Winners

Okay, this is going to be a snippy little blog, I admit it.

Every Sunday the ritual at my house is to read the NewYork Times Style Section for the wedding announcements. Wedding advertisements, really. But that's another rant.

My wife refuses to allow me to read them aloud. I used to do this, but it interrupted her doing the crossword puzzle and as she has gotten older, she will not broke interruptions to the things which really matter in life.

So, now the ritual is we read them separately and then comment on them, without mentioning names, but just the schools, the little stories they tell about how they met, we refer to these later in the day, as we are walking the dog. It's actually even more fun that way.

This Sunday, there was a real gem. She was magna cum laude, Harvard College. Then Johns Hopkins medical school. He was magna cum laude, Princeton, then Harvard Med.

She went on to get into the hardest of all subspecialties to get, dermatology. He went on to another difficult field in which the competition for a residency is intense: plastic surgery.

They meet at a "recruiting dinner," at Hopkins and he is attracted to her and she is not interested because she has a rule about not dating residents in the same institution because she has watched Scrubs, or some television show which depicts the torrid bedroom life of medical trainees who spend very little time thinking about patients and quite a lot of time thinking about which hot ticket in scrubs they want to bed next.

Her rule is grounded firmly in Fox TV.

As luck would have it, they meet over a patient they see together the next morning and he is blown away by "the compassion she showed as a dermatologist."

And there you have it.

My wife, being of the medical world did not have to explain, she simply drawled, "the compassionate dermatologist."

Now, I love my dermatologist. But, truth be told, dermatologists are dentists with MD's. They work hard, moving quickly room to room, excising and snipping and burning and freezing, but compassion is not really part of the game. Dermatologists make an exorbitant amount of money, the highest paid specialty, with virtually no on call, no hospitalized patients and low malpractice premiums. It's the ideal specialty and there are seventy applicants for every training spot. Women, in particular, strive to get derm residencies because you can bill like a star and still get home to greet the kids as they come home from school. Your patients, in general, do not die or ever get very sick and they are pretty grateful because they usually improve. It's a great specialty.

And, I have known plastic surgeons I respected enormously--the reconstructive guys who take a woman who's lost a breast and they try to restore some sense of body image, or they repair an abraded or lacerated face after an auto accident.

But, you and I both know this particular Princeton product, this particular plastic surgeon is not of that ilk. He is Nip Tuck, and all about thread counts in the bed linen.

Can you imagine what their dining room looks like? And his car? What does he drive? Hers is a little easier to imagine, but with him, well you could spend hours speculating. This would be a very important part of him. And, if you really want to run wild, think of their children. Think of their children's rites of passage--birthday parties, weddings.

Their whole lives stretch out before us. They are what immigrants dream about, well Asian immigrants, Jewish immigrants, when they dream about America. They are real lace. They are beyond real lace. These are the people reality shows will be built around in the future.

These are the Warner Brothers lot people, all front, but when you look behind, what is there?

My patients need compassion. Her patients need compassion. We are passionate about what we do, because, after all, look at the dire circumstances we help our patients through, that woman with the acne, at age thirty. That woman with the puppet lines running from the corners of her mouth to her jaw. They need help and they need compassion. And maybe some botox.

It is true, the dermatologist worked, for some part of her day, on an incurable disease, scleroderma, for which neither plastic surgeons nor dermatologists have a single useful thing to offer. But those scleroderma patients afford them a few minutes of the day during which they can develop the compassionate side of themselves.

It's like flying to Tanzania for five days and getting pictures taken of you in your scrubs with your arms around native children, before your airplane returns you to the safety of your plush office Stateside.

I told you it was going to be snippy.

But, oh, please. The compassionate dermatologist and the Nip Tuck plastics guy she won by touching his perfect body with her mind.

Thinking Fast and Slow: Who Defines Intelligence?

Daniel Kahneman, in his new book, Thinking, Fast and Slow, presents a psychologist's delight, this problem: A plastic bat and ball costs $1.10. The bat costs $1 more than the ball. How much does the ball cost?

Most people see the answer quickly and answer: The ball costs 10 cents, but, of course, if you stop to think about it, the ball costs 5 cents, because you have been told the bat costs $1 more than the ball so $1.05 - 0.5= $1.00, but $1.00-0.10= 0.95.

Kaheman tells us about only about 10% of students going to state schools answered correctly and about 52% of the kids getting into Harvard got it right. Kahneman goes on to assure us that one important aspect of intelligence is this capacity, to stop your "Fast Thinking (System 1)" the intuitive, quick thinking, and to bring to bear the slower "System 2" thinking.

I beg to differ.

I think this capacity is simply a matter of privilege and training. Once you have been told about this sort of trick, you can see it in many questions, and you can find the right answer. The kids whose parents can afford to send them to Kaplan SAT preparatory courses can learn these games, to become "more competitive," and can score high on exams which test this sort of thing, namely the SAT's.

The real definition of intelligence, read, "aptitude" or talent, i.e. the sort of thinking we find valuable in the world is quite different.

In fact, in my world, the person who can use his System 1 is at a premium. You can teach him to bring his slower thinking, System 2, to bear; that can be trained.

The patient is carried in to your examining room in the Emergency Room in shock. Looking at the patient, you take in hundreds, thousands of data bits and form an impression. He may have anything from a penetrating wound and blood loss to cardiogenic shock, and you go down one road or another based on initial observations, knowing as data comes in, you'll redirect. But you go with the first answer the ten cent ball, and that works until it doesn't, then you correct.

You do not, however, fail to come back around to the other possibilities, you have a check list for the things System 2 would have made you think about, and you get around to covering all the bases, at minute fifteen. But until that time, you have gone with System 1, and played the most likely possibilities, based on snap observations and judgments. And that is intelligence.

Quarterbacks, looking over defensive arrays at the line of scrimage take in lots of data, read cues, make mistakes, correct and fire off an answer in the form of a pass or an audible change to the planned play at the line. All of this puts quick thinking and slow thinking in play, but the predominant, and very intelligent, function is fast thinking.

When I was in middle school I had to take a course called, "Mechanical drawing," in shop class. Shop, I knew, was a "minor" subject, for kids who weren't "smart enough" to to go to college.

But I found mechanical drawing both difficult and fascinating. It made me look at a desk from just one angle an to see and draw only what you can see from that angle and it did not look at all like a desk from that angle. It was just a rectangle, could have been anything. It is precisely this sort of intelligence which is required of radiologists, as they move through different "slices" of abdominal organs and see them only from one angle, from north to south, head toward toe, then from back to front. The radiologist then has to reconstruct a three dimensional image in his mind from the two dimension images he's been scanning through.

As far as I know, there are no examinations given medical students for this intellectual capacity. Future radiologists are chosen based on examination which test skills more like "the bat and ball cost $1.10" variety.

Why? Because, there are no such exams available. The chiefs of radiology have never got together to think about what sort of skills and aptitudes radiologists really require and then worked with test makers to identify these capacities among medical students who will become radiology residents.

Or maybe the chiefs of radiology departments figure they do not need such exams because this sort of "intelligence" can be taught.

There is no Super Bowl in radiology. If chiefs recruit lesser talents, there is no way to know. No other radiology department beats you if you recruit a bunch of losers who had straight A's from kindergarden on, but who could not reconstruct an image to save their lives.

Medical school classes, in fact, are filled in much the same irrational way. They select kids who, to use the phrase from Moneyball, look good in jeans. That is, in baseball, talent scouts choose players who look athletic, who run the fastest sprint times and who look good in the baseball uniform. But, as a more methodical method was developed, teams discovered the player who looked terrible in a uniform, was often the better player: Yogi Berra was a pretty good catcher, but he could never impress anyone with his foot speed or his vertical leap.

Intriguingly, Daniel Kahneman, the man whose business it is to define intelligence, to devise tests which reveal real insight in those select few, commits the most astonishing leaps of assumption himself, in his discussion of studies which match behavior to blood glucose levels.

It is well established the brain runs of two things, minute to minute: oxygen and glucose. Deprive the brain of either for more than a few minutes and it spirals into dysfunction. But taking that little piece of knowledge, he spins off into studies which show that judges are more likely to grant parole to prisons in the hour after they've eaten lunch. There is so much wrong with his conclusions about the effect of blood glucose on brain glucose and brain function, it's hard to know where to begin.

He also spins off. drawing conclusions about behavior from imaging studies in which different parts of the brain "light up" as glucose utilization in those parts of the brain increase, conclusions which make the ten cent baseball look like genius.

The fact is, the brain is more like a ball of string than an assembly line. In the assembly line, you can pinpoint, geographically, anatomically, just where certain parts get added to the automobile. The brain is more like a computer, where things are lighting up and electrons are flowing in many places at oncem. True, there are "regions" where speech is centered, where vision is localized, more or less, but these regions are far more fluid and plastic than current imaging can really show.

I have not yet finished Kuhneman's book. This is just a progress report, a bulletin from the front. But I am beginning to see the general drift of the argument.

This is enlightening, because it suggests, just maybe, where we have gone wrong in our research and development world, at least that part of the R&D world located i the university, is we have been awarding the glittering prizes to the sons and daughters of the upper classes, and called it "Meritocracy."

It must also means something that Bill Gates and Zuckerberg both dropped out of Harvard, once they got their first glimmer of where the real ideas were pullulating.

It reminds me of the story told about Tony Fauci, which he has never forthrightly denied. Fauci is the chief the the National Institutes of Health Institute of Allergy and Infectious Diseases. He is also head of the task force on AIDS research. He was called into the office of the Chief of Medicine the day after he finished his chief residency at Cornell and all the grand mucky mucks of the Cornell University Mecical College were there and the Chief fo Medicine told him he was would be given admitting privileges to The New York Hospital/Cornell Medical Center and appointed to the faculty. Fauci turned him down. The room was aghast. The news went viral through the medical center in a heart beat--and these were the days before computers.

Somebody asked Tony how he could turn down this ultimate plum, this glittering prize above all prizes.

"Well, " Fauci said. "Some day I'm going to be either very rich or very famous. If I stayed at Cornell, I'd be neither."

Tony could answer that question about the bat and ball, but he knew that's just gamesmanship. He wanted to make a real difference.

Nobody Owns Money

There is a wonderful scene in The Wire, where Omar crashes a poker game and holds a gun on the high roller drug lords around the table as his partner scoops up the cash from the table.
One of the drug lords says, "That's my money you're taking."
Omar, smiling corrects him, "You don't own money. You just get to use it for a while. Nobody owns money."
Omar, of course, has no more than a high school education, but he understands something today's pundits do not seem to appreciate. (Of course, Omar is really David Simon & Co.) What he (they) are saying is that money, cash, is a creation of the government and of society, it's a medium of exchange, no one person owns it.

In another scene, Ziggy lights up a $100 bill in a bar and the longshoremen react as if he has destroyed something which belongs to them, and he has. Ziggy doesn't own that bill, the whole country does.

Consider a Van Gogh painting. Any Van Gogh. I love Van Gogh. One of his paintings now sells for $20 million dollars. You can buy a huge mansion in the Hamptons for $20 million. Think of all those stone masons, all those electricians, plumbers, construction workers, painters, gardeners, landscapers who worked to create that mansion. Van Gogh painted that painted in three days.

Or think of giving Albert Pulhous, a baseball player, $250 million dollars. Now, you can say, he is paid what the market says he's worth. He can fill baseball stadiums. If a stadium of 50,000 fans pays an average of $20 a ticket, he brings in $2 million days that one day. And there are 80 home games, so thats $160 million. But, the fact is, he does not bring in that much money. He is playing with other players. Nobody can say he fills stadiums. Nobody will come to the stadium even if he hits a home run every third time at bat, if his team is in last place.

What am I saying?

I'm saying we all have a stake in the use of money. If a dimwit burns a $100 bill at the bar, it diminishes the value of the $100 bill I just earned by working an hour. If a painter or a painting's owner can get $20 million for a painting, it diminishes the value of the work of all those workers who built the $20 million dollar mansion. Individuals can damage the value of something we all own collectively.

And they shouldn't be able to do this.

But, how, practically to put my value into practice?

I'd say, if I were the dictator in this plutocracy/monocracy we have, I'd insist that for any contract over $1 million dollar some bureaucrat ought to pass judgment on whether or not the guy getting the money is entitled to it. Or something like that.

We need a balancing mechanism.

I'm still a little fuzzy on the details of how to practically achieve that. But I go the principle pretty well worked out.

Doomed to Repeat It

If you want a truly eerie experience, read a history of the 1920's. I've been reading Only Yesterday and Howard Zinn's The Twentieth Century, but you can check out Roger Butterfield's The American Past, or any of a variety of accounts of that era.

Of course, every period has its own peculiarities, but what is so weirdly familiar is the odd little echos. During the Harding and Coolidge presidencies the Secretary of the Treasury was one of America's super rich, a man who would feel quite comfortable among today's one percenters, Andrew Mellon. He ushered through Congress, in 1923 "The Mellon Plan," which Zinn notes, called for "What looked like a general reduction of income taxes, except that the top income brackets would have their tax rates lowered from 50 to 25 percent, while the lowest-income group would have theirs lowered from 4 to 3 percent."

As Congressman William Connery (Massachusetts) noted, this "is going to save Mr. Mellon himself $800,000 on his income tax." Today, Mitch McConnell and John Boehner are channeling Mellon, as they declaim we simply must cut taxes on the richest Americans, (the "job creators" is the Republican re branding of the 1%) as they dig in their heels and refuse to allow the income tax rates on millionaires and billionaires be raised from 28% to 31%, or some numbers in that vicinity.

It's the same fight--we must cut taxes for the rich. Cutting taxes for the rich is good for the poor, for the jobless. Money will flow from the rich to the poor.

As if. As if, ever.

Because this was an act of Congress, the Mellon plan was entirely legal. This law was just one way the rich wrote the laws to enrich themselves, while selling it to the 99% of their day on the notion the Republicans were taking the government off their backs.

There is a certain fairness to this Republican swindle, of course: If you can sell this to Joe Sixpack, Joe Sixpack deserves his place at the bottom of the barrel . Anyone who is this stupid, deserves to be flushed down the toilet and kept there.

During these years, America saw income distribution fall into a steep pyramid. "One tenth of one percent of the families at the top received as much income as 42% of the families at the bottom," as the Brookings Institution reported. Sound familiar? Pie graphs today, actually, look even worse.

When the stock market crashed in 1929, the blame was assessed through the lenses of the beholder. The verdict from Milton Friedman, the Nobel prize winning libertarian economist from the University of Chicago, a man who believed nothing the government ever did was right, was that the whole calamity was just a big government blunder. Specifically, Friedman said the Federal Reserve caused the crash by tightening the money supply and that was that.

(This, if I may digress, simply illustrates how a Nobel prize may be won by an imbecile. The Nobel committee may have been impressed by Friedman's mathematical models, which the committee did not understand. They may have been impressed by his clarity, which made complex jumbles understandable. What they apparently missed,was that he was simply wrong, but working in a field where there is no experimental process, so he could say outrageous, patently stupid things and nobody could prove he was wrong.The man may have been revered by his colleagues, but truth be told, he was an imbecile. He was the original Chauncey Gardner.)

Of course, John Kenneth Galbraith saw it differently, in his classic study, The Great Crash. He pointed to a complex of infirmities, but most basically the severe redistribution of wealth, with the very few rich and the many poor. Unhealthy corporate and banking practices--and they didn't have mortgage backed securities or modern day derivative trading--trouble in foreign economies and trade.

The problem capitalism has, is once the bottom 42% do not have enough money to buy the things made by the 1% and their factories, there are no customers to support the 1% any more. Henry Ford realized this, which is why he paid his workers more than he really had to, in strictly short term terms. On some level, he realized, he had to make somebody just rich enough to buy his cars, so he started with his own workers, selling his product to the men on his assembly lines. He paid them a wage and they paid him back by buying his cars. There was the original, and most benign version of trickle down. Henry Ford was no friend of the working man, but he at least realized he needed the masses, if only to manipulate them.

Mitch McConnell and his patrons cannot even grasp that much. They don't think they need the lower 80% at all, except as voters.

The Republican President, Calvin Coolidge, looking on from retirement, set the standard for sophistication of economic analysis, as he inveighed in all his wisdom: "When more and more people are thrown out of work, unemployment results."

Today's Republicans, of course, are less reality based. They believe the whole problem with joblessness is we haven't made our richest 300,000 rich enough. This 300,000 richest would be hiring and turning the economy into high gear if only we cut their taxes even more than we already have, and promised them enough money so they will be finally willing to spend some money on hiring new workers.

Of course, most rich people run businesses. And most businesses need customers with money to spend on things the businesses provide. But, not to worry, if you just make these rich richer, they will not worry about where the customers are going to come from--they'll hire and trickle down wealth, because, ultimately, they are very nice rich people.

What is particularly disturbing about all this is not so much we have heard it all before, nor even that when we heard this before it was just before the bottom fell out. What is really disturbing is when you read about what Mellon did and said, and when you read about how the American voters voted in Harding, then Coolidge, then Hoover, all of whom were owned by the richest 1%, and were saying these very same things, the American voters kept voting them in.

Every four years, you hear the reassuring phrase: Voters are not fools.

But the evidence is to the contrary.

What you hear locally is voters do not remember beyond yesterday. They remember the last political ad they heard before they got in their car to drive to the polls. They are, simply put, incompetent. And they elect the wrong people.

What they have voted for, with the Tea Party revolution, was a government shut down. The guiding concept was government is the problem, not the solution. It's an old Reagan line, one of those lines Rush Limbaugh makes his living exploiting.

And it's this thinking which will destroy Medicare, Social Security, and ultimately, our military, our interstate highway system, our bridges, ports, airports and our economic power, along with our universities, our capacity for research and development and anything which depends on cooperative effort.

Name me a country which has prospered, let alone prevailed, which had a weak central government.

This is really what Barney Frank said, when they asked him why he was leaving Congress. Was he simply fed up with the vitriol welling up from Congress? Were the Republicans now just too venomous to deal with? He kept replying, Congressmen do not parachute in through the Capitol Dome. They are elected by voters at home. Nobody knew what he was saying. He was saying: Stupid people voted these stupid people in. I cannot keep working in an institution controlled by stupid people. For this, Barney Frank is despised as being elitist, a bully and mean. Of course, he is none of these things. He simply refuses to remain politically correct. He is pugnacious just as Rush and Mitch McConnell are. But David Brooks and others are offended by Barney because he does not suffer fools gladly and sees stupidity as something which should be challenged.

He made cub reporters think before they asked a question, so Barney is a bully. And the Congress and the cub reporters will not save us.

Eventually, the stupidity will catch up with us.