ebrso
11mo ago
I lost my beloved younger brother a few years ago to drug addiction. He was 35. He struggled for years (and I mean really struggled) to stop using heroin, with some periods of success. When he was using drugs, he would lie and steal. But even during those times, he was always a very generous person when he could be. He was very sensitive (in some ways, I think this was actually a burden for him), and he made friends easily. He was funny and smart (which was perhaps another burden). He had very serious depression and anxiety his entire life. I'm sure my parents will never recover from the loss.
My point here is that many of the drug addicts you despise are actually struggling desperately. Most have had difficult lives. Some have loved ones that care deeply about them and want to see them get healthy. Others don't have anyone in the world who cares about them, either because they never had a family, or because their families died, or because they alienated them through their behaviors.
There are important conversations to be had about whether drug addiction is more of a choice or more of a disease. And there are conversations to be had about the balance between community interests and the interests of those with substance abuse disorders, and how community burdens should be fairly distributed. And there are conversations about which policies or actions actually help individuals with substance abuse disorders, versus which policies are counter-productive because they just enable or encourage these disorders.
But calling someone "dysfunctional scum" or "druggie" or "biowaste" isn't the way to start these conversations. That's the kind of language people use to dehumanize others. I think you should be ashamed of yourself.
ebrso
2yr ago
Imagine a student getting plastered and, noticing her RA's MAGA cap, calling the RA a "Nazi" two hundred times.
In your hypothetical, the student is characterizing being a Nazi as detestable. In the real-life event, the student is characterizing being Black as detestable.
I'm skeptical of widespread American anti-Black racism narratives, and I don't think this case supports them (except weakly at the margin). I think it's possible (although unlikely) that the White girl doesn't harbor meaningful animus towards Black people, and that she was just grasping clumsily for an epithet that carried a powerful valence. I also assume the White girl has some fairly serious emotional problems (as do many people, such as myself) which were exacerbated by alcohol use.
Nevertheless, the White girl's behavior was grotesque. I have no objections at all to expelling her from school.
ebrso
1yr ago
I was on one of these busses that was filled with migrants sometime around the beginning of the year. The bus was traveling from San Antonio to Dallas. It was a normal Greyhound bus, and I had purchased a ticket. When I got to the bus station, there was some kind of (possibly Christian) charity group distributing boxed lunches. Most passenger wore stickers on their chests listing their names and final destinations.
I talked a bit to the guy sitting next to me (I speak Spanish). I'll call him L. L was from Venezuela, but had been living the past few years in Ecuador. He had a wife and 2 kids remaining in South America. He'd crossed north through Central America and then Mexico through some combination of foot, car, and rail. Finally, he'd arrived at the US border a few days prior. He proceeded to cross-over around Laredo, TX, then surrendered himself to American immigration agents. L was detained for a few days in some kind of immigration facility, then discharged to the streets with an (online) court date for a year in the future. Someone told L he should proceed to some kind of homeless shelter, so that's what he did. He stayed there for a few days, and then someone came and offered him (and other migrants) a free, 1-way bus ticket to the American city of their choosing. L chose Indianapolis, because he had some relatives living there. Some days later, he was escorted into a shuttle with other migrants, transported by shuttle to the Laredo bus station, handed a stack of bus tickets (there's no direct route from Laredo to Indianapolis!), and encouraged to board the bus. His first stop was San Antonio. L told me he'd worked as an auto mechanic before, and that he hoped to find similar work in Indianapolis, but that he was willing to work at any kind of job.
A few points:
- L maintained that he had been treated well during his few days in detention. (I asked.)
- L was clearly an economic migrant. He wasn't fleeing violence, or religious persecution, or climate change, or anything like that. He saw America as an economic opportunity for himself and his family (correctly or not).
- L seemed intent on finding a job ASAP. He asked me whether I could help him find work.
- L seemed intent on learning English. He asked me some questions about how to say simple words in English.
- L expressed the hope of saving money, then sending for his wife and kids to join him. He maintained that he would fly them to America, because it would be too dangerous for them to travel across land as he had done.
- I have no idea who the agent was who distributed bus tickets, or on whose authority he was acting. Did he operate in a governmental capacity? As a private citizen? As part of an NGO? I don't know.
- There was some kind of charity group (it seemed) greeting the migrants in San Antonio. I don't know who they were or what their role was, or how they were organized.
- L maintained that he hadn't been coerced into leaving Texas.
- This was a normal, commercial bus. It wasn't chartered. I had purchased a ticket online. Most of the people on the bus seemed to be migrants.
- L had received a medical evaluation when he entered detention, but he didn't mention any medical exam having been administered prior to his boarding the bus.
- I have no idea how typical L's case is.
ebrso
1yr ago
A major discrimination settlement has been reached with NYC candidate teachers.
The NY Post is reporting that New York City has reached a $1.8B bias settlement with roughly 5200 Black and Hispanic teachers who failed a New York State teaching certification exam, which prevented them from serving as teachers in NYC public schools. At least 225 would-be teachers will receive payments exceeding $1M (not including ancillary benefits like lifetime pensions for jobs that were never performed).
I am not a lawyer, and I have no familiarity with this kind of litigation, but I was surprised at the settlement. It's possible that NYC got spooked by recent high-profile discrimination lawsuit outcomes (jury verdict against Equinox here, settlement with Fox News here), and it's possible the legal fees and likely result of a trial made settling prudent for NYC. But I wonder whether NYC politicians (or bureaucrats) failed to mount a vigorous legal defense out of ideological sympathy for the plaintiffs.
I also don't see how this kind of settlement - available only to failed candidates based on their race - can satisfy an Equal Protection standard. Won't failed white candidates have a discrimination claim?
Anyway, there's no shortage of culture war angles to this story. NYC famously pays $38,000 per public school student / year, with mediocre outcomes; once again the tax payer seems to get a raw deal. There are the perennial issues around disparate racial impact from ostensibly race-blind hiring practices. The NYT doesn't seem to have reported on this, which raises questions about media coverage. And so on.
I want to focus on a different question, though: to what extent (if at all) do such high-profile, lottery-style bonanzas undermine the case for honest, low-paid toil among the working class? I have a pet theory that the seeming arbitrariness of financial success in America (and perhaps other countries) is a major factor (not the only one!) among prime working age men exiting the labor market. Events like this feel deeply unfair - why work your whole life if you can get paid to not work? And nobody wants to participate in a system that's rigged against them.
ebrso
1yr ago
Is a peaceful resolution to the Israeli-Palestinian conflict conceivable in this decade?
Warning: I know very little about the details or history of the Israeli-Palestinian conflict.
In business negotiations, there's a concept of Zone of Possible Agreement (ZOPA), which boils down to the range of possible negotiation outcomes that both parties would consider preferable to the alternative (i.e., preferable to a failure to arrive at any negotiated agreement).
Take the sale of a used car, for example. The buyer is willing to purchase the vehicle for a price up to $3000 (this figure is private). The seller is willing to sell for a price that's at least $2750 (also private). In this scenario, a Zone of Possible Agreement exists between $2750 and $3000, where both the buyer's and the seller’s minimal terms can be met.1
The important point is that any negotiated agreement will be somewhere in the ZOPA. The buyer's goal in the negotiation is to achieve an agreement on the low end of the ZOPA, and the seller's goal is to achieve an agreement on the high end of the ZOPA. It doesn't mean they'll arrive at an agreement, but at least both parties prefer to reach an agreement in the ZOPA than to not reach any agreement at all.
But not all scenarios admit a non-empty ZOPA. For example, if the buyer were willing to pay no more than $2000, then there is no ZOPA. Negotiation would be pointless.
Obviously, this framework tremendously over-simplifies the present conflict. Still, I don't know of a better one.
So, is there any conceivable resolution to the Israeli-Palestinian conflict that both sides2 would prefer over continued conflict (hot or cold)?
My sense, unfortunately, is that the most painful concessions that can be extracted from either side would be insufficient for the other side.
And thus, war remains as "the continuation of political intercourse with the addition of other means."
[1] This example is the one provided at the link, modified slightly for clarity.
[2] One way in which this framing is an over-simplification is that it ignores that each side contains multiple relevant constituencies, each with its own preferences.
ebrso
1yr ago
Married men of The Motte, how do you “make peace with” life-long monogamy?
I’m a heterosexual male. During my 20s and early 30s, I had a non-trivial amount of novel sexual experience (probably averaging 2 or 3 new sex partners each year over this period, with exceptions for years in which I was in various committed relationships). Now, I’m old (40). I’ve had a girlfriend for a long time (5 years), and I’m considering marriage.
The thing is though, I’m freaked out by the idea of only having sex with one woman for the rest of my life. I get really uncomfortable watching Will Ferrell’s character in “Old School.”
I doubt my girlfriend would accept a non-monogamous relationship (I don’t even really want this myself), and I don't intend to be unfaithful (if only because the stress / feelings of guilt would eat me alive). I've always preferred vanilla sex; novelty's my only kink.
Should men like myself seek to "make peace with" life-long monogamy? If so, where do I start?
ebrso
1yr ago
hockey has long had a culture of policing things that aren't quite illegal, but considered excessive via player-based enforcement in fights.
Why are fights between athletes considered just part of the game, rather than serious crimes? I assume that if I were to take a swing at someone in my office, in front of a million spectators and filmed from fifty angles, I would (quite appropriately) face jail time. But this doesn't seem to hold for, e.g., baseball players.
ebrso
7mo ago
In 2010, the vibe (to me at least) was that self-driving cars had effectively been developed; by 2025, substantially all the cars on the roads of American cities would be fully autonomous (without requiring a human standing at-the-ready to take over in a crisis).
So what happened? Why, at least outside Silicon Valley, is my Uber cab still driven by a human? Do technical challenges remain in developing autonomous technologies? Is regulation / liability the major obstacle to adoption?
ebrso
9mo ago
Anyone have tips for combatting the green-eyed monster? I often find myself begrudging others’ successes and good fortune. My resentment applies to friends [1], but also extends to people whom I barely know in passing (or even public figures).
[1] Although am I really their friend if I react this way?
ebrso
1yr ago
When I think about "bad" doctors the ones I run into are generally lazy/burnt out types, or outright malicious/unethical types. Traditional incompetence is rare,
This is my impression as well, although I attribute it to gatekeeping effects (entry into American medical schools is traditionally so hard as to exclude truly incompetent candidates, and entry to practice in America from foreign training has similar gatekeeping).
By the way, I've always found it interesting that Scott, who seems like a brilliant and caring, almost ideal physician, attended medical school in Ireland - was that personal preference, or could he not get admitted in the U.S.? I remember him mentioning that he had a very difficult time achieving placement into a U.S. residency afterwards.
Traditional incompetence [among American physicians] is rare, because those people get kicked out of medical school or residency
I thought the stats showed that the overwhelming majority of individuals entering American medical schools are promoted to full privileges? Like, well over 95%. And presumably, a non-trivial part of those who don't get promoted aren't "kicked out" of medical school / residency for lack of competence, but rather leave due to other factors (medical problems, voluntary career change, etc.).
I'm sympathetic to the arguments that American medical school screening processes (appropriately) exclude candidates that lack the skills necessary to be successful as physicians. But alarm bells start ringing in my mind when I hear one set of people saying "admissions standards aren't necessary in the current system because we have such exacting training standards," while the other set of people is saying, "serious training standards aren't necessary in the current system, because we have such exacting admissions standards."
ebrso
1yr ago
What would you do with a free 2 months?
At 41, probably as some kind of mid-life crisis, I've decided to go back to graduate school. I start in June.
I have a bullshit email job, and I'll give notice soon (tomorrow, perhaps). That leaves me 2 months free. I have no partner and no kids.
So, what are some ideas for things I should do with this free time? Money is no object. I'm open to pretty much anything. The last time I had a few months free I wasted it sleeping to noon everyday and playing online chess compulsively.
ebrso
1yr ago
Some narrow questions about the current conflict.
I have some narrow questions about the conflict that I'm having trouble getting good answers to. None of these is intended as a "gotcha."
-
Why can't Palestinian civilians flee to Egypt across Gaza's southern border? What considerations or pressures (internal or external) prevent Egypt from granting entry now to Palestinian refugees?
-
What is the status of the Israeli hostages? Should we believe that they're still alive? Are they assumed to all be held in Gaza? Are they being detained together? Who coordinates their care? Do we have any knowledge of their treatment in detention?
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What is Hamas? Is it a political party? Is there separate civil and military leadership? Does it have a clear command chain? Are leaders identified publicly? Is it clear which particular leaders were likely involved in planning / authorizing Saturday's incursion into Israel? Do these leaders currently reside inside of Gaza? Are they in communication with one another, or are they isolated now? Do they continue coordinating activities, or are they relegated to being bystanders? Is there any line of communication open now between Israeli and Gazan political leadership? Leaving aside willingness, are there Gazan political leaders who would be capable of enforcing the Gazan side of a potential ceasefire?
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What are the strategic objectives of Israel's current bombardment / siege of Gaza? Is it aimed at weakening military capabilities in preparation for a ground invasion / occupation? Is it aimed at weakening military capabilities to limit Hamas's ability to launch another strike against Israel? Is it bloodlust / punishment / revenge? Is it a show of force to warn other regional actors (from the West Bank, Iran, or Lebanon) to stay away? Is it intended to "break the will" of Gazans, so that popular support will wane for military strikes on Israel? Is it aimed at disincentivizing future military strikes on Israel (by impressing upon prospective actors that the consequences of such strikes will be severe)?
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Is there significant continued Gazan military resistance to Israel's bombardment? Are missiles still being launched from Gazan territory? If so, are these coordinated actions, or are they actions taken at the initiative of small, independent groups of actors in Gaza?
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If Israel's total blockade of the Gaza strip persists, how will the civilian population be affected? Clearly, medically-vulnerable people will be severely impacted in the immediate term. But over what timeframe will the general population face life-threatening hardship (and not simple inconvenience)?
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Leaving aside ethical and moral obligations, is there a case that Israel has a proactive legal obligation to permit the influx of humanitarian supplies to Gaza along their shared border?
I assume that others here have their own narrow questions. If so, maybe they could go in this thread.
ebrso
1yr ago
Figuring out the cause of dropping out is hard because people lie for ego defense reasons which complicates matters, I do know people who have claimed some other kind of hardship but it was academics.
I mean, sure, if someone leaves an academic program, then on some level it's related to academics. But even in cases where someone's involuntarily separated from their program due to bad grades, those bad grades don't necessarily indicate a failure of earlier-stage preparation or a deficit of natural ability. Often, bad grades are downstream from emotional problems, or from a general ambivalence about the training. I speak from some personal experience here, albeit outside of medicine (I don't think this is simply "ego defense").
I don't want to get too distracted from my main point, which is that, based on data and personal observation, I'm skeptical that American physician training requires as much intellectual horse power (or even hard work) as American physicians maintain it does. I do think it requires a high level of conscientiousness, which is surely related, but also different.
ebrso
1yr ago
Medical exams are hard (and not like most exams you see), someone who was in the top 5% of their class at a respectable undergrad institution can spend two years studying for Step 1 and still barely pass it.
In 2021, before USMLE Step 1 moved to pass-fail, 98% of 1st-time takers from MD programs passed per here. By comparison, the first-time pass rate for the California bar exam (to practice law in the state) is roughly 45% per here.
ebrso
1yr ago
More research has shown pretty wide outcome disparity and things like a dramatic increase in costs from the NPs (due to unneeded referrals and excess testing, the later of which is often a direct harm to the patient).
Here's an example link: https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs?utm_campaign=Advocacy
It's worth noticing that this source is from the AMA, which is an American physicians' group that lobbies to protect American physicians' class interests, including preventing mid-level health care professionals (NPs, PAs, etc.) from encroaching on practice areas seen as reserved for physicans. The url itself identifies this article as part of an advocacy campaign. The article highlights:
The AMA is advocating for you [American physicians] The AMA has achieved recent wins in 5 critical areas for physicians.
That doesn't necessarily make anything it says wrong, of course. But I'd expect the article published by the corresponding NPs' association to emphasize different observations and to reach different conclusions.
ebrso
1yr ago
you have yet to acknowledge that American doctors don't make what you think they do. The average American doctor probably has a lower net worth than the average Australian doctor . . . Doctors have relatively low net worths into their 50s, here's a citation. https://www.bfadvisors.com/net-worth-by-age-for-doctors/
This is grossly misleading. The first line of the article is literally, "When it comes to wealth-generating occupations, physicians usually make the top of the list." The graph shows that 50% of doctors ages 45-49 have a net worth of at least $1M, and that average physician comp is $350k/year. I appreciate that American doctors choose partners at Goldman Sachs as their peer cohort for compensation comparisons, but this is not based in reality.
Decreasing doctor salaries also does nothing substantial to decrease U.S. health care costs.
Physician compensation is roughly 9% of U.S. health care costs per here. If you slashed physician comp 50% (so that physicians were "only" averaging $175K/year), U.S health care costs would be reduced by 4.5%, or about $250B across the U.S. per year (4.5% of $5T total annual health care spend). A few $250B here, a few $250B there . . . pretty soon we're talking about real money.
And your solution [of importing physicians from other countries in order to drive down physician costs] seems to me to be wildly immoral and you make no effort to defend it.
Again, Is that your true rejection? If so, would you be satisfied with importing international physicians if those physicians pledged to remit some of their American comp to their countries of origin? Because I'm sure they'd be happy to do so.
ebrso
1yr ago
I mean what I say quite literally, you can be a top of your class science student at a reasonably good institution, study for two years specifically for the test (including a multi-month "dedicated" period where your only job is to study for this test), spend thousands of dollars on incredibly well designed test prep material and that still might not be enough.
That might qualifier is doing an awful lot of work here. The same student might also get crushed by a falling piano on the way to the test center. The point of statistics is to evaluate likelihoods, not possibilities.
and while the [USMLE Step 1] fail rate is low, failing it fucks you over incredibly
This seems hysterical (marked by hysteria). The same data set showed that re-takers had an almost 70% chance of passing. Substantially anyone who manages to drag himself across the finish line will be able to make $200k/year as a GP in a high status profession (more if they're willing to live outside a major city, where the money will go further). I don't know in what universe this qualifies as being fucked over incredibly. Even the small minority of medical students who can't gain licensure to practice will still have fine life outcomes, by and large.
ebrso
1yr ago
NPs have 500 hours of training and doctors have 10k-20k. That gap is enormous and even if each hour of training is mostly worthless....it's a lot.
This seems to refer to clinical hours. Per wikipedia: During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training in addition to the clinical hours required to obtain their RN. Let's leave aside the RN component. If clinical hours are the focus, then a typical NP who's been practicing professionally for 10 years has more than a physician who's been practicing professionally for 5 years.
This conversation brings to mind Yud's Is That Your True Rejection. Doctors are better than NPs, they have more clinical experience. No? Well then doctors are better, they have better outcomes. No? Well then doctors are better, they cost the system less money. No? Well then, doctors are better, their training is more rigorous. No? Well then, doctors must be better for some other reason.
ebrso
1yr ago
I think if you'd framed it in these terms originally, then I wouldn't have objected.
I agree. Failing your medical licensing exam (as 2% of test takers do) limits your ability to earn $1M/year as an LA plastic surgeon.
ebrso
1yr ago
Pour liquid propane inside could help I think. It displaces all the oxygen . . . they will run out of oxygen.
I'm not an expert, but I assume this would reasonably qualify as a chemical weapon (an asphyxiating gas). Separate from the legal questions, I would consider it an escalation in the conflict.
Leftist inclined people want to create racial equality of outcomes, and they therefore boost whichever kinds of rationalizations they can come up with for the achievability and justification of such equality. Rightist inclined people want to preserve racial inequality of outcomes, and they therefore boost whichever kinds of rationalizations they can come up with for the unachievability of equality and justification of inequality. There's some honest people on either side who have been swept up in the drama, but in terms of the direction of the energy which drives the whole debate, this is what lies underneath it.
I think HBD conversations would improve if focus were to shift from cognitive factors to athletic factors. For example, are the extraordinary accomplishments of recent-African-heritage sprinters in international track & field competitions attributable to genetic factors that are relevant at the population level? If we can't make progress on this question, then how can we hope to make progress on (far harder) questions about cognitive factors?
ebrso
1yr ago
Great outcomes are gone yes, as are the good and okay.
Just to be clear, is your position that a life making $200k/year practicing internal medicine in a small town 50 miles outside Philadelphia is not an okay outcome? Why not?
ebrso
1yr ago
Every physician I know who doesn't have a financial stake in midlevels (and isn't in admin) tells their friends and family to only see doctors whenever possible. That's for a reason.
Every acupuncturist I know tells me to see an acupuncturist. It's funny how that works.
Physicians spend years being abused and called idiots in order to develop caution, intellectual humility.
I don't consider American doctors as a model for intellectual humility. Do you?
Yeah, I think in ice hockey especially, fights aren't seen as pathological, but rather as an important part of a self-policing culture. I can understand that. What I don't understand is why the local district attorney would take that stance (and not prosecute offenders).
Baseball doesn't have the same opportunities to deliberately inflict injury within the standard ruleset of the game, so the same sort of culture never developed.
Interestingly, and consistent with your theory, my sense is that the proximate cause for most professional baseball fights is a perception of inappropriately aggressive play on the part of the opponent: high-and-inside fastball, sliding into 2nd base with spikes up, and so on. It's also interesting to me that in both baseball and ice hockey, the culture broadly prohibits using weapons in fights. The first thing a hockey / baseball player will do at the start of his fight is throw down his stick / bat. Again, this is consistent with the theory that fights serve to self-police / enforce expectations for conduct.
American midterm election predictions?
Does anyone wish to use this space to register predictions for outcomes in tomorrow's American midterm elections?
Personally, I take a kind of efficient markets approach to this stuff, so I'll defer to the betting consensus. But if you want your time-stamped judgment registered as part of the official Motte record, here's your chance!
Mods - please feel free to remove if you don't think this is a good fit for the space.
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