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America’s vaccination against equity, and its adverse effects

America’s vaccination against equity, and its adverse effects published on No Comments on America’s vaccination against equity, and its adverse effects

The language used to justify policy is…fraught. Every new program is a triumph, as is every cut to an existing one. Every new rule is a sea change, and every executive order a roadmap to utopia. These flowery-but-decisive statements come from all politicians, pointing in all directions, and they always have.

But in the United States, where healthcare is uniquely political and we persist in being humans with health needs, these statements directly impact our lives. We must pay attention. We must recognize how deeply our government controls our healthcare if we hope to influence its decisions, and that means listening to its own words.

This post examines the political language surrounding healthcare in recent events. I won’t, however, pretend to have some decoder ring for politicians’ inner thoughts. I don’t need one—their intentions are right there in plain language. It’s not subtle political narrative; it’s a series of rhetorical Kool-Aid men crashing through the walls of your consciousness, yelling “OH YEAH!” every time. Every. Single. Time.

“Lowering costs”

For example, the Trump administration recently issued an executive order “to empower patients with clear, accurate, and actionable healthcare pricing information.”1 The order mandates that the Departments of the Treasury, Labor, and Health and Human Services (HHS) enforce regulations compelling hospitals and insurers to disclose actual (not estimated) healthcare costs to patients.

The goal is “lowering costs for American families.” “The executive order states “Price transparency will lower healthcare prices and help patients and employers get the best deal on healthcare.”2

Enforcement of these regulations falls to the Centers for Medicaid and Medicare Services (CMS) within HHS, using three main avenues for monitoring compliance. If a hospital does not comply, their site says, “we may issue a warning notice, request a corrective action plan, and impose a civil monetary penalty and publicize the penalty on a CMS website.”3

To be clear, I think healthcare pricing transparency is a great idea.4 But that great idea seems unlikely to be implemented in light of other recent events, including a drop in employer numbers after most of them were offered a buyout5 by the new administration, and 5,200 probationary employees were fired.6

Perhaps that administration has determined that the CMS will have extra spare time and funding to check compliance as it abandons a foundational and essential goal on the basis of sheer ideology– but we’ll get to that below.

Juxtapose the healthcare costs transparency order with one issued roughly a month earlier that, it turns out, is directly relevant. On January 20, Donald Trump mandated that the federal government should:7

Terminate, to the maximum extent allowed by law . . . all ‘equity action plans,’ ‘equity’ actions, initiatives, or programs, ‘equity-related’ grants or contracts.”

We are currently witnessing the fallout of that order, and of the nationwide moral panic amongst the political right that drove him to issue it on his first day in office.

“Eq*ity”

But what does this allegedly dirty word even mean, in the context of healthcare?

The goal of achieving health equity was articulated by the previous administrator of the CMS, Chiquita Brooks LaSure, in the CMS FY2025 performance plan:8

As the Nation’s largest administrator of health benefit programs, CMS is uniquely positioned to accelerate initiatives that advance the Secretary’s commitment to enhance mental health services, transform pandemic preparedness capabilities, and advance health care quality. To accomplish our vision, CMS will build upon the Affordable Care Act (ACA)9 to support affordable health coverage, address health disparities to promote health equity, and inform policymaking through community and partner engagement.

And (for now, at least) the CMS.gov website defines health equity in this way:

The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factor that affect access to care and health outcomes.10

How long has the concept of health equity been around? A recent paper titled The historical roots and seminal research on health equity11 says “A very, very long time.”

Research on health equity experienced three important historical stages: origins (1800–1965), formative (1966–1991) and development and expansion (1991–2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899).

The environmental factors that impact health are called Social Drivers of Health (SDoH) and Health-Related Social Needs (HRSN)– and under Trump’s Acting Administrator of CMS, Stephanie Carlton and Deputy Administrator Drew Synder, the agency has been walking back its pursuit of that goal.

An “ideological crusade”

As of March 4, The Centers for Medicare & Medicaid Services (CMS) has pulled information on health equity for the Medicaid and Children’s Health Insurance Program (CHIP) through Section 1115 waivers,12 a move that former chief medical officer for the Medicaid program at CMS Andrey Ostrovsky, M.S. calls “a demonstration that the Trump administration does not understand and/or care about the drivers of poor health.” “Failing to finance HRSNs or SDOHs with Medicaid,” he said, “will disproportionately harm patients and taxpayers in Republican states.”13

Senator Ron Wyden of Oregon was more blunt, accusing newly-minted Secretary of HHS Robert Kennedy of an “ideological crusade against Medicaid.”14

Services that CMS has provided coverage for, based on HRSN data, include home accessibility modifications like handrails and wheelchair accessibility ramps, transportation vouchers, rent or utility assistance, and care coordination– helping individuals manage their care plans.

What’s the justification for the change? A memo15 by Snyder states:

To support implementation of coverage of certain services and supports to address “health-related social needs” (HRSN) in State Medicaid programs and Children’s Health Insurance Programs (CHIP), the Center for Medicaid and CHIP Services (CMCS) issued two Center Informational Bulletins (CIBs). The first. . . discusses opportunities available under Medicaid and CHIP to cover certain services . . .that purport to address HRSN. . . To evaluate policy options consistent with Medicaid and CHIP program requirements and objectives, CMS is rescinding the November 2023 and December 2024 CIBs.

“Purport”

In other words…no justification. Not even an attempt– just “We no longer care about this. Because, that’s why.”

But that little word “purport” in there fascinates me. Why bother to include it, if you’re dismissing the relevance of HRSN to begin with? Like, if services like installing wheelchair ramps only “purport” to address health-related social needs, then what would actually addressing them look like?

My brain, desperate for a bit of levity, snorts briefly at an idea: Maybe Snyder thinks they’re not going far enough. Maybe he’s like “Fools, you don’t even know how much we can address health-related social needs! Watch me cook!” And then he tells everybody to look under their seats like Oprah: “You’ve got Medicaid serves, and you’ve got Medicaid services, and you’ve got Medicaid services!”

Sadly unlikely, but I sure wouldn’t mind living in that universe.

I actually suspect that it’s a little flicker of the cognitive dissonance that sometimes escapes when right-wingers try to portray something transparently and obviously good– like health equity– as if it isn’t.

Trump’s executive order from January 20 refers to the “Biden Administration forced illegal and immoral discrimination programs, going by the name ‘diversity, equity, and inclusion’ (DEI),” without spending a millisecond explaining how DEI is immoral or illegal. Why? For the same reason that Elon Musk declared war on “woke” policies in his rampage to defund the entire federal government without explaining why– because they don’t have to.16

“Make America Healthy Again”

Let’s go back to CHIP for a moment. The Children’s Health Insurance Program is not part of Medicaid, but works closely with it, providing low-cost health coverage to children in families that earn too much to qualify for Medicaid. If health-related social needs are not considered when determining how to deliver healthcare, that means ignoring a major reason why children need low-cost health coverage in the first place.

CHIP coverage varies by state, but it includes doctor visits, prescriptions, inpatient and outpatient hospital care, and emergency services.17

Why do kids need all of those? Because they’re human beings, of course, but also because they exist in a social environment that makes some or all of those needs especially relevant. Some examples:

  • Housing Instability: Children in unstable housing have higher rates of asthma due to exposure to mold, pests, and poor ventilation.
  • Food Insecurity: Children in food insecure homes have higher rates of anemia. Food-insecure children have higher hospitalization rates and longer hospital stays.
  • Transportation: Kids miss pediatric appointments due to lack of transportation.

“Vaccine hesitancy”

This is also kind of important:18

  • Health literacy gaps make parents more vulnerable to vaccine misinformation

An assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 months were not following the recommended early childhood immunization schedule. Furthermore, a 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Vaccine hesitancy is now associated with a decrease in vaccine coverage and an increase in vaccine-preventable disease outbreaks and epidemics in the United States. 

Oh, and there’s that measles outbreak in West Texas:19

Texas health department data shows the vast majority of cases are among people younger than 18: 39 infections are in kids younger than 4 and 62 are in kids 5-17 years old. Eighteen adults have measles and five cases are “pending” an age determination. . . Most kids will recover from the measles if they get it, but infection can lead to dangerous complications like pneumonia, blindness, brain swelling and death.

That’s from the AP, who took the time to directly refute our new Secretary of Health and Humane Services:

The MMR vaccine is safe and highly effective in preventing measles infection and severe cases of the disease. . .

Before the vaccine was introduced in 1963, the U.S. saw some 3 million to 4 million cases per year. Now, it’s usually fewer than 200 in a normal year.

There is no link between the vaccine and autism, despite a now-discredited study and health disinformation.

“But I do have reservations with your past on vaccines”

And yet Robert Kennedy, who made a promise to Sen. Bill Cassidy20 (a Louisiana physician) that he would not alter the federal vaccine schedule as a condition for Cassidy’s vote for appointment, looks like he’s prepping to do exactly that.21

Speaking for the first time to thousands of U.S. Health and Human Services agency employees, he vowed to investigate the childhood vaccine schedule that prevents measles, polio and other dangerous diseases.

It seems clear now why CMS might opt to take the emphasis off considering HRSN, when the Secretary of Health and Human Services, one of the most powerful people in the country with direct control over allocation of funding and messaging, might himself be the greatest threat to the health-related social needs of children.

“Nothing is going to be off limits”

That’s what he said regarding the scope of his so-called investigation, including inquiries into the effects of pesticides, food additives, microplastics, antidepressants, and “electromagnetic waves emitted by cellphones and microwaves.”

But in reality, he’s referring to children’s’ lives. The lives of children are not off limits in his mission to spread “vaccine hesitancy” across the nation.

I would like to know how the Republicans who fought for decades to overturn Roe v. Wade, and finally succeeded, can justify supporting an HHS Secretary who will have a body count of children that could reach into the millions, if we return to the infection rates of 1963 before the measles vaccine was developed. Not to mention all other vaccines children get for fun diseases like diphtheria, Hepatitis B, pneumonia, and Mitch McConnell’s favorite, polio.22

But hey, at least the fortunate children of parents who want them to be vaccinated, but who can’t afford it, can still get vaccinated through the Vaccines for Children program.23

Oh dear, maybe I spoke too soon:

The CDC’s Vaccine for Children (VFC) Program’s website describes it as “one of the nation’s most important contributors to health equity.”

That word again.

  1. https://www.whitehouse.gov/fact-sheets/2025/02/fact-sheet-president-donald-j-trump-announces-actions-to-make-healthcare-prices-transparent/ ↩︎
  2. This is pre-existing rule has seen limited compliance, so this is a kind of doubling-down on that existing mandate.2 ↩︎
  3. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals ↩︎
  4. The only one Trump has ever had? ↩︎
  5. https://www.pbs.org/newshour/politics/hhs-makes-25000-buyout-offer-to-most-of-its-workers-as-trump-administration-continues-cuts ↩︎
  6. https://apnews.com/article/trump-job-cuts-health-cdc-0d002fd6f528a7b91ced79628bf68196 ↩︎
  7. https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-and-wasteful-government-dei-programs-and-preferencing/ ↩︎
  8. https://www.hhs.gov/sites/default/files/fy2025-performance-plan.pdf ↩︎
  9. Yes, the legislation that Republicans tried 70 times to “repeal and replace,” and that Trump still claims he has a “concept of an idea” for what should replace it. ↩︎
  10. https://mmshub.cms.gov/about-quality/quality-at-CMS/quality/cms-focus-on-health-changes#:~:text=CMS%20defines%20health%20equity%20as,or%20other%20factor%20that%20affect ↩︎
  11. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1058-3 ↩︎
  12. Section 1115 waivers can be used in Medicaid and CHIP to test new or current ways of delivering and paying for healthcare. ↩︎
  13. https://www.fiercehealthcare.com/payers/cms-rescinds-medicaid-health-related-social-needs-guidance ↩︎
  14. ibid. ↩︎
  15. https://www.medicaid.gov/federal-policy-guidance/downloads/cib03042025.pdf ↩︎
  16. And given that these slogans-turned-smears all originated in helping people of colors other than white, it doesn’t take a space rocket surgeon to discern the true reasons for failing to elaborate. ↩︎
  17. https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/ ↩︎
  18. https://pmc.ncbi.nlm.nih.gov/articles/PMC7712553/ ↩︎
  19. “In particular, Cassidy was worried about a potential measles outbreak if Kennedy were to assume control of America’s health agencies and continue to raise doubt about the vaccine, which had been used for decades to prevent the highly contagious and potentially deadly childhood disease.” https://abcnews.go.com/Politics/bill-cassidy-lifelong-vaccination-advocate-voting-rfk-jr/story?id=118451128 ↩︎
  20. https://www.help.senate.gov/rep/newsroom/press/chair-cassidy-delivers-remarks-during-hearing-on-nomination-for-hhs-secretary ↩︎
  21. https://apnews.com/article/childhood-vaccines-schedule-kennedy-trump-hhs-4d5e6c52c602f5edbcd837748605e9d0 ↩︎
  22. https://www.instagram.com/leadermcconnell/p/CTSOL8ZhCSy/?hl=en ↩︎
  23. https://www.cdc.gov/vaccines-for-children/about/index.html, accessed 3/10/25. ↩︎

Deux ex Smartphone: Healthcare Access Isn’t Going to Democratize Itself

Deux ex Smartphone: Healthcare Access Isn’t Going to Democratize Itself published on No Comments on Deux ex Smartphone: Healthcare Access Isn’t Going to Democratize Itself

One of my first-year classes in college was History of Theater, in which I learned how the Greeks built amphitheaters into hillsides, carving out a semicircle of seating for the audience around the stage to maximize. The scenery for a play completes the circle, just as it does for any show in an amphitheater today. It’s the structure providing the necessary atmosphere for the experience.

Imagine sitting in such a theater, watching Euripides’ Helen, and seeing the demigods Castor and Polydeuces (Helen’s pissed off brothers) descend into the scene by a wooden crane—a mechane — whereupon they put an end to all of this murderous nonsense, and everybody lives happily ever after. It’s a literal top-down solution.

That’s where the expression deus ex machina, or “god from the machine,” comes from. And it became used, and mocked, throughout the world of fiction as a plot device providing a too-convenient, cheap ending to a story.

But my mind just keeps going back to that silly crane. It used to dangle a man dressed as a god before the audience, but these days he’d more likely be a techbro holding a smartphone, probably talking about the wonders of AI.

That’s on my mind today because in this post, I’m about to dangle a hypothetical mobile app in front of my audience– you. I illustrate our country’s mess of a healthcare system, and perhaps even reckon with it. This play isn’t ending any time soon, and we need to find a role in it (else one is chosen for us).

Healthcare data and analytics company Arcadia recently launched its own talk show, Spicy Takes, to discuss “hot perspectives in healthcare” while sampling—you guessed it—spicy food. The first episode placed President and CEO Michael Meucci in conversation with Chief Product and Technology Officer Nick Stepro and Chief Medical Officer Dr. Kate Behan.

I watched it while reading about their SDoH (social determinants of health) package, which promises to justify the time and expense required of providers to consistently record SDoH data by creating registries mapping that data with diagnostic codes, for use in proactively identifying patients at risk and connecting them to resources. While looking over the tear sheet, I heard Meucci say this:

I think that this is such a great platform for digital health as we start to think about how do you democratize access. Because if a patient is concerned that they’re not going to get the right treatment because of the color of their skin or the community they live in, the smartphone is a great equalizer. We talk about what’s changed for the last 10 years—that, to me is the biggest thing, the fact that you can pull out your phone and get connected with a doctor in 15 minutes.

“To your point, Stepro replied, “all of the technology and all of the access to healthcare in the world doesn’t change the fact that the single worst diagnosis you can have as a patient is being poor. You can’t address that with a healthcare institution. We can measure that poor people have lower outcomes but ultimately, we need to find and attack the problem of homelessness and poverty because you can’t just solve that in a clinic or with a smartphone.

I stopped reading and played that section of the show again.  Meucci didn’t say that the healthcare industry can solve poverty with smartphones; he said we could democratize healthcare access. If that’s a spicy take then you can call me Spice Girl, because that’s my healthcare platform now. But I suppose coming from someone like him, that’s practically revolutionary.

And he’s right. As a country, America is primed for solutions like that: over 91% of Americans have smartphones. Even households without broadband hang on to their smartphones, because of course they would—it’s a tiny computer that can do more than any of us ever seem to realize, or ever will.

Democracy—another word with ancient Greek origins– literally means “power in the hands of the people.” What would it even look like to do that with a smartphone?

Let’s do a thought experiment to find out.

Time to design a smartphone app.

Imagine that in the beginning of The Legend of Navigating the American Healthcare System, our player character is given their first smartphone.

On that phone there’s an app installed (that I’ve just invented) called HACK: Health Agency, Care, and Knowledge.

Health – A full, patient-owned medical history

Agency – Control over your care, your records, your choices

Care – The power to find, compare, and advocate for treatment

Knowledge – Because to be informed is to be empowered

Does your vision of this app include it conferring access to all of an individual’s health records, stored securely but also accessible in their entirety at any time? If so, you’ve envisioned something better than what existing patient portal apps currently provide.

So yes, let’s absolutely start there, if we’re designing an app that democratizes healthcare in America.

And remember that democracy means that the power is in the hands of the people—not the “patients.”

Problem: we’re not in the driver’s seat.

Social Drivers of Health (SDoH) is the category of data on an EHR encompassing the non-medical factors affecting an individual’s health. In other words, your life, from the hospital where you were born (if you were born in a hospital) to the destination of your organs when you die.

They’ve been called the social determinants of health, but the word “determinant” suggests finality, immutability—that there’s nothing you (or anyone) can do about it. A driver, on the other hand, suggests that while the deck may be stacked against you, things could always change.

How easily could you could do that? *shrug* It depends, but we can safely say that “resident of the United States” is not an easy “driver” to change. We’re driving that road whether we want to or not.

And I hate to break it to you, but we live in a hostile health environment.

A 2024 study titled Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System was conducted by The Commonwealth Fund to understand why America is doing so poorly by comparison—that is, going beyond the factor that rhymes with “schmooniversal schmealthcare.” The categories they used are:

  • Access to Care
  • Administrative Efficiency
  • Equity
  • Care Process
  • Health Outcomes

In all but one of those categories, America comes in dead last or next to last.

To summarize the report, it found that Americans spend more on healthcare as a percentage of GDP to receive lower healthcare system performance than other countries. It faces the most barriers to accessing and affording healthcare. Its physicians and patients are most likely to face hurdles related to insurance rules, billing disputes, and reporting requirements. Equity in healthcare access and experience is low. And we live the shortest lives and have the most avoidable deaths. All by a longshot. USA! USA!

The one exception in these categories is Care Process, where we came in second. Their comments:

Care process looks at whether the care that is delivered includes features and attributes that most experts around the world consider to be essential to high-quality care. The elements of this domain are prevention, safety, coordination, patient engagement, and sensitivity to patient preferences. 

I interpret this result as an indication that some version of enabling people to take charge of their own healthcare is key to accessing that care in spite of all other factors. It could even, possibly, raise America in those other categories where we’re currently ranking dead last!

Okay, probably not, but it could definitely help us face the hostile health environment in which we currently exist:

Misinformation is everywhere.

  • We live in an era where vaccine misinformation spreads faster than the viruses they prevent, leading to the resurgence of eradicated diseases, overwhelmed hospitals, and preventable deaths fueled by fear rather than science.
  • We live in an era where people google their symptoms and often reach the worst, scariest conclusions that inadvertently contribute to their paranoia, where “doing their research” on healthcare can lead to being convinced of conspiracy theories and pseudoscience. 
  • We live in an era where the president of the United States once advocated for injecting disinfectant as a means of staving off Covid, and in his next term has appointed a raw-milk-drinking anti-vaxxer as Secretary of the Department of Health and Human Services. 
  • We live in an era where social media influencers with no medical expertise gain massive followings by promoting unproven “natural cures,” convincing people to reject evidence-based treatments in favor of detox teas, essential oils, and dangerous fad diets

We can’t afford anything.

  • We live in an era where Cost-Related Nonadherence (CRN) is the primary reason for medical nonadherence (failure of patients to take their medication as prescribed due to cost) in some cases forced to choose between “treating and eating.”
  • We live in an era where the term “dual ineligibility” refers to the status of undocumented immigrants in the U.S. who qualify for both Medicaid and Medicare, but are unable to access either one.
  • We live in an era where medical debt is the leading cause of personal bankruptcy, where a single hospital visit can trap families in a cycle of financial ruin, and where crowdfunding platforms have become a substitute for a functioning healthcare system.
  • We live in an era where rural hospitals are closing at alarming rates, leaving entire communities without nearby emergency care, prenatal services, or even a local doctor, forcing low-income patients to travel hours for basic medical attention they still might not be able to afford.

Neighbors hate and fear their neighbors.

  • We live in an era where in transgender healthcare, patients frequently encounter providers who lack adequate knowledge of gender-affirming care or hold prejudiced views that hinder appropriate treatment.
  • We live in an era where in reproductive healthcare, political and ideological barriers, including misinformation and ignorance, stand in the way of basic, safe medical care.
  • We live in an area where Black patients are more likely to have their pain underestimated and undertreated, leading to worse health outcomes. 
  • We live in an era where in disability healthcare, patients struggle to have their pain, symptoms, and autonomy taken seriously, with providers sometimes dismissing concerns as psychological or unavoidable aspects of their condition rather than treatable medical issues.
  • We live in an era where in chronic illness care, patients—especially women—are more likely to be dismissed as exaggerating their symptoms, leading to years-long delays in diagnosis for conditions such as endometriosis, fibromyalgia, and autoimmune diseases.
  • We live in an era where in elder care, aging patients often have their autonomy disregarded, with medical decisions made on their behalf without full consent, reinforcing the notion that age diminishes a person’s right to control their own body and treatment.
  • We live in an era where fat patients are often told to lose weight as the solution to every health issue, leading to delayed diagnoses and overlooked conditions that have nothing to do with body size.
  • We live in an era where for immigrants, language barriers, lack of documentation, and fear of discrimination or legal consequences discourage people from seeking medical care, exacerbating preventable conditions.

But remember: “they” are us, and we all deserve better.

If you’re still thinking about this in terms of how we can help them by this point, stop it. That’s “patient engagement” speak, and our identify is not “patient.”

Our identity is “person,” i.e. member of the human species, class Mammalia, spending every second of life alive, for 100% of the time (until we’re not), thus making our health, and healthcare a relevant part of our lives 100% of the time. Yes, even for doctors.

We all should get a remote control.

A note on dignity:
Meucci mentioned not getting the “right” treatment based on the color of your skin or the community you come from, suggesting that a smartphone could be “a great equalizer.”

That’s a powerful thought, given the indignity that confronts many Americans when they try to interface with the healthcare system at any level, including when they see their providers—whether the providers intend that or not. The hypothetical HACK app, simply by virtue of being an app, confers a sense of dignity that we might not get in the doctor’s office, or indeed anywhere else.

As a survey on dignified care put it, “Dignity is at the heart of personalization. Dignity means treating people who need care as individuals and enabling them to maintain the maximum possible level of independence, choice and control over their own lives.”

We live in an era where America’s healthcare system does not prioritize dignity. Is it possible to claw some of that back?

If you’re going to design a healthcare app to democratize healthcare access for people, that includes you.

In another Spicy Takes exchange, Stepro observes, “Isn’t it better when the consumer is educated and activated—after all, it’s our own body on the line? I’m glad folks are turning to Google or GPT for answers, even if they aren’t perfect, because it shows a healthier dynamic.” Behan responds that unvalidated or wrong information is hard to overcome, and Stepro sarcastically asks if misinformation in medicine has been a persistent issue.

Well, yeah, those problems face all of us, don’t they? We all consult with Dr. Google occasionally, because it’s free, and you can consult it at any hour and ask it any stupid question you want. The downside is that the answers aren’t reliable and can’t substitute for what an actual doctor might advise. And Dr. Google has no idea what your full medical history is (not that you want it to).

Some third-party apps like Ada Health improve dramatically on Dr. Google by using symptom checkers based on verified medical information. Chatbots based on large language models can certainly look up your ailments and dispense advice, although you should be wary if they encourage you to eat rocks. If you’re fortunate enough to have access to the Wolters Kluwer’s UptoDate clinical decision support service, you can find loads of evidence-based data refuting social misinformation. You can even get mobile access to it, and at $60 a month that’s not too shabby.

It’s still pretty far from “free,” however, and UptoDate doesn’t know whether you have a medical condition that could make any recommendations it offers highly dangerous. But if that feature is integrated into the HACK app, you lose the danger of uninformed recommendations, and get to keep the endlessly useful medical library.

On that subject, what else can we pack into this thing?

What an app wants, what an app needs

So far, the HACK app has two big features:

A library of trustworthy medical information that you can consult for any reason, at any time, that’s informed by your medical history included in the app.

Your entire medical history, including all lab results, hospital stays, specialist care, etc. regardless of which healthcare provider you saw for any of these treatments.

Let’s continue stealing important features from other smartphone apps to integrate them into the HACK app, bearing in mind that they must be for the individual using the HACK app—not features designed for providers to gather data from, or to influence the behavior of, the patients they treat. 

What else?

Let’s say the app has an UptoDate level of education materials in a database that connects to your specific data and diagnosis using MedlinePlus Connect. Give the app a chatbot that can pull from this database to answer all of your questions, regardless of how sensitive or embarrassing, and deliver that information in simplified terms without jargon. Now you’ve got a semi-omniscient doctor in your pocket who can tell your uncle (or RKF Jr.) to stuff it when he goes on about vaccines causing autism.

Let’s say the app prioritizes having control over your own data and lets you update and make corrections to your EHR data using a souped-up version of OpenNotes. It also includes a data permissions management dashboard, with the ability to see an audit trail of who has accessed that information—even if there’s nothing you can do about it.

Let’s say the app can also be a buddy who just happens to have a weird fixation on making sure you follow your treatment plan. It incorporates behavior modeling tools from Health Catalyst’s UpFront app to take over remembering stuff when your brain is full (i.e., cognitive offloading). “Hey, you were supposed to schedule that colonoscopy three weeks ago—want me to go ahead and set up the appointment, ya big baby?” Okay, to be fair, Upfront would be nicer than that.

Let’s say the app can create a localized map of all healthcare providers and resources in your area that you can filter by available services. It builds this using tools like Unite Us’s resource directory or ZocDoc’s appointment booking platform, but no referrals are required—you self-refer. “Hi, I have a weird rash and need to see somebody within a week. What do you have available and how much is it going to cost?”

Let’s say the app also has a filter that flags conditions you have, and procedures you might need in the future that might become, you know, illegal in your area at some point. The app could tell you the next closest location where it’s still legal, and point to ride-sharing and other assistance to help you get there/afford it. It could even alert you to events like Texas Attorney General Ken Paxton suing HHS to slide past HIPAA protects to access data indicating you had an abortion.

For that matter, the app could shield you from (some of) the effects of federal cuts to health services with built-in compliance to existing regulatory measures that protect and preserve your data.

Let’s say the app has access to population health data showing the health risks you face most imminently and what you can do about them, incorporating those insights from Arcadia’s population health platform and Health Catalyst’s Ignite platform. The risks matter whether they’re nature or nurture, and you need to know ASAP what you can do about those affecting you.

Let’s say that provider map also lets you sort by pricing, using resources like ClearHealthCosts. It could point out doctors working to alleviate medical debt in partnership with Undue Medical Debt.

Finally, let’s say the app, while placing all of this individualized information and these resources in a little device in your individual hand, also puts you in touch with communities of other human beings affected by the same conditions you are, by offering a feature like HealthUnlocked. You were never alone in this, and here’s the proof.

Nice little fantasy app you’ve got there. Who’s going to make it, though?

Ah, the mask has fallen. The jig is up. The cat’s out of the bag, and the deus is off the machina. What now?

Just kidding. This is a thought experiment for a reason—I don’t expect anyone to make the app. America is ripe for such an app, we need such an app, and we have the tools to create such an app—but that doesn’t mean we’re going to.

But let’s continue to be optimistic– perhaps I’m wrong on that second point. So, okay, what would developing the HACK app require?

  • A governing body to make sure the app is trustworthy
  • A sustainable funding model (Stop laughing– we just got started!)
  • Interoperability across all EHR vendors (I said stop laughing!)

Assume that we have satisfied all three requirements. This is, once again, a thought experiment.

Now, can we seriously address the matter of who makes the HACK app– and why?

What are our options?

The ONC

This one is obvious, because they already oversee FHIR and TEFCA, and interoperability is their dream. They also have regulatory power without a profit motive. But they don’t make software—they just regulate it. Somebody else would have to make it, and put the ONC in charge.

A private tech company (e.g. Microsoft, Google, Apple)

Microsoft attempted something similar with HealthVault, a site where users could store and share their health information, which fizzled and died in 2019.

Google Health was born in 2008, died, and then came back again, finally dying off for good in 2023.

But Apple Health is alive and kicking, using Fast Healthcare Interoperability Resources (FHIR) to let users import and view their health data on their iPhones and iPads after retrieving it. FHIR standards, importantly, were developed and adopted after Microsoft and Google made their respective shots.

When Microsoft and Google started leveraging FHIR, they were no longer in the “patient records for patients” business. Azure Health Data Services and Google Cloud Healthcare API are data platforms used by healthcare systems, payors, research institutions, and so on.

But in none of those cases was the focus on providing services based on patient records—just the records themselves. Apple Health can only function as a sort of meta-patient portal, requiring users to log into their actual patient portals to access their records, and their providers have to agree to letting Apple share the records in the first place.

If a private company like this developed the HACK app, you could argue that it democratizes access far more than the patient-portal-like products these companies previously developed, but, again—it would be their product, for better or worse, and arguably so would we.

A public-private partnership

This means:

  • Private tech company builds the infrastructure.
  • Nonprofit coalition manages the project.
  • ONC (or other federal agency) sets the standards and governs the data.

I guess that’s an option. But if this combination of entities could accomplish something like the HACK app today, why haven’t they done so already?

Who’s going to own it?

Taking on the project of creating the HACK app through that kind of partnership would be a tacit admission that the current system has failed, and that it’s going to take an app to save it—or at least, to survive in the face of that failure.

That’s the paradox of designing a “subversive” app promising to democratize healthcare through the backdoor, while only requiring access to all of the health records that healthcare systems are refusing to share right now, even after the ONC has hounded them to do so for over 20 years. 

Each of the app’s features “stolen” from an existing technology really would have to be stolen, and it’s hard to imagine healthcare tech companies welcoming someone pirating their platforms.

On the other hand, it’s also hard to imagine a better example of the healthcare industry doing what it can to make a difference. “I helped someone understand their own medical records and make plans for future treatment today, when otherwise they wouldn’t have” is not nearly as sexy a claim as “I helped someone out of poverty today,” but it’s a lot more realistic– and on a higher scale, both of those claims could easily be true.

But because healthcare tech platforms sell patient engagement tools to providers rather than to people, there’s no motivation to develop a HACK app per se.

And even if the motivation was there, America has a population of—what—over 340 million at this point? How’s the HACK app going to reach all of us, even a large fraction of us?

How do we get this kind of reach?

Let’s assume that the HHS is developing the app—it would have to, to approach anywhere near that reach.

I’ve actually done a lot of research and writing lately about another app, developed by another U.S. federal governmental department, that reached as many as 64 million—while also stringently adhering to high security and data protection standards and relying on nationwide interoperability and data integration. It’s installed on my phone now, actually, though I’ll admit that I haven’t used it recently.

Maybe the HACK app could take some lessons from it?

  • Federal development and oversight—If HHS takes direct ownership of the app, just as this other agency did, that would mean developing the app in-house rather than outsourcing it to private industry.
  • Security and data protection—The HACK app would need to encrypt personal data, require strict user authorization as well as access control and permissions management, and comply with federal security standards, just as the other app did.
  • AI and automation for user navigation—Both apps rely on automated data processing, proactive notifications and engagement, AI-driven risk assessment, and smart eligibility and routing systems that guide users through decision trees based on their data.
  • Large-scale user support and infrastructure—Both apps must be scalable to handle millions of simultaneous users, both use mobile-first design, and both require redundancy and real-time threat monitoring for resilience against system failures and cyberattacks.

That’s a very general list of requirements, but if another government-developed app can succeed on this level, couldn’t the HACK app do the same? Assuming that the HHS has access to all information and other resources required to do it, that is.

Now, if your answer is “Yes,” how shocked will you be to learn that the other app is CBP One? You know, the app developed by Customs and Border Patrol to scan the faces of migrants and use that as a basis to determine if they can enter the country? The one that Trump shut down on his first day in office, forcing me to defend it after bashing it for months? Yes, that one.

I know, different government agency altogether. Different goals, altogether.

But that’s my point– regardless of how you think about immigration or healthcare, it says a lot that even after such an app was (successfully) developed to regulate immigration, it’s impossible to imagine the government developing a similar app to get healthcare access to Americans.

CBP One has something else in common with regular patient portal apps—it wasn’t developed for its intended end users, but rather the organizations providing the app. And as with patient portal apps, that didn’t stop government officials from boasting about how the app provides migrant empowerment—”There’s a lot of people who would love to migrate to the United States. In essence, they see CBP One as sort of a self-petitioning mechanism that we’ve never had before.”

*cough* So, anyway…

After all of this, have we democratized access to healthcare yet?

No, but we’ve shown that it’s possible to make a tool for getting there.

The U.S. in 2025 is a country:

  • where the best way to reach the greatest number of the population, regardless of demographics, is via a smartphone
  • with a disaster of a healthcare system that we have no choice but to navigate
  • where, within in that system, our healthcare needs are socially driven out of our hands
  • where huge advancements in healthcare technology have been made, and continue to be made, every day
  • whose government has already built a large-scale, high-security, interoperable app for mass data processing, supporting daily access by millions of people. Granted, that was for a very different purpose– but still, they did it

All of the problems standing in the way have been solved—just in different directions, for different people, with different purposes.

And now, the goddess Panacea would like a word.

She’s been quietly waiting in the wings, refusing to step anywhere near that cursed crane, even though she’s arguably the most qualified to do so.

She wants us to remember that America is now an older country than it ever has been, and older folks are sicker folks. They’re also notoriously bad with tech—but they’ve come far since the days when everybody was posting screenshots of their parents failing spectacularly at texting. And we’re at the point where the first generation to grow up using computers is eligible for AARP, anyway. So while the HACK app won’t replace their knees later on, it would be the next best thing to having a personal nurse (or tireless family member) with them 24/7.

She also points out that administrative efficiency is one of the categories included in the Commonwealth study where the U.S. tanked, with wasteful administrative spending estimated as high as $570 billion in 2019. And the HACK app could streamline patient access to records, real-time cost transparency, and insurance verification outside of the doctor’s office. Just sayin’.

Lastly, she wants us to know that the deux ex machina isn’t always what we think it is.

If your job is making boots, and you make boots for soldiers to wear to go to war, then boots are not your deus ex machina for winning the war. They’re just the tiny but significant contribution you can make, using the power and skills you have, to make winning the war more possible.

Likewise, if you’re in the business of making healthcare apps, your apps are not your deus ex machina for democratizing access to healthcare—they’re the tiny but significant contribution you can make, using the power and skills you have, to make democratized access to healthcare more possible.

She departs stage left with a warning: Stop hanging gods from cranes, she says. Just build some damn ladders, and let people climb.

Tardigrade parade

Tardigrade parade published on No Comments on Tardigrade parade

Why yes, I am watching Cosmos…why do you ask?

Actually I think I first time learned about extremophiles, including tardigrades, was while watching the BBC’s Blue Planet series…which I have on DVD, and have watched so many times. I’m looking forward to re-watching Cosmos too, because there are so many things to absorb that one viewing isn’t nearly enough.

I figure the the tardigrade in this parade is on a scale of about 10,000 times its normal size. It just amused me to think of blowing one up that large and using it like a Chinese dragon in a festival. Tardigrades are incredibly resilient (that’s an understatement), but they’re not the most attractive creatures out there– they look like a naked mole rat and a lamprey had a threesome with a trash bag which resulted in progeny. They are fascinating, though, because they seemingly can exist– and even thrive– anywhere. It’s amazing that the tardigrade isn’t any sports team’s mascot…at least, that I know of.  It’s definitely worthy!

Full of Sound and Fury: The Media Response to Dennett

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This post previously published as an article in the journal Method & Theory in the Study of Religion in 2008.

What is the best way for a well-known, unabashedly atheistic philosopher to have a discussion with the American general public about the value and nature of religion? It is not an easy question to answer. Daniel Dennett’s recent undertaking of just that task in his book Breaking the Spell has certainly not been short of controversy or criticism, which is entirely as he expects. “By asking for an accounting ofthe pros and cons of religion,” Dennett explains, “I risk getting poked in the nose or worse, and yet I persist” (257). Clearly, he believes the potential nose-poking an acceptable risk to take in order to deliver an urgent message to Americans: that they need to take a hard look at the matter of why religious belief and behavior is so compelling in the first place, as well as what religion is really “good for,” and for whom. The appropriate way to address this matter, Dennett argues, is through a scientific approach-that is, one based on methodological naturalism. Contra Eliade, there will be no privileged space for the sacred, no sense in which religion will be considered sui generis. Dennett dwells in the overlapping realms of evolution and cognition, and it is in these terms that his inquiry takes place.

But wait a minute …. hasn’t this inquiry been going on for quite some time already? What exactly is Dennett trying to do which hasn’t been done already by scientists such as Tom Lawson and Bob McCauley, Pascal Boyer, D. Jason Slone, David Sloan Wilson, and Walter Burkert? The main, critical difference is that Dennett is not only trying to present the best explanations for religion from cognitive science so far, but additionally to a) advocate for this form of inquiry in the first place to the American general audience, and thereby b) encourage a detached evaluation of the purposes (pragmatic and normative) that religion may serve for such an audience. Make no mistake; Dennett is wading into the culture war. And he is trying to do so from the vantage point of the concerned counselor, but whether the audience will accept him in this role is a different story.

A reader used to Dennett’s previous work, expecting a treatment of religion along the lines of Consciousness Explained, may well find Breaking the Spell a bit of a shock. The reason for this is itself an interesting thing to contemplate. The book is explicitly speculative, offering tentative explanations but stipulating that the exploration of religion as a naturalistic phenomenon still has very far to go. Fair enough. But nevertheless Dennett wants to use these ideas to put forth the notion that maybe, just maybe, religion not only does not benefit us in the proximate, here-and-now sense (as opposed to the ultimate sense, a distinction evolutionary accounts often make), but perhaps it doesn’t even benefit us ultimately. perhaps it exists simply to further itself. To make this case he must establish it on memetic theory, painting a picture through a series of metaphors of religion as a possibly parasitic, possibly symbiotic sort of virus that infects humans because of certain qualities which make it appealing because of adaptations we have evolved for other purposes. Certain inference systems we already have make certain aspects of religion “catchy.” It is an epidemiological account, applied to religion previously by Boyer. But it’s a bit unfortunate that Dennett had to introduce this concept, indeed introduce the book, by likening religion to the lancet fluke-a parasite that invades the brain of an ant and causes it to climb to the top of blades of grass in order to be more easily consumed by cows, into whose bellies the parasite seeks to travel. A cunning analogy? Certainly, but not very flattering. Dennett draws this comparison to point out that humans have evolved to a point at which our own biological fitness-producing a larger number of grandchildren than our neighbors-has taken a backseat to proximate interests. Democracy, freedom, justice-these are “ideas to die for,” as he puts it, and we’re comfortable admitting that. But we wouldn’t say that the ant is “dying for” the lancet fluke. Rather, it is killed by, which is a different kettle of fish entirely. And that is why memetic theory, even (or especially) if it is true, is so discomforting. But then again, some respondents simply find the idea vacuous. Columnist Andrew Brown of the Guardian complains that Dennett “sees the difficulties [of theorizing about religion], marches bravely into the swamp and then – about halfway through the book, at exactly the point where we’re wondering how to reach firm ground – he stops, inflates a hot air balloon that’s labeled “memes”, climbs into it and floats away” (February 25, 2006). H. Allen Orr of the New Yorker agrees: “The existence of a god meme is no better established than the existence of a god” (March 27,2006).

Dennett wants to argue that religious memes are ideas that we sometimes die for or kill for, but more commonly devote our lives to, and that perhaps we should step back and contemplate whether we ought to be doing so. But this requires exhorting us to “rebel against the tyranny of selfish replicators,” as Dawkins originally put it when he coined the term in 1976, leaving us to ask precisely who is doing the rebelling, and with what. For it seems that everything is a meme. It remains highly questionable whether the meme of memetic theory-indeed, of naturalistic inquiry into religion-can be more infectious than the religious memes themselves, and perhaps Dennett is being too optimistic to expect them to be. I suspect that he would say that he has to espouse them regardless.


What kind of counselor? 

Probably the most interesting thing about the reactions to Dennett’s book is the perceptions of how he treats his reader. The book is sprinkled with particular asides to particular types of audiences, ostensibly so that he can cover all of his bases and acknowledge the variety of worldviews that people might bring to his work. But quite a few readers have deemed Dennett not to have the best bedside manner. In a particularly scathing appraisal in the New York Times Book Review, Leon Wieseltier complains that “if you disagree with what Dennett says, it is because you fear what he says … Dennett’s own ‘sacred values’ are ‘democracy, justice, life, love and truth.’ This rigs things nicely. If you refuse his ‘impeccably hardheaded and rational ontology,’ then your sacred values must be tyranny, injustice, death, hatred and falsehood” (February 19,2006). Rupert Sheldrake agreed in the Toronto Globe and Mail that “he is pompous when he tries to persuade, even bully, religious believers to go on reading his book, and patronizing toward those who have not achieved the intellectual superiority to which atheists lay claim” (February 4, 2006). But how much of this reaction might stem from Dennett’s candid and proud self-description of atheism? Sheldrake continues that “his commitment to atheism makes him dismiss out of hand the significance of religious experiences.” Adam Kirsch of the New York Sun accuses the book of “frank hostility to religion” and objects that because of his own lack of faith, Dennett is missing the point completely: “at the heart of organized religion, whether one accepts or rejects it, is the truth that metaphysical experience is part of human life. Any adequate account of religion must start from this phenomenological fact. Because Mr. Dennett ignores it, treating religion instead as at best a pastime for dimwits, at worst a holding cell for fanatics, he never really encounters the thing he believes he is writing about” (February 8, 2006).

What sort of response might the book have received had Dennett made no mention of his personal (a)religious convictions? It’s difficult to tell, and as a vocal proponent of the “bright” movement, Dennett would likely argue that that would be missing the point (July 12, 2003). Attempting to give an objective account of religion and its value should not mean taking for granted that religion is true, therefore there shouldn’t be any problem with a person endorsing just that approach who isn’t religious himself. Of course to some people, this makes about as much sense as a tone-deaf person studying music. But such a person can study music-he can study it from the detached perspective of examining how people produce it and how it affects them, which is precisely how Dennett proposes to study religion. That the old insider/outsider problem should rear its ugly head again comes as no surprise, however we must not make the mistake of assuming, as Dennett himself occasionally seems to do in advance, that any objection to his tone or presentation of the issues should be based on that.

Near the end of the book, Dennett describes believing in God as “a kind of falling in love”- no rational evaluation is made, but rather a kind of helplessness in the face of the object of one’s affection (or faith) which results in a steadfast and enduring commitment (254). And ind~ed, his tone occasionally makes Dennett sound like he is playing the role of relationship counselor to an abused spouse. But he may be up against a love much stronger than he bargained for-after all, people tend to fall in love with more than one person in the course of their lives, and at least with another human you have their continuing presence directly confronting you to remind you of their flaws. When one’s love object is perfect and immaterial, who (or what) can compete? A blogger known as Razib on the blog Gene Expression wrote, “Dennett’s schtick that those who think that religious people can’t analyze their beliefs rationally are being patronizing seems really laughable to me. Most atheists I know have a hard time getting around the fact that many people who are extremely bright (no pun intended in the context of Dennett) sincerely believe that supernatural agents exist and affect the world around us … If the likes of Dennett wish to examine religion as a ‘natural phenomenon,’ they need to acknowledge that perhaps for many humans it is as crucial to their cognitive functioning as elimination is to their digestive system” (March 5, 2006). And indeed, that is exactly the basis on which Kirsch argues that Dennett wants to eliminate religion: “By showing that we evolved to believe, Mr. Dennett hopes to reduce belief to the status of an ordinary human disposition, no more mysterious than our appetite for sweets or our sexual drives. And from there, he hopes, it will be only a short hop to demolishing belief altogether, as a vestige of our prehistory that has become maladaptive in an advanced civilization” (February 8, 2006). Dennett does make the argument that religious memes have become “domesticated” over the years, requiring human stewards for their maintenance and reproduction in a way similar to that in which sheep require shepherds. It would not be too far off the mark to suggest that he is also arguing for them to be domesticated in the sense of pacification as well. Not the absence of Christianity or Islam, but rather a “toothless” version, which doubtless is frightening enough to some.

But … is there a god? 

Perhaps the issue that most readers on either side of the fence, theistic or atheistic, anticipated Dennett addressing was the one that has fascinated analytic philosophers of religion for years does God exist? “Is the theistic account ofthe cosmos true or false? Dennett, amazingly, does not care,” writes Wieseltier. ”’The goal of either proving or disproving God’s existence,” he concludes, is “not very important'” (February 19,2006). And indeed, precious few pages are devoted to the question. Precisely because the topic has been quarrelled over for so long without a good record for converting people from either side to the other, Dennett is not especially interested in wading through the arguments, whether they be ontological, cosmological, or teleological (readers interested in the latter argument would be better advised to read Darwin’s Dangerous Idea). However, this is not to say that attributes ascribed to God cannot be tested-and this is precisely what Dennett advocates. If a theist wishes to affirm the existence of a god with empirical effects on the world, such as miracles of healing, then these can and should be proved or disproved using empirical methods.

Such a god, a creator god who is a person to whom you could pray, who intervenes in the world, is the one in relation to whom Dennett is an atheist (“bright”). This he makes clear in the book, though it is not (in my impression) the explicit mission of the book to make all readers into atheists as well. There are obviously those who disagree, and it is difficult to tell whether they would do so regardless of what Dennett wrote, provided he also included the commentary about being a “bright” and being proud of it. Does this mere admission amount to evangelism? And does Dennett’s outspoken atheism, in combination with his reliance on and endorsement of evolutionary theory both in past books and the most recent one, equate evolution itself with atheism? Florida State philosopher of biology Michael Ruse seems to think so, as does Intelligent Design proponent Michael Dembski, and a couple of writers at the Guardian seem uncertain, after a recent print exchange which took place in a variety of formats.

The first shot was thrown by someone who wasn’t actually a participant in the conversation- Wieseltier, who in addition to being personally offended by Breaking the Spell, pronounced it a “sorry instance of present-day scientism,” and other reprehensible things. After reading this review, Ruse decided to email Dennett and jab him about it, to which Dennett replied that he thought the New York Times Book Review under the spell of the “Darwin dreaders,” and suggested that Ruse might be unwittingly helping them out. The exchange grew yet more heated, with Ruse taking umbrage at this comment and taking the opportunity to note that he didn’t find Dennett’s new book worthy of him, with a culminating comment: “I think that you and Richard are absolute disasters in the fight against intelligent design – we are losing this battle, not the least of which is the two new supreme court justices who are certainly going to vote to let it into classrooms – what we need is not knee-jerk atheism but serious grappling with the issues – neither of you are willing to study Christianity seriously and to engage with the ideas – it is just plain silly and grotesquely immoral to claim that Christianity is simply a force for evil, as Richard claims – more than this, we are in a fight, and we need to make allies in the fight, not simply alienate everyone of good will” (February 21, 2006). Then for some reason Ruse decided to pass on these emails to William Dembski, who promptly (probably gleefully) posted them on his blog Uncommon Descent. 

The exchange was then picked up by the Guardian’s Andrew Brown, earlier the author of a less-than-flattering review of the book, who described the blow-by-blow in a gossipy tone as a battle between evolutionists on the question of how best to combat creationism (March 6,.2006). Then columnist Madeleine Bunting, also of the Guardian, related the matter as part of a piece entitled “Why the intelligent design lobby thanks God for Richard Dawkins,” agreeing with Ruse that both Dawkins and Dennett provide unintentional aid to ill proponents because of their ferocity and frank atheism. She quotes Ruse explaining a particular concern: “If Darwinism equals atheism then it can’t be taught in US schools because of the constitutional separation of church and state. It gives the creationists a legal case. Dawkins and Dennett are handing these people a major tool” (March 27, 2006).

Dennett then replied that this was nonsense, as the public schools in American routinely teach facts that conflict with certain religious doctrines-especially in biology (no virgin births, sony) and geology (the earth’s a bit older than 6,000 years).2 But we need to pause now and consider an element of Ruse’s allegation a bit more closely. “If Darwinism equals atheism” … what exactly does that mean? There are several possibilities. Clearly, Ruse does not himself believe that Darwinism “equals” atheism, but he is afraid that Dawkins and Dennett are giving the impression that it does, so the precise meaning must be considered. And would any possible meaning make his statement of the implications correct?

Perhaps he means that evolution forces atheism-that upon hearing about evolution, any theistic person will be instantly de-converted. This obviously is not the case, and no sensible person would claim such since all one need do to disprove it would be to produce a theistic evolutionist (Kenneth Miller would do the job nicely). Then perhaps Ruse is saying that evolution means atheism-that describing evolution is the same as explaining that God does not exist. This would be a hard one to argue, since there is no reason to mention God at any point in a lesson on evolution (one could argue that this in itself is the evidence, though one need not mention God in order to explain how to bake a cake either, and it would be daft to say that cake-baking “means” atheism). Then maybe Ruse means that, rationally considered, evolution makes belief in God incoherent or at least unnecessary. This is a possibility. At least with the respect to the type of god regarding whom both Dawkins and Dennett are atheists, Dawkins at least would likely affirm this to be true. Dennett is rather more cautious, though in his reply to Bunting he notes that “A few evolutionists, such as Ruse and Eugenie Scott, the director of the National Center for Science Education, favor the tactic of insisting that evolutionary biology doesn’t deny the existence of a divine creator … Many others, such as Dawkins and myself, fear that the evasiveness of this gambit fuels suspicion and so contributes to ongoing confusion in the US” (April 4,2006).

I think it would be a fair assessment to say Dennett believes that evolution makes consistent the justification of atheism (if atheism needs justification), and logically negates the type of god in whom most Americans profess belief (whether they really believe, or merely believe in belief), the type of god who receives so much space in his book. Is this what it means to “equal” atheism? And if so … so what? What are the implications?

This year’s meeting of the Human Behavior and Evolution Society featured a lunch-time presentation entitled “It’s Time to Speak Up: A Panel Discussion on the Role of Evolutionary Scientists in Public Discourse.” Dennett was a member of the panel, as was U.S. District Judge John Jones, who presided over Kitzmiller v. Dover Area School District. After Jones had given his talk (introduced with a standing ovation), Dennett stood to praise all of the work that Jones had done, and to take exception to a single statement from the conclusion of the Dover ruling: “Repeatedly in this trial, Plaintiffs’ scientific experts testified that the theory of evolution represents good science, is overwhelmingly accepted by the scientific community, and that it in no way conflicts with, nor does it deny, the existence of a divine creator [emphasis added].” He questioned whether these scientific experts had had their “feet held to the fire,” and was thankful (with a wink) that he and Richard Dawkins had not been the experts called to the stand.

Michael Ruse and those who agree with him may be doing their best to make evolution palatable to the religious believer in the U.S., and may even be correct that people such as Dennett and Dawkins are not helping their cause. But that is a matter of public relations, not constitutional rights, and anyone who tried to make a freedom of expression case on the grounds that evolution “equals” atheism would not have a prayer of winning. If the claim is going to be made (repeatedly) that evolution is compatible with belief in God, then perhaps we ought not leave it at that. Perhaps an attempt ought to be made to explain exactly how it is compatible, and with which kindof god. This is the case Dennett is making, in the name of forthrightness. In every issue on which science is in conflict (or apparently in conflict) with public opinion, there will be those who lean more toward palatability, and those who lean toward “Just the facts, ma’am.” It seems pretty clear who is on which side in this matter. Dennett’s political campaign is not just for the acceptance of evolution, but for the acceptance of atheism-for the population of “brights” in the country. How can he reasonably be expected to remain silent about one while espousing the other?

In Breaking the Spell, Dennett really pulls no punches. The urgency of the book, the candidness of his tone, and his moral arguments mark it as not merely as an introduction to the cognitive science of religion, but an overt attempt to persuade Americans of faith (and without) to carefully, objectively, consider what that means for them as individuals and for society. This in itself would earn the book a negative response from many, leaving aside the question of whether Dennett comes off as genuine in his open-minded approach of “religion may be good for us or bad-let’s find out.” That will have to be left to the reader. Many have waded in on the subject already, and doubtless many more will follow. But when doing so, hopefully they will remember that most of Dennett’s arguments can easily be made by a theist as well, and become intrigued to discover more about what the scientific study of religion has to offer. After all, we’re still only at the beginning, and there are exciting times ahead.

No special snowflakes

No special snowflakes published on 1 Comment on No special snowflakes

Dr. X commented recently on just world bias, as displayed by Oprah while interviewing Lance Armstrong:

Just one slightly weird blip in an otherwise good job. She asked Armstrong more than once if he expected his day of reckoning to come. Fine enough question, but with an almost cult-like, true believer, fast-clip delivery, she explained the basis for her question, and I paraphrase: 

Did you expect that this day would come, because the Second Law of Movement says you will get what you put out? 

I’m watching and I’m like, what the hell, Oprah? I assume she was referring to Newton’s Second Law of Motion, which is about physics, not mental life or cosmic justice. I found it a bit annoying that she not only misused the concept but, in particular, she used it to assert the Just World Hypothesis which isn’t a law of nature; it’s a known psychological bias — a pernicious distortion of reality. Oprah isn’t just wrong; she came off as having zombie-like belief in a falsehood that does a lot of harm to people. Applied to Armstrong’s situation, it may not sound like a bad thing. But the unexamined flip side is, for example, if you were raped, it was because of something you did that was wrong. So the rape was a natural outcome of your own bad actions. It’s cosmic law. Excuse me, but that’s fucked.

Fucked, maybe, but certainly common, if not commonly described as the “Second Law of Movement.” I would dare say, even, that just world bias is the unfortunate glue that binds traditional religions and more New Agey beliefs together. If you believe in God, then God is supposedly the reason that good deeds are rewarded and bad deeds are punished. If you believe in The Secret (or karma), then you are the reason. Either way, you have a situation in which the universe itself not only cares about the moral significance of your behavior but actually responds to it, positively or negatively.

And Dr. X succinctly points out the problem with and the very unscientific nature of that position– science never appeals to a cosmic will to explain reality. Not because such a thing is utterly impossible, as because such a thing hasn’t been demonstrated to exist, and therefore appealing to it has no explanatory power. Good thing, considering how often very bad things happen to people who are very good, or just minding their own business!

If anything, the truth is that science keeps uncovering more and more ways in which the universe doesn’t give a damn, and religion becomes less and less powerful in its ability to punish the scientists who reveal this.

And we– ordinary, evitable, happenstance beings that we are– we go on.

Sam Harris on a NDE as drug trip

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I wrote this week about Eben Alexander’s account of his must-be-true experience with the afterlife, which made the cover story in Newsweek. Now I see Sam Harris has weighed in on the topic, and he definitely has opinions. First, he incredulously asks how a neurosurgeon could deliver such an account:

Everything—absolutely everything—in Alexander’s account rests on repeated assertions that his visions of heaven occurred while his cerebral cortex was “shut down,” “inactivated,” “completely shut down,” “totally offline,” and “stunned to complete inactivity.” The evidence he provides for this claim is not only inadequate—it suggests that he doesn’t know anything about the relevant brain science. Perhaps he has saved a more persuasive account for his book—though now that I’ve listened to an hour-long interview with him online, I very much doubt it. In his Newsweek article, Alexander asserts that the cessation of cortical activity was “clear from the severity and duration of my meningitis, and from the global cortical involvement documented by CT scans and neurological examinations.” To his editors, this presumably sounded like neuroscience. The problem, however, is that “CT scans and neurological examinations” can’t determine neuronal inactivity—in the cortex or anywhere else. And Alexander makes no reference to functional data that might have been acquired by fMRI, PET, or EEG—nor does he seem to realize that only this sort of evidence could support his case. Obviously, the man’s cortex is functioning now—he has, after all, written a book—so whatever structural damage appeared on CT could not have been “global.” (Otherwise, he would be claiming that his entire cortex was destroyed and then grew back.) Coma is not associated with the complete cessation of cortical activity, in any case. And to my knowledge, almost no one thinks that consciousness is purely a matter of cortical activity. Alexander’s unwarranted assumptions are proliferating rather quickly. Why doesn’t he know these things? He is, after all, a neurosurgeon who survived a coma and now claims to be upending the scientific worldview on the basis of the fact that his cortex was totally quiescent at the precise moment he was enjoying the best day of his life in the company of angels. Even if his entire cortex had truly shut down (again, an incredible claim), how can he know that his visions didn’t occur in the minutes and hours during which its functions returned?

Then he wonders, as I wondered, how Alexander didn’t even consider the possibility that he was just experiencing a really intense high:

Alexander believes that his E. coli-addled brain could not have produced his visions because they were too “intense,” too “hyper-real,” too “beautiful,” too “interactive,” and too drenched in significance for even a healthy brain to conjure. He also appears to think that despite their timeless quality, his visions could not have arisen in the minutes or hours during which his cortex (which surely never went off) switched back on. He clearly knows nothing about what people with working brains experience under the influence of psychedelics. Nor does he know that visions of the sort that McKenna describes, although they may seem to last for ages, require only a brief span of biological time. Unlike LSD and other long-acting psychedelics, DMT alters consciousness for merely a few minutes. Alexander would have had more than enough time to experience a visionary ecstasy as he was coming out of his coma (whether his cortex was rebooting or not). Does Alexander know that DMT already exists in the brain as a neurotransmitter? Did his brain experience a surge of DMT release during his coma? This is pure speculation, of course, but it is a far more credible hypothesis than that his cortex “shut down,” freeing his soul to travel to another dimension. As one of his correspondents has already informed him, similar experiences can be had with ketamine, which is a surgical anesthetic that is occasionally used to protect a traumatized brain. Did Alexander by any chance receive ketamine while in the hospital? Would he even think it relevant if he had? His assertion that psychedelics like DMT and ketamine “do not explain the kind of clarity, the rich interactivity, the layer upon layer of understanding” he experienced is perhaps the most amazing thing he has said since he returned from heaven. Such compounds are universally understood to do the job. And most scientists believe that the reliable effects of psychedelics indicate that the brain is at the very least involved in the production of visionary states of the sort Alexander is talking about. 

I hadn’t realized that Alexander was writing, or has already written, a book on this experience. I imagine that books describing the author’s trip to the celestial afterlife do much better than books describing the author’s really amazing drug trip, but that’s just a hunch.

Tripping a little more

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A few more thoughts on Eben Alexander’s near-death experience:

PZ Myers describes the story in a post called Newsweek panders to the deluded again, which isn’t an inaccurate label (it is indeed a delusion to say that the experience of one questionably conscious neurosurgeon “proves” anything, much less the existence of an afterlife) but I think he misconstrues the experience a bit:

But here’s the real killer for me. People who go through these fantasies often tell of awe-inspiring insights that they receive and are quick to tell us how brilliant they were in Heaven. Alexander is no exception.

That would be the “noetic” part of mysticism, and if we could manage to induce Myers to have a mystical experience whether by drug trip, brain damage, or ESB (as Julia Sweeney put it “People who wore this helmet experienced a sense of transcendent understanding, an overwhelming peace and connectedness, and sometimes the presence of God. Or, of aliens”), he’d probably experience the same thing. He just hopefully wouldn’t go on to present that knowledge as real evidence of anything, as Alexander has. If a person comes out of a mystical experience with, say, knowledge of how to build a perpetual motion machine, then there might be something to what they claim to have experienced. It wouldn’t prove the rest of their story, but it would at least be interesting! But what generally happens is that the person feels strongly as though he or she has been confronted with the greatest underlying truths of the universe, and yet…couldn’t tell you what they are. Or else gives you some rather banal messages like the ones Alexander mentioned:

“You are loved and cherished, dearly, forever.”“You have nothing to fear.””There is nothing you can do wrong.”

I recall in one of Dan Savage’s books– Skipping Towards Gomorrah— he described how a friend of his kept a wicker basket of New Agey phrases printed on laminated slips of paper by the front door for visitors. These were intended to be self-esteem enhancers, pulled randomly from the basket whenever needed in order to create a feeling of empowerment:

When my friend saw me picking through her little wicker basket of affirmations, she folded her arms across her chest, cocked her hip, and said “Go ahead, Dan, make fun of me.” She was asking for it. So I pulled out an affirmation, said “I’m Adolf Hitler,” and then I read Hitler’s affirmation. “I’m a good person, and I want good things.” “That’s awful!” my friend said. “I’m Pol Pot: ‘I strive to spread love and understanding.'” “I’m Richard Speck: ‘I am respected and admired, and people want to be near me.'” “I’m Trent Lott: ‘My inner beauty is like a bright light.'” By now, my sensitive friend was, yes, crying. I know, I know, I’m a terrible person. Which is precisely my point. The problem with setting out a basket of affirmations is that you’re assuming each and every person who comes into your home or spa is a good person  who wants good things. With all the respect due a basket of laminated affirmations, I beg to differ. 

It sure sounds to me like Dr. Alexander encountered that wicker basket in “Heaven.” Hmm…does everybody who goes on a similar trip? Is there nobody who catches a glimpse of the afterlife and is told “You’ve been a very bad person and have plenty to fear; step it up!” Ebenezer Scrooge-style? Yes, there are such cases. But I’m pretty sure they are vastly outweighed by the other variety.

There’s another important thing about the specific messages Eben (no, I’m not going to make a joke about that) Alexander says he received– they are themselves passive. They are the kind of messages it would be appropriate to give a person who is seeing a movie, especially a scary movie, for the first time ever. Don’t worry. There’s nothing to be afraid of. You can’t do anything wrong here. You can’t do anything wrong because you can’t do anything— the story is going to play out as it does regardless. The only time it’s possible to not be able to do anything wrong is when nothing you do matters, which is when you’re experiencing something that’s not real. In the real world, there is plenty to fear. There are all kinds of things you can do wrong. And…there’s no guarantee that you will be loved, much less forever.

So I can see why a person would cling to such an experience, much like a security blanket. I can’t see why someone would wave that blanket around claiming that others must cling to it as well, especially why a supposed news magazine would declare that they should. Alexander, and Newsweek, should know better than that.

I’m tripping over you, God

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In a Newsweek article grandiosely (to put it lightly) titled Proof of Heaven: A Doctor’s Experience With the Afterlife published yesterday, Dr. Eben Alexander recounts a story of what it was like to visit Heaven (apparently) and speak with God (apparently) which supposedly took place while he was in a coma due to bacterial meningitis. His sole basis for believing that this was an actual experience he had and not simply something his mind conjured up, like it might any dream (or drug trip), is the “fact” that it occurred during the coma, while his neocortex was shut down and conscious thought impossible.

What Alexander had was a mystical experience, no doubt. It fits William James’ still-very-useful criteria for such experiences:

1) Noetic quality — Alexander describes special knowledge as having been imparted to him, knowledge which he couldn’t have comprehended otherwise:

Each time I silently put one of these questions out, the answer came instantly in an explosion of light, color, love, and beauty that blew through me like a crashing wave. What was important about these blasts was that they didn’t simply silence my questions by overwhelming them. They answered them, but in a way that bypassed language. Thoughts entered me directly. But it wasn’t thought like we experience on earth. It wasn’t vague, immaterial, or abstract. These thoughts were solid and immediate—hotter than fire and wetter than water—and as I received them I was able to instantly and effortlessly understand concepts that would have taken me years to fully grasp in my earthly life. (Spoiler: Alexander never says what these concepts were, or tries to explain them himself)

2) Ineffability — Alexander does his best to describe the experience, but he can’t truly convey the majesty and meaning of it in words. Such a thing would be impossible. He wasn’t even able to comprehend himself for a very long time:

It took me months to come to terms with what happened to me. Not just the medical impossibility that I had been conscious during my coma, but—more importantly—the things that happened during that time.

3) Transience — Alexander doesn’t say how long the experience took. But it was definitely temporary. He’s not still floating around amongst the clouds and speaking to mysterious women in brightly-colored dresses:

“We will show you many things here,” the woman said, again, without actually using these words but by driving their conceptual essence directly into me. “But eventually, you will go back.”

4) Passivity — Alexender describes all of these things happening to him, without any real volition occuring on his part. Entities appearing to him. Things being shown to him. He describes the experience as a journey, but this journey is not a series of choices he makes– it’s a sensory experience, entirely about what he sees and hears.

So yes, mystical experience. Fine. Well and good. Those have happened throughout history, all over the world, in various forms. But Alexander is insistent that his mystical experience is real:

I’m not the first person to have discovered evidence that consciousness exists beyond the body. Brief, wonderful glimpses of this realm are as old as human history. But as far as I know, no one before me has ever traveled to this dimension (a) while their cortex was completely shut down, and (b) while their body was under minute medical observation, as mine was for the full seven days of my coma.All the chief arguments against near-death experiences suggest that these experiences are the results of minimal, transient, or partial malfunctioning of the cortex. My near-death experience, however, took place not while my cortex was malfunctioning, but while it was simply off. This is clear from the severity and duration of my meningitis, and from the global cortical involvement documented by CT scans and neurological examinations. According to current medical understanding of the brain and mind, there is absolutely no way that I could have experienced even a dim and limited consciousness during my time in the coma, much less the hyper-vivid and completely coherent odyssey I underwent.

For all of the insistence that Alexander makes during his essay that he is a scientist, and his assurances that he approaches his understanding of the brain with skepticism and rigor, this is a bizarre thing to say. It overlooks several things that should be obvious to any person, let alone a neurosurgeon. Namely:

  • Alexander has no idea of the chronology of his experience. The only thing he knows is that it was over by the time he opened his eyes– and let’s note that his interpretation of his experience went on for months, while he was entirely conscious. He has absolutely no way of knowing whether his experience took place while his neocortex was “off.” Our assessment of the duration of dreams during REM sleep is notoriously unreliable, but Alexander doesn’t even seem to consider the length of time that it might have taken for his brain to switch from “off” to “on,” and whether a malfunction just might have occurred during that time. That’s possible, but not likely I think. Alexander’s description of his experience is typical of mysterical experiences, but not of near-death experiences (NDEs). Those are generally described as the experience of heading down a tunnel and/or “into the light” that you hear about. Alexender describes something more like a dream or a drug trip.
  • On the topic of dreams and drug trips– you don’t have to consume drugs to go on a drug trip. Chemical reactions can happen in your brain which cause you to experience fantastic visions for other reasons including severe fatigue and asphyxiation. Gee, can you imagine one of these being a factor in a person recovering from a coma? Mystics in many different religions induce religious visions by starving themselves, staying out in the hot sun, and/or keeping themselves awake for extended periods which might very well cause their brains to go into a state similar to Alexander’s when he was on his way back from coma-land.
  • So Alexander’s body was “under minute medical observation” for a week while he was comatose. How is this supposed to substantiate his belief that his NDE was authentic? Were the attending physicians supposed to have noticed a sudden change in his brain which indicated that his spirit had gone on temporary vacation? So far as I know there is no way to test for such a thing via fMRI, CT, PET, or EEG. Tests of these kinds have been performed on people supposedly having religious experiences at the time, and their results are very interesting. But they’re not performed for a week, and they say nothing about whether the state of the person’s brain means that he has gone dimension-tripping while leaving his body behind, or whether he just thinks he has. Think about it– how easy would it be to catch someone at the precise time they’re having an out-of-body experience and get them into a scanner? Not very easy. And even if/when you can do it, the information you gather is neutral regarding whether they actually spoke with God or whatever it is they claim to have experienced. Even if it turned out they have a brain tumor, hey– the brain tumor could’ve been put there by God as a means of communicating with them! A very morbid, tragic way of communicating, but still. “God made your brain that way/do that thing so that he could talk to you” is an untestable but still possible explanation.

Do I think that Alexander had a near-death experience? Sure, possibly. If the details of his explanation of the bacterial disease he contracted are correct– and there’s no reason to doubt that part– are true, then I see no reason not to believe that he had a profoundly beautiful experience that might or might not have resulted from him actually becoming literally brain dead, temporarily. That doesn’t mean that I have to accept his interpretation of it as happening anywhere outside of his own head, or signifying the truth of anything he claims to have gleaned from it. And what’s more, having had time to think about this in the four years since he came out of this coma, I’d think the neurosurgeon himself would have some doubts as well. But no, he doesn’t. Because he does not think of it like a scientist. He thinks of it like a die-hard believer who thinks he found confirmation:

I know full well how extraordinary, how frankly unbelievable, all this sounds. Had someone—even a doctor—told me a story like this in the old days, I would have been quite certain that they were under the spell of some delusion. But what happened to me was, far from being delusional, as real or more real than any event in my life. That includes my wedding day and the birth of my two sons.What happened to me demands explanation.Modern physics tells us that the universe is a unity—that it is undivided. Though we seem to live in a world of separation and difference, physics tells us that beneath the surface, every object and event in the universe is completely woven up with every other object and event. There is no true separation.Before my experience these ideas were abstractions. Today they are realities. Not only is the universe defined by unity, it is also—I now know—defined by love. The universe as I experienced it in my coma is—I have come to see with both shock and joy—the same one that both Einstein and Jesus were speaking of in their (very) different ways.I’ve spent decades as a neurosurgeon at some of the most prestigious medical institutions in our country. I know that many of my peers hold—as I myself did—to the theory that the brain, and in particular the cortex, generates consciousness and that we live in a universe devoid of any kind of emotion, much less the unconditional love that I now know God and the universe have toward us. But that belief, that theory, now lies broken at our feet. What happened to me destroyed it, and I intend to spend the rest of my life investigating the true nature of consciousness and making the fact that we are more, much more, than our physical brains as clear as I can, both to my fellow scientists and to people at large.

No scientist holds that the universe is devoid of any kind of emotion. No good scientist, anyway– humans are part of the universe, and we’re pretty darn emotional. And no good scientist starts with a firm belief derived from something out of his own head and then assumes that it can be proven empirically, and sets about to find evidence which will confirm this to his peers. One would hope that a neurosurgeon would have spent a good chunk of his life “investigating the true nature of consciousness” before being interrupted by a mystical experience, but perhaps not. If Dr. Alexander is really interested in this topic I can certainly recommend Daniel Dennett’s Consciousness Explained or Susan Blackmore’s Consciousness: An Introduction— heck, I’d recommend those to anybody– but he won’t find confirmation of his unconfirmable convictions in either of those. Quite to the contrary, he will find evidence that the brain really does generate consciousness. In order to find someone who is willing to claim otherwise, you have to drop the pretense of talking about science. You have to drop the aspiration of convincing your fellow scientists, that is if you intend to convince them as a scientist rather than as a true believer. And Alexander is not even willing to speak as a non-Christian or at least Christianity-neutral, even though according to his own account there is nothing Christian-specific about what he experienced. The fact that the only recognizable being he conversed with was a woman speaks against that, all by itself. 

You want to know which part makes me saddest, though? Here’s what makes me saddest:

Without using any words, she spoke to me. The message went through me like a wind, and I instantly understood that it was true. I knew so in the same way that I knew that the world around us was real—was not some fantasy, passing and insubstantial. The message had three parts, and if I had to translate them into earthly language, I’d say they ran something like this: “You are loved and cherished, dearly, forever.” “You have nothing to fear.” “There is nothing you can do wrong.” 

Three platitudinous cookie fortunes are the only “truths” he derived from this experience.

These are the sum of the precious inviolate knowledge he received, the extent of the gnosis passed on unto him, the sole actual revelation in the entire bad science fiction/fantasy tale. Really, if there’s one statement that, more than anything, sums up the ability to appreciate the grandeur, mystery, and ineffable beauty of a mystical experience, it’s “You had to be there.” And, by the way? A college student who has been on an acid trip could tell you that.

Hat tip to Pharyngula for mentioning the story, albeit with a rather different interpretation.

Rillion’s Law applied

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I have my own law, devised under the screen name Rillion which I’ve used since about 2000. The law isn’t quite that old, but it has existed at least since 2005. Rillion’s Law states:

The amount of knowledge a person has about a particular subject is inversely proportional to his or her tendency to make universal, authoritative statements about it.

Yes, I know how pretentious it is to devise your own law– especially if you’re not remotely famous. And doing so is not an indication that I am in any way immune to the phenomenon in question. Quite to the contrary, the law exists in part to remind me to avoid it, and I don’t always succeed.

The reason that this phenomenon exists– generalizing grossly and erroneously with an air of authority about things you don’t really understand– is because people want to have opinions. They want to have a stance to offer when asked, or when they haven’t been asked, and lack of knowledge on a subject makes one incredibly susceptible to glossing over important distinctions within it. Generalizing itself is not a bad thing. It’s a necessary thing in situations when you need to focus on a small number of salient facts about a group to which other facts are irrelevant. Generalizing is important in science, where these situations are frequent. But it should always be done while ensuring that generalizing is what you’re doing, that the facts you consider salient are salient for your purposes but might not be for someone else, and that the facts you’re dismissing as irrelevant to the statements you’re making are in fact irrelevant. Otherwise you end up grouping things together for bad reasons and disregarding important causal factors. You become an example of Rillion’s Law in action. And when the universal, authoritative statements you’re making are about people and end up grossly misrepresenting them, those people are not going to be very happy.

Jason Thibeault, who blogs as Lousy Canuck at Freethought Blogs, posted yesterday asking something along these lines: Are universal statements always a problem? His answer: maybe. He says:

It occurs to me that many (“ALL!” “Shh.”) of our problems around these parts viz every new conflagration, from our recent conversation with Mallorie Nasrallah, to thestatement by DJ Grothe that we only blog about controversial topics for hits, to the pushback against a Rebecca Watson blog title as though it meant she hates all atheists, is the fact that we as skeptics seem to have a problem with blanket universals even when they are not intended as universals. They are the quickest single thing you can do to engender hatred amongst your commentariat. Much of the problem with Mallorie’s open letter to the skeptical community has to do with the universal statement that skeptics “shouldn’t change for anyone”. While she claims she wrote the letter solely for the purpose of expressing her own views of the community, she presented it in the midst of a number of controversies wherein people have been demonstrably misogynistic to bloggers like Greta Christina or new women in the community like the 15 year old Lunam on r/atheism. This caused some outrage in the context of the greater fight we’ve been waging — the fight against entrenched sexism in our communities. For context, I always use the plural for communities because neither atheism nor skepticism have a single overarching community, much less a greater community for either one. We have a set of loosely allied communities, each manifesting their own sets of values and beliefs. The commenters and bloggers at Freethought Blogs appear to have clustered around beliefs in humanism as well as skepticism and atheism, and will fight a misogynist comment as quickly as a creationist or woo-peddling one. I don’t believe that the levels of sexism in our collective online communities are very different from the background of the internet as a whole, no matter how much of a safe space we’ve carved out here. However, there are three things that are important and mitigating factors to that blanket statement about the levels of sexism. 1: The internet is, as a whole, a far cruder and crasser place than real life, owing largely to anonymity and the Greater Interent Fuckwad Theory.
2: Our real-life meatspace communities are very often being organized via the internet, so there’s a lot of overlap between what goes on in meatspace and what came from the internet to begin with.
3: we have experienced by my estimation a significant amount more pushback than most other communities built around other topics, against the very idea that people shouldn’t use sexist slurs at women, or treat women like they’re just there as dating pool material, because either of those are likely to result in women who might otherwise participate bleeding away from our communities. DJ Grothe described our fight against this pushback as being solely intended to drive controvery, to drive a wedge in the community, done solely for the hits. What makes this a short-sighted blanket statement is in part the misidentification of the problem, the misidentification of what it is we’re trying to do about it, and the misidentification of what’s actually being said about the community as a whole. Stephanie’s post itemizing the times when he’s exhibited this sort of blind spot for ongoing fights was met with doubling down, and DJ declared that the whole episode served as proof to him that that’s all the feminist bloggers in our community want to do is to tear other communities apart over sexism. 

Hasty generalization is, as we know, a basic fallacy. Rillion’s Law is really just an observation about what causes people to generalize hastily. And what Nasrallah and Grothe have done, it seems, is hastily generalize about both the problem of sexism in skeptical communities and the people speaking out about it. Greta Christina has a post up today about Grothe, doing her best to be fair and give him the benefit of the doubt, but it’s pretty damning nonetheless.

I have two questions for JREF President D.J. Grothe. They’re questions that I find unsettling and upsetting to even consider, questions I wouldn’t have thought I’d have to ask a leader of a major organization in this movement. But I’ve been reading some things Grothe has been saying recently… and apparently, I have to ask. Question #1: Do you really think there is any context in which making threats of gender-based, sexualized violence — towards a person of any gender, but especially towards a female writer and her readers — can be justified? Question #2: Do you really think that feminist bloggers in the atheist/ skeptical movements are writing about sexism and misogyny, and pointing out examples of it in our communities, primarily so we can manufacture controversy and draw traffic? I would like to think that the answers to both questions is an obvious and resounding “No.” D.J. and I have had some differences, but we’ve also had a largely cordial and even friendly professional relationship. I know he thinks of himself as an ally in the effort to make the atheist/ skeptical movements more welcoming to women. And I know that he takes pride — justifiably so — in, among other things, drawing more women to TAM, both as speakers and attendees. But I’ve been following the discussion on Almost Diamonds about him, and about an apparent pattern he has of defending sexist language and behavior in the atheist/ skeptical communities. I’ve been reading the things he himself has been saying in this conversation. And I am extremely distressed to realize that the answers to both these questions appears to be, “Yes.”

In essence, Greta Christina is saying “I think you’re making some universal authoritative statements without being aware of the ignorance that enables you to make them. Or at least, I hope you are, because it’s better than the alternative. And I’m giving you the opportunity to look around, understand, and amend your position on that new understanding.”  That’s a charitable reading. No doubt she’s extending it because Grothe has a reputation for being an understanding, charitable guy himself. Perhaps to a fault, and in the wrong direction, in this case.

It’s not fun for female bloggers, scientists, and activists to keep talking about the sexism thing, trust me. It’s a pain in the ass, in large part because it means getting dismissed as a mere attention-seeker in precisely the way Grothe appears to be doing. But the existence of sexism in communities that presume to be so rational and fair-minded in the first place is a roadblock to even being comfortable to participate in the first place, and– sorry– people who aren’t confronted with that on a regular basis can find it easy to forget, and dismiss as complainers people who do have to deal with it and speak up about it.

*removes needle from the broken record*

ETA: Grothe’s reply

Pareidolia of the day: Holy sh!t!

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Today’s incidence of pareidolia is a doozy. Or a doo-….no, I’m just not going there. The title for this post was enough. For the record, pareidolia is

a psychological phenomenon involving a vague and random stimulus (often an image or sound) being perceived as significant. Common examples include seeing images of animals or faces in clouds, the man in the moon or the Moon rabbit, and hearing hidden messages on records played in reverse.

Or in this case, bird poo. From Bryan, Texas:

Image Of Virgin Mary Appears In Bird Dropping On Area Family’s Truck The image that came in an unlikely form of a bird dropping appeared on Sunday. That was the first time Salvador Pachuca had been back to the home since having an accident there four months ago. “I told my brothers come over here and see what this is and they say this is the Virgin,” he said.

Family members made their way outside to see the image on the truck’s side mirror. Cristal Pachuca said she took pictures and began making calls to invite others to see, what she describes as, a miracle. “We just all feel protected. It’s a blessing to our family and to everybody that comes to see it,” says Cristal Pachuca. Cristal says the truck doesn’t get much use, but last weekend her husband decided to take it out of their garage and wash it. 

A few moments later the image appeared. Since Sunday, a steady stream of family, friends, neighbors and strangers has stopped by to pray and take pictures of the image. The Pachuca’s say the image is more than a coincidence especially since it happened on the 12th. The family says in Mexico, Dec. 12 is celebrated as the day of The Virgin Guadalupe. 

Onlookers say the image is a miracle because the distinct colors and outline of the image on the truck match the image of Virgin Guadalupe. The Pachuca’s say they will continue to welcome anyone who wants to see the image, because the image isn’t going to go away anytime soon. “I think we’re going to just put it on a shelf outside, probably take off the mirror and keep it there cause its something special to us. I’m not going to wash it off,” says Cristal Pachuca.