Sunday, January 22, 2017

Social media break....

I'm two days into a break from Twitter and Facebook. I'm not doing anything so foolish as to say I'm "quitting" this time — I know myself too well, so I only intend to be gone a week. (Basically, this seems like a good time to slow my roll a bit.) There's been a little bit of withdrawal: The Trump Administration's penchant for "alternative facts" seems to require a response.

But it's getting one without me. Probably telling.

Other than that, it's been a fantastic weekend for reading and thinking without the need to spread word of my thoughts immediately. Some highlights:

• The New Yorker's article about El Salvadorans who've been deported back to their home country is infuriating, increasingly so at every new revelation along the way. Basically: Young people who are Americans for all intents and purposes — having come here too young to remember their home country — are deported back, where they end up serving as the cheap workforce for a company that handles phone-based customer service for American companies. It gets worse.

• It's interesting to read the New Yorker's article about the effectiveness of primary care physicians in combination with today's NYT piece about "The Conversation Placebo."

Yet, somehow, having a primary-care clinician as your main source of care is better for you. 
Asaf tried to explain. “It’s no one thing we do. It’s all of it,” he said. I found this unsatisfying. I pushed everyone I met at the clinic. How could seeing one of them for my—insert problem here—be better than going straight to a specialist? Invariably, the clinicians would circle around to the same conclusion. 
“It’s the relationship,” they’d say. I began to understand only after I noticed that the doctors, the nurses, and the front-desk staff knew by name almost every patient who came through the door. Often, they had known the patient for years and would know him for years to come. In a single, isolated moment of care for, say, a man who came in with abdominal pain, Asaf looked like nothing special. But once I took in the fact that patient and doctor really knew each other—that the man had visited three months earlier, for back pain, and six months before that, for a flu—I started to realize the significance of their familiarity.
This is a finding that should give all medical professionals pause: Communication alone was more effective than treatment alone. The patients who got electrical stimulation from engaged physical therapists were the clear winners, with a 77 percent reduction in pain. 
This type of study provides hard evidence for what shamans, witch doctors and assorted mystics have known for millenniums: A substantial portion of “healing” comes from the communication and connection with the patient.
This kind of confirms an instinct I had in coming back to Lawrence. I was treated by some of the best doctors in the world in Philadelphia. With one exception, though, my communication with them was shitty. That was unavoidable: They see so many patients that you end up on a conveyor belt. Lawrence may not have the best doctors in the world, but the ones I've seen so far take time to listen and communicate. I know that's better for me.

• Also, please read this piece from WaPo about "Americans have been lying to themselves about the economy for way too long."
A new study out of Harvard shows how Alger’s legacy continues to steer our perceptions of the economy. Unlike Europeans, Americans vastly overestimate the likelihood of moving up the economic ladder, according to economists Alberto Alesina, Stefanie Stantcheva and Edoardo Teso.

“We find that this idea of the American Dream, going from rags to riches, is really salient in people’s minds,” Stantcheva said. “In the U.S., people are too optimistic about intergenerational mobility, particularly about the chances of making it from the very bottom to the very top.” Such perceptions — or misperceptions, as the case may be — are important because they may influence how we think about government programs such as the social safety net or public education.
It's especially important to know this if you're reading David French's essay at National Review about the moral inferiority of the poor. It's behind a paywall, but in essence, it comes down to: "If only the poor made better choices — like getting married — they wouldn't be poor! If only they would make choices for long-term gain instead of short-term satisfaction!"

It's standard conservative boilerplate. But even leaving the WaPo study behind, it's infuriating. Why? Because studies show that it's so exhausting to be poor in the first place that making good decisions, or decisions with an eye on the long-term is actually more difficult for poor people. French's essay reduces poverty to a morality play, and certainly some people are able to  make good choices that enable them to climb out of poverty. But any piece that focuses totally on the choices of poor people without dealing with the relevant scientific literature isn't worth taking seriously. It's just posturing.

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