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
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.
Does anyone have thoughts about the potential link between childhood fluoride exposure and lower IQ? Alternatively, links to reasonable discussion?
In particular, I'm narrowly interested in what the science says about (1) whether fluoride exposure at levels to which Americans were occasionally exposed causes IQ decreases and (2) if so, what kinds of threshold effects might exist.
For what it's worth, I (along with many of my friends) took daily 1 mg fluoride tablets (supplements) as a kid on the recommendation of our pediatrician, and I have mild dental fluorosis to show for it (although I've never had a cavity in my life). The idea that this may also have cost me a few IQ points is distressing.
https://www.nytimes.com/2025/01/08/health/fluoride-children-iq.html
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
9mo ago
In my experience (both second-hand and personal), getting pushed-out of a job you don't like is often a very positive thing - essentially a "blessing in disguise."
ebrso
11mo ago
Kamala is not going to win. She's going to say things like "space is neat" and "who doesn't love a big yellow schoolbus" on the debate stage.
These pithy, assured pronouncements are tedious and call to mind the expression often wrong, but never in doubt. The betting market consensus now is that Harris has a nearly 40% chance of winning in November; it's moronic to declare that "Kamala is not going to win."
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
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
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."
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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?
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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
but not really—the robots won’t play trivia and if they do, the questions will be a lot harder
Two robots can play chess with each other right now, but humans still do it because it's fun and challenging for us. I walk in the park even though jets can outpace me.
I think the implication - possibly tongue-in-cheek - was that robots will replace humans within 200 years.
ebrso
10mo ago
One idea I've seen is having a multiplicity of status hierarchies . . . In practice, we could have that now, but we don't.
My instinct is that we absolutely have a multiplicity of status hierarchies operating today in a largely independent fashion. For example, there are plenty of American sub-groups in which status and money don't seem closely aligned. If you're a full professor of history at a large state university, then your status among colleagues will derive primarily from your research output and its reception. If you're a Hasidic Jew in Brooklyn, then your status in the synagogue will derive from your knowledge of Torah. If you're a Texas adolescent boy, then your status at school will derive from how many touchdowns you throw. These qualities are not closely related to earnings (if they're even related at all).
ebrso
11mo ago
ebrso
1yr ago
The problem is about to get much worse [due to preferential treatment of URMs].
Separately, I'm concerned about the effectiveness of medical (and pre-medical) training performed remotely during the pandemic. I also think the integrity of admissions / promotion standards are potentially compromised by pandemic-era shifts, particularly rampant cheating and grade inflation.
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
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
Hamas is backed, formally or tacitly, by a host of Middle Eastern nations, at least one of which (Iran) is a nuclear power.
I don't think Iran is known to be a nuclear power, at least as I understand the phrase (possessing nuclear weaponry).
ebrso
1yr ago
I personally haven't carried a phone (smart or otherwise) since sometime in July, when I dropped and broke my iPhone. Before that, I hadn't been without a smart phone since around 2012. I don't have a land line. If I need to make a call, I use Google voice on my laptop.
Mostly, I've been phoneless as an experiment. Overall, the experience has probably been net negative, and I'll likely get a phone soon.
On the plus side, I can focus somewhat better (on reading, or work, or watching a movie at home, or whatever) without the phone constantly interrupting me or threatening to interrupt me (or just being an attractive distraction). I also take satisfaction in the idea that I've opted out of a part of modern consumer culture. I think I'm reading books now when previously I would have been scrolling on my phone (this is an improved use of my time, in my opinion).
On the negative side, there've been a few times where I could've used a phone (e.g., I got locked out of my office, and had to just go home for the afternoon). I know it's an annoyance (and concern) to my family that they can't reach me at any moment. There are various sites (for banking and such) that use the ability to receive texts as a 2nd authentication factor. If I had a social life, I assume not having a phone would be a major impediment. I feel like I'm losing touch with friends whom I used to call and text. I can't call Uber. If I get lost, I don't have access to maps.
I will say that the first week without a phone felt very unnatural (ironically), but after that, I guess I got used to it.
ebrso
1yr ago
Yes undergraduate it's fundamentally more or less the same classes, with the caveat that you have to get pretty much only get As (average GPA is somewhere in the 3.7 to 3.8 range)
The average GPA at a school like Brown is about 3.8. This is hardly exclusive tier. It reminds me of Mr. Evil (one milllllion dollars).
you have a ton of demands on your time outside of class work (shadowing, volunteering, MCAT prep).
Many students have, like, actual jobs outside of classes. And grad schools have grad school admissions test (LSAT, GRE, MBA, etc.) - test prep is hardly unique to medicine.
You know any other jobs where you'll be sewing up a corpse on hour 36 of being at work and awake while your attending shouts at you "hurry up you useless fuckhead he's dead already anyway, we've got to move on" until you finish?
Bullies exist in all professions. If someone said that to me in a professional environment, I'd look him in the eye and calmly explain why it was inappropriate, and why he couldn't treat me that way going forward. And then he wouldn't treat me that way going forward.
ebrso
1yr ago
If you sacrificed your college experience and didn't have any fun of any kind in your 20s and took on a half a million dollars in debt in order to become a surgeon then yes, obviously.
I guess I just don't understand this mentality. I don't see why you can't have fun in your 20s and also become a doctor. You seem to maintain that American medical training is uniquely hard and awful, and I'm just not convinced. I appreciate that many pre-meds think their training is hard, but I took orgo and biochem in college, and I can tell you, it wasn't any harder than the classes for my math major.
I also think there's some distortion in the choice of comparison group. If anything, it sounds like a lot more fun to spend your 20s in medical school and residency than to spend this period in a cubical farm. Sure, it's probably more fun to spend your 20s relaxing on a beach somewhere in Mexico than either of these options, but this plan faces its own challenges.
Separately, this $500k debt figure seems like misdirection. It seems manageable for a normal doctor. More manageable, certainly, than a $100k debt figure for an MFA.
Many medical trainees will refuse to practice in that environment and will drop out or just choose to make less money practicing in a bigger city with a worse patient population or job.
I'm extremely skeptical that medical trainees leave the profession at rates higher than any other profession. And this complaint that doctors are forced to make financial tradeoffs in choosing where to practice seems bizarrely out-of-touch to me - who among us doesn't face financial considerations in choosing where to live?
ebrso
1yr ago
From the article
One professor said that a student in the operating room could not identify a major artery when asked, then berated the professor for putting her on the spot.
She knows literally less than a decent butcher.
The qualifier major is carrying a lot of weight here. There are thousands of named arteries in the human body, ranging from the aorta (which every medical student in clinical rotations really should be able to recognize, at least when it's exposed to plain view) to tiny branches that exhibit tremendous variation across individuals, and which even the absolute best students (and expert physicians) won't be able to reliably identify in cadaveric dissection (never mind in the operating theater). Viewing angle, anatomical posture, and similar (physical) factors can also make it much easier or harder to identify individual vessels.
So, even if we take this anonymous source's claim at face value (i.e., we assume that some incident occurred in which a medical trainee failed to identify a "major" artery on request, and then reacted badly), how should we understand the term "major," and why do we assume that there was a clear presentation? (And of course, one case, however egregious, doesn't establish a trend.)
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
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
Re-reading what you wrote, I agree - I quoted your remark about humility in an abbreviated form that misrepresented the point you were making. I apologize for that. It genuinely wasn't intentional.
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?
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:
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