Domasio's new book

Unfortunately, starting from neuroscience, as Antonia Domasio does (see, for instance, this review by Ned Block) in his new book Self Comes to Mind; Constructing the Consious Brain, ignores the most interesting phenomena of mind and consiousness.  Better to look at something like Thomas Ogden in The Primitive Edge of Experience, or many other interesting places.  Neuroscience has made many advances, but once they start trying to talk coherently about dreaming or phenomenal experience we are left with little.  Call it a sort of mind/brain dualism if you want, but I don't think we need to come to any ontological conclusions here.  That, I think modern philosophy has shown, is an intractable problem.

That said, I appreciate Domasio's emphasis on the old brain...the brainstem, cerebellum and other such primitive structures.

Election

Nate Silver is my election night guide. Way better info than tv pundits. Maybe I will check Larry Sabato as well, since he claims to be so prescient. I don't really care too much who wins...I figure if the republicans win the house they will have to govern. You cannot just say no forever. My prediction for the future past election night: the economy will turn around and people will be happy and Obama will win in a landslide in 2012. A good thing because Obama is the best president we have had since Teddy Roosevelt. He will get to claim credit for the economy just as he being blamed for it now (not just by right-wingers but lefties as well such as Rachel Maddow and Paul Krugman). The reality is that he doesn't have much to do with it. I think most economists (who are not partisans) would say such an idea is silly.

BTW: I am glad the health care bill passed, but it is a mess. The nonpartisan bill (sponsored by Bob Bennett and Ron Wyden) was much better. The right is mostly to blame for the stupidity surrounding discussion of the bill but the democrats screwed up in catering to the old guard who run the committees in the Senate. But politics is messy. The old saying: two things you do not want to see being made---sausage and law.  Those on the left who want Medicare for everyone have never managed to explain how they were going to pay for it.  Or how to make decisions on what to cover.  Everyone cannot have any medical treatment they want.

Gladwell's "Talent Grab"

Malcolm Gladwell is assuredly one of the best current non-fiction authors, writing for the best magazine, The New Yorker. In his recent “Talent Grab” he, as usual, hooks in his readers in the opening paragraph. Gladwell tells stories, and the first story is of Marvin Miller, the pugnacious union attorney who freed ballplayers from being the property of the owners, and ultimately the elimination of the reserve clause and free agency.

The question he addresses is why professionals in various fields make so much money. And he makes clear that this situation is one that arose in the recent past. Other examples are publishers/writers, models/modeling agencies, and finally investment bankers. Gladwell has a prism to view these relations from the economists Aya Chacar and William Hesterly, drawing on the work of Alan Fiske. a U.C.L.A. anthropologist. People use one of four models to guide the way the interact with one another: (1) communal sharing; (2) equality matching; (3) market pricing; and (4) authority ranking. For how these apply to real situations, you need to read the article.

Gladwell illuminates human behavior and sees the world in an idiosyncratic way. Of course, he is not always right. But he makes you think. For instance, Robert A. Burton in On Being Certain persuasively argues that Gladwell, in Blink, gets wrong some of the insights of the book that Gladwell admired, Strangers to Ourselves, by Timothy Burton. In his last two articles, Gladwell’s ultimate “conclusion” is only loosely connected to the article. Here, Gladwell is nostalgic for the old days when professionals were the property of Capital. But why do ball-players, writers, movie stars, models and investment bankers make so much money at what they do? Because people freely pay them. How much does it cost to go to a professional sporting event these days? A lot.

Note: You must subscribe to The New Yorker to read this article. Some articles are freely available on-line. Gladwell’s previous article, which compares the civil rights movement to contemporary social revolutionaries, is available here. Again, it seems to me that the "conclusion" is quesitonable.  "If you are of the opinion that all the world needs is a little buffing around the edges, this should not trouble you. But if you think that there are still lunch counters out there that need integrating it ought to give you pause."

Afghan Conundrum

It is time to return to the issue of Afghanistan and our seemingly endless futile quest.  To do what?  The first question we need to consider what are our objectives are in this rugged and lawless place?  "War on terror" is the wrong term to use.  One of the Bush administration's many misleading characterizations of events.  But Obama increased the number of troops there vastly.  What are we trying to do and how to measure success? 

Rory Stewart raises these sorts of questions in his essay The Real Reason We Are in Afghanistan.  I think that he correctly says that Obama increased troops for political reasons. 

The opinion of Frank Rich, the liberal New York Times columnist, is obvious from his essay Kiss This War Goodbye.  I already mentioned the conservative position in the Cato Institute Cato's Letter, which although I have a print copy, does not yet seem available on-line.  But he doesn't think we should be there, either.  Patrick Cockburn, the very liberal pundit, offers suggestions of what to do now in Getting Out of Afghanistan.

Finally, Mohammed Hanit discusses our very troubling relationship with Pakistan in In Pakistan, Echoes of American Betrayal.

So much of what seems right to me any more has to do with "recognizing our limits." I came across a funny quote the other day about the absurdity of training Afghan troops and police to fight. Like many Afghans haven't spent their entire lives in warfare (reminds me of my ancestors in Scotland). This is mostly just another civil war with our "ally" Pakistan supporting terrorists. And a government that stole an election. Time to end the charade.  But do we just want to pull all the troops out?  I am undecided on this question, but I think we should leave a small long-term presence there.  After all, the main goal was to prevent the Taliban from taking control so that terrorists could not use Afghanistan as a training ground.  That was easily accomplished. 

Now, somehow, we need to find a way to try to get Pakistan to help create a more peaceful place across its border (the Army cannot control its side of the border, either).  As Hanif notes, while the ISI (Pakistani secret police) and the Army have often been on the side of the Taliban, the Pakistani populace wants an end to war.  I am going to reread these pieces and suggest something more specific, but Cockburn may be on the right track.  More later on this issue.

Consider this counterfactual.  What if we and the Saudis had never aided the mujahdeen in defeating the Soviets?  They would not have all the sophisticated weapons they have now and the problems would still be Russia's to solve.  Can we learn something from this possible world?  Steve Coll's Ghost Wars is an excellent historical account of this time period, especially from the 1980's to 9/11.

Questions surrounding dying and health care

Here is a remarkable article by Atul Gawande in the current issue of The New Yorker.  This cuts through many of the simple-minded arguments of the right and the left, which I have criticized repeatedly, although it certainly comes down hardest on the stupidity of "death panels," or at least the ignorance of those who believe those who shamelessly make such arguments. 

It reminds of a moment when I was still fighting to save my colon and another treatment had failed.  My doctor recommended a colonectomy with the strong possiblity that I would have a bag the rest of my life.  Well, I was astounded.  I wasn't ready to "give up."  Everyone else apparently knew it was hopeless and Tita told me tonight that he was afraid I was going to die.  I asked him if he gave this advice to everyone at this stage of treatment or was it something about my particular colon.  He said "your colon sucks."  That sort of honesty is greatly appreciated in the aftermath.  More doctors should learn how to deal with such unpleasant facts.

Here are some quotes from Gawande:

"This is the moment in Sara’s story that poses a fundamental question for everyone living in the era of modern medicine: What do we want Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do?

The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.

Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. Medical spending for a breast-cancer survivor, for instance, averaged an estimated fifty-four thousand dollars in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop...."

"People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives."

"The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want."

"Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year."

"The subject seems to reach national awareness mainly as a question of who should “win” when the expensive decisions are made: the insurers and the taxpayers footing the bill or the patient battling for his or her life. Budget hawks urge us to face the fact that we can’t afford everything. Demagogues shout about rationing and death panels. Market purists blame the existence of insurance: if patients and families paid the bills themselves, those expensive therapies would all come down in price. But they’re debating the wrong question. The failure of our system of medical care for people facing the end of their life runs much deeper. To see this, you have to get close enough to grapple with the way decisions about care are actually made."

Drugs and violence

I haven't watched the PBS Newhour for awhile but switched over there after the local weather last night.  There was a very sad and compelling feature on the violence in northern Mexico.  And there was a piece on the new Arizona law which apparently encourages police to harass people who look Hispanic, with at least one sheriff saying that he did not have near enough resources to enforce the law.  My general view is that if you are going to ask Hispanics for their "papers," you must ask everyone to prove their citizenship.  However, beyond that, our drug laws again strike me as ludicrous.   They have never prevented drugs from being readily available, like prohibition did not prevent alcohol.  They cost a lot of money in law enforcement.  They lead to violence in Mexico and here between drug gangs.  I realize the paternalistic point that it is to try to help people avoid becoming addicts, and maybe this can be defended with regard to children.  But wouldn't it make more sense to tax drug sales and spend more on treatment for addiction?  Because drugs are illegal, smugglers are able to make huge profits (and buy weapons and government officials).  Why cannot we just get over the big brother approach and help the taxpayers out at the same time?

Of course, this is a very libertarian approach.  Why don't more conservatives favor it?  You tell me, but I think this is one more example of inconsistentcy in the supposed philosophy of conservatism, which really doesn't amount to much more than a dislike of liberals and a cluster of often conflicting beliefs.  Read The National Review sometime.  The Cato Institute recently had a good critique on the point of our endless wars (by Joe Scarborough in the most recent Cato's Letter, which did not have a link yet).   The cost is not worth the benefit, similar to the "war on drugs."

Addendum 7/31:  Here is an article on the deaths in Mexico.  The main point to me is the lack of facts regarding what is happening and the murder of journalists who attempt to report them.   It is from The Nation, so I take it with a grain of salt.  I'm not sure what the author implies:  that President Calderon and the Army are murdering civilians?  For what purpose?

Trivial bits

The exploration of Scottish and Irish roots and the complicated histories of the countries and other groups (like clans) has paused, to return with a look at the penal laws and the "ascendency" in Ireland in the late 1600's which made not only Catholics but Presbyterians second class citizens, resulting in the sort of persecution that lead many to leave.  But that is for later.

I've got a rotator cuff injury and am getting physical therapy.  We do not know if there is a tear in the top muscle.  Only an MRI would show that and it is very expensive.  Similary, when we were looking at my heart condition we were looking at cholesterol and triglyceride levels.  There is a carotid artery scan that can actually show the amount of plaque in your arteries, but it is very expensive.  Bottom line is that as a society we cannot afford to give everyone what they want in health care.  But in the health care debate it was never addressed what sort of basic health care which people should be entitled.  Rather, it appeared to be a choice between all or none.  But mostly it was ignorant blather.  And conservative seniors complaining about their benefits being examined is about as hypocritical as you can get, especially if they also complain about welfere.  Medicare is welfare.

I have similar feelings about the immigration debate.  If you are going to have a law like Arizona's, then everyone should be checked for their citizenship papers all the time, and that includes white people.  You will probably need to establish some sort of national i.d. program first.  Of course, a lot of the backlash by white people is rascist.  But that does not mean that we must allow anyone who wants to sneak into the U.S. to stay.  We clearly need a guest worker program unless we are willing to see food prices jump 1000%.  And I am all for granting immigrants citizenship, but I don't see why being here illegally should put you at the front of the line.

A friend chided me for having a land phone line the other day.  I do need one to get updates on my satellite tv, but something else has struck me...all those people yacking on or staring at their cell phones everywhere.  I can understand the need for some business people to be accessible all the time, but for most people it is completely trivial.  Yacking on the phone is not particularly something I enjoy anyway.  You miss the nonverbal cues of real conversation.  If you want to send information, use e-mail.  I will continue to only have my cell-phone on in certain situations.  It is just not that important usually for people to easily reach me.

I was greatly irritated when the news broke that Goldman Sachs announced that they agreed to the largest settlement in history with the SEC for their derivative wrong-doing.  I turned on the NBC nightly news and it was not even mentioned as a major story.  The Banksters almost blew up the world economy and everyone has now moved on (or didn't really understand it in the first place).  How can a democracy work when so many of its citizens are not only uninformed but are emotionally resistant to questioning their own beliefs?  That is a question that has been swirling backstage for some time.  So I am checking out my brother-in-law's book:  Critical Masses and Critical Choices (by Kerry Herron and Hank Jenkins-Smith).  Had to skip most of the first part.  Too dry and technical.  But I think that there might be some hints there.