Category Archives: health

If The Scots Can Do This, Why Can’t We?

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A November report in the BBC News indicates that a solar-powered boat has been developed and launched in the Philippines. http://tinyurl.com/52vyjys4

Aside: [I Googled this story and found no indication of coverage by any major U.S. news outlet online or otherwise.]

This is a solar-powered version of the “banca” boat, a traditional vessel typically made of wood and powered by a diesel engine, notorious polluters.

Stromness-based Aquatera, an Orkney company, said this was the first of its kind to be powered by renewables. The banca forms the backbone of coastal communities in the Philippines, providing lifeline sources of food, water, and livelihoods through tourism and fishing.

The new version can carry six passengers and two crew and travel up to five hours with a maximum speed of 11 knots. It has a cold-storage facility for the delivery of perishable goods and temperature-sensitive commodities, such as vaccines, to remote communities.

Ian Hutchison, director of Oceantera, said:

Through this initiative, we plan to work with local businesses, communities, and partners to help establish fossil-fuel-free transportation networks across the Philippines and wider South East [sic] Asia.

The project was included in the Renewable Energy-Powered Marine Transport for Island Communities project, funded by the United States Agency for International Development.

One small step for man ….

Can We Save Ourselves?

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It’s hard to figure out what’s worse: the collapse of the common understanding of how adherence to the U.S. Constitution defines our nation or the collapse of our common understanding of what it’s going take for mankind, as a species, to survive on our dying planet. It’s the classic Hobson’s Choice: both bad.

A recent article (November 2023) in the Washington Post discussed our use and abuse of plastics, the once-miracle material that now threatens to destroy everything. http://tinyurl.com/45cbc7xm  Here are a few mind-numbing facts assembled by Journalist Tatiana Schlossberg, author of “Inconspicuous Consumption: The Environmental Impact You Don’t Know You Have” and the newsletter “News From a Changing Planet:”

Between 1950 and 2021, humanity produced about 11 billion metric tons of virgin plastic — that’s the weight of 110,000 U.S. aircraft carriers. Only about 2 billion tons of this is still in use. The rest — some 8.7 billion tons — is waste: 71 percent has ended up in landfills or somewhere else in the environment, including the ocean; 12 percent has been recycled; 17 percent has been incinerated. At the rate we’re going, global plastic waste will rise 60 percent by 2050.

As things stand, from 2010 to 2050 alone, the world could generate enough to cover all of Manhattan with a pile of plastic more than two miles high.

Microplastics have been found in breast milk and in our blood. Around the world, up to 60 percent of all recycled plastic is collected by waste pickers, often members of poor and marginalized communities, who suffer from inhaling caustic fumes from burning plastic and drinking water heavily contaminated with microplastics.

The author strikes a note of optimism by citing a 175-country agreement in 2022 to “develop a legally binding international treaty to end plastic pollution by 2040.” This is the classic “agreement to agree” scenario, if we can. The author maintains that a combination of a mere nine policies “could reduce annual plastic waste by more than 87 percent.”

I will spare you the agonizing details of what’s possible and let you read for yourself. Then you can decide whether you think any of this will happen. Just note this:

U.N. negotiators just finished meeting again in Nairobi to begin crafting the actual treaty, in hopes of completing it by the end of next year [2024], though progress seems to have stalled, a result of excessive influence from oil and gas industry lobbyists, according to nongovernmental organizations. [emphasis added]

Those folks will no doubt be joined by the likes of Amazon and, in the DC area, Giant Foods, whose packaging practices have zero apparent regard for the efficient use of cardboard and plastic packing materials. As the world’s number-one plastic polluter, we should be able to count on U.S. leadership in this effort to save the planet, but don’t count on it.

It will take, I suggest, a massive public uprising to compel industry to pay attention to this existential threat to the survival of our species. Given everything else going on in American politics right now, such an uprising seems a pure fantasy.

One thing seems certain, when the end comes, it won’t be pretty. The worst dystopian stories you’ve ever read will seem like child’s play. We almost at the irrevocable tipping point on climate change, so add the destruction of the oceans and all the rest and you can begin to imagine what will happen. This is not a movie, and there will be no miraculous “save” just before the end.

On the Precipice

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As we approach with bated breath the change of years on the calendar, the flow of events continues. The calendar is an artificial device invented by humans for counting time but time ticks forward regardless. So, here we are, about to celebrate another “year” lived and with hope, we hope, for a better future for everyone.

Given all that, it’s a good idea to review some things about the recent past that have a large bearing on the near future. For this, I turn to Heather Cox Richardson, brilliant Boston College historian to whose daily newsletter [Letters From an American] I have recently subscribed. I’m pretty sure she’s ok with my repeating her thoughts/information because each issue of the newsletter as a “Share” button at the end with options for email, Twitter, Facebook, and others. And we’re on the same team.

Here are some of HCR’s observations about the Biden administration’s performance:

  • The U.S. economy is stronger than that of any other country in the Group of Seven (G7)—a political and economic forum consisting of Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States, along with the European Union—with higher growth and faster drops in inflation than any other G7 country over the past three years.
  • … growth accelerated to an astonishing 4.9% annualized rate in the third quarter of the year while inflation cooled from 6.4% to 3.1% and the economy added more than 2.5 million jobs.
  • The S&P 500, which is a stock market index of 500 of the largest companies listed on U.S. stock exchanges, ended this year up 24%. The Nasdaq composite index, which focuses on technology stocks, gained more than 40%.
  • … new businesses are starting up at a near-record pace.
  • … holiday sales this year were up 3.1%.
  • Unemployment has remained below 4% for 22 months in a row for the first time since the late 1960s.
  • … unionized workers in the automobile industry, UPS, Hollywood, railroads, and service industries [won] higher wages and other benefits.
  • Real wages have risen faster than inflation, especially for those at the bottom of the economy, whose wages have risen by 4.5% after inflation between 2020 and 2023.
  • the nation has had a record drop in homicides and other categories of violent crime. The only crime that has risen in 2023 is vehicle theft.

One must wonder why this kind of news does not get more attention from at least the so-called Mainstream Media. I get a vast array of news articles from a vast array of sources every day and you would think from the headlines/content of most of them, that the United States is on the brink of economic collapse. I have wondered in other posts why the Democratic Party’s message of progress/achievement/hope is not keeping up with the relentless drumbeat of lies/deceptions/deflections from Donald Trump and his acolytes. I will wonder.

The “new” science of Behavioral Economics [see Kahneman, Thinking Fast and Slow] teaches us about cognitive biases and the influence of salience on how we generalize our understandings of “reality.” To some significant degree, the repetition of the lies and distortions of Trump’s dark vision of America have led many people to believe we are on the precipice of collapse brought on by immigration, socialism, communism, abortion, and transgenderism, etc etc. The facts say otherwise.

That is not to say, obviously, that there are no problems. One of them, that gets too little attention, is our continued dependence on other countries, most notably but not solely China for many vital products, including critical microchips. See https://www.ted.com/talks/rob_toews_ai_s_single_point_of_failure/transcript?user_email_address=f286772a6726b8e7d0d1da2e91e7f0c9 There are many others but the scale of the United States, its history and its attachment to capitalism inevitably cause problems. For an honest explanation of some by a brilliant scholar who believes in capitalism, see Charles Lindblom’s The Market System (2001), as valid today as when written.

So, as we approach the “New Year,” there is much to celebrate and much about which to be concerned. Maybe this is nothing new, but it feels more ominous for reasons I have discussed in other recent posts. For now, just for today, I will desist from worrying and, with Heather Cox Richardson, accept that we have much to appreciate in our current political leadership, that we still have hope because the good guys outnumber the bad guys, and trust that the good guys will, as they have in past, do what must be done as Americans who still believe in our aspiration set out in the Preamble to the Constitution:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

HAPPY NEW YEAR!!

No Way to Run a Government

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USAToday reports that Republican Senator Tuberville’s hold on over 400 military promotions (excluding four-star nominees) has ended. https://tinyurl.com/yeyvkxk5

The former football coach turned U.S. lawmaker in one of the world’s most important deliberative bodies has stymied the promotions for 10 months while trying to force the Pentagon to yield to his desire to stop the Pentagon from giving service members time off and pay for travel to have an abortion. The policy was put into effect after the Supreme Court overturned Roe v. Wade last year.

Thus, we have a government in which a single Senator, one of one hundred, can stymy the earned promotions of hundreds of military personnel vital to the nation’s defense because he, one Senator out of a hundred, objects to a Pentagon policy. Not coincidentally, note that the policy he wanted to thwart directly helps only women. And, of course,

The retired college football coach said he has no regrets blocking the nominations in protest of the Pentagon’s policy.

Of course he has no regrets. The Senator will now try to force the Pentagon to his will by having Republicans in the House, where they have a very slim majority, to force the Pentagon’s hand through the annual defense spending bill. After all, who needs defense when you are trying to impose your religious views on the entire government? Even Mitch McConnell apparently thought Tuberville was off base on this one, calling his action “dangerous.”

Among other preposterous and grossly irresponsible aspects of Tuberville’s blockade was that it led a group of senators to spend five hours in November on the Senate floor trying to secure individual votes on each promotion. Apparently, the great deliberative body had plenty of time on its hands, so no problem jumping through procedural hoops trying to overcome the obstinate resistance of one Senator.

This is no way to run a government. A single legislator, elected by 1,392,076 voters, representing 1.7 percent of the 80,821,083 total votes cast for Senators in 2020, is able to dictate policy to the entire government. I rest my case.

When Will We Learn?

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Two cases in point.

Case One:

The Yale School of Public Health reports that

Some “non-menthol” cigarettes that are being marketed as a “fresh” alternative in states where traditional menthol cigarettes are banned use synthetic chemicals to mimic menthol’s distinct cooling sensations, researchers at Yale and Duke University have found.

The synthetic additives could undermine existing policies and a U.S. Food and Drug Administration ban on menthol cigarettes expected later this year that is intended to discourage new smokers and address the harmful health effects of tobacco use.

https://tinyurl.com/35r7t7wz

….

Hundreds of municipalities across the United States and some states – Massachusetts and California – have already restricted the sale of flavored tobacco products, including menthol cigarettes.

In a study published Oct. 9 in the Journal of the American Medical Association, researchers from the Yale School of Public Health, the Center for Green Chemistry & Green Engineering at Yale, and Duke School of Medicine identified a synthetic flavoring agent known as WS-3 in the newly introduced “non-menthol” cigarettes that delivers similar, or stronger, cooling sensations as menthol but without the minty aroma or taste.

….

Flavored tobacco products such as menthol cigarettes tend to reduce tobacco’s harsh effects making them particularly popular among young people and those just starting to smoke. Historically, menthol cigarettes have also been aggressively marketed towards African Americans, with up to 90% of African Americans who smoke using menthol cigarettes.

It seems likely that this “gap” in the regulatory regime for death-dealing cigarettes results from the regulations being based on specific chemicals rather than on the effects of flavor-enhancing chemicals regardless of type. The lesson to be learned from this, yet again, is that industries looking to make money regardless of impacts on public health will always look for an escape route and finding such routes is always easier when the “thing to avoid” is named rather than relying on the effects of the danger factor or the way it influences behavior.

The historical conduct of the tobacco industry, among others, should be a lesson for governments at all levels that you have to think very deeply about what you’re trying to prevent and how such prevention may be avoided. This doesn’t seem that hard.

Case Two:

The Virginia Highway Use Fee (the “HUF”).

I only recently learned about this assessment even though we bought a highly fuel-efficient hybrid vehicle in late 2020. The fee is not a lot of money, but the purpose of the fee is offensive and counter to other goals, or what should be other goals, as we try to offset some of the worst environmental effects of our dependency on automobiles.

The fee is $25 a year. The Virginia law provides a way of saving, maybe, $5 of the fee but is very complicated and, in my judgment, not worth the effort that involves obtaining another “reader” for your windshield, taking and reporting readings, etc. No thanks. Not to save $5.

More troubling is the motivation for this fee.

According to the Virginia Department of Motor Vehicles,

     You pay the HUF if you register a:

    • Fuel-efficient vehicle, which is a vehicle that has a combined fuel economy of 25 miles per gallon (MPG) or greater
    • Vehicle made in a year in which the average combined MPG rating for all vehicles produced in that year is 25 MPG or greater
    • Low Speed Vehicles, pay an annual $25 HUF

The highway use fee (HUF) helps make up for the fuel taxes that drivers with fuel-efficient and electric vehicles spend less on, because they’re not using as much fuel.

Among the vehicles exempted from the HUF are:

  • Vehicles with a combined MPG rating less than 25 MPG
  • Autocycles
  • Motorcycles
  • Mopeds

The HUF was started in 2020 but in July 2022,

the state launched an alternative program to let drivers pay the fee at a per-mile rate — a cost savings for those who drive less than the average amount, which officials peg at 11,600 miles annually. For drivers of battery-powered cars, that fee works out to a penny per mile. [https://tinyurl.com/yh4kt6tx]

In plain English, Virginia wants to penalize you for using a fuel-efficient vehicle (like a hybrid or fully electric, that, by the way, costs more than a regular gas-using vehicle) by forcing you to pay taxes based on gasoline consumption you don’t use, BUT you can potentially reduce the penalty slightly by signing up for the complex pay-per-mile program.

Or you can have what’s behind Curtain No. 1.

Seriously, this crazy scheme is a product of multiple conflicting forces, including Congress’s failure to increase gas taxes since 1993, the attraction of fuel-efficient vehicles and the inability of states to see the clear alternative of just taxing vehicles sufficiently to provide the revenue they need for road maintenance without depending on gasoline consumption. The current system must be beloved in the hallowed halls of the oil companies as it disincentivizes the purchase of fuel-efficient vehicles.

The more one looks at these systems of regulation, the more our government looks like something created by the Keystone Kops. If you don’t know what they are, see https://en.wikipedia.org/wiki/Keystone_Cops

 

The Music We Cannot Hear

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I have finally finished my slog through the third book by Siddhartha Mukherjee, The Song of the Cell (2022). You may know that Mukherjee won the Pulitzer Prize in 2011 for the extraordinary work, The Emperor of All Maladies: A Biography of Cancer.

I say “slog,” because I understood only a fraction of what I read in this remarkable book and could only take it in small doses. Even then it was a challenge, not because of exposition issues but because I simply cannot understand how scientists know what they know. Much of the story of the cell, which is really a multitude of highly differentiated “things,” has been learned in fairly recent times, but that reality is one of the keys to what I did come to realize as I moved through the astonishing complexities of cell-level biology.

The realization was how most of what we think is known by those who know this stuff is the product of accumulated trial, and sometimes egregious error, by a vast array of people over extended periods of time. Typically, someone in a laboratory somewhere comes up with some idea, inspiration, theory, call it what you will. He (typically a “he,” but thankfully less so over time) works on it, sometimes for years and then, with or without a meaningful or useful conclusion, moves on to other pastures.

Then, and this is the key to the whole story, years, sometimes decades later, some other scientist in a lab somewhere else, or maybe just in a library, finds a paper about the earlier person’s work, decides to take it up for further exploration perhaps with the benefit of intervening developments in the science, expands the theory, tests it and … sometimes … makes a major new discovery. The old idea may be rejected entirely or merely extended with the use of new technologies.

This narrative occurs over and over and over again through time. One discovery or idea builds on another, then is added to by someone else, then another person or entire team takes it up and … discovery occurs. Truth emerges. Theory becomes practice. Concepts become medical solutions to previously unsolvable mysteries of illness. One thing builds on another. Along the way there are many false starts, mis-directions, failed experiments, misunderstandings.

Sometimes the “establishment” rejects out of hand a new idea that challenges the current orthodoxy. Reputations are ruined for some along the way. Some give up and just move on to other subjects until someone else, somewhere, picks up the trail, has a new insight, solves a seemingly unsolvable mystery.

Thus, are born immunotherapy and a multitude of medical “miracles” never conceived of. Transplants of organs become possible. Open heart surgeries. On and on. It’s never easy and there is often resistance to progress. When embryonic stem cells were being investigated,

…critics, mostly from the religious right, would have none of it. They argued that human embryos had been destroyed – defiled – during the production of these cells and that embryos constituted humans. That these IVF [in vitro fertilization]-produced embryos were yet to acquire sentience, had no organs, were no more than a ball of undifferentiated cells that would otherwise have been discarded anyway, hardly placated them; it was their potential to form future humans that made them currently human …. In 2001 President George W. Bush, pressured by opponents of ES cell research, passed a law restricting federal funding to research involving ES cells that had already been derived …; any attempts to make new ES cells could not be federally supported. In Germany and Italy, too, research on human ES cells was highly restricted and, in some cases, banned.

The book touches on other “cutting edge” dilemmas, as well, such as human enhancement through genetic engineering.

But for me, the main story was the way in which science moves forward. Working scientists separated by time and space find each other and each other’s work, building on it and bring humanity the most remarkable discoveries. Not least of these were the vaccines that brought an end, more or less, to the COVID pandemic. At least for now. The work will continue, just as the challenges will continue to come. And the song of the cell will expand into new rhythms, new stanzas, new understandings without end.

Why Are Doctors Not Allowed to Practice Everywhere?

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For reasons I don’t recall, I subscribe to the JAMA Network, which is a monthly medical journal published by the American Medical Association with a large variety of articles about the biomedical sciences. I’m reasonably sure my interest was driven by the pandemic. In any case, much of the contents are beyond my ability to understand. But every so often, I find something compelling either about some disease or, in the present case, about the manner and method by which medicine is practiced in our peculiar collection of regions we call “states.”

The present issue is how we have collectively prevented doctors from counseling patients across state lines into states where they are not “admitted to practice.”

As a retired lawyer, I certainly understand the reason we limit, with a notable exception, unadmitted lawyers from the practice of law in states in which they have not passed the state bar exam. That reason is that the laws of each state often vary significantly, particularly regarding the details of procedure but also in many substantive areas such as estate law. It would be problematic to permit lawyers with no knowledge of those laws and procedures to regularly give advice to clients in those states.

There is, as stated, a notable exception, which is that out-of-state lawyers may appear in trials and some other court proceedings if they associate with “local counsel,” an attorney who is admitted to practice in that jurisdiction. The “foreign” attorney may do all the work, but “local counsel” must sign off on it as assurance to the court that the foreign attorney is complying with local law and procedure.

Turning then to the issue of “foreign” doctors “practicing medicine” by, in modern times, counseling patients using technologies like Zoom for “televisits,” I have wondered for some time why the states restrict this activity. Laws and procedures differ from state to state, but is the science on which medical practice is based different from state to state? I am not aware that it is.

Yet, as reported in Jama Network, https://tinyurl.com/5dab4tcm, Providing Responsible Health Care for Out-of-State Patients:

while exceptions may have been made here and there during the pandemic, the states have returned to their prior position of barring “foreign” doctors from remotely advising patients:

…physicians have increasingly been told by lawyers and compliance officers that calling patients located in another state is a legal gray area and introduces a risk of sanctions. States have accelerated this concern. The New Jersey Attorney General’s Office recently warned out-of-state physicians that, without a New Jersey medical license, “any practice by way of telemedicine, will constitute the unlicensed practice of your profession, and may subject you to administrative and criminal action” (email communication, March 31, 2023). These restrictions are impeding other communications as well. When Virginia ended its temporary pandemic regulations around physician licensure, Johns Hopkins had to inform more than 1000 patients they were no longer eligible to utilize telehealth appointments with its providers.

Physicians given this advice are understandably frustrated because these restraints disrupt and reduce the quality of the care they provide. This is especially true for specialty physicians who serve a broad geographic area and physicians whose practice is near a state border. For example, many states lack any pediatric subspecialists and the majority of the population must travel more than 100 miles.

Notwithstanding the negative consequences for patients who may have a long-standing successful relationship with a doctor in another state where the patient, for example, once lived, state laws say such relationships must end. The law of Texas is typical:

Any “person who is physically located in another jurisdiction but who, through the use of any medium, including an electronic medium, performs an act that is part of a patient care service initiated in this state…that would affect the diagnosis or treatment of the patient, is considered to be engaged in the practice of medicine.

I didn’t know this, but the JAMA article notes that many telemedicine visits are now accomplished by persistent and/or desperate patients who “sit in cars or coffee shops on smartphones, searching for good WiFi and sharing tips about the best parking lots that are just across the state border.”

 These constraints severely inconvenience patients, especially those with serious illness, physical disabilities, or lower income and limited resources; threaten patient privacy; encourage discontinuity of care; and might force private health care conversations to take place in ineffective and public settings.

Have we lost our collective minds?

Not only is this bad for patients, but it places doctors in a precarious legal situation in which the “best” solution for them is simply to “fire the patient.” Every doctor these days carries medical malpractice insurance. Is continuing to advise an out-of-state patient malpractice under those policies? Or is the opposite true, that failing to continue giving needed advice is malpractice? What about the not-unusual situation where the patient cannot reach a local doctor and seeks out his former doctor in the prior state of residence? Should that doctor respond? Not respond? It’s a Hobson’s choice.

The authors of the JAMA article propose several common-sense solutions that, for example, allow for “any follow-up care after a relationship has been appropriately established through in-person or virtual means.” A “bigger” solution would be federal preemption of the field that would override state laws. Examples include expansion of the principles in the Sports Medicine Licensure Clarity Act in which reasonable exceptions for licensure are created to cover clinicians who travel with a sports team to another state and provide care, even if they are not licensed in the state in which the sporting event occurs.

Interestingly, the authors note that:

the delivery of medical care could be defined as being rendered where the physician is located, although that could potentially upend our existing system and impact state licensure authority. Although congressional action would mean the federal government supersedes, or preempts, existing state regulations, the advantage of either federal legislative approach is uniformity and clarity, rather than requiring physicians to navigate through 50 different approaches to the issue.

Indeed, such action would likely face a gauntlet of opposition from local doctors wanting to preserve their “monopoly” on access to local patients, present and future. Therein lies, I believe, the root of this problem. If someone can convince me that medical practice should vary from state to state in the manner of local law, I will confess error. Until then, I will assign “blame” for the present shameful situation on doctor protecting their turf.

If it was medically acceptable to do interstate televisits during the pandemic, then it must be true that there is no medical problem in the post-pandemic period to allow interstate doctor-patient communications as they choose.

This situation cries out for a federal solution. I understand that some states limit medical services such as assistance in death (known as Death with Dignity) which is forbidden in Virginia but allowed in many other states. A federal solution would leave responsibility for knowing such local restrictions to the doctors in question. Beyond that, let them practice their magnificent craft unimpeded by artificial state boundaries and licensure rules designed to protect doctors’ incomes rather than promote the welfare of all patients.

An Appalling Failure of a Great City

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I just posted New York City is Back! https://shiningseausa.com/2023/06/03/new-york-city-is-back/ And it is.

But I remain astonished and appalled that New York City, whose history is bound so closely to the subway system used by millions of people to get around the vast city every year, has failed to address the problem of access for the elderly and physically limited traveler in any meaningful way after all these years.

The passenger-use data tells an interesting story – the subway system consists of more than 6,455 cars that collectively traveled about 331,000,000 miles in 2021 through 472 stations on 665 miles of track. https://tinyurl.com/muksdukt Too big to comprehend but not too big to fail. In 2021, the first year of post-pandemic recovery, about 760,000,000 people rode the rails. While that is an amazing figure, it is less than half the volume that rode in 2016 (nearly 1.8 billion)!

I was forcefully reminded of this on our Memorial Day weekend trip, when, already worn out, we approached the 30thStreet Station in Astoria to find an elevated platform. The only observable means of getting to the train platform was to climb not one but two flights of stairs. I did it but I cannot imagine that many people my age or with other physical limitations could do so.

The 30th Street Station in Astoria is not the only such problem site. Only 98 of the 472 stations (covering all boroughs but not counting the Staten Island Railway) are ADA-accessible. https://new.mta.info/document/25961 Many stations counted as ADA-accessible meet that test in only one direction, or only for some subway lines or only at some times of day.

I understand that adding escalators and elevators would be very costly and, given the physical constraints, could result in reducing stairwell access in some cases. Given the substantial reduction in ridership since 2016, there is no better time to fix this problem than now. I am astounded that the people of New York City put up with this situation for so long and that New York politicians have been able to escape accountability for their failure to require the MTA to act.

I have read that a Judge Approves MTA Deal to Make Subways 95% ADA-Compliant by 2055 as part of a class action settlement [https://tinyurl.com/yc5398d2] but, seriously, by 2055? No doubt this was a victory of sorts, but that deadline, even if met, is 32 years away. The number of New York City residents with some form of disability is close to one million and more than 15 percent are 65 or over. It is unconscionable that their transportation needs have been ignored for so long and still are.

Let’s Hear It For the Women

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Any society that stagnates or retrogresses is unlikely to survive in a digitally unified world. Societies that are moving backward toward what is perceived as “better times back then” are almost certainly doomed in the long run. Cultural and ethnic diversification is a force that may be delayed for a while, even reversed, but not indefinitely. As it happens, one of the moving forces in this country, perhaps the only one that can save it in the long run, is the women. The women who marched for women’s rights, the women who went to work doing “men’s labor” during the last world war. Many of them never went back, mentally, to the “role that women are supposed to occupy.” While some men have not adapted to the new reality of equality, they face an unhappy and unproductive future. The tide of history cannot be stopped. The love affair of white men with male dominance is a mirage. Loss of status hurts. Get over it. Move on. Think of how exciting it is to know intelligent, thoughtful women who believe in themselves and what they can contribute. There is no going back.

Yesterday established that women will not be suppressed. Voters in all five states where there were ballot measures on abortion rights, the right of women to control their own bodies and health decisions, opted for freedom for women. The women have spoken, Republicans. Good for them. Good for all of us.

The Root of All Evil

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A Biblical quotation worked its way into the popular vernacular a long time ago: the love of money is the root of all evil. The quote is often abbreviated to “money is the root of all evil.”  I have no idea whether the attribution to Apostle Paul is correct, but I also don’t care. I don’t believe either version of it is true.

The love of money, like the love of many other things, both physical and otherwise, can certainly lead to problematic outcomes. But the opposite of love can equally lead to problematic outcomes. There are just too many problematic outcomes to assign all the blame on love of money or just on money. When I think about this, I am reminded of the wonderful Robert Frost poem, Fire and Ice:

Some say the world will end in fire,

Some say in ice.

From what I’ve tasted of desire

I hold with those who favor fire.

But if it had to perish twice,

I think I know enough of hate

To say that for destruction ice

Is also great

And would suffice.

In my view, ignorance is the real root of all evil. Donald Trump once said, “I love the poorly educated!” He knew something that had apparently escaped the notice of even experienced political analysts. It’s not that the “poorly educated” are unintelligent. Many of them are quite intelligent and can perform many tasks effectively. They can be successful in many lines of commerce and in life generally.

On the other hand, the “poorly educated” may be susceptible to believing misinformation/false information because they have not been exposed to the discipline of education and have not undertaken to study on their own. But they are not alone in that, so being poorly educated is neither explanation nor excuse, despite Trump’s claimed admiration for them. During the height of the pandemic, we saw nurses and doctors embrace conspiracy theories, promote quack remedies for COVID and resist vaccination. And many members of Congress who support insane conspiracy theories and engage in traitorous and illegal activities are highly educated.

The problem is more complicated than the simple explanation that the “poorly educated” mistakenly thought Trump as president would be good for them. In trying to understand this, I have read numerous books, articles, theories, and studies. Most recently I discovered Strangers in Their Own Land, by Arlie Russell Hochschild, professor emeritum of sociology at the University of California, Berkeley, and the author of many notable books. The book was a 2016 Finalist for the National Book Award. This work is based on her personal research conducted in post-Katrina, post-Deepwater Horizon coastal Louisiana. The date of publication, 2016, was just before Trump was elected president and all that ensued. The book nevertheless seems wholly predictive of everything that followed.

Hochschild defined her mission at the outset as an effort to explore feelings, the “emotion in politics.” Strangers at 15. Some of those feelings were disturbing – she notes that “reminders of the racial divide were everywhere.” Strangers at 20. She did not draw much on that fact of coastal Louisiana life but indirectly seemed to acknowledge its abiding and broad influence on political life there.

Strangers focuses on what Hochschild calls the Great Paradox, stated roughly as the massive disconnect between the economic and life interests of the local people and their devotion to the Tea Party which was in full flower in the period covered. The locals were adamantly opposed to regulation, especially federal regulation, that might help restore the opportunity to continue the livelihoods they had pursued for generations in fishing/hunting/farming the abundant natural resources of coastal Louisiana.

One of the Tea Party’s darlings was Bobby Jindal. As Hochschild notes at the end of the book, Louisiana was left a “shambles” after eight years of Tea Party-style leadership by Governor Jindal. Yet his support among locals never waned. They bought into the capitalism mythology completely. Such devotion also led to support for Republican congressman David Vitter who opposed all federal environmental intervention, voted to terminate the Environmental Protection Agency and more. Strangers at 48.

The author said she was struck by what political candidates avoided in their pitches to voters: “that the state ranks 49th out of 50 on an index of human development, that Louisiana is the second poorest state, that 44 percent of its budget comes from the federal government – the Great Paradox.” Strangers at 59. People with little to begin with worried more about what others were getting (“non-working, non-deserving people”) than about destruction of the environment or years lost to bad health conditions.  Somehow this was seen as a loss of “honor” and that was more important than more tangible issues. Strangers at 60-61.

They knew that Big Oil and Big Chemical had undeniably wrecked the local environment, but they adhered to the mythology that the companies also brought jobs and other economic benefits that could not be secured under any form of regulation. They concluded that the honorable thing was to muddle through, accepting their fate while continuing to assert their” principles.”

Hochschild notes three paths by which Tea Party believers arrived at their profound dislike for the federal government:

their religious faith (the government curtailed the church, they felt),

hatred of taxes (which they saw as too high and too progressive), and

the government’s impact on their loss of honor …. [Strangers at 35]

They bought into the belief that taxes went to lazy welfare cheats and “government workers in cushy jobs.” Id. They thought climate change was bogus science. They resented what they perceived to be bias against the “little guy,” meaning mainly the little white guy, and interference with the role of God in overseeing humanity. Strangers at 52. Those are easy myths for resentful people to embrace without having to make the effort to understand complex systems and ideas. Indeed, for many, the outcome was in the hands of their God and humans thus had little responsibility for outcomes.

In portents of things to come, Hochschild notes that at the Republican Women of Southwest Louisiana meeting,

I heard a great deal about freedom in the sense of freedom to – to talk on your cellphone as you drove a car, to pick up a drive-in daiquiri with straw on the side, to walk about with a loaded gun. But there was almost no talk about freedom from such things as gun violence, car accidents, or toxic pollution. [Strangers at 71]

The perplexing reality is that people living with more pollution are more likely to believe in less regulation and more likely to be Republicans. Strangers at 79. This mental orientation set them up for manipulation and exploitation.

The initial tip to the problem of the book’s analysis comes at the beginning. Hochschild observes that the reason for population shifts in the United States had changed: people moved less to find better jobs, housing or (she didn’t mention this) education but rather to align more closely with people of similar political views. The sharpening of political division is, she says, attributable to the ‘right moving right.’ Strangers at 6-7. She recounts the dire economic conditions afflicting the southern states, Louisiana being among the worst of the worst:

Given such an array of challenges, one might expect people to welcome federal help. In truth, a very large proportion of the yearly budgets of red states – in the case of Louisiana, 44 percent – do come from federal funds. $2,400 is given by the federal government per Louisianan per year.

But Mike S_____ doesn’t welcome that federal money and doubts the science of climate change. “I’ll worry about global warming in fifty years,” he says. Mike loves his state, and he loves the outdoor life. But instead of looking to government, like others in the Tea Party, he turns to the free market. [Strangers at 9]

He turns to the same “free market” exploited by Big Oil and others to wreak havoc on the state that Mike purported to love so much. Thus, again, the Great Paradox.

The other major theme in the book is the Deep Story, the myths by which social groups, or tribes, are developed and sustained. Strangers at 135. Here perhaps is the core principle at work. In coastal Louisiana the Tea Party promoted, and locals accepted, the idea that undeserving people were cutting into the line ahead of hard-working “true Americans.” While their perceptions of race are complex, older whites interviewed by Hochschild saw Blacks especially as a problematic class afflicted by special issues not shared by most white people.

Economic class distinctions tracked race and distinguished between “makers” and “takers,” with the latter being the “line-cutters” supported by the federal government, those people unfairly getting ahead of everyone else. This grievance was at the root of many white Louisianans’ attitudes unrelated to the reality of local social and economic standing. Strangers at Ch. 9, and at 157-159.

Despite noting the data showing that “the higher the exposure to environmental pollution the less worried the individual was about it” [Strangers at 253], Hochschild concludes that the continuation of the Great Paradox is not the result of ignorance. [Id.] But that view is remarkable because it’s not supported by most of the data cited in the book. One of dozens of examples is the belief that 40 percent of all U.S. workers are employed by the federal government. The actual figure at the time was 1.9 percent. Strangers at 161.

Such ignorance of economic reality was at the root of many local people’s vigorous resistance to all forms of regulation. Such interventions could have helped to restore the balance of nature and, along with it, the jobs and environment they claimed to cherish. Yet, by and large, they wanted none of it. Hochschild was aware of this because data in Appendix C to the book was often interspersed in the text to illustrate how the real facts refuted the central myths on which the resistance depended. Peoples’ explanations of their views were rife with classical political myths and massively wrong factual beliefs.

Locals that Hochschild interviewed appeared to believe that a woman’s role was to be completely subordinate to her husband. Strangers at 174. This attitude is consistent with the analysis of “what makes a Republican” in George Lakoff’s 1996 Moral Politics that, controversially, applies principles of cognitive science to politics. As summarized in Wikipedia:

Lakoff argues that the differences in opinions between liberals and conservatives follow from the fact that they subscribe with different strength to two different central metaphors about the relationship of the state to its citizens. Both, he claims, see governance through metaphors of the family.

Conspiratorial thinking was also rampant among Hochschild’s subjects. Few people believed science had made the case for global warming. Strangers at e.g., 183. They did not understand what the lives of the seriously poor were like, rejected much historical truth, adopted phantasmagorical solutions dependent upon the “free market” and adopted what has come to be known more recently as “replacement theory.” Strangers at Ch. 14.

In the end, it seemed to me that the author was profoundly fooled by the mannered façade she experienced in her research with the locals whose “good-hearted acceptance” of her, their “great personal warmth and famous Southern hospitality,” misled her to conclude that

in human terms, the [empathy] wall can easily come down. And issue by issue, there is possibility for practical cooperation. [Strangers at 233]

There is nothing in the buildup to the end of the book or in the data set out throughout it that would support such a conclusion. And, of course, the history under Trump’s presidency is the most profound refutation of the “we can all just get along” thesis. The author’s starry-eyed belief in future harmony and progress was, I believe, a grievous error by a researcher whose approach to her study was primarily based on just talking with locals, eating meals with them, and looking at the surrounding conditions that determine their lives and livelihoods.

The book confirms my suspicions in its treatment of the rise of Trump as a political power.

Three elements had come together. Since 1980, virtually all those I talked with felt on shaky economic ground, a fact that made them brace at the very idea of “redistribution.” The also felt culturally marginalized: their views about abortion, gay marriage, gender roles, race, guns, and the Confederate flag all were held up to ridicule in the national media as backward. And they felt part of a demographic decline; “there are fewer and fewer white Christians like us….”        [Strangers at 221]

Economically, culturally, demographically, politically, you are suddenly a stranger in your own land. The whole context of Louisiana – its companies, its government, its church and media – reinforces that deep story. [Strangersat 222]

Trump, consciously or otherwise, fed this sense of disaffection and loss.

His supporters have been in mourning for a lost way of life Many have become discouraged, others depressed. They yearn to feel pride but instead have felt shame. Their land no longer feels their own. Joined together with others like themselves, they now feel hopeful, joyous, elated … in a state of rapture… no longer strangers in their own land. [Strangers at 225]

Rapture indeed. This degree of magical thinking is beyond imagining: a Pew Research Center 2010 study reported that “41 percent of all Americans believe the Second Coming “probably” or “definitely” will happen by the year 2050.” Strangers at 125. Hochschild labels them “victims without a language of victimhood.” Strangers at 131, a missing element that Donald Trump readily supplied.

My overall conclusion about this book is that the people it discusses suffer from a central fatal flaw: they mistakenly believed that the land belonged to them in the sense that the whole of it was their natural right. Anything that challenged that idea was alien, undermining their sense of “our land.” This, I think, is about as un-American a concept as you will find. It ignores history, economic reality, and the nature of democracy. The root concept that “this land is ours then, now and always,” meaning us God-fearing white people who have an entitlement that others are unjustly trying to steal, fundamentally misunderstands the nature of the country, its origins, and its development.

This issue may be connected to education, but I suspect it’s much deeper than that. The possessory and superiority components of these cultural beliefs leave these people vulnerable to the “it’s ok to hate” message from a demagogue like Donald Trump who lacks any core value system of principles except greed. These people have less to fear from interlopers than from their own ignorance.

The problem, however, is that someone so ignorant is usually unaware of his ignorance and simply feels put upon by the forces of change. He just wants what he thought he had before, notwithstanding that the oil-based economy was a complete fraud on coastal Louisiana society, wrecking the environment while failing to deliver the economic benefits that locals were sure existed. It’s also often true that the ignorant are unwilling to learn; they lack empathy and see others’ gains mainly as their losses.

I don’t want to be told I’m a bad person if I don’t feel sorry for that [sick African child on TV with Christiane Amanpour]” Strangers at 128.

But even those who fancy ourselves as “not ignorant” are capable of delusional thinking. I have confessed multiple times to having fundamentally misunderstood the degree of disfunction in the country. I thought the election of Barack Obama was a sign that, overall, the country had changed. That was wrong.

The essential proof is that despite his record of lies, incompetence and corruption, Trump received 74 million votes in 2020. Joe Biden received many more, of course, but the thinnest of margins remains in both houses of Congress. People with short term concerns about things like inflation, and no or limited understanding of its causes, may drive the country back into an abyss from which democracy may not re-emerge. It can happen here. Only the voters can prevent it.

I heard recently from a reliable source that many young people, in their 20’s and 30’s, may not feel they are much affected by what is happening in politics. That absence of perceived impact often makes them indifferent to the outcome of critical issues. If that is true, we are in even more trouble than I imagined.

Republicans are highly motivated by their grievances and can be expected to turn out in large numbers in the 2022 mid-terms. If Democrats stay home, it’s game over. You have been warned.