Cages

Four items in the recent news stand out as examples of our current predicament. We are in a time when really bright people are looking into the nooks and crannies of our world and finding little gems, often intricate puzzles sorted out from the complex maze of reality, that allow them to benefit without returning equivalent good to the rest of us. Their schemes may be clever, but they are clearly contrary to the general intent and problematic with regard to the public good.

What can we do about really bright people that really don't give a damn? If you try to put them in cages, they tend to find exits. For that matter, what we really want to do is to channel their efforts, which are not without merit. In fact, such channeling efforts, restraints, if not cages, can be considered metaphors for their lives, cat-and-mouse games that they play very well. Our point is to be able to establish and conduct policy frameworks that will almost trick them into acting in the public interest.

It is interesting to contrast the caginess of such people with others that are actually in cages, that do not know how to get out. The first group should more effectively be confined because they do not care. The second may or may not care, but should somehow be allowed to go free, metaphorically and physically.

First, the uber-technologists, the Googlers, do not understand why the arrangement under which they have paid only .087% of their revenues in the UK over the last five years as taxes when the stated tax rate is 23% is problematic to others. Their chair, Eric Schmidt, expressed incredulity with regard to the backlash that the situation created. His sole argument? It is not illegal, so what is your problem?

Another example is a guess by a financial expert as to how Mitt Romney ended up with about $150 million in his 401(k) account. Rather than use the tax exemption to commit the two thousand dollar limit per year "for a rainy day" as was intended by Congress, it is thought that Mr. Romney probably probably put "essentially worthless stocks" into his account that "surprisingly" were later worth tens of millions of dollars, over and over again. No rule broken, wink, wink. "So, is there a problem?" is the cagey response...

In the Google case, the "nothing wrong" has something to do with a tax deal struck with Ireland, registries in the Netherlands, and a Bermuda corporation, etc. Similarly, the Cheshire grin. Oh, its only money, so why should we care? For one thing, these people are the ones that we are turning all of our data over to. Of course, there are rules, but you can see what rules mean to this crowd, wink, wink.

There are people, organizations, that do pay the 23%. Are they just stupid?

The third case has to do with doctors in the UK. As it turns out, in the last decade, it was hoped that if the doctors there were to be paid more money, they would be better doctors, more caring, more hardworking, more effective. As is playing out across England, the results for the pay raise, to over 100,000 pounds on average, are not good, as outlined recently in the Daily Mail. Mick McDermott, a science editor, is relegated to reporting that tens of thousands of people with acute conditions that are not being attended to, even poorly. There are a lot of cool scientific things that could be considered just now, but we are looking here at something much lower on the totem pole.

This is sandbagging of a different sort than the Googler wink, but the issues are largely the same. There is an expectation that the public good is at issue, but the commitment is just not there. The range of behavior is "work or don't work". It needs to be significantly re-characterized, with different incentives.

There is news of the young man in a cage in China. He doesn't seem to have been able to figure things out, plus he has emotional/behavioral problems. The government there doesn't assume responsibility, so the family acted in this manner to defend themselves.

This is something that my wife and I know about. We have such a son, now twenty-three years old. He had an infection in his brain as an infant, has had many seizures, and has had much support from the educational and rehabilitation system in the United States. The system has failed quite dramatically and we are left to work out the aftermath each day. I know, he is our son, we love him, and we are responsible, but it wasn't intended that it be this way. The program was supposed to help him to find meaning, to find employment, to fit in to society. If this is to happen eventually, it is something that we will have to resolve as a family. We need to help him to break out of his cage.

I believe that the answer to questions of cages on both ends of the spectrum is not dissimilar. The "cheaters" rely on discontinuity between documented rules and their intended outcomes. They love jumping from one context to another while bringing their "jewels" along for the ride. Do we want to resolve this? I think so. We cannot continue to sustain such societal and economic losses with just a poultice and a few winks. To resolve these issues, we need far more detailed approaches, more nuanced, informed regulation and collaboration among parties and authorities. This isn't about "data", it is about "process". Policy-speaking, they need to be put into cages that will hold; their behavior as it were needs to be modified.

The people in cages need to be freed. This, too, is a complex task. I don't know about conditions with regard to the young man in China, but I do understand issues with regard to my son. As it stands, any risks he brings to the table, justifying possible restraint, is in large part due to his frustrations. He wants to have a normal life, but as it stands, he cannot. His speech lacks clarity. He has some cognitive and physical limitations, but they are spotty. In some ways, he is normal and he has talent bordering on giftedness in some ways.

For his life to be normal and fulfilled would require some infrastructure. Some excellent work has been done in his case by behaviorists that have structured his daily life around low level incentives that help to control him, but they have left him with a festering level of frustration because of the resulting daily grind that is growing day-by-day. He is miserable. The story could still turn out to be an unhappy one. We have a fresh new hole in one wall in the home, now covered over with a piece of craft work because I am not really good at fixing drywall. Interestingly, in his case, I am convinced that his talents could serve as the basis for an interesting and successful company. He is obsessed with cars, with design, with color. He is particularly with choice of color, shading, color combinations, texture. He has designed thousands of examples -- hundreds that are very good by my estimation. I have never seen anything on the highway or roads like many of his designs. I don't obsess over cars like he does, but my guess is that those that do would find a lot that they like.

Of course, how would this be paid for? If I am right, it would be self-sustaining at some point. Would it, could it, be considered to have intrinsic value if it wasn't ever to be self-sustaining? This is the ever-present social services question, is it not? The three examples, the Googlers, the slicksters, and the prime-time doctors want to live off of one side of the equation in ways that ignore the other side.

One of my mentors calls this a disability, one that is common in the leadership of our institutions. All of the societal elements, including laws and norms and the willingness to pay taxes even though you know about ways of dodging them, and educators and neighbors and others that have helped them along the way, are forgotten. They may engage in projects they favor, but are unwilling to put resources to the general good. True, many may call attention to apparent illegitimacy of governments, bad behavior, etc. Efforts to support reform are important, but ultimately supporting the legitimacy of the governments in question is in order. They peruse the borders and keep the peace and much more.

We would prefer to live without cages. Some will obviously always be necessarily. Their existence helps to bring others into the light.

First, you have to get sick

I recently went to a conference dedicated improving health care. The attendees and the presenters were billed as reformers. They reiterated in all of the sessions that something significant needed to be done.

Funny, though. There were wide variances on what kind of action is warranted. In some cases, they indicated that the problem was only a matter of better communication. Others expressed anxiety about such limited steps, but didn't really outline a cohesive plan.

In one session, the presenter started out with the question, "What is our medical system" as a way of setting the agenda and stimulating conversation. There was an awkward silence, not uncommon in a crowd.

So I contributed what was in my mind, "First, you have to get sick".

He lowered is head a little. His mouth opened a lot, but not to speak. He stared at me for a few seconds. Then he changed the subject and went on.

I am sure that this was not a seminal moment in the history of health and medicine, but it was a sign of the compromised state of affairs. There is a fine-tuned dialog based on derivative issues that are doomed to fail. If only we could get nature to cooperate with our carefully negotiated healthcare deals. Isn't there some way, we would hope, to to embed ourselves into the evolutionary process right now to immediately get what we want?

Of course, the answer is "no".

As emphasized by Dr. Miroslaw Manicki, health plans are typically based on wishful thinking. We have finely-tuned schemes, mostly about how to pay for services, but not about much else. Physicians continue to do pretty much what they want. There is a huge gap between the science and the practice. This is odd, given that much of the apparent legitimacy of medical practitioners comes from their proximity to esteemed scientific research centers. The scientists don't really mind as long as they continue to get funded. They like solving puzzles and they are not really involved in the process of using them or getting others to do so.

Even though nature does not assume a seat around the health care negotiation table, its effects loom large. Largely this comes from poor performance with regard to chronic diseases.

Colin Campbell provides an interesting example of one aspect of the problem. In his recent book, Whole, he describes an encounter with a member of his family and an oncologist. A diagnosis of cancer had been declared. The doctor indicated that there were three options, combinations of these. They were surgery, chemotherapy, and radiation therapy. The Campbells responded that they wish to follow an integrative approach, most particularly an approach that emphasized the role of nutrition. The doctor was openly dismissive In effect, he issued a death sentence if the didn't act immediately.

The Campbells elected to follow the integrative approach, and after several years the results have been very good. Dr. Campbell is clear to say that this result is not a scientific finding, lacking the statistical and sampling requirements for credible generalizability, etc. On the other hand, the outcome was a good one, backed by much research in many related fields -- dating in fact back to Otto Warburg and his observations on the cellular origins of cancer. Genomics, proteomics, metabolomics, and many other research areas are providing evidence of the importance of nutrition and other holistic factors in the ongoing defeat by the body of cancers and other unwanted health conditions.

If Dr Campbell, a world-renowned scientists, was not able to persuade the doctor, what chance do others have? He estimates that approximately 2,000 to 3,000 such sessions between doctors and their clients occur each day in the United States. People need information to gain leverage, if not to supplement their own actions. As recently described in the New England Journal of Medicine, the doctors themselves find themselves in a vise, depending on the expensive, invasive methods and drugs.