Tag: Fear

Second Order Brother’s Keeper

person behind mesh fence
Photo by Mitch Lensink on Unsplash

I apologize for the late post this week. I had a few ideas kicking around in my head, but given the updates, I felt this ramble-post was a better attempt to capture some of the zeitgeist, rather than my usual attempt to feign some sort of authority on whatever it is I’m trying to accomplish on this site. Maybe I’ll rant another time about the scummy people who are profiteering through the COVID-19 scare.

Most of the information circulating concerns how an individual can help protect themselves from contracting the virus. Obviously this information is spread around not to protect any one individual, but because it’s the government’s attempt to flatten the curve and ease the economic and public health downsides to the current behaviours of people, from clogging up emergency rooms with sniffles to wholesale runs on items in the grocery store.

I’m heartened by some of the genuinely positive messages being shared around, from people finding clever ways to spend time with loved ones in lockdown, to our Canadian Prime Minister ending his recent public address with a message of watching out for each other, to care for each other, and reinforce this as a Canadian value.

I’m not entirely sure what I should write about this week. It’s pretty hard to form a coherent thought when the majority of my bandwidth is occupied with keeping up with the shifting narrative around what’s going on. Thanks to technology, information (or misinformation) spreads quickly, and we are seeing multiple updates per day as a result. At my place of employment, they took the unprecedented step of shutting down face-to-face curriculum delivery. Unlike the faculty strike from Fall 2017, the College is working to keep the educational process running. While it may be that in the School of Engineering it can be impossible to replicate lab or shop time, the majority of faculty are working hard to translate their delivery to an online format.

So far, our employer has done a good job, in my opinion, with taking prudent steps to a.) keep people meaningfully occupied in their work so that no one has to lose their salary, and b.) do its part to stop the spread of the virus. I’m not saying that things couldn’t be better, but given the circumstances they’ve done a good job.

I’ve been thinking about the purpose of social isolation as a pandemic response. As I said above, the point is less about protecting oneself and is instead about protecting hospitals from being overwhelmed. If we’ve learned anything from countries around the world that are going through the worst right now, it’s that it becomes impossible to protect our vulnerable when there is a shortage of hospital beds. Hospitals are having to triage patients to focus on saving those who can be saved, who have the highest chances of recovering.

It is because of this that I’ve been thinking about the concept of a “brother’s keeper.” It’s not necessarily enough that governments or citizens remain mindful about the well-being of our vulnerable populations. Oftentimes while we are focusing on immediate dangers before us, we tend to not anticipate higher-order consequences of our policies or decisions.

Closing schools is great in theory – children are rabid spreaders of contagions, whether they are actually symptomatic or not, which means they infect their parents (some of whom are front line medical workers). But when we close schools, you have second order consequences that parents struggle with childcare, or children living in poverty lose access to food that is supplied at school.

When you close borders, you stop carriers of the virus from entry. But it also means that our international students (who are in some cases being vacated from post-secondary residences as school’s work to limit social contact among students) have no where to go. Airports are limiting international travel and the cost of purchasing tickets are skyrocketing. By them being in a foreign country, these students are vulnerable and caught in difficult positions on how to keep themselves safe.

By shutting down public spaces, you are helping to keep people from accidentally infecting each other. But when you close down businesses such as restaurants, you cut off people from the economic means they need to support themselves. Sure, the government is offering assistance to persons and businesses alike, but that will provide little comfort to people who can neither travel for groceries, nor pay for the supplies they need.

And let’s not forget what panic purchasing is doing to our supply chain – leaving store shelves cleared out of supplies, which means folks like the elderly are left without.

The hardest part I’m finding in all of this is the feeling of being powerless. You can’t control other people, and so you are forced to anticipate their moves to ensure you won’t be left without. But it’s this kind of thinking that leads to more drastic measures being taken. The virus also makes you feel powerless because you feel like an invisible stalker is coming for you – you don’t know who will be the final vector that leads to you. And you aren’t totally sure if our ritualistic hand-washing and hand-sanitizing is actually keeping us safe, or merely providing comfort. You can’t predict the future, and you can’t be sure you’re doing everything you can; you always feel like there is more you could be doing.

This reminds me of the story of the tinfoil house and pink dragons. A person covers their house in tinfoil, and when asked about it they say it keeps the pink dragons away. When asked if it works, the person shrugs and says “I don’t know, but I haven’t been attacked yet.” Of course, asking “if it works” is the wrong question here because there are no pink dragons. But as Taleb tells us in his book about Black Swans, there are always those highly unprobable events with massive downsides that we don’t see coming. Public policy and budgets are created to deal with clear and present dangers, and those policies and budgets are eroded when it’s felt that the money is not being allocated optimally. Therefore, you run into problems where you are never sure if the resources you spend to prevent something actually works – it’s really hard to prove causality in something that never happens.

Instead, we often are left to scramble to try and get ahead of trouble when we are already flat-footed, which means that our vision narrows as we focus on the fires in front of us that needs to be put out. Fighting fires is great (even heroic at times), but often the measures we take to deal with crisis have unanticipated second-order consequences that become difficult to deal with.

I’m not sure how to deal with this, but it makes me wonder about being my brother’s keeper, and what I can do to protect them.

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

History Snippets – Demagoguery

demagogue-2193093_1920
Image by John Hain from Pixabay 

It is sometimes amazing how cyclical social and political problems can be.  While I am not pessimistic in our ability to move forward in something that can be recognized as “progress,” I do have some cynical attitudes towards our collective habit to backslide.  I realized some time ago that while we espouse enlightened positions, such as “never again,” people as a whole tend to by historically myopic and prone to letting fear get the best of them – or to quote Agent Kay “A person is smart. People are dumb, panicky dangerous animals and you know it.”

As of writing, I’m working my way through Ron Chernow’s biography of Alexander Hamilton.  Around ten-hours into the audiobook, Chernow is discussing the political maneuvering between Hamilton and New York Governor George Clinton over trying to get the newly-drafted Constitution ratified in 10 States in order to bring it into force.  The two sat on opposite sides of the federal government question, with Hamilton believing a strong central federal government was the key to sustaining the American experiment, while Clinton was distrustful of a central government superseding the power of the States.  Hamilton had a poor opinion of Clinton, believing Clinton to be only concerned with consolidating his own wealth and power, and only pandering to the populace when elections rolled around.

Chernow gives a striking description of what Hamilton feared, and in a single line spells out a looming threat we are seeing anew in our own modern political discourse.  Hamilton worried that “American democracy would be spoiled by demagogues who would mouth populace shibboleths to conceal their despotism.”

Chernow penned those words some fifteen years ago.  Whether it’s 1788, 2004, or the dawning of the neo-20’s, the fears expressed in those words caution us that we must remain vigilant against those who seek to exploit our fears to manifest their vision in reality.

Stay Awesome,

Ryan

Failure by Psych-Out

Yesterday I went to a climbing gym with my co-workers for our summer staff party.  It’s been at least five years since the last time I tried rock climbing, and over a decade since the last time I actually climbed a rockface.

The experience was interesting.  On the one hand, the venue is great, and the staff were awesome.  My co-workers were all super supportive, and in no way did I feel like I didn’t belong because of other people.  I did, however, felt like I didn’t belong because I’m a 325lbs mass of meat that doesn’t have the greatest cardiovascular system and a nervous suspicion of gravity.

I made two attempts to climb a fairly easy 5.5 wall.  The first attempt, I chickened out about a quarter of the way up.  A little while later, I made a second attempt and got around 80% of the way up before I stopped, thought about things, and promptly started climbing back down.  In other words, I psyched myself out before I reached the top.

I was really bummed out about it afterward, because I knew that if I pushed through the mental barrier and went up the last 5-10 feet, I could have made it.  Instead, I saw that I still had a bit to go and felt that I didn’t trust the auto-belay device to support my weight, and the hand-holds near the top would have been tricky to climb back down on.  So, instead I decided to turn back and climb down until I was a safe height up from the ground where I could let go and still not injure myself if the auto-belay device didn’t arrest me.

It’s really stupid to let myself succumb to this kind of thinking.  I know that the equipment is safe, and I know that I won’t injure myself if I slip.  Nevertheless, I let my fear get the best of me, and I turned back before the end.

We can’t win them all.  I’ll try to do better next time.

Stay Awesome,

Ryan