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Saturday, July 4, 2020

Practising humility: how philosophy can inform general practice

Chris Murphy in BJMP:

As a philosopher turned GP myself, David Hume has long been my favourite philosopher. He lived in 18th-century Scotland, with renowned Scottish physician William Cullen as his own doctor and friend. Hume attended university at age 12, early even in those days, pushing himself so far that he ended up developing the ‘Disease of the Learned’ — a malady that seems to have been a sort of depression or nervous breakdown. Philosophers can suffer from burnout too.

In philosophical circles, Hume is considered to be ‘one of the most important philosophers to write in English’1 but his isn’t the name that springs to mind if the man on the street is asked to name a famous philosopher. In fact, there’s much to recommend Hume as the most ‘GP’ figure of the Enlightenment. In An Enquiry Concerning Human Understanding he sets out to apply the scientific method to the study of human nature. I can’t think of a more succinct way to describe the aims of modern general practice. A morning surgery can provide several patients with not much in the way of textbook pathology, but human nature is always on full display. If Hume himself was sitting in on my consultations, I imagine him suggesting that, because reason is ‘impotent’, I must ‘excite the moral passions’ of my patients. If smokers really wish to change their behaviour, Hume would think that it is not enough to print ‘SMOKING KILLS’ on the packet — you must also include a disgusting picture of a diseased lung. And he might have a point.

Hume teaches humility. A recent thoughtful editorial about medically unexplained symptoms2 drew a variety of responses. It is clear that, for some doctors, the idea that certain things might be ‘unexplained’ or even ‘unexplainable’ is anathema. Their message is clear: we must simply try harder.3

But Hume spilt a lot of ink concerning the idea of cause and effect, and indeed expressed ‘sceptical doubts concerning the operations of the understanding’.4 He thought many of the beliefs we form seem to be the product of ‘some instinct or mechanical tendency’ rather than any truly rational process.

More here.

Saturday Poem

RK As a Young Gardener

where is the grass in your garden, bob, that thrives in drought at 40
below,  and drives spikes into the heart of the garden you are
hoping to turn into a hot bed of noxious poetry and how beset by
mildew and beetles does your cabbage grow

i sing of pig weed dock and lamb’s quarter sing the cows who
amble stoically through the ragweed taller than rain forests you
felled and ploughed by dandelions that shone like wet suns witness
to your faith in cauliflower until you pulled one just for a fistful of
yellow a clump of dirt you raked spring looking for snakes and
crickets and what we called portulaca that clung to clay roads and
gravel lanes and your front yard except it was camomile where
they propped cars and thistles popped like revolutionaries from
shadow and from the shallow dirt into proper muffs that
turn purple and bristle under a sun that shriveled your mother’s
petunias the cows knowing there was stinkweed first thing in
spring, shockingly lush, which they leaped moons and fences to
eat, trampled wire and post, spoiled the milk with their slobbery
green breath moseyed near the leggy brown-eyed susans alongside
the ditches that rolled in clover a hard row to hoe where the
potatoes dug in like sappers and someone plucked the lady bugs
doused them in kerosene

by Robert Kroetsch
The Typescript

The Day the White Working Class Turned Republican

Clyde Haberman in The New York Times:

Kuhn, who has written before about white working-class Americans, builds his book on long-ago police records and witness statements to recreate in painful detail a May day of rage, menace and blood. Antiwar demonstrators had massed at Federal Hall and other Lower Manhattan locations, only to be set upon brutally, and cravenly, by hundreds of steamfitters, ironworkers, plumbers and other laborers from nearby construction sites like the nascent World Trade Center. Many of those men had served in past wars and viscerally despised the protesters as a bunch of pampered, longhaired, draft-dodging, flag-desecrating snotnoses.

It was a clash of irreconcilable tribes and battle cries: “We don’t want your war” versus “America, love it or leave it.” And it was bewildering to millions of other Americans, including my younger self, newly back home after a two-year Army stretch, most of it in West Germany. My sympathies were with the demonstrators. But I also understood the working stiffs and why they felt held in contempt by the youngsters and popular culture.

New social policies like affirmative action and school busing affected white blue-collar families far more than they did the more privileged classes that spawned many antiwar activists. For Hollywood, the workingman seemed barely a step above a Neanderthal, as in the 1970 movies “Joe,” about a brutish factory worker, and “Five Easy Pieces,” in which a diner waitress is set up to be the target of audience scorn. (Come 1971, we also had “All in the Family” and television’s avatar of working-class bigotry, Archie Bunker.)

It was, too, an era when New York was changing fast and not for the better.

More here.

Friday, July 3, 2020

Megha Majumdar: The novelist discusses the politics of silence, questioning your idols, and the accumulation of shame

Madhuri Sastry in Guernica:

Megha Majumdar’s polyphonic debut novel, A Burning, follows the loosely intertwined lives of Jivan, Lovely, and PT Sir in Kolkata, during a time of rising Hindu Nationalist sentiment. Jivan, a Muslim girl, happens to be present at a train station during a terrorist attack that ends with a locomotive in flames. Soon after, she makes a Facebook comment critical of police inaction, and government’s consequent complicity in the deaths of innocent people. She writes: “If the police watched them die, doesn’t that mean that the government is also a terrorist?” She is arrested and imprisoned for her “anti-national” comment, her religious identity serving as ostensibly irrefutable evidence of her disloyalty to the Indian state. Before her arrest, Jivan taught English to Lovely, a transgender woman with silver-screen dreams. Lovely has information that could exonerate Jivan, but her Bollywood dreams hinge on the role she will play in Jivan’strial. PT Sir, the Physical Education teacher at Jivan’s school who occasionally shares food with her out of pity, taps into political aspirations he didn’t even know he had, rising steadily through the Jana Kalyan Party ranks and accumulating power at great costs, including to Jivan.

Majumdar’s novel — and our conversation about it — centers on the oppressive nature of systemic marginalization, and how it affects individual existence and political participation.

More here.

Cosmic Rays May Explain Life’s Bias for Right-Handed DNA

Charlie Wood in Quanta:

If you could shrink small enough to descend the genetic helix of any animal, plant, fungus, bacterium or virus on Earth as though it were a spiral staircase, you would always find yourself turning right — never left. It’s a universal trait in want of an explanation.

Chemists and biologists see no obvious reason why all known life prefers this structure. “Chiral” molecules exist in paired forms that mirror each other the way a right-handed glove matches a left-handed one. Essentially all known chemical reactions produce even mixtures of both. In principle, a DNA or RNA strand made from left-handed nucleotide bricks should work just as well as one made of right-handed bricks (although a chimera combining left and right subunits probably wouldn’t fare so well).

Yet life today uses just one of chemistry’s two available Lego sets. Many researchers believe the selection to be random: Those right-handed genetic strands just happened to pop up first, or in slightly greater numbers. But for more than a century, some have pondered whether biology’s innate handedness has deeper roots.

More here.

The Guardian view on Israel and annexation: unlawful, unwise and immoral

Editorial from The Guardian:

Annexation looks like the executioner of the two-state solution. Israel has changed the facts on the ground, with the rapid growth of settlements rendering that goal less and less viable. But the declaration of sovereignty over parts of the occupied territories, in putting a formal seal on physical realities, will be a new and terrible moment, and above all a fresh injustice to Palestinians.

Under the deal agreed to form Israel’s unhappy unity government, the prime minister, Benjamin Netanyahu, can begin annexation from 1 July. But the plans may be delayed. Benny Gantz, Mr Netanyahu’s coalition partner and political foe, has said that the date is neither “sacred” nor urgent, given a second surge in coronavirus cases and economic damage from the first. While Donald Trump is as erratic as ever, Israeli media have reported that a lack of US support is pushing back an announcement.

More here.

Art by Women About Women Making Art About Women

Melissa Febos at The Believer:

The first lesbian movie I loved was Heavenly Creatures, Peter Jackson’s sumptuous 1994 film starring a young Kate Winslet as a dangerously charismatic schoolgirl who enraptures a sallow classmate with her phantasmagoric fantasy world. In the end, they kill the classmate’s mother. At age fourteen, that squared with my concept of love: predicated on fantasy, eroticized by power imbalance, likely to end in murder—not so much that of anyone’s mother, but more likely of me, by the strength of my own whirling feelings.

A year later, it was The Incredibly True Adventures of Two Girls in Love, Maria Maggenti’s considerably less gothic tale of high school senior Randy (a young, butch Tina from The L Word), who has been sleeping with an older, married woman when she meets Evie, a rich and popular girl who stops at the gas station where Randy works. The movie ends with the two kissing amid a chaotic muddle of class tension, homophobic friends, and angry parents and school administrators. 

more here.

God’s Architect

Ingrid D. Rowland at the NYRB:

St. Peter’s Basilica, Vatican City, 1993

To this aged Michelangelo, with his frailties, his frustrations, and his insoluble contradictions, William Wallace has devoted the latest and most poignant of his books on the artist (there are six others). Because all creative people start out as young people, we have a tendency to ascribe creativity to youth itself, but mature masters like Michelangelo remind us that the urge to create has nothing to do with age or the lack of it, but rather with that inventive spirit both he and Vasari called ingegno—inborn wit, cleverness, genius. The spirit often manifests young, but like wine and wood, it depends on age to reveal its full complexity. When Michelangelo turned seventy, as he does at the beginning of Michelangelo, God’s Architect, he had nineteen more years to live, every one of them spent at work. As dear friends died and his body weakened, he took on a remarkable series of huge, daunting projects, fully aware, as Wallace emphasizes, that he would never live to see them completed. In his deeply spiritual vision of the world, his own limits hardly mattered; God had called him, and he had answered.

more here.

The Cancer Chair

Christian Wiman in Harper’s:

The second-worst thing about cancer chairs is that they are attached to televisions. Someone somewhere is always at war with silence. It’s impossible to read, so I answer email, or watch some cop drama on my computer, or, if it seems unavoidable, explore the lives of my nurses. A trip to Cozumel with old girlfriends, a costume party with political overtones, an advanced degree on the internet: they’re all the same, these lives, which is to say that the nurses tell me nothing, perhaps because amid the din and pain it’s impossible to say anything of substance, or perhaps because they know that nothing is precisely what we both expect. It’s the very currency of the place. Perhaps they are being excruciatingly candid.

There is a cancer camaraderie I’ve never felt. That I find inimical, in fact. Along with the official optimism that percolates out of pamphlets, the milestone celebrations that seem aimed at children, the lemonade people squeeze out of their tumors. My stoniness has not always served me well. Among the cancer staff, there is special affection for the jocular sufferer, the one who makes light of lousy bowel movements and extols the spiritual tonic of neuropathy. And why not? Spend your waking life in hell, and you too might cherish the soul who’d learned to praise the flames. I can’t do it. I’m not chipper by nature, and just hearing the word cancer makes me feel like I’m wearing a welder’s mask.

In the cancer chair there is always a pillow and a blanket. I’ve never used either, though on two occasions (2007, 2013) my spastic reactions to my cure led nurses to hurriedly pile blankets on my feverish form in the way I pile blankets on my twin girls when they are cold. Now why did I have to think of that. The comparison, I mean. It is wildly inapt: the nurses’ ministrations are efficient and mirthless, and not once have they concluded with a good tickle. Why must the mind—my mind—make these errant excavations into pure pain? I was just digging along like a dog, chats and chairs, a pillow and a blanket.

My children have never seen a cancer chair. They’ve visited me during extended hospital stays, but that’s different, and the last one is just far back enough in their consciousnesses to be, for now, benign.

More here.

The Belt That Listens to Your Bowels

Alan Burdick in The New Yorker:

In 2005, Barry Marshall, an Australian gastroenterologist and researcher, shared the Nobel Prize in Medicine for the discovery that peptic ulcers are caused not by stress, as was commonly thought, but by a bacterium called Helicobacter pylori. (Marshall, the director of the Marshall Centre for Infectious Diseases Research and Training, at the University of Western Australia, proved this in part by ingesting H. pylori himself and becoming ill.) The finding meant that ulcers could be treated with antibiotics, and it has made stomach cancer, often associated with ulcers, a rarity in developed countries.

Marshall has also spent considerable time confronting another common gut ailment, irritable-bowel syndrome, or I.B.S. “It occupies about thirty per cent of my practice,” he told me recently. I.B.S. is a complex of conditions that is defined mainly by its broad array of symptoms, which can include stomach pain, bloating, cramps, diarrhea, constipation, or any combination thereof; eleven per cent of Americans suffer from it. “It’s a diagnosis of exclusion,” Marshall said, meaning that it’s the vague category of what’s left over when more serious possibilities are ruled out. As a result, patients often must endure a steeplechase of uncomfortable tests—colonoscopies, biopsies, stool samples—only to learn, months later, that they have I.B.S., which can be treated with medicine, changes in diet, or both.

Marshall now thinks he’s found a way to diagnose I.B.S. quickly and directly: by listening to it. Earlier this week, at the annual Digestive Disease Week conference, in Washington, D.C., Marshall described a device that he and colleagues are developing: a wide belt, to be worn by the patient, that records the creaks and undulations of the gut, analyzes them with software, and recognizes the distinct sonic signature of I.B.S. For centuries, physicians have used their ears to pick up hints of trouble in the heart and lungs. In theory, I.B.S. should succumb to a similar approach. Marshall described the ailment as “a motility problem”—an abnormal movement of matter and gases through the intestines, producing a wild range of sounds as the bowel squeezes harder or softly at different times in different places. But the gut, unlike the heart or lungs, is more than twenty feet long, and, although physicians can listen to it, “they don’t listen long enough, and it’s hard to know what to listen for,” Marshall said. He began to imagine a high-tech gadget that could listen for a couple of hours, parse the many frequency patterns, and analyze the results. “That was just a concept,” Marshall said. “When we started, it wasn’t obvious that this would work.”

Marshall drew his inspiration, in part, from his son, who helps analyze seismic data from the seabed for hints of undiscovered reserves of petroleum.

More here.

Friday Poem


Poetry catches me with her toothed wheel
and forces me to listen stock-still
to her extravagant discourse.
Poetry embraces me behind the garden wall, she picks up
her skirt and lets me see, loving and loony.
Bad things happen, I tell her,
I, too, am a child of God,
allow me my despair.
Her answer is to draw her hot tongue
across my neck;
she says rod to calm me,
she says stone, geometry,
she gets careless and turns tender,
I take advantage and sneak off.
I run and she runs faster,
I yell and she yells louder,
seven demons stronger.
She catches me, making deep grooves
from tip to toe.
Poetry’s toothed wheel is made of steel.
by Adélia Prado
The Alphabet in the Park
Wesleyan University Press, 1990

Original Portuguese at “Read more”
Read more »

Thursday, July 2, 2020

A Book Nominally About Rubens Offers An Honest Portrait Of The Way The Author’s Mind Works—And Sometimes Doesn’t

Jackson Arn in Art in America:

In his new book, The Drunken SilenusMorgan Meis doesn’t dabble in faux honesty. He goes for the real deal, and the book is all the better for it. Although he barely writes about his personal life, The Drunken Silenus is as much of a warts-and-all self-portrait as any the autofiction boom has produced. It’s a portrait of the way his mind works, and occasionally doesn’t work, and as such, it is sometimes very humiliating indeed. The book begins as a close analysis of the titular Rubens painting and ends, 172 pages later, as an analysis of, give or take, everything. Along the way, one finds a speculative character study of Silenus (in Greek mythology, Dionysus’s fat, drunken sidekick); a biographical sketch of Rubens’s father; a reading of Nietzsche’s The Birth of Tragedy, another book that takes Silenus as the jumping-off point; a biographical sketch of Nietzsche; and a long spiel about the madness of war.

That this all fits together as well as it does isn’t a triumph of structure or careful reasoning so much as a triumph of tone—a certain erudite, insolent, shallowly deep, deeply shallow tone. Meis doesn’t make points so much as bellow them with varying levels of coherence, and he seems to get a kick out of stretching already questionable analogies within an inch of their lives. Consider the following: “Rubens had learned a lesson that Nietzsche was never quite able to get through his head. It doesn’t matter. It just doesn’t matter where you do it, where you live out your life. If the shit inside is solid then it will never matter. Alas, as we’ve already noted, the shit inside Nietzsche was anything but solid. It was runny.” Isn’t this slightly awful, and rather brilliant?

More here.

Survivors of SARS-CoV-2 infection may be susceptible to reinfection within weeks or months

Amanda Heidt in The Scientist:

A pair of studies published this week is shedding light on the duration of immunity following COVID-19, showing patients lose their IgG antibodies—the virus-specific, slower-forming antibodies associated with long-term immunity—within weeks or months after recovery. With COVID-19, most people who become infected do produce antibodies, and even small amounts can still neutralize the virus in vitro, according to earlier work. These latest studies could not determine if a lack of antibodies leaves people at risk of reinfection.

One of the studies found that 10 percent of nearly 1,500 COVID-positive patients registered undetectable antibody levels within weeks of first showing symptoms, while the other of 74 patients found they typically lost their antibodies two to three months after recovering from the infection, especially among those who tested positive but were asymptomatic.

In contrast, infections caused by coronavirus cousins such as SARS and MERS result in antibodies that remain in the body for nearly a year, according to The New York Times.

More here.

Why the Arctic Is Warming So Fast, and Why That’s So Alarming

Matt Simon in Wired:

On Saturday, the residents of Verkhoyansk, Russia, marked the first day of summer with 100 degree Fahrenheit temperatures. Not that they could enjoy it, really, as Verkhoyansk is in Siberia, hundreds of miles from the nearest beach. That’s much, much hotter than towns inside the Arctic Circle usually get. That 100 degrees appears to be a record, well above the average June high temperature of 68 degrees. Yet it’s likely the people of Verkhoyansk will see that record broken again in their lifetimes: The Arctic is warming twice as fast as the rest of the planet—if not faster—creating ecological chaos for the plants and animals that populate the north.

“The events over the weekend—in the last few weeks, really—with the heatwave in Siberia, all are unprecedented in terms of the magnitude of the extremes in temperature,” says Sophie Wilkinson, a wildfire scientist at McMaster University who studies northern peat fires, which themselves have grown unusually frequent in recent years as temperatures climb.

The Arctic’s extreme warming, known as Arctic amplification or polar amplification, may be due to three factors.

More here.

Consider The Eel

Patrik Svensson at The Paris Review:

In one of the twentieth century’s most memorable scenes from literature, a man is standing on a beach, pulling on a long rope that stretches out to sea. The rope is covered in thick seaweed. He yanks and tugs, and out of the foaming waves comes a horse’s head. It’s black and shiny and lies there at the water’s edge, its dead eyes staring while greenish eels slither from every orifice. The eels crawl out, shiny and entrails-like, more than two dozen of them; when the man has shoved them all into a potato sack, he pries open the horse’s grinning mouth, sticks his hands into its throat, and pulls out two more eels, as thick as his own arms.

This macabre fishing method is described in Günter Grass’s 1959 novel, The Tin Drum. Rarely has the eel been more detestable.

more here.

All About Swimming

Fran Bigman at Literary Review:

Until I read Howard Means’s Splash! and Bonnie Tsui’s Why We Swim, my main encounter with the history of the sport had been a Victorian-inspired swimming gala organised by members of my local team at north London’s Parliament Hill Lido. We competed in novelty races that predated the streamlining of swimming into a competitive sport, swimming upright holding umbrellas in one race, wearing blindfolds in another. We jumped into the pool in vintage dresses to see what it was like to swim hampered by heavy fabrics.

I learned much from both books. The first-known depictions of swimming are pictographs made eight thousand years ago on the walls of the so-called Cave of the Swimmers in the middle of the Sahara, where there were once deep-water lakes. The ancient Greeks often triumphed in battle due to their swimming prowess.

more here.