Wednesday, April 26, 2017


Scientism, like any ism, is an ideology, and, like any ideology, is driven as much by ambition, wishful thinking, and base emotion as it is by rational analysis. Science is not the fount of human perfection and happiness; it is a product of humankind’s ability to reason and to apply reason in human affairs. The beneficial application of science requires moral guidance and ethical scrutiny, because blind pursuit of scientific knowledge leads to uncomfortable spaces.
The Nazis dunked soviet POWs in frigid water in a “scientific” attempt to devise strategies to help downed Luftwaffe pilots survive in the North Sea. One conclusion of such experiments was that exposure to cold caused cerebral hemorrhages. This “scientific” discovery turned out to be wrong. The United States government scientifically investigated the course of untreated syphilis in African-Americans; very scientific, yet somehow unpraiseworthy. The Imperial Japanese Unit 731 did competent scientific work, so much so that their biological warfare experiments were able to decimate several Chinese villages. (The scientifically oriented American government, rather than opting for war crimes complaints gave many of the perpetrators immunity, because, hey, SCIENCE!). The soviets' use of psychiatry on political dissidents is probably not an example of “improved policies and regulations that serve our best interests.” Orbiting the white nationalist fringe is the “human biodiversity” movement that uses scientific evidence to argue that certain racial and ethnic groups have intelligence, behavioral and personality traits that are heritable and therefore partially genetically determined, a scientific hypothesis that would likely be rejected by scientism on grounds unrelated to method.
One concern that naturally arises is that of avoiding "abuses" of science. Science has no reliable way of identifying “abuses” apart from human values. Science has no inherent conscience.
The modern scientist has much in common with the prehistoric thinker who thought that virgin sacrifice kept volcanoes from erupting or that fickle gods made the sun rise and rains come., Both applied the evidence at hand to questions relevant to their interests and reached conclusions constrained by the state of their knowledge. Much of what modern science knows is wrong; there is even a book, “Ending Medical Reversals” that focuses on the harm done by adopting  therapies and theories as scientific based more on apophenia and wishful thinking than on rational rigor This is why “consensus” is irrelevant to the advance of scientific knowledge, and is no substitute for it. Remember saccharin and how it causes cancer? Or how drotrecogin was the holy grail of sepsis treatment? What was the state of consensus regarding phlogiston theory 400 years ago? What does one one say about the scientific certainty regarding “gender fluidity?”
Science, is a tool without an inherent moral or ethical constraint. The scientific method is useful, for both good and ill, but is not infallible. Its usefulness derives from the ability of human reason to make sense of objective evidence, and that is all it is. It is not something to be venerated or blindly believed. It is something that can be cynically exploited by charlatans. It may be used as a prop to argue for greater government control over people’s lives just as hucksters with knowledge of solar eclipses were able to con those innocent of astronomic knowledge by implying some mysterious power. Science does not validate atrocity or immorality (as the Tuskegee syphilis and Unit 731 experiments show) merely by their being scientific, and science does not validate any ideology or political fashion that presumes otherwise. The use of science for political ends does not have a happy history.

Saturday, April 08, 2017

Healthcare policy principles

There are a few principles that should govern healthcare policy-making:

1.)  The fundamental characteristic of a sustainable healthcare system is not compassion, or comprehensiveness, or justice, or equality, or cost effectiveness. It is predictability. Predictability is why we have written laws it is the characteristic that allows engineers to design aircraft and computers, and chemists to develop new pharmaceuticals. Predictability is what allows actuarial analysis and rational assessment of risk. Predictability is what allows people to make plans with a reasonable expectation of favorable outcomes. The first step in formulating a sustainable healthcare policy is to excise as much caprice, and uncertainty as possible.

2.) Healthcare policy does not determine who gets care, it determines who gets rich. In point of fact there is almost no one in this country who does not have access to at least least some healthcare. It may be inefficient; it may not be cost effective and it may not be particularly thoughtful, but no one need die of tuberculosis or typhus or beri-beri unless psycho-social factors intervene. The future of healthcare as asocial asset will be determined more by technology and the principles of economics; the future of healthcare as an industry will be determined by regulation and policy.

3.) The Pareto principle applies to healthcare: 80 % of the care can be delivered for 20% of the cost.

4.) All systems of benefits and resource allocation become multi-tiered. There is a multi-tiered educational system in this, and every country. There is a multi-tiered judicial system. there is a multi-tiered public health system and a mult-tiered infrastructure system. It does not matter if policy prescribes a single payer system, some sort of hybrid, or a totally market-based system, it will be multi-tiered. This is not the avoidable result of corruption or malign intent on the part of policy makers, although that will certainly make matters worse. It is rather the result of the uneven distribution of inherent advantages and disadvantages, tangible and intangible, across any sizable group of people.

5.) The next big revolution in healthcare will be probabilistic medicine driven by enormous strides in data processing. the cognitive aspects of computers will yield to a significant degree to massive decision algorithms that incorporate huge volumes of data from tens of millions of patients.

Sunday, March 26, 2017

The future of healthcare

There are a few principles that will dictate the future of the American healthcare system:

1. There will always be a two-tiered system. This will not be due to a flaw in system design or implementation, but is due to the unalterable dynamics of societies. there is not a country on earth that does not have multi-tiered healthcare. The United States will not have a single tiered system for the same reason that it does not have, in fact, a single tiered educational system, or a single tiered legal system, or a single tiered social welfare system. Economics, technology and data management will have a much greater influence on the shape of the American healthcare system than will politics. Politics however, will have a much greater influence on who becomes rich as a result.

2. Healthcare in general, and medical care in particular, can be divided up into three functional categories:
     i. The technical or procedural aspect. This is the part of healthcare where someone takes out your appendix, adminsters chemotherapy, does endoscopy, or performs a CT scan;
     ii. The cognitive aspect. This is where someone interprets data and makes decisions about interventions, and
     iii. The clerical aspect. This is where data is collected, collated,and and packaged.

These three aspects will become more distinct and regardless of what type of healthcare reform or payment system is implemented, will dictate the future of healthcare.

The procedural aspect will be taken over by technicians. this trend has been underway for a couple of decades and has resulted in niche practices by "proceduralists.: It is also apparent in the now common practice of attending physicians or primary care providers referring patients to specialists who perform procedures on request, with no other role in diagnosing or managing a patient;s condition. In the future, these people will be less educated in broad aspects of medicine and will be hyper-specialized technicians. Since these procedures will be will established and understood, the practitioners performing them will be more like tradesmen than professional decison makers. They will have less education and more procedural training, and consequently will be expected to do less and will be paid less.

The cognitive aspect will largely be displaced by massive data management systems. This will commonly be referred to as AI, but will involve computer algorithms classifying each patient and processing huge amounts of epidemiologic, genetic, and clinical data to arrive at diagnostic and treatment plans for individual patients. These systems will become more reliable as experience is gained and they will drive down the costs associated with routine care. One offshoot of this will be a new medical specialty: the "outlierist" or the "anomalist" who will be looked to for the artisanal elements of medicine when the data driven computer algorithms are unsuccessful.

The clerical aspect is taking up a larger portion of providers time right now. They spend significant time gathering and entering data that eventually will form the databases on which the artificial neural networks, inference engines, Bayesian belief networks, and other computer modeling systems will operate. Provider systems and payers will soon realize that these tasks can be both largely automated and performed by medium skilled workers without medical degrees.


If you earn respect, you will have self respect.
If you demand respect, you will have self pity.

There are two things with which self respect should never be confused: self pity and self esteem.

When faced with challenges, self esteem often becomes self pity; self respect becomes courage and determination.

Sunday, March 12, 2017


It is very difficult to teach a person something that he is convinced he already knows.

Monday, February 20, 2017

Speech as action

A piece by David Solway entitled "Free Speech vs. 'Hate Speech'" makes the following assertion:

Of course, speech itself can be an act, as philosopher J.L. Austin has shown in How to Do Things with Words: in his most famous example, when the minister states “I now pronounce you husband and wife,” an act has been performed since it changes the status of the participants.

This is wrong. The words themselves are innocuous absent other considerations. If a second grader speaks the quoted words to two other second graders,the latter are not thereby married. More importantly, if a minister says the words to two people who do not wish to be married, or in fact merely disagree with those words, their status does not change. In the former case, the words are powerless because of the status of the speaker. She has no authority to change the status of her classmates, regardless of the words used. The latter case is more fundamental, because it is an example of a larger principle: the effect of words in the absence of external force is dependent on the acceptance of the hearer. Certainly, when a judge pronounces a sentence, the words used wold be of little significance apart from a mechanism to enforce them. The same result holds if the judge has no authority to pass such a sentence, as for example if  jury had acquitted the accused.

The effect of words in such case would depend on the subjective acceptance of their object. To put the matter more succinctly, no one is obligated to be offended by speech, and no one is required to perceive injuries in mere opinions. 

Saturday, February 18, 2017

Safe spaces

The concept of civilization only makes sense in the context of interactions between humans. A solitary individual having no interactions with others would have no use for norms and traditions that are useful in public life. A civilized society is one in which the clashes and confrontations that inevitable arise when human beings interact are managed by certain understandings regarding tolerance, accommodation and compromise. The norms and institutions of civilization are means by which the clashes of individual interests and diversity of opinions are processed so as to make social interactions worthwhile. Civilization is a consequence of the public benefits which arise from preserving individuality. Civilization thrives when individual differences are allowed to compete.

A "safe space," in the current usage of the term, is a place that is free from distressing opinions or disquieting deviations from uniformity. They are precincts where feeble ideas are allowed to persist unchallenged and unimproved, not because of the intellectual validity of those ideas but because of the emotional discomfort occasioned by alternative views. Safe spaces only appear so because of uniformity and conformity, and as such are intellectually stagnant. The aversion to individual thought and dispute makes them intellectually inert and emotionally anesthetic. The adjective "safe" is a euphemism intended to disguise an environment that is intellectually desolate, intolerant and craven.


The most significant difference between Donald Trump and Hillary Clinton, at least as it concerns practical politics, is that there was a significantly greater risk of corruption being normalized under a Clinton administration than under Trump. This is independent of whether a Clinton led government would be any more or less corrupt than the current administration. In the former case, corruption would be viewed by institutions such as the media and entrenched interests as a price to be paid for favorable policies; in the latter case, it is a target of opportunity by which to advance one's agenda and protect one's interests. Normalization of corruption is far more damaging than any policy which could be reasonably implemented by either candidate.

Sunday, February 12, 2017

Thought experiment

Consider a woman, a citizen in a western democracy, Now consider that it is desirable to someone, for whatever reason, to have her behave in a particular way, to conform to some model, or submit to some reform. One way to accomplish this would be to use coercion, to invoke force or the prospect of undesirable consequences to influence her in the desired direction. Another alternative would be to use persuasion, appeal to reason, and try to convince her of the wisdom and benefit of the desired behavior, model or reform.

The first method is the resort to force. She will be made to conform regardless of her her own reason, values or choice. The second is a resort to rational discourse, to principles of analysis and evidence. Only the second of these is consistent with a respect for dignity; i.e. that a person is worthy, all else being equal, of living her life in accord with her own conscience.

Now image that the second method, the use of persuasion, is discouraged on grounds that the method of persuasion, i.e. free speech, might cause offense to someone. Thus we have in stark relief the malignancy at the heart of political correctness: that it is better to use force and the threat of personal consequences to bring about some policy or other, because to allow reasoned debate might offend subjective sensibilities. Rejection of political correctness is rejection of the notion that the benefits and individual dignity must be surrendered to protect the sensitive from disquieting opinions..