When it happens in a cartoon, it’s funny, isn’t it?  Is it so amusing when 536 people (for those who dozed off during high skool civics, that’s 100 senators, 435 representatives, and one president) keep promising that if you’ll just let them a smidgen deeper into your pocket now, why, next year they’ll get squared away?  Really.  We promise.  And we are expected to believe them.

And we do.  Time, after time, after time.

And ought your doctor serve it out to you, whether or not you can “handle it”?  For that matter, is it for your doctor to decide whether you can handle it?

One of the most basic human cravings is for certainty.  We spend enormous amounts of time, energy, and wealth on efforts which all come down to knowing the future or controlling it, which is just the second verse of the same song.  Illness, serious illness for which there exists no known cure beyond cutting out part of one’s body and hoping the doctor cut high enough (to borrow Jennie Churchill’s injunction to her own doctor, although that was gangrene), is about as diametrically opposite to certainty as you can get.  Even if you’ve just been plucked off the street by Stalin’s NKVD, there’s actually a human will on the other side of your dilemma, and you can know something about that will and how it’s likely to deal with you.  Cancer has no mind, no will, and very little predictability.

So how long do I have, doc?  What are my chances?

Is it ethically more defensible to give someone a hope to cling to, when in one’s mind and heart one knows that hope is nearly certain to be blasted?  Is it more proper to speak in terms of “percent” chances, when those percent chances are derived from sample sizes in the tens of thousands, and you have exactly one patient in the consulting room?  I mean, this patient either will or will not live more than six months.  As a statistical proposition, I do not have a “60% chance” of dying within six months.  Of all people diagnosed with my same cancer at approximately the same stage as mine, 40% may live longer than six months, but that really tells me nothing.  Where am I in that sample?

I’m not a doctor and I’ve never sat in on a conversation like the ones described in the article.  But it strikes me that the doctor and the patient are talking about two completely different things.  The doctor says, “Six months,” by which he means something along the lines of “half of the people diagnosed in your condition will be dead no later than six months post-diagnosis”; in other words, he’s talking about the median survival period.  The patient hears, “You will die roughly six months from today.”  One is statistically correct but irrelevant to the specific patient and to what the specific patient wishes to know.  The other is almost assuredly incorrect.

Serious illness, especially when not of a kind correlated to the patient’s own behavior (e.g. lung cancer for the life-long heavy smoker, or cirrhosis for the incorrigible drunkard), has to be perceived as, among other things, a monstrous injustice.  This is not supposed to happen to me.  I was good.  I did all the “right” things.  I ate my damned broccoli, after all.  I went to the gym; I ate whole wheat bread; I bought “organic” fruit; I skipped dessert.

How is it helpful to someone in that condition, who’s just been handed what’s tantamount to a death sentence for something neither he nor anyone else did, to add to his burden of injustice?  Three months out and I’m dying.  The doctor said I had six months.  This is not supposed to be happening to me!!  I’m not asking to get well; I’ve come to understand that.  But I just want those three months.  Why can’t I have my last three months?  At this point to sit the patient down and explain that well, them’s just the breaks, doesn’t seem to be doing much kindness.  They were always the breaks; all you as the doctor have now done is defer the point at which the patient confronts that fact until a time at which the patient may not have the energy, the psychical strength, or even the simple time to come to terms with it.

I will answer at least one question which Dalrymple poses, and that to the effect that the patient must in the end own his disease and its treatment.  The duty to think clearly about oneself and one’s life is universal and without caveat.  “Tell me what I want to hear,” is an unacceptable position to present to any advisor.  If I had a nickel for every time a client kept asking versions of, “But if I ‘incorporate’ I can’t be sued, right?” I wouldn’t have to keep lawyering much longer.  Same for people who want me to tell them all they’ve got to do is “go to the courthouse and file some papers” and the walls of their personal Jericho will come crashing down.  Or when I explain that, assuming the facts as they’ve told them to me are correct, the outcome of any particular legal dispute ought to be X, but that they should not assume their particular dispute will have outcome X.  But that’s the law!!  That’s right, and you need to understand how frequently a legal dispute’s outcome is only moderately predictable with reference to demonstrable facts and known rules of law.  The client must confess, as it were, to his own degree of risk (in)tolerance, both in an absolute sense (how likely is an incorrect versus a correct outcome?) and relatively to that outcome (can the client bear the financial burden of achieving even a correct outcome?).  Clients who will not confront that question honestly, or who give you some version of, “We’re just counting on you to protect our interests,” (which is to say, we’re looking for someone to sue if we don’t like how this turns out) are to be gently shown to the door.  They will absorb, burn up, all the energy you would otherwise devote to those clients who are willing to engage with the uncertainties of their existence.  And that is deeply unfair to those clients.

Which is to say that I come out on the side of telling the patient everything that I can know about his specific situation, and to be extremely careful about how I present statistical statements.  You as the doctor do have a duty to treat a patient consistently with that patient’s stated desires (up to a point).  You cannot, however, grant absolution from death, or numbers.  To present oneself as an oracle when one knows one is not and cannot be such is to deceive the patient about one’s role.  Shade the facts, “spin” the truth?  How can that help?  That is not to say, however, that you must present all information to every patient in the same way.  With a little bit of luck you can pick up sufficient clues about how this particular patient perceives things that you can sense to what extent he is given to hearing what he wants to hear, or to have his worst fears confirmed, no matter what you say.  If you’re lucky.  But even if you haven’t been permitted sufficient time with this particular patient to have any idea of how he’s likely to respond to any particular factual statement, at some point he’s a grown-up and is morally chargeable with the ability to listen carefully and to think clearly.  This is not a duty you as the doctor ought to assume, even if you could.  Your burden is enough, just figuring out what’s wrong and what’s the most likely to make it better, without presuming to think for your patient.

Yours are the healing arts, after all.  Deceit does not heal.

I haven’t watched the linked video, but when I navigate to the Facebook homepage, there’s a video link at the login.  The text says, “Things that connect us.  We honor the everyday things that bring us together . . . .”  And so forth.

The opening shot of the video link is an empty chair, suspended in mid-air.

. . . and arms that could probably twist my neck off in about the time it takes . . . well, to drag, disassemble, shift across about 30 feet of air, re-assemble, and fire three times a field gun (complete with limber) the barrel assembly of which weighs just shy of 900 pounds.

This is cool.  This is way too cool.  The Brits may have starved their navy of money and veneration, but in a country where there’s no place more than roughly 90 miles from the ocean in any direction, there will always be a Royal Navy, and ‘Er Majesty’s tars will always be among the toughest bastards on the water. 

I still remember seeing a Royal Navy frigate operate with our U.S. battle group in 1988.  An American destroyer captain, if he wants his career to flourish at all, will try — with very, very good reason, let it be said — never to get within five miles of an aircraft carrier.  Let’s be honest, exactly how much sea sense can you expect when you put a pilot in command of 100,000+ tons of floating steel?  Lemme tell you, though, that RN frigate plastered herself alongside Forrestal, it looked like less than 1,000 yards distance, and she just hung there.  I ought to add that Forrestal, on that cruise, IO/MED/LANT 2-88, was about the very worst-driven ship it was ever my misfortune to attempt to work with.  I got a very profound respect for the Royal Navy watching that little frigate drive.

Is this a practical exercise in seamanship?  Of course not.  Is Great Britain safer by one jot because there are honking great sailors who can man-handle wood, steel, and lines like this?  Nope.  But as long as she can produce sailors who do stuff like this, for fun, there will always be a hard kernel on which she might yet again build a navy that will, if not rule the waves alone any more, in all events maintain her rightful place in the world and command respect for the White Ensign wherever it flies.  Long may it.

. . . to sell its daughters into marriage when they’re anywhere from 11 to 15 years old.  One of the girls in this picture series was married off to a man in his mid-20s.  She was eleven at the time of marriage and was delivered to her husband shortly after her 12th birthday, when she still had not had her first period.  She attempted not to consummate the marriage . . . until the village women (way to stick together, sisters!) got after her, whereupon she gave in.  I can understand, just barely, selling a daughter into marriage when the choice is she gets married off to someone who may be able to feed her or she starves at home with you.  Just barely. 

But according to this report “even in good times” a full third of all girls in Niger are married off by the time they’re 15.  According to the lead-in, world-wide among women now between 20 and 24 years old, a full one-third were married off while still children.

The next time one is tempted to condemn the patriarchal, phallo-centric power structure of entrenched dominance &c. &c. &c. &c., in the fashion of those tiresome all-sex-is-rape gas-bags, remind them that pretty much not any of that one-third of the forced marriages of children occurred in a Western country.  And the next time one hears someone gush about “it takes a village,” remember the child in this picture series (she’s no. 5), whose daddy back in the ol’ village has three wives and 23 children, which, you know, just may have something to do with his difficulties feeding them all.  Just sayin’.

But most of all, remember, ladies:  It’s Mitt Romney and all them awful Rethuglicans who are after your lady parts.

. . . and immigration policy, please do keep in mind that people like Alla Axelrod are also among the people in whose face you spit when you argue that any attempt to keep out swarms of illegals is somehow deeply unfair, nay, racist.

This is the view from someone who lived and grew up in the socialist, re-distributionist utopia that Dear Leader really thinks the U.S. ought to be more like.  These are vignettes from the “single-payer” healthcare system that he and his allies tout.  This is what the ways of the U.S. looked like to someone so fresh off the boat that she spoke almost no English (and having tried to function — even a little — in a society of whose language I spoke almost zero, her coming here, to live and work in NYC, fills me with immeasurable awe).

And these are the thoughts and discussions that are current among those who played the game, honestly, correctly.  Who paid their dues, digging fans for an un-airconditioned NYC apartment from the garbage, digging up a mattress from the same source.  Who walked 16 blocks to the subway through early 1980s NYC dirt and crime.

To pretend that there can be no two good-faith sides to the discussion about immigration policy, about government hand-out policy, about tax policy, about socialized medicine, is neither more nor less than dishonest.  This woman’s intellectual legacy isn’t of patriarchal, dominant-culture, slave-holding exploitation over sundry oppressed minorities on whose necks she and her ancestors stood to enjoy the Good Life.  Her legacy is just about the diametric opposite of that.  Her resentment of shucking out her taxes to fund drug habits and sturdy beggars is not that of someone who’s finally being asked to “pay her fair share” to those whose misery is the foundation of her prosperity.

Disagree with her if you want.  But you cannot dismiss her out of hand.

Gee whiz, I’m so glad that Dear Leader tried to normalize relations with Iran.  Is he still trying?  It’s hard to say one way or the other.  The recent claim that he’d sent word through the Swiss that he “recognized” Iran’s “nuclear rights” sure doesn’t sound too much as though he’d got his little fingers burnt enough to remember it.

I’m pleased, you see, I’d hate to think that we didn’t have a mutually helpful relation with a regime one of whose first acts on taking power was to arrest thousands upon thousands of its citizens, as young as 16 or 17, torture them, and then during the course of the first wave of arrests (cf. Solzhenitsyn’s descriptions of the “waves” that washed through GULag during the course of the years) in power slaughter between 3-5,000 of them.

This is a survivor’s story, as told in an interview in the Frankfurter Allgemeine Zeitung.  She was 17 years old in 1979.  She’d been on the streets, protesting against the Shah.  Her father, an academic, didn’t like the Shah but didn’t trust the mullahs, either.  “They preach democracy,” he said; but wait until they get power, “then they’ll show you.”  “You children will see it.”  Shoulda listened to daddy, little girl.  She was living in a commune with other students when she was arrested one day on her return.  The thing they demanded of her was where were the others.  She was taken, blind-folded, to prison.

While in prison, they were herded into cells, up to 70 women, some with children, in 20 square meters.  There was no room to lie flat (try sitting on the floor with your legs scrunched up; now try sleeping like that.  Now try sleeping like that for weeks, months on end.  At night time they counted the shots in the execution yard.

This witness was placed in a cell roughly six square meters with five other women, the oldest of whom was 20 or so, the others still schoolgirls.  Three were already badly wounded from their torture.  The Islamic method is to sling them upside down and beat them on the soles of the feet; so was it with these girls.  Some of them had been beaten so severely that the skin was gone from the soles; a doctor in the prison figured out how to remove skin from other locations on their bodies and sew it on to the feet.  This witness describes such victims, years later, with oddly-shaped scars on their bodies, in the placed whence the skin was taken.

Islam — that religion of peace — forbids the execution of a virgin.  What do you do with a prison full of 17 and 18 year-old girls?  Right:  You “marry” them to their guards, who then rape them; the next day you shoot them, and the grieving “widower” is then free to “re-marry.”  They’d send the bodies to the families, together with the “decencies” due to a deceased married woman.  It’s how the families knew what had happened to their daughters.

During this time the Europeans (O! those sophisticated Europeans, not at all like our stoopid cowboy presidents at the time, were they?) came to Iran to celebrate the mullahs in much the same fashion they’d been to Lenin’s and then Stalin’s Soviet Union.  Like Walter Duranty (have we mentioned that the New York Times still refuses to disclaim the Pulitzer he won for being Stalin’s willing mouthpiece?), they were shown the Potemkin portions of the prisons, the show-piece prisoners.  They reported how wonderful it all was.

And at night they still counted the shots.

At least the Europeans of 1979 could claim some sort of innocence about the nature of the regime the mullahs set up.  Just barely could they claim it; the ink on Solzhenitsyn’s magnum opus was scarcely dry.

What’s Dear Leader’s excuse for sucking up to these murderous would-be genocidaires?

Here’s the world’s oldest warship afloat, underway on her own:

I grew up using the 1928 edition of the Book of Common Prayer, and it still had a prayer for the Navy in it (they’ve since just lumped it all in to a prayer for the armed services):

“Eternal Lord God, who alone spreadest out the heavens, and rulest the raging of the sea; Vouchsafe to take into thy almighty and most gracious protection our country’s Navy, and all who serve therein. Preserve them from the dangers of the sea, and from the violence of the enemy; that they may be a safeguard unto the United States of America, and a security for such as pass on the seas upon their lawful occasions; that the inhabitants of our land may in peace and quietness serve thee our God, to the glory of thy Name; through Jesus Christ our Lord. Amen.”

Than which more need not be said.

See how your governor stacks up against his peers, courtesy of the Cato Institute.

As they say at Instapundit, read the whole thing.

Because taxes are for the little people, right?

The Frankfurter Allgemeine Zeitung reports today (unfortunately they took their English-language site down several years ago, so the link is to their regular site) that the Greek tax enforcers have come into the possession of a USB thumb drive which was provided by the French to the Greeks some two years ago, but which went . . . errmmmm . . . missing in action without being examined.  It has now re-surfaced, and among other interesting tea and scandal on it are the names of roughly 2,000 Greek citizens who have Swiss bank accounts.  The same article reports that some 60 Greek politicians, including three (alas! unnamed) senior government officials are being actively investigated for money laundering, graft, and tax evasion.  To this the FAZ adds mention of some 15,000 Greek citizens who can’t seem to explain their foreign holdings.  The tax folks are examining as well some 22 billion Euros in money transfers out of Greece.

But wait!  This can’t be right!!  I thought living in a socialist country was supposed to generate selflessness, a desire to “pay one’s fair share,” to do what our dear vice president has described as one’s patriotic duty.  Why, I thought that socialism was the sovereign remedy for human nature.  I’ve been told by so many Deep Thinkers that all we had to do was to “rob[] selective Peter to pay for collective Paul,” as Kipling phrased it, and all human avarice, selfishness, and dishonesty would burn off like a morning mist.  “Potential plenty” would be achieved, the millenium would come, the lion would lie down with the lamb and both would get up no worse off for the experience, and we Little People would find spread before us only bright, dew-bespattered, gleaming pastures (cleared, fertilized, fenced, tended, and paid for by Someone Else, of course) for all to graze on to our hearts’ content.

OK, children, let’s review one more time, dammit:

“As it will be in the future, it was at the birth of Man
There are only four things certain since Social Progress began.
That the Dog returns to his Vomit and the Sow returns to her Mire,
And the burnt Fool’s bandaged finger goes wabbling back to the Fire;

And that after this is accomplished, and the brave new world begins
When all men are paid for existing and no man must pay for his sins,
As surely as Water will wet us, as surely as Fire will burn,
The Gods of the Copybook Headings with terror and slaughter return!”

I’d meant to ignore politics this morning, but I’ll just observe that one of our candidates would agree with the above, and the other never will.  Which do we trust to boss the joint?

Update (08 Oct 12):  According to a report in today’s FAZ, the main newspaper in Athens quotes from data assembled by the Greek tax enforcement folks.  Seems that socialism hasn’t quite accomplished its goal of re-forging citizens into kinder, more giving, more willing-to-share-the-burden philanthropists.  A farmer who reported €497 per annum somehow managed from that modest — nay, impoverished — income to transfer €12,587,184 abroad.  A gardener who ‘fessed up to €2,275 annual income still found a money stump with €610,000 for him to ship out of the country.  In both cases the transferors somehow omitted to share the fact of the transfer with the (ahem) responsible authorities.