Friday, October 18, 2013

The Killing Or How I Learned to Hate Netflix

Sarsgaard
Enos


Kinnamon
Let it be understood: "The Killing" is not "The Wire."
Both are bleak police procedurals,  but "The Killing" has none of insight into social and economic complexity of the "Wire." 
While both deal with dysfunctional institutions, the dysfunction of "The Killing" derives simply from the dysfunction of wounded, twisted, inadequate individuals, not from a more complex miasma of disintegrating,  structurally flawed cauldrons of destroyed families, desperate economic conditions, foul political structures and inadequate educational and journalistic institutions. 

In "The Killing" it's personal angst and anomie turning its hollowed out face to the gray green rain of Seattle, where people crawl out of their holes to slink through another day of existential dread, and where life is, to paraphrase Hume, squalid, brutal, ruthless and short. It's that Munch painting, "The Scream," but with a different palate: grays, blacks, muted greens.
 And yet...there are unforgettable characters, namely Holder (Joel Kinnaman) Linden (Mireille Enos) and a condemned death row inmate (Peter Sarsgaard.)

If an actor has ever given a more powerful sustained performance than Sargaard's, if an actor has ever created a more complex, enthralling character who is by turns repellent, sympathetic, hardened, vulnerable, real, The Phantom has not yet run across that.

The best argument against the death penalty is simply that human beings are too pathetically inept to get the verdict right often enough to justify the death penalty. That elaborate charade of pseudo truth seeking, which has a much chance of actually rigorously examining facts and arriving at the correct conclusion as a monkey has of writing Hamlet on his first try at a keyboard, which we call a "trial" is simply inadequate to the task. 

So we put innocent people to death with regularity. Only DNA science has been powerful enough to expose the thoroughgoing ineptitude of juries, the venality of prosecutors the stupidity of police and the phoniness of the whole system.

When you watch the state executing its somber, sanctimonious will in the form of legal execution, you learn more about America than you care to.

It is a bleak, Scandinavian view of  America the beautiful, and of life,  and you finish watching an episode and turn on the lights, in a cold sweat, relieved it was only a bad dream.

Of course, if you watch it on Netflix, which streams the drama interrupted every 30 seconds by ads for the same zombie programs, you had better have your thumb on the fast forward.  The third season is only available in the zombie riven form.

But if you can wend your way past Netflix defiling the art, and if you can accept the occasional implausible explanation and connection, the reward for working your way through "The Killing" is the closest thing you are likely to find since "The Wire."

It's bleak, in a good way. 

Worlds better than Breaking Bad, which is more to the American taste, with explosions and lots of cartoon characters, "The Killing" is worth it because you can see astonishing actors in memorable roles. If you read The Stranger in college and could never quite forget it, you really ought to watch, "The Killing."

Monday, October 14, 2013

Command and Control: How Things Spin Out of Control

Eric Schlosser
A single death is a tragedy.
A million deaths is a statistic.
                --Joseph Stalin


The Phantom's general theory of large numbers is that the bigger the number, the less likely it is to represent anything real. The corollary to this rule is large numbers of things become unmanageable and if you really want to lose something, do not hide it in a desolate place,  but in a place filled with large numbers of things.

To illustrate:  Whenever you hear a particular disease kills ten million people a year, you know that is wrong. That can only be based on death certificates and even one death certificate is unreliable, and a hundred is 1/100 less reliable and so forth. Whenever you hear a disease, like osteoporosis costs $15 billion a year, you know, ipso facto that's a bogus number. Nobody in the cost analysis of disease business knows how to count that high.

On the if you really want to lose something, hide it among lots of other things: You have only to think of the final scene in Raiders of the Lost Arc, where the arc is hidden, for good, in a large government warehouse, in a wooden box amid thousands of other wooden boxes--the classic needle in a haystack.

As for manageability--you have only to read Eric Schlosser's wonderful book, Command and Control, to see firsthand, how, when you have thousands of nuclear missiles, as opposed to dozens, the supervision of each missile becomes thinner, less expert, more likely to devolve to the care of less than rigorous human beings.

So, here you have a nuclear missile in Arkansas, one of thousands peppered across the continent, cared for by several shifts of Air Force enlisted men and officers, most of them in their 20's, which is perforated, accidentally, by an airman wielding a wrench, which loses its socket, which falls and clangs off the side of the missile, perforating it's metal,  penetrating to the fuel supply, which spurts out in a pressurized stream from the inside of one compartment near the bottom of the three staged missile, which results in a compartment at the base of the tower becoming empty and unable to support the weight of the missile compartments above, which will then collapses down toward the concrete floor in a collapse like what we all saw in films of the World Trade Center collapsing, which will set off a nuclear detonation, which can trigger nuclear detonations in nearby silos and which can vaporize the state of Arkansas and parts of a few neighboring states. 

And the whole idea of having thousands of missiles was that it was supposed to make us safer.

And this all happens--the manufacture and placement of thousands of missiles--because somebody had an idea and sold that idea--that all these missiles would make us safe from Soviet attack. 

Problem is, this idea is not, you'll excuse the phrase, rocket science. In fact, as far as this theory of nuclear "deterrence" is concerned, there is no science at all, which is to say, no testing of the theory.  All this effort gets made because somebody thinks it will work, without ever being able to, or inclined to test that theory.

It's essentially a theory of psychology: We can frighten them with all these missiles.  We can hold our cards and never have to play them, because they will all be terrified of calling our cards. They just won't risk their pot.

Could we have terrified the Soviets with just 100 missiles, spread out among nuclear submarines, along the 48th parallel and along the Alaskan coast?  

We had General Curtis LeMay talking to how many generals in the Pentagon, to the President and to how many Congressmen?  And this system of 10,000 missiles gets built. 

We would never invest that kind of effort or money on any medical research effort, or on any healthcare system.

But when it came to building a missile attack system built on a dream, we were all over that, right here in America.

One has to ask:  Why is that?


Monday, October 7, 2013

Alan Rusbridger: The Trouble with Whistle Blowers

Tougher than he looks Alan Rusbridger
Okay, the Phantom admits he likes the Guardian on line newspaper.  For a long time, he did not know why, exactly, he liked it, but he found the stories confirmed many suspicions he harbored about the world.

But now, in a piece in The New Yorker he learns more than he ever really wanted to know about what goes on at The Guardian.

It turns out, the paper is not like any other, in the sense it really does not need to make a profit: It is supported by a trust fund, and the whole goal, financially, is to simply lose money less rapidly than it is currently doing, and to sustain itself for as long as it can, until it bleeds its trust fund dry.

This allows it to pursue stories like the publication of articles based on material released by Mr. Edward Snowden, which showed the NSA spies on Americans by tracking their cell phone data. Presumably, conversations of ordinary Americans are simply too dreary and boring to warrant actually listening to them, so the NSA simply tracks who called whom when and for how long.  Listening to American cell phone conversations would constitute cruel and unusual punishment, and would  require heroic levels of stoicism we cannot expect even from America's most heroic heroes. 

Anyone who has ever had to ride from Washington, D.C. to New York when all the seats in the quiet car are filled,  and been stuck for over 4 hours, listening to the intensely inane cell phone conversations  knows this form of torture would be too much to ask, even of intrepid National Security Agency agents. 

One learns, to one's chagrin,  all about Buffy's troubles with Jimmy, and Jimmy's room mate and about  Buffy's job, the accounts she has to visit in New York, the dress she almost bought, the shoes she saw at Jimmy Choo's , where she ate lunch and what she ate and what was wrong with it, and how drunk she got last Friday at some club,  and we just passed Wilmington, and whatever goes on in Wilmington?...We are spared no detail.

So, when the grand master editor of The Guardian was handed the treasure trove of information about the NSA listening in or not listening in, but at least tracking all these conversations, he had a special room at The Guardian done up and three new computers put into that room loaded with Mr. Snowden's stuff, and to get into any of them, you needed three passwords and only one password was given to each of three people and, oh, it was very James Bond.  On these computers was the Snowden stuff. 

And to make it even more important and clandestine sounding, there was a gay reporter in Brazil, an American ex-pat and a sultry woman documentary maker and some other guy who sounds pretty nerdy, but he had won a Pulitzer prize, which lends a little gravitis if not veritas to the whole fan-dangle. 

It is all compared with that great whistle blower scoop, Daniel Ellsberg, who released the Pentagon Papers which showed, among other things, the war in Vietnam was a bad idea, which anyone who watched Walter Cronkite during those years already knew four years before the Times published Mr. Ellsberg's revelations. 

But the big revelation from The Guardian's efforts at walking in Mr. Ellsberg's tracks has been, so far, the revelation that the American government, through its clandestine super secret agency, is tracking cell phone conversations.

But, really, did anyone  ever think their cell phone conversations were secret or confidential?  After blathering for hours on the train, walking down the street, in the park, shouting into the damn things, annoying everyone for blocks around, is there anything secret about cell phone conversations? If only.

The major revelation about all this, as far as the Phantom is concerned, is that the grand wizard editor of the Guardian, which loses tens of millions every year, this editor makes almost a million dollars a year, although recently, in a grand gesture, he accepted a pay cut of around $100,000 a year, just to show how very committed he is to the special kind of journalism possible at a not-for-profit news organization.

This wizard editor, Mr. Alan Rusbridger is an Oxbridge type, who plays piano recitals of Chopin for select friends,  and who has written a play about Beethoven,  and who, in order to be the grand wizard, had to write a "manifesto" no less, which the other board members had to embrace before he could be made grand wizard.

Of Mr. Rusbridger, it is said, "His physical appearance doesn't tell you how tough he is," which is a good thing, because, as you can see from his photo, he does not look very tough at all, so it is good to know.

In fact, reading this long, fascinating profile by Ken Auletta, the word "effete" kept drifting up before the Phantom's eyes. Here is how people in England cash in on their long tribulation in private (called public) schools.  They call each other tough and brilliant and accomplished and really very upper crust, first rate sort of chap, and they latch on to huge salaries  which from all appearances,  appear to be unconscionable, and they play Chopin for their friends.
 

Monday, September 30, 2013

Targeted Federal Government Shutdowns




Targeted  therapies are all the rage in medicine nowadays.

The Phantom suggests we target therapy for Congress.

Can we not identify the relatively small number of Congressional districts (shown above) from which the obstructionist/anarchist/arsonist Representatives hail and then simply shut down all federal services to those districts?  They don't want a Federal government anyway, let them live without it.

So:  No postal service, no Social Security checks, no Medicare payments, no FAA air traffic controllers for their airports...you get the idea.

Let those anti government imbeciles live without the federal government for a few months and as a condition for re admission to the Union, make them recall their T party Representatives. 

Sunday, September 29, 2013

America The Grotesque

We once had style and grace in this country
The Phantom knows he is rapidly aging. 
 One sure fire sign of the winged chariot hurrying near is the perception that people have become more grotesque and taste putrefied.

Last night, the Phantom attended "West Side Story" at the Ogunquit Playhouse, a stunning production, with astonishing sets, wonderful voices and actors and music, the closest America has got to Andrew Lloyd Weber, not to mention Shakespeare.

Behind him, sat two octogenarians and when the first few bars of "Maria" were sung from the stage, they started singing along, like dogs picking up the howl. A few seats away, down the row, a woman madly texted on her smart phone, the screen glowing in the dark theater and on the other side of the aisle a man sat with his huge, edematous, naked legs protruding from beneath his shorts and flowered shirt. 

The Phantom looked around him and thought, "This is not 'West Side Story,' this is Fellini."

It's not just Maine.

The Phantom unearthed a photograph of his mother, caught by a street photographer as she walked down Fifth Avenue, circa 1940, in hat, gloves, handbag.  She looked wonderful. "Oh, you would never think of going out in public without gloves and a hat," she said. "It just wasn't done."  And the Phantom's mother was not from money--her parents were tailors, living in a fourth floor walk up. But she had style and she was impeccably dressed and fitted out.

This is not mother, but the point remains: Taste was not confined to the rich.
Over the years, Presidents at press conferences point to members of the press corps and call on them by first names:  "John," or "Judy."  Everyone is on a first name basis in America now.

To say, "Mr. Smith," or "Ms. Jones" is to be insufferably stuffy and distant and aloof or, heaven forbid, arrogant.

Heaven deliver America from informality. Look what it has wrought.



Now look at us.

You would not see this in Paris.

Even the Brits would be appalled.

This is America. This is us.
 

Saturday, September 28, 2013

American Physicians and Multiple Intelligences


"This system results in rigid, time-based, non-learner-centered training...Some analysts have suggested that the average duration of medical training could be reduced by approximately 30%--partly by eliminating 1 year of medical school--without compromising physician's competence or the quality of care provided."
--Steven Abramson, New England Journal of Medicine September 19, 2013.

 One of the many things the Phantom admires about his dog is there is no future or past tense in his mind--he lives entirely, as far as the Phantom can discern, in the present tense.

When the Phantom reads and reacts to Dr. Abramson's article about shortening medical school, he is thrown back 40 years to his own experience in medical school, which can only be described as transformative, and he realizes nothing he has to say will be heard as anything but the plaintive ruminations of a man past his prime, stuck in 20th century thinking,  a use-to-was-er, destined for the trash heap of outdated, obsolete ideas and experience.

In some ways, the suggestion to eliminate the 4th year of medical school arises from the decision, motivated by the prospect of financial advantages for the university medical schools of the mid twentieth century, to no longer require specific clinical rotations for the 4th year--no more second rotation to the medical ward, to the surgical ward, to the obstetrical ward--but students could leave the campus entirely, go off to wander Africa, Europe, Asia, as long as their "program" received the very readily granted permission of some dean.  

Most medical students of his era, when queried about the value of that 4th year will say it was the best time they had since 2nd semester senior year in high school, which is to say, it was full blown fun in the fields of the gods of bacchanalia. Then, they will pause, get a funny look in their eyes and say, "But, you know I learned stuff...stuff I'll never forget, some of it was medicine."

What Dr. Abramson is saying, of course, with the phrase "time-based, non-learner-centered," is that simply requiring a student to spend time, a year, four years, before awarding a degree is unnecessary and backward thinking. If a student can learn enough material to pass his examinations in three years, two years, six months, then that examination is the measure of what it takes to be called, "Doctor." 

Of course, this sort of thinking has wrought huge changes in American medicine. If the exam is the only important thing, then it doesn't matter whether you've trained at Harvard or Columbia, or at The American Medical School of the Caribbean, at Guadalarjah, at the Ohio School of Osteopathy--if you can pass your exam, you are as well trained, knowledgeable and competent as the kid from Harvard.

And, for at least two decades, this sort of democratization of opportunity has been operative in American medicine. Unlike the prestigious, high paying law firms which limit their recruitment to Harvard, Yale and Stanford law schools, beyond a very few American faculties of medicine, the only thing that counts when doctors go looking for a job is whether or not they have the paper they need--have they passed their exams, got their licenses, a pulse, and can they speak enough English to find their way to the cafeteria.
 
Well over 90% of American physicians are not self employed, but are employees, and the corporations and groups hiring them do no "vetting," no evaluation of them personally. If they have the paper, they are hired, on short term (not more than 3 years, often one year) contracts and if they do well enough, in terms of producing dollars for the company, they will be offered a new contract; if not, they are sent packing to another job which will hire them on the same basis.

The problem, of course, is the concept of the "the test."  Is there any test which can be given and graded by machine, i.e., which is not essay but multiple choice, or some version of computer format, which can assess the multiple intelligences a person uses to acquire the ability to diagnose and treat patients?

The Phantom thinks of the time an eighteen year old woman was wheeled down the ward floor, direct admission from the Emergency Room, with her eyes rolled up into her head, as if she were fixed focused on the ceiling, weeping.  The wheeled chair passed a gaggle of medical students and interns at the nurses' station, and one of the interns, an Asberger's/ autistic type intern said "Better get a syringe of Benadryl. That's an occulogyric crisis. Someone probably gave her Compazine."  The Phantom ran off with a syringe of Benadryl, injected the patient and her eyes came down, like magic. The Phantom asked the intern how he knew that and he said, "There isn't much I haven't read about. I know everything in Harrison's [the standard textbook of medicine]."  There was the raw power of knowledge, not time spent, nor charm nor personality. 

But, fact remains, the Phantom had also read about occulogyric crisis occurring in children and adolescents given Compazine, but until he had actually seen his first case, it meant nothing to him and he missed the diagnosis. Once he had seen it, he would never forget it. And likely, that intern, who claimed he knew everything there was to know in medicine because he had read every word of every textbook, would never have known what he was looking at,  had he not spent enough time on the busy wards of The New York Hospital, and seen a wide variety of illnesses, drug reactions, and other clinical events.

As far as the Phantom is concerned, the most valuable stuff he learned as a medical student was not in his room with his books--and he spent plenty of hours there--but on that astonishing field of trauma and trial--the hospital, where 30 years of experience could be compressed into four years of trial by fire. It was time-based, to be sure, and it was not "learner-centered"--it was patient centered--but it was where the learner should have been centered.





Thursday, September 26, 2013

Edith Windsor, Ariel Levy, Louis Menand, Eric Schlosser: All May Not Be Lost. Intelligence Survives.






Two extraordinary stories appear in this week's New Yorker.  In some ways, they are connected only by the binding of the magazine and by the superb writing, but they are connected into the insight they provide into a supremely dysfunctional democracy which is ruled, not by intelligence, but by groupthink.

The first story, by Ariel Levy,  is about the selection of Edie Windsor as the ideal plaintiff to challenge the Defense of Marriage Act, and the legal/social/psychological/cultural/political strategies integral to the presentation of that case to the Court, in particular to Antonin Scalia's court.


Ariel Levy


The second is a book, Command and Control  by  Eric Schlosser,  reviewed by Louis Menand about the occurrence of near catastrophes with nuclear weapons: among many were one in which  the Russians came within minutes of launching an all out attack against the USA because the Norwegians innocently launched a rocket with a weather satellite, and another,  in which a 19 year old repairman dropped a wrench socket down a shaft which nearly caused an explosion of a nuclear missile,   which would have leveled the entire state of Arkansas. These are but two of thousands of near catastrophes, some of which are recounted in what sounds like a must read/must not read book.
Eric Schlosser

Windsor and Spyer 
The story of Edie Windsor and the lawyer who selected her case is astonishing on many levels: 1. The description of Windsor's ardor for her spouse, the physical joy and intensity of their relationship, even as her spouse declined physically with multiple sclerosis  2. The portrait of what that disease does to a person 3. The oblique portrayal of true devotion on the part of one human being in behalf of another 4. The history of oppression of gays in America--there was a time it was illegal to have homosexual sex, and illegal to even dance in an erotic way with a member of your own gender. The whole story of the police riot at the Stonewall bar in Greenwich Village.  5. The elucidation about how Supreme Court cases in some instances are waged not as legal arguments, but as arguments about what the prevailing values of the nation are and ought to be.


This is an astonishing issue of a consistently high quality magazine. 
There is much talk about continuing education, and much marketing by universities to attract dollars from aging populations, but the institutions of the New Yorker, the New York Times and Public Television constitute a fifth estate of not so much of  intelligentsia,  as of reason.

It is a fragile estate, but an essential one.