Tag: <span>Douthat</span>

The Tricky Business of Reality Construction

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I.

I was recently at a meetup with some Slate Star Codex readers, and I decided to bring up my impressions of The Deep Places by Ross Douthat, which I had recently read and reviewed. For those who may have missed the review, the book was a chronicle of Douthat’s struggles with chronic Lyme disease (CLD). The problem, both in the wider world and at the meetup, is that there are serious questions about the reality of this condition. Or as Wikipedia says:

Despite numerous studies, there is no evidence that symptoms associated with CLD are caused by any persistent infection…

From this we might say that in “reality”, at least as constructed by most doctors and at least some of the people attending the aforementioned meetup, CLD does not exist. According to them, Douthat was not suffering because he still had Borrelia burgdorferi bacteria (the cause of Lyme disease) in his body. On the other hand, the “reality” Douthat constructed asserts the exact opposite.

Recently this business of reality construction, or more formally, the discipline of epistemology, has become a lot more complicated, and for me the primary appeal of Douthat’s book was that he explained the minutia of his reality construction project—down to the studs as they say. His own journey from CLD doubter to CLD believer, and all the empirical evidence he collected which supported this transition.

One assumes that when the doctors and the participants of the meetup take issue with the existence of CLD that they are taking issue with this journey, and the manner in which Douthat has gone about constructing this reality. These issues presumably extend to other sufferers, and of course the rogue doctors who do believe in the existence of CLD.

We’ll get to the conflict within the healthcare establishment in a bit, but first I want to consider the pushback I got at the meetup. I’ll confess I was surprised by the certainty that was exhibited. First I would think that someone’s priors on the assertion “mainstream medicine never makes mistakes” would have taken a significant hit during the pandemic. Second, the people pushing back weren’t dogmatically committed to all of the claims of mainstream medicine. More than one fringe idea had already been asserted as being true by the people pushing back.

For example, one of the most vociferous anti-CLD arguments came from someone who had already claimed that soap doesn’t work. So in the reality he had constructed, CLD was all in one’s head, but so were the benefits of using soap when showering. Of course both things may be true in some objective sense, but I’m interested in how he arrived at each of them given that one—his rejection of CLD—is totally in line with constructing reality using the “lumber” of medical authorities, while the other—his rejection of soap—is the exact opposite. But of course these days one has all sorts of material to choose from when constructing a reality, and perhaps his technique for getting at “truth” involves using different material depending on the seriousness of the subject (is this a load bearing wall?) and the quality of the evidence. And perhaps one can construct a perfectly secure foundation upon which both facts can rest.

The point is not to criticize his particular construction methodology, but to point out how many methodologies the modern world has given us, and the difficulty of determining which of them to use, particularly since combining different ones may in fact produce the best results.

To use Douthat as an example of how things have changed. In the not too distant past he would have had a handful of doctors available to consult, who had a handful of medicines to recommend, and that was it. These days the number of specialized doctors has multiplied, and some of them might have a podcast or a blog. The number of medicines has also vastly increased. To this can be added a nearly infinite variety of supplements. Douthat could also exchange info with sufferers from all over the world on social media. And even if he’s trying to be exceptionally rigorous and go straight to scientific papers, there are hundreds of those as well. Beyond all this, perhaps the biggest change is that Lyme disease only became endemic over the last 50 years.

On the other hand, it could be argued that having so many methodologies and materials to choose from has been, on net, a bad thing. That having wide agreement on something that’s 80% true may be better for society than having the ability for a small number of people to get to 99% truth.

Before moving on, I should hasten to add that while I used this one person as an example, I’m not in any sense trying to make him look bad or prove him wrong. In fact part of my point is that without coming to a consensus on a decision making framework it might not even be possible to “prove” him wrong. Also I like this guy, he’s obviously smart, probably smarter than me. And interestingly enough he wasn’t even the only “anti-soaper” at the meetup. What I’m mostly interested in is how the construction of reality and the pursuit of truth has become so fractured recently. 

II.

Obviously Douthat is not the only person trying to get down to the “studs” of reality, and I thought his book was interesting and useful not only because of its detail, but because of its subject matter. Discussing the “reality” of a disease would appear to be more tractable than a discussion of the “reality” of racism. While we might someday discover a way of detecting lingering Borrelia burgdorferi bacteria in sufferers of CLD, we are unlikely to come up with some similar methodology for detecting racial animus in the human soul. Also, everyone is currently involved in their own, similar reality construction project with respect to COVID, and many of the questions Douthat was asking about CLD are being asked in various forms by billions of people and thousands of organizations.

As interesting as it might be to wade into that mess, it might be more productive to look at how reality was constructed during the 1918 flu pandemic. 

Obviously the tools available to doctors in 1918 were much more limited than the tools we have available now. Vaccination was still in its infancy, and the first flu vaccine was still 20 years away. But they did have some drugs available. In particular, people tried using aspirin and quinine to combat the disease. Hydroxychloroquine is a synthetic version of quinine, which provides one of the many fascinating parallels between the two pandemics. In both cases, the best science says that they were/are ineffective. The story of aspirin, however, is where it gets interesting.

Aspirin had not been around for very long at this point, and it truly was (and still is) kind of a wonder drug, but there was also a lot that wasn’t understood about it. Doctors, unable to do much of anything else, recommended that people take a lot of aspirin—as in an amount that these days is considered dangerous. Meaning that overuse of aspirin may have contributed to the death rate. This idea was first proposed in a 2009 paper, and it’s worth quoting the abstract of that paper in full:

The high case-fatality rate—especially among young adults—during the 1918–1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely “wet,” sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

I only uncovered this fascinating bit of information in the course of writing this post. Which was surprising, I would have thought that it would be one of the major pieces of evidence brought forward by the anti-medical establishment crowd. (And maybe it is and I just missed it.) I am not interested in using it in this fashion. I’m more interested in using it to illustrate the differences between now and then. Back then there were conspiracy theories about aspirin killing people, but they all revolved around the idea that aspirin was made by Bayer and Bayer was a German company. And, when the Spanish Flu emerged, and during that October death spike, we were still at war with Germany. We know now that they were right to be cautious about aspirin (though for the wrong reasons), but it took until 2009 for us to figure out the “reality” of the situation.

Not only is this example more productive because it avoids current, unresolved controversies, it’s productive because it provides a contrast between the reality construction materials available in 1918 and those available today. The primary difference being of course the scarcity of our metaphorical construction materials back then as compared to the abundance we currently possess. In 1918, authority and science were far more monolithic. The number of potential treatments was far smaller. To the extent people were looking for nefarious schemes the narrative of these schemes was simpler. “We’re at war with Germany! They must be behind it!” But of all the differences perhaps the most consequential is that there was far, far, far less data.

Had the same thing played out during the current pandemic (and it has though perhaps in reverse with ivermectin) there might still be people blaming the Germans, but they would also be blaming the Chinese and the Russians, Big Pharma, and Bill Gates. There would also be people pointing out the results of past studies about the harms of aspirin; new studies would be conducted,and huge debates would erupt over the methodology of all of these studies and their statistical significance. Some people would start refusing to take any aspirin for any reason and some would make it a point of pride to take exactly the recommended dosage. There would be pro- and anti- aspirin blogs, and subreddits and message boards and personalities dedicated to each side. 

The big advantage of all the data, of all the methodologies, of all the reality construction materials available to us, is that unlike the doctors of 1918 we would almost certainly uncover the truth. We would also uncover 99 other explanations for things that weren’t the truth, and some people, perhaps many, would have a hard time deciding which of the 100 explanations to believe. Now to be fair, I’m probably exaggerating the uncertainty. Our science is powerful enough that we would reach consensus on the harmful effects of taking 31 grams of aspirin (31 grams!! I still can’t get over that) pretty quickly. But here we arrive at another difference between today and 1918. We have plucked all the low hanging fruit. In those places where reality was straightforward to construct it has already been built. The questions we need to form opinions on today are far more subtle. 

III. 

As I was writing this post I finished reading Why Liberalism Failed, by Patrick Deenen. (You can find my review here.) As is so often the case, after coming across a new idea, you’re tempted to think it explains everything. It almost certainly doesn’t, it’s just the idea is recent, but while that’s the case I’m going to dig into what it explains about this problem. Deenen makes a particular point of talking about the bifurcation of liberalism, that there is a massive increase in individualism coupled with a massive increase in government authority. While this split manifests in lots of different ways, I think the problems Deenen describes mostly stem from how this results in two different levels of reality construction. We have pushed it to the very highest levels as well as to the deepest recesses of the soul.

The promise of science is that if we devote enough resources toward answering a particular question we can arrive at the Truth, or at least an answer with a high probability of being true. When the question is “What are the effects of taking 31 grams of aspirin every day?” our methodology works pretty well. But what about the effects of taking less than 100 milligrams a day? Since 2007 doctors have recommended that people over 40 with a heightened risk of cardiovascular disease take a small daily dose of aspirin, generally in the 75 mg to 100 mg range. But now 15 years later they have backed off of the recommendation somewhat, particularly for older individuals, recommending that people over 70 avoid it entirely. 

I and others have written about the difficulties of creating a broad scientific consensus, so I don’t want to spend too much time rehashing that, but the presence and difficulty of such efforts should be kept in mind as we continue our exploration of how people construct the reality of their own lives, of what happens in the “deepest recesses of the soul”. Here again disease, and more broadly health and wellness in general, provide a great arena for this investigation.

The internet has empowered individual reality construction to a remarkable degree, but when considering health and wellness what’s striking is the degree to which it has also legitimated these individualized efforts. If you tell someone that you found some advice online or a technique or some other wisdom and you tried it out and it made you feel better, most people would, at minimum, applaud you for being proactive and responsible. Beyond that, even if they had doubts about whether a particular bit of wisdom was actually backed by science, a majority would nevertheless congratulate you on your improved sense of well-being. The assumption being that however bizarre your beliefs, how could they ever be more of an authority on your health than you are?

This is the other big thing about individual health and wellness: the empiricism is individual as well. To return to the anti-soapers, this appears to be what happened. They discovered some advice on the internet that recommended showering without soap. Something that would never have happened 30 years ago. They then tried it out, did their own n=1 experiment and decided that it produced a better outcome as far as health, and moved to make it part of their lifestyle. And as I mentioned it’s weird that at least one of them (maybe both, I don’t recall) objected to Douthat’s description of CLD, because that’s precisely what he did as well, only he spent much more time and went much deeper with his efforts.

In my review of Douthat’s book I ended with some questions for those who doubted his assessment. I’m going to end this section and begin the next by revisiting them.

First, the question I’m most curious about: what do these people (the doubters) imagine they would do if they were in Douthat’s shoes? If they had the same symptoms and those symptoms all responded in the same way to the same things? Would they still not believe in CLD? Or do they imagine that it couldn’t happen to them and thus the question is irrelevant? (Asserting their own immunity seems to be something of a matter of faith so we should probably set it aside.) Finally, what do they think is going on? Even if you believe that it’s all in someone’s head, which I think is what the guy from the meetup was claiming, you’re still unlikely to think that the right argument or the right set of facts will make someone go from experiencing symptoms to not experiencing them. (“This brochure cured me!”) Particularly given that the person suffering from the disease is probably, as illustrated by Douthat, actually open to any argument if it will just bring them relief

Still, I would be interested in taking a closer look at any advice the person might have on alternative reality construction methods Douthat should have used instead of the one he did. Because I think he tried most of them, which is another thing that made the book so impactful for me. Douthat starts with the mainstream view of CLD, he really wants to believe there’s no such thing, it’s only when his symptoms persist that he is eventually convinced. Which is why I’m so curious what doubters imagine they would do if they were in Douthat’s shoes.

It’s time to finally jump from diseases to a broader discussion of the problems of reality construction. Which takes us to the next question from my review. What is your position on fringe diseases and other fringe beliefs? Do your views entirely conform to those held by the mainstream medical establishment? 

To come at it from a different angle, we can imagine that there are some problems that are basically part of everyone’s reality: flu, cancer or broken bones as diagnosed by an x-ray. And then there are health issues almost no one thinks are real, like electromagnetic hypersensitivity (If you’ve seen the TV show Better Call Saul it’s what his brother Chuck suffers from.) But then there is clearly a large gray area between these two extremes. 

Where does one draw the line between real problems and fake problems? Your first impulse might be to make an argument around evidence and data. Or if either of those is insufficient, to gather more. To draw the line by referring to science or conducting more of it. If you really wanted to go the extra mile you could assign probabilities, perhaps as some sort of Bayesian exercise. This brings me to another question from my review: When someone says they don’t believe in CLD or for that matter electromagnetic hypersensitivity, what certainty level does this equate to? 51%? 90%? 100%? How certain are they that it’s made up? It might be said that my chief argument for this post is that modernity rather than delivering certainty has ended up burning it under a mountain of data subject to endless revisions. And it might be said that my chief argument with respect to Douthat’s book is that it should be impossible for someone to read it and reach the end possessing the same certainty they had going in.

What does one do with this large area in the middle? With diseases that are neither completely understood, nor obviously in someone’s head? Or to expand it out, most people obviously believe that COVID is real, but there’s still a huge debate over how dangerous it is, how best to deal with it, and whether such measures have unintended consequences, debates which I won’t rehash here. Beyond that is a whole universe of issues unrelated to disease where the science isn’t clear. 

We have long imagined that the tools of modernity, most especially science, would allow us to increase our certainty and end these debates. That they would make us better at the business of reality construction. But it seems increasingly clear that the opposite has happened. Why is that? 

I’ll conclude by trying to gather together the elements I have already discussed, while also introducing a couple of new ones:

  1. All of the problems we have left are subtle ones: We have picked all the low-hanging fruit and now all that’s left are issues where the data is messy and hard to collect.
  2. People recognize the power of science and so it’s become a weapon: This can range from researchers trying to make a name for themselves with exciting results to science being twisted to political ends.
  3. The bifurcation: We have individuals who feel empowered to collect and disseminate their own “science” on the one hand, and the government trying to generalize all data into something they can recommend universally. The former generates too much nuance, the latter too little.
  4. The flood of data: Closely related to the above, we have an enormous quantity and variety of reality construction tools available to us. Not only are there the standard observations about the internet, but we’re also doing far more science. There are dozens of studies just on the effectiveness of ivermectin. 
  5. What’s possible: Something I haven’t seen mentioned a lot, and perhaps it deserves its own post: modernity has increased the number of possible realities. In 1918 you could imagine that the flu was a disease or you could imagine that Bayer was doing something to aspirin tablets, and really only the first withstood scrutiny. These days you can imagine that COVID is natural, that it’s a natural virus which leaked from a lab, that it’s an artificial virus which was created using gain of function research which then leaked from a lab, or possibly something else, and find plenty of data to support any conclusion. Beyond that because we have DNA-sequencing and can identify how different omicron is, it’s possible to have an entirely different set of answers for this variant vs. the alpha variant. And I’m just scratching the surface.

Modernity has given us far more tools and far more materials with which to construct our individual realities. Some have taken these tools and materials and done great things with them. But some have taken them and used them in unintended and strange ways. By and large because reality construction has become so tricky, we’ve mostly gotten a lot worse at it, both individually and collectively. And if we can’t build a secure and consensual “reality”, well… we’re not going to be doing much of anything else either.


COVID spelt backwards is DIVOC and as our own battle against COVID seems to be traveling that direction it’s worth asking what DIVOC going on. Thank you folks, I’m here every week. If you appreciate that, consider donating.


The 8 Books I Finished in November (And the One Series I Decided Not to Finish)

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  1. The Deep Places: A Memoir of Illness and Discovery by: Ross Douthat
  2. Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History by: Yasmeen Abutaleb and Damien Paletta
  3. The Premonition: A Pandemic Story by: Michael Lewis
  4. Morning Star by: Pierce Brown
  5. Star Trek: The City on the Edge of Forever Teleplay by: Harlan Ellison
  6. The Economics of Violence by: Gary M. M. Shiffman
  7. The Hobbit, or There and Back Again by: J. R. R. Tolkien
  8. Chorazin: (The Weird of Hali #1) by: John Michael Greer
  9. The Great Game: The Struggle for Empire in Central Asia by: Peter Hopkirk

I’ve always been a big fan of November. I’m a big fan of fall in general, and November has the start of the holidays going for it as well. Along the way, at some point in the month, one nearly always gets a spell of Indian summer, where the temperature is perfect and the leaves are still pretty. 

It was particularly nice to be somewhat back to normal in terms of family gatherings. Last Thanksgiving our big family gathering was cancelled and so I took my immediate family to a restaurant. (I’m not saying that option was necessarily safer, it’s just the option we took.) 

Writing wise I’m trying to prioritize working on my book as the first writing I do every day, which made the essays drag out a little bit, so I’m still trying to strike a balance there. But hopefully I’m dialing it in. 

Finally, since by the next time this section rolls around it will already have passed. I guess this is the time to wish everyone a Merry Christmas and a Happy New Year!


I- Eschatological Reviews

The Deep Places: A Memoir of Illness and Discovery 

by: Ross Douthat

224 Pages

Briefly, what was this book about?

Epistemology in an age of unlimited information and experimentation. 

I suppose, if you want to split hairs, the story of Douthat’s battle with chronic lyme disease (CLD) also features prominently, but mostly it’s about epistemology.

Who should read this book?

It’s possible that over the two and a half years I’ve been publishing my reviews, that I have been too liberal with my “everyone” designation. As in:

“Who should read this book?”

“Everyone.”

I will be more parsimonious going forward, because I want “everyone” to mean something. Particularly now, because I really do think that everyone should read this book.

General Thoughts

After that intro the first question you might have is “Why?” “Why should everyone read this book?” Well to begin with Douthat is a great writer, and even Freddie deBoer, who was critical of the book, acknowledges that:

The Deep Places tasks us with becoming intimately familiar with Douthat’s body and mind, and succeeds in that way that is unique to reading. The book depends on that willingness to inhabit Douthat’s life, including its most private spaces, a profound change of pace even from his memoiristic first book. If he had failed to draw his readers in, if he hadn’t successfully opened up his self to be picked over by strangers, the book would have failed completely. At that first prerequisite task he’s succeeded, to the degree that it’s hard for me to imagine someone reading this book and not wanting desperately to alleviate Douthat’s pain. This is all the more impressive given the degree of difficult[y] here; it’s a book that requires a leap of faith. The size of that leap will depend on your priors.

If even someone critical of the book describes it as immersive and impressive, then hopefully you can start to see why I’m saying that everyone should read it. But it’s that last part, the “leap of faith”, the part that deBoer takes issue with, which is where the book goes from immersive and impressive to important

As you may, or may not have already guessed, it’s in the existence of CLD where deBoer and much of the medical world argue that faith is required. Faith, because there’s no proof. Or as Wikipedia says:

Chronic Lyme disease is the name used by some people with “a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to Borrelia burgdorferi infection” to describe their condition and their beliefs about its cause. Both the label and the belief that these people’s symptoms are caused by this particular infection are generally rejected by medical professionals, and the promotion of chronic Lyme disease is an example of health fraud… 

Despite numerous studies, there is no evidence that symptoms associated with CLD are caused by any persistent infection…

A number of alternative health products are promoted for chronic Lyme disease, of which possibly the most controversial and harmful is long-term antibiotic therapy, particularly intravenous antibiotics. Recognised authorities advise against long-term antibiotic treatment for Lyme disease, even where some symptoms persist post-treatment. Following disciplinary proceedings by state medical licensing boards in the United States, a subculture of “Lyme literate” physicians has successfully lobbied for specific legal protections, exempting them from the standard of care and Infectious Diseases Society of America treatment guidelines. Such legislation has been criticised as an example of “legislative alchemy”, the process whereby pseudomedicine is legislated into practice.

In the book Douthat argues against all of that. That he did have CLD and it was because he was still infected. That the studies are wrong, and that it was only after massive experimentation with antibiotics, intravenous and otherwise, that he finally started feeling better. And all of this was only possible because of the existence of “Lyme literate” physicians. 

(I’m not sure if Douthat still thinks he’s infected, or if he thinks his CLD has moved on to being “post-treatment Lyme disease syndrome”.)

So who do we believe, the “recognized authorities” or Douthat? Well even Douthat initially wanted to believe the “recognized authorities” and that’s part of what makes the book so compelling. The way it demonstrates the journey of someone who desperately wants to believe the recognized authorities, but the longer things go the worse their advice gets and the more attractive the fringe becomes.

He starts off in the exact opposite position as someone who actively rejects fringe thinking and really wants to “follow the science”. So when the doctors in DC tell him he doesn’t have Lyme disease, he believes them, and really tries to come to terms with a world where his bizarre array of incredibly serious symptoms are all just psychological. But treating it from this angle is singularly ineffective, and things continue to get worse. But then, he moves to the Northeast where Lyme disease is endemic, even “by the book” doctors tell him, “Oh, you obviously have Lyme disease.” At this point should he follow the DC science or the Northeastern science? Presumably the latter because they have more data, right? Does this trend continue towards believing people on the internet who’ve actually cured CLD? No? Why not? Where do we draw the line?

Answering this question of how to conduct science when you’re the subject, is the entire point of the book, and why I think it’s a book about epistemology. Douthat’s process is important enough and interesting enough that I’m going to include a very long quote from the man himself.

The first, an infectious disease specialist in New York City, had an avuncular, reassuring manner. Yes, he said, I probably had Lyme — my symptoms fit, the blood tests missed lots of cases, he saw people like me all the time. But no, I didn’t need to worry that much about the disastrous chronic cases I was now reading about on the internet. Yes, some Lyme cases took more than a few weeks to clear, and he usually prescribed antibiotics for a little longer than the official guidelines. But that would be enough, he promised: I would be much, much better by the holidays, and well within a year.

The second doctor had a wood-paneled office one town over from our new Connecticut house, more like a den than a clinic, and books and pamphlets littering the waiting room, each seeming to offer a different theory on how one might treat an entrenched case of Lyme. He talked to me for 90 minutes, took copious notes, asked a thousand questions, and informed me that chronic Lyme was an epidemic, wildly underdiagnosed and totally mistreated. Could he get me better? Probably, but I was obviously very sick, and it would take a while. Most of his patients took high doses of antibiotics for around a year; I might need more; some needed years and years of treatment.

The first doctor reassured me; the second doctor frightened me. So I chose to believe the first one, to trust his version of the science, and for months I followed his prescriptions — while also seeing doctors who told me that even his approach was too aggressive, that if I had Lyme disease at one point I no longer did, and that I should stop the antibiotics altogether and wait for my body to recover on its own.

But the body’s experiences are their own form of empirical reality, and as a patient you can’t follow a scientific theory that doesn’t succeed in practice. And in the end the reassuring doctor’s theories didn’t work — I didn’t get better on his steady dose of antibiotics, the constant pain didn’t go away — while the advice to go off antibiotics entirely led to disasters, where I stopped the drugs and disintegrated quickly.

So I went back to the doctor who frightened me, feeling that otherwise I could be sick forever, sick until I died. And the rest of the story unfolded, over a very long period of time, roughly as the dissenting faction of Lyme doctors would have predicted.

…after about a year of trying different combinations of antibiotics and extremely high doses, I finally found a cocktail that first made my symptoms more predictable, and then enabled me to begin slowly gaining ground, month upon month and year upon year — in a process that has taken me from almost-constant pain to something approaching normal life and health.

So that dissenting doctor — and others like him, and many researchers doing work on Lyme disease treatments outside the official line — saved my life. But I also saved my own life, because I was the only one who could actually tell what treatments made a difference.

So what is one to make of all this? DeBoer reads the whole book (which is full of much more stuff than could be included in the quote) and ends his review by pointing out the ways in which the book “triumphs”, but then immediately follows that declaration with this final paragraph:

But I still don’t believe in chronic Lyme. And I wish I could say I was sorry.

I ended up reading deBoer’s review before I read the actual book, and after reading the actual book I was stunned by this assertion. And it raises a host of questions in my mind:

  • When he says he doesn’t believe, what’s his certainty level? 51%? 100%? Did reading the book move the needle at all? If so, by how much?
  • How does deBoer feel about other diseases on the fringes? Does he just have a beef with CLD? What about chronic fatigue syndrome (CFS)? How does he feel about people who think CLD may be misdiagnosed CFS? 
  • How much of his dismissal is tied into Douthat’s Catholicism? Which is to say his belief in other non-scientific phenomena? (I’ll have just a little bit more to say about this in the religious section at the end.)
  • Finally, and most importantly, what does deBoer imagine he would do if he were in Douthat’s shoes? If he had the same symptoms and those symptoms all responded in the same way to the same things? Would he still not believe in CLD? Or does he imagine that it couldn’t happen to him? (Perhaps because of the aforementioned religiosity?)

The problem with that, is it’s already happening to all of us. Which takes me to:

Eschatological Implications

I don’t have the space to go into why it happened, and in any case I’ve touched on those subjects elsewhere—the history of the internet, and conspiracy theories and the various ideological camps, each seemingly possessed of their own fringe ideas. But somehow we’ve all ended up suffering from the same epistemological chaos as Douthat. Most (though not all) are fortunate enough that it doesn’t affect their health and doesn’t leave them in constant pain. For most people it’s ideological and evidentiary chaos. A million voices screaming at them all the time that this thing is important, no this other thing is important. With very little way to make sense of it except by doing their own crude experiments, following their gut, and choosing which flavor of the fringe they find most palatable.

Yes, there are still authorities, but beyond the obvious fact that their authority has been diminishing for years, it’s also much harder to be an authority, as knowledge, opinions and innuendo have proliferated, seemingly exponentially. And so, like Douthat we are left to construct our own authority on those issues we care most deeply about. In this effort, it’s clear that we’re not all that good at it, but that also it doesn’t take much to be better than the experts. Or, to put it another way, is there really any greater authority on Douthat’s condition than Douthat? Before the internet, sure? Afterwards, no way.

I don’t know what this atomization of authority means for the future of our society. But I do know that it’s happening, and that Douthat’s is the best book I’ve seen for describing what that atomization feels like from the inside.


II- Capsule Reviews

Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History 

by: Yasmeen Abutaleb and Damien Paletta

496 Pages

Briefly, what is this book about?

The Trump administration’s handling of the COVID-19 pandemic.

Who should read this book?

I read two books about the pandemic last month. Of those two I would recommend reading Michael Lewis’ (see my next review) before reading this one. But if you have already decided that Trump is THE bad guy and you just want that decision to be confirmed, you will probably really enjoy this book.

General Thoughts

It is my eventual intention to take this book and the next book, plus a third book which I have yet to read and pull all of them together into a post mortem on the initial handling of the pandemic, along with what I believe are some long term lessons we should take from things.

Until that point, the key thing to know about this book is that it’s not a book about the pandemic, it’s a book about what Trump did during the pandemic. As an example of what I mean, when the book gets to the point in the narrative when BLM protests erupt in the wake of George Floyd’s killing the authors spend three pages talking about Trumps march to St. John’s Church and only a paragraph discussing whether the large gatherings might contribute to the spread of the virus. The former had nothing to do with the pandemic while the latter represented one of the biggest questions of the whole period. 

Not only is the book focused on Trump, it has clearly taken sides as well. The very first thing it does is introduce Trump as the bad guy while introducing Fauci as the good guy. 

Despite what I feel are its evident biases, I do think that the insider account of how the pandemic was handled at the highest levels is very interesting and useful, but unfortunately the biases mean that it’s also very narrow.


The Premonition: A Pandemic Story 

by: Michael Lewis

320 Pages

Briefly, what is this book about?

Modern attempts to prepare for pandemics going back to George W. Bush, and how this preparation played out when we actually had a pandemic. 

Who should read this book?

At this point I’ve only read one other book about that pandemic, which is not surprising, the story is still ongoing. But out of those two I would definitely recommend this one. But it’s also entirely possible that the real definitive work is yet to be published. 

General Thoughts

Lewis is a great writer, and this is a very enjoyable book. As I already said I’m going to wait to really dig into it in a separate post. But I guess it’s worth comparing this book to the previous book. In this book the Trump administration is something of a villain, but it’s not the villain, nor is it all directed at Trump either. Also one gets the impression from Lewis’ book that there were a lot of moving parts, and that it’s really difficult to isolate which ones could have saved us and which ones really hurt us. Which is to say Lewis’ is definitely the more nuanced of the two.

Perhaps the best way to compare the two books, though certainly not 100% accurate, is that Lewis is promoting the Mistake Theory version of the story. While Abutaleb and Paletta seem to be promoting more of the Conflict Theory version.


Morning Star

by: Pierce Brown

544 Pages

Briefly, what is this book about?

The concluding events of the initial Red Rising trilogy, where the Gold’s finally get what’s coming to them, or something, I got about 20% of the way through it and couldn’t stomach it anymore.

Who should read this book?

After reading book 2 of the series I decided that it was a combination of Dune, Game of Thrones and the Hunger Games, but bloodier and more duplicitous than all of them. If that sounds appealing maybe you should read this book. For myself I can’t recommend the series and I probably can’t even recommend just reading the first book.

General Thoughts

Imagine if someone experienced the Red Wedding from Game of Thrones and said, “I’m going to write a book that is nothing but Red Weddings!” That’s how book 3 felt to me. Before abandoning it, I decided to read the plot summary on Wikipedia, I was not wrong. 


Star Trek: The City on the Edge of Forever

Originally by: Harlan Ellison

Adapted by: Scott & David Tipton

128 Pages

Briefly, what is this book about?

A graphic novelization of Harlan Ellison’s original script for “The City on the Edge of Forever”. One of the best regarded of the episodes from Star Trek’s original series.

Who should read this book?

If you like Harlan Ellison, Star Trek, or graphic novels, you will probably enjoy this book.

General Thoughts

Wikipedia asserts that “The City on the Edge of Forever” is frequently named as the best Star Trek episode of the entire Star Trek franchise. Harlan Ellison always maintained that they butchered his original script and that what you saw was just a pale imitation of the majesty of the original. Having heard this accusation for years, when I saw that there was a graphic novelization of his original I bought it immediately, so that I could finally decide for myself. 

It was great, and thoroughly enjoyable, but having read it I would say Ellison oversold things, and was probably insufficiently appreciative of what they had managed to do with the actual episode. But if you’re familiar at all with Ellison that probably won’t surprise you. Still the man could write.


The Economics of Violence

by: Gary M. M. Shiffman

244 Pages

Briefly, what was this book about?

That the conventional wisdom that cartel violence is different from mob violence, is different from terrorism, is wrong. That really all violence can be explained using economic incentives. 

Who should read this book?

Previously we had an “everybody”? Well this one is “nobody”. Shiffman is so taken by his one idea, that he pushes it past the point of utility into being less useful than the idea he’s trying to replace. Plus he spends way too much time getting into the minutia with his various examples.

General Thoughts

Answering the question of, “Why should everyone read this book?” is difficult. For this one I have to answer the opposite question, which of course is far easier. Given how many books are out there, to a first approximation the vast majority of books are read by nobody. Why should this book be any different? I suppose the next question is, if the book shouldn’t be read, is there a point in reviewing it either? Particularly as one of the highly selective reviews of the world renowned We Are Not Saved blog?

Perhaps not, but given that I read it for a book club I ended up with some fairly extensive notes, and it would be a shame to let all that go to waste.

Shiffman’s one big idea is to note the similarities between the actions of violent organizations and the actions of normal businesses. Pointing out how both are responding to market forces and financial incentives. This is useful and interesting, but Shiffman is so taken by the idea that he tries to squeeze everything into that framework. I think this could have been a far more useful book if he had also used this model to draw a contrast between violent organizations and businesses. A couple of examples:

First, I have a friend who feels that a disproportionate number of people at the highest levels of business and government are psychopaths. If you also believe that, and also believe Shiffman, then it’s not surprising that you would also find psychopaths at the head of violent organizations. But clearly rising to be the head of the Medellín Cartel, or the Lord’s Resistance Army, or Al Qaeda selects for psychopathy to a far greater degree than being the head of a Fortune 500 company. And I would be inclined to argue that it is this quality that is more predictive of success in a violent organization than being a savvy businessman. Shiffman talks about sadism, but dismisses it as being only a tiny part of the story. I would argue that it’s one of the key differentiators between a normal business and a violent organization. But since Shiffman’s project is to minimize these differences, he also minimizes its role.

Second, Shiffman talks extensively about how important ties of family and ideology are to the cohesion and success of violent organizations. That: 

People face scarcity, and so have almost constant need for others: need to know the “us” and the “them” so we know who to look out for and who will look out for us when matters of survival and growth arise. Issues such as “radical Islam” matter only in the way that branding and marketing matter for a firm.

But family and ideology generally aren’t that big of a deal in a normal business, and comparing “radical Islam” to branding and marketing, is a gross exaggeration of the power of marketing and a gross understatement of the appeal of radical Islam. 

In both of these cases leaning into the contrast between the two would have been more informative than what Shiffman did, which was to lean into the similarities.

Yes, there are similarities between violent organizations and business, but this is neither as groundbreaking nor as widespread an insight as Shiffman thinks.


The Hobbit, or There and Back Again 

by: J. R. R. Tolkien

320 Pages

Briefly, what was this book about?

I assume everyone knows what this book is about.

Who should read to this book?

Actually, as with the majority of the books, though I’m coy about it, I listened to this book. Specifically I wanted to listen to The Hobbit as narrated by Andy Serkis (the guy who did the voice and motion capture for Gollum in the movies.)

General Thoughts

The book is even better than I remembered. And I remembered it as being very good. Serkis’ narration was also a delight, as expected. If you need some “comfort” listening over the holidays, it would be hard to do better than this.


Chorazin: (The Weird of Hali #3) 

by: John Michael Greer

255 Pages

Briefly, what was this book about?

It’s the next book in the “What if the elder gods were the good guys?” series.

Who should read this book?

If for some reason you’ve started this series (perhaps on my recommendation) then there’s nothing in this book that should make you stop.

General Thoughts

This book spent a fair amount of time on world building, which was nice, though that did make the first part drag a little bit. But I thought the action and reveal at the end were satisfying enough to make up for it. As I have said in my past reviews, the chief appeal of this series is its premise. If the premise sounds appealing to you then you’ll probably like the book. If you have no idea what an elder god is, and the name Cthulhu means nothing to you then I would avoid these books.


The Great Game: The Struggle for Empire in Central Asia 

by: Peter Hopkirk

564 Pages

Briefly, what was this book about?

The Central Asian rivalry between the United Kingdom and Russia which played out during the 19th Century.

Who should read this book?

If you like good history, then you’ll appreciate this book. Though make sure to read it with a map handy because you won’t have heard of most of the places where the action takes place.

General Thoughts

In some of my previous posts on Afghanistan I mentioned Mohammad Najibullah, the last president of Afghanistan while it was controlled/supported by the Soviets. In between Najibullah’s capture by the mujahideen and his execution by the Taliban he spent his time translating this book into Pashtun so that the Afghans could better understand how they got to where they are. To the best of my understanding the translation was unfinished when he died. But I can see why he undertook the project, if I hadn’t read about the history of things I’m not sure I would have believed it myself. 

The book is worth reading just for the story of the First Anglo-Afghan War, or as the British call it the Disaster in Afghanistan. Take the biggest military fiasco you can imagine, multiply it by 10 and then imagine the most cinematic ending possible, and that’s the story. Essentially of the 16,500 British citizens, soldiers and camp followers who started the retreat from Kabul, only one nearly dead assistant surgeon made it to safety.

I’m something of a collector of horrible, preventable tragedies and this is one of the most terrible ones I’ve encountered. It makes me wonder if anyone associated with the recent withdrawal from Afghanistan had read this book, because beyond all of the interesting historical events, the book is obviously still relevant today. Up until a few months ago we were still fighting over Afghanistan. We’re still trying to figure out what to do in Central Asia. And we’re still suffering massive, preventable tragedies.

III- Religious Observation

The Deep Places: A Memoir of Illness and Discovery 

Before leaving the book entirely I wanted to briefly include a comment about Douthat’s religion. Obviously Douthat’s faith is a big part of who he is and how he went about recovering. And there was one story in particular which really struck me, because Douthat describes an interaction with God which is almost an exact parallel to some of my own experiences with God:

On the last morning, I was up early as always and I carried my son, now six months old and heavy, down the long, low-tide strip of sand. The pain was mostly in one shoulder, though I knew it would be somewhere else soon enough. There was a spot where the sand gave way to barnacled rocks bewigged with seaweed, where the tide met the stones; sometimes in her youth, my mother had found sand dollars there. I had never found one in decades of looking, and over time it had become a game I played – If I find one today, it means that God exists. If I find one today, it means that the girl I have a crush on has a crush on me. If I find one today, it means I’ll get into the college I want. If I find one today, it means…

Inevitably, I had been playing the game all that vacation week, casually glancing in the shallows as I waded with my kids.

If I find one it means I will get better.

If I find one it means I will get better.

If I find one it means I will get better.

On that last day, though, I was in too much pain to play. I held my son in my right arm, watching the seagulls sweep above, feeling the fire spread down my left arm and side. At a certain point, the combination of beauty and agony broke me, and I began to sob there, on the empty sandbar beside the flat, blue bay, while my son cooed curiously, and from somewhere in the depths I came out with a desperate, rasping croak.

“Help me, God. Why won’t you help me?”

My eyes dropped to the water. There between my feet, as tiny as a nickel and as pale as a wedding dress, was the only sand dollar I have ever found.


I don’t think that everyone should read my blog, but neither do I think nobody should read it either. Rather I think you should read it if you think the next 20 years are going to be particularly difficult to navigate. And you should donate to it if you think I might in some sense be helping to navigate it better.