Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for February, 2018

Brief Thoughts While Abroad (from Sunday musings…)

Man, if you read pretty much any news item from any viewpoint it certainly sounds like the world is heading to hell in a hand basket. War, terrorism, and murder abound making the world less safe than 10 or 20 or 100 years ago. Life expectancy went down in the U.S.; diseases must be winning the war. We are destroying the planet with the effluent of human existence, and the scourges of poverty oppress and suppress more people to a greater degree as wealth disparity increases worldwide.

It’s enough to make you bag your WOD and belly up to Pizza Hut delivers.

Only none of it is true. Well, except for the increase in wealth disparity that is. Even here it’s important to note that across the world extreme poverty is roughly 25% of what it was just 30 years ago, and real famine now affects less than 1% of the world’s population. 55% of countries now allow their citizens to vote, up from 1% in the 1800′s. 85% of the world’s citizens can read and write. Death from war is 1/4 of what it was in 1980, 1/6 of what is what in 1970, and 1/16 of what it was in the 1950′s.

How about here at home? The homicide rate is down to 5.3/100,000 from 8.5 over the last 3 decades. We are 95% less likely to die on the job, 96% less likely to die in a car crash, and 99% less likely to die in a plane crash over the past century. We work 22 fewer hours per week than 1900, and lose 43 fewer hours to housework. All but the smallest minority of the poor are housed with heat and air conditioning, are not malnourished, and have access to modern “necessities” like the internet.

What about the environment? Aren’t we dooming our planet because of our ever-increasing insults to the land, water, and land? 30 years ago we in the U.S. delivered 20 million tons of sulfur dioxide and 34.5 million tons of particulate matter pollution into the air. Those numbers are now 4 million and 20.6 million despite more people, more production and more miles driven. In 1988 there were 46 major oil spills; in 2016 there were only 5.

My point is simple: the world is NOT getting worse. It is NOT worse than it was in 1990 or 1970 or 1950, it is better. In no way do I wish for you to think that I am telling you that we should be satisfied with this, only that we ought not be working to continue to improve our world from a Henny Penny, the world is falling point of view. Reasonable people can disagree on the effects of disproportionate distribution of wealth on a forward going basis, but any objective evaluation of the progress of the human condition across the globe over the last 30 years must certainly reach the conclusion that the world is better off today.

I have found over the course of my brief moment on this rock that I am simply better at my own tiny contribution to making a tiny slice of the rock better if I am coming from a place of optimism rather than one of despair. Your mileage may vary, and I certainly do not mean to dismiss the negative effects of very personal trauma and challenge. For me what I see is momentum, and a challenge to maintain this very positive momentum.

Offloading info/Work

Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.

Equality and a Just Society

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine. An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists.

Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting. Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least.

A just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled. Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work.

We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

Sunday musings 2/4/18

Sunday musings…Planes, trains and automobiles. Stuck in airports and on tarmacs without real internet connections…

Each year around this time Mrs. bingo and I travel to Mexico, ostensibly for work. Actually, I really do work while I’m here, although it’s easy to pretend I’m just on vacation when it’s 80 degrees and blue sky sunny. Especially with snow in the forecast in The Land. Funny trip in many ways this year, maybe our 5th going to the same hotel. Some of the staff clearly have at least a fuzzy memory of our last visit (Mrs. bingo is nice to everyone!), and although we were in the lap of luxury there was a slightly heightened sense of the country’s culture which seemed to be more evident for some reason.

“When in Rome…” ┬áis an apt sentiment. Cultural sensitivity, being aware of where you are and those things that are just enough different there that you make an effort to avoid inadvertent offense, has gotten easier for me as I’ve gotten older. Wonder why that is? Anyway, I find myself on alert for little ways that I can demonstrate that I’m paying attention. For example, in Mexico your greeting changes with the time of day. “Hi, how are you?” fairly screams “American”, you know?

There are plenty of other examples of course, but the sentiment remains the same: open awareness that it is you who is the outsider, you who are the guest, should bring with it an effort at accommodating the customs of your hosts rather than the other way around. While I happen to be out of the country this is the case if you happen to be visiting a part of your home country that is starkly different from your home town. It’s a very simple kindness, too easy to offer to let the chance go by.

You know…like packing my red, white and blue #12 jersey during my layover in Philly.

I’ll see you next week…

–bingo

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