Tuesday, November 30, 2010

Living an Extra Seven Years - Adjustment

Part 1  Part 2  Part 3  Part 4  Part 5
My grandfather came to California from Oklahoma at 18 with a nickel in his pocket. He got a blue collar job working at Ralphs. It was good work that paid well enough, but the hours were long. The managers, wanting to be kind to their employees, gave them a smoke break. My grandfather, a nonsmoker, tried to take a break with his coworkers, only to be told that it was a smoke break, not a do-whatever-you-like break. So he took up smoking.

Imagine a researcher asked, “Does working at Ralphs cause lung cancer?” There are two ways to answer the question. You could say yes: working at Ralphs causes smoking, and smoking causes cancer. Statistically, this is called “un-adjusted risk.” Un-adjusted risks tend to be a less specific and so less convincing answer. The 87% increase in risk of dying from never going to church is unadjusted.

But maybe it wasn’t Ralphs’ smoke-break policies, but some other factor which causes lung cancer (maybe they used dangerous chemicals in the canning process). How could you tell the difference? You’d look at the non-smokers. Were non-smokers getting lung cancer, too? If so, you’d suspect that there was some other factor at the cannery. Using the data from the nonsmokers, you can “subtract” the effect of smoking from the smokers and find out for someone like my grandpa, if there was any “adjusted” risk of working at Ralphs. That is, you can find out if there is any effect outside of the known effect of smoking.

So can we tell if the 87% increase in life expectancy is just from Christians reducing known risk factors? The researchers in the papers subtracted the effects of age, gender, race, socioeconomic status, social support (e.g. marital status, number of friends, relatives), health risks (e.g. smoking, alcohol consumption). If church improved health by working through these things, after we’d subtracted the effects of bad behavior, there would be no difference between the churchgoers and the abstainers. We would conclude that the church is a really good way of changing unhealthy behaviors. But even after these risk factors were taken out, the effect remains. Church does indeed lead to healthier lifestyles (less smoking, drinking, etc.). After subtracting all these from the 87%, someone who never goes to church still has a 50% higher chance of dropping dead compared to a frequent churchgoer (6, 15). Church attendees live longer and we don’t know why.

There is speculation, but no solid data to support them. It might be volunteerism. Maybe it’s a more positive outlook on life. Perhaps there is some unidentified good of being in community (“psychosocial effect”). Or maybe there is actually something supernatural going on in church (7). For all we know, it could be the potlucks. But does it matter how it works? Or more accurately, for whom does it matter? Certainly researchers ought to pursue the Truth wherever it goes. But for the average American, mechanism is much less important. And for the average physician, an understood mechanism rarely comes before a treatment.

We have a very strong case for church attendance. Our case for church attendance today is stronger than our case against smoking was in 1950. Our statistical sophistication and our data collection have improved a lot since the 1950’s. But for the family practice physician, does it matter? To the policy makers, does it matter? We started lecturing patients and slapping warning labels on cigarettes before we knew how they were bad.

[All references are listed under the first post]

Monday, November 29, 2010

Living an Extra Seven Years - Introduction

Part 1  Part 2  Part 3  Part 4  Part 5
In 1912, Dr. Isaac Alder suggested that there was a link between smoking and lung cancer. Immediately everyone stopped smoking. Actually, that’s not true at all. He was promptly and almost universally ignored. It took another four decades before anyone really listened. By 1957, the evidence had accumulated and the Surgeon General declared that smoking caused cancer. One year after this announcement, 44% of Americans believed smoking caused lung cancer. In 1964, “Smoking and Health” was published, and laws started getting passed restricting smoking, from advertisements to taxes (8). In 1968, 78% of Americans believed smoking caused lung cancer. Unfortunately, knowing something is good for you is not the same thing as doing what’s good for you.

For decades we didn’t know for sure if smoking was bad for you. Movie stars and cool kids pushed the habit, and when we found out it was bad, it was too late. People were already addicted. For those who did quit, severe damage was already done. The slowness of the research, the industry lobbying, and the lack of will on the part of the government and public cost countless lives.

Smoking remains to be one of the most important risk factors for heart disease and cancer. It’s not just hypothetical risk. Life insurance, an industry which bets on your life and death, is keenly aware of this risk and charges smokers much more because of this high risk. A smoker has a 70% higher annual risk of death than a nonsmoker (8). Smoking is the single best observable factor in determining your risk of dying. Or at least it was. What if I told you that there’s another behavior that is even better at tracking with lifespan than smoking is?

People who don’t demonstrate this behavior have an 87% higher annual risk of than those who do (9). A 20 year old who did engage in this behavior throughout his life would live 7 years longer than one who didn’t (for blacks, it’s even better: 14 years longer). You might be thinking you know what it is: exercise! Nope. Exercise is good, but not that good. Those who do what the American Medical Association tells them to do (1400 calories per week of exercise; 30 minutes daily) (2) have a 29% lower annual risk of death(1). What about losing weight? Those who are normal weight (BMI <24) have a 25% lower annual risk of death compared to those who are overweight (BMI >26) (1). What could this behavior be? What could be more important than what our doctors talk about when we visit? What’s more important than smoking? What’s more important than exercise? What’s more important than weight loss?

Church attendance. People who never go to church(3) have an 87% increased chance of dropping dead compared to those that attend more than weekly. Statistically speaking, never going to church is worse for your health than smoking a pack a day for the rest of your life (9). I’m not joking. This is an effect that has been seen in dozens of studies over the last thirty or so years. Scientists really don’t like it, but it’s there, and it’s real.

We have lots of evidence that church attendees have a lower risk of dying. We have so much data in these studies, we can even ‘pool’ it, adding up the results of many studies into one “meta” analytic study. The best meta study that did this found, after looking at a total of over 125,000 people in 42 separate investigations, the odds of a churchgoer surviving were better than a non-churchgoer (10).

But how can this be? Perhaps churchgoers are just goody-two-shoes who never smoke or drink or cuss. To evaluate that theory, I need to tell a story.

[Note: this is the first of a 5-part post. The references for all 5 will be posted here in the first post]


(1) Paffenbarger, RS; Hyde, RT; Wing, AL; Lee, IM; Jung, DL; Kampert, JB. The Association Of Changes In Physical-Activity Level And Other Life-Style Characteristics With Mortality Among Men. NEJM, 328 (8): 538-545 Feb 25 1993.
(2) Pate RR; Pratt M; Blair SN; Wilmore JH; et. al. Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402-407.
(3) Most of the studies are representative US populations and so are literally measuring church attendance. Others look at ‘religious service attendance’ and find the same thing. I will use ‘church attendance’ in this article as these results do not have enough data to religious services of other faiths (though it is my belief that this would be true).
(4) Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there' – xkcd.com/552/ . Also, I am among those who are not happy about the monopoly that the Randomized Control Trial has on science. It’s a good technique, but not the only good technique.
(5) Sloan, RP. Should physicians prescribe religious activities? NEJM 342(25): 1913-1916 JUN 22 2000
(6) Powell, LH; Shahabi, L; Thoresen, CE. Religion and spirituality - Linkages to physical health. AMERICAN PSYCHOLOGIST, 58 (1): 36-52 JAN 2003
(7) I say supernatural not to give up the search, but to focus it. The effect might be mediated through an undiscovered non-classical mechanism; perhaps it is a hyper-dimensional effect, perhaps it is quantum mechanical. With regard to unsolved mysteries, we must always be ready for a paradigm shift to be hiding underneath it.
(8) “The Reports of the Surgeon General” <http://profiles.nlm.nih.gov/NN/Views/Exhibit/narrative/smoking.html>
(9) Hummer RA; Rogers RG; Nam CB; Ellison CG. Religious Involvement and U.S. Adult Mortality. Demography 36(2): 273-285 May 1999
(10) McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C. Religious involvement and mortality: a meta-analytic review. Health Psychol.19(3):211-22 2000 May
(11) FASTSTATS. Accessed on 10/23/2010. Centers for Disease Control. <http://www.cdc.gov/nchs/fastats/deaths.htm>
(12) American FactFinder. Accessed on 10/23/2010. US Census Bureau. <http://factfinder.census.gov/home/saff/main.html?_lang=en>
(13) US Population: 310,546,653. US Mortality rate: 803.6 per 100,000.

(14) Mokdad AH; Marks JS; Stroup DF; Gerberding JL . Actual Causes of Death in the United States, 2000 JAMA. 2004;291:1238-1245
(15) This trend is supported by the meta-study (reference 10) but with a smaller magnitude. It reports that the increased chance of survival for those who attend is 25% after adjustment. The difference is probably because of a dose-effect in the Hummer paper (reference 9); they didn’t just measure attender/non-attender, but the frequency of attendance. Running 50 minutes every day is better for you than running 5 minutes, and so it seems that going to church more than weekly is better for you than going only on Christmas and Easter. The data in the Hummer paper does appear to agree with the more modest 25% if you ignore the dose-effect and pool all church attenders together.

Friday, November 12, 2010

Venipuncture and the Essence of Love – Conclusion


Perhaps the two definitions are not different. Maybe we just are bad judges at what ‘benefit’ is. Indeed, our modern working definitions of ‘relationship’ seem to give us an average of one year of pleasure before it’s used up and we need to move on (slightly longer in ‘marriage’).

Is it really “more blessed to give than to receive”? That is, are we happier when we give to others, or when we get? In a materialistic world, this statement is sheer insanity. Anyone who has truly given something knows the truth of this statement. Even Derek Zoolander knows this is true, “The other day I was thinking about volunteering to help teach underprivileged children to learn how to read. And just thinking about it was the most rewarding experience I've ever had.”

Maybe the best marriage is one around giving. And that means that it doesn’t matter what the other person is doing. If either party is getting more pleasure out of giving than getting, their happiness is independent of the other person. If you get when you give, and you get when you get (instead of just getting when you get), there is no reason not to give. It’s like an easy game theory problem:

On Sacrifice Theory

(Husband) Give
(Husband) Don’t Give
(Wife) Give
(Wife) Don’t Give

On Benefit Theory

(Husband) Give
(Husband) Don’t Give
(Wife) Give
(Wife) Don’t Give

The jump from this situation to a political system is not that long. An employer and employee:

(Employer) Pay Well
(Employer) Don’t Pay Well
(Employee) Work Hard
(Employee) Don’t Work Hard

Why doesn’t this happen in relationship or the workplace? Because we’re operating under the benefit theory. We think the way we get happiness is getting stuff. Like trying to drive a car on the highway in reverse, we’re doing it wrong. The car has nothing wrong with it; there is just ignorance that can easily be repaired with knowledge.


Jesus says, “Love thy neighbor as thyself.” This, if it requires anything, requires sacrifice. When asked to expound on this, Jesus tells the parable of the Good Samaritan. The Samaritan finds a Jew robbed and beaten, and gives him oil and wine, lets him ride on his own donkey, and then pays for his stay at a first-century hospital (the inn). This is a story of sacrifice. Sacrifice is the essence of love.
If this is true, then we should seek to love and make love abound in every aspect of life. It seems to me that God has arranged the world to permit us to sacrifice for each other. I think that we should order our relationships, our careers and our society after the same pattern. If the essence of love is sacrifice, then we have a lot of work to do in our own lives and in the world.

Part 1, Part 2, Part 3, Part 4


As if in honor of Stanford's second years studying the reproductive health block right around now, a big sex study was published a month ago: the "National Survey of Sexual Health and Behavior (NSSHB), a nationally representative study of the sexual and sexual health related behaviors of 5,865 adolescents and adults in the U.S." How I didn't hear about it until now given how Facebookable this is, I don't know. Here are some of the interesting findings:

1. Single people report using condoms ~33% of the time; 14-17 year old boys are highest (80%), and white women are lowest (20%).
2. Male orgasm correlates with a consistent partner; female with sex variety (i.e. vaginal/oral).
3. 8% of men, 7% of women identified as being gay; between 8-15% (depending on type of sex, age, male/female) have ever tried it.
4. In 16-17 year old boys/girls, 30%/32% have ever had sex, 79%/54% have ever masturbated; in 18-19 year old boys/girls, 60%/61% have ever had sex.

This was pulled from Time's webpage here: http://bit.ly/cUZFu8
I intend to go through the primary literature here (Stanford med proxy): http://bit.ly/d021WR

Sunday, November 7, 2010

P-Zombie Apocalypse

[This is a beta version of the story. Please tell me how it can be improved, what is lacking, what you want to know more about, even typos. Your help is much appreciated.]

I opened my eyes and it was dark. Very dark. Too dark. Where was I?

I was lying down and it was cold. I sat up and felt around. It seemed that I was sitting in what felt like a bathtub. I felt that there were some wires attached to stickers on my chest. EKG leads? Perhaps a hospital? Where was I?

I tore them off and stood up, trembling. I had seen enough movies to know that waking up in a darkened medical facility with no recollection of why you were there was a bad sign. I felt around the room and discovered it was small, the size of a bathroom. A door! I turned the handle and it opened. But it was still too dark to see. I looked left but saw nothing. But wait! To my right was something, maybe. I walked right, leaning on the wall with my left hand, my right hand in a fist, ready. But ready for what?

My left hand passed over door after door. This was evidently a hallway. The something ahead of me got brighter. I could faintly make out the corner of the hallway. I approached it cautiously and looked around it. In the darkness, I saw a lobby lit by starlight through two large glass doors. Nothing looked awry. No broken glass. No corpses. Everything was in its place; it looked like it would be opening in the morning. The glass had the building name engraved into it: “Abundant Life Suspended Animation Center.”

The jingle for this place came to mind, “Don’t Die, Delay!” I remembered the reports that the technology was new, and could not be guaranteed to keep a person’s memories intact. The hope was that people would be woken up when their terminal diseases had cures.

As I reflected, a shadow crossed by the edge of my vision. I picked up the heavy slab of stone that the secretary was using as a paperweight. Then I waited for the moan of grief and horror. But it never came. I was prepared for it if it came, but it never did. It just walked in silence. The anticipation drove me crazy. My confidence immediately evaporated, and I hid behind the desk. No movie could have prepared me for what I saw. It was hideous, covered with filthy clothing, its face obscured by a tangle of blackened hair. Long fingernails grew from skeletal hands. My courage broke, and I tried to run; I knocked the stapler onto the ground. It hit with a loud clang, echoing in the silence. It turned at me yellowed eyes. And I had a split second to wonder what kind of zombie it was.

Over the ages, many types of zombies have been described and imagined. My hope was that this would be a classic Day of the Dead zombie, slow-moving and stupid. They are powerful only in great numbers and can be re-killed rather easily with head trauma. Their bite is infectious, but I figure once you’re a zombie, you don’t care too much about wishing you were human. My worst fear was that this would be a 28 Days Later zombie. It was also infectious, but it had superhuman strength and speed.

My split-second question was immediately answered as it began running toward me with terrible speed. I realized my weapon would be useless, and I would certainly get bitten even if I did manage to kill it. There was only one way out, and it was coming through it. Once it was inside, I threw my slab of rock at its head and ran for the door. It must have glanced its head, because it wasn’t able to catch me as I ran past, but it lost only a few seconds in its pursuit of me.

I was on the street and I ran with all my strength. Fortunately, the suspended animation process, with the use of high-dose steroids and electrical muscle stimulation, had left me in decent shape. I ran down the street, looking for some place to bar myself into. Maybe a mall? There are all kinds of ways to beat zombies in a mall. But there was no mall.

The zombie would certainly gain on me on this straight street. Perhaps being a zombie wouldn’t be too bad. Maybe I wouldn’t even know I was a zombie. Maybe being a zombie was better than being a human. But my animal survival instinct overrode my philosophizing when I saw a manhole cover ajar. I climbed down the ladder, and replaced the cover just in time. It clawed in vain at the cover.

To my surprise, I could see. It was not completely dark. There was a little bluish light at the base of the ladder. I climbed down and saw a little camp: an open can of beans, a handle of whiskey and a little LED light! Signs of human life! Maybe that’s why the manhole cover was off. Smelling the beans I realized I was ravenously hungry, and feeling cold, I eyed the whiskey. I helped myself to the remainder of the beans and washed them down with the whiskey.

I noticed a little book by the light and I opened it. It was a journal. “Day 37: The zombies have overrun the city. I have taken refuge underground. They don’t go underground… I hope.” I flipped ahead, “Day 337: I have finished the last of the vegetable cans. I dare not leave the city where there is no underground, and there are no supermarkets that are safe. The abandoned liquor stores are plentiful, so I must resort to getting my calories there. This will make my reflexes dull and decisions clouded, but I need the food.” “Day 971: The jaundice is getting worse. I know I cannot survive much longer like this. Perhaps things will change. This cannot last forever, can it? After all, how long can zombies live?”

And then everything went black. It must have been instantaneous because I woke up and saw the zombie standing over me, its long, hideous teeth, sunken cheeks and terrible yellow eyes. The reek that must have come from his rotting flesh was overpowering. I gritted my teeth and prepared to be eaten.

“Who are you?” asked the zombie.

I was on my side and I saw the rock that had bounced off my head; it seemed that he had returned the rock I threw at him earlier. Then I saw that he wasn’t alone. There was not just one zombie, but ten. All of them looked as he did. Some, perhaps, had been female in their real lives.

“Pardon me?” I said by instinct.

“Who are you?” repeated the first zombie.

Maybe dementia is the first sign of zombie infection. Maybe he already bit me and this was the beginnings of my brain being eaten away by the zombie virus. So be it. No sense in fighting it now. I might as well play along.

“My name is Joel. It’s a pleasure to meet you,” I said.

“I’m Robert. These are my friends, and the pleasure is mine,” replied the zombie who was apparently named Robert. “You’re not a zombie,” he said, looking deep in thought. This impression of so hideous and obviously mindless a creature looking thoughtful further convinced me that I was approaching zombiehood at an incredible rate. But I wasn’t there yet. I was still self aware, still thinking myself.

“No. At least not yet,” I replied.

“How did you escape the Zombie Apocalypse?” he asked.

“I think I slept through it. I woke up an hour or two ago at the Abundant Life Suspended Animation Center,” I said. He looked at me accusingly. “From there, I was chased by a zombie into this sewer. And if I’m not mistaken, the zombie looked very much like you, good sir.”

“Yes, that was me who chased you. I needed to get you underground and safe, away from the real zombies,” said the zombie.

I laughed. “Do I look like a zombie? I have full muscles and skin that is not rotting. I have white eyes and clean teeth. I don’t have a ghoulish reek about me, as you do.”

“You must be from a time where you thought of zombies only from the outside. The true zombie is not the man who is a zombie on the outside, but who is one on the inside. The man who has lost himself, the part that makes him human, is a zombie. I am no zombie,” the zombie said. But its philosophical assertion made me think. It was probably right: the rotting flesh was only a symbol for what had happened to his personality.

“So Mr. Zombie, why do you think you’re not a zombie. How do you explain the rotting flesh and yellow eyes?” I asked with a smile.

He smiled back, “Because I make choices. I choose to live in this sewer with my wife and friends.” He gestured to the zombies standing around him. “I choose sacrifice. I chose to risk my life above ground, looking for survivors of the apocalypse. Zombies do not make choices. My skin is rotting because I likely have scurvy, my teeth are rotten and long from gum disease. We have run out of food and have been getting most of our calories from alcohol. I look like a skeleton because I am very, very hungry and my eyes are yellow from jaundice. The liver disease also has given me very, very bad breath. Before Z-Day, I had an alcoholic friend whose doctor said he had Fetor Hepaticus, medical jargon for ‘breath of the dead.’”

“Come, now, Mr. Zombie,” I continued. “You have bitten me and I will soon be a zombie. It’s as simple as that.”

“You are confused. My name is Robert and I am a human being. I have not bitten you; you cannot become a zombie through a bite. Check yourself and you will find no bite marks. Zombie is not a disease of the body, but of the soul.”

I checked myself all over, and I could not find any marks. Maybe he was right. “OK, Robert. Maybe I’m not a zombie, and maybe you’re not a zombie. But then who is a zombie?”

“Everyone else.”

He said it with a doom that hung in the air, as heavy and rank as the breath on which the words traveled. I had

“What happened?”

“The Zombie Apocalypse. Or, more accurately, the P- Zombie Apocalypse. It was an event that was a century in the making. It started toward the end of the Twentieth Century. People began to realize the grave consequences of freewill and choice. After the death of God in the University and the passage of the 66th Amendment, the so-called ‘Freedom from Religion and Liberty for All Amendment,’ society had no ability to inspire people to virtuous living. The only legal way to change the behavior of people was through rational ‘evidence-based’ incentives. Preachers and salespeople were both neutered. The leaders of the free world realized that freedom could only exist if people behaved properly. People, it seemed, would not choose to behave properly. So, little by little, choices were eroded. It started innocently enough. They fined people who didn’t wear seatbelts. Then they started taxing ‘unhealthy’ foods. But they cut away at the freedom of humanity through things more subtle and powerful than these. For example, everyone had to go to training centers called ‘college’ to gain employment; there they were taught about how there was no soul, no will and no choice. To have standing in society, they required people to take enormous burdens of debt to buy houses. The debt then made sure that people behaved properly and kept working. They were kept from most choices through financial pressure.”

“But people still had choices. I made plenty of choices. For example, I used to give generously to charity,” I interjected.

“Really? How generously? Up to 1% of your income?” Robert inquired.

“Well, not that much. But I was extremely generous!” I argued.

“You are like your people. You haven’t chosen charity, only the appearance of it. And it’s not your fault; you had no choice but to give either 0% or 0.5% of your income. The other 99.5% had to go to home loans, car payments, insurance and taxes; or at least this is what they convinced you of. You didn’t choose charity, so the government mandated it. It took money from the rich and hired people to do charity. People didn’t choose courage, so it paid them well to take the dangerous jobs in the military. People didn’t choose temperance, so it taxed intemperate options. People didn’t choose prudence, so they were fined for imprudence and their place in society was withheld until they attended a learning institution to gain it. People didn’t choose justice, so they instituted a progressive tax. These pressures increased through the Twenty First Century and precious few choices were left. But then came the master stroke.”

“What was the master stroke? Was it a mind-eating virus?” I asked.

“It was a virus of sorts. It wasn’t a mind-eating virus, but a soul-eating one. The people were infected with pleasure, and the entire society ended up bending itself around to maximize it. The mechanism was a technology that gave immediate feedback, immediate punishment and reward for behavior. This is what finally laid freedom to rest. The brain sciences developed a wearable device which measured brain-waves in real-time that could tell what people were thinking about. Employers bought these NeuroScan devices, and employees were required to wear them at work. They paid employees for high mental performance and right thought. Employees had a small display that showed them their hourly wage multiplier with alerts and alarms which informed them of their good or bad thoughts. There were legal fights, of course, but ultimately the evidence showed that people that had them were more productive, got paid more, and worried less than those who didn’t (after they got used to it).

“People argued this didn’t increase productivity in ‘creative endeavors’ but since the artists couldn’t quantify what they meant by ‘creative endeavors,’ they were ignored. People argued that life wasn’t about maximizing output and the pleasure that resulted; they said that ‘right thought,’ could not and should not be rationally decreed by an employer or a government. But they couldn’t provide objective evidence for their subjective ideas, like ‘freedom’ and ‘virtue’ and so they were ignored.”

“The government got into the game and, with a huge tax cut to those who agreed to be monitored, incentivized ‘proper’ behavior. It taxed improper behaviors and thoughts (everything from speeding to buying unhealthy foods). For the particularly resistant, they gave them a heroin drug pump that released low-dose heroin throughout the day. Proper behaviors were rewarded with a shot; improper behaviors were punished with withdrawal. Many tyrants tried to subdue the will of men, but they always resisted. But it was because they lacked the technology allow man to do what he always wanted: to sell his freedom for comfort.”

“With immediate reward and punishment, people no longer had to make decisions. People had only to do their duty, nothing less and nothing more. There was no place for sacrifice; all that was needful was provided. People no longer needed to exercise their freewill. Any deviation from the proper resulted in immediate pain, and so there were no deviations. Parents realized they could also use these tools, and an entire generation was born that lived their entire lives without making a decision.”

“The soul of man shriveled, and virtue was lost. But the greatest tragedy of all is the death of love. That ages-old wonderful thing written of by the poets has perished up above. There is perfect comfort; no one can do anything for anyone else. No one can lay down his life for his friend, because there is nothing to lay it down for. Violence and crime are ended, so there are no bullets to jump in front of. There is no poverty, so there is never a need to sell your car to provide for your friend. Sacrifice is ended, and so too is love. The old saying, “No greater love hath a man than this: that he lay down his life for his friends” became “No greater love hath a man than this: that he benefit his friends maximally.” People marry, but it is a relationship of convenience and mutual pleasure. Their NeuroScans make sure that they never think badly about the other, and that sex is maximally pleasurable for both. “If you want to save your life, you must lose it,” has become, “If you want to save your life, you must
save it.”

“But a world without crime and poverty is everything we hoped and dreamed we could achieve! Perhaps it was worth it?” I exclaimed.

“And because the world was convinced that pleasure was the purpose of life, our race has ended. The idea that the Good is comfort is a plague that has infected us and, but for we few survivors, has driven us to extinction. Zombies now rule this planet. Either you are hiding underground with a wasted and inhuman body, or you live above ground with a wasted and inhuman soul.”

There was a great silence. I couldn’t keep from staring at the hideous creatures around me and thinking about how sad they looked. Not that they looked sad; they looked rather alert and strangely content (if such an expression could be used of a zombie). Perhaps I mean to say that I was sad for them; they were pitiable.

Robert continued, “You now have a choice to give up choosing. What will you choose? Freedom or slavery? Do you want to join us and remain a human, or will you forsake your race and become a zombie?”

I stood there, looking at the degenerate form before me. I saw his little camp and the misery in which he lived with his fellows. And I then I saw in my mind’s eye the glorious pleasures to be experienced up above. Above our heads was a Garden of Eden, expect without the tree of the Knowledge of Good and Evil to tempt. What is my will and why is it important? I don’t remember having used it much in my old life anyways. Perhaps Robert’s was something worth saving; it must be, if he was willing to live as he did to keep it. But I don’t think I’ve got what he does.

Don’t get me wrong; I’m a pretty good guy. I’ve made my mistakes, but I’ve never really hurt anyone. Am I virtuous? Probably not in the sense that he means it. But why does he care so much about it? People up above were living with far better behavior than this zombie clan. In fact, if he describes them properly, they were living perfectly. What did he think he had that they lacked?

He’d probably say something philosophical. But philosophy isn’t something I can hold onto. I can hold onto clean skin and full flesh. I can hold onto a green, juicy apple; a soft, warm bed; a hot steak. I can hold on to health. I can hold onto comfort. And I think I will hold onto them. Philosophy hasn’t gotten him very far.

“Thank you, Mr. Zombie, sincerely for your concern, but I think I’d better be going.”

Then he said something that I will never forget. It sent shivers down my spine, more than on first seeing him. Ten years have passed since that day, and I still don’t understand what he meant. Maybe I never will. He said to me, “May the chains of comfort rest lightly upon you. Goodbye, Mr. Zombie.”

Friday, November 5, 2010

Venipuncture and the Essence of Love – Miscellaneous Implications


I think most modern people (or at least most of my peers) operate from a Utilitarian framework: the greatest good for the greatest many. It makes The Good into something at least conceptually measurable, appealing to our science instincts. But fundamentally, I think the reason so many of my peers believe in it is because they hold the second definition of love: to benefit maximally. About a third of my generation thinks Socialism is a better economic system than Capitalism. In a Socialist system, benefits (health care, housing, etc.) are universal. It is the State that sacrifices, not the People. And (assuming Socialism worked) this would clearly be the optimal solution. It is a society with the greatest benefit-love. However, with benefit maximized, opportunities for real sacrifice to neighbors are minimized. To maximize sacrifice-love, there needs to be more suffering available to bear, and people need to have more freedom to bear it.

I think I have finally discovered the root of my support for small government. A country with a small government demands that people sacrifice-love one another. It is a dangerous place, and a place exactly as beautiful as the people who reside in it. A big government benefit-loves its people. It is a safe place, and a place that is neither very beautiful nor very ugly.


Doctors avoid suffering. We are taught to turn off our emotions because it hurts. We’ll ‘burn out’ if we empathize with patients. A benefit-love for our patients is curing them; no empathy is necessary. If we do not suffer for our patients, then our job is simply a job; we have shown no sacrifice-love. A friend of mine in nursing was too close to a patient in the psychiatry emergency room. The charge nurse told her to keep her distance and to protect herself; she advised my friend to treat the patients like “rabid dogs.” You can benefit-love a rabid dog through cure; you cannot sacrifice-love one.

Problem of Evil

Why is there suffering? This is a profoundly important question that I can only give superficial treatment to here; I recommend that you look at the many other great resources on it (Job from the Bible asks this; contemporary philosopher William Lane Craig gives a good talk on it; Dostoyevsky’s Grand Inquisitor from the Brothers Karamazov also discusses this question). How can God permit suffering? Let us ask an easier question: how can a father permit his child to suffer (say, by needlestick)? He, if he is good, must have some morally justifiable reason for it (like immunization). God, if He is good, must have some morally justifiable reason for it. Since the evaluation of this question requires a full accounting of all people in all time, this is a question we are woefully ill-equipped to answer. This is a point of human ignorance; we cannot draw any logical conclusion from it. We don’t have a complete fossil record and never will but it does not follow that Evolution did not occur; it is valid to fill in the gaps with inference. We can bridge gaps in knowledge by anchoring on things we do know (this is called in science a ‘theory’ and in religion ‘faith’).

One of the theories is that the morally justifiable reason God allows suffering is freewill. God may permit suffering because only by it can humanity have true freewill. Only in a world of suffering can God show His sacrifice-love for us, and only in a world of suffering can humans truly sacrifice-love each other.

Part 1, Part 2, Part 3, Part 4