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Tribalism and Medical Ethics

Science is intended to discover the “is”, not the “ought;” facts, not values. Science can’t tell us whether an action is moral; it can only provide evidence to help inform moral decisions. For instance, some people who believe abortion is immoral reject birth control methods that prevent implantation of a fertilized ovum on the grounds that it constitutes abortion; science can determine that a particular birth control method prevents fertilization rather than preventing implantation of a fertilized ovum. A new book, Moral Tribes: Emotion, Reason, and the Gap Between Us and Them, by Joshua Greene, provides some intriguing insights that are pertinent to medical ethics.

He thinks tribalism is the central tragedy of modern life. Evolution equipped us for cooperation within our own tribe but not for cooperation with other tribes. Cooperation with related individuals helps spread our own genes, but we are in competition with other tribes and cooperating with them might help spread their genes to the detriment of our own. It boils down to Us vs. Me and Us vs. Them. He uses the word “tribes” not in the original sense (Hutus vs. Tutsis), but to include Democrats vs. Republicans, Catholics vs. Protestants, CAM vs. science-based medicine, Arabs vs. Israelis, climate change activists vs. climate change deniers, and any other ideological or nationalistic group.

He says morality is not what generations of philosophers and theologians have assumed. It is not a set of freestanding abstract truths, but rather a manifestation of moral psychology.

  • Morality is a suite of psychological capacities designed by biological and cultural evolution to promote cooperation.
  • It is implemented through emotional moral intuitions, gut reactions that cause us to value the interests of (some) others.
  • Different human groups have different moral intuitions, resulting in conflict.

Opponents of abortion feel strongly that it is always “wrong” to destroy a fetus. Proponents of abortion feel just as strongly that it is always “wrong” to interfere with a woman’s control of her own body. Their positions are incompatible, and they are unable to agree on a policy that will satisfy both tribes. Greene thinks we can only make progress if we understand what morality is, how it got here, and how it’s implemented in our brains. He describes recent studies in experimental psychology and cognitive neuroscience that can help us understand.

Trolleyology

The science of “trolleyology” investigates the role of emotions in morality. The basic trolley scenario: a trolley is headed down the track towards 5 people, and will kill those people unless you throw a switch and send it down another track where it will only kill one person. Most people agree that it is better to throw the switch; but if the choice is to stop the trolley by pushing a person off a footbridge onto the track, most people wouldn’t do it. The math is the same: sacrificing one life to save five. But most people who are not psychopaths have a strong emotional reaction that makes them feel it is more immoral to actively push someone than to throw a switch. This is a gut reaction that doesn’t involve reasoning. But what if the person you push is a rapist and murderer? What if the one person killed by switching tracks is your child? Variations on the trolley theme are a good tool for investigating how our brains work.

We have dual-process brains

We have dual-process brains: we react automatically, but we can also think things through deliberately. The automatic mode allows us to react quickly and appropriately to danger (see lion, run); the manual mode allows us to weigh the consequences of our actions and defer temporary pleasures for long-term gain (stopping to eat berries vs. continuing to follow the trail of a mastodon that you can kill to feed the whole tribe.) A gizmo in our brains responds negatively to violent acts, regardless of whatever benefits they may produce. It also gives us a taste for punishing others when they act unfairly and makes us far more concerned about the plight of people who are present than about the plight of those who are far away. The gizmo has an important function; but we should recognize that while our moral intuitions are generally sensible, they not infallible.

Greene compares the brain to a camera with general-purpose automatic settings that can be over-ridden to customize the settings for specific purposes. Emotions serve as heuristics, mental shortcuts that we use to make decisions. They allow rapid, efficient action that is generally adaptive. Reason can free us from the tyranny of emotion, but it can’t produce the best decisions without some emotional input. Think Mr. Spock and Capt. Kirk. Emotions that are not tempered by reason can lead to irrational mistakes; both our perceptions and our sense of fairness are biased. Selfishness can be overcome by our automatic settings for the benefit of the tribe; moral inflexibility in the face of another morally inflexible tribe can only be overcome by shifting into manual mode.

Facts are not enough

We like to think that if people are given the facts and have critical thinking skills, they will recognize the truth about climate change, vaccination, etc. Not true. People who are more scientifically literate are more adept at defending their tribe’s beliefs, whether they are true or not. Ordinary people are hopeless slaves to tribal prejudice. People are willing to consult experts about most things, but expert consensus means nothing once a false belief has been culturally entrenched and has become a tribal badge of honor. Experts agree on climate change, but there’s widespread disagreement among the public. Egalitarian communitarians accept the scientists’ consensus of great risk and the need for collective action; hierarchical individualists trust their own tribe’s chosen high-status authorities and are wary of collective actions.

Many of our debates hinge on standard value premises of security vs. freedom. This becomes crystal clear in discussions of vaccines. Pro-vaccinationists value the security of eliminating preventable diseases for everyone; anti-vaccinationists value the freedom to make individual decisions and to put what they perceive to be their own personal interests above the interests of herd immunity.

Political divisions often boil down to individualism vs. collectivism. Should everyone pay the same flat income tax, or should the rich pay more than the poor? One side thinks the individual should reap the rewards of his own hard work and believes it is unfair to take goods from him and give to others who have not earned them. The other side thinks justice requires the more fortunate to share with the less fortunate. Both sides are more committed to their ways of life than to producing good results. Their values are not about “whatever works” but about deep moral truths.

Harms caused by action vs. harms of omission

We instinctively feel that harms caused by actions are worse than harms of omission. This can be debunked. Our brains can’t keep track of all the things we are NOT doing. The brain considers actions and omissions in fundamentally different ways, and actions are more accessible to our minds. The AMA distinguishes intentional euthanasia (forbidden) from providing drugs to relieve pain that also happen to end a patient’s life. Under the AMA Doctrine of Double Effect and the Doctrine of Doing and Allowing, terminally ill patients may not get what’s best and what they want for themselves. Our automatic gizmo creates opposition to physician-assisted suicide, mandatory vaccination, and policies surrounding organ donation and abortion.

We are working against 6 psychological tendencies

  1. Human tribalism favors Us over Them
  2. Tribes place different emphasis on rights of individuals vs. good of the group
  3. Different groups follow different moral authorities, often religious
  4. Biased fairness – group self-interest distorts sense of justice
  5. Biased beliefs – from self-interest and social dynamics
  6. We tend to underestimate the harm we cause others

Is utilitarianism the solution?

Greene thinks an enlightened utilitarianism is the answer: we should do whatever will produce the best overall consequences for all concerned. Caution is required, because it’s easy to fool ourselves into thinking that what we want serves the greater good. Some might argue that slavery could be an overall good if the advantages to the slave owners outweigh the harm to the slaves. It’s easy to show that belief to be false by simply asking whether they would agree to live half their life as slaves in order to reap the benefits of being a slave owner during the other half of their lives, especially if the order of events is randomly chosen and there is no guarantee of humane treatment for slaves. In principle you might be able to maximize happiness by oppressing some people, but in the real world oppression does not make the world a happier place. “In the real world, there is no fundamental tension between happiness and justice.”

Greene argues for Mill’s “higher pleasures.” Things like getting drunk or overeating are temporary pleasures that don’t benefit the individual in the long run; higher pleasures like the gratifications of learning are often those that also build durable and shareable resources. Our instincts serve us well to confront the moral temptations of everyday life (matters of Me vs. Us): they will stop us from hurting a neighbor by lying, stealing from him, or killing him. But when it’s a matter of Us vs. Them our instincts are not reliable and we should resort to explicit thinking about the greater good.

Three approaches to moral truth that fail:

  1. Religion: relies on personal revelation not accessible to all; relies on different interpretations of God’s will.
  2. Reason: founded on axioms. After centuries of trying, no one has found a serviceable set of moral axioms that are (a) self-evidently true and (b) can be used to derive conclusions that settle real-world moral disagreements. Reason can make our moral opinions more consistent, but it can’t tell us how to make trade-offs between competing values of different moral tribes.
  3. Science: fails on the “is/ought” level. Evolution can explain how morality evolved to promote cooperation within groups for the sake of competition between groups. Our genes might be better spread by killing all the other tribe than by cooperating with them. The axiom “what’s right is what fulfills the purpose for which morality evolved” is not self-evidently true. Cooperation is not the ultimate moral good: it can result in misery for those who cooperate. The Borg is highly cooperative but isn’t much fun, and most of us would not choose to join. Cooperation is not an end in itself, but is valuable because of the happiness and relief from suffering that it brings.

Abortion

Greene quotes Barack Obama:

Democracy demands that the religiously motivated translate their concerns into universal, rather than religion-specific, values. It requires that their proposals be subject to argument, and amenable to reason. I may be opposed to abortion for religious reasons, but if I seek to pass a law banning the practice, I cannot simply point to the teachings of my church or [invoke] God’s will. I have to explain why abortion violates some principle that is accessible to people of all faiths, including those with no faith at all.

Abortion debate boils down to strong but complicated feelings that we can neither justify nor ignore. But we can ask questions about consequences. What impact do policies have on our lives? What happens if legal access to abortion is restricted?

If abortion is illegal, it removes an important safety net from millions of people, it tends to interfere with the enjoyment of sex, it causes people to seek illegal abortions at great expense or risk, it forces women to endure the discomforts and health risks of pregnancy against their will, it disrupts life plans, it tends to remove women from the work force, and it even costs lives (the death rate from pregnancy is higher than from therapeutic abortion). There’s no good argument against abortion except that it would grant life to people who wouldn’t otherwise exist. Those who are concerned about overpopulation would disagree that that was a good thing; and even for those who agree, this argument is TOO good: if it is valid, it should also apply to all forms of contraception and nonreproductive sex. Remember Monty Python’s “Every Sperm is Sacred.” In an unbiased assessment of the consequences, pro-choice wins, although it still hasn’t determined where to draw the line. If you go by fetal viability, the line changes as technology improves. Any line is arbitrary, but it could always be adjusted based on good evidence of harms vs. benefits. If our gut reaction is that early abortion is OK but 3rd trimester is not, we can look for a moral theory to match our feelings, but gut reactions were not designed to be organized, and they weren’t necessarily designed to serve truly moral ends.

Our reasons are confabulations

Science shows that most of the reasons we give are confabulations to rationalize preferences. People primed with words like ocean-moon were more likely to choose Tide detergent, but gave reasons like “Mom used it” or “I liked the box”. We constantly interpret our own behavior, building a plausible narrative about what we are doing and why. We rationalize to justify the emotionally-compelling moral dictates of our automatic settings.

Death penalty proponents and opponents cite evidence that it does or doesn’t reduce crime, but if they are proven wrong they fall back on “It’s still wrong on principle” or “It’s the moral right of an aggrieved society.” Heads I win, tails you lose.

Claims about what will promote the greater good (whether the death penalty will reduce crime, whether a policy will increase or decrease the total happiness of society) can be supported by evidence; claims about “rights” are oblivious to evidence.

People think they understand how things like zippers and toilets work but when asked to explain them, they realize that they don’t really know. In a brilliant set of experiments, people were asked about policy proposals like single-payer healthcare systems. Those who opposed a proposal were asked to explain the details of how it would work and were forced to realize they really didn’t fully understand it; this realization changed their attitudes and made them less opposed. People who were just asked for reasons for their opinion didn’t change. And we know that people whose reasons are challenged only become more convinced they are right. So forcing people to confront their ignorance of essential facts may be a way to make them more moderate. I wonder if it would help to ask anti-vaccine activists to explain how vaccines are developed and how they work?

Pragmatic utilitarianism as a solution to conflicts?

The first step to agreement is to concede that your opponents are not evil and hold their beliefs and values as strongly as you do yours. People are all basically alike. To me, I’m special; to them, they’re special too.

The next step is to set aside gut reactions and look objectively at consequences. We can capitalize on the values we share and seek a common currency there. The Golden Rule is generally accepted by everyone. Science also offers a common currency. Tribes may believe earthquakes are caused by the thrashing of giant catfish or the earth’s shivering when it is ill; such myths vary and contradict each other. But science is the same everywhere and we all ought to be able to agree that a scientific explanation based on plate tectonics is preferable to unsubstantiated myths.

How should we think about the foolish man who refused to buy health insurance? Is healthcare a right or a product? We can use manual-mode thinking to reach agreements with our “heads” rather than our “hearts” – to yield a moral philosophy that no one loves but that everyone “gets” – to acquire a second moral language that members of all tribes can speak. We can acknowledge that:

taking a bit of money from the haves hurts them very little, while providing resources and opportunities to the have-nots, when done wisely, goes a long way. That’s not socialism. That’s deep pragmatism.

Greene says:

Utilitarianism asks only that we push ourselves to be morally better, to care more than we do about people beyond our immediate circles. Utilitarianism doesn’t ask us to be morally perfect. It asks us to face up to our moral limitations and do as much as we humanly can to overcome them. Here science can help, showing us just how fickle and irrational our sense of duty can be.

This fits well with Michael Shermer’s hierarchy of morality in his book The Science of Good and Evil. He says we become progressively more moral as we expand our sphere of caring from self to immediate family to relatives to strangers to groups to nations to animals to the entire biosphere.

Conclusion

We have the capability to understand the psychology of our instinctive morality, overcome our automatic gut reactions when appropriate, and replace them with something better. We can aspire to overcome tribalism and become a global tribe that works towards the greatest possible happiness and welfare for all its members simply because it’s good. We can’t define good in any justifiable abstract philosophical way, but we can enhance the moral instincts evolution equipped us with to create a pragmatic utilitarianism that works for the benefit of everyone.

Greene’s ideas are applicable to controversies in medicine like abortion, euthanasia, circumcision, mandatory vaccination, universal healthcare coverage, and policies about CAM. They also apply to major global problems like poverty, violent conflict, terrorism, and global warming/environmental concerns and to domestic problems like taxes, capital punishment, gay rights, and many others. His book will make you think and will challenge you to recognize that you, too, have tribal biases. It’s well worth reading.

Posted in: Book & movie reviews, Critical Thinking, Evolution, Medical Ethics

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92 thoughts on “Tribalism and Medical Ethics

  1. windriven says:

    I propose that you start a book club, we’ll call it ‘H’. I’ve gotten a number of outstanding recommendations from your blog and I’m looking forward to reading this one. The H seal of approval has proved rock solid (though in the end I wasn’t as taken with the Bunge as I wanted to be).

    “The first step to agreement is to concede that your opponents are not evil and hold their beliefs and values as strongly as you do yours”

    But sometimes in fact they are evil. History has shown that failure to act in the face of great evil carries often horrific consequences. Hatred of, say, Jews can be characterized as a cultural artifact in some societies. But beliefs beget actions. I’ll be interested to see if and how Greene approaches this.

    In general, while the first step may be conceding that one’s opponent is not evil, not much will change until one’s opponent accepts the same premise.

    “Greene’s ideas are applicable to controversies … like violent conflict…”

    Violent conflicts often include genetic (e.g. ‘yellow peril’ otherness) and memetic (e.g. ‘final solution’) components. That it is desirable to eliminate these without violence is a banality. The question is: what are the tools to can reach this end. Perhaps Greene has some answers.

    1. Sawyer says:

      WD,

      Do you use Goodreads at all? I could make a list on their site of all books that have been reviewed here. I’ve come to trust Harriet’s recommendations as well, but it’s probably best to title it “Science Based Medicine Reading” or something similar to make things clear.

      1. windriven says:

        I do use Goodreads Sawyer, and I think that is a marvelous idea. There are some other titles that have appeared here from time to time that deserve mention as well. Monkey Girl springs to mind. I finished that just recently after a couple of commenters mentioned it.

        And I was just kidding about ‘H’ – it was meant as a play on the Oprah book club that I believe is called ‘O’.

        1. WilliamLawrenceUtridge says:

          Monkey Girl was fantastic, among my favourite books. May I suggest 1491 and 1493, both by Charles Mann? You will be amazed.

          Simon Winchester’s The Meaning of Everything was suprisingly riveting, considering it’s about a dictionary.

          And everyone should read The Emperor of all Maladies by Siddhartha Mukherjee.

          And Bill Bryson’s A Short History of Nearly Everything.

          Books are awesome. I review mine on Google Books, which pretty much ensures that nobody will ever pay attention to them.

          1. windriven says:

            Excellent recommendations, William. I’ve read Emperor and the Bryson book. I’ll certainly get the two Manns and the Winchester in the queue.

            In return I’ll recommend How to Humble a Wingnut and Other Lessons from Behavioral Economics a series of essays by Cass Sunstein.

        2. Sawyer says:

          Ask and ye shall receive:

          https://www.goodreads.com/list/show/52624.Science_Based_Medicine_Recommends

          I’ve added all the books with positive reviews from 2012 and 2013 so far and I’ll get the rest soon. Tried to weed out negative reviews. I’d like to keep the list exclusive to SBM articles since there are already dozens of lists for general science, medicine, and skepticism. There are a few books that get mentioned over and over again here that haven’t been officially reviewed but could merit mentioning, but I’m trying to avoid having a dozen Carl Sagan or Richard Dawkins books at the top.

          Feel free to share and vote for your favorites! Because the world need more Mar… err, books to read.

          1. windriven says:

            Good man Sawyer! Tonight I’ll review my library and make some additions. There are a couple of books by Edelman, Dennett, and Sam Harris that spring to mind.

            1. Sawyer says:

              I was trying to avoid adding books that weren’t reviewed or heavily referenced on this site. The reason The Moral Landscape is in there is because Harriet did a book review for it a few years ago. Of course it’s a public list so I can’t control what people add, but it might be nice to keep a narrow focus rather than adding all our favorite science books.

              I was a bit surprised looking at my library that no one has ever written about The Immortal Life of Henrietta Lacks here, considering how popular the book was when it came out. Somehow Seth Mnookin’s book isn’t on there either, although maybe it got mentioned in a Paul Offit book review. Perhaps we could add a few medical “classics” even if they’ve never been officially reviewed?

          2. windriven says:

            @Sawyer

            Well crap. I’ve never added books to a Goodreads Group before and apparently I’m not clever enough to figure out how. I tried to add about a dozen but it doesn’t appear of have ‘taken’. Any thoughts?

          3. Jon Brewer says:

            I’ve read a lot of those. I have issues with Science Left Behind (false equivalence, the claim that studying racial differences in intelligence somehow merits serious discussion, again tracing evo psych to Darwin as if “Bob is right about one major thing” means “Bob agrees with me, therefore I’m right”), but most of the ones I have read, I liked. I loved Freakonomics especially on how, get this, if people can cheat and not get caught, they usually will, and any belief otherwise is naïve.

            1. Sawyer says:

              I cut out all the stuff that had blatantly negative reviews but Science Left Behind fell into a gray area. Harriet was still fairly positive about it so I left it on the list. And I was trying not to let my blatant liberal bias show through. :)

              If there are any books you felt were particularly worthwhile please vote for them so the good stuff rises to the top.

              1. WilliamLawrenceUtridge says:

                Science Left Behind‘s biggest weakness is its sourcing and referencing – citing blogs and opinion pieces. Having read through it, I was consistently disappointed that this ostensibly scholarly book had such poor-quality sources. Of course, since it’s based on a series of blog posts prettied up into a book and published in a dead-tree version, it’s not surprising. It read like a series of blog posts. Interesting conceptually, but not convincing. For me at least.

                That being said, it definitely gave a good skewering to the left-leaning liberal side, who really, really do need it pointed out that they’re abusing science in the exact same manner that the right-leaning conservatives are. Political allegiance does not a scientist make. I would say the book should be read mostly to challenge the thinking that somehow the Democrats are on the sides of angels in all things scientific, when really it’s only with some pet topics.

    2. Calli Arcale says:

      But sometimes in fact they are evil. History has shown that failure to act in the face of great evil carries often horrific consequences.

      But they don’t *think* they are evil. In fact, they may even regard *you* as evil because you disagree with them. Someone who believes in the Protocols of the Elders of Zion might regard a plea for tolerance as treachery to the whole of humanity. Within their world view, their hatred makes sense. If you want to persuade them towards tolerance, to go ahead and act in the face of great evil, I think he’s right that you do have to understand that.

      The whole idea of good versus evil is a moral construct, after all. And as much as we might like to believe there’s a universal morality, there really isn’t. The hatred of others is a manifestation of tribalism, and to an outsider will appear evil, but an insider is absolutely moral.

      1. Bruce says:

        I would tend towards agreeing with the premise that most, if not all people do not think that what they are doing is evil, and that their actions are driven by their attempts to rid the world of those people or ideas they think are evil.

        Following on from the discussion on books, George R R Martin’s Song of Ice and Fire actually explores this concept very well. The narrator changes every chapter and when you see the actions of one from their own point of view you often change your ideas on how “evil” they really are.

        I would also caution people to remember that history is always written by the victors, so it is entirely possible that the attrocities we see in the rear view mirror might had some very logical or moral basis back when they were committed.

  2. BobbyGvegas says:

    “We have the capability to understand the psychology of our instinctive morality, overcome our automatic gut reactions when appropriate, and replace them with something better.”
    __

    Good luck deriving consensus on the word “better” here.

  3. Keating Willcox says:

    What a dreadful essay. You ignore the driving force between all modern tribalism – money and corruption. The first example is the deliberate “stoning” of Wakefield regarding a pattern of administering one particular virus, and the 28 published peer review studies that have at least suggested he is onto something. The big pharma companies used their devious economic advantage to destroy him. So this isn’t about tribalism or rational thought, it is about evil and craven companies making sure their interests supercede both science and good medicine. How about Merck and Vioxx, how about the “little dutch boy” ads for lead paint in children’s rooms, how about the dangerous vaccines for Gardasil. Big Pharma companies are constantly buying off the regulators with campaign contributions and are constantly paying big fines for their crimes. And even there, they talk perfectly smart doctor’s into massive overuse and off label use of so many drugs…Why are prescriptions for ADHD meds 20 times less in France.

    Good science and the advancement of knowledge has always been a battle between factions. What killed the dinosaurs seems like a dry academic topic, but proponents of each theory fight each other fang and claw. And, this is a great thing, since each side is working 100% to disprove the other.

    In the same vein, tribalism in economics produces the churn that makes for our massive growth in science and technology driven by our massive increase in wealth.

    As for abortion. Notice anyone missing? yes, there are far fewer Down’s Syndrome children out there. That is because they have been systematically slaughtered, even though they are sweet and loving children. They are inferior according to our modern lifestyle. So, doctors become whores of death, providing counseling and suggesting that amniocentesis is useful for health reasons. I remember that Hitler’s program of death camps started with the mentally ill as well, “releasing them from their agony.”

    Uh oh. If someone finds the gay gene, they will all be gone as well. And African Americans are doing to them selves what no Klan member could ever do. A black fetus in New York City has a 60% of being murdered by their own mother. 60%. That’s not personal choice. That’s genocide, a joy to White Supremacists everywhere.

    Your utilitarianism is simply a way to permit the elite to make decisions for all of us, using big government and force to drive decisions by the elite on all of us. What evil…what stupidity.

    1. BobbyGvegas says:

      Lordy. One hardly knows where to begin. You need to start an A.M. Radio talk/screed show.

    2. windriven says:

      “the driving force between all modern tribalism – money and corruption.”

      Citation, please. I think a strong case could be made that competition for scarce resources lies at the root with an able assist from religious ideologies. Money and corruption are, relatively speaking, bit players.

      Oh. I should have read the rest of your rant before I started to respond. Echoing Sawyer below, you really don’t have anything useful to say about “Moral Tribes”, nor about Dr. Hall’s review. This is just an opportunity for you to flash us with your shriveled little conspiracy rant, not unlike a deviant in a trench coat.

      OK, now we’ve seen it Keating. It looks just like an meaningful argument, only much smaller.

      1. Keating Willcox says:

        The evidence you ask for can be seen at its most obvious in Big Pharma by Law, and there have been similar books on Lipitor, and Accutane, and there are similar articles and books on Vioxx, both about the coverup and the lawsuits.

        I agree that religious doctrines can be both good and bad. Until recently most of the medical care in the world was provided by religious orders and religious institutions, and most of the charity and extreme charity hospitals are funded by outlandish groups such as the Shriners, God bless the Shriners, funny hats and all. Few doctrines get in the way of extreme medical care or advanced science. It just happens that advanced scientists tend to be far more atheists than the general population. (by a factor of 850%)

        As to the allegation that taking a middle of the road attitude towards pro-life, it was announced today that there is an enormous growth industry in China, based on Eugenics. Their plan is to make big profits on culling out fetuses that are not high IQ. They have developed a technique and plan to sell it. In related news, other scientists are closing in on the prediction due to heritable genes of fetuses likely to grow up as homosexuals. So, should we adopt the Hall approach of a gentle and affirming reasoned discussion with this Chinese business, or are they closer to the Hitler dream of getting rid of all homosexuals, and making a fancy profit all at the same time. I would suggest that the best behavior is to call them out on this evil behavior, do what we can to make sure its evil nature is well known by all, and short of warfare, try to stop it. How many million gay people will otherwise be slaughtered before they are born. You know the answer to that one.

        So, I fell strongly that the Hall approach is not the right one.

        1. Andrey Pavlov says:

          You do realize this is not the “Hall approach” right? That this is a review of a book written by someone else that Dr. Hall is discussing?

        2. CHotel says:

          Goodwin’s Law met in only the second response? I’m almost impressed.

    3. WilliamLawrenceUtridge says:

      Good science and the advancement of knowledge has always been a battle between factions. What killed the dinosaurs seems like a dry academic topic, but proponents of each theory fight each other fang and claw. And, this is a great thing, since each side is working 100% to disprove the other.

      Fortunately the factor used to resolve disputes is further data. Over time, as more data accumulates, there is more and more evidence to support which hypothesis is the “true” one, as verified by testing and proving/disproving specific predictions. While many ideologically-motivated people like to pretend all results are negotiable and consensus-based, the reality is that data ultimately wins out and is self-improving. Medicine is unfortunately hampered by being incredibly complicated.

      A black fetus in New York City has a 60% of being murdered by their own mother. 60%

      No it doesn’t. Such a high level of infanticide would lead to the extinction of all black people in New York within a generation, and you would see dramatic evidence of this in the demographics.

      Your utilitarianism is simply a way to permit the elite to make decisions for all of us, using big government and force to drive decisions by the elite on all of us. What evil…what stupidity.

      Your conspiracy-driven reasoning seems like a facile justification for never having to take any meaningful action or change your mind. There’s even evidence for this, Scientific American had an article a while back about conspiracy theorists, and how they tend to be far more passive (and depressed) than the non-paranoid because they feel helpless.

      I’m sure your gross simplifications gives you a powerful explanatory framework that takes some of the randomness out of the events of the world, but that doesn’t mean it is correct. Further, it might be predisposing you to some self-imposed misery that is completely unnecesary. May I suggest instead that you empower yourself by learning about some of the issues you are so concerned with? That way you may undestand them rather than papering over your ignorance with glib pseudo-explanations?

      1. Keating Willcox says:

        It is a fair criticism. The number is very high. I found the statistic in that conservative bastion, the New York Times. 3 of 5 fetuses of Black women in new York die by murder by their own mother.

        I am not alarmed but dismayed at the personal invective, which gets in the way of factual disputes. But, I don’t want to be the pot calling the kettle black as I tossed some hard rocks at the author.

        As to Wakefield, my claim is that his science was simply to request further study about the appearance of problems with the MMR vaccine. he never said, don’t use vaccines, but suggested combination vaccines need further investigation. So, even though the Big Pharma companies used private investigators to destroy him, what have been the results? Is this Laetrile? Is he a crackpot? Let’s look at some crazy journals…

        Here is a list of 28 studies from around the world that support Dr. Wakefield’s research:

        The Journal of Pediatrics November 1999; 135(5):559-63
        The Journal of Pediatrics 2000; 138(3): 366-372
        Journal of Clinical Immunology November 2003; 23(6): 504-517
        Journal of Neuroimmunology 2005
        Brain, Behavior and Immunity 1993; 7: 97-103
        Pediatric Neurology 2003; 28(4): 1-3
        Neuropsychobiology 2005; 51:77-85
        The Journal of Pediatrics May 2005;146(5):605-10
        Autism Insights 2009; 1: 1-11
        Canadian Journal of Gastroenterology February 2009; 23(2): 95-98
        Annals of Clinical Psychiatry 2009:21(3): 148-161
        Journal of Child Neurology June 29, 2009; 000:1-6
        Journal of Autism and Developmental Disorders March 2009;39(3):405-13
        Medical Hypotheses August 1998;51:133-144.
        Journal of Child Neurology July 2000; ;15(7):429-35
        Lancet. 1972;2:883–884.
        Journal of Autism and Childhood Schizophrenia January-March 1971;1:48-62
        Journal of Pediatrics March 2001;138:366-372.
        Molecular Psychiatry 2002;7:375-382.
        American Journal of Gastroenterolgy April 2004;598-605.
        Journal of Clinical Immunology November 2003;23:504-517.
        Neuroimmunology April 2006;173(1-2):126-34.
        Prog. Neuropsychopharmacol Biol. Psychiatry December 30 2006;30:1472-1477.
        Clinical Infectious Diseases September 1 2002;35(Suppl 1):S6-S16
        Applied and Environmental Microbiology, 2004;70(11):6459-6465
        Journal of Medical Microbiology October 2005;54:987-991
        Archivos venezolanos de puericultura y pediatría 2006; Vol 69 (1): 19-25.
        Gastroenterology. 2005:128 (Suppl 2);Abstract-303

        look at all that…you thought, because Big Pharma told you that Wakefield was a nutcase…guess not.

        @William is correct, additional science usually helps get a better answer. I would add, pace North that factions with intense disagreements are often the way to provide funding and energy to answer a disputation. And don’t expect the losers to concede, the overall scientific community usually starts to endorse the obvious winner.

        1. Frederick says:

          Wakefield and corruption are good in the same sentence, you know he was PAID to construct his “studies” wich was totally a fraud and statistically insignificant ( 12 subject) and that he had plan to make money out of the fear he created ( he also know that this fear was a fraud, ) he is a criminal. and yes there was a conspiracy, Him and those lawyer wanting to make money in suing the company that made the vaccine and out of the people they scared. he also Made unethical test too young kid, In my view,he tortured them.
          oh and don’t trow those conspiracy explanation to justifies, we all know those a all Lies and BS, and i’m not a Sheep that blindly follow those
          Wakefield also sue media show that stop talking about him, there a lots on him On brian Deer site, the guy who was the first to uncover that man as a fraud.

          http://briandeer.com/

        2. Chris says:

          We wen through that brain dead list a year ago. The citing of an entire year of one journal is just precious: “Journal of Neuroimmunology 2005″

          Since this blog’s WordPress engine won’t let me post the link where the entire list is discussed, it is the “Just The Vax” blog and the article “Still no independent confirmation of Wakefield’s claims” was posted on Sunday, May 8, 2011. Just use Google.

          I would appreciate if some one else can list the actual, since Mr. WIllcox may not be able to find it. Thank you.

        3. Chris says:

          Oh, great… second time: just look for Just The Vax blog”, and the article “Still no independent confirmation of Wakefield’s claims” was posted on Sunday, May 8, 2011.

        4. Chris says:

          Mr. Willcox: “As to Wakefield, my claim is that his science was simply to request further study about the appearance of problems with the MMR vaccine. he never said, don’t use vaccines, but suggested combination vaccines need further investigation.”

          Oh, good grief. You really are a Wakefield fanboi.

          Oooooh, so the the combination vaccines need further investigation?

          Well, here is a newsflash: the MMR vaccine has been in use in the USA since 1971, about two decades before Wakefield came along. The DTP vaccine was in use for an even longer time (since the 1940s in the USA).

          Now, here is a question for you, Mr. Willcox, why don’t you come up with the verifiable data that shows there was an increase in autism in the USA due to the MMR vaccine during the 1970s and 1980s? Make sure the document is dated no later than 1990.

          Then we will have some other proof that Wakefield had data to start his hypothesis, instead of a handful of UK taxpayer Legal Aide funds flashed in front of him by the lawyer Richard Barr.

          1. Harriet Hall says:

            OK, Wakefield never said “don’t use vaccines.” But he might as well have. He announced in a press conference “there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components.” And since the single vaccines were not available at the time, that amounted to a recommendation not to vaccinate. And that’s how it was interpreted by the public, leading to a drop in immunization rates and the recurrence of a preventable disease in the UK. Incidentally, Wakefield was in the process of developing his own single component vaccine, so he stood to benefit financially from his recommendation.

            1. Chris says:

              I assume you are addressing Mr. WIllcox.

              Even that small now retracted case study showed no relationship between any of the several MMR vaccines used in the UK (plus the other one used on the American boy) and autism. Wakefield said so in his video announcement of the paper, and worse off… it was widely publicized in a truly horrible TV movie called “Hear the Silence” in 2003 (I tried watching it on youtube, but it was terrible):
              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC293044/

              Take note that I mentioned there was more than one MMR vaccine. The UK introduced three MMR vaccines to their schedule in 1988. Two of them had the Urabe mumps strain, which turned out to cause a wee bit too much meningitis, so they were removed in 1992. Then Wakefield included an American in his case studies, who had a fourth MMR vaccine. This pretty shows how bad he was at research, he did not control for MMR vaccine brand.

              Oh, and another thing: when Wakefield called for separate vaccines, there was none approved in the UK for mumps. So what did some enterprising private clinics do, they illegally imported a Urabe mumps vaccine. The same strain that caused too much meningitis!

              See this warning:
              http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con2031106.pdf

        5. WilliamLawrenceUtridge says:

          Until I see the actual NYT article that 60% of all black fetuses are killed by their own mothers, I’m going to assume the claim is based on a gross misunderstanding rather than a vile lie.

          You may see my description of your beliefs as paranoid conspiracy theories to be hurtful or a personal attack. In my mind I am merely describing them as I see them – a continuous waving away of contradictory data with pseudo-explanations rather than engaging with the substance of why Wakefield’s claims were nonsense and why he’s a pretty contemptible person and worse scientist. You’re free to take offence, claiming my observations are purely based on personal dislike rather than facts is per prerogative.

    4. Chris says:

      Third try, because I don’t even get a “comment in moderation” note. This has happened before where WordPress has randomly decided that I am not allowed to post any links.

      Mr. Willcox said: “The first example is the deliberate “stoning” of Wakefield regarding a pattern of administering one particular virus, and the 28 published peer review studies that have at least suggested he is onto something.”

      Actually that is wrong. A few of us went through that list and found that they were not as claimed. It seems that WordPress does not like the website, so I’ll just post the details of the blog post:

      It is the “Just The Vax blog”, and the article “Still no independent confirmation of Wakefield’s claims” was posted on Sunday, May 8, 2011.

      I will also add that it seems Mr. Willcox has a habit of posting similar comments on articles, and never comes back to answer questions he is asked. It seems he is not interested in honest discussion, so it would be pointless to engage him. Though I would like to correct that one very wrong statement about Andrew Wakefield, who was himself driven by “money and corruption.”

      1. nancy brownlee says:

        @Chris
        “I don’t even get a “comment in moderation” note. This has happened before where WordPress has randomly decided that I am not allowed to post any links.”

        Is that what’s happening? Because it happens to me. I thought I was just somehow spacing out and forgetting to hit ‘post’. Somehow it never happens to my stupider comments.

      2. windriven says:

        Chris and Nancy – might I recommend trying a gmail login instead of WordPress? I changed to that some months ago and now end up in moderation only when I richly deserve it.

        1. Chris says:

          It is not our login, it the WordPress engine of this blog!

          1. windriven says:

            Interesting, Chris. I used to have the same trouble. Maybe I’m just holding my mouth right or something ;-)

            1. Chris says:

              This is my third attempt, WordPress is now preventing me from posting a link to a comment from this very blog!

              This has happened before, for some reason the some comments get tossed into ether. It happened on December 18, 2012 at 10:39 am, which is when Paul Ingraham replied on the SBM article “Vaccines work. Period” which was posted by David Gorski on Dec. 2nd.

            2. Chris says:

              Now WordPress won’t let me post that particular URL to the Respectful Insolence blog! Mr. Willcox is over there trying to edumacate us on the evils of Big Pharma.

    5. Jon Brewer says:

      You might like Ben Goldacre’s Bad Pharma The tl;dr version is, things like Vioxx don’t mean homeopathy works or vaccines don’t. (In fact, Goldacre spends a good deal of the time demonstrating how the more questionable side of medicine pretty much uses the same tropes, regardless of whether it’s a Merck representative or not.)

      Also, how is Gardasil dangerous? I mean, there’s a small risk of side effects, but we’re talking, one in a couple million, and not “make your child retarded”, as Bachmann said, in the most Cowboy Bebop At His Computer sort of way. (Somehow “MMR vaccine causes autism” became “Gardasil causes mental retardation”.)

      Also, I’m assuming you’re white. If so, you have no right to mansplain to people of color. Say, remember when the pro-lifers accused Cecilia Fire Thunder of “child sacrifice” (for opening a women’s health clinic) a few years back? She lost the game of thrones over that one, but more because tribal politics is all about backstabbing and opportunism. But we understand that, she understood that, and the impeachment had more to do with a chance to remove a popular politician than any real anti-abortion sentiment. You and your allies don’t.

    6. Liz Ditz says:

      The first example is the deliberate “stoning” of Wakefield regarding a pattern of administering one particular virus, and the 28 published peer review studies that have at least suggested he is onto something.

      My, Mr. Willcox, your reading comprehension needs some work. NONE of those 28 papers are independent replication of his work, or even indicate “he is on to something”, as you would know if you had even given a cursory glance at the papers. I did, and go into some depth in discussion the shortcomings of each of the papers.

      A list of 28 studies from around the world that DO NOT support Wakefield’s research.

      The big pharma companies used their devious economic advantage to destroy him.

      That’s quite a claim, which you make without a scintilla of evidence to support it. Well, nevermind — there is no evidence that anyone other than Wakefield’s own corrupt actions resulted in his striking-off by the British Medical Council, or his current state of non-employment. Evidence for my claims are in the record of the GMC’s hearings, and Wakefield’s subsequent actions, consorting with such folk as white supremacists, and fear-mongers like Alex Jones.

      1. Chris says:

        Thank you, Liz!

    7. lilady says:

      Au Contraire Keating Willcox. Your hero Andrew Wakefield perpetrated a monumental scientific fraud.

      Have you read the entire transcripts of Wakefield’s Fitness-to-Practice Hearing that are available on the internet and the decision of the GMC to revoke his medical license in the U.K.? They are available on the internet, for your perusal.

      Why didn’t Wakefield offer up testimony in his own defense during the GMC Hearing?

      Why didn’t any of the parents of the children involved in Wakefield’s “study”, who now proclaim their undying love and respect for Wakefield’s “research”, testify on his behalf at the GMC hearing?

      Rather than admitting that falsified medical records, Wakefield published a book “Callous Disregard” for the few credulous ignorant fools, who still “believe” in his dishonest research.

      I just became aware of a newly published scientific paper, authored by a retired epidemiologist, who dissected all the lies that Wakefield published in “Callous Disregard”.

      http://www.benthamscience.com/open/tovacj/articles/V006/TOVACJ20131126002.pdf

      Thanks for the laughs…I can’t remember when I’ve read so many factoids and dumb statements in one comment.

  4. Sawyer says:

    Do you not realize this is a book review? Every single comment you made would have a huge non-sequiter to a normal post, but considering this is a summary of another author’s work your rant is even less relevant. And what is Dr. Hall supposed to do, kidnap the authors and force them to change the second edition? From the way you write it’s not clear you even understand Dr. Hall and Joshua Greene are different people.

    I’ll repeat a similar plea to the one we offered stan the other day: please go take some classes at your local community college in basic technical writing, debate, and formal logic. Regardless of your scientific or medical literacy, its unclear to me that you have mastered the simple communication standards everyone else here is employing.

    1. Ritzenschlitzer says:

      I find it amusing that, considering your presumptuous recommendations, you yourself managed to misspell “non sequitur”. Intellectual elite!

      1. windriven says:

        @Ritzenschlitzer

        Cutting to the heart of your own pettiness are you? Do you have something useful to say about Sawyer’s comment or are you, like Willcox, an intellectual flasher?

      2. Sawyer says:

        I’m an atrocious speller and SBM’s no edit policy is a perpetual thorn in my side, but I endure it for the greater good. I am however an “intellectual elite” when it comes to appreciating irony, and get tremendous joy in seeing a non sequitur, about “non sequitur”, about a non sequitur. But let’s cut off the endless loop before it continues and talk about the content of the book.

        1. WilliamLawrenceUtridge says:

          Google chrome has built-in spell check, as does Firefox…

          1. Sawyer says:

            Yep, and it doesn’t like the correct versions of my Latin phrases either. Sic semper tyrannis googlus.

    2. Keating Willcox says:

      @Sawyer is correct. i did not notice the second author.

      1. Sawyer says:

        I doubt we’re going to see eye to eye, but thank you for admitting your mistake.

  5. daedalus2u says:

    I will use this opportunity to link to my blog post on xenophobia.

    http://daedalus2u.blogspot.com/2010/03/physiology-behind-xenophobia.html

    and how I think tribalism is invoked. The “explanations” may be “genetics”, but xenophobia and tribalism are not innate, they are learned. An individual can’t learn to hate a phenotype before that phenotype can be recognized. Human sensory pattern recognition isn’t fully formed at birth, it requires neurodevelopment to occur. “The others” all “look alike” because the sensory systems that do pattern recognition on faces didn’t develop the expertise to differentially identify members of that “other” ethnic group.

    1. Harriet Hall says:

      “xenophobia and tribalism are not innate, they are learned”
      I think the tendency to mistrust “others” and to develop xenophobia and tribalism is innate, while the focus on particular groups of “others” is culturally learned.

      1. Andrey Pavlov says:

        I think what daedalus may be trying to get at Dr. Hall, and what I would agree with, is that who is “other” is learned but that there is “other” is a sentiment that we primed for in our evolutionary and genetic heritage. I think the idea that you can some genetically encode a particular feeling or cognition is nonsensical. But it can be primed that certain reactions to stimuli are and then those can be refined, heightened, or even abrogated for other means entirely different. For example I see the belief in CAM to be just a different manifestation of the belief in gods and religions which indicates to me that there is an underlying human tendency for a behavior that lends itself to such belief states. I find these to be personally fascinating because whatever that genetic state is, I seem to be lacking it having never once merely believed something, even as a young child. Never once do I recall genuinely believing in Santa Claus, the tooth fairy, or any religion despite the fact that I was baptised and given the Bible to read and told that it was true.

        So from my perspective I see xenophobia not as a separate genetic state that is evolved, but an extension of the evolutionarily ingrained cognitive state of self preservation. Almost universally if you genuinely threaten physical harm to an individual they will react. As collective groups formed, consciousness emerged, and cooperativity became common, this notion could extend beyond the self and to others-like-self. And this sort of construct most certainly did not begin with primates of the genus Homo or even primates at all as we see myriad examples of it in almost all phyla. Hence why you can have a puppy and a bird playing together as friends.

        In other words “other” or “not other” is an extension of the remnants of ancient evolution necessarily demanded a preservation of self into who is “like self” and who is “not like self.” This would be an example of polyphenism.

        (Obviously much more complicated than just that and unlikely to be acting in isolation, but to me from what I know about evolutionary biology, seems a very reasonable conclusion with supporting evidence)

        1. Ritzenschlitzer says:

          “I think the idea that you can some genetically encode a particular feeling or cognition is nonsensical.”

          Do you not believe in the existence of instincts, e.g. people feeling afraid in the dark although there is no situational reason to be?

          1. Andrey Pavlov says:

            I’d engage you in discussion, but based on your demonstrably low level of engagement in rational discourse vis: your pedantry on spelling followed by ad hominem I will decline.

            1. irenegoodnight says:

              Andrey, I think it was a reasonable question and don’t really see any ad hominem. I also saw the irony in the “non sequester” business. People seem to interpret and respond very differently to real or perceived “tone”!

              :-) :-) :-)

              1. Andrey Pavlov says:

                @GNI:

                Yes, I agree the question is reasonable. Hence I said I would have engaged had Ritzenschlitzer not already made it clear (s)he was not interested in genuine dialogue. I agree that it could have been a comment lacking ad hominem but in context (and even in re-reading it now) I have difficulty assuming it doesn’t. Why make an entire comment asserting “presumptuous recommendations” followed by a jab at a spelling mistake and then finish with an exclamatory “Intellectual elite” if not to indicate that the recommendations are poor because the “intellectual elite” recommending them are obviously not genuine intellectual elite because of a spelling error? It doesn’t seem to me to be an unjust reading of tone and meaning. And it was supported by future comments.

              2. windriven says:

                @irene

                Echoing Andrey, it was a fair question, but… And the (wo)man is not stupid. I would have enjoyed a back and forth on this issue. But the picky pedantry is a pain in the ass and robs the exchange of momentum and joy.

                I’m more than happy to trade barbs – it adds to the fun in some exchanges. But spelling and punctuation complaints are, to me, the mark of an interlocutor who has run out of intellectual ammunition.

              3. Andrey Pavlov says:

                Worse than than windriven… it wasn’t just that she ran out of intellectual ammunition, that was the opening volley!

    2. nancy brownlee says:

      I’ve just finished my second reading of Edward O. Wilson’s ‘The Social Conquest of Earth’ – what did you (or any commenters!) think of it?

    3. Calli Arcale says:

      Indeed, they’re not innate, but perhaps the basic processes that allow for creating them *are* innate. Just like language. English is not innate. But the ability to learn human language definitely is.

  6. Ritzenschlitzer says:

    “Reason: founded on axioms.”

    I find that an odd criticism as all systems, including language and logic itself, are necessarily axiomatic. Utilitarianism, for example, axiomatically defines the greater good as the prime purpose of morality.

    1. windriven says:

      “I find that an odd criticism as all systems, including language and logic itself, are necessarily axiomatic.”

      You ignore part (b) of her criticism: “can be used to derive conclusions that settle real-world moral disagreements.” If we accept ‘axiomatic’ in its common philosophical usage of ‘accepted as self-evidently true’ it begs the question: accepted as such by whom? Because if the axiomatic acceptance of a proposition were universal then that proposition would be expected to settle relevant disputes.

      1. Ritzenschlitzer says:

        My main point was that utilitarianism and all other moral/ethical systems are necessarily axiomatic, so the dilemma she outlined cannot actually be solved logically by resorting to utilitarianism, as if its axioms were universally shared. Arguing about morality is ultimately absurd, but so is everything human.

        As an intellectual flasher, however, I feel it is my utmost duty to inform you, and especially publicly, that “begging the question” and “raising the question” are not the same.

        1. Harriet Hall says:

          “Arguing about morality is ultimately absurd”

          Yes, but trying to understand our concepts of morality and where they come from is not absurd.

        2. windriven says:

          ” that “begging the question” and “raising the question” are not the same.”

          In modern vernacular usage, I, ahem, beg to disagree. But in the form that I employed it, the implied assumption is that acceptance is not universal.

          So … I’m good with the expression no matter which you prefer.

          “As an intellectual flasher…”

          Interesting. Is Ritzenschlitzer a sock puppet for Willcox? Or are you embracing your inner flasher in response to my question at 5(1)(1): “or are you, like Willcox, an intellectual flasher?”

          Whatever, your pedantic picking of nits remains tiresome.

          “Arguing about morality is ultimately absurd”

          Perhaps. But a society without a shared moral framework – imperfect and incomplete as it may be – is not only absurd but frightening. Are arguing moral relativism, radical libertarianism, or something else?

  7. Harriet Hall says:

    “utilitarianism and all other moral/ethical systems are necessarily axiomatic, so the dilemma she outlined cannot actually be solved logically by resorting to utilitarianism, ”

    Maybe my review didn’t make it clear. The book itself makes it clear that there IS no LOGICAL solution, neither through utilitarianism nor through any other means. It proposes a practical approach that is NOT based on religion, logic, or science, but is consonant with our instincts and an understanding of our psychology and that incorporates what evidence is available. Even if you can’t define “good” or justify it with reason, few would argue that seeking the welfare of all people is a “bad” thing.

    1. windriven says:

      @Dr. Hall

      “Maybe my review didn’t make it clear.”

      Actually, I thought it did.

    2. BobbyGvegas says:

      “few would argue that seeking the welfare of all people is a “bad” thing.”
      ___

      Among those few are the poignant Ayn Randianistas, who continue to swoon at her dictum that “altruism is the greatest evil because it requires the sacrifice of the competent to the incompetent.”

      1. windriven says:

        “few would argue that seeking the welfare of all people is a “bad” thing.”

        Unfortunately the devil is in the details. LBJ’s Great Society was intended to thrash poverty. Instead, it robbed people of their dignity by asking nothing of them and gave them in return very nearly nothing. The poverty rate today is not substantially different than it was in 1965, in fact it has bounced around between 11 and 15% for over 40 years*.

        EITC, rejiggered perhaps, and with a government-as-employer-of-last-resort guarantee seems a much better approach. It all but eliminates the moral hazard issues and rebalances some of the labor rate differentials that have off-shored many jobs in low-tech manufacturing. If we coupled that with substantial changes to capital gains and estate taxation America would be transformed with closer to full employment and a GINI coefficient trending away from oligarchy.

        *US Census Bureau Population Survey 1960-2012

        1. Harriet Hall says:

          Yes, the devil is in the details. That’s why we need to carefully consider all the consequences of a policy. These can’t always be foreseen, but we can periodically re-evaluate the evidence (like no change in the poverty rate) and keep changing the policy until we get better consequences.

      2. Harriet Hall says:

        I don’t think she would have argued that seeking the welfare of all people is a bad thing: she just wanted each individual to take the responsibility to seek his own welfare. :-)
        She was firmly in the individualism tribe against the collectivist tribe. Her uncompromising militancy is exactly the kind of thing that interferes with settling tribal disagreements. Fortunately, her selfish tribe doesn’t have many members.

        1. windriven says:

          I love libertarianism in the abstract. As a political philosophy not so much. Oddly enough it was Charles Murray, himself a passionate libertarian, who started me on the path away from libertarianism. In his book with Herrnstein, “The Bell Curve” he argued that a bifurcated society of techno-oligarchs (my characterization, not his) and left-behinds was an outcome toward which we are headed but that promises only misery and grief.

          1. BobbyGvegas says:

            I don’t live in the abstract.

            1. windriven says:

              One needn’t live in the abstract to appreciate it for what it is. There is much about both Marxism and Christianity that appeal to me in the abstract. But I am neither a Marxist nor a Christian.

      3. Andrey Pavlov says:

        “altruism is the greatest evil because it requires the sacrifice of the competent to the incompetent.”

        Of course the implicit and necessary assumption of this, which has since been shown false, is that the incompetent choose to be so of their own “free will.” When you realize that this is not the case and apply John Rawls veil of ignorance you’d have to be a fool to continue to ascribe to such philosophy.

  8. Harriet Hall says:

    These comments by Sam Harris tie right in to this discussion: http://www.samharris.org/blog/item/thinking-about-go

  9. Keating Willcox says:

    @windriven is correct. The Bell curve talked only about a static situation where smarts equal goodness. Ask any marine about basic training. folks with just OK smarts can be come strong, proud and disciplined, with a driven purpose in a matter of weeks. Just as a lot of this new microfinance has produced a bumper crop on entrepreneurs who are climbing up the ladder pretty quickly. We can all change, for both better and worse.

    If I can take anything else away from your ideas, I thing that the invisible evil that comes from too much collectivism, and two little individualism are the reasons that people who lived in socialist countries did not like them very much, and those parts of our society with the most government control do the worst.

    1. windriven says:

      @keating Wilcox

      “the reasons that people who lived in socialist countries did not like them very much, and those parts of our society with the most government control do the worst.”

      I’d like to direct your attention to Denmark, a nation with high taxes, high levels of government services, a high rate of happiness and well-being among its citizenry – and according to the latest WSJ rankings, more economic freedom than the US.

      Denmark may not be a socialist country in all respects but whatever it is certainly rhymes with socialism.

      1. Keating Willcox says:

        You are correct. So also, finland and Norway. Both have very high government budgets. Their success is remarkable and make a good case for a well managed welfare state. EU has 5% of the world’s population and 50% of the welfare state expenses.

        1. windriven says:

          “a well managed welfare state.”

          A real obstacle in the US. Some US bureaucracies work fairly well, others not so much. Moreover the perception, at least among the majority of my friends and acquaintances, is that the federal bureaucracy is inefficient, inept, and occasionally corrupt.

    2. Republicus says:

      “those parts of our society with the most government control do the worst”

      Oh gee, I wonder why that might be? It’s certainly not because people who are hungry are those most in need of government intervention.

    3. Jon Brewer says:

      Oh, it gets worse than that. Herrnstein and Murray cited (favorably) studies claiming among other things a negative correlation between penis size and intelligence. Seriously.

  10. dh says:

    Just observing one’s own self-righteous and irritated judgements is enough to see that nearly the whole human race is judgmental, moralistic and sanctimonious. Sit and count how many such judgements you make in the course of an hour – you will be astounded. This is one of the great values of having a personal meditation practice, as it can free you from constant “judgmentalism”. I am learning the source of my judgements.

    1. windriven says:

      Is it just me or does this comment seem rather self-righteous?

      1. DT35 says:

        And judgmental. And irritating.

      2. David Gorski says:

        And judgmental and sanctimonious…

  11. Jon Brewer says:

    I object somewhat to the use of the term “tribalism”. Tribe meaning “ethnic group” probably dates itself to the use of the term for Indians in a vain attempt to claim Indians were lost Jews, a belief that was already getting debunked in the mid-17th century. But that’s neither here nor there.

    The big issue with utilitarianism is, it’s what drives the animal rights movement. Seriously.

    In essence, the big problem with information is that people tend to dig their heels in more when presented with evidence to the contrary. Part of this is also because these people also view attempts at compromise as “I get to make more insane demands. Yay!”

    “Greene’s ideas are applicable to controversies in medicine like abortion, euthanasia, circumcision, mandatory vaccination, universal healthcare coverage, and policies about CAM. They also apply to major global problems like poverty, violent conflict, terrorism, and global warming/environmental concerns and to domestic problems like taxes, capital punishment, gay rights, and many others. His book will make you think and will challenge you to recognize that you, too, have tribal biases. It’s well worth reading.”

    I can actually solve many of those by applying common sense:

    Abortion: Voluntary only. Obviously coerced abortion is wrong. But since pregnancy can harm or even kill a woman, and it’s better to be a wanted child, voluntary abortion is another thing entirely. (You’ll note that traditionally pro-lifers have not opposed abortion for victims of rape or incest, putting lie to the claim that it’s about the babies. These days, even life-saving abortions are endangered.)
    Circumcision: The big problem here is that circumcision advocates make claims that are highly improbable. (Specifically, the claim that circumcision prevents male-to-female transmission, even though HIV is, of course, in semen. Meaning it can’t protect gay men, women, or anyone who injects illicit substances.) Moreover, you can save a life for $10,000 or so with a lifetime supply of condoms and HIV tests, compared to $300,000 for circumcision, if you believe Bailey and Halperin’s numbers (and I don’t).
    Mandatory immunizations: Yes. Because people die if you don’t. Not even just those who object to vaccines, but to anyone who can’t take them for reasons related to HIV, chemotherapy or otherwise suppressed immune systems. Oh, and vaccines don’t cause autism, and even if they did, autistic and alive is still better than, you know, dead.
    Universal healthcare: I’ve always been divided about the ACA. Essentially, the left-leaning circle I hang with wanted healthcare nationalized (and as a side bonus for here, it makes the sticker shock of SCAM more obvious). I’m against the Harkin amendment, obviously. And I’m also against the attempts to include Indians in it, when we already have IHS. (History aside, IHS’s biggest problem in the 21st century is underfunding and understaffing.) I do wish Obama would admit that the problem with vaccines isn’t paying for them; it’s Jenny McCarthy.
    CAM: I really want a huge 24-point or larger disclaimer “For entertainment purposes only.”, much like one you might see at the bottom of the screen for a psychic hotline infomercial (although those were in 8-point, and white, often with a very light bottom of the screen anyway, you know, because, scammers). What kind of entertainment one can derive from a pill is best left to minds more familiar with human psychology than mine.

    Euthanasia is the more difficult one.

  12. Self Skeptic says:

    I’ve put in a request for Greene’s Moral Tribesat my local library network; all the copies in the system are checked out, so it’s getting a good audience.

    Thanks, Dr. Hall, for choosing this book to review. The us-vs.-them issue is very relevant to the topics I’ve been exploring here at SBM. As you’ve probably noticed, I’ve been making a case that the necessities of the culture of medicine are somewhat contradictory to some of the necessities for the culture of science. I’ve assumed this is why doctors can be outraged by scientists’ criticism of the way mainstream medicine works, and scientists can be outraged by some of the claims mainstream medicine makes, as being based on science. In my view, It doesn’t necessarily mean anyone is wrong, or crazy; it could be a clash of somewhat incompatible priorities.

    This doesn’t mean I don’t think any view is ever wrong, or crazy; there are a rather large number of consensual views, that I think fall into those categories. In other words, I’m not a relativist or post-modernist. But I think the idea that absolutism and relativism are competing values, is a false dilemma; rather, they are descriptive terms that we use when we want to point out a particular thought-mistake we think someone else is making. Or, if we’ve adopted Feynman’s ethic of “bending over backwards to see how we might be wrong,” we can use these terms to weed out our own philosophical system, as well as that of others.

    Whenever I think about tribalism and the us-vs-them temptation, I’m reminded of a book that I find captivating (but that some people hate; it’s got the most even distribution of ratings at Amazon, from 5 stars to 1 star, that I’ve ever seen). The book is Germania: In Wayward Pursuit of the Germans and Their History, by Simon Winder, and it’s an extended musing on Germany, by a Brit. The quote is near the beginning of a chapter titled “The Grandeur and Misery of Nationalism”. Winder starts the paragraph by saying “Nationalism is one of the most confusing subjects of the nineteenth century, with the added bonus of becoming worse and worse the more anyone thinks about it.” (Which would also serve as an excellent description of the medicine/science divide, in my estimation.)
    Later in that paragraph he says “…there can be no doubt that the characters [in the 17th century novel Simplicissimus] are aware of nationalism –

    that they are proud to be sociable, comradely, fair-minded Badenese or Swedish or French, that they are equally contemptuous of the small-minded, miserly, vicious Badenese or Swedish or French.”

    This point that been made a countless number of times, of course. But this particular expression of it is my favorite.

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