Intellectuals, Marxists, Communists and Just Plain Folk

I have just finished Podhoretz’s republication of his book, Making It, published by the New York Review of Books Classics. One should compare this to William Barrett’s book, Truants, which examines the same group of people but of a prior generation. The two, I believe, should be read in parallel. They each give a valuable window on how previous generations thought.My comments below are my opinion alone and reflect also my personal peripheral participation in some areas. Thus I may have a bit of a bias, for that I stand accused.

In my opinion, Podhoretz writes a self-congratulatory work on the collection of Marxist oriented intellectuals in the post WW II generation. For the most part they are Columbia University related and works on such “journals” as Commentary, Partisan Review, and the like. Barrett is somewhat self-effacing and presents his fellow participants in all their glory and grunge. He speaks of such fellow travelers as Hannah Arendt and Mary McCarthy, the philosopher (former lover of Heidegger who was the German philosopher and Nazi follower) and the Vassar graduate who seems to have made her career by publicizing her sexual exploits starting when she was fourteen! Then there was Rhav and Delmore Schwartz, the brilliant and socially complex participants. This was New York from 1930 to about 1960. It is New York when Greenwich Village was a place where one could walk through book stores and drink coffee at all hours, have conversations on any author one felt important and find a fellow conversationalist to compete with one’s views. Now of course Greenwich Village is NYU real estate and millennial startups.

Now Podhoretz starts as a fellow traveler of the left wing associates and then sees this a means to promote himself to some form of greatness. Unlike today where such greatness is being an early player in some start up then the player was someone who would write and publish a critique of some alleged work of art. The edgier the review was the more one felt a sense of self-worth.

Podhoretz presents his perceived path to glory. It was his ability to come out of Brooklyn as an East European Jew and move across the East River to Morningside Heights and achieve greatness by disavowing and abandoning his past, and taking up the culture of his new found associates. Eventually Podhoretz becomes one of the NeoCons in the early 1970s and into the Bush II administration. Specifically he was a major player in the Coalition for a Democratic Majority, which I also played a small role in when at MIT, before going to Washington. It was this change from classic Democratic to neo-conservatives, a pro-Defense move of what were called Jackson Democrats. Strange that so many started as extreme left wing critics of the arts and became strong right wing critics of an evolving Democratic Party, a post-Vietnam Progressive movement now in full bloom.

Barrett by contrast is a well-accepted philosophy professor, who made his acclaim as an early interpreter of Existentialism. In fact Barrett had the opportunity to provide some support to the travels of Simone de Beauvoir on her US trip post WW II. He had great insight into her views, often her confused and distorted perceptions of the US. What contrasts Barrett is that he is a true intellectual whereas Podhoretz is an interpreter of current political movements. Barrett aged into a classic professor and Podhoretz into a classic political commentator.

Thus Podhoretz’s book is worth the read peripherally for understanding the people and the times, but more so to understand Podhoretz, whereas Barrett is less understanding Barrett than in understanding the many personalities he so ably brings to life.

There does not seem to be any group of intellectuals like these. Those that try have flocked to cable TV and become participants in the cacophony of the new medium. Clearly McLuhan and his understanding of how a new medium can change what we understand as truth changes dramatically.

The interesting question would be; will the millennials use the evolving media to create their own new truths, and will we ever be able to understand the past by having a document like Barrett’s again?

Technology, China and Competition

The Telegraph has a good short piece in China's technological development. They note:

AI director at the Turing Institute in London, believes that while the UK has made “great progress in certain areas” we are “very far off” in others. “To date, the West has been leading research across many areas of AI but clearly China is catching up quickly and may be overtaking us in some areas,” he says. “Chinese students are coming to the UK and US and going back to China, and the government is making sure that it is a leader in these areas. Like us, they want to do well in the space.”

 We have argued before that the students coming to the US, and whose studies are often paid for under US DoD or similar university contracts, take what they have learned and go back to China and compete with the West. That seems to be an area that the current Administration, like all previous ones, seem to ignore to the benefit of China.

They continue:

The strengths and weaknesses of each region differ greatly. The US is more steeped in technological expertise and has the deep pockets of Silicon Valley. Most of the technology revolves around automation, typically with the goal of cutting cost or generating revenue. This has seen human jobs replaced by AI to cut costs or time. Companies have created AI designed to do a better job at sentencing prisoners than judges, and many job interviews are now conducted using AI-fuelled programmes to cut HR budgets.

 The question is not what AI can do but who will it replace. There must be buyers for products, even products produced by AI. Who then will do this? Somehow the lack of coverage of this by US media is appalling.

Dentists and a General: Not the Military Kind

Dentists are in a world of their own. In the US at least they have no connection to Medicare nor is a Dental Plan unlimited if one has such.

Frances Woolley, one of my favorite Canadian observers of the world, reflects on what is not just a Canadian issue but perhaps a worldwide one, namely the expanding procedures in the world of dental care[1]. She opines on the use of general anesthesia for extractions. I most heartily agree with her conclusion but for a different reason. A general anesthesia, a “General”, is always a high risk procedure. However it does allow the practitioner to add to the fee charged for a nominal increase in costs, namely what may be administered. A local such as lidocaine or a related anesthetic numbs the pain, yet the patient does endure the procedure.

 However as an old rule of thumb, a patient takes one month’s time to recover from a one hour General. That means that for a thirty minute extraction under a General you are not quite yourself for two weeks or more. For a Local you are back somewhat in 24 hours of less. The Local allows you to experience the process and putatively experience it and expunge it. The General is a suppressed experience that somehow requires a longer psychological recovery. That is why people who have a four hour General for say a prostatectomy take a long period to “feel themselves” again. Just what the process is I have no idea.

Now for dentists in general. Often one heard in Medical School that you can examine any part of the patient’s body except the teeth! There are people who handle that and in almost all cases they are dentists. A physician can do eyes, brains, toes, skin, intestines and the list goes on, but “no teeth”. I often wondered why? The answer in my humble opinion is that the handling of teeth is still somewhat stuck in the late Middle Ages. It is a craft, and part art.

You see, when God made man, or woman for that matter, but with women he corrected for a few mistakes in the first model, they live longer, but God assumed that these creatures would not live that longer than the first few batches out the gate. Thus God designed teeth to last say 30 to at most 40 years, slowly falling out along the way. Then along came physicians extending life spans, despite attempts to keep it low by using tobacco and the like. God’s current plan on shortening life span seems to be obesity so we will have to see how that plays out. But back to teeth. They were poorly designed. Like a 1957 Chevy chrome front bumper. Good to look at in the showroom but by the second or third year rotting away! Then along came the dentists, tear out the old bumper and attach a new one. Then keep that process up a bit but as anyone remembers the 57 Chevy lasted no more than 5 years because the engine or floor boars went as well.

Now back to Frances. She observes:

And if it makes having a tooth extracted less unpleasant, what's the harm? Well, the harm may be to your brain. General anesthesia may increase the chance of post-operative cognitive decline. This article using Taiwanese administrative data found a link between dementia and a history of surgery under general anesthetic. On the other hand, this study found no differences between patients receiving a general anesthetic and those receiving epidurals in terms of cognitive functioning three months post-surgery - although patients receiving an epidural had better surgical, as well as better short-term cognitive, outcomes. Many surgical procedures can be performed either with an epidural or under a general anesthetic. It is hard to find any study suggesting that general anesthesia produces superior results in cases where local anesthetic is a viable option. This study finds that general and local anesthetics produces similar outcomes, but local is cheaper. This one found that epidurals produced better patient outcomes than general anesthetics, and this one also comes down in favour of the local option. This leaves aside the 40 percent risk of post-operative nausea and vomiting after having a general anesthetic. Perhaps one day we'll see the Canadian dental association issuing guidelines on the use of general anesthesia. Insurance companies might step up and only reimburse the cost of general anesthesia in exceptional circumstances.

I think that she may be understating the issue. I would avoid a General at all costs. Last time I remember was when I had my tonsils out. They used ether, yes I am that old. Then after they ripped out the little lymph organs from the back of your mouth, pumped your lungs with ether, and some ended up in your stomach, you awake and have emesis emptying the last of your stomach contents past the now ripped out organ! Thank God medicine has advanced. But dentists using a General should really be extremely cautious. It must be a last resort in my opinion and done only when emergency facilities are proximate.

The same risks apply for example to colonoscopies. One can use a General or a more controlled use of fentanyl and versed. Even that has risks and requires a good backup plan. Thus the general use of a General is in my opinion highly unadvisable and Frances makes a compelling argument worth note to all.

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[1] http://worthwhile.typepad.com/worthwhile_canadian_initi/2018/03/its-time-to-blunt-dentists-incentives-to-use-general-anesthetics.html

So You Want a Government Operated Health System?

One need go no further than the London Review of Books to see how the NHS in the UK is working. They note:

In the year of its seventieth anniversary, the 1.3 million people who work for the National Health Service in England find themselves in a surreal situation. They’re effectively working within two realities at once, expected simultaneously to inhabit an NHS universe where a radical, highly optimistic reform programme is under way, and a second universe in which the organisation is unmistakeably close to breakdown. In universe one, the NHS will be upturned to give most of the healthcare people need at home or on their doorstep and admit to the big hospitals only patients with major trauma, or suffering diseases that demand intensive care, or complex surgical or biochemical expertise. Big hospitals are to become centres of research, high technology, rare skills and dramatic, life-saving interventions. Everything else will be diffused to the community. Loosely directed by the head of NHS England, Simon Stevens, money, staff and new investment are being directed towards primary care – family doctors, community nurses, souped-up local clinics, systems to help the chronically unwell live at home.

Yep, that is 1.3 million people in what is left of the UK, one third that of the US or even less. If we did this in the US it would be almost 5.2 million people. But the US has per Kaiser about 12.5 million already. So what does tell us?

Simply, we have a lot more per population. UK population is about 65 million and the US is about 325 million. Thus about 4:1. So we have about 2.5 times the people per person than the UK. But you can see the UK problem, people actually dying for lack of resources. Namely rationing and letting the old folks and sick kids just fade away! That is what it looks like from the numbers.

Truth and Media

I am frequently reminded of one of the most powerful quotes about the media and what is understood a truth. Peter Drucker in his remembrances has a chapter on McLuhan.

As a second perspective of the impact of technology as a dominant driver, we can refer to McLuhan and his development of the concept of media. Drucker has referred to the presentation of McLuhan's doctoral thesis and McLuhan is quoted as follows (See Drucker, P., Adventures of a Bystander, Harper Row (New York), 1979, p. 250):

"Movable type, rather than Petrarch, Copernicus, or Columbus was the creator of the modern world view.”

“Did I hear you right," asked one of the professors as McLuhan had finished reading, "that you think printing influenced the courses the universities taught and the role of the university, altogether?”

"No, sir,” said McLuhan, "it did not influence; printing determined both, indeed, printing determined henceforth what was going to be considered knowledge.”

This concept later evolved into the medium being the message. In our context it is the fact that both Kuhn and McLuhan recognized, albeit in differing fields and in differing ways, that fundamental changes in technology and technique, call it paradigm or the medium, will change the world view, also the message.

What McLuhan said was that, in my opinion, the transmitted “truth” was defined by the medium by which it was disseminated. Spherically, what one uses to transmit something plays a controlling role in what was meant to be transmitted.

Let’s take a brief walk down memory lane. Take Homer for example. Homer was meant to be memorized and then recited, not written down and read. Early Greeks all had memorized Homer as Muslims often memorize the Koran, and in the old days as Catholics had memorized sections of the Latin Mass. Then someone got the bright idea to write down Homer’s stuff. One can read it, even in Homeric Greek, but it is not the same thing. It is like seeing Shakespeare and reading the same play in High School. Henry V at Agincourt is Branagh, not Mrs. Jones having “Luis Smith” stand and read! Even Churchill was better! Really.

Now let’s move to the 14^th century. Two events are critical. First is Wycliffe and his English Bible. Wycliffe was protected by John of Gaunt, the King’s brother and father of Henry IV. Wycliffe wrote in Middle English a Bible, not for the Church but for the people. That was 150 years before Luther and his German version. One of Wycliffe’s friends was a fellow called Chaucer, perhaps some may have heard of him. Chaucer did for English what Wycliffe did for religion. He wrote in Middle English, the vernacular, but for the people. His tales were of the common folk. Not like Dante, a political polemic, nor Boccaccio, about the Florentine elite. The Widower’s tale was clearly a women’s liberation tale to beat all! It was in 1390! So much for the Middle Ages. But the point was that the medium of written documents set off a cycle that led to Luther. More people, common people could read, a new medium for sending forth truths. The production of the copies was slow and a bit costly and demand increased. Thus Guttenberg was responding to a market demand, and thus Luther! There is a cycle here that one must understand, since I argue we are seeing the same thing happen now.

One could thus ask if the Internet was a response for a demand in more access. However in a McLuhan sense the Internet and its media have actually changed what we see as truth. I may examine Latin texts of Gregory I, in simple 7^th Century Latin, and then compare it to books commenting on them, and then to YouTube commentaries and remarks (Yes there are YouTube commentaries on Gregory I). Who is the true Gregory? Does Gregory and his ideas change if we go from Latin words to English words to YouTube videos? I think so.

But even more so, what we could do in the written word took time. Like this short piece, I thought about it, wrote it, edited it, and then placed it in this blog. Maybe you are even reading it. Thus I may have had to work a bit to get these ideas straight. By the way that is why thankfully I dropped Facebook and Twitter. One often does not think what one is saying. Freud would have had a great time examining the subconscious elements here. I will avoid our Tweeting President.

But clearly, as I am certain it is not just the Russians who understand this, the medium of Facebook and Twitter actually define new “truths”. They create new “truths”. At least people believe so. No longer does anyone ask; what is the basis of your statement? Gone are any rules of evidence. Yes, we do have rules of evidence, another artifact of the Middle Ages forgotten by the Millennials.

So when one uses a new medium for communications one should beware that the “truths” elicited therefrom may not conform to those of the prior “medium” and in fact may have no basis in reality at all!

Sticks and Stones

Silicon Valley some fifty plus years ago was an interesting place. Mostly Defense related stuff, Lockheed, TRW etc., and lots of people in short sleeve shirts, ties and pocket protectors reflecting whatever identity they wanted besides their picture ID cards. No sweat shirts, expensive T shirts, hoodies and the like, some even worse a sports jacket.

Houses were not that expensive and 101 was a bit crowded at rush hour but otherwise driveable. Then wave after wave occurred. Defense stuff moved elsewhere, and in came the chip types, then the system types and slowly creeping in were the software types. Each type was truly different and that is a study unto itself. The 80s in the Valley had dozens of telecom systems types, epitomized by Cisco and some large scale software types like Oracle. Their customers were large enterprises. People did not buy a Cisco product nor an Oracle product, companies did.

Then came the “dot com” folks. The door opened for the consumer with the likes of “pets.com” and others, and then the collapse. Most likely too much and too early. After the fall the opening was created for the current batch. Seeing from the failure of their predecessors, and picking up valuable pieces comes Google, at first a “do no harm” entity, and then Facebook, if one believes the tale alleged it was a ruthless battle of accretion.

From the NY Times we have[1]:

Two days after Donald J. Trump won the 2016 election, executives at Google consoled their employees in an all-staff meeting broadcast around the world. “There is a lot of fear within Google,” said … the company’s chief executive, according to a video of the meeting viewed by The New York Times. When asked by an employee if there was any silver lining to Mr. Trump’s election, the Google co-founder … said, “Boy, that’s a really tough one right now.” …. the finance chief, said Mr. Trump’s victory felt “like a ton of bricks dropped on my chest.” Then she instructed members of the audience to hug the person next to them.

How about that “sexual harassment” stuff? What if I did not want to be touched by another or worse yet hugged? Who would they then blame? It sounds in my opinion like a cult organization. Would the engineers at Ford Aerospace do this when Nixon was elected? Their only interest was continued DOD funding. So who “funds” Google and Facebook? The customer there is the folks who may have very well voted for the person they are now fearing. Does anyone see a logical break here?

Perhaps these darlings of the Valley should expand their reach. Really, out to the heart land. I saw what they did in Cambridge, drove out any parking spaces for the academics and drove the parking rates from $11.00 per day to almost $60.00! Why, well they seem in my opinion to want their own world. This world has its own rules, and as if a religion, these rules can be enforced only by an Inquisition.

 

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[1] https://www.nytimes.com/2018/03/30/technology/silicon-valley-trump.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

NASA and Budgets

NASA is a complex and often inefficient organization. Nature notes the just announced delay in the new space telescope.

NASA will delay the launch of its ambitious James Webb Space Telescope (JWST) by nearly a year, until approximately May 2020. That is likely to push the cost of the mission — the most complex space-science telescope ever built — over the US$8-billion limit set by the US Congress. It is the first major setback since NASA revised its plans for the project in 2011, after years of slipping schedules and rising costs. NASA announced the delay on 27 March, saying that engineers needed more time to assemble and test the components of the spacecraft at its main contractor, Northrop Grumman in Redondo Beach, California. Among other problems, the collapsible, tennis-court-sized sunshield that protects the observatory’s 6.5-metre mirror took weeks longer than expected to fold and refold during testing.

The $8 billion will most likely become $9 billion and hopefully they have not messed up like the last one. There is now some sixty years of project management methods and procedures in systems like this and it is amazing that after all of those capabilities we see this again and again!

An Interesting Report

In a HealthLeaders report they note a CONVERYS report on misdiagnosis which states:

The report from the medical liability insurer analyzed more than 10,500 closed medical liability claims from 2013-2017 and found that:

• Diagnosis-related events are the single-largest root cause of liability claims. The 3,466 closed claims with diagnosis-related allegations from 2013-2017 account for 33% of all claims and 47% of indemnity payments.
   
• 35% of diagnostic errors occur in non-emergency department outpatient settings, such as physicians’ offices.
   
• 33% of diagnosis-related claims allege the decision-making breakdown happened as a result of a failure during the patient evaluation.
   
• The four phases of testing -- ordering, performance, receipt/transmittal, and interpretation―account for 52% of diagnosis-related claims.
   
• Among diagnostic failure claims, the largest number of cases involve a missed or delayed diagnosis of cancer, especially breast, lung, colorectal and prostate cancers.
   
• Of the claims that cited an EHR issue, 58% had an injury severity considered high―a category that includes death.

 I find the issue of cancer misdiagnosis as a concern. PSA testing has been down played and even breast testing has been somewhat lowered.