Friday, November 30, 2018

Stacy Peralta talks frankly about Tony Alva on his instagram


View this post on Instagram

Tony Alva circa 1978. Tony is one of the few individuals whose skating talent literally took my breath away. On numerous occasions I saw him do things that stopped my heart dead. He was stunning and spellbinding to watch. He skated with a form of aggression that was backed by pure emotion and furious desire and that was coupled with a physical style that was magnificent in its perfection of the human form. — And yet for so much of the time we spent together I hated Tony. I hated him for his arrogance and his ego and his need to be the center of attention at all times. But I probably hated him most for making me a better skater. He made me better. He made all of us better. He was so deadly serious about what skateboarding meant to him, that if you weren’t living up to how he saw it, then he was going to make you pay by humiliating you with his talent. I saw this happen time and again. — Over the years I’ve come to appreciate Tony for the person he is now and the person he was then. He was chosen to play a very large role in skateboarding and it was a role destined for him. No one else could have done it. His abrasive and intense personality was as important as his skating talent because the young sport needed a compelling rebel figure like Tony to help define it. More than anyone from our generation, Tony had the innate ability to set on fire the hearts and minds of skaters the world over and he did it through his living example. He was the ideal skateboarder in its purest form. And more than anything, and this is where my appreciation reaches its highest level; Tony was able to recognize, develop, contain and focus the extraordinarily powerful gift that was given to him at such a young age. Responsibility comes with gifts; the first is to figure out how to develop that powerful and precious gift, the next is how to share it with the world. Tony did just that, he infused the gift he was given with love and fury and he shared it with all of us, and I believe we are all better for it.

A post shared by Stacy Peralta (@peraltastacy) on

Sunday, November 25, 2018

SUNDAY SERMON:
Pope condemns the "wealthy few" who hoard the riches that "belongs to all"

from Boing Boing:


Pope Francis continues his streak of fighting for economic justice (though he's an unrepentant monster on abortion, women's rights, and the rights of queer people).

His sermon last Sunday lamented the plight of exploited people, indigent people and migrants, blaming "the wealthy few" for hoarding the riches that "in justice, belongs to all."

The sermon was delivered to 6,000 invited poor people, 1,500 of whom were fed afterwards at a Vatican lunch; it's part of the Pope's anti-poverty initiative in Vatican City, which includes free healthcare provided to homeless and poor people in St Peter's Square.
He also drew attention to the plight of abandoned elderly, the friendless and “the cry of all those forced to flee their homes and native land for an uncertain future. It is the cry of entire peoples, deprived even of the great natural resources at their disposal.”

Francis said the poor were weeping “while the wealthy few feast on what, in justice, belongs to all. Injustice is the perverse root of poverty.”

“The cry of the poor daily becomes stronger but every day heard less,” he said. That cry is “drowned out by the din on the rich few, who grow ever fewer and more rich,” the pontiff said.
Pope decries that ‘wealthy few’ feast on what belongs to all [Frances D'Emilio/AP]



Saturday, November 24, 2018

Snoop Dogg gets a star on Hollywood Walk of Fame

from Boing Boing:


From Eastside Long Beach Crip to rapper to celebrity chef, there's pretty much nothing the Dogg can't do. Today, the entertainer and Los Angeles icon Snoop Dogg received a long-deserved star on the Hollywood Walk of Fame.

The performer born in Long Beach as Calvin Cordozar Broadus Jr. was feted by Dr. Dre and other hip-hop royalty in Los Angeles today.

Here's the live feed, rewatchable in entirety:






Friday, November 23, 2018

BLACK FRIDAY WORTHY:
FedEx driver delivers racist attacker to the afterlife



from Boing Boing and Washington Post:
Working as a delivery driver is an easy path to a long dark night of the soul. Eight hours of folks wondering why their package wasn't delivered earlier, miserable traffic conditions and heavy carrying heavy stuff up flights of stairs or wheeling boxes around tight corridors on a dolly and people that won't get the hell out of the way is enough to wear anyone down.

And that's before bringing racists into the equation.
From The Washington Post:

Timothy Warren was driving his FedEx truck through a verdant Portland, Ore., neighborhood when the man he would soon kill screamed that Warren was going too fast.

Warren stopped his truck. He was exhausted, he tried to explain to Joseph Magnuson that night in late September, and just wanted to get done with his work.

Magnuson was unrelenting and hurled numerous aggressive insults and racist slurs toward him.

That was something Warren, who is black, could not abide.

He stepped out of the truck, and both men yelled at one another.

Magnuson took a swing. Warren swung back, connecting a single blow above Magnuson’s left eye that sent him tumbling to the ground.

Magnuson, 55, briefly lost consciousness, then died later that evening.
When police began the task of piecing together what the hell had happened, they had plenty to work with. Six people witnessed Magnuson's racist rant. Three of the six had seen the whole thing go down, from soup to nuts. Everyone the cops spoke with said that Warren had been driving safely. He hadn't been speeding. The witnesses all agreed that Magnuson had used racial slurs. Magnuson threw a drink at Warren. He threw a punch at Warren. Magnuson's was killed by his own hatred. When questioned about the incident, a man acquainted with Magnuson offered that nothing would have happened if Warren had kept on driving.

If Magnuson hadn't looked to break the body and soul of a man innocent of all but doing his job, Warren wouldn't have needed to stop driving. He wouldn't have had to stand up to hatred. He wouldn't have to live with the death of a hateful man.

The police and the district attorney's office concluded that Warren acted in self-defense and that no charges would be laid.

Thursday, November 22, 2018

Thanksgiving!

Enjoy your day off...

Eat foods that are good for you and the planet, please.







Tuesday, November 20, 2018

Alexandria Ocasio-Cortez: abolish Columbus Day,
replace it with Voting Day




from Boing Boing:
Alexandria Ocasio-Cortez (previously), the youngest woman ever elected to Congress, has proposed abolishing Columbus Day (which honors a raping, murdering, enslaving, genocidal pedophile) and replacing it with a day off for voting (which most other developed democracies give their citizens).

Ocasio-Cortez first mooted an Election Day holiday, then replyied to Daily Mail’s U.S. political editor David Martosko, who tweeted that "AOC hasn't even started the job yet and she's already angling for more vacation days," by saying, "While I would disagree with your complaint that Americans get too much vacation time (we work some of the longest hours of any dev country & have no Fed required paid leave), I am willing to compromise by eliminating Columbus Day to give Election Day off. See? I can be pliant."
The idea that Election Day should be a national holiday was proposed by independent Vermont Senator Bernie Sanders, for whom Ocasio-Cortez was an organizer, when he pursued the Democratic primary for the 2016 presidential election.

After a turnout of only about 36 percent in the 2014 elections, according to the University of Florida’s United States Elections Project, Sanders co-sponsored a bill to establish “Democracy Day” to make it easier for Americans to vote.

“Election Day should be a national holiday so that everyone has the time and opportunity to vote. While this would not be a cure-all, it would indicate a national commitment to create a more vibrant democracy,” Sanders wrote on his website. “We should not be satisfied with a 'democracy" in which more than 60 percent of our people don't vote and some 80 percent of young people and low-income Americans fail to vote.”
Alexandria Ocasio-Cortez Wants to Replace Columbus Day With Holiday for Election Day [Jessica Kwong/Newsweek]


Monday, November 19, 2018

School of Life Monday:
What Comes After Religion

The debate between believers and atheists usually goes nowhere. The real issue is: what should fill the gaps created by the end of widespread belief? What should fill the God-shaped hole?

Sunday, November 18, 2018

Sunday Sermon: CAPITALISM IS KILLING PATIENTS…
AND THEIR PHYSICIANS

from PopularResistance.org :

Physician burnout, depression, and suicide increasingly invade discussions within the medical field. Depression and suicide are more common among male and female physicians, with suicide rates 1.41 and 2.27 times greater than that of the general male and female populations, respectively. Though, the insults to the mental health of physicians begins much earlier in their career.

While the numbers may vary from study to study, some 28 percent of medical residents experience a major depressive episode during their training compared to 6 to 8 percent of the general population. These numbers are important, not only because suffering physicians are suffering humans in their own right, but also because this epidemic leads to poor patient care.

As a recent study out of the Stanford School of Medicine suggests, burnout and depression in physicians can lead to medical error and death. Many have tried to explain the causes of the epidemic, referencing everything from unmanageable workloads and work inefficiency, to lack of meaning in work and lack of work-life balance. Films are now being produced to shine light on the issue. In her TED talk “Why Doctors Kill Themselves,” Pamela Wible points to a medical school culture of hazing and bullying that continues into residency, along with a professional culture that hinders physicians from obtaining mental health treatment.

These factors certainly contribute to the epidemic, but when discussing physician suicide, we ignore the elephant in the room: capitalism. We are unable to recognize how the exploitation and alienation of physicians is integrally connected to this dominant economic system, but nothing could be more poignant, given in the state of the world today.

Ironically, the same destructive system that is driving physicians to extremes is also the main driver of the deterioration of health of the patients and populations, requiring patients to see physicians in the first place. The sooner we realize and confront our own exploitation, the sooner we can join in the fight to address the real driver of disease that is plaguing physicians and patients.

The System Outlined

Busy physicians may not have time to study how the world’s prevailing economic system functions, but doing so could benefit both our profession and the patients with whom we work. To briefly discuss, inside this system the working class that does not own the means of production is forced to sell its labor to an employer to survive.

A few corporations control most of the market for each of the commodities they produce. In these corporations, a very small sector of a board of directors and majority shareholders makes essentially all of the decisions on what to produce, where to produce and how to distribute profits. This puts the working class in a vulnerable position. With the ultimate goal of profit maximization, decisions are often made by the corporate class which are not in the best interest of workers and negatively affect the health of entire communities.

Outsourcing work, closing factories, creating poor working conditions to cut costs, polluting waterways and the environment–decision after decision may initially increase profits, but in the long term harms health. This harm to health can be more obvious, as when air and water are polluted, or more subtle, for example when families are put under chronic stress–which eventually leads to various forms of illness– from poor workplace conditions or income insecurity secondary to factory closure and outsourcing.

In this system, certain “costs”–the health of families, and entire communities being destroyed–are “externalized.” This means the business itself does not pay for these costs of poor societal health, which are created secondary to decisions made by business executives to increase profits. Such decisions are made by a small number of wealthy, powerful individuals pursuing their interests for greater wealth and power accumulation at expense of all else.

As economists such as Thomas Piketty have shown by combing through economic records from as far back as the 18th century, capitalism inherently generates inequality, concentrating wealth into the hands of the few at expense of everyone else. Study after study shows us that socioeconomic inequality itself is detrimental to patient health and actually increases morbidity and mortality.

Despite the negative effects, the working class today is more productive than ever, while wages remain flat (or are sometimes even lower) and work hours continue to increase. Workers struggle to put food on the table and meet basic needs, while the ownership class continues to become richer. Workers are exploited and reduced to tools for industry, many times forced to do mundane tasks or assignments over and over. They are alienated, or separated from the control and the product of their labor, each day they go to work. Inside this system workers are ultimately reduced to mechanistic cogs producing profit for large corporations.

This combination of being overworked and lacking true meaning and fulfillment in the work being done, drives more and more throughout both the white and blue collar sectors into despair. As Johan Hari, shows in his recent work Lost Connections: Uncovering the Real Causes of Depression and Unexpected Solutions, workers become separated from loved ones and from things that bring them joy as they work multiple jobs for longer hours as they struggle to make ends meet.

This constant stress leads to anxiety, depression, and various other forms of disease. Meanwhile, all medicine has to offer for them are at best poor attempts–many times with questionable supporting data demonstrating efficacy– to numb the pain that much larger systemic structures continue to create.

Unfortunately, the corporate elite know no limits in this system, they continue to exploit the masses and drive more and more into poverty and desperation while concentrating wealth in ever fewer hands. In America today, the three wealthiest individuals own the same wealth as the entire bottom half of the population, more than 160 million individuals. In order to maintain this system, the elite must ensure that the members of the working class fight amongst themselves rather than direct their rage toward those who are benefiting off of the oppression of the masses.

The capitalist system, born from racism and white supremacy as highlighted in studies such as Edward Baptist’s The Half That Has Never Been Told: Slavery and the Making of American Capitalism, continues to separate members of the working class based on social constructs such as race. At the same time, through a multitude of mechanisms, the system creates a self-loathing, insecure public, driven to constant consumption, leading to the pollution of the earth and poisoning of community after community.

These various forms of structural violence are the true drivers of disease and suffering, of which the health care system sees the results, but has little to no ability to truly address. The health of the majority of the population deteriorates and the elites benefit. Capitalism’s need to endlessly expand and its effect on the earth, has literally lead some scientists to call for the designation of a new geologic era called the anthropocene to describe the effect humans have had on the earth.

Scientists now warn we have moved into the sixth great mass extinction of species seen in our world’s history. A new report by the World Wildlife Fund (WWF) suggests, “Humanity has wiped out 60% of mammals, birds, fish and reptiles since 1970, leading the world’s foremost experts to warn that the annihilation of wildlife is now an emergency that threatens civilisation.” Meanwhile, a new U.N. Intergovernmental Panel on Climate Change (IPCC) report warns us that humanity has only a dozen years to address global warming to avoid increasing droughts, floods, etc., which will inevitably lead to more poverty and illness.

Capitalism does not just threaten the health and well being of every human, but life on this earth as we know it. Capitalism operates as a terminal cancer, knowing no limits to its endless growth and consumption, destroying systems necessary to survival and threatening the continued existence of its host.

Medicine Has Not Escaped

What is outlined above are the underlying causes of the majority of disease and suffering. The prevailing economic system in the world today commodifies every aspect of life including health care. As a result, the health of the public, especially the US public, is subjected to a barrage of market mechanisms.

US medical professionals, while often paid more than the typical member of the working class, are still forced to operate inside of this system that places profits above patient health. We see how this system harms our patients, limiting availability of the care they need, but we tend to miss that we also are damaged by this same system.

As Howard Waitzkin and the “Working Group on Health Beyond Capitalism” state in the book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health,” until the 1980s, doctors, for the most part, owned and/or controlled their means of production and conditions of practice.” This allowed them to have control over things such as their work hours and how much time to spend with patients. As the Working Group references, “loss of control over the conditions of work has caused much unhappiness and burnout in the profession.

As other members of the proletariat, or working class, have experienced for years, doctors now no longer have control over their labor. Now corporations or other large institutions control such decisions. Physicians have become “proletarianized” and while not members of the traditional working class, they have become tools in the corporate wheel of profit production. This has left us with a health system parasitized by the capitalism that cares more about profit production than it does the care of human beings.

The medical industrial complex, made of a multitude of different institutions–hospital corporations, large insurance companies, or pharmaceutical and device corporations and, more specifically the corporate elite who control these corporations–ultimately governs a majority of the large scale, structural decisions that affect patient care. The elite in these institutions, just like other capitalist organizations, make decisions that affect the lives of the majority with little to no input from those who are affected by these decisions.

They govern the prices of drugs–often leading to the obscene drug prices–and how long a physician should be spending with his or her patients in the clinic. These organizations have the primary goal of maximizing profit (regardless of whether they bear the title of “for profit” or “non-profit”) above all else. Consequently, patient health really becomes secondary in this system.

The metastasis of capitalism’s perverse incentives to even the sector that claims to care for the health of human beings, has given us the ineffective, damaging system we have today. Since profit production is of prime importance, physicians–and really health care providers in general–must be trained to be efficient tools for profit, seeing more patients more quickly, knowing how to bill appropriately, etc.

These incentives limit a physician’s ability to do what he or she actually went into medicine (or should have) for: to help people. Physicians want to help their patients, but are simply not able to truly address patient suffering because addressing the causes, as highlighted above, are outside the scope of a profit based medical system.

To understand how exactly this system creates human tools for health care profit while in the process leaving them physically and mentally broken, we must delve into the medical education and training structure and analyze how medical providers are conditioned to accept their own exploitation.

Training in the Art of Being Exploited

Step 1: Medical School

Medical trainees in the US enter medical school at least generally claiming they have some interest in caring for other human beings. Unfortunately, little do they know, they are entering a system designed to prime them for their own exploitation from the second their training begins—one could argue even well before that point–and subsequently throughout their residency training.

During medical school, students are forced to study innumerable hours while being told they have to “lay a good foundation” of knowledge for their future practice. The first 2 years in most medical schools are classroom based, where insurmountable amounts of information are thrown at students as they are told “this is just the way medicine is, get used to it.”

Unfortunately though, much of the information students spend their time studying–or more often mindlessly memorizing–will never be used when caring for patients. This information is absorbed, regurgitated on an exam, and then often forgotten. One thing students do begin to learn–if they hadn’t already through their undergraduate education or their grade school education prior–is to listen to authority figures’ demands if they would like to succeed.

Students have little influence on what they are being taught. Instead, they must accept what they are being told or they may not pass their next exam. Students who entered medicine eager and idealistic, hoping to help others, begin to slowly withdraw from their individual passions and interests simply because tests, rotation evaluations determined by the opinions of supervising providers students must impress, and board exams are deemed more important. They are taught that listening to authority figures at the expense of their own interests and passions, comes first and then they can try to pursue their interests if they have time. This obviously can affect the mood and morale of a training physician.

During their third year, medical students are forced to spend numerous hours in the hospital. They are also required to take “shelf exams” at the end of each rotation, which can often have a large impact on their overall rotation grade. Because slight differences in grades can affect residency opportunities, students spend free-time studying for these exams instead of participating in activities to maintain their own mental and physical well being. While the exam scores offer little insight into the type of a physician the student will become, they serve to add extra pressure on students and ensure that they spend little time actually thinking for themselves while they are out of the hospital.

During fourth year many students are expected to complete sub-internships in the fields they are are interested in going into for residency training. These sub-internships normally require students to work near their 80 hour work limit, congruous to work limits of residents (more on that shortly). Medical students often carry their own patient panels, write notes that can be co-signed, and can even pend medication orders to be approved. The main difference between them and an actual paid intern is that they do not get paid. Instead they must work to “impress” their superiors in hopes of obtaining a positive evaluation. Once again, students are taught that listening to and striving to impress authority is their ultimate goal.

After four years of indoctrination, in addition to a medical degree, most medical students are given one final parting gift on their way into residency: hundreds of thousands of dollars of debt. This debt serves as a convenient way of pushing newly minted doctors into financial constriction when entering their residency.

No matter how they view their new employer or the field they have chosen, they know that they now have hundreds of thousands of dollars that they must find some way to pay back. This makes them much less likely to question or challenge authority in their new positions because doing so could impede completion of their training, sabotaging their career and only chance to escape debt. Along, with the inherent emotional stress of caring for sick patients, these financial difficulties can lead to depression, anxiety and a host of mental health issues in the newly minted physician.

Step 2: Residency

Once medical school graduates enter residency, they have already been primed for their inevitable exploitation, understanding that they need to take direction from authority, curtail their passions to make them more palatable to superiors, and most importantly, suppress any depression or anxiety they feel secondary to an ineffective, exploitative system. They now have few options–or are at least told so–other than to continue through residency. They know that to find themselves at this stage, they have made significant financial and emotional sacrifices, often losing connection with the people and things they love in order to fulfill education requirements.

Unfortunately, the exploitation of these newly minted doctors is just beginning. During training, residents are forced to work often 80 hours per week doing a large portion of the patient care in hospitals (not to mention the additional hours of preparation outside of hospital or clinic, which are not counted toward this 80 hour limit). Residents are salaried, so they provide a cheap, efficient source of labor for hospitals and clinics. Residents become physically and emotionally exhausted trying to care for maxed out patient loads effectively in understaffed hospitals. Work hours become normalized over time and residents simply expect to be working an unhealthy amount of time in the hospital or at least convince themselves that it is normal to maintain their own sanity. It is no wonder this situation plunges many, who are already at risk, into burnout and depression.

Throughout residency, residents do, admittedly, grow exponentially in their ability to care for patients and become independently functioning physicians. Though, there is another type of growth that occurs during these years, which is seldom discussed.

Residents are groomed to be efficient, effective profit producers once they enter the workforce. For example, over their time in residency, a large degree of emphasis is placed on residents meeting particular “quality measures” for the clinic or hospital settings. Training after training is spent ensuring residents understand how to properly bill and submit insurance claims. Residents learn how to see patients extremely quickly and complete entire patient visits within 15 minutes. As anyone who has even interacted with a health care provider can attest, this is not enough time to actually make any significant interpersonal connection with a patient.

Either during this visit or after, residents must also learn to input information into whichever electronic medical record their training center uses. As Matt Anderson notes in Health Care Under the Knife commenting on EMRs, “most were designed to capture billing and quality information, not facilitate clinical care.” Residents end up spending more time looking at a computer than they do connecting with a patient. In the inpatient setting, a hospitalized patient might only see their doctor for a few minutes each day. This is partially because the rest of the day is spent documenting a coordinating care inside of a completely nonsensical system to ensure hospitals will be able to cash in on patient hospital stays.

This puts individuals, who went into medicine to care for and make connections with patients, torn between still trying to achieve this goal and meeting designated “quality measures.” If they are not able to see patients fast enough in the clinic or inpatient hospital setting they may not be seen as “marketable” to employers. This is clearly an environment that can breed physical, mental, and emotional suffering in the exploited trainee.

Even while studies have shown these grueling hours put both patients and residents at risk, when it comes to actually addressing the problems highlighted above, the onus is consistently put on the provider to maintain “self care.” From the beginning of residency, different “mental health departments” speak with residents about the importance of maintaining self care and “balance,” while at the same time maintaining an exploitative system that overworks its employees and drives suffering. Residents are a cheap form of labor for hospitals or clinics, and actually addressing this problem at a systemic level would be too threatening to the profitable status quo.

How the system’s leaders speak about these work conditions is very telling. For example, in 2016 Dr. Janice Orlowski the Chief Health Care Officer with the Association of American Medical Colleges (AAMC), stated “The individual is going to go into a profession where their profession calls on them to work extended hours and to be available at unusual hours […] We need to train individuals who can learn to pace themselves, who can recognize when they have sleep deprivation or when they are stressed.”

This is an interesting statement, coming from someone who should know the demands put on residents drastically limits their capacity to “pace themselves.” It is clear that there is much more concern for protecting a public image of medicine and hospital programs than there is for addressing the crisis of physician depression and suicide.

Step 3: Practicing Physicians

Finally, if not already burned out, the physician has escaped residency and now believes that he or she will be able to practice “however one wants.” Unfortunately, any overburdened physician–either fresh out of residency or seasoned–who has worked inside a busy hospital or clinic, can attest to feeling tired, overworked, and often unfulfilled, in part due to their lack of patient connection as they are rushed from patient to patient and progress note to progress note.

Again, citing Matt Anderson in the Health Care Under the Knife’s section “Becoming Employees: The Deprofessionalization and Emerging Social Class Position of Health Professionals,” concepts typically lauded again and again in the health sector–”value, efficiency, quality, and market discipline–are part of an ideology to justify corporate control over the work of physicians and other works providing health services.” He references Marx’s concept of alienation–the separation of worker’s control over his or her labor– and describes how more and more health care providers are separated from what they once truly loved about their work, and now must fill the primary role of profit producer and secondary role of health care provider. If this separation did not occur during residency, there is a good chance it will when outside of training working for an employer.

While practicing, providers are still attempting to treat patients who present with illnesses created by the much larger system of capitalist exploitation referenced above, but their training prior to starting independent practice in no way, shape, or form has actually prepared them to join the communities they serve in combating these larger oppressive systems. On the contrary, what they were taught was to keep their head down, survive, and make it through exploitative residency programs. They are in regular practice and know how to put in a billing code and attempt the near impossible task of making a true connection with someone in a 15 minute clinic visit, but have not remotely learned how to begin to resist a parasitic capitalist system damaging both their colleagues and their patients.

At the same time, even if a physician did want to step outside of traditional boundaries to help challenge the true socioeconomic and structural causes of disease highlighted above, the provider still has a massive amount of student loans constricting their decisions. They may also have started a family or accumulated other financial constraints during residency. This leaves them with few options and many find it easier to get back in the clinic, put their heads down, and tell themselves they are really helping to address patient health. When in reality, they have been indoctrinated into a system based on profit maximization and blunting of patient suffering at best.

This endless process of day after day in clinic, seeing little to no progress at a systemic level, can become frustrating and make one’s work seem futile. Imagine spending over 10 years in training–from college, through medical school, through residency–to find yourself in this position. It is no surprise that more and more physicians are burning out, and feeling so desperate, that harming oneself becomes a viable option to escape.

Recognizing One’s Exploitation and Fighting Back

Capitalism’s parasitic economic structure has infiltrated all aspects of our society, and medicine has not been spared. This results in physicians being trained and conditioned to be obedient profit producers above all else. It leads them to be alienated from their loved ones and from their true passions. Inside our healthcare system, physicians are separated from the things that truly brought them joy and fulfilment. Yet we still continue to question why physicians are killing themselves?

Some maintain hope that there will be action around these issues from residency administrations, hospital working groups, or any number of hierarchical bodies that govern medical education, graduate medical education, or our healthcare system in general. The reality is that these issues will never be solved by any large committees or “task forces” we currently have in place, which continually put the onus onto medical students, residents, and practicing physicians to develop more “resilience” inside of a system that is build to do the exact opposite.

Those who have made it to the top positions of organizations such as the Accreditation Council for Graduate Medical Education (ACGME) or the Association of American Medical Colleges (AAMC) are there because they will continue to support the status quo. As political dissident and linguist Noam Chomsky discusses in reference to elite control of institutions, “an unstated but crucial premise is that the ‘responsible men’ achieve that exalted status by their service to authentic power, a fact of life that they will discover soon enough if they try to pursue an independent path.” These institutions will never consider the best interests of physicians or the patients they serve. Their leaders have been groomed to support the status quo. It is up to us to realize our exploitation and begin to fight against it.

Realizing this fact is easier said than done, as most physicians, due to the filtering mechanisms throughout our educational system, which typically lead to those from the upper classes securing seats in medical school, come from the exploitive classes themselves. Physicians are also paid more than a majority of other employees within our healthcare system such as nurses, technicians etc. They are conditioned to believe that they are somehow different or more important than the rest of the working staff when in reality all members are important in caring for the patient and all members are overworked and exploited by the same system.

Giving one member of an exploited group–in this case the physician–more benefits than others, helps to keep the fighting going between all groups as opposed to collaboration and organizing. We will be able to begin addressing the crisis of physician suicide once we, as physicians, accept that just as this capitalist system exploits our patients and coworkers, it is also exploiting us. And then we organize against it.

Whether it is consciously recognized or not, physicians specifically are also often boosted up with a false sense of elitism from the second they step into the field. This creates a blind spot for them being able to recognize their own suffering and exploitation and organize against it. They are given special white coats, which–besides becoming completely filthy after 80 hour work weeks–distinguish them from other hospital staff and distinguish themselves by the title of “doctor.”

While other staff members, such as nurses, actually have the collectivist mindset to organize against the damage the health care industrial complex causes to the patients they care for and even strike when necessary, physicians–especially those in the US–have been conditioned to believe they are too important to the system to do the same, even while that system is actively damaging them. Their administrators and peers say, “If we aren’t caring for patients, our patients will die.”

Those with a vested interest in maintaining the business as usual hold patients as hostages inside this system, guilting providers into accepting the status quo (inadequate care, inadequate access to care, medical errors, and crushing debt) with this rhetoric. It is despite the fact that physicians around the world have been able to organize and strike effectively while also continuing to provide absolutely necessary care.

Referencing Mark Ames’s 2005 book, Going Postal: Rage, Murder, and Rebellion: From Reagan’s Workplaces to Clinton’s Columbine and Beyond is useful for understanding this current phenomenon. In the book, Ames evaluates the mental anguish caused by Reagan era policies and analyzes how our capitalist system degrades and humiliates workers until they are pushed to harm themselves and others. In the following passage he speaks of how people can often deny their own exploitation until it is too late. He notes:

The middle class persistently denies its own unique pathos, irrationally clinging to an irrational way of measuring it, perhaps because if they did validate their own pain and injustice, it would be too unsettling–it would throw the entire world order into doubt. It is more comforting to believe they aren’t really suffering, to allocate all official pathos to the misery of other socioeconomic groups, and its more comforting to accuse those who disagree of being psychologically weak whiners. Despite its several hundred million strong demographic, the white bourgeoisie’s pain doesn’t officially count–it is too ashamed of itself to sympathize with its own suffering.

Until physicians are willing to accept the fact they they are being exploited by the same system that harms their patients, there will be no progress made in addressing physician depression and suicide. At that same time, until health care providers generally accept that it is our current capitalist system which puts profit production above the well being of every living thing on this planet–including themselves–we will not be able to effectively address true social and structural causes of disease and suffering.

Capitalism exploits, damages, and destroys us all. History shows us, large scale systemic change has never come from the beneficence of those in power and, frankly, it never will. As historian Howard Zinn writes speaking about public activism, the rights of the citizenry only come when “citizens organize, protest, demonstrate, strike, boycott, rebel, and violate the law in order to uphold justice.”

As physicians, if we truly care about the well being of our coworkers and of our patients, we must begin to organize, unionize, and rebel inside our practices, residency programs, etc, resisting business as usual, and finding ways to threaten the profits of capitalists if we want to see systemic change. We must begin to organize with communities and populations resisting oppression from a parasitic capitalist system as physicians in the past have done with groups such as the Black Panthers and Young Lords.

Once physicians can begin to view the dynamics of our capitalist system more clearly–and view the dynamics of our healthcare system as just one microcosm of how capitalism harms us all–it will become clear what needs to be done. We must put down our fancy white coats and begin to organize with our fellow healthcare staff–and, more importantly, with our patients–against a system that exploits and damages us all. Only then will be able to begin developing a new system that actually cares about both people and the planet.

Michael Pappas graduated from Georgetown Medical School and is currently training in Family Medicine residency in New York City. He can be reached at pappasm898@gmail.com.
* please go to original story for links that support article

Saturday, November 17, 2018

Noam Chomsky on Pittsburgh Attack:
Revival of Hate Is Encouraged by Trump’s Rhetoric

The nation is continuing to grieve the 11 Jewish worshipers who were gunned down at the Tree of Life synagogue in Pittsburgh Saturday in what is being described as the worst anti-Semitic attack in U.S. history. Funerals were held Thursday for three more victims of the shooting: husband and wife Sylvan and Bernice Simon, and Richard Gottfried. Robert Bowers, who is accused of the mass shooting, pleaded not guilty Thursday. Bowers is charged with 44 counts, including murder and hate crimes. We speak with Noam Chomsky, the world-renowned professor, linguist and dissident, about the synagogue shooting in Pittsburgh and other recent white supremacist and right-wing attacks.

Friday, November 16, 2018

Deaths From Gun Violence:
How The U.S. Compares With The Rest Of The World

from NPR.org

Every fall the University of Washington produces a report comparing the past year's rate of gun violence in the United States to the rates in other countries.

The timing of this year's report couldn't be more apt — or more grim. The statistics were released on Thursday just as Americans were waking up to the news that a gunman had opened fire the night before at the Borderline Bar and Grill in Thousand Oaks, Calif. He killed 12 people and was found dead at the scene.

The attack came just 11 days after the fatal shooting that claimed 11 lives at Pittsburgh's Tree of Life synagogue. Eight months before that, a gunman shot 17 people dead at Marjory Stoneman Douglas High School in Parkland, Fla. And just over a year ago a gunman massacred 58 people at a music festival in Las Vegas.

As in previous years, the University of Washington's latest data indicate that this level of gun violence in a well-off country is a particularly American phenomenon.

When you consider countries with the top indicators of socioeconomic success — income per person and average education level, for instance — the United States is bested by just 18 nations, including Denmark, the Netherlands, Canada and Japan.

Those countries all also enjoy low rates of gun violence. But the U.S. has the 28th-highest rate in the world: 4.43 deaths due to gun violence per 100,000 people in 2017. That was nine times as high as the rate in Canada, which had 0.47 deaths per 100,000 people — and 29 times as high as in Denmark, which had 0.15 deaths per 100,000.

The numbers come from a massive database maintained by the University's Institute for Health Metrics and Evaluation, which tracks lives lost in every country, in every year, by every possible cause of death. The 2017 figures paint a fairly rosy picture for much of the world, with deaths due to gun violence rare even in many countries that are extremely poor — such as Bangladesh, which saw 0.07 deaths per 100,000 people.

Prosperous Asian countries such as Singapore and Japan boast the absolute lowest rates, though the United Kingdom and Germany are in almost as good shape.

"It is a little surprising that a country like ours should have this level of gun violence," Ali Mokdad, a professor of global health and epidemiology at the IHME, told NPR in an interview last year. "If you compare us to other well-off countries, we really stand out."



To be sure, there are quite a few countries where gun violence is a substantially larger problem than in the United States — particularly in Central America and the Caribbean. Mokdad said a major driver is the large presence of gangs and drug trafficking. "The gangs and drug traffickers fight among themselves to get more territory, and they fight the police," said Mokdad. And citizens who are not involved are often caught in the crossfire. Another country with widespread gun violence is Venezuela, which has been grappling with political unrest and an economic meltdown.

Mokdad said drug trafficking may also be a driving factor in two Asian countries that have unusually high rates of violent gun deaths for their region, the Philippines and Thailand.

With the casualties due to armed conflicts factored out, even in conflict-ridden regions such as the Middle East, the U.S. rate is worse.

The U.S. gun violence death rate is also higher than in nearly all countries in sub-Saharan Africa, including many that are among the world's poorest.

One more way to consider these data: The institute also estimates what it would expect a country's rate of gun violence deaths to be based solely on its socioeconomic status. By that measure, the U.S. should be seeing only 0.46 deaths per 100,000 people. Instead, its actual rate of 4.43 deaths per 100,000 is almost 10 times as high.


please go to the original article to see more of the graphs.

Thursday, November 15, 2018

Wednesday, November 14, 2018

How The NRA Silenced the Science of Gun Violence Prevention

from Medium:

If, as the NRA claims, more guns lead to less crime, why are they opposed to funding studies that could back up their assertion?


Another mass shooting.

Another body count.

Another unending list of questions.

Why does this keep happening? Are we missing warning signs? Can we identify high-risk individuals ahead of time? Are there laws that could prevent or reduce firearm injuries and deaths? If so, what laws are most effective at mitigating the risks?

These are questions that are answerable through the scientific method. Indeed, we might very well know the answers to these questions, or at least have a growing body of evidence to guide us, if leading government scientists and federal agencies were given the funding to study them.

But they’re not: Thanks to a 23-word rider attached to a federal spending bill in 1996 and enacted in 1997, research on gun violence has been frozen for two decades.

The Scandalous History of The Federal Freeze on Gun Violence Research Funding

The freeze on federal funding for gun violence research can be traced back to 1993, when Dr. Arthur Kellerman and colleagues published the results of a CDC-funded study in the prestigious New England Journal of Medicine (NEJM). The study, “Gun ownership as a risk factor for homicide in the home,” found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide. Rather than confer protection, the study concluded that people who keep guns in the home faced a 2.7-fold greater risk of homicide and a 4.8-fold greater risk of suicide.

The NEJM article was the subject of significant media attention, and the National Rifle Association (NRA) responded by trying to shut down the entire center that had funded the study, the CDC’s National Center for Injury Prevention. The center itself survived, but in 1996, Dickey — backed by the NRA — authored an amendment that cut $2.6 million from the CDC’s budget — the exact amount the CDC had invested in research on firearm injuries the previous year.

Passed by a Republican-dominated Congress, the NRA-backed ‘Dickey Amendment’ stated that “[n]one of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” While the amendment doesn’t explicitly ban research on gun violence, the deliberately vague wording — combined with an onslaught of harassment of researchers — had a chilling effect on scientific progress, effectively ending all federal research programs related to gun violence. As Dr. Mark Rosenberg, former director of the CDC’s National Center for Injury Control and Prevention, put it: “The scientific community has been terrorized by the NRA.



“Precisely what was or was not permitted under the clause was unclear,” Dr. Kellerman wrote in a December 2012 article in the Journal of the American Medical Association. “But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up.”

It’s important to note that the freeze on funding doesn’t just impact federal agencies — it applies to federally-funded researchers everywhere. At universities and medical centers nationwide, where research is highly dependent on federal grants, published studies on gun violence dropped off dramatically after the passage of the Dickey Amendment — by about 60% between 1996 and 2010 — while federally funded gun violence research dropped by approximately 96% during the same period. Furthermore, CDC officials say the funding freeze and subsequent lapse in gun violence research caused lasting damage to the field. After funding was cut off, leading researchers moved on to other areas of study that were still supported by the government, and some researchers even discouraged students from specializing in gun violence research because of the lack of funding. Although private violence prevention agencies continued to support research on gun violence, they were unable to produce or analyze nationwide data on gun violence without the work of institutions like the CDC.

The amendment — and the message it sent to scientists — also had the effect of making gun-related research questions controversial even for studies not funded by the government, as scientists feared such research would be held against them if they applied for federal grants in the future. According to a 2017 study published in the Journal of the American Medical Association, gun violence was the least-researched cause of death in the U.S. and the second-least funded cause of death over the past decade.

“As a result of [the Dickey Amendment], many, many people stopped doing gun research, [and] the number of publications on firearm violence decreased dramatically,” Dr. Fred Rivara, a professor of Pediatrics and Epidemiology at the University of Washington at Seattle Children’s Hospital, and a co-author of the 1993 NEJM study, told PRI’s The Takeaway. “It was really chilling in terms of our ability to conduct research on this very important problem.”

Silencing The Science of Gun Violence Prevention

Over the last two decades, Republicans have exploited the Dickey Amendment to argue their case that gun violence is not a public health issue — a view that stands in stark contrast to the position of professional medical and public health organizations, at least 52 of which have independently urged lawmakers to treat gun violence as a pressing public health epidemic. Despite this overwhelming consensus from the scientific community, congressional Republicans actually expanded the scope of the Dickey Amendment to apply to the National Institutes of Health in 2011, after Dr. Douglas Wiebe, an epidemiologist at the University of Pennsylvania’s Perelman School of Medicine, authored a 2009 NIH study that confirmed a significant association between gun possession and gun assault.

In 2013, following the shooting at Sandy Hook Elementary School, President Obama called on the CDC to resume funding for research into the causes of gun violence. He also asked on Congress to give the CDC $10 million so they could carry out such research, but Congress has not allotted any of those funds in subsequent budgets. While the CDC developed a plan to use this funding on studies addressing firearm injury prevention and control, the agency’s research agenda remains frozen due to congressional inaction. Most recently, in the wake of the 2015 Charleston church shooting, the GOP-controlled Appropriations Committee of the U.S. House of Representatives rejected an amendment that would have lifted the federal funding freeze. Former House Speaker John Boehner defended the lack of government research, saying “a gun is not a disease.”

Notably, we heard the exact same argument back in the middle of the 20th century, when motor vehicle accidents were responsible for killing more than 50,000 Americans a year. The common wisdom, as told by carmakers, was that automobile fatalities were the fault of individual drivers — in other words, ‘cars don’t kill people; drivers kill people.’ This assertion was ultimately shown to be false, but we only discovered the truth after years of rigorous injury prevention and control research conducted by scientists at the CDC. Contrary to the claims of the automobile industry, vehicle design was found to be just as much to blame for high fatality rates as bad drivers. Researchers also discovered that motor vehicle deaths could be significantly reduced with simple safety devices such as air bags and seat belts, as well as road design features such as median barriers. The National Traffic and Motor Vehicle Safety Act of 1966 mandated many of these improvements. It also marked the start of a decades-long federal effort to better understand automobile and highway safety through systematic data collection and analysis. As a result of these studies — and the policies that grew out of them— the motor vehicle fatality rate per mile traveled has fallen 80 percent since 1966.

The insights that emerged from this line of research formed the foundation of the public health approach to injury prevention, an evidence-based model that incorporates 1) ongoing surveillance and monitoring of trends in injury-related morbidity and mortality; 2) identification of risk and protective factors; 3) continuous evaluation and development of prevention strategies; and 4) dissemination of the most efficacious strategies for reducing the incidence and burden of injuries. In addition to motor vehicle safety, this basic model has been applied successfully to reduce the public health burden of intentional and unintentional causes of injury, including poisonings, drownings, child and elder abuse, dating violence, and sexual violence.



We could use the same injury prevention model to study gun violence and reduce its massive public health impact. But unlike car manufacturers, the gun industry — led by the NRA — has been successful in their efforts to suppress scientific inquiry into gun violence and potential approaches to prevention. Moreover, while certain federal agencies like the ATF collect basic data on criminal uses of firearms, prohibitions on data-sharing have stymied scientific research on the subject. For example, as Jennifer Mascia explained in The Trace, the ATF is prohibited from “releasing crime-gun trace data to anyone other than a law enforcement agency or prosecutor — leaving academics and researchers without easy access to valuable data.”

The end result is that many fundamental questions about gun deaths and injuries, such as how many Americans are shot each year, remain unanswered, and we lack the data to establish basic parameters like the magnitude, scope, characteristics, and consequences of firearm violence. That’s important, as public health professionals rely on this type of data to identify risk and protective factors, as well as to develop effective violence prevention strategies. Insufficient research also makes it difficult for policymakers, even in states with strong firearm laws like Massachusetts and California, to know which laws will be effective, since there’s very little data for evaluation. This has meant in practice that “there is no scientific consensus on the best approach to limiting gun violence,” the New York Times reported in a 2011 article, “and the NRA is blocking work that might well lead to such a consensus.”

Even former Congressman Dickey — the Republican who wrote the original provision banning gun violence research — has recanted and urged Congress to repeal the ban, writing in an op-ed that, unlike researchers studying car accidents or infectious disease, “U.S. scientists cannot answer the most basic question: what works to prevent firearm injuries?”

If, as the NRA claims, more guns lead to less crime, why are they opposed to funding studies that could back up their assertion? The very thought is apparently enough to terrify the NRA, which is why they’ve gone to such extreme lengths to suppress this line of research and any policies that might grow out of it.

“If there is no research, it is harder to make suggestions for policy reform,” Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis, told the Huffington Post. “And if you have a vested interest in stopping policy reform, what better way to do it than to choke off the research? It was brilliant and it worked. And my question is how many people died as a result?”

We didn’t have to ban automobiles to cut motor vehicle fatalities — and we don’t have to ban guns to reduce gun-related deaths. What we do need, however, is a willingness to objectively examine the causes of gun violence — and elected leaders who care enough about American lives to go where the data lead.


click on the original article link to see more references.

Monday, November 12, 2018

School of Life Monday:
Against Philanthropy

The best way to do good in the world is not to be a philanthropist. It’s to be a good capitalist. The need to 'give back' is generally chiefly a sign that people took too much to begin with.

Sunday, November 11, 2018

Sunday Sermon: go to Twitter and check #ThisIsMyLane

NO GUNS NO NRA - The country is better than what this greed and ignorance portrays us to be. Go to twitter and read the truth from doctors!



The NRA sent a tweet this week asking doctors to stay in their lane when it comes to gun violence research. In response, the medical community has begun tweeting out images of gun violence saying “#ThisIsOurLane.”

Just days after a single gunman took the lives of 12 at a bar in Thousand Oaks, Calif., the National Rifle Association sent an angry tweet Thursday suggesting that the medical community stay out of the gun debate. “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control,” wrote the NRA. “Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

On Saturday, nurses, doctors, and emergency medical services who have spent years trying to save the lives of gun violence victims launched a viral campaign in response: “#ThisIsMyLane.”

“Hey @NRA, have you ever had to look a mother in the eye and tell her, ‘I’m sorry, we did everything we could, but your child died’ after they were shot? Because I have,” tweeted Elizabeth Laverriere, MD, of Johns Hopkins University. “Preventing gun violence is completely in my lane. No one should EVER hear that. #PedsICU #PedsAnes #thisismylane

Saturday, November 10, 2018

Let's be clear on what I think of Guns


FUCK GUNS!

Not for you, Not for me, Not for the police.

It's such a travesty that people who use the stupid 2nd amendment argument for guns, that was put in place so the people could face off to a tyrannical government with power, NOW have a tyrant in the oval office and don't do shit about it, but support the Lying CON MAN. Ignorance abounds, and the greedy have you tricked.

Y'all will be sorry, and feel as stupid as you look to us, one day when you realize how fucking dumb you've been to let this shit go as it has.






Friday, November 9, 2018

Televangelists




U.S. tax law allows television preachers to get away with almost anything. We know this from personal experience.

Thursday, November 8, 2018

Henry Rollins on Society, People and Politics | ARTST TLK

Watch as Henry Rollins and Pharrell Williams take on America's modern day problems -- from marriage equality to health care to war in this, the second half of their two-part interview. Rollins shares his experiences exercising his 1st Amendment Rights on tour with the USA and talks about how the interacFons with servicemen and their families have touched him. Pharrell asks Rollins about being a social agitator and taking advantage of every opportunity to try new things.

Monday, November 5, 2018

School of Life Monday:
PHILOSOPHY - Augustine

The philosopher and theologian Augustine had fascinating things to say about success and failure.

Sunday, November 4, 2018

Sunday Sermon:
Noam Chomsky Calls Trump and Republican Allies "Criminally Insane"



Chomsky on the Trump-led Republican Party: "There have been many monsters in the past, but it would be hard to find one who was dedicated to undermining the prospects for organized human society, not in the distant future -- in order to put a few more dollars in overstuffed pockets."

from The Scientific American blogs:
The great linguist and political critic remains hopeful that we can overcome global warming and other threats.

I don’t really have heroes, but if I did, Noam Chomsky would be at the top of my list. Who else has achieved such lofty scientific and moral standing? Linus Pauling, perhaps, and Einstein. Chomsky’s arguments about the roots of language, which he first set forth in the late 1950s, triggered a revolution in our modern understanding of the mind. Since the 1960s, when he protested the Vietnam War, Chomsky has also been a ferocious political critic, denouncing abuses of power wherever he sees them. Chomsky, who turns 90 on December 7, remains busy. He spent last month in Brazil speaking out against far-right politician Jair Bolsonaro, and he recently discussed the migrant caravan on the radio show “Democracy Now.” Chomsky, whom I first interviewed in 1990 (see my profile here), has had an enormous influence on my scientific and political views. His statement that we may always "learn more about human life and human personality from novels than from scientific psychology” could serve as an epigraph for my most recent book, Mind-Body Problems. Below he responds to my emailed questions with characteristic clarity and force. -- John Horgan

Do you ever chill out?
Would rather skip personal matters.

Your ideas about language have evolved over the decades. In what ways, if any, have they remained the same?
Some of the earliest assumptions, then tentative and only partially formed, have proven quite robust, among them that the human language capacity is a species property in a double sense: virtually uniform among humans apart from serious pathology, and unique to humans in its essential properties. The most basic property of the language faculty is that each internal language generates an unbounded array of structured expressions, each of which yields an interpretation at the interface with other cognitive systems (basically a linguistically-articulated thought) and can be externalized in some sensorimotor system, usually speech, in ways that allow others to access our thoughts – a property of language that Galileo and his contemporaries rightly regarded with awe and wonder. Basic ideas about the mechanisms that have these remarkable properties have also proven fairly stable, though there has been great progress in refining them and reducing them to principles simple enough to provide sound explanations for many surprising aspects of language and to suggest a plausible evolutionary scenario. From the outset, 65 years ago, the languages investigated closely were typologically varied, and in tandem with theoretical advances inquiry has proceeded to unprecedented typological range and depth.

Your claims about the innateness of language helped inspire evolutionary psychology and behavioral genetics, which attempt to trace human thought behavior to their biological roots. And yet you’ve been critical of these fields. Why?
Not so much of the fields, which are surely legitimate and important, but of some of the practices within them.

You once said we will probably “always learn more about human life and human personality from novels than from scientific psychology.” Is that still your view?
Another thought that has proven robust.

John Ioannidis and other scholars have discovered that many peer-reviewed scientific claims cannot be replicated. Do you have an explanation, and possible cure, for the so-called replication crisis?
Nothing beyond the obvious. Sometimes failure of replication has to do with complexity of what is being studied and with inadequate tools and ideas. The intense pressure to publish and sometimes ugly competitiveness are other factors. As compared with other domains, the scientific culture is quite admirable I think, though hardly without flaws that can and should be corrected.

Do you take seriously the Singularity, the idea that artificial intelligence and other fields will soon radically transform humanity?
One can certainly imagine how, in principle, systems that can detect patterns with massive data processing might find hitherto unknown ways of constructing theories that surpass those within the reach of human intelligence. And that could have all sorts of effects. But among the concerns we face, this doesn’t seem to me to rank high. Even tasks mastered almost reflexively by infants are far beyond the capacities of contemporary AI.

In his recent book Enlightenment Now, your former MIT colleague Steven Pinker argues that life has gotten better and better, morally and materially, and he scolds other intellectuals for knocking western civilization. What's your view of his perspective?
I don’t find these broad-brush observations very helpful or informative. The devil is in the details.

There is work on these matters that seems to me much more compelling. In his very important study on the rise and fall of American growth, Robert Gordon observes that there was virtually no economic growth for millennia until 1770, slow growth for another century, and then a “special century” until 1970, dependent largely on specific inventions. Since the 1970s the picture is much more mixed: in the US, with actual decline in real wages for non-supervisory workers over 40 years and even increased death rates in recent years. These are among the features of the neoliberal era that have led to the rise of the kind of “morbid symptoms” that Gramsci warned about from Mussolini’s prison cell, as we see all too clearly in the western world today. Elsewhere we find different patterns. Thus Russia suffered severe economic decline and demographic collapse when market reforms were introduced in the ‘90s. China has been different again. As Amartya Sen has shown, Maoist China saved about 100 million people – not a small number – as compared with democratic capitalist India from independence to 1980, not from “enlightenment” in the usual sense, but from rural health programs and other reforms. And since then it has undergone spectacular growth and provided the bulk of the reduction in global poverty, in a society that’s not a model of enlightened values. Nazi Germany experienced very rapid growth in the ‘30s, not a triumph of enlightenment. There are numerous other complexities that are of major significance, but that disappear in unanalyzed statistical tables.

As for “moral growth,” there are even greater complexities. The American Revolution introduced the novel and important idea (put aside the fact) that “we the people” should take control of our fate –- and at the same time developed the most vicious system of slavery in human history, the foundation of much of US-British wealth and economic development. Or take Germany again. In the 1920s, it was at the peak of western civilization in the arts, the sciences and mathematics, and even political development, regarded as a model of democracy. Ten years later it was descending to the depths of human savagery. A decade later it was recovering what had been lost.

As for the Enlightenment and modern science, no serious analyst can question their major achievements – or overlook their role in the age of discovery that brought untold horrors to much of the world, devastating the Western Hemisphere and Africa, crushing the leading world centers of civilization in India and China.

With all that, a good case can be made I think that moral horizons are, overall, slowly widening, including recent years, when the activism of the ‘60s has had a considerable civilizing effect in many areas.

Pinker, Richard Wrangham and Edward Wilson have suggested that human males are innately warlike. Do you agree? Can humanity move past militarism once and for all?
Since humans (males and females) are sometimes warlike, it follows that their intrinsic nature permits this outcome under certain circumstances. Under other circumstances they prefer peace – normally I think. But it’s highly misleading to say that they are “innately warlike” or “innately peaceloving.” I don’t know of any argument showing that we cannot create circumstances under which warlike tendencies will be suppressed – as has often been the case in history.

Are you a pacifist? Is violence sometimes justified in pursuit of justice?
Not an absolute pacifist. I didn’t object to entering World War II after Japan attacked military bases in two virtual colonies and Germany declared war, and in fact thought that the US should have intervened more forcefully before. But it’s also worth bearing in mind that the Nazi plague could have been contained before it led to war.

Why did you recently call the Republican Party “the most dangerous organization in world history”?
Take its leader, who recently applied to the government of Ireland for a permit to build a huge wall to protect his golf course, appealing to the threat of global warming, while at the same time he withdrew from international efforts to address the grim threat and is using every means at his disposal to accelerate it. Or take his colleagues, the participants in the 2016 Republican primaries. Without exception, they either denied that what is happening is happening – though any ignorance is self-induced – or said maybe it is but we shouldn’t do anything about it. The moral depths were reached by the respected “adult in the room,” Ohio governor John Kasich, who agreed that it is happening but added that “we are going to burn [coal] in Ohio and we are not going to apologize for it.” Or take a recent publication of Trump’s National Highway Traffic Safety Administration, a detailed study recommending an end to regulations on emissions. It presented a rational argument: extrapolating current trends, by the end of the century we’ll be over the cliff and automotive emissions don’t contribute very much to the catastrophe – the assumption being that everyone is as criminally insane as we are and won’t try to avoid the crisis. In brief, let’s rob while the planet burns, putting poor Nero in the shadows.

This surely qualifies as a contender for the most evil document in history.

There have been many monsters in the past, but it would be hard to find one who was dedicated to undermining the prospects for organized human society, not in the distant future -- in order to put a few more dollars in overstuffed pockets.

And it doesn’t end there. The same can be said about the major banks that are increasing investments in fossil fuels, knowing very well what they are doing. Or, for that matter, the regular articles in the major media and business press reporting US success in rapidly increasing oil and gas production, with commentary on energy independence, sometimes local environmental effects, but regularly without a phrase on the impact on global warming – a truly existential threat. Same in the election campaign. Not a word about the issue that is merely the most crucial one in human history.

Hardly a day passes without new information about the severity of the threat. As I’m writing, a new study appeared in Nature showing that retention of heat in the oceans has been greatly underestimated, meaning that the total carbon budget is much less than had been assumed in the recent, and sufficiently ominous, IPCC report. The study calculates that maximum emissions would have to be reduced by 25% to avoid warming of 2 degrees (C), well above the danger point. At the same time polls show that -- doubtless influenced by their leaders who they trust more than the evil media -- half of Republicans deny that global warming is even taking place, and of the rest, almost half reject any human responsibility. Words fail.

Wasn’t Richard Nixon worse than Donald Trump?
Nixon had a mixed record. In some respects, he was the last liberal president: OSHA and EPA for example. On the other hand, he committed terrible crimes. Arguably the worst was the bombing of rural Cambodia, a proposed article of impeachment but voted down though it was incomparably more important than the others. And the article was much too weak, focusing on the secrecy. There has been little attention to the orders that Nixon delivered, relayed to the Pentagon by his faithful servant Henry Kissinger: “A massive bombing campaign in Cambodia. Anything that flies on anything that moves.” It is not easy to find comparable orders for genocide in the archival record. But all of Nixon’s crimes pale in comparison with the decision to race towards the precipice of environmental catastrophe.

Are the U.S. media doing their job?
It depends on what we think their job is. They are businesses, so by accepted standards their job is profit. By other standards, they have a duty to the public to provide “all the news that’s fit to print,” under a concept of “fitness” that is as free as possible from submission to power interests or other distorting factors. About this there is a great deal to say – I’ve devoted many words to the topic elsewhere, as have many others. But in today’s strange climate of Trumpian “alternative facts” and “false reality,” it is useful to recognize that with all their flaws, which are many, the mainstream media remain an indispensable source of information about the world.

Can incremental reforms transform the U.S. into a just, prosperous society, or are more drastic measures required? In other words, are you a reformer or a revolutionary?
Both. Generalizations are misleading; too much depends on specific circumstances. But some have a fair degree of validity, I think. One is that there is both justification and pressing need for radical changes in the socioeconomic and political orders. We cannot know to what extent they can be achieved by incremental reforms, which are to be valued on their own. But unless the great mass of the population comes to believe that needed change cannot be implemented within the existing system, resort to “drastic measures” is likely to be a recipe for disaster.

My students are pretty gloomy about the future. What can I tell them to cheer them up?
Apart from the truly existential threats of nuclear war and global warming – which can be averted – there have been far more difficult challenges in the past than those young people face today, and they have been overcome by dedicated effort and commitment. The historical record of struggle and achievement gives ample reason to take to heart the slogan that Gramsci made famous: “pessimism of the intellect, optimism of the will.”

What’s your utopia?
I don’t have the talent to do more than to suggest what seem to me reasonable guidelines for a better future. One might argue that Marx was too cautious in keeping to only a few general words about post-capitalist society, but he was right to recognize that it will have to be envisioned and developed by people who have liberated themselves from the bonds of illegitimate authority.