Map of life expectancy at birth from Global Education Project.

Wednesday, May 23, 2018

Economic Anxiety?

Eduardo Porter in the NYT reviews the latest research on the motivations of Trump voters. It's clear and supported by multiple lines of evidence: their anxiety isn't economic, it's about losing white status privilege. Referring to work by pollster Stanley Greenberg Porter writes:

The research zeroed in on white Trump voters without a bachelor’s degree who were either Democrats or independents and had voted for Mr. Obama at least once. Focus groups detected the same underlying theme that had motivated the Reagan Democrats more than 30 years before: a view of America as divided between “us” — white, struggling and aggrieved — and a nonwhite “them.”
So yes, Republicans are engaged in identity politics It's just that we are trained not to think of white, non-Hispanic as an "identity." Some years ago I was at a conference where I attended a meeting of people interested in behavioral health services for Latinos. We went around and introduced ourselves and this old white guy said - really - "I always wished I had a culture. When I was growing up I'd see the Hispanic kids and the Asian kids and I'd think, 'Why can't I have a culture like them?'" I told him, "I assure you sir, you do have a culture."

Trump voters, in fact, had median incomes above the population as a whole. A few of them no doubt had lost income since the steel mill or the coal mine closed down, but most of them are doing fine.
In a place that is more than 80 percent white, Mr. Trump’s Democrats share “pretty powerful feelings about race, foreignness and Islam that lead them to see white people as victims in a country feeling increasingly foreign to many of them,” the study noted.
The single strongest predictor of support for Vladimir Putin's candidate is racism, broadly construed. This is what causes conservative white voters to oppose policies that will actually benefit them, such as universal health care and expanded educational opportunity: they think that more of it will go to people of other tribes, and they are more interested in retaining their relative privilege than in their absolute well being. Of course they feel other threats to their traditional concepts of community, including growing acceptance of diversity in gender, sexuality and religion.

But here's what I think folks. Open your minds. Don't identify narrowly as a straight white male. Try on a broader self-definition, as, say, a proud citizen of a dynamic, diverse, and inclusive nation. We will all do better when we try to do well together. The divisive politics of the current Resident are not just retrograde and repulsive. They are downright dangerous. 

Monday, May 21, 2018

With all the turmoil and craziness, too much is flying under the radar

I didn't even know that it appears a truly horrible version of so-called "right to try" is about to become federal law. I have written about this before, but when legislation was only being passed at the state level it didn't really matter. The FDA still controls access to experimental drugs and state law can't preempt it, so state legislation was purely symbolic.

The link is to an essay by the notoriously long-winded David Gorski. Do read it if you want all the details, but I'll try to give a succinct version.

For background, the drug approval process has several stages. First, trials in animals have to show some evidence that a chemical may be promising to treat human disease and establish evidence about safety. People are not mice, however, and unfortunately most agents that show promise in animals turn out not to be useful for human health care, due to lack of efficacy, safety, or both.

So, the next step is a so-called Phase One trial. This involves giving the agent to a small number of human volunteers, starting with very small doses and increasing them until adverse effects are observed. This is not intended to show anything about efficacy, just to get an idea of how much of the drug can be administered safely in a larger study.

Phase Two trials are relatively small trials which are not powered (i.e. do not have a large enough sample size) to really prove efficacy, but do have at least one control arm (a placebo or existing standard treatment) and produce more information about safety (at least in the short term) and enough of an indication of treatment effect to establish the sample size needed for a large scale Phase Three randomized controlled trial. A lot of agents flunk out at this stage, and never make it to Phase Three.

So, in order to get access to an experimental drug you need to enroll in a clinical trial. And of course, you might end up in a control arm and not actually get the experimental drug. Which is at least 50% likely to be good news for you, because the experimental drug might not work and might not be safe. If there already is an established treatment and you have a somewhat serious condition, in the control arm you'll get the standard treatment because placebo control would be unethical. Got that?

The FDA has licensed drugs based on safety and efficacy since the thalidomide catastrophe. But so-called right to try means that terminally ill people will be allowed access to drugs that have only passed Phase One. People intuitively think, "What's wrong with that? Freedom!" Well, there's a lot wrong with it, but it might not be an absolutely terrible idea under some conditions. Unfortunately the legislation that's teed up now is in fact an absolutely terrible idea.

Note the following. Insurance companies will not pay for experimental treatments. People who want them outside of clinical trials will have to pay out of pocket. The drug companies can charge whatever they want. Note also that it is not only the case that evidence for effectiveness is not compelling: there is no evidence of effectiveness whatsoever based on a Phase One trial. The treatment is as likely to make people worse off as it is to help them. Okay, they're dying, what have they got to lose? Other than their children's inheritance, that is. Take it away, Dr. Gorski:

Consistent with their libertarian origin, right-to-try laws also strip away many protections from patients. First, there is no requirement that companies provide the drugs for free or at a reduced price. Indeed, these laws explicitly state that insurance companies are under no obligation to pay, even though such a statement is unnecessary given that insurance companies don’t reimburse for experimental therapies. As a result, the only people who would potentially be able to access right-to-try are the rich or people who are very good at fundraising. A terminally ill person trying to access right-to-try can easily spend away his estate or even go bankrupt before dying. It’s even worse than that. The language in many of these laws can be interpreted to mean not just that insurance companies don’t have to pay for right-to-try but that they don’t have to pay for medical care as a result of complications suffered from using a drug under right-to-try.

Another aspect of these bills is, as Jann Bellamy and I have described many times, how, compared to existing expanded access programs, they strip patient protections away from patients who access them. One way to see this is by comparing what happens when a patient accesses an experimental therapeutic under the FDA expanded access program to what happens when another patient accesses one under a right-to-try law. Under FDA expanded access, patients retain full protections under federal and state laws. They can sue for malpractice if there is any, and their care is still monitored by an institutional review board (IRB), with any adverse events recorded and considered by the FDA. Moreover, the FDA approves nearly all such requests (99%). In contrast, under right-to-try, there is no IRB oversight. It’s all between the company and the patient, a libertarian paradise!

These laws also immunize companies providing right-to-try drugs and physicians overseeing their administration from liability. Right-to-try laws also limit what patients can do in the event of malpractice or negligence. All of them broadly immunize physicians advising or administering right-to-try medications or using right-to-try devices against malpractice suits or actions against their medical license by the state medical board related to their participation in right-to-try. All of them also immunize companies providing experimental therapeutics under right-to-try from liability. All of them contain provisions stating that state employees can’t interfere with a patient seeking right-to-try, which could be interpreted to mean that a doctor at an academic medical center at a state university couldn’t counsel a patient not to seek right-to-try without running afoul of the law. As Jann notes, even if state authorities believe, for example, that an elderly person is being exploited for financial gain by a physician, presumably this provision would prohibit their acting.
Finally, this creates a situation in which legitimate clinical trials may be compromised.  If it isn't possible to recruit enough people who are willing to undergo randomization, because too many people are already clamoring for the experimental drug, we will never know if it really works and is really safe. I will finally note that if a drug shows what appear to be truly miraculous results in Phase One trials, then even a relatively small scale Phase Two trial may who strong evidence of effectiveness, in which case movement toward approval will proceed quickly and expanded access may be offered under existing regulations. This seldom happens. Of course the Koch brothers are behind this particular outrage.

Sunday, May 20, 2018

Sunday Sermonette: Just when you think it couldn't get more depraved

As we have seen, whatever the Bible may be it is not a manual for morality. Genesis 16 takes it to 11. (But don't worry, it gets worse.)

Now Sarai, Abram’s wife, had borne him no children. But she had an Egyptian slave named Hagar; so she said to Abram, “The Lord has kept me from having children. Go, sleep with my slave; perhaps I can build a family through her.”
Abram agreed to what Sarai said. So after Abram had been living in Canaan ten years, Sarai his wife took her Egyptian slave Hagar and gave her to her husband to be his wife. He slept with Hagar, and she conceived.
Credit to the NIV for calling a slave a slave. For some reason they haven't been willing to do it up until now. It's interesting that in this situation Hagar becomes Abram's "wife." Later, we will meet the institution of concubinage, in which the sex slaves don't get to be called wives.

When she knew she was pregnant, she began to despise her mistress. Then Sarai said to Abram, “You are responsible for the wrong I am suffering. I put my slave in your arms, and now that she knows she is pregnant, she despises me. May the Lord judge between you and me.”
“Your slave is in your hands,” Abram said. “Do with her whatever you think best.” Then Sarai mistreated Hagar; so she fled from her.
The angel of the Lord found Hagar near a spring in the desert; it was the spring that is beside the road to Shur. And he said, “Hagar, slave of Sarai, where have you come from, and where are you going?”
“I’m running away from my mistress Sarai,” she answered.
Then the angel of the Lord told her, “Go back to your mistress and submit to her.” 10 The angel added, “I will increase your descendants so much that they will be too numerous to count.”
It's obviously hard for us to get inside the head of someone in Hagar's situation. But it does make sense that if you're a slave, and you're bearing the owner's child, you get some improved status. No doubt this was true of Sally Hemmings, though Thomas Jefferson's wife had died when Jefferson started having sex with her. In any case, Abram doesn't want Sarai to be jealous so he lets her mistreat Hagar. God evidently has a plan, however, which requires Hagar to submit to an abusive slavemaster, so tough shit. Then we get another prophecy:

11 The angel of the Lord also said to her:
“You are now pregnant
    and you will give birth to a son.
You shall name him Ishmael,
    for the Lord has heard of your misery.
12 He will be a wild donkey of a man;
    his hand will be against everyone
    and everyone’s hand against him,
and he will live in hostility
    toward all his brothers.”
"Ishmael" means God hears.  That seems scant consolation. God has heard of your misery, and insists that you remain in it. And here we have yet another prophecy, which, like the curse upon Cain, doesn't actually happen.

13 She gave this name to the Lord who spoke to her: “You are the God who sees me,” for she said, “I have now seen the One who sees me.” 14 That is why the well was called Beer Lahai Roi; it is still there, between Kadesh and Bered.
15 So Hagar bore Abram a son, and Abram gave the name Ishmael to the son she had borne. 16 Abram was eighty-six years old when Hagar bore him Ishmael.
The name of the well could be one of those stupid Jeopardy! questions. It  means "well of the living one who sees me." Later, Abe (whose name will have been changed by then for no apparent reason, to Abraham) will have a second son, Isaac, who will thenceforth be referred to as his only son. This may be true in a sense because Abraham will  eventually kick Ishmael out of the house and disown him. I know I'm getting ahead of myself here but we're trying to keep track of what it would really mean to "live biblically." If there is one thing God does not know, it's right from wrong. 

Thursday, May 17, 2018

Royal Heinie

I suppose it's just harmless fun, but the obsession of the American public with British royalty seems bizarre to me. That a B-list American celebrity is about to marry a parasite on British society (who by the way, is not in the line of succession to the throne unless his brother and his family are wiped out, not that it matters) is the biggest consumer of TV time and column inches even as, well, certain other stuff is happening, seems disconcerting..

If I am correctly informed, the colonies who have since become the United States fought a war to get out from under the British throne. Since then, the rest of Europe has eliminated or privatized their monarchies. But the Brits squander massive taxpayer cash on allowances, horse drawn carriages and ceremonial officials whose only function is to wave around ritual objects, soldiers in medieval garb who practice human statue routines, and the maintenance of massive, impractical ancient structures. All this makes the useless twits who constitute the Windsor family the most fascinating people in the world, it seems.

In case you didn't know it, the pet cause of the Prince of Wales is the promotion of homeopathy.

But at least the symbolism of the wedding may be positive. Although it won't produce a monarch of African or common descent, it does signify that British culture has changed. Nobody wants to mention that subtext, however. I suppose it would be unseemly to point it out. What would really be a step forward, however, would be for Britain to become a republic and make these people get real jobs. I'm not holding my breath.

Wednesday, May 16, 2018

Wow, how did this get by me?

The new director of the CDC is named Robert Redfield. The U.S. Centers for Disease Control and Prevention (still abbreviated CDC because "prevention" was added later) is the country's public health agency. Here are some fun facts about Redfield.

He was in charge of the armed forces' response to the HIV epidemic in  the 1980s. Among his policies:

  • Mandatory HIV testing of all troops, without confidentiality. Positive tests were revealed to the entire chain of command.
  • HIV+ troops were kept in isolation and dishonorably discharged when they developed AIDS. . .
  • Which meant they were dumped on the street without health insurance and died in poverty. Many committed suicide.
He was associated with a Christian extremist organization called Americans for a Sound AIDS Policy, which called for mandatory testing of the entire population and isolation of people who were infected. He wrote the introduction to a book by the organization's leader, in which he said:

It is time to reject the temptation of denial of the AIDS/HIV crisis; to reject false prophets who preach the quick-fix strategies of condoms and free needles; to reject those who preach prejudice; and to reject those who try to replace God as judge. The time has come for the Christian community — members and leaders alike — to confront the epidemic.
The book, by W. Shepherd Smith, Jr., asserted that AIDS was God's judgment against homosexuals.

He fraudulently promoted a worthless HIV vaccine, and got congress to appropriate $20 million to study it. As the linked FP article informs:

The VaxSyn product never worked, and its elevation to top dog status, despite lack of scientific support, was denounced in the Washington Post as “pork-barrel research.” The “MicroGeneSys soap opera,” as Science reporter Jon Cohen dubbed it, dragged on through investigations and scandal into 1994. Eventually, the Army tried the concoction on more than 600 HIV-positive military personnel, concluding they showed “no clinical improvement.” In his 2001 book, Shots in the Dark, Cohen detailed the Redfield saga and showed that he continued promoting VaxSyn and using it on human volunteers with the financial support of Smith’s ASAP long after the Army had concluded it didn’t work.
Our health, and our very lives, depend on sound, science based public health policy. This dishonest, bigoted, thieving, religious fanatic lunatic is probably not the right person for the job.




Sunday, May 13, 2018

God as con artist

For some reason we don't hear much preaching about Genesis 15, even though it seems pretty juicy. Here it is.

After this, the word of the Lord came to Abram in a vision:
“Do not be afraid, Abram.
    I am your shield,
    your very great reward.”
But Abram said, “Sovereign Lord, what can you give me since I remain childless and the one who will inherit my estate is Eliezer of Damascus?” And Abram said, “You have given me no children; so a servant in my household will be my heir.”
Then the word of the Lord came to him: “This man will not be your heir, but a son who is your own flesh and blood will be your heir.” He took him outside and said, “Look up at the sky and count the stars—if indeed you can count them.” Then he said to him, “So shall your offspring be.”
Abram believed the Lord, and he credited it to him as righteousness.
You may recall that previously, Abram was going to have as many descendants as there are motes of dust in the world. That's a lot! But actually, there are only about 5,000 stars visible to the nude eyeball, of which half are in the hemisphere you can't see. So even under the best of circumstances, Abram is going to have no more than 2,500 descendants. Of course, including stars that can't be seen without a telescope, there are more than 100 billion in our galaxy alone.

He also said to him, “I am the Lord, who brought you out of Ur of the Chaldeans to give you this land to take possession of it.”
But Abram said, “Sovereign Lord, how can I know that I will gain possession of it?”
So the Lord said to him, “Bring me a heifer, a goat and a ram, each three years old, along with a dove and a young pigeon.”
10 Abram brought all these to him, cut them in two and arranged the halves opposite each other; the birds, however, he did not cut in half. 11 Then birds of prey came down on the carcasses, but Abram drove them away.
In the Torah we learn that God really digs it when people kill animals and burn them. In this particular case, for some reason, as we will see momentarily,  God actually sets them on fire himself. This is abnormal, however. Usually the people are expected to do it. Later on we'll see all sorts of elaborate instructions for how to go about killing and burning the animals. One is hard pressed to understand why God wants people to do this, and as it turns out later, ha ha! He didn't really mean it. Starting with Psalms, and later prophets, God does not want animal sacrifices, are you kidding me? E.g.

Sacrifice and offering thou didst not desire. Psalm 40:6
Will I eat of the flesh of bulls, or drink the blood of goats? Psalm 50:13
For thou desirest not sacrifice ... thou delightest not in burnt offerings. Psalm 51:16

12 As the sun was setting, Abram fell into a deep sleep, and a thick and dreadful darkness came over him. 13 Then the Lord said to him, “Know for certain that for four hundred years your descendants will be strangers in a country not their own and that they will be enslaved and mistreated there. 14 But I will punish the nation they serve as slaves, and afterward they will come out with great possessions. 15 You, however, will go to your ancestors in peace and be buried at a good old age. 16 In the fourth generation your descendants will come back here, for the sin of the Amorites has not yet reached its full measure.”
So the Jews are God's chosen people, but he's going to enslave them for 400 years? Why? (As it turns out it was actually 430 years but who's counting. Oh yeah -- there were not 4 generations between Abram and Moses, there were six. But again, who's counting?

17 When the sun had set and darkness had fallen, a smoking firepot with a blazing torch appeared and passed between the pieces. 18 On that day the Lord made a covenant with Abram and said, “To your descendants I give this land, from the Wadi[e] of Egypt to the great river, the Euphrates— 19 the land of the Kenites, Kenizzites, Kadmonites, 20 Hittites, Perizzites, Rephaites, 21 Amorites, Canaanites, Girgashites and Jebusites.”
This promise God definitely did not keep. The land between the Nile and the Euphrates would include what is today Syria, Jordan, and most of Iraq. The Jews never got a fraction of that. Bullshit artist.




Wednesday, May 09, 2018

The corporate media is taking a long time to wake up from its slumber

Here is Jonathan Chait saying fairly succinctly what we know to be true. It is now a confirmed fact that a Russian oligarch -- which ipso facto means a crony of Vladimir Putin -- paid $500,000 to a shell company set up by Donald Trump's bag man, a firm with no employees that had no apparent function other than making secret payments on Trump's behalf. We have learned this thanks to the lawyer for a porn star who received one such payment. (Really. We are talking about the president of the United States here.) Chait notes:

For all the speculation about the existence of the pee tape, the latest revelations prove what is tantamount to the same thing. Russia could leverage the president and his fixer — who, recall, hand-delivered a pro-Russian “peace plan” with Ukraine to Trump’s national-security adviser in January 2017 — by threatening to expose secrets they were desperate to keep hidden. Whether those secrets were limited to legally questionable payments, or included knowledge of sexual affairs, is a question of degree but not of kind.

 Chait goes on to tell the sordid tale of the chair of the House Intelligence Committee making every effort to undermine and obstruct the investigation, including trying to expose a secret intelligence source who would likely pay the price of his life:

Think for a moment what this report tells us. The chairman of the House Intelligence Committee, who enjoys the full backing of his party’s leadership, is willing to risk what his own government describes as the betrayal and potential loss of life of an intelligence source. And officials within this government believe the president would do the same, all in order to obstruct an investigation into the president’s secretive ties to a foreign power. They are acting as though Trump is compromised by Russia, or at the very least, that he cannot be trusted to defend his own country’s security against it. The sordid Russia scandal has already brought some version of a very dark nightmare scenario to life.
This is where we stand. The president is a tool of a foreign adversary, the president's party in congress knows this full well and is trying to protect him rather than expose him, and the corporate media are covering their eyes and plugging up their ears. This is treason.

PS: There are obviously dozens of good reasons to give hundreds of thousands of dollars to Michael Cohen that have nothing to do with Donald Trump. I invite y'all to list them.

Sunday, May 06, 2018

My friend Mel

Here is the rest of Genesis 14.

17 After Abram returned from defeating Kedorlaomer and the kings allied with him, the king of Sodom came out to meet him in the Valley of Shaveh (that is, the King’s Valley).
18 Then Melchizedek king of Salem brought out bread and wine. He was priest of God Most High, 19 and he blessed Abram, saying,
“Blessed be Abram by God Most High,
    Creator of heaven and earth.
20 And praise be to God Most High,
    who delivered your enemies into your hand.”
Then Abram gave him a tenth of everything.
21 The king of Sodom said to Abram, “Give me the people and keep the goods for yourself.”
22 But Abram said to the king of Sodom, “With raised hand I have sworn an oath to the Lord, God Most High, Creator of heaven and earth, 23 that I will accept nothing belonging to you, not even a thread or the strap of a sandal, so that you will never be able to say, ‘I made Abram rich.’ 24 I will accept nothing but what my men have eaten and the share that belongs to the men who went with me—to Aner, Eshkol and Mamre. Let them have their share.”
First of all, I must point out that the translators of the NIV have cleaned up an embarrassment. In the original Hebrew, it is completely ambiguous whether Abram gives the tithe to Melchizedek, or Melchizedek gives it to Abram. Many commonly used translations preserve this ambiguity, but the NIV just adopts the more common understanding. The literal translation of the phrase is just "He gave him tithe of all," with no clarity as to who "He" is. The idea appears to be that since Melchizedek is the "priest of God Most High," he gets to collect a fee in exchange for Abram's victory. Thus we have the prototype for hucksters everywhere, from Jim Bakker to Reverend Ike.

In the New Testament book Hebrews, we learn that:

7:1 For this Melchisedec, king of Salem, priest of the most high God, who met Abraham returning from the slaughter of the kings, and blessed him;

7:2 To whom also Abraham gave a tenth part of all; first being by interpretation King of righteousness, and after that also King of Salem, which is, King of peace;

7:3 Without father, without mother, without descent, having neither beginning of days, nor end of life; but made like unto the Son of God; abideth a priest continually.

7:4 Now consider how great this man was, unto whom even the patriarch Abraham gave the tenth of the spoils.
So he was never born, God just conjured him up for the occasion. And apparently he's still around. The idea is supposed to be that he somehow prefigures Jesus. A psalm also suggests that Mel is a prototype for the Messiah. But here he is still hogging a tenth of Abram's loot.


Friday, May 04, 2018

The Afterlife

British physician and commentator Margaret McCartney discusses the Alfie Evans and Charlie Gard cases in this week's BMJ. She touches upon, but doesn't try to go too deeply, into the role of religion in these disputes.

Systematic studies have found that deeply religious people -- or at least Christians, since the studies I am aware of were done in the U.S. where that's the predominant sect -- are more likely to insist on continued medical intervention with family members after doctors have concluded that further treatment is futile. And indeed, it is Catholic and right wing evangelical Christians who show up as political activists when one of these cases is highly publicized. Catholic clergy organized demonstrations to keep Terry Schiavo on life support, and the pope always seems compelled to weigh in on these situations.

Superficially, this seems odd. One of the evident functions of Christian doctrine is to facilitate acceptance of death. You get to go to heaven and hang out with your ancestors, and bask in the glory of God. Or you go to the lake of fire. Either way, you have it coming to you.

But this doesn't seem to work. Devout Christians actually seem to fear and deny the reality of death more than less religious and non-religious people. A glib explanation is reverse causation: people who have a harder time accepting death are more prone to seize on religious denial of its reality, but at heart they don't really believe that so they still insist on futile measure to prolong even the appearance of life.

The leaders of these sects need to stop promoting irrationality. Until recent decades, obviously, it was impossible to keep the tissues of brain dead people perfused with oxygen so we didn't have this problem. Whatever Jesus may have thought about death in 30 A.D. still pretty much applied. But now we need to decide when the time has come to pull the plug, and we need to decide as a society. We can't make it an individual family decision because that would give some people an unlimited claim on societal resources and take needed care away from people who could actually benefit.

Somebody needs to have a conversation with the pope.

Monday, April 30, 2018

Life Support

I am still trying to process the mind-boggling idiocy of people regarding the tragic case of Alfie Evans. Most of his brain was gone and his skull was full of water and cerebrospinal fluid. He was already dead when the doctors turned off his ventilator.

Now I am going to say this absolutely clearly. Anyone who does not understand this is provably an idiot. This outcome has no relationship whatever, none, to socialized medicine or any other characteristic of how medicine in the United Kingdom is organized and paid for. It was a judicial decision in which cost, or who was paying, or who was in charge of health care and health care policy, played no part whatever. The judge decided that continued treatment was not in the best interest of the child. That is all.

Now think about this. If you believe that the bodies of people without functioning cerebral cortices should be connected to machines that push air into their lungs and nutrients into their blood streams, and keep their hearts beating, forever or at least as long as the heart can be kept going, then this is what you are demanding:

That the nation steadily build vast warehouses filled with mechanically ventilated corpses.

Somebody has to pay for that. I propose that the Pope pay. He can sell off his solid gold candlesticks.

What Albert Burneko says

That is all.

Sunday, April 29, 2018

Sunday Sermonette: Don't know much about history

Genesis 14 is presented as a historical chronicle. It begins:

 At the time when Amraphel was king of Shinar, Arioch king of Ellasar, Kedorlaomer king of Elam and Tidal king of Goyim, these kings went to war against Bera king of Sodom, Birsha king of Gomorrah, Shinab king of Admah, Shemeber king of Zeboyim, and the king of Bela (that is, Zoar). All these latter kings joined forces in the Valley of Siddim (that is, the Dead Sea Valley). For twelve years they had been subject to Kedorlaomer, but in the thirteenth year they rebelled.
In the fourteenth year, Kedorlaomer and the kings allied with him went out and defeated the Rephaites in Ashteroth Karnaim, the Zuzites in Ham, the Emites in Shaveh Kiriathaim and the Horites in the hill country of Seir, as far as El Paran near the desert. Then they turned back and went to En Mishpat (that is, Kadesh), and they conquered the whole territory of the Amalekites, as well as the Amorites who were living in Hazezon Tamar.
Then the king of Sodom, the king of Gomorrah, the king of Admah, the king of Zeboyim and the king of Bela (that is, Zoar) marched out and drew up their battle lines in the Valley of Siddim against Kedorlaomer king of Elam, Tidal king of Goyim, Amraphel king of Shinar and Arioch king of Ellasar—four kings against five. 10 Now the Valley of Siddim was full of tar pits, and when the kings of Sodom and Gomorrah fled, some of the men fell into them and the rest fled to the hills. 11 The four kings seized all the goods of Sodom and Gomorrah and all their food; then they went away. 12 They also carried off Abram’s nephew Lot and his possessions, since he was living in Sodom.
In the first place, you may be wondering about Tidal who was "king of Goyim." Today, "goy" means a non-Jewish person; goyim is the plural. But in Biblical Hebrew, "goy" means nation. So tidal is the kind of nations that, for some reason, are unnamed. As for the other kings, they do not correspond to any known facts in the archaeological record. Indeed, attempts to map them onto known entities have resulted in historical impossibilities since the dates don't match up. The Wikipedia discussion of the battle of Siddim is interesting because it shows how biblical scholarship eventually managed to demonstrate only that this is almost certainly not a record of actual historical events. So what is it? According to one hypothesis (see the Wikipedia entry):

One modern interpretation of Genesis 14 is summed up by Michael Astour in The Anchor Bible Dictionary (s.v. "Amraphel", "Arioch" and "Chedorlaomer"), who explains the story as a product of anti-Babylonian propaganda during the 6th century Babylonian captivity of the Jews:
After Böhl's widely accepted, but wrong, identification of  Tu-ud-hul-a with one of the Hittite kings named Tudhaliyas, Tadmor found the correct solution by equating him with the Assyrian king Sennacherib (see Tidal). Astour (1966) identified the remaining two kings of the Chedorlaomer texts with Tukulti-Ninurta I of Assyria (see Arioch) and with the Chaldean Merodach-baladan (see Amraphel). The common denominator between these four rulers is that each of them, independently, occupied Babylon, oppressed it to a greater or lesser degree, and took away its sacred divine images, including the statue of its chief god Marduk; furthermore, all of them came to a tragic end ... All attempts to reconstruct the link between the Chedorlaomer texts and Genesis 14 remain speculative. However, the available evidence seems consistent with the following hypothesis: A Jew in Babylon, versed in Akkadian language and cuneiform script, found in an early version of the Chedorlaomer texts certain things consistent with his anti-Babylonian feelings.
Anyhow, to continue:

13 A man who had escaped came and reported this to Abram the Hebrew. Now Abram was living near the great trees of Mamre the Amorite, a brother of Eshkol and Aner, all of whom were allied with Abram. 14 When Abram heard that his relative had been taken captive, he called out the 318 trained men born in his household and went in pursuit as far as Dan. 15 During the night Abram divided his men to attack them and he routed them, pursuing them as far as Hobah, north of Damascus. 16 He recovered all the goods and brought back his relative Lot and his possessions, together with the women and the other people.
The New International Version is dissembling here. The "318 trained men born in his household" are slaves. (The KJV calls them "menservants.") Remember Genesis 12, when "Abram acquired sheep and cattle, male and female donkeys, male and female servants, and camels." The people are his possessions, mentioned among the livestock. 

Note further proof of anachronism. Abram caught up with Kedorlaemer and the gang in Dan; but the city of Dan did not exist until the time of the Judges; and the person for whom it is named is not yet born. 

We'll do the rest of this chapter next week.  But once again think about this. Why is this text sacred? What moral or spiritual message might it convey to believers? Why would we want to read this?


Saturday, April 28, 2018

And around we go again

Another brain dead baby is removed from life support in Britain and the "Christians" start howling. The case of Alfie Evans is pretty much identical to that of Charlie Gard, which we went through last year. Both had neurodegenerative conditions which resulted in the destruction of the cerebral cortex and a vegetative state. In both cases, their physicians wanted to take them off of life support and the parents fought it, refusing to accept reality. Along came the Pope and the Christian right calling the doctors murderers.  We also got the plain old right claiming that it was socialism that was killing these babies.

First, let's dispense with "socialism" nonsense. Britain does have socialized medicine but that has absolutely nothing to do with either case. It was the doctors, not the government, who proclaimed both cases hopeless. The policy in the U.K. is to do what can be done to keep babies alive, but these babies were dead. And the exact same scenario happens in the United States, with regularity.

In fact, with socialized medicine it is more likely that more will be done in such cases because if  everybody has insurance, and there is  a deeper risk pool, and more widely shared stakes. In the U.S., people with no insurance, or inadequate insurance, die all the time from preventable causes. That is perfectly okay with the same sanctimonious right wingers who are blaming socialism for these babies' deaths. The UK is a parliamentary democracy and if there was a public consensus, or even a substantial but highly motivated minority, who wanted these babies to be kept by machines in a state that simulates life, then politicians would make sure it happened. They didn't, because that's not what most British people want.

The reason most British people don't want that is because they are reasonable. If what was once a human organism has no awareness, no volition, and no hope of ever recovering any, then that is no longer a living human in any meaningful sense and it is pointless to spend vast sums of money keeping most of their cells alive. This is not about Christianity or socialism. It's about common sense.

The pain the parents are feeling is unimaginable and I can understand why they were mired in such deep denial. But humoring that denial is not doing them any favor either. It's just prolonging their torture, for your own sanctimonious satisfaction or self-promotion. People die. That's life.

Wednesday, April 25, 2018

Veterans Affairs

People think of the VA as mostly an immense integrated medical system, but it also administers numerous non-medical benefit programs and has a cemetery department as well. As has been widely reported lately in relation to the new nominee to be VA Secretary, VA budget is $273 billion, although a billion or so of that is actually the cost of disability benefits and other direct payments. Still, $170 billion is a chunk of change, and it supports some 378,000 people.

I can tell you from personal experience that the VA has labyrinthine bureaucracy, in part unavoidably because they need to have a very high level of security concern and congress has given them intricate legal obligations. There have been a lot of reports about long waits for care and other problems with the adequacy and quality of services. This is not, however, because most VA employees aren't trying to do their best for veterans. It's because George Bush II started two big wars and some smaller ones that he pretended weren't going to cost anything or actually hurt anybody. Instead we wound up with 8,000 military personnel killed in action and more than 50,000 wounded, plus hundreds of thousands more with non-combat injuries and psychological trauma, and 2.6 million post-911 veterans. (The VA has officially diagnosed more than 200,000 post-911 veterans with PTSD.) Bush didn't ask for any money to take care of them, on the assumption that they wouldn't exist, so the VA is still trying to catch up.

So fixing this is a big job which requires somebody with major management skills and experience. White House doc Ronnie Jackson is not that. He got nominated for the job because he gave a speech declaring the Resident to be the healthiest person who ever lived, while trimming his weight and stretching his height enough to make him officially non-obese. That's it. As Yglesias says, who cares if he drinks on the job or hands out happy pills? He doesn't know what he's doing in such a job, has absolutely no relevant qualifications (the job does not involve actually being a doctor), and the weirdest thing about all this is that Jackson would actually want it, because he is guaranteed to fail.

Sure, the Republicans want to destroy HUD and the EPA and the DOE, which is why they appointed grossly unqualified people. But presumably they don't want to destroy the VA. Why on earth would Republican senators vote to confirm this clown? Loyalty to the country and the Republican party have nothing to do with each other.

Tuesday, April 24, 2018

We get e-mail

Seriously:

Hello Mr./Ms.,
I wanted to email you to see if we can schedule an interview with [redacted] Skincare,  a line that is infused with crystals and made with pure intention.  Crystals are placed around the products as they’re being made.  Filled with intentions and positive energy to add to the product’s overall vitality the space where the products are created bans cell phones and no outside  conversation is allowed.  Only energy infused crystals, purity, positive intentions, and very high quality ingredients, packaged in the most eco-friendly packaging!

Is there hope for humanity?

Sunday, April 22, 2018

Sunday Sermonette: Ill-gotten Gains

Genesis 13:

So Abram went up from Egypt to the Negev, with his wife and everything he had, and Lot went with him. Abram had become very wealthy in livestock and in silver and gold.

Yeah, which he got by pimping out his wife to Pharaoh. 

 
From the Negev he went from place to place until he came to Bethel, to the place between Bethel and Ai where his tent had been earlier and where he had first built an altar. There Abram called on the name of the Lord.
Now Lot, who was moving about with Abram, also had flocks and herds and tents. But the land could not support them while they stayed together, for their possessions were so great that they were not able to stay together. And quarreling arose between Abram’s herders and Lot’s. The Canaanites and Perizzites were also living in the land at that time.

No telling how Lot got his loot. As for the Canaanites, you may recall that God cursed them to be forever slaves. Curses seems inoperative.
 
So Abram said to Lot, “Let’s not have any quarreling between you and me, or between your herders and mine, for we are close relatives. Is not the whole land before you? Let’s part company. If you go to the left, I’ll go to the right; if you go to the right, I’ll go to the left.”
10 Lot looked around and saw that the whole plain of the Jordan toward Zoar was well watered, like the garden of the Lord, like the land of Egypt. (This was before the Lord destroyed Sodom and Gomorrah.) 11 So Lot chose for himself the whole plain of the Jordan and set out toward the east. The two men parted company: 12 Abram lived in the land of Canaan, while Lot lived among the cities of the plain and pitched his tents near Sodom. 

Spoiler alert! Sodom and Gomorrah are going to be destroyed! Why are we getting this info now? Probably because the reader might know that the plain of Jordan toward Zoar, on the southwest edge of the Dead Sea, is arid scrubland.

13 Now the people of Sodom were wicked and were sinning greatly against the Lord.

Again, this seems out of context. We aren't actually told what their wickedness was, but Christians generally assume that it was homosexuality, for some reason.

14 The Lord said to Abram after Lot had parted from him, “Look around from where you are, to the north and south, to the east and west. 15 All the land that you see I will give to you and your offspring forever. 16 I will make your offspring like the dust of the earth, so that if anyone could count the dust, then your offspring could be counted. 17 Go, walk through the length and breadth of the land, for I am giving it to you.” 18 So Abram went to live near the great trees of Mamre at Hebron, where he pitched his tents. There he built an altar to the Lord.

Well, as it turns out God won't exactly keep his promise. The area was ruled by the Canaanites; if Abram really was there, it was as a nomadic herder, not as possessor of the territory. And of course, as we will see, his descendants are kicked out and Joshua later reconquers the territory. Even that turns out to be temporary. Today, Hebron is a Muslim Arab city, in Palestine. And there are probably more motes of dust in my living room than all the humans who have ever lived. But we'll take that one as a metaphor.  However, the mythical grant of the land to Abram and his descendants constitutes the basis of the Zionist claim on the territory. Really. That's it.