In the grand tradition of men wondering what it is that women want, or grownups discussing the depravity of youth, I think it’s time to address the Conservative Problem. Story after story comes out about hawks who never served in the military, closet gays with public homophobia, and now I hear about a church pastor and apparent serial rapist who helps decide on women’s health at the national level. The mind boggles. Inquiring minds want to know what the hell is going on.

Let’s start by going back to basics. People younger than seventy, or possibly a hundred, won’t remember this, but in the Old Days conservatives were supposed to be the voice of caution. They argued against spending too much money on hard luck cases, but, strange to say, this was not because they wanted the money for themselves. In those days, conservatives tried to hold down spending because they feared bankruptcy. They also argued for larger armies because they feared war. So, yes, they were a voice for fear, but fear does have a useful function. It keeps us away from harm.

So far, so good. Nothing crazy there. These are not the conservatives I’m talking about. These are not the Conservative Problem.

The problem is radical conservatives, who have taken fear to the realm of insanity.

One of the few remaining unmentionables is to point out that fact. After all, a cornerstone of democracy is respect, and few things are less respectful than labelling someone a loony. On the other hand, continuing to tolerate people who are dismantling tolerance is idiocy of another kind.

There are many different kinds of insanity: repeating actions that have never worked, expecting magical effects from unrelated events, and generally being disconnected from reality. Every kind seems to be represented among radical conservatives. I’ll rehash the usual evidence.

Consider the “just say no” campaigns, especially the ones dealing with sex. In thousands of years of recorded history, telling people not to have sex has not worked. So the conservative solution to a lethal disease like Aids is exhortations not to have sex. Likewise, no one has ever been forced to be free. So the solution to Middle Eastern despotism is an invasion.

One could argue that the cover story has nothing to do with the real motivation, such as stealing oil or finding a cheap way to ignore a public health problem. I’m sure that’s true for many of the politicians involved, but if the only trouble was corrupt kleptocrats, we wouldn’t be fooled for long. The power of radical conservatives comes from those who really believe that the light they see at the end of the tunnel is not an oncoming train. That’s why it is important to identify the vision for what it is.

Evidence of irrationality is not limited to things that can double as convenient excuses. The US reaction to terrorism is another case in point. The country was turned on its ear over a few envelopes containing anthrax. Meanwhile, vaccine stocks for flu and measles are currently depleted to the point where the next epidemic will claim hundreds of lives. (Luck has kept us from having an epidemic so far, which is not the same as having effective countermeasures.) Similarly, millions of tons of air, ship, and truck cargo enter the country with barely a glance, while security agents worry about the quantity of explosives grannies might be hiding in their shoes. This is hysteria, not caution.

Interestingly enough, radical conservatives don’t deny their disconnectedness from reality. On the contrary, they seem to be proud of it, judging by the now-famous quote reported by Suskind in the NYTimes Magazine (Oct. 17, 2004). “We,” said a senior adviser to Bush, “create our own reality,” unlike those in the “reality-based community” who are reduced to studying it. Usurping God’s role as Creator seems like a strange thing to do for an administration that prides itself on faith, but lunacy and consistency don’t usually go together.

Being uninterested in reality is not necessarily harmful (so long as there’s someone to provide dinner and do the laundry), but radical conservatives seem to demand everyone’s participation in their delusions. It’s interesting to understand why this is so, especially for its value in predicting what they’re likely to do next.

Psychologists have studied conservative and liberal attitudes. Conservatives, both problematic and normal, have something the boffins call “reduced stimulation seeking.” In other words, conservatives avoid the unfamiliar, the unknown, and the new. That’s hardly a surprise, since it’s almost a definition of conservatism. (See Jost et al., 2003, Political conservatism as motivated social cognition, Psychological Bulletin 129: 339-375 for recent research and original sources spanning decades, all the way back to 1936. The article can be ordered downloaded here, but I haven’t found direct links.)

Psychologists have also contributed the perspective that shows where those feelings fit on the whole spectrum of fear-related attitudes. The normal roots of conservatism lie in the same caution anyone needs for self-preservation, which is what makes it hard to realize that extreme forms are not normal. It would be like hearing someone laugh, and then realizing that they’d been laughing for no reason for twelve hours straight.

The critical point about feeling fear is the predictable reaction. Nobody says, “Ooh, my brain chemistry is very interesting today.” Instead, an external threat is found, even if none exists, that can explain the feeling. The tendency grows, for instance, to see communists islamists behind every problem. The sense of persecution is central to the world view, and only the labels change.

Given that conservatives generally feel higher levels of fear, it clarifies why right-wingers also tend to find a group, or groups, whose fault it must be. Anyone will do as a target–blacks, Jews, women, or the liberal media. The only actual requirement is that the group be no real threat, so that they’re safe to dump on.

Another psychological characteristic shared by many conservatives is an orientation toward authority rather than self-direction. It stands to reason that a heightened sense of fear would lead to a desire for a strong protector, whether that is a specific person or a group. If the fear is strong enough to unseat reason, then strength becomes the most important thing. Once it is more important than truth or justice, the government ceases to be one of laws and becomes instead the biggest dog on the block. (Or tries to.)

Desire for protection means putting oneself in the hands of a protector, that is, downgrading one’s own sense of right and wrong in favor of the authority’s. Without an internal compass, the world becomes an even more frightening place, and it is more necessary than ever to shelter behind an authority. Obviously, a less-than-benign authority could tell its loyal minions to do just about anything. In recent history, it has. And does.

The easiest way to feel part of a powerful group is to exclude someone else. Combined with the need to explain feelings of fear, there’s even more reason to find someone, anyone, to put down (in both meanings of the phrase).

The important result is that tolerance, in that world view, becomes the problem, not the solution. There is no point preaching live-and-let-live or pluralistic democracy. All it means to someone irrationally in the grip of fear is that the floodgates of evil will be opened.

One final point completes the picture of caution gone crazy. In a world view that fears what’s different and needs to exclude it, women are always available as an easy target. Even homogeneous societies have two sexes in them, one of which has less muscle. The opposite sex is mainly interesting for, well, sex. So if men are going to despise women, they’ll wind up despising sex. However, it’s kind of a drag to fight your hormones your entire adult life, so the simple solution is to put the enforcement function onto women. Before you know it, evil is being defined as sex for its own sake, and women need to stay at home to avoid being polluted.

Aside from the fact that this is no fun, the biggest problem is that it’s impossible. Trying to live against human nature has as much chance of success as jumping your way to orbit. So large numbers of people don’t actually lead the sexless lives they preach, which, to an outsider, looks like hypocrisy. On the inside though, there are mental tools for dealing with it. Among some Christians, for instance, the contradictory behaviors fit into an arc of sin and redemption (and sin and redemption and sin and redemption and so on). This is taken as evidence of God’s love, not of hypocrisy. Never say humans aren’t an inventive species.

The other effect of trying to live an impossible life is the desire for rigid rules. After all, under the circumstances, one needs all the help one can get. Again, tolerance and the freedom to live and let live are the problem in this worldview, not the solution.

Moving along to the question of where radical conservatism is headed, it’s first worth asking whether we really have nothing to fear but fear itself. Isn’t it better, it could be argued, to err on the side of caution? You can’t be too safe, right?

That seems like a reasonable view, and yet history says otherwise. How many countries have failed through fearlessness? How many have killed themselves by being too kind? None.

On the other hand, how many have bankrupted themselves building huge armies against non-existent threats? How many have torn themselves apart by destroying their own people? Every empire that fell of its own weight did it this way.

This is not to say that external threats don’t exist or that defense is a waste of time. There’s nothing wrong with caution. It’s erring on the side of caution that is unsafe, no matter how good it feels.

So, radical conservative ideas are destructive, as you might expect from delusions, and radical conservatives are crazy. That’s what’s wrong with them. Does the recognition serve any purpose, aside from the obvious satisfaction of labelling the opposition?

The advantage to seeing the insanity clearly is that one can see where it’s headed. Totalitarian governments are the only ones that can meet the needs of people for whom tolerance and freedom are the problem. That’s where they’re taking us. The writing has been on the wall for a while.

The hallmark of losing a government of law is, well, losing it. Extralegal detentions, detentions without trial, and torture are found in dictatorships. And they’re always done for the same reason: in the service of a higher good.

The US currently carries critical hallmarks of a dictatorship: detention without trial, torture of prisoners, and a population that is willing to look the other way.

Comparisons between the US and dictatorships are considered offensive, which they are. But if they fit the facts on the ground, they are also essential. Saying “it can’t happen here” doesn’t make it so.

The usual excuse is to say that in our case, it’s different. The reason why the targeted group has to lose its rights is different. It’s not the same old lunacy this time. This time it’s justified.

However, the differences mean nothing. Everything is always different. Nothing ever happens the same way twice. South African apartheid is different from Saudi Arabian, which is different from ghettoizing Jews, which is different from Hutus slaughtering Tutsis. It’s not the differences that tell us what we’re dealing with. It’s the awful similarities.

We need to get our heads around a few simple facts. No matter how reasonable it looks, no matter how great the threat (which is another way of saying no matter how great our fear), it is never all right to deprive other human beings of the same rights given to full citizens. It was insanity the last time, and it is insanity this time. There is no way to be a civilized society and do those things. It is crazy, obviously, to destroy civilization in order to save it.

For those of us who want to stop enabling lunacy, it is important to call things by their right names. We need to stop being respectful toward attitudes that destroy respect. Reserve tolerance for opposing points of view. Insanity does not need tolerance. It needs treatment.

As a person who’s heavily on the freedom side of the freedom vs caution debate, I certainly wouldn’t advocate compulsory treatment. Moonbats can live next door, if they want, so long as they keep to themselves. However, in public life, whether for voters, politicians, or media, intolerance cannot be tolerated.

If radical conservatism continues to be tolerated as something normal, it’s not hard to see what will happen. Those few symptoms–detention without trial, torture, or making up legal excuses in the name of a greater good–tell us that we’ve crossed the line. We’re not headed for the slippery slope. We’re on it. It is past time to say no. The only question now is when we’ll open our eyes and see where we’re going.

Update: July 12, 2006

It seems John Dean is getting it figured out (via Raw Story). The only thing I don’t understand is why he says it’s not generally known that conservatives blindly follow authority. It’s been obvious since the 1930s or so. I can’t even say you heard it here first. I wonder how many more years will pass before Dean and company see the rest of the whole twisted mess that I, following so many others, have been ranting about for a while now.

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[Fair warning: this is on the longish side. Links below lead to headings]

Free Speech | Informed, independent voters | Voting | Minority protections | Representation | Conclusions

Democracy is comatose when governments can go to war against the will of large majorities. Choosing to die for a cause is the most fundamental decision people can make, and in a democracy that decision is supposed to be in their hands. Yet governments made war in Iraq against every indication of what their citizens wanted, including in the US (where the majority at that point was small). It’s time to admit that our democracies may still be lying there, but they’re not doing much.

There are many other examples of governments ignoring majorities. In the US, poll after poll shows that most people want a medical payment system in line with the rest of the developed world, yet a little bit of advertising at election time seems to be enough to prevent us from getting it. Poll after poll shows that people the world over want sustainable environmental policies, but those policies aren’t implemented even when they cost less. The simple reason is always that some vested interest prefers otherwise. This is understandable, but it is not democratic.

Diffuse sources can be as anti-democratic as the more easily identifiable point sources. A striking recent example was the election in Iraq. There was talk of how the Sunni minority, at about 37% percent of the population according to the CIA, would deal with being outvoted by the more numerous Shia (approx. 40%), and what role the Kurds would play, who are about 20%. The exact figures don’t matter. Give or take ten percent, if you like. Meanwhile, there was almost no talk about the likely effect of–or on–a huge 60% majority. After years of war and dictatorship, women are between 55% and 65% of the adult population. Two thirds of the citizens were written off, not just by the Iraqis but also by the supposedly democratic West, which ignored this problem. When two thirds of the people are invisible, that is not democracy. It is a charade.

Recognizing how far we are from democracy leads to a series of questions. First, is it worth worrying about? Maybe some other form of government would serve us better, and poor old democracy should join all the other failed experiments on the ash heap of history. Then, if it is worth saving, how can that be done? What led to the coma to begin with, and what needs to be done differently?

The first question is easy because a few thousand years of recorded history give a clear answer. As Churchill famously said, democracy is the worst system of government, except for all the other ones that have been tried. It’d be nice, however, if we didn’t simply have to make the best of a bad job, i. e. government. There has to be a better way to find the right direction than to stumble through every wrong one first.

Science, which yanked us out of the center of the universe and into the company of apes, is helpful here as well. There is some actual evidence that many heads are better than one. In a simple experiment, people guessed the number of beans in a jar. Very rarely did any single person get it right, but the average of all the guesses was surprisingly close to the truth. “Market” experiments, where people invest (bet, really) on the outcome of anything from wars to elections to the price of turnips also tend, in the aggregate, to predict what actually happens. (James Surowiecki wrote a book, The Wisdom of Crowds (2004), on the evidence for the idea and its implications.)

That outcome feels counterintuitive, because the behavior of mobs has given the intelligence of the many-headed a bad name. The crucial difference is that certain conditions must be met for the wisdom of crowds to manifest itself. The people participating in the experiment must act independently of each other, and they must all have access to the same, reasonably complete, information. These two simple conditions are enough to explain why current “democracies” really aren’t.

Independence is the first problem. Every person on Earth will say they ignore ads, that they can make up their own minds about the news, and that it’s absurdly easy to distinguish between reality and TV. And yet, when all the shouting has died down, the politicians with the biggest advertising budgets are almost always the ones elected. Whatever we may be capable of individually, when we’re all together, you can tell us anything.

So the first requirement of a democracy is that you can’t tell the people anything. You must tell them the truth.

(I know, I know. Wait a minute. Hear me out.)

Free Speech

Requiring truth raises a whole rat’s nest of issues, starting with the deeply philosophical one of what is truth. However, absolute truth is not essential. What I’m talking about is facts, and so, within reasonably broad limits, the situation is not hopeless. It is feasible to tabulate how closely statements match actual facts. It’s also possible to find out how well-informed the consumers of given news outlets are. It’s been done. The 2003 PIPA/Knowledge Networks Poll(pdf file) showed, for instance, that 67% of the people who watched Fox News believed that Saddam Hussein and Al-Qaeda were in cahoots. This would be like a cabal between the Mafia and the people who blow up abortion clinics. It’s not impossible. Few things are impossible. But the standard of proof for the highly unlikely is higher, not lower. There needs to be some hard evidence before wild ideas are broadcast. If a news program broadcasts wild ideas based on entertainment value rather than evidence, that should be enough to lose one’s license to use the public airwaves (or internet backbone or space program).

News organizations aren’t the only culprits. Politicians have made names for themselves as liars, and what the appropriate penalty is for them, I’m not sure. Making ten retractions to the same audiences for every lie? Duct-taping their mouths shut for a while? Maybe they need a three strikes policy: three definite falsehoods, and they’re barred from holding office. Ignorance is no excuse. After all, if they, of all people, don’t know the facts, how are they supposed to run the country?

Talk of lost licenses and offices leads directly to free speech issues. There’s irony in the way unregulated free speech ends in gluts of BS from the highest bidder that drowns out free speech. The same is true of unregulated anything. Stock markets may be the core of capitalism, but they are among the most tightly regulated activities in the world in order to prevent the demise of free markets. Free speech won’t stay free for long without some regulation, which is recognized in the obvious exception that it does not cover yelling false alarms of “Fire!” in a crowded theater. However, technology has swamped the puny regulations that worked in the past. A tidal wave of political advertising drowns out any discussion. Gluts of spam have made mail, phone, and the web barely usable. We’re told we have to put up with this for the sake of free speech.

What nonsense.

Free speech itself is worth dying for, and it’s even worth some inconvenience. Agreed. But this has nothing to do with free speech. The purpose of free speech is to protect freedom of thought, not the freedom to make a buck by any means possible. As a matter of fact, the latter comes awfully close to the fire-in-a-crowded-theater misuse, which is why there are such things as truth in advertising laws and punishments for fraudulent claims. There is no such thing as commercial free speech, nor should there be. Speech whose purpose is to get something out of you, be it money or a vote, needs to be subject to consumer protections. The restrictions on speech designed to get your money could be looser than those on talk designed to get your vote–what’s money, after all, compared to the life of the republic?–but both of them have to avoid obvious lies. We need to catch up to the technology here.

Of course, nobody whose profit or job depends on pretending to the truth willingly admits to selling lies. However, when their noses are pushed into their messes, the usual plea is that they’re only doing what people want. This may or may not be true, but it is still no excuse. There are always people to buy all the heroin you can sell, but that doesn’t make it a good thing to push. Pedophiles will pay for kids to abuse, but that doesn’t mean they should be provided. If something does no harm, by all means, sell it. But lies in the body politic are killing democracy, so it doesn’t matter whether people like lies or not. Lies cause at least as much harm as yelling fire in a crowded theater. They simply cannot be allowed.

That said, let me rush to stress that I am not, NOT, saying that the interpretation of facts should be controlled in any way. It’s up to Fox News if they want to say, “There is no evidence of a connection, and we think that means we have double the worry, since there are two independent groups instead of one.” Anyone can have any opinions they want. They just can’t make up any facts they want.

One advantage of regulations is that everyone has to abide by them. Fox couldn’t provide rollicking good yarns that pull profit away from, say, CNN which then has to provide something even more rollicking. The same would go for website A and website B. Anyone who writes or talks about politics should be constrained to make sure of their facts before disseminating them, just as the same is true of commercial products or stock prices.

There is legitimate fear of free speech regulations because they could be abused to limit speech we care about. Since regulations are a can of worms, it is customary to say at this point that it is up to the voter to take responsibility, to be analytical, and to become informed. That would be great. It would also be nice if charitable contributions could stretch far enough to prevent poverty, provide good educations, and fund medical care. It would be good if corporations took social responsibility and didn’t pollute. Many people’s lives would be simpler if married people were faithful. Lots of things would be good. Basing social policy on hopeful noises about human nature, however, is a recipe for disaster. Communism tried to rely on altruism, and look what happened.

It is better to recognize the danger of abuse and to build prevention of abuse into the regulations, than it is to lose the very free speech we care about in the din of greed.

I may, of course, be laying myself open to the objection that I’m making the same mistake. I’ve taken account of the human tendency to collar the conversation, regardless of having anything to say, but what about boredom? People are supposed to be bored silly by facts. Actually, I doubt that. We all care deeply about things that affect our lives. People are bored by misdirection, obfuscation, manipulation, and everything else that requires excess energy to cut through crap. But all the important things in politics are easy to understand–or can be. It is easy to present the crucial facts about health insurance, war, pollution, and even computer-based markets versus floor-trading. However, there are very powerful interests who would rather not, so we have idiotic “he said, she said” journalism and head-bobbing pundits who say these things are beyond ordinary folk. I don’t think so.

Informed Voters, Independent Voters

The architects of democracy operated in the 1700s and 1800s, at a time when the threats to the vote were mainly at the back end. The dangers were ballot-stuffing, votes from dead people, and dishonest counts. The architects didn’t worry too much about manipulation of voters rather than of the vote because they didn’t need to. Times change. Propaganda became a high art very recently.

The fact is, if voters are to have reasonably complete information–not too little, and not so much that they’re swamped–some large changes in standard operating procedure are needed. (At least, large changes to how things work in the USA.)

The first point is that political advertising is not a form of information, at least not as currently practiced. Its purpose is to drown independent judgment in repetition. I know that this has no effect on you, or me, or anyone we know. And yet its effectiveness at manipulating the vote is so good that the first priority of politicians is to throw all the money they have at it.

Vote manipulation of any kind, whether front- or back-loaded, is a sure way to prevent the wisdom of crowds from manifesting itself. It has to be reduced to a level that is not incompatible with thought, which is not impossible. Sociologists and psychologists know how to measure comprehension and bias. My guess would bethat political campaigns should run no longer than six weeks, and ads within that time should be limited to some small number of minutes per 24 hours. Enough already, is the phrase that comes to mind.

Reducing advertising might solve an array of problems in addition to voter bamboozlement. Campaign finance should be less of an issue. If fundraising ceases to be the point of politics, corruption of the legislative process is less likely. Political advertising is a keystone in the arch that props up quite a few of the problems in modern democracies.

Politicians might object that such a straitjacket would leave them no way to spread the word about themselves, but I doubt it. People would pay attention to real debates. Debates have everything: tension, possible drama, and information to boot. There’s also face-to-face campaigning. Voter information booklets are highly useful, and could be expanded to include electronic formats, podcasts, and, for all I know, direct transfer to surgically attached phones. It doesn’t matter what form the information comes in, so long as it is information and not manipulation.

An informed electorate depends on one last point, and it is the biggest of all. The voters have to be capable of being informed. Common sense is the really essential ingredient, but it does help the process of getting the word out if voters are literate and numerate. Just imagine the whole world, including the female half of it, able to read and write and knowing where to get real information about politicians. It would be a different world, wouldn’t it? That’s how far away we are from full-fledged democracies.

Voting

Once the informed and independent voter reaches the polls, the voting process itself is not as simple as it seems. Counting the votes is the most tediously straightforward part of democracy, and yet it has sprouted enough issues to bring the whole thing down. The issues include: plurality versus majority rule, and how majorities are tallied; direct versus electoral college voting; how to register voters, where polling should take place, and how to guard against voter fraud; how to draw voting districts; and who should vote.

The actual business of filling in secret ballots, secure ballot boxes, and accurate counts are parts of the process that we know how to do at this point, although recently there have been some curious irregularities with electronic voting machines in the US. (The simplest solution to the latter problem is a proper paper trail. The solution is so obvious, forgetting to implement it seems downright peculiar.)

The more difficult problem is tallying the votes. I don’t mean the physical process of counting them, but how they are added together. It seems straightforward that the candidate with the most votes wins, but it’s not. This was brought home to Americans vividly in the 2000 election. If the majority who opposed Bush had been voting in unison, it would have been called a landslide victory. Instead, a minority candidate won because what we really have is plurality rule, not majority rule. (If we had majority rule, there would never have been an iffy situation for the Supreme Court to decide.)

If you do the math, plurality voting is the worst way of reflecting the will of the voters. There is some argument about what’s best, but none that plurality is the worst. It stands to reason, of course. If there are more than two choices–and there always are since None of the Above is implicitly present even with only two candidates–plurality voting facilitates the election of a minority candidate.

Instant runoff and approval voting are the other two main methods of determining a winner. Instant runoff allows voters to rank candidates. Rounds of elimination of candidates with the fewest first place votes finally leave two contenders, and one emerges the winner. The fundamental problem here is related to the one in plurality voting. In the latter, voter preferences for everyone except their first choice are lost. Instant runoff, however, loses sight of preferences for eliminated candidates. This is less of a problem than losing sight of all but one, but it can still be a problem. (See this example for details, or go to Science News, Nov 2, 2002, Are we using the worst voting procedure? by E. Klarreich, for a more in depth discussion.)

Approval voting gets around the instant runoff paradox described in the example, but at the price of favoring “consensus” candidates, which could also be called “least common denominator” candidates. In the approval method, voters rank candidates according to how much they approve of them, so to speak. Each rank carries its own weight, and the “heaviest” candidate wins. The result is that someone who is everyone’s second choice will win if votes for first choices are more or less evenly split.

Having seen approval voting at work in an academic department, and having seen just how mediocre a candidate can be elected that way, I’m not a big fan of the method, even though it sounds, in theory, like a rational approach. Instant runoff voting is less likely to elect a mediocre candidate (since he or she would not get many first choices and would be eliminated early on). It also has the advantage of being easy to understand, and hence less subject to voter error. Possibly what’s needed is a hybrid system in close cases, which are the ones that cause all the problems.

The important point is that there is nothing sacrosanct about any particular method. Nor is there anything sacrosanct about breaking ties, which is the focus of some theories of voting. A democracy is not about breaking ties. It’s about reflecting the will of the voters. The best method to that end is what we should be using.

Direct election versus electoral college-type procedures can lead to very different results based on the same votes, just as the voting methods themselves do. Initially, that was the whole point. The aforementioned architects of democracy were sure that the undiluted voice of the people would be an inarticulate grunt, and that a layer of more intelligent people should buffer the ignorance of the masses. Most democracies have gone to direct voting, and the US is one of the last holdouts of the antique system. The reason for this isn’t really because anyone here believes voters are too stupid to elect a president. It’s the same reason for all the other anti-democratic admixtures in democracies: powerful vested interests prefer it this way. And if they didn’t have it this way, they wouldn’t stay powerful for very long.

How to vote is not a hard question, but it keeps being muddied by people who would prefer to reduce the number of voters. The answer, of course, is voting should be as easy as possible. The current system of marching off to a physical booth and standing in line is based on 18th century technology (and the landed gentry’s ability to take half the day to vote). At this point, assuming there was genuine interest in universal suffrage, voter registration could take place at post offices, driver’s license bureaus, by mail, phone, or web. Voting itself could take place by mail, or, assuming all the security and fraud issues are worked out, electronically. These methods have been tried in various places and work perfectly well, with no more, and possibly with less, error and fraud than the traditional system. Without a secure postal service, there may be a need for a booth-and-box system, but otherwise our inconvenient, time-consuming, and boneheaded process seems designed mainly to exclude voters.

When the politicians select the voters, rather than the other way around, gerrymandering is at work. In that form of vote manipulation, a voting district is carefully carved out to contain a majority of the kind of voters that the carving politician or party needs. This is no less a manipulation of the vote than any other kind of cheating. The original idea was to allow people who form a natural unit to vote conveniently. For instance, residents of town A vote there even if they live in a valley which is closer, as the crow flies, to town B. There’s nothing wrong with the original idea, and with modern statistics, mathematics, and mapping methods, voter convenience could be accommodated in an otherwise geometrically compact area.

There is, finally, argument about who should vote. This is no longer about which groups are qualified. That question was decided decades ago, after it was discovered that citizens included not only blacks, Jews, and poor people–they included women too (!). The big question now is whether the vote should be limited to the willing, or should include everyone. Is voting a civic duty that citizens can be called upon to perform, or is it something best left to personal inclination? I tend toward the civic duty side of the argument, but then I tend to vote at every opportunity, so I’m biased. If the largest number of informed, independent voters gives the best answer, the pool of voters should be as large as possible. But if the pool then includes totally bored slackers, maybe this is not so good. It’s a difficult question.

Minority Protections

The problem of minorities is a structural weakness in democracies. Majority rule is the whole point of democracies, so they’ll necessarily be less than ideal for minorities. The solution isn’t to say, “Get used to it,” because minorities have legitimate needs that cannot be ignored. A dictatorship of the majority is still a dictatorship

Part of the purpose of bicameral legislatures is to protect minority interests. In the US, the way the Senate is elected artificially increases the power of the least populous states. At the turn of the 1800s when the system took shape, the important minority was farmers. Farmers remain a minority and they remain important, but they are far from the only minority group whose rights need protection. Ignored minorities are endangering democracies, or preventing their birth, all over the globe. Sectarian, tribal, ethnic, and racial strife are endemic at this point. By facilitating gradual change, democracies are supposed to prevent the need for violent overthrow, but their inability to accommodate minorities is leading to predictable results. Democracies must get better at respecting minorities or they really will become failed experiments on the ash heap of history.

The first line of protection for less-powerful citizens is judicial. Solid–and enforced–bills of rights and freedoms, and both punishment and prevention of all discrimination go a long way toward avoiding problems to begin with. Autonomous regions might be part of the solution in some cases. However, the point here is what can the democratic process itself do to help the situation, and that is much less obvious.

The most promising idea I have heard is Lani Guinier’s one of “proportionate interest representation.” Hendrik Hertzberg explains it on the fairvote.org site: “It’s really a modified at-large system. In a citywide election for five council seats, say, each voter would have five votes, which she could distribute among the five candidates any way she likes. If a fifth of the voters opted to “cumulate,” or plump, all their votes for one candidate, they would be able to elect one of the five. Blacks could do this if they chose to, but so could any cohesive group of sufficient size. This system is emphatically not racially based: it allows voters to organize themselves on whatever basis they wish. It has actually been tried in a few jurisdictions — including the proverbially American city of Peoria, Illinois — and has had notable success in all of them.”

Cumulative voting differs from approval voting in that voters express how much of a given rank they want to give to a specific choice. They don’t just vote for, say, three out of the five candidates and then have their choices weighted for them by the counting method. They can give A three votes, and B and C one each, or they can give A and B each two votes, and C one.

Cumulative voting together with instant runoff choices would make for an interesting ballot. Too interesting, some might say. However, since the will of the voters is the heart of democracy, this is not the place to cut corners. Voter information and optimal visual design of ballots can solve this problem, which is, really, no harder than tracking sports scores. The process shouldn’t be any harder than it has to be, but neither should it be so simple that democracy itself disappears.

Representation

The evidence suggests to me that the whole idea of political representatives is another structural weakness of democracies. I haven’t seen this idea mentioned before, so maybe my thoughts on the subject are loopy (or even loopier than usual), but consider the facts.

Voting, in a democracy, is not supposed to be the only expression of the will of the people. The basic idea is that they elect representatives, who then represent their interests while carrying out the day to day chores of keeping society running smoothly. Politicians do worry about what their constituents think, but mainly with a view to being re-elected, which is not the same thing. That is most clear when re-election and representation conflict, in which case most politicians would rather keep their jobs than do them. In other words, they’re just like you and me, doing what they need to do to get by, and representing themselves.

It’s silly on the face of it to think that most people in government would ignore their own needs, when most people outside government certainly don’t. Instead of bemoaning this fact, or wasting energy talking up better behavior, government needs to be designed on the premise that the people in it are human beings. The solution is to harness self-interest, not to fight it.

However, although it’s clear that calling “representatives” on the carpet every few years is not working, better alternatives are less clear. The opposite extreme to representation is government by direct vote, where everything is decided by plebiscites. That would break down in days. Information is essential for crowds (or individuals) to have any wisdom at all, and there is no way a quorum of citizens could take the time to know enough to make sensible decisions. Government is a full time job.

The core problem is interest. Government is a basically boring, administrative job, more like housework, if it is done right, than it is like ruling the world. It consists of trying to prevent messes and cleaning up other people’s when prevention failed. People who aren’t in government, and many who are, have better things to do than worry about other people’s problems. Once those problems grow bad, they just want them to go away. That is not the same as solving them.

So, two criteria emerge. One is that citizens can’t do the job of government themselves, and that therefore some form of oversight is necessary. Two is that the oversight has to take as little time and energy as possible.

Energy, in the sense of the amount of attention people are willing to give, is a big limiting factor in democracies. Citizen oversight is essential, but it won’t happen unless it’s easy to do. In this connection, it’s important that it is easier to focus on what’s wrong than what’s right. Pain draws attention. People are quicker to vote against things rather than for them, and to listen to negative ads rather than nice ones. So, on the principle of harnessing motivations rather than fighting them, the attention-getting potential of annoyance could be used to stop emerging problems. Instead of elections for candidates or initiatives, we should have votes of no confidence against failures.

In other words, citiziens wouldn’t elect leaders. They would unelect them. I don’t know if a system of unelections has already been tried somewhere, and if there are good ways to implement it. One possibility is to have no-confidence votes as a constant cudgel in the background, the way parliaments do. I could see a rolling system, which would dovetail with a convenient from-home voting process. An accumulation of legitimate complaints against either politicians or laws would lead to the calling of an unelection against them. No doubt, there would be enough of these things to warrant a regularly scheduled ballot, and the current crop of culprits with sufficient complaints against them would appear on the next one.

A recall could get rid of unsatisfactory politicians, but it says nothing about how to find officeholders in the first place. How to find competent people is the big question much wiser heads than mine have been unable to answer. Democracies answer the riddle by saying the question is unnecessary. Common sense is all we need, so the current method of selecting officeholders basically asks for volunteers on the assumption that anyone can run a government. The current state of the world suggests that the assumption is flawed.

The volunteers, once they’ve stepped forward, are then expected to campaign. That is an overlooked problem in itself. Campaigning is all right for Miss or Mr. Congeniality, but the requirements for a good campaigner and the requirements for a good administrator are just about mutually exclusive. What we need in government is the sort of person willing to worry about the effect of accounting rules on inventory. Boring? Yes, until depleted vaccine inventories result in an uncontrollable measles epidemic and brain-damage for your child. What we need are boringly competent administrators. What we want–and what we vote for– are people who feel like friends. Is it any wonder that government isn’t working too well?

So, somehow, the selection process has to be compatible with tedious competence. However, a dignified procedure to appoint the best qualified would result in nothing but the hegemony of the best-connected. Maybe the solution is to continue to rely on volunteers, but to narrow the pool to those who have more than a mosquito’s chance in a hurricane of actually handling the job. The proven way to see what people can handle is their track record. So maybe the volunteers should be limited to people with a couple of decades as excellent administrators(as determined by their subordinates and their clients), whether what they administered was MegaCorp Inc. or the church bazaar.

Having a potential pool of officeholders still doesn’t tell us how to select the one to do the job. There is no easy answer that avoids overburdening voters and cronyism, both at once. I’d like to suggest a wild idea that might be worth trying only because it hasn’t already been tried and failed many times over. How about using a simple lottery to pick one person out of the pool?

Don’t laugh. It might work. There aren’t many systems with randomly chosen leaders, but one example is Tibetan Buddhism. The supreme leader is chosen by a priest based on visions of reincarnation. From the standpoint of a non-believer, they choose someone at random and then educate him to the task from a tender age. Out of fourteen Dalai Lamas, two, the Fifth and the current one, have been outstanding. Neither democracies nor monarchies can boast a 14% success rate, and dictatorships aren’t even on the map. Maybe we should give randomness a try. The officeholders could always be unelected if they didn’t work out. Just a thought.

Conclusions

There are many things working against current democracies. Some of them are corruptions, such as attempts to limit who can vote or the use of political office to protect the officeholder. But some of them are structural problems. They are an intrinsic part of democracy and need to be explicitly compensated or the whole system can succumb. The big structural weaknesses are that voter attention is finite, that minority interests are ignored, and that representatives represent mainly themselves.

Some of the cures are easy. Sensible voting and tallying systems could be implemented tomorrow. They’d throw many current politicians out of office, so they won’t be, but the point is, they could be. Achieving a literate and numerate electorate is also not difficult in any real sense of the word. It’s just expensive. On the other hand, restructuring the selection process for officeholders, and working out the best combination of rewards and restraints, would require much research and experimentation to arrive at an effective solution.

So, are we depressingly far away from democracy? Yes. But, as the saying goes, “scientific studies show” that democracy would work well if we actually implemented it. The closer we’ve been to the ideal in the past, the more satisfied people have been with their governments, so the track record supports the theory.

The good news is that nobody can say democracy has failed. It can’t have done, because we haven’t tried it yet.

legal:  Site covered by a creative commons license with the following limits: content may only be used  without modification, for non-commercial purposes, and with attribution to Mia Molvray and her home page as noted here.

Slightly changed from an LA Times letter to the Editor of the Sunday Magazine, regarding an article by Matthew Heller, Healthy, Wealthy, but Wise? The article concerned the controversy about regulation of ephedra and ephedrine, which speed up metabolism, and therefore help weight loss, as well as cause heart problems and even death in some people. I was an ethnobotany (Special Concentrations) major as an undergrad, have a naturopathic doctor’s degree, and a PhD in botany, so herbs and drugs are subjects I feel very strongly about. Hence the rant.

The hoopla over weight loss drugs is just the beginning. There are tens–hundreds–of potentially dangerous things people can take for their “health.” Go into any health food store and take a look at the products that “support vitality.” The flyers, although not the labels, suggest anything from bigger and better Viagra substitutes to cures for old age. The only reason there isn’t more of a problem is that most of them don’t work. If even one of them was as effective as ephedrine for what it claims to do, the National Guard would have to be called out to contain the stampede.

Supplements are called that because they’re supposed to be benign, like food, rather than dangerous, like drugs. Disregarding for now whether such a neat division is real, some natural products are harmless and some aren’t. Dosage is the critical issue. Coffee is natural and rather benign, but a teaspoon of pure alkaloid caffeine would kill you. The milky juice in the central stem of lettuce contains compounds similar to opiates, but salads don’t have the same effect as heroin, and even the most fanatical just-say-no campaigner has never refused a plate of greens.

Ephedrine is no different. A little bit, such as in a tea made of ephedra, is no worse (and maybe no better) than a cup of coffee. However, it is utter bilge to call the pure alkaloid harmless. A statement like that can only be rendered true with a lot of fine print about not exceeding recommended dosages.

If we were all rational, all the time, none of this would be a problem. Labels would never make big promises, and would clearly list the maximum dose and possible side effects. Consumers would never look for hope in a bottle. But even in a perfect world, well-intentioned ignorance could still cause problems. Kava, for instance, is an excellent tranquilizer and generally harmless, yet it turns out to cause liver damage in a few people. This is analogous to the bad effect of aspirin on a few children, and could be dealt with the same way, by providing clear information. However, some people feel that a total ban is the right response.

The appropriate response is a thorny issue. It would be nice to find a middle ground between requiring prescriptions for lettuce and allowing the sale of an herbal Viagra that causes parts to fall off. The Germans have dealt with this issue by demanding proof of safety, but not of effectiveness, which means that people who would like to pay for pink sugar pills, can do so. That is perhaps as it should be.

Who decides on the regulations is also problematic. Science would like to, but it has its own brand of ignorance. In the 1950s, for instance, the official position ridiculed people who took vitamins. After decades of evidence on the benefits of vitamins, including such things as the recent discovery that vitamin B6 helps prevent spina bifida, officialdom takes a different line. Given their track record, I’m not at all sure that the AMA or the FDA deserves to have a lock on what is defined as good or healthy.

Difficult as these issues are, they’d become easier if we could get our minds around a few simple facts. Drugs are drugs, whether packaged by Nature or Merck. Low-dosage drug delivery, whether as camomile tea or coca leaves, isn’t the same as high dosage, whether it’s alkaloids or antibiotics. If we grasp that, a more rational approach becomes possible to the whole issue of drugs, whether legal and illegal, herbal or pharmaceutical, and safe or unsafe.

Technorati tags: drugs herbal medicine FDA supplements

[This is a re-posting of an earlier post, with the comments turned on this time. Unfortunately, current events–read: “Kansas” [Oct24, 2005: good grief, and now Dover!]–keep making it relevant. It’s amazing that almost a century after the Scopes monkey trial, we STILL have to argue about this nonsense.]

Evolution is said to be one dogma among many, nothing more than part of the orthodoxy known as science. Other beliefs are just as valid, and they deserve equal time because anything less is unfair.

There is only one thing wrong with this viewpoint. Evolution is not a belief. Even though nobody is ever going to see birds evolving from dinosaurs, evolution does not rest on the same sort of faith as, say, belief in an afterlife. You might as well say you believe in stars or electrons because you, personally, have never seen great flaming balls of gas or infinitesimal blips zipping by. Switching on a lamp or a computer doesn’t feel like an act of faith. (Well, maybe just a little bit, in the case of computers.) The physical world isn’t something to believe in. It’s just there. Likewise, believing in science would be like believing in a yardstick. It’s just a way of studying that world.

Science is defined by a method, and that method explicitly involves only measurable objects and testable predictions whose results can be independently verified. That means science doesn’t work on anything that can’t be measured and verified. It does *not* mean that everything immeasurable is unimportant. Quite the contrary, since love, joy, hate, hope, beauty, and God are all beyond measurement. Science doesn’t have the tools to tell us anything about them.

What science can tell us about is the physical world, and it is so effective in its own limited range that it’s given us vast power. This has a whole slew of unscientific consequences. Humans, as a matter of observable fact, adore power, so science has acquired a mantle of god-like authority that doesn’t remotely fit. Scientists, who are human beings in their spare time, tend to like the authority and all the perks that go with it, and they’ve certainly come up with their own share of stupid orthodoxies. But that has nothing to do with science itself. Science is not, and by its nature cannot be, a belief system any more than carpentry could be.

So where does that leave evolution? It’s called the Theory of Evolution, and in order to understand what that means one has to understand how scientists use language. Truth is immeasurable, so science can’t find truth. It doesn’t try to. It talks only about the likelihood that a given result will be observed again.

All scientific conclusions are probability statements: an observation is repeated a number of times and, say, nine times out of ten the results confirm a given idea, so . . . the idea is thrown out. A ninety percent chance of being right is not good enough. The probability of being right has to be nineteen out of twenty in the biological sciences. It has to approach ninety nine out of a hundred in the physical sciences. Imagine applying those standards in your personal life.

In science, that’s just the beginning. The hypothesis, which is an expensive word for educated guess, is merely said to be confirmed once it passes that bar. These guesses are dignified with the name of “theory” when they have been confirmed so many times there is no real chance they won’t continue being confirmed. They are called “laws” when that certainty becomes crushing, but even laws are probability statements. The law of gravity is a probability statement with an extraordinarily low chance of not working.

Against that backdrop, evolution is called a theory because there are so many facts in its favor. It’s a parallel case to our understanding of stars and electrons. We have no personal experience of any of them, but scientists who have studied the facts have come up with coherent explanations that pan out. Evolution can explain practical things, such as how bacteria develop antibiotic resistance and why measles epidemics run in cycles, and it can provide mind-altering insights such as that insects and mammals have the same basic body plan, except the plan is back to front.

None of the other ideas for explaining the patterns of life rests on any facts that contradict evolution. The theory of intelligent design (and “theory” is used here in its common meaning) has not been able to show the existence of intelligence in the design, using scientific methods. Creationists can’t show that creation occurred. If the scientific method is not used, the result is not science.

People who argue against evolution can, and do, fit some of the facts into their theories, but they have to ignore all the facts that disagree, which is about as far from the scientific method as you can get. They have no measurable observations and no testable, independently verifiable predictions.

Intelligent design and creationism, by those or any other names, are not competing scientific theories. They are simply theories. They may deserve equal time, but only with their equals in the realm of ideas. Discussing intelligent design in a class on evolution is like considering theories on good government when building a rocket ship.

At the heart of the problem lies confusion about science and religion. Both may have authority and try to explain the world, but the worlds they’re trying to explain are different, the way they explain things is different, and their authority rests on different foundations. Science is not, *and cannot be*, in conflict with religion because they address fundamentally different questions. Facts can certainly contradict specific scriptures, because God’s stenographers do suffer the occasional hiccup, but that doesn’t mean science can suddenly answer cosmic questions about the reason for our existence, or that religion becomes a good way to cure AIDS.

Using religion, or anything else for that matter, to argue against facts is a hopeless endeavor. You can’t argue with facts any more than you can believe in them. And evolution is as close to a fact as biology gets. In Bill Bryson’s inimitable words, denying evolution proves conclusively that the danger for those who try it is not that they may be descended from apes but that they may be overtaken by them.

Technorati tags: evolution intelligent design creationism

We’re not literally all gay, of course, because if we were, there wouldn’t be a problem. The problem is that we’re all different. Or is it?

Homosexuality has gone from unspeakable crime, to merely unspeakable, to downright speakable. The more familiar we grow with it, the harder it is to see gays as monsters. This is causing much concern in some quarters.

Ironically, Aids*, which kills people, had a lot to do with turning gays into people, for those who hadn’t noticed before. Aids was ignored in the early days, except among the “Christian” Taleban, who hoped it would become God’s Final Solution for perverts. Instead, Aids showed gays to be people who die, like us. People who grieve, like us. People who care for those they love, like us, and who want to be with them in their final hours, so very much like us.

Aids turned out to be, indeed, God’s Final Solution, in that it made us recognize our common humanity and begin the long process of learning to live together in peace.

However, that was one bridge too far for some people. We had, in recent memory, accepted Jews, which worked out surprisingly well. Except for a decided improvement in the quality of sandwich meats, there was no discernible difference to society. So that was all right. Then came the concept of treating blacks as equals. We swallowed hard, and figured out other ways of keeping our distance, but at least we could talk the talk on that one.

Then things started to get messy. Women began claiming they belonged to the same species. That hits us right where we live, in our love lives and in our families. Even talking the talk proved to be too much, but human beings are very adaptable. We got around the problem by saying it had been dealt with years ago, and it wasn’t an issue any more. Surprisingly enough, in a world where rape is barely worth a mention in the back section of the paper, and where women are still considered partial people when it comes to pay, this worked.

The frozen limit, however, has now been reached. Homosexuals are saying they have rights, and not just a few small rights, but the same ones as everyone else. This can’t be allowed. Where will it all end, if the natural order of things is so completely ignored? People will start marrying dogs, and civilization will crumble.

The world is now divided into those who find that point of view laughable (of whom I’m obviously one), and those who cannot understand how anyone can be blind to the opening of the floodgates of evil. There is no one in the middle. You either see it, or you don’t, like the drawing which can be either a vase or two profiles, but which it is impossible to see as both at once.

Leaving for another screed the concept that gays are evil, the question is whether exclusion can work at all. The general idea is that exclusion will solve something. Things will be better with the undesirables removed. The idea behind excluding gays is that they are “unnatural,” with the subtext that the person making the judgment is, of course, “natural.” In other words, it’s an us versus them argument, in which “we” are better than “them,” who are excluded.

Let’s grant for the moment that excluding gays makes the remaining group better. It will soon become evident that it is not yet perfect. It could be even better. If the problem is “them” preventing “us” from achieving a smoothly functioning group, then we have to exclude the new troublemakers. Let’s say this new set are people who vote conservative, and obviously cause all the trouble in the world. There are some minor problems due to antiquated customs involving secret ballots, but with an improved Patriot Act, we manage to identify the blighters and get rid of them. The relief is immense. But it’s soon obvious that there is still room for improvement. Problematic relationships continue to crop up. The new troublemakers are those who are taller than average and have a snooty way of looking over the tops of our heads. They are cast into outer darkness. And so it goes until the group is homogeneous enough to exchange organs without tissue typing. Then the people wearing black socks start looking askance at the misfits wearing white socks.

I cannot think of one single historical example where exclusion of “troublemakers” did not follow that pattern. The undesirables might be anything: female, Jewish, black, Asian, witches, or people from outside a gated community. Usually sooner rather than later, the ingroup finds that some of its members are more equal than others. No group that I ever heard of managed to exclude enough people to feel satisfied.

Exclusion fails on a personal level as well as the social one. Whichever difference is grounds for exclusion, it must also be stamped out, or at least hidden, within ourselves. No human being is purely one thing or another. We all have many facets, and any one of them may turn out to be less than “cool.” Life under the hope that exclusion can solve any problems becomes a matter of constantly looking over one’s shoulder, waiting to be “found out” … and hoping that the Final Solution will lead at last to peace. Unfortunately, reapplication of a failed solution has never resulted in success.

The problem isn’t differences; it’s the way they’re handled. The problem isn’t living our way; it’s letting other people live their way.

Inclusive societies have their own problems. You have to put up with people with purple hair, or people holding hands, or whatever. For that, though, other people have to put up with you. You get to live your life without looking over your shoulder. Oddly enough, the peace that is imagined to lie on the other side of the Final Solution turns out to be right here, without the tedious necessity of doing all that housecleaning first.

So it may be worth remembering what the argument is really about, while controversies swirl around gay rights. Or anyone else’s rights, for that matter, right down to poor thirteen year-olds who are wards of the State. These things don’t merely affect gays, or any other subgroup of the month. They affect how we feel about each other and about ourselves. They affect the feel of our whole society and whether we choose to live in fear or in acceptance. It’s not somebody else’s problem when someone else’s rights are denied. It’s yours and mine. We must either all be accepted, or nobody will be.

[*I’m going with the British convention for common acronyms. I’m tired of all those capital letters screaming at me.]

Technorati tags: discrimination homophobia prejudice

[A medical episode, which started as an eye emergency, and taught me more about getting the treatment than I wanted to know.]

The trouble started innocently enough. I had something in my eye, so I rubbed it. As any mother or eye doctor can tell you, that didn’t help. Three days later my left eye was swelling visibly and growing more painful by the hour. I had a strange, dizzy sensation from being unable to see straight. There was no longer any question of toughing it out, but, naturally, the problem turned into a crisis on Sunday. I didn’t know it yet, but I’d begun a learning experience about everything from acute problems in emergency rooms to the chronic conditions caused by incomprehensible bills.

At eight thirty in the morning, my partner, Paul, drove me to the emergency room. I stood there, with an eye that felt like someone was poking a nail into it, while he filled out paperwork. I was lucky. I had someone to drive me, someone to fill out forms, and someone to hold my hand. There are no words for how screamingly irrelevant forms are at a time like that. I was thinking that every telemarketer in the world knew all about me, but the hospital needed my name filled out on five different forms. What did they think? That it might change between forms one and two? Why couldn’t they just copy my driver’s license and not bother me?

An eye emergency, with its potential for blindness, is treated almost as seriously as imminent death. So I was taken care of quickly, as these things go for walk-ins. In about half an hour, I was shown to a bed and soon thereafter had an IV needle inserted in the thin, sensitive skin on the back of my hand. It was taped down to my hand and attached to nothing. Nobody told me what it was for. The hard external part of the needle kept touching things, like the mattress and the bed railings, and causing new stabs of pain.

A doctor came by who was reassuring and looked concerned. He left to take care of some activity elsewhere in the emergency area. There were curtains surrounding the individual beds, but the brief words I could hear suggested car accident victims had arrived. Hours trickled by because emergency rooms can, apparently, deal with only one emergency at a time, which seemed a tad understaffed for a town of 80,000. My eye, meantime, was swelling visibly and the double vision became noticeably worse.

At eleven, I was trundled off for a CAT scan. I was told to keep my head perfectly still, which was like being told not to think of pink elephants: impossible once somebody mentions it. Furthermore, I had to keep my head still through not one, but two series of scans because some were taken with iodine for contrast. The iodine solution affects the veins, and I could feel it spreading through my body in a wave. It was not unpleasant, but I didn’t know whether it would get worse, which made it disquieting.

The doctor decided my case needed input from a specialist, but no ophthalmologist was available on a Sunday, so the ear-nose-throat doctor was contacted instead. I don’t remember worrying about whether I’d go blind on one side. The exploding pain in my eye took all the energy I had to worry about anything, and the thing that bothered me most was the apparently useless IV needle. It made every motion feel like the skin was being torn off the back of my hand.

When the ENT doctor arrived, he took one look at me and the CAT scans, said the case was way beyond him, and referred me to an eye specialist at the Dean McGee Eye Institute in Oklahoma City. I hadn’t even known there were whole clinics specializing in eye problems. The doctor gave me an IV dose of broad-spectrum antibiotics, just in case the swelling was caused by infection, and told us to get to the hospital immediately. Paul raced home and packed a bag for me, while the antibiotic IV fluid finished infusing. I was given a patch for my eye, which by now looked like something out of a horror movie. Don’t stop for gas on the way, the doctor said. Go straight there.

We went. We arrived at the emergency entrance to one of the big local hospitals at one thirty. The problem with an eye emergency is that you arrive walking. I looked healthy and normal, with my monstrous-looking eye covered by a patch. There were about ten people in the waiting room, generally looking no worse than me. There was nobody else. No receptionist, no nurse, no doctor. A door some way up the hall said “Triage,” but nobody was there either. We stood around, confused, Paul holding my bag, his briefcase, and a huge floppy envelope containing my CAT scans, which he had to be careful not to bend. I was fully occupied with snuffling because my eye was tearing in all directions, including down the inside of my nose. We sat down, totally puzzled.

Some time later, one of the women in the waiting room, who had been chatting with a couple of the people waiting there, stood up and took her seat behind the receptionist’s counter. With a new kind of amazement, we walked up, and she shoved some forms at us. Paul filled them out, and I signed things. I could have been signing murder confessions. He handed them back. She did nothing further. She called no one, she made no arrangements for anyone to see me. She waved us toward the chairs. We sat in the chairs. Nothing happened.

After some time, my partner stood up, walked over, and explained the situation again. We’d been told to get here fast. I needed to see an eye doctor immediately, he repeated. The receptionist gave no sign of being conscious of his or anyone else’s existence and filed papers. It was now half a day after I’d left home in a quest for help, and I had nothing to show for it but a spiking emergency and a really, really annoying IV needle.

A woman in a white coat walked into the door marked Triage. With some hesitation, we walked over and found an overworked nurse. I grew obstreperous about my need for a doctor, and finally he was called. I was shown to an examining room to wait for him.

The other ten people in the emergency room were still waiting when I last saw them with my one good eye. Most of them were not white, were definitely more patient, and probably didn’t have Ph. D.s in biology like Paul and myself. I know the statistics about emergency room visits and how people have to use them these days for routine care. That bothers me, but even more disturbing was that nobody had checked to see who was at death’s door and who wasn’t. If it took serious effort for two professional white people, one of them in perfect health, to get emergency walk-in care, what happens to other people?

I waited for the doctor and thought about anatomy. The eye sits cupped in the bones of the skull. The bone at the back of the eye, which separates it from the brain, is paper-thin. Enough pressure inside the eye cavity can cause the bone to rupture with likely fatal consequences. The pain didn’t seem severe enough for that outcome, but it was getting hard to be sure.

The doctor turned out to be a tall, thin young man who swung into the open door of the little room at about five miles an hour. A shorter-legged person would have been running. They keep residents busy, and first-year residents busiest of all I suspect. Dr. Murphy took a history of the condition, did a number of tests, and then couldn’t manage to measure my intraocular pressure. That requires a puff of air to be blown onto the eye, but I couldn’t open my left eye wide enough for any puffs. It was so irritated that if he gently pried it open, the blink reflex took over and that was that. It was frustrating for both of us. Given that my problem was an eye the size of a lemon, it was important to know how bad the pressure was. I can’t remember whether he finally succeeded or gave up. I do remember that he looked at the data and called in a third-year resident. The new doctor went over the diagnostic data, looked at my horrific eye, and both doctors decided they needed to confer with the orbital tissues specialist. I didn’t even know there was a specialty for the soft tissues around the eye.

Dr. Murphy returned and explained that he wasn’t sure what was wrong, but that the specialist, Dr. Sigler, would be seeing me tomorrow. In the interim, I’d be admitted to the hospital, and, since the most dangerous possibility was a rapidly spreading infection of some kind, he’d continue me on a broad spectrum antibiotic.

I mentioned the worsening double vision, a symptom that really worried me because I thought it indicated some kind of neurological damage. Certain brain conditions can cause double vision. That, he said, was caused by the inflammation pushing the whole eye forward. He took the CAT scans made that morning and showed me the relevant picture. It was amazing. There was my poor little eyeball, visibly being pushed out of its socket. This young man, I thought to myself, will go far. He was the first person to explain anything in what had been a long day.

Pain, all by itself, is exhausting. I remember very little of the process of checking into the hospital. I couldn’t have done it by myself. I don’t know how people manage who have nobody else. Maybe there are social workers standing ready to assist people, but somehow I doubt it.

What I do remember is a nurse starting the procedure to insert a new IV needle.

“Wait a minute! I have an IV.”

No, they had to put in a new IV.

“What! Why? I’ve had this thing all day, banging into things, hurting, and causing problems. It was only used for all of five minutes, infusing some antibiotic, and now you’re saying I can start over? Why? What for?”

The nurse seemed to feel that orders were orders, but I wasn’t going to go quietly. I’d had just about enough.

She finally indicated that the hospital had to have its own IV needle inserted because of liability issues that I was not in the right frame of mind to understand. It seemed truly petty compared to the prospect of added pain and discomfort.

Fine, I thought. Take the stupid enemy IV out. “But why put in a new one right before I try to go to sleep? I’m not on any IV fluids. What do I need it for, bothering me while I do my best to sleep with an exploding eye?”

It turned out that jabbing all comers with IVs is standard procedure, in case the patient needs to be started on something at a moment’s notice. Nobody had explained this before inserting the wretched needle I’d been carrying around all day. It would have been nice to know that extra little bit of torture was not a mistake, which was how it felt. Of course, knowing that I was being used as a pincushion to satisfy some legal beagle might have pushed me right over the edge.

I made some forceful demands about placing the new IV on my forearm, where it was the most out of the way. Even this took argument. Apparently, hospitals like to work their way up your veins to leave themselves as much pristine blood vessel as possible. IVs bother veins and have to be moved every so often. At this point, I didn’t give a tiny damn what hospitals liked. I didn’t need instant IV access at all for my condition. I was being made more miserable for the sake of a nonexistent malpractice suit, and I was not in a good mood.

She tried to soothe me by pointing out this IV would have a soft cannula, in other words the needle part under the skin would be a soft plastic and wouldn’t hurt. I didn’t believe it for a second. However, when she was done, I had to admit she knew what she was talking about. So long as I didn’t actually hit the bandaged area, I hardly knew it was there.

Since the inflammation kept growing rapidly worse despite the first dose of IV antibiotics, Dr. Murphy had ordered the strongest stuff known to science, vancomycin, in the fear that I might have a drug-resistant infection. Drug resistance is everywhere these days, but the last-ditch knockout drugs still work in most cases, including, I hoped, mine. A totally drug-resistant infection would mean I’d go blind in that eye, and possibly die. The optic nerve is a pencil-thick connection between the eye and the brain, and it didn’t take a lot of imagination to know that my life was measured in days if I had an uncontrollable infection. Oddly enough, the prospect didn’t worry me much. I don’t know why. I just remember having no energy to spare for anything besides staying on top of the pain and going through the motions required of me, like getting into bed.

The vancomycin dripping into my vein made it ache and cramp in protest. This was seriously mean stuff. It felt like it was corroding my veins from within, which was precisely what it was doing.

The last order of business was to relieve the pain in my eye. I could understand not being given anything sooner, since it wouldn’t do to suppress the symptoms before the doctor could see them, but I wondered how somebody would have felt who wasn’t aware of that reason. It was one of the many things that hadn’t been explained. Pain relief for a nasty inflammation usually involves corticosteroids, but they depress the immune system, and that was the last thing I needed if I was really fighting a bad infection. The nurse gave me a hospital strength tylenol-codeine pill, before leaving me to my own devices. Tylenol, I told her, upsets my stomach, but she didn’t want to hear it. I felt terribly clever because I remembered enough about hospital procedures to ask that I not be woken in the middle of the night.

Paul raised the back of the bed so I could sleep in a near-sitting position, which reduced the throbbing in my eye. He put the tissues within reach, found extra blankets, opened the window, and generally made me feel that there was someone in my corner. I could feel my blood pressure settling down. He left, obviously massively worried. He had to teach the next morning, but he’d be back in the afternoon.

The codeine did nothing for the pain. I remember noticing the strange patterns behind my closed eyelids. Instead of the usual nebulous, shifting colors, there were very well-defined, three-dimensional shapes. I’d wandered into an incomprehensible art gallery full of nonfunctional vases. Maybe ophthalmologists could use that as a symptom of elevated pressure, I thought. Most of the time, I didn’t think. I just lay there, incapacitated, stranded in an alien universe full of alien shapes. After a while, the codeine put me to sleep.

However, it didn’t put me to sleep for long. A few minutes later–it was actually two hours–a night nurse woke me up to take my temperature, blood pressure and pulse to make sure I wasn’t dead yet. I’m pretty sure I didn’t scream at anyone or try to use a thermometer as a weapon, but it was a near thing. My teeth must have been clenched when I pointed out that I had asked not to be woken, because she got out of there with the speed of a startled rabbit. But the damage was done. My eye hurt so badly I broke into sweats, off and on. The vancomycin-damaged vein in my left arm added a dull, persistent ache and made it impossible to find a tolerable position. Worst of all was the boiling fury that they couldn’t let a sick person sleep. The simple-minded civilian thinks hospitals are places to help you heal. I was rapidly being cured of that misconception. It was hours before I fell asleep again from utter exhaustion.

The next morning, the hospital’s cluelessness about what a sick person wants, or at least, what this sick person wanted, was again in evidence at breakfast. I seem to remember an apple on the tray, but everything else was greasy, fried, or stodgy. It turned my stomach just to look at it on a table several feet away. I covered the dishes back up and put the tray on the other side of the room.

Paul showed up early and unexpectedly, bringing wonderful food from home, but I had no stomach even for that, except half a piece of bread. It was nearly an hour’s drive up and back, and he could only stay about five minutes if he was to make it to his class. I didn’t remember when I’d been so happy to see anyone in my life.

I was visiting the bathroom briefly when the nurse showed up for my morning vancomycin IV. She disappeared. As one of the few ambulatory patients on this ward of cardiac and renal cases, I could stand out in the hallway and collar people. A nurse walked by in purplish scrubs, was duly collared, but it did no good. She wasn’t a nurse. She was a nurse’s aide, and there were several ranks of aides. Some could clean rooms and make beds, others could do more skilled work, like bring meals. Yet others were certified to help patients wash. Further up the scale, an LPN could dispense some drugs, but only an RN could do IVs. My RN had vanished, and nobody else could do anything. I finally received my medication two hours late.

I’d had a similar problem earlier in the morning when my period started. (Murphy’s Law dictated that it was due. Of course, in the pressure of other business, I hadn’t remembered it.) The bed-making aide didn’t know where the pads or tampons were kept. The LPN had more important things to do, but would ask the relevant aide. Nobody came, so I buzzed the nurses’ station. They would attend to it. More time went by, occupied in hoisting myself off to the bathroom for more toilet paper. I buzzed the station again. I was surrounded by people suffering from heart attacks and renal failure, and felt more than stupid bothering the staff about tampons.

When the doctor came, it turned out I was to go to the Eye Institute itself for my eye exam. Apparently, I was an “interesting case” and there would be several doctors. There were. The small examining room filled up with white coats. The good thing about an eye condition is that you don’t mind white coats. If this had been a pelvic exam, I would have been severely annoyed. As it was, I was rather proud to be so important. Usually, I can’t even get people to return my phone calls.

Several of the white coats wanted to see how my eyes tracked finger movements. Not well, of course. I could barely see out of my left eye, and it was so swollen that the eye-motion muscles hardly worked. Then an older gentleman in a regular business suit showed up. He wore a bow tie and was one of the grand old men at the Institute. Whether he deserved his reputation or not, I have no way of knowing because I never saw him again and don’t remember his name, but he had the most amazing hands. I could hardly touch my own eye, and it felt dreadful when any of the doctors examined it, but the doctor in the bow tie could open the swollen eyelids and even palpate the tissues without causing pain. I boggled. I tried to figure out a polite way of asking whether this was a natural talent or something he’d worked hard to learn, but I never found a way to put the question.

Dr. Sigler himself, the soft tissue specialist, had been held up at a surgery, but now appeared, still dressed in his green scrubs. He examined my eye, and looked at the CAT scans pinned to the viewer. He asked some questions, and hemmed somewhat dubiously about the diagnosis of an infection. There was no pus, he pointed out. An infection would have generated pus by now. He leaned toward the idea that it was an immune response, possibly an autoimmune condition.

Great, I thought. That’s all I need: something like lupus following me around for the rest of my life. He said an illness known as pseudotumor could mimic the symptoms I had, except that the eye muscles themselves were also swollen in that condition, whereas in my case the CAT scan showed that they weren’t. It was all very mysterious, and the flock of doctors adjourned somewhere to discuss it. I sat in the little room, vegetating as well there as anywhere else, until someone remembered to shepherd me back to my ward.

Meanwhile, I spent the day complaining. The tylenol-codeine pills did nothing but make me queasy without touching the pain. My eye was still swelling, although more slowly, and was now the size of an orange. A medium-sized orange. It was horribly sensitive to everything, even puffs of air, and there was no eye cup large enough to cover it without touching it. I complained about needing a bigger eye cup, but they don’t make them any bigger than the one I already had. After the nurses grew tired of listening to me, a prescription for a morphine derivative and naproxen (the generic equivalent of Aleve) appeared. It seemed sensible to try the softer drug first, but there wasn’t any naproxen at the nurses’ station. It hadn’t come up from central supply. The nurse told me there was morphine or nothing. I suggested we call the doctor about this. The naproxen appeared. What do people do who are not healthy enough, aggressive enough, and educated enough, to chase after their own medicines? Unfortunately, hospital-strength naproxen also barely dented the pain.

Dinner arrived. Whether it was due to the medications or the pain or both, I still had no appetite, even after two days with nothing but a half slice of bread. Everything on the tray looked inedible, starting with the country-fried steak. This kind of steak, for those who don’t know, is a thin piece of overdone meat covered in a thick layer of breading and fried in some oil I could smell right across the room. The hospital wasn’t trying to be mean. This was Oklahoma City and some of the locals dream about country-fried steak, but to me the stuff was down there with beetle grubs and palolo worms. I quickly covered the dishes back up, and put the tray on the other side of the room.

Paul arrived, bringing more food I didn’t have enough liver function to eat. He, as a tall man with a healthy appetite, took an interest in the dreadful stuff from the hospital kitchen. He tried to make me more comfortable, and tried to distract me by discussing the world outside my four walls and the hospital smell.

Then it turned out I was lucky to have an empty stomach. My evening vancomycin IV made me throw up about five minutes after it started circulating in my system. I was told this is a common side effect of the antibiotic. Since there was nothing in my stomach except water, it wasn’t as nasty an experience as it could have been.

Vancomycin or not, the eye inflammation was not settling down. I felt even worse than the previous night and while I tried to go to sleep I thought about Jim Henson, the creator of the Muppets, who had gone very quickly from living to dead. My problem had the potential to go from being a mere speck in my eye to an entirely changed life, or no life, in no time. I had a sense of detachment and calm which I remember thinking was odd. Probably it came from not really believing in blindness or death.

I took the first of my morphine-type pills, a white thing the size of a pinhead. I waited for the pain to disappear. This, after all, was the real thing, the hard stuff, the alpha and omega of painkillers. It did absolutely nothing. At least, it did absolutely nothing for my pain. It made me too woozy to worry about it, but the sensations themselves were unchanged. The feeling was most peculiar.

What it did do was put me to sleep, but only until midnight when it wore off and the pain woke me again. The swelling was now so severe that it reached all the way to the jawline and midline of the upper lip, and there was even a slight swelling at the bottom of my right eye in sympathy with the left. The slightest motion of my eyes hurt, but the only way to keep your eyes still is to paralyze the eye muscles. I rang the nurse’s station for another dose of morphine, but only an RN could dispense it. The RN was elsewhere. Instead, an LPN came to take my vital signs. I do not, I told her, need my temperature taken. Or my blood pressure. Or my pulse. What I needed was sleep. Sleep. Get me the damn morphine and let me go to sleep. She couldn’t give me my damn morphine. Only the RN could do that. I decided to stand in the hallway until I got what I needed. Lying quietly with the excruciating pain and waiting for a nurse to show up in her own good time was more than I could do.

While I waited, I could hear a man across the hall, a bed-ridden cardiac patient who’d been brought in that afternoon. He was repeatedly and patiently explaining to someone that it was time for one of his regular medications, something for blood pressure, I think. A nurse came by to give me my tiny white pill. When I went back into my room, the fellow across the hall still hadn’t received what he needed.

Two hours later, someone woke me up to take vital signs.

#

Dr. Sigler’s day must have started as early as a first year resident’s, because he came by the next morning at 6:30. I spent several minutes of his time expressing my opinion of night nurses, vital signs, and justifiable homicide. Well, not exactly, but he did write an order on my chart that I was not to be disturbed at night.

For the first time, the swelling was no worse than it had been a few hours earlier, but the doctor didn’t like it anyway. It wasn’t improving quickly enough, he said. I couldn’t have agreed more.

Breakfast and lunch were again inedible, and one of the nurses, a Native American named Yvette, noticed that I wasn’t eating. Was I anorexic, she wanted to know. Now, I’m a naturally thin person, but I’ve been known to eat three desserts when I can get them and I’d never been accused of dieting, to say nothing of anorexia. I wasn’t eating because I had no appetite. My body was trying to tell me something, as far as I was concerned. Besides, I may be thin, but I’m not that thin. I have reserves in the usual places. Then she shifted to worrying about fluids. How much water had I drunk? Not nearly enough, apparently. I was going to get dehydrated. She gave me a twenty ounce container of water with a straw and told me to drink as often as possible. Personally, I thought she was a busybody. It was my first taste of what nursing was really supposed to be, and I didn’t like it.

However, an hour later, after dutifully sipping on the water as per instructions, I needed to visit the bathroom, and then I realized that my last visit had been ages ago. Some time the day before, perhaps. She’d been right about the dehydration.

I didn’t like the bathroom. There was a toilet at one end and a shower at the other, which was fine. What was not fine was a contraption made out of white PVC pipe with black straps that looked like a poor cousin of an electric chair. It could be rolled to the toilet for people unable to sit far enough down, and the straps were to keep people upright who needed that extra assistance. Its function was benign, but it looked awful.

I spent all of that day sleeping off a succession of morphine tablets, with brief intervals of painful lucidity while waiting for the next dose. During one of those intervals, I heard a major conference across the hall about the cardiac patient whose condition had inexplicably worsened. Then word trickled up from the patient about the missing night medication. There was much back and forth and somebody was quite clearly in disgrace, as they bloody well should have been. I was finding out what happens to people who aren’t well enough to demand and get their medications.

During another interval, I took a walk–or, to be honest, a totter–up and down the hall. Dr. Murphy had told me I had to move around as much as possible. I’m a relatively athletic person and I was amazed at how doddery I was. Maybe Yvette was right that I needed to eat something, even if I didn’t have any appetite. I thought maybe I could face an orange, if I had to.

A minister dropped by while Paul visited that evening. At first, I didn’t even realize that’s what she was. She had a quiet, unobtrusive, calm manner that was the spiritual equivalent of the ophthalmologist’s hands. I am, as you may have gathered, not a particularly patient person, and being in severe and constant pain did nothing for the sweetness of my disposition. At the best of times, I frown on uninvited people, phone calls, or mail. Yet nothing about this woman irritated me. A sense of wonder came over me at the oceans of benevolence there had to be behind her calmness, and at the calling which led her to share it with others. I have no idea what her religion was, except that obviously, being a female minister, she must not have been a Catholic. Their loss.

That night nobody hassled me, and the next day I woke feeling much better. The pain was noticeably reduced, although the swelling was down only slightly. Dr. Sigler still didn’t approve, ordered another CAT scan, and started me on IV corticosteroids. That stuff was at least as nasty to the veins as vancomycin. Heroin must be much gentler, because otherwise I don’t understand how addicts do it.

The doctor also pointed out that my eye patch was contributing to the tremendous irritation of the conjunctiva and soft tissues around my eye. But if I took it off, I touched my eye all the time before I could stop myself. That wasn’t good either. There was no solution. Nobody makes a simple patch big enough for this sort of condition.

Later in the afternoon, a very tentative, very blonde girl peered into my room. She carried a clipboard.

“I’m with a class?” she said doubtfully, as if I might contradict her. If I did, I could see she would take my word for it. “I’m studying to be an LPN? Could I take your vital signs?”

I said, “Sure.” It wasn’t the middle of the night and she looked very earnest.

She did a careful, thorough job, and wondered dubiously whether she could ask me several questions. She was supposed to learn how to take a medical history, too. So we were talking away, when I happened to mention my eye patch issue. She brought her instructor over, who was also blonde, but in her thirties and not the least bit hesitant. She was a wonderfully energetic and cheerful woman named Ms. Harris, and the sort of person who made me feel optimistic and healthier, just looking at her. The eye patch was a Nursing Problem, and she set her class of eight or nine women to solving it.

And damned if they didn’t come back with one of those dust masks painters use, which they thought could be cut to size and made to work. Paul had arrived for his afternoon visit and got into the project. He’d worked in New Guinea many years ago, and had improvised plant misters out of nothing, and electrical timers for the misters out of even less. He’s very handy and always carries a pen knife. Between him and the student nurses, in a few minutes the dust mask had been cut and shaped to something that could cover my eye without touching it. I was comfortable for the first time in days and tickled absolutely pink.

Why, I expostulated to Ms. Harris, can’t working nurses do things like that? But it was a rhetorical question. I never saw a nurse or a nurse’s aide so much as sit down to drink a cup of coffee, and I was quite a regular walker in the hallways, passing the nurses station several times a day. I never saw them chatting or doing anything except working as fast as they could to take care of everything they had to do and to never, ever, ever, make a mistake doing any of it.

“And what,” I asked, “is the big idea behind splitting nursing tasks so fine that bringing breakfast trays and bringing tissues requires two separate people?” This was something that had been puzzling me. It seemed arranged for maximum inefficiency.

“That’s the Team Nursing concept,” said the hesitant young woman.

This sounded like a group of competent professionals, orbiting around my bed, making sure I was doing well. But what it really meant was that one nurse did medications, another did IVs, a third checked whether drugs arrived in the ward from Central Supply, and so on. The result was that the one person you needed was always elsewhere, because there was only one of her to go around, and you could never get what you needed when you needed it. The fact that the system made it impossible even for good nurses to do a good job didn’t enter into it. Creating umpteen levels of certification meant hospitals never had to hire someone with more than the minumum of education to do their job??or pay them a cent more than their qualifications required.

Paul took me on my longest stroll so far, outside the hospital to a little duck pond on the grounds. Real air and light were a revelation and the ducks were a miracle. The light was impossibly bright. Why weren’t more of us patients out here? I remembered seeing pictures of hospital grounds littered with patients in bathrobes. Then I realized that nowadays everyone in a hospital, except me, was too sick to move. That is, everyone except me and one thin, frail lady who showed up, towing an IV stand and smoking. Smokers are the only outdoor people left. She fed the ducks, talked and laughed and enjoyed herself, cancer and all. I admired her. I still admire her.

Dinner time approached and it turned out that Paul had brought a special surprise: sushi. They looked and smelled so delightful, I found myself feeling hungry for the first time in four days. Dr. Murphy came in just then on his afternoon rounds, and his eyes grew wide at the sight of the sushi. He looked impressed, although he refused the offer to partake, and even more impressed at Paul’s altruism in eating the cafeteria chow so that there would be more sushi left for me.

By the next morning there was so much improvement in my condition that the doctors decided to take me off IV vancomycin and continue with another, weaker antibiotic in pill form. However, the pharmacy couldn’t seem to locate either my regular corticosteroid injection or the new antibiotic. Hours went by. My eye seemed to be improving steadily, and if that was due to the medications, stopping them suddenly like this might be a bad idea. Another few hours went by with me nagging about the drugs and the pharmacy apparently on another planet.

The conscientious Yvette arrived with a clear plastic bag of IV vancomycin. I could see the label. “No,” I told her, “the doctor’s orders have been changed.” “No they haven’t,” she responded. “Yes, they have,” I insisted. Being meticulous, she went off to double-check. It turned out there was a new person working the order update desk, and by two pm she hadn’t reached the nine am orders yet. This also meant it wasn’t the pharmacy goofing off on my antibiotic. They’d never received an order for it. The question in my mind was which would come first: my discharge from the hospital, or permanent damage from terminal understaffing.

I was lucky. I was sent packing the next day. My eye was no longer painful and the swelling was much reduced, although still hideous by normal standards. I returned home to a regimen of pills too complicated to follow, even with a Ph. D. in science. I knew I was a wuss to be overwhelmed, but I was. I had two different pills to take, an antibiotic and Prednisone (a corticosteroid). I was still on both because the cause of my problem remained unknown. The antibiotic was to be taken four times a day, not with meals and with plenty of water. The Prednisone had to be taken twice a day, definitely with meals and with an antacid because it is very irritant, and the dosage was to decrease down to half pills twice a day and then to half pills once a day, then one every two days, and so on and on and on. It made my head swim. I had to make myself a calendar with each dose and time on it, and tick the pills off as I took them or I became hopelessly confused. AIDS patients taking tens of different drugs, each on its own schedule, should be given honorary degrees.

The pills were far from the worst of it. When I returned home, the chronic phase set in: financial wasting disease. It started with two fat envelopes from my insurer about use of out-of-network physicians. I was to call phone numbers listed somewhere in all that paper, but the numbers had only bad music and no satisfaction. In an emergency, doctors are still close enough to their roots to send the patient to the best person for the job, but the insurance companies see it differently. And I was one of the lucky ones. I had an insurance company to fight with.

Then there were the bills themselves. A deductible was straightforward enough. I could handle that. But then came co-pays. Ten percent of this, twenty percent of that, thirty percent of the other. I tried to make sense of the bills, but I couldn’t. I passed calculus (barely), and do my own complicated taxes. Not only that, but I have some background in medicine and know what “Lab agglutination proc” and “nemboplute 10cc” mean. If anyone, who is not an insurance adjuster, should have been able to understand those bills, it was me. And I didn’t. I couldn’t help feeling that was intentional.

My essential wussiness surfaced again because I gave up. After a few days of phone calls, voicemail, bad music, more voicemail, dropped connections, more phone calls, voicemail, real live human beings who couldn’t answer anything or do anything, more music, more voicemail, more phone calls . . . anyway, I gave up. There are people, tens of thousands of people, who deal with that every day, while they’re ill, for months and years. Here again, I was lucky. I could afford to give up and throw money at the gougers. By now, I was sure that this result was also intentional.

It took weeks for the double vision to go away, but the sense that capitalism and medicine don’t mix has never gone away. Every problem I had, starting with the emergency room, had its roots in cutting corners to save a buck. Understaffing at every level was the most obvious, most dangerous, and most unpleasant consequence, for both professionals and patients.

At the same time, nobody wants to pay even more for medical care. National health insurance was shot down in the early ’90s after insurance company-funded ads said it would cost more and do less. Logically, that means we’ve made our choice to pay less and get less, and we should live with it.

We’re getting less, all right. That part has worked perfectly. But we are not paying less. Per capita medical costs in the USA are higher than any other country’s in the world. Our personal, out-of-pocket expenses are twice and three times more than the norm in other industrialized countries, such as Great Britain or Germany. We’re paying more and getting less. If our priority is choice, we’re not getting that either. The lists of in-plan physicians can be so short that the choice boils down to paying hundreds of dollars more for an out-of-plan doctor or driving for hours to find an “approved” one. Nor can we say that at least we have the best care in the world. US infant mortality is at the bottom of the scale for First World countries, and our life expectancy after surviving infancy isn’t all that great either, by comparison. There is something wrong here.

It’s hard to see how it could be otherwise, given that our medical dollars pay to staff insurance companies as well as hospitals. There are dozens of insurance companies, all with their own secretaries, receptionists, janitors, adjusters, actuaries, medical experts to second-guess doctors, handlers of regulatory issues, directors, executives, and presidents. This, we’re told, is efficient. It’s certainly efficient at pulling money out of us.

More is at stake than mere money. Doctors and nurses spend hours of each day filling out mountains of redundant forms. That’s time they can’t spend on you and me when we’re sick. Practicing doctors are bailing out of medicine because dealing with insurance companies is unbearable. Students avoid medical careers because they hear about the problems. And I wonder what the statistics would show if someone studied the number of stress-related illnesses among patients dealing with insurance issues. The problem expands beyond time and stress right into medical practice. The insurance companies do everything to minimize their costs, at any price, so liability issues and expense become more important than medical judgment or patient comfort. This is insane.

All the other problems afflicting medicine are smaller than medicine itself. Malpractice, bad doctors, untrained nurses, even hospital administrators, none of them corrupts the entire practice of medicine the way the influence of the insurance companies does. However, although identifying the problem isn’t too difficult, figuring out the solution is. Atul Gawande has an excellent article in the April 4, 2005 New Yorker on this very topic. He talks about ways of funding health care, and how none of them have actually provided cheaper, faster, and better medicine. Except one. On a small scale, techniques worked that failed as soon as the group practice grew. Maybe that’s a starting point. Maybe we need to pay more attention to scale, and less to imagining we can force people to be good doctors or good patients.

The situation is desperate. That is obvious to everyone, except maybe the insurance companies, because the current situation is perfect for them. In my case, for instance, they’ve won on all counts. Being ill was bad enough, but I would have gotten over a simple life-threatening disease. What I can’t get over is the annoyance of a thousand irritations: waiting for emergency care, waiting for IVs, waiting for drugs, waiting for tampons, waiting on the phone, waiting for more bills. I’ll do my damndest never to darken the doors of a hospital again. I’m still paying for insurance, God knows why, because next time they won’t have to cover any expenses. If I don’t get better on my own, I’ll die. It’ll be less trouble.

[This was originally part of an essay contest sponsored by the Economist and Shell Oil Co in 2003. Oddly enough, considering the sponsors, the topic was “Do we need nature?” This essay didn’t place, but, as Wodehouse says, like all authors, I know that what I wrote is wonderful (in spite of the equally universal need to maybe just polish it up a bit here and there). So here it is.]

While eating breakfast and leafing through a magazine, I saw the call for a discussion about whether we need nature. Surely, this was a trick question. Without nature, I’d have no plate, no eggs, no energy to cook the eggs, and no me, for that matter. The answer seemed more than obvious. But the questioners must have wanted more than a simple “yes,” or they wouldn’t have insisted on an answer shorter than two thousand words.

Perhaps they’re right. Even at its simplest, as a mere source of raw materials, nature has more than one level. If I were turned into a pile of ash, I’d be worth pennies, but it would take serious money to buy my component biomolecules. Anyone who pays for vitamins or drugs knows how much big molecules can cost. Sometimes they are beyond price. The whole field of genetic engineering depends on a heat-stable enzyme found in Thermus aquaticus, an obscure bacterium hidden in hot springs at Yellowstone National Park. (By extension, bioengineering depended on national parks, too). As for what remains to be found, it could be something as small and welcome as a means of removing tooth plaque without the need for all that tedious flossing, or it could be the cure for old age. And yet, arguing for nature on the basis of utility seems to miss the point as badly as valuing humans only for the pieces into which we could be broken.

Besides, nature’s usefulness doesn’t say how much of it is useful. A mere reference collection should be small on a planetary scale, but the evidence from seed banks, botanical gardens, zoos, and parks indicates that the only permanent reference collection is as big as all outdoors. Yet, even once science puts a number on how big that is, it still won’t answer the question of what, exactly, “useful” means. Nor is the simple extreme of leaving everything untouched an option. We have to muck about with nature. Otherwise there are simply too many smelly, dangerous, freezing, broiling, and sickening aspects to put up with.

There is a very broad line between paving everything and touching nothing. How much we can muck about is far from clear, and that means choices, decisions, and problems. Who decides how much is enough? Who gets the money? Who gets the muck?

Two very different issues are intertwined in these questions: ethical limits and biological ones. Ethics are particularly difficult in diverse societies because they depend on consensus. In a cosmic sense, ethics may be absolute, but enforceable limits are ones believed by a large majority of people. Edicts handed down by popes or ethics experts or even the law will be circumvented if they violate too many people’s feelings on the matter. The consequences of that are nontrivial, as evidenced for instance by the growth of the Mafia during Prohibition in the United States. The really bad news is that, as with all issues requiring consensus, there is no shortcut to reaching it. People need time and information to make their decisions, and I, much as I might like to, don’t constitute a consensus.

Nature, it’s been pointed out, is a Mother, so it stands to reason that the difficulties only grow worse. Important as ethical limits are, they are not fatal, in themselves, but breaking nature’s laws is punished by death, and ignorance of the law is no excuse. It is the queasiness about what lies beyond lines we haven’t crossed that leads to the feeling it is dangerous to take destiny in our own hands. However, we’re over a hundred thousand years too late to worry about altering destiny. We’re doing it. The only question is whether we will do it well.

One obvious way to do badly is to find the limit by stepping over the edge of a cliff and saying, “Oh, that’s where it i-EEEEE.” Science can help avoid this outcome because it is a good tool for finding the edges even as it pushes us closer to them (which suggests that there may be justice in the universe). Being a tool, though, science doesn’t relieve us of the responsibility of deciding how to act on the information it gives.

The same problems surface in all kinds of environmental and biomedical issues, but I’ll take genetic engineering as an example. There are all kinds of guesses about what might happen with unrestrained bioengineering. Nightmare visions of clones farmed for their organs compete with the horror of a planet covered in bespectacled copies of Bill Gates. But it’s not the problems we’re afraid of that bite us. Dinosaurs cannot be made from chicken’s eggs, with or without added ancient DNA, nor can genetically modified food make a Frankenstein. (Yes, I’m sure. I’m a biologist who sequenced DNA for a living.) The human body, people once feared, would die from the violent speed of a horseless carriage. These days we go at Mach 3 without disintegrating, but the real problem is keeping our cities alive.

Likewise, the real problem with cloning, to take one instance of bioengineering, is certainly not the bare fact of it. I have two neighbors who are clones, but they’ve never followed orders from a groupmind. They’re identical twins. Admittedly, they are clones of each other, not of their parents, but clones are clones. There’s been a hitch with artificial cloning of human beings because of our unexpectedly complicated eggs, but once we succeed, we’ll have a new, expensive, and less pleasurable way of producing human beings. (As if overpopulation wasn’t enough of a problem.)

Cloning organs, as opposed to whole humans, suggests a range of scenarios. Heart cells grown in a flask for transplant don’t seem upsetting, but the same heart grown in a farmed person would be beyond horrible. On the other hand, if the heart is part of an immune-altered pig, it seems no different from killing the pig for pork. I do get upset about killing pigs, but the destination of the pig’s parts is not what matters. To put it bluntly, the limit of cloning for me seems to be the shape involved, together with the feeling that the shape could sit up and say good morning. And even that simple rule doesn’t answer many further questions. Should rich people have access to cloning when it is too expensive for poor people? Are the byproduct embryos people or not? If they are, can they be deprived of life so long as we give them proper funerals, in the same way as we treat many adults?

Another aspect of bioengineering is the novel combination of genes. What do we know about the real dangers of mixing genes from jellyfish and geraniums? The answer is: not much. Genetic engineering started yesterday, for all practical purposes. Human allergies or other immune responses to “frankenfoods” are only starting to be studied. The environmental effects are barely known. Viruses can transfer genes beyond the target organisms in unexpected ways, so almost anything is possible. If a gene were introduced to increase seed set in wheat, it might end up increasing seed set in weeds. What is worse, the effects last forever and propagate, because unlike pesticides or pollution, genes don’t break down. Another consideration is that the businesses developing these foods want cheap, good-looking products. The fact that they may have all the nutritional value of styrofoam is not the companies’ concern.

Some consequences are easy to extrapolate from previous, similar situations. Breeding the perfect cow or rice causes the loss of other varieties, and potentially lethal susceptibility to the slightest perturbations. Poor farmers who can’t afford the cost of the new varieties lose their livelihoods (which suggests a sardonic, not to say cynical, sense of humor among those pushing GM foods as the answer to famine).

There are some truly ominous signposts of future directions. One of the first genetically engineered crops does not resist pests or weeds. It resists weedkiller. Farmers can grow a patented crop that allows them to easily kill all weeds with large doses of herbicide. This means more damage to the environment, more residues to the consumer, and more expense to the farmer. It seems like a stunningly bad idea, except that the same company sells the patented seed and the weedkiller.

The usual objection to dire warnings about crossing invisible lines is that we’re still here. How could the warnings matter if we’ve survived? But that’s exactly the point. We find out what’s survivable by surviving it. If we don’t, nature has no appeals court. Do we really want to make that kind of experiment? It seems self-evident that the correct course to follow with respect to biological limits is to stay away from them and to take what scientists call the conservative option. This is not the same thing as political conservatism.

Limits mean that questions about nature can have wrong answers. But, as with ethics, the difficult questions have no right answers. The desirable balance of profit, convenience, cost, diversity, clean air, fresh water, health, and wealth is determined by social consensus. And this is one discussion where it makes a great deal of sense to include as many people as possible, because then some of the people getting the muck will have a voice to let everyone know where the problems start. This is good, even though it slows down progress–especially because it slows down progress. The progress being slowed in that case, may be the kind that’s headed over the cliff. The greatest good of the greatest number may be more than a hopeful ideal. It may be the only way to survive.

I’ve spent the day mulling what seemed a simple question and found mainly that I can’t answer it. This is frustrating, and my favorite way of dealing with that is to bicycle down to the beach and watch the sun set. I find it impossible to stay annoyed while looking at the waves foaming pink in the evening light. There are island mountains far offshore, and today their summits are trailing rose-colored mists in the turquoise sky. As the whole world briefly glows, it becomes obvious to me that I want much more than mere survival. Nature, in the common meaning of the word, does things for us that I’ve never felt in a parking lot, even if the asphalt is made of transformed Devonian seas and of gravel that was a mountain once.

Asking whether we need nature is like asking whether a fish needs water. It’s like asking whether a fish needs fish. It’s just a question of how many parts of ourselves we’d like to cut off.

(SpaceShipOne: First Private Launch, 21 June 2004)
by Mia Molvray, photos by Paul J. Kores
(c) 2005

SpaceShipOne’s rocket runs on rubber and laughing gas, and two days later I could still feel the laughing gas. Watching the ship reach for space was a charge that just doesn’t go away.

It didn’t start that way. It started with being turned away from Mojave Airport in the middle of the night while a gale like a tornado in training pounded the car. “The parking lot isn’t set up yet,” said the polite man whose job it was to guard the entrance to the airport. Not “set up”? What did they plan to do? Unroll it from storage in a hangar somewhere? This did not sound promising.

Sunrise at Mojave Airport

Miss Mojave, in tiara and blue jeans, helps the cause

We turned around, like the enthusiasts ahead of us, and headed off into the inhospitable night. It was our own fault, unfortunately. The web site said clearly that the lot would open at three a.m. for the 6:30 launch, but my partner, Paul, and I wanted to arrive early. Nothing would be worse than missing the launch because we were stuck in a traffic jam of arriving sightseers. A parking lot, we thought, is a parking lot, and we’d just wait the hours out somewhere, dozing on lawn chairs.

At Mojave Airport, we found out, that’s not the way it works. Unlike most little rural airports, Mojave’s is huge. Part of it is even used as an airplane junk yard for 747s and other big jets, and they just look like small planes in the distance, which shows how enormous the place is. An airport that size, it turned out, has no trouble accommodating thousands of cars. They just wheel generators and flood lights onto the packed dirt and, presto, there’s an instant parking lot. It says a lot for the folks who run the airport that traffic wardens and lights were ready a mere hour later, long before three a.m., and long before the whole town could become a snarl of frustration and lost tempers.

Our notion of dozing in lawn chairs proved ridiculous. Any native could have told us it wouldn’t work. The town of Mojave is not as dry as the desert of the same name, but it is in the desert, so daytime temperatures in June can reach over a hundred and cool off into the fifties after dark, which causes high night time winds. Sand and dust blew off the packed dirt of the airport in clouds, rocking our car and sandblasting the paint. Paul, who’s over six feet tall, couldn’t sleep in our small car no matter what, so he wrapped up in his windbreaker and some towels and braved the elements. I tried to sleep draped across the seats, despite a gear shift and parking brake that were out of sympathy with this project. Supposedly, the winds died down toward morning, which was why the flight was scheduled for 6:30, but it didn’t seem possible that the raging sandstorm could disappear in mere hours. Weeks seemed more likely.

I was surprised to find myself waking up (it had been one of those nights where I knew I hadn’t slept a wink). Early dawn spread a sapphire glow in the east. People had been arriving all night long, and setting up chairs along the fence marking the viewing area. Paul, it turned out, had found prime spots right along the runway, while I and the gear shift had negotiated our uneasy truce. In less time than it took to suck down a morning cup of tea from our thermos, the sky grew flame-colored and the sun floated up from behind one of Mojave’s low mountains. The wind was a gentle breeze ruffling the hair of little kids who’d be going to Mars someday because of what they were seeing here.

The improvised parking lot was now a sea of cars. One van was painted with rockets and stars and said “62 miles up or bust!” SpaceShipOne’s target was 328,000 feet, which is the European definition of the beginning of space. (NASA’s is lower.) The crowd was fifty people deep or more at its thickest along the fence, but sparser where we were. The fence consisted of a yellow nylon rope strung between steel posts set every ten yards or so. Anyone, large or small, could have stepped right through, but nobody did. There was supposed to be a three foot gap between the public and the fence, and airmen from the Civil Air Patrol at nearby Edwards Air Force Base marched up and down trying to get all of us to pay attention to the rules. They had about as much success as you would expect, but they were very nice about it.

Well before 6:30 the excitement started cresting. Rumors would sweep through the crowd that the White Knight had been sighted, that it was on this runway, that it was on that runway, or that it was near the media area a few hundred yards away. The White Knight is a twin-engine jet, also designed by Burt Rutan, and made to carry SpaceShipOne up to launch altitude.

There was supposed to be a link between the control room and a local radio station, but a glitch interfered. The radio station played country music and there was talk of waving a handkerchief out the control tower to give people a heads up at major points. When the White Knight carrying SpaceShipOne underneath it did appear, it was without any fanfare. A few minutes after 6:30 the world’s most elegant and unearthly aircraft rolled easily down the runway.

We were cheering our hearts out as it rolled past. Technological achievements can be exciting, awe-inspiring, and life-changing, but they’re not, as a rule, aesthetically pleasing. The White Knight and SpaceShipOne are take-your-breath-away beautiful. The White Knight is not large, as aircraft go, and it looks so light and ready to fly that a strong breeze should be enough to send it swooping skyward.

The mood in the crowd was friendly, excited, tolerant, and polite . . . even toward the one gent (there’s always one) who was on his cell phone giving a loud blow-by-blow account to someone at the other end. “It’s coming down the runway now. It’s rolling past us now. It’s stopping at the end. . . . Yes, it’ll be turning soon for take-off.” I tried to remind myself that the poor person at the other end couldn’t be here, and that it was all in a good cause, but it didn’t help. It was like being at the movies when someone two rows over says, “Ooh, look Darryl, he’s about to kiss her. Ooh, he’s getting closer. Ooh–,” and so on. Kill all cell phones.

Well, the plane did turn, waited a moment, gathered speed for takeoff, and lifted effortlessly into the air. They say the mark of genius is to make difficult work look easy, and Burt Rutan is definitely a genius.

The White Knight – SpaceShipOne pair, followed by two chase planes, flew higher and higher in wide circles over the airport. At over 45,000 feet, SpaceShipOne would drop away and fire its rocket for the flight to space. The process was going to take an hour or so, which meant there was time enough to wait in line at the Porto-Lets. A connection between the control room and the radio station had been established, so word would come through when it was time to scan the skies for the historic event.

I found out when I came back that it is next to impossible to spot a small white plane that was growing smaller by the second in the vast bowl of bright blue sky. At one point, it passed through an atmospheric layer where it and a chase plane left contrails, so I finally managed to focus them through my binoculars. The problem was that their altitude-gaining circles took them right past the sun, which was well up in the sky by now. Looking at the sun through binoculars is a disaster, so tracking the planes required split-second decisions about whether it was better to lose the aircraft or my eyesight. I chickened out and lost the aircraft. And, in the perverse way of real life, they were no longer leaving contrails. The whole crowd of us was standing around saying, “Can you see them? Can *you* see them?” Nobody could see them, not even one man who’d brought a three-inch telescope to track the event.

Suddenly, not far from the sun, there was a lengthening line of white. SpaceShipOne had fired its rocket. Everyone was yelling and cheering and pointing. There was a brief interruption in the plume of white and a sort of kink in the trajectory, but I had no way of knowing whether that was all part of the plan or not. The plume of white resumed and the leading tip moved faster than anything I’d ever seen. In what felt like no time, but was actually 80 seconds, the rocket burn stopped and we all knew that Mike Melvill was coasting to space, looking at a black, starry sky and a round Earth. We found out later that he was also tossing candy up there and watching it float.

Minutes went by, all of us waiting, looking up, as if what we were trying to see wasn’t invisible. Then came the double sonic boom of SpaceShipOne’s re-entry, like a huge single heartbeat. Moment’s later, someone spotted the tiny dots of aircraft meeting the space ship and following its glide down. Through the binoculars, I could see SpaceShipOne, already in its gliding configuration with its wings flat like an airplane’s rather than up to stabilize its descent. It floated down as effortlessly as it had gone up, following a similar spiral path. Soon it touched down in a perfect landing while a storm of whooping, hollering, whistling, cheering and shouting broke out.

A short while later, the White Knight seemed to be about to land, but instead it revved its jets, climbed steeply, and banked like a fighter in a fully deserved victory lap. Then it landed.

Over the next few hours, details emerged that those of us actually watching the event didn’t know. The kink in the trajectory had been due to a problem with the trim of the wings. Mike had worked around it, but it had taken 30,000 feet from the spacecraft’s altitude. Even so, Edwards AFB reported that the rocket reached the 328,000 foot boundary of space with 491 feet to spare. The trim problem turned out to be minor, and by the time you are reading this the Xprize for the first passenger-carrying, private launches to space has likely been won, and most likely by this very ship.

The last event on the program was a close-up view of SpaceShipOne as it was towed past the cheering crowds. Mike Melvill was standing on top of the ship, waving with as much exuberance as all of us behind the fence. It’s not entirely fair to NASA, since they have lofted a spacecraft or two, but somehow this felt more like the real thing than anything that has gone before. This was *us* doing it, not some bureaucracy with carefully scripted astronauts.

Unexpectedly, the van towing the space ship stopped and Burt Rutan himself got out. He came running across the wide trough of packed dirt up toward the fence. In seconds, he was headed back to the van with a big grin on his face holding a sign one of the viewers had given him. He passed it to Mike and the cheering broke out all over again. The sign said SpaceShipOne: Government Zero.