Radiolab: Blame

Radiolab: Blame

Recenlty, WNYC‘s Radiolab ran one of the most intense and interesting podcasts I have heard in quite sometime.  The podcast, titled “Blame,” is about the intersection of law, technology, and moral responsibility.   

The first story, “Fault Line,” is about a New Jersey man epilepsy may or may not have play a role in his child pornography addiction.  Here is a description of “Fault Line”

Kevin* is a likable guy who lives with his wife in New Jersey. And he’s on probation after serving time in a federal prison for committing a disturbing crime. Producer Pat Walters helps untangle a difficult story about accountability, and a troubling set of questions about identity and self-control. Kevin’s doctor, neuroscientist Orrin Devinsky, claims that what happened to Kevin could happen to any of us under similar circumstances — in a very real way, it wasn’t entirely his fault. But prosecutor Lee Vartan explains why he believes Kevin is responsible just the same, and should have served the maximum sentence.

The second story, “Forget about Blame?”, is a conversation between the hosts of Radiolab with David Eagleman, a neuroscientist who argues that the law should forget about retributivism and blame. Eagleman defends the “my brain made me do it” defense and suggests that neuroscience should fundamentally alter how we think about criminal law.

Here is a description of the story: 

Nita Farahany, who’s been following the growing field of Neurolaw for years now, helps uncover what seems to be a growing trend — defendants using brain science to argue that they aren’t entirely at fault. Neuroscientist David Eagleman thinks this is completely wrongheaded, and argues for tossing out blame as an old-fashioned, unfair way of thinking about the law. According to David and Amy Phenix, a clinical and forensic psychologist who relies on statistics, it makes more sense to focus on the risk of committing more crimes. But Jad and Robert can’t help wondering whether that’s really a world they want to live in. 

Finally, the third story, “Dear Hector”, is a remarkable tale of forgiveness.  It is about a father who befriends his daughter’s murderer.  

Reporter Bianca Giaever brings us a story of forgiveness that’s nearly impossible to comprehend — even for the man at the center of it, an octogenarian named Hector Black.

Veterans and Suicide, an Unsolvable Problem ?

Well the shut down is over, meaning all the doom and gloom that would have affected the veteran community did not happen. As of a few days ago, the VA website announced it would be resuming normal operations.
While looking for something to write about this week, I stumbled upon a fairly old announcement on the VA website; September was Suicide Prevention Month. For those that are unaware suicide is a major problem for the veteran community particularly with large numbers of vets coming home after having sustained both physical and mental losses.

To combat this problem there are prevention coordinators at all 151 VA medical centers and a hotline people can call when they feel they need help. Typically when someone talks about veteran suicide, PTSD is inevitably mentioned. This of course is for good reason as depression can be a symptom in someone suffering from PTSD, but I have always believed there is more to it than that.
I got out of the Marine Corps in 2009, each year since then someone I served with has committed suicide. Some of them were pretty good friends; others I only knew in passing. In the military, and especially the infantry units, the bond between brothers-in-arms is close. One guy who committed suicide, I think I only spoke to once or twice, but it still stung. The reason it stings is because, I would argue, the hard part is over. These vets have made it through enemy fire, IED’s , and all the other stuff that can kill you in Iraq or Afghanistan and yet they come home can cannot cope.
I am not going to get into deep medical or psychological evidence as to why any of this happens because, quite frankly, I am not convinced the experts even know much about the problem. What I do know is that for those of us who have been in combat, life back home is often not the same. A young infantryman returning home often finds friends have either moved away or are not the same people they were when you left. Wives and girlfriends in some cases are also not there anymore, and it can be difficult if they are getting used to being around them again. A friend of mine got drunk and angry because his wife wouldn’t let him hold his child. He promptly killed himself with a pistol. Nobody that knows him really knows why. He just did. There is no policy that can be put in place to prevent that. Out of all the people I know who have committed suicide, not one of them asked for help from their loved ones. To my knowledge none of them called a help line at the VA. Each year I was in the Marines I sat through hours of mandatory depression and suicide prevention classes designed to make us aware of the emotional problems that befall so many.
War is difficult, being in the military is difficult, and life after can be even more difficult. These are just facts of life. The solution is not an easy one. For those of us where depression is not an issue, all we can do is wait for the call for help, look for the signs, and hope our friends come out OK.

Health Insurance Reservations

I am now a semi retired older physician who started practicing rheumatology in Syracuse in 1975. During the recent government impasse, I experienced a curious relief that universal health insurance might not happen. Although I have supported universal health insurance for decades, working within Medicare guidelines as made me suspicious of government control. I doubt most patients care about documentation requirements in order to bill for medical services through Medicare. Patients might be surprised to learn a complete review of systems encompassing 12 areas of possible complaints must be documented in order to bill for a complicated consultation. In the past, we [the physicians] could simply ask whether anything else was bothering you. Now we must go through a laborious inventory asking about menstrual problems, memory loss, extra-marital sex, etc., and whether or not you are using a seat belt and are agreeable to routine HIV testing. I have always resisted becoming the patient’s biographer as most of the data is none of my business, and the answers do not usually impact my specialty services. Medicare forces me to go way beyond my comfortable limits. The process started as an innocent attempt to ensure appropriate services were rendered, but has evolved in typical government fashion, to include a 1-2 page confusing list of mostly irrelevant issues.

I remember when everyone paid directly for services. Then, it was not unusual for some patients to decline expensive investigation. Many would refuse additional x-rays especially if there was no direct impact on treatment. With insurance, patients have already paid. They want their money’s worth, which means some want every test and treatment possibly relevant. Many expect an MRI of the affected area and feel neglected if not done.

When patients paid directly they limited their requests to attainable goals requiring expert opinion/services. Now, in a further attempt to get their money’s worth some keep adding on additional complaints many of which are impossible to solve satisfactorily. For example, being overweight and fatigued usually has a straightforward solution… eat less and exercise more. With insurance, some feel entitled to diet advice, appetite suppressants, in depth evaluation to exclude anemia, cancer, etc.. Modern medicine has not solved the problem of how to reduce fatigue and excess weight with a simple pill. Good health is not yet effortless, but insurance makes it worth a try.

Another consequence of insurance results from the natural tendency to discount advice that comes for free. Our recommendations, which used to cost real out of pocket money, is now treated as coming for free in the same way as supplement advertisements, or cheap shot advice off the Internet. Most pay directly for their lawyer’s advice and are often happy to do so. I doubt this would be the case if/when legal advice becomes a government supplied insurance benefit with little or no direct payment required.

My last reservation is that perhaps lifesaving healthcare is not affordable. We can often afford to patch things up for hours to days, but often treatments such as intensive care unit support for months, organ transplantation, or intensive genetic testing are very, very expensive. We have been willing to spend enough so that the sick and dying do not get left in the street, but are we able to pay indefinitely for costly care that could consume over 20-30% of GDP?

Nevertheless, the nagging discontent with the hidden consequences of insurance pale by comparison with the frustration that develops when simple effective treatment cannot be delivered due to lack of funds. I therefore still support the affordable care act but worry about some of the consequences.

Hopefully, these issues can be addressed to evolve a smooth running efficient medical system. But given our current collective inability to work together, I am not holding my breath.

 

 

This past Sunday on Fareed Zarakia GPS, Fareed provided his take on the Republican party and the conservative movement. Zakaria critiques conservatism as being overly ideological and detached from the practical realities that face the United States.

Progressives will likely find Zarakia’s critique compelling. I suspect Conservatives might not find it entirely fair. What do you think?

Here is a description of the video:

For many conservatives today, the “rot” to be excoriated is not about economics and health care but about culture. A persistent theme of conservative intellectuals and commentators – in print and on Fox News – is the cultural decay of the country. But compared with almost any period in U.S. history, we live in bourgeois times, in a culture that values family, religion, work and, above all, private business. Young people today aspire to become Mark Zuckerberg. They quote the aphorisms of Warren Buffett. They read the Twitter feed of Bill Gates. Even after the worst recession since the Great Depression, there are no obvious radicals, anarchists, Black Panthers or other revolutionary movements – except for the Tea Party.

Now, for some tacticians and consultants, extreme rhetoric is just a way to keep the troops fired up. But rhetoric gives meaning and shape to a political movement. Over the past six decades, conservatives’ language of decay, despair and decline have created a group of Americans who fervently believe in this dark narrative and are determined to stop the country from plunging into what they see as imminent oblivion. They aren’t going to give up just yet.

The era of crises could end, but only when this group of conservatives makes its peace with today’s America. They are misty-eyed in their devotion to a distant republic of myth and memory and yet they are passionate in their dislike of the messy, multiracial, capitalist-and-welfare-state democracy that America actually has been for half a century – a fifth of this country’s history. At some point, will they come to realize that you cannot love America in theory and hate it in fact?

Watch the video for the full Take or read more in the Washington Post.

Zakaria to Conservatives: Get Real, Lighten Up

#FeminismIsForWhiteWomen?

The Oxford Dictionary defines feminism as “the advocacy of women’s rights on the grounds of political, social, and economic equality to men.” The definition is race-neutral, and yet a quick Google search of “feminism” led me down a rabbit’s hole of feminist ideologies — including traditional feminism and black feminism.

Too often, I sit in a room of self-proclaimed feminists, and it dawns on me that I am the only person of color in the room. For a long time, I wondered if my white friends noticed. My question was answered recently as our meeting came to a close.

“Did you notice how the room was full of white women?” my friend, a white woman, asked me anxiously. I nodded, scanning the room as it slowly emptied. We talked about ways to bring in more women and men of color, and the conversation drifted towards a recent trending hashtag on Twitter: #SolidarityisforWhiteWomen. The topic was born of Twitter drama, and provided a forum to discuss an old debate: whether feminism excludes the experiences and testimonies of women of color.

The Twitter drama began when writer Mikki Kendal responded to tweets posted by Hugo Schwyzer, who is an author, blogger, speaker and former college professor. In August, he admitted to targeting black feminists who “got in his way.”

Kendall complained about white feminists who “enabled” Schwyzer for years, instead of standing by the women of color targeted by him.  Interestingly, Schwyzer identifies as a male feminist and promotes inclusivity, saying “Feminism points out ways in which rigid gender roles don’t work out for men and women – particularly for women. But not by any means exclusively for women.”

The conflict between Kendall and Schwyzer sparked a social media debate, in which women of all shades questioned the inclusiveness of mainstream feminism.

Some people, including Schwyzer, complained that the thread was divisive. Others took the “fly-on-a-wall” approach, taking the opportunity to enter the minds of women of color.

And still others took the opportunity to engage in dialogue with other feminists. Women of all ethnicities jumped in the conversation and online writing communities called for testimonies from feminists of color.

For the past couple of years, students of color have made up about 20-25% of the student population at the College of Law, which suggests that meetings need not be so homogenous. An honest conversation about the dynamic between white feminists and feminists of color will help further our common mission of gender equality in all aspects of life. The conversation needs the voices of all women, regardless of color, class, creed, sexual orientation or identity. And yes, diversity encompasses more than racial diversity. Within any group of people are varying values, experiences, and ideas–race is simply one part of who we are.

I challenge you to discuss your differences, and stumble upon your similarities. #FeminismIsForAllOfUs