Moonflower*
MARY TO JESUS
Dearest Yeshu,
you don’t visit, you don’t write.
Do I even have a son?
I prepared a Passover seder;
all your brothers and sisters came.
Only your place stayed empty.
We waited for you as for Elijah.
Who do you think you are?
The Messiah?
It’s my fault, I know.
Aunt Mattie used to say,
“You’re raising this kid
as if he is God.”
Now look at you —
your bones stick out,
your stomach’s ruined with fast food.
Worse, I hear that you preach,
“Leave your mother and father,
your brother, sister, wife,
and follow me.”
This in the name of God
who you claim is love.
What can anyone know
about forgiveness, love,
except from mother, brother,
father, sister, wife?
You want to practice what you preach?
get married.
That would teach you more
than any fasting in the desert could.
You’re over thirty now —
how come you only have male friends?
and the women who seek you out —
epileptics, sinners, and demoniacs.
People tell me you say,
Let the dead bury the dead.
Has my little boy gone mad?
Don’t you know what family means?
That the room where we gather to eat
is the real Holy of Holies?
Yeshu dear, mothers preach
more than any rabbi ever will.
Mothers know that God is not
up there in blue void of heaven,
but right here with noise and smells.
When I’m cooking, there’s more
religion in the kitchen
than in the temple on a Sabbath.
Or when it rains and your brother
holds his coat over his wife.
When your sister picks up a crying child.
My son, you said it yourself:
he who doesn’t know love
cannot enter the Kingdom.
Yeshu, come soon. I’ll cook lentil stew,
I’ll bake honey cake
with my secret, a drop of bitter herbs.
Yeshu, this meschugge idea
of having a mission from God
will only get you crucified.
That’s what happens to the sons
who do not listen to their mothers.
~ Oriana
I've chosen this poem because it may be regarded as blasphemy, which I discuss later on in the blog. But the humor here is only a part of the story. The mother also dispenses some real wisdom. The value of blasphemy is proportional to the amount of truth and wisdom it contains.
*
NEARING NINETY BY WILLIAM MAXWELL
~ Out of the corner of my eye I see my 90th birthday approaching. It is one year and six months away. How long after that will I be the person I am now?
I don't yet need a cane but I have a feeling that my table manners have deteriorated. My posture is what you'd expect of someone addicted to sitting in front of a typewriter, but it was always that way. ''Stand up straight,'' my father would say. ''You're all bent over like an old man.'' It didn't bother me then and it doesn't now, though I agree that an erect carriage is a pleasure to see, in someone of any age.
I have regrets but there are not very many of them and, fortunately, I forget what they are. I forget names too, but it is not yet serious. What I am trying to remember and can't, quite often my wife will remember. And vice versa. She is in and out during the day but I know she will be home when evening comes, and so I am never lonely. Long ago, a neighbor in the country, looking at our flower garden, said, ''Children and roses reflect their care.'' This is true of the very old as well.
I am not — I think I am not — afraid of dying. When I was 17 I worked on a farm in southern Wisconsin, near Portage. It was no ordinary farm and not much serious farming was done there, but it had the look of a place that had been lived in, and loved, for a good long time. The farm had come down in that family through several generations, to a woman who was so alive that everything and everybody seemed to revolve around her personality. She lived well into her 90's and then one day told her oldest daughter that she didn't want to live anymore, that she was tired. This remark reconciled me to my own inevitable extinction. I could believe that enough is enough.
Because I actively enjoy sleeping, dreams, the unexplainable dialogues that take place in my head as I am drifting off, all that, I tell myself that lying down to an afternoon nap that goes on and on through eternity is not something to be concerned about. What spoils this pleasant fancy is the recollection that when people are dead they don't read books. This I find unbearable. No Tolstoy, no Chekhov, no Elizabeth Bowen, no Keats, no Rilke. One might as well be --
Before I am ready to call it quits I would like to reread every book I have ever deeply enjoyed, beginning with Jane Austen and going through shelf after shelf of the bookcases, until I arrive at the ''Autobiographies'' of William Butler Yeats. As it is, I read a great deal of the time. I am harder to please, though. I see flaws in masterpieces. Conrad indulging in rhetoric when he would do better to get on with it. I would read all day long and well into the night if there were no other claims on my time. Appointments with doctors, with the dentist. The monthly bank statement. Income tax returns. And because I don't want to turn into a monster, people. Afternoon tea with X, dinner with the Y's. Our social life would be a good deal more active than it is if more than half of those I care about hadn't passed over to the other side.
I did not wholly escape the amnesia that overtakes children around the age of 6 but I carried along with me more of my childhood than, I think, most people do. Once, after dinner, my father hitched up the horse and took my mother and me for a sleigh ride. The winter stars were very bright. The sleigh bells made a lovely sound. I was bundled up to the nose, between my father and mother, where nothing, not even the cold, could get at me. The very perfection of happiness.
At something like the same age, I went for a ride, again with my father and mother, on a riverboat at Havana, Ill. It was a side-wheeler and the decks were screened, I suppose as protection against the mosquitoes. Across eight decades the name of the steamboat comes back to me -- the Eastland -- bringing with it the context of disaster. A year later, at the dock in Chicago, too many of the passengers crowded on one side, waving goodbye, and it rolled over and sank. Trapped by the screens everywhere, a great many people lost their lives. The fact that I had been on this very steamboat, that I had escaped from a watery grave, I continued to remember all through my childhood.
I have liked remembering almost as much as I have liked living. But now it is different, I have to be careful. I can ruin a night's sleep by suddenly, in the dark, thinking about some particular time in my life. Before I can stop myself it is as if I had driven a mine shaft down through layers and layers of the past and must explore, relive, remember, reconsider, until daylight delivers me.
I have not forgotten the pleasure, when our children were very young, of hoisting them onto my shoulders when their legs gave out. Of reading to them at bedtime. Of studying their beautiful faces. But that was more than 30 years ago. I admire the way that, as adults, they have taken hold of life, and I am glad that they are not materialistic, but there is little or nothing I can do for them at this point, except write a little fable to put in their Christmas stocking.
''Are you writing?'' people ask -- out of politeness, undoubtedly. And I say, ''Nothing very much.'' The truth but not the whole truth -- which is that I seem to have lost touch with the place that stories and novels come from. I have no idea why. I still like making sentences.
Every now and then, in my waking moments, and especially when I am in the country, I stand and look hard at everything. ~
(The New York Time Magazine. March 9, 1997)
*
The epitaph marking Maxwell's memorial gravestone in Oregon reads, "The Work is the Message”
~ Maxwell was born in Lincoln, Illinois on August 16, 1908. During the 1918 flu epidemic, the 10-year-old Maxwell became ill and survived, but his mother died. After his mother's death, the boy was sent to live with an aunt and uncle in Bloomington, Illinois. After the flu epidemic, young Maxwell had to move away from the house where he lived at the time, which he referred to as the "Wunderkammer" or "Chamber of Wonders". He spoke of his loss, "It happened too suddenly, with no warning, and we none of us could believe it or bear it ... the beautiful, imaginative, protected world of my childhood swept away.” ~
His writing includes They Came Like Swallows (1937) – autobiographical novella about the cruel impact of the 1918 flu epidemic, as seen through the eyes of an 8-year-old Midwestern child and his family.
Mary:
I enjoyed Maxwell's description of how he feels near 90, nearing his own death. The description of time spent mostly contemplatively, reading, dreaming, remembering, seems at once rich and full of peace. There is a kind of process here of "letting go," similar to that you talk about as part of your own creative process..stop struggling and wrestling for a solution, wait attentively, and it will come, from that tremendous well of the unconscious, the way dreams come, or memories, a gift, one you can only receive in the quiet of your own solitude.
Oriana:
He's remarkably serene . . . as might be expected in someone who has had a fulfilling life, and is now enjoying every last drop of it — or, to change metaphors, every remaining hue of the twilight.
*
“Happiness is in the quiet, ordinary things. A table, a chair, a book ... And the petal falling from the rose, and the light flickering as we sit silent.” ~ Virginia Woolf, The Waves
*
*“There's only one subject for fiction or poetry or even a joke: how it is. In all the arts, the payoff is always the same: recognition. If it works, you say that's real, that's truth, that's life, that's the way things are. There it is.” ~ Robert Stone
A POLISH JOURNALIST SPEAKS ABOUT HER BOOK ON ELLIS ISLAND
~ Malgorzata Szejnert (Polish journalist, author of Ellis Island: A People’s History): When I started looking through the archives on the Island I found a huge amount of information about what had intuitively struck me before—the organization of the place and its people. The conflict they were wrestling with. They were the children or grandchildren of immigrants themselves, after all, decent people raised in a spirit of democracy. But, as loyal citizens, they had to carry out the demands of the immigration laws, which oftentimes required acts of cruelty.
Sean Gasper Bye (translator) : The book doesn’t have a single, overarching narrative, but rather is made up of interwoven individual stories that come together to form the history of the Island. What made you chose this sort of form?
MS: I’m a reporter, people are what interest me. I was struck by the richness of their roles and personalities. They could feel they were playing a role in history, which meant many of them left behind incredibly interesting memoirs.
SGB: Such as Ludmila Foxlee, a Czech-American social worker on the Island, whose recollections you often quote.
MS: She lifted the spirits of Slavic peasant women who arrived worn out by the journey and apprehensive. She found them beautiful American dresses so they would feel more confident as they stepped onto land to meet their waiting husbands or fiancés.
Or the first commissioner of the Island, John Weber, who went specially to Russia to investigate why so many Jews wanted to leave that country. He spoke to impoverished women in a stocking factory, to patients in hospitals, to prisoners and witnesses of pogroms, to students and soldiers. The report he wrote affected the approach taken with immigrants from the Jewish Pale of Settlement in the Russian Empire.
Or the interpreter—and later mayor of New York City—Fiorello La Guardia, who did what he could to get the immigrants through the island smoothly and honestly.
Or Dr. Howard Knox, who developed an insightful system to test people suspected of mental illness, who were often simply frightened and confused by the conditions in a developed country that they’d never seen before.
. . .
SGB: I noticed a buttonhook on your desk.
MS: I bought it for next-to-nothing at a flea market in London. It was already after my first visit to Ellis Island and I wanted to have it as a memento. Buttonhooks were used as often at the turn of the century as zippers are today. Women buttoned their dresses and shoes with rows of tiny buttons and a buttonhook—as the name implies—helped with this operation.
As you know, buttonhooks played a sinister role on Ellis Island. They helped the medical personnel test if the new arrivals were bringing trachoma, and they used the buttonhooks to pull back their eyelids. Trachoma was contagious, they didn’t know how to treat it and the United States wouldn’t let in anyone who had it. This let to loved ones being tragically split up, or entire families being sent back if parents didn’t want to separate from their sick children.
SGB: Incidentally, I learned from your book that my family history is fairly typical. A poor family comes over bit by bit, relatives already in the US help the newer arrivals find work. In my family’s case that was in the coal mines in northeast Pennsylvania. My grandmother remembers her town was almost all immigrants—from Poland, Slovakia, Ukraine, Italy, Lithuania, Ireland… And each group apparently had its own Catholic church on the main street.
MS: What about your father’s family?
SGB: Well here we have that contrast you write about between Ellis Island and Plymouth Rock. My father’s ancestors weren’t Pilgrims, but they were English Quakers who received land outside Philadelphia at the turn of the 17th and 18th centuries. So I’m a representative of exactly that tension you highlight—between the generations of older colonists and the new immigrants.
MS: Do children in American schools learn in history class about what happened at Ellis?
SGB: Yes, but looking back I can see it was fairly mythologized. The turn of the century was presented as this Golden Age of American immigration—that there was a so-called “open-door policy,” that anyone who wanted could come to the United States. Lots of people I knew in school had some kind of family story from Ellis.
In time I learned about the darker side—about the Chinese Exclusion Act, the quotas and so on. But by then that myth of the Golden Age was already embedded in my mind.
MS: Did you find anything in the book that was surprising to you, as an American?
SGB: Yes! The discrimination against unmarried women, who as a matter of course were suspected of prostitution. And the singling out of people with physical and mental disabilities. The separation of families at Ellis Island was a real shock for me. You tell an awful story where an old Jewish man arrives with his adult son, but the older man is sent back for being a potential burden for the United States. And both the father and the son accept the situation in silent despair.
Just as I was translating that passage, the news was full of the separations of immigrant families on our southern border. Some people were saying nothing like this had ever happened in the history of our country. And others noted that before the Civil War, enslaved families were often split up. But I don’t think I heard anyone talking about Ellis Island.
MS: Do you find my book topical?
SGB: I think since it came out in Poland ten years ago it’s only gotten more topical—the whole world is going through a migration crisis. But I’ve noticed you’re hesitant to compare the past of Ellis Island with the conditions of the crisis today. Is that the reserve of an experienced journalist who’s seen a great deal and understands the danger of easy comparisons?
MS: Exactly. Ellis Island and the current migration crises are different experiences. But they do have something in common: the battle between selfishness and humanitarian values. If a book about Ellis Island is topical, it’s because it draws attention to the pride of Ellis and the shame of Ellis.
https://lithub.com/a-polish-journalist-finds-the-gatekeepers-of-ellis-island/?fbclid=IwAR2yzMsB42qRxoc9DPuggdXASwxMaq5FNfV-PTS5DZYMxFPdiNETPI8kMGo
Oriana:
I was particularly affected by the paragraphs about the button hook and the palpable (it made me wince) cruelty of using it that way, to check for an eye disease, and then detaining the sick family member — or the whole family could choose to go back, after the ordeal of the passage. Still, I understand the idea that you didn’t want to let sick people into the country. Countries have the right to put the protection of its citizens first. Quarantine has been with us for centuries, and for a good reason. And if a disease is both incurable and contagious, denial of entrance was the only means of self-protection.
Another striking passage deals with the kind people who helped those arriving. I can’t stop thinking about the social worker who provided “beautiful dresses” for the impoverished brides or wives. Not just “dresses,” but “beautiful dresses.” Every woman can understand this magnificent act of kindness.
*
TWO MEANINGS OF “JUSTICE”
The murderer kills because he seeks “justice." ~ Steven Pinker (in a lecture on the culture of honor versus the culture of dignity)
Oriana:
Humans are moralizing animals, with a curious need to pass judgment on others and see that they get punished. Pinker studied the causes of violence, including the most common motive for homicide. According to police records, it’s not material gain; it’s “justice.” The killer is carrying out capital punishment; his victim deserves to die for this or that reason (cf “I want justice” in “The Godfather”)
Likewise, wars tend to be justified using the language of moral principles. Pinker suggests we need to think of morality less in terms of blame and punishment, and more in terms of minimizing harm and maximizing flourishing.
It seems to me that when progressives speak of justice, it’s likely to mean human rights, equal opportunity, equal pay, etc. When conservatives speak of justice, they mean retributive justice: punishment, vengeance. Not in 100% of the cases, but it’s a tendency.
Mary:
That idea of justice that means vengeance or retribution is a source of endless trouble. Yes, humans are moralizing creatures, but here that tendency does more irreparable harm than any precepts for living a good and upstanding life. It always seems to have its source in that Old Testament vengeful and punishing god, the self-righteous wielder of power who could and would incinerate a city, or exterminate all life, saving only a handful who were not, in his judgement, sinners unworthy of his favor.
Though religion tells us "Vengeance is mine, saith the lord," the human "righteous" seem both willing and eager to act in his stead. And feel absolutely sure they are justified, even blessed, by doing so. I have heard people say something should be done to punish China for the covid virus. The assumption is of blame and responsibility, that China caused or created the virus now causing such worldwide suffering. When I asked how that would help, what it would solve, the answer was it would give "satisfaction." Revenge, I guess, is still temptingly sweet, and the urge to find someone to blame essential. All bad things must come from the bad acts of bad people, sinners, blasphemers, strangers, foreigners, anyone whose behavior is outside our particular norms.
This is a mindset that itself has caused and continues to cause endless suffering. Pogroms, genocides, honor killings . . . and while it may not be the cause of wars, it is certainly used to bolster and fuel them. The urge to vengeance seems something primitive and primal, difficult to avoid or deny, but destructive and mistaken as a response that cannot lead to a positive outcome, no matter how satisfying we might feel it would be.
*
ALAS, POOR HABERMAS
~ To celebrate Habermas's ninetieth birthday, Raymond Geuss published a piece in philosophy magazine The Point in which he argued that Habermas's ideas have very definitely been shown by history to be wrong. In the age of Brexit and Donald Trump, the fraying of liberal internationalism and the resurgence of the populist right, Habermas — and Habermasianism — have been left thoroughly, both politically and philosophically, refuted.
Habermas is the sort of thinker whose work is full not only of jargon, but also of fine, scholastic distinctions, so it can be hard to sum up for a lay audience in a clear, satisfactory way. But to put it reductively: his work pursues a sort of philosophical justification of the idea, popular among contemporary centrists, that the best way to combat any evil is to debate it.
Central to Habermas's thought is the idea of “communicative rationality.” For Habermas, norms of rationality are implicit in communication — hence rationality itself is the necessary outcome of our communicating with one another successfully. Of course, in the real world, not all communication is successful in this way: people as they really exist lie, cheat, exploit each other's ignorance, employ cheap rhetorical tricks; they have selfish interests which conflict with the common good. But we can posit an “ideal speech situation” in which none of this is able to go on. In theory then (although to be clear: not all Habermasians believe it would be possible to attain such an ideal speech situation in practice, and in his later work Habermas himself moves away from it at least somewhat), any problem could be solved simply by talking it through — everything yielding to the “forceless force” of the better argument.
But as Geuss points out, in the face of something like Brexit, this theory must seem — regardless of any qualifiers one may couch it in — completely absurd. It's not just that the debate over Brexit in the UK has both resulted from, and perpetuated, a crisis in communicative rationality, with few (if any) forums in which anything even approximating to a good-faith discussion of the issues surrounding Britain's membership in the European Union (which itself in truth is only one of the issues subsumed under the figure “Brexit”) can be had. This is certainly the case — although to Habermas's credit, he has himself written fairly extensively about the nature and significance of such crises. It is rather that Brexit gives us a very clear-cut example of an issue where not discussing it — refusing to discuss Britain's membership of the EU at all — would have been a lot more helpful. As Geuss puts it:
“It is only the discussion of the last four years, stoked by a few newspaper owners (many of them not domiciled in the U.K. at all), a small group of wealthy leftover Thatcherites and some opportunistic political chancers, that generated any interest in the subject at all. Dyed-in-the-wool Europhobes didn’t constitute more than 10 percent of the population. It was only the process of public discussion that permitted that hard-core to create conditions in which another 10 percent of the population articulated what was previously a merely latent mild discontent of the kind any population will be likely to have with any political regime, and express it as skepticism toward the Union.”
Thus, he continues:
“Discussions, even discussions that take place under reasonably favorable conditions, are not necessarily enlightening, clarifying or conducive to fostering consensus. In fact, they just as often foster polemics, and generate further bitterness, rancor and division... I get along with most people better the less I know about what they really think and feel.”
Obviously the main example Geuss uses here is Brexit — but he could equally have cited “no-platforming” controversies at universities, as well as something like Gamergate. Almost every day gives us another example of the sort of thing that Geuss (or rather: a Geuss more obsessively plugged-in to internet and popular culture) could have raised in support of his argument. The other week, a handful of comments in a Facebook thread led to an internet-wide controversy about Jason Momoa being “body-shamed”; almost simultaneously, a guy filmed causing a scene in a bagel shop was given a platform from which he was able (despite his racist YouTube channel) to claim to be the “Martin Luther King of short men”. Discourse begets discourse — but that discourse often works actively against real understanding. To put it bluntly, the interests of humanity would often be better-served by passing over certain issues in silence.
In response to this, both Martin Jay, a leading historian of the Frankfurt School, and Seyla Benhabib, a political philosopher heavily influenced by Habermas who teaches at Yale, wrote sniffy, somewhat pearl-clutching rejoinders scolding Geuss for his rudeness in even daring to question their mentor. “A poisoned polemic,” Benhabib wrote of Geuss's article. “A thinker of Habermas's stature deserved a more measured exchange of opinions about his work on (his 90th birthday).” (Presumably, the norms of communicative rationality entail always being ideally deferential to other peoples's teachers).
Both rejoinders cover pretty similar theoretical ground. They argue that, in rejecting Habermas's specific ideas about communicative rationality, Geuss is denying the possibility of rational communication as such. He thus gives any would-be dictator theoretical leeway to ride roughshod over the institutions underpinning liberal democracy; indeed, without communicative rationality, any criticism of the people in power would be subject to a sort of performative contradiction. As Jay puts this point: “having already abandoned the very idea of grounds or reasons or justifications, Geuss has preempted the possibility of objecting to anything at all that might happen in (a) post-discussion future world.” (Hence why both accuse him of being somehow in thrall to Putin).
But this is a ridiculous conclusion to draw from Geuss’s critique. Geuss doesn’t reject the “very idea” of justifications — just the assumption that these justifications might always best be teased out, be formed and re-formed, through discussion. A similar thought is advanced by Habermas’s own mentor, Theodor Adorno, who grounded his critical theory not in abstract ideals of justice, but rather than in the brute, unjustifiable and often incomprehensible fact of bodily, physical suffering. “The physical moment tells our knowledge that suffering ought not to be, that things should be different,” Adorno writes in Negative Dialectics. “‘Woe speaks: Go’. Hence the convergence of specific materialism with criticism, with social change in practice.”
The fact of suffering can be a grounds for discourse, giving us a reason to ask the questions which must guide any discussion. But it can also lead us to come to the conclusion that the time for discussion has come to an end. Ultimately “only human action,” as Geuss also insists, can “bring about clarification and resolution.” (sometimes, yes, that action can appropriately take the form of a discussion — but not always).
Today, no matter how many people are suffering, we seem precisely unable to act. MEL Magazine's Miles Klee has written about how this is inability is being encoded into our very language; phrases like “you love to see it” and “you hate to see it” are uttered even in response to events we are swept up in; they imbue our orientation towards the world with the passivity of spectators watching sports on TV. In the face of climate change and the resurgence of the far right; the erosion of democracy, as more and more of the world's resources are channeled into the power of a privileged few, with concentration camps on the U.S.'s southern border, we are experiencing a deep crisis of political agency. We all know that something must be done, but seem totally passive in the face of our duty to do it. Indeed, in the contemporary pathology of “raising awareness,” we see how discussion has become a substitute for action, a sort of pseudo-activity.
Perhaps, in all this, discourse really can be part of the solution, but if so, it is going to have to confront the fact that it’s also part of the problem.
Thus what might initially seem like a petty spat between some aging philosophers, yapping territorially over the legacy of another even older one, can in fact help us articulate a deep crisis in both political thought and action. If critique is to “converge” with “social change in practice,” we need our thinkers to do better. We need radical thinkers who can respond to the real suffering in our world, with both the hope and the urgency that might help people in general to eliminate it. ~
https://theoutline.com/post/7734/habermas-failure-political-philosophy?zd=1&zi=6wgkzy3t
Oriana:
~ Central to Habermas's thought is the idea of “communicative rationality.” For Habermas, norms of rationality are implicit in communication — hence rationality itself is the necessary outcome of our communicating with one another successfully. ~
The author argues that debate itself can be a problem, especially the excess of it. We talk too much and do too little, putting our energy into the debate rather than any much-needed action.
Or, as has been stated more succinctly, “Talk is cheap.”
But, as I see it, the first problem with debate is the assumption of rationality. This denies how much we are ruled by emotions. It's primarily our emotional side that defines whether we lean to conservatism or liberalism, for instance. And, alas, debate serves only to rationalize our positions. As for "facts," we selectively accept only those that confirm our bias. If the facts happen to be such that we can't deny them, we can interpret them away. The smarter and the more educated a person is, the easier it is for them to muster evidence for their position — even though that position is rooted in emotions, ultimately going back to our childhood — were our parents and teachers mostly authoritarian or mostly nurturing?
That's not to say that rational argument is absolutely doomed to ineffectiveness. But it's an uphill battle, and much has been written about the thorny matter of persuasion. History, alas, presents the sad picture of how millions can be manipulated through an appeal to emotions, not reason.
Mary:
Our current polarization does not have its roots in rationality, but in habit, emotion, social and cultural experience, fears of loss and change. No rational discussion can bridge the gap. In fact, rational discussion doesn’t seem likely or even possible. We are so far from convincing each other we seem to be getting less and less able to talk at all, seem less and less to share the same world, be able to agree on any "facts," even want to consider the possibility of compromise, of actions that move toward cooperation rather than its true opposite, violence. In all the shouting, no one's mind is changed. We just keep pushing.
Oriana:
What worries me is that the polarization has gotten so much worse over the decades. It’s a “cold civil war.” For instance, there didn’t use to be all that much difference between the Republicans and the Democrats when I arrived in the U.S. — definitely not the abyss that separates them now.
I know one man whose father disagreed with him over Vietnam, and the father and son stopped speaking to each other — for forty years! I'm afraid that’s where we are heading as a divided country . . .
*
HOW TO CHANGE PEOPLE’S MINDS WITHOUT PUSHING THEM
~ Jonah Burger is a professor of marketing at the Wharton School of Business at the University of Pennsylvania and author of The Catalyst: How to Change Anyone’s Mind. Berger studies how beliefs catch on, stick long term, and how to change them.
“We have a very emotional attachment to things we're doing already. Whether it's the products we're using, the services we engage in, or the ideas we have at the office — we are emotionally attached to them,” Berger tells Inverse. “And so we build logic around those things to support it and look for information that supports our existing beliefs rather than disagrees with it.”
This phenomenon is called confirmation bias, and it’s prevalent in every kind of belief and subsequent choice, from what kind of coffee we drink to our spiritual practice.
Yes, people can get stuck in their ways and beliefs, Berger acknowledges, but he argues it is also possible to change someone’s mind. It just requires rethinking the whole approach.
“Often, we tend to think if we just give people more facts, more figures, more reasons, more information, they'll come around,” Berger explains. “But pushing people doesn't work. When we push people rather than just going along, they often push back.”
“Great catalysts don't push harder or add more energy,” Berger says. “They figure out what the barriers are and they reduce them.”
Push and pull — Typically, when we come up against something or someone we want to change, we approach it with force. But often, this aggressive technique makes people defensive and causes them to dig into their beliefs more deeply.
“People don't like being told what to do,” Berger says. “When they feel like someone's persuading them or trying to persuade them, they put up their radar and they ignore, they avoid, or even counter argue against the message.”
In his research, the five barriers that come up repeatedly are:
Reactance: people’s tendency to be defensive and push back when they are pushed.
Endowment: the amount of time or money someone has sunk into a belief or practice — where they become attached to what they're doing already.
Distance: when people can’t relate to the other perspective or idea because it’s too much of a “leap” beyond their current belief frameworks.
Uncertainty: new things or ideas often feel too risky to try or adopt.
Corroborating evidence: when people simply demand more information or proof to change.
To become a better catalyst for change, Berger suggests to:
Find the gaps. Rather than push or persuade someone, highlight a gap between their attitudes and their actions, and then get them to persuade themselves. For example: If someone is reluctant to wear a mask at work, ask them if they would wear one if their child or elderly parent were in the office. Ask why that same care or concern isn't present with their colleagues?
Provide a “menu” of choices. Rather than unilaterally force a single solution on others, give people the freedom and autonomy to choose from a few options. This is one way to reduce people’s gut resistance, and again, help them persuade themselves.
Cut through perceived risks. If people feel like a new idea is controversial or risky, explain your personal experience as to why you think it is more relatable and less extreme than they think.
At the end of the day, having these conversations —successfully— isn’t easy, and it may take repeated attempts. But employing these strategies, instead of pushing someone to bend to your will, can lead to far better outcomes down the line.
https://www.inverse.com/mind-body/how-to-win-arguments-actually-change-someones-mind?utm_source=pocket-newtab
*
“A SMOOTH EXIT FROM ETERNAL INFLATION?”: STEPHEN HAWKING’S LAST PAPER
~ Stephen Hawking, who died in 2018 at the age of 76, was a physicist from another time. He had more in common with the celebrity scientists of the first half of the 20th century — especially the politically-inclined scientist-intellectuals like Robert Oppenheimer, Richard Feynman, and Enrico Fermi who came out of the Manhattan Project — than he did with any of his contemporaries. This isn’t so much a question of brainpower as it is of public positioning, as getting the public to understand new scientific ideas is a very different job than coming up with them. On the whole, our most prominent science communicators (Neil deGrasse Tyson, Bill Nye, Michio Kaku, etc.) do not actively produce science. Consequently, they are removed from the everyday slog and department politics that pervade the life of a working researcher. Meanwhile, our greatest researchers (a huge list of people I don’t want to enumerate for fear of leaving someone out) don’t prioritize telling the public what their work is and why it matters. Hawking, with his precise insights about physics and beyond who also possessed the power to capture the attention of the public, was a rare link between these two groups.
However unique it was, the power of Hawking’s celebrity — which meant that every pronouncement he made had the potential to shift public conversation in ways that could affect researchers’ lives — incensed some fellow physicists. For instance, he once made a $100 bet that the Higgs boson, the elusive particle that gives mass to matter, could not be found. This was right after the Large Electron-Positron (LEP) Collider came out with a null result in their search, and some feared that Hawking’s statement might limit future research funding. Peter Higgs, a notorious media recluse, came out to chastize Hawking in 2002 for meddling in a subfield that wasn’t his: “His celebrity status gives him instant credibility that others do not have.” Others said that Hawking’s contributions to astrophysics were not commensurate with his public stature. When the Higgs was found ten years later, those physicists didn’t pile on him again. In a talk given shortly after Peter Higgs and his research partner Francois Englert were awarded the Nobel Prize for their work, Hawking was gracious and funny about the affair, saying, “Congratulations to them both. But the discovery of the new particle came at a personal cost… The Nobel prize cost me $100.”
The Higgs boson wasn’t the only bet Hawking didn’t get right. He was also wrong in thinking that the gamma-ray source Cygnus X-1 was not a black hole (it was). And in believing that black holes destroy information (they don’t). His bet against cyclic inflation is still unresolved (currently, it is untestable).
By the time A Brief History of Time, one of the first books meant for a general audience about cosmology, broke sales records in the late 80s, Hawking had an impressive academic career and was intent on continuing it. For the last ten years of his life, he proceeded to publish a paper or two on cosmology or black holes a year: not a unique pace, but consistent. It isn’t entirely unusual for physicists to continue active research beyond retirement age, but Hawking also remained director of research at the Cambridge department of applied math and theoretical physics. His last grad student graduated in 2010. And, again, he was literally jet-setting to conferences around the world and staying politically active when most people his age were overwhelmingly voting for Brexit. So while it’s true that Hawking was no Paul Dirac — the Nobelist who quantified the quantum mechanics of matter and has so, so many concepts named after him — he did remain deeply invested in making a mark on physics until the end, though many might not have seen it.
Hawking’s final paper, titled “A Smooth Exit from Eternal Inflation?” which was published in the Journal of High Energy Physics this past week, has been called everything from his “Final Theory of the Universe” to “mind-bending” to proof that “the universe is a hologram”, none of which it really is. Media reports about physics are usually overblown because no one wants to read about papers that build incrementally on scientific knowledge between breakthroughs. But this being Hawking’s final bit of science and all, there exists an incentive to read deep meaning into this bit of what the philosopher of science Thomas Kuhn would call “normal science” — that filling-in-the-blanks that fleshes out the consequences of theories, rather than something worthy of causing a paradigm shift or even a fit.
In the case of this paper, Hawking links together weighty ideas like general relativity and string theory to make a case for our universe being a possible product — at least in terms of size and physical continuity — of a strange but consequential form of cosmic inflation.
Eternal inflation is the idea that the sudden, gargantuan expansion at the earliest stage of our universe’s life kept going outside of our visible bubble, creating other bubbles — other universes — in a multiverse. Think of electricity running through a string of Christmas lights, except instead of lighting up the lights it is also creating them, and none of the lights can detect each other. And it’s happening in a bunch of inconceivable dimensions rather than along a cord. So maybe it isn’t much like Christmas lights, but whatever. And though none of the concepts in the paper are new, you can see that Hawking is indeed grappling with Big Questions about space, time, and general existential stuff.
Whether they were groundbreaking mechanisms or just theoretical baubles, Hawking’s astrophysical ideas fleshed out some the central questions that plague cosmologists: “What happens in a black hole?”; “How was the universe born?”; “What is time?”. Sure, many people want to trap the truth of the universe in their mind as some kind of Infinity Gauntlet power trip, but so few people have the skills and humility to face those questions and chip away at them, day after day, without being overcome with hubristic theories that overpromise and underdeliver. Hawking wasn’t afraid to fail under the brightest scientific spotlight, and for that, he should be celebrated. His final paper doesn’t need to be an overarching theory of everything, anyway. After all, the title ends in a question mark. ~
https://getpocket.com/explore/item/what-stephen-hawking-s-final-paper-really-means?utm_source=pocket-newtab
quasar
An artist’s concept of a quasar. Wiki: "A quasar (/ˈkweɪzɑːr/) (also known as a quasi-stellar object abbreviated QSO) is an extremely luminous active galactic nucleus (AGN), in which a supermassive black hole with mass ranging from millions to billions of times the mass of the Sun is surrounded by a gaseous accretion disk."
*
WHAT DID JESUS WEAR?
~ The Jesus we’ve inherited from centuries of Christian art is not accurate, but it is a powerful brand. A man with long hair parted in the middle and a long beard – often with fair skin, light brown hair and blue eyes – has become the widely accepted likeness. We imagine Jesus in long robes with baggy sleeves, as he is most often depicted in artworks over the centuries. In contemporary films, from Zefirelli’s Jesus of Nazareth (1977) onwards, this styling prevails, even when Jesus’ clothing is considered poorly made.
There is no neat physical description of Jesus in the Gospels or in ancient Christian literature. But there are incidental details. From the Bible (for example, Mark 6:56) you can discover that he wore a mantle – a large shawl (“himation” in Greek) – which had tassels, described as “edges”; a distinctively Jewish tallith in a form it was in antiquity. Usually made of wool, a mantle could be large or small, thick or fine, colored or natural, but for men there was a preference for undyed types.
He walked in sandals, as implied in multiple Biblical passages (see Matthew 3:11; Mark 1:7, 6:9; John 1:27), and we now know what ancient Judaean sandals were like as they have been preserved in dry caves by the Dead Sea.
He wore a tunic (chitōn), which for men normally finished slightly below the knees, not at the ankles. Among men, only the very rich wore long tunics.
Indeed, Jesus specifically identifies men who dress in long tunics (“stolai”, Mark 12:38) as wrongly receiving honor from people who are impressed by their fine attire, when in fact they unjustly devour widows’ houses.
Jesus’s tunic was also made of one piece of cloth only (John 19:23-24). That’s strange, because mostly tunics were made of two pieces sewn at the shoulders and sides. One-piece tunics in first-century Judaea were normally thin undergarments or children’s wear. We shouldn’t think of contemporary underwear, but wearing a one-piece on its own was probably not good form. It was extremely basic.
‘Shamefully’ Shabby?
Perhaps it is unsurprising, then, that Jesus was remembered as looking shabby by a scholar named Celsus, writing in the mid second century, in a treatise against the Christians. Celsus did his homework. He interviewed people, and he – like us – was quite interested in what Jesus looked like. From Jews and others he questioned, he heard that Jesus “wandered about most shamefully in the sight of all”. He “obtained his means of livelihood in a disgraceful and importunate way” – by begging or receiving donations.
From the perspective of respectable people, we can surmise then that Jesus looked relatively rough. When the Christian writer Origen argued against Celsus, he rejected many of his assertions, but he did not dispute this.
And so while Jesus wore similar clothes to other Jewish men in many respects, his “look” was scruffy. I doubt his hair was particularly long as depicted in most artwork, given male norms of the time, but it was surely not well-tended. Wearing a basic tunic that other people wore as an undergarment would fit with Jesus’ detachment regarding material things (Matthew 6:19-21, 28–29; Luke 6:34-35, 12:22-28) and concern for the poor (Luke 6:20-23).
This, to me, is the beginning of a different way of seeing Jesus, and one very relevant for our times of massive inequality between rich and poor, as in the Roman Empire. Jesus aligned himself with the poor and this would have been obvious from how he looked.
The appearance of Jesus matters because it cuts to the heart of his message. However he is depicted in film and art today, he needs to be shown as one of the have-nots; his teaching can only be truly understood from this perspective. ~
https://getpocket.com/explore/item/what-did-jesus-wear?utm_source=pocket-newtab
Oriana:
It seems only natural that Jesus would wear a short tunic; when you walk on dirt roads, you don’t want to be wearing a long robe. But we never get to see Jesus’ legs, except in the depictions of the Crucifixion. There seems to be a taboo against showing male legs — unless it’s Adam and Eve, that nudist couple, or John the Baptist. Since he lived in the desert and wore animal skins, he’s usually portrayed in a realistic way.
But the real point of this article is that Jesus dressed the way poor people dressed. He looked downright “shabby.” And besides, only the rich could afford a long robe.
I think the author makes a good point when he says: “The appearance of Jesus matters because it cuts to the heart of his message. However he is depicted in film and art today, he needs to be shown as one of the have-nots; his teaching can only be truly understood from this perspective.”
*
BLASPHEMY: NOT MISSING THE MISSING GOD
I see, or rather read, more and more “blasphemy.” My father had nothing but contempt for the catholic church, but in childhood I didn’t consider it blasphemy, the church being a flawed human institution, a cheap substitute for real holiness. So what if priests had “relations” (I didn’t really know what the word meant).
But then, when I was ten or so, my mother saw my anguish, guessed that it was over sin and hell, and said, out of the blue, “There is no hell. God wouldn’t be so cruel.” BLASPHEMY! I winced with horror: hell was the very foundation of sacred teachings, and now my mother, a blasphemer, was going straight to hell for sure.
Then at 14, it was my turn. After the insight that the religion that had been forced on me was just another mythology, still half-believing but having decided that a cruel god like that did not deserve worship, I said in my mind, “If god exists, let him strike me with lightning.” And waited, utterly terrified. I’ll never forget those five minutes of terror. I stood in one spot -- I vaguely remember pavement and trees, the cooing of pigeons — I literally could not move, paralyzed with fear. I was waiting for that lightning (it wasn’t even a stormy day, but that did not matter to the part of me that still believed; the laws of nature were irrelevant; I had blasphemed and would be punished).
Finally I unfroze and continued walking to wherever I was going — maybe to the nearest kiosk to buy the newspaper for my blaspheming parents.
*
Many years later I confided in a boyfriend that as a young girl I felt embarrassed using the bathroom, pulling down my pants — after all, god was looking! and here I was, a nine-year-old sinner, exposing myself . . . “We should expose ourselves every chance we get,” my boyfriend replied; then, raising his voice — “confront him with the mess he made!” He shook his lifted fist and shouted, “Asshole!”
I admit I was shocked. It’d been more than a dozen years since I left the church, yet such is the emotional power of indoctrination that in spite of the lapse of time I still experienced shock. That was before the “new atheism. Now “blasphemy” is nothing special. If anything, it’s ridiculous, given that someone is insulting a fictitious character. If a modern reader called Achilles an asshole, that would be just literary criticism.
"Father, Son and the Holy Cat" (found captioned that way on Facebook) But the awareness that blasphemy was once punishable by burning at the stake is always with me. The clergy understood that in the absence of divine punishment, they had to be the executioners. This morning I was thinking about capital punishment for blasphemy in some Islamic countries (unbelief falls under the category of blasphemy). It struck me that such punishment itself constituted blasphemy, a lack of faith that god himself would exact revenge. Punishment simply could not be left in god’s hands! (And, come to think of it, nothing could be left in god’s invisible hands.)
Archangel Michael weighing the souls*
Let me continue that thought, with a swerve toward the unconscious (not the Freudian unconscious, but as the “back-burner” activity of the brain, some of which is communicated to the consciousness):
THE MOST RELIGIOUS COUNTRIES SEEM TO HAVE THE LEAST FAITH, OR THE INFINITE IMPOTENCE OF GOD
Let me repeat: the awareness that blasphemy was once punishable by burning at the stake is always with me. The clergy understood that in the absence of divine punishment (odd, how lightning failed to strike the blasphemers), they had to be the executioners. Punishment simply could not be left in god’s hands! The most religious countries seem to have the least faith.
This reminds me of how someone on Facebook commented that god, being omnipotent, is supposed to be able to do anything — “but in reality can’t even say Hi.”
And it also reminds me of a friend of mine, K, who once lost her job — a job she was about to quit, so it was not distressing. But a co-worker urged her to appeal. K replied, “I think it’s best to leave it in god’s hands.” The co-worker pleaded, “I too believe in god — but I don’t think you should leave it in his hands!”
No, we don’t leave anything in god’s hands. We know better than that.
Michelangelo, the Sistine Chapel ceiling: “God leaving for the earth to create plants”*
IN MY CASE: “LET GO AND LET THE UNCONSCIOUS”
You may have heard the expression “Let go and let God.” This is a slogan used by 12-Step groups that encourages members to “turn it over” rather than miserably struggle on their own. This sounds like “leaving it in God’s hands” — but I have a different take on it.
I see it as a special case of the wisdom of Taoist “non-doing.” When I see that I am “trying too hard,” and my efforts are futile or even harmful, I know that it’s time to “let go.” In my case, especially if it’s a creative problem, it’s “Let go and let the unconscious figure it out.” Or “let me sleep on it” — which amounts to the same thing — letting the unconscious do its work and provide a deeper answer when it’s ready.
It was the creative process that taught me to trust the unconscious, not because it’s not infallible but because the answers it comes up with tend to be more interesting, “from the depths.” In time I realized that this approach applies to all kinds of problems, not just creative work.
*
”In some ways suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice.” ~ Viktor Frankl
In my late teens I asked my mother, a scientist, how come all the animals sent into space died, in spite of extensive training, while humans routinely survive. My mother said, “That's because a human being knows the meaning of what he is doing.”
*
HOW INDIA PLANS TO MAKE ITS HOSPITALS EVEN MORE AFFORDABLE
~ In the mid-1990s, Shetty began experimenting with a business school concept alternately called upskilling or task-shifting. The idea is for everyone involved in a complex process to work only at the top of his qualification, leaving simpler tasks to lower-paid workers. In a hospital, this might mean that the costliest staff—experienced surgeons—enter the operating theater only to complete the most difficult part of a procedure, leaving everything else to junior doctors or well-trained nurses. Then they move to the next theater to perform the same task again.
In 2000, Shetty secured a $20 million investment from his father-in-law, the owner of a successful construction business, to create the first Narayana hospital, which would put assembly line surgery into action. (Narayana was the benefactor’s middle name.) Initially focused solely on cardiac procedures, Shetty gradually expanded Narayana’s remit to include most major operations and set up regional hospitals that could feed patients with complex conditions into its two largest facilities: the Bangalore flagship and another in Kolkata.
“Everyone does as much as they can,” Ashwinikumar Kudari, a senior gastrointestinal surgeon, says toward the end of a busy day at the Bangalore hospital. He’s just removed two malignant tumors the size of golf balls from a middle-aged woman’s intestines—the seventh surgery he’s performed or supervised since morning. A compact man with a trim mustache and a wry smile, Kudari is soon on the move again, checking in briefly on a gallstone removal next door before dashing up a spiral staircase to another operating theater. There, he takes over from a colleague who’s struggling to locate a particularly tricky fistula. “Our margins are low on one surgery, but because we do so many in a day, we can make enough,” he remarks after the elusive fistula—the longest he’s ever seen—is found, running from the man’s anus to above his groin. By working at this pace, the average Narayana surgeon performs as many as six times more procedures annually than an American counterpart.
Shetty’s philosophy of thrift is everywhere. The surgical gowns are procured from a local company for about a third of the cost of international suppliers. The tubes that carry blood to heart-and-lung machines are sterilized and reused after each surgery; in the West, they’re thrown away. The machines themselves, along with devices such as CT and MRI scanners, are used well past their warranties, kept running by a team of in-house mechanics. The operating rooms, pieces of real estate so expensive that many hospitals bill for their use by the minute, are also part of the assembly line.
Whereas preparing a U.S. surgical theater for the next patient can take 30 minutes or more, Narayana has gotten the process down to less than 15, in part by keeping turnaround teams with fresh instruments, drapes, and other supplies on immediate standby, ready to roll the moment a room is available. Even patients’ families are part of the upskilling model.
Narayana trains them to bathe patients and change bandages in the hospital, as they’ll do when they get home. This allows paid staff to focus on more challenging work. Through all these methods and more, Narayana has been able to get the retail cost of a heart bypass, its most common operation, down to $2,000, about 98 percent less than the U.S. average.
It’s all a far cry from the high-touch treatment Westerners expect, but Shetty is adamant that none of the practices compromise safety. Sterilizing and reusing clamps and tubing is permitted under the standards of the Joint Commission, a U.S.-based body that vets and accredits hospitals worldwide, including Narayana’s cardiac hub. Involving properly instructed family members in the simplest care tasks isn’t unheard of in Europe and North America, and some studies suggest it may improve patients’ prospects. (Unlike busy nurses, relatives have just one person to focus on.)
The data appear to back Shetty up. In part because its huge volumes help surgeons quickly develop proficiency, the chain’s mortality rates are comparable to or lower than those in the developed world, at least for some procedures. About 1.4 percent of Narayana patients die within 30 days following a heart bypass, according to the Commonwealth Fund, which studies public health, compared with 1.9 percent in the U.S. Narayana also outperforms Western systems in results for valve replacements and heart-attack treatment, the group found.
Yet even for bypasses—Narayana’s bread-and-butter procedure, with greater economies of scale than any other—Shetty needs to cut costs further, because Modicare will reimburse only about $1,300 for each surgery. For other treatments, the difference between current price tags and Modicare payment schedules is much wider. “They are paying less than what it costs,” Shetty says. “Unless you have someone paying more than what it costs, you may be able to survive for five years, but what about when the machines get old and need to be replaced?” Even at Narayana, thrift goes only so far.
Modi is trying to contain one of Asia’s widest budget deficits, and he’s allocated the equivalent of only $900 million for Modicare in the coming fiscal year. (Costs are generally split 60-40 between Delhi and the states.) Private hospitals aren’t obliged to accept Modicare, and several hospital groups and physicians’ associations are boycotting the program, criticizing its low rates. Thousands of providers have nonetheless opted to participate, both to gain access to new patients and to avoid antagonizing the prime minister. And even if Modi loses in the national elections taking place in May, most observers expect the program will continue.
In contrast to the ultra-itemized billing familiar to Americans, Modicare pays flat fees for every procedure, including the entire hospital stay required to get it done. (Narayana operates the same way.) The longer a patient occupies a bed, the greater the hit to the hospital. So it’s in the interest of Narayana, and anyone who wants to make money off Modicare, to get ancillary costs as low as possible without jeopardizing outcomes.
The team Shetty has charged with doing so works a half-hour’s drive from the Bangalore hospital, in a neighborhood that illustrates some of the tensions created by the city’s emergence as India’s answer to Silicon Valley. Across the road there’s a gleaming juice bar; about 300 feet away, a garbage fire burns at a deserted construction site. The street is home to two startups, and inside a tiny white office building that Narayana leases is a third, of sorts.
There, about 70 programmers and product specialists set up their laptops every day wherever they can find a spot, WeWork-style. They’re building Atma, a platform intended to handle the back end of everything that happens at Narayana hospitals: admissions, payments, scheduling, pharmacy dispensations. Every time a piece of equipment is used—something as trivial as a syringe or as complex as an MRI machine—the system will record it, along with data on outcomes and complications. Narayana will then begin endlessly combing through the numbers, looking for unnecessary costs and devising ways to stamp them out.
The other main component of Narayana’s plan to overhaul itself for Modicare is more conventional: getting some people to pay more. At the top of a private elevator in the Bangalore hospital is the Platinum Wing, which opened in 2015. Although its customers receive the same treatment from the same doctors as regular patients, they recuperate in style. Rooms have hardwood floors and rainfall showers, and soft flute melodies are piped into the hallways. In addition to South Asian staples, the canteen serves locally exotic dishes such as tuna salad and chicken stroganoff. Platinum Wing patients pay an extra 8,500 rupees a day in addition to the cost of a basic single room. It’s money Shetty is counting on to subsidize the rest of Narayana, and he’s planning to expand the concept to more of the company’s hospitals. Even in India’s poorest cities, he estimates that 10 percent to 20 percent of the population might be willing to pay for such comforts.
Modicare is still in its infancy—as of March just 1.5 million people had used it—and Narayana is only partway through preparing for full implementation. Making the changes required to prosper under its constraints will be the work of years, a constant battle to shave off a few rupees here and there. But if Narayana succeeds, it may become a model not only for competitors in India but also for Western health-care operators, which are trying desperately to contain costs.
Nowhere is this more true than the world’s most expensive health-care market, the U.S. “There’s going to be a lot of interest in how India is pulling this off,” says Ashish Jha, the director of Harvard’s Global Health Institute. “You’re going to see health-care organizations in America and elsewhere really rethinking their business model and how they do things.”
That’s a notion the elder Shetty enthusiastically endorses. “I would like in my lifetime for every citizen of this planet to get health care at a price they can afford to pay without having to beg or sell something,” he says.
https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper?utm_source=pocket-newtab
Mary:
I am very interested in the article on cost cutting in Indian medicine. Our own system is crippled by being geared to profit, and how it is welded to an intimate and adversarial relationship with the insurance industry. The actual delivery of care is terrible in our system, unaffordable for many, ruinous for many, profit-driven to the point of the patient becomes prey.
This is getting to be more and more prominent and visible. Many practices are focused on "building your practice," rather than caring for your patients. The system described in the article does much that is amazing, but most of all, it delivers affordable care, even highly advanced care, like transplants, so that more people can be served. However, I can't imagine surgeons in the US adopting assembly line surgery. There would be a lot of hurdles, not the least of which are the surgeon's "star" mystique, and the threat of liability in our lawsuit prone society.
Oriana:
Likewise, I can’t imagine American surgeons agreeing to “up-skilling.” You can’t get there from here, here being a place where a physician can just stick his head into your room, say, “Hi, how are you?” and charge your insurance an unbelievable sum for a “specialist visit.” And yet — a major miracle — hospice care got successfully introduced, and the secret of why it’s so good, I was told, is that it’s run by nurses. So perhaps there is some slight chance of at least reducing the profit-driven corruption.
*
CHILDHOOD "THREAT TRAUMA" MAY CAUSE FASTER AGING LATER
~ A recent study found evidence that children who experience abuse and violence age faster, biologically, than children with no such history. Scientists have known that the wear and tear of stress, and the way we handle it, can make the mind and body "older" or "younger." Nobel Prize-winning scientist Elizabeth Blackburn and health psychologist Elissa Epel researched the psychological factors that may damage our telomeres—the protective tips that reside at the end of chromosomes. When telomeres become too short, they stop dividing, and cells grow old. In addition to shortening, however, the scientists discovered that telomeres also lengthen, which slows down the aging process.
Some of the factors that may determine the aging of the telomeres and prevent premature aging at the cellular level are a healthy diet, genetics, how you respond to stress, ample sleep, and regular exercise. But in addition to these factors, the scientists identified five toxic thought patterns that might also lead to shorter telomeres and premature aging: pessimism, cynical hostility, rumination, thought suppression, and mind straying.
But previous research has reported mixed results on whether childhood adversity is linked to accelerated aging. In the newest study, published in the recent issue of the Psychological Bulletin, the researchers examined two categories of adversity among 116,000 participants: threat-related adversity, such as abuse and violence, and deprivation-related adversity, such as physical or emotional neglect or poverty. They found that children who suffered threat-related trauma were more likely to enter puberty early and also showed signs of faster aging on a cellular level—including shortened telomeres. But children who experienced poverty or neglect did not show either of those signs of early aging.
Next, the scientists examined data from 3,253 participants in 25 other studies to pinpoint associations between early life adversity and brain development. They found that childhood adversity was indeed associated with cortical thinning—a sign of aging, as the cortex thins as people age. Trauma and violence were related to thinning in the ventromedial prefrontal cortex (involved in social and emotional processing) and deprivation was associated with reduced cortical thickness in the frontoparietal, default mode, and visual networks, which are involved in sensory and cognitive processing.
The implications of the results, according to the study’s authors: “These findings suggest specificity in the types of early environmental experiences associated with accelerated biological aging and highlight the importance of evaluating how accelerated aging contributes to health disparities and whether this process can be mitigated through early intervention.”
~ https://www.psychologytoday.com/us/blog/the-right-mindset/202008/can-childhood-trauma-make-the-body-and-brain-age-faster
*
OLDER MEN NEARLY TWICE AS LIKELY TO BECOME SEVERELY ILL AND DIE OF COVID AS OLDER WOMEN
~ The coronavirus may infect anyone, young or old, but older men are up to twice as likely to become severely sick and to die as women of the same age.
Why? The first study to look at immune response to the coronavirus by sex has turned up a clue: Men produce a weaker immune response to the virus than do women, the researchers concluded.
The findings, published on Wednesday in Nature, suggest that men, particularly those over age 60, may need to depend more on vaccines to protect against the infection.
“Natural infection is clearly failing” to spark adequate immune responses in men, said Akiko Iwasaki, an immunologist at Yale University who led the work.
The results are consistent with what’s known about sex differences following various challenges to the immune system.
Women mount faster and stronger immune responses, perhaps because their bodies are rigged to fight pathogens that threaten unborn or newborn children.
But over time, an immune system in a constant state of high alert can be harmful. Most autoimmune diseases — characterized by an overly strong immune response — are much more prevalent in women than in men, for example.
“We are looking at two sides of the same coin,” said Dr. Marcus Altfeld, an immunologist at the Heinrich Pette Institute and at the University Medical Center Hamburg-Eppendorf in Germany.
The findings underscore the need for companies pursing coronavirus vaccines to parse their data by sex and may influence decisions about dosing, Dr. Altfeld and other experts said.
“You could imagine scenarios where a single shot of a vaccine might be sufficient in young individuals or maybe young women, while older men might need to have three shots of vaccine,” Dr. Altfeld said.
Dr. Iwasaki’s team analyzed immune responses in 17 men and 22 women who were admitted to the hospital soon after they were infected with the coronavirus. The researchers collected blood, nasopharyngeal swabs, saliva, urine and stool from the patients every three to seven days.
The analysis excluded patients on ventilators and those taking drugs that affect the immune system “to make sure that we’re measuring natural immune response to the virus,” Dr. Iwasaki said.
The researchers also analyzed data from an additional 59 men and women who did not meet those criteria.
Over all, the scientists found, the women’s bodies produced more so-called T cells, which can kill virus-infected cells and stop the infection from spreading.
Men showed much weaker activation of T cells, and that lag was linked to how sick the men became. The older the men, the weaker their T cell responses.
“When they age, they lose their ability to stimulate T cells,” Dr. Iwasaki said. “If you look at the ones that really failed to make T cells, they were the ones who did worse with disease.”
But “women who are older — even very old, like 90 years old — these women are still making pretty good, decent immune response,” she added.
Compared with health care workers and healthy controls, the patients all had elevated blood levels of cytokines, proteins that rouse the immune system to action. Some types of cytokines, called interleukin-8 and interleukin-18, were elevated in all men but only in some women.
Women who had high levels of other cytokines became more seriously ill, the researchers found. Those women might do better if given drugs that blunt these proteins, Dr. Iwasaki said.
The study has limitations. It was small, and the patients were older than 60 on average, making it difficult to assess how the immune response changes with age.
The study also did not offer a reason for the differences between men and women. Because the women were past menopause, on average, “it is doubtful that sex steroid hormones are involved,” Dr. Klein said.
Still, the new findings are “exciting” because they begin to explain why men fare so much worse with the coronavirus, she added: “The more robust T cell responses in older women could be an important clue to protection and must be explored further.”
https://www.nytimes.com/2020/08/26/health/coronavirus-men-immune.html?campaign_id=9&emc=edit_nn_20200827&instance_id=21656&nl=the-morning®i_id=62348556§ion_index=2§ion_name=three_more_big_stories&segment_id=37015&te=1&user_id=e18ae510841c77329a0e2626cc03d351
Oriana:
It’s true that men and women differ in their immune response to pathogens, with women mounting a more vigorous response. But what about children? We know that young children don’t have a strong immune system, and yet they are least susceptible to suffering Covid symptoms. Perhaps the most obvious answer is that children are also the least likely to have “underlying conditions” such as cardiovascular disease, lung damage, obesity, or diabetes.
On the other hand, that’s probably not the whole answer. We are learning a lot from this pandemic, and are learning it the hard way.
*
ending on beauty:
The last story I tell
will be about
a late summer day.
A slight wind.
Cool.
I am sitting on a park bench
in San Francisco on a hill
overlooking the Pacific.
The ocean is alive
for ever and ever.
And so am I
~ John Guzlowski
