Facts, Truth & Being Nice to One Another

Truth sign“Critical thinking,” says author Tom Nichols, “is that thing that says ‘Start asking questions. Don’t be afraid of where they go.’ It is okay to change your mind.”

Nichols, who has changed his mind more than once but has never not been a critical thinker, was in San Francisco recently promoting his latest book, The Death of Expertise: The Campaign Against Established Knowledge and Why It Matters. He is more than a little concerned that the acceptance of untruths and outright lies, and the increasing willingness to ignore experts on all subjects, is going to get our democracy into deep trouble.

“There’s been a change,” he says, “from ‘I doubt you; explain.’ to ‘I know more than you do.’”

Tom Nichols & Melissa Caen 5.24.17

Tom Nichols & interviewer Melissa Caen

Nichols is unquestionably an expert himself – a professor at the U.S. Naval War College, at the Harvard Extension School, a Sovietologist, and a five-time undefeated Jeopardy! champion (among a long list of other credentials on his Wikipedia page) – and sees many reasons for the death of expertise. A virtual epidemic of narcissism, for one; technology in many of its uses and abuses for another. But the danger of the “collapse of expertise,” he says, is that it can easily lead to mob rule. And poof, there goes democracy. Nichols is concerned, as he writes in The Death of Expertise, that “Americans have reached a point where ignorance, especially of anything related to public policy, is an actual virtue.”

House minority leader Nancy Pelosi was also in town recently, talking a good bit about facts and truth herself. Unsurprisingly, Pelosi feels there is not much respect for either in the present administration. She opened her remarks with a report on President Trump’s first meeting with congressional leaders. “The first thing the president said was, ‘Do you know I won the popular vote?’ Now first, that wasn’t relevant to what we were there for. And it wasn’t true.”

Nancy Pelosi & Scott Shafer 5.30.17

Pelosi with interviewer Scott Shafer of KQED

Pelosi repeatedly said she felt things could get done, including on many issues that would require  cooperation between Democrats and Republicans. “But we have to start with facts. Data. Truth.”

Nichols says the best way to get the facts – “the real story” – is to read multiple sources. (“I read the Washington Post, New York Times, and Wall Street Journal.”) And to those who would say, “I don’t have time,” Nichols has one answer: “Yes. You. Do.”

If the issues and the problems are complex, Nichols suggests that part of the answer is sublimely  simple: “We have to be nicer,” he says. “We have to believe we want the best for each other.”

That has, in a not-so-distant past still fondly recalled by more than a few Americans, been true.

 

 

 

Talking Your Way into a Better Death

Angelo Volandes

Angelo Volandes

“If you do something to my body that I do not want,” says physician/author Angelo Volandes, “it is assault and battery. But if I do the same thing to you in (a medical situation,) it is standard of care.”

Volandes thinks this last is a bad idea. He is on a campaign to change the way American doctors and patients, and indeed the country at large, understand what is done to American bodies at life’s end. He spoke of this campaign, and his new book The Conversation that outlines it, at a recent Commonwealth Club event in San Francisco. When he’s not taking time out to promote the book and the campaign, Volandes practices internal medicine at Massachusetts General Hospital in Boston and is on the faculty at Harvard Medical School. He is Co-Founder and President of Advance Care Planning Decisions, a non-profit foundation dedicated to improving patients’ quality of care.

“Ninety percent of people want to die at home,” Volandes says; “most die in hospitals. There is a misalignment between the type of medical care they want and what they get.” About this unwanted care? “If you’re in the hospital and get unwanted care you never bargained for, I still get paid for it.”

After watching too many patients endure end-of-life treatments he was sure they would not have chosen, Volandes started an unusual practice: taking every one of his patients to visit the intensive care unit, and some to visit the dialysis unit. Once they gained a better understanding of what some of the aggressive treatments – CPR, breathing machines, etc – actually looked like, the patients almost always moved away from “Do everything” to comfort care as their choice.

The basic change Volandes believes is needed begins with a conversation between physician and patient. Those conversations do happen, and there is now Medicare reimbursement, but few physicians find them easy, and few patients know how to inaugurate them or what to say. “Never did a senior physician have to certify that I could talk to a patient,” Volandes says. “The patient needs to know ‘What are the questions I need to ask? What are my options?’ Life’s final chapter needs to be written – but the problem is, I’m writing it (instead of the patient.)”

This writer has been advocating for individuals to write their own final chapters for over two decades. With others writing those chapters instead, the costs are monumental and unnecessary – and millions of Americans die after undergoing painful indignities they would never have chosen. Physician aid-in-dying – approved by a majority of doctors and 7 in 10 Americans and now legal in five states – is one key piece of the puzzle. But the elephant-size puzzle piece is how to get every one of us to make known, well before those “end-of-life” days arrive, what medical care we do or do not want.

Volandes’ conversations could put that piece in place. Every person alive who takes time for the conversation (and for writing it all down) will likely die a better death.

 

 

Music as – – – the better alternative

The author with the Lewis' - father & daughter

The author with the Lewis’ – father & daughter

If music is balm for the soul, what else might it be?

A lot, according to Peter Lewis – musician, composer, songwriter and founding member of the 1960s rock band Moby Grape. Lewis and his daughter Arwen Lewis – also musician, composer, songwriter, and someone who holds down a day job as a waitress – explored this question at a recent event at San Francisco’s Commonwealth Club.

The event was officially billed as a discussion (with live music!) of Music as an Alternative to Adversity. It evolved into a rambling discourse on good love and bad, on the sixties, spirituality and freedom, and how music winds through it all. The elder Lewis did the lion’s share of talking, with daughter Arwen benevolently looking on. But Arwen, an accomplished musician who bears a resemblance to her glamorous paternal grandmother Loretta Young, repeatedly brought her father back to the song they were about to sing.

It was an hour of memorable music and musical food for thought:

Peter Lewis on music overcoming adversity: “When you get born you cry until you’re fed; later you’re singing for your supper. It’s spiritual. Spirits move through us, and through each other – but there are all kinds of different songs.”

On “Sailing,” the first song played by the duo: “I wrote this with Skip Spence of Moby Grape; its first recording will be released in February. It’s about longing. Songs are not written in a vacuum; you feel something – and the song is born.” Spence, who suffered from addiction, bad drugs and schizophrenia, died in 1999 at the age of 53.

On loneliness and the blues: Arwen – “I live with my parents near Santa Barbara and drive 65 miles a day to work as a waitress. I wrote ‘The Lompoc Blues’ when I was having a bad day.” Peter: “We live in a nice community near the Air Force base and the penitentiary. But you can go all day and never see anybody smiling.”

On being the son (and granddaughter) of a famous movie star – Peter: “I asked my mom what it was like . . . She was brought to Hollywood by her mom, who ran a boardinghouse. I went to Purdue, in the pilots program; it was my mom’s boyfriend who got me in. I wasn’t one of the seven best pilots in America. But it was a scary deal, the draft. I’m in this line, and you don’t go home from the induction center; I was crying like a baby.” (According to his Wikipedia page, Lewis served in the Air Force, and afterwards worked as a commercial pilot.) “My mom said, ‘Either cut your hair or get out of my house.’” Loretta Young, whose two sisters also began acting as children, died in 2000 after retiring from a noted career in film and television. Arwen: “She used acting as an alternative to adversity.”

On bad love – Arwen: “I sing lead in this, which is more sing-song-y. It’s about the sixties, when there was a lot of loneliness . . .” Peter: “Love’s a two-way street. We were all trying to be characters in a Jack Kerouac novel – so you write some facetious tunes. The sixties were not so much about rebellion as about freedom.” The duo then launched into a song that included the lines, “If you can’t learn from my mistakes, honey I can’t learn from yours;” and eventually, “If you can’t pay for my mistakes, honey I can’t pay for yours.”

Nearing the end of their time, Arwen reminded her talkative father that they still had several songs to go. Only one could be squeezed in: a closing number with an almost Latin/blues rhythm, “You must believe in love.”

Good love won.

 

It was — 1933 — a very good year

Ruth Bader Ginsberg

Ruth Bader Ginsberg

Ruth Bader Ginsberg is too old? Perhaps she should consider stepping down from the Supreme Court?

These suggestions were floated more than once in the Q&A session after a recent Commonwealth Club talk by University of California Hastings Professor of Law Scott Dodson. Dodson is the editor of a newly released collection of essays, The Legacy of Ruth Bader Ginsberg, whose writers suggest nothing of the kind. Contributors to the book, and Dodson himself, focus instead on the significant contributions made thus far by the 82-year-old justice, and the impact she continues to have on jurisprudence and on life in the U.S.

Dodson was drawn to write about Ginsberg because he “kept encountering her clear and consistent opinions” and wanted to create an objective view of her legacy – notably including gender discrimination, as in the case that ended Virginia Military Institute’s male-only admission policy, and racial discrimination, as in the voting rights case Shelby County v Holder. In the latter case, Ginsberg famously wrote that throwing out an anti-discriminatory measure as no longer needed “is like throwing away your umbrella in a rainstorm because you are not getting wet.”

As New York Times columnist Gail Collins wrote several months ago: Ruth Bader Ginsberg has no interest in retiring.

Carol_Burnett_1958

Carol Burnett in 1958

Several days before the Dodson talk, David McCullough, 82, spoke at another San Francisco event in conjunction with his most recent book, The Wright Brothers. McCullough did not go into detail about his next project, but gives every indication that he is a writer with no interest in retiring.

Meanwhile in Texas, Willie Nelson, 82, has another concert coming up, and the next show planned by Carol Burnett, 82, is almost sold out.

This writer may not have anything else in common with Ruth, David, Carol and Willie, but we take what we can get. 1933 wasn’t a bad year to be born.

 

ISIS: What’s In A Name?

Islamic State flag

Remember when Isis was just a Greek goddess? The goddess of – among other things – health and wisdom?

Not many people today would know the goddess, but there are few who don’t know ISIS. According to a new CNN/ORC poll, people in the U.S. consider ISIS a greater threat than Iran, Russia, North Korea, China – or probably even the economic woes of the earlier Isis’ native land.

In an effort to increase understanding of the situation, Celia Menczel of San Francisco’s Commonwealth Club Middle Eastern Affairs group recently assembled a panel of experts to discuss the issue in both human and political terms. Moderated by Media Analyst Dina Ibrahim, the program was titled The Islamic State. Panelists included Honorary Consul General of Turkey Bonnie Joy Kaslan; Kurdish human rights activist Karaman Mamand; University of California, Davis Professor Karima Bennoune, author of the irresistibly titled Your Fatwa Does Not Apply Here; and Jordanian academic Maher Kalaj.

Panelists were invited to give a brief overview of their perspectives. This unfortunately was an impossible assignment; though several panelists made valiant attempts, it turns out that expert views and insights on the Islamic State simply cannot be condensed into ten minutes – if, indeed, a day. The issue is too vast, too complex, too fraught and too weighted with centuries of conflict.

But on one issue there was emphatic agreement: ISIS is not a state.

Kaslan led off her summary with that declaration, and concluded by stressing the importance of this distinction: ISIS, ISIL, SIC, IS, Da’ish is many things, but not a state. Among the many things it is? A terrorist organization; an amorphous group of men who commit unspeakable acts of violence and brutality; a sprawling movement that condones and conducts beheadings, kidnappings, mass executions of religious groups, absolute subjugation of women.

A state, most would argue, involves more than territorial control – which ISIS surely has, in constantly shifting areas – and more than the declaration of power. A state exhibits some degree of care and concern for its people – and the rest of humankind.

Many diverse elements of the troubling terrorist movement were illuminated by members of the distinguished panel, but this was perhaps the key:

Whatever ISIS is, it’s not Islamic to the vast majority of believers in Islam…… and hopefully it will never become a state.

Life: a sexually transmitted, fatal condition

Life: a sexually transmitted, fatal condition

sunset

Life is a sexually transmitted condition that is invariably fatal.

That well-phrased truth – often attributed to British author Neil Gaiman – led off a talk not long ago at San Francisco’s Commonwealth Club by Atul Gawande, physician and author of, most recently, Being Mortal. Gawande’s message was all about being mortal, and facing that inevitable death in advance. In other words, if we mortals could please just admit our mortality – and talk about what we’d like our final days/weeks/months to look like – much good would result.

This writer has been on that soapbox for several decades.

Gawande and his interviewer, University of California San Francisco professor Alice Chen MD, spoke of the need for shared decision-making, shifting away from the paternalistic ‘doctor knows best: here’s what we’re going to do for you’ attitude to the physician giving information and involving the patient in making choices. But their decision-making would still put the doctor first and patient second. This writer respectfully disagrees.

Atul Gawande

Atul Gawande

In response to a question from the audience, Gawande agreed that “a patient with unbearable suffering should be given the option to hasten death.” But he followed this perfectly rational statement with an irrational comment: “every hastened death is a failure of the medical system.”

Give us a break.

The medical system needs, at some point, to confront this reality: Life… is invariably fatal. The medical system cannot forestall anyone’s death forever. The medical system cannot protect, absolutely, against unbearable suffering. Compassionate physicians across the U.S. are recognizing this fact, and increasingly backing the legalization of aid in dying for the mentally competent terminally ill.

Gawande, Chen and countless others are proponents of palliative care, an excellent, relatively new segment of care in this country. They would have us believe that palliative care is the be-all and end-all of end-of-life care, and they oppose the option of legal aid in dying. Palliative care, an option many choose, is a fine addition to healthcare. It can keep pain to a minimum and often insure comfort; as a last resort, palliative sedation can render the patient essentially unconscious for whatever hours or days remain until death comes.

But it is a cruel myth that palliative care, or even the best hospice care, can guarantee anyone will slip peacefully from good life to gentle death. Pain, indignity, discomfort and distress are part of the process; some of us don’t want much of that.

Legal aid in dying, the option to choose at what point to let invariable fatality happen, is the only guarantee. It’s an option that we should all have.

Russia-Ukraine Conflict in One Fast Hour

Foreign Affairs 101:

Ukraine_Majority_Language_Map_2001

Ukraine Majority Language Map

If it’s possible to condense the incomprehensibly complex Russia/Ukraine conflict into one coherent hour, Matthew Rojansky can do it. Rojansky, Director of the Kennan Institute and an expert on the region, proved that in a recent presentation at San Francisco’s Commonwealth Club. A listener who blinked could miss a paragraph, but Rojansky’s fast-paced illustrated lecture had most of his audience too engaged to blink. What follows is an abbreviated summary of the presentation.

Yanukovich estate

Yanukovych Estate

For openers, Rojansky explained that Ukraine, under now-deposed leader Viktor Yanukovych, was “a society absolutely primed for revolt. A few years ago,” Rojansky said, “I moved to Kiev with my family, (finding) Yanukovych one of the most corrupt politicians in history – and that’s saying something.” Illustrating his point, Rojansky showed slides taken during his time in Kiev including views of some of Yanukovych’s perks: a heli-pad; a palace with gold, jewel-encrusted design, 3-lane bowling alley, billiard room, private floating pirate-themed restaurant reported to have cost a few billion dollars – a rather definitive picture of excess. Rojansky also mentioned the stuffed lion guarding a corridor leading to the nail salon and spa, and a collection of exotic cars and animals. It was not just personal excess, he said, “there was government corruption on a grand scale.”

By the fall of 2013, Ukranian citizens were tiring of this. A peaceful protest known as the Euromaidan began in the square Rojansky and his family could see from their apartment window. “It was surreal.” Public sentiment favored closer connections to Europe, Rojansky said, but Yanukovych instead signed an agreement with Russia’s Vladimir Putin. Thus began the increasing protests fueled largely by social media, with help for the needs of Euromaidan solicited via constant Facebook postings.

Matthew Rojansky

Matthew Rojansky at the Commonwealth Club 3.6.15

Initially, Rojansky explained, the movement was not political. But also thanks to social media – Twitter users began receiving messages letting them know they were registered as protesters – things quickly changed. And on January 16, 2014, the dictatorship laws were passed: No protests, no groups, no gatherings. The movement against abstract corruption became ‘Yanukovych Must Go.’ Things came to a crisis when someone gave the order to fire and all-out shooting began. Despite the European Union intervening to broker a deal in late February, Yanukovych escaped – with boxcars of treasure – though leaving behind the exotic animals still being cared for on his former palatial estate outside Kiev.

Soon came the time of “the little green men” in Crimea, a significant chunk of Ukraine on the Black Sea. Rojanksy explained that there have always been Russians in Crimea; the little green men wore Russian military garb minus the insignia, carried Russian weaponry, but Putin at the time denied they were sent by Russia.

Donetsk airport

Donetsk Airport

By May of 2014, Rojansky said, regions of Ukraine that are heavily Russian-speaking began to hold referenda to break away – not to become independent, but to become part of Russia. Things accelerated significantly with the downing of a Malaysian Airlines plane in July, 2014, and the ground war began. “This was not World War II,” Rojanksy explained, but guerilla warfare with terror tactics, firing on civilian buildings, the destruction of the once-beautiful Donetsk airport. “This is insane stuff.”

As to what Mr. Putin wants out of all this? Rojansky listed three main points;

1 – Domestic politics are life-or-death. If the idea that when regular people take to the streets life gets better catches on, Russians might say “What about us?”

2 – Putin has a major image issue. He’s the tsar. He is never wrong. There’s God, and then there’s the Tsar.

3 – Geopolitics are important. If Russia and Crimea get together, Putin’s bargaining power is greater.

Rojanksky characterizes Ukraine as being between a rock and a Russian hard place. The hard place is boosted by the fact that half the people in Ukraine speak Russian, and many more watch Russian TV with its decidedly nationalist fervor.

For now, Rojansky says the wise course is “Don’t show up giving out cookies. Get observers on the ground as fast as possible, and eyes on the ground on the borders. Watch to see if sanctions are working.

And in the very long term: “Ukraine matters. We have to help Ukraine defeat corruption. Things we can do include letting Ukrainians come here, and knowing about the region.” In the end:

“There are no easy answers.”

Disclaimer: This writer knows as little about Russia and Ukraine as a few long-ago college courses and one unforgettable trip from Moscow to St. Petersberg might suggest. But listening to Matthew Rojansky’s take on the current situation is enough to convince one to pay attention.