I don’t want to spoil the festive mood by estimating the probability that you will have a happy new year.
So I take the middle road.
Thank you, Doris.
Perhaps, forming resolutions for the new year, you would like to include, “become a better predictor.” But so formulated, it sounds like a demand for performance, rather than a change one could actualize on one’s self.
IARPA, the Intelligence Advanced Research Projects Activity, actually has an interest in this. I’d like to help sort this out. Unfortunately, since I am not administering an IARPA program, the only example available for study here is myself. There are many ways to skin a cat, and people compartmentalize themselves in amazing ways. Since I don’t know what the limits of compartmentalization are in other people, let’s assume that the things I know about myself, and which might presumably be useful to some other people, constitute the whole person.
In other words, maybe you could be a bigoted, card-carrying member of some extremist organization, or an incessant political ranter. Perhaps, more mildly, you have dedicated your life to a worthy cause. Maybe, through some miracle of compartmentalization, you could be a good predictor.
I couldn’t, because my compartmentalization skills are limited, confined to the grim realities of existence. So I have a hunch that there is a useful division between doers and observers. The world is full of people who do and see nothing, those who only desire to “do”, and those who observe, some with particular acuteness. The competition among persons for the opportunity to make or change history is acute. Many individuals augment their participation as voters in democratic government with activism, a great thing. But others channel the “do” drive into a blind alley of excess emotion. This is frequently expressed as “frustration with the ways things are going.”
Even with the religious reference removed, the Serenity Prayer still offers one of the basic foundations of being a good predictor:
God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
In purely secular vocabulary, a certain level of detachment is basic to predicting. We cannot allow what we wish to be to influence the prediction. And while there is no shortage of people who want to change things, there is a severe shortage of clear vision.
In Mein Kampf, Hitler wrote, “Mankind has grown strong in eternal struggles, and it will only perish through eternal peace.” You can find this on page 310 of Henry Kissinger’s Diplomacy, in chapter 12, “The End of Illusion.” Hitler was not the originator of this thought, but merely the foremost practitioner of modern times. He is preceded by Friedrich Nietzsche, in “That which does not kill us makes us stronger”, and his Übermensch.
To the above recipe for totalitarian dictatorship, add the interpretation of Hegel to say, “might makes right.” Hegel did not say it, but what he did say, “The state is the actuality of the ethical Idea”, has been so interpreted, notably by Karl Popper. (See Hegel: A Very Short Introduction, for an opposing view.)
All this must have been fuel for Hitler’s dreams, where, instead of sugar-plum fairies, Wagner’s Valkyries danced. Those ladies are eternally attractive, still gracing the covers of science fiction magazines and the themes of computer games.
In the world of the Theory of Relativity, there are no events. Nothing is created, destroyed, or modified. There are only experiments with clocks and rulers. Our governance ruler needs marks. On one far end of what can be lies Mein Kampf. Read it. In your hopefully ethical hands, it is just a mark on the ruler. On the other, more attractive end of the ruler lie the many thinkers of the Enlightenment and Liberalism. Appeals to the past, typical of conservative thought, are not marks on the ruler, but sometimes their positions can be inferred. The placement of many other philosophies of governance is variable, depending upon who is saying what.
But for someone who consciously went shopping for the constitution of a warrior state, we must look to antiquity, to Lycurgus of Sparta. His virtues are remarkably easy to understand: equality (among citizens), military fitness, and austerity. The Spartan system was cruel by western standards of 1945 to present; not so cruel 1933-1945, and positively enlightened compared to 1 July and 18 November 1916 on the Western Front, with more than a million casualties in the Battle of the Somme, or the two million of Stalingrad in a longer period.
Missing from Plutarch’s account of Lycurgus’ synthesis is the “why”, perhaps an anticipation of Richelieu’s “raison d’État“, which may have been sublimated as an ideal of “virtue.” This seems to be Putin’s major concern today, displacing the previously expressed desire to join the West and share in the fruits of prosperity. But after the financial crisis of 2007-2008 showed the literal bankruptcy of the prosperity aspect, it might have appeared to Putin that there is no connection between Western governance and prosperity. So why bother? Freed of that aspect, he went shopping for philosophy.
Critics of amateur psychoanalysis would ask, “How do you know this?” It’s like this. It doesn’t matter whether there is any reality or respect due to philosophy. Arguably, the history of philosophy is just a history of mistakes. After all, the philosophers couldn’t build a car, they didn’t solve the governance problem in a satisfactory way, and their medicine was lousy.
But as packages of thought with proven motivational value, the great philosophies fit the bill. They had followers; ergo, their ideas, however erroneous, were attractively packaged. With the sole exception of exalting the Russian identity, Putin appears to be an eclectic pragmatist. Perhaps he intended to give Russians the Good Life, based upon extrapolations of nearly limitless oil wealth. This would require only a very simple, paternalistic power structure to divy out the wealth, and some way to prevent jealous external forces from accomplishing the dismemberment of the country. Perhaps, after 2008, he decided that the pluralism of thought so necessary to an entrepreneurial economy simply wasn’t necessary. With all the wealth in the ground, it might even be dangerous.
But how, then, could the Russians be prevented from becoming something like the Eloi of H.G. Well’s The Time Machine? Disturbing trends already manifest. This, and dismemberment from the outside, threaten Russia like no other state.
Putin and Lycurgus appear to have a resonance:
Next: A book Putin read. And maybe, The Grand Unification Putin Theory.
In the opinion piece, “Strong or weak, bully or buffoon? Will the real Russia please stand up?”, Michael Kofman asks a helluva lot of questions, answers none of them, and decries, “Amateur psychoanalysis has largely replaced professional policy analysis.”
Amateur psychoanalysis is frequently practiced in this blog. In response to the question of the title of Kofman’s piece, permit me to answer on behalf of Vladimir Putin: “No, and you can’t make me.”
Mr. Kofman goes on to say, “But why the West lost objective reality in its approach to Russia remains the real mystery.” The answer lies in the phrase, “professional policy analysis.” Mr. Kofman, with his extensive academic background, imposes a framework of thinking on the problem, a “thought-container”, which he calls “”professional policy analysis.”
The definition of “policy” may be found via a Google search. The results are all similar; apparently there is not a lot of disagreement about what a policy is. The purpose of a policy is not a part of the definition, but it’s probably something like this:
Sometimes, policy is a natural outcome of ideology. Marx had a lot of input into Lenin’s policies, because, even though Marx was dead, he defined the goals. Mao’s Little Red Book gave methods of policy, described by pithy slogans like, “Political power grows out of the barrel of a gun.” Muammar Gaddafi had his Green Book. Hitler’s Mein Kampf laid out his destiny, from which policy would flow.
Putin has no book. His philosophy, or pragmatic inclinations, which have lately taken a disagreeable turn, are a work in progress. The puzzlers of Mr. Kofman’s article are frustrated because you can’t pigeonhole something that isn’t finished yet.
My college room mate was an international relations major. Every other morning, he would angrily wave the NY Times in my face, irritably proclaiming the latest violation by the U.S. of international law. My foolish reply was that there was no such thing as international law. Yes there is, no there isn’t…
Yes, there is, to the extent that anything can be willed to exist, if enough people believe it. But international law does not have the binding force of domestic law. The label “international law” is the name of a container that may be empty, or partially full.
So it is with “policy.” The United States, with a highly pluralistic power structure, is a country with particularly strong examples of policy. It can take 50 years to drop one, as just happened with Cuba. It happened without warning, because a policy is not a law, but that does not negate the prior existence of the policy.
On behalf of the West, Mr. Kofman asks, “Meanwhile, the West is still wondering if Putin is in complete control in Russia after tightening the screws on the last vestiges of opposition voices. Or is he a fledgling autocrat dependent on public support that cannot last?”
This is another misshapen thought-container. To find the answer, the container has to be appropriately shaped to contain all the possibilities. Here is one which it does not contain: Putin is the central point through which all power flows. He connects all the wires. The Russian “elite” have long feared what they themselves call “a split in the elite.” If the wires should pull away from Putin and find another central point to connect through, Putin will fall. In active defense, Putin shears away potential challenges. Particularly visible to us are those oligarchs who attempt to oppose Putin on the political plane. Grousing about economics seems to be OK.
Can you put the above in a tidy thought-container, such as “autocrat”, or “Mussolini”? Yes? Good. No? Good. How much predictive power does the label have? In some fields, the intellectual framework intends to capture ideals. In others, such as IR, important practical purposes are to predict and counter. This is not served by shoehorning Putin and Russia into abstract thought-containers.
Policy makers are supported by legions of analysts who have been through an educational process that is supposed to give them an edge in understanding Russia. But this process also gives them a mental framework, chock full of “isms” and ideologies that confound understanding someone who rolls his own (as in cigarettes) as he goes along.
“We mean that man first of all exists, encounters himself, surges up in the world – and defines himself afterwards. If man as the existentialist sees him is not definable, it is because to begin with he is nothing. “
This has been paraphrased to say, a man’s life is his act of creation, and he is not fully created until he dies.
Putin is still alive.
In “Putin, rodeo bull rider”, I wrote, “It is doubtful that he can [back out of Ukraine aggression]. Putin is riding a bull, and if he gets off, he will get stomped”, and,
” By now, the oligarchs have gotten the message that, if they betray the rebels, some people who are handy with guns and have long memories will obtain what they call justice. It would be hard to distract these disaffected people, because it is hard to become fat, happy, and lazy in Russia. Life is just not that easy there.”
In “Putin’s Next Move; Winter in the West”, I wrote, “If he can’t back up because of political constraints, then we may more anticipate elements of surprise and creativity.” I’m quoting myself to encourage you to read the posts. Russia is about to experience great pain. The reward of that travail, the “Donetsk People’s Republic” is thin gruel for this.
If Putin’s body politic were as malleable as when he assumed the throne of Russia, he could just back out of Ukraine. The last chance for this may have been in July, when the rebels made an accusation of cowardice, covered by Time in “Ukraine Rebels Call Putin a Coward After Russian Inaction.” If Putin were to back out now, he would have to face down Igor Strelkov, a very dangerous man.
While an errant oligarch can be buried in the penal system, Strelkov cannot, because he would recruit the jail. With the loyalties he has accumulated, Putin could terminate Strelkov. But Strelkov is more than just a face. He is also the tip of the iceberg of Russian nationalism. Nationalism is a primal force of both sociology and international relations. It is its own “first cause”, the prime mover. In consequence, once it springs into existence, it is very hard to destroy, because there are no causes to remove.
It appears that the Russians bear the mental legacy of their isolation from the West during the Soviet period. One indicator of this is the almost universal acceptance in Russia of Putin’s spin on events. Even without the information isolation of the Iron Curtain, Putin’s propaganda machinery seems to work as well as it did in 1952. It out-competes all other sources because Putin has used Russian nationalism to rebuild the state identity lost with the breakup of the Soviet Union.
The land borders of huge and underpopulated Russia are not secure against an adjacent land power, flush with people, money, drive, and busying themselves with construction of their own national, celestial myth. People like that have to be stopped with guns. In a paper of a few years back, I asked, “Who will pick up the gun for Russia?” Putin sought to tap the primal sources of nationalism, which appear to be myth and religion, though they are just window dressing for something else.
In any state, nationalism is the large scale manifestation of tribalism, which arguably is rooted in sociobiology. According to the Selfish Gene Theory of Richard Dawkins, kin cooperate to propagate their shared, common genes, while discriminating against unrelated genes. It’s a selection process that competes with Natural Selection, which is this simple: A successful gene has consequences of behavior as if it has an “interest” in surviving. It is the reason one pack of dogs fights another pack of dogs, for the benefit of their respective genes. The difference is, we humans decorate it with song and dance.
The imperative of the Selfish Gene, applied to international relations, has a snappy name, “raison d’État“, survival of the state, coined by Cardinal Richelieu. But Western Europe, birthplace of Napoleon and Hitler, is now quiescent. To us, it may seem permanently pacified. As much as anything can be permanent, this is actually plausible, since Western Europe seems to have evolved beyond the nation-state as the focus.
So it seems a misdirection that Russia should be so concerned with buffering its borders with the West. The doctrine of “balance of power”, conceived by Machiavelli during a fractious period of small nation states trying to solve the map-coloring problem, is dead in Western Europe. The Europeans are too conscious of their smallness. The equivalence of land with national wealth, which formerly meant anything that could be farmed, now has a very specialized meaning, of exploitable mineral resources.
But balance-of-power and buffer states have been part of history since the ancient empires. In Richelieu’s time, when balance of power became the dominant theory of European foreign relations, it was such a universal assumption of reasoning that it could be discussed or written about without definition. Since world leaders, as a group, seem to be more influenced by history than novelty, perhaps it should not surprise us that Putin is beholden to the concept.
Achieving balance of power has always been a devious endeavor, involving the sacrifice of “principles”, which in the old days meant religion, and today means anything of moral value. Laid bare, the fundamental strategy is, “The enemy of my enemy is my friend.”
But even with this moral flexibility, those who wish to practice balance-of-power today have a problem. The strategy was practiced during a time when the world was a patchwork quilt of borders which defined communication and commerce. The patchwork still exists, but C&C have acquired an infinite-dimensional aspect, which means that everything is right next to everything else, regardless of physical distance of separation.
In the early part of the two-thousands, before he decided to revive the KGB term “Main Enemy”, which means the U.S., Putin announced that Russia wanted to be part of Europe. He may have had in mind that Europe could balance China. Richelieu’s landscape, interpreted today, looks like this:
This is not a landscape in which balance-of-power can be made to function. The Russians repeatedly refer to the collapse of the Soviet Union as causing the loss of it, reviving the threat of the “Main Enemy.” Only China can balance the U.S. But from the military point of view, this is absolutely ludicrous.
China and Russia share a border 2,607 miles in length. The two countries fought a 7 month war in 1969. Until recently, the entire length of Siberia was traversed by just a single two-track railway. Now it has two lines, but both are close, in terms of military vulnerability, to the Manchurian border. On the north side of the border, there are about 40 million Siberian Russians, of a total Russian population of 90 million, with a large proportion of elder-folk, and a dislike of making babies. About 30% of the babies who do get made have various congenital problems. Not a very healthy situation.
South of the border, there are currently 1.357 billion Chinese, in what, given the standard of living, is a surprisingly healthy country, thanks to alternative Chinese medicine. This multitude of people need Lebensraum. Even if military conflict between these two nuclear powers seems unlikely, there is another way, assimilation. China could assimilate Russia with no more difficulty than the belches from a meal of moo goo gai pan. The process might take a century to complete, leaving a few more Chinese with blue eyes.
This is getting too long. I haven’t gotten to Lycurgus, yet. But I will, and Ukraine is in the offing.
Stealing Putin’s line, I’ll be back.
Although at least one theory of fear arrays the basic emotions on a color wheel, it’s questionable to symmetrize them, because emotions appeared at different points in the evolution of the central nervous system. There is some evidence that reptiles experience pleasure, including one story (citation missing) of an Australian crocodile that surfed for no good utilitarian reason.
The human brain, like that of all mammals, is an example of Ernest Haeckel’s famous dictum, “Ontogeny recapitulates phylogeny”, which is to say, the development of the individual recapitulates the evolution of the species. Modern biology discredits Haeckel, but this is because of a scientific penchant for exactness, and the unpopularity of poetry. The further one steps back from the details, the more of Haeckel remains. Human embryos have gills. Before they have gills, they are blastocysts, when there is little to distinguish them from primitive invertebrates. I leave it to your curiosity why Haeckel’s theory is not literally true.
The mammalian brain is built in concentric shells. The innermost, the “old brain”, is similar to that of reptiles. The new brain, the cortex and neocortex, appear in mammals. In modern theories of consciousness, it’s popular to correlate it with a neural loop of self-observation that involves both the old brain and the new brain. This has some backup from real time PET (positron emission tomography) experiments involving anesthesia. This goes against the older idea that consciousness derives from a pin-point homunculus located just behind the eyeballs. Consciousness, like life itself, is a process, not a thing.
It’s nice when theory precedes and is supported by experiment. Douglas Hofstatdter expressed something like this in Godel, Escher, Bach, published 1979 and really laid it on I Am A Strange Loop, published 2007. What is not so nice is that fear, which even fish appear to feel, is rooted in the old brain, which is definitely still in the loop. As part of the loop, the old reptilian brain is critiquing every moment of conscious existence. (One bit of research suggests that a man’s tie actually represents the colorful sagittal crest of some birdlike male reptiles.)
Because it is so ancient, fear is the most problematic emotion. Uniquely, fear can be the object of itself, which may be why fear has a tendency to run away with itself. While the neocortex tries to reason things out, the old brain demands the response it is programmed to give. The reptilian nervous system is characterized by rigid, programmed responses. The general scheme is that new brain modulates, directs, and suppresses those responses.
What wisdom does the old brain have? None. In response to fear, it offers only two choices: fight or flight. It also offers the instinct of survival. The new brain couldn’t care less, as Archimedes came to briefly rue. On the other hand, airplane test pilots discovered that, to survive, it was vital to conquer (suppress) fear. They had The Right Stuff.
This might seem like a lot of discussion about a four-letter-word, but the causes of history, no matter how rationally argued, are largely complexities with primitive roots of hate and greed. Love, you ask? There was only one Cleopatra. Margaret Thatcher doesn’t count.
Fear is a bias on the human brain, on and against all rational decision making, the result of a bit of neural inheritance about 500 million years old. For most people, for something to be an active object of fear, it has to have a presence or sensual, visceral element. Genuine threats, which are known only abstractly, tend to be ignored. The neurological threat matrix is wired for a primitive world of phobias: acrophobia, agoraphobia, starvation, poisonous food, aggressive males, dangerous animals, etc.
The old brain script is rigid: Arousal, stress reaction, fight or flight, and, survival permitting, relaxation and recovery from stress. The stress reaction of an organism, with secretion of adrenaline and corticosteroids, cannot be maintained, or the organism dies. We can’t have continuous nine-elevens. The public has become acclimatized, barely more fearful than before 9/11. After all, nothing massive has happened in 13 years.
This presents a problem for policy-makers. If a threat has to be intellectualized, it is hard for the public to grasp. We could sidestep hard thinking with sensual portrayal of the threat, but then the old brain kicks in with primitive responses, which we call hysteria, “exaggerated or uncontrollable emotion or excitement, especially among a group of people.” Was Jack Nicholson was right? We can’t handle the truth? Or is the truth manipulated to enslave us?
We are on the horns of a dilemma with multiple instances. Edward Snowden disclosed NSA warrantless surveillance, monitored, perhaps ineffectually by the secretive Foreign Intelligence Surveillance Court, that by eluding “checks and balances”, arguably fails to safeguard a “natural right”, the right to privacy. It is also arguable that NSA warrantless surveillance is or was a vital defense against terror. The qbit of quantum computing opens our eyes to the possibility that Snowden can be a hero and a traitor at the same time. If not in one sentence, certainly in the same paragraph.
C.I.A. torture is more visceral than NSA/Snowden, undefended by evidence that it worked. Dick Cheney’s temperament comes a lot closer to Jack Nicholson’s Colonel Jessup. But in 2003, little conjuring was needed to summon the ghost of 9/11. He says, “I would do it again in a minute.” As to his motives, two things can be excluded, money and fame. That leaves fear.
It seems there is some gap-space between the touchstones of public safety, ethics, law, and human decency. In times of extreme threat, we wander in it like travelers lost in a forest. When danger recedes, we slap ourselves and return to the way things should be. Every war is accompanied by a loss of civil liberties. When the war is over, they are restored with vague regrets. But this time, there is no light at the end of the tunnel.
Groucho Marx, always a man of principle, said, “Those are my principles, and if you don’t like them… well, I have others.” Are you a person of principles, or are you intuitive and unprincipled? Here’s a mandatory homework exercise to help you discover yourself. Draw a Tic-tac-toe board. The nine squares represent combinations of threat-level and ethics.
The vertical axis, representing threat, has three entries, corresponding to the three rows of the Tic-tac-toe board. The first is “Clear and Present Danger”, meaning, of something really horrific, such as the destruction of L.A. The second, middle row, contains a “maybe”, a scenario of all kinds of intermediate proportions. The third, “low probability”, equates to the weatherman’s “sunny day” symbol, with isolated tornadoes.
The horizontal axis, representing how far you are prepared to go to protect the public, has these labels: “Anything Goes”, (which can be refined by you), “Stretch the Law”, and “Read him Miranda.” There are nine combinations. Put an “X” in every square that combines a threat level and a response of which you would approve. Disapprove a square with an “O”. Don’t leave any blank. This is due on Friday, when we will compare our answers with Justice Scalia’s.
Next: But what could there possibly be to be afraid of?
Supreme Court Justice Anthony Scalia just said (CNN), “I think it is very facile for people to say ‘Oh, torture is terrible,'” he said. “You posit the situation where a person that you know for sure knows the location of a nuclear bomb that has been planted in Los Angeles and will kill millions of people.”
Former F.B.I. interrogation expert Ali Soufan, cited for his conviction that torture does not work, has something interesting to say at the end of a PBS interview, at 28:40. “I oppose them mainly from an efficacy perspective…If it was saving lives…Look, if it was saving lives, and I saw that it was saving lives, Look I hate to tell you, and probably I will be attacked, but yes, maybe…” You owe it to Mr. Soufan to go to minute 28:40, and not rely on my partial transcription. You owe it to him to hear the hesitancy of his voice, and his inability to articulate the exact conditions under which he would use torture. Maybe nobody can. Maybe you just have to be there.
Justice Scalia gives me the courage to continue to write about this subject. I am not myself a conservative thinker, and my reference to his statement is not to prove torture is OK. But Judge Scalia gives evidence that, even with a lifetime of focus on jurisprudence and necessarily concomitant ethics, the answer is not obvious, and so, worthy of discussion. This series of posts might help a personal eclectic synthesis.
In the past, torture has come so easily to human beings in every region, and every time period, that there must be, for some, an element of enjoyment in the infliction. The movie Zero Dark Thirty, of which the first half hour is a torture scene, was made with the creative input of some pretty canny Hollywood execs, who think they know what the public wants to see. Sitting through the first 30 minutes would be torture, so I haven’t watched it. But the Internet Movie Database pollsters gave it a “thumbs up,” with 181,394 viewers rating it a 7.4/10.
It appears that, as an elective activity, the attractiveness of torture lies somewhere between sex and self-mutilation. That so many Zero-Dark viewers enjoyed watching it implies that a significant minority of the unincarcerated population, particularly males, have a sociopathic potential. So it wasn’t hard for the C.I.A. to find employees willing to conduct “enhanced interrogation.” But they might have been overpaid. Milgram got his volunteer torturers for 4 bucks an hour.
So the historical purpose of torture may have been enjoyment, permitted against those who transgressed the social order. Even the claims of the Catholic Inquisition, “…for the public good in order that others may become terrified and weaned away from the evils they would commit”, are suspect. They may have enjoyed their work a little too much.
But today, it is fairly clear that, apart from the motives of the interrogators themselves, about which I know nothing and decline to guess, the motive for torture, a.k.a. “enhanced interrogations” was fear. Those who authorized the measures, and who are themselves significant enough to be judged by history, were afraid.
Next: The Anatomy of Fear.
The post “Ebola Vaccines, Medical Ethics, and Manslaughter” comes as close as I dare to describe an ethical judgment. It expresses a suspicion, that Borio and Cox are vulnerable to a challenge, to produce reasoning that their requirement of control-group testing reduces risk to life, rather than increasing it. A discussion of the Senate Report is more dangerous to the detachment of this blog.
Long before release of the Senate report, former F.B.I. agent Ali Soufan determined that “enhanced interrogation techniques” did not work. But in judging the ethicality of an action, does efficacy matter? The outcome is binary: it stopped something, or it didn’t. If it had stopped a WMD attack, would the Senate report have been written?
Subject to stringent conditions of national permission and encouragement called “war”, you may find yourself with a gun in your hand, and the obligation to inflict a wound on the defined enemy that is not immediately lethal. It could be an abdominal wound, leading to sepsis, with an agonizing, prolonged death. The outlawing of certain kinds of weapons and ammunition that tend to produce this death reduces the probability, but does not make it negligible.
If given the choice of personal fate, between water-boarding and death by sepsis from an abdominal wound, you might choose the former. So it is possible that the subconscious objection to torture is not the state of the victim, but the state of mind of the inflicter. In most cases, the soldier who fires the gun returns to civilian life with the original moral character, or with increased wisdom and reverence for life. But we suspect that the torturer, whose involvement with the victim is much more visceral, may have developed a taste, or may be a sociopath, born to the job.
If you think it’s edgy to even discuss this, consider the Milgram Experiment, in which 65% of the subjects administered electric shocks to a victim who we know was actually an actor. The subjects were told the victim had a heart condition, and he put on a pretty good show of “close to croaking.” The subjects were paid 4 bucks to do this. In the year of the experiment, 1963, America had not yet walked the road paved with good intentions called Vietnam.
So let’s conduct a private experiment on ourselves. Consider the following scenarios:
Perhaps you say yes to some of the above, but you say, you’re not a Milgram subject. And you are proud to be a veteran, or you admire veterans who served in war zones, and who may have applied lethal force.
If you have ethically OK’ed some of the above choices, your personal allowance is motivated by the common element of “clear and present danger.” If so, you are allowing the infliction of what, to the intruder, is completely equivalent to torture.
The are two differences with the actions condemned by the Senate report.
This is beginning to look like a minefield. I know why torture scares me. As Milgram showed, the potential exists within most of us. Possibly, all of us. It has the elements of paradox. We can’t define a moral use for torture, yet it grades smoothly into actions that, conditionally, under some circumstances, we might endorse. The C.I.A. activities fall mostly under the last element of the list of scenarios, with some upwards excursion. Someone died of hypothermia while chained to a floor.
It is possible that some of the torturers enjoyed their work. Since only one country, Iran, has a theological authority who has provided religious justification for the torture of suspect subversives, enjoyment comes closest to universal condemnation. But those who set the policy and those communicated the policy never participated in “enhanced interrogation.”
The roads to all theological destinations are paved with good intentions. Next, what made them think they were doing the right thing.
Matthew Herper’s article in Forbes, “Ebola, Ethics, And The New Normal Of Scary Germs” is good journalism. It’s centered around an article by Borio and Cox, in the New England Journal of Medicine, arguing “…arguing that despite the hopes of some public health experts, both vaccines and drugs will need to be tested against control groups that include a placebo.”
This makes me mad, which is why the title of this post includes the word “manslaughter.” The purpose here is to sharpen up the logic surrounding the assessment of Borio/Cox with my own hostile appraisal. In the post “Ebola, Public Health, and Sloppy Thinking Part 1”, I wrote, “The bureaucracy of health and medicine, which, while providing the individual with paternal protection from naivete and quackery, has a knowledge base that, Dr. Ioannidis has shown, has severe methodological flaws.”
and, “The decision processes of the CDC and NIH are reliant on the same decision processes that create the studies torn apart by Ioannidis. It’s the same culture. The brightest minds in CDC and NIH must know this in an academic way. But if all the real estate, stretching to the horizon, is quicksand, what does a builder do? You build anyway, institutionalizing defective thinking.”
Medical ethics is joined at the hip to this culture. In the past, the requirements of medical ethics, as defined by individuals in the class of Borio/Cox, have been responsible for protocols that, rigidly adhered to, resulted in the effective denial of drugs to cancer patients. One of the gyrations of the medical establishment has been alternations in policies regarding risky or questionable drugs. The point to be extracted is not whether a particular drug should be offered or denied. It is that the reversals show that being a specialist in some branch of “ethics” isn’t all it’s cracked up to be.
Medical ethics exists as a specialty not because it answers ethical questions, but because it appears to do so. We might as well do the flip-flops ourselves. In this case, Borio/Cox assert that blind trials with control placebo groups are required to validate Ebola vaccines before they are deployed.
This they require, while in some countries, Ebola “hospitals” were recently equivalent to death camps. But Borio/Cox are correct about supportive care. The African overall mortality rate appears to be dropping; in October, it was about 2/3 overall, dropping in late November to about a third. It is likely that this is due to better supportive care. So why don’t Borio/Cox win the argument?
There is no objective solution to any question of medical ethics. It is inherently a subjective question. There are those of us who feel that “ethics and religion are opinions that you have.” I regret if any sensibilities are hurt, but our legal system tacitly recognizes this. Neither of these statements is acceptable in a court of law:
In a statistical fashion, the members of the test group, including those receiving the placebo, have one of these fates:
If the statistical element were absent, so that the will of the ethical experimenter directly determined the fate of individuals, it would be clear that the ethicist was, to the individual subject, in every way equivalent to the Nazi Death Camp guard selecting the unfortunates for the gas chambers.
Does statistics make it alright? I don’t think so. But you argue, we really don’t know whether the vaccine works at all, or whether it could harm. There are more than a few problematic pathogens. Dengue is an example. There are four strains of dengue. While an infection with one strain provides immunity against that strain, it makes subsequent infections worse. By the time you reach the fourth strain, you might be dead. AIDS is another. Other errors are choosing the wrong antigen as as target, or a negative effect from immunization against the wrong viral strain. With bacterial pathogens, there can be cross-reactivity with human tissues, resulting in an autoimmune disorder.
That’s what separates the experiment from murder, and makes it a laudable activity. That could be true, if human experiment were the only tool available. Fortunately, there are other ways of knowing. A common element of vaccine development is the animal model, a species with response to infection similar to the human. The symptomology and immune response of the model animal is extensively characterized, so that it can serve as a proxy for the human in preclinical studies. For influenza, the animal of choice is the ferret. It’s small, cheap, and it catches the flu very easily.
The FDA deals with the current Ebola scenario with the “animal rule” adopted in 2002. Quoting from the The NIH article, “Current Ebola vaccines”,
“In these cases the ”animal rule” permits efficacy data from studies using animal models that accurately recapitulate human disease…However, for this purpose the correlate(s) of protection predictive of survival in the relevant animal model have to be defined, so that these data can be used to predict human efficacy.”
The animal in question is any nonhuman primate, although the Great Apes, which in this case practically means chimpanzee, confer some advantage. In these animals, Ebola is typically 100% fatal, compared to the human mortality, which maxes out at 90. The caveat comes in the next paragraph:
“Unfortunately, until now there has been only limited success in defining these correlates of immunity, although it could be shown that there is some correlation between antibody titres (but not necessarily neutralizing antibody titres) and survival…”
So there is a rule, and there is math, and it is likely that the conclusion of Borio/Cox is due to the failure of the animal model to satisfy the math of the rule. By how much, I wonder? Sadly, I do not have access to the New England Journal of Medicine. This excruciatingly vital part of the debate is hidden behind a paywall, an archaic aspect of scientific publishing that some of us think goes against academic freedom and the right of the public to know.
The referral to “correlates of immunity” suggests that the rule may require more than survival rates to validate the vaccine. Correlates are measurements of antibody concentrations and immune system activation. If this is the case, if the rule requires more than survival rates of the model animal, it expresses a need to quantize the “why” of survival. Quantization is not the same as understanding, but this is a bureaucracy we have to feed. They want to know “why it works”, because they want to assume that the numbers will be transferable to human responses.
But do we always need to know why? Suppose you’re trapped in a submarine and water is streaming in. Someone taps out a message in Morse Code on the hull: “PULL LEVER B TO SURFACE.” Do you need to know why? Just pull the lever.
Borio and Cox suggest that the ethically correct course is to build lots of intensive care wards. But it’s not simply a case of hooking up the right I/V lines to rehydrate. In the industrialized world, intensive care units have climate control. In Africa, isolation wards are tin-roofed structures or tents, with ventilation restricted by the need for isolation. Building modern facilities with all the features favorable to patient survival would be the Manhattan Project of Africa. And the supporting infrastructure doesn’t exist. How many people would die in the interim?
Given that Borio/Cox are part and parcel of the system of thought that has so far bungled handling of the Ebola epidemic, a very high standard of thought, exhibiting truly independent reasoning, is required. My suspicion is that their points of view suffer institutional contamination. Another way of putting it would be that they are defending their intellectual turf. Perhaps they would refer to the Hippocratic Oath: Do no harm. But Hippocrates saw one patient at a time. Over what time period? Over what sample? What makes their requirement different from manslaughter? I want it technical.
A reductio ad absurdum drives it home. Suppose a vaccine is developed against malaria, but it has a mortality somewhat higher than the yellow fever vaccine, which, containing a live, attenuated virus, actually kills about 1 in 50,000 recipients. Borio/Cox could say (putting ridiculous words in their mouths), “You really ought to get rid of the mosquito.”
Yes, it is ridiculous. Yet, having come full circle, we see that murder and sainthood are neighbors. They come out of their abodes, mosey over to the fence, slap high fives, shoot the bull, and get along just fine.