Professional Development

I sat on a panel today for premeds for the first time. They asked questions about (see if you can guess) getting into medical school. Would it look bad if I ____? Would doing ____ help me get in?

After about an hour, I got frustrated. They had become slaves; they were living their lives for admissions committees. Every decision they made was made with a committee's opinion in mind. In considering a volunteer opportunity at a hospital, the only end for one of the students was medical school. No thought was put into the impact he could make or the virtue in humble service. The decision was entirely based on how it would look. Eventually my frustration boiled over and I said to them, "Who cares if you get into medical school? Do what is right and what is good. If you get into medical school, great."

I strive to live by my own words, to do things for the goodness of them rather than how it would make me look. But I am a fallen man. I have not consistently maintained this attitude. But I recognize it as sin. I don't think these students see their attitude towards medical school as a problem. And that is frightening.

Though their end is a theoretical good ("Helping people"), it seems that it is achieved by four years of disregard for goodness, efficacy and excellence. Though the best applicants are those who do pursue goodness (it has been my experience that Stanford, being incredibly selective, includes mostly this sort of student), many (perhaps most) who go to medical school are those who were best able to please admissions committees. And these are the men and women who become doctors. Are we surprised that doctors, when they become doctors, are not passionate about the good, are not ruthlessly efficient and cost-controlling, and are not always role models of excellent human beings? Perhaps our selection process is filtering out those who would are Good in favor of those who are good at pleasing others.

Why are so many striving for this end? I think a part of it is power. Doctors command a power and a respect in our society that is rivaled by few. Those who care about 'medical service' rarely even consider DO school (which arguably give better clinical training), because we'd only get DO behind our name and not the coveted MD. MD's have more power than DO's. And Harvard MD's have more social power than UCLA MD's. Even I am guilty of desiring this power. You might ask, "But isn't it power for a good end?" It is. At least at first. The trick is keeping one's focus on the Good; good intentions can quickly devolve. Even if the start is noble, the Good can get lost in the pursuit of power.

There is a great danger in living one's life to please men. This is a warning I need to remember myself. Though my career is a valid consideration, the Good is ever what I ought to strive for. Too often I do not think, "What is the best thing I can do here? What is Right?" and instead think, "How do I make myself look good to those who will evaluate me?" My decisions are too often made with respect to the opinions of others disregarding God. Too often I fear man rather than God. And then I euphemize my sin and call it, "Professional Development."

Pro 29:25

The fear of man bringeth a snare: but whoso putteth his trust in the LORD shall be safe.

What is International Health?

Before I answer the question, I’ll answer "How did we come to call our work International Health?" I imagine it’s because it was doctors who were the first ones to go abroad and serve the poor. As its field diffused, the people working for the poor abroad probably found that all their colleagues self described their field as “International Health,” so by force of peer pressure, it spread.

Believing “International Health” to be a field, undergraduates with this ambition all change their majors to conform to it. Lacking a particular major, they choose the closest approximation. And so the result is every college now has a major full of bright-eyed global service-minded freshmen leaving other departments drained of such people.

But what is it? Despite high enrollment in Hum Bio, International Health is not a unified by field. It includes people from most disciplines who have very different approaches and roles to play. It’s certainly not just doctors (as much as we, in medicine, like to think of ourselves as it’s lynchpin).

Even in its philosophy it is not unified. Some are involved because they believe that human rights are being violated. These view the matter as a sort of legal violation of people by corrupt governments or corporations. Others are quite moralistic about it; they believe they are morally obligated to work abroad. Still others hold that service to the poor is primarily an opportunity to do good; they focus more on the virtue of the service than on the evil in the situation. Some haven’t even thought through their own motivations.

International Health’s real unification is not in philosophy, skill set, or even field (despite the implications of the phrase “International Health”); we are unified by our common desire to improve the condition of the poor (who happen to mostly live abroad). We have a common and united heart. Humanist Moralists and Christian Virtue-Ethicists can work together for the cause of their poorer brothers. So too can anthropologists and artists join with doctors and dentists in bringing help to those in need. International health is not about externals of career or field, nor is it about a unified way of thinking. International Health is a movement of those who have a common heart to improve the condition of the poor abroad.

It seems that the clunky six-syllable name we have inherited is both imprecise and inaccurate. Other alternatives have been suggested like Social Justice (which is definitely snappy but implies a particular philosophy) and International Development (which can get confused with building tract houses in Saudi Arabia), but none have quite captured what it is that unifies us.

I propose the phrase “Global Compassion.” The focus here is on the heart of those engaged in it, not on the field (this may release people from the implied obligation to major in it). It’s specific enough to talk about the focus being abroad, and ‘compassion’ is broad enough to include work in any field motivated by a good heart. Additionally, compassion demands a relationship; it may help us to remember that, though we may transform corrupt governments and implement stellar public health efforts, our goal in the end is to help individual people.

How would I like to define International Health? “A phrase used in the late twentieth and early twenty-first centuries to describe work in what is now called ‘Global Compassion.’” And I would define Global Compassion as: “A movement characterized by a heart to improve the wellbeing of the poor in all dimensions through the application of various disciplines.”

A Far Cry From Communities

We have forgotten the community. We think of problems as either being solvable by governments (through public policy and politics) or by the individual (microfinance, ‘grassroots’). We don’t think much about the community, but it is the location and society where most of humanity has its existence. What is a community? Many a debate can be had on this, but I’ll give a practical definition. I mean the people you will reasonably run into at the grocery store or pass on a sidewalk. This is your community. Sure you live in Los Angeles, but the 10,000 or so people in your immediate vicinity have a bigger impact on your life than the 3.8 million others.

Sure you’re an American, but there’s vastly more variation from West LA to East LA than there is between “America” and “Britain.” Your community, not your country and not even your race, is more predictive as to whether you’ll get diabetes, graduate from high school, or get killed by gang violence.

In light of that, how many of us vote in our local elections? We think about changing America or the world, but how many have thought changing the community a valid ambition?

When we think about Global problems, we think of it in terms of governments and individuals. I can’t name you a single village or town in Africa. But I know that Zimbabwe is suffering from Cholera, and that Malawi is dealing with HIV. I know that DRC has unstable governance and that Sudan has a refugee problem. We pass laws and give aid to governments and countries. We don’t care about communities.

Also, I’ve seen pictures of a starving child, or an AIDS patient, but I can’t tell you a thing about the community from which they came. We give microloans to individuals and sponsor individual children. But what about their communities?

But what has been shown to be effective? In banking, much expert opinion is suggesting locally administered financial institutions (not the huge mega-global banks). Centralized administration in education, government and even taxation has been shown to be far less effective than local administration, closer to the community. Why have we ignored so crucial a part of our human experience? Why do we think solutions lie in a single individual (the Republican ideal) or in governments (the Democratic ideal), when we live and work in communities?

I propose we bring back the community. We, as a community, work with others in communities to change the world. Let us remember how we, humans, operate. Let us hear the call of our community, far away and faint, and let think rightly about what kind of creatures we are.

Nightmares and Eternity

It’s right behind you. You’re running as fast as you can. But not fast enough. It sinks its foul teeth into your neck. You scream, but you cannot. You wake up. It was only a nightmare.

“What do you mean only a nightmare,” you should ask. Wasn’t the horror real? Surely the cold sweat proves that at least some part of you was in terrible torment moments before waking. But as soon as you see that it isn’t real, it’s better. The memory may linger, but the suffering is gone.

I’m not quite sure why it’s better when you wake up. For other things where the ‘suffering is gone,’ like a past trauma, it’s certainly possible for it not to be better. But nightmares, where you have experienced horrific losses, embarrassments, and died many times over, don’t often have the same sort of power.

I don’t know the mechanism, but I know the effect. In the presence of reality, that which is ethereal passes away as unimportant. Perhaps this is what happens in Eternity. Suffering really happened, as nightmares did, but it doesn’t matter anymore.

In the Lord of the Rings, Sam has this feeling at the end of the book; when he sees Gandalf he asks, “Is everything sad going to come untrue?” I think the answer is, “Yes.”

The Self and Its Brain

We had a lecture today on “Neuroethics,” and the topic of dualism was briefly touched on, but in a manner which was rather disturbing.

Dualism, as described by the Stanford Encyclopedia of Philosophy (SEP) is, “…the theory that the mental and the physical — or mind and body or mind and brain — are, in some sense, radically different kinds of thing.” This is the view that has been traditionally held by the majority of people, and the view that most easily allows one to believe in an immortal soul (so obviously favored by religious folks through the ages). At least it’s a valid theory, right?

Well, not according to what we learned today in lecture.

"The whole universe of your perceptions, your thoughts, your actions, your intentions, your motives your purposes, it's neurons giving off and taking up packets of neurotransmitters, and that's pretty much all there is...The “I” that they experience is really just dopamine and serotonin and other stuff being given off and picked up, and ions going in and ions coming out.... There's certainly no scientific evidence for dualism, for the idea that there's a little homunculus someplace, incorporeal, not physical, that somehow through some magical method connects to your brain, but that it is you and your brain isn't. Your mind, as far as we can tell, is what your brain does."

The strength of the rejection was jarring. I thought it was a legitimate theory. Nope. It’s “some magical method.” But because of the strength of rejection, I was forced to second-guess myself. So I did a bit of research. Who supported it?

I did not expect what I found. Beyond the usual suspects who are way too smart to count for anything (people like Aristotle, Augustine, Plato, Aquinas, Descartes), dualism found support among a very impressive list of scientists and philosophers in the twentieth century. There are strong supporters even in Neuroscience itself.

And I’m not talking about fringe characters. I’m talking about people who laid the foundations of neuroscience. A dualist (Sherrington) won the Nobel Prize for "discoveries regarding the functions of neurons” in 1932. I’d say neurons are pretty important to neuroscience. A decade later, Sherrington wrote a book called “Man on his Nature” expressing dualism. Another dualist named Eccles got the Nobel Prize in 1963 for figuring out how synapses worked and then went on to defend dualism the rest of his life. Later in his life, he worked with a famous philosopher of science, Karl Popper. Popper was hugely influential in our modern understanding of science (he introduced the idea of science having to be ‘falsifiable’). Popper and Eccles published, “The Self and its Brain” in 1977 defending dualism.

It’s hard for me to imagine a better list of advocates for my position: the most important philosopher of science last century, the guy who discovered neurons, and the guy who figured out synapses. Of course there are others. Jeffry Schwartz, a Psychiatrist at UCLA is treating people with OCD according to the philosophy that the mind is not just the brain. Roger Penrose, a giant in mathematical physics, argues for the inadequacy of physics to explain consciousness. Daniel Robinson, a brilliant scholar trained both in philosophy and neuroscience (and who co-authored a book with Eccles), speaks and writes extensively on this topic.

If such brilliant people support it, why is there such opposition? Robinson offers one possible reason, “It would be naive to ignore one fundamental difference between that world [of Sherrington] and the present: the gargantuan monetary stakes and associated perquisites on offer to those who can make and keep the brain sciences big science. There is so much of all this to go round that even philosophers of the right sort stand to gain.” In other words, you can get huge grants to investigate ‘the neurological cause of crime,’ only so long as crime is a brain state. If human responsibility exists beyond the brain, you can’t study it with expensive fMRI machines.

Are all modern philosophers against dualism? According to SEP, the answer is ‘No’: “Amongst mainstream philosophers, discontent with physicalism led to a modest revival of property dualism in the last decade of the twentieth century.” So I am satisfied. If I looked around on my side and saw nobody (as was suggested was the case by our lecturer today), I would be concerned. But indeed the case is reversed. On this philosophical question, I have all on my side but most modern scientists and some philosophers, whose views are severely biased by preexisting commitments to Materialism and money. Even the agnostic founders of neuroscience agree with me. Indeed, as the SEP entry on dualism describes, “although dualism has been out of fashion … the argument is by no means over.”

http://plato.stanford.edu/entries/dualism/ - Most of my references come from here.

Proposition X

What if Proposition X was on the ballot? It would take volunteers from the overcrowded prisons to work on the San Andreas fault. The evidence shows that it would greatly benefit California. It would turnaround the economy, lower crime, reduce prison overcrowding and best of all, reduce the frequency of minor earthquakes which were costly to our infrastructure. On first glance, the naïve voter would surely vote Yes on X. But the opponents of X come out and show that with all the good, it will cost the lives of 1000 Californian inmates, many of whom were imprisoned for non-violent crimes and some of whom that may be wrongly imprisoned.

How would we make this decision? Even if we agree on the facts of the situation, what is the moral thing to do? What is the good thing to do? Is there a difference?

My position is that this, like almost all political matters, is an amoral issue. The “Yes on X” and “No on X” are both supporting their side for good moral reason: for California and for inmates. Their intents are good. There’s nothing immoral with allowing people to voluntarily work a dangerous job. There’s nothing immoral with not doing a public works project. Moreover, the foundations for our moral beliefs are difficult to discuss, particularly in public. What is accessible and much easier to discuss is the amoral (that is, not regarding morality) facts of the situation.

Benefits: Good commerce, better infrastructure, less prison overcrowding
Costs: 1000 deaths

We’d need to discuss which of two possible societies is better. We’d need to weight the lives of 1000 volunteer inmates against the good that will come from the work project. We can be Society A, which allows a few people to choose dangerous jobs for the benefit of all of us or Society B, which values the lives of its citizens so highly that it does not permit them to take such jobs, even though it is costly to all. I hold that we are almost always choosing between two amoral ends and trying to determine which makes for the best society. Certainly there are exceptions. There are no two ways about the Holocaust. Slavery is not an amoral issue (though even Lincoln saw it that way at times). But most everything else in politics falls into a moral gray area in my own worldview. When we make laws, we ought to talk about what we agree on (Society A vs. Society B) and not taking our own position to be the moral one and condemning those who disagree. At least this is how I think we’ll get things done. We can judge each other in the privacy of our own homes.

It is from that framework I’d like to reconsider Prop 8. I guess this is a little late to be directly relevant, but I had a very stimulating conversation gay marriage about an hour ago and felt inspired to write. The central question in my mind was “What is good for society?” In considering Prop 8, the conservative thinking (not Libertarian, which I tend to be…I’ll pretend to be a conservative for the purposes of this paper) supporting Prop 8 goes something like this:

Benefits: Stronger families.
Costs: Perception (though not reality) of disenfranchisement against gays.

My friend saw the world this way:

Benefits: None.
Costs: Weaker families; true and terrible disenfranchisement/discrimination; assault on the gay identity and worldview; massive increase in suicide and depression.

So who’s right? I think both sides exaggerate, but I think both sides are partly right. It made me reconsider the cost. I didn’t think the costs were high, myself not being deep within a social network that the proposition would affect. My accounting of the cost was much closer to the conservative position.

But what if I miscalculated the cost? Even assuming I’m right about the benefits, what if the costs were closer to my friend’s estimation? What if the cost of “stronger families” was 1000 additional suicides by people who felt disenfranchised? It would change the equation even if we assumed these deaths were collateral (that is, non-malicious; an unintended consequence). Clearly if we were considering “executing 1000 gays” for the sake of “stronger families,” then this would be one of the few clear-cut moral issues in politics. But as it is an unintended consequence (if this remained an amoral issue), the deaths (assuming they were real; I haven’t seen the data) would still need to be considered in the “Cost” section of the analysis.

Another miscalculation I made was in failing to properly put myself in the position of another. I naïvely thought, “How would I feel if I were in their shoes?” I thought about it like this: for many gays, their core identity is their sexual orientation; my core identity is a Christian. What if people told me, a Christian, I could not have legal marriage status and could not practice my religion in public. Would I care deeply? Would it affect my identity? No, not at all. I don’t know if I’d be like the disciples in Acts 5:41 who were “rejoicing that they were counted worthy to suffer shame for his name,” but I wouldn’t be all that sad. My identity is based on God, not on the opinions of men. The important part of my religious practice is in private alone and in small groups anyways. I’d still illegally “get married” in private and know my wife (in the Biblical sense :)) in my bedroom. It’d be tough, but as a Christian, that’s what I signed up for (and what we get blessings for enduring). (And as an aside: I did sign up for Christianity when I was about 12; a personal decision independent of parents or tradition is a key element of Protestantism, especially today).

And that is where I made my mistake. I imputed my disregard for legal status upon others for whom legal status (or more likely, “social acceptance,” legal status being symbolic of acceptance) is supremely important. I projected my indifference (or mild desire for) persecution upon others who do not see it the same way.

So with these two adjustments, my analysis becomes this:

Benefits: Stronger families
Costs: Terrible feelings of disenfranchisement, increased gay suicide rate

My friend said, “You would not hold the beliefs that you do if you had more gay friends.” I said he may be right. I now know why: talking to those who would be most affected would help me better estimate the cost of such a bill. My perception suffers from not having many friends out of the closet.

I don’t know the final answer or the ultimate benefit of Prop 8, but I do know that I make a mistake in calculating the cost. If only this argument were made to me rationally instead of calling me an immoral bigot from an arbitrary moral framework, I might have changed my vote.

The Core of Christianity

[For Christians...and interested Jews]
I was considering “the Gospel”. I considered the question in isolation. I wanted to find out how the Bible defined the Gospel without ulterior motives or plans to write this. After reading through the a dozen key verses that talk about ‘good news,’ I settled on 3 core truths (with 2 additional sub-points) about the Gospel. After an exhaustive reading of verses that use “Gospel,” I decided that I needed to add two more. And that the 2 sub-points were worthy of promotion to ‘core truth’ status. So I ended up with 7 core truths that seem common to definitions (and passages about) the Gospel (even though I’m prone to trying to make things fit patterns like that, this one was certainly not consciously designed). I found four verses which I believe are the only ‘definitional’ verses on the Gospel (that is, those which say something like, “The Gospel is…”) and based my list of 7 core doctrines on these: 1Ch 16:23-5, Isa 52:7-9, Rom 1:16-17, 1Cr 15:1-9. (See previous entry)

Independently, I’ve been considering what is the core of the message of God? What cannot be taken out of Christianity and it still be Christianity? I was having a very interesting conversation with a friend on Paul’s strategy for planting churches: very sloppy. They didn’t have perfect doctrine by the time he left. He had to work it out from a distance years later. What, then, were the churches he founded based on?

As God usually does, it seems these independent thoughts didn’t stay that way. I had never really thought of the “good news” as being central, which is silly when you think about the core texts being called ‘Gospels’. Perhaps by trying to define “Gospel,” I stumbled across the non-negotiables. Everyone seems to have their own list of things you need to believe/do to be saved. So here’s mine:

1. God is great.
2. Yahweh is Salvation (translates to “Jesus”).
3. We will live by faith.
4. God loves Israel and will be faithful.
5. God loves the Gentiles, too.
6. The scriptures confirm the above.
7. We should declare #1-6

Conspicuously present is ‘Israel;’ conspicuously absent is ‘obedience’ (both of which are good cult litmus tests. “Israel’s not Israel, we’re Israel!” and “Christ’s sacrifice wasn’t enough for salvation!” are two dead giveaways... though this is a high sensitivity and low specificity test). The Christology is not as developed as in most Christian statements of faith, but the cross-scriptural message is the same: Yahweh is Salvation. Whether you lived late enough to know that God meant that literally (that some dude would take on that name and be the very provision by which God would bring about salvation), or like Abraham, you just believed in the fact without knowing the mechanism. I’ve come to the conclusion that “The Gospel,” could have been preached by Jacob, Moses, David, Isaiah, John (or his remnant disciples in Acts), Jesus (pre-crucifixion) or Paul (post-resurrection). The message has never changed; we just have details added.

Like I said, I didn’t set out to come up with a list need-to-believes. But this looks about right. The core doctrines of Christianity are all here, albeit with some shifts in emphasis (compared to what a seminary student would produce).

Perhaps these represent the core of the faith. Are these elements truly the central ones? In my next entry, I plan to look at sermons by Paul, Peter and Jesus to see if these seven elements are indeed common to their preaching.