On happiness and mind control.

On happiness and mind control.

Many of us would like to feel happier.

In the United States, people are having sex less often.  And between alcohol, marijuana, recreational painkillers – not to mention anti-depressants and anti-anxiety medication – we take a lot of drugs. 

Many of us work long hours at jobs we dislike so that we can afford to buy things that promise to fill some of the emptiness inside.  The most lucrative businesses are advertising companies … one of which, Facebook, is designed to make you feel worse so that you’ll be more susceptible to its ads.

The suicide rate has been rising.

From Dan Diamond’s Forbes blog post
Stopping The Growing Risk Of Suicide: How You Can Help.”

It might seem as though we don’t know how to make people happier.  But, actually, we do.

Now, I know that I’ve written previously with bad medical advice, such as the suggestion that intentionally infecting yourself with the brain parasite Toxoplasma gondii could make you happier.  This parasite boosts dopamine levels in your brain (dopamine is a neurotransmitter that conveys feelings of pleasure and mirth) and makes you feel bolder (in controlled laboratory experiments, infected mice show less stress when making risky decisions, and observational data suggests the same to be true for infected humans).  You also might become more attractive (infected rodents have more sex, and portrait photographs of infected human men are perceived as more dominant and masculine).

There are drawbacks to Toxoplasma infection, of course.  Infected rodents are more likely to be killed by cats.  Infected humans may become slower as well, both physically and intellectuallyToxoplasma forms cysts in your brain.  It might increase the chance of developing schizophrenia.  It can kill you if you’re immunocompromised.  And the surest way to contract toxoplasmosis, if incidental exposure hasn’t already done it for you, is by eating cat excrement.

My advice today is different.  No feces required! 

And I’m not suggesting anything illegal.  I mentioned, above, that people in the United States take a lot of drugs.  Several of these boost dopamine levels in your brain.  Cocaine, for instance, is a “dopamine re-uptake inhibitor,” ensuring that any momentary sensation of pleasure will linger, allowing you to feel happy longer.

But cocaine has a nasty side effect of leading to incarceration, especially if the local law enforcement officers decide that your epidermal melanin concentration is too high.  And jail is not a happy place.

Instead, you could make yourself happier with a bit of at-home trepanation, followed by the insertion of an electrode into the nucleus accumbens of your brain.  Now, I know that sounds risky, what with the nucleus accumbens being way down near the base of your brain.  But your brain is rather squishy – although you’ll sheer some cells as you cram a length of conductive wire into your cranium, the hope is that many neurons will be pushed out of the way.

The nucleus accumbens tends to show high activity during pleasure.  For instance, cocaine stimulates activity in this part of your brain.  So does money — tell research subjects that they’ve won a prize and you’ll see this region light up.  If rats are implanted with an electrode that lets them jolt their own nucleus accumbens by pushing a lever, they’ll do it over and over.  Pressing that lever makes them happier than eating, or drinking water, or having sex.  They’ll blissfully self-stimulate until they collapse.  From James Olds’s Science paper, “Self-Stimulation of the Brain”:

If animals with electrodes in the hypothalamus were run for 24 hours or 48 hours consecutively, they continued to respond as long as physiological endurance permitted.

Setup for Olds’s experiment.

Perhaps I should have warned you – amateur brain modification would carry some risks.  Even if you have the tools needed to drill into your own skull without contracting a horrible infection, you don’t want to boost your mood just to die of dehydration.

After all, happiness might have some purpose.  There might be reasons why certain activities – like eating, drinking water, having sex … to say nothing of strolling outdoors, or volunteering to help others – make us feel happy.  After discussing several case studies in their research article “How Happy Is Too Happy,” Matthis Synofzik, Thomas Schlaepfer, and Joseph Fins write that using deep brain stimulation for the “induction of chronic euphoria could also impair the person’s cognitive capacity to respond to reasons about which volitions and preferences are in his or her best interests.

When an activity makes us feel happy, we’re likely to do it again.  That’s how people manage to dedicate their lives to service.  Or get addicted to drugs.

And it’s how brain stimulation could be used for mind control.

If you show me a syringe, I’ll feel nervous.  I don’t particularly like needles.  But if you display that same syringe to an intravenous drug user, you’ll trigger some of the rush of actually shooting up.  The men in my poetry classes have said that they feel all tingly if they even see the word “needle” written in a poem.

For months or years, needles presaged a sudden flush of pleasure.  That linkage was enough for their brains to develop a fondness for the needles themselves.

If you wanted to develop a taste for an unpalatable food, you could do the same thing.  Like bittermelon – I enjoy bittermelons, which have a flavor that’s totally different from anything else I’ve ever eaten, but lots of people loathe them.

Still, if you used deep brain stimulation to trigger pleasure every time a person ate bittermelon, that person would soon enjoy it.

Bittermelon. Image by [cipher] in Tokyo, Japan on Wikimedia.

Or you could make someone fall in love. 

Far more effective than any witch’s potion, that.  Each time your quarry encounters the future beloved, crank up the voltage.  The beloved’s presence will soon be associated with a sense of comfort and pleasure.  And that sensation – stretched out for long enough that the pair can build a set of shared memories – is much of what love is.

Of course, it probably sounds like I’m joking.  You wouldn’t really send jolts of electricity into the core of somebody’s brain so that he’d fall in love with somebody new … right?

Fifty years passed between the discovery of pleasure-inducing deep brain stimulation and its current use as a treatment for depression … precisely because one of the pioneering researchers decided that it was reasonable to use the electrodes as a love potion.

In 1972, Charles Moan and Robert Heath published a scientific paper titled “Septal stimulation for the initiation of heterosexual behavior in a homosexual male.”  Their study subject was a 24-year-old man who had been discharged from the military for homosexuality.  Moan and Heath postulated that the right regimen of electrode stimulation – jolted while watching pornography, or while straddled by a female prostitute whom Moan and Heath hired to visit their lab – might lead this young man to desire physical intimacy with women.

Moan and Heath’s paper is surprisingly salacious:

After about 20 min of such interaction she begun [sic] to mount him, and though he was somewhat reticent he did achieve penetration.  Active intercourse followed during which she had an orgasm that he was apparently able to sense.  He became very excited at this and suggested that they turn over in order that he might assume the initiative.  In this position he often paused to delay orgasm and to increase the duration of the pleasurable experience.  Then, despite the milieu [inside a lab, romping under the appraising eyes of multiple fully-clothed scientists] and the encumbrance of the electrode wires, he successfully ejaculated.  Subsequently, he expressed how much he had enjoyed her and how he hoped that he would have sex with her again in the near future.

The science writer Lone Frank recently published The Pleasure Shock, a meticulously researched book in which she concludes that Heath was unfairly maligned because most people in the 1970s were reticent to believe that consciousness arose from the interaction of perfectly ordinary matter inside our skulls.  Changing a person’s mood with electricity sounds creepy, especially if you think that a mind is an ethereal, inviolable thing.

But it isn’t.

The mind, that is. The mind isn’t an ethereal, inviolable thing.

Zapping new thoughts into somebody’s brain, though, is definitely still understood (by me, at least) to be creepy.

Discussing the contemporary resurgence of electrical brain modification, Frank writes that:

In 2013, economist Ernst Fehr of Zurich University experimented with transcranial direct current stimulation, which sends a weak current through the cranium and is able to influence activity in areas of the brain that lie closest to the skull. 

Fehr had sixty-three research subjects available.  They played a money game in which they each were given a sum and had to take a position on how much they wanted to give an anonymous partner.  In the first round, there were no sanctions from the partner, but in the second series of experiments, the person in question could protest and punish the subject. 

There were two opposing forces at play.  A cultural norm for sharing fairly – that is, equally – and a selfish interest in getting as much as possible for oneself.  Fehr and his people found that the tug of war could be influenced by the right lateral prefrontal cortex.  When the stimulation increased the brain activity, the subjects followed the fairness norm to a higher degree, while they were more inclined to act selfishly when the activity was diminished.

Perhaps the most thought-provoking thing was that the research subjects did not themselves feel any difference.  When they were asked about it, they said their idea of fairness had not changed, while the selfishness of their behavior had changed. 

Apparently, you can fiddle with subtle moral parameters in a person without the person who is manipulated being any the wiser.

The human brain evolved to create elaborate narratives that rationalize our own actions.  As far as our consciousness is concerned, there’s no difference between telling a just so story about a decision we made un-aided, versus explaining a “choice” that we were guided toward by external current.

Frank believes that Heath was a brilliant doctor who sincerely wanted to help patients. 

When bioethicist Carl Elliott reviewed The Pleasure Shock for the New York Review of Books, however, he pointed out that even – perhaps especially – brilliant doctors who sincerely want to help patients can stumble into rampantly unethical behavior.

The problem isn’t just that Heath pulsed electricity into the brain of a homosexual man so that he could ejaculate while fooling around with a woman.  Many of Heath’s patients – who, it’s worth acknowledging, had previously been confined to nightmarish asylums – developed infections from their electrode implantations and died.  Also, Heath knowingly promoted fraudulent research findings because he’d staked his reputation on a particular theory and was loathe to admit that he’d been wrong (not that Heath has been the only professor to perpetuate falsehoods this way).

Elliott concludes that:

Heath was a physician in love with his ideas. 

Psychiatry has seen many men like this.  Heath’s contemporaries include Ewen Cameron, the CIA-funded psychiatrist behind the infamous “psychic driving” studies at McGill University, in which patients were drugged into comas and subjected to repetitive messages or sounds for long periods, and Walter Freeman, the inventor of the icepick lobotomy and its most fervent evangelist.

These men may well have started with the best of intentions.  But in medical research, good intentions can lead to the embalming table.  All it takes is a powerful researcher with a surplus of self-confidence, a supportive institution, and a ready supply of vulnerable subjects.

Heath had them all.

It’s true that using an electrode to stimulate the nucleus accumbens inside your brain can probably make you feel happier.  By way of contrast, reading essays like this one make most people feel less happy.

Sometimes it’s good to feel bad, though.

As Elliott reminds us, a lot of vulnerable people were abused in this research.  A lot of vulnerable people are still treated with cavalier disregard, especially when folks with psychiatric issues are snared by our country’s criminal justice system.  And the torments that we dole upon non-human animals are even worse.

Consider this passage from Frans De Waal’s Mama’s Last Hug, discussing empathy:

[University of Chicago researcher Inbal Ben-Ami Bartal] placed one rat in an enclosure, where it encountered a small transparent container, a bit like a jelly jar.  Squeezed inside it was another rat, locked up, wriggling in distress. 

Not only did the free rat learn how to open a little door to liberate the other, but she was remarkably eager to do so.  Never trained on it, she did so spontaneously. 

Then Bartal challenged her motivation by giving her a choice between two containers, one with chocolate chips – a favorite food that they could easily smell – and another with a trapped companion.  The free rat often rescued her companion first, suggesting that reducing her distress counted more than delicious food.

Is it possible that these rats liberated their companions for companionship?  While one rat is locked up, the other has no chance to play, mate, or groom.  Do they just want to make contact?  While the original study failed to address this question, a different study created a situation where rats could rescue each other without any chance of further interaction.  That they still did so confirmed that the driving force is not a desire to be social. 

Bartal believes it is emotional contagion: rats become distressed when noticing the other’s distress, which spurs them into action. 

Conversely, when Bartal gave her rats an anxiety-reducing drug, turning them into happy hippies, they still knew how to open the little door to reach the chocolate chips, but in their tranquil state, they had no interest in the trapped rat.  They couldn’t care less, showing the sort of emotional blunting of people on Prozac or pain-killers. 

The rats became insensitive to the other’s agony and ceased helping. 

You could feel happier.  We know enough to be able to reach into your mind and change it.  A miniscule flow of electrons is enough to trigger bliss.

But should we do it?  Or use our unhappiness as fuel to change the world instead?

On protest, the Supreme Court, and autocratic minority rule.

On protest, the Supreme Court, and autocratic minority rule.

I was planning an essay on cell phones and surveillance.  The central thesis was that our Supreme Court is a massively flawed institution.  Many of our current Supreme Court justices are both willfully ignorant and opportunistically illogical.  This set of people are not exceptionally knowledgeable, nor are they particularly clever.  But we have given them extraordinary power to shape our world.

I will still write that essay – Carpenter v. United States is definitely worth discussing – but shortly after I prepared my outline, the Supreme Court released a slew of misguided, malicious decisions.  And then Anthony Kennedy – who is already a pretty crummy jurist – announced his resignation.  A narrow-minded ideologue will be nominated to replace him.

Last weekend, people gathered across the country to protest recent developments at our nation’s immigration detention centers.  And I couldn’t help but think that the protesters’ energy and enthusiasm was misdirected.

Screen Shot 2018-07-02 at 2.19.43 PM

Don’t get me wrong – wrenching families apart is awful.  Every citizen of this country should feel ashamed that this is being done on our behalf, and we should want for it to stop.  It’s worth being upset about, both these new developments at immigration detention centers and when families are severed because the parents were incarcerated for semi-volitional medical conditions like drug addiction.

(To be fair, living with addicts is often also horrible.  It’s a point of pride among people in jail if they kept clean while their kids were young.)

In My Brother Moochie, Issac Bailey writes beautifully about the harms suffered by millions of families across the country:

Bailey_BrotherMoochieFINAL-260x390.jpgAs a member of the perpetrator’s family you don’t know what you are allowed to feel, or think.  Victims can mourn, and others will help them mourn.  When prosecutors and pundits talk about justice, they are referring to victims and their families, not families like mine.  Why should anybody give a damn that the ripple effects of crime change our lives, too?  We don’t get to mourn.  We don’t get to reflect, at least not fully, not publicly.

To stand by a man you love after he has done something dastardly is to be accused of having a lack of respect for what the victim has endured.  To demand that he not be known solely by his worst act is to be accused of excusing evil.  To not be there for him would feel like a dereliction of familial duty, a betrayal of the worst order.  To state the truth – that sentencing him to a long stay behind bars would be a devastating blow to your family – is to open yourself up to ridicule and screams of, “He should have thought about that before he decided to kill a man.”

Although the numbers are smaller, what we’re doing at immigration detention centers is worse.  The only “crime” that these people are accused of is fleeing torture, rape, and murder.  They migrated to land controlled by the U.S. government too late – European immigrants already staked claims to territories by murdering the previous inhabitants.  Those prior inhabitants had immigrated from Siberia and staked their claims by murdering dangerous macrofauna and their human competitors.  

All claims of sovereignty, among almost all species, have involved violence.  Even plants strangle their competitors, or steal sunlight, or waft poisons through the air. 

But I digress.  My worry isn’t philosophical.  I’m simply afraid that horrendous abuses of power like what’s happening at the immigration detention centers will become tragically routine. 

Lots of people voted for POTUS45 in the last presidential election, but demography is working against his political party.  Through gerrymandering, a minority party can maintain control over democratically-elected legislative bodies for a long time.  (Indeed, the electoral college is itself a form of gerrymandering, designed as a tool to suppress the influence of liberal northerners.)

But the Supreme Court is an even better tool for minority control.  A mere quintet of hate machines can shape the entire country.  Barring a constitutional amendment imposing term limits, or a wave of Supreme Court assassinations during the next administration, they will.

Given their fundamental misunderstandings regarding terms like “free market,” “privacy,” “speech,” and “person,” it will be pretty horrible.

1024px-Panorama_of_United_States_Supreme_Court_Building_at_Dusk.jpg

On the Bush years, from the perspective of the 45th.

On the Bush years, from the perspective of the 45th.

attheriverofslimeIn Ghostbusters II, the parapsychologists learned that certain words were dangerous.  A strange pink slime burgeoned beneath New York City, bringing with it a wide variety of malevolent spirits.  Every vile, hateful thing that anyone said caused the slime to grow in power.  Let slip too many insults and the muck might expand to engulf the world.

Similarly, our nation is currently helmed by an erratic figurehead that seems to draw strength from every intonation of his name.  During the primaries, and then the general election, much of what was said about our 45th was bad.  But content was irrelevant.  All that mattered was the name.  After all, the name is his key asset.  In the business world, most of his ventures folded, and the empire rebounded from bankruptcy on the value of the name alone, a crisp, bold, status-conferring word to adorn crassly gilded buildings.

And so, even though there is obviously more to write about the state of our nation, K (with the help of some lovely letters to the editor) convinced me to stop using the name.

I’ve also been binging Eliot Weinberger’s essays on my Netflix lately.  (Clarification from K: “By ‘Netflix,’ he means his library card.”)

EliotWeinbergerBW350Until I picked up his Ghosts of Birds, I’d never read anything by Weinberger.  This is tragic, because he’s been publishing phenomenal essays for decades.  “The Falls,” from Karmic Traces, is a brutal compression of three thousand years of racism.  An Elemental Thing is gorgeous throughout its two hundred pages.  Written Reaction is riddled with wry snark and lovely poetry recommendations.

And then there’s 2005’s What Happened Here: Bush Chronicles, which has proven invaluable to me as I attempt to make sense of our nation’s current political situation.

From the opening page:

bushchronicles.jpgAl Gore received some 540,000 more votes than George W. Bush.  Presidential elections, however, are determined by the archaic system of an Electoral College, to which each state sends  representatives who vote according to the will of that state’s voters, nearly always on a winner-takes-all basis.  An 18th-century invention, the College was a last-minute political concession to Southern slave owners when the Constitution was written.  Representatives were apportioned according to population; slaves, of course, could not vote, but they were considered to be three-fifths of a human in the calculations, thus increasing the populations of the slave states and the number of their representatives.

Enlightened now, we have done away with slavery.  We’ve kept the electoral college, though, which continues to suppress the voice of populous urban areas.  And we’ve kept the system of counting voice-less black bodies to inflate the votes of their oppressors: we build prisons in white, rural, Republican-leaning districts.  The prisoners count toward the local population – not the population of whatever district they lived in & will return to – but are not allowed to vote while there.

Stealing representation from prisoners’ home districts matters most for the composition of congress.  But the basic premise of the electoral college – intentionally undercounting urban votes – subverted the will of the American people in 2000, when Gore won by half a million votes, and more egregiously in 2016, when Clinton won by two million.

7301022116_374439c45e_oAwarding the presidency to the losers was constitutional.  Somewhat less so in 2004, when clownish Supreme Court justices with clear conflicts of interest prevented the state of Florida from accurately awarding their votes, but constitutional nonetheless: in Weinberger’s words, “Our Founding Fathers had a limited enthusiasm for democracy.

After the inauguration, though, it didn’t take long for the constitutional egress to begin.  Bush tortured innocent Muslim men.  45 keeps attempting to ban them from our country.  Bush practiced an obscene cronyism.  Here’s Weinberger:

If you drill into Bush’s skull, what you mainly find is a pool of oil.  It’s difficult to understand Bush – especially when he speaks – but it is somewhat easier if one realizes that he sees the whole world exclusively in terms of the production and consumption of oil.

But if you drill to the core of George W. Bush’s being, there is something else, something that seems so hyperbolic, that so smacks of the cliches of old Communist propaganda, that it is hardly believable.  And yet the evidence of his term as the Governor of Texas, and the daily evidence of his presidency, proves that it is true.  Once one clears away the rhetoric that he is handed to read out loud, it is apparent that Bush believes that his role, his only role, as President of the United States is to help his closest friends.

And yet, somehow, 45 has taken this practice further.  Rather than presume that his role in office is to help his friends make money, 45 acts only to help himself.  He uses the presidency as an advertising platform; he badgers corporations that threaten his family brand; he reaps membership fees from wealthy individuals purchasing the opportunity for political contact; he bestows favors on nations where he owns significant properties (note, for instance, which nations were left off his executive orders on immigration).

Of course, neither Bush nor 45 could act alone… but Weinberger has you covered here, too.  Despite being over a decade old, his “Republicans: A Prose Poem” is still tragically relevant.  If anything, a reprise would be even more grim.  The piece is charming, though.  And a lot of fun, with lines like:

George W. Bush, President of the United States, is a Republican.  To demonstrate personal sacrifice and his determination to win the War on Terror, he gave up desserts and candy a few days before he announced the invasion of Iraq.

And yet Bush, despite his unpopularity and incompetence – nominating a governor from a wretchedly polluted state who believed in “voluntary compliance” to run the EPA; inundating the public with lies and misinformation (Weinberger: “Reagan, as everyone knows, was the master of transforming Washington into Hollywood, with his photo opportunities and careful scripts.  Bush has taken this one step further: Whereas Reagan’s scenarios were advertisements meant to promote what he was doing, Bush’s are often heartwarming television vignettes that are the opposite of his actual policies.  Thus we have had Bush in the forest extolling the beauty of the national parks, while opening them up for logging and mining, Bush reading to schoolchildren (as he was yesterday) while cutting the budgets for libraries.  Or, my favorite Bush moment: a speech he gave to something called the Boys and Girls Clubs of America, a community-service group, calling them exemplary of what makes America strong and free.  The next day, his administration completely eliminated their government funds.”); selecting a racist, hateful white southerner to serve as attorney general – was elected to serve a second term.

Address to the Nation on Immigration. Oval.

It’s unlikely Bush could have won in 2004 (after all, he’d lost in 2000, before people even realized what a mockery he’d make of our government) if the 9/11 terrorist attacks had not occurred.

And we’re in a similar situation now.  From Mark Danner’s “What Could He Do”:

we must see the likelihood of a crisis as the vital springboard of a [45] presidency, especially an increasingly shaky, unpopular, and unstable one.  The lower his poll numbers, the more outlandish his lies, the greater the resistance from opponents within the bureaucracies, the thicker his scandals and chaos, the likelier he will be to seek to use a crisis and all the opportunities it offers to lever himself from a position of defensiveness to that of dominating power.

To maintain power, 45 needs the United States to be attacked.  From that perspective, his foreign policies are totally reasonable.  In Danner’s words:

If, as the Islamic State has asserted, the goal of its attacks in the West has been to “eliminate the gray zone” … then [45]’s immigration ban goes far toward accomplishing the same thing: isolating Islamic communities, placing them all among a besieged minority whose travel is restricted and whose loyalty to their adopted countries is put into question. … If one sought to design a policy to encourage radicalization, it would be hard to suggest a better one.

Similarly, why not deliberately offend every other nation.  45 cannot guarantee that his belligerence against Muslims will prompt the attack he so sorely needs.  Every possible “other” who might be molded into a threat is worth pursuing: Muslims, Mexicans, Koreans, Chinese… our own citizens who happen to have more epidermal melanin than 45 himself does… hell, even Australians… any attacker who is not a good white Christian American would do.

But at least we have Eliot Weinberger, writing to warn us.  His words from January 2001, months before the attack:

If the economy sinks, as it probably will, a return to Iraq will certainly be the most expedient distraction.

And Weinberger’s words from September 12th, the day after the attack:

…the logic of George Bush’s seeming cowardice has received some ingenious explication.  Today, administration officials claimed that the terrorist attack was actually an assassination attempt, that the airplane that struck the Pentagon was intended for the White House (but hit the Pentagon by mistake), and that the plane that had crashed in Pennsylvania was somehow supposed to crash into the President’s jet, Air Force One.  I happened to watch these pronouncements on television with a group of 13-year-olds; they all burst into derisive laughter.

That in a time of national crisis – a moment when, amidst waning government powers everywhere, government actually matters – the country is being led by a man laughed at by children may create psychic wounds as severe as those caused by the attack itself.

And, from 2003’s “Poetry is News,” collected in Weinberger’s Oranges & Peanuts for Sale:

The good news about the monstrosity of the Bush administration is that it is so extreme and so out of control that it has finally woken up the left…

On medical spending.

On medical spending.

Trepanation_-_feldbuch-der_wundartzneyBack when doctors were curing headaches by drilling holes through people’s skulls, or slapping on a few leeches to drain out the bad blood when sick patients came stumbling through the door, medical spending wasn’t a big deal.  There weren’t any serious political considerations attached.  If you were wealthy, you might visit a doctor and get yourself killed.  If you were poor, you’d probably go without medical care.  You’d live or die according to the virulence of your disease and the quality of your diet.  Maybe you’d buy a small amulet representing one of the healing saints, or pay a witch to bury herbs in an auspicious location near your house.

I haven’t done an extensive review of the historical data, but to the best of my knowledge no ancient kingdoms were bankrupted trying to provide leeches to all their sick citizens.

Now, though, the situation is different.  Medical care is better.  Doctors know enough that patients receiving care fare significantly better than those left untreated.

There are dramatic economic consequences of improved medical care, though.  Leeches and bloodletting and trapanation were ineffectual, but they were cheap.  Modern medical care actually saves people’s lives, but it comes at a huge cost.  In the United States, health care spending is about a fifth of the total economy, and rising.

US_health_costs_GDP

Albrecht_Dürer_-_Death_and_the_Lansquenet_(NGA_1943.3.3611)Death is scary.  For people who started learning philosophy with Camus (which is not something I’d recommend — this can result in an excessively bleak world view and is probably appropriate only for incurable depressives), inescapable death seems to be the major quandary in our attempt to ascribe meaning to life.

The fear of death fuels medical spending.  Also our spending on biomedical research.  Medical care is pretty great currently, especially if you’re comparing statins and anti-retrovirals and insulin to leeches.  But people still die.  We haven’t reached the singularity yet (thank goodness).

Leeching-largeBiomedical research spending makes the population as a whole sicker, though.  Most research innovations — and certainly the most lucrative ones — are for managing chronic conditions, not curing them.  People who would’ve died — how many leeches do we prescribe for atrial fibrillation? — survive instead, lowering our population’s average health.  And raises average age, since those first few maladies aren’t killing people as often.

It’s not so difficult to imagine that, if these biomedical research trends continue, people might survive until a hundred and fifty, maybe two hundred years old … and health care spending will rise until it’s a third of the U.S. economy, or fifty percent, or more.

That could doom the country.

But the real tragedy, to my mind, is the way that health care money is being spent.

9781250044631I think a passage from Damon Tweedy’s Black Man in a White Coat gives an elegant summary of the problem.  The whole book is great — I’d highly recommend it to anyone who cares about either racial inequality or the U.S. medical industry.  Tweedy’s writing is so compassionate, always looking to describe the best in people even when his narrative compels him to shown them at their worst.

The passage I want to quote appears just after Tweedy describes a preventable medical tragedy brought on by poor lifestyle choices.  Tweedy grabs a hasty meal with some of his colleagues and is still mulling over what more could’ve been done to help the patient.  Ironically, this leads to a conversation about counseling patients to eat better, but Tweedy and the other doctors are scarfing extremely unhealthful meals.

It really is a great book — big-hearted and earnest, with Tweedy always clear-eyed about his own failings.  His descriptions of his own struggles with poor lifestyle choices really dramatize his efforts to address other black men’s unhealthy lifestyles.

(Oh, and, I fixed a minor typographical error in the following quote without marking it — I always think  sic erat scriptum sounds snarky, and Tweedy’s book was good enough that I’d feel like a total jerk if I made him look bad for what was probably someone else’s mistake.)

pizza
Medical doctors should know better than to eat hospiteria (hospital cafeteria) pizza.

I asked them their thoughts on counseling patients about nutrition and exercise.

“That’s the responsibility of his outpatient primary care doctor,” he said.  “We’re here to deal with the life-and-death stuff.”

This focus on biomedical treatment over preventative care is not limited to Duke or similar schools.  Indeed, outpatient primary care physicians — the doctors that Mike felt bore the responsibility for counseling patients on diet and exercise — are often no more inclined than other doctors to have this discussion, even for diseases where these interventions are vital.  There are many barriers, among them money (dietary counseling is reimbursed poorly compared to medical procedures), time (physicians often see patients every ten or fifteen minutes), and the sense that nutrition talk is better left to dieticians, and that doctors should focus on their expertise (prescribing medications, interpreting tests, and performing procedures).  In addition, experience has made many doctors cynical about patient behavior and the likelihood for change.

The tragedy of U.S. health care spending isn’t just that we shovel too much money into it, which limits what we can spend on other, more important causes, but also that we pour huge sums of money into end-stage therapies that don’t increase quality of life nearly as much as cheaper, earlier interventions.

My father-in-law’s treatment is a great example.  By the end of his life, the federal government was spending hundreds of thousands on his care.  Medication for cholesterol and diabetes, high-tech surgery to replace arteries & restore nervous function in his hands after they’d been numbed by diabetic neuropathy, installing an internal defibrillator once his heart began to fail…

Those treatments helped.  Sure.  They kept him alive longer.  He was incredibly happy after the hand surgery — for months he’d been unable to play guitar because he couldn’t feel anything and could barely exert enough pressure to fret the strings, and after that surgery he could play again, invited everyone he knew for another potluck & jam session.

When K dropped her father off after that surgery, she realized our government’s medical spending on him was actually helping dozens of people — all his neighbors were outside waiting to greet him, and once he could use his hands well enough to cook again he resumed baking loaf after loaf of sourdough bread to give to them.

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I couldn’t find an image of any breads that look quite as dense as the whole-wheat loaves Mike used to bake for everyone, but David Jackmanson‘s seems close.

At the same time, our government could’ve brought K’s father — and everyone he helped — more joy by helping him earlier.  They spent nothing on him until his untreated conditions left him too disabled to work.  Only then, and even more so after he reached sixty-five, could he get help.

It’s crummy knowing that he would’ve been happier, and would’ve been able to give more back to his community, if he’d been helped earlier.  His childhood was rotten, but nothing was spent to overcome the scars left from hostile parenting.  Our government didn’t help him get counseling after a traumatic event in his early adulthood, either, and that was the root of so many of his later problems.  A few thousand spent to help him then could’ve kept him from becoming indigent. A few thousand spent on psychiatric counseling then would’ve staved off the need for the hundreds of thousands in medical care that were provided later.

This bizarre state of spending priorities is reflected very clearly in our federal budget.  For instance, there’s no money set aside for universal pre-K education.  This would only cost on the order of $10 billion dollars, though, whereas we spend something like $500 billion on health care for the elderly.  But if our goal is to produce good health, childhood education accomplishes much more than surgery and pharmaceuticals for the elderly.

As Tweedy wrote, simply teaching people to eat better would obviate the need for a significant percentage of our medical spending.  Maybe we’d need to spend some money subsidizing real food so that a better diet was within more people’s reach, but, still… that’s much cheaper than the life-and-death medical care that Tweedy was trained to provide.

After an education worth some hundred thousand dollars, after two decades of hard work & studying on his part, Tweedy served as part of a care team working arduous thirty-hour shifts … all to save people who might’ve stayed away from the hospital entirely if they’d been eating vegetables.

On sex work, reparations, a global wealth tax, and the connection between the three.

On sex work, reparations, a global wealth tax, and the connection between the three.

CaptureMany people are upset that Amnesty International finally came out in favor of decriminalizing sex work.

Not me.  I think decriminalizing sex work is a step in the right direction.  Sex workers’ lives are often miserable.  Their underground status denies them police protection; instead, they are often actively abused by the police.

The philosophical rationale for outlawing sex work is at least more sound than the equivalent rationale for outlawing the drug trade, though.  I’m in favor of decriminalization for both, but in the case of sex work I acknowledge that there are extremely valid reasons to feel squeamish about the tacit approval conferred by decriminalization.

Laws are just only insofar as they protect people.  Driving laws are imminently just — letting people drive however they wanted would endanger the lives of everyone else on or near roadways.  Whereas drug laws appear at first glance to be imminently unjust — if a burnout decides to loaf around his apartment, smoke a jay, watch some television, it would seem that no one else is harmed.

Only two arguments I’ve seen for outlawing drug use have any merit.  One is that a person under the influence of a particular compound cannot be trusted to peacefully loaf in his apartment.  Amphetamine use, for instance, both confers extra energy and impairs judgement (the latter effect is due mostly to lack of sleep, not a pharmacological effect of amphetamines themselves, but I think it’s fair to make this approximation since amphetamines impede sleep.  This is especially true for the methylated analogues because that methylation slows drug metabolism; the half-life is so long that a single dose can prevent someone from sleeping for a day or two).

It’s reasonable to guess that people given free access to amphetamines would become unlawful.

CaptureOf course, we outlawed amphetamines poorly.  They are all scheduled, meaning they are all illegal to purchase or possess without a prescription… but many flavors can be purchased in large quantities with a valid prescription.

In practice, this means that amphetamines are outlawed for poor people.  Wealthy college students and medical doctors and tenure-track professors all have ready access.  So the way amphetamines are outlawed in this country is clearly unjust, and rampant abuse among wealthy populations belies the notion that amphetamines lead to lawless behavior… but as long as you ignore the empirical evidence and just focus on the theory, the philosophical rationale makes sense.

The other argument for outlawing drug use is that compounds are so addictive, and so dangerous, that we should accept some harm to adults (imprisonment, the danger of participating in underground markets) in order to prevent children from ever trying drugs.  Children, knowing that the laws make users’ lives awful, might consider that extra cost and decide that a first taste isn’t worth it.  Additionally, the laws might reduce access, so there’d be less risk that a child ever has an opportunity to choose poorly.

Personally, I think this is a rotten strategy.  There are viable alternatives that allow adult access while still keeping a good or service out of the hands of children.  These strategies also tend to break down in markets for illegal goods or services.  In many regions of our country it is easier for children to buy marijuana than alcohol.  And we now have nearly a half-century’s worth of evidence that harm caused by the War on Drugs outweighs the potential paternalistic protection afforded to children.

The War on Drugs has led to heroin overdoses because illegal goods have limited quality control.  Brutality & murder in impoverished urban areas because people without access to police protection depend upon reprisal to maintain order.  Brutality, murder, rape, kidnapping, terror & more in huge swaths of Mexico, all clearly the result of U.S. drug policy.  And millions of harmless people denied their freedom in U.S. prisons, effectively state-sponsored partial murders because those people forfeit the bulk of their adult lives.

But, again, that’s merely empirical evidence.  None of that contradicts the theoretical justification for outlawing drug use, the idea that some harm to adults is acceptable in order to protect children.  Perhaps our legislators simply care about children’s well-being much more than I do.

(Except, right, they don’t care about children in Mexico.  Or those living in our nation’s dangerous inner cities.  Or those who grow up without access to their incarcerated parents.  But, give our legislators a break!  Empathy fatigue is real!  They can’t be expected to maintain the same degree of concern for everyone.  Shouldn’t they be commended that they at least care deeply about the well-being of privileged suburban children?)

It felt necessary to detail those arguments because they also provide the motivation for outlawing sex work.

The feminist argument resembles the supposition that people allowed to buy drugs will then behave unacceptably.  The idea is that men who are allowed to purchase women’s bodies will devalue women in general.  I’m skeptical, though.  After decriminalization, most bodies will still not be for sale.  No one would be forced to participate in the sex trade.  And just because you can walk into a sparring gym and pay a boxing instructor to let you take some swings at him does not mean that people think it’s fair game to throw down some bills and punch whomever they like.

shutterstock_128676716-800x430It’s true that we live in a very misogynistic culture.  Some misogynists might feel empowered to talk & act even more crudely if they were legally allowed to purchase sex.  But it’s not as though misogynists are currently unable to purchase sex.  And our current system denies sex workers protection against bad actors — decriminalization would confer dignity and allow them to demand more respectful treatment from their clientele.

And there is a serious problem with the “increase the cost of participation in the sex trade to protect people from it” argument.  A major reason why people need to be protected from joining the trade is that it is illegal.  Decriminalization would reduce the dangers.  And even though current laws against sex work increase the cost of participation, there are still many people willing to pay that cost.  There are individuals who want to buy sex.  There are desperate people who need money.  Ironically, the laws against sex work even reduce the amount of money that the latter group can earn.

(Some economics in brief: demand for most goods is based on price.  If price increases, demand goes down.  For purchasers of illegal sex, the risk of being caught is an additional cost.  Which means that in every transaction they are paying in both dollars and risk.  If the legal risk were instead zero, the amount of dollars that buyers would be willing to pay for identical services would increase.)

This is where my personal qualms come in, by the way.  I’m willing to believe that some people are genuinely willing to sell sex.  I’ve spoken with several people who enjoy working as massage therapists, and to my mind some types of sex work differ in degree, not in kind, from massage.  A professional uses practiced touch to confer physiological and psychological wellness.

The problem is that people who did not want to but had no other options might also sell sex.

Lydia_Cacho_en_entrevistaI’m in favor of decriminalizing sex work, but I think that if we do decriminalize sex work but make no other changes to the world, the result will be evil.  Women will continue to be hurt in ways resembling those documented by Lydia Cacho in her book Slavery, Inc.  (The book is great — if you care about these issues, it’s well worth a read.  Also, if somebody ever starts printing heroic human rights worker trading cards, I’d definitely nominate Cacho to appear in the first set.)

Without a concurrent effort to address poverty, decriminalizing sex work could reasonably be construed as coercive.  The impoverished might well feel compelled to participate in order to survive.  If people have extremely limited options, making one option more attractive does funnel people into participation.  It wouldn’t be entirely against their will, but survival impetus means it wouldn’t be entirely voluntary either.  Ironically, their near-forced participation would also reduce the amount that all those desperate people could earn from each unwanted act.

(The other side of price equilibrium is based on supply — if supply of a good is high, like if many hungry people have to sell sex to have enough money to eat, the price has to be lowered to move the whole quantity.  Poverty-impelled participants would undermine each other’s wages.)

Part of why this is so crummy is that we have sufficient resources to fix this.  The productivity gains from modern automation and agriculture mean we could probably provide all people with food, shelter, and basic utilities (water will get trickier as time goes on) for free.  The rudiments of survival don’t cost that much relative to modern production capacity.

And a guarantee of subsistence would make the idea of decriminalized sex work much more palatable.  The idea of sex being traded as commerce isn’t so problematic in and of itself — as I mentioned, I see it as being on the same continuum as legal massage… or mosh pits, which also provide paid access to human contact.  The horrors come from people feeling pressured to sell sex in order to survive.

In my opinion, a guaranteed minimum standard of living is also the most practical form for reparations to take.

320px-Ta-Nehisi_CoatesI really enjoyed Ta-Nehisi Coates’s article about reparations (“The Case for Reparations”).  It wasn’t at all pedantic or abstract — which means that I was clearly not the intended audience — but I enjoyed it all the same.  One of his main aims is to show that people alive today have been victimized by the long legacy of racially-motivated abuse in the United States.  Which means reparations would be not only an acknowledgement of long-past wrongs, but would also serve to ameliorate very recent & ongoing harm.

In his article, however, Coates did not address who would pay or how reparations might be fairly distributed.  To my mind those practical considerations are of utmost importance in deciding whether the idea is at all viable.

I think it is.  I think that a global wealth tax used to fund a minimum standard of living for all people is plausible, philosophically justifiable, and would have meaningful economic & psychological consequences for the decedents of oppressed peoples.

I wrote about some of the underlying principles in my previous post about the creepy parallel between gene duplication and oppression — the idea that our cultural & technological heritage is the product of exploitation because subjugation of the world’s many allowed a free-riding few to pursue goals other than subsistence.  This has rough equivalence to the way advancement comes about in evolution — gene duplication produces free-riding DNA sequences that are allowed to drift because the original copy takes care of required function.

But the basic idea behind using a wealth tax to fund reparations is even simpler: wealth begets wealth.  Initial inequalities in distribution (which probably even existed amongst “egalitarian” hunter gatherers) will, over time, magnify into dramatic unfairness.  Wealthy heirs earn far more by renting their property than our hardest workers possibly could via effort alone.

I’m not sure anyone still thinks that communism is a reasonable fix for this, though.  As much as I dislike Ayn Rand’s writing (although it’s fascinating to me that many feminists and conservative Christians both like her books… this despite repeated depictions of Rand’s ideal men sexually assaulting her ideal women and Rand’s clear disdain for Christianity), I agree with some of her arguments against communism.  Knowing that you can’t profit from your efforts saps motivation.  Absolute equality undermines personal value.  And it seems just plain strange to have your net worth instantly decrease whenever a stranger has a child.

345829246_a7434a76dcMore reasonable, to my mind, is a tax on total wealth.  This would not devalue effort because it ignores income; the tax would be based on current holdings.  Taxation at any amount less than the rental income rate would still leave that maxim “wealth begets wealth” untouched… the only change would be that wealth would beget slightly less wealth.  (A reasonable rate of return on wealth right now, like if you buy some certificates of deposit, is about 3%.  Historically 5% is standard, and the largest property holders are often able to attain rates of 8% – 12%.  If you’d like to read a little more about this, you could check out my previous post on wealth tax, automation, & human trafficking.)

A global wealth tax would be philosophically justifiable as an acknowledgement that all current holdings can be traced back through time to violence and oppression.  For instance, no one created land (this isn’t entirely true — China has been constructing islands, and you could argue that draining the weather-buffering swamps in Florida and Louisiana was akin to creating land — but for most places, though most of history, it’s true enough).

It’s pretty easy to see land entitlement as having resulted from violence.  Humans migrated into new territory, killed off the dangerous animals that were there, then were murdered in turn by a new wave of human migrants, who were then murdered by new migrants, over and over until the conquerors were sufficiently powerful to defend their property and stop the cycle of theft.

Or there’s the case of the United States.  Our current wealth reflects our long history as a global superpower, but that history began somewhere.  First European settlers massacred the Native Americans.  Our meteoric rise was then propelled by cotton.  And how was the United States able to dominate the world’s cotton market?

Oh, right.

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Our nation’s rise as an economic superpower was due to the brutal exploitation of black laborers.

Murder of those who resisted their enslavement.  Rape to propagate an imprisoned people.

Because wealth begets wealth, and because economic reparations were never paid, all current wealth in this country can be traced back to that initial evil.  Our nation’s initial prosperity came from sin.  Everyone who enjoys good fortune here today benefits from & is thereby marked by crimes whose reverberations have not ended & will not end on their own.

I’m not saying that no one did honest work later.  Obviously hundreds of millions did.  Your parents presumably did not oppress anyone in order to purchase their house.

But that doesn’t change the legacy.  If they were lucky, your parents received a decent education — their schools’ funding did not materialize wholesale from the aether.  They presumably received a loan to be able to purchase a home (the Coates reparations article has some excellent documentation for historic and contemporary harm perpetuated by both our nation’s banks & federal lending policies).  The original inhabitants of the land on which that home was built were murdered.  The national prosperity that makes that land more valuable than an equivalent parcel elsewhere was bled out of generations of slaves.

It’s too late to seek forgiveness for sins perpetuated against those who are now dead, but economic reparations could serve to make current wealth clean.

There is, of course, the question of who should benefit from reparations.  History is sufficiently tangled that I don’t think any attempt at strict accounting of whose ancestors were harmed & how much would be fruitful.  Nor do I think an accounting of that sort is necessary.  In contemporary times, the most egregious harms result from our failure to provide for the children of the poor — in our country, not only does wealth perpetuate itself, we have policies that go a long way toward guaranteeing that poverty will perpetuate itself as well.

This could be ameliorated by providing all people with a minimum standard of living.  Children can’t learn when they’re hungry. It wouldn’t cost much to offer all students a peanut butter & jelly sandwich (or a calorically-equivalent hypoallergenic meal) at the beginning of each school day.  Instead we let them sit in classrooms with rumbling stomachs & agitated minds and chastise their teachers when they fail.

Children who work long hours to help their parents pay rent (please scroll to the bottom of this article and read the final 10 paragraphs — the rest is good too, but I’ve picked out the most heartbreaking section for you) can’t learn well either.  Even children who simply stay awake worrying what’ll happen to their families are at a major disadvantage.  If you’re worried about having enough money to survive, you can’t really think about anything else (feel free to check out Mani et al.’s “Poverty Impedes Cognitive Function” if you haven’t seen it yet, or see this recent post).

If food & shelter & basic utilities were guaranteed, we’d cut down on those worries.  Poor people would be given room to breathe and think and plan.

(Are you one of those people who likes numbers?  Here is a tiny bit of math to support my claim that this is feasible.  I’d say $500 per month per person is reasonable to provide food, shelter, and utilities — honestly, this amount comes close to cutting it in Bloomington IN, and that’s without any dedicated infrastructure for the project.  For most of the globe, $500 might be a vast overestimate.  With a world population of seven billion, that puts us at needing $3.5 trillion per year if all people wanted to take advantage of the crappy minimum offerings.  Under a twentieth of the gross world product.  And, regarding a wealth tax, it would take approximately a 1.5% tax on wealth holdings to fund that full amount.  That’s well below the historical 5% rate of return for capital.)

This implementation wouldn’t explicitly target blacks.  Maybe that’s a bad thing, because it wouldn’t make the apology aspect of reparations explicit.  This nation, as a collective, has done wrong and should atone for it.  But our nation’s blacks do suffer the slings of poverty more severely than other citizens (largely because we still have policies in place that ensure that they will), so a serious program to address poverty would benefit many who’ve inherited that legacy of mistreatment.  And the impoverished masses in other countries generally reside in areas that were once (or are still) exploited by our world’s now-wealthy nations.  Their plight reflects past theft of their resources.

And, getting back to sex work — many of the problems that will come from decriminalized sex work would not arise in a world with guaranteed subsistence.

People might feel compelled to sell sex against their wishes if the practice is decriminalized and they need money to survive but have no other way of obtaining it.  Many of the current ails of sex workers result from their criminal status.  But without addressing poverty, it is likely that sex workers will still be denied police protection because they’ll still be considered criminals.  Instead of being criminals by virtue of being sex workers, they’ll be considered criminals because of immigration status.  Impoverished people have long been trafficked to regions with decriminalized sex work and held hostage by the threat of fines, deportation, and reprisal against their families.

5611594783_8e9a533564_bWhich obviously sounds grim.  But I don’t think those are inherent consequences of decriminalized sex work.  Those are the consequences of impoverished desperation amongst people with few options.  Similar economic motivations underlie participation in unethical organ markets (which I wrote about for my first post to this website).

Still, I’d like to thank Amnesty International.  Their advocacy for decriminalization is sorely needed.  But I expect to hear many more horror stories akin to those documented in Cacho’s book unless we make a sincere effort to combat poverty.  Micro-loans or not-quite-enough-to-live-on food allotments are not going to cut it.  People need to know that they’ll at least survive if something goes wrong.

Also, how did I type up this whole post without including the Balzac epigraph from Mario Puzo’s The Godfather?  I’ll include it here — please pretend you read it earlier, to punctuate any of the above paragraphs where it would’ve been appropriate.

“Behind every great fortune there is a crime.”