A Bioethical Dilemma in the UK Vaccine Rollout

Oops:

The government and NHS England has ruled that GPs must move the second dose of the vaccine to 12 weeks after the first, instead of the originally planned three-week gap.

And from Monday, January 11 they were informed that they had to postpone any second dose vaccines they had originally booked within the timeframe.

Since December 15, 2,000 people in Tameside and Glossop received their second dose before the change in policy.

Dr Alan Dow, who works at in Cottage Lane Surgery in Glossop told a meeting of the primary care committee that some GPs feel they have been put in an ‘impossible position’ by the new national mandate.

“The breaking of the consent for the three week promise was a big thing,” he said.

“I personally told people that face to face as I vaccinated them on the day and then suddenly we can’t do it. That’s a big thing in general practice actually, breaking consent with our patients.

“It is close to moral injury, if not actually. I already think we’re out on a limb in terms of evidence.”

Moral injury is defined as the profound psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code.

Dr Dow added that he could understand the position of the medical chiefs to delay the second dose, but did not know how much that took into account ‘breaking consent which has been the model of personal care in the NHS for 70 plus years’.

The Pfizer vaccine has only been validated for its original 2 dose protocol (with that specific timing). We do not know how a 4x increase in the spacing affects the protection afforded by the vaccine. Perhaps you end up with the same protection (≈90%). Perhaps it’s a bit better. Perhaps it’s a lot worse! (There’s evidence of some protection from a single dose, but we probably only have data from three weeks after.) Lots of things could happen. We haven’t studied it so we don’t know. We don’t, as far as I know, have a great theoretical model that would help us make an educated guess.

Thus, a bunch of people are being subjected to an experimental treatment. It’s likely to be safe (i.e., the risks from the treatment itself are low…thought that’s more theoretical; mRNA clears in a few weeks; exposure to vaccine levels of spike protein don’t trigger cytokine storms; thus, from a safety perspective, get as many shots as you like). But we don’t know how effective it is and we won’t know until we see how many people in the new arm of the experiment contract severe COVID.

This would be fine…if the people involved gave informed consent in advance. They, of course, did not give such consent. The GPs told their patients they were going to get a certain treatment and then had to tell them they were going to get an untested alternative instead.

Ordinarily, this is no dilemma. It’s straight up wrong. Oh sure, if the second doses were destroyed or contaminated, etc., it would be unfortunate but not a wrongdoing in the simple scenarios. If only some were, then we’d have an allocation problem. Of course, assuming stocks can be replenished we could always have an interrupted treatment and then do the full treatment when possible.

But there is a dilemma! The UK is in the midst of a very bad outbreak with the whole country experiencing high rates of infection. The whole healthcare system is near the breaking point.

Things will get worse before getting better due to the time lag between exposure and manifestation of illness as well as the lack of transmission control and asymptomatic spreaders. Some people who will get sick are already infected. Some people who will get sick in the current trajectory are not yet infected. If we can get some of the second group at least one dose of the vaccine it could perhaps half the number of that second group getting hospitalised for COVID.

From a bioethics instruction perspective this is a pedogogically well structure dilemma. In first framing, you have deontological considerations (lack of consent) in tension with utilitarian ones (saving lives). If you poke at little further you have consequentialist issues buttressing the deontological ones (some of the people who relied on the normal course might get seriously ill; the “moral injury” is also a factor). There’s a lot of potential second order effects.

I wish it were a hypothetical instead of this grim reality.

I don’t envy any of the decision makers.

Ideally, everyone would eventually get the normal two dose protocol (for a total of three doses). It’d be best if everyone who’s received a dose got a choice whether to finish their treatment or postpone it, but it would depend a bit on the numbers. I think doing a one does, then delayed two dose is better than an off label 2 dose (unless we get excellent results from wide spaced 2 dose trials).

The damage to doctor/patient relations needs addressing as well. The government so routinely squanders everything, it’s hard to know the marginal effect of this overall, but there are directly relations that need restitution as well.

Update: Hmm:

For the Pfizer vaccine, the impact of stretching out the two doses hasn’t been tested in clinical trials. Pfizer cautioned that its trial only investigated giving two doses 21 days apart – far less than 12 weeks. But evidence increasingly suggests that spacing out doses of the AstraZeneca/Oxford vaccine may be more effective at protecting people.

The main risk is that people’s level of immunity falls before they receive their second dose, putting them at risk of Covid-19 – although this risk would still be lower than if they’d received no vaccine, and would be boosted when they eventually received their second shot.

However, a consensus statement by the British Society for Immunologists said that delaying the booster dose by eight or nine weeks was unlikely make much difference in the longer term.

Hmmmmm (following the AZ link):

Evidence now suggests that spacing out doses of the AstraZeneca/Oxford vaccine may be more effective at protecting people. Clinical trials revealed the efficacy of the vaccine was substantially higher, at 90%, in a subgroup of people who received half a dose followed by a full dose, rather than two full doses, which had an efficacy of 62%.

But Prof Wei Shen Lim, the chair of the Covid-19 immunisation group of the JCVI, told MPs further analysis by AstraZeneca showed the improved protection came from spacing out the doses.

“People who had the half dose then full dose were those who were vaccinated at a longer time interval, roughly six to 12 weeks, and what they’ve seen in their data is that people who have the second dose later probably have a three times higher antibody level than those who were vaccinated earlier. So if anything, it suggests that increasing the dose interval is beneficial,” he said.

Sir Mene Pangalos, the executive vice-president of biopharmaceuticals research and development at AstraZeneca, told the committee the first vaccine shot was more protective over time.

“What we’re seeing with our data so far is that as you go to the eight- to 12-week interval, you actually increase vaccine efficacy. People are protected enough with the first dose, to around 70%, but we see that within that eight- to 12-week interval is actually the sweet spot,” he said.

Again, I’ve not delved, but this reporting is worrisome. It is suggestive of motivated reasoning.

The brutal fact is that AstraZeneca and Oxford botched their trial. They didn’t do what they said they would do by accident. Maybe this will be a happy accident, but now you have, “Oh it’s the half dose, no, Oh it’s the spacing, no, oh, maybe it’s not the booster”. That’s not good!

It doesn’t mean that they are wrong but it’s all rather untrustworthy.

Blocked on Twitter

I don’t engage that much on Twitter so I’ve not been blocked all that much. But I was today! And by apparently noted author and literary journalist Ron Rosenbaum.

Ron made a mistake:

https://twitter.com/RonRosenbaum1/status/1079006088522067969

The thread is hilarious:

https://twitter.com/maxkennerly/status/1078777955562729472?s=21

People quickly piled on. Ron did not handle this well.

At one point, I decide to jump in but to do so without mockery and with some attempt at sympathy:

https://twitter.com/bparsia/status/1079073455725862913?s=21

In particular:

https://twitter.com/bparsia/status/1079080278155579392?s=21
Welp, Ron did not like this and went down the insult trail until he blocked me.

So, I was 99% sure this would happen. These are not situations even very careful and considerate people get out of. But I thought it’d be interesting to try.

Note that one move I made that definitely didn’t help was not giving him any way of being right. Of course, there is in fact no way for him to be right but it’s even harder for people to get out of those situations without a way of feeling that they were right about something.

While the first rule of holes may be to stop digging, the first rule of people is that they need to save face.

So I regret not trying to give him more face instead of trying to persuade him of the simple truths.

(Don’t get me wrong. I’m a big believer in blocking. Block block block. Block for wrong reasons. Block for good reasons. You don’t have to read what you don’t want to read or interact with people you don’t want to interact with.)

Now, I’m not particularly interested in reading his stuff, but I won’t, in abstract, write them off. They may be excellent for all that I know and I know that this introduction will taint any initial reading I might make. I peeked at a few articles and wasn’t engaged even though some of the topics are of interest to me. He makes a lot of claims that I don’t see tons of evidence for (in my causal perusal) and his style makes me think he wants a lot of trust as an author.

I don’t know if I want to do the work to give him that.

Cherry Picked Lists Aren’t Good

Connor Kilpatrick has an article in Jacobin called “It’s Okay to Have Children.’

It’s not a illegitimate topic per se. Whether to have children, when to have them, how many to have, whether we should have policies promoting or discouraging having children, etc. are all perennial and sometimes interesting topics.

Ex ante, I’m pretty skeptical that Kilpatrick is a good choice for such a piece. Katha Pollitt doesn’t like it which is a bad sign:

Some Twitterers complained about Pollitt’s tweet (“Where exactly is the substantive criticism of this piece here? Just saying that it’s sexist doesn’t cut it. This is the best thing I’ve read all year.” This “substantive criticism” line is echoed by the editor of the piece.)

Sometimes, even for stuff from suspect sources, I like to verify criticism I see, so I went to read the piece. I got stuck very early:

In the Guardian alone, the past two years have seen headlines such as “Would you give up having children to save the planet? Meet the couples who have”; “Want to fight climate change? Have fewer children”; “‘It’s the breaking of a taboo’: the parents who regret having children,” “Want to save your marriage? Don’t have kids.” In the New York Times, “No Children Because of Climate Change? Some People Are Considering It.” At Business Insider, “7 reasons people shouldn’t have children, according to science.” And this new logic is quickly making its way through liberal culture writ large: “Feminist funnywoman Caitlin Moran says the planet doesn’t need your babies.

It’s hard not to get the message. Yet it seems to be falling on deaf ears.

It’s clear that this pile o’ links is meant to make the reader think there’s a pretty overwhelming trend. The article is a bit sneaky though “the Guardian alone, the past two years” and ” quickly making” and “liberal question writ large” all are intended to make us think it’s a big, widly held, nigh consensus view on the left, at least in the intelligencia. Indeed, there is a message, it’s not hard to get.

But why the past two years? Why the GuardianNew York Times, and Business Insider? (Are these all liberal in any real sense?) Why 4 from the Guardian, but only 1 each from the other two? At least one of the Guardian articles (“‘It’s the breaking of a taboo’: the parents who regret having children,”) isn’t anti-natalist per se it’s about people who regret having children and how it’s socially difficult to feel or express that regret. It’s also about how sexism shapes the experience of motherhood:

When Emma was four months old, she was offered a freelance job that involved a lot of foreign travel. The reaction from friends was discouraging. “Is any job really more important than being a mother? Don’t you have a husband?” people asked. “A mother suffers when she is away from her children, and it’s a crucial time for a child, developmentally. You ought to be there.” (“How, then, do fathers cope with missing these crucial stages?” Fischer grumbles. “Besides, I’m broke.”) “Well, it’s your own fault,” her husband told her. “It was your decision.”

Note that the clear overwhelming social pressure is for parenthood, esp. for women to be the right kind of mothers:

Fischer’s book was prompted by a study carried out by Israeli sociologist Orna Donath, described by the newspaper Haaretz as “the face of the non-parenting movement”. Regretting Motherhood: A Sociopolitical Analysis comprised interviews with 23 anonymous Israeli women sharing their regrets about having children, and the extreme social pressure they felt, whether or not they were cut out for motherhood. “I’m not alone!” Fischer remembers thinking.

Andrew G Marshall is a British relationship therapist and author of many books. He says he has never had a client tell him outright that they regretted having children. “It is the biggest taboo. The sheer terror is what parents tell me about. The internet has created this child-worship, where anything beyond obsessive motherhood is bad motherhood. But it’s perfectly acceptable to be an individual, to ask ‘What’s my life’s meaning?’ and not feel it can only be your children.”

It’s hard to imagine an article entitled “It’s Okay to Have Children” which is remotely responsive to this article which describes people who regret being parents and felt a lot of pressure to be parents. Indeed, Kilpatrick refers to “the message” as “this misanthropic anti-natalism.” That’s just wrong and rather awful mis-statement.

So, right there. Here you go. A substantive criticism. He cites a piece which is not remotely, in any tenuous way, expressing misanthropic anti-natalism as such and never engages with the content of that article. It’s just a prop. I’m skeptical that either Kilpatrick or the editor read it.

But let’s go a bit further. Is the Guardian a hotbed of anti-natalism (misanthropic or otherwise)? Let’s do a quick study. Let’s consider the same time frame (2 years). I’ll use Google with a simple search “site:https://www.theguardian.com/ “don’t have children” (this biases toward Kilpatrick’s thesis). I’ll just look at the first two pages, excluding links more than two years old. I’ll mostly look at the title and excerpt fragments on Google. We’ll code them as pro-, anti-, neutral, and childfree-positive. The last is to distinguish articles which recommend not having children vs. those which are just about people who happen not to want children. That the latter are lumped in with a misanthropic anti-natalism is part of the standard injustice toward them. In any case, here’s the first page of results:

  1. ‘The desire to have a child never goes away’: how the involuntarily (pro)
  2. Would you give up having children to save the planet? Meet the (anti)
  3. What’s it to you if some people don’t have kids? | Barbara Ellen (childfree-positive)
  4. If you have no children, who will care for you when you’re old? | Sonia (pro)
  5. My partner didn’t want children. I did. Then I got pregnant… (pro)
  6. Read this before you have a baby (especially if you’re a woman) (anti to neutral)
  7. Want to fight climate change? Have fewer children (anti)
  8. Help! I’m almost 30 and my friends are procreating like humanity (neutral)

2 of the first 10 (sorted by relevance) were out of the date range.

So the total is 3 pro, 1.5 are neutral, 2.5 are anti, and 1 is childfree-positive.

The .5 (#6) anti is really a collection of stats that show that mothers are symmetrically burdened. That’s not really anti.

Even the antis aren’t what Kilpatrick needs. Consider 2, it’s primarily reporting on anti-natalism, not championing it. And a lot of the anti-natalists aren’t misanthropic at all:

The last thing [Münter] wants to do is make parents feel guilty, or to shut them out of the conversation. Procreation, after all, is natural. And if you have two children, you are only replacing their parents, rather than adding extras. But if you’re not yet a parent and can’t suppress your parental instincts, says Münter, “my ask is that you consider adopting one of the 153m orphan children that are already on the planet and need a home. Or, if you are dead set on having your own, my hope would be that you just have one and then if you want more, adopt.” Ultimately, she says, “your kids and your kid’s kids will be the ones who benefit from humans deciding to slow down our rate of growth. It will slow down climate change, ocean acidification, cutting down the wild places.”

Despite being a supporter of VHEMT [Voluntary Human Extinction Movement], Angela wouldn’t call herself an antinatalist, because she associates it with negative feelings towards humankind. “I don’t, on a human level, resent people who have kids. That wouldn’t be constructive at all. Both my sisters have children.”

Indeed, a fair bit of the article is about being child-free positive.

And 7, in spite of the headline, is about a study about the carbon impact of various activities. Having a kid is high impact, as one might expect. But:

“We recognise these are deeply personal choices. But we can’t ignore the climate effect our lifestyle actually has,” said Nicholas [one of the researchers on the team]. “It is our job as scientists to honestly report the data. Like a doctor who sees the patient is in poor health and might not like the message ‘smoking is bad for you’, we are forced to confront the fact that current emission levels are really bad for the planet and human society.”

“In life, there are many values on which people make decisions and carbon is only one of them,” she added. “I don’t have children, but it is a choice I am considering and discussing with my fiance. Because we care so much about climate change that will certainly be one factor we consider in the decision, but it won’t be the only one.”

These are the best case for Kilpatrick’s thesis and they are terrible for it. Utterly horrible. I’m pretty skeptical that there’s a broad based misanthropic anti-natalism on the liberal left, but Kilpatrick certainly hasn’t established even a prima facie case.

I think we have good reason not to read this article.

The Loss of Loss Aversion

As with ego depletion, loss aversion turns out to probably not be a thing:

However, as documented in a recent critical review of loss aversion by Derek Rucker of Northwestern University and myself, published in the Journal of Consumer Psychology, loss aversion is essentially a fallacy. That is, there is no general cognitive bias that leads people to avoid losses more vigorously than to pursue gains. Contrary to claims based on loss aversion, price increases (ie, losses for consumers) do not impact consumer behavior more than price decreases (ie, gains for consumers). Messages that frame an appeal in terms of a loss (eg, “you will lose out by not buying our product”) are no more persuasive than messages that frame an appeal in terms of a gain (eg, “you will gain by buying our product”).

People do not rate the pain of losing $10 to be more intense than the pleasure of gaining $10. People do not report their favorite sports team losing a game will be more impactful than their favorite sports team winning a game. And people are not particularly likely to sell a stock they believe has even odds of going up or down in price (in fact, in one study I performed, over 80 percent of participants said they would hold on to it).

I have not dug into the paper so…who knows?! but I find it plausible.

This is super annoying. The ego depletion one was extra annoying due to the fact that the literature had seemed good. Loss aversion loss is annoying because of the pervasiveness of use of the concept. It was the example of behavior economics.

We really need to separate out the work that is inherently high risk in fields like psychology and nutrition.

Note: when looking up the ego depletion stuff I came across a post touting recent “strong” evidence for ego depletion in the form of two sorts of large studies with preregistration. That’s prima facie interesting but I’m going to retain a pretty high level of skepticism. Certainly when folks write (emphasis added)

Moreover, combining results from the two studies, there was an overall small, but statistically significant, ego depletion effect even after removing outlier participants (and this was after only a five-minute self control challenge, so you can imagine the effects being larger after more arduous real life challenges).

Arrrrrgh! The results of two studies with a combined n of around 1000 is a small but “statistically significant” (I presume p=0.05) effect. No no no no. That’s super dangerous.

Worse, speculating about how much bigger the effects would be with bigger manipulation is super duper dangerous. This is stoking confirmation bias. And we shouldn’t be looking at current tiny effects as evidence for future awesome effects.

Renata Wassermann on Belief Revision in DLs

I used some of Renata’s work in my thesis and we’ve corresponded on and off. One of her students is visiting us and she came and gave a talk! It was very nice.

One interesting bit was that did some experiments on partial meet vs kernel based revision and found “contrary to computer science intuition” partial meet generally is more efficient. Ok that’s a lot of jargon here’s an attempt to sort it succinctly.

Given a set of beliefs, B, (think propositional sentence ie things which can be true or false), and some sentence S which follows from B, how can we shrink B so S no longer follows? This isn’t easy! S may not be a member of B. S might be entailed by lots of different parts of B.

One approach is to find all the minimal subsets of B which entail S. Since they are minimal, we can break the entailment by deleting just one element. If we fix each subset then we have a fix for B. These subsets are called kernels (or justifications). They correspond nicely to typical debugging approaches.

Alternatively, we could try to build a maximal subset of B which doesn’t entail S. There will be many such subsets but obviously each does the job. Call such a set a remainder. We can just pick one remainder, or take the intersection of several (or all). If we take fewer than all we have partial meet contraction.

Now Renata said something that didn’t make sense to me ie that the reason kernal contraction has been preferred is that computer scientists think it’s more efficient because “kernels are smaller”. But…I’ve never heard that. The concepts are dual but kernels are easier for humans to deal will. They capture the logic of how the undesired entailment works. It never occurred to me to even ask which approach is more efficient. It depends on the nature of the sets!

One interesting bit is that a difference between debugging and revision folks is that debugging folks usually consider minimal repairs, ie, selections from the set of justifications that contain no repairs. This corresponds to full meet contraction which has a number of issues. If you go for partial meet then you have to do a bit of work to get an algorithm that finds desirable contractions compared to the remainder based approach.

Of course, even from a debugging perspective a partial meet approach might make sense. When you figure out a bug, you might make more changes than just the minimum one to fix the focus broken test. After all, you might get an insight about a particular function call and change how you call it everywhere. You might realise that a module is just irredeemably broken and replace it entirely.

Trust Not In Pundits with Too Much Bonkers Confidence

I put all my blogging energy into an LGM comment about the problems with Seth Abramson, Twitter legal conspiracist, albeit against Trump these days:

Seth has done an outstanding job on this.

Really?

First, some context:

https://www.huffingtonpost.com/seth-abramson/5-things-weve-learned-abo_b_9772408.html

https://www.huffingtonpost.com/entry/in-sanders-wins-californi_b_10252990.html

https://www.huffingtonpost.com/entry/how-to-explain-the-sanders_b_10206250.html

He wrote a lot of bonkers stuff during the election. Not in the league of HA Goodman or even Greenwald, but a lot of silly stuff all with the same breathless, relentless, overconfident air.

This should give us a bit of pause. It doesn’t mean he didn’t change for the better, but it means we should take care.

Second, that thread:

Trump didn’t “as good as” out himself as a Russian agent—he *literally* did, and his statement about DNI Coats literally proves it.

“Literally” eh?

Trump’s hand-picked Republican Director of National Intelligence, Dan Coats, has the *same* intel on Russia’s attack on America Trump has—by definition. It’s undisputed.

Say what? I mean, the only sense in which this is true is that Trump has *formal* access to everything Coats has. We also know that Trump reads almost nothing, cannot sit through most briefings, retains little, ignores everything, and makes up a ton more.

So, it’s not undisputed that Trump is working rationally and knowingly off the same information. In fact, that’s certainly not true!

This is the key for some wacko inferences:

Or *would* be, if we didn’t know that there is *one* difference between the two men’s intelligence sources.

Trump doesn’t read, listen, or care about them?

The *one* difference between the intel Coats has and the intel Trump has is that *Trump has met privately with Russians on multiple occasions*. He did so—without the necessary meeting attendees, including advisers and witnesses—in the Oval Office, at a prior summit, and today.

See, this is very silly. This is obviously a difference, but it’s one of a multitude. It’s significant, but not necessarily dominant.

So the only explanation for Trump saying that he “disagrees” with intel his own DNI is 100% on is if he’s relying on the sources *he* has that DNI Coats doesn’t

I mean, what? The right explanation for Trump saying that he disagrees is that the US intelligence communities information is really bad for Trump. In all sorts of ways. That’s totally sufficient for Trump to say it’s wrong. He said that the content of an interview with him from a conservative UK paper was false mere hours afterwards. He didn’t have “intel” the paper didn’t. He just didn’t like the fallout.

So what did Trump do with the additional intelligence he received from the Russians in his three (at a minimum) protocol-busting meetings with hostile foreign actors? He used that intelligence—and the disagreement with Coats it bred in him—to *attack the United States* on TV.

We think that he got “intelligence” from the Russians? I mean, this stretches the meaning of the term out of shape. The Russians aren’t sharing intelligence with Trump! They may be lying to him, blackmailing him, or colluding with him, but not by sharing intelligence that he acts upon. I mean come the fuck on.

And now:

In doing so, Trump *literally* was acting as an agent of Russia, relying on Russian intelligence as his marching orders in spreading dangerous propaganda on international television. *That’s* why Brennan called his actions treasonous—because they *literally* (by law) are.

“Intelligence as marching orders” is incoherent and redundant. Whatever this is, it isn’t a proof that Trump “literally” confessed or that Coats’s statement “literally” proves it. It just isn’t. It’s a bizarre inference which isn’t necessary to reach a reasonably analogous conclusion.

And it’s really doubtful that his actions now are “literally” by law treasonous. The president has enormous power and wide latitude esp in foreign affairs. It’s not determined that he’s given “aid and comfort” to an “enemy” because he has a great deal of influence of who counts as an enemy! So, like with impeachment, whether what he’s doing is treason will be primarily a political determination.

If Seth’s hackery bore useful political fruit, I’d wince and be ok. It’s not at all clear that it does. I’ll leave you with these sage words:

I’ve been a metamodernist creative writer for many years now, but had not seen an opportunity to bring this earnest, optimistic, and loving art practice into my professional writing activities until Bernie Sanders came along. Not only do I fully support and endorse Senator Sanders’ agenda, I see in his political methodology evidence of the metamodern, just as I know for certain when I hear Clinton’s cynical incrementalism that I am in the presence of a postmodern political ethos. The reason we think of Bernie Sanders as impractical or even naive is that he is; what most fail to see, however, is that his is the “informed naivete” of metamodernism. He sees that our economic and cultural markets are in a terminal state of deconstruction, and yes, this makes him angry and “negative” in a certain respect, but he sees too that the opportunity this deconstruction affords us all is a moment in which we can reconstruct everything we’ve known in a way that better reflects our values.

So when I wrote that “Bernie Sanders Is Currently Winning the Democratic Primary Race, and I’ll Prove It to You,” I was offering a “minority report” of the Real:

Nonsense presented as analysis is a problem cf Glenn Greenwald. It often is concealed under a torrent of “evidence”. This irks me as I’m a torrent of evidende sort of guys and I resent people using the form poorly for bad ends.

Making Principled Unprincipled Choices

I like principled decision making. Indeed, few things inspired me as much as this quote from Leibniz:

if controversies were to arise, there would be be no more need of disputation between two philosophers than between two calculators. For it would suffice for them to take their pencils in their hands and to sit down at the abacus, and say to each other (and if they so wish also to a friend called to help): Let us calculate.

Alas, there’s no decision making situation where this vision holds, even in principle. But still, I like my decisions to conform to some articulable rationale, preferably in the form of some set of general rules.

But some of my rules are meta-rules which focus on resource use. Obviously, one goal of decision making rules in to maximise the chances of making the “right” choice. But for any metric of rightness (let’s say, an appliance with the best value for money) there’s a cost in the effort to assure the maximum (e.g., research, testing, comparing…lots of shopping). That cost can be quite large and interact with subsequent satisfaction in a variety of ways. I’m prone to this and, indeed, end up in decision paralysis.

In response to this, one of my meta-rules is “don’t over-sweat it”. So, for small stuff, this reduces to “don’t sweat the small stuff”. But, because of my anxiety structures, I tend to see certain classes of small stuff as big stuff. So, I dedicate some effort to seeing small stuff as small. Sometimes, this means making it invisible to me. Poor Zoe often has to make the actual purchase after I’ve done the research, or even make the decision after I’ve done the research. For various classes of minor, irrevocable sub-optimal decisions, I prefer not to know about them. I will obsess, and that doesn’t help anyone.

When the decision is essentially arbitrary (because all choices are incommensurable in toto, or their value is unknowable at the moment), I try to make myself flip a coin (metaphorically, at least). What I try to avoid is building a fake rationale (except when that enables the choosing or makes me happier with the arbitrary choice).

Technical (or teaching) decisions often are best treated as arbitrary, but we have tons of incentives to treat them as requiring a ton of analysis to make the “right” choice. At the moment, I’m evaluating what Python testing framework to use and teach in my software engineering class. I currently use doctest and unittest and have a pretty decent lesson plan around them. doctest is funky and unittest is bog standard. I’d consider dropping doctest because I need room and we don’t do enough xUnit style testing for them to really grasp it. They are also built into the standard library.

But then there’s pytest which seem fairly popular. It has some technical advantages, including a slew of plugins (including for regression testing and BDD style testing). It scales in complexity nicely…you can just write a test function and you’re done.

But, of course, it’s a third party thing and needs to be installed. Any plugins would have to be installed. Is it “better enough” to ignore the built in libraries? Or should I add it on with the builtin libraries? AND THERE MIGHT BE SOMETHING YET BETTER OUT THERE OH NOES!!!!

No. The key principle here is a meta-principle: Don’t invest too much more effort. Make a decision and stick with it. In the end, any of the choices will do and a big determiner will be “does it spark my interest now?” while the other will be “how much extra work is that?”

And that’s fine.

 

A Bit on Alfie Evans

Note: This is all phrased in cold, blunt terms. I don’t think any member of his family will read this and it’s not at all the kind of language one should use when discussing it with people who are involved. I’d caution about reading this if you had an analogous loss: I didn’t write it with such readers in mind so the way I put things might be upsetting. Self care is important! What I wrote isn’t mind blowing or so unique that anyone needs to read it.

Kevin Drum wonders why cases like Alfie Evans generate so much activity from the sanctity of life folks:

The general tenor of their criticism was that the abortion lobby was no longer satisfied with killing infants in the womb. Now they wanted to kill them after they were born based on nothing more than their opinion about Alfie’s quality of life.

I find it puzzling that this is a hill they want to die on. It’s much like the Terry Schiavo case, and in both cases the pro-life folks were defending the notion that a person could still be alive even if their brain was all but destroyed. Why? There are always judgment calls to be made about when life ends, but lack of brain activity is pretty clear cut. In the case of Alfie Evans, his parents were effectively performing an experiment to see how long a brain-dead child’s heart can be kept beating.

But wouldn’t it be better to have that argument in a case that’s genuinely on the bubble rather than a case in which it’s absolutely indisputable that the child’s brain is gone? Why is the pro-life right so attached to cases like this? Keeping the heart beating in a brain-dead child really doesn’t seem to serve anyone’s purpose.

I want to talk a bit about the ethic of this case, but first a quick point about the politics and Drum’s question: It’s almost certainly not planned or the result of any strategy. Basically, only hopeless cases generate much conflict between caregivers and family members. Some few of them go viral and there you are. Even if there were master planning, hopeless cases might make sense precisely because they are irrational (so the judges and caregivers and sensible family members won’t defer). That the pro life movement is never up in arms against insurance companies is awful and terribly inconsistent, but yeah, that’s how political movements are. The narratives are not subject to overall consistency checks but to identity, repetition, history, etc.

Ethically, if we ignore the parents wishes for a moment, this is an easy case. There was no treatment and there was (essentially) no brain (or at least no brain that supports any cognition or experience). There’s was no medical point in maintaining the body.

From what I can tell, there’s no suffering either. Even if some sort of pain signals and processing occurred, there’d be no subject to experience it.

But here’s where it seems a big old “Why not let the parents do the pointless thing they want to do?” question has a lot of punch. It’d be a tremendous waste of resources to have flown Alfie Evens to Italy, but it was all, essentially, private money. We “waste” money on all sorts of things, including elaborate coffins. Drum discusses the need to protect the parents from hustlers, but here the “hustler” is the Catholic Church. And they would pay for it. We don’t think that’s the kind of hustle adults need or get protection from. (Obviously, if you don’t think the Catholic Church isn’t a hustle but a reasonable form of life and a respect worthy culture, this point is even stronger. However, even if you do think its a hustle, it’s a protected hustle and definitely not on part with quacks and pop up cults, etc. The family won’t lose all their assets at the end of it.)

Even if we take a strong line against medical quackery and on the welfare of the child, it seemed pretty clear that there was no child. If we believe that, then all that’s left is resource allocation, family suffering, and political fallout. It’s private money, the family probably suffered more with the given decision, and it was probably net bad politics. (I.e., it didn’t make sensible rulings, decisions, and laws more likely and may have made them less likely.)

In medicine, preserving dignity is important, but we have to be very careful when determining what concept of dignity is controlling. Given that Alfie wouldn’t suffer harm (since he was already dead), how the parents wanted to deal with his (breathing!) corpse seems to control (up through resource allocation and safety).

I doubt that yielding would have that much beneficial political effects though it might have yielded fewer death threats. But the family would have been happier.

The Viz Fallacy

Taxonomies are fun and usually treeshaped. Trees are “easy” to visualize. When people have a taxonomy they often like to visualize them.

But the results aren’t always so nice. Given that this is a taxonomies of fallacies, I found their misuse of a visualization highly amusing. It is also reminiscent of one of my thesis topics (non logical reductios).

mc et al called this the pathetic fallacy (of RDF).

The Risk of Appropriation and Inappropriateness

The copy of Whistle Down the Wind that I bought from the HMV bricks and mortar store.

My sweetie, Zoe Mulford, is white. I’m at least half white (depending how you count my Iranian father). We both grew up with a fairly high socio-economic status and we retain a big ole chunk of that. We can afford for Zoe to be a full time musician with essentially zero net income (or, properly accounted, negative, as we subsidize her work from the household income). There was a point where this was challenging on our joint income (though we always had family and friends to help out…which makes a huge difference) but we’re pretty well off now. Our household income is well in excess of the median for the UK.

So we are very very privileged on a world scale and even on a US/UK scale.

Zoe is a folk musician…a singer-songwriter. I believe that she’s is very very good. (This isn’t too surprising, given my relationship with her, but there’s plenty of other evidence thereof.) However, she is, to date, obscure. She has had a slowly rising profile, but it’s small. Having “The President Sang Amazing Grace” covered by Joan Baez is a big (potential) inflection point for her career. I’ve been obsessively tracking reviews and other events that mention Zoe’s song and there’s been a lot of good stuff. A lot. Way more (by volume, not necessarily intensity) than ever before.

We figured that if any song from Small Brown Birds would blow up at all, it’d be “The President Sang Amazing Grace”. We did a little prep for this (mostly making a video).

And this is great. I’m exhilarated and proud and excited. If you look at Zoe’s songbook, you’ll see this is no fluke. She deserves notice.

However, the song is about a tragedy and Obama’s response. That tragedy happened to black people because they were black. We’re benefiting indirectly from that tragedy. We will receive some money in terms of royalties. Zoe already gets some from sales of Small Brown Birds, but I expect that will be tiny compared to the royalty check…not that the royalty check will be huge. If it were to go gold, it might…might…yield tens of thousands of dollars (total). That would be really surprising as no Baez album since the 80s has gone gold. In today’s world of streaming etc. it seems very unlikely. While there’s a big (by our standards) publicity push, it’s not like her label is paying HMV to put Whistle Down the Wind on an endcap. Obviously, it’s still a pretty significant career boost, so that’s a benefit as well and a pretty significant one.

Note: I just went to HMV and Whistle Down the Wind does have special placement. I don’t know if I just missed it yesterday or they put it up after I was there. You can see in on the “New and Trending” wall.

Thus, we have to deal with issues of appropriation and inappropriateness.

The song came to Zoe, as many do. The election of Trump had just happened and she kept thinking about how we were going to miss the Obama’s in the White House. The contrast in policy and propriety between the Obama administration and the Trump could not be more dramatic. “The President Sang Amazing Grace” came out of that feeling of loss and dread. She was concerned about whether she had the right…or whether it was right…to write and record and perform this song. She consulted with various people who were positive, but we both can imagine other people who would not be. There is a case for it being, if not quite typical appropriation, of being inappropriate. There’s inherently some degree of standing over rather than standing with when people in our position benefit from our reactions to such events. There’s also some standing with!

One mitigation is to donate some chunk of the royalties (or beyond!) to Black Lives Matter (or similar groups; BLM is our first stop). That’s our current plan.

The best thing would be for history to change so the shooting never happened and that Cynthia Marie Graham Hurd, Susie Jackson, Ethel Lee Lance, Depayne Middleton-Doctor, Clementa C. Pinckney, Tywanza Sanders, Daniel Simmons, Sharonda Coleman-Singleton, and Myra Thompson survived that day as an ordinary, quiet day.