Friday, June 23, 2017

It’s a powerful tool of dehumanization

This is a mess of a column. From The End of the Left and the Right as We Knew Them by Thomas B. Edsall. I enjoy reading Edsall's work. He is among the strongest left leaning commenters, principally because he so often bases his arguments on logic applied to data rather than based on simple ideological emotion. Engaging with his arguments is almost always useful and a learning experience.

That's why this column is so surprising. The argument seems almost incoherent. No doubt we live in unsettled political times with electorates across the OECD turfing out the smug and comfortable vested elites, choosing unknown, incomprehensible, or even inconceivable alternatives.

Edsall looks at this pattern and wants to make it an issue of globalism versus populism which seems a pretty weak reed. Yes, globalism, among many other issues, is involved. And yes, the rejection of the vision of the self-anointed elites might be characterized as populism. But globalism and populism are words of clay, molded to mean whatever you want them to mean.

Edsall has a lot of OECD examples and data but he, as a voice of the American Left, seems compelled to make this consistent with the American postmodernist, critical theory assumptions. Race and xenophobia have to be a root cause. Those with whom we disagree must be racist. He ends his column with:
What we are seeing now is the replacement of class-based politics, a trend apparent in the United States and Europe. This gives us a more racialized and xenophobic politics, on one hand, and a politics capitalizing on increasing levels of education and open-mindedness in the electorate on the other. If the building of a viable left coalition is possible, it is likely to require some thoughtful and humane co-optation in the form of deference to our limits and boundaries.
These global changes aren't about race as we understand it in the US. Edsall tends to be much more sophisticated than this.

Scott Alexander, another intelligent writer of the left, has had a number of excellent thought pieces on the foolishness and profoundly immoral instinct to ascribe everything to an ad hominem slander of racism. Its not about racism and xenophobia. Its much simpler than that. If the self-anointed elite of both the left and right keep blinding themselves to the interests, challenges, and needs of the majority, then the electoral upsets will continue happening. From You are still crying wolf by Scott Alexander, November 16th, 2016.
Trump made gains among blacks. He made gains among Latinos. He made gains among Asians. The only major racial group where he didn’t get a gain of greater than 5% was white people. I want to repeat that: the group where Trump’s message resonated least over what we would predict from a generic Republican was the white population.

Nor was there some surge in white turnout. I don’t think we have official numbers yet, but by eyeballing what data we have it looks very much like whites turned out in equal or lesser numbers this year than in 2012, 2008, and so on. [EDIT: see counterpoint, countercounterpoint]

The media responded to all of this freely available data with articles like White Flight From Reality: Inside The Racist Panic That Fueled Donald Trump’s Victory and Make No Mistake: Donald Trump’s Win Represents A Racist “Whitelash”.

I stick to my thesis from October 2015. There is no evidence that Donald Trump is more racist than any past Republican candidate (or any other 70 year old white guy, for that matter). All this stuff about how he’s “the candidate of the KKK” and “the vanguard of a new white supremacist movement” is made up. It’s a catastrophic distraction from the dozens of other undeniable problems with Trump that could have convinced voters to abandon him. That it came to dominate the election cycle should be considered a horrifying indictment of our political discourse, in the same way that it would be a horrifying indictment of our political discourse if the entire Republican campaign had been based around the theory that Hillary Clinton was a secret Satanist. Yes, calling Romney a racist was crying wolf. But you are still crying wolf.

I avoided pushing this point any more since last October because I didn’t want to look like I was supporting Trump, or accidentally convince anyone else to support Trump. I think Trump’s election is a disaster. He has no plan, he’s dangerously trigger-happy, and his unilateralism threatens aid to developing countries, one of the most effective ways we currently help other people. I thought and still think a Trump presidency will be a disaster.

But since we’re past the point where we can prevent it, I want to present my case.

I realize that all of this is going to make me sound like a crazy person and put me completely at odds with every respectable thinker in the media, but luckily, being a crazy person at odds with every respectable thinker in the media has been a pretty good ticket to predictive accuracy lately, so whatever.
And just this week Alexander has Against Murderism. Murderism being analogized to racism - a generic moral claim to the high ground without the hard work of actually comprehending the position of the other.
There are a bunch more frameworks like this, but they all share the common warning that cross-cultural communication is really hard, and so a lot of the concerns of people who aren’t like us will probably sound like nonsense. And most of them say that our demographic – well-educated people proud of our commitment to logic and reason – are at especially high risk of just dismissing everyone else as too dumb to matter. The solution is the same as it’s always been: hard work, renewed commitment to liberal values, and a hefty dose of the Principle of Charity.

Racism-as-murderism is the opposite. It’s a powerful tool of dehumanization. It’s not that other people have a different culture than you. It’s not that other people have different values than you. It’s not that other people have reasoned their way to different conclusions from you. And it’s not even that other people are honestly misinformed or ignorant, in a way that implies you might ever be honestly misinformed or ignorant about something. It’s that people who disagree with you are motivated by pure hatred, by an irrational mind-virus that causes them to reject every normal human value in favor of just wanting to hurt people who look different from them.

This frees you from any obligation to do the hard work of trying to understand other people, or the hard work of changing minds, or the hard work of questioning your own beliefs, or the hard work of compromise, or even the hard work of remembering that at the end of the day your enemies are still your countrymen. It frees you from any hard work at all. You are right about everything, your enemies are inhuman monsters who desire only hatred and death, and the only “work” you have to do is complain on Twitter about how racist everyone else is.

And I guess it sounds like I’m upset that we’re not very good at solving difficult cross-cultural communication problems which require deep and genuine effort to understand the other person’s subtly different value system. I’m not upset that we can’t solve those. Those are hard. I’m upset because we’re not even at the point where someone can say “I’m worried about terrorism,” without being forced to go through an interminable and ultimately-impossible process of proving to a random assortment of trolls and gatekeepers that they actually worry about terrorism and it’s not just all a ruse to cover up that they secretly hate everyone with brown skin. I’m saying that when an area of the country suffers an epidemic of suicides and overdoses, increasing mortality, increasing unemployment, social decay, and general hopelessness, and then they say they’re angry, we counter with “Are you really angry? Is ‘angry’ just a code word for ‘racist’?” I’m saying we’re being challenged with a moonshot-level problem, and instead we’re slapping our face with our own hand and saying “STOP HITTING YOURSELF!”

People talk about “liberalism” as if it’s just another word for capitalism, or libertarianism, or vague center-left-Democratic Clintonism. Liberalism is none of these things. Liberalism is a technology for preventing civil war. It was forged in the fires of Hell – the horrors of the endless seventeenth century religious wars. For a hundred years, Europe tore itself apart in some of the most brutal ways imaginable – until finally, from the burning wreckage, we drew forth this amazing piece of alien machinery. A machine that, when tuned just right, let people live together peacefully without doing the “kill people for being Protestant” thing. Popular historical strategies for dealing with differences have included: brutally enforced conformity, brutally efficient genocide, and making sure to keep the alien machine tuned really really carefully.

And when I see someone try to smash this machinery with a sledgehammer, it’s usually followed by an appeal to “but racists!”
Across the developed world, citizens are revolting against the regulated rich (bankers, lawyers, doctors and everyone else whose access to wealth is regulated by the government) and the protected powerful (the bureaucrats writing the regulations). This is an issue of vested interests, a structural deficit in democracy, and self-annointed elite dehumanizing their less fortunate fellow citizens in order to pursue policies beneficial to the regulated rich and the protected powerful.

This isn't about ignorance and racism, deplorables and bitter clingers. This is about empathy, understanding, and a capacity to comprehend the rational desires of one's fellow citizens.

The problem in the first half is the solution in the second half! You can't have it both ways.

From "Inkblot" is the wrong meme for the gerrymandering problem in the case the Supreme Court is looking at. by Ann Althouse. Althouse is a retired constitutional law professor who is accustomed to reading texts in a critical and detailed manner. Most of us vacuum up words like a baleen whale does krill. We don't distinguish the individual words but get a general sense.

Althouse looks at every word no matter what she is reading - a law, an article, a song, literature.

That detailed critical reading sometimes pays off. In this article she shines light on the incoherence of a NYT article, Gerrymandering Case Echoes in Inkblot-Like Districts Across the U.S. by Michael Cooper.

Gerrymandering is a favorite bugbear for reformers on both sides of the aisle, a position I long shared. And still do to an extent. What has changed for me is that I still think gerrymandering to be a vile effort at manipulating power but I am now more inclined to suspect that it is not strategically as consequential as I once believed.

There are three articles of faith in gerrymandering conversations. 1) Gerrymandering is real. 2) Gerrymandering is effective at changing the voting outcomes. 3) Gerrymandering is an evil exclusively perpetrated by the other party.

We know gerrymandering is real though its extensiveness is disputed.

We know that both parties gerrymander.

What has changed in the past twenty years are new questions arising as to whether it makes much of a difference. The gerrymandering forced by the Civil Rights Act has been effective at ensuring greater racial representation in Congress than might otherwise have been the case. However, since the African American vote is overwhelmingly a Democratic Party vote, the Civil Rights Act gerrymandering is simply constitutionally sanctioned political gerrymandering.

While all partisans believes gerrymandering works, there hasn't until recent years, been much of a capacity to test that assumption. However, with the increasing power of computers and access to voting data, researchers in recent years have been able to run simulations that allow us to answer the question about effectiveness.

Obviously any outcome makes a difference to an individual candidate and the voters for that position but that doesn't determine whether it makes a difference in the aggregate.

What researchers have done is used actual party affiliation and voting patterns at a polling station level and run those numbers against randomly generated districts and compared the results. What they have found is that when you compare actual party counts from gerrymandered districts against thousands of randomly generated districts, in aggregate the differences in outcome are minute: 1-5% in most of the research I have seen.

Again, I am not discounting that gerrymandering throws districts towards one party or another and that in particular circumstances a 1% difference can swing things one direction or another. However, the great bulk of the electorate live in largely homogenous areas and therefore only a few voting districts are routinely competitive between the parties and in only a few of those competitive districts does it appear that gerrymandering influences the outcome at all.

We are investing a lot of effort fighting over gerrymandering and yet the evidence seems to suggest that, while real, it simply doesn't influence the outcomes in a predictable or material way.

Which is all backdrop to the actual NYT article Althouse is dissecting.

The NYT is a solidly Democratic Party organization and so in their worldview, gerrymandering is done excessively by Republicans to the detriment of Democrats and they want it stopped. In this instance, Cooper has accidentally gotten himself tangled up. Most criticisms of gerrymandering hinge on the appearance of a district shape - is it an incomprehensible mutant (gerrymandered) or is it compact, following terrain and geography (not-gerrymandered). This is simplistic heuristic as gerrymandering is the manipulation of voter headcount to an predictable outcome. The fact that in order to get the headcount numbers to work the geographical map may look peculiar is incidental to the actual targeted event (headcount manipulation.)

Cooper mistakes the visual evidence of gerrymandering with the actuality of gerrymandering. He starts with an instance in Pennsylvania where there are all sorts of Republican gerrymandered districts with very odd shapes and extended forms.
A Rorschach-test inkblot of a district that has been likened to “Goofy Kicking Donald Duck,” this district meanders through five counties and is so narrow in parts that it is only the width of a restaurant in King of Prussia and of an endoscopy center in Coatesville
For Cooper, gerrymandering in Pennsylvania is bad because it is being done by Republicans and it leads to weirdly shaped districts.

In contrast, in Wisconsin, the gerrymandering is bad because it is done by Republicans and it leads to compactly shaped voting districts.
Indeed, one of the defenses made by Wisconsin officials is that their districts are compact.

[snip]

“They don’t look bizarre,” William Whitford, one of the Democratic plaintiffs suing over the Wisconsin map, said Monday on a conference call with reporters. “But if you really know the Wisconsin political geography — and that’s a learning curve! — they are bizarre.”
As Althouse points out:
Did the NYT not notice that the article is insane? The problem in the first half is the solution in the second half! You can't have it both ways. Which is kind of why the Supreme Court hasn't figured out what to do with these cases (other than to allow the litigation to proceed, which is some sort of deterrent to the most aggressively partisan gerrymandering).
You could easily gloss over the self-contradicting argument Cooper makes. Althouse is much more attendant to the particulars of the argument which is presumably what makes her a good constitutional lawyer.


Thursday, June 22, 2017

Postmodernism - its foul pestilential breath infected every youthful ambition.

The Satyricon by Petronius, translated by J.P. Sullivan. Sound like the lamentations about the corruption of academics and the decline in our magnificent universities? Universities forced into self-disrepute through their cultivation of postmodernist critical theory? This isn't so much a reminder that all is as it ever was. Rather, it is a reminder that across cultures and ages, youthful folly is outgrown.

The opening paragraph.
'Our professors of rhetoric are hag-ridden in the same way, surely, when they shout "I got these wounds fighting for your freedom! This eye I lost for you. Give me a hand to lead me to my children. I am hamstrung, my legs can't support me." We could put up even with this stuff if it were a royal road to eloquence. But the only result of these pompous subjects and this empty thunder of platitudes, is that when young speakers first enter public life they think they have been landed on another planet. I'm sure the reason such young nitwits are produced in our schools is because they have no contact with anything of any use in everyday life. All they get is pirates standing on the beach, dangling manacles, oracles advising sacrifice of three or more virgins during a plague - a mass of cloying verbiage: every word, every move is just so much poppycock.

People fed on this kind of thing have as much chance of learning sense as dishwashers of smelling clean. If you'll pardon my saying so, you are mainly responsible for ruining good speaking. Your smooth and empty sound effects provided a few laughs, and as a result you took the guts out of real oratory, and that was the end of it. Young men were not tied down to the rhetorical exercises when it was Sophocles and Euripides who developed the proper language for them. Academic pendants had not addled their wits when Pindar and the nine lyric poets shrank away from the Homeric style. And apart from the poets I can cite, I certainly cannot see Plato or Demosthenes going in for this sort of training. The elevated, what one might call the pure style, is not full of purple patches and bombast: it is lifted up by its intrinsic beauty. It is not so long since the long-winded spouting of yours travelled from Asia to Athens and its foul pestilential breath infected every youthful ambition. Once the rules go, eloquence loses vigour and voice. In short, who since then has equalled Thucydides or Hyperides in their reputation. Why, not even poetry has shown a spark of life. All forms of literature have been faced with the same diet and lost their chance of a ripe old age. Even the great art of painting has met the same fate since the unscrupulous Egyptians invented short cuts for painters.

Agamemnon, after his own sweat in the classroom, did not allow me to hold forth in the colonnade for longer than himself.

'Young man,' he said, 'your opinion shows extraordinary good taste and you have that extremely rare quality - a love for intellectual merit. So I shall not baffle you with any expertise. Of course teachers are making immemorial concessions with these exercises - they have to humour the madmen. If the speeches they make do not win the approval of their young pupils, as Cicero says, "they will be the only ones in their schools".

[snip]

"What's the answer? It's the parents you should blame. They won't allow their children to be properly controlled. In the first place they sacrifice everything, even their hopes, to their ambition. Then in their over-eagerness they direct these immature intellects into public life. They will tell you that there is no mightier power than oratory and they dress their boys up as orators while they are still drawing their first breath. If only parents would not rush them through their studies! Then young men who are prepared to work would cultivate their minds with solid reading, mould their characters with sensible advice, and prune their words with a stylish pen. They would wait and listen before they tried themselves and they would realize that an adolescent taste is quite worthless. Then the noble art of oratory would have it's true weight and dignity. Boys today are frivolous in school; young men are laughing-stocks in public life; and, the greatest shame of all, even when they are old they refuse to give up the mistakes they learnt earlier.
We've got it all in the Roman first century AD. Dunning-Kruger effect, youthful idiocy, public discourse polluted by the platitudinous, hack professors, debasement of values, decline of the humanities and even helicopter parents.

Home is the sailor, home from the sea

Robert Louis Stevenson wrote the following poem which I love. It was later inscribed as an epitaph on his gravestone.
Requiem
by Robert Louis Stevenson

Under the wide and starry sky
Dig the grave and let me lie:
Glad did I live and gladly die,
And I laid me down with a will.

This be the verse you 'grave for me:
Here he lies where he long'd to be;
Home is the sailor, home from the sea,
And the hunter home from the hill.
I have just discovered that A.E. Housman, another poet I greatly admire, has a similar poem. As best I can tell, Housman wrote this in admiration of, or as a tribute to Stevenson.

Strange that I should have read so much of both their poetry and never have made the connection.
Home Is the Sailor
by A.E. Housman

Home is the sailor, home from sea:
Her far-borne canvas furled
The ship pours shining on the quay
The plunder of the world.

Home is the hunter from the hill:
Fast in the boundless snare
All flesh lies taken at his will
And every fowl of air.

'Tis evening on the moorland free,
The starlit wave is still:
Home is the sailor from the sea,
The hunter from the hill.

Wednesday, June 21, 2017

Are media viewpoints skewed simply because it is more comfortable for them to interview people who are pretty much like themselves?

From Why Ossoff Lost by Molly Ball reporting on yesterday's defeat of Democrat Jon Ossoff in the Georgia District 6 special election, an event blown all out of proportion in terms of its actual significance. Given how much was spent on media advertising (tens of millions) for this very local race, you can't help but wonder whether there wasn't media collusion to make a mountain out of a mole hill. It certainly was financially remunerative to them.

All sorts of digital ink being spilled on this nothing burger.

The only reason to draw attention to Ball's reporting is as an example of how the internet allows a degree of fact checking on reporters which was not possible even ten years ago.

In this case, the checking capability relates to LinkedIn. Ball quotes three Ossoff supporters (Hazel Hunt, Jennifer Orlow, and Jessica Zeigler) and three Karen Handel (the Republican candidate) supporters (Debbie Moscato, Sandy Capparell, and Joe Webb). Given that all six are on LinkedIn, that allows us to do some very basic eye-balling - Are they representative of the electorate? Whether there is any significance to their conformance or divergence from the demographics is an open question. And obviously, six is a non-significant sample. Likely much of the variance might have to do with chance or unconscious bias on the part of the reporter.

The first thing that leaps out is that 83% of the quoted interviewees are women in an electorate that is 50% female. Is that random chance, deliberate bias, or simply an unconscious bias? Don't know, but it is striking.

Age is another striking element - No one is young among the six. Two retirees and four middle-aged.

Profession is another - four of the six are involved in the healthcare field (two each from Democrat and Republican). One is a teacher (Democrat) and only one is from the competitive private sector (a retired IBM executive.) Education and healthcare, two professions highly dependent on government subsidies or regulations. Again, 83% of those interviewed are professionally involved in fields dependent on the whim and largesse of government. That would certainly skew their views and opinions.

Education attainment is also striking - All six are college graduates versus only 30% amongst the electorate at large.

Country of origin is also out of whack - 15% of Americans are foreign born whereas 33% of those interviewed were foreign born. Presumably, given that they were voting in an election, they are now citizens. 66% of the Ossoff supporting interviewees were foreign born.

That's just a ten minute scan with no other searching. Ball's sample of voters is evenly balanced between Republican and Democrat. Other than that, the sample is markedly skewed. Oversampled on female, college education, foreign birth and in professions that are essentially extensions of the government.

I am not intending to bash Molly Ball. I am pretty certain I have read articles of hers before, and given that she writes for the Atlantic, almost certainly she is strongly partisan. But partisanship is not necessarily what comes through from the sampling of interviews. What manifests most strongly is class and identity insularity.

Where are all the high school graduates, the farmers, the blue collar workers, the minimum wage services people, the young, the STEM people, those in the 75% of the economy which is competitive rather than government regulated/influenced?

Ball interviewed people who are in many ways just like her: college educated, female, and in an industry that is tied to government.

Maybe the media is so skewed in their viewpoints because it is easiest to simply talk to people pretty much like themselves, even if they might be on the other side of the political aisle. That would be a pretty strong bubble shaping your view of the world.

AI is the administration of things

From The Administration of Things by Ben Kafka.
“If men never disagreed about the ends of life, if our ancestors had remained undisturbed in the Garden of Eden, the studies to which the Chichele Chair of Social and Political Theory is dedicated could scarcely have been conceived,” Isaiah Berlin told his audience at Oxford when he assumed that position in 1958. Philosophy was at its best when it was being contentious, especially when it was being contentious about the meaning and purpose of our common existence. Too much agreement was an abdication of its ethical responsibility:
Where ends are agreed, the only questions left are those of means, and these are not political, but technical, that is to say, capable of being settled by experts or machines like arguments between engineers or doctors. That is why those who put their faith in some immense, world-transforming phenomenon, like the final triumph of reason or the proletarian revolution, must believe that all political and moral problems can thereby be turned into technological ones. This is the meaning of Saint-Simon’s famous phrase about ‘replacing the government of persons by the administration of things’, and the Marxist prophecies about the withering away of the state and the beginning of the true history of humanity. This outlook is called utopian by those for whom speculation about this condition of perfect social harmony is the play of idle fancy. Nevertheless, a visitor from Mars to any British—or American—university today might perhaps be forgiven if he sustained the impression that its members lived in something very like this innocent and idyllic state, for all the serious attention that is paid to fundamental problems of politics by professional philosophers.
The task of philosophy was not to settle disputes, but to unsettle them, to encourage them, to keep them going. For it was only through disputation that we could resist the rule of experts and machines, the bureaucratic-technocratic society foretold by Saint-Simon and championed by Marx and Engels, a society in which we replace the “government of persons by the administration of things.”

Berlin was hardly alone in his concern about the implications of Saint-Simon’s formula. In Natural Right and History, Leo Strauss argued that “in order to reach his highest stature, man must live in the best kind of society, in the kind of society that is most conducive to human excellence. The classics called the best society the best politeia. By this expression they indicated, first of all, that, in order to be good, society must be civil or political society, a society in which there exists government of men and not merely administration of things.” 3 He reiterated this criticism in a slightly more confused way in The City and Man: “On the basis of the break with Aristotle, one could come to believe in the possibility of a simply rational society, i.e., of a society each member of which would be of necessity perfectly rational so that all would be united by fraternal friendship, and government of men, as distinguished from administration of things, would wither away.” 4

Hannah Arendt was even blunter. After citing Lenin’s assertion that administration in the future would become so simple that even a cook could take charge of it, she remarked, “Obviously, under such circumstances the whole business of politics, Engels’s simplified ‘administration of things’, could be of interest only to a cook, or at best to those ‘mediocre minds’ whom Nietzsche thought best qualified for taking care of public affairs.” 5 Still other mid-century thinkers objected that the administration of things would lead to the thingification of people. Thus Raymond Aron argued that “the totalitarian regimes of the twentieth century have shown that if there is one false notion it is that the administration of things can replace the government of people. It has emerged very clearly that if you want to administer all objects you must control all individuals at the same time.” 6 And in The Coming of Post-Industrial Society, Daniel Bell warned “the administration of things—the substitution of rational judgment for politics—is the hallmark of technocracy.” Or even more succinctly: “In the evolution of technocratic society, things ride men.”
This is from five years ago and echoes the terminology I occasionally use, the distinction between determinists and the tragedians. The determinists, of whom Marx, with all his Iron Laws was one, see man as a malleable input of the social process who can be perfected for purposes of the state. Tragedians view life as contingent on complex and often effectively incomprehensible human processes. Man must remain free to make their own decisions because complexity and uncertainty are universal.

These passages seem to echo some of the visceral fear that many are expressing of AI and the possible displacement of humans from the future integrated system where an increasing portion of decisions are made on our behalf by learning machines. That prospect is the ultimate realization of humans having been displaced by the administration of things.

Tuesday, June 20, 2017

A surprising find from the past

I am clearing out a lot of old research materials and papers that are now digitized. In that process, I came across an article from the Spring 1994 edition of American Scholar, Bourgeois Virtue by Donald McCloskey (now Dierdre McCloskey). McCloskey has written a series of books about the Bourgeois Virtue value system and how it underpins the success of the western world.

What caught my eye was this brief passage from 23 years ago. Of course we see his name everyday now, but he was no shrinking violet even back then.
Donald Trump offends. But for all the envy he has provoked, he is not a thief. He didn't get his millions from aristocratic cattle raids, acclaimed in bardic glory. He made, as he put it in his first book, deals. The deals were voluntary. He didn't use a .38 or a broadsword to get people to agree. He bought the Commodore Hotel low and sold it high because Penn Central, Hyatt Hotels, and the New York City Board of Estimate—and behind them the voters and hotel guests—put the old place at a low value and the new place, trumped up, at a high value. Trump earned a suitably fat profit for seeing that a hotel in a low-value use could be moved into a high-value use. An omniscient central planner would have ordered the same move. Mar-ket capitalism should be defended as the most altruistic of systems, each capitalist working, working, working to help a customer, for pay. Trump does good by doing well.
He was offensive back then, to the great and the good, because he was a real estate developer. McCloskey is pointing out that in that role, he was virtuous - providing people more of what they wanted, even if the elite might wrinkle their noses.

I have wondered, since his election, just how much the revulsion of the Acela Cabal is due to any policy position of Trump, how much is due to the fact that he pitches his deal to ordinary Americans rather than the self-avowed elite, and how much is just longstanding social stigma given that he was a businessman and a developer at that.

Funny to see this passage though given the changed times.

That is a big duck

Among the first headlines I come across this morning: Why Canadians are mad about this huge rubber duck by Andrea Romano. Two responses immediately leap to mind - "The world we live in . . . " and "First world problems."



Monday, June 19, 2017

France has probably produced the most reprehensible coterie of public intellectuals that any country has ever managed

From an in with Dr. Jordan Peterson. My transcription.
What happened in the 1960s, the later 1960s, as far as I can tell, this happened mostly in France, which has probably produced the most reprehensible coterie of public intellectuals that any country has ever managed, is that in the late 1960s when all the student activists had decided that the Marxist revolution wasn't going to occur in the Western world, and had also finally realized that apologizing for the Soviet system was just not going to fly anymore. Given the tens of millions of bodies that had stacked up, they performed a philosophical sleight of hand and transformed the class war into identity politics war. That became extraordinarily popular mostly transmitted through people like Jacque Derrida who became an absolute darling of the Yale English department and had his pernicious doctrines spread throughout North America partly as a consequence of his invasion of Yale. What happened with the postmodernists is that they kept on pedaling their murderous breed of political doctrine under a new guise. Resentful people all over the world fell for it.

Good habits, clear communication, core networks.

A useful case study of decision-making in complex, dynamic multi-causal systems. From A dog bite sent him to the ER. A cascade of missteps nearly killed him. by Sandra G. Boodman.

A dog bite leads to an uncommon infection which in turn leads to a near death outcome along with hearing loss and toe amputations.

The couple are just 50, they are educated professionals, he an industrial engineer and she a university STEM professor.

Other than lacking a spleen (from a car accident in his twenties), he was in good health until bitten by a dog. From that point, his health collapsed over a period of several days. Personal health and healthcare systems are both complex, dynamic multi-causal systems. This occurred in the UK where healthcare is nationalized with the pros (free) and cons (rationed and overburdened) attendant to such a system.

A straight-forward dog bite leading to near death. Here were the things that went wrong, and indeed, most had to go wrong for this multi-causal chain to lead to the outcome that it did. If only one or a few of these things had not happened, the catastrophic outcome would have been avoided.
Patient had no spleen (critical to the immune system and therefore making him especially susceptible to infection).

Patient and spouse were unaware of needing to take special health precautions owing to absence of a spleen.

Patient did not advise doctors that he did not have a spleen in the first few days.

Patient had no routine doctor.

Patient had not had a check-up in years.

Patient did not have any routine immunizations.

Patient was infected with a rare bacterium, not routinely experienced by healthcare practitioners.

Patient waited a day before visiting an urgent care clinic.

Patient declined antibiotic recommended by the clinic.

Clinic did not make clear that the probability of infection was 20% rather than 5% as communicated.

Patient returned to the clinic 24 hours later to be referred to a nearby hospital.

Patient and Clinic did not communicate clearly with one another as to which local hospital he was to go to.

Patient arrived at the emergency room which was overcrowded and had to wait. While waiting, patient's spouse left to take of their dogs. Important as it is often important to have a clear thinking advocate in a hospital environment.

Patient gave an incomplete description of condition to the triage nurse, omitting that he had no spleen, that he had been recently bitten by a dog or that he had been administered a tetanus shot.

Contextual circumstances masked some of the diagnostic clues. Specifically, patient mentioned he was a runner who often have low blood pressure, masking what would have otherwise been a diagnostically significant condition.

Emergency room was so over-crowded that the wait to see a doctor was several hours long without a clear time commitment.

Spouse called another hospital emergency room but their wait down was also several hours.

Patient and spouse did not know patients' normal blood pressure and ignored advice from a paramedic to stay in the emergency room because of the low blood pressure.

Patient and spouse left after several hours without having seen the doctor and without knowing the seriousness of patients' condition.

Patient and spouse waited several more hours before returning to the emergency room.

It was six-days after hospitalization before a specialist with the necessary experience (he had seen a case of the rare bacterium several years before) saw the patient.
By my count, at least 21 things had to go wrong for this outcome.

It is easy to fall into a legalistic or moralistic effort to adjudge whose fault this was. Was it the patient for failing to follow routine basic health maintenance actions (primary care doctor, routine check-ups, up-to-date vaccinations)? Was it poor communication between healthcare providers and patient? Was it disregard for the gravity of the situation by patient and spouse? Was it poor National Health Service administration for underfunding emergency room capacity? Was it poor emergency room diagnostic practices? Was it bad luck that contextual circumstances (running) masked the health conditions?

Yes, all these contributed and more. It is a dynamic, complex, multi-causal system.

The interesting question when dealing with a dynamic, complex, multi-causal system is not so much whose fault it is as what are the changes that could have been made to avoid the bad outcome. Whatever those changes, they might or might not be feasible or affordable in a resource constrained environment, but that is a choice.

It is, I think, important to acknowledge that the patient and spouse did at least one thing right, given the probabilities involved. There is no inherent reason to assume that a routine dog bite is a serious matter. They did exactly the right thing in terms of waiting an amount of time before they could see that there were complications, they were right to start at a clinic. They were right to attend the emergency room. The escalation protocol makes sense.

What is especially alarming about this case is that the patient and spouse, given their professions, are almost certainly from the upper quintile in terms of intelligence, competence, experience, capability, etc. If the system can fail this catastrophically for them, what does that bode for the other 80%?

Of course, this is an extreme example and says nothing about the overall healthcare system effectiveness (that's a different discussion.) But it is striking that at least 21 process failures not only had to occur but did occur. Nearly every one of the failures was not unreasonable in its context. It is nearly impossible to design a human system with zero quality defects.

There is not enough information in the article to do a detailed process analysis but the reality, I suspect, is that there are few improvements that are feasible, affordable and would make a material difference in aggregate. Perhaps it is not process improvements where we ought to focus but rather more strategic issues.

Three things stand out from this case to me. The first is that the couple might have avoided much of this complication had they followed basic routine health practices (primary-doctor, routine check-ups and up-to-date vaccinations). Had they done that, patient likely would have been more alert to the risk represented by not having a spleen and would have communicated that more clearly and earlier.

The second is the importance of clear, accurate, and timely communication. Had this occurred at various stages, again the outcome might have been circumvented.

The third is the importance of advocacy within an emergency room or hospital environment. Constrained, high tension, dynamic, complex, multi-causal systems are difficult to navigate at the best of times. If you are in ill-health, you really need someone else to manage that for you. Your social network (usually anchored in your family) needs to be robust enough that someone is there as your advocate when you need them.

Strategically that suggests that process deficiencies can be mitigated by good habits, clear communication, core networks.