Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine

00:00 Only Fans bans porn, https://www.outsidethebeltway.com/porn-site-onlyfans-bans-porn/
03:00 The Children of Pornhub, https://www.nytimes.com/2020/12/04/opinion/sunday/pornhub-rape-trafficking.html
04:00 Why Do We Let Corporations Profit From Rape Videos?, https://www.nytimes.com/2021/04/16/opinion/sunday/companies-online-rape-videos.html
08:30 Israel, Once the Model for Beating Covid, Faces New Surge of Infections, https://www.nytimes.com/2021/08/18/world/middleeast/israel-virus-infections-booster.html
14:45 DSM: A History of Psychiatry’s Bible, https://www.wsj.com/articles/dsm-review-the-meanings-of-madness-11629062194
22:00 Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine, https://www.amazon.com/Diagnosis-Therapy-Evidence-Conundrums-American-ebook/dp/B0037CFD8C/

* “For much of human history death was associated with the infectious diseases that took their heaviest toll among infants and children. Beginning in the late nineteenth century—for reasons that are not clearly understood—infectious diseases began to decline as the major causes of mortality. The reduction in mortality among the young permitted more people to reach adulthood and thus to live longer. Under these circumstances it is not surprising that long-duration illnesses—notably, cardiovascular-renal diseases and a variety of neoplasms—became more prominent elements in morbidity and mortality patterns. These diseases were associated with advancing age; the longer individuals lived, the greater the risk of becoming ill or dying from them. In one sense the increasing prominence of long-duration (or chronic) diseases as in part a reflection of the fact that more and more people were enjoying greater longevity.

* During the latter half of the twentieth century, however, a dramatic perceptual transformation took place. Nowhere was this better expressed than in the constitution of the World Health Organization, promulgated in 1946 and ratified in 1948. “Health,” the constitution stated in its declaration of principles, “is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” Such a definition implied new roles for the medical profession. The care and treatment of the sick and infirm remained part of the physician’s responsibility. But to this were added the functions of making people healthy, happy, and socially adjusted.”

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Who Cares About Afghanistan?

From a Yale Law paper: If Americans know one thing about their system of government, it is that they live in a democracy and that other, less fortunate people, live in dictatorships. Dictatorships are what democracies are not, the very opposite of representative government under a constitution.

The opposition between democracy and dictatorship, however, is greatly overstated. The term “dictatorship,” after all, began as a special constitutional office of the Roman Republic, granting a single person extraordinary emergency powers for a limited period of time. “Every man the least conversant in Roman story,” remarked Alexander Hamilton in The Federalist No. 70, “knows how often that republic was obliged to take refuge in the absolute power of a single man, under the formidable title of Dictator” to confront emergencies caused by insurrection, sedition, and external enemies. No political constitution was well designed, Hamilton believed, unless it could confront emergencies and provide for energetic executive powers to handle them.

…Nor should we forget John F. Kennedy’s actions during the Cuban Missile Crisis. It is often viewed as Kennedy’s finest hour because the United States avoided a nuclear exchange with the Soviet Union. What is often overlooked in the dramatic tales surrounding those “thirteen days”‘ of meetings in Washington with Kennedy and his Ex-Comm (Executive Committee of the National Security Council) is that everyone participating assumed that it was up to the President to decide whether or not to embark on what would surely have become a nuclear war with the Soviet Union. The exact nature of the crisis was hidden from almost everyone in the country. Kennedy’s acolyte Theodore Sorenson reports that at the time Kennedy estimated the odds of nuclear war at one in three. Interestingly enough, Abram Chayes, in his flattering portrayal of Kennedy’s conduct during the Crisis, did not suggest that there was anything amiss in Kennedy’s risking nuclear annihilation. Kennedy’s behavior seems even more potentially reckless if one accepts the argument made at the time-in secret, of course-by Defense Secretary Robert McNamara that the Cuban missiles in fact posed little or no threat to actual American security. After all, the United States had an overwhelming nuclear stockpile and Soviet leaders surely believed that the United States would use it in response to any missiles fired from Cuba.

One is tempted to analyze the Cuban Missile Crisis-and perhaps foreign wars in general-as purely problems of “foreign policy” or “international relations.” But these issues-and the ways presidents approach them-are often deeply influenced by domestic politics. One of the reasons that Kennedy found himself in such a delicate situation was the fact that constitutionally required elections were about to take place for Congress, and Republican New York Senator Kenneth Keating, among others, was denouncing him for being soft on Soviet penetration of Cuba. Kennedy needed to retain healthy Democratic majorities in both the House and Senate because he could not always depend on Southern Democrats to support his “New Frontier” agenda. Kennedy was also concerned about
his prospects for reelection in 1964.

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The CDC confuses Americans on masks (8-16-21)

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The Undoing Project: A Friendship That Changed Our Minds

Michael Lewis writes in his 2016 book The Undoing:

* All the leading behaviorists were WASPs—a fact that didn’t go unnoticed by young people entering psychology in the 1950s. Looking back, a casual observer of the field at that time couldn’t help but wonder if there shouldn’t be two entirely unrelated disciplines: “WASP Psychology” and “Jewish Psychology.” The WASPs marched around in white lab coats carrying clipboards and thinking up new ways to torture rats and all the while avoided the great wet mess of human experience. The Jews embraced the mess—even the Jews who disdained Freud’s methods and longed for “objectivity” and wished to search for the kinds of truth that might be tested according to the rules of science.
Danny, for his part, longed for objectivity. The school of psychological thought that most charmed him was Gestalt psychology. Led by German Jews—its origins were in early twentieth-century Berlin—it sought to explore, scientifically, the mysteries of the human mind. The Gestalt psychologists had made careers uncovering interesting phenomena and demonstrating them with great flair: a light appeared brighter when it emerged from total darkness; the color gray looked green when it was surrounded by violet and yellow if surrounded by blue; if you said to a person, “Don’t step on that banana eel!,” he’d be sure that you had said not “eel” but “peel.” The Gestalists showed that there was no obvious relationship between any external stimulus and the sensation it created in people, as the mind intervened in many curious ways. Danny was especially struck by the way that the Gestalt psychologists, in their writings, put their readers through an experience, so that they might feel for themselves the mysterious inner workings of their own minds…

* If you went to a doctor in the seventeenth century, you were worse off for having gone. By the end of the nineteenth century, going to the doctor was a break-even proposition: You were as likely to come away from the visit better off as you were to be worse off. Amos argued that clinical psychology was like medicine in the seventeenth century, and he had lots of evidence to support his case.

* When B. F. Skinner discovered as a young man that he would never write the great American novel, he felt a despair that he claimed nearly drove him into psychotherapy. The legendary psychologist George Miller claimed that he gave up his literary ambition for psychology because he had nothing to write about. Who knows what mixed feelings William James experienced when he read his brother Henry’s first novel? “It would be interesting to ask how many psychologists come up short next to great writers who happen to be near them,” one prominent American psychologist has said. “It may be the fundamental driver.”

* Across North America, more people died every year as a result of preventable accidents in hospitals than died in car crashes—which was saying something. Bad things happened to patients, Redelmeier often pointed out, when they were moved without extreme care from one place in a hospital to another. Bad things happened when patients were treated by doctors and nurses who had forgotten to wash their hands. Bad things even happened to people when they pressed hospital elevator buttons. Redelmeier had actually co-written an article about that: “Elevator Buttons as Unrecognized Sources of Bacterial Colonization in Hospitals.” For one of his studies, he had swabbed 120 elevator buttons and 96 toilet seats at three big Toronto hospitals and produced evidence that the elevator buttons were far more likely to infect you with some disease.
But of all the bad things that happened to people in hospitals, the one that most preoccupied Redelmeier was clinical misjudgment.

* “Physicians deal with patients one at a time, whereas health policy makers deal with aggregates.”
But there was a conflict between the two roles. The safest treatment for any one patient, for instance, might be a course of antibiotics; but the larger society suffers when antibiotics are overprescribed and the bacteria they were meant to treat evolved into versions of themselves that were more dangerous and difficult to treat. A doctor who did his job properly really could not just consider the interests of the individual patient; he needed to consider the aggregate of patients with that illness.

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Brave New World (8-15-21)

Here are my notes on the book:

* At the end of the book, I had nothing. I had no comments. I had no reactions. I didn’t laugh or cry or have any emotional or intellectual reaction to the book. It did not remind me of problems we face today. I might have been too familiar with the book, so nothing in it surprised me or delighted me. I’ve had to work harder to come up with comments on this book than any other book I remember. I guess the book did not trigger me, or stimulate me. It just felt like reading someone’s intellectual exercise.
* Aldous Huxley is mocking the type of world he wants to build. Around this time, he flirts with world government, eugenics, centralized authoritarian control. He does not think democracy is up to the job.
* Everyone gets inoculated at birth against various diseases, which I think is a good thing.
* Huxley displays a snobbish looking down on the lower classes. He thought western societies were going down, he wanted state power and propaganda, he was willing to sacrifice individual liberty but saw the downside of what he wanted.
* Social classes are inevitable and a caste system has upsides and downsides, at least people know who they are.
* Huxley was reacting to WWI, when government took unprecedented control, just as in Covid, government has taken unprecedented control of our lives.
* He satirizes Keynes, we just had massive Keynesian intervention for Covid, and it seems like it was the right thing to do.
* Intellectuals despise consumption by the masses. In our problems today, consumerism and industrialization rank low on the list.
* Brave New World, written in 1931, is a satire on California: Lenina: “Hug me till you drug me, honey; Kiss me till I’m in a coma: Hug me, honey, snuggly bunny; Love’s as good as soma.” California is the least traditional state, it has the fewest family, religious, ethnic ties compares to other states. California is where people come to get away from traditional ties.
* Brave New World is also a satire on the United States and Henry Ford’s auto factory (intellectuals look down on businessmen).
* Brave New world satirizes the American commitment to happiness, BNW is a world dedicated to happiness.
* Unlike Rousseau or TH Lawrence and the romantics, Brave New World depicts the savage reservation as a dystopia.
* Is brave new world a utopia or a dystopia? There is no war, no pain, no age, no early death. Imagine there’s no Heaven. It’s easy if you try. No Hell below us, Above us only sky. Imagine all the people Livin’ for today. Imagine there’s no countries — It isn’t hard to do. Nothin’ to kill or die for And no religion, too. Imagine all the people Livin’ life in peace.
* I would rather live in Brave New World than 1984
* How many liberties would you give up to reduce crime?
* We have nothing like soma. Opiates and valium come closest. I don’t think we live in anything like BNW. Propaganda does not work much.
* It makes sense that the state would have an interest in reproduction.
* More or less government control — not clear which is best…Eugenics, tech, meds can be useful… Hierarchy is normal… The worst people are reproducing… If you need a license to drive a car, why should you not need a license to have kids?

* We spend so much money taking care of people in the last years of life…

* Any kind of control is usually better than chaos… Trad Judaism thought it was better for women to be married than single, almost any marriage was better than being a spinster.

* There is a tension between individual freedom, relationships, stable society, living in community.

* Rule by aristocrats is not an absurd idea, not inherently worse than popular democracy.

* 1984 is about fear, Brave is about pleasure.

* Huxley has such contempt for pop culture, which comes from America, feelies and talkies and particularly group singing. Huxley’s POV is described in depth in the great work, The Intellectuals and the Masses: Pride and Prejudice Among the Literary Intelligentsia 1880-1939, by John Carey.

* Manic enjoyment, you must smile for photos. What we have today is a bit like the book.

* Huxley ends up as a hallucinogenic guru in CA.

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