Links: Annie Duke and probability, Joyce Carol Oates being herself, free speech, and more!

* “Annie Duke on Poker, Probabilities, and How We Make Decisions.” Often hilarious.

* The Unruly Genius of Joyce Carol Oates.

* “China Suppression Of Uighur Minorities Meets U.N. Definition Of Genocide, Report Says.” Yet this gets almost no play among the culture-war people. Why not?

* ‘A Preventable Catastrophe’, by James Fallows, and a deeply reported and extremely distressing article about what went wrong with the United States’s COVID response, or lack thereof. This is perhaps the most distressing part:

“China is a very hard target,” a man who recently worked in an intelligence organization told me. “We have to be very deliberate about what we focus on”—which in normal times would be military developments or suspected espionage threats. “The bottom line is that for a place like Wuhan, you really are going to rely on open-source or informal leads.” During the Obama administration, the U.S. had negotiated to have its observers stationed in many cities across China, through a program called Predict. But the Trump administration did not fill those positions, including in Wuhan. This meant that no one was on site to learn about, for instance, the unexplained closure on January 1 of the city’s main downtown Huanan Seafood Wholesale Market, a so-called wet market where wild animals, live or already killed, were on sale along with fish and domesticated animals. It was at this market that the first animal-to-human transfer of the virus is generally thought to have occurred, probably from a bat. But by that time, as Marisa Taylor of Reuters first reported, the Trump administration had removed dozens of CDC representatives in China.

We had the opportunity to have eyes and ears on the ground, we fumbled it. Long-time readers may remember this. At the time I didn’t specify a pandemic as a or the likely reason why the individual in question was (and is) unfit, but the pandemic response is in keeping with what’s written there. One of the best long-term things the U.S. can do is inflict severe brain drain on China, and yet we’re now doing the exact opposite.

* More China news: “Did a Chinese Hack Kill Canada’s Greatest Tech Company? Nortel was once a world leader in wireless technology. Then came a hack and the rise of Huawei.” On the other hand, from the Hacker News comments: “I interned at Nortel in early 2000’s right before it all went down. I can tell you the engineering culture was rotten within. No-one was doing anything useful for years. Many orgs were built around milking the ancient layer 2 passport switch. The layer 3 router meant to compete with Cisco was 3 years late and only sold a few dozen units. There was accounting fraud going on at the highest level – delivery trucks circles around to pad the books.”

* “Conflict culture is making social unsocial.” Maybe getting off social media will, or can, help?

* Boom’s supersonic jets are ready for rollout, one hopes.

* What the police really believe.

* The movie Starship Troopers is still very good and germane, though it wasn’t understood when it was released. Art endures.

* “A Land of Monopolists: From Portable Toilets to Mixed Martial Arts: Private equity ‘roll-ups’ hit virtually everything in the economy, from mail sorting software to mixed martial arts to portable toilets to dentists.” One of these stories that, if accurate,

* An ugly story, on Twitter, about “cancel culture.”

* “Imagine a future without cars.” NYC could be the leader in this, but many other cities could follow, if they really wanted to.

* Black Death, COVID, and Why We Keep Telling the Myth of a Renaissance Golden Age and Bad Middle Ages.

Links: Cultures that build, culture more generally, love, lifeguards, thinking, and more!

* On Cultures That Build. This blog, Scholars Stage, has been consistently interesting on a range of topics for a long time, and so it’s recommended for your RSS feed.

* Useful: “Ramit Sethi talks about how you can just not reply to stuff. It felt rude at first, but then I realized it was ruder to ignore the people I care about to respond to things I didn’t ask for in the first place. Selective ignoring is the key to productivity, I’m afraid.” Notice the word “selective.” If you ignore everything all the time, that’s probably bad. But if you’re “on top of things” you may not be advancing the more important projects.

* 10% less democracy might improve outcomes. Too little voting is bad but too much voting may also be bad.

* “The University Is Like a CD in the Streaming Age.” Maybe. It’s an intriguing analogy I don’t really buy. Also, what percentage of people go mostly for the social and development aspects, as opposed to the learning-things aspect?

* “Can an Unloved Child Learn to Love?” On the ghastly Romanian orphanages. In “Foster Family Agencies (FFAs) and why political rhetoric rarely focuses on child abuse,” I mention that orphanages could conceivably offer a better system than the current foster-care system, but their PR is terrible, due to articles just like this one.

* Boss of the beach, about NYC lifeguards and, more importantly, the dysfunctions of public-sector unions. Seems mostly hilarious in the first half—more hijinks than outright evil—but allowing people to drown is terrible.

* Another quit-lit piece from an academic, or former academic.

* “Much of today’s intelligentsia cannot think.” I’d say that much of it doesn’t even try and, perhaps more vitally, the dopamine hit of social media and the fast regurgitation of pre-digested but possibly wrong ideas is superficially attractive, like drinking pop and eating fast food. There have always been “intelligentsia” who repeat wrong slogans (look at the apologists for the Soviet Union, for example), but the incentives for them to form mobs is higher than it once was. Twitter is worse than blogs! The link below, “The silence is deafening,” also applies fruitfully to this one. It may be that the most intelligent part of the intelligentsia is not the loudest.

* “Cycling, Art, and Utopian Possibilities.”

* Apple and Facebook, an analysis from Ben Thompson at Stratechery; something about Facebook in particular renders most intelligent writers inane or blinkered, and Thompson is the big exception to that principle. I’m not a big Facebook user or fan but that seems a minority taste on my part.

* Oklo, developer of ‘micro’ nuclear reactor, aims to prove environmentalist doubters wrong. More vitally, they seem to be making real progress.

* “Forget Google, time to end the Visa-MasterCard duopoly.”

* Why does DARPA work? Much more interesting than the title may suggest.

* “Losing the Narrative: The Genre Fiction of the Professional Class.” Overstated, yes, but among the most interesting essays I’ve read in a long time, and I read a lot.

* “The silence is deafening,” on why many defaults in social media don’t work and often produce poor outcomes.

Links: Being still, robot food delivery, reading others’s reading, and more!

* Can you be still?.

* The starship food delivery app delivers food via autonomous robots. My guess is that this one isn’t quite ready for primetime but is getting better every year. Learned via The pandemic is bringing us closer to our robot takeout future. We’re not there yet, but we’re starting to see the shape of things to come.

* Shakespeare and Company’s clientele’s book lists. Many “high culture” writers read everything—high, low, in between—as you’d expect.

* Bruce Sterling: Farewell the beyond. He’s been writing his blog for 17 years and is finally—and sadly, in my view—giving it up.

* Studies on slack. High sophistication, lots of unexpected ideas.

* How battery costs fell six-fold in a decade.

* MacOS 10.15: Slow by design. Thankfully I haven’t “upgraded,” although MacOS 10.15 doesn’t seem to be an actual upgrade, to my eye.

* “Elon Musk Is the Hero America Deserves.” SpaceX is getting ready to send astronauts into space: focus on the substance, not the noise.

* Social Anxiety, #MeToo, and Disaster. Not just more of the usual; note: “Rather than counter-productively condemn others for their paranoia, my goal is to deescalate the tensions. ‘Safety first’ is a tempting but dangerous motto. Instead, let us all try to ‘Make risk reasonable again.’ Use moderate caution yourself- and kindly invite others to do the same. Listen to both Anxious and Angry. Side with neither.” Something about social media seems to encourage with-us-or-against-us, false-binary thinking. The culture of “safetyism” that seems to have taken root rarely seems to be questioned.

* “Donald Trump, the Most Unmanly President: Why don’t the president’s supporters hold him to their own standard of masculinity?” Funny venue for this one, too.

* The future of college is online, and it’s cheaper? Maybe.

* Don’t believe the China hype. Maybe, again.

* Millions of abandoned oil wells are leaking methane, a climate menace.

* Dropbox is a total mess. This matches my experience, and Dropbox’s steady bloat and creep has made me keep an eye out for a replacement.

Engineering in the dark: Why American street design is almost uniformly awful.

* Rachel Harmon on policing, a substantive interview and podcast. I’m surprised police unions weren’t mentioned, though, since that seems like an obvious era to reform. I’ve also not seen any localities or state legislatures dissolve any police unions (if I’m wrong on this, let me know). My guess is that legislators think the protests will pass and voters have short memories, but the police unions will continue to be pivotal in local and state elections for years to come. In other police news, the Atlantic finds, The Culture of Policing Is Broken.

* The coming chip wars.

“Why technology will never fix education”

Why technology will never fix education” is a 2015 article that’s also absurdly relevant in the COVID era of distance education, and this paragraph in particular resonates with my teaching experience:

The real obstacle in education remains student motivation. Especially in an age of informational abundance, getting access to knowledge isn’t the bottleneck, mustering the will to master it is. And there, for good or ill, the main carrot of a college education is the certified degree and transcript, and the main stick is social pressure. Most students are seeking credentials that graduate schools and employers will take seriously and an environment in which they’re prodded to do the work. But neither of these things is cheaply available online.

For the last few years, I’ve often asked students to look at their phones’s “Screen Time” (iOS) or “Digital Wellbeing” (Android) apps. These apps measure how much time a person spends using their phone each day, and most students report 3 – 7 hours per day on their phones. The top apps are usually Instagram, SnapChat, and Facebook. Student often laugh bashfully at the sheer number of hours they spend on their phones, and some later confess they’re abashed. I ask the same thing when students tell me how “busy” they are during office hours (no one ever says they’re not busy). So far, both the data and anecdotes I’ve seen or heard support the “ban connected devices in class” position I’ve held for a while. The greatest discipline needed today seems to be the discipline not to stare relentlessly at the phone.

But what happens when class comes from a connected, distraction-laden device?

In my experience so far, the online education experience hasn’t been great, although it went better than I feared, and I think that, as norms shift, we’ll see online education become more effective. But the big hurdle remains motivation, not information. And I too find teaching via Zoom (or similar, presumably) unsatisfying, because it seems that concentration and motivation are harder on it. Perhaps online education is just increasing the distance between highly structured and self-motivated people versus everyone else.

 

A simple solution to peer review problems

Famous computer scientist and Roomba co-founder Rodney Brooks writes about the problems of peer review in academia. He notes that peer review has some important virtues even as the way it’s currently practiced generates many problems and pathologies too. Brooks says, “I don’t have a solution, but I hope my observations here might be interesting to some.” I have a partial solution: researchers “publish” papers to arXiv or similar, then “submit” them to the journal, which conducts peer review. The “journal” is a list of links to papers that it has accepted or verified.

That way, the paper is available to those who find it useful. If a researcher really thinks the peer reviewers are wrong, they can state why, and why they’re leaving it up, despite the critiques. Peer-review reports can be kept anonymous but can also be appended to the paper, so that readers can decide for themselves whether the peer reviewers’ comments are useful or accurate. If a writer wishes to be anonymous, the writer can leave the work as “anonymous” until after it’s been submitted for peer review, which would allow for double-blind peer review to occur.

Server costs for things like simple websites are almost indistinguishable from zero today, and those costs can easily be borne by the universities themselves, which will find them far lower than subscription costs.

What stands in the way? Elsevier and one or two other multi-billion-dollar publishing conglomerates that control the top journals in most fields. These giants want to maintain library fees that amount to thousands of dollars per journal, even if the journal editors are paid minimally, as are peer reviewers and so on. Only the companies make money. Academics live and die based on prestige, so few will deviate from the existing model. Publishing in top journals is essential for hiring, tenure, and promotion (the tenure model also generates a bunch of pathologies in academia, but we’ll ignore those for now).

There are pushes to change the model—the entire University of California system, for example, announced in 2019 that it would “terminate subscriptions with world’s largest scientific publisher in push for open access to publicly funded research.” In my view, all public funding bodies should stipulate that no research funded with public money can be published in closed-access journals, and foundations should do the same. There is no reason for modern research to be hidden behind paywalls.

Coronavirus and the need for urgent research has also pushed biomed and medicine towards the “publish first” model. Peer review seems to be happening after the paper is published in medRxiv or bioRxiv. One hopes these are permanent changes. The problems with the journal model are well known but too little is being done. Or, rather, too little was being done: the urgency of the situation may lead to reform in most fields.

Open journals would be a boon for access and for intellectual diversity. When I was in grad school for English (don’t do that, by the way, I want to reiterate), the peer reviewer reports I got on most of my papers were so bad that they made me realize I was wasting my life trying to break into the field; there is a difference between “negative but fair” and “these people are not worth trying to impress,” and in English lit the latter predominated. In addition, journals took a year, and sometimes years, to publish the papers they accepted, raising the obvious question: if something is so unimportant that it’s acceptable to take years to publish it, why bother? “The Research Bust” explores the relevant implications. No one else in the field seemed to care about its torporous pace or what that implies. Many academics in the humanities have been wringing their hands about the state of the field for years, without engaging in real efforts to fix it, even as professor jobs disappear and undergrads choose other majors. In my view, intellectual honesty and diversity are both important, and yet the current academic system doesn’t properly incentivize or reward either, though it could.

For another take on peer review’s problems, see Andrew Gelman.

Links: Falling birth rates, book reviews as book reviews, space dust, and more!

* “The Secret Lives of Fungi.”

* “A Radical Proposal: Book reviews should review books: Give us more judgement, more opinions and more criticism.” Sure, why not?

* What happens to all that space dust hitting the atmosphere? “An international team found that rooftops and other cityscapes readily collect the extraterrestrial dust in ways that can ease its identification, contrary to science authorities who long pooh-poohed the idea as little more than an urban myth kept alive by amateur astronomers.” We really are all made of stars.

* “Exclusive: Tesla’s secret batteries aim to rework the maths for electric cars and the grid.” Maybe. It does seem that nickel and low-cobalt batteries are coming. The second-life systems are also hugely impressive: one rarely appreciated reason to pick electric vehicles is that their batteries can be repurposed for grid storage when the car itself reaches end-of-life. Over time, “Millions of used electric car batteries will help store energy for the grid,” which sounds good to me.

* Why are American kids treated as a different species from adults? See also Bringing Up Bébé by Druckerman.

* The novel isn’t central the cultural conversation anymore. Why? That said, I think the novel will appeal to people who find a lot of video boring—although that might be a declining segment of the population.

* HN commenter on Huawei’s practice of stealing source code and technology.

* Colleges are deluding themselves. I wonder how Lambda School is doing? Separately, in 2018 one person wrote: “Modern universities are exercises in insanity?” Maybe, although this one is missing a lot, too.

* “If I could bring one thing back to the internet it would be blogs.” Many good lines in this one. Here you all are, too! Making blogs happen.

* “Door dash and pizza arbitrage.” Unexpectedly hilarious.

* Beware of underpriced drugs for covid-19 treatments. Or, put another way, “We must be willing to reward value because today’s prices send signals to future market participants.” Capping profits today means fewer efforts tomorrow: this is a repeated game, not a one-off game.

* Benefits of cutting out sugar.

* U.S. birth rates fall to record low. These articles never mention the way U.S. housing prices have outpaced inflation for years, due to parochial land interests wielding local zoning to increase the value of their property, and the failure of states or the federal government stepping in to stop this practice. At the same time, healthcare costs are bizarre and unpredictable: a few years ago, it cost me a random $4,500 to fix a minor problem on my toe, and none of the podiatrists I talked to were willing to give me a cash fee quote. All of them were deeply interested in my deductible and making sure I hit it. I’d like to see mandatory price transparency in healthcare, but almost no one is pursuing that policy, to the detriment of all of us.

Links: Chestnut trees, oil’s collapse, Adam Tooze, writing, and more!

* “A Satellite Lets Scientists See Antarctica’s Melting Like Never Before.” It’s also possible that Rising CO2 Levels May Trigger Cognitive Impairment. If you haven’t, get an Autopilot home CO2 monitor. My bedroom, when the door is closed, will routinely exceed 3000 ppm CO2—and sometimes 4000 ppm. For reference, humans evolved in an environment of around 220 – 240 ppm. Cognitive decline may set in as soon as 1000 ppm. Have you ever been in a meeting and felt your head start to swim by the end? It might not just be boredom: it might be all the CO2 in the room. Bring your CO2 monitor and be the hero your organization needs.

* Can genetic engineering bring back the chestnut tree? If so, that would be great news: chestnuts produce lots of cheap food and good wood.

* “Oil’s Collapse Is a Geopolitical Reset In Disguise.” Good. If we hasten the move to electric vehicles, low prices could be sustained indefinitely.

* The Early Days of China’s Coronavirus Coverup. If not for Chinese censorship, the rest of the world might have been much better prepared.

* Adam Tooze interviewed on many subjects, including:

the historically unusual decision to have a high-cost lockdown during a pandemic, why he believes in a swoosh-shaped recovery, portents of financial crises in China and the West, which emerging economies are currently most at risk, what Keynes got wrong about the Treaty of Versailles, why the Weimar Republic failed, whether Hitler was a Keynesian, the political and economic prospects of various EU members, his trick to writing a lot, how Twitter encourages him to read more, what he taught executives at BP, and his advice for visiting Germany.

You’ve seen him appear here before.

* The politics of information: Much deeper and more profound than it may at first appear.

* “It’s time to take UFOs seriously. Seriously.” My default bet is still that the recent Navy videos were released deliberately, as part of an underlying (dis)information campaign. But the probability of UFOs being aliens has gone up—from what to what, I can’t quite say, but “up.”

* “World’s Largest Producer of Rubbing Alcohol Can’t Manufacturer Hand Sanitizer.” I don’t want to do a lot of the outrage pieces, but this is indeed outrageous.

* “Our bookless future.” You’ve probably seen similar, but here’s another sample. “Twilight of the Books,” from 2007, is also a fine version of this basic idea.

* “The coming disruption to college.” A bit too rant-y and overstated, but he’s got a point, no? Tyler Cowen also think the crisis on campus is here to stay. The extent to which international students subsidize U.S. higher ed is also well-known in the business and poorly known everywhere else.

* “When Did Humans Become a Burrowing Species? Digging into our drive to tunnel, bore, and head underground.”

* “The Confessions of Marcus Hutchins, the Hacker Who Saved the Internet: At 22, he single-handedly put a stop to the worst cyberattack the world had ever seen. Then he was arrested by the FBI. This is his untold story.” The story is bonkers and amazing, and it’s also waiting to made into a movie.

* Megan Abbott on writing and Dare Me: “I’m not fast. People think I am because I have a lot of books, but I just don’t do anything else.” I watched the TV version of Dare Me and found it pallid compared to the book: the book is narrated from Addy’s perspective, and Beth looms large in Addy’s view. In the TV show, they both seem like angsty, conceited, ridiculous teenagers—not scary or powerful but ridiculous.

Links: Geopolitical shakes, energy still matters, Robert Stone, and more!

* “Xi fears Japan-led manufacturing exodus from China: The year of the metal rat returns every 60 years — and brings calamity with it.”

* The Limits of Clean Energy.

* Higher education economic problems. Some of the framing and political jabs can and should be ignored, but the material points remain.

* Lockdown socialism will collapse. A good post and something too few of us are acknowledging. I think we’re also not admitting that we’re going to see a real standards-of-living reduction.

* The anti-Trump Republicans. We call these “the honest ones.”

* On Robert Stone.

* Gem Fatale, on the movie Uncut Gems. I started Uncut Gems but one of the protagonist’s early decisions seemed so foolish (giving that important item to Garnett, for example) that I quit. Too much shouting, too. Some good scenes. The author of the linked essay is Clancy Martin, who wrote How to Sell. Given Hollywood’s desire to make everything into a movie or TV show, I’m surprised no one has taken up How To Sell.

* We’ve Built Cities We Can’t Afford.

* “Build Cities for Bikes, Buses, and Feet–Not Cars.” Seems obvious. Few people who understand induced demand or the dangers of small particle air pollution believe otherwise.

* It’s time to build for good. Congruent with the above two links.

* 68 bits of advice from Kevin Kelly, who is unusually interesting.

Briefly noted: Inadvertent, Normal People, and Un-wifeable

* Inadvertent (Why I Write), by Karl Ove Knausgaard: Lots of subtle ideas in this one, and those ideas have been stated before, but they’re stated well here: “Literature is not primarily a place for truths, it is the space where truths play out. For the answer to the question —that I write because I am going to die – to have the intended effect, for it to strike one as truth, a space must first be created in which it can be said. That is what writing is: creating a space in which something can be said.” I’m not sure about the run-on in the first sentence, but the idea that literature not being about “truths” (plural), but about being “the space where truths play out” seems accurate: once you get away from the hard truths of math and physics, and get into the squishy contingent truths of jostling human societies, there isn’t “a” truth—there are a bunch of them, many rivalrous with one another, and part of art is the wrangling of those truths.

Finnegans Wake and Mallarmé are mentioned on one page (63), Game of Thrones (64) the next. Why does he keep watching? For emotional ideas, yes, but, also, “What we seek in art is meaning.” Are we seeking that in social media, too? Is Twitter art? Why or why not? The problem with talking about art is that it generates infinitely more talk about art. Or maybe that’s a solution. This book has lots of truths, or, if they’re not truths, idea-generating statements.

* Normal People, by Sally Rooney: It’s a much better book than the first one, Conversations with Friends

There’s much about social power in the novel—”If she wanted, she could make a big show of saying hello to Connell in school. See you this afternoon, she could say, in front of everyone. Undoubtedly it would put him in an awkward position, which is the kind of thing she usually seems to enjoy. But she has never done it,” but most of that social power goes unused. If the protagonists could care less about what other people, who they don’t care about, think of them, they’d get on quite well, but there’d also not be a novel. The bits observing adolescence are sharp, like “Marianne had the sense that her real life was happening somewhere very far away.” “Real life” gets mentioned four times. “Weird” gets used 32 times: there’s nothing worse in modern upwardly mobile life than being “weird,” it seems. I found myself drifting back to thoughts of Peter Thiel’s book Zero To One, where he speculates that part of the reason successful startup founders often are on or seem to be on the autism spectrum is because that enables them to ignore what other people think and pursue novel ideas other people make fun of. Learning to ignore other people might be a very useful skill in a massive, globally connected world where one can come into contacted with ignorant strangers constantly—including the ignorant strangers at school.

Normal People‘s climax—this is not giving anything substantial away—involves Connell getting into an MFA program, no doubt expensive, in New York. It’s like watching the student loan monster, holding a knife, creep up on the protagonist in a Stephen King: Connell is going to end up being 30, with a bunch of degrees but no assets or marketable skills, like many thousands of other “bright” people of his age and class. Somehow, I think this climax is supposed to be a triumph, rather than a tragedy. No one seems to understand that accumulating pricey degrees in one’s 20s is not necessarily a thing to aspire to. It was, maybe, 30 or 40 years ago, but the world has changed.

I read another novel, The Glass House, in which student loans are among the villains, and the student loans that plague so many people of my generation mirror the ponzi scheme propelling and perpetrated by Jonathan Alkaitis. That’s a more realistic depiction of the academic system. In The Glass House, Alkaitis’s job is fraud and Vincent’s job is sex work, although being a trophy wife is never quite described as such. They’re both good novels, but Normal People feels like a fairy tale—not because of love’s triumph, or maybe adulthood’s triumph but because of institutional arrangements, while The Glass House feels grittily real; student loans and attitudes towards schools are the key differentiators.

At the end of Normal People, Marianne is brushing the knots from her hair, but really she’s trying to brush the knots out of her life—which is probably impossible, but worth attempting.

* Un-wifeable by Mandy Stadtmiller: Being at the edges of the celebrity economy sounds really unpleasant—even being in the center doesn’t sound real pleasant. Lots of celebrities have said and written as much, but somehow it sinks in more here, when we’re seeing the sort of person who writes the pointlessly mean celebrity takedowns. The persons doing the takedowns have something poisonous in their own lives and souls, naturally, and Un-wifeable is, among other things, a chronicle of the poison. I have my problems, but next to Stadtmiller’s stories they seem minor.

Some of the lessons are obvious, like “getting drunk is also often bad, particularly around strangers who don’t wish you well.” And not only for Stadtmiller: “How many times have I said cruel things—including to my ex-husband—that I may not even remember because I was in a rage blackout? I need to turn everything around. I cannot continue this cycle of victimization.” One admirable part of this memoir is that Stadtmiller doesn’t primarily cast herself as a victim, which she could have; the temptation was probably there, but she resisted.

New York has no glamor in Un-wifeable, unless perhaps you recognize the various celebrities named. Stadtmiller finishes her decade or so in the city with tons of credit card debt and no family, although she doesn’t seem to want the former and does seem to want the latter. I don’t understand how Stadtmiller drinks as much as she does and writes, though, to be fair I don’t understand how Fitzgerald or Hemingway did either. Drinking and writing are incompatible for me.

A lot of Stadtmiller’s stories are about the downsides of no boundaries. People, and especially children, need boundaries and connections. Stadtmiller lacks the former and that impedes the latter. Her parents are unconventional, to the point that they’ve “studied at the Esalen Institute, birthplace of the human potential movement,” like characters in a Houellebecq novel. Did you read “A Bellow From France” carefully? Have you read Houellebecq? Stadtmiller is a female Houellebecq character, except that instead of giving up and shrugging, she still cares and is struggling against herself (“The column affords me the perfect way to superficially seek love while never exploring the more difficult questions about what true love for oneself and others really takes.”) As a culture, I don’t think we want to explore “the more difficult questions.” I don’t, mostly.

One takeaway might be, “Don’t move to New York if marriage and family are important to you.” Obviously people in New York get married and have families, but the city is not geared for that, and Stadtmiller is pushing against the hardest gear to get herself uphill. Ideally one chooses to do a hard thing the easiest one way can, rather than attempting to do a hard thing made harder by environment.

What’s happening in the hospitals?

And not just in the emergency rooms and intensive care units:

Doctors learn the business of the body, not the business of medicine. But modern health care is an industry with a bottom line measured in dollars, not wellness. As we train, we’re told to “stay in our lane”—an important lane, to be sure—and just worry about being good healers. The rest, the pesky business of how the wheel turns, can be managed by the rapidly expanding pool of administrators. In “staying in our lane,” we don’t feel the insidious ways the business of medicine has eroded the value of the doctor-patient relationship. Instead, patients have become a commodity and physicians a cog. We’re blind to the chaos and danger around us. We might note how focused administrators are on metrics of efficiency and patient satisfaction scores, even if efficiency doesn’t mean quality, and higher patient satisfaction scores are linked to higher overall mortality rate. But we’re hired to provide the services approved by the hospital, and insurers, which is frequently not to our own standards of patient care.

I see this dynamic continuing in the midst of the COVID crisis. As hospitals and politicians continue calling for help in public, the rhetoric has been that there are too few doctors to manage the crisis. They said this even as doctors were fired or told to leave midshift for wearing their own protective equipment. Colleagues who were pointing out dangerous practices for both employees and patients were asked or pressured into leaving. Colleagues who were lower risk and looking for fairly paid work were passed over because other health care workers—who were made to believe there were no other doctors available to work—were being brought in as unpaid labor. They were told there was no money to be found, despite high reported revenues and administrative salaries in the multimillions.

Much more at the link; look for the April 17 entry, which is the most substantive part.

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