This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
Apologetics for America
I'm a big fan of the United States. It's a big country. It's a safe country. The people are wealthy, kind, industrious, and have done more than their fair share of upholding the Pax Americana under which the majority of the world prospers, including those who would tear it down.
I would go so far as to say that I'd be significantly happier if I had been so lucky as to have been born in a counterfactual universe where my parents had emigrated there, even keeping all my myriad flaws like ADHD and depression.
It's a country that holds multitudes, and has had such a good track record of making good on its promise of embodying:
And then achieving the minor miracle of making the vast majority of them upstanding proud Americans regardless of caste and creed.
(To such an extent that it has lost the memetic immune system needed to assimilate some of the people who meet that criteria but are resilient to anything but force)
It is gorgeous. Even after the visiting the UK, a nation that even in its sclerosed and ailing state is significantly better than India, I found myself grossly disappointed at how small and dull the place was, compared to what I've seen of the States.
I count myself lucky to still have the memories of when I visited as a toddler, some of my earliest, a period I enjoyed so much that I came back home speaking English with an American accent when I hadn't even been conversant in the language when I left.
I stare at the reels and pictures posted on Insta by my friends studying there with ill-concealed envy. It looks so huge, so clean, so vibrant, so picturesque and unspoiled. Still a land where someone with innate talent, having landed with but a penny to his name, can ennoble himself through hard work, or at the very least his descendants.
If it were not for the fact that I'm currently ineligible to give the USMLE today, for no fault of my own, I'd bid adieu to my current aspirations for practising and settling in the UK. The latter is still better than India, but do you really need me to tell you how low a bar that is to beat?
I'm about as pro-American as it gets without driving a pickup truck with the stars-and-stripes hanging off it!
The people eat great food. They live in huge houses that appear outright intimidating to the rest of us. They can afford to waste gigaliters of water on a modestly appealing perennial grass and mostly not begrudge the expense.
They can travel visa free to most of the world, and act the fool there (can, not necessarily do, the worst I can say about most American tourists I've met is that they were rather underinformed about where they'd ended up), content in the knowledge that none but utter pariah states would dare raise a hand at them out of fear of Uncle Sam.
They earn salaries that make us all look like paupers. The median wage for a doctor in the US is $250k, fresh out of residency, whereas a senior consultant in the UK might be content to make half that. Indian doctors can only weep, especially lowly ones like me. Even my father, so talented in his surgical field that he'd be nationally famous if he was more fluent in English (instead just being regionally famous), makes only $50k PA at the very peak of his career, after a life of suffering and hustling so his sons would have to suffer and hustle just a bit less.
Even that seemingly colossal sum of money does not achieve the QOL a naive purchasing power calculation would suggest. Even billionaires here must be content to have their money only buy quick trips with their windows rolled up from only upper class enclave to the next.
The world, somewhat more multipolar than it once was, still wobbles unsteadily if you try and make it rotate around an axis not centered on America.
I'd give a lot to be there. I really would.
That is why it so severely vexes me that my girlfriend, a smart, intelligent and hard working woman who makes for an enviable partner to have at my side, holds a view of it so jaundiced you don't know whether to cry or laugh.
Like many Americans, she has had her perception of the States clouded by sheer propaganda that is more interested in cherrypicking out all of America's real problems, and when even all the real ones no longer suffice, concoct ones out of half-truths and whole-cloth to terrorize a broken primate brain that only notices the bad and becomes inured to the good, such that it no longer bears a resemblance to how fucking good they have it.
She stares at me like I'm mad when I tell her I've always wanted to live there, and the few warts on the face of the nation can't hide its timeless beauty.
She believes that abortion has been banned. When I protest otherwise and say that it's only a few states putting restrictions on it, and even then, just a few, she shakes in existential terror at the idea that there's a seething crowd coming for the rights of women, eager to snatch them all away. She thinks racism is a serious concern for hardworking and talented immigrants who speak fluent English, whereas you could put me in a room with a Confederate flag and I'd find a way to end up drinking beers and shooting AR-15s before dawn.
Did I mention she's terrified of gun violence, even if she could live a dozen lives in parallel and not get shot?
She categorically refuses to follow me if I wistfully make plans to find some route to make it there, be it fighting tooth and nail with my med school and the ECFMG to give me the right to at least try my luck, so that I can show them I meet even their high standards.
I'm at the point that I am seriously debating abandoning clinical medicine as a career, to upskill myself in medical ML, so that I have an easier route to the States that isn't gated behind a professional licensing exam I'm not allowed to give. I am still young. I am allowed to dream.
She's rather be middle class in the UK, unable to afford air-conditioning, living in a tiny house, watching our salaries erode into nothingness, and then, if Sunak successfully makes doctors into a thin wrapper for GPT-5, potentially resign ourselves to a life of mediocrity, or worse, come back to India with our tails between our legs where we'd have to settle for working shit jobs with longer hours and worse pay.
She's scared of paying the medical bills, when the kind of comprehensive coverage that two professionals making 500k together buys care beyond the dreams of the NHS. Perhaps not value for money, but value.
I criticize America all the time, but only because I love it. I want to gorge myself on cheeseburgers with ridiculous portion sizes, because even if I die fat, I die happy.
I cherish what the Founding Fathers built, a shining city built on a hill of negentropy and abundance, rising out of a swamp wherein dwell the majority of us, only a generation or two removed from near-Malthusian conditions. I would die to keep the barbarians away from the gates, if only because I want to cross them myself, as an esteemed guest if nothing else, hopefully to be one of their own.
I set out to write a post somewhat glorifying (fairly) America, and to invite others to submit arguments that would let my girlfriend see reason. It would seem I've inadvertently done all the heavy lifting, if not for the fact that I've marshaled all these arguments before her and still found them wanting.
I don't want to jump to the conclusion that the two of us are moral mutants who can never reconcile our preferences. I prefer to think that she's wrong about her fears, or weighs the wrong facts too heavily and the right ones not at all.
Help me convince her. I will find it hard to live with myself if I fail.
Oh, and Happy Fourth of July to you all, ye sons and daughters living several decades in the future, hailing from the nation from whose physical and mental toil most of the good things in the world come.
Wait, is it a bit late for that? Um, I blame timezones, pernicious and insidious things that they are.
Don't think I don't see the cracks in the pristine facade, the erosion of the meritocracy that made your country glorious. I simply think that if America wakes up and patches a few holes, it can earn the right to slumber again in peace for centuries hence.
America is better for the middle class (and for doctors), but I’d rather be rich in London than be rich anywhere else in the world (and so, seemingly, would quite a lot of people). Your view of the states isn’t wrong, but it’s not really right either. Even on your theoretical $500k joint income, you might find you’d be less wealthy than you imagine, I’ll put it that way.
And Brits aren’t “too poor” to afford air conditioning, it just hasn’t been hot enough for more than 10-15 years in the summer to warrant it. A/C is cheap to install in the brick terraces in which most average Brits live; average citizens of many much poorer southern European countries have it. It’s just not a huge thing here yet. If you live in a very expensive $10m listed townhouse in central London it’s harder to install (although still completely possible, many people I know have it), but you wouldn’t live in one of those for a while.
America is a great place, and average people have more material wealth in the US than pretty much anywhere else in the world, but they don’t seem (in my experience) much happier or more satisfied than their British or European peers. You have bought into the dream that the reality might or might not live up to. I will stay in ‘declining’ Britain for as long as the next Labour government don’t go full retard (I have low expectations, don’t worry). We shall see how long that takes, if it happens.
What’s your specialty? You can make a few hundred thousand a year as a consultant in London, provided you’re in something in-demand for private work. I wouldn’t expect a life of poverty as a British doctor.
I'm perplexed as to why you'd consider that a small amount of time to be baking in >30° C temperatures. You'd hope they'd learn by now.
Even the poorest Indians have ceiling fans, if they have a house for it, and I haven't seen this amenity at all in the UK in the dozen or so odd houses I visited.
I've regularly heard horror stories from my UK peers about how hot and suffocating NHS hospitals get in the summer, with many of them still not having air-conditioning (at least operational units), and once again without the small comfort of a fan. Indian doctors would riot, and we already are inured to far worse.
I'd rather cry in a limo than weep in a bus. I don't expect the US to outright cure all that ails me, but I'd be exceptionally surprised if it didn't make a dent. I hope you have a rough idea of how hard it is to indulge in the hobbies I'm interested in or find the kind of people I want to meet here.
I'm what would be called a Junior Doctor in the UK, at CT1 level. I have yet to specialize, but I might apply for Core Psychiatry Training in the UK if I can make the cutoff this year. I India, that makes me a GP, not that that's what I normally do. I'm usually working as an RMO, a nominally transitional role before one specializes, though I know poor bastards who get stuck there for decades.
If I do go for the USMLE, I'd certainly at least try to go for Psychiatry there too, albeit the snooty buggers don't recognize the credentials of anyone who didn't do their residency there even if they're a fully qualified UK shrink, or just done with the CCT.
We’re almost halfway through July (and the hot months in Britain are June/July/August) and we’ve had one or two days where it’s been uncomfortably hot, by which I mean 30 or 31 Celsius. There’s usually maybe three or four really bad days in summer where it gets up to 35-38 for an hour or two, but even then it drops back to 20-25 at night at the most.
In parts of the US that have similar climates to the UK there are also many people who don’t have air conditioning, even wealthier ones in old houses. Only now after last year’s horrific heatwave and fires are many people in the Pacific Northwest who didn’t previously had it getting it, and the UK obviously never has stuff like that happen.
It’s cultural, rather than financial, given how ubiquitous A/C is in second-world countries where disposable incomes are 1/5th or less of what they are in Britain. Conversely in even wealthier countries than the US that only occasionally have hot days, like Switzerland or Luxembourg for example, air conditioning is still not the norm. I have a ceiling fan (that I didn’t install) in London, although if I run it on the highest setting my upstairs neighbors complain, but I think it’s because there isn’t a dampener as in better ceiling fans.
I see. If it's only a few days, I can probably grit my teeth and bear with it. I've had to attend a non-ac school in the summer where the temperature hit 50°C, and not wet bulb either.
I've certainly never heard an Indian complain about their fan's vibrations disturbing anyone upstairs, but we like our houses sturdy. One downside of otherwise spacious American homes is how paper-thin the walls are, especially in apartments. My neighbors could be fucking and organizing BDSM parties next door and I wouldn't hear it.
What did you mean by this? If you’re interested in rationalist/TheMotte type hobbies you’ll find more people into them in London than in almost any US city other than San Francisco and New York (and even then it’ll be close). Outside of London the ratios will be similar to the US beyond those cities.
If you’re specifically into shooting Britain has an extensive shooting subculture, I walk past a few gun stores on my way to work every day where you can get your $20,000 shotgun customized with your family crest or whatever. I probably attend three shooting weekends a year and even if you run in other circles, clay pigeon shooting is pretty cheap,
there’s a huge hunting scene, many of my coworkers have outdoor hobbies like fishing or survivalist type stuff. The only thing you can’t get here are handguns.
When you were in London, where did you stay? There is something deeply depressing about a certain kind of middling urban British high street littered with kebab shops, fried chicken, betting stores and nail salons under a grey cloudy sky in the middle of the ‘dark’ season (November-March). But - yes, even with the NHS - on two doctors’ salaries, particularly those of two ambitious doctors, you really don’t have to worry about that being your life. There is great natural and cultural beauty here.
Fair point. I still crave the kind of close-knit community of rat adjacent people the Bay Area can claim.
I'm a gun nerd, and I primarily prefer the kind of tacticool shit you can get in the US. AR-15s, AR-10s, all the Picatinny rails, AN/PEQs and the like. Shotguns don't appeal to me in the least, the majority are too drab and boring, not to mention they're largely obsolete. I don't want guns for something as utilitarian as home defense, which is about all they're good for, but I still prefer the more modern stuff. Call it an artifact of playing more first person shooters than I care to name, and like 3.5k hours in Arma 3.
To help convey the point, since despite your general knowledge being excellent, you're unlikely to be familiar with this topic, it's akin to telling a guy crazy into pimping out his car with all the cool mods that he should be content to drive the tiny little toys the Japanese are fond of, since they suffice for getting you from A to B and have 4 wheels on them.
I'm not even that big on hunting, though I wouldn't say no to trying, and even there the kind of game you can bag in the US is far more interesting than the odd fox or pheasant. Shooting wild hogs with wildly overpowered guns from the side of a chopper? Hell fucking yeah.
My Airbnb was in Dagenham/Ilford, hardly the most bedazzling part of London. I still did tour the city, and while I liked it, I find myself merely fond of it rather than head over heels. I could just as easily live in Manchester, the only other city I visited, and I don't think there are any others that measure up to even the latter. Could well be wrong, but the UK is dotted with cities that have had the life blood drained from them to London.
I'd be far happier there if I made the kind of money you presumably do, but that's clearly not on the cards while living there, and if it is, it's because I'm overestimating how much you're worth.
Further, I don't know how closely you follow the affairs of the local doctors, but as someone who has kept a finger on their pulse for years, they're mad. Hopping, fuming mad. Years of pay erosion, no, decades, mid-level scope creep, rotational training, MDTs treating doctors like they're on the same rung of the ladder as nurses and pharmacists, terrible EMRs (most deaneries can't afford EPIC), London locum caps, the government responding to their demands in industrial action with an offered "pay raise" that's below inflation, it's all added up to make even the mild and timid locals, long content to sacrifice themselves on the altar of the ideals of the NHS, have enough.
Even an IMG like me is an assault on their value, since we're far more likely to accept shit pay and working conditions, though they don't really hate us as much as they should if they were looking out for their own self interest. No wonder the exodus to the other parts of the Commonwealth, once a trickle, is now a tsunami.
Even the paltry pay raise that comes with seniority is eaten up by inflation.
Maintaining my current standard of living, as accustomed as I am to a father making a 99.99th percentile income, is hard. You have to run just to stay in place.
Is it still better than India? Of course! I merely see it as a transitional time till fairer pastures unless I literally can't do better.
Not a doctor, but as somebody who did a lot of dating in the last year or so in UMC circles in Australia,, I was pretty flabbergasted by both the sheer amount of UK medicos that'd relocated down here + the conditions they reported financially & work-wise. These were caring, type-A, intelligent women and largely just decided post COVID years that they no longer had any interest in continuing to engage with the system in the UK.
I'd like to call myself one of them soon enough, if I can (barring the type A personality or being a woman, both seem rather intractable haha)
The majority who remain in the UK are simply grumbling through the CCT program, or have personal ties and family that makes it hard to move. While I have those myself, after I'm already committed to leaving the matter, that's moot.
More options
Context Copy link
More options
Context Copy link
I think most of that is legal in the UK, at least some variants of the AR-15 are I believe. Bolt action and semi-automatic rifles are legal. There might actually be some guns that are illegal in the US (or perhaps in certain states) but legal in the UK, at least so I was told by my friend who shoots regularly. It really is mainly just handguns that are prohibited.
My condolences, yeah that’s exactly what I’m talking about. These are some of the worst places in London, especially Dagenham. Two doctors on £70,000 a year have a household income of £140,000 (this is indeed 99th percentile for the UK), you can definitely live in a much, much nicer part of London (depending on how many kids you have, obviously). As I understand it, junior doctors whose “official” pay is only £35-40k actually make much more than that because of extra shifts and bonuses and locum stuff etc etc. I know many junior doctors aged 27-30 and they live in fairly nice places, travel a lot, that kind of thing. They all complain wildly, as you note, and yet they don’t actually seem as poor as they constantly declare themselves to be.
Also, you’re an ambitious guy and want to go into psych. My Harley Street psychiatrist charges £790 for a 45 minute consultation. He can’t be much older than forty. I very much doubt he’s a poor man.
I meet more people into that stuff out here than I ever did or do in NYC. London is home to Deepmind, home to StabilityAI, Meta has a pretty big team here, there are a lot of AI policy/lobby/think tank people around. The “kind of people” who are into this stuff a relatively common, at least. There are a ton of collaborations with doctors, I know a young ophthalmologist (maybe 35) working with Deepmind on using AI to find evidence of diseases in people’s retinas or something. The NHS is actually very open to AI research (as you joke), which actually could be an opportunity for you.
I looked it up, and the only legal AR-15s in the UK are chambered in .22lr, a glorified airgun. To reuse the previous framing, it's like offering the same car nut something that looks like a Lambo and has the engine of a 1993 Camry in it.
I mean, better than nothing, sure, but doesn't scratch the same itch.
(Bolt-actions fall into the same category as shotguns IMO, largely obsolete, I like the kind of guns you see after the 2000s, with all the drip, but that's just me, I'm sure there are people who treat them with more reverence)
Honestly I didn't dislike the place. I have a distant aunt and uncle who live in London, and by God they made it sound like you couldn't leave the house after nightfall. It seemed like a sleepy neighborhood to me, with plenty of expensive cars and no obvious security measures. The closest thing to being unsafe was when I was the tall dark dude in a hoodie walking home and mildly scared a young white couple entering their home.
I wouldn't be opposed to living there, but UK houses (that I can afford) are still tiny for my taste.
Barking was a little more exciting, I kept an eye out for the apparent plague of phone snatchers, but no luck. Other than a lot of places selling jerk chicken, it was largely inoffensive to me.
All of those represent additional work on top of the ~48h work week. I just applied for an ER job in India for a few months, because I know that ER locums are quite lucrative and I want to go prepared, even if I hate it. Even then, locums are drying up as more people bow out of training and perma-locum. Add in London rate caps that are a blatantly cartel-like action by a monopsony employer. Not all doctors locum, and if I have a reasonable assessment of the circles you run in, you're likely meeting the more driven/successful lot.
I intend to use my ADHD as a convenient excuse to work LTFT and then locum on top, but that has a mild risk of pissing off the ARCP examiners. I don't think simply locum-maxxing is an option, because my Skilled Workers visa needs a sponsor.
By all means I'm not saying that it's the worst possible life, it clearly beats India, but I need to make money, fast. That, or citizenship in a First World country, and while the UK is straight forward in that you just need to stick around for 6 years (5+1 for the whole rigmarole), that's about past my median timeline for AGI. In an ideal world I would qualify for an investor visa somewhere that can take care of its citizens after they're economically obsolete.
I am deeply lazy, and if you want me to work more than I absolutely have to, you'd best offer me a motivating salary. Can't complain if the free market doesn't share the same high assessment of my worth, but the NHS is the very opposite.
GPT-4 is a better doctor than I am. The UK government knows that's true for most doctors, and is already using it as a cudgel to scare them. The fact that they're not terrified and rioting is a sign of their ignorance, not the government's. Shame this had to be the one place where the government was remotely farsighted. It'll happen everywhere of course, but later in the US where doctors have more leverage to raise hell.
You then have the potential for robotics to improve (and it has), or simply the trained monkeys like ACPs who can do procedures at the behest of Dr. House LLM.
Even if not literally all doctors are useless, a mere 90% of them being superannuated and then fighting for the remaining positions will make life hard if nothing else.
To end up in that position would take 7 years minimum, same issue. I can still be hopeful, but betting my future on it? Not the same IMO. In fact I expect opportunities like that to be entirely gone before I get a good thing going.
At least in ML I get in on the thing that's going to eat the world, assuming I can cut it.
So, in order of preference:
I fix the ECFMG issue and go to the US, or at least Australia, New Zealand or Canada. Subjectively 80% chance of me being happy.
Upskill myself into a related but different line of work. 60%?
Stay in the UK and make the most of it. Like 40 at best.
Return to India, where at least my dad owns a hospital. It's a small hospital, but it's still something. Just highly at risk from the rest of the country catching fire. Man the odds are bad.
Can you disagree on timelines and implications? Certainly, I'm no expert, just a very scared person trying to sell beachfront properly as the tides get higher. I consider myself lucky to at least know it's coming, and make the trivial preparations I can.
Hmm, that's a cause for hope!
TL,DR: UK not great not terrible.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link