To join or not to join...

Before I contribute to our SETI topic, I wanted to post about something that I've been deliberating over the past week or so. Recently, my med school email account has been flooded with emails asking me to join the American Medical Association (AMA), not to be confused with the American Medical Student Association (AMSA), which I'm a part of. Needless to say, I've done a lot of research about the organization, and the information I found was pretty interesting. I thought I would share some of this info, as well as how they are trying to entice me to join as a med student, since I feel like this is only the tip of the iceberg with regards to organizations/companies trying to get the support of med students and doctors.

The AMA was founded back in the mid 1800s, and it was basically established to improve medical education, promote public health, advance medical science, and create a standard set of ethics for doctors around the country. Today, they claim to be the largest medical association in America. I was shocked to find out that less than 20% of doctors are actually members of the AMA, and about 30% of the members are actually medical students, residents, or fellows--not practicing, licensed, physicians. I think it would be accurate to say that most Americans believe that the AMA is the spokesperson for the beliefs of all physicians, but this is clearly not the case from these statistics. This is an important point. The AMA does not speak for the majority of practicing physicians in the U.S. However, they are seen as having tremendous political power, acting as the lobbyist for the entire medical community. The President of the United States makes it a point to speak at AMA meetings every once in a while, and Obama was relieved that the AMA accepted the House Health Reform Bill not too long ago. The AMA also performs charity work on national and international levels, contributing money and physicians for public health improvement.

On to my dilemma.

The emails I have gotten about the AMA have all been incentive-oriented. Here's the basic layout of all these emails:

Hello, and congratulations on being accepted to _______ School of Medicine! I know how hard the first year of medical school can be, which is why I would like to invite you to join the largest support group of medical students in the nation. Because the AMA helps create policy, you can make a difference in the issues that matter most to students like us: expanding coverage for the uninsured, medical school loan debt relief and reasonable resident work hours. You also receive complimentary subscriptions to a number of AMA publications, most notably the Journal of the American Medical Association, to help keep you informed on these and other issues. We are currently offering a 4-year membership, which is $68, and free Netter Flashcards, a $35 value, which are essential for Human Structure. If you happen to already have the flashcards we also will have very nice dissection kits that you can choose instead, also a must have for Anatomy. Join the AMA today and start making a difference.

As much as I like flashcards and dissection kits, I wanted to know what the real benefits were of joining the organization. What better place to look but their website, where they detail the top 10 reasons for joining. I won't spend too much time on them here, since you can read them for yourselves, but a good number of their reasons for joining are again these small incentives: flashcards, online subscriptions to their journal--which incidentily every medical student should have access to through their school, a residency search tool--which again everyone has access to (if you're a member, you can print mailing labels!), access to certain health policy internships in D.C. (politics isn't really my cup of tea as a med student...I rather spend the extra time doing something to increase my abilities as a physician, and worry about politics later), networking through conferences and meetings (networking as a med student should not be one of your highest priorities, in my opinion), and a web-based forum (now that's cool!--sarcasm intended), and other misc. leadership opportunities/advocacy benefits. To be honest, I still wasn't persuaded to join or not to join at this point. I had to do more fishing around on their website, to get a clear idea of what they stood for ethics-wise.

Now, before I get into specific ethical stances, I want to discuss how the AMA works. Essentially, the AMA is a union. Doctors get benefits, and they agree to abide by certain rules and regulations of the union--otherwise, bad things happen. The code of ethics is basically the AMA's set of rules, and, as I understand it, members have to agree to the code to become members. What can the AMA do to doctors who don't abide by its rules? Well, the networking structure that the AMA has can be a blessing or a curse, depending what your standing is with them. For example, they could effectively cut off your referrals from other AMA members, making it harder to get patients. Word of mouth is an untamed beast, especially in medicine. Ultimately, they could kick you out of the organization for numerous violations of their code, which would not look good to anyone reviewing your CV. Fortunately (or unfortunately?) they do not have the membership that they once had, so dissenters of the AMA have much less to worry about than they used to.

Conveinently, the AMA has their code of ethics section right on their website. I found a couple of entries in this code to be contrary to what I deem is ethically correct. The AMA believes that euthanasia and physician-assisted suicide are absolutely wrong in every case, and that performing these acts is "incompatibile with the physician in a role as healer." It's interesting, then, that palliative sedation is deemed ethically permissible by the AMA. If euthanasia and physician-assisted suicide are not allowed, why should palliative sedation be any different? Along these lines, I feel like the role of a physician is not only that of a healer, which seems to run counter to the very ideologies that the AMA holds. In the role of a healer, physicians treat diseases. They fix pathological issues in the body. Of course I do not disagree with this statement...this is what doctors do! But I feel that doctors should be treating illnesses, which encompass much more than the disease itself. Illnesses affect the patient, their families, and their psychological, social, and physical issues. Doctors have a responsibility to care for the entire patient, something that I feel is lost in our culture of attacking diseases and waging wars against pathogens, etc. End-of-life care is as much in the doctors realm as is giving a vaccination to a child.

I also find objection to the AMA's stance on gift-giving by companies. While they do take a stance that is mainly anti-gifts, they do allow for companies to take physicians on trips and provide meals, etc. that are "for the ultimate benefit of the patient." I believe that under no circumstances should a doctor become entangled with the companies that provide them with medical supplies and equipment. The act in itself is not beneficial for the patient, as it may persuade the doctor to give medication or perform a procedure that is ultimately unnecessary or not in the patient's best interest.

Finally, I am not one to let others make decisions for me, which would essentially be the case both with advocacy in Washington and in providing care for my own patients if I became a member of the AMA. Members are finding this hard to swallow in recents weeks, with the AMA's support of the House Health Reform Bill. The former AMA president as well as various AMA regional groups are in strong opposition of the AMA's support of the bill, since it will decrease physician salaries and allow for less physician control in the care of their patients. They are finding out the hard way that only a select few people have a tremendous amount of power in the organization, determining organization-wide policy endorsements when there is considerable divide in the organization itself. That's a shitstorm that I will happily avoid.

So, in the end, I decided not to join the AMA. I felt that surrendering my ethics to the AMA was too high of a cost, not to be outweighed by the promise of professional networking and a nifty set of flashcards. As much as I appreciate their efforts to get higher salaries for physicians, money won't make me a better doctor. Having a good set of ethics will.

Jim

An Awful Waste of Space?

Nearly thirty-two years ago, a giant radio telescope in Ohio working on a SETI (Search for Extraterrestrial Intelligence) project made a curious discovery: an unidentified signal that remains to this day the best candidate for a genuine ET transmission. This discovery—dubbed the Wow! signal due to the enthusiastic scribblings of its finder—was a spike in radio emissions to over 30 times the natural background levels coming from somewhere in the constellation Sagittarius and possessing the “expected hallmarks of [a] potential non-terrestrial and non-solar system origin.” Moreover, it came at a frequency of about 1420 MHz, the so-called “water hole” of the radio spectrum—-likely the most natural frequency for members of the galactic radio wave-transmitting community to favor. Unfortunately, despite repeated searches for it, the signal was never detected again and remains unexplained to this day.

But how likely is it to have been the product of an extraterrestrial intelligence? To even attempt to answer this—and the bigger questions of how likely there is to be someone out there to transmit and how likely SETI is to someday be successful—requires a very large range of scientific and social knowledge. That’s why this will be the first of several posts on a range of subjects germane to these cosmic questions and supplied by each of the contributors to this blog (in our first collaborative effort). Posts sharing their unique expertise should trickle in over the next week or so.

I’m going to open up the discussion with a very brief overview of a staple of any SETI discussion: the Drake equation. Astronomer Frank Drake launched SETI in 1960 with Project Ozma, a search for ET radio signals emanating from two nearby Sun-like stars. (On a geeky sidenote, I’ve seen up close the telescope Drake used—an 85-foot radio telescope at the National Radio Astronomy Observatory in Green Bank, West Virginia.) A year later, Drake devised the equation that bears his name to help organize the discussion at the first conference held to discuss the nascent SETI. Though the Drake equation ostensibly yields a value for the number of radio-transmitting civilizations in the galaxy, it is far from being a hard-and-fast formula; rather, it is a tool for sharpening our understanding of what factors are key to the existence of civilizations like ours. The Drake equation is a chain of reasoning, from the physical to the biological to the social, in which each new link of the chain cuts down our estimate of the number of civilizations in the galaxy. Let’s break it down:

● The Physical Factors. We start by considering the rate of star formation in the galaxy (or, more simply, the total number of stars). Now, what percentage of stars have planetary systems? And, in those systems, how many planets (on average) will be physically capable of supporting life?

● The Biological Factors. Once we’ve zoomed in on potentially life-supporting planets, we face the hardest question yet: what fraction of those go on to actually develop some kind of life? And once we’ve estimated that: what fraction of those life-sustaining planets go on to eventually develop intelligent life?

● The Social Factors. Now that we’ve gotten this far, we need to consider what percentage of planets with intelligent life go on to develop civilizations that eventually create radio telescopes or something similar. The final factor is to consider is how long such civilizations last, either in terms of actual longevity (i.e. do they destroy themselves?) or in terms of a communication window bounded by the technological point where ETIs are undetectable to us in our SETI efforts.

Each of these steps is a discussion unto itself and each is crucial. Solutions to the Fermi paradox (put simply, if the naïve assumptions that humans are typical and that life like us is common in the universe are correct, why have we seen absolutely no trace of anyone else?) can be found by making a very pessimistic estimate for virtually any of the factors found in the Drake equation. The simple and inexorable logic of the Drake equation has guided discussions on SETI for the past forty-eight years. So shall it guide ours as we post our thoughts on different aspects of the problem over the next few days.

Who's Gonna Save Us?

There is a point in Howard Zinn's A People's History of the United States (in a chapter called "The Coming Revolt of the Guards") where he writes:

All those histories of this country centered on the Founding Fathers and the Presidents weigh oppressively on the capacity of the ordinary citizen to act. They suggest that in times of crisis we must look to someone to save us: in the Revolutionary crisis, the Founding Fathers; in the slavery crisis, Lincoln; in the Depression, Roosevelt; in the Vietnam-Watergate crisis, Carter. And that between occasional crises everything is all right, and it is sufficient for us to be restored to that normal state. They teach us that the supreme act of citizenship is to choose among saviors, by going into a voting booth every four years to choose between two white and well-off Anglo-Saxon males of inoffensive personality and orthodox opinions.

The idea of saviors has been built into the entire culture, beyond politics. We have learned to look to stars, leaders, experts in every field, thus surrendering our own strength, demeaning our own ability, obliterating our own selves. But from time to time, Americans reject that idea and rebel.

There's plenty of fertile ground in there for discussion but for now I'm interested primarily in the form of hero-worship that infects politics. More broadly, I'm talking about the need for Good Guy vs Bad Guy story lines. In some sense that tendency seems to be rooted in human nature. We sympathize with a particular side or find one side to be more in line with our stated values (be they freedom, democracy, liberalism, or whatever). I can't claim to be immune to these impulses. I've elevated certain political figures to hero status, overlooking their many shortcomings and giving in to the urge to demonize their political antitheses.

Two events in the past month have helped to bring this issue into focus for me. The first is the upheaval in Iran following the disputed presidential election there. Discussions of the events with a few friends and readings of select prominent liberal blogs reveal a certain romanticization of the situation similar, I suspect, to the way we romanticize our own country's revolutionary beginnings. This is not to suggest that some immaturity or naivete exists on the part of anyone; rather, it reflects a more general tendency to identify with a side and, for lack of a better term, "root" for them. This does, however, seem to be done often with imperfect knowledge of exactly what it is one is rooting for.

My knowledge of Iranian politics and history is somewhat general and limited but I nevertheless found the Iranian protests last month to be fascinating. My sense from the beginning was that the mere existence of dissent and anger--regardless of how intense it may be--need not lead to large and lasting change. Massive urban unrest has occurred without (arguably) leading to large structural change in stable nations like the United States. Political change in the United States is usually incremental by virtue of the political system's design: legislation has to make its way past a bicameral legislature and a president, making it subject to crucial "pivot points" like the Senate filibuster and the presidential veto. Political change in contemporary Iran, on the other hand, can be nearly impossible, also by design. Legislation passed by the Iranian parliament--the Majlis--must be approved by the Guardian Council, a group of 12 clerics that also must approve all candidates who wish to run for president or for a seat in the Majlis. So even when a reformist candidate is elected--like Mohammad Khatami was in 1997--and reform-minded legislators manage concurrently to win a large majority of seats in the parliament--as was the case when the Sixth Majlis was elected in 2000--large changes can still be blocked by the Guardian Council and the Supreme Leader. A likely fraudulent presidential election in 2009 is merely a symptom of a political system in which elections fail to be meaningful.

For this reason I was wary of the Iranian protesters' (apparent) decision to rally around Mousavi (though several protesters also carried signs with the picture of Mohammad Mosaddeq on them). Though he is evidently reform-minded, he was only a candidate in this race because he was approved by the Guardian Council. He may wish to change it but he is undeniably part of the political system in Iran. In the United States, we often lament that our candidates are "chosen" by differential media coverage or corporate donations and we accept that political changes will be incremental, not only because of the design of our institutional features mentioned above but because politicians have a stake in preserving the current power structure that so benefits them. The difference is that most of us believe that the current system is an imperfect one that must be constantly tweaked not a fundamentally flawed one that must be overthrown. If Iranians want free and meaningful elections, they will have to change the very way that their government is structured. And, despite the recent anger over the presidential election, I don't know how much support exists for such a radical move. Rather, I think this illustrates the point Howard Zinn was making in the quote I posted above: many of the political "heroes" we honor and idolize, particularly in the wake of crisis situations, do not seek to pursue large changes that may be called for by the situation or by the masses. Instead, these heroes use their considerable political acumen to pacify the popular will and return them to a state of complacence with a flawed status quo. It is for this reason that I find the excitement and admiration heaped upon Mousavi (no matter how "good" his intentions may be) by American bloggers to be potentially misplaced.

The second event I alluded to above is the ongoing political turmoil in Honduras. This situation is one I know virtually nothing about but it seems that President Zelaya engaged in activities "ruled illegal by Honduras' Supreme Court, attorney general, top electoral body, and human-rights ombudsman" in pursuit of a referendum to potentially extend his stay in office. Zelaya was then arrested and exiled by the military, apparently on the orders of the Honduran Supreme Court. In reading comments on a story about this on a prominent liberal political blog, I was again struck by the need for every political story to have a clear-cut Good Guy and Bad Guy. The consensus seemed to be that Zelaya was the Good Guy by virtue of having been elected to his office; as Americans, it seems, we don't support the deposition of political leaders unless we question the legitimacy of their form of government.

Perhaps, as I speculated above, this sort of black-and-white thinking is ingrained in our psyches but I can't help but wonder if our educational system's habit of building a mythology around all "great" political figures contributes. We stress the need to think critically and along multiple dimensions, yet rarely fail to identify a Good Guy and Bad Guy in every war, nay, every conflict, be it military, political, or even economic. Certainly, I'm not immune to this phenomenon. It's easy to slip into the habit of considering domestic political opponents to be enemies or the liberal Western way of thinking as the only valid political philosophy. But it isn't up to me to decide what form of government is right for Iran; even suggesting that it's up to the Iranian citizenry to decide for themselves betrays a Western liberal bias, with its emphasis on personal liberty and equality, self-determination and consent of the governed. I can only offer a somewhat Darwinian (or perhaps Machiavellian) view: if the Iranian government values self-preservation and throws enough pittances at its angriest citizens to pacify them, it will likely survive in its current form (indeed, for the time being, this is the outcome that seems most likely). If it fails to retain legitimacy (as the Shah's Iran did three decades ago), it will fall. In short, what will happen will happen. Making the value judgment of what should happen would require either a focus on Realpolitik (what would most benefit the United States?) or a more presumptuous reliance on the conviction that one's own political ideology is best for everyone.

The point, from which I seem to have strayed, is that blind hero-worship of a redeeming political figure (e.g. a Barack Obama) or even simply choosing to read a political situation while operating under the assumption that some leader (a Zelaya or a Mousavi) must be "the Good Guy" is dangerous and misguided. Things happen for complex and sometimes obscure reasons. We currently have four bloggers here--a policy scientist, a historian, a medical student, and an engineer (aspiring, all)--and each of us can attest to the veracity of this fact in our respective fields. Identifying political actors as good or bad (/evil) and thus "explaining" their motives is often a shortcut that fails to illuminate the reasons things played out as they did.

Note: The title of this post was taken from the politically-charged song of the same name.

The Curse of 2012--Who's Next?

What a year it‘s been for virtually any Republican who has been thinking about running in 2012. It‘s like the Carter expedition that went into King Tut‘s tomb. What‘s going on here? -- Chris Matthews

First, Bobby Jindal introduced himself to the American public by responding to Obama's speech to Congress with his best Kenneth-the-Page impression. Soon after, Jon Huntsman was shipped off to China and swept off the American political landscape. Then Newt Gingrich stuck his foot in his mouth and his middle finger in the face of the growing Latino community when he began tweeting unequivocally that Sonia Sotomayor is a racist. Next John Ensign and Mark Sanford, defenders of the sanctity of marriage and condemners of President Clinton, were exposed as adulterous hypocrites. Now we may have the latest victim of this insidious, Republican-smashing force.

If you follow the news even a little, you've no doubt already heard about the political bombshell dropped on this holiday weekend's Friday news dump: Sarah Palin is resigning as governor of Alaska at the end of the month. This lipsticked pitbull has been champing at the bit to start the 2012 election season for months now, so the fact that she's opted not to run for re-election in 2010 should come as no surprise to most political junkies. As Rudy Giuliani found out the hard way last time around, Iowa and New Hampshire are what count when it comes to making presidents. And Alaska is a long way from both.

The obvious question is why on earth she would resign as governor 30 months into her first term, particularly if she wants a promotion. As noted, it makes some sense not to seek re-election because the long commute times entailed by simultaneously governing Alaska and campaigning in the heartland simply make the whole thing infeasible. But throwing in the towel now doesn't make much political sense. Viewers hoping to see some glimpse of a rational thought process at work behind this decision by watching Palin's press conference today were disappointed. The only apt way to characterize it is to paraphrase a wonderful rebuke from Billy Madison:

Mrs. Palin, what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul. (Dont-cha-know.)

Let's muse a bit to try and figure out what she's thinking. The working assumption here--given Palin's continuing efforts to endear herself to the Republican base and stay in the news cycle--is that the soon-to-be former governor desperately wants to run for president in 2012. Since the 2012 Republican field looks to be even more anemic and laughable than the last one, this plan isn't a horrible one. But why resign now?

● Scandal. This one doesn't make any sense if Palin still intends to run for president; what good would resigning her governorship do? If (and certainly this a big if) there were some scandal she'd prefer never sees the light of day, resigning and fading out of the public spotlight might work. But since I doubt she plans to really leave the limelight any time soon, we're either about to be treated to something juicy in the next few weeks or this is just a far-fetched interwebs wet dream.

● Campaigning. Maybe she wants to get started early and spend more than three years campaigning. If this is really her reason, she must have the worst political instincts of her generation. This move makes her look like even more of a lightweight than she already did (no small feat) and nudges her even closer to irrelevance.

● Disinterest. By far the most alarming prospect is that she simply doesn't feel like governing or dealing with legislators anymore. It wouldn't be particularly surprising if Gabby Gimmick just got tired of the difficult and thankless task of, you know, doing her job. The fact that she might then want to go on to run for president would be funny if it wasn't so sickening.


In fairness, in her press conference Palin indicated that she didn't feel lame ducks should be collecting paychecks (no word on per diem reimbursements) and, since she doesn't intend to run for re-election, there's no place for her in Juneau. Of course, the logic of that doesn't really make any sense but we'll let that slide. Maybe she's really just throwing in the towel and giving up the political game. If so, she'll likely be spared further retribution from the Curse. If, however, she continues on the path to opposing Obama in the next election, the Curse may well strike down upon her with great vengeance and furious anger. She could end up becoming an elected official in Wasilla again.

Anybody have any thoughts on why she's quitting? Or who the Curse will go after next?

Obama's "Prescriptions for America"

I felt compelled to watch Obama's "Prescriptions for America" meeting the other night (transcript available here), where he talked about America's health care system and what he wants to change about it. I was curious about what he was going to say, especially after his speech to the AMA, where he said he would not put caps on malpractice rewards. For this post, I think I'll focus on the things that I didn't agree with during his meeting, and I'll leave the things that I agreed with for another time.

One of the first things mentioned during the introduction to the program was that Obama supports a health care system that resembles today's medicare, where the government handles the financing but patients still have the freedom to choose their doctors and hospitals. Now, don't get me wrong, I like the idea of universal health care. I don't mind government involvement at all, especially if it can get care for those millions of Americans that can't afford medical treatment. Like it or not, however, there is some benefit that insurance companies provide: they spread out patients to various providers, and they make people stick with their choices. People have a few doctors to choose from on their plan, and because of this they have to stick with their doctor. You might be thinking that this is horrible--what if you have a doctor you absolutely hate? Well, the good news is that you can usually switch a couple times until you find one you like. When we eventually get universal healthcare, there are going to be 50 million or so people looking for a primary care provider to call their own. The health care system will be much more stressed, and I feel that we need at least a few ways to organize the people entering the system, rather than allowing for a blind clusterfuck to occur. I already thought that primary care physicians would be specializing in the future, to where there would be divisions in primary care based on age, disease type, or even gender. This may provide the necessary stabilization to the program. Who knows. There is also something to be said about establishing a relationship with your patients, something that frequent doctor-shopping does not allow. We have to consider if too much of a good thing (freedom to choose a health care provider) is a bad thing in this situation, especially with such a large population entering the system.

There was also some discussion on private vs. public health insurance, but I think that a lot of people are missing the point. A lot of people believe that public health insurance will, in itself, lower costs for everyone. It's the simple fact that we have insurance for health care which is driving up costs. Looking strictly at costs, it won't matter what kind we have. A simple car insurance analogy illustrates this pretty well.

A while back, I was in a small car accident with an emo teenage girl bitch, probably talking to her friends on the phone about how her parents hate her, her boyfriend dumped her again, or someone left a nasty message on her myspace (I might be bitter). Anyway, she hit my stationary car in a parking lot while talking on her phone, causing a surprisingly significant amount of damage to my back bumper. I went to the repair shop, where the first words out of their mouths were "is her insurance paying for it?" When I said yes, they instantly put on a big smile, and we walked out to the car to see what the damage was. You would be amazed what these guys said needed to be fixed, all because her insurance was paying for it. They pretty much wanted to replace (or order the parts to replace) the entire back end of the car, when they obviously didn't have to. The mechanic even said that, if I was paying for the repair myself, I would be paying only $700. But the bill to her insurance company was $3400. In turn, this girl's rates are going to go up (ha! fuck her...sorry, I'm still bitter), and she'll be paying a lot more for any other accidents she inevitably gets into. Guess what? The same thing happens with health insurance. *Gasp*

Though it isn't as obvious in health care, and there are many more checks to make sure this doesn't happen...it does. In some instances, it is even encouraged. A skilled doc can tell when his patients have pneumonia when they walk through the door. They have an unmistakable cough, and their histories and physical exams confirm the diagnosis. Docs really don't need x-rays to diagnose it, but they have to. They're required to. By the insurance companies, no less. Otherwise, they won't pay the doc for the patient's treatment. Because they weren't there to examine the patient, the insurance companies need visual confirmation of the disease. So the docs get paid for the x-rays and the treatment, fucking over the patient in the process (because their rates may or may not go up, but they can still get points on their record for that x-ray) and wasting money. That's why health care costs so much. Will public health insurance fix the problem? Maybe, but why would it? Docs will still have to answer to the insurance companies, so "covering their asses" with needless procedures will still be the norm. Insurance is insurance...and it sucks.

So why do docs have to "cover their asses?" Well, Mr. Obama, it's because the pointy stick of malpractice is always about to ram them in the ass. It's why docs pay over $100,000/year in malpractice insurance (which, based on the previous paragraph, also sucks). High malpractice claims do cost the healthcare system money, and they cost patients money. Malpractice is one of the main reasons why costs are so high (and why docs are often grumpy). Fuckin' a, Obama, fuckin' a.

One of the last things I wanted to talk about was Obama's statement that more people need to be encouraged to enter medicine, especially family medicine, through loan forgiveness etc., etc. I hope Obama gets to the realization that the problem isn't that people don't want to go into medicine. The problem is that there are not enough medical schools and thus not enough people graduating from medical school. If all of these students went into primary care, we would probably still not have enough docs for the millions of people about to enter the system. I have dozens of friends who didn't get into medical school for one reason or another, but I know they'll be excellent doctors, just by knowing their study habits and their desire to help people. More than likely, they'll just apply and get in to medical school next year or the following year. It's not like we weed out everyone who doesn't get into medical school...we just delay their entering if they don't get in (40,000 people every year don't get into medical school--20,000 do. In the next year, over half of those who do not get in will apply again, and the cycle continues). It's been proven that students only need a 20 on the MCAT (out of 45) and a GPA of 3.0 to do well in med school. There aren't many people applying who don't get above these scores. Let's reconsider how we educate our physicians, and maybe a few pieces of the puzzle will naturally fall into place.

Hopefully I've shown a bit of my stance on national health care in this post--I think it's important to consider all of these things in the establishment of a new system. I'll probably end up doing more about this in the future, especially as more ideas get tossed around in D.C. about the topic.

Jim

Political Nihilism

It's been nearly two weeks since I received a $184,178 piece of paper declaring that I have some negligible amount of expertise in the nebulously defined field of "Public Policy Studies." The most common question about this area--one I freely admit to not having a complete answer to--is straightforward: what the hell is public policy? The very close runner-up is probably "is that like political science?" I'm going to indulge myself by ruminating on these questions for a bit.

To understand what public policy is, it is necessary to tackle politics first. Let's consider two kinds of thinkers: Politicians and Utopians. The difference between the two is the difference between what is and what should be. The Politician has the unenviable task of facing the harsh realities of today. Politics is invariably ugly and unpleasant because it is the mirror society holds up to itself. The Politician is responsible for representing the views of his constituents--sometimes ugly, sometimes irresponsible--well enough to get re-elected. The Utopian is tasked with envisioning the Good Society and outlining its structure. Unconcerned with constraints, the Utopian is preoccupied by possibilities, meticulously constructing elegant solutions to intractable social problems. Rough caricatures that these labels may be, they do an adequate job of making the distinction clear.

Public policy, in an ideal world, is the bridge between the world of the Politician and the world of the Utopian. Not quite myopic enough to appease only the Politician and not quite bold enough to satisfy the Utopian, public policy is a tiptoe--perhaps a half-step in extraordinary times--toward a goal envisioned by the Utopians. Thus public policy is borne of a collaboration between the Politicians and the Utopians of the world. It is a program or course of action--or inaction--to which the government commits itself with some purpose in mind.

Of course, one likes to think that few pure Politicians or Utopians exist in the world. We prefer to believe that our elected officials serve with some purpose and some vision and that those academics, policy analysts or advocates, and long-shot candidates who help to shape our discourse are not completely divorced from reality. Übercynics and ivory tower buffoons would make strange bedfellows indeed. But only the shrewdest of operators can successfully navigate both worlds to produce good policy.

The question of what constitutes "good" policy is, of course, the great unresolved social question that occupies us every two years. "Good policy" is often--erroneously, I believe--assumed to lie in the purview of the Utopian; the Politician merely mucks up the implementation of the Utopian's pristine plans. "We know what works but the political system will never let us do it," a friend majoring in political science once complained to me. The fatal flaw in this logic, of course, is that it ignores the purpose of a representative democracy. The questions at the heart of public policy are philosophical: what is important to us? How should the world be? What is the role of government in society? And so on. The Utopian assumes certain answers to these questions and proceeds to prescribe antidotes to the problems he diagnoses in society.

Therein lies the paradox. As any public policy student can attest, identifying a problem is the first step toward developing a policy solution. But problem definition is an inherently political process: there are no "right" answers, only consensus answers. And we have elected not to leave the decision-making to a select group of Utopian oligarchs. Instead, we are all afforded a say in making the value judgments underpinning the public policy process: we get to elect representatives of our views. This is why the idealistic view of public policy-making as a strict matter of quasi-scientific problem-solving best left to the Utopians is untenable. This view forgets that the philosophical questions underlying every step of the policy process from problem definition to the formulation and implementation of solutions can be answered only by the body politic. We can be idealists or democrats but not both.

But once we accept--not grudgingly but enthusiastically--the key role the political process must play things become very murky. Complexities begin to pile on top of complexities. Elected officials are more than just representatives of districts; they are not simply vessels through which the will of a constituency is done. They lead and follow at the same time, they manipulate the masses as they are manipulated by the opinions and passions of their districts. Policy-making becomes more than just a contorted sort of problem-solving in which palatable solutions are developed to address problems identified by consensus. Solutions can be decoupled from problems; indeed, problems can be conjured to fit pre-existing solutions. The distinctions between "campaigning" and "governing" begin to blur and no longer can each be identified simply by noting whether it happens to be an even or an odd numbered year.

The noble vision of policy-making and governing fades into a less gratifying image: that of a game. A grave game with enormous consequences but a game nonetheless. The culprit, I suspect, is, in part, uncertainty. The dissolution of the Absolute--the Good Society toward which we strive--leaves us rudderless. We--the collective public--drift between political persuasions with the ebbs and flows of popular opinion often dictated by events seemingly beyond our control. Compare the political climate of 1920 with that of 1932 or the prevailing political winds of 1980 with those of 2008. "Right" answers are elusive. Some people grasp onto an ideology that contains the philosophical precepts that offer a guide to formulating public policy (i.e. contain an implicit picture of what the Good Society will look like), while others prefer a more pragmatic and less ideologically-anchored approach.

A participant in the policy process who becomes unmoored from ideological preferences and personal passions finds himself in a dire situation. The loss of faith leaves him with only the cold embrace of cynicism. He can be little more than a "hired gun," choosing a side and playing to win by any means necessary. Politics and policy-making become solely about the acquisition of power or a simple love of the game. The notion of identifying desirable social goals and using policy to launch us in the direction of the Utopian's dream becomes quaint and, if anything, simply a tool in the political manipulator's arsenal. This sense of purposelessly drifting through the political landscape is what I'll call political nihilism (a usage of the phrase that differs a bit from what Wiki tells me is usual). It isn't any more endemic to society than is religious agnosticism but I suspect--as with religious agnostics--there are many adherents among us. However, this might be getting a little simplistic and less coherent so I'll stop for now. More to come, I think.

Teej's college rant

My apologies for the (extremely) late post. I can't really comment about parties here at Case, just because my school is actually known for hardly having any parties at all. Those that we do have are hosted by the frats, which means they're either recruitment events or ridiculous wastes of time, mainly because a couple hundred people are all trying to maneuver in a small living room. So I don't think we have Teej's problem of apathetic students. Our problem is exactly opposite in nature--a lot of people don't socialize at all. I'd go as far to say that they worry too much about school. Even though our workload is insane, there's no reason/need to spend so much time staring at textbooks (unless you're a BME...you'll probably find a new major soon anyway). There's a reason why 90%, and most of the time 80 or 85% for the more advanced classes, is the minimum for an A. People who study all the time and get 100+% get the same grade in the end as someone who balances their life and gets a 92%. Moral of the story--get out of the fucking library once in a while.

A lot of people at Case are continuing to grad school to be a lawyer, doctor, or some other professional. They feel that spending all day/night studying is the only way they'll ever get into grad school, and they also think that hitting the books as much as possible in undergrad will somehow make things easier when grad school rolls around. I'd actually argue the opposite. Who wants a doctor so socially inept that they can't properly communicate with you before a crucial operation? What about a lawyer who has a hard time collaborating with clients and collegues? They might know every court case by memory, but would that make them the best lawyer in the world? Definitely not. I'd also argue that undergrad only has a few benefits for grad school. The subject matter isn't really one of them. Sure, you get the basics that you need for success, but it's just idiotic to study so much that you memorized the Krebs cycle, the names of all the compounds involved, the enzymes, and the three dimensional structures of the compounds. In med school that's called "an introduction to aerobic respiration." In undergrad, that's called overkill. We should be learning how to manage our time, learn basic material, and in my opinion learn about a large range of topics, not just a select few--especially if you're going on to higher education. Med students who spent every waking hour studying in undergrad have to not only relearn most of their textbook knowledge (I guarantee most of the stuff they've spent so much time trying to learn will evaporate before they see it again in med school), but they also have to figure out how to socialize with other docs and students. In many parts of the world, like India, they skip "undergrad" completely, going on to med school or whatever right out of high school. I'd also argue that Indian doctors are just as competent, if not more so (due to more time in clinical practice) than their American counterparts. Maybe I'm just anti-American.

In agreement with Teej, I guess I'd also like people to take a step back to consider what they're currently focusing on is really beneficial for them, and more importantly (in my view), going to help others in the future. Studying incessantly and knowing everything might turn you into a Ken Jennings, or it might also end up turning you into a horrible doctor, lawyer, teacher, etc.