18 May 2018

Dear Interested Readers,


Truth and Honor, and Personal Responsibility

Have you ever noticed how certain themes keep coming up? This week I have heard two programs and read a couple of articles about psychedelic drugs. It did not take me long to realize that Michael Pollan's publishers were doing such a great job of keeping the subject in front of me that I almost went to Amazon to order a copy of Pollan’s new book when it came out on Tuesday, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

The other subject that keeps coming up for me is truth, or if you prefer, honesty. There are obviously many other connected subjects like facts, honor, and character. Discussions of the opposites to truth like lies, dishonesty, fake news and manipulation of facts are also quite ubiquitous. These subjects quickly lead to discussions of dialog, discourse, and negotiations. Not far away from the core discussion of truth is the discussion of society organized along lines of democracy versus authoritarian rule. While we are talking about democracy versus authoritarian regimes we begin to think about empathy and understanding contrasted with bullying and abuse of power. From these connected subjects we venture into tribalism, inequality, and finally, how best to pursue life, liberty, and happiness in a complex world that is simultaneously characterized by both abundance and beauty from one perspective as well scarcity and ugliness viewed from another angle.

In the end I am left with the idea that truth is centrally important, especially as we try to negotiate a better future. Truth may be so important that without it we have nothing but chaos and conflict. Certainly the prospect of something so fragile as good healthcare for all of us that is provided within a set of sustainable societal resources can feel as if it is beyond our collective capability unless we can find effective ways to discuss the way forward. Perhaps we need alternative realities. This may be a very good time for Pollan to bring out his new book advocating a fresh look at the benefit of psychedelics!

I enjoy a good “bedtime book.” A good bedtime book is one that I have wanted to read for years, is incredibly dense with thought provoking ideas, and requires so much concentration that I can only read a few pages before I fall asleep with it on my chest or give up consciousness and roll away from the light coming from my wife’s side of the bed where she continues to read. With the right book I can be asleep within a few seconds of realizing that I have read the same paragraph three times and still do not know what it says.

Lately my “bedtime book” has been Thomas Merton’s 1948 autobiography of faith, The Seven Storey Mountain. If you do not know who Merton was and perhaps are not familiar with this book that has sold over 4 million copies since 1948, I would suggest following the link to get more information. I had not known much about Merton until Patty Gabow suggested that I read Paul Elie’s The Life You Save May Be Your Own: An American Pilgrimage. It is an interesting book that connects the stories of four Catholic writers: Merton, Dorothy Day, Flannery O’Connor and Walter Percy. Of the four only O’Connor was born into a Catholic family.

To my surprise as I was nodding off on Monday night Merton spoke to me across 70 years and suggested that many of the issues that plague us now are not new. He described a transatlantic voyage that he had taken to return to school in England after spending a summer with his grandparents in America. The passengers on this slow boat to England fell into two groups that could not understand each other. There was much debate that was focused on generational differences of opinion between older passengers and the younger set composed of Merton and some young women from Bryn Mawr. Reflecting on himself at this time Merton says:

For it had become evident to me that I was a great rebel. I fancied that I had suddenly risen above all the errors and stupidities and mistakes of modern society --there are enough of them to rise above, I admit-- and that I had taken my place in the ranks of those who held up their heads and squared their shoulders and marched into the future. In the modern world, people are always holding up their heads and marching into the future, although they haven't the slightest idea what they think the “future” is or could possibly mean. The only future we seem to walk into, in fact, is full of bigger and more terrible wars, wars well calculated to knock our upraised heads off those squared shoulders.

I read Merton’s self analysis as one that was applicable to me. He recognized that when we think we “rise above” others we are vulnerable. His words implied to me that as we go forward into an uncertain future we must be very careful to construct our conversations, our ideas about one another, less on regard for own correctness and more on a willingness to empathetically listen to others in a collective search for “truth.” It follows that we need to have a willingness to listen to other people’s opinions about how to apply “truth” to the “future” we can negotiate to avoid “more terrible” wars. Truth and honor are definitely connected, but to focus only on one’s own “truth” sets us up for conflict.

The subject of “truth” is complicated. The subject “facts” is a little more straightforward but still tricky, if your “facts” are really measurements subject to error or remain “theories.” All of this is to say that it is clear to me that my discussion of truth last week was a beginning for me and not an end. The way forward toward better care for everyone and progress toward the Triple Aim at some point in the future requires much more than everyone accepting the same facts, although facts are a starting point. As I was having these thoughts I discovered that Michael Bloomberg has been in the same groove. What follows is a summary of thoughts about honor and honesty that further enlarge the subject. I was so impressed by the speech that he gave to the 2018 graduates of Rice University that I decided to pass on some of the highlights to you. If you would like to read or listen to the whole speech, just click on the link. It is well worth your time.

After a few introductory jokes about life at Rice and the possibility of returning home to live with parents after graduation, Bloomberg reminded the grads that they began their undergraduate journey with an introduction to the Rice honor code and its centrality to academic life. Then he asked them a rhetorical question and gave them a definition:

...To be honorable, you must be honest. And that means speaking honestly, and acting honestly, even when it requires you to admit wrongdoing -- and suffer the consequences. The commitment to honesty is a responsibility that you accepted as an Owl. [The Rice mascot is an Owl] It is also, I believe, a patriotic responsibility.

He then reminds us of the legend of George Washington and the cherry tree and [Honest] Abe Lincoln. Then he suggests how far we have fallen from our national self image in an age of “post truth” and “alternative facts.”

We’ve always lionized our two greatest presidents -- Washington and Lincoln -- not only for their accomplishments, but also for their honesty. We see their integrity and morals as a reflection of our honor as a nation.

“In 2016, the Oxford English Dictionary's word of the year was ‘post-truth.’ And last year brought us the phrase, ‘alternative facts.’ In essence, they both mean: Up can be down. Black can be white. True can be false. Feelings can be facts.

Last week I repeated Senator Daniel Patrick Moynihan’s comment about facts and opinions. Bloomberg has an advantage over me. He actually knew Moynihan.

“A New York Senator known for working across the aisle, my old friend Pat Moynihan, once said: ‘People are entitled to their own opinions, but not their own facts.’ That didn’t used to be a controversial statement.

...Today, though, many of those at the highest levels of power see the plain truth as a threat. They fear it. They deny it. And they attack it -- just as the communists once did. And so here we are, in the midst of an epidemic of dishonesty, and an endless barrage of lies...When elected officials speak as though they are above the truth, they will act as though they are above the law. And when we tolerate dishonesty, we get criminality...If left unchecked, these abuses can erode the institutions that preserve and protect our rights and freedoms -- and open the door to tyranny and fascism...The only thing more dangerous than dishonest politicians who have no respect for the law, is a chorus of enablers who defend their every lie.

He cast a big net that catches both those that are purveyors of distortions of the truth and those who tolerate and enable them. The reason is clear. Dishonesty endangers all of us. Using Rice’s honor code as a guide, he expands its concepts to community:

And the same is true in our country. If we want elected officials to be honest, we have to hold them accountable when they are not -- or else suffer the consequences.

At this point he references the fact that the EPA and other departments of the federal government have banned the use of phrases like “climate change.” Then he draws a chilling conclusion:

Scientific discovery permeates practically every aspect of our lives -- except, too often, our political debates.

The dishonesty in Washington isn't just about science, of course. We weren’t tackling so many of the biggest problems that affect your future – from the lack of good jobs in many communities, to the prevalence of gun violence, to the threats to the economy and threats to the environment -- because too many political leaders are being dishonest about facts and data, and too many people are letting them get away with it.

He moves on to ask the critical question: How did we get here? The answer is what he calls “extreme partisanship.” My interpretation is that extreme partisanship is what you get if we all act with the attitude that Merton describes in his confession.

Extreme partisanship is like an infectious disease. But instead of crippling the body, it cripples the mind. It blocks us from understanding the other side. It blinds us from seeing the strengths in their ideas -- and the weaknesses of our own. And it leads us to defend or excuse lies and unethical actions when our own side commits them.

He goes back further than the current moment and reminds us that Democrats looked the other way in the ‘90s. He points to both sides of the aisle.

In the 1990s, leading Democrats spent the decade defending the occupant of the Oval Office against charges of lying and personal immorality, and attempting to silence and discredit the women who spoke out. At the same time, leading Republicans spent that decade attacking the lack of ethics and honesty in the White House.

When someone's judgment about an action depends on the party affiliation of the person who committed it, they're being dishonest with themselves and with the public. And yet, those kinds of judgments have become so second nature that many people -- in both parties -- don't even realize that they are making them.

There is a way to resolve the dilemma:

...honesty leads to trust and trust leads to freedom ...If we aren't honest with one another, we don't trust one another, then we place limits on what we ourselves can do, and what we can do together as a country... It doesn't have to be that way.

He describes his personal experience as the Mayor of New York that allows him to say:

...I never once asked someone his or her party affiliation during a job interview, or who they voted for. As a result, we had a dream team of Democrats, Republicans, and independents. That diversity made our debates sharper, our policies smarter, and our government better...Arguments were won and lost on facts and data -- not parties and polls...Studies show that people become more extreme in their views when they are grouped together with like-minded people. And that’s now happening in both parties. And as a result, I think it's fair to say the country is more divided by party than it has ever been since the Civil War…

He surprised me with references to pop music and finishes on a positive note. I guess that he knew his audience:

...in order to preserve those truths, and the rights they guarantee us, every generation must take that same pledge…

He is an experienced man whose words deserve serious consideration for reasons beyond the fact that he is worth 50 billion dollars and gives billions to healthcare, education, and efforts to improve the world in which we live. It is true that his wisdom and actions have made a difference, but more importantly his words ring true.


We Must Be Inept Because We Do Spend Enough To Do a Better Job

In those weeks when my own well of inspiration and self proclaimed insight seems to be temporarily running dry, I compensate by passing on what I am learning from others. There has been a lot to learn from others and to pass on this week. I was particularly intrigued by the graphics and the conjecture in an article in the New York Times this Monday by Austin Frakt, “Medical Mystery: Something Happened to U.S. Health Spending After 1980.”

The bottom line for me after reading the article is that “the harder we try and the more we spend the behinder we get.” A lack of willingness to spend money is not the reason that our outcomes as measured by life expectancy are reason for a collective red face of embarrassment. My old coach use to humiliate me with game films when he was trying to assess blame for a failure on the field. He would say, “Gene, pictures do not lie!” That was in the sixties. Perhaps now we can photoshop lies and creatively present statistics to manufacture a point, but I am willing to accept the veracity of the graphics that appeared in Frakt’s article. We have seen this data before. What is new is the assessment that explains the graphics. There is much to be considered.

The first graphic below suggests that since 1980 the more we have spent the further we have fallen behind in relative life expectancy as compared with other advanced economies. The picture is depressing and should be motivation enough to cause us to sit down together and attempt to solve the problem with a bipartisan effort. How can we not ask the question, “What is going on here?” How can we not hold our elective officials accountable for the resolution of this disturbing reality? We should all be engaged in an attempt to answer the question, “Why do we spend so much and yet have such lackluster numbers.”Possible answers to that question range from ineptitude and disinterest and include the possibility of gross negligence, or a generalized focus on personal benefit without much regard for expense or the experience of others.