Fide Occupational Qualifications for a car mechanic), tending to routine maintenance regularly, and not doing Really Dumb Things.  Some car problems are Really Dangerous, and some are just trivial or unpleasant.  Check with your mechanic to see which is which, and don’t hesitate to get a second opinion when the first one doesn’t sound right. Since most of their calls involve cars over five years old (that’s forty-five in people years), they have no gee-whiz technology to call upon, just basic grease-monkey stuff.  [Cars with GPS and rear view cameras are still brand new and under dealer warranty, so the Car Talk Boys never hear about them.]

This is precisely the level of technology most of us need to hear about when our bodies act up, except that we don’t usually give off telltale noises (other than the stuff stethoscopes listen for, which was probably a much larger part of the practice of medicine seventy years ago.)  Unfortunately, doctors are mostly too nervous about getting sued to offer medical advice to strangers on the public airwaves (note that the Car Talk Boys never issue any disclaimers about their advice. Is this because so far, most of us don’t sue our mechanics?)  There should be ways to work around this.  Because, at least until we start heading into the Geezer Years, most of us think of our bodies pretty much the way we think of our cars: we just want to keep them running reasonably well at reasonable cost for as long as possible.  We want our doctors to function like good car mechanics.  Mostly, we want them to specialize in doing things we mostly think we could do for ourselves if we wanted to take the time and trouble, but it’s easier to let somebody else do it.  We want hints on how to do some of the easy stuff for ourselves, and then we just want to leave the complicated stuff to them.  If we could drop our bodies off at the hospital and come back for them later, most of us probably would, especially if we could get a suitable loaner in the meantime (Here’s a slightly used Mel Gibson, shouldn’t give you any trouble, but it’s only got a quarter tank of gas, be sure and have dinner on the way home tonight…)

And in the Geezer Years, we probably don’t expect what the medical establishment seems to think we do.  We don’t want to live forever. We just want to keep functioning more or less normally for as long as possible. We don’t want to fight as long as possible.  Whose idea was it to depict medical intervention in terms of combat in the first place anyway?  These days, a lot of patients regardless of gender seem to buy into the model, but I suspect that’s mostly because they are made to think they ought to.  I know the denizens of That Other Blog will say I’m pushing euthanasia or assisted suicide or something, but I think if the medical establishment were willing to tell patients it’s okay to give up or give in beyond a certain point, a lot of people would, thereby sparing themselves a lot of unnecessary pain and perhaps also cutting down on the enormous proportion of lifetime health care expenditures that is now spent in the last six months of life.    Nurses are often better at talking about these realities than doctors, and maybe they should be encouraged to do it more often.  It is their primary job, after all, to care about how the patient feels. Maybe hospital chaplains should be recruited for these discussions too; they are mostly connected with faith traditions that tell us the soul is more important than the body, after all.  Doctors, on the other hand, tend to see themselves as the patient’s designated champion in the combat against death.

Well, enough of awkwardly chosen metaphors (a man’s reach should exceed his grasp, or what’s a metaphor?)  Now that Obama has started talking about what used to be health care reform as health insurance reform, we will need to start looking elsewhere to change the health care system.  Stay tuned for The Body Talk Boys, Mark and David Welby, and don’t eat like my brother.