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Re: (damn) [Re: sirfun] #2873581
11/09/18 10:54 PM
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https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html


By Gary Greenberg
Nov. 7, 2018



The Chain of Office of the Dutch city of Leiden is a broad and colorful ceremonial necklace that, draped around the shoulders of Mayor Henri Lenferink, lends a magisterial air to official proceedings in this ancient university town. But whatever gravitas it provided Lenferink as he welcomed a group of researchers to his city, he was quick to undercut it. I am just a humble historian, he told the 300 members of the Society for Interdisciplinary Placebo Studies who had gathered in Leidens ornate municipal concert hall, so I dont know anything about your topic. He was being a little disingenuous. He knew enough about the topic that these psychologists and neuroscientists and physicians and anthropologists and philosophers had come to his city to talk about the placebo effect, the phenomenon whereby suffering people get better from treatments that have no discernible reason to work to call it fake medicine, and to add that it probably works because people like to be cheated. He took a beat. But in the end, I believe that honesty will prevail.

Lenferink might not have been so glib had he attended the previous days meeting on the other side of town, at which two dozen of the leading lights of placebo science spent a preconference day agonizing over their reputation as purveyors of sham medicine who prey on the desperate and, if they are lucky, fool people into feeling better and strategizing about how to improve it. Its an urgent subject for them, and only in part because, like all apostate professionals, they crave mainstream acceptance. More important, they are motivated by a conviction that the placebo is a powerful medical treatment that is ignored by doctors only at their patients expense.

And after a quarter-century of hard work, they have abundant evidence to prove it. Give people a sugar pill, they have shown, and those patients especially if they have one of the chronic, stress-related conditions that register the strongest placebo effects and if the treatment is delivered by someone in whom they have confidence will improve. Tell someone a normal milkshake is a diet beverage, and his gut will respond as if the drink were low fat. Take athletes to the top of the Alps, put them on exercise machines and hook them to an oxygen tank, and they will perform better than when they are breathing room air even if room air is all thats in the tank. Wake a patient from surgery and tell him youve done an arthroscopic repair, and his knee gets better even if all you did was knock him out and put a couple of incisions in his skin. Give a drug a fancy name, and it works better than if you dont.

You dont even have to deceive the patients. You can hand a patient with irritable bowel syndrome a sugar pill, identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention. Depression, back pain, chemotherapy-related malaise, migraine, post-traumatic stress disorder: The list of conditions that respond to placebos as well as they do to drugs, with some patients is long and growing.

But as ubiquitous as the phenomenon is, and as plentiful the studies that demonstrate it, the placebo effect has yet to become part of the doctors standard armamentarium and not only because it has a reputation as fake medicine doled out by the unscrupulous to the credulous. It also has, so far, resisted a full understanding, its mechanisms shrouded in mystery. Without a clear knowledge of how it works, doctors cant know when to deploy it, or how.

Not that the researchers are without explanations. But most of these have traditionally been psychological in nature, focusing on mechanisms like expectancy the set of beliefs that a person brings into treatment and the kind of conditioning that Ivan Pavlov first described more than a century ago. These theories, which posit that the mind acts upon the body to bring about physical responses, tend to strike doctors and researchers steeped in the scientific tradition as insufficiently scientific to lend credibility to the placebo effect. What makes our research believable to doctors? asks Ted Kaptchuk, head of Harvard Medical Schools Program in Placebo Studies and the Therapeutic Encounter. Its the molecules. They love that stuff. As of now, there are no molecules for conditioning or expectancy or, indeed, for Kaptchuks own pet theory, which holds that the placebo effect is a result of the complex conscious and nonconscious processes embedded in the practitioner-patient relationship and without them, placebo researchers are hard-pressed to gain purchase in mainstream medicine.

But as many of the talks at the conference indicated, this might be about to change. Aided by functional magnetic resonance imaging (f.M.R.I.) and other precise surveillance techniques, Kaptchuk and his colleagues have begun to elucidate an ensemble of biochemical processes that may finally account for how placebos work and why they are more effective for some people, and some disorders, than others. The molecules, in other words, appear to be emerging. And their emergence may reveal fundamental flaws in the way we understand the bodys healing mechanisms, and the way we evaluate whether more standard medical interventions in those processes work, or dont. Long a useful foil for medical science, the placebo effect might soon represent a more fundamental challenge to it.

In a way, the placebo effect owes its poor reputation to the same man who cast aspersions on going to bed late and sleeping in. Benjamin Franklin was, in 1784, the ambassador of the fledgling United States to King Louis XVIs court. Also in Paris at the time was a Viennese physician named Franz Anton Mesmer. Mesmer fled Vienna a few years earlier when the local medical establishment determined that his claim to have cured a young womans blindness by putting her into a trance was false, and that, even worse, there was something unseemly about his relationship with her. By the time he arrived in Paris and hung out his shingle, Mesmer had acquired what he lacked in Vienna: a theory to account for his ability to use trance states to heal people. There was, he claimed, a force pervading the universe called animal magnetism that could cause illness when perturbed. Conveniently enough for Mesmer, the magnetism could be perceived and de-perturbed only by him and people he had trained.

Mesmers method was strange, even in a day when doctors routinely prescribed bloodletting and poison to cure the common cold. A group of people complaining of maladies like fatigue, numbness, paralysis and chronic pain would gather in his office, take seats around an oak cask filled with water and grab on to metal rods immersed in the water. Mesmer would alternately chant, play a glass harmonium and wave his hands at the afflicted patients, who would twitch and cry out and sometimes even lose consciousness, whereupon they would be carried to a recovery room. Enough people reported good results that patients were continually lined up at Mesmers door waiting for the next session.

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It was the kind of success likely to arouse envy among doctors, but more was at stake than professional turf. Mesmers claim that a force existed that could only be perceived and manipulated by the elect few was a direct challenge to an idea central to the Enlightenment: that the truth could be determined by anyone with senses informed by skepticism, that Scripture could be supplanted by facts and priests by a democracy of people who possessed them. So, when the complaints about Mesmer came to Louis, it was to the scientists that the king at pains to show himself an enlightened man turned. He appointed, among others, Lavoisier the chemist, Bailly the astronomer and Guillotin the physician to investigate Mesmers claims, and he installed Franklin at the head of their commission.

To the Franklin commission, the question wasnt whether Mesmer was a fraud and his patients were dupes. Everyone could be acting in good faith, but belief alone did not prove that the magnetism was at work. To settle this question, they designed a series of trials that ruled out possible causes of the observed effects other than animal magnetism. The most likely confounding variable, they thought, was some faculty of mind that made people behave as they did under Mesmers ministrations. To rule this out, the panel settled upon a simple method: a blindfold. Over a period of a few months, they ran a series of experiments that tested whether people experienced the effects of animal magnetism even when they couldnt see.

One of Mesmers disciples, Charles dEslon, conducted the tests. The panel instructed him to wave his hands at a part of a patients body, and then asked the patient where the effect was felt. They took him to a copse to magnetize a tree Mesmer claimed that a patient could be treated by touching one and then asked the patient to find it. They told patients dEslon was in the room when he was not, and vice versa, or that he was doing something that he was not. In trial after trial, the patients responded as if the doctor were doing what they thought he was doing, not what he was actually doing.

It was possibly the first-ever blinded experiment, and it soundly proved what scientists today call the null hypothesis: There was no causal connection between the behavior of the doctor and the response of the patients, which meant, as Franklins panel put it in their report, that this agent, this fluid, has no existence. That didnt imply that people were pretending to twitch or cry out, or lying when they said they felt better; only that their behavior wasnt a result of this nonexistent force. Rather, the panel wrote, the imagination singly produces all the effects attributed to the magnetism.

When the panel gave dEslon a preview of its findings, he took it with equanimity. Given the results of the treatment (as opposed to the experiment), he opined, the imagination, directed to the relief of suffering humanity, would be a most valuable means in the hands of the medical profession a subject to which these august scientists might wish to apply their methods. But events intervened. Franklin was called back to America in 1785; Louis XVI had bigger trouble on his hands and, along with Lavoisier and Bailly, eventually met with the short, sharp shock of the device named for Guillotin.

The panels report was soon translated into English by William Godwin, the father of Mary Shelley. The story spread fast not because of the healing potential that dEslon had suggested, but because of the implications for science as a whole. The panel had demonstrated that by putting imagination out of play, science could find the truth about our suffering bodies, in the same way it had found the truth about heavenly bodies. Hiving off subjectivity from the rest of medical practice, the Franklin commission had laid the conceptual foundation for the brilliant discoveries of modern medicine, the antibiotics and vaccines and other drugs that can be dispensed by whoever happens to possess the prescription pad, and to whoever happens to have the disease. Without meaning to, they had created an epistemology for the healing arts and, in the process, inadvertently conjured the placebo effect, and established it as that to which doctors must remain blind.

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It wouldnt be the last time science would turn its focus to the placebo effect only to quarantine it. At a 1955 meeting of the American Medical Association, the Harvard surgeon Henry Beecher pointed out to his colleagues that while they might have thought that placebos were fake medicine even the name, which means I shall please in Latin, carries more than a hint of contempt they couldnt deny that the results were real. Beecher had been looking at the subject systematically, and he determined that placebos could relieve anxiety and postoperative pain, change the blood chemistry of patients in a way similar to drugs and even cause side effects. In general, he told them, more than one-third of patients would get better when given a treatment that was, pharmacologically speaking, inert.

If the placebo was as powerful as Beecher said, and if doctors wanted to know whether their drugs actually worked, it was not sufficient simply to give patients the drugs and see whether they did better than patients who didnt interact with the doctor at all. Instead, researchers needed to assume that the placebo effect was part of every drug effect, and that drugs could be said to work only to the extent that they worked better than placebos. An accurate measure of drug efficacy would require comparing the response of patients taking it with that of patients taking placebos; the drug effect could then be calculated by subtracting the placebo response from the overall response, much as a deli-counter worker subtracts the weight of the container to determine how much lobster salad youre getting.

In the last half of the 1950s, this calculus gave rise to a new way to evaluate drugs: the double-blind, placebo-controlled clinical trial, in which neither patient nor clinician knew who was getting the active drug and who the placebo. In 1962, when the Food and Drug Administration began to require pharmaceutical companies to prove their new drugs were effective before they came to market, they increasingly turned to the new method; today, virtually every prospective new drug has to outperform placebos on two independent studies in order to gain F.D.A. approval.

Like Franklins commission, the F.D.A. had determined that the only way to sort out the real from the fake in medicine was to isolate the imagination. It also echoed the royal panel by taking note of the placebo effect only long enough to dismiss it, giving it a strange dual nature: Its included in clinical trials because it is recognized as an important part of every treatment, but it is treated as if it were not important in itself. As a result, although virtually every clinical trial is a study of the placebo effect, it remains underexplored an outcome that reflects the fact that there is no money in sugar pills and thus no industry interest in the topic as anything other than a hurdle it needs to overcome.

When Ted Kaptchuk was asked to give the opening keynote address at the conference in Leiden, he contemplated committing the gravest heresy imaginable: kicking off the inaugural gathering of the Society for Interdisciplinary Placebo Studies by declaring that there was no such thing as the placebo effect. When he broached this provocation in conversation with me not long before the conference, it became clear that his point harked directly back to Franklin: that the topic he and his colleagues studied was created by the scientific establishment, and only in order to exclude it which means that they are always playing on hostile terrain. Science is designed to get rid of the husks and find the kernels, he told me. Much can be lost in the threshing in particular, Kaptchuk sometimes worries, the rituals embedded in the doctor-patient encounter that he thinks are fundamental to the placebo effect, and that he believes embody an aspect of medicine that has disappeared as scientists and doctors pursue the course laid by Franklins commission. Medical care is a moral act, he says, in which a suffering person puts his or her fate in the hands of a trusted healer.

I dont love science, Kaptchuk told me. I want to know what heals people. Science may not be the only way to understand illness and healing, but it is the established way. Thats where the power is, Kaptchuk says. That instinct is why he left his position as director of a pain clinic in 1990 to join Harvard and its why he was delighted when, in 2010, he was contacted by Kathryn Hall, a molecular biologist. Here was someone with an interest in his topic who was also an expert in molecules, and who might serve as an emissary to help usher the placebo into the medical establishment.

Halls own journey into placebo studies began 15 years before her meeting with Kaptchuk, when she developed a bad case of carpal tunnel syndrome. Wearing a wrist brace didnt help, and neither did over-the-counter drugs or the codeine her doctor prescribed. When a friend suggested she visit an acupuncturist, Hall balked at the idea of such an unscientific approach. But faced with the alternative, surgery, she decided to make an appointment. I was there for maybe 10 minutes, she recalls, when she stuck a needle here Hall points to a spot on her forearm and this awful pain just shot through my arm. But then the pain receded and her symptoms disappeared, as if they had been carried away on the tide. She received a few more treatments, during which the acupuncturist taught her how to manipulate a spot near her elbow if the pain recurred. Hall needed the fix from time to time, but the problem mostly just went away.

I couldnt believe it, she told me. Two years of gross drugs, and then just one treatment. All these years later, shes still wonder-struck. What was that? she asks. Rub the spot, and the pain just goes away?

Hall was working for a drug company at the time, but she soon left to get a masters degree in visual arts, after which she started a documentary-production company. She was telling her carpal-tunnel story to a friend one day and recounted how the acupuncturist had climbed up on the table with her. (I was like, Oh, my God, what is this woman doing?  she told me. It was very dramatic.) Shed never been able to understand how the treatment worked, and this memory led her to wonder out loud if maybe the drama itself had something to do with the outcome.

Her friend suggested she might find some answers in Ted Kaptchuks work. She picked up his book about Chinese medicine, The Web that Has No Weaver, in which he mentioned the possibility that placebo effects figure strongly in acupuncture, and then she read a study he had conducted that put that question to the test.

Kaptchuk had divided people with irritable bowel syndrome into three groups. In one, acupuncturists went through all the motions of treatment, but used a device that only appeared to insert a needle. Subjects in a second group also got sham acupuncture, but delivered with more elaborate doctor-patient interaction than the first group received. A third group was given no treatment at all. At the end of the trial, both treatment groups improved more than the no-treatment group, and the high interaction group did best of all.

Kaptchuk, who before joining Harvard had been an acupuncturist in private practice, wasnt particularly disturbed by the finding that his own profession worked even when needles were not actually inserted; hed never thought that placebo treatments were fake medicine. He was more interested in how the strength of the treatment varied with the quality and quantity of interaction between the healer and the patient the drama, in other words. Hall reached out to him shortly after she read the paper.

The findings of the I.B.S. study were in keeping with a hypothesis Kaptchuk had formed over the years: that the placebo effect is a biological response to an act of caring; that somehow the encounter itself calls forth healing and that the more intense and focused it is, the more healing it evokes. He elaborated on this idea in a comparative study of conventional medicine, acupuncture and Navajo chantway rituals, in which healers lead storytelling ceremonies for the sick. He argued that all three approaches unfold in a space set aside for the purpose and proceed as if according to a script, with prescribed roles for every participant. Each modality, in other words, is its own kind of ritual, and Kaptchuk suggested that the ritual itself is part of what makes the procedure effective, as if the combined experiences of the healer and the patient, reinforced by the special-but-familiar surroundings, evoke a healing response that operates independently of the treatments specifics. Rituals trigger specific neurobiological pathways that specifically modulate bodily sensations, symptoms and emotions, he wrote. It seems that if the mind can be persuaded, the body can sometimes act accordingly. He ended that paper with a call for further scientific study of the nexus between ritual and healing.

When Hall contacted him, she seemed like a perfect addition to the team he was assembling to do just that. He even had an idea of exactly how she could help. In the course of conducting the study, Kaptchuk had taken DNA samples from subjects in hopes of finding some molecular pattern among the responses. This was an investigation tailor-made to Halls expertise, and she agreed to take it on. Of course, the genome is vast, and it was hard to know where to begin until, she says, she and Kaptchuk attended a talk in which a colleague presented evidence that an enzyme called COMT affected peoples response to pain and painkillers. Levels of that enzyme, Hall already knew, were also correlated with Parkinsons disease, depression and schizophrenia, and in clinical trials people with those conditions had shown a strong placebo response. When they heard that COMT was also correlated with pain response another area with significant placebo effects Hall recalls, Ted and I looked at each other and were like: Thats it! Thats it! 

It is not possible to assay levels of COMT directly in a living brain, but there is a snippet of the genome called rs4680 that governs the production of the enzyme, and that varies from one person to another: One variant predicts low levels of COMT, while another predicts high levels. When Hall analyzed the I.B.S. patients DNA, she found a distinct trend. Those with the high-COMT variant had the weakest placebo responses, and those with the opposite variant had the strongest. These effects were compounded by the amount of interaction each patient got: For instance, low-COMT, high-interaction patients fared best of all, but the low-COMT subjects who were placed in the no-treatment group did worse than the other genotypes in that group. They were, in other words, more sensitive to the impact of the relationship with the healer.

The discovery of this genetic correlation to placebo response set Hall off on a continuing effort to identify the biochemical ensemble she calls the placebome the term reflecting her belief that it will one day take its place among the other important -omes of medical science, from the genome to the microbiome. The rs4680 gene snippet is one of a group that governs the production of COMT, and COMT is one of a number of enzymes that determine levels of catecholamines, a group of brain chemicals that includes dopamine and epinephrine. (Low COMT tends to mean higher levels of dopamine, and vice versa.) Hall points out that the catecholamines are associated with stress, as well as with reward and good feeling, which bolsters the possibility that the placebome plays an important role in illness and health, especially in the chronic, stress-related conditions that are most susceptible to placebo effects.

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CreditPhoto illustration by Paul Sahre
Her findings take their place among other results from neuroscientists that strengthen the placebos claim to a place at the medical table, in particular studies using f.M.R.I. machines that have found consistent patterns of brain activation in placebo responders. For years, we thought of the placebo effect as the work of imagination, Hall says. Now through imaging you can literally see the brain lighting up when you give someone a sugar pill.

One group with a particularly keen interest in those brain images, as Hall well knows, is her former employers in the pharmaceutical industry. The placebo effect has been plaguing their business for more than a half-century since the placebo-controlled study became the clinical-trial gold standard, requiring a new drug to demonstrate a significant therapeutic benefit over placebo to gain F.D.A. approval.

Thats a bar that is becoming ever more difficult to surmount, because the placebo effect seems to be becoming stronger as time goes on. A 2015 study published in the journal Pain analyzed 84 clinical trials of pain medication conducted between 1990 and 2013 and found that in some cases the efficacy of placebo had grown sharply, narrowing the gap with the drugs effect from 27 percent on average to just 9 percent. The only studies in which this increase was detected were conducted in the United States, which has spawned a variety of theories to explain the phenomenon: that patients in the United States, one of only two countries where medications are allowed to be marketed directly to consumers, have been conditioned to expect greater benefit from drugs; or that the larger and longer-duration trials more common in America have led to their often being farmed out to contract organizations whose nurses only job is to conduct the trial, perhaps fostering a more placebo-triggering therapeutic interaction.

Whatever the reason, a result is that drugs that pass the first couple of stages of the F.D.A. approval process founder more and more frequently in the larger late-stage trials; more than 90 percent of pain medications now fail at this stage. The industry would be delighted if it were able to identify placebo responders say, by their genome and exclude them from clinical trials.

That may seem like putting a thumb on the scale for drugs, but under the logic of the drug-approval regime, to eliminate placebo effects is not to cheat; it merely reduces the noise in order for the drugs signal to be heard more clearly. That simple logic, however, may not hold up as Hall continues her research into the genetic basis of the placebo. Indeed, that research may have deeper implications for clinical drug trials, and for the drugs themselves, than pharma companies might expect.

Since 2013, Hall has been involved with the Womens Health Study, which has tracked the cardiovascular health of nearly 40,000 women over more than 20 years. The subjects were randomly divided into four groups, following standard clinical-trial protocol, and received a daily dose of either vitamin E, aspirin, vitamin E with aspirin or a placebo. A subset also had their DNA sampled which, Hall realized, offered her a vastly larger genetic database to plumb for markers correlated to placebo response. Analyzing the data amassed during the first 10 years of the study, Hall found that the women with the low-COMT gene variant had significantly higher rates of heart disease than women with the high-COMT variant, and that the risk was reduced for those low-COMT women who received the active treatments but not in those given placebos. Among high-COMT people, the results were the inverse: Women taking placebos had the lowest rates of disease; people in the treatment arms had an increased risk.

These findings in some ways seem to confound the results of the I.B.S. study, in which it was the low-COMT patients who benefited most from the placebo. But, Hall argues, whats important isnt the direction of the effect, but rather that there is an effect, one that varies depending on genotype and that the same gene variant also seems to determine the relative effectiveness of the drug. This outcome contradicts the logic underlying clinical trials. It suggests that placebo and drug do not involve separate processes, one psychological and the other physical, that add up to the overall effectiveness of the treatment; rather, they may both operate on the same biochemical pathway the one governed in part by the COMT gene.

Hall has begun to think that the placebome will wind up essentially being a chemical pathway along which healing signals travel and not only to the mind, as an experience of feeling better, but also to the body. This pathway may be where the brain translates the act of caring into physical healing, turning on the biological processes that relieve pain, reduce inflammation and promote health, especially in chronic and stress-related illnesses like irritable bowel syndrome and some heart diseases. If the brain employs this same pathway in response to drugs and placebos, then of course it is possible that they might work together, like convoys of drafting trucks, to traverse the territory. But it is also possible that they will encroach on one another, that there will be traffic jams in the pathway.

What if, Hall wonders, a treatment fails to work not because the drug and the individual are biochemically incompatible, but rather because in some people the drug interferes with the placebo response, which if properly used might reduce disease? Or conversely, what if the placebo response is, in people with a different variant, working against drug treatments, which would mean that a change in the psychosocial context could make the drug more effective? Everyone may respond to the clinical setting, but there is no reason to think that the response is always positive. According to Halls new way of thinking, the placebo effect is not just some constant to be subtracted from the drug effect but an intrinsic part of a complex interaction among genes, drugs and mind. And if shes right, then one of the cornerstones of modern medicine the placebo-controlled clinical trial is deeply flawed.

When Kathryn Hall told Ted Kaptchuk what she was finding as she explored the relationship of COMT to the placebo response, he was galvanized. Get this molecule on the map! he urged her. Its not hard to understand his excitement. More than two centuries after dEslon suggested that scientists turn their attention directly to the placebo effect, she did exactly that and came up with a finding that might have persuaded even Ben Franklin.

But Kaptchuk also has a deeper unease about Halls discovery. The placebo effect cant be totally reduced to its molecules, he feels certain and while research like Halls will surely enhance its credibility, he also sees a risk in playing his game on scientific turf. Once you start measuring the placebo effect in a quantitative way, he says, youre transforming it to be something other than what it is. You suck out what was previously there and turn it into science. Reduced to its molecules, he fears, the placebo effect may become yet another thing on the conveyor belt of routinized care.

Were dancing with the devil here, Kaptchuk once told me, by way of demonstrating that he was aware of the risks hes taking in using science to investigate a phenomenon it defined only to exclude. Kaptchuk, an observant Jew who is a student of both the Torah and the Talmud, later modified his comment. Its more like Jacob wrestling with the angel, he said a battle that Jacob won, but only at the expense of a hip injury that left him lame for the rest of his life.

Indeed, Kaptchuk seems wounded when he complains about the pervasiveness of research that uses healthy volunteers in academic settings, as if the response to mild pain inflicted on an undergraduate participating in an on-campus experiment is somehow comparable to the despair often suffered by people with chronic, intractable pain. He becomes annoyed when he talks about how quickly some of his colleagues want to move from these studies to clinical recommendations. And he can even be disparaging of his own work, wondering, for instance, whether the study in which placebos were openly given to irritable bowel syndrome patients succeeded only because it convinced the subjects that the sugar was really a drug. But its the prospect of what will become of his findings, and of the placebo, as they make their way into clinical practice, that really seems to torment him.

Kaptchuk may wish to help reconfigure biomedicine by rejecting the idea that healing is only the application of mechanical tools. He may believe that healing is a moral act in which caring in the context of hope qualitatively changes clinical outcomes. He may be convinced that the relationship kindled by the encounter between a suffering person and a healer is a central, and almost entirely overlooked, component of medical treatment. And he may have dedicated the last 20 years of his life to persuading the medical establishment to listen to him. But he may also come to regret the outcome.

After all, if Hall is right that clinician warmth is especially effective with a certain genotype, then, as she wrote in the paper presenting her findings from the I.B.S./sham-acupuncture study, it is also true that a different group will derive minimum benefit from empathic attentions. Should medical rituals be doled out according to genotype, with warmth and caring withheld in order to clear the way for the drugs? And if she is correct that a certain ensemble of neurochemical events underlies the placebo effect, then what is to stop a drug company from manufacturing a drug a real drug, that is that activates the same process pharmacologically? Welcomed back into the medical fold, the placebo effect may raise enough mischief to make Kaptchuk rue its return, and bewilder patients when they discover that their doctors bedside manner is tailored to their genes.

For the most part, most days, Kaptchuk manages to keep his qualms to himself, to carry on as if he were fully confident that scientific inquiry can restore the moral dimension to medicine. But the precariousness of his endeavors is never far from his mind. Will this work destroy the stuff that actually has to do with wisdom, preciousness, imagination, the things that are actually critical to who we are as human beings? he asks. His answer: I dont know, but I have to believe there is an infinite reserve of wisdom and imagination that will resist being reduced to simple materialistic explanations.

The ability to hold two contradictory thoughts in mind at the same time seems to come naturally to Kaptchuk, but he may overestimate its prevalence in the rest of us. Even if his optimism is well placed, however, theres nothing like being sick to make a person toss that kind of intelligence aside in favor of the certainties offered by modern medicine. Indeed, its exactly that yearning that sickness seems to awaken and that our healers, imbued with the power of science, purport to provide, no imagination required. Armed with our confidence in them, were pleased to give ourselves over to their ministrations, and pleased to believe that its the molecules, and the molecules alone, that are healing us. People do like to be cheated, after all.


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Edward Snowden Explains Blockchain to His Lawyer and the Rest of Us

By Ben Wizner, Director, ACLU Speech, Privacy, and Technology Project
NOVEMBER 20, 2018 | 3:30 PM

[This piece originally appreared in McSweeneys new issue, The End of Trust, a collection featuring over 30 writers investigating surveillance, technology, and privacy, with special advisors the Electronic Frontier Foundation.]

Over the last five years, Edward Snowden and I have carried on an almost daily conversation, most of it unrelated to his legal troubles. Sometimes we meet in person in Moscow over vodka (me) and milkshakes (him). But our friendship has mostly taken place on secure messaging platforms, a channel that was comfortable and intuitive for him but took some getting used to for me. I learned to type with two thumbs as we discussed politics, law, and literature; family, friends, and foster dogs. Our sensibilities are similar but our worldviews quite different: I sometimes accuse him of technological solutionism; he accuses me of timid incrementalism.

Through it all, Ive found him to be the clearest, most patient, and least condescending explainer of technology Ive ever met. Ive often thought that I wished more people or perhaps different people could eavesdrop on our conversations. What follows is a very lightly edited transcript of one of our chats. In it, Ed attempts to explain blockchain to me, despite my best efforts to cling to my own ignorance.

Ben Wizner: The Electronic Frontier Foundation recently joked that the amount of energy required to download tweets, articles, and instant messages which describe what the blockchain is and how decentralized currencies are the future will soon eclipse the total amount of power used by the country of Denmark. Its true that there are a lot of blockchain explainers out there. And yet Im ashamed to admit I still dont really get it.

Edward Snowden: Are you asking for another math lesson? Ive been waiting for this day. You remember what a cryptographic hash function is, right?

BW: This is where Im supposed to make a joke about drugs. But no, I do not now nor will I ever remember that.

ES: Challenge accepted. Lets start simpler: what do you know about these mythical blockchains?

BW: That I could have been rich if Id listened to you about this four years ago? But really, Ive heard a lot and understood little. Decentralized. Ledgers. What the hell is a blockchain?

ES: Its basically just a new kind of database. Imagine updates are always added to the end of it instead of messing with the old, preexisting entries just as you could add new links to an old chain to make it longer and youre on the right track. Start with that concept, and well fill in the details as we go.

BW: Okay, but why? What is the question for which blockchain is the answer?

ES: In a word: trust. Imagine an old database where any entry can be changed just by typing over it and clicking save. Now imagine that entry holds your bank balance. If somebody can just arbitrarily change your balance to zero, that kind of sucks, right? Unless youve got student loans.

The point is that any time a system lets somebody change the history with a keystroke, you have no choice but to trust a huge number of people to be both perfectly good and competent, and humanity doesnt have a great track record of that. Blockchains are an effort to create a history that cant be manipulated.

BW: A history of what?

ES: Transactions. In its oldest and best-known conception, were talking about Bitcoin, a new form of money. But in the last few months, weve seen efforts to put together all kind of records in these histories. Anything that needs to be memorialized and immutable. Health-care records, for example, but also deeds and contracts.

When you think about it at its most basic technological level, a blockchain is just a fancy way of time-stamping things in a manner that you can prove to posterity hasnt been tampered with after the fact. The very first bitcoin ever created, the Genesis Block, famously has one of those general attestations attached to it, which you can still view today.

It was a cypherpunk take on the old practice of taking a selfie with the days newspaper, to prove this new bitcoin blockchain hadnt secretly been created months or years earlier (which would have let the creator give himself an unfair advantage in a kind of lottery well discuss later).

BW: Blockchains are a history of transactions. Thats such a letdown. Because Ive heard some extravagant claims like: blockchain is an answer to censorship. Blockchain is an answer to online platform monopolies.

ES: Some of that is hype cycle. Look, the reality is blockchains can theoretically be applied in many ways, but its important to understand that mechanically, were discussing a very, very simple concept, and therefore the applications are all variations on a single theme: verifiable accounting. Hot.

So, databases, remember? The concept is to bundle up little packets of data, and that can be anything. Transaction records, if were talking about money, but just as easily blog posts, cat pictures, download links, or even moves in the worlds most over-engineered game of chess. Then, we stamp these records in a complicated way that Im happy to explain despite protest, but if youre afraid of math, you can think of this as the high-tech version of a public notary. Finally, we distribute these freshly notarized records to members of the network, who verify them and update their independent copies of this new history. The purpose of this last step is basically to ensure no one person or small group can fudge the numbers, because too many people have copies of the original.

Its this decentralization that some hope can provide a new lever to unseat todays status quo of censorship and entrenched monopolies. Imagine that instead of todays world, where publicly important data is often held exclusively at GenericCorp LLC, which can and does play God with it at the publics expense, its in a thousand places with a hundred jurisdictions. There is no takedown mechanism or other lets be evil button, and creating one requires a global consensus of, generally, at least 51 percent of the network in support of changing the rules.

mechanically, were discussing a very, very simple concept, and therefore the applications are all variations on a single theme: verifiable accounting. Hot.
BW: So even if Peter Thiel won his case and got a court order that some article about his vampire diet had to be removed, there would be no way to enforce it. Yes? That is, if Blockchain Magazine republished it.

ES: Right so long as Blockchain Magazine is publishing to a decentralized, public blockchain, they could have a judgment ordering them to set their office on fire and it wouldnt make a difference to the network.

BW: So how does it work?

ES: Oh man, I was waiting for this. Youre asking for the fun stuff. Are you ready for some abstract math?

BW: As ready as Ill ever be.

ES: Lets pretend youre allergic to finance, and start with the example of an imaginary blockchain of blog posts instead of going to the normal Bitcoin examples. The interesting mathematical property of blockchains, as mentioned earlier, is their general immutability a very short time past the point of initial publication.

For simplicitys sake, think of each new article published as representing a block extending this blockchain. Each time you push out a new article, you are adding another link to the chain itself. Even if its a correction or update to an old article, it goes on the end of the chain, erasing nothing. If your chief concerns were manipulation or censorship, this means once its up, its up. It is practically impossible to remove an earlier block from the chain without also destroying every block that was created after that point and convincing everyone else in the network to agree that your alternate version of the history is the correct one.

Lets take a second and get into the reasons for why thats hard. So, blockchains are record-keeping backed by fancy math. Great. But what does that mean? What actually stops you from adding a new block somewhere other than the end of the chain? Or changing one of the links thats already there?

We need to be able to crystallize the things were trying to account for: typically a record, a timestamp, and some sort of proof of authenticity.

So on the technical level, a blockchain works by taking the data of the new block the next link in the chain stamping it with the mathematic equivalent of a photograph of the block immediately preceding it and a timestamp (to establish chronological order of publication), then hashing it all together in a way that proves the block qualifies for addition to the chain.

BW: Hashing is a real verb?

ES: A cryptographic hash function is basically just a math problem that transforms any data you throw at it in a predictable way. Any time you feed a hash function a particular cat picture, you will always, always get the same number as the result. We call that result the hash of that picture, and feeding the cat picture into that math problem hashing the picture. The key concept to understand is that if you give the very same hash function a slightly different cat picture, or the same cat picture with even the tiniest modification, you will get a WILDLY different number (hash) as the result.

BW: And you can throw any kind of data into a hash function? You can hash a blog post or a financial transaction or Moby-Dick?

ES: Right. So we hash these different blocks, which, if you recall, are just glorified database updates regarding financial transactions, web links, medical records, or whatever. Each new block added to the chain is identified and validated by its hash, which was produced from data that intentionally includes the hash of the block before it. This unbroken chain leads all the way back to the very first block, which is what gives it the name.

Im sparing you some technical nuance here, but the important concepts to understand are that blocks in the chain are meant to be verifiable, strictly ordered by chronology, and immutable. Each new block created, which in the case of Bitcoin happens every ten minutes, effectively testifies about the precise contents of all the ones that came before it, making older blocks harder and harder to change without breaking the chain completely.

So by the time our Peter Thiel catches wind of the story and decides to kill it, the chain has already built a thousand links of confirmable, published history.

Money is, of course, the best and most famous example of where blockchains have been proven to make sense.
BW: And this is going to save the internet? Can you explain why some people think blockchain is a way to get around or replace huge tech platform monopolies? Like how could it weaken Amazon? Or Google?

ES: I think the answer there is wishful thinking. At least for the foreseeable future. We cant talk Amazon without getting into currency, but I believe blockchains have a much better chance of disrupting trade than they do publication, due to their relative inefficiency.

Think about our first example of your bank balance in an old database. That kind of setup is fast, cheap, and easy, but makes you vulnerable to the failures or abuses of what engineers call a trusted authority. Blockchains do away with the need for trusted authorities at the expense of efficiency. Right now, the old authorities like Visa and MasterCard can process tens of thousands of transactions a second, while Bitcoin can only handle about seven. But methods of compensating for that efficiency disadvantage are being worked on, and well see transaction rates for blockchains improve in the next few years to a point where theyre no longer a core concern.

RESTORE NET NEUTRALITY

SEND YOUR MESSAGEBW: Ive been avoiding this, because I cant separate cryptocurrency from the image of a bunch of tech bros living in a palace in Puerto Rico as society crumbles. But its time for you to explain how Bitcoin works.

ES: Well, I hate to be the bearer of bad news, but Zuckerberg is already rich.

Money is, of course, the best and most famous example of where blockchains have been proven to make sense.

BW: With money, what is the problem that blockchain solves?

ES: The same one it solves everywhere else: trust. Without getting too abstract: what is money today? A little cotton paper at best, right? But most of the time, its just that entry in a database. Some bank says youve got three hundred rupees today, and you really hope they say the same or better tomorrow.

Now think about access to that reliable bank balance that magical number floating in the database as something that cant be taken for granted, but is instead transient. Youre one of the worlds unbanked people. Maybe you dont meet the requirements to have an account. Maybe banks are unreliable where you live, or, as happened in Cyprus not too long ago, they decided to seize peoples savings to bail themselves out. Or maybe the money itself is unsound, as in Venezuela or Zimbabwe, and your balance from yesterday that couldve bought a house isnt worth a cup of coffee today. Monetary systems fail.

BW: Hang on a minute. Why is a bitcoin worth anything? What generates value? What backs the currency? When I own a bitcoin, what do I really own?

ES: Good question. What makes a little piece of green paper worth anything? If youre not cynical enough to say men with guns, which are the reason legal tender is treated different from Monopoly money, youre talking about scarcity and shared belief in the usefulness of the currency as a store of value or a means of exchange.

Lets step outside of paper currencies, which have no fundamental value, to a more difficult case: why is gold worth so much more than its limited but real practical uses in industry? Because people generally agree its worth more than its practical value. Thats really it. The social belief that its expensive to dig out of the ground and put on a shelf, along with the expectation that others are also likely to value it, transforms a boring metal into the worlds oldest store of value.

Blockchain-based cryptocurrencies like Bitcoin have very limited fundamental value: at most, its a token that lets you save data into the blocks of their respective blockchains, forcing everybody participating in that blockchain to keep a copy of it for you. But the scarcity of at least some cryptocurrencies is very real: as of today, no more than twenty-one million bitcoins will ever be created, and seventeen million have already been claimed. Competition to mine the remaining few involves hundreds of millions of dollars worth of equipment and electricity, which economists like to claim are what really backs Bitcoin.

Yet the hard truth is that the only thing that gives cryptocurrencies value is the belief of a large population in their usefulness as a means of exchange. That belief is how cryptocurrencies move enormous amounts of money across the world electronically, without the involvement of banks, every single day. One day capital-B Bitcoin will be gone, but as long as there are people out there who want to be able to move money without banks, cryptocurrencies are likely to be valued.

BW: But what about you? What do you like about it?

ES: I like Bitcoin transactions in that they are impartial. They cant really be stopped or reversed, without the explicit, voluntary participation by the people involved. Lets say Bank of America doesnt want to process a payment for someone like me. In the old financial system, theyve got an enormous amount of clout, as do their peers, and can make that happen. If a teenager in Venezuela wants to get paid in a hard currency for a web development gig they did for someone in Paris, something prohibited by local currency controls, cryptocurrencies can make it possible. Bitcoin may not yet really be private money, but it is the first free money.

Bitcoin has competitors as well. One project, called Monero, tries to make transactions harder to track by playing a little shell game each time anybody spends money. A newer one by academics, called Zcash, uses novel math to enable truly private transactions. If we dont have private transactions by default within five years, itll be because of law, not technology.

As with all new technologies, there will be disruption and there will be abuse. The question is whether, on balance, the impact is positive or negative.
BW: So if Trump tried to cut off your livelihood by blocking banks from wiring your speaking fees, you could still get paid.

ES: And all he could do is tweet about it.

BW: The downside, I suppose, is that sometimes the ability of governments to track and block transactions is a social good. Taxes. Sanctions. Terrorist finance.

We want you to make a living. We also want sanctions against corrupt oligarchs to work.

ES: If you worry the rich cant dodge their taxes without Bitcoin, Im afraid I have some bad news. Kidding aside, this is a good point, but I think most would agree were far from the low-water mark of governmental power in the world today. And remember, people will generally have to convert their magic internet money into another currency in order to spend it on high-ticket items, so the governments days of real worry are far away.

BW: Explore that for me. Wouldnt the need to convert Bitcoin to cash also affect your Venezuelan teen?

ES: The difference is scale. When a Venezuelan teen wants to trade a months wages in cryptocurrency for her local currency, she doesnt need an ID check and a bank for that. Thats a level of cash people barter with every day, particularly in developing economies. But when a corrupt oligarch wants to commission a four hundred million-dollar pleasure yacht, well, yacht builders dont have that kind of liquidity, and the existence of invisible internet money doesnt mean cops wont ask how you paid for it.

The off-ramp for one is a hard requirement, but the other can opt for a footpath.

Similarly, its easier for governments to work collectively against real criminals think bin Laden than it is for them to crack down on dissidents like Ai Weiwei. The French would work hand in hand with the Chinese to track the activity of bin Ladens Bitcoin wallet, but the same is hopefully not true of Ai Weiwei.

BW: So basically youre saying that this wont really help powerful bad actors all that much.

ES: It could actually hurt them, insofar as relying on blockchains will require them to commit evidence of their bad deeds onto computers, which, as weve learned in the last decade, government investigators are remarkably skilled at penetrating.

BW: How would you describe the downsides, if any?

ES: As with all new technologies, there will be disruption and there will be abuse. The question is whether, on balance, the impact is positive or negative. The biggest downside is inequality of opportunity: these are new technologies that are not that easy to use and still harder to understand. They presume access to a level of technology, infrastructure, and education that is not universally available. Think about the disruptive effect globalization has had on national economies all over the world. The winners have won by miles, not inches, with the losers harmed by the same degree. The first-mover advantage for institutional blockchain mastery will be similar.

BW: And the internet economy has shown that a platform can be decentralized while the money and power remain very centralized.

ES: Precisely. There are also more technical criticisms to be made here, beyond the scope of what we can reasonably get into. Suffice it to say cryptocurrencies are normally implemented today through one of two kinds of lottery systems, called proof of work and proof of stake, which are a sort of necessary evil arising from how they secure their systems against attack. Neither is great. Proof of work rewards those who can afford the most infrastructure and consume the most energy, which is destructive and slants the game in favor of the rich. Proof of stake tries to cut out the environmental harm by just giving up and handing the rich the reward directly, and hoping their limitless, rent-seeking greed will keep the lights on. Needless to say, new models are needed.

BW: Say more about the environmental harms. Why does making magical internet money use so much energy?

ES: Okay, imagine you decide to get into mining bitcoins. You know there are a limited number of them up for grabs, but theyre coming from somewhere, right? And its true: new bitcoins will still continue to be created every ten minutes for the next couple years. In an attempt to hand them out fairly, the original creator of Bitcoin devised an extraordinarily clever scheme: a kind of global math contest. The winner of each roughly ten-minute round gets that rounds reward: a little treasure chest of brand new, never-used bitcoins, created from the answer you came up with to that rounds math problem. To keep all the coins in the lottery from being won too quickly, the difficulty of the next math problem is increased based on how quickly the last few were solved. This mechanism is the explanation of how the rounds are always roughly ten minutes long, no matter how many players enter the competition.

The flaw in all of this brilliance was the failure to account for Bitcoin becoming too successful. The reward for winning a round, once worth mere pennies, is now around one hundred thousand dollars, making it economically reasonable for people to divert enormous amounts of energy, and data centers full of computer equipment, toward the math or mining contest. Town-sized Godzillas of computation are being poured into this competition, ratcheting the difficulty of the problems beyond comprehension.

This means the biggest winners are those who can dedicate tens of millions of dollars to solving a never-ending series of problems with no meaning beyond mining bitcoins and making its blockchain harder to attack.

BW: A never-ending series of problems with no meaning sounds like nihilism. Lets talk about the bigger picture. I wanted to understand blockchains because of the ceaseless hype. Some governments think that Bitcoin is an existential threat to the world order, and some venture-capital types swear that blockchains will usher in a golden age of transparency. But youre telling me its basically a fancy database.

ES: The tech is the tech, and its basic. Its the applications that matter. The real question is not what is a blockchain, but how can it be used? And that gets back to what we started on: trust. We live in a world where everyone is lying about everything, with even ordinary teens on Instagram agonizing over how best to project a lifestyle they dont actually have. People get different search results for the same query. Everything requires trust; at the same time nothing deserves it.

This is the one interesting thing about blockchains: they might be that one tiny gear that lets us create systems you dont have to trust. Youve learned the only thing about blockchains that matters: theyre boring, inefficient, and wasteful, but, if well designed, theyre practically impossible to tamper with. And in a world full of shifty bullshit, being able to prove something is true is a radical development. Maybe its the value of your bank account, maybe its the provenance of your pair of Nikes, or maybe its your for-real-this-time permanent record in the principals office, but records are going to transform into chains we cant easily break, even if theyre open for anyone in the world to look at.

The hype is a world where everything can be tracked and verified. The question is whether its going to be voluntary.

BW: That got dark fast. Are you optimistic about how blockchains are going to be used once we get out of the experimental phase?

ES: What do you think?


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Re: (damn) [Re: sirfun] #2881835
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https://www.nytimes.com/2018/11/29/opinion/maga-trump-manufacturing.html


Lets face it: Make America Great Again was a brilliant political slogan. Why? Because it could mean different things to different people.

For many supporters of Donald Trump, MAGA was basically a promise to return to the good old days of raw racism and sexism. And Trump is delivering on that promise.

But for at least some Trump voters, it was a promise to restore the kind of economy we had 40 or 50 years ago an economy that still offered lots of manly jobs in manufacturing and mining. Unfortunately for those who trusted Mr. Art of the Deal, Trump never had any idea how to deliver on that promise. And even if he had a clue about policymaking, he couldnt have changed the long-term trajectory of our economy, which is moving steadily away from making physical stuff and toward providing services.

As a result, Trump, who cares above all about image, is now getting headlines that make a mockery of his campaign posturing headlines about closing auto plants and lost jobs. Now, autos are a special case; overall manufacturing employment is still rising, although not especially fast. But relative to his grand promises, whats happening is an embarrassing bust.

Why was the vision of revived manufacturing nonsense? Talking about what Donald Trump doesnt know is, of course, a vast task, since his ignorance is both broad and deep. But he seems to have misunderstood three specific things about manufacturing.

First, he believes that trade deficits are the reason weve shifted away from manufacturing. But they arent.

To be fair, those deficits have played some role in shrinking U.S. industrial employment. If we could eliminate our current trade imbalance, wed probably have around 20 percent more workers in the manufacturing sector than we actually do. But that would reverse only a small part of manufacturings relative decline, from more than a quarter of the work force in 1970 to less than 10 percent now.

Indeed, even countries that run huge trade surpluses, like Germany, have seen big declines in manufacturing as a share of employment. Trade just isnt the main story. Whats happening instead is that as overall spending grows, an increasing share goes to services, not goods. Consumption of manufactured goods keeps rising, but technological progress lets us produce those goods with ever fewer workers; so the economy shifts toward services.

By the way, if you want to know what services means: Of the four occupations the Department of Labor expects to add the most jobs over the next decade, three are some kind of nursing (food workers are the fourth). And if you cant imagine how a prosperous economy can be built on services, bear in mind that health care is a large source of middle-class jobs, and could provide even more with the right policies.

Editors Picks

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Opinion
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Still, even if trade deficits are a distinctly secondary cause of manufacturing decline, cant Trump help a little by getting tough on foreigners? That brings us to his second fallacy: No, trade deficits arent caused by unfair foreign trade practices.

The truth is that while tariffs and so on can affect trade in particular industries, the overall trade balance mainly reflects exchange rates, which in turn are mainly driven by capital flows: The dollar is strong because foreigners want to buy U.S. assets. And Trumps policies tax cuts for corporations, big deficits that drive up interest rates are so far making the dollar even stronger.

Finally, Trumps angry reaction to auto plant closings is a reminder of his third big policy misunderstanding: He believes that you can run the economy by yelling at people.

Why is he wrong? Its not just that businesses have learned to discount his threats. More important, our economy is too big to make policy by singling out individual companies and ranting. How big is it? Around 1.7 million U.S. workers are fired or laid off every month. So even a president who spent less time golfing couldnt bully or threaten enough employers to make a significant difference to the labor market.

Or to put it differently, running America isnt like running a family business. It has to be done by setting broad policies and sticking to them, not by browbeating a few people whenever you see a bad headline.

So Trumps promise to restore U.S. manufacturing was doomed to fail. Why did he make it in the first place?

For what its worth, I suspect that in this case Trump wasnt actually trying to scam voters. My guess is that he genuinely believed that he could bring manufacturing, coal mining and so on roaring back, that others had failed to do so only because they werent tough enough.



You might wonder where his confidence came from, given how little he obviously knows about economics. The answer, probably, is the Dunning-Kruger effect: inept people are often confident in their abilities, because theyre too inept to know how badly theyre doing.

But the real question isnt whether Trump will ever realize that he doesnt know how to MAGA. Its whether and when his supporters will figure it out. I guess well learn the answer in the months ahead.



roflmao


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Re: (damn) [Re: sirfun] #2882473
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https://wokesloth.com/man-shoots-himself...b7iiXPyQNRmWezk

a little too tragic for my ironic sense of humor but damn

"that'll put some lead in his pencil" !! )


roflmao


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DAMN !! )


https://www.theatlantic.com/ideas/archive/2018/12/john-dingell-how-restore-faith-government/577222/




I Served in Congress Longer Than Anyone. Heres How to Fix It.
Abolish the Senate and publicly fund elections.

6:00 AM ET
John D. Dingell
Represented Michigan in Congress for over 59 years
John Dingell
LAUREN VICTORIA BURKE / AP
In my six decades in public service, Ive seen many changes in our nation and its institutions. Yet the most profound change Ive witnessed is also the saddest. It is the complete collapse in respect for virtually every institution of government and an unprecedented cynicism about the nobility of public service itself.

These are not just the grumblings of an angry old man lamenting the loss of the good old days. In December 1958, almost exactly three years after I entered the House of Representatives, the first American National Election Study, initiated by the University of Michigan, found that 73 percent of Americans trusted the federal government to do the right thing almost always or most of the time. As of December 2017, the same study, now conducted by the nonpartisan Pew Research Center, found that this number had plummeted to just 18 percent.


This article is an excerpt from The Dean: The Best Seat in the House, by John Dingell with David Bender
There are many reasons for this dramatic decline: the Vietnam War, Watergate, Ronald Reagans folksy but popular message that government was not here to help, the Iraq War, and worst of all by far, the Trumpist mind-set. These jackasses who see deep state conspiracies in every part of government are a minority of a minority, yet they are now the weakest link in the chain of more than three centuries of our American republic. Ben Franklin was right. The Founders gave us a precious but fragile gift. If we do not protect it with constant vigilance, we will most certainly lose it.

As an armchair activist, I now have the luxury of saying what I believe should happen, not what I think can get voted out of committee. Im still a pragmatist; I know that profound societal change happens incrementally, over a long period of time. The civil-rights fights of the 1950s and 60s, of which I am proud to have been a part, are a great example of overcoming setbacks and institutional racism. But 155 years after the Emancipation Proclamation and less than two years after our first African American president left office, racism still remains a part of our national life.

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Just for a moment, however, lets imagine the American system we might have if the better angels of our nature were to prevail.

Here, then, are some specific suggestionsand they are only just that, suggestionsfor a framework that might help restore confidence and trust in our precious system of government:

An electoral system based on full participation. At age 18, you are automatically registered to vote. No photo ID, no residency tests, no impediments of any kind. Advances in technology can make this happen effortlessly. Yes, voting should be restricted only to American citizens. Strict protections against foreign meddling are also necessary.

Read: Voter suppression is the new old normal

The elimination of money in campaigns. Period. Elections, like military serviceeach is an example of duty, honor, and service to countryshould be publicly funded. Can you imagine if we needed to rely on wealthy donors to fund the military? I know there are those who genuinely believe in privatizing everything. They are called profiteers.

Public service should not be a commodity, and elected officials should not have to rent themselves out to the highest bidder in order to get into (or stay in) office. If you want to restore trust in government, remove the price tag. I am fully aware that the Supreme Court has declared that money is speech. Thats nonsense. The day my wallet starts talking to me, I might reconsider that view. Until then, I believe that the pernicious influence of money on our elections must be removed.

The end of minority rule in our legislative and executive branches. The Great Compromise, as it was called when it was adopted by the Constitutions Framers, required that all states, big and small, have two senators. The idea that Rhode Island needed two U.S. senators to protect itself from being bullied by Massachusetts emerged under a system that governed only 4 million Americans.

Today, in a nation of more than 325 million and 37 additional states, not only is that structure antiquated, its downright dangerous. California has almost 40 million people, while the 20 smallest states have a combined population totaling less than that. Yet because of an 18th-century political deal, those 20 states have 40 senators, while California has just two. These sparsely populated, usually conservative states can block legislation supported by a majority of the American people. Thats just plain crazy.

The math is even starker when you look at places like Wyoming and Vermont, each of which has fewer people in the entire state (575,000 and 625,000, respectively) than does the Twelfth Congressional District of Michigan, which I last represented and whose more than 700,000 residents are now in the hands of my wife, Debbie. She fights her heart out for them every single day. Yet her efforts are often stymied simply because it is understood that even should a good bill make it through the hyper-partisan House, it will die a quiet death in the Senate because of the disproportionate influence of small states.

With my own eyes, Ive watched in horror and increasing anger as that imbalance in power has become the primary cause of our national legislative paralysis. In primaries, the vocal rump of a minority of obnoxious asses can hold the entire country hostage to extremist views. This insanity has sent true public servants fleeing for the exits. The Electoral College has the same structural flaw. Along with 337 of my colleagues, I voted in 1969 to amend the Constitution to abolish it. Twice in the past 18 years, weve seen the loser of the popular vote become president through the Electoral College formula, which gives that same disproportionate weight to small states, each of which gets two automatic votes for its two senators.

My friend Norm Ornstein, a resident scholar at the American Enterprise Institute, sees a demographic shift coming that will effectively transform us into two countries. He tells me that in 2050, 70 percent of Americans will be living in just 15 states. That 70 percent will then have 30 senators, and the remaining 30 percent of the people, mainly those living in the smallest and poorest states, will have 70 senators.

How do we fix this? Practically speaking, it will be very difficult, given the specific constitutional protection granted these small states to veto any threat to their outsize influence.

There is a solution, however, that could gain immediate popular support: Abolish the Senate. At a minimum, combine the two chambers into one, and the problem will be solved. It will take a national movement, starting at the grassroots level, and will require massive organizing, strategic voting, and strong leadership over the course of a generation. But it has a nice ring to it, doesnt it? Abolish the Senate. Im having blue caps printed up with that slogan right now. They will be made in America.

Read: The people vs. the U.S. Senate

The protection of an independent press. This is where the Founding Fathers got it exactly right. Jefferson said, Were it left to me to decide whether we should have a government without newspapers, or newspapers without a government, I should not hesitate a moment to prefer the latter.

Trump has said of reporters, I would never kill them, but I do hate them. And some of them are such lying, disgusting people.

My father started out life as a cub reporter for the Detroit Free Press. He always believed that journalism was a tremendously honorable profession. We cannot restore respect to our institutions of government until we put an end to the systematic attacks on journalism that have become prevalent. The playbook is simple: Lie. Repeat the lie. Then attack the journalists who expose those lies as being liars themselvesor, in modern parlance, promoters of fake news. The Nazis propaganda minister, Joseph Goebbels, replaced journalism with state-run propaganda and created a political climate based on fear and falsehoods.

The Washington Post won a Pulitzer Prize for its coverage of Russian interference in the 2016 election. The Fourth Estate is not a branch of government, but none of the branches of government can be trusted to function honestly without an unfettered free press vigilantly holding it accountable.

Thomas Jefferson had the first word and he should have the last word: Our liberty depends on the freedom of the press, and that cannot be limited without being lost.

Dan Rather and Eliot Kirshner: Why a free press matters

As a young man, I served in the Army during World War II. My father was a member of Congress. I learned from him and, later, from my own experience that history always repeats itself unless we remember it with clarity and conscience.

Now I am an old man. My age bears with it a responsibility to share what Ive witnessed so that future generations avoid making the same mistakes. My advice always begins with the truth, which is why would-be despots and demagogues try so hard to discredit it. They hate it like the devil hates holy water.

The conduct and outcome of the 2016 presidential election have put the future of our country in mortal peril. After a lifetime spent in public service, I never believed that day would come. Yet it has. And we now find ourselves on the precipice of a great cliff. Our next step is either into the abyss or toward a higher moral ground. Since before the Civil War, weve been told that Providence watches over fools, drunkards, and the United States. Yet the good Lord also granted us free will. The direction we choose to follow is ours alone to make. We ask only that he guide our choice with his wisdom and his grace.

Its up to you, my dear friends.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

JOHN D. DINGELL was a member of the United States House of Representatives from December 13, 1955, until January 3, 2015, the longest tenure of any member of Congress in American history.


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https://thehill.com/opinion/criminal-justice/419530-did-manafort-plead-guilty-to-spy-for-trump

roflmao

Few things tick off a federal prosecutor more than being double-crossed by a defendant who came sniffing around for a plea deal the day before his trial was set to begin.

Enter Paul Manafort, Donald Trumps former presidential campaign chairman.

Last week The New York Times reported that after Manafort signed a cooperation deal with Special Counsel Robert Mueller, Manaforts attorney regularly met with Trumps attorneys and disclosed valuable insights into the special counsels inquiry and where it was headed.

As a former federal prosecutor who handled hundreds of cooperation deals like Manaforts, I can comfortably say that what Manafort did would be uniformly perceived by prosecutors as a double-cross.

When a defendant enters into a cooperation deal, like Manafort did with Special Counsel Robert Mueller, there is an understanding of good faith that both parties will work toward the same goal. The defendant will truthfully disclose information about criminal activities of himself and others. In exchange, the prosecutor will reward the defendant by recommending a reduced sentence.

In the process of interviewing a cooperating defendant, questions asked by the prosecutor will unintentionally, but necessarily, reveal information about the prosecutors investigation. The questions can disclose criminal events of interest, people who are targets of the investigation, and evidence that the prosecutor has obtained.

In Mr. Manaforts case, the events he was questioned about are undoubtedly the very things Mr. Trump will need to defend against. So, while it may not have been illegal, it was a sleazy move for Manafort to agree to fully cooperate with Mr. Mueller and then secretly work to undermine his investigation.

Making matters worse, at the same time Manaforts attorneys were running to Trumps team and divulging Mueller information that would help the president, Manafort apparently was lying to the prosecutors during the course of his interviews. The special counsel said as much when he filed a notice announcing that Manafort had breached his plea agreement by repeatedly lying and committing new crimes.

Paul Manafort has been operating as a savvy fraudster for more than a decade. By taking a cooperation deal, Manafort knew that Mueller controlled his fate and that if a sentence reduction was in the cards, it would come through Mueller.

When you are trying to get a squirrel to eat out of your hand, you dont make any big moves. Lying to Mueller and running to Trumps lawyers with Muellers secrets is a big move. Its legal suicide.

Unless, of course, Manafort knew he had the ear of someone who could do more for him than Mueller.

For Manafort, the only thing better than serving less time in prison is serving no time in prison. A presidential pardon would have that covered. But, what would motivate the president to put pen to pardon paper?

The Presidents personal attorney, Rudolph Giuliani, acknowledged to the Times that information Manaforts attorney took from meetings with Mueller and delivered to Trumps lawyers, helped shape Mr. Trumps defense strategy and provided ammunition in his public relations campaign against Muellers office.

Having a mole inside the prosecution team, who pretends to be cooperating with the special counsel but is really lying to prosecutors and passing information to Team Trump, well, that sounds an awful lot like spying.

To the extent there was any ambiguity about the Manafort-Trump arrangement, with a series of tweets last Tuesday, the President appeared to begin laying the groundwork to satisfy his part of the apparent quid pro quo. Trump tweeted that Muellers investigation into Russian interference in the 2016 presidential election was ruining lives of witnesses who were refusing to lie. He followed with heroes will come of this, implying that witnesses who resisted cooperating with Mueller are heroes. Yes, Mr. Manafort, hes referring to you.

If the tweets represented Mr. Trump dipping his toe in the water to test the current, by the following day the president was in waist-deep. In an interview with the New York Post, the President said that a pardon for Mr. Manafort was not off the table. No one should be surprised if Trump soon drops the double negatives and affirmatively places Manaforts pardon on the table with a holiday garnish.

There are several possibilities why Paul Manafort agreed to cooperate with Special Counsel Mueller and then did the opposite. However, the link between Manaforts silence, his attorneys disclosure of Muellers strategy, and a presidential pardon is quickly evolving from shadowed line to highway lane marker.

Im not suggesting anything as crass as a direct statement from Trump to Manafort. I imagine something more analogous to the Presidents now infamous soft-peddle effort to convince former FBI Director James Comey to drop the investigation into former National Security Advisor Michael Flynn: I hope you can see your way clear to letting this go, letting Flynn go. He is a good guy. I hope you can let this go.

Given that Manafort is in custody, Im also not suggesting that he spoke directly with the President. Thats where the regular meetings between Manaforts attorney and Mr. Trumps attorneys comes in. The regular contact between the Manafort and Trump camps would have made for an easy arrangement with no paper, email, or phone trail.

The Presidents reference to Paul Manafort as a hero reminds me of the 1960s TV sitcom Hogans Heroes, which centered around Bob Hogan, a WWII prisoner-of-war. Hogan was an American in a German prison camp.

Manaforts circumstance is like Hogans except that Manafort was working to undermine an investigative team appointed to ensure free democratic elections, and Hogan risked his personal safety for the good of his country in an effort to do the right thing. Other than that, sure, Manafort is a hero.

Michael J. Stern was a federal prosecutor for more than 24 years with the Department of Justice in Detroit and Los Angeles, prosecuting high-profile crimes, including conspiracy cases related to international drug trafficking and organized crime. He has since worked on the indigent defense panel for the federal courts.


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America's Two Political Parties Are Asymmetrical - The Atlantic


Michael Avenatti was never going to be president. The Avenatti boomlet, which began in August, lasted for a little less than three months, until the attorney officially took himself out of the running on Tuesday, citing concerns about his family.

Avenatti made a name for himself representing the adult-film actress Stormy Daniels, whom President Donald Trump paid during the closing months of the 2016 campaign to keep quiet about an alleged affair a few years earlier. Avenatti has a telegenic presence, and he satisfied a need among angry liberals for a champion who was as nasty to the president as the president is to, well, almost everyone.

I believe our party must fight fire with fire, Avenatti told a crowd at a Democratic event in Iowa in August. When they go low, I say we hit harder.



That doesnt mean, however, that Avenatti, who has never held elected office, made a good or appealing presidential candidate. Avenatti was arrested on domestic-violence charges in November, and his declaration that the next Democratic presidential nominee better be a white male raised eyebrows, to say the least. Although numerous pundits speculated that Avenatti would become the Democrats version of Trump, this assessment misunderstands the nature of the two major parties. Trump emerged from a crowded GOP presidential field because of his expressions of public loathing against demographic groups that conservatives fear and his promises to use the power of the state against them. But the Democratic Party is simply too reliant on a base that is both ideologically and ethnically diverse to support a candidate who is a negative image of Trump. It is not that Democrats are more virtuous. It is that the Democratic Partys viability rests on too many different types of people to run campaigns that rely entirely on promises to crush the other side.


Although the Republican Party has grown more conservative in recent years and the Democratic Party has grown more liberal, the Democrats rely far more on conservative voters than the GOP does on liberal voters. According to Pew, only 4 percent of Republicans identify as liberal, 27 percent as moderate, and 68 percent as conservative. By contrast, 46 percent of Democrats identify as liberala large increase from 2000, when that figure was only 28 percent, but far less than the percentage of Republicans who identify as conservatives. Moderates account for 37 percent of Democratic voters, and conservatives 15 percent.

That asymmetry means that Democrats are forced to appeal to groups that lean Republican in order to win. This sometimes leads to comically awkward panderingthink of former Vermont Governor Howard Dean declaring that he wants to be president for the guy who has a Confederate flag on his truck, or Hillary Clinton needling Barack Obama over his lack of support from hardworking Americans, white Americans. When a Democrat with statewide or national ambitions does antagonize one of these conservative-leaning groups, whether its Obama describing Clinton primary voters as people who cling to guns and religion or Clinton saying that half of Trump supporters are racist, it is a potentially campaign-ending gaffe.

Read: Michael Avenatti is the 1990s-style celebrity lawyer of the Trump age

Contrast that with a Republican senator like Ted Cruz, who accused his Democratic rival of trying to make Texas like California, right down to tofu and silicon and dyed hair. When Democrats trash Republican-leaning constituencies, its a political catastrophe. When Republicans trash Democratic-leaning constituencies, its Tuesday.

A premature autopsy of Beto ORourkes run against Cruz, in which he came within three points of unseating the incumbent, argued that Democrats win in red states not by painting bold contrasts but by minimizing differences. This was a bit of a strange assessmentORourke did far better than a number of more conservative Democrats running in other states, who got wiped out; he helped Democrats overwhelm Republicans in dozens of down-ballot races; and he came closer than any Democrat in a generation to winning a statewide race in Texas. But it underscores the point that unlike Republicans, Democrats cannot afford to alienate huge swaths of the population and still expect to win big races. ORourke came close not because he trashed prospective Cruz voters or even Cruz himself, but because he offered the kind of unifying, starry-eyed liberal rhetoric that has proved successful for certain Democrats in the past.

This asymmetry isnt just ideological. Forty-three percent of white voters are Democrats, compared with 51 percent of white voters who lean GOP. That means white voters remain an essential part of the Democratic coalitionwhich is precisely why Fox News and other conservative media outlets serve so much culture-war red meat, fomenting white panic about diversity, telling their audiences that Democrats are racist against white people or want to take away Christmas. But unlike the Republican Party, Democrats must also draw support from black, Latino, and Asian votersmeaning they cant afford to antagonize them, and must be responsive to their interests.

Republicans are almost entirely reliant on white voterswhich is why generalizations about racial and religious minorities meet with so little pushback within the party. There is simply no constituency willing to hold Republican politicians accountable for such remarkson the contrary, most of the party either sees both the generalizations and the discriminatory policy approaches that emerge from them as admirable or remains in denial about what is happening.

Conor Friedersdorf: What progressives can learn from Michael Avenattis mistake

The divergence is clear even in the respective parties choice of standard-bearers. Obamas rise to political stardom came after a speech in which he declared that theres not a black America and white America and Latino America and Asian America; theres the United States of America. And Trumps came from his strategic deployment of the slander that the first black president was born abroad and was therefore illegitimate.

These distinctions mean that Democrats cannot afford to attack Americans who have only a high-school education the way that Republicans wage culture war against academia. Democrats cannot dismiss seniors the way Republicans condescend to young voters. Democrats cannot represent white men as a national-security threat after a terrorist attack the way Republicans can call to ban members of an entire religion from entering the country. Democrats must take care to not alienate police in the aftermath of unjustified police shootings, while Republicans can assassinate the character of entire communities. Democrats seeking higher office cannot hate the people who vote Republican the way that Republicans can hate people who vote for Democrats, not because Democrats are inherently better people but because they need the votes. And that means that without a fundamental change in the constituencies of both parties, there can never be a Democratic Trump.


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Interesting and correct


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Originally Posted By: sirfun


corporate profits and dignity of work are at loggerheads


if you haven't smoked DMT you have no credibility on any subject in surfing or outside of surfing...
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https://www.theatlantic.com/science/archive/2018/12/don-delillo-anniversary-apollo/578266/

Fifty years ago this month, the three-man crew of Apollo 8 swung around the moons far side and encountered a vision never before seen by human eyes: the sunlit Earth, juxtaposed against an ashen lunar plain, and a backdrop of infinite black space.

Frank Borman, Apollo 8s commander, has expressed frustration that he and his fellow astronauts failed to convey, with words, the cosmic import of their experience. I dont think we captured, in its entirety, the grandeur of what we had seen, he once said.

By the time Apollo 8 splashed home in the Pacific, writers had already tried to bridge the gap between the astronauts limited literary powers and the extraordinary sight they beheld. To see the Earth as it truly is, small and blue and beautiful in that eternal silence, the poet Archibald MacLeish wrote in the Christmas 1968 edition of The New York Times, is to see ourselves as riders on the Earth together, brothers on that bright loveliness in the eternal cold, brothers who now know they are truly brothers.

Many literary interpretations of this new motifthe astronaut gazing back at Earthwould follow. But perhaps none has surpassed a two-paragraph passage in Don DeLillos 1983 short story, Human Moments in World War III, about two men aboard an orbiting military space station, one of whom becomes entranced by his view of Earth through the stations window. The planet fills his consciousness, DeLillo writes, the answer to a lifetime of questions and vague cravings.

With special permission from Mr. DeLillo, the passage will appear here at The Atlantic through next Julys anniversary of the first moon landing.

Ross Andersen

Vollmer has entered a strange phase !! ( :

https://www.theatlantic.com/science/archive/2018/12/don-delillo-anniversary-apollo/578266/

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