stimulant

From Cory Doctorow’s talk at GoogleNYC, talking about his book, Little Brother:

“[…] who discover, after a terrorist attack on the Bay Area, that destroys the Bay Bridge, that in fact that as bad and terrifying a terrorist attack is, it at least has an ending. Whereas the police response to a terrorist attack has no graceful ending, it continues unbounded, and has a natural inertia that causes it to grow and grow and grow. In the name of security, all things are possible.

Social reforms involving a minority¹ approach their task with a mixture of two strategies:

• Changing the way those in power perceive those whom you seek to help.
• Changing the way those whom you seek to help present themselves to those in power.

This is not as subtle a statement as I’ve made it seem² . There is the existing power structure and those who suffer within it. Myriad factors influence the minority’s situation; however, these factors penultimately terminate with how the empowered and disempowered relate. Deciding which tact to pursue is a process frequently fraught with unspoken judgments and assumptions about how self-reliant the minority is or could be. This builds into the foundation of many reform efforts a basic tension between the helpers and the helped.

Consider attempts to address racial inequality in the United States. Affirmative action attempts to force a dissonance between the way those in power see a minority and the way they are treated. Some contingents lash out at such efforts: Bill Cosby caught flak for his [in]famous “Pound Cake” speech, as well as plenty of accolades, split by exactly Rotter’s idea of a locus of control.

And with that, we skirt a linguistic quagmire: the way people differentiate blame, responsibility, guilt, and power. I’d like to sidestep the issue. What’s pertinent is not a careful analysis of causality³ , but an understanding of how people’s perception of the loci of control in a situation determine the character of suggested reforms.

Recent discussion about uncontacted tribes in the Amazon⁴ spurred the realization that deciding why we implement a reform is often a subtle value judgment wrapped up in facile rationalizations. It is taken for granted that the front lines of social reform are along the boundaries of basic, human rights: quality of life, equal representation, etc. But, consider the case of the uncontacted, Amazonian tribe: the rallying cry was to leave them be. Several people suggest that these uncontacted tribes should not be isolated, but at least offered the chance for integration. Ethnocentrism is far more frequently fingered as cause for concern, conflating many issues. For the purposes of this discussion, I just want to point out that if anyone in a city lived in the conditions under which these aborigines live, the call for aid and change would be unanimous. There is no discussion of winding industrialization back to preclude the need for isolation. So, when do we decide that it’s the majority that needs changing, and when do we decide that it’s the minority that needs to change?

The reasons offered supporting the isolation of the tribe range from complaints about the fundamentally toxic nature of the industrial world to claims of cultural terrorism. Underlying these judgments is the assumption that we have the power and right to make this decision for the people involved. And it is this thread that connects the discussion of uncontacted tribes in the Amazon to most attempts at social reform. While completely distributed social reform is nominally possible⁵ , historically reform has comprised the reformers, those on whose behalf reformers work, and everyone else. Even if the reformers and their beneficiaries are one and the same, there is rarely explicit approval of reform efforts⁶.

The fact that reform necessarily involves varying degrees of participation (and as such, varying degrees of control and power) means that those who are more active implicitly make decisions for those who are not. When society at large decides a reform is “necessary,” it is frequently cast in a disempowering light: the needy well, need us to help. And we know best how to do it. But history doesn’t bear that confidence out (from welfare to affirmative action, reforms begun at large scales, under the public eye, by an institution as a whole, founder more frequently than attempts at self-regulation).

Looking over historical reform efforts, it is clear that reformers’ decision to focus on the majority or the minority is consistently tinged by moral judgment. Deciding at whose feet to place blame is a different task than deciding who is best equipped to change the situation, but it is a conflation we often make. And it’s not clear to me that we can generalize the answer to that question: the “give a man a fish” line of thinking oversimplifies the situation. Figuring this out is at the core of many of my questions: while it is clear that empowerment is the long-term goal, can we say anything about the extent to which the ends can justify the means? Even this language is misleading — the effects of the means with which a group is empowered is coupled more strongly to the social norms surrounding those means than the means themselves. More concretely: the disempowering elements of welfare or affirmative action are not money or college admission, respectively. The set of social norms surrounding each are what we’re really interested in engineering. How can we think about how strongly means are coupled to the norms they evoke? What are tools for controlling social norms? Doesn’t this process have exactly those problems I’ve touched on already?

Confusion abounds. At the core of the various metrics we have used to decide reform’s necessity is the idea of progress. And I suspect that the complexity of resolving that definition (well-documented by Illich) is largely responsible for this confusion (even without considering the emotional and philosophical complexity of charity). There’s a lot more to say about this, but I’d like to do it in a different — less abstract — context, which will be provided by forthcoming posts. Stay tuned.

1. By minority I don’t mean minority in number, but in power. e.g. Women. Or students. [↩]
2. Despite this, I’ve found it increasingly helpful to think in these terms. It seems that I’m after a cause-agnostic language for thinking about reform. It’s not clear that generalization is helpful, but I’ve made unanticipated — and unfortunately, undocumented — progress in classifying mistakes made in social reform. And I remain convinced that successful social reform is less a matter of doing things well than a matter of not making predecessors’ mistakes. [↩]
3. What we even mean by that in social situations is unclear. [↩]
4. UPDATED 062408: They weren’t lost. [↩]
5. I have no good examples, and would be extremely interested in hearing about some. [↩]
6. Save highly structured efforts that occur in contexts like a union. [↩]

I have no idea what the justification for this ridiculousness is, but please contact Jeffrey Hampton, Senior Zoning Planner for the City of Boston and register your protest.

A new city regulation in Boston will limit the number of undergraduate college students sharing the same apartment to no more than four. more stories like this The Boston Zoning Commission unanimously approved the measure Wednesday after a tense City Hall hearing. Opponents of the restriction include property owners and college students who say the occupancy limit violates property rights and unfairly singles out a specific group of people.

Yesterday, I heard about the Boston Public Library’s baleful DRM policy, and a protest staged by the Free Software Foundation and DefectiveByDesign in front of the BPL this afternoon from 1-3PM. So, I arrived at the BPL around 12:55PM, waited ‘til 1:35PM, and then left.

No one showed up.

So, I wrote a letter to the BPL Board of Trustees, instead.¹ And left the fifty flyers I printed in various shops in Boston and on campus.

1. And you should, too! [↩]

Really, when she was first appointed, I was optimistic. But I’ve lost that optimism.

Last week, Secretary Spellings spoke at a meeting of the National Advisory Committee on Institutional Quality and Integrity (NACIQI). Reading through the transcript, I was struck by how deeply conflicted and fundamentally screwed up Spellings’s vision of education is. Surprised by how poorly thought out her positions were, I looked into her background, and discovered what felt so familiar about her mistakes: she has never taught. People with limited or no teaching experience frequently say things that make sense on the sound-bite level, but are fraught with contradiction upon closer inspection.

Like this:

All of us know that our higher education system is in a period of transformation. Where a college degree was once a sign of privilege, it’s now all but a prerequisite for opportunity. As a result, our postsecondary system is now called upon to serve a larger, more diverse group of people with diverse and ever-changing needs who are entering into an ever-changing labor market. […] As higher education changes, so must our accreditation system. Instead of only looking at process, we must work to emphasize results.

How do you reconcile crass credentialism with an emphasis on “results?” On the one hand, Spellings acknowledges college’s history of classism. On the other, she concludes that the triumph of credentialism necessitates egalitarianism. This is some train wreck of a syllogism: credentialism intrinsically opposes the egalitarian ideals Spellings cites in highlighting the need for education to “serve a larger, more diverse group of people with diverse and ever-changing needs who are entering into an ever-changing labor market.”

And then to call for a focus on results, instead of process? Spellings’s claim is that we can make the process of giving credentials more meaningful by requiring they more closely couple to the results of one’s education. All the hoodoo goes on in those few words: “requiring they more closely couple.” And therein lies the “assessment debate,” which frankly, I find difficult to engage without bringing along with me a slew of philosophical baggage that needs to be handled, first.

Setting that aside,

We are the only independent gatekeepers in the accrediting system. Without us, the process would be organized and governed by the same people it’s meant to evaluate. […] We do not expect medical or financial professionals to do their work without independent oversight.

This is plainly false. Both doctors and lawyers are examples of self-regulating bodies. The American Medical Association (AMA) is full of doctors; bar associations are full of lawyers and judges. I’m not suggesting that we should use our health and legal systems as models; however, it is valuable to point out that self-regulation is possible. Thinking in terms of gatekeepers and independent assessment creates top-down solutions characteristic of bureaucracy. In an industry plagued by complaints of administrative lethargy, I can’t imagine that the right step to take is to introduce reforms requiring even more bureaucracy.

Students rely on us to oversee issues from student outcomes to student lending. […] on behalf of consumers, be they students, families, or institutions, we have the right and the responsibility to ask for more and better information. […] In any enterprise, informed consumers can make smarter choices. The more knowledge students have, the easier it is to find the school that suits their needs. And the easier it is for taxpayers to see what their investments yield.

We rely on you implicitly and ignorantly! One of the most frustrating and frightening tendencies of a ballooning government is to obfuscate under the protection of self-righteousness. Bureaucracies are rarely malicious; it is their good intentions that lead them so far astray. Rather than concluding that a position as a public servant entails license to act on our behalf (as you see fit), it should conservatively entail the obligation to act on our behalf. I think a better first step would be to make the role the government plays in higher education transparent. I am far more concerned about the freedom and flexibility accorded colleges than potentially fraudulent accrediting bodies.

Spellings points out — rightly — that more data are needed. But she bites off more than she should in claiming that the government has a right to parse and dole that data out. I’m not asking the government to answer the “assessment question” for me. If the government wants to interpret that data and generate reports from it, fine. But first, please tell me what data you’re after, then work out how you’ll make that data available to me before jumping the gun and telling me what I should do.

Most students don’t know that different types of accreditation exist until they encounter hurdles. Every year, millions repeat coursework because their credentials don’t transfer. As a result, billions of dollars are wasted, not to mention lost time, productivity, and talent.

Let’s get this straight: talent is wasted if not validated by accreditation? This is an excerpt from the same speech in which Spellings proclaims the importance of putting results ahead of process! It is unconscionable to perpetuate a system whose mere incompetence and irrelevance is capable obviating talent.

Let me repeat: no one-size-fits-all measures. No standardized tests. All I ask is that institutions be more clear about the benefits they offer to students. Through the accrediting process, we can help bring this about.

I get it: you want to distance yourself from your miscarried NCLB poster child. But when was the last time governmental intervention made for more clarity? I know that’s taking an unfair (well, unsubstantiated) shot; however, I am convinced that the government’s reputation as the epitome of poor, wasteful organization and unnecessary bureaucracy (alongside the military) is well-deserved.¹ I’m just asking that before we look to impose a top-down solution, unavoidably involving the government at a very fine scale, let’s try some more organic, distributed solutions.

I say that blithely, but unfortunately, this unavoidably requires straightforward discussion of what we want out of education. Despite the centrality of this question, by and large it is a question that goes unaddressed. I suspect that Spellings’s ambiguity about what information we should be getting from colleges stems from a fundamental ambiguity about the purpose and aims of education. And no committee convened to draft a statement of purpose for the educational system will ever be able to agree on something specific enough to be meaningful or general enough to be useful.

And you know why this is? It is because education is a fundamentally personal process.

1. For the time being, at least — Obama’s efforts for transparency inspire hope. [↩]

A strange juxtaposition from the Death and Taxes site for the budget graph, visualizing the relative proportions of the national budget by department and project:

It reminds me of the the first chapter of Dale Carnegie’s How to Win Friends and Influence People, wherein Carnegie recounts the capture of infamous gunman, “Two Gun” Crowley. During the final shootout, Crowley penned a letter:

But how did “Two Gun” Crowley regard himself? We know, because while the police were firing into his apartment, he wrote a letter addressed “To whom it may concern.” And, as he wrote, the blood flowing from his wounds left a crimson trail on the paper. In his letter Crowley said: “Under my coat is a weary heart, but a kind one — one that would do nobody any harm.” A short time before this, Crowley had been having a necking party with his girl friend on a country road out on Long Island. Suddenly a policeman walked up to the car and said: “Let me see your license.” Without saying a word, Crowley drew his gun and cut the policeman down with a shower of lead. As the dying officer fell, Crowley leaped out of the car, grabbed the officer’s revolver, and fired another bullet into the prostrate body. And that was the killer who said: “Under my coat is a weary heart, but a kind one — one that would do nobody any harm.” Crowley was sentenced to the electric chair. When he arrived at the death house in Sing Sing, did he say, “This is what I get for killing people”? No, he said: “This is what I get for defending myself.”

Carnegie goes on to cite Al Capone, who said:

“I have spent the best years of my life giving people the lighter pleasures, helping them have a good time, and all I get is abuse, the existence of a hunted man.” That’s Al Capone speaking. Yes, America’s most notorious Public Enemy — the most sinister gang leader who ever shot up Chicago. Capone didn’t condemn himself. He actually regarded himself as a public benefactor — an unappreciated and misunderstood public benefactor.

The point being, of course, that most everyone tries to do what they see as right, most of the time (or at the very least, the end up believing that they do right). Including Kevin Marlowe. Note that I am not comparing Kevin’s job to Capone or Crowley’s deeds. I’m simply comparing the disparity between Vanessa and Kevin’s assessment of his work and our assessment of Capone and Crowley’s lives, versus their own. However, I would be remiss if I did not point out a fundamental weakness in Kevin’s claim: taking the budget as a literal quantification of voter trust is specious. In fact, this is much of what is wrong with politics: the power (even as roughly encoded by budgets) is not well-coupled to the people’s will. Thus, for instance, a genuinely unpopular war is possible.

It’s essential to keep in mind that when you’re trying to talk to somebody about a field that perceived as rapidly progressing, you need to be more vigilant about securing the timeliness of your credibility. Reading Illich’s Medical Nemesis, I found myself constantly questioning his conclusions, given their foundation upon statements like:

Awe-inspiring medical technology has combined with egalitarian rhetoric to create the dangerous delusion that contemporary medicine is highly effective. Although contemporary medical practice is built on this erroneous assumption, it is contradicted by informed medical opinion.

My instincts suggested, “Well, maybe now that’s no longer true. Think of all the progress we’ve made!” Of course, I was forgetting what I already knew; namely, that the aggregate benefit of our increasing level of health care has not been shown to have any effect. In fact, a number of studies establish the exact opposite.

In any case, I found it interesting that even as a receptive reader, the instincts with which a cultural emphasis on progress has programmed me dominated. It’s a concrete example of what’s so hard about getting people to question the assumption that what we call progress is progress, and is actually the direction in which we want to go. In particular, it strikes me as very similar to the friction I encounter when talking to people about the role of technology in education, or the difficulty people have when trying to draw attention to the metrics we use in assessing students, as opposed to the “effects” of pedagogy as measured by those metrics. Embedding assumptions in an otherwise (ostensibly) open debate is an awfully effective strategy.

From Matt Yglesias, a concise pearl:

This is the basically fraudulent nature of the American enterprise in Iraq. We’re told we can’t leave because of the civil war that would break out or intensify or whatever if we do. But our troops aren’t really capable of meaningfully impacting the result of the sectarian conflict anyway. Instead, they’re just being plopped into the middle of it and exposed to harm, so that when the conflict eventually ends (as conflicts tend to) we can call the results “victory” and stay in Iraq forever. If the violence waxes, that shows the war needs to continue. If it wanes, that shows that we’re winning and need to keep on keeping on. Meanwhile, in the real world the civil war and ethnic cleansing we’re supposed to be preventing are things that have already happened.

I’ve been thinking about how to design self-suffcient, scalable communities. A big theme in my thinking is that scale is a fundamental, but often overlooked factor in the behavior of complex adaptive systems (CASs). We don’t have a good handle on any of the basic, conceptual primitives we want to use when discussing CASs: complexity, order, disorder, structure, patterns, emergence — none of these linchpins are well-articulated, much less well-understood. However, we have made significant inroads understanding what scale means, and the roles that it plays in the natural world.

Despite the fact that the science of networks and complexity is pretty stylish, the really valuable ideas have been slow to percolate outward from the natural sciences. This is understandable, given that scientists are confused about all those other big ideas — when these get bandied about, our ignorance is rarely part of the qualification.

This is a real shame, because I’m increasingly convinced that simple ideas of scale can be very revealingly employed in thinking about social and societal reform. More specifically, many of the problems that we see in our social organizations are a product of mismatched scales, i.e. trying to solve problems on the wrong scale. To generalize, our society too frequently implements top-down solutions that attempt to address problems at a very high scale, using centralized, hierarchical infrastructures which are intrinsically brittle.

But, let’s start from the beginning with the case in point I’ve been thinking about recently: health care.

Ivan Illich’s Tools for Conviviality introduced me to the idea that modern medicine has stolen from us a sense of ownership of our bodies. We’ve lost our natural authority when it comes to our health. This has been replaced by a slavish attachment to the opinions of doctors. In Illich’s words:

The crisis of medicine lies on a much deeper level than its symptoms reveal and is consistent with the present crisis of all industrial institutions. It results from the development of a professional complex supported and exhorted by society to provide increasingly “better” health, and from the willingness of clients to serve as guinea pigs in this vain experiment. People have lost the right to declare themselves sick; society now accepts their claims to sickness only after certification by medical bureaucrats.

The same way that students are unable to gauge if they’ve learned something without a teacher, we’re unable to determine whether we’re healthy or sick (or how we’re sick or how to get better) without a doctor. This dovetails surprisingly well with how poorly studies revealing the aggregate irrelevance of today’s hypermedical health care have been received:

So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to dare other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.

Robin Hanson first alerted me to this via the wonderful blog Overcoming Bias:

Readers of the medical literature, as well as readers of medical media coverage and students in health and medicine, have all been given the strong impression that in the aggregate, more medicine produces more health. This was the impression thirty years ago as much as today. Yet our single clearest data point, the RAND experiment, confirms the typical result of aggregate correlation studies: we see no such relation. Thus the medical research literature must suffer from severe biases, such as fraud, funding bias, treatment selection bias, publication selection bias, leaky placebo effects, misapplied statistics, and so on. How else can we square the usual positive benefit found in medical publications with a net zero benefit? Furthermore, what else but education and media biases can explain why this experiment, very expensive, well published, and the most important medical study ever, remains mostly unknown to medical students, professionals and the public?

<

p> This prompted me to start thinking about health care more carefully. The first thing I do when confronting a systemic or infrastructural problem is to consider the role of scale. Scale is a factor which complements Illich’s statement about stolen engagement, when it comes to both learning and medicine: when we try to address these problems as societal factors, we naturally use a top-down approach. Top-down approaches are well-known for their tendency to disempower, disenfranchise, and dehumanize. There aresituations wherein they are desirable. Top-down solutions are very good for top-down problems. But generally — particularly as the internet makes emergent solutions increasingly flexible and feasible — bottom-up solutions are more robust, effective, and reliable. What does this mean for health care? First of all, given that in aggregate, medical spending is overwhelmingly ineffective, the fact that the largest consumers of health care are those who benefit the least from it (i.e. the elderly), it’s clear that more emphasis on lifestyle as opposed to health care is desired. As Longman points out in The Health of Nations:

To get an idea of how wildly ineffective our health-care system is, consider this: The United States spends roughly $4,500 per person on health care each year. Costa Rica spends just $273. That small Central American country also has half as many doctors per capita as the United States. Yet the life expectancy of the average Costa Rican is virtually the same as the average American’s: 76.1 years. How can that be? According to public health researchers, the biggest reasons are behavior and environment. Costa Ricans consume about half as many cigarettes per person as we do. Not surprisingly,they are four times less likely to die of lung cancer. The car ownership rate in Costa Rica is a fraction of what it is in the United States. That not only means that fewer Costa Ricans die in auto accidents, but that they do a lot more walking, and hence they get more exercise. Thanks to a much lower McDonald’s-to-citizen ratio, the average Costa Rican thrives on a traditional diet of rice,beans, fruits, vegetables, and a moderate amount of fried food — and therefore enjoys one of the world’s lowest rates of heart disease and other stress-related illnesses.

More importantly, the way we dispense all this unnecessary care is itself broken. Although it’s unclear whether alienation from our body is the chicken or the egg (vis a vis the exaggerated importance of medical care), it is clear that the problems of health care are essentially local in infrastructure. There is a significant mismatch between the scales of the system currently in place and the set of problems the health care system alleges it addresses. The difficulty in creating a distributed system is that the current infrastructure has created a very insular, expert class whose centralization unsurprisingly recapitulates the same, structural problems.

The scarcity of expertise puts constraints on the scale of the system, and it seems that these constraints result in the overly top-down approach, yielding the mismatch in scale I blame for a lot of the health care system’s problems. But what if we question how atomic a doctor’s expertise actually is: the granularity of medical knowledge is much finer than “seven years of medical training.” In reality, medical knowledge can come in bits and pieces as small as knowing how to set a broken bone. The problem of health care is really the problem of distributing this resource (medical knowledge) and effectively pairing it with the materials necessary to deploy this knowledge (e.g. medical equipment).

Consider what a medical system that takes advantage of this granularity to create an emergent, distributed health care system might look like. There could be public x-ray machines which people could become licensed to use. These people would be indexed and reachable, and you would create a “micromarket” for their skills. Some people would only occasionally render their services, others would make a living providing high quality medical service. There would be a distribution of medical knowledge in the general population ranging from novice to expert, and people could capitalize on this knowledge as necessary. You could find and call upon neighbors specializing in what you need. It would become not only prudent, but natural to be engaged with your body and your health. Your medical identity would travel with you, not with your doctors. Your medical history and background would be generated by your use of this system, and this would provide the foundation upon which doctors could build, with their particular expertise, when necessary. But it is certainly clear that most visits to the hospital are for common, curable, simple medical problems. Why not re-empower people to solve their own problems, and those of their neighbors? Patients could rate the services provided by various groups and people, giving rise to a natural market [pressure] to sustain the sector. Lab work requiring equipment not feasibly made public can be outsourced — the same way you can have t-shirts printed today, you could have your DNA sequenced and your blood tested. This would create enormous demand for high-throughput, high-quality labs within a community. Response time in disaster situations would be instantaneous. The system would promote awareness and militate against the exploitation of people’s current insecurity and ignorance when it comes to health. The insurance landscape would be completely turned around: as you put more power in people’s hands, you put more responsibility, as well. The rarity of doctors currently perverts market pressure, but by distributing expertise, you can distribute not only the time load, but the vacuum in expertise across millions of people. The leading cause of malpractice isn’t incompetence: it’s the fact that doctors and nurses are rushed and overworked because the health care system isn’t keeping up with our demands. Decentralizing it changes not only the supply, but fundamentally alters the way that demand for health care is created. The benefits just keep piling up — you can imagine plenty of cute and clever subsystems to make this run smoothly, effectively, and far better than what we have currently.

I ran across a story on kottke.org about Jay Parkinson today:

Dr. Jay Parkinson M.D. emailed in to tell me about his new medical practice in Williamsburg. He’s got no office (housecalls only), takes appointment requests via SMS, email, or IM, handles some follow-ups over video chat, and specializes in the 18-40 age group without traditional health insurance. The goal, states Parkinson, is to “mix the service of an old-time, small town doctor with the latest technology to keep you and your bank account healthy”.

The infrastructure exists to support a vision of distributed health care! It’s happening already! The market possibilities are endless. Rather than tying up services with the medical infrastructure, you tie services to their only real requirement: expertise. This expertise then shares communal medical resources (e.g. public x-ray machines). Streamlining the routes to distribute the basic resources medical care provides (expertise, medicine, and equipment) is simple when you envision what it means to decentralize the distribution.

I’m eager for someone to critique these ideas — scale and decentralization seem to frequently fall just short of a panacea. Someone pinch me, tell me what’s wrong.

Some people deny that Wikipedia has a liberal bias: