The Moral Crisis of America’s Doctors

Eyal Press in The New York Times:

Some years ago, a psychiatrist named Wendy Dean read an article about a physician who died by suicide. Such deaths were distressingly common, she discovered. The suicide rate among doctors appeared to be even higher than the rate among active military members, a notion that startled Dean, who was then working as an administrator at a U.S. Army medical research center in Maryland. Dean started asking the physicians she knew how they felt about their jobs, and many of them confided that they were struggling. Some complained that they didn’t have enough time to talk to their patients because they were too busy filling out electronic medical records. Others bemoaned having to fight with insurers about whether a person with a serious illness would be preapproved for medication. The doctors Dean surveyed were deeply committed to the medical profession. But many of them were frustrated and unhappy, she sensed, not because they were burned out from working too hard but because the health care system made it so difficult to care for their patients.

In July 2018, Dean published an essay with Simon G. Talbot, a plastic and reconstructive surgeon, that argued that many physicians were suffering from a condition known as moral injury. Military psychiatrists use the term to describe an emotional wound sustained when, in the course of fulfilling their duties, soldiers witnessed or committed acts — raiding a home, killing a noncombatant — that transgressed their core values. Doctors on the front lines of America’s profit-driven health care system were also susceptible to such wounds, Dean and Talbot submitted, as the demands of administrators, hospital executives and insurers forced them to stray from the ethical principles that were supposed to govern their profession.

More here.



Suddenly, It Looks Like We’re in a Golden Age for Medicine

David Wallace-Wells in The New York Times:

Hype springs eternal in medicine, but lately the horizon of new possibility seems almost blindingly bright. “I’ve been running my research lab for almost 30 years,” says Jennifer Doudna, a biochemist at the University of California, Berkeley. “And I can say that throughout that period of time, I’ve just never experienced what we’re seeing over just the last five years.”

A Nobel laureate, Doudna is known primarily for Crispr, the gene-editing Swiss Army knife that has been called “a word processor” for the human genome and that she herself describes as “a technology that literally enables the rewriting of the code of life.” The work for which Doudna shared the Nobel Prize was published more than a decade ago, in 2012, opening up what seemed like an almost limitless horizon for Crispr-powered therapies and cures. But surveying the recent landscape of scientific breakthroughs, she says the last half-decade has been more remarkable still: “I think we’re at an extraordinary time of accelerating discoveries.”

More here.

Friday, June 23, 2023

Imaginative Rebels: A Conversation Between Terese Svoboda and Jim Ruland

Jim Ruland and Terese Svoboda in the Los Angeles Review of Books:

TERESE SVOBODA: At first, Make It Stop reads like a fast-paced action adventure with a superhero, but the mission fails, people die. Imagine that in a Bond film! So, while the reader’s gliding along in the narrative, lots of plot builds up, people struggle with sadness and what it’s like to be a hero, particularly an unknown super-ish hero. I love the term “powerless to unfuck” that you use to underscore their struggle. More and more of these heroes in media are presented with complex personalities. Were you influenced by that trend?

JIM RULAND: I don’t think so. You see a lot of that stuff in superhero movies, and before the pandemic I’d go see them with my daughter, but I read those comic books when I was her age in the ’80s. I knew from the very beginning that the vigilante group that my character Melanie was a part of would be highly dysfunctional, but I didn’t want it to be superficial. In blockbuster movies, there’s a scene or two where the main character is allowed to be sad and then it’s time to save the world again. Melanie’s world has been ripped apart—much like the narrator of Dog on Fire. What forces shaped your novel?

More here.

Femmes finales: natural selection, physiology, and the return of the repressed

David Haig at Qeios:

Nineteenth-century final causes were ‘barren virgins’, an aphorism attributed to Francis Bacon, but twentieth-century teleology was a ‘mistress’, an adage of uncertain provenance. A study of historical uses of these gendered metaphors is used to probe changing attitudes toward teleological reasoning in biology. At the beginning of the nineteenth-century, invocations of final causes were commonplace but such idioms are rarely used at its end. This change is commonly attributed to publication of the Origin of Species in 1859 which completed the ejection of final causes from biology. Charles Darwin, however, openly and unashamedly uses teleological reasoning and language in his botanical research. He believed he had naturalized, rather than eliminated, the concept of final cause. A more important reason for the eclipse of final causes was the shift within physiology toward the explanatory modes of the physical sciences which had long held final causes in disrepute. The rejection of final causes as explanatory principles occurred despite a persistence of teleological reasoning that was experienced as a ‘guilty secret’ likened to a mistress that a physiologist could not give up but would not acknowledge in public. Biology’s ambivalent attitude toward teleological explanations persists in the twenty-first century.

More here.

Strategies of Denial

Grey Anderson in Sidecar:

There has been a lively debate on the American left about the Biden Administration’s industrial strategy. Discussion has focused on the prospects opened up by the massive stimulus – totalling some $4 trillion, if we factor in the American Rescue Plan, the Bipartisan Infrastructure Law and the CHIPS and Science Act alongside the Inflation Reduction Act – from training up ‘progressive technocrats’ to retrofit buildings to the feasibility of capitalist state-led ‘decarbonization’ under conditions of global overcapacity and falling economic growth.

So far, assessments have been mixed, differentiating ‘the good, the bad, the ugly’, albeit with the stress on the first. If the boost to employment and ‘green’ good works promised by the IRA cannot be dismissed, nor can its shortcomings: lack of funding for housing and public transport, neutered regulatory standards in the electricity sector, leasing agreements that give oil and gas producers access to public land. ‘The IRA’, a representative appraisal in Jacobin reckoned, ‘is at once a massive fossil fuel industry giveaway, a historic but inadequate investment in clean energy, and our best hope for staving off planetary catastrophe’.

In other words, the left critique has gone beyond ‘good, but not big enough’ – but perhaps not very far beyond. Almost entirely absent in these discussions is the geostrategic rationale that powers this national-investment drive, reshoring production on the US mainland, bagging lithium mines and sponsoring construction of microchip factories, in a militarized bid to outflank China.

More here.

The Emblems Of German Fire Insurance

Sonja Lau at Cabinet Magazine:

By the middle of the nineteenth century, such signs had become a familiar sight in many parts of Germany. In The Intercepted Love Letter, an 1850s painting by the Munich-based artist Carl Spitzweg, a young man is lowering a secret note from a garret window to his beloved sitting at the window one floor below. On the facade of the house, between the two floors, can be seen the fire mark of the Munich insurer Deutscher Phoenix, which bears a depiction of the mythical bird. Interestingly, the placing of the fire mark must have been a deliberate painterly choice, as such marks were never placed at such a height. Prominently displayed in this unusual location, the sign is perhaps intended to indicate to the viewer the social station of the young woman, who clearly comes from a good (Phoenix-insured) home. But it is also a risk-averse home, one that presumably would not encourage fiery love, love that shuns middle-class calculations about long-term security, financial and otherwise. It has been noted, however, that the pair of doves (read: lovebirds) to the right of the fire mark are presented slightly enlarged, perhaps an indication that, unlike fire, love finally cannot be extinguished. Whichever reading one subscribes to, Spitzweg’s painting figures the fate of love in the age of modern insurance, a history that has yet to be written.

more here.

What Cormac McCarthy Knew

John Gray at The New Statesman:

Cormac McCARTHY, American novelist in a restaurant. 1992.

In its surrender to mystery, McCarthy’s sensibility was religious. Unlike the religions with which we are familiar, he does not offer any glimpse of a final harmony. Even Buddhism, by the standards of Western monotheism an atheist faith, holds out the prospect of nirvana, release from suffering. McCarthy comes closer to the faiths of ancient Mexico, on which DH Lawrence drew in The Plumed Serpent (1926). There is no evidence that he read the prolific English writer, but there are parallels between the religion implicit  in McCarthy’s novels and that sketched in Lawrence’s writings on Mexico. In both, human beings are not accidentally embodied minds but mortal creatures  of flesh and blood, whose fates are as random and inescapable as those of birds and toads. All living things find themselves in a state of war. As Judge Holden put it:

“It makes no difference what men think of war… As well ask men what they think of stone. War was always here. Before man was, war waited for him. The ultimate trade awaiting its ultimate practitioner.”

more here.

Friday Poem

The Sea

I need the sea because it teaches me.
I don’t know if I learn music or awareness,
if it’s a single wave or its vast existence,
or only its harsh voice or its shining
suggestion of fishes and ships.
The fact is that until I fall asleep,
in some magnetic way I move in
the university of the waves.

It’s not simply the shells crunched
as if some shivering planet
were giving signs of its gradual death;
no, I reconstruct the day out of a fragment,
the stalactite from the sliver of salt,
and the great god out of a spoonful.

What it taught me before, I keep. It’s air
ceaseless wind, water and sand.

It seems a small thing for a young person,
to have come here to live with his own fire;
nevertheless, the pulse that rose
and fell in its abyss,
the crackling of the blue cold,
the gradual wearing away of the star,
the soft unfolding of the wave
squandering snow with its foam,
the quiet power out there, sure
as a stone shrine in the depths,
replaced my world in which were growing
stubborn sorrow, gathering oblivion,
and my life changed suddenly:
as I became part of its pure movement.

by Pablo Neruda
from
Poetic Outlaws

OpenAI CEO Sam Altman Is Pushing Past Doubts on Artificial Intelligence

Felsenthal and Perrigo in Time Magazine:

You ever watch Star Trek?” Sam Altman, the CEO who has become the most visible face of the current artificial-intelligence boom, has just called us an Uber. The 38-year-old serial entrepreneur has lately become known for talking up the risks of AI, but he is at his most animated in talking about its possibilities. So transformative is this new technology that responds naturally to our verbal commands that he envisions new hardware for it—something, eventually, like the Star Trek holodeck, in which characters use their voice to conjure and interact with 3D simulations of the world. An interface like that feels “fundamentally right,” he says.

Altman’s company, OpenAI, is only seven years old. It has fewer than 500 employees. Pipe some pan flutes and whale sounds into the airy, light-filled lobby of its headquarters in San Francisco’s Mission District, and it could almost be mistaken for a spa. But in the span of 6 months, the company—through its viral product ChatGPT—has vaulted AI into public consciousness. Few doubt it’s at the vanguard of a revolution that will, for better or worse and probably both, change the world.

More here.

Adjusting Your Body Clock May Stave Off Cancer

Lydia Denworth in Scientific American:

I usually get up by 7 A.M. and am in bed by 10 P.M. I tend to eat meals at the same times of day, too. This may sound a little dull, but it’s essential for my productivity. It’s also a schedule that rarely disrupts my body clock. And a steady clock, it turns out, just might help me and many other people avoid cancer and some other diseases, according to new research.

What I call a body clock really means circadian rhythms, from the Latin for “about” and “day.” These are the body’s internal biological pacemakers, physiological fluctuations that help us adjust to the phases of a 24-hour day by synchronizing with environmental cues such as light, dark, temperature and food intake. These rhythms affect sleeping and waking, feeding and fasting, endocrine cycles, immune function, and cell growth.

More here.

Thursday, June 22, 2023

The Astonishing Awfulness of the Submarine Lost at Sea

Shannon Palus in Slate:

But this week, like so many of us, I’ve been thinking about the other direction that can apply to that comment about Silicon Valley—what happens when the goal, having achieved so much else, is not extending life, but risking it? Because if placing a bet on living forever is one leisure activity to put your vast wealth toward, another is extreme feats of travel. The rich people of today can buy tickets to outer space. Or to the deep ocean. Where things can go very wrong, very quickly.

Scrambling to make sense of the unfolding submersible tragedy—it is very strange to know a group of people only has a handful of oxygen hours left—writers, including this one, turned our attention to the sheer cost of it all: tickets aboard OceanGate’s Titan were $250,000 a pop. Interestingly, that’s double what the CEO originally charged—he set the price tag to be more on par with space travel, after realizing his offering, a seatless minivan-sized can that dips to wild depths, really was similar to space travel.

Did the people floating with—checks the live blogs—20 hours of oxygen left now know what they were getting into when they boarded the vessel? A video clip of David Pogue, who took a press trip aboard the Titan last summer for CBS, went viral. He flipped through the waiver form, and told the camera: “An experimental submersible vessel that has not been approved or certified by any regulatory body and could result in physical injury, disability, emotional trauma, or death. Where do I sign?”

More here.

Drawing inspiration from nature, synthetic biology offers exciting opportunities to transform the future of medicine

Alison Halliday in The Scientist:

Bringing together engineers, physicists and molecular biologists, the field of synthetic biology uses engineering principles to model, design and build synthetic gene circuits and other molecular components that don’t exist in the natural world. Researchers can then piece together these biological parts to rewire and reprogram living cells – or build cell-free systems – with novel functions for a variety of applications.

“For me, the most exciting thing about synthetic biology is finding or seeing unique ways that living organisms can solve a problem,” says David Riglar, Sir Henry Dale research fellow at Imperial College London. “This offers us opportunities to do things that would otherwise be impossible with non-living alternatives.” Scientists are harnessing the power of synthetic biology to develop a variety of medical applications – from powerful drug production platforms to advanced therapeutics and novel diagnostics.

In recent years, rapid decreases in the cost of DNA sequencing and synthesis – and the development of gene-editing technologies, such as CRISPR-Cas9 – have enabled researchers to engineer biological systems with unique and increasingly complex functions. “The combination of these tools has provided us with unprecedented opportunities to apply synthetic biology to study living systems and understand how they work,” states Riglar.

More here.

Thursday Poem

Stories From Life

I thought I was entitled to tell only one story, my story,
until I heard yours. You told me about yourself in a way
that made your story a part of me, giving me two stories.
One night I told them to a friend in a bar—she was sitting
next to her husband, who was talking to someone on his
other side, so she listened, and then she told me her story,
and it made me richer. My face hurt, as it does when I smile
and listen. I took our three stories to a party, and in telling
them I mixed them up, and the stranger I was with grew
excited and claimed to understand. We sat in a corner, and
our time together seemed more than flirting. But looking back,
I think it was flirting. I was carried away like a person who
wears jewels.

by Nancy Lagomarsino
from
The Secretary Parables
Alice James Books, 1991

On Mircea Cărtărescu

Nicholas Dames at n+1:

MIRCEA CĂRTĂRESCU HAS EXISTED IN ENGLISH for less than two decades, and in only a fraction of the original Romanian. Julian Semilian’s 2005 translation of Nostalgia, Cărtărescu’s coda to the Ceaușescu period, was the introduction. One volume of his Orbitor trilogy, published as Blinding and translated by Sean Cotter, followed in 2013; the rest of the trilogy has yet to appear. More, though not significantly more, is available in Spanish and French, and the vast bulk of Cărtărescu’s workseveral other novels, two of which postdate Solenoid; volumes of journals and criticism; considerable amounts of verse, including Levantul, a notoriously “untranslatable” epic poem from 1990 that doubles as a history of Romanian poetryremains inaccessible. But with Cotter’s translation of Solenoid, there is now just enough in English to see the outlines of Cărtărescu’s territory.

It is continent-sized in its imaginative breadth, but largely restricted to one city: Bucharest. More so, to the immediate environs of his upbringing.

more here.

The Life, Music, and Mystery of Connie Converse

Chris Molnar at the LARB:

CONNIE CONVERSE is remembered now, if at all, as a rediscovered relic of blog-era music oddity. Like Rodriguez, Donnie and Joe Emerson, Sibylle Baier, Lavender Country, or Converse’s near-contemporary and kindred spirit, Molly Drake, the cracks she slipped through became her calling card. Converse was notable for preserving a greater level of obscurity more extreme than any of the others: recordings never commercially available; no connections to any scene or famous figure; being a guitar-playing singer-songwriter (and home-taper) in the early 1950s, before such a thing existed, who played only among friends before dropping out of music in the 1960s and ultimately disappearing shortly after. It was not until the 2000s that some of her work was finally made available for those who were never in a room with her.

This is how musician and New Yorker contributor Howard Fishman came across Converse: overhearing How Sad, How Lovely, her first commercially available album, at a party in 2010, just a year after its long-delayed release.

more here.

Learning to be a loser: a philosopher’s case for doing nothing

Costica Bradatan in Psyche:

Except for a painful one-year stint as a high-school teacher of philosophy in his native Romania, Emil Cioran never had a real job. ‘I avoided at any price the humiliation of a career,’ he observed toward the end of his life. ‘I preferred to live like a parasite [rather] than to destroy myself by keeping a job.’ When he chose to move to France, in 1937, it mattered to him that Paris was ‘the only city in the world where you could be poor without being ashamed of it, without complications, without dramas.’

Like his ancient predecessor, the Cynic Diogenes of Sinope, Cioran turned his poverty into a badge of philosophical honour. For the most pressing needs of his body, he would rely on the kindness of strangers and the generosity of friends. He wore other people’s hand-me-down clothes or entertained them with his wit and erudition in exchange for a meal. He would do anything, except take a proper job.

More here.

IBM quantum computer passes calculation milestone

Davide Castelvecchi in Nature:

Four years ago, physicists at Google claimed their quantum computer could outperform classical machines — although only at a niche calculation with no practical applications. Now their counterparts at IBM say they have evidence that quantum computers will soon beat ordinary ones at useful tasks, such as calculating properties of materials or the interactions of elementary particles.

In a proof-of-principle experiment described in Nature on 14 June1, the researchers simulated the behaviour of a magnetic material on IBM’s Eagle quantum processor. Crucially, they managed to work around quantum noise — the main obstacle for this technology because it introduces errors in calculations — to get reliable results.

More here.