Transplanting a Seattleite

Once upon a time, when the first Bladerunner movie came out and I was obsessed with all things Harrison Ford (I got over it, as I think most of us have), I tracked down the Alan Nourse book as a paperback in a library. I tried reading it then, and was incredibly confused. I somehow learned that the movie was based on PK Dick’s Do Androids Dream of Electric Sheep, and tried reading that, and didn’t much care for that either. I’d always known that the relationship of written works to derivative plays / film / TV series was fraught, but wow, this whole thing was Extra.

Recently, I realized I could access The Bladerunner by Nourse via Kindle Unlimited. I selected it, and it sat around until today, when I tried to read it. And I’ll just say straight up: it’s a really bad book. It’s bad science fiction, because there’s all this complicated pay phone stuff while at the same time there are autohelicopters that you can make video calls from. Make it make sense. Don’t tell me no one had imagined mobile phones. Everyone knew all about tricorders and communicators from Star Trek: TOS, and everyone knew about mobile phones. Cellular phones were ever so slightly later, but plans were in the works by the time this thing was published. It’s just bad science fiction.

That would make it problematic, but nothing can save this book from its reprehensible politics. It’s honestly reassuring to learn that Heinlein dedicated Farnham’s Freehold to Nourse, and Friday was based in part on Nourse’s wife. Nourse’s actual career as an actual medical doctor was, shockingly, even shorter than my career as a programmer, which is really saying something. The description of the robots trying to learn from Dr. Long (surely a reference back to Heinlein) and Dr. Long’s efforts to subvert that process are on a par with all the episodes of bad SF TV in which someone logics some piece of alien something or other into exploding because of a paradox or whatever.

While it is nice to have a depiction of disability in SF, when you name the person with the clubfoot Billy Gimp, it’s real hard to have any respect for the author.

But I think the most insane part of all of this is the backstory on how what sounds like Medicare for All broke healthcare and all of society. This is the weirdest fever dream straight from a Republican member of the AMA in the 1950s, complete with an anti-healthcare mob firebombing the doc’s house, killing his wife and baby, as part of his motivation for providing illicit health care. The eugenics component of the story is exceptionally wild, 100% the kind of nonsense that circulated during the debates leading up to the ACA. In this world, you can only get official health care at government clinics if you agree to sterilization if you get treatment more than three times. They don’t do this to kids under 5, but apparently they really are doing tubals prepubescent girls and vasectomies on prepubescent boys. I think if I kept reading, I’d find out they were euthanizing some of the patients, but I’m not inclined to stick around for that. I nearly bailed out when Doc Long starts smoking a pipe _at the hospital_. But what did me in was the explanation how vaccinations campaigns wiped out natural resistance and that’s why everyone kept getting sick.

“A medical triumph [successful childhood vaccinations against diphtheria in the 1940s and 1950s], it had seemed, until sporadic outbreaks of a more virulent, drug-resistant form of diphtheria began striking adults in the 1970s, with antibiotic treatment now ineffective and the death rate rising to over 60 percent of all victims. Within another ten years widespread epidemics were sweeping the country and mass immunization campaigns were needed to damp the flame of a dreadful disease running wildfire through a population left naked of any natural resistance.”

Ok, what the actual fuck. Obviously, none of this actually happened, but what we’re seeing here is someone who almost certainly was run out of medicine in the 1950’s because he was anti-vax then uses science fiction to predict that diphtheria will kill off 60% of its adult victims in waves, during the same time frame that old people are living longer and longer? How does that even work? Also, having diphtheria does not protect that well against getting it again! Worse than vaccination, actually! This is so weird!

“Rupert Heinz had analyzed this pattern and come up with a frightening thesis: that medical intervention in itself had contributed the lion’s share to the massive spread of this virulent infection. Without immunizations earlier in the century, natural resistance would have kept the milder disease under control; now even a massive immunization campaign would be no more than a stop-gap, with horrible future epidemics to be expected as new virulent strains of diphtheria developed in the population.”

Anyway. While this book is of moderate interest as a window into just how long a certain strain of thinking has been kicking around in some corners of our society (Nourse did not make it to 70, and he died in Thorp, so I’m pretty sure we all know what corners I’m referring to), it’s way too painful for me to actually finish reading.

DNF. Ugh.

I haven’t read any James White in years, but I remember really loving the Sector General stories and novels. Having perused the wikipedia entries for White and Nourse, it’s not hard to understand why I loved White, and why I bounced so hard off of Nourse. Now, while experiencing moderate temptation to reread White, mostly I’m remembering enjoying Jenny Schwartz’s book, Doctor Galaxy, and wondering if there’s anything else current in the mashup of doctor / hospital stories and science fiction that I have sometimes enjoyed and sometimes abhorred.

ETA: I’ve never read S.L. Viehl’s Stardoc series, so I’m off to try a sample of that.

ETAYA: Accidentally stayed up late reading Stardoc. This is not great literature, but at least it’s fun!

Here’s an odd one.

https://www.science.org/content/article/war-prediabetes-could-be-boon-pharma-it-good-medicine

I have some mixed feelings about this. It quotes John Ioannidis favorably, and during the pandemic he was pretty vocal in ways that people got pretty mad about and I just don’t know what to think of him.

I was kind of startled by this paragraph:

“A 2011 study in JAMA examined health outcomes in women living in stressful, low-income housing projects who had been randomized into three groups: One got a voucher for better housing and help moving, one a voucher for moving to any area without help, and a control group got neither. Women who got the most housing assistance suffered the least obesity and diabetes—over 20 years, about 15% had become diabetic, compared with 20% in the control group.”

I landed in this article because I got curious about old people (>80 years of age, come on, that is old, don’t argue with me) taking diabetes medication that they did not need (that doctors had told them they did not need). I had heard about a friend’s father doing this, and then I recently learned that I knew someone more closely related to me who was doing this. I wondered if this was common and tried to design a search to answer the question, failed, but ran across interesting other things such as this.

I guess we really should focus on housing first.

Also, I ran across one of those cool Danish studies about olds taking diabetes medication, when (if) they discontinued, when they died, lots of interesting statistics.

Basically, if you are taking medication for your diabetes or prediabetes or whatever, it is in hopes of benefiting about 7 years in the future from reduced risk of wtf. If you are over 75, it’s not clear whether there is any hope of there being such a benefit, and if you are well into your 80s, the odds are very much against living long enough to enjoy it, even if there would be one if you did.

I gotta say, revelatory. I love shit like this. Perspective is all.

You are probably trying to avoid the news, so following this link right now could lead to problems for you.

https://www.nytimes.com/2020/10/27/health/meth-addiction-treatment.html

I will summarize in detail instead! OK, basically describe the underlying thing and sprinkle with my own opinions.

There is a thing called “contingency management” for treating addiction. If you are treating opioid addiction, medication management is the gold standard, but not for people who have trouble with stimulants, especially meth. If you have any familiarity with incentives, you know some of the following:

(1) Incentives can be “intrinsic” or “extrinsic”. “Intrinsic” incentives are good-feelings produced by something inherent in the action / behavior / activity. For example, if you love looking at a completed jigsaw puzzle, then this is an “intrinsic” reward for doing jigsaw puzzles. If someone pays you for doing a jigsaw puzzle (or cooks you dinner in exchange for helping with a jigsaw puzzle, or praises you for doing a jigsaw puzzle), this is an “extrinsic” incentive or reward.

(2) Contrary to literally everything you have ever heard about good parenting, uncertainty of extrinsic rewards makes them way more effective as incentives. If literally _every single time_ you feed the dog, your parent says, “You are a good boy, Johnny”, then the day the parent does not say that is the day you stop feeding the dog. But if your parent says, “You are a good boy, Johnny”, about 1 our of 3 times you feed the dog, and it is not predictable (like you sometimes get it twice in a row, and sometimes you go 5 times without hearing it), you will _never_ stop feeding the dog and you might get a new dog when the dog dies, in hopes that the parent will say you are a good boy, and you might even keep trying to get the good boy after you have moved out and/or the parent has died.

(3) Whenever people receive extrinsic rewards for an activity, whether it is consistent or inconsistent and _even if they originally did the activity for intrinsic reasons_, they tend to stop. So, if you turn your hobby into a job, and then quit getting paid, you will probably NOT go back to doing it as a hobby (there are exceptions). If you quit using meth because you are getting paid (unevenly) for not using, then when you quit using, you are at very high risk of relapse.

Some genius figured, hey, let’s set up some erratic extrinsic rewards for people passing their drug test / showing up for therapy or group / getting detoxed, etc. One version involves pulling pieces of paper from a bowl. Some say, “You are a good boy, Johnny”, some are $1, $10, $25, whatever. Usually, it is not cash cash, but constrained cash (card usable at a certain group of coffee shops in the facility, or one of those EBT type cards that does not let you buy alcohol or whatever with it. Maybe it is coupons for free egg mcmuffin or whatever.

Lots of people have lots of issues with this, and an obvious one is, while people do show up for their therapy, and they start to get the intrinsic benefits of therapy / group / whatever, an awful lot of people relapse when the extrinsic (money) rewards stop entirely. OTOH, keeping them going forever would probably be cheaper than what we do with these kinds of people, so there are people in favor of permanently instituting this as a recovery management tool.

I think the whole thing is pretty interesting, and since AA thinks you should go to AA meetings forever, and people on methadone are expected to be on methadone forever, and in general, people need money to live, contingency management (compensating people with really serious meth issues) seems like an entirely plausible strategy to me. I mean, we gotta eat to live, and people with Borderline Personality Disorder are expected to need maintenance therapy forever and all that is more expensive than this. If you want people to show up to take their drug test, paying them to do so is one of the cheapest ways of getting them to be there (arresting them and/or assigning someone and paying that person to track them down and drag their ass in are all more expensive). If on top of that, paying them erratically can get them to take the drug test _and not use drugs so they test negative_, well, bonus!