Tuesday, August 15, 2017

Leaves: Don't Forget To Let Them Blow Your Mind

Paul Cézanne, Forest [Public domain], via Wikimedia Commons

I thought we might all need a break from the awfulness and chaos of the world, so I am going to talk to you about leaves.

I live in a part of the world where there are a lot of trees, and a lot of them are deciduous (a word I seem to recall learning at a surprisingly young age). It is also an area of great seasonal variation. What this means is that in the fall, leaves dry up and fall off of trees, and then in the spring, new leaves grow.

We say that like it's nothing. But if you think about it for even a few minutes, it can become completely mind-boggling. Thing about all those trees. Think how many leaves are on each tree. Even a small group of trees is generating millions of leaves. And all those leaves are reborn every year. 

In fact, this site estimates there are 1.5 to 2 million leaves just on a single oak tree. According to these people who seem to know what they're talking about, a healthy forest has about 40-60 trees per acre, and an overstocked one can have 100-200 per acre (interesting facts about how forests are getting denser because there used to be more forest fires). According to this estimate, there are 30.2 million acres of forest in New York State. So just looking at actual areas of forest, and not counting the zillions of just incidental trees just around, and even lowballing the estimate, that's 1,000,000 times 50 times 30 million = 1,500,000,000,000,000 leaves just in NYS.

Somehow in the fall I don't think about leaves as much, maybe because I live in a condo and don't have to rake leaves and clean them up, or maybe because it's back to school time and I'm thinking of other things. Or maybe it's just that death is less impressive, somehow, than life. I guess in the fall we're all thinking about the beauty of the "fall colors," which is sort of seeing the leaves as a giant collective instead of the little miracle individuals that they are.

Then all winter, there's something so natural about the leafless trees that this starts to seem like their normal state. They're like the furniture -- so familiar, their existence fades into the background. I start to think of "trees" as those naked, but still beautiful, things that stand out starkly against a snowy background.  

But then in the spring -- OMG. Where I live, there's a kind of long late winter, and just as it's starting to warm up, you start to notice buds all over. Insanely, each of those millions of trees is producing its own thousands and thousands of leaves. I don't know what your area is like, but even in the city where I live, I walk past tons and tons of trees, and a quick trip on an interstate highway you see thousands and thousands of trees. All being birthed, a new, and all emerging over a few day period. How insane is that.

For me this is much more interesting and exciting than thinking about "grains of sand on beaches" or "stars in galaxies" or whatever. Each of those leaves is made up of multiple complicated parts, and each has an actual function, soaking up sunlight and releasing (life-giving!) oxygen. Each leaf has internal structure of different kinds of cells, all working together to do photosynthesis. And each year, each one dies off and is replaced by a completely new one. Even thinking about it in the cool light of day, I just can't get over it.

I remember when I was a little kid, there would be phases of life where the idea of the "seasons" would kind of fade into the background of life. I mean, I would see the leaves fall, and the snow come, and the new plants, and the warmth of summer, but my mind would kind of be elsewhere. Then, occasionally, I would notice something dramatic or beautiful or I'd be wading through the fall leaves on the ground and I'd be recalled to the whole thing. Oh yeah. Fall means leaves. And here are leaves. Because it's fall!

At some point in adulthood, though, I started to become very season-attentive and now I notice everything. It's August now, which means the summer leaves have themselves become part of the familiar landscape, fading into the background of consciousness. But as you get older times moves more quickly, and the one good thing about that is that no matter what time of year it is, I basically feel like spring will be here soon.

When I went to label this post I realized almost nothing was right, and then I selected "the extraterrestrial point of view." I think it's a good fit. If you came from a planet where there were animals and plants but the plants were all small or evergreen, and you came to earth and saw the whole deciduous tree situation, I think your reaction would be much like mine in this post: Oh my god, so many leaves!

Tuesday, August 8, 2017

Ethical Perspectives On Social Equality And Innovation In the US Health Care Debate

There are many reasons people favor market-based health care systems over alternatives like universal care and single-payer, and this post is about just one of them: the idea that the innovations produced by market systems are worth the trade-offs required by the deficiencies of market systems.

About a month ago, Vox ran an interview with health care economist Craig Garthwaite, who said that market-based solutions are important because competition drives innovation. Innovation creates new treatment options, so we can cure more diseases and help more people. In fact, he said, the health care systems of other countries -- like those in Western Europe and presumably Canada -- are sort of mooching off the innovation produced in the US and thus not paying their fair share. Acknowledging that health care for some people will suffer under a market system no matter what, he says that we should try to create an improved market-based system, making the ACA work better and properly funding Medicaid to take care of people who can't afford insurance.

Correctly inferring that the issues are fundamentally value-based, the author of the piece summarizes this way:

"Either we value providing adequate care to the most people possible or we value providing ideal care to fewer people in a system that produces more innovation. That’s the fundamental trade-off, and where you come down turns on what you value."

I don't know whether those empirical claims are true -- whether, in fact, innovation markedly suffers when you move away from a market-based health care system. It's a complicated question, because there are so many variables. But let's say for the sake of argument that it is true. In that case, how should we go about making these value-based trade-offs?

It's sometimes suggested that there are rational ways of calculating that would give you an answer. For example, in consequentialism, we evaluate actions and policies based on a calculation of costs-and benefits. You could estimate the QALY's -- quality adjusted life-years -- that would be produced or preserved by various policies and choose that way. This means directly weighing the negatives of under-treated people -- like women who die in childbirth or poorer people with long-term diseases like cystic fibrosis -- against the positives of new treatments like innovative cures for cancer, brain injuries, etc. You'd count how long people live, and how many people, and just add it up.

For a lot of complicated reasons, I think this wouldn't be the right way to judge the trade-off. One reason has to do with justice and fairness. What about the fact that people who are already the subjects of discrimination and historical injustice end up also being the "costs" instead of the benefits? For example, if you can increase the life-span of a few rich white people by worsening health care for poor black people, then cost-benefit analysis seems to say that as long as the increases are dramatic enough, that's a good plan. That must be the wrong answer. Another reason has to do with the idea of "quality-adjusted." As disability-rights activists point out, their lives are systematically undervalued in this framework. Because of the way "quality-adjustment" tends to be operationalized, improvements to able-bodied people count as more significant.

A more subtle way of making trade-offs is through the "interchangeability" concept associated with the work of John Rawls. Rawls suggests that to determine what is a just society, we should ask what we'd be willing to agree to if we didn't know who in that society we would be -- whether we'd be rich or poor, healthy or sick, educated or not.

This way of proceeding also faces problems and challenges, but it's interesting that the economist being interviewed says that in a Rawlsian framework he'd "probably want to be in another country." That is, if you didn't know whether you might be at the bottom, you'd choose to structure your society with more protections for more people -- even if that's at the cost of innovation. Given the cost of the ACA insurance, I expect a lot of middle-class people would prefer to be in the other systems as well.

I think a lot of people have a value-system that includes various potentially conflicting ideals, and that these ideals often include a commitment to the idea that someone who works hard should be able to afford a decent life. Prioritizing this ideal over others would also lead us to conclude that it's worth sacrificing some innovation to make sure everyone can access health care.

When I think about innovation and trade-offs, I sometimes imagine returning to the technology of the 1980s, when I was young. In the 1980s we had no internet. If you wanted to call someone on the phone, they had to be home. If you wanted to see them, you'd have to arrange in advance. If you wanted to buy something, you had to go to the store, and if you wanted to do research, you had to go to the library and track down bibliographies on paper and use these huge books that would index research articles. If you wanted to watch porn, you had to go somewhere and get it.

Would we sacrifice all the innovation improvements of the last few decades if it meant an improved way of life for people who are poorer and sicker? I don't know about you, but I would in a heartbeat. Sure, in a world where everyone has a cell phone, it sucks not to have one. But if no one had one, who cares? Were people really less happy in the 1980s? Given that modern crises of inequality and anxiety, especially for young people, we may well have been mostly better off.

In reality, there are no easy trade-offs like this, and slowing innovation would definitely be bad in some ways. For example, for some people who have health conditions and disabilities, the innovations of the last few decades may well have led to radically improved lives. But if it's really true that only certain kinds of systems produce that kind of innovation, then we need new solutions for ameliorating the costs.

And it's worth remembering that innovation isn't always technology. US maternal mortality is rising, and is three times that of the UK and eight times that of Norway. California recently bucked the US national trend of more and more US women dying in childbirth through innovative organizational changes in how pregnant women are evaluated and treated. Ultimately, those researchers also said that it comes down to a question of values: "a key driver of America’s maternal mortality problem is that America doesn’t value women."

These innovations came partly from Stanford University and partly through the California Maternal Quality Care Collaborative, not from markets.

Again, I don't know if it's true that the deficiencies of the US system are essential to its successes. But given that the costs of the deficiencies are so high, and given that the successes are mostly enjoyed by the already privileged, and given the many social factors that can bring about innovation -- we have to look for new alternatives.

Tuesday, August 1, 2017

A Trip To The Sex Machines Museum

When I was in Prague recently, I went to the Sex Machines Museum. It was small and it could have used more in the way of historicizing information, but it was interesting. I was excited to get a professional discount for being a professor and I considered requesting reimbursement for my ticket as a research expense -- but honestly the price was so low it would have purely been symbolic and not worth the hassle.

I don't know what you think when you think "sex machines," but the first thing I think of is the vibrator and its amazing history. If you don't know anything about the history of the modern vibrator, you owe it to yourself to find out about it. We live in an era where we think that the way we see things is the only obvious way to see them, and this -- very recent! -- period in Anglo history can really shake up your complacency.

I learned about this years ago from Rachel Maines's amazing book, The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction, but you can get a good quick overview here.

Basically, it was common in the Victorian era to think that women were not sexual beings -- that they tolerated sex for the sake of their husbands and to have children. Especially since women do not typically have orgasms from intercourse alone, women in this context would sometimes develop a nervous irritability accompanied by a feeling of heaviness in the abdomen, wetness between the legs, and erotic fantasies. We would call this sexual frustration, but because this wasn't a concept, it was understood as "hysteria," -- a medical ailment that needed treatment.

Medical treatment involved a physician rubbing the woman between the legs until "hysterical paroxysm" occurred. Again, we would call this an orgasm, but it wasn't understood as sexual, it was understood as medical. Though it brought in good money, the treatment was considered a pain: boring and time-consuming. It also gave the doctors achy cramped hands. Maines calls it "the job nobody wanted."

So the vibrator was introduced as a labor saving device for doctors, something they would use on women to treat them. Not long after, technology evolved to the point where vibrators could be designed for use inside the home; at the same time their connection to sexuality became more obvious and so they were marketed blandly as "massagers."

The sex machine museum did have vibrators from this period, and it had some other interesting things I thought I'd share. First, here are two characteristic vibrators:

An early vibrator.

A later vibrator.

One of the things that surprised me the most at the Sex Machines Museum was the number of machines using electricity -- I mean, not just powered machines but machines that would deliver current. Yikes! Here is a picture of some complicated contraptions where a "soaked ring" would be slipped onto the penis allowing electrical current stimulates erections:

"Portable electric device" for the penis.

Another thing I was surprised by was this enormous wooden contraption:

German "erotic device."

The information card for it reads "A faithful copy of the instruments used by a female prison in Germany to calm the 'restless minds' of some prisoners. The penis moved by stepping on the pedal."

So many questions. I don't know if you can see in the photo but the "penis" in this thing is huge, especially at the base. Is the implication that it was intentionally painful and abusive? If not, how did penetration from a wooden penis avoid the same problem the vibrator was meant to solve -- that women don't usually have orgasms from penetration?  Was "calm the restless minds" a euphemism? Or is the whole thing just fake? I have no idea.

Another thing I learned was about chastity belts. I always had the same cartoon thought that most moderns have about this concept, that it was a thing a jealous or possessive spouse or parent would put on a person to make sure they didn't have sex. In fact, they were often used by women to protect themselves from rape! Check out this amazing picture:

Chastity belt.
Most of the machines in the museum were for having a good time, but of course not all. The "anti-masturbation" belts for male adolescents were to prevent nocturnal masturbation; in the event of an erection, sharp spikes would dig into the penis.

To me the most disturbing of these devices was the one below, meant to alert parents to nocturnal erections: as the placard explains, "there was a ring on the boy's penis, and when an erection would occur, it rang a bell placed in the parents' bedroom."

Anti-masturbation device for boys.