Category: Drugs

Not Intellectuals Yet Not Idiots

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Back at the time of the Second Gulf War I made a real attempt to up my political engagement. I wanted to understand what was really going on. History was being made and I didn’t want to miss it.

It wasn’t as if before then I had been completely disengaged. I had certainly spent quite a bit of time digging into things during the 2000 election and its aftermath, but I wanted to go a step beyond that. I started watching the Sunday morning talk shows. I began reading Christopher Hitchens. I think it would be fair to say that I immersed myself in the the arguments for and against the war in the months leading up to it. (When it was pretty obvious it was going to happen, but hadn’t yet.)

In the midst of all this I remember repeatedly coming across the term neocon, used in such a way that you were assumed to know what it meant. I mean doesn’t everybody? I confess I didn’t. I had an idea from the context, but it was also clear that I was missing most of the nuance. I asked my father what a neocon was and he mumbled something about them being generally in favor of the invasion, and then, perhaps realizing that, perhaps, he wasn’t 100% sure either, said Bill Kristol is definitely a neocon, listen to him if you want to know.

Now, many years later, I have a pretty good handle on what a neocon is, which I would explain to you if that what this post were about. It’s not. It’s about how sometimes a single word or short phrase can encapsulate a fairly complicated ideology. There are frequently bundles of traits, attitudes and even behavior that can resist an easy definition, but are nevertheless easy to label. Similar to the definition of pornography used by Justice Stewart when the Supreme Court was considering an obscenity case,

I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [“hard-core pornography”], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it(my emphasis)

It may be hard to define what a neocon is exactly, but I know one when I see it. Of course, as you have already surmised, neocon is not the only example of this. Other examples include, hipster, or social justice warrior, and lest I appear too biased towards the college millennial set, you could also add the term “red neck” or perhaps even Walmart shopper.

To those terms that already exist, it’s time to add another one: “Intellectual Yet Idiot” or IYI for short. This new label was coined by Taleb in just the last few days. As you may already be aware, I’m a big fan of Taleb, and I try to read just about everything he writes. Sometimes what he writes makes a fairly big splash, and this was one of those times. In the same way that people recognized that there was a group of mostly Jewish, pro-israel, idealistic, unilateralists, with a strong urge to intervene who could be labeled as neocons, it was immediately obvious that there was an analogous bundle of attitudes and behavior that is currently common in academia and government and it also needed a label. Consequently when Taleb provided one it fit into a hole that lots of people had recognized, but no one had gotten around to filling until then. Of course now that it has been filled it immediately becomes difficult to imagine how we ever got along without it before.

Having spent a lot of space just to introduce an article by Taleb, you would naturally expect that the next step would be for me to comment on the article, point out any trenchant phrasing, remark on anything that seemed particularly interesting, and offer amendments to any points where he missed the mark. However, I’m not going to do that. Instead I’m going to approach things from an entirely different perspective, with a view towards ending up in the same place Taleb did, and only then will I return to Taleb’s article.

I’m going to start my approach with a very broad question. What do we do with history? And to broaden that even further, I’m not only talking about HISTORY! As in wars and rulers, nations and disasters, I’m also talking about historical behaviors, marriage customs, dietary norms, traditional conduct, etc. In other words if everyone from Australian Aborigines to the indigenous tribes of the Amazon to the Romans had marriage in some form or another, what use should we make of that knowledge? Now, if you’ve actually been reading me from the beginning you will know that I already touched on this, but that’s okay, because it’s a topic that deserves as much attention as I can give it.

Returning to the question. While I want “history” to be considered as broadly as possible, I want the term “we” to be considered more narrowly. By “we” I’m not referring to everyone, I’m specifically referring to the decision makers, the pundits, the academics, the politicians, etc. And as long as we’re applying labels, you might label these people the “movers and shakers” or less colloquially the ruling class, and in answer to the original question, I would say that they do very little with history.

I would think claiming that the current ruling class pays very little attention to history, particularly history from more than 100 years ago (and even that might be stretching it), is not an idea which needs very much support. But if you remain unconvinced allow me to offer up the following examples of historically unprecedented things:

1- The financial system – The idea of floating currency, without the backing of gold or silver (or land) has only been around for, under the most optimistic estimate, 100 or so years, and our current run only dates from 1971.

2- The deemphasis of marriage – Refer to the post I already mentioned to see how widespread even the taboo against pre-marital sex was. But also look at the gigantic rise in single parent households. (And of course most of these graphs start around 1960, what was the single parent household percentage in the 1800s? Particularly if you filtered out widows?)

3- Government stability – So much of our thinking is based on the idea that 10 years from now will almost certainly look very similar to right now, when any look at history would declare that to be profoundly, and almost certainly, naive.

4- Constant growth rate – I covered this at great length previously, but once again we are counting on something continuing that is otherwise without precedent.

5- Pornography – While the demand for pornography has probably been fairly steady, the supply of it has, by any estimate, increased a thousand fold in just the last 20 years. Do we have any idea of the long term effect of messing with something as fundamental as reproduction and sex?

Obviously not all of these things are being ignored by all people. Some people are genuinely concerned about issue 1, and possibly issue 2. And I guess Utah (and Russia) is concerned with issue 5, but apparently no one else is, and in fact when Utah recently declared pornography to be a public health crisis, reactions ranged from skeptical to wrong all the way up to hypocritical and, the capper, labeled it pure pseudoscience. In my experience you’ll find similar reactions to those people expressing concerns about issues 1 and 2. They won’t be quite so extreme as the reactions to Utah’s recent actions, but they will be similar.

As a personal example, I once emailed Matt Yglesias about the national debt and while he was gracious enough to respond that response couldn’t have been more patronizing. (I’d dig it up but it was in an old account, but you can find similar stuff from him if you look.) In fact, rather than ignoring history, as you can see from Yglesias’ response, the ruling case often actively disdains it.

Everywhere you turn these days you can see and hear condemnation of our stupid and uptight ancestors and their ridiculous traditions and beliefs. We hear from the atheists that all wars were caused by the superstitions of religions (not true by the way). We hear from the libertines that premarital sex is good for both you and society, and any attempt to suppress it is primitive and tyrannical. We hear from economists that we need to spend more and save less. We heard from doctors and healthcare professionals that narcotics could be taken without risk of addiction. This list goes on and on.

For a moment I’d like to focus on that last one. As I already mentioned I recently read the book Dreamland by Sam Quinones. The book was fascinating on a number of levels, but he mentioned one thing near the start of the book that really stuck with me.

The book as a whole was largely concerned with the opioid epidemic in America, but this particular passage had to do with the developing world, specifically Kenya. In 1980 Jan Stjernsward was made chief of the World Health Organization’s cancer program. As he approached this job he drew upon his time in Kenya years before being appointed to his new position. In particular he remembered the unnecessary pain experienced by people in Kenya who were dying of cancer. Pain that could have been completely alleviated by morphine. He was now in a position to do something about that, and, what’s more morphine is incredibly cheap, so there was no financial barrier. Accordingly, taking advantage of his role at the WHO he established some norms for treating dying cancer patients with opiates, particularly morphine. I’ll turn to Quinones’ excellent book to pick up the story:

But then a strange thing happened. Use didn’t rise in the developing world, which might reasonably be viewed as the region in the most acute pain. Instead, the wealthiest countries, with 20 percent of the world’s population came to consume almost all–more than 90 percent–of the world’s morphine. This was due to prejudice against opiates and regulations on their use in poor countries, on which the WHO ladder apparently had little effect. An opiophobia ruled these countries and still does, as patients are allowed to die in grotesque agony rather than be provided the relief that opium-based painkillers offer.

I agree with the facts, as Quinones lays them out, but I disagree with his interpretation. He claims that prejudice kept the poorer countries from using morphine and other opiates, that they suffered from opiophobia, implying that their fear was irrational. Could it be instead, that they just weren’t idiots

In fact the question should not be why the developing countries had problems with widespread opioid use, but rather why America and the rest of the developing world didn’t. I mean any idiot can tell you that heroin is insanely addictive, but somehow (and Quinones goes into great detail on how this happened) doctors, pain management specialists, pharmaceutical companies, scientist, etc. all convinced themselves that things very much like heroin weren’t that addictive. The people Stjernsward worked with in Kenya didn’t fall into this trap because basically they’re not idiots.

Did the Kenyan doctors make this decision by comparing historical addiction rates? Did they run double-blind studies? Did they peruse back issues of the JAMA and Lancet? Maybe, but probably not. In any case whatever their method for arriving at the decision (and I strongly suspect it was less intellectual than the approach used by western doctors) in hindsight they arrived at the correct decision, while the intellectual decision, backed up by data and a modern progressive morality ended up resulting in  exactly the wrong decision when it came time to decide whether to expand access to opioids. This is what Taleb means by intellectual yet idiot.

To give you a sense of how bad the decision was, in 2014, the last year for which numbers are available 47,000 people died from overdosing on drugs. That’s more than annual automobile deaths, gun deaths, or the number of people that died during the worst year of the AIDS epidemic. You might be wondering what kind of an increase that represents. Switching gears slightly to look just at prescription opioid deaths they’ve increased by 3.4 times since 2000. A net increase of around 13,000 deaths a year. If you add up the net increase over all the years you come up with an additional 100,00 deaths. No matter how you slice it or how you apportion blame, it was a spectacularly bad decision. Intellectual yet idiot.

And sure, we can wish for a world where morphine is available so people don’t die in grotesque agony, but also is simultaneously never abused. But I’m not sure that’s realistic. We may in fact have to choose between serious restrictions on opiates and letting some people experience a lot of pain or fewer restrictions on opiates and watching young healthy people die from overdosing. And while developing countries might arguably do a better job with pain relief for the dying, when we consider the staggering number of deaths, when it came to the big question they undoubtedly made the right decision. Not intellectual yet not an idiot.

It should be clear now that the opiate epidemic is a prime example of the IYI mindset. The smallest degree of wisdom would have told the US decision makers that heroin is bad. I can hear some people already saying, “But it’s not heroin it’s time released oxycodone.” And that is where the battle was lost, that is precisely what Taleb is talking about, that’s the intellectual response which allowed the idiocy to happen. Yes, it is a different molecular structure (though not as different as most people think) but this is precisely the kind of missing the forest for the trees that the IYI mindset specializes in.

Having arrived back at Taleb’s subject by a different route, let’s finally turn to his article and see what he had to say. I’ve already talked about paying attention to history. And in the case of the opiate epidemic we’re not even talking about that much history. Just enough historical awareness to have been more cautious about stuff that is closely related to heroin. But of course I also talked about the developing countries and how they didn’t make that mistake. But I’ve somewhat undercut my point. When you picture doctors in Kenya you don’t picture somehow who knows in intimate detail the history of Bayer’s introduction of heroin in 1898 as a cough suppressant and the later complete ban of heroin in 1924 because it was monstrously addictive.

In other words, I’ve been making the case for greater historical awareness, and yet the people I’ve used as examples are not the first people you think of when the term historical awareness starts being tossed around. However, there are two ways to have historical awareness. The first involves reading Virgil or at least Stephen Ambrose, and is the kind we most commonly think of. But the second is far more prevalent and arguably far more effective. These are people who don’t think about history at all, but nevertheless continue to follow the traditions, customs, and prohibitions which have been passed down to them through countless generations back into the historical depths. This second group doesn’t think about history, but they definitely live history.

I mentioned “red necks” earlier as an example of one of those labels which cover a cluster of attitudes and behaviors. They are also an example of this second group. And further, I would argue, that they should be classified in the not intellectual yet not idiots group.

As Taleb points there is a tension between this group and the IYI’s. From the article:

The IYI pathologizes others for doing things he doesn’t understand without ever realizing it is his understanding that may be limited. He thinks people should act according to their best interests and he knows their interests, particularly if they are “red necks” or English non-crisp-vowel class who voted for Brexit. When plebeians do something that makes sense to them, but not to him, the IYI uses the term “uneducated”. What we generally call participation in the political process, he calls by two distinct designations: “democracy” when it fits the IYI, and “populism” when the plebeians dare voting in a way that contradicts his preferences.

The story of the developing countries refusal to make opiates more widely available is a perfect example of the IYI’s thinking that they know what someone’s best interests are better than they themselves. And yet what we saw is that despite, not even being able to explain their prejudice against opiates, that the doctors in these countries, instinctively, protected their interests better than the IYIs. They were not intellectuals, yet they were also not idiots.

Now this is not to say, that “red necks” and the people who voted for the Brexit are never wrong (though I think they got that right) or that the IYI’s are never right. The question which we have to consider is who is more right on balance, and this is where we return to a consideration of history. Are historical behaviors, traditional conduct, religious norms and long-standing attitudes always correct? No. But they have survived the crucible of time, which is no mean feat. The same cannot be said of the proposals of the IYI. They will counter that their ideas are based on the sure foundation of science, without taking into account the many limitations of science. Or as Taleb explains:

Typically, the IYI get the first order logic right, but not second-order (or higher) effects making him totally incompetent in complex domains. In the comfort of his suburban home with 2-car garage, he advocated the “removal” of Gadhafi because he was “a dictator”, not realizing that removals have consequences (recall that he has no skin in the game and doesn’t pay for results).

The IYI has been wrong, historically, on Stalinism, Maoism, GMOs, Iraq, Libya, Syria, lobotomies, urban planning, low carbohydrate diets, gym machines, behaviorism, transfats, freudianism, portfolio theory, linear regression, Gaussianism, Salafism, dynamic stochastic equilibrium modeling, housing projects, selfish gene, Bernie Madoff (pre-blowup) and p-values. But he is convinced that his current position is right.

With a record like that which horse do you want to back? Is it more important to sound right or to be right? Is it more important to be an intellectual or more important to not be an idiot? Has technology and progress saved us? Maybe, but if it has then it has done so only by abandoning what has got us this far: history and tradition, and there are strong reasons to suspect both that it hasn’t saved us (see all previous blog posts) and that we have abandoned tradition and history to our detriment.

In the contest between the the intellectual idiots and the non-intellectual non-idiots. I choose to not be an idiot.

On The Limitations of Science

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There are lots of people out there condemning the debauchery of our modern world, and generally with more eloquence than I can muster. Additionally there are prophets, both ancient and modern who have already offered up rousing sermons and trenchant observations (one of which I took as the theme of this blog) and I would urge you to study the writings of those prophets before reading anything I write. So, if there’s better stuff out there why do I bother to blog? I believe there is a gap in the commentary. A hole in the discourse that I can fill. It doesn’t need to be filled. What I write is not critical to anyone’s salvation. I am not uncovering any lost principles of Christ’s gospel, nor am I speaking in a more timely manner than what you hear at the semiannual General Conferences. If that’s so, what niche do I fill? What unique insights do I provide?

If you read my very first post, then you’ll remember that I already touched on this. This blog will specifically focus on comparing the LDS Religion to the Religion of Progress and examining how the Religion of Progress has failed. The sacrament of the Religion of Progress is science. And it is appropriate that it be so. I myself am a believer in science. But like all sacraments, the sacrament of science can be partaken of unworthily. It can be misunderstood, and distorted. Just as partaking of the actual sacrament every week doesn’t immediately absolve you of all your sins if you’re not also actively exercising faith, repenting of those sins and seeking forgiveness; partaking in the sacrament of science doesn’t immediately make what you do and what you believe scientific, no matter how much you proclaim your love for it. Science has serious limitations, even if one is doing everything right, which most of the time they’re not. And many of the failures of the Religion of Progress comes when it ignores those limitations (or in the case of the last post, trades science for emotion.) Consequently, this post is all about examining those limitations.

Let’s start by examining the limits of science even if everything is done correctly. To begin with it’s really hard to do it correctly, and 90% of the time what passes for quality science are efforts which leave out a lot of the rigor necessary for truly conclusive results. This was not always the case at the beginning of the scientific revolution there was a lot low hanging fruit. Scientific results of surpassing clarity and rigor that could be obtained with only moderate effort (the gentleman scientist working nearly alone was a fixture of the time.) All that low-hanging fruit is gone, but people still expect science to come up with similarly ironclad results even though the window during which that was possible is long past. Also most of the really solid science involves physics, and the farther you get away from that, the less amenable things are to experimentation in general because there are too many variables.

Thus you’re left in a situation where if you want to do solid, incontrovertible science your best bet is to do more physics, and that’s going to cost billions of dollars, or you can use pieces of the scientific method and take a stab at the questions which remain after all the low-hanging fruit has been picked. I say pieces of the scientific method because, for example, there are all manner of subjects which can’t be subjected to an experiment with a control. This is a limitation in many fields, but one of the best examples is economics, particularly macroeconomics. You can’t create a copy of the world and have one world where the global economy stays on the gold standard and the control, a world where everyone moves to floating currency. You will still have economist who will tell you that one is better than the other, but this is based off bits of data they’ve gathered from a very messy environment. Not any kind of conclusive, replicable experiment.

Related the problem of creating a control group is the difficulty of isolating the variable you hope to study. Even if we were somehow able to create two versions of Earth, and create a control, how do we know that all the differences between 2016 gold-standard Earth and 2016 floating-currency Earth are due to the different currency systems and not other random fluctuations? Obviously this is already a fairly ridiculous example, but it illustrates the impossible hurdles necessary to even approach true experimentation on something like the economy.

Now you should not assume from this that I’m anti-science, far from it. I have a deep respect for science. And I think that, if anything, the world needs more science not less, but as part of that, we need, particularly if we’re piling up more science, to recognize the limitations of science, especially as it’s actually put into practice. Science isn’t conducted by perfectly objective robots, it’s conducted by scientists who have careers to think of, biases which blind them and limitations of time and money to contend with. All of which takes us to the next way that science can go wrong.

When I say the next way, there are literally hundreds of ways that scientific efforts can go wrong, but rather than try to focus on all of them we’re just going to look at something that has been in the news a lot lately, the replication crisis.

What’s interesting about the replication crisis is that it happened even in cases where it truly appeared that people were doing everything correctly. Trained scientists were conducting ground-breaking experiments, designed according to the best thinking in their field, the results were passed through a process of peer-review and then the results were published in a respected journal. Obviously this is not to say that there weren’t papers published where everything was not being done correctly, even some examples of outright fraud, but even if we exclude those there were still a lot of results which got published which later turned out to be impossible to reproduce. The biggest contributor to this appears to have been publication bias, or what is sometimes called the file-drawer effect because people only submit positive, exciting results and the rest get put in the file-drawer with all of the other experiments that didn’t show anything. This is a problem not only with the people doing the experiments but with the publications themselves, which are far more likely to publish positive results (or to be technical, statistically significant results) than a paper which didn’t have any results (or a null result). And as you’ve probably heard, for most scientists it’s publish or perish. Another factor which almost certainly contributed to the crisis..

You may think that a positive result is a positive result regardless of whether there were 100 other, negative results which got put in the file cabinet. The problem is that it’s not. If you take 100 coins and flip each of them 7 times you’ve got better than even odds that one of them will come up 7 heads in a row. You might then decide that that coin is unfair, and publish a paper, “On the Unfairness of the 1947 Nickel”, but in reality you just started with a big sample size. Doing 100 experiments works very similarly. (For a really in depth discussion including p-values and lots of statistics go here.) The problem of course becomes that people reading or citing your paper don’t know that you have 99 failed experiments which never saw the light of day they only know about the one successful experiment that actually got published.

Thus far I haven’t mentioned how often a study fails to be replicated, and you may think that it’s no big deal. A few here and there, but nothing to worry about. Well as it turns out in general less than half of studies can be reproduced and sometimes less than 15%! This would mean that six out of every seven studies put forth conclusions which later turned out to be untrue.

Once again it’s important to recognize that there is a continuum of scientific results. There’s not a 50% chance that the theory of gravity is wrong, or that protons don’t exist. But when it comes to the softer sciences (and they’re labeled that way for a reason) there is a better than even chance that their conclusions will turn out to be untrue.

Of course when the average person talks about scientific discoveries, ignoring for the moment whether the results can be reproduced, they’re generally not talking about what the scientist actually found. To a first approximation no one reads the actual scientific paper, and probably only 1 in 10,000 people even read the abstract. If you hear about a scientific result you’re hearing about it through the media, which further undermines the utility of science by distorting results in an effort to make them appear more interesting. In short when people think of science they think of gravity, but what they’re actually getting is a Buzzfeed article written based on a press release from a conversation with a scientist who shelves most of his work, is desperate for tenure, describing a conclusion that is more than likely irreproducible. That’s like five layers of spin on top of a result that’s most likely false!

If the kind of “science” I’m talking about were framed as an amusing hobby and an article about bacon prolonging life was treated in the same fashion as a movie review then it wouldn’t be that big of a deal, but for many people science has taken the place of religion. And more than just religion, it has taken the place of deep thinking about the fundamental questions of life in general. People have replaced virtue with a sort of sloppy rationality which cloaks itself in science and is therefore considered progressive, but is really just the idea of doing whatever makes you feel good cloaked in a bunch of pseudo scientific babble. And decisions are being made which can cost people their lives.

As an example of this, I just finished the book Dreamland by Sam Quinones. It’s an in depth look at the opiate epidemic in America, and a stunning indictment of what passes for science these days. You’ve probably heard about the opiate epidemic, if not follow the link. The effects of the epidemic are so bad that as to be baffling and a whole host of factors combined to make the problem so terrible, but the misuse of science was one of the bigger factors, possibly the biggest. It’s not possible to go into a complete description of what happened (I highly recommend the book) but in essence using a combination of poor science and a morality devoid of any underpinning in religion or tradition, doctors decided that people could essentially have unlimited opiates, the best known of which is oxycontin. Exactly what I mean by doing whatever makes you feel good cloaked in pseudo scientific babble.

The first part, the misuse of science, hinged on placing far too much weight on a one paragraph letter published in the New England Journal of Medicine in 1980 which claimed that opiates only ended up causing addiction in 1% of people. Getting past the fact that the author never intended it to be used in the way it was, to base decades of pain management on one paragraph is staggeringly irresponsible. Even more irresponsible, when the pharmaceutical companies got around to trying to confirm the result they found the it didn’t hold up (to no one’s surprise) and they ended up burying and twisting the results they did get. The number of people that died of accidental overdoses directly or indirectly from this misuse of science is easily six figures, possibly seven, particularly since people are still dying. Of course in addition to the misuse of science there was the over reliance on science. I assume that on some level the pharmaceutical companies knew that they were not being scientific, but countless doctors, who were either naive or blinded by the gifts provided by the pharmaceutical company chose to at least to pretend that they were doing what they were doing because science backed them up.

I mentioned that one of the other factors was a morality devoid of any underpinning in religion or tradition. I’m not going to say that any religion specifically forbids overprescription of opiates, but most of them have some broad caution about drugs in general. And even if you want to set religion aside there is a strong traditional distaste for opium. And here is where the limits of science are most stark.

Frequently, people use science to declare any belief or practice or tradition or religion which is insufficiently scientific (which of course includes all religions, most traditions, and a majority of practices and beliefs over a few decades old) as nothing more than baseless superstitions. And while it was not labeled as such this is precisely what happened with opiates. All religions I’m aware of recognize that a certain amount of suffering is part of existence, but in 1980, doctors more or less decided it wasn’t. Sure they couched in the language of science with lots of caveats, but this is precisely the problem. The science turned out to be wrong and the caveats turned out to be insufficient barriers to abuse and somewhere north of 100,000 people died.

As I have repeatedly said, I’m not anti-science, but science without tradition, without morality, and without religion is prone to huge abuses. This blog will attempt to unite religion and science, but in doing so, religion is always going to hold primacy over science. And it’s not even necessarily because religion is backed by divine infallibility. Forget about that. Set that aside. While, I certainly believe that that’s the case, in these circumstances it doesn’t matter. The problem with science is that it hasn’t been around very long, and it assumes a sterile, rational world which bears no resemblance to the world we actually live in. Setting aside whether God exists, religion and tradition has been tested in the crucible of history. And have provided insights, particularly in the realm of morality that people ignore at their peril. Which will be the subject of my next blog post.