A Draft Ontology of Shipwrecks and Identity

In a recent podcast episode I was listening to, the hosts were speaking glibly about progressivism. I won’t name the show because who was saying it is ultimately unimportant. At the crux of their tangential discussion away from Plato’s Greater and Minor Hippias was their dismissal of progressivist attitudes towards the flow of history, that those who come later in history will assert some sort of superiority (technological, moral, intellectual) over less developed, unenlightened peoples of the past. While I think they were onto something in thinking that any sort of change is not prima facie better, I was unconvinced of their move to dismiss it because they didn’t adequately set out a criteria by which to judge advancement. Instead, they proceeded to discuss (within the context of Plato’s dialogue) the relative comparisons of Athenian and Spartan laws. And when they came to a discussion in the text about the relative merits of spoons according to function and form, the one host came dangerously close to undermining his rebuttals of progressivism in my estimation.

But this isn’t a post about their podcast episode – truthfully I haven’t taken the time to go back and listen to their post for the fidelity of the above paragraph because that’s not what I want to write about. It serves as a frame from what it made me think about.

Instead, their conversation reminded me of folks who complain about changes to our understanding of the world, especially as it relates to mental health and/or personal identity concerning gender. There is a resistance to keeping an open mind because it doesn’t harmonize with a worldview they hold that’s often formed and set in ones late teens or early twenties. You see this come out in a number of ways in the way they talk about these issues, but a canonical refrain is “back in my day, they didn’t have x,” whether that is expanded definitions of mental health issues or nonbinary categories of gender. Instead, the proliferation of new words to capture experiences is seen as a self-evident refutation of these developments because they think the relative plurality of new understandings of the world must not be grounded in anything solid or universal. That is to say, if they haven’t experienced it, then it must clearly not be real in an ontological sense.

When I say real in an ontological sense I mean that the phenomenon the word is attached to doesn’t carry existence attached to a concrete thing1. In the podcast, they discussed this in the context of trees and trying to identify tree types. In the Platonic tradition, trees are trees because the thing I’m seeing out my window that grows tall, has a solid brown body covered in a rough exterior that is thicker near the bottom and branches out at the top, terminating in green thin pieces, participates in the Form of tree or tree-ness. The concept of tree is tied to the physical object, but to Plato the Form of tree exists independently of the tree in front of me. In biology, living things are categorized according to common, reliable traits that distinguish different types of organisms from another. A maple tree and a pine tree don’t share many common physical appearance traits, but they share a sufficient number of them that we call them both trees. The concept of tree is an abstraction used to describe something about the physical object. If we are being rigorous, there may be a debate whether the concept of tree as described above (as a Platonic Form) has an ontological existence, but for the purposes of our discussion, tree as a category is real because it is tied to a thing that physically exists out there in the world.

And so to circle back, the anti-progressivist disclaims new labels on people on the thinking that the label/category doesn’t map to something real. There is a reduction problem in their mind – the mental disorder or gender identity (in this sentence, I treat them as two separate concepts that are not intended to be inclusive) are not mapped to anything that can be pointed to. To them, gender identity is reducible only to secondary sexual characteristics (genitals), and mental health is based on stereotype behaviours easily observed (signs) rather than reported (symptoms). In the anti-progressivist mind, creating a new name or category means creating a new phenomenon; a phenomenon that did not exist before.

Here we come to the title of this post’s line of thinking. What the anti-progressivist is confusing is the difference between creating new categories, and giving words to describe something already existing but had yet to become clarified. For this, I invoke the late Paul Virilio and shipwrecks. The anti-progressivist2 treats mental disorder and gender identity as concepts invented wholly new like the concept of a shipwreck. Before the invention of the ship, there was no concept of shipwreck, or train derailment before trains, car crash before automobiles, etc.3 These concept categories did not exist previously, and their existence is contingent on us inventing them (even if by accident). But I think this is the wrong way to capture what is going on when we create a new category of understanding.

It is not the case that more children are coming out as transgender because its faddish, trendy, or a socially acceptable way of acting out against social norms. To the contrary, it’s more likely that more children (or people generally) are publicly identifying as trans (or nonbinary, or homosexual/bisexual/asexual, etc.) because we’ve given them language to make sense of what they are feeling within. I do not have a source to provide, but I read a lament once that because of previously draconian crackdowns on LGBT communities, many people did not live long enough to allow their existences to be counted. The number of people who identify as LGBT is not growing because people are suddenly “becoming queer.” Rather, our language and society is moving towards a place that has space for a plurality of lives.

And I think the same thing is happening as we redefine and clarify mental health issues – these issues are likely not new4, but instead we are better able to understand the internal lives of others because we are listening to what these individuals are saying about their experiences. We aren’t inventing new categories so much as we are finally recognizing things that can now be counted. As the saying goes, what gets measured gets managed. The old terms that were used to medicalize people’s internal lives were insufficient to either understand or treat the person, and so we refine our language to better capture their experiences.

When we reclassify our language, we create nuance. We create a more interesting and vibrant world. This is a good thing – we understand the world in new ways and can appreciate the diversity and complexity that comes from this understanding. I agree that progress for its own sake is not automatically good. Progress must be paired with wisdom and experience if we want to avoid creating harm in the future. But progress should not be halted on the belief that change is flippant, nor should it be dismissed because it introduces complexity to our worldview. The anti-progressivist seems to hold that society is sliding from order to disorder, away from some ideal that we must actively work to return to. To them, anything new is to be distrusted merely because past progress yielded harms. They place more weight on the mis-steps and ignore the improvements to the quality of our lives. This view is just as false as assuming a teleological bent to society evolving – that society is always aiming at getting better.

Society is neither sliding away from perfection nor building towards it. It is moving from simplicity to complexity; from blunt and clumsy to fine and precise.5 As our understanding of the world grows, so too must our language to describe it. With understanding comes language, with language comes empathy, with empathy comes diversity, and from diversity comes strength.6

Stay Awesome,

Ryan

[P.S. – A few days after publishing this, I read a post from Seth Godin on Cyber-realists that says some of what I say above about wisdom tempering progress, but much more succinctly.]

Notes:

1For those who have studied metaphysics and ontology, I apologize if my take comes off as uninformed – I must admit that this is me working through the ideas in my head.

2I’ve typed this word many times in this post without critically thinking whether this is the appropriate term to give to the person/line of thinking to which I’m responding. However, this post is mostly a first-draft attempt at clarifying my thoughts, and so I leave it for now with the understanding that this is all mutable upon further consideration.

3This is perhaps one of the few areas where I’m sympathetic to the anti-progressivist – not all progress is devoid of negatives or downsides. With any effect, there will be unintended or unanticipated side effects and consequences. The technology that helps preserve food and makes it cheaper to produce might also be causing health problems from fast food, for example.

4Here I’m talking about reclassifying old or outdated diagnostic methods, rather than genuinely new classifications that are the result of modern life, though this might be up for debate – is it genuinely new or merely a sub-classification of already existing conditions, such as video game addiction. I’m out of my expertise here, so I can’t say anything with authority on the matter.

5There is a conversation to be had here that brings Kuhn into the party, but this post has groaned on too long. I like Kuhn’s ideas that rather than a steady march of progress, science changes through the adoption of new worldviews, but I think this is less about knowledge and more about the sociology of knowing-peoples. People, ideology, and politics makes science messy.

6Admittedly, this is appears to be a slippery slope that requires a lot more argument to make clear. As with Kuhn, this could be left to a different post, but my main argument is that diversity is good because it hedges against downsides. I think there are limited cases where uniformity and homogeneity are preferable, but those are exceptions that prove the rule.

A Well-Designed Vaccination Process

I was fortunate to receive my first vaccine dose yesterday. While I initially thought I would have to wait until a later phase, I recently found out that I qualified based on my BMI. It bummed me out to learn that I’m perhaps not as “healthy” as I thought and I had felt a sense of pride being among those who would have to wait until the end. It’s irrational, I know. However, I felt it was my duty to get my vaccine as soon as I was eligible in order to do my part and help with public health measures.

The vaccination process I participated in was very smooth and efficient. A friend asked me how the experience went – here were the notes I sent:

My appointment was scheduled for 4:45pm, and I arrived at 4:40 (a 30min commute from home to the site).  They had a sign outside saying they were now taking the 4:45 appointments.  I went through several layers of people asking me questions, but it was super smooth and efficient:

  • Security Guard at the door ask the standard screeners (I don’t have symptoms, no one in my house has symptoms, I haven’t travelled in the last 14 days), and to check I had an appointment confirmation email/text.
  • Queue person to direct me to the check-in.  They also directed me to sanitize my hands and handed me a mask with tongs, saying I could either replace the one I was wearing or use it to double-up.  I chose to just double-up.
  • Check-in to confirm my appointment.
  • Nurse to take my health card info.
  • Queue person to direct me to which chair to sit in.
  • Doctor who asked screeners and gained consent. (we chatted for a little bit)  My receipt notes I received my shot at 4:43.
  • After the shot, the doctor wrote a time on the top of my information form and directed me through a door to a gymnasium for observation.
  • Queue person to explain the chairs (basically, wait until my time was up, and whatever chair I chose, flip the sign to indicate I sat in it so it could be sanitized when I left).
  • Get up from the chair at 5:04 and go in one direction around the seating area to another nurse (observed by security guard).
  • Final nurse confirmed who I was, ask for family physician to notify them, confirmed my email, then printed and emailed me my receipt.

I texted my wife at 5:11 that I was done and heading back.  Well oiled, well directed, very relaxed. 

I am incredibly grateful for the care and thought the local Public Health Unit put into this process. I never felt lost or unsure about how to proceed, and all the staff were friendly and professional.

So far, almost 20-hours post-shot, I feel great. The soreness in my arm is similar to vaccines I received previously, so time will tell if I feel any of the other side effects (aches, fever, etc.).

We’re all in this together.

Stay Awesome,

Ryan

Friday Round-up – May 1, 2020

Note – this is an experimental posting format. I’ve thought about increasing the number of posts I commit to per week, but I don’t want to add unnecessary work if I’m not willing to stick it out. Let’s be honest: sometimes it’s really hard to get a single post out each Monday that I’m satisfied with, so increasing my posting frequency just to for the sake of increasing my output is a terrible idea. I will run a short experiment to see how easy it is for me to get out a Friday Round-up for the next month. If the experiment goes well, I’ll consider making it a part of the regular rotation. You can find the first round-up post here from April 24th.

Have you ever noticed the tendency that when you’re thinking about a topic, you seem to notice it everywhere? I first became aware of its phenomenology back in my university days, where stuff that I was learning in my lectures seemingly popped up randomly in my non-class time. Turns out, there is a word for that feeling – the Baader-Meinhof phenomenon, also known as the frequency bias. It’s why you start to see your car’s model everywhere after buying one. I bring this up because today’s articles are all loosely connected with scientific literacy in the digital age (especially as it relates to COVID). The more I read about thoughts concerning how to understand research about the pandemic, the more content I noticed about the topic of scientific literacy in general. This might be the phenomenon/my bias at play, or maybe the algorithms that govern my feeds are really in tune with my concerns.

Here is my round-up list for the week ending on May 1st:

📖Article – What You Need to Know about Interpreting COVID-19 Research | The Toronto Star

My round-up for the week started with this short article that was open in one of my browser tabs since last week. There is a lot of information floating around in our respective feeds, and most of it can charitably be called inconclusive (and some of it is just bad or false). We’ve suddenly all become “experts” in epidemiology over the last month, and I want to remind myself that just because I think I’m smart, doesn’t mean I have the context or experience to understand what I’m reading. So, this article kicked off some light reflection on scientific and data literacy in our media landscape.

📖Article – Experts Demolish Studies Suggesting COVID-19 is No Worse Than Flu | Ars Technica

This next piece pairs nicely with our first link, and includes reporting and discussion of recent flair ups on Twitter criticizing recent studies. Absent of the pressure being applied by the pandemic, what this article describes is something that normally takes place within academic circles – experts putting out positions that are critiqued by their peers (sometimes respectfully, sometimes rudely). Because of the toll the pandemic is exacting on us, these disagreements are likely more heated as a result, which are taken to be more personally driven. I link this article not to cast doubt over the validity of the scientific and medical communities. Rather, I am linking to this article to highlight that our experts are having difficulty grappling with this issues, so it’s foolish to think us lay-people will fare any better in understanding the situation. Therefore, it’s incumbent on journalists to be extra-vigilant in how they report data, and to question the data they encounter.

📽Video – Claire Wardle: Why Do We Fall for Misinformation | NPR/TED

The Ars Technica piece raises a lot of complex things that we should be mindful of. There are questions such as:

  • Who should we count as authoritative sources of information?
  • How do we determine what an authoritative source of information should be?
  • What role does a platform like Twitter play in disseminating research beyond the scientific community?
  • How much legitimacy should we place on Twitter conversations vs. gated communities and publication arbiters?
  • How do we detangle policy decisions, economics, political motives, and egos?
  • How much editorial enforcement should we expect or demand from our news sources?

There are lots of really smart people who think about these things, and I’m lucky to study at their feet via social media and the internet. But even if we settle on answers to some of the above questions, we also have to engage with a fundamental truth about our human condition – we are really bad at sorting good information from bad when dealing at scale. Thankfully, there are people like Claire Wardle, and her organization FirstDraft that are working on this problem, because if we can’t fix the signal to noise ratio, having smart people fixing important problem won’t amount to much if we either don’t know about it, or can’t action on their findings. I was put onto Claire Wardle’s work through an email newsletter from the Centre for Humane Technology this week, where they highlighted a recent podcast episode with her (I haven’t had time to listen to it as of writing, but I have it queued up: Episode 14: Stranger Than Fiction).

📖 Essay – On Bullshit | Harry Frankfurt

All of this discussion about knowledge and our sources of it brought me back to grad school and a course I took on the philosophy of Harry Frankfurt, specifically his 1986 essay On Bullshit. Frankfurt, seemingly prescient of our times, distinguishes between liars and bullshitters. A liar knows a truth and seeks to hide the truth from the person they are trying to persuade. Bullshit as a speech act, on the other hand, only seeks to persuade, irrespective of truth. If you don’t want to read the essay linked above, here is the Wikipedia page.

I hope you find something of value in this week’s round-up and that you are keeping safe.

Stay Awesome,

Ryan

Friday Round-up – April 24, 2020

Note – this is an experimental posting format. I’ve thought about increasing the number of posts I commit to per week, but I don’t want to add unnecessary work if I’m not willing to stick it out. Let’s be honest: sometimes it’s really hard to get a single post out each Monday that I’m satisfied with, so increasing my posting frequency just to for the sake of increasing my output is a terrible idea. I will run a short experiment to see how easy it is for me to get out a Friday Round-up for the next month. If the experiment goes well, I’ll consider making it a part of the regular rotation.

Many of the bloggers and thinkers I follow have some sort of curated list they share on a regular basis of the best pieces of content they came across in their weekly browsing. During this week, I came across a few thought provoking posts that I felt deserved to be shared.

Here is my round-up list for the week ending on April 24th:

📖 Blog – All models are wrong, some models are useful | Seth’s Blog

We should be reminded that maps are not the terrain, and that models are predictions (read: guesses), not certainty. We rely on models to help us understand the world, but we should remember that they have their limitations.

📖 Blog – COVID-19: What’s wrong with the models? – Peter Attia

Paired nicely with Seth Godin’s post above, Dr. Attia gives a good lay-primer on how a model is created, and what the limitations are when trying to model something like a virus when so little is known about it. The two takeaways I have from this piece are: we should be more willing to accept that good models gives us ranges, not fixed numbers (and we should be more comfortable with the ambiguity); and just because the worst case didn’t arrive, it doesn’t mean that the model was overblown – we need to find out more about why the model was off. It might be that the virus isn’t as dangerous as we initially thought, or it might be that physical distancing greatly impacted the viruses capacity to spread (it’s probably a little of both), but until we know which side maps to reality, we can’t be confident of what we should do next.

📽 Video – BEST Pomodoro Timer on YouTube | Ticking Sounds … – Virtual Crickets

This is actually something I’ve used for some time, but wanted to share. When I’m trying to focus, I have discovered that I can’t listen to music (even of the lo-fi variety) because I find the melodies too distracting. However, I’ve found it helpful for me to listen to regularly repeating noises, such as white noise and ticking metronome sounds. I’ve experimented with a few options, such as a 10-hour “cosmic white noise” video, but while working from home during the pandemic, I’ve settled on this Pomodoro video that I also have paired with a Pomodoro Chrome browser extension that plays white noise (the ticking gives me focus, the white noise blocks out ambient sounds in my room). Forcing myself to focus in 25-minute spurts keeps me on track while I move through my to do list.

Let me know if you find any of these interesting or useful. Also, feel free to share your best round-ups in the comments below.

Stay Awesome,

Ryan

Appealing to my Smarmy Brain

selective focus photography of spiderweb
Photo by Nicolas Picard on Unsplash

From time to time, I catch myself thinking some pretty stupid stuff for entirely dumb reasons. A piece of information finds a way to bypass any critical thinking faculties I proudly think I possess and worms its way into my belief web. Almost like a virus, which is a great segue.

A perfect example of this happened last week in relation to the COVID-19 news, and I thought it important to share here, both as an exercise in humility to remind myself that I should not think myself above falling for false information, and as my contribution to correcting misinformation floating around the web.

Through a friend’s Stories on Instagram, I saw the following screencap from Twitter:

My immediate thought was to nod my head in approval and take some smug satisfaction that of course I’m smart enough to already know this is true.

Thankfully, some small part at the back of my brain immediately raised a red flag and called for a timeout to review the facts. I’m so glad that unconscious part was there.

It said to me “Hang on… is hand-sanitizer ‘anti-bacterial’?

I mean, yes, technically it is. But is it “anti-bacterial” in the same way that it is getting implied in this tweet? The way the information is framed, it treats the hand-sanitizer’s anti-bacterial properties as being exclusively what it was designed for, like antibiotics. For example, you can’t take antibiotics for the cold or flu, because those are not bacterial infections but viral infections.

Rather than leaving this belief untested, I jumped on ye ol’ Googles to find out more. I found a write-up in the National Center for Biotechnology Information discussing alcohol sanitizers.

According to the author on the topic of alcohol-based hand sanitizers (ABHS),

A study published in 2017 in the Journal of Infectious Diseases evaluated the virucidal activity of ABHS against re-emerging viral pathogens, such as Ebola virus, Zika virus (ZIKV), severe acute respiratory syndrome coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus (MERS-CoV) and determined that they and other enveloped viruses could be efficiently inactivated by both WHO formulations I and II (ethanol-based and isopropanol-based respectively). This further supports the use of ABHS in healthcare systems and viral outbreak situations.

There are some special cases where ABHS are not effective against some kinds of non-enveloped viruses (e.g. norovirus), but for the purposes of what is happening around the world, ABHS are effective. It is also the case that the main precaution to protect yourself is to thoroughly wash your hands with soap and water, and follow other safety precautions as prescribed.

The tweet, while right about the need for us to wash our hands and not overly rely on hand-sanitizers, is factually wrong generally. Thanks to a mix of accurate information (bacteria =/= virus) and inaccurate information(“hand sanitizer is not anti-bacterial”), and a packaging that appeals to my “I’m smarter than you” personality, I nearly fell for its memetic misinformation.

There are a number of lessons I’ve taken from this experience:

  1. My network is not immune to false beliefs, so I must still guard against accepting information based on in-group status.
  2. Misinformation that closely resembles true facts will tap into my confirmation bias.
  3. I’m more likely to agree with statements that are coded with smarmy or condescending tonality because it carries greater transmission weight in online discourse.
  4. Appeals to authority (science) resonate with me – because this was coming from a scientist who is tired of misinformation (I, too, am tired of misinformation), I’m more likely to agree with something that sounds like something I believe.
  5. Just because someone says they are a scientist, doesn’t make the status true, nor does it mean what they are saying is automatically right.
  6. Even if the person is factually a scientist, if they are speaking outside of their primary domain, being a scientist does not confer special epistemological status.
  7. In the aftermath, the tweet was pulled and the person tried to correct the misinformation, but the incident highlights that the norms of Twitter (and social media more broadly) are entirely antithetical to nuance and contextual understanding.

It’s interesting how much information spread (memetics) resembles pathogen spreading. If the harmful thing attacking us is sufficiently designed to sidestep our defenses, whether that’s our body’s immune system or our critical thinking faculties, the invading thing can easily integrate within, establish itself within our web, and prepare to spread.

The one thing that really bums me out about this event is the inadvertent harm that comes to scientific authority. We as a society are caught in a period of intense distrust of the establishment that is coinciding with the largest explosion of information our species has ever seen. The result of this is not that good information is scarce, but rather the signal-to-noise ratio is so imbalanced that good information is getting swept away in the tide. If people grow distrustful of the sources of information that will help protect us, then forget worrying about gatekeepers that keep knowledge hidden; there will be no one left to listen.

Stay Awesome,

Ryan

A Modern Cartesian Demon

grey and brown concrete building close-up photography
Photo by Marius on Unsplash

During a throwaway thought experiment in his 1641 treatise, Meditations on First Philosophy in which the existence of God and the immortality of the soul are demonstrated, René Descartes posited the idea of an evil genius or demon that systematically deceives us to distort our understanding of the world. Contrary to first year philosophy students everywhere (a younger version of myself included), Descartes did not actually believe in the existence of an evil manipulator that was holding us back from understanding the nature of the real world. Instead, he was using it as part of a larger project to radically re-conceive epistemology in an era of rapid advancements in science that was threatening to overturn centuries of our understanding of the world. He felt that knowledge was built upon shaky ground thanks to an over-adherence on the received authorities from Greek antiquity and the Church’s use of Aristotelian scholasticism. Similar to Francis Bacon twenty years earlier, Descartes set out to focus on knowledge that stood independent of received authority.

Through Meditations one and two of his book, Descartes considers the sources of our beliefs and considers how we come to know what we think we know. He wants to find an unshakable truth to build all knowledge from, and through an exercise of radical doubt he calls into question many of the core facts we hold – first that knowledge gained from the senses are often in error, that we often can’t distinguish the real from fantasy, and through the use of the evil genius, that perhaps even our abstract knowledge like mathematics could be an illusion.

André Hatala [e.a.] (1997) De eeuw van Rembrandt, Bruxelles: Crédit communal de Belgique, ISBN 2-908388-32-4.

When I teach this to first year students, they either don’t take his concerns seriously because of the force of the impressions the real world gives us in providing sense data for knowledge (a stubbed toe in the dark seems to forcefully prove to us that the external world to our senses is very real), or they take Descartes too seriously and think Descartes really thought that a demon was actively deceiving him. Regardless of which side the student falls on, they will then conclude that Descartes’ concerns are not worth worrying about; that this mode of thinking is the product of an earlier, less sophisticated age.

Unless you are a scholar delving into Descartes’ work, the real purpose of teaching the Meditations is to provide students with a framework to understand how one can go about thinking through complex philosophical problems. Descartes starts from a position of epistemic doubt, and decided to run with it in a thought experiment to see where it took him. The thought experiment is a useful exercise to run your students through to get them to think through their received opinions and held-dogmas.

However, in light of my rant a few weeks back about informed consent and vaccines, I’ve discovered a new contemporary use for thinking about Descartes’ evil genius. In some sense, the evil genius is *real* and takes the form of fear that shortcuts our abilities to learn about the world and revise our held beliefs. Descartes posited that the evil demon was able to put ideas into our heads that made us believe things that were completely against logic. The demon was able to strip away the world beyond the senses and even cast doubt on abstract concepts like mathematics.

Much in the same way Descartes’ demon was able to “deceive” him into believing things that were contrary to the nature of reality, our fear of the unknown and of future harm can cause us to hold beliefs that do not map onto facts about the world. Worse yet, the story we tell about those facts can get warped, and new explanations can be given to account for what we are seeing. This becomes the breeding ground for conspiracy thinking, the backfire effect, and entrenched adherence to one’s beliefs. We hate to be wrong, and so we bend over backwards to contort our understanding of the facts to hold-fast to our worldview.

In truth, we are all susceptible to Descartes’ demon, especially those whom believe themselves to be above these kinds of faults of logic. In psychology, it’s called the Dunning-Kruger effect, of which there are all sorts of reasons given why people overestimate their competence. But in the context of an entrenched worldview that is susceptible to fear of the unknown lurks Descartes’ Demon, ready to pounce upon us with false beliefs about the world. Its call is strong, its grip is tight, and the demon is there to lull us into tribalism. We fight against those we see as merchants of un-truth and in a twisted sense of irony, the weapons of truth we yield only affect those already on our side, while those we seek to attack are left unaffected. It becomes a dog-whistle that calls on those who already think and believe as we do.

If we hope to combat this modern Cartesian demon, we’ll need to find a new way of reaching those we see on the other side.

Stay Awesome,

Ryan

Informed Consent and the Virus of Harmful Rhetoric

person injecting someone on his arm
Photo by Hyttalo Souza on Unsplash

In the ethics of conducting research with human participants, there is the concept of “informed consent.” At its foundation, informed consent is the process of communicating a sufficient amount of information about a research project to a prospective participant so that the prospect is able to decide whether they want to consent to being a participant in a study. There is a lot of nuance that can go into selecting what gets communicated because you have a lot of necessary information that needs be shared but you don’t want to share so much information that the participant is overwhelmed by the volume of information.

When I review research ethics applications, I am privy to a lot of information about the project. In the course of reviewing the project, I have to make judgement calls about what should be included in the informed consent letters that participants read. It would be counter-productive if the participant had to read all the documentation I am required to read when reviewing an application, so we use certain best practices and principles to decide what information gets communicated as a standard, and what is left in the application.

There is, of course, some challenges that we must confront in this process. As I said, when reviewing a research project, you have to balance the needs of the project with the needs of a participant. All research, by virtue of exploring the unknown, carries with it an element of risk. When you involve humans in a research project, you are asking them to shoulder some of the risk in the name of progress. Our job as researchers and reviewers is to anticpate risk and mitigate it where possible. We are stewards of the well-being of the participants, and we use our experience and expertise to protect the particpants.

This means that one challenge is communicating risk to participants and helping them understand the implications of the risks of the research. In many instances, the participants are well aware of risks posed to their normal, every-day lived experiences and how the research intersects with it. The patient living with a medical condition is aware of their pain or suffering, and can appreciate risks associated with medical interventions. A person living in poverty is acutely aware of what it means to live in poverty, and understands that discussing their experiences can be psychologically and emotionally difficult. Our jobs (as reviewers and researchers) is to ensure that the participant is made aware of the risk, mitigate it as much as we can without compromising the integrity of the research program, and to contextualize the risk so that the participant can make choices for themselves without coercion.

The concept of informed consent is hugely important, arguably the most important component of research projects involving humans as participants. It is an acknowledgement that people are ends in themselves, not a means to furthering knowledge or the researcher’s private or professional goals. Indeed, without a respect for the autonomy of the participant, research projects are likely to not be moved into action even when research funds are available.

All of this is a preamble to discuss the anger I felt when I read a recent CBC report on how anti-vaxxer advocates are using the concept of informed consent as a dog-whistle to their adherents, and are using informed consent as a way of both furthering their awareness and raising money with well-meaning politicians and the public.

In fairness, I can see the chain of reasoning at play that tries to connect informed consent with concerns about vaccines. For instance, in the article there is a photo of supporters of a vaccine choice group with a banner that reads “If there is a risk there must be a choice.” This sentiment is entirely consistent with the principles of informed consent. The problem with this application is that the risk is not being communicated and understood properly within context, and instead fear, misinformation, and conspiracies that lead to paternalistic paranoia are short-cutting the conversation. Further, the incentive structures that are borne out of the economics of our medical system are doing little to address these fears. Because so little money is flowing from the government to the medical system, doctors are forced to maximize the number of patients they see in a day just to ensure enough money is coming into the practice to pay for space, equipment, staff, insurance, and supplies. Rather than seeking quality face-to-face time with a patient, doctors have to make a choice to limit patient time to just focus on a chief complaint and address questions as efficiently as they can.

I don’t think it’s all the doctor’s fault either. I think we as patients, or more specifically we as a society, have a terrible grasp of medical and scientific literacy. I don’t have a strong opinion about what the root cause of this is, but some combination of underfunded schooling, rapid technological innovation, growing income disparities, entertainment pacification, a lack of mental health support, increasingly complex life systems, and precarious economic living in the average household are all influencing the poor grasp people have about what makes the world around us work. Rather than being the case that we are hyper-specialized in our worldviews, I think it’s the case that “life” is too complex for the average person to invest time into understanding. Let’s be clear, it is not the case that the average person isn’t smart enough to grasp it (even if sometimes my frustration with people leads me to this conclusion). Instead, I think that people are pulled in so many directions that they don’t have the time or economic freedom to deal with things that don’t immediately pay off for them. People are so fixated on just making it day-to-day and trying not to fall behind that it becomes a luxury to have the leisure time to devote to these kinds of activities.

What this results in, then, is the perfect storm of ignorance and fear that congeals into a tribal call to rebel against the paternalism of a system that is ironically also too cash-strapped to allow the flexibility to educate people on the nature of risk. People don’t have the time and ability to educate themselves, and doctors don’t have the time to share their experiences and knowledge with their patients.

Within this gap, opportunistic charlatans and sophists thrive to capitalize on people’s fears to push their own agendas. This is why bad actors like the disgraced former doctor Andrew Wakefield and movement leader Del Bigtree are able to charge fees to profit from speaking at anti-vaccination events. I’m not saying a person who spreads a message should do it for free. What I am saying is that they are able to turn a personal profit by preying on people’s fears while doing little to investigate the thing they claim to worry about.

We must find a way to communicate two simultaneous truths:

  1. There is an inherent risk in everything; bad stuff happens to good people, and you can do everything right and still lose. Nevertheless, the risks involved when it comes to vaccines are worth shouldering because of the net good that comes from it and the risks themselves are vanishingly small.
  2. In the 22 years since Wakefield published his study and the 16 years since its retraction, there has not been any peer-reviewed credible evidence that supports many of the claims given by the anti-vaxx movement. The movement is predicated on fears people have of the probability of something bad happening to them or their loved ones. The motivation behind the fear is legitimate, but the object of the fear is a bogeyman that hides behind whatever shadows it can find as more and more light is cast on this area.

The anti-vaxx ideology knows it cannot address head-on the mounting scientific evidence that discredits its premise, and so it instead focuses on a different avenue of attack.

This bears repeating: the anti-vaxx ideology cannot debate or refute the scientific evidence about vaccination. We know vaccines work. We know how they work; we know why they work. We understand the probabilities of the risk; we know the type and magnitudes of the risks. These things are known to us. Anti-vaxx belief is a deliberate falsehood when it denies any of what we know.

Because of this, the anti-vaxx ideology is shifting to speak to those deep fears we have of the unknown, and instead of dealing with the facts of medicine, it is sinking its claws into the deep desire we have for freedom and autonomy. It shortcuts our rational experience and appeals to the fears evolution has given us to grapples with the unknown – the knee-jerk rejection of things we don’t understand.

Informed consent as a concept is the latest victim of anti-vaxx’s contagion. It’s seeping in and corrupting it from the inside, turning the very principle of self-directed autonomy against a person’s self-interest. It doesn’t cast doubt by calling the science into question. Instead, it casts doubt precisely because the average person doesn’t understand the science, and so that unknown becomes scary to us and we reject or avoid what brings us fear.

Anti-vaxx ideology is a memetic virus. In our society’s wealth, luxury, and tech-enabled friction-free lives, we have allowed this dangerous idea to gain strength. By ignoring it and ridiculing it until now, we have come to a point where it threatens to disrupt social homeostasis. Unless we do something to change the conditions we find ourselves in – unless we are willing to do the hard work – I fear that this ideology is going to replicate at a rate that we can’t stop. It will reach a critical mass, infect enough people, and threaten to undo all the hard work achieved in the past. We have already seen the evidence of this as once-eradicated diseases are popping up in our communities. The immunity and innoculations have weakened. Let’s hope those walls don’t break.

Stay Awesome,

Ryan

Books on Vocational Reflection

I finished reading Complications by Atul Gawande last week and really enjoyed it.  It was his first book and covered stories from his apprenticeship phase of becoming a surgeon.  I thought back to the first book I read from him, The Checklist Manifesto, and realized that while I enjoyed the topic Manifesto covered, I found it lacking a certain charm that Complications had.

Manifesto felt like a good idea that was stretched a bit too thin to fit the book format, and was heavily supplemented with references to studies done by other researchers.  This isn’t meant as a criticism – it was a good book!  But what I felt Complications (and his other book Better) had is the first hand reflection on one’s professional development.  It’s not just a memoir of one’s life, nor is it a tell-all, but instead it’s a focused meditation on the training, learning, failures, achievement, and lessons one gains from devoting themselves to their vocation.

Over the last three and a half years of reading, I’ve found I really enjoyed these kinds of  books.  I looked over my reading list and pulled a bunch of examples randomly below.  Some of them are about medicine, others are of actors, and a few books from the business world.  The common thread is that it’s less about the personal biography of the person and more about the development of the professional (for this reason, I didn’t include Elon Musk’s and Enrico Fermi’s biographies, or career retrospectives like the books from James Comey and Hillary Rodham Clinton).

It describes a world bigger than the person telling the story, and their attempt to grapple with the epistemological, ethical, and professional obligations that comes from entering a profession, and where their limits lie.  These are not stories about heroes – the stories are about human error and fallibility, and learning to deal with that revelation.  It also keeps its eye towards what it means to serve others, and where the profession should go in the future.

Ultimately, these books differ from the animated bibliography in one crucial area.  The animated bibliography is often a book that results from a person researching and stitching together the ideas of others.  In some cases, these books will require the author to attempt to put the ideas into practice, but in my opinion this is in service of selling the credibility of the book.  However, the books I’m discussing here and listing below are different because they are an account of people who are learning by doing.  They are applying what they previously learned during formal education, and reflecting on the outcomes to see what lessons can be derived.  In some sense, the books are an autopsy that try to tease out causes, or at least serve as a cautionary tales for those who come later.

 

A Thousand Naked Strangers – Kevin Hazzard

 

Doctored – Sandeep Juhar

 

I’d Like to Apologize to Every Teacher I Ever Had – Tony Danza

 

Total Recall – Arnold Schwarzenegger

*Note – I include this mostly because of his telling of his time as a body-builder and actor.

 

A Life in Parts – Bryan Cranston

 

The Art of Learning – Josh Waitzkin

 

Shoe Dog – Phil Knight

 

Creativity, Inc. – Ed Catmull

 

The Checklist Manifesto – Atul Gawande

 

Better – Atul Gawande

 

Complications – Atul Gawande

Stay Awesome,

Ryan

Keep Your (First Aid) Skills Sharp

I wrote my masters thesis in 2012 on the relationship of knowledge, first aid, and the moral requirements of rescue.  The thesis argued that 1.) if you have special knowledge or training (first aid), you are morally required to render aid, even if there is no pre-existing legal requirement; and 2.) everyone should be trained in first aid.  While it is the case that I have to keep my first aid certificates current in order to work at the bar, I believe that it’s important to keep these skills fresh and sharp regardless of your occupation.

You never know when you’ll need to draw upon the skills, so frequent practice is important if you want to be effective.

There have been two instances while working at the bar where a pedestrian was struck by an automobile while I was working.  The first was New Years Eve a few years back, and the second was this past St. Paddy’s Day.  Thankfully, in both instances the person did not seem to be critically harmed in the incident, and both were conscious when they were loaded into the ambulance to be taken to the hospital for further attention.  I suspect that while both had some degree of recovery ahead of them, they thankfully won’t likely experience prolonged physical suffering.

In both instances, I was working on the door, so I was the first responder on scene to start treatment.  In the case of a traffic collision, the most important steps are to protect yourself, and start control of the scene.  I can confidently say that I’m terrible at the first thing, and half-decent on the second.  This is why consistent practice is important.

Protect yourself

I fail on this in two regards.  I have a tendency to run out into the street to reach the pedestrian quickly, meaning that I put myself at risk of getting hit by a car while on scene.  The other thing I’m bad at is getting to the pedestrian and starting treatment before I finish the scene survey (which includes putting on medical gloves to protect myself).  These are big no-no’s.  I expose myself to unnecessary risk while trying to be first to the injured, when realistically I should take an additional 15-30 seconds to stop, take in the scene, and put on my gloves.

Control the Scene

I am adequate at this because I tend to default to immobilizing C-Spine and trying to talk to the pedestrian if they are conscious.  I could do this better in a number of way, such as having a fellow staff member control the spine while I assess for additional injuries and control the scene (directing people around me, updating EMS, taking notes, etc.).  In regards to the staff at the bar, I am probably the most experienced first aider, so removing myself from the decision-making portion of the response has benefits and drawbacks.  I am the best person to perform first aid until advanced medical care arrives, but I also have enough experience to understand the dynamics of the scene.  At this point, it’s best that I trust my fellow staff to respond appropriately.

Responding to a traffic incident is chaotic, noisy and confusing.  On top of this, adrenaline courses through your body, making your hands shake and your limbs jittery.  Your brain feels like mush because your thoughts are lightning quick.  Time seems to slow down, and that ambulance that is 5-8 minutes away always takes an eternity.  You are hyper-focused on your patient, but aware that there is a light din of noise at your periphery.  It’s like a bubble is around you, and you are hoping like hell that you don’t mess anything up under the spotlight of the gawking mass of people encircling the scene.

This is all normal.  It (sadly) gets easier the more you do it.  You become calmer each time you respond; it’s happening to me already.

The lesson to take from this is to always keep your certs current, and find time to meaningfully practice your skills.  Someones life may depend on it.

Stay Awesome,

Ryan