Tag: <span>Epistemology</span>

The 13 Books I Finished in February

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  1. The Constitution of Knowledge: A Defense of Truth by Jonathan Rauch
  2. Trans: When Ideology Meets Reality by: Helen Joyce
  3. The Hard Sell: Crime and Punishment at an Opioid Startup by: Evan Hughes
  4. Think Again: The Power of Knowing What You Don’t Know by: Adam M. Grant
  5. The Moth Presents Occasional Magic: True Stories about Defying the Impossible by: Various
  6. Nicholas and Alexandra: The Fall of the Romanov Dynasty by: Robert K. Massie
  7. Greenlights by: Matthew McConaughey 
  8. The Midnight Library by: Matt Haig
  9. Trouble on Paradise: Expeditionary Force, Book 3.5 by: Craig Alanson
  10. Black Ops: Expeditionary Force, Book 4 by: Craig Alanson
  11. Zero Hour: Expeditionary Force, Book 5 by: Craig Alanson
  12. Mavericks: Expeditionary Force, Book 6 by: Craig Alanson
  13. Renegades: Expeditionary Force, Book 7 by: Craig Alanson

As you can see I read even more books in February than I did in January. I took a trip to Alaska, where I mostly did stuff like driving, walking and snowshoeing and those all combine well with audiobook listening. So I did a lot of it.

If you’re interested in more pictures you can email me.


I- Eschatological Reviews

The Constitution of Knowledge: A Defense of Truth 

By: Jonathan Rauch

280 Pages

Briefly, what was this book about?

How both right and left have abandoned the reality-based community, with its constitution of knowledge, and how returning to, and strengthening that community is the solution to all our problems.

Who should read this book?

If you think the vast epistemological crisis we’re suffering is purely a feature of the right or the left, then it might be worth reading this book, though even in that case you should probably just skip to the chapters in question. (Chapter 6 is about the sins of the right and Chapter 7 is about the sins of the left.) Beyond that the book is a rehash of classical liberal arguments that have been made better elsewhere.

General Thoughts

In some of the press for his novel Termination Shock (see my review here), Neal Stephenson recommended this book, along with five others. I’m a big fan of Neal Stephenson, and I’d heard good things about it from other sources as well, so I was surprised to find it to be unimpressive. Though perhaps calling it unimpressive is both too harsh and too kind. The amount of work that obviously went into it was definitely impressive. Rauch’s obvious passion was also impressive. Accordingly, calling it unimpressive is being too harsh. But on the other hand, to merely say that it’s unimpressive is to be far too kind to the book—to overlook its central and glaring flaw. To cut to the chase: the book is hopelessly naive. 

Despite “constitution of knowledge” being the book’s title, the book’s premise actually hinges on the idea that there is a “reality-based community” (RBC) that follows and maintains that constitution. It would be one thing if Rauch was claiming a constitution of knowledge is something we need, but have never had. Under those circumstances we might usefully aspire to acquire one, and furthermore optimistically assume that it will fix the problems he describes. But if we already have such a constitution and a group that reveres it, then our task becomes determining whether it ever fixed the problem, and if so what caused it to stop. Under the first scenario it’s permissible to imagine that the constitution will fix the problem, under the second scenario we know that it didn’t, and our whole task is to determine why.

This is where Rauch’s naiveté comes into play. We know the RBC failed, so arguing that we just need to strengthen it without understanding why it failed is just to double down on that failure. 

To be clear he spends a lot of time on what has happened, but it’s always happening outside of the RBC. I would almost say that this creates a book length version of the no true Scotsman fallacy but Rauch doesn’t even make it that far, because that would require him to concretely define the RBC and then to offer explanations for times when it failed. Instead Rauch’s RBC is an amorphous designation, something described in anecdotes, but also somehow concrete enough to provide the answers to all of our questions, and if this were not enough, the RBC is so flawless that it is the originator of none of our problems.

To the extent that Rauch does define the RBC it probably includes scientists and journalists. But already you can see where we have the beginnings of no true Scotsman, because he’s pretty selective in the scientists he profiles, and as you might imagine huge swaths of right-wing media have been excluded from being designated as journalists. But if scientists and journalists are part of the RBC, upon which Rauch pins all his hopes, then one would think it would be very important to examine instances where they failed. When discussing science it’s remarkable that he never mentions the replication crisis. And the journalistic profession, no matter how narrowly you want to define it, contains even more examples of times the constitution of knowledge was violated. One presumes that Rauch includes the NYT in his RBC designation, and yet he makes no mention of the egregious twisting of the historical record perpetrated by the 1619 Project, nor the changes made to its assertions without an accompanying formal retraction, a violation of one of the ironclad rules of the constitution of knowledge.

Rauch does mention the NYT, but only to illustrate the problems of left-wing cancel culture. For his example he uses the Tom Cotton editorial, where the younger members of the editorial staff freaked out because they disagreed with Tom Cotton’s viewpoint, but rather than rebutting it they tried to cancel it. 

To cut to the chase (and recall I still have 12 more books to review) Rauch’s criticism of the right is comprehensive and deep, while his criticism of the left is narrow and perfunctory. One gets the impression that to the extent the RBC can be identified, Rauch believes it resides with the left. And that if young people could just be weaned off their desire to cancel opinions they disagree with and learn to engage with them, the left could re-assume the role of the RBC and everything would turn out okay.

Even if I agreed with this narrow diagnosis I still think Rauch would be understating the difficulties involved in recovery. He points out that the underlying reason for canceling instead of engaging is the phenomenon of safetyism. In making this point he draws a lot on Jonathan Haidt’s and Greg Lukianoff’s Coddling of the American Mind (see my discussion of that here). I think there are other things that contributed to the creation of cancel culture, but even if safetyism was the only disease the left was grappling with, it still represents a huge and deeply embedded behavioral trend that goes back decades and has penetrated nearly everything. 

But of course I don’t agree with Rauch’s narrow diagnosis, I think the problems created by the left are just as consequential as the problems which originated on the right. Rauch makes much of the importance institutions play in maintaining the constitution of knowledge, and of all those institutions none is more critical than the university. There’s also no institution which is more heavily tilted to the left, and if we snapped our fingers and got rid of safetyism, the university would still be left with an enormous array of problems.

Eschatological Implications

What are these problems of which I speak? There are many, and one of the many purposes of my blog is to document them in all their variety, but for the moment let’s just focus on one:

The acquisition of truth and knowledge, regardless of how well designed your “constitution”, is neither as easy nor as certain as it once was. I know I say this a lot, but we have picked the low-hanging fruit.

Rauch mentions Newton and positions him as one of the very first members of the RBC, as he should. And while I would not say that Newton’s discovery was easy, it is very easy to replicate and beyond that ironclad in it’s predictions. Since his time science has only gotten more difficult and less ironclad, to the point where these days most findings can’t be replicated and even if they can, they mostly just suggest probabilities rather than laying down the law in the fashion of Newton. All of this means that those parts of “reality” people are inclined to fight about are hard to pin down. Science is unable to swoop in and grant either side a decisive victory, and so the war continues.

This is why the book is, at its core, hopelessly naive. Science is not powerful enough to provide a reality on which to base a community, and that is particularly the case when it comes to the issues that divide us. 

Of course everyone wants science to be able to decide such issues, and at the risk of overgeneralizing, the two sides have come at it from opposite directions. The left has adopted the tactic of weaponizing scientific authority, and in response the right has weaponized doubt. Rauch is definitely lined up on the left side of things and his book is replete with appeals to scientific authority rather than appeals to actual science. The difference can be subtle. But if you assert that the authority of institutions which conduct science is the same as science, as Rauch does, that only works if they have no other motivations, and no ideological biases, but these days everyone has both of those. 

Finally, a couple of very short points, points that I was going to expand on but ran out of space.

First, for all the problems I have with the rationalist community, and there are definitely more than a few, I think they are as close to an RBC as you’re likely to find these days. And of course the most common criticism I hear about this community is that it leans right. 

Second, I think Rauch’s definition of “reality” is fatally hampered by ignoring the is-ought problem. Science is at its most powerful when it’s telling us what is, it has no actual ability to tell us what ought to be. To the extent people try to use it in that fashion, bias enters into science. As an example of this bias, Rauch’s view of science-based reality ends up being a decidedly progressive one, even if he takes aim at some of its worst excesses.

I leave it as an exercise for the reader to determine if there’s any connection between the progressive “ought” bias and the many excesses Rauch takes aim at. Speaking of which: 


Trans: When Ideology Meets Reality

by: Helen Joyce

331 Pages

Briefly, what was this book about?

A comprehensive overview of the history of the transgender movement culminating with a discussion of it’s many manifestations in the present day, and their attendant overreach. 

Who should read this book?

Helen Joyce is one of the editors of The Economist. If you already think that magazine is horribly transphobic, then you’re probably not going to like this book, though it is also a book length defense of that position if you’re looking to steelman it. On the other hand, if you feel that The Economist is a moderate voice of reason when it comes to this controversy, then you’ll really appreciate this book, even as it horrifies you. 

General Thoughts

Let’s start with two personal observations:

One, I’ve never been much of a feminist. (I know you’re all very surprised.) I think that, particularly once you account for differences in interest, second wave feminism largely succeeded, and after that things get complicated. To the extent my feminism has a peak it was reached while reading this book. Joyce makes the claim that there are a lot of people who have been victimized by transgender ideology, the vast majority of these people are women. Reading their stories I have never felt more deeply the need for feminism, particular feminism centered on the needs of natal females.

Two, I am more and more convinced that, should we survive the next 50 years, that people will put transgenderism in the same category as eugenics. Something which seemed sensible, but actually caused enormous and numerous harms to some of the very most vulnerable people, all in the name of what, at the time, was considered the height of progressivism. I don’t expect to live 50 more years, but I’m confident enough in things that I’m willing to make this same bet with a 30 year time horizon.

As I’ve already repeatedly pointed out, I have a lot of books to cover this month, and I imagine that anyone reading this has already made up their mind one way or the other on the transgender issue, so I won’t spend much time in the weeds. Further complicating the discussion, much of the data is anecdotal, which is easy to be horrified by if that’s your inclination and alternatively easy to dismiss if you’re of the opposite inclination.

As an interesting side note, part of the reason why there isn’t better data (and this firmly relates to the previous book review) is that many institutions don’t track transwomen separately from women and transmen separately from men, hewing to the supposedly “reality” that there’s no reason to, they’re the same. 

In an attempt to tie all of these things together let’s talk briefly about Canadian prisons. Joyce points out that getting data from the relevant Canadian authorities on the number of transwomen housed in female prisons has proven to be exceptionally difficult. But it has happened that men who have done nothing to transition other than identifying as female have been transferred to women’s prisons. One of the best people working this beat is a female former inmate named Heather Mason. If you’re interested in what she has to say here’s one of her tweets:

We have Self-ID in Canada they started transferring males when I was still in. There have been sexual assaults, physical assaults, pregnancies, abortions, and HIV passed on. One of the males beat up the woman he impregnated and she miscarried his baby. Incarcerated women are silenced

And if you’re really interested in what she has to say my friend Stuart Parker interviewed her on his podcast. The anecdotes are horrifying, the question is how widespread is the problem. Which takes us to:

Eschatological Implications

How you feel about the long term implications of this issue will depend on how you feel about the aforementioned anecdotes. The anecdotes are extensively sourced, so you can’t ignore them, but it’s certainly possible to argue that they are just inevitable speed bumps on the way to our glorious, completely authentic future. Alternatively you might argue that, yes, transgender identification and wokeism more generally has gone to far, but that it’s about to (or has already) peaked, so yes the pendulum has swung too far, but it’s about to swing back.

If you take either of those positions then you might be comfortable minimizing the anecdotes or at least delaying doing anything expansive or hasty based on them. But there are of course some who believe that these situations are not temporary, that they’re not going away, that in fact what we’re seeing is just the tip of the iceberg. 

I think as with so many things that we should hope that people are starting to realize things have gone too far, but act as if they’re not and it’s a crisis. Though with transgender issues there’s another problem: “people”, as in the majority, mostly aren’t aware of the excesses of gender self-id. As Joyce points out, transgender activists have mostly succeeded by flying under the radar. To the extent that gender self-id is the norm, it has mostly been accomplished through the courts, not national referendums. As a consequence, most voters have no idea that murderers and rapists are being transferred to women’s prisons based merely on self-id. Nor do they really understand what self-id entails, that merely declaring yourself to be a different gender makes it so, without any other efforts to transition.

To sum up here’s what I’m worried about:

  1. To reference the previous book: the surreality and Orwellian tactics of gender self-id is doing lasting and potentially irreversible harm to the RBC.
  2. Gender self-id is easy to abuse, and instances of it being abused are going to become more frequent.
  3. Transgender advocacy has not peaked and it will get worse before it gets better.
  4. Even if we do get rid of the craziness around the edges, it will still be mainstream to prescribe puberty blockers and practice unquestioned affirmation, which has a nearly a zero percent success rate, as opposed to waiting things out which has a 90% success rate. Success with what? Making people happy in the body they were born with.

It’s amazing how radical that last suggestion has become. The idea that the best option is not taking drugs or undergoing major, frequently sterilizing surgery.


II- Capsule Reviews

The Hard Sell: Crime and Punishment at an Opioid Startup

by: Evan Hughes

288 Pages

Briefly, what is this book about?

The history of Insys Therapeutics and in particular their drug Subsys, an under the tongue fentanyl spray, which was approved in 2012, when we were already well into the opioid crisis. 

Who should read this book?

If you’re really interested in the opioid crisis this is a fascinating footnote. And the way Insys marketed Subsys is appalling, but if you’re familiar with the way Purdue marketed Oxycontin then you’ve already heard that story. 

General Thoughts

This was another book I read in preparation for my eventual post (maybe my next one?) on the drug crisis. I don’t think it added much to my understanding of the subject, which is why I would only weakly recommend it. 

What’s most interesting is how Insys was basically able to re-run the same playbook as Purdue after Purdue had already gotten in trouble for it. Recall that Purdue’s first settlement was in 2007, but despite that Insys was still able to come along and do basically the same thing in 2012. Now to be fair it was on a much smaller scale, and Insys was more brazen than Purdue, but on the other side of the equation you have to consider that we’re talking about fentanyl. If that drug doesn’t make people pay close attention I don’t know what would.

Of course people did eventually pay attention, but it took five years, and probably would have taken longer if Insys had been just a little bit more careful. And in those five years the owner of Insys, John Kapoor became a billionaire, and I’m sure hundreds if not thousands of people died. One could say that the government eventually fixed things, but given that this all took place well into the crisis, why did it take so long? And perhaps the better question is why did they approve the drug in the first place?

If the government can’t be trusted to keep an eye on something with such a clear potential for abuse, perhaps we can turn to the market? Here again we’re going to be disappointed. In the two and a half years after the release of Subsys, Insys’s stock price increased by 1500% (which is how Kapoor became a billionaire). And it was still beating the performance of the S&P 500 even a couple of years after people started getting arrested.

If you can’t trust the government to manage this sort of thing, and you can’t trust the market, all that’s left is the individual and the community. Consider that a preview of my upcoming post.


Think Again: The Power of Knowing What You Don’t Know

by: Adam M. Grant

320 Pages

Briefly, what is this book about?

Questioning assumptions, deep thinking, examining the evidence, all the stuff recommended by the “constitution of knowledge”.

Who should read this book?

If you’ve read Scout Mindset you probably don’t need to read this book as they cover very similar territory. But otherwise anyone interested in leveling up their critical thinking would probably benefit from this book.

General Thoughts

As is so often the case it feels like the books I read in a given month end up being connected. This one is definitely closely related to The Constitution of Knowledge and I might even argue that it gives a better description of what that constitution entails, particularly for the individual, than Rauch’s book. But as a consequence it also fails in similar ways. Though because Think Again is less ambitious its failures are both more subtle and more forgivable. 

The problem with both books is they promise if you dig deep enough that you will eventually strike bedrock, and unfortunately that’s just not the case. There is no bottom to the complexity of the modern world. It’s turtles all the way down. This is not to say that I think critical thinking is pointless. It’s tremendously important and Think Again is a great introduction to it. The problem comes when people assume/assert that critical thinking will solve our problems. That if we trained everyone to think critically that we would all end up on the same page and our disagreements would go away. That’s not what has happened, and despite the efforts of books like this it’s not what will happen. Critical thinking is not a method for achieving societal harmony. 


The Moth Presents Occasional Magic: True Stories about Defying the Impossible

by: Various

368 Pages

Briefly, what is this book about?

A collection of stories originally told as part of The Moth Radio Hour, an NPR program featuring amazing stories.

Who should read this book?

If you’re already a fan of The Moth radio program you might like this handy “best off” collection. Otherwise if you like stories these are pretty good, though not as exceptional as I would have expected.

General Thoughts

I expected a truly extraordinary collection of stories, and in the end they were just good, with a couple that qualified as great. I think part of it is that (like many people) I’m weary of content where the primary point is to impart some lesson about social justice, and not to just be a good story. I didn’t keep track, but if I had to hazard a guess I’d say that 80% of the stories in the book had a very clear social justice message. Which is not to say the stories weren’t good, they were, it just made things repetitive, and ever so slightly preachy.


Nicholas and Alexandra: The Fall of the Romanov Dynasty

by: Robert K. Massie

672 Pages

Briefly, what is this book about?

The reign of Tsar Nicholas, in which he was strongly influenced by his wife Alexandra who in turn was strongly influenced by Rasputin. With particular emphasis on World War I and their tragic end.

Who should read this book?

Anyone who loves great history, particularly if you’re interested in the history of Russia.

General Thoughts

Massie is probably my favorite historian, and this is probably his masterpiece. I can’t possibly do a 672 page book justice in my short review, so I’ll just quickly list off a few things that stood out to me:

  • However bad you think Rasputin was, the truth is he was far worse.
  • Nicholas and Alexandra despite making nearly all the mistakes you could make as a leader were nevertheless good people who were basically doing their best.
  • This whole period is one of the most fertile for asking “What if?” What if Alexei hadn’t been a hemophiliac? What if Rasputin had never existed? What if World War I hadn’t happened or had happened two years later?
  • It was fascinating to hear about the immense difficulties they had in keeping Alexei from injuring himself by being rambunctious. You get the feeling that if anything he was less rambunctious than a normal boy of his age. But these days I can’t imagine there being any problem. Of all the things which have suffered over the last few decades I think the rambunctiousness of boys has to be very high on the list.

Greenlights 

by: Matthew McConaughey

304 Pages

Briefly, what is this book about?

This is both McConaughey’s memoir but also his book of life advice.

Who should read this book?

If you are a particular fan of McConaughey you will probably really enjoy this book. And in particular I would recommend listening to it as he also does the narration.

General Thoughts

I like McConaughey, and I liked the book. That said it wasn’t revelatory or anything like that. Also I think I had already heard the book’s best stories during his appearance on the Graham Norton show.

Also like so many memoirs written by successful people this book vastly understates the role of luck. McConaughey was lucky to be born fantastically good looking. And lucky to just happen to be around and looking for work when Dazed and Confused was being filmed. 

But as has often been said McConaughey is alright, and if you go in looking for some of that alright-ness you’ll find it. But it doesn’t break any new ground as either a memoir or as a self-help book.


The Midnight Library 

by: Matt Haig

304 Pages

Briefly, what is this book about?

After attempting suicide Nora Seed finds herself in a library where she can try out every possible life she might have lived, and choose the one that will actually make her happy.

Who should read this book?

Dolly Parton called this a “charming book”. If that’s the sort of thing you’re looking for you’ll probably enjoy this book, and it’s short.

General Thoughts

One downside of reading books fast which I didn’t mention in my defense of the practice is that if a book is short enough there’s very little resistance to adding it to your library. So for a while there if I heard of a book that seemed interesting and it was less than 10 hours I would almost reflexively grab it. This book was from that period. Which is not to say it was a bad book, I quite enjoyed it, but it wasn’t so light as to be diversionary, and the areas in which it was serious were not areas in which I needed additional seriousness.

Beyond that a few rapid fire thoughts:

  • It reminded me of Short Stay in Hell which I read almost exactly a year ago, though where Stay was about as pessimistic as it’s possible to imagine, Library was pretty optimistic.
  • It’s always interesting for me that when people want to signal contentment and happiness it almost always involves being married and having children. I’m not sure if that’s because, on some deep level it’s true or if it’s just something that’s easy for people to grasp.
  • Minor spoiler: It kind of ends up in the same place as It’s a Wonderful Life. And to the extent that people criticize it, it’s for this, or more generally not being creative, but I find it hard to imagine how it could be otherwise.

I guess I also wonder how some 300 page books are 8 hours while some 300 page books are nearly 18 hours. Speaking of which:


Expeditionary Force Series

By:  Craig Alanson

Book 3.5: Trouble on Paradise

98 Pages

Book 4: Black Ops

276 Pages

Book 5: Zero Hour

299 Pages

Book 6: Mavericks

289 Pages

Book 7: Renegades

314 Pages

Briefly, what is this series about?

Military science fiction about humanity suddenly discovering that the galaxy is full of super powerful warring aliens, and their attempts to avoid being collateral damage in those wars.

Who should read these books?

As I mentioned last month this is a quick diverting series that goes down super easy. If you’re looking for a fun diversion and you enjoyed previous books in the series it’s probably worth it to continue.

General Thoughts

One of the reasons why this series is so easy and quick to read is that the number of characters is very limited. However, by the time you get to book seven that strength can become a weakness, as the characters start to become caricatures. This happens with all long running sitcoms and maybe that’s the best way to describe this series, a military sci-fi sitcom. Another weakness of sitcoms is repetitive plots, which is also a weakness of these books. And I will admit that by book seven I was starting to get annoyed. I have various reasons for believing that he might turn a corner in book eight, so I’m going to keep reading. Also I continue to enjoy his world building and the mysteries he’s introduced and seeing how those mysteries resolve would be almost enough on it’s own to keep me reading, though probably not at quite the blistering pace I’ve maintained thus far. 


For all the criticisms I have of a reality based community, I hope that you consider me part of it. Even if or especially if my version of reality is uniquely eccentric. If it is, as they say, just crazy enough to work then consider donating. Craziness isn’t as cheap as it’s made out to be.


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 Deneen. (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. Deneen 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 Deneen 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.