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Hospitals Are Terrible

by Belle Waring on February 23, 2017

Being in a multi-bed room overnight, or being in the OR, or even sometimes when the chemotherapy room is crowded over-full and they are putting people in cheap plastic chairs before hooking them up to clear bags of poison—this is the worst. And the worst thing about being in the hospital overnight is that you can’t sleep. I understand intellectually that your doctors need to know what your blood pressure is. I mean, sort of. What if you don’t have any heart problems? Why always with the blood pressure? But between your IV bag running out and beeping and the irrational fear that air bubbles will get inside you and kill you, and the checking of the temperature and blood pressure every four hours, and the breakfast you actively don’t want being slammed down at 6:30, and the cleaning staff, well, you don’t sleep. No knitting up the raveled sleeve of care for you! And this is true even in a private room! This article in the NYT explores a very obvious point, namely that multi-bed wards are a terrible idea all the time. I felt vindicated to read that the decrease in hospital-borne infections outweighs the cost of constructing a hospital with individual rooms.

As a doctor, I’m struck daily by how much better hospitals could be designed. Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.

It’s no secret that hospital-acquired infections are an enormous contributor to illness and death, affecting up to 30 percent of intensive care unit patients. But housing patients together very likely exacerbates the problem. Research suggests that private rooms can reduce the risk of both airborne infections and those transmitted by touching contaminated surfaces. One study reported that transitioning from shared to private rooms decreased bacterial infections by half and reduced how long patients were hospitalized by 10 percent. Other work suggests that the increased cost of single-occupancy rooms is more than offset by the money saved because of fewer infections. Installing easier-to-clean surfaces, well-positioned sinks and high-quality air filters can further reduce infection rates.

The whole thing is worth a read. Perhaps unsurprisingly, having a window out of which you can look at trees or nature has a huge impact on recovery time. I personally have always wanted to get the Magic Mountain treatment in which I am bundled in specially folded blankets and put out on a lounger to enjoy a view of the Alps.

The author doesn’t discuss bad fluorescents, though the commenters do. New compact bulbs can mimic the warmer light of incandesents reasonably well now, and that is another terrible hospital thing that could be fixed. I feel I should note two things here. One, the staff at hospitals is almost uniformly composed of kind helpful people who are working very hard. Nurses are great. The sub-nurses who are supposed to be just emptying bedpans or whatever are delightful. But let’s be honest: the actual doctors are the least friendly. Sorry actual doctors. I know you are busy. (But so are the ladies emptying the bedpans, probably?) Two, I am not in the hospital or accompanying anyone to same at the moment and this is just a general complaint so don’t worry about me; more importantly my migraine treatment worked. Since I made it to the first week (at which the Botox takes full effect) I have used my migraine meds only once. John was disappointed that I can have a headache at all but he doesn’t know that not having a real migraine every day after having had that happen for months oh God is a fairy wonderland (I don’t know why I’m not being more sparkly and cheerful all the time; I’m sorry, beloved family. I have terrible jet lag still). I asked my neurologist if there were any side effects and he said, “you’ll be running back here every twelve weeks begging me to do it again, but other than that, no.” OMG Dr. Fineman you are right. Thanks for the Tinkerbell-clapping, everyone! Now tell me of your experiences with flimsy curtains separating you from people with dementia shouting all night. The airing of grievances can be therapeutic; anyway it’s better than reading articles about politics amirite?

Who’s Up For Tabletop Games?

by John Holbo on October 26, 2016

You know what kids like? They like playing the Munchkin Adventure Time card game. I have verified this with girls and boys, ages 10-50. When the younger daughter’s friends come over, they want to play Munchkin Adventure Time. So you might as well buy the expansion set – and order pizza. It adds to the humor if you are an Adventure Time fan, which you should be. But everyone else can get the jokes easily. [click to continue…]

Knee Deep In The Hoopla

by John Holbo on September 2, 2016

Earworms are having a moment. As if they needed one. “All Songs Considered” served up a rewind of an old episode on “Worst Songs”. (I really can’t imagine hating Meatloaf, “Paradise By The Dashboard Light”. It’s just a blues cheese track that doesn’t take itself seriously, in a Rocky Horror way. What’s to hate? It isn’t even an earworm. Also “We were barely 17 and we were barely dressed” is great lyrics.)

But mostly it’s this GQ article getting linked around on FB: an ‘oral history’ of Starship’s “Built This City”. Here’s my favorite bit: [click to continue…]

Scholars and critics may learnedly dispute when Schulz did his finest work with Peanuts. Let me say, I’m reading Volume 11 (1971-2) with the younger one, and we were dying over the whole Bunny-Wunnies business. I’ll quote from the wiki bibliography of Miss Helen Sweetstory’s collected works:

The Six Bunny Wunnies and Their Pony Cart
The Six Bunny Wunnies Go to Long Beach
The Six Bunny Wunnies Make Cookies
The Six Bunny Wunnies Join an Encounter Group
The Six Bunny Wunnies and Their XK-E
The Six Bunny Wunnies and Their Water Bed
The Six Bunny Wunnies and Their Layover in Anderson, Indiana
The Six Bunny Wunnies and the Female Veterinarian
The Six Bunny Wunnies Freak Out

Let’s not forget the time Snoopy became disillusioned with Miss Sweetstory’s collected works and gifted the set to a grateful Linus. [click to continue…]

Last night, I had a bout of insomnia. So I picked up the latest issue of Vanity Fair, and after reading a rather desultory piece by Robert Gottlieb on his experiences editing Lauren Bacall (who I’m distantly related to), Irene Selznick, and Katharine Hepburn (boy, did he not like Hepburn!), I settled down with a long piece by Sam Tanenhaus on William Styron and his Confessions of Nat Turner.

A confession of my own first: I read Confessions sometime in graduate school. I loved it. Probably my favorite work by Styron, much more so than Sophie’s Choice or even Darkness Visible. I say “confession” because it’s a book that has had an enormously controversial afterlife, which Tanenhaus discusses with great sensitivity, even poignancy.

Anyway, I recommend Tanenhaus’s article for a variety of reasons: great narrative pace, with that perfect balance of distance and engagement; it blows hot and cold exactly where and when you need it to; and it moves with an almost symphonic sense of time, back and forth across the decades and centuries.

But here are three things I wanted to comment on. [click to continue…]

Book report

by John Quiggin on August 7, 2016

I’ve been getting lots of free books lately, and the implied contract is that I should write about at least some of them. So, here are my quick reactions to some books CT readers might find interesting. They are

The Great Leveler: Capitalism and Competition in the Court of Law by Brett Christophers

The Rise and Fall of American Growth:
The U.S. Standard of Living since the Civil War
by Robert J. Gordon

The Sharing Economy:The End of Employment and the Rise of Crowd-Based Capitalism by Arun Sundararajan

Econobabble: How to Decode Political Spin and Economic Nonsense by Richard Denniss

Generation Less: How Australia is Cheating the Young by Jennifer Rayner

I’ll be on a panel discussing the last two of these at the Brisbane Writers Festival, Sep 11-16.

[click to continue…]

The Kith of the Elf-Folk – Unberufen?

by John Holbo on August 6, 2016

As I believe I have mentioned, I’m teaching Kierkegaard. K is an excellently – some say inordinately – literary-aesthetical sort of fellow, so we want to welcome that quality, when we invite him to come give a talk to our class. But there comes a stage in man’s life when he wearies of undergraduates writing yet another paper about Fight Club and/or The Matrix, or even “The Grand Inquisitor” from Dostoyevsky. More broadly, there is an academic convention – who knows when it got started? – of nudging the young into equating a work of philosophy to a work of literature/art, i.e. pretending the latter is likely to be, let alone was intended to be, a vehicle for the expression of the former. And so it turns out Hamlet was Shakespeare’s ham-handed attempt to write an essay on Freud, or what have you. These attempted equations invite minor (or major) fraud. (Not that I think this is a major social problem. Mostly it’s just silly and strained.) And for what? You can fit things to things without exaggerating the degree of fit. (Kierkegaard was a weirdo. What are the odds any literary figure, who wasn’t K, ever produced a Kierkegaardian work of literary fiction? Hell, even K had to pretend he wasn’t himself, half the time, to keep from falling into error about his author’s meaning.)

I’m thinking of assigning a few short works that are, to my eye, not Kierkegaardian. But one can make connections, draw lines. For example, Lord Dunsany’s “The Kith of the Elf-Folk”. Here we have spheres of existence, I guess you could say: aesthetic, religious – ethical? (Now we are pushing it.) And there is a nice question, twinkling in the author’s eye: which is higher? How could one be in a position to say? And there is an implied indictment of modern society (who could wish for less?) And there is a lyrical seriousness, yet ironic playfulness. So the question I’m going to ask the kids is: suppose you had to rewrite “The Kith of the Elf-Folk” to be a parable of Kierkegaard’s stages – which it plainly is not. What changes would you have to make? Defend your adaptive edits!

Or maybe that’s a really, really bad question that will produce bad results in my classroom.

But my question for you is a bit different. How great is this story? Pretty great, right? [click to continue…]

Last night, Donald Trump shocked the world, or at least the pundit class, when the New York Times published a wide-ranging interview Trump had given the paper on the subject of foreign policy.

Trump said some scary things: that he didn’t think, for example, that the US should necessarily come to the aid of a NATO country if it were attacked by Russia.

But he also said some things that were true. Like this:

When the world sees how bad the United States is and we start talking about civil liberties, I don’t think we are a very good messenger.

And while the article makes a muchness of Trump’s refusal to pressure Turkey over its response to the failed coup, the fact is that Obama hasn’t done anything concrete on that score either (as the article acknowledges). Nor did Obama do much about the coup in Egypt or Honduras. To the contrary, in fact.

But that wasn’t the focus of last night’s chatter on Twitter. Instead, the pundits and experts were keen to establish the absolutely unprecedented nature of Trump’s irresponsibility: his recklessness when it came to NATO,  his adventurism, his sheer reveling in being the Bad Boy of US Foreign Policy: this, it was agreed, was new.

In a tweet that got passed around by a lot of journalists, Peter Singer, senior fellow at the New America Foundation (who’s written a lot of books on US foreign policy), had this to say:


Hmm, let’s see. [click to continue…]

The Clinton campaign made a major announcement today:

Democratic presidential candidate Hillary Clinton will pursue a debt-free college for all policy, including a proposal to eliminate the cost of college tuition for a significant portion of the public.

Clinton’s new proposals move her beyond previous statements that she would try to make college “as debt-free as possible“ and toward making “debt-free college available to all.”

Clinton is adding three features to her plan for higher education policy, called the “New College Compact.“ They include eliminating tuition at in-state public universities for families making under $125,000 by 2021 and restoring year-round Pell Grant funding so students can take summer classes to finish school quicker.


The plan isn’t great. I think means-testing higher ed makes about as much sense as means-testing Social Security or elementary school (though, alas, we still do that in this country through local funding and property taxes). I would have preferred free higher ed for everyone.

That said, and assuming Clinton can get this plan through (a big assumption), this is still a big step forward. For three reasons.

First, lots of men and women—students and their families—will get this benefit, not in a far-off time, but soon. And make no mistake: whether you’re going to CUNY, where annual tuition is a little over $6000, or Berkeley or Michigan, where in-state tuition is about $13,000, this will come as welcome relief to a lot of people.

Second, and more important for the long term, I’ve been saying forever that the biggest challenge facing contemporary liberalism is that, from the point of view of the average taxpayer, it has so little to offer. Imagine you’re someone who lives in a house with the median household income of about $54,000 per year. You pay your taxes, but what do you concretely get for the taxes? Sure, I can point to the roads (which are often falling apart) or the schools (which are often not so good), or, down the line, to Social Security or Medicare (which, we’re often told, aren’t in great shape either, and in the case of Social Security, certainly can’t fund a retirement). But it’s hard to make the case to your average man or woman that taxes fund things that help you concretely and directly. Particularly when, at least going back to Mondale, the only message we’ve heard from Democrats on taxes is either: a) we’ll cut them; or b) we’ll increase them in order to cut the deficit and pay off the debt.

Way beyond anything between Clinton v. Sanders, this plan by Clinton is something that can, potentially, change the way people think about their taxes and what the state can do for them. It’s a step toward a political and ideological realignment.

That said, there’s this, too:

The new plan, announced by [Clinton’s] campaign Wednesday, incorporates a major plank of Sen. Bernie Sanders’ (I-Vt.) platform and is a direct result of the private meeting Clinton had with the Vermont senator in June, the campaign said.

Clinton’s embrace of one of the most popular parts of Sanders’ platform comes as she is trying to get his core supporters — including many young people worried about college debt — to enthusiastically support her candidacy in November.

Sanders gained huge support among young voters by pushing for tuition-free public colleges nationwide, and Clinton now says she would do that for families making less than $125,000.


Which brings me to my third reason.

At moments like this, you really need to get beyond the personal politics a lot of DC and media people want to make all politics into. Despite the fact that they accuse Bernie supporters of being a cult, of worshipping an ancient socialist patriarch, they’re the ones who often think of these electoral campaigns completely in terms of personality, of who’s winning and who’s losing. To my mind, this announcement today goes way beyond the Clinton/Sanders horserace or the Clinton/Trump race. If there is anyone to be celebrated here, it’s the millions of people—particularly young people—who pushed so hard during this campaign, and who have been slowly changing American politics outside the electoral realm.

One of the biggest challenges facing democracy—as opposed to liberalism—and democratic ways of thinking and doing things, is the sense, among a lot of citizens, that political action, whether in the electoral realm or the streets, doesn’t matter. That sense is not delusion; there’s a lot of evidence to suggest that on some fundamentals, it doesn’t matter, at least not yet. But you don’t change that common sense by repeating it over and over to people. Sometimes, we on the left do that. We forget that when we do, we’re not telling the average citizen anything she doesn’t already know. We’re merely repeating what she does know. And reinforcing her sense that there’s really no point in even trying to do anything, whether at the voting booth or in the streets.

It’s way too soon to say what I’m about to say, but I’ll say it anyway: If this plan of Clinton’s does come to pass—again, a big if—it could help, ever so slightly (I stress that ever so slightly), change our sense, if we claim this victory as our own (not as a beneficent handout of an elite neoliberal politician but as a response to real pressure from citizens, particularly younger citizens who have been active in so many social movements these last few years), it could help change our sense of where power lies. It could help more people see what the good activist and the smart organizer already sees: that if we could just possibly get our shit together, we might, sometimes, find power elsewhere. Not power in the abstract, but power to change the concrete terms and conditions of our daily lives.

So here’s my new (really, hardly new at all, and actually not mine) political slogan, as we enter a season of (I hope) increasing, if ultimately finite, concessions from the neoliberal state: Take this, demand more, seize all.

Update (6:45 pm)

A hepful Vox piece reports on three other elements of the Clinton college plan that we should not be thrilled about.

What you need to remember—and I had forgotten—is that today’s plan builds off the previous plans Clinton has announced. Those plans featured three elements, which, according to this article, will remain in play and will apply to the tuition-free plan:

First, the funding for the tuition-free plan will follow the Obamacare Medicaid expansion model, which—thanks to the Supreme Court—states can refuse to participate in. That’s exactly what happened with Republican states. So even within the less than $125k range, this isn’t guaranteed to be a universal benefit.

Second, students have to work ten hours a week to get the benefit. That seems like a huge boondoggle of free labor either to the university (which might wind up firing workers) or to local employers (which could do the same). Not to mention that the whole point of taxpayer-financed benefits like this is that you deserve them as a right of citizenship—and pay for them as a taxpayer—and not because you’re earning them as a worker.

John Protevi pointed out to me that in her famous Daily News interview, Clinton gave us a sense of what she had in mind:

Okay, so you’ve got the states, you’ve got the institutions and you’ve got the families, and then students who want to take advantage of debt-free tuition have to agree to work 10 hours a week. It’s work-study at the college or university, because a couple of public institutions — Arizona State University being a prime example — have lowered their costs by using students for a lot of the work. Yes, it’s free. It’s in effect in exchange for lower tuition. So I want that to be part of the deal.

And here is a nice primer on what that Arizona State program looks like in practice:
Education at Work (EAW) begins expansion outside Cincinnati, where it was founded, at Arizona State University in an innovative three-way partnership with worldwide online payments system company PayPal. Students working at the non-profit contact center will have the opportunity to earn up to $6,000 a year in GPA-based tax-free tuition assistance in addition to an hourly wage. The students will work as part-time employees in a fast-paced, collaborative contact center environment responding to social media and email inquiries.

Go PayPal!

Third, colleges and universities have to “work to lower the cost of actually providing the education — by, for instance, experimenting with technology to lower the cost of administration.” A link in the piece takes us to an article that elaborates thus:

It’s not yet clear what colleges would be required to do about costs in order to participate in the grants, but the adviser mentioned keeping spending on administration in check and using technology to lower the cost of education — for example, making it easier for some students to fulfill some requirements online. (Sebastian Thrun, the founder of Udacity, a provider of free online courses, was one of the advisers on Clinton’s plan, according to the campaign.)

The neoliberal state giveth. And the neoliberal taketh—and taketh.

 

My Resistance to Elie Wiesel

by Corey Robin on July 3, 2016

Trigger Warning: This post may upset you. [click to continue…]

A Very Very Brief Intellectual Autobiography

by Corey Robin on April 2, 2016

Reading Samuel Freeman’s review of conservative philosopher Roger Scruton in the latest NYRB, I had a mini-realization about my own work on conservatism, which features Scruton a fair amount.

In the mid-1970s, conservatism, which had previously been declared dead as an intellectual and political force, started to gain some political life (its intellectual rejuvenation had begun long before). As it did, conservatism began to have an impact on liberalism. Politically, you could see that influence in the slow, then sudden, retreat from traditional New Deal objectives, culminating in the election of Bill Clinton. What that meant was a massive turnaround on economic issues (deregulation, indifference to unions, galloping inequality) and a softer turnaround on so-called social or moral issues. While mainstream Democrats today are identified as staunch liberals on issues like abortion and gay rights, the truth of the matter is that in the early 1990s, they beat a retreat on that front (not only on abortion but also, after an initial embrace of gays and lesbians, on gay rights as well).

Among liberal academics, the impact of conservatism was equally strong. Not only in the obvious sense that conservatism became an object of increasing scholarly interest, particularly among historians. But also in a deeper sense, as the categories of traditional conservative concern, like religion, came to assume a greater role in scholarly inquiry.

The impact was especially dramatic in the world of liberal political theory. [click to continue…]

Cory Doctorow links to a nifty graphic design project: crowdsourced covers for public domain classics. If you know anyone teaching a relevant art class at the high school level, or above, I think this might make a fine class project. Everyone pick a title and go for it!

Cory: “I can’t figure out what license the new covers are under and whether anyone can use them as covers in their own collections of public domain books, or whether permission must be sought for each design.” I wondered about that as well. The info page doesn’t cover rights. I signed up to see what one would have to agree to. Answer: a CC license. (Cory will be gratified to hear it!) [click to continue…]

V-Day is coming and so I figure I should get Belle a copy of Weird Love: You Know You Want It! (Volume 1). I’m pretty sure she wants it. Anyway, it was for sale on Comixology. (Psst. Don’t tell her. I want it to be a surprise!) [click to continue…]

I have graded 300 undergraduate papers about why Plato’s Republic is stupid. Not the book itself, but the plan of Plato’s hypothetical city. Even when I offer students four, five, six different essay topics, some instinct almost always compels them to take on the plan of the city and how evil, impossible, tyrannical, nonsensical, cruel, absurd, dysfunctional, and doomed they think it would be if put into practice.  So, when I read The Just City and its sequels, I couldn’t stop thinking about that instinct, those papers, and how one of the great wishes these books grant is the wish of anyone who teaches Plato to see a more mature and developed examination of the same question.  The tragedy of student papers is that the authors have only a week between first meeting the giant mountain of mind-bending ideas that is Plato’s Republic and having to write about it.  Even the best can’t get past the first glance reaction because it is a first glance reaction.  Which is why my favorite way of going through The Just City is to review my mental list of the standard undergraduate reactions to the Republic, and look at what Jo Walton, a Plato veteran who has chewed on the same problem for years, can do. [click to continue…]

On Tuesday night, Alexandra Schwartz, a critic at The New Yorkerposted a piece criticizing the young supporters of Bernie Sanders. Ordinarily, I’d be mildly irritated by an article titled “Should Millennials Get Over Bernie Sanders?” In this instance, I’m grateful. It clarifies the dividing line between Sanders’s supporters in the electorate and the liberal journalists who can’t abide them.

First, some context. Exit polls from Iowa, according to Vox, show that “Sanders absolutely dominated young adult voters, in a way that even Barack Obama couldn’t in 2008.” Eighty-four percent of voters under 30, and 58% of voters between 30 and 44, cast their ballots for Sanders. More generally, as countless articles have noted, younger voters are shifting left, embracing ancient taboos like socialism and other heresies.

Schwartz finds this all puzzling:

Bernie would not be pressing Hillary without the support of the youth of America, a fact that I—a voter north of twenty-five, south of thirty—have pondered over the past few weeks with increasing perplexity.

Why are young people, she asks, ”rallying behind the candidate who has far and away the most shambolic presentation of anyone on either side of this crazy race?”

A second’s Google search turns up an answer: [click to continue…]