Andrew Hickey

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July 8th, 2014: La Marseillaise, ladies and gentlemen! I actually don't know what the anthem of the Klingon Empire is :( :( D: – Ryan

The more I think about it, the more I think a humble, sympathetic, non-domineering, non-entryist engagement with the anti-oppression movements springing up around issues of gender identity (i.e. Trans issues) is going to be absolutely crucial for the Left in the coming years. 

This isn't just a moral imperative.  Sure, the Left must stand with the oppressed.  Always.  By definition.  Otherwise why bother being on the Left?  Otherwise, what does 'The Left' mean?  But it's also a tactical imperative.  The system must be attacked at its weakest points.  The righteous and rightful rage felt by many on the axis of Trans oppression is absolutely one of the system's weakest points.  It hits people where they live: in their bodies.  Bodies are oppressed, disciplined, punished, curtailed, invaded, wounded and even dissected by capitalism... and it behoves the Left to realise that this happens in arenas outside the sites of direct capitalist production.  This is one of those things that everyone formally 'gets' and then puts to one side.  That's not good enough.  Capitalist oppression is total, hegemonic, far-reaching and omnipresent.  It is intimately and demonstrably bound up with oppression along lines of personal identity, bodily autonomy, bodily identity, sexual identity, gender, sexuality, and race.  This is why intersectionality is a crucial concept that's only going to get more crucial.  The task will be to relate all these issues to class.  Not so that they can be subsumed, assimilated and/or digested, but so the analysis wielded by the Left can be enlarged, educated, made stronger and more inclusive.  That is an end in itself - if we know what our ultimate goal really is.

The good news is that class is as intimately bound up with these things as the Left thinks it is.  The bad news is that we have to stress the importance of class without playing 'issue trumps' (i.e. our preferred axis of oppression is more crucial or 'primary' or 'causal' than yours... and, by the way, how dare you stress the issues that hit you where you live before the issues that we think of as theoretically more important???). 

But there is more good news.  We can stress how capitalism, and thus class exploitation along lines of work and wage exploitation (which is basically just another way of saying 'capitalism'), generates and exacerbates such oppression... for the simple reason that it bloody does; it's the currently regnant form of class society, and we can adduce powerful facts to show how the structure of class society generates sexism, female oppression, gender essentialism, the reduction of people to categories, the reification of socially constructed categories into hegemonic 'facts of life', etc. 

That's why this is so good.  There isn't anything in there that constitutes new and startling revelation, but it's a great little summary/primer/starting-point, from the perspective of a totally 'on-side' Marxism.  I found it so anyway - speaking as someone who personally embraces the elderly Goya's maxim "I'm still learning".

One (related) crucial issue to remember... and here I'd proffer the great work of Silvia Federici... is that the oppression of women is not an optional extra with capitalism, nor is it a by-product of capitalism.  It is certainly generated and exacerbated by capitalism (part of the argument the Left needs to make) but is also a precondition of capitalism, intimately bound up with the creation of capitalism, and partly capitalism's parent. 

The oppression of women existed before capitalism, because capitalism is a form of class society built on top of previous forms of class society (in Europe, feudalism)... just as the capitalist states are forms adapted from pre-capitalist states.  And the rise of capitalism in Europe was absolutely and fundamentally bound up with the further domestication, persecution and economic subjugation of women (see Federici, among others).  There really is very little wiggle room here to say that one caused the other.  They are two sides of the same coin.  And 'causality' or 'primary position' loses its meaning in a truly dialectical (i.e. a truly Marxist) analysis.  Besides, its an academic question.

LGBTQIA+ oppression is, once again, related.  (BTW: please forgive my using the long acronym as shorthand if you don't like the 'lumping together' effect, or if you're on the other side and worry that trying to be that inclusive accidentally implies that anything not covered is, by definition, not included... and also, please don't construe my raising of LGBTQIA+ oppression as an afterthought.)  LGBTQIA+ oppression is intimately connected with the issue of women's oppression, and not in the sense of being a 'product' or 'by-product' or 'side effect' of it, but rather as another aspect of the suffocating enforcement and reification of gender that class society entails, relies upon, and by which it is partly produced.

As a fledgling nerd in my teens and early twenties, grammar pedantry was an important part of geek identity for me. At the time, I thought that being a geek had a lot to do with knowing facts and rules, and with making sure that other people knew you knew those facts and rules. I thought that people wouldn’t be able to communicate with each other clearly without rigid adherence to grammatical rules, a thought that may have been influenced by the predominance of text-based, online communication in my social life at the time.

The image shames people for where they place commas and suggests sarcastically that a punctuation error could result in misunderstanding of a suggestion to have a meal as a suggestion to practice cannibalism.

If Facebook had existed at the time, I would have been sharing this image, and others like it, with the best of them. I was sure that correct use of punctuation and adherence to the grammatical rules of standard American English was an essential step along the way to achieving truth, justice, and the American Way. Though I wasn’t sure exactly how. It definitely seemed a lot easier to teach people how to use commas correctly than to teach them how to take another’s point of view (something I wasn’t very good at myself at the time), and like the drunk looking for their keys underneath the lamppost because that’s where it’s easier to see, I ran with it.

Nerds, Rules, and Race

A few years ago, Graydon Hoare mentioned Mary Bucholtz’s article “The Whiteness of Nerds” (PDF link) to me. As a recovering grad student, I don’t read a lot of scholarly articles anymore, but this one has stayed with me. Perhaps that’s because the first time I read it, felt embarrassed. I felt that I had been read. By this point, I suppose I had let go of some of my attachment to grammar pedantry, but I still felt that it was just a bit of harmless fun. I realized that without being consciously aware of it, I had been using devotion to formal rules as a way to perform my whiteness — something that I would certainly have denied I was doing had someone accused me of such.

Bucholtz argues, in short, that geek culture (among American youths) is a subculture defined, essentially, by being whiter than white:

“This identity, the nerd, is racially marked precisely because individuals refuse to engage in cultural practices that originate across racialized lines and instead construct their identities by cleaving closely to the symbolic resources of an extreme whiteness, especially the resources of language.”

Bucholtz is not saying that there are no nerds of color — just that nerd culture, among the teenagers she studied, was defined by hyper-devotion to a certain set of white cultural norms (which some youths of color are perfectly happy to adopt, just as some white youths perform an identification with hip-hop culture).

If we accept her analysis of nerd culture, though, it’s clear that it excludes some people more than others. Adopting hyper-whiteness is an easier sell for people who are already white than for people who are potentially shrugging off their family of origin’s culture in order to do so. If it’s assumed that a young person has to perform the cultural markers of nerd culture in order to be accepted as someone who belongs in a science class or in a hackerspace, then it’s harder for youths of color to feel that they belong in those spaces than it is for white youths. That’s true even though obsessing about grammar has little to do with, say, building robots.

In my own youth, I would have said that I liked nitpicking about grammar because it was fun, probably, and because I wanted to communicate “correctly” (perhaps the word I would have used then) so that I could be understood. But was I harping over it for the intrinsic pleasure of it, or because it was a way for me to feel better than other people?

I think people who have been bullied and abused tend to use rules in the hopes that rules will save them. It’s true that many kids who are academically gifted and/or interested in science, math and engineering experience bullying and even abuse, even those who are otherwise (racially, gender-wise, and economically) privileged. It’s also true that some of the same people grow up to abuse their power over others in major ways, as most of the previous posts on this blog show. As a child, I thought that someday, someone was going to show up and stop my mother from abusing me and that that would be made possible by the fact that it was against the rules to hit children. I think that’s part of how I got so interested in formal systems of rules like grammar — eventually leading me to pursue programming language theory as a field of study, which is about using formal systems of rules to make computers do things. I suspect many nerds had a similar experience to mine.

But it’s easier to like formal systems of rules when those rules usually protect you. If you live in a country where the laws were made by people like you, and are usually enforced in ways that protect you, it’s easier to be enamored of technical adherence to the law. And, by analogy, to prescriptive sets of rules like “standard English” grammar. It’s also easier to feel affection for systems of rules when people like yourself usually get a say in constructing them.

Not all nerds are abuse survivors, so perhaps other nerds (as adults) value rule-following because they believe that their aptitude for compliance to formal systems of rules is the key to their economic success. From there, it’s easy to jump to victim-blaming: the line of thought that goes, “If other people would just learn and follow the rules, they would be successful too.”

“Mrs. Smith is a wonderful linguist. Give her a few hours with a grammar and she’ll know everything except the pronunciation.” — Graham Greene, The Comedians

In Graham Greene’s novel The Comedians, set in Haiti in the 1950s, Mrs. Smith — an American who is in the country to proselytize for vegetarianism (not realizing that in the country she’s visiting, nobody can afford to eat meat) — believes that all she needs to do to speak the language of the natives, wherever she’s going, is to memorize the language’s grammatical rules. Not only does she not (apparently) realize the difference between Haitian Creole and Parisian French, she doesn’t seem to know (or doesn’t care) about idioms, slang, or culture. If she really is a wonderful linguist, perhaps she has a native ability to pick up on connotations, which she’s discounting due to her belief that adherence to rules is what makes her successful.

In general, it’s possible that some grammar pedantry is motivated by a sincere belief that if others just learned how to speak and write standard English, they’d be able to pull themselves up by the proverbial bootstraps. But success doesn’t automatically grant insight into the reasons for your success. Maybe understanding rules is secondary to a more holistic sort of talent. Maybe you’re ignoring white privilege, class privilege, and other unearned advantages as reasons for your success, and others won’t enjoy the same outcome just by learning to be good at grammar.

Maybe it’s especially tempting for programmers to play the prescriptivist-grammar game. By nature, programming languages are prescriptive: for programs to make sense at all, a language has to have a formal grammar, a formal mathematical description of what strings of characters are acceptable programs. If there was a formal grammar for English, it would say, for example, that “The cat sat on the mat.” is a valid sentence, and “Mat cat on the sat.” is not. But there isn’t one; English is defined by what its speakers find acceptable, just as every other human language is. Different speakers may disagree on what sentences are acceptable, so linguists can outline many different dialects of English — all of which are mutually understandable, but which have different grammatical rules. There is no correct dialect of English, any more than any given breed of dog is the correct dog.

Programming consists largely of making details explicit — because you’re talking to a not-very-bright computer — that most other humans would be able to fill in from context. Context is why most of the grammar memes that people share are very shallow: no English speaker would actually sincerely confuse “Let’s eat Grandma!” with “Let’s eat, Grandma”, because of contextual knowledge: mostly the contextual knowledge that humans don’t treat each other as food and so the first sentence is very unlikely to be intended, but also the contextual knowledge that we’re talking to Grandma and have been talking about preparing dinner (or, I suppose, the knowledge that we have survived a plane crash and are stranded with no other food sources). If punctuation really was a life-and-death matter any appreciable portion of the time, the human race would be in deep trouble — on the whole, we’re much better at spoken language, and written language is a relatively recent and rare development.

But I think programmers have a good reason to value breaking rules, because that’s what programmers do whenever they are being truly creative or innovative (sometimes known as “disruption”). Hacking — both the kind sometimes known as “cracking” and the legal kind — are about breaking rules. In spoken language, grammatical rules are often (if not always) developed ex-post-facto. It’s probably more fun to study how people actually use language and discover how it always has internal structure than it is to harp on compliance with one particular set of rules for one particular dialect.

Bucholtz argues that nerds are considered “uncool” by virtue of being too white, surprisingly, since white people are the dominant cultural group in the region she was studying. She made that observation in 2001, though. Now, in 2014, “nerd” has come to mean “rich and high status” (at least if you’re male), much more than it means “unpopular and ignored”. We hear people talk about the revenge of the nerds, but are we really talking about the revenge of the hyper-white? Nerds often see themselves as rebelling against an oppressive mainstream culture; is it contradictory to resist oppression by defining oneself as “other” to the oppressor culture… by outdoing the oppressor at their own game?

Bucholtz addresses this question by arguing that while “cool” white youths walk a delicate balance between actng “too black” and “too white”, “nerdy” white youths resolve this tension by squarely aiming for “too white”. I don’t think she would say that the “cool” white kids are anti-racist, just that in defining themselves in opposition to the cool kids’ appropriation of Black American culture, nerds run the risk of behaving so as to devalue and stigmatize the culture being appropriated, intentionally or not.

Moreover, we know that cultural appropriation isn’t a respectful act; are the “hyper-white nerds” actually the anti-racist ones because they refrain from appropriating African-American culture? And does it matter whether we’re talking about youth culture (in which intellectualism can often go unappreciated) or adult culture (where intellectualism pays well)? I’d welcome any thoughts on these questions.

Unbundling Geekiness

What am I really doing if I click “Share” on that “Let’s eat Grandma!” image? I’m marking myself as discerning and educated, and I don’t even have to spell out to anyone that by doing those things, I’m shoring up my whiteness — the culture already did the work for me of convincing everyone that if you’re formally educated, you must be white; that if you aren’t, you must be poor; and then if you’re a person of color and formally educated, you must want to be white. I’m also marking myself as someone who has enough spare time and emotional resources to care a lot about something that has no bearing on my survival.

Incidentally, I’m also marking myself as someone whose neurology does not make it unusually difficult to process written language. There are similar memes I can share that would also mark me as someone who is not visually impaired and thus does not use a screen reader that would make it impossible for me to spell-check text for correct use of homophones. An example of the latter would be a meme that makes fun of someone who writes “fare” instead of “fair”, when the only way to avoid making such a typographical error is to have the ability to see the screen. In “Why Grammar Snobbery Has No Place in the Movement”, Melissa A. Fabello explores these points and more as she argues that social justice advocates should reject grammar snobbery. I agree, and also think that geeks — regardless of whether they also identify as being in “the movement” — should do the same, as it’s ultimately counterproductive for us too.

Geek identity doesn’t have to mean pedantry, about grammar or even about more substantive matters. The Hacker School Rules call out a more general phenomenon: the “well-actually”. The rules define a “well-actually” as a correction motivated by “grandstanding, not truth-seeking”. Grammar pedantry is almost always in the former category: it would be truth-seeking if it was about asking what unclear language means, but it’s usually targeted at language whose meaning is quite clear. I think that what the Hacker School document calls “grandstanding” is often about power dynamics and about who is favored and disfavored under systems of rigid rules. But rules are to serve values, not the other way around; I think geekiness has the potential to be anti-racist if we use our systems of rules in the service of values like love and justice, rather than letting ourselves be used by those systems.

Thanks to Chung-Chieh Shan and Naomi Ceder, as well as Geek Feminism bloggers Mary and Shiny for their comments on drafts.

Thursday:

This time it’s Tom Clarke writing in the Gruaniad to assert:

“How the Tories chose to hit the poor”

http://www.theguardian.com/commentisfree/2014/jul/02/tories-poor-george-osborne-inequality-conservatives

(and just look at all those buzzwords in that URL!)

“George Osborne claims to have cut inequality,” adds the sub-editor. “But look behind the figures and it's clear the Conservatives can't take any credit.”

To summarize: the existing data points do not agree with his thesis so he says that they don't count and makes up what next year's figures will say instead.

It seems Iain Drunken Swerve isn’t the only one for whom denial is a preferred tactic.


The implications of the piece are that the CHOICES of the Coalition are bad ones, and therefore that any beneficial outcome is accidental. To come to that conclusion it is necessary to downplay, ignore or indeed run away and hide from the contribution of the Liberal Democrats to Coalition policy.


Inequality, measured by the Office for National Statistics figures for 2011/12, FELL in the UK under the Coalition, and the new 2012/13 figures show that fall has not reversed.

As Lib Dem Voice reports, the Institute for Fiscal Studies have commented that inequality is now lower than since before Tony Blair brought Labour back into government in 1997.

This is a fact.

A startling one but indisputably a fact. Startling not just because this is the first fall in inequality for nearly three decades, but also because it is unique among Western nations.

Is this a beneficial outcome?

What has happened has happened in the worst way. I – and I think most Liberals – would prefer to reduce inequality by raising everyone up, not grinding the richest down. Making the rich pay, that’s Labour’s way. In this recession, everyone has had to take a hit, including hitting some of the least well off, but proportionately the better off you were the more you’ve been asked to pay – from each according to their means, as it were. And it must gall Labour and the left that this Coalition has been more socialist than the socialists ever were.

But if, as Labour do, you subscribe to the “Spirit Level” thesis that more equal societies are happier, healthier and better then you would have to say this is a beneficial outcome. Even if you don’t subscribe, you would have to accept that the cost of the Crash had to be borne by someone, and these figures show that the better-off have shouldered their share of the burden. Those better able to pay have paid and as a result there has been a slight rebalancing of income after tax and benefits.

So is this just by accident or does it down to the choices we have made in government?

It is not difficult to see how it’s happened. Salaries were frozen or even reduced, whereas, at the insistence of the Liberal Democrats, benefits continued to be increased*, and with a triple lock pensions – more than half the Social Security budget – were and still are increased by even more.

(*Full disclosure: for the period covered by these figures, benefits were increased in line with inflation. For 2013/14 benefits were still increased, but we could not stop George Osborn capping many increases, but not pensions, at 1% – a cut in real spending power as it is below the rate of inflation. Because pensions increase by more than inflation, the impact of this is uncertain, but it does, of course, form the basis of Mr Clarke’s speculation that inequality will rise again in next year’s official figures.)

Add to that the effect of the flagship Liberal Democrat tax policy of raising the personal allowance, a tax cut directly aimed at the less well-off earners.

And the Liberal Democrats also required, in the price for Coalition, that Capital Gains Tax – a tax largely paid by the well-off – be increased from Labour’s inequality-creating low level of 18% to a more reasonable 28%.

Furthermore, the Lib Dems would not let Master Gideon reduce the top rate of tax from 50% to the 40% rate that it was under Labour.

Remember when Labour raised the top rate to 50p… for a MONTH. The Coalition because of the Liberal Democrats has a rate of 45% that is still higher than under any budget presented by Gordon Brown.

Remember when Labour DOUBLED the tax paid by those in the lowest band, and how Mr Balls still wants to reintroduce the 10p starting rate? The Coalition because of the Liberal Democrats gave those people a ZERO starting rate and took them out of paying income tax altogether!

You can see the theme here: Labour under Mr Blair and Mr Brown – who, if you recall, were in the words of Mr Peter “Prince of Darkness” Mandelson: “intensely relaxed about people getting filthy rich” – saw inequality rise like a rocket. The Coalition, because of Liberal Democrats’ fair tax policies, has seen a remarkable fall.

For that fall in inequality to come about because “the Tories chose to hit the poor” IS. NOT. POSSIBLE.


Remember Labour’s COMPLICITY in the Great Crash of the Twenty-Nothings. It wasn’t ALL down to a few “rogue bankers”. I’ve written before of how Labour’s “borrow and spend” economic policy buoyed the bubble, how their “let the good times roll (on tick)” philosophy cheered on many millions of small borrowers to risk more than they could afford on the (fictitious) promise of a never-ending supply of cheap money lent from China – how often did Gordon Brown say “no more boom and bust”? What did he think he was encouraging people to do?

Remember how Labour were taking bungs and favours from everyone from Bernie Eccleston to Rupert Murdoch. They were deeply entwined with the really filthy rich.

Remember the facts of what Labour really DID, not the fairy story of good times that they want you to believe in.

Labour, even when they nationalised a bank or two, were only ever socialist by accident; we have achieved this by design.

In this crash (which, whatever the causes, you have to admit happened on Labour’s watch) everyone has done worse. But Liberal Democrat choices have made good on the Chancellor’s promises of being “all in this together”.

And that’s important to us because we CARE about a Fairer Society as well as a Stronger Economy.

The impression from his article is that Mr Clarke appears not to care that Labour never really cared at all.

"…so when the truth finally outs, what will be the response?"

Practically an admission there that he doesn't know that either. So he’s just making that answer up too. Not necessarily an unreasonable prognostication – Mr Drunken Swerve has form – but still not in fact fact.

The 2013/14 data – when it comes out next year – may (or may not!) undermine the Chancellor's current statement, but at least Mater Gideon is basing his words on the facts as they are known now. Mr Clarke and the Graun are not.

And the confirmation bias of 450 below the line CiFers nodding and saying “he’s right you know” does not count as supporting evidence.

Mr Clarke touches their G (for Grauniad) spot again by referring to the 2008 crash as “Lehman Brothers' implosion” pinning the blame on the bank and definitely not the profligacy of any governments that might have supposedly had oversight of the economy at the time.

And again we have the lazy accusation against the Coalition of “a government that has lurched to the right”.

Then there is this:

"This week's data only takes us up to this point, the financial year that began in April 2012"

This is such a weirdly constructed sentence that I have to wonder if it's deliberate. If you are talking about the point that the data takes us to, then surely it only makes sense to talk about the *end* of that Financial Year, so April 2013.

By using 2012 (whether by accident or design) it conveys the impression that the data is even more out of date and only covers maybe a year or so when the Coalition were in charge, rather than 60% of the current Parliament.

If you are going to criticize the use of statistics by others, then you must take the greatest care that no distortion creeps into your own version – that he has failed to do so critically undermines his argument.

I realize Mr Clarke has a book to sell – it’s actually advertised right there in the article (or “advertising feature” as these things used to be called) and "oops I have no evidence" doesn't help with that, but really this is just hiding from the facts.

Inequality has fallen. This is not because the Tories chose to hit the poor. It’s because the Liberal Democrats chose to defend the poorest-off where we could and to raise fair taxes from the rich.

Miri – the person, not the organization – writes about depression. There’s a lot there worth thinking about, but one part caught my eye:

I’m a little tired of being told that SSRIs “don’t work” when they’re part of the reason I didn’t try to off myself four years ago. There is compelling evidence to suggest they do not actually work and there is compelling evidence to suggest that they do actually work, so I’m comfortable saying that the jury’s still out on this one.

I think the jury is less out now than it was a couple of years ago. I think there’s at least kind of a consensus on the data, mixed with a lot of debate over how to express a very complicated reality to the public in a concise way.

And I am going to bypass that debate by just braindumping eight thousand words worth of very complicated reality on you.

The claim that “SSRIs don’t work” or “SSRIs are mostly just placebo” is most commonly associated with Irving Kirsch, a man with the awesome job title of “Associate Director Of The Program For Placebo Studies at Harvard”.

(fun fact: there’s actually no such thing as “Placebo Studies”, but Professor Kirsch’s belief that he directs a Harvard department inspires him to create much higher-quality research.)

In 1998, he published a meta-analysis of 19 placebo-controlled drug trials that suggested that almost all of the benefits of antidepressants were due to the placebo effect. Psychiatrists denounced him, saying that you can choose pretty much whatever studies you want for a meta-analysis.

After biding his time for a decade, in 2008 he struck back with another meta-analysis, this being one of the first papers in all of medical science to take the audacious step of demanding all the FDA’s data through the Freedom of Information Act. Since drug companies are required to report all their studies to the FDA, this theoretically provides a rare and wonderful publication-bias-free data set. Using this set, he found that, although antidepressants did seem to outperform placebo, the effect was not “clinically significant” except “at the upper end of very severe depression”.

This launched a minor war between supporters and detractors. Probably the strongest support he received was a big 2010 meta-analysis by Fournier et al, which found that

The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

Of course, a very large number of antidepressants are given to people with mild or moderate depression. So what now?

Let me sort the debate about antidepressants into a series of complaints:

1. Antidepressants were oversold and painted as having more biochemical backing than was really justified
2. Modern SSRI antidepressants are no better than older tricyclic and MAOI antidepressants, but are prescribed much more because of said overselling
3. There is large publication bias in the antidepressant literature
4. The effect size of antidepressants is clinically insignificant
5. And it only becomes significant in the most severe depression
6. And even the effects found are only noticed by doctors, not the patients themselves
7. And even that unsatisfying effect might be a result of “active placebo” rather than successful treatment
8. And antidepressants have much worse side effects than you have been led to believe
9. Therefore, we should give up on antidepressants (except maybe in the sickest patients) and use psychotherapy instead

1. Antidepressants were oversold and painted as having more biochemical backing than was really justified – Totally true

It is starting to become slightly better known that the standard story – depression is a deficiency of serotonin, antidepressants restore serotonin and therefore make you well again – is kind of made up.

There was never much more evidence for the serotonin hypothesis than that chemicals that increased serotonin tended to treat depression – making the argument that “antidepressants are biochemically justified because they treat the low serotonin that is causing your depression” kind of circular. Saying “Serotonin treats depression, therefore depression is, at root, a serotonin deficiency” is about as scientifically grounded as saying “Playing with puppies makes depressed people feel better, therefore depression is, at root, a puppy deficiency”.

The whole thing became less tenable with the discovery that several chemicals that didn’t increase serotonin were also effective antidepressants – not to mention one chemical, tianeptine, that decreases serotonin. Now the conventional wisdom is that depression is a very complicated disturbance in several networks and systems within the brain, and serotonin is one of the inputs and/or outputs of those systems.

Likewise, a whole bunch of early ’90s claims: that modern antidepressants have no side effects, that they produce miraculous improvements in everyone, that they make you better than well – seem kind of silly now. I don’t think anyone is arguing against the proposition that there was an embarrassing amount of hype that has now been backed away from.

2. Modern SSRI antidepressants are no better than older tricyclic and MAOI antidepressants, but are prescribed much more because of said overselling – First part true, second part less so

Most studies find SSRI antidepressants to be no more effective in treating depression than older tricyclic and MAOI antidepressants. Most studies aren’t really powered to do this. It seems clear that there aren’t spectacular differences, and hunting for small differences has proven very hard.

If you’re a geek about these sorts of things, you know that a few studies have found non-significant advantages for Prozac and Paxil over older drugs like clomipramine, and marginally-significant advantages for Effexor over SSRIs. But conventional wisdom is that tricyclics can be even more powerful than SSRIs for certain very severe hospitalized depression cases, and a lot of people think MAOIs worked better than anything out there today.

But none of this is very important because the real reason SSRIs are so popular is the side effect profile. While it is an exaggeration to say they have no side effects (see above) they are an obvious improvement over older classes of medication in this regard.

Tricyclics had a bad habit of causing fatal arrythmias when taken at high doses. This is really really bad in depression, because depressed people tend to attempt suicide and the most popular method of suicide attempt is overdosing on your pills. So if you give depressed people a pill that is highly fatal in overdose, you’re basically enabling suicidality. This alone made the risk-benefit calculation for tricyclics unattractive in a lot of cases. Add in dry mouth, constipation, urinary problems, cognitive impairment, blurry vision, and the occasional tendency to cause heart arrythmias even when taken correctly, and you have a drug you’re not going to give people who just say they’re feeling a little down.

MAOIs have their own problems. If you’re using MAOIs and you eat cheese, beer, chocolate, beans, liver, yogurt, soy, kimchi, avocados, coconuts, et cetera, et cetera, et cetera, you have a chance of precipitating a “hypertensive crisis”, which is exactly as fun as it sounds. As a result, people who are already miserable and already starving themselves are told they can’t eat like half of food. And once again, if you tell people “Eat these foods with this drug and you die” and a week later the person wants to kill themselves and has some cheese in the house, then you’re back to enabling suicide. There are some MAOIs that get around these restrictions in various clever ways, but they tend to be less effective.

SSRIs were the first class of antidepressants that mostly avoided these problems and so were pretty well-placed to launch a prescribing explosion even apart from being pushed by Big Pharma.

3. There is large publication bias in the antidepressant literature – True, but not as important as some people think

People became more aware of publication bias a couple of years after serious research into antidepressants started, and it’s not surprising that these were a prime target. When this issue rose to scientific consciousness, several researchers tried to avoid the publication bias problem by using only FDA studies of antidepressants. The FDA mandates that its studies be pre-registered and the results reported no matter what they are. This provides a “control group” by which accusations of publication bias can be investigated. The results haven’t been good. From Gibbons et al:

Recent reports suggest that efficacy of antidepressant medications versus placebo may be overstated, due to publication bias and less efficacy for mildly depressed patients. For example, of 74 FDA-registered randomized controlled trials (RCTs) involving 12 antidepressants in 12,564 patients, 94% of published trials were positive whereas only 51% of all FDA registered studies were positive.

Turner et al express the same data a different way:

. The FDA deemed 38 of the 74 studies (51%) positive, and all but 1 of the 38 were published. The remaining 36 studies (49%) were deemed to be either negative (24 studies) or questionable (12). Of these 36 studies, 3 were published as not positive, whereas the remaining 33 either were not published (22 studies) or were published, in our opinion, as positive (11) and therefore conflicted with the FDA’s conclusion. Overall, the studies that the FDA judged as positive were approximately 12 times as likely to be published in a way that agreed with the FDA analysis as were studies with nonpositive results according to the FDA (risk ratio, 11.7; 95% confidence interval [CI], 6.2 to 22.0; P

The same source tells us about the effect this bias had on effect size:

For each of the 12 drugs, the effect size derived from the journal articles exceeded the effect size derived from the FDA reviews (sign test, P

I think a lot of this has since been taken on board, and most of the rest of the research I’ll be talking about uses FDA data rather than published data. But as you can see, the overall change in effect size – from 0.31 to 0.41 – is not that terribly large.

4. The effect size of antidepressants is clinically insignificant – Depends what you mean by “clinically insignificant”

As mentioned above, when you try to control for publication bias, the effect size of antidepressant over placebo is 0.31.

This number can actually be broken down further. According to McAllister and Williams, who are working off of slightly different data and so get slightly different numbers, the effect size of placebo is 0.92 and the effect size of antidepressants is 1.24, which means antidepressants have a 0.32 SD benefit over placebo. Several different studies get similar numbers, including the Kirsch meta-analysis that started this whole debate.

Effect size is a hard statistic to work with (albeit extremely fun). The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision.

Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”.

(please note that “clinically insignificant” is very different from “statistically insignificant” aka “has a p-value less than 0.05.” Nearly everyone agrees antidepressants have a statistically significant effect – they do something. The dispute is over whether they have a clinically significant effect – the something they do is enough to make a real difference to real people)

There have been a couple of attempts to rescue antidepressants by raising the effect size. For example, Horder et al note that Kirsch incorrectly took the difference between the average effect of drugs and the average effect of placebos, rather than the average drug-placebo difference (did you follow that?) When you correct that mistake, the drug-placebo difference rises significantly to about 0.4.

They also note that Kirsch’s study lumps all antidepressants together. This isn’t necessarily wrong. But it isn’t necessarily right, either. For example, his study used both Serzone (believed to be a weak antidepressant, rarely used) and Paxil (believed to be a stronger antidepressant, commonly used). And in fact, by his study, Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. But since the difference was not statistically significant, he averaged them together and said that “antidepressants are ineffective”. In fact, his study showed that Paxil was effective, but when you average it together with a very ineffective drug, the effect disappears. He can get away with this because of the arcana of statistical significance, but by the same arcana I can get away with not doing that.

So right now we have three different effect sizes. 1.2 for placebo + drug, 0.5 for drug alone if we’re being statistically merciful, 0.3 for drug alone if we’re being harsh and letting the harshest critic of antidepressants pull out all his statistical tricks.

The reason effect size is extremely fun is that it allows you to compare effects in totally different domains. I will now attempt to do this in order to see if I can give you an intuitive appreciation for what it means for antidepressants.

Suppose antidepressants were in fact a weight loss pill.

An effect size of 1.2 is equivalent to the pill making you lose 32 lb.

An effect size of 0.5 is equivalent to the pill making you lose 14 lb.

An effect size of 0.3 is equivalent to the pill making you lose 8.5 lb.

Or suppose that antidepressants were a growth hormone pill taken by short people.

An effect size of 1.2 is equivalent to the pill making you grow 3.4 in.

An effect size of 0.5 is equivalent to the pill making you grow 1.4 in.

An effect size of 0.3 is equivalent to the pill making you grow 0.8 in.

Or suppose that antidepressants were a cognitive enhancer to boost IQ. This site gives us some context about occupations.

An effect size of 1.2 is equivalent to the pill making you gain 18 IQ points, ie from the average farm laborer to the average college professor.

An effect size of 0.5 is equivalent to the pill making you gain 7.5 IQ points, ie from the average farm laborer to the average elementary school teacher.

An effect size of 0.3 is equivalent to the pill making you gain 5 IQ points, ie from the average farm laborer to the average police officer.

To me, these kinds of comparisons are a little more revealing than NICE arbitrarily saying that anything below 0.5 doesn’t count. If you could take a pill that helps your depression as much as gaining 1.4 inches would help a self-conscious short person, would you do it? I’d say it sounds pretty good.

5. The effect of antidepressants only becomes significant in the most severe depression – Everything about this statement is terrible and everyone involved should feel bad

So we’ve already found that saying antidepressants have an “insignificant” effect size is kind of arbitrary. But what about the second part of the claim – that they only have measurable effects in “the most severe depression”?

A lot of depression research uses a test called the HAM-D, which scores depression from 0 (none) to 52 (max). Kirsch found that the effect size of antidepressants increased as HAM-D scores increased, meaning antidepressants become more powerful as depression gets worse. He was only able to find a “clinically significant” effect size (d > 0.5) for people with HAM-D scores greater than 28. People have come up with various different mappings of HAM-D scores to words. For example, the APA says:

(0-7) No depression
(8-13) Mild depression
(14-18) Moderate depression
(19-22) Severe depression
(>=23) Very severe depression

Needless to say, a score of 28 sounds pretty bad.

We saw that Horder et al corrected some statistical deficiencies in Kirsch’s original paper which made antidepressants improve slightly. With their methodology, antidepressants reach our arbitrary 0.5 threshold around HAM-D score 26. Another similar “antidepressants don’t work” study got the number 25.

Needless to say, when anything over 23 is “very severe”, 25 or 26 still sounds pretty bad.

Luckily, people completely disagree on the meanings of basic words! Very Severely Stupid is a cute article on Neuroskeptic that demonstrates that five different people and organizations suggest five different systems for rating HAM-D scores. Bech 1996 calls our 26 cutoff “major”; Funakawa 2007 calls it “moderate”; NICE 2009 calls it “severe”. APA is unique in calling it very severe. NICE’s scale is actually the exact same as the APA scale with every category renamed to sound one level less threatening. Facepalm.

Ghaemi and Vohringer(2011) go further and say that the real problem is that Kirsch is using the standard for depressive symptoms, but that real clinical practice involves depressive episodes. That is, all this “no depression” to “severe” stuff is about whether someone can be diagnosed with depression; presumably the people on antidepressants are definitely depressed and we need a new model of severity to determine just how depressed they are. As they put it:

the authors of the meta-analysis claimed to use the American Psychiatric Association’s criteria for severity of symptoms…in so doing, they ignore the obvious fact that symptoms differ from episodes: the typical major depressive episode (MDE) produced HDRS scores of at least 18 or above. Thus, by using symptom criteria, all MDEs are by definition severe or very severe. Clinicians know that some patients meet MDE criteria and are still able to work; indeed others frequently may not even recognize that such a person is clinically depressed. Other patients are so severe they function poorly at work so that others recognize something is wrong; some clinically depressed patients cannot work at all; and still others cannot even get out of bed for weeks or months on end. Clearly, there are gradations of severity within MDEs, and the entire debate in the above meta-analysis is about MDEs, not depressive symptoms, since all patients had to meet MDE criteria in all the studiesincluded in the meta-analysis (conducted by pharmaceutical companies for FDA approval for treatment of MDEs).

The question, therefore, is not about severity of depressive symptoms, but severity of depressive episodes, assuming that someone meets DSM-IV criteria for a major depressive episode. On that question, a number of prior studies have examined the matter with the HDRS and with other depression rating scales, and the three groupings shown in table 2 correspond rather closely with validated and replicated definitions of mild (HDRS 28) major depressive episodes.

So, depending on whether we use APA criteria or G&V criteria, an HRDS of 23 is either “mild” (G&V) or “very severe” (APA).

Clear as mud? I agree that in one sense this is terrible. But in another sense it’s actually a very important point. Kirsch’s sample was really only “severe” in the context of everyone, both those who were clinically diagnosable with major depression and those who weren’t. When we get to people really having a major depressive episode, a score of 26 to 28 isn’t so stratospheric. But meanwhile:

The APA seem to have ignored the fact that the HAMD did not statistically significantly distinguish between “Severe” and “Moderate” depression anyway (p=0.1)

Oh. That gives us some perspective, I guess. Also, some other people make the opposite critique and say that the HAM-D can’t distinguish very well at the low end. Suppose HAM-Ds less than ten are meaningless and random. This would look a lot like antidepressants not working in mild depression.

Getting back to Ghaemi and Vohringer, they try a different tack and suggest that there is a statistical floor effect. They quite reasonably say that if someone had a HAM-D score of 30, and antidepressants solved 10% of their problem, they would lose 3 HAM-D points, which looks impressive. But if someone had a HAM-D score of 10, and antidepressants (still) solved 10% of their problem, they would only lose 1 HAM-D point, which sounds disappointing. But either way, the antidepressants are doing the same amount of work. If you adjust everything for baseline severity, it’s easy to see that antidepressants here would have the same efficacy in severe and mild depression, even though it doesn’t look that way at first.

I am confused that this works for effect sizes, because I expect effect sizes to be relative to the standard deviation in a sample. However, several important people tell me that it does, and that when you do this Kirsch’s effect size goes from 0.32 to 0.40.

(I think these people are saying the exact same thing, but so overly mathematically that I’ve been staring at it for an hour and I’m still not certain)

More important, Ghaemi and Vohringer say once you do this, antidepressants reach the magic 0.5 number not only in severe depression, but also in moderate depression. However, when I look at this claim closely, almost all the work is done by G&V’s adjusted scale in which Kirsch’s “very severe” corresponds to their “mild”.

(personal aside: I got an opportunity to talk to Dr. Ghaemi about this paper and clear up some of my confusion. Well, not exactly an opportunity to talk about it, per se. Actually, he was supposed to be giving me a job interview at the time. I guess we both got distracted. This may be one of several reasons I do not currently work at Tufts.)

So. In conclusion, everyone has mapped HAM-D numbers into words like “moderate” in totally contradictory ways, such that one person’s “mild” is another person’s “very severe”. Another person randomly decided that we can only call things “clinically significant” if they go above the nice round number of 0.5, then retracted this. So when people say “the effects of antidepressants are only clinically significant in severe depression”, what they mean is “the effects of antidepressants only reach a totally arbitrary number one guy made up and then retracted, in people whose HAM-D score is above whatever number I make up right now.” Depending on what number you choose and what word you make up to describe it, you can find that antidepressants are useful in moderate depression, or severe depression, or super-duper double-dog-severe depression, or whatever.

Science!

6. The beneficial effects of antidepressants are only noticed by doctors, not the patients themselves – Partly true but okay

So your HAM-D score has gone down and you’re no longer officially in super-duper double-dog severe depression anymore. What does that mean for the patient?

There are consistent gripes that antidepressant studies that use patients rating their own mood show less improvement than studies where doctors rate how they think a patient is doing, or standardized tests like the HAM-D.

Some people try to turn this into a conspiracy, where doctors who have somehow broken the double-blinding of studies try to report that patients have done better because doctors like medications and want them to succeed.

The reality is more prosaic. It has been known for forty years that people’s feelings are the last thing to improve during recovery from depression.

This might sound weird – what is depression except people’s feelings? But the answer is “quite a lot”. Depressed people often eat less, sleep more, have less energy, and of course are more likely to attempt suicide. If a patient gets treated with an antidepressant, and they start smiling more and talking more and getting out of the house and are no longer thinking about suicide, their doctor might notice – but the patient herself might still feel really down-in-the-dumps.

I am going to get angry comments from people saying I am declaring psychiatric patients too stupid to notice their own recovery or something like that, but it is a very commonly observed phenomenon. Patients have access to internal feelings which they tend to weight much more heavily than external factors like how much they are able to get done during a day or how many crying spells they have, sometimes so much so that they completely miss these factors. Doctors (or family members, or other outside observers) who don’t see these internal feelings, are better able to notice outward signs. As a result, it is pretty universally believed that doctors spot signs of recovery in patients long before the patients themselves think they are recovering. This isn’t just imaginary – it’s found it datasets where the doctors are presumably blinded and with good inter-rater reliability.

Because most antidepressant trials are short, a lot of them reach the point where doctors notice improvement but not the point where patients notice quite as much improvement.

7. The apparent benefits of antidepressant over placebo may be an “active placebo” effect rather than a drug effect – Unlikely

Active placebo is the uncomfortable idea that no study can really have a blind control group because of side effects. That is, sugar pills have no side effects, real drugs generally do, and we all know side effects are how you know that a drug is working!

(there is a counterargument that placebos very often have placebo side effects, but most likely the real drug will at least have more side effects, saving the argument)

The solution is to use active placebo, a drug that has side effects but, as far as anyone knows, doesn’t treat the experimental condition (in this case, depression). The preliminary results from this sort of study don’t look good for antidepressants:

Thomson reviewed 68 double-blind studies of tricyclics that used an inert placebo and seven that used an active placebo (44). He found drug efficacy was demonstrated in 59% of studies that employed inert placebo, but only 14% of those that used active placebo (?2=5.08, df=1, p=0.02). This appears to demonstrate that in the presence of a side-effect-inducing control condition, placebo cannot be discriminated from drug, thus affirming the null hypothesis.

Luckily, Quitkin et al (2000) solve this problem so we don’t have to:

Does the use of active placebo increase the placebo response rate? This is not the case. After pooling data from those studies in which a judgment could be made about the proportion of responders, it was found that 22% of patients (N=69 of 308) given active placebos were rated as responders. To adopt a conservative stance, one outlier study (50) with a low placebo response rate of 7% (N=6 of 90) was eliminated because its placebo response rate was unusually low (typical placebo response rates in studies of depressed outpatients are 25%–35%). Even after removing this possibly aberrant placebo group, the aggregate response rate was 29% (N=63 of 218), typical of an inactive placebo. The active placebo theory gains no support from these data.

Closer scrutiny suggests that the “failure” of these 10 early studies to find typical drug-placebo differences is attributable to design errors that characterize studies done during psychopharmacology’s infancy. Eight of the 10 studies had at least one of four types of methodological weaknesses: inadequate sample size, inadequate dose, inadequate duration, and diagnostic heterogeneity. The flaws in medication prescription that characterize these studies are outlined in Table 3. In fact, in spite of design measurement and power problems, six of these 10 studies still suggested that antidepressants are more effective than active placebo.

In summary, these reviews failed to note that the active placebo response rate fell easily within the rate observed for inactive placebo, and the reviewers relied on pioneer studies, the historical context of which limits them.

In other words, active placebo research has fallen out of favor in the modern world. Most studies that used active placebo are very old studies that were not very well conducted. Those studies failed to find an active-placebo-vs.-drug difference because they weren’t good enough to do this. But they also failed to find an active-placebo-vs.-inactive-placebo difference. So they provide no support for the idea that active placebos are stronger than inactive placebos in depression and in fact somewhat weigh against it.

8. Antidepressants have much worse side effects than you were led to believe – Depends how bad you were led to believe the side effects were

As discussed in Part 2, the biggest advantage of SSRIs and other new antidepressants over the old antidepressants was their decreased side effect profile. This seems to be quite real. For example, Brambilla finds a relative risk of adverse events on SSRIs only 60% of that on TCAs, p = 0.003 (although there are some conflicting numbers in that paper I’m not really clear about). Montgomery et al 1994 finds that fewer patients stop taking SSRIs than tricyclics (usually a good “revealed preference”-style measure of side effects since sufficiently bad side effects make you stop using the drug).

The charmingly named Cascade, Kalali, and Kennedy (2009) investigated side effect frequency in a set of 700 patients on SSRIs and found the following:

56% decreased sexual functioning
53% drowsiness
49% weight gain
19% dry mouth
16% insomnia
14% fatigue
14% nausea
13% light-headedness
12% tremor

However, it is very important to note that this study was not placebo controlled. Placebos can cause terrible side effects. Anybody who experiments with nootropics know that the average totally-useless inactive nootropic causes you to suddenly imagine all sorts of horrible things going on with your body, or attribute some of the things that happen anyway (“I’m tired”) to the effects of the pill. It’s not really clear how much of the stuff in this study is placebo effect versus drug effect.

Nevertheless, it is worth mentioning that 34% of patients declare side effects “not at all” or “a litte” bothersome, 40% “somewhat” bothersome, and 26% “very” or “extremely” bothersome. That’s much worse than I would have expected.

Aside from the sort of side effects that you expect with any drug, there are three side effects of SSRIs that I consider especially worrisome and worthy of further discussion. These are weight gain, sexual side effects, and emotional blunting.

Weight gain is often listed as one of the most common and debilitating effects of SSRIs. But amusingly, when a placebo-controlled double-blinded study was finally run, SSRIs produced less weight gain than placebo. After a year of pill-taking, people on Prozac had gained 3.1 kg; people on placebo had gained 4.3. There is now some talk of SSRIs as a weak but statistically significant agent for weight loss.

What happened? One symptom of depression is not eating. People get put on SSRIs when they’re really depressed. Then they get better, either because the drugs worked, because of placebo, or just out of regression to the mean. When you go from not eating to eating, you gain weight. In the one-year study, almost everyone’s depression remitted (even untreated depressive episodes rarely last a whole year), so everyone went from a disease that makes them eat less, to remission from that disease, so everyone gained weight.

Sexual side effects are a less sanguine story. Here the direction was opposite: the medical community went from thinking this was a minor problem to finding it near-universal. The problem was that doctors usually just ask “any side effects?”, and off Tumblr people generally don’t volunteer information about their penis or vagina to a stranger. When they switched to the closed-ended question “Are you having any sexual side effects?”, a lot of people who denied side effects in general suddenly started talking.

Numbers I have heard for the percent of people on SSRIs with sexual side effects include 14, 24, 37, 58, 59, and 70 (several of those come from here. After having read quite a bit of this research, I suspect you’ve got at least a 50-50 chance (they say men are more likely to get them, but they’re worse in women). Of people who develop sexual side effects, 40% say they caused serious distress, 35% some distress, and 25% no distress.

So I think it is fair to say that if you are sexually active, your chances with SSRIs are not great. Researchers investigating the topic suggest people worried about sexual side effects should switch to alternative sexual-side-effect-free antidepressant Serzone. You may remember that as the antidepressant that worked worst in the efficacy studies and brought the efficacy of all the other ones down with it. Also, it causes liver damage. In my opinion, a better choice would be bupropion, another antidepressant which has been found many times not to cause sexual side effects and which may even improve your sex life.

(“Bupropion lacks this side effect” is going to be a common theme throughout this section. Bupropion causes insomnia, decreased appetite, and in certain rare cases of populations at risk, seizures. It is generally a good choice for people who are worried about SSRI side effects and would prefer a totally different set of side effects.)

There is a certain feeling that, okay, these drugs may have very very common, possibly-majority-of-user sexual side effects, but depressed people probably aren’t screwing like rabbits anyway. So after you recover, you can wait the appropriate amount of time, come off the drugs (or switch to a different drug or dose for maintenance) and no harm done.

The situation no longer seems so innocuous. Despite a lack of systematic investigation, there are multiple reports from researchers and clinicians – not to mention random people on the Internet – of permanent SSRI-induced sexual dysfunction that does not remit once the drug is stopped. This is definitely not the norm and as far as we know it is so rare as to be unstudyable beyond the occasional case report.

On the other hand, I have this. I took SSRIs for about five to ten years as a kid, and now I have approximately the pattern of sexual dysfunction associated with SSRIs and consider myself asexual. Because I started the SSRIs too early to observe my sexuality without them, I can’t officially blame the drugs. But I am very suspicious. I feel like this provides moderate anthropic evidence that it is not as rare as everyone thinks.

The last side effect worth looking at is emotional blunting. A lot of people say they have trouble feeling intense emotions (sometimes: any emotions at all) when on SSRIs. Sansone and Sansone (2010) report:

As for prevalence rates, according to a study by Bolling and Kohlenberg, approximately 20 percent of 161 patients who were prescribed an SSRI reported apathy and 16.1 percent described a loss of ambition. In a study by Fava et al, which consisted of participants in both the United States and Italy, nearly one-third on any antidepressant reported apathy, with 7.7 percent describing moderate-to-severe impairment, and nearly 40 percent acknowledged the loss of motivation, with 12.0 percent describing moderate-to-severe impairment.

A practicing clinician working off observation finds about the same numbers:

The sort of emotional “flattening” I have described with SSRIs may occur, in my experience, in perhaps 10-20% of patients who take these medications…I do want to emphasize that most patients who take antidepressant medication under careful medical supervision do not wind up feeling “flat” or unable to experience life’s normal ups and downs. Rather, they find that–in contrast to their periods of severe depression–they are able to enjoy life again, with all its joys and sorrows.

Many patients who experience this side effect note that when you’re depressed, “experiencing all your emotions fully and intensely” is not very high on your list of priorities, since your emotions tend to be terrible. There is a subgroup of depressed patients whose depression takes the form of not being able to feel anything at all, and I worry this effect would exacerbate their problem, but I have never heard this from anyone and SSRIs do not seem less effective in that subgroup, so these might be two different things that only sound alike. A couple of people discussing this issue have talked about how decreased emotions help them navigate interpersonal relationships that otherwise might involve angry fights or horrible loss – which sounds plausible but also really sad.

According to Barnhart et al (2004), “this adverse effect has been noted to be dose-dependent and reversible” – in other words, it will get better if you cut your dose, and go away completely when you stop taking the medication. I have not been able to find any case studies or testimonials by people who say this effect has been permanent.

My own experience was that I did notice this (even before I knew it was an official side effect) that it did go away after a while when I stopped the medications, and that since my period of antidepressant use corresponded with an important period of childhood socialization I ended out completely unprepared for having normal emotions and having to do a delicate social balancing act while I figured out how to cope with them. Your results may vary.

There is also a large research on suicidality as a potential side effect of SSRIs, but this looks like it would require another ten thousand words just on its own, so let’s agree it’s a risk and leave it for another day.

9. Therefore, we should give up on medication and use psychotherapy instead – Makes sense right up until you run placebo-controlled trials of psychotherapy

The conclusion of these studies that claim antidepressants don’t outperform placebo is usually that we should repudiate Big Pharma, toss the pills, and go back to using psychotherapy.

The implication is that doctors use pills because they think they’re much more effective than therapy. But that’s not really true. The conventional wisdom in psychiatry is that antidepressants and psychotherapy are about equally effective.

SSRIs get used more than psychotherapy for the same reason they get used more than tricyclics and MAOIs – not because they’re better but because they have fewer problems. The problem with psychotherapy is you’ve got to get severely mentally ill people to go to a place and talk to a person several times a week. Depressed people are not generally known for their boundless enthusiasm for performing difficult tasks consistently. Also, Prozac costs like 50 cents a pill. Guess how much an hour of a highly educated professional’s time costs? More than 50c, that’s for sure. If they are about equal in effectiveness, you probably don’t want to pay extra and your insurance definitely doesn’t want to pay extra.

Contrary to popular wisdom, it is almost never the doctor pushing pills on a patient who would prefer therapy. If anything it’s more likely to be the opposite.

However, given that we’re acknowledging antidepressants have an effect size of only about 0.3 to 0.5, is it time to give psychotherapy a second look?

No. Using very similar methodology, a team involving Mind The Brain blogger James Coyne found that psychotherapy decreases HAM-D scores by about 2.66, very similar to the 2.7 number obtained by re-analysis of Kirsch’s data on antidepressants. It concludes:

Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

Another study by the same team finds psychotherapy has an effect size of 0.22 compared to antidepressants’ 0.3 – 0.5, though no one has tried to check if that difference is statistically significant and this does not give you the right to say antidepressants have “outperformed” psychotherapy.

If a patient has the time, money, and motivation for psychotherapy, it may be a good option – though I would only be comfortable using it as a monotherapy if the depression was relatively mild.

10. Further complications

What if the small but positive effect size of antidepressants wasn’t because they had small positive effects on everyone, but because they had very large positive effects on some people, and negative effects on others, such that it averaged out to small positive effects? This could explain the clinical observations of psychiatrists (that patients seem to do much better on antidepressants) without throwing away the findings of researchers (that antidepressants have only small benefits over placebo) by bringing in the corollary that some psychiatrists notice some patients doing poorly on antidepressants and stop them in those patients (which researchers of course would not do).

This is the claim of Gueorguieva and Krystal 2011, who used “growth modeling” to analyze seven studies of new-generation-antidepressant Cymbalta and found statistically significant differences between two “trajectories” for the drug, but not for placebo. 66% of people were in the “responder” trajectory and outperformed placebo by 6 HAM-D points (remember, previous studies estimated HAM-D benefits over placebo at about 2.7). 33% of people were nonresponders and did about 6 HAM-D points worse than placebo. Average it out, and people did about 3 HAM-D points better on drug and placebo, pretty close to the previous 2.7 point estimate.

I don’t know enough about growth modeling to be sure that the researchers didn’t just divide the subjects into two groups based on treatment efficacy and say “Look! The subsection of the population whom we selected for doing well did well!” but they use many complicated statistics words throughout the study that I think are supposed to indicate they’re not doing this.

If true, this is very promising. It means psychiatrists who are smart enough to notice people getting worse on antidepressants can take them off (or switch to another class of medication) and expect the remainder to get much, much better. I await further research with this methodology.

What if there were actually no such thing as the placebo effect? I know dropping this in around the end of an essay that assumes 75% of gains related to antidepressants are due to the placebo effect is a bit jarring, but it is the very-hard-to-escape conclusion of Hróbjartsson and Gøtzsche’s meta-analysis on placebo. They find that three-armed studies – ie those that have a no-treatment group, a placebo-treatment group, and a real-drug-treatment group – rarely find much of a difference between no-treatment and placebo. This was challenged by Wampold et al here and here, but defended against those challenges by the long-name-Scandinavian-people here. Kirsch, who between all his antidepressant work is still Associate Director of Placebo Studies, finds here that 75% of the apparent placebo effect in antidepressant studies is probably a real placebo effect, but his methodology is a valiant attempt to make the most out of a total lack of data rather than a properly-directed study per se.

If placebo pills don’t do much, what explains the vast improvements seen in both placebo and treatment groups in antidepressant trials? It could be the feeling of cared-for-ness and special-ness of getting to see a psychiatrist and talk with her about your problems, and the feeling of getting-to-contribute-something you get from participating in a scientific study. Or it could just be regression to the mean – most people start taking drugs when they feel very depressed, and at some point you have nowhere to go but up. Most depression gets better after six months or so – which is a much longer period than the six week length of the average drug trial, but maybe some people only volunteered for the study four months and two weeks after their depression started.

If Hróbjartsson and Gøtzsche were right, and Kirsch and the psychiatric establishment wrong, what would be the implications? Well, the good implication is that we no longer have to worry about problem 7 – that antidepressants are merely an active placebo – since active placebos shouldn’t do anything. That means we can be more confident they really work. The more complicated implication is that psychiatrists lose one excuse for asking people to take the drugs – “Sure, the drug effect may be small, but the placebo effect is so strong that it’s still worth it.” I don’t know how many psychiatrists actually think this way, but I sometimes think this way.

What if the reason people have so much trouble finding good effects from antidepressants is that they’re giving the medications wrong? Psychiatric Times points out that:

The Kirsch meta-analysis looked only at studies carried out before 1999. The much-publicized Fournier study examined a total of 6 antidepressant trials (n=718) using just 2 antidepressants, paroxetine and imipramine. Two of the imipramine studies used doses that were either subtherapeutic (100 mg/day) or less than optimal (100 to 200 mg/day)

What if we’ve forgotten the most important part? Antidepressants are used not only to treat acute episodes of depression, but to prevent them from coming back (maintenance therapy). This they apparently do very well, and I have seen very few studies that attempt to call this effect into question. Although it is always possible that someone will find the same kind of ambiguity around maintenance antidepressant treatment as now clouds acute antidepressant treatment, so far as far as I know this has not happened.

What if we don’t understand what’s going on with the placebo effect in our studies? Placebo effect has consistently gotten stronger over the past few decades, such that the difference between certain early tricyclic studies (which often found strong advantages for the medication) and modern SSRI studies (which often find only weak advantages for the medication) is not weaker medication effect, but stronger placebo effect (that is, if medication always has an effect of 10, but placebo goes from 0 to 9, apparent drug-placebo difference gets much lower). Wired has a good article on this. Theories range from the good – drug company advertising and increasing prestige and awareness of psychiatry have raised people’s expectations of psychiatric drugs – to the bad – increasing scientific competence and awareness have improved blinding and other facets of trial design – to the ugly – modern studies recruit paid participants with advertisements, so some unscrupulous people may be entering studies and then claiming to get better, hoping that this sounds sufficiently like the outcome the researchers want that everyone will be happy and they’ll get their money on schedule.

If placebos are genuinely getting better because of raised expectations, that’s good news for doctors and patients but bad news for researchers and drug companies. The patient will be happy because they get better no matter how terrible a prescribing decision the doctor makes; the doctor will be happy because they get credit. But for researchers and drug companies, it means it’s harder to prove a difference between drug and placebo in a study. You can invent an excellent new drug and still have it fail to outperform placebo by very much if everyone in the placebo group improves dramatically.

Conclusion

An important point I want to start the conclusion section with: no matter what else you believe, antidepressants are not literally ineffective. Even the most critical study – Kirsch 2008 – finds antidepressants to outperform placebo with p

An equally important point: everyone except those two Scandinavian guys with the long names agree that, if you count the placebo effect, antidepressants are extremely impressive. The difference between a person who gets an antidepressant and a person who gets no treatment at all is like night and day.

The debate takes place within the bounds set by those two statements.

Antidepressants give a very modest benefit over placebo. Whether this benefit is so modest as to not be worth talking about depends on what level of benefits you consider so modest as to not be worth talking about. If you are as depressed as the average person who participates in studies of antidepressants, you can expect an antidepressant to have an over-placebo-benefit with an effect size of 0.3 to 0.5. That’s the equivalent of a diet pill that gives you an average weight loss of 9 to 14 pounds, or a growth hormone that makes you grow on average 0.8 to 1.4 inches.

You may be able to get more than that if you focus on the antidepressants, like paroxetine and venlafaxine, that perform best in studies, but we don’t have the statistical power to say that officially. It may be the case that most people who get antidepressants do much better than that but a few people who have paradoxical negative responses bring down the average, but right now this result has not been replicated.

This sounds moderately helpful and probably well worth it if the pills are cheap (which generic versions almost always are) and you are not worried about side effects. Unfortunately, SSRIs do have some serious side effects. Some of the supposed side effects, like weight gain, seem to be mostly mythical. Others, like sexual dysfunction, seem to be very common and legitimately very worrying. You can avoid most of these side effects by taking other antidepressants like bupropion, but even these are not totally side-effect free.

Overall I think antidepressants come out of this definitely not looking like perfectly safe miracle drugs, but as a reasonable option for many people with moderate (aka “mild”, aka “extremely super severe”) depression, especially if they understand the side effects and prepare for them.

I think at this point in the century, everyone reading this blog—with the [possible] exception of certain lurkers who are required by virtue of their position within their company to toe the Party Line and therefore may not be free to say what they really think—is clear on the drawbacks of DRM.

But regional restrictions make me wince, because from an author's point of view the situation is a bit more complicated.

In principle, I oppose region restrictions. As a reader, they make me itch. But in practice, the way book distribution works across international borders is worse than imperfect: it's broken. If I sell world English language rights to one of my books to a publisher, that publisher can't just print and distribute the book everywhere in the English-speaking world. Publishers used to be regional, not global, players. And even in the wake of the wave of takeovers that resulted in the Big Six Five owning about 70% of the business, mergers between publishing houses are incredibly slow and complicated due to contractual encumbrances. As a result, publishers generally don't have the branding, imprint, and corporate connections to sell books in more than one territory. Let me emphasize this: they're regional, not global, operations.[*] So if they find they've got publishing rights to territories where they don't have printing and distribution arrangements they generally sub-license the rights to other, local, publishers who've got the connections to sell books to the local trade channels.

This means that they can't offer me a bigger book advance for world rights than they would for their own regional rights (because they might not succeed in licensing those territorial sub-rights—this has bitten me in the past). If they paid a world-rights-sized advance for what turned out to be regional sales they'd make a huge loss, which in turn would make them very leery about doing repeat business with me. Consequently we end up with different editions published by local publishers at different prices, with regional distribution restrictions.

Also, when publishers sell sub-licenses, the contract side is generally handled by clerical staff who handle the sub-rights for hundreds of books a year, with no particular incentive for prioritizing my work.

Consequently I prefer to get my literary agent to split the various regional rights up and sell them separately, so I get paid for North American rights by my US publisher and UK/Commonwealth (except Canada) rights by my UK publisher. This results in more money for me. It also results in better royalty contracts—my agent takes a 15% commission, so the bigger the deal the more money she gets (and the more money I get).

But from a book-buying reader's point of view ...

This was fine in the old paper book days—books were uneconomical to bulk-ship internationally, and thanks to the first sale doctrine readers who really wanted foreign editions could legally mail-order them and pay for shipping. What the casual buyer doesn't see on the shop shelves they don't feel the lack of: so everybody was happy, more or less.

But in the age of ebooks, borders are increasingly porous. And Brits can see what is in the Kindle store on Amazon.com, and Americans can see what's in the Kindle store on Amazon.co.uk, and British and American publishers can see how each others' titles are doing. Regional publishers are jealous of their regional sales—nobody wants a big rival from another country to kick down the door and eat their lunch—so they enforce contractual terms on the ebook stores that lock in territoriality. The ebook stores for the most part are more than happy to go along with this: it gives them a valuable lever for selling their DRM-enforced walled garden model of ebook publishing to publishers. The walled gardens in turn lock end-customers into the e-book store's platform, be it Kindle or iBooks or Adobe Digital Editions.

So what started out as a natural side-effect of books being heavy and not worth shipping across oceans has turned into a royal pain in the ass for readers—but where the desired solution for the readers (global sales, a flat worldwide market) will cause significant pain to the authors in the medium term (and by "pain" and "medium", I invite you to consider how you'd reply to a proposal that you take a 20-40% pay cut for 3-5 years).

What I'd like is a publisher who could genuinely operate globally—that is, publish a single edition throughout the English-speaking world, offering advances for my books that reflected global sales potential rather than regional, and removing the need for regional restrictions and DRM completely. And indeed—you saw that [*] footnote asterisk up top?—such a global publisher exists within my field. But it's Orbit ... a subsidiary of Hachette, and while there are a lot of good things I can say about Hachette their corporate high-level policy makes DRM mandatory, no exceptions. (Digression: Don't be fooled into thinking that Tor are a global player. While Tor US and Tor UK are both subsidiaries of Macmillan, which operates worldwide, they are entirely separate companies. Turns out, sibling rivalry is a thing: they're as jealous of their regional rights as any other rival companies.) So right now I can have my books published without DRM, in return for putting up with lots of regional messing-around (which is why the new Merchant Princes omnibuses won't be available on paper in North America until the back end of this year, a year after their UK publication). Or I can have a single publisher who operates globally ... but insists on DRM. Shorter Charlie: you can't win.

Hopefully the situation will improve in the medium term—meaning before the end of the decade. But your guess is as good as mine. And this is by way of explaining why you'll see different covers for my books, and different prices and publication dates and ISBNs, in different countries. Globalization: nice theory, shame about the practice.

#801, 19th September 1998

Expansive of theme, expensive of sample, “Millennium” is a self-conscious event single, carrying itself as if Number One was never in doubt. But while Robbie Williams was the biggest star in Britain, he’d fluffed getting to the top with several iconic songs. Robbie’s most famous track of all, career ignition ballad “Angels”, had missed by several places. He was taking no more chances. Sweeping into the charts wearing a borrowed John Barry tuxedo, “Millennium” is as brazen a Number One as I’ve ever covered, but as needy a one too.

Robbie is, I’ve often felt, a difficult star to write about, hard to define for all his brashness. Not chameleonic like Bowie, but complex. Solo pop stars either arrive lusting for fame – the Elvis or Madonna route – or they are already famous, and the solo career is a careful transition into the sole spotlight: the Annie Lennox or Sting method. Robbie fits neither model. He appears in flight, hungering for the right type of fame, desperate not to sell his soul but to get it back. What defines him for me is a restlessness, a sense that the dissatisfaction that freed him from boyband clowning turned out to be something deeper and harder to scratch. Some of the Number Ones we track beyond this are major, some minor, but several tell the story of his chafing at his stardom, probing its edges.

So he breaks publically away from Take That and becomes – what? He surfaces at Glastonbury, paying court to Oasis: but he’s indulged not embraced – the Beatles never needed Cliff. In his next phase he’s a 70s showman – Freddie, KISS, Elton on “Angels”. He’s big, by now, but there’s still something ersatz about him. Questions linger: what’s the point of Robbie Williams, exactly? What records does he make that nobody else would?

“Millennium” is a step towards an answer. The first thing to notice is that it’s all sung in the first person plural – an unusual pop choice, the mark of a song that’s trying to speak for something bigger than itself. “Some say that we are players, some say that we are pawns / But we’ve been making money since the day that we was born” – defiant (against who?), open-armed (for who?), “Millennium” sets out its stall in those first lines as a wannabe generational anthem. So it makes sense to ask – what generation?

I’m not using the word in that all-embracing sense so beloved of marketers – “Millennium” isn’t “Millennials”. But Robbie Williams was at the top of the UK’s pop cultural pyramid at a specific time – the end of the 20th Century, the first Tony Blair government. If there was something presumptuous and irritating about his jumping the gun on the Millennium two years early (“three!”, I hear some of you squawk), that sense has mostly faded for me. He did own this stretch of pop history. He has the right to close the century out.

But it’s an odd, bitty stretch to own. To get a handle on it, it’s better to look outside pop music, to take in the rest of what Britain loved or feared from 1998 to 2001. Harry Potter. Who Wants To Be A Millionaire. David Beckham. Big Brother in its “psychological experiment” years. Queer As Folk. Nick Hornby. Gail Porter. Lock, Stock And Two Smoking Barrels – and a host of geezerish knock-offs. Soccer AM. Friends Reunited. WAGs. Ringtones. Goodness Gracious Me. Ali G. Bacardi Breezers. Topless darts. “Name And Shame”. Spaced. Zadie Smith. Docusoaps. Mandelson and The Millennium Dome. The League Of Gentlemen. Playstation. Cold Feet. Changing Rooms…

It was a complacent time in many ways – hedonistic, drearily blokey, but not as nationalistic or cartoonish as the mid-90s. Britain was a nation at ease with itself, but also casually interested in itself after the cathartic upheavals of Blair and Diana. The TV of the era finds virtue and intrigue in the ordinary – explores its marriages, exaggerates its local quirks, peeps through its net curtains just before Lawrence Llewelyn Bowen tears them out. The downside is that it can seem a self-satisfied, low-stakes period. The upside is that space was made for other kinds of “ordinary” – gay experience, British Asian experience – to stake a claim as such in a way the Britpop era hadn’t always encouraged. Big Tent culture, to borrow a Blairite phrase.

And part of it all, casually huge above a kaleidoscope music scene, was Robbie. In many ways he’s a perfect ringmaster for the Big Tent – at the cheeky end of laddish, adoring the limelight, desperate to entertain. The reality TV idea of the ordinary guy or gal who turns out to have the X Factor and becomes an enduring star – that’s a much harder sell without Robbie, who is pushing his personality as much as his talent. “I have only one ambition,” he wrote on his CV, just before joining Take That, “which is to be famous.”

Okay – then what? “We all enjoy the madness, cos we know it’s gonna fade away… we know we’re falling from grace…” “Millennium” isn’t especially coherent about fame, or the “we” it’s speaking for, or the millennium itself, but what power it has is in its mess, hopscotching from those big bittersweet statements to repurposed aggro (“Come and have a go….”) to its venomous end – “Get up and see the sarcasm in my eyes”. It’s a pot-pourri of one-liners and stray ideas, turning out on the world in anger, turning back to deny itself, reflexive, defensive.

That’s where “You Only Live Twice” comes in. It gives the song grandeur – borrowed grandeur, of course, and at the time I really resented “Millennium” for lashing its half-cocked stumble to such a great backing. But that very contrast – the Olympian heights of the John Barry strings and Robbie’s earthbound plainness as a singer – gives the song a bittersweet tint: Robbie can’t live up to his own song’s promises and defiance.

The giant, prominent sample nods at another curious thing about “Millennium” – how much it owes to hip-hop. Robbie isn’t trying to rap yet, but he peppers the song with ad-libs: “it’s like a jungle… sounds like jungle” and his very broad Stoke accent on “And we won’t stop” at the end. Hip-hop, by this point, is the root of American pop music, and becoming a default inspiration for global pop, with every region having its own hybrids and creoles. Britain, ultimately, will get its own localisation, but in the late 90s British MCs had almost no industry support. You can see “Millennium”, Robbie’s step out of the 70s and into the 90s, as a sideways British response to hip-hop that just about works.

And “Just about works” is as far as I can go with this song, maybe with Robbie as a whole. He’s a major part of the story of the next few years – but there’s something about him as a pop star, at the time and since, that feels lacking. He had endless drive and charm but little vision – there’s nothing you could point to and say “that is why pop music needed Robbie Williams as much as Robbie Williams needed pop”. But then a satisfied, easy-going nation doesn’t need new pop icons. It produces them nonetheless, and this broken anthem from a restless star is what we get.

As those of you who follow me on Twitter will have already seen, I’ve recently re-read Conrad Russell’s An Intelligent Person’s Guide To Liberalism. It was originally published in 1999 as part of a series of ‘Intelligent Person’s Guide To…’, though they now seem to be out of print and are hard to find. I found it a fascinating read, and as it is so hard to find, I thought I’d try and provide a summary of it, which will hopefully prompt some other thoughts.

Russell acknowledges from the start that trying to capture every variety of Liberalism in a short book like this would be a fool’s errand, and so takes as his key focus ‘the ideas that have given continuity to the Liberal Party in its various forms since 1679′ though ‘this is not to claim that there has ever been a time when all liberals were in the Liberal Party’. That starting date is not arbitrary – in his academic career, Russell was a historian of the English Civil War and its surrounding issues, and he sees British liberalism emerge as a distinct position in the aftermath of those conflicts and their focus on the rights and responsibilities of rulers, subjects and citizens. Russell doesn’t depict liberalism as an abstract ideology, but one that emerged and adapted over the centuries.

This view sees liberalism as an ideology with core principles that have grown and developed. He uses the imagery of an onion: ‘a series of outer leaves growing tightly around a central heart’. For Russell, ‘Liberalism is and remains largely about power’ – how it can be justified and how it can be controlled:

We know that a civilised community needs power, and is not safe without it. Power, like sex, should be subject to two restrictions. First, it is unlawful if it does not rest on consent. Second, it is often more enjoyable and more rewarding if it is set in the context of a relationship. The art of Liberalism has never been to destroy power. It has been to set it in the context of these two types of restriction, and thereby to secure a two-way relationship between those who exercise it and those over whom it is exercised. The less categorical the distinction between the governors and the governed becomes, the more Liberal the society in question.

The principle that the people are superior to their government, and it can only exist with their consent, is the through line Russell uses to link the original Whigs of 1679 to the modern Liberal Democrats but ‘an apparently simple general principle, if held firmly and as a central conviction, turns out to have all sorts of implications of which its founders were unaware.’

He’s clear that this control of executive power by the people is not achieved solely by elections: ‘It is not enough to claim we have an ascending theory of power if it comes up from the people once every five years, and then comes down again in a five-year uncontrollable avalanche from Downing Street.’ This is why British liberalism has had a long interest in reforming the way the British government works, to ensure that the people can properly hold their government to account. Government must rest on consent, and the systems by which government is carried out must demonstrate that consent, not assume it.

Building from that first principle of consent and controlling power, Russell then moves on to the implications that come from it in developing liberal thought. His next key principle is pluralism, which serves a double purpose in representing both a plurality of power and a ‘cult of diversity’ which ‘defends the rights of the under-privileged, whoever they happen to be at the time.’ These both come from the principle of ‘equality before the law’, resulting in a liberal vision where power is dispersed amongst various bodies to enable ‘our instinctive preference…for devolving power downwards whenever possible, for returning power towards the people who are its source.’ But for that plurality of power to have meaning, individuals must be free to exercise their role in it, and Russell here traces a Liberal history of opposing and overturning discrimination from Locke’s Letter Concerning Toleration, through removing restrictions on Nonconformists, Jews and others to modern campaigns over sexuality. Russell here advocates an activist liberalism that helps to deliver on its promises but is also aware that there may be battles yet to come which we have not imagined yet, though in these Liberals will find themselves fighting for the underdog.

It’s that principle of standing up for the underdog that runs through Russell’s examination of liberal views on the economy where he holds that liberalism does not have a consistent economic philosophy because as an ideology it’s more concerned with power and pluralism than money or class: ‘a gut commitment to equal competition with a gut commitment to support the underdog…was the mentality Liberals brought into the task of acquiring an economic policy.’ He rejects the idea that laissez-faire was or is an intrinsically liberal idea, but instead one that could be used at certain times in history to bring about liberal ends. Nineteenth century liberals supported free trade to improve the lives of the poor and to attack monopolies and the unaccountable power of the great landlords: ‘abuse of power…had never been confined to the power of the state.’ Even in the nineteenth century, liberals advocated using the power of the state to empower individuals even before Hobhouse and the New Liberalism.

the party never agreed with Hobbes that ‘liberty is the absence of restraint’. That purely negative definition of liberty leads to Thatcherism, not Liberalism. It leads to an identification of liberty with minimum government action, and that is something in which Liberals have never believed. That is the liberty of the powerful: it is not the liberty of a party which, at all stages of its existence, has been dedicated to defending the powerless against privilege.

The next layer of liberalism Russell introduces is internationalism. He looks at how Gladstone’s support of nationalism and national liberation stemmed from the principle of consent, and how nationalism and liberalism then diverged in the early twentieth century, leading to the awareness ‘of the limits of the nation state as a means of tackling international problems’. Liberal internationalism goes back to the principle of controlling power – if nation states are not capable individually of controlling abuses of power on a global level, then they must work together to achieve it: ‘We have always believed in plural centres of power, and we have believed for a long time that human rights and other issues create norms of international conduct whose authority goes well beyond any one sovereign state.’ However, he also warns against attempting to create liberal utopias by fiat because ‘there is no alternative to consent.’ Any liberal international order has to be built piecemeal and on that principle, not by deciding what our personal utopia may be and working backwards from there to make it happen, no matter how desirable it may seem: ‘Desperate need for haste does not make it possible to do a job faster than it can be done. The route by consent may be painfully slow, but it is the only route which does not become dictatorial and therefore self-defeating.’

Following on from internationalism, Russell then turns to the liberty of the individual, again looking at how liberal principles on this began with Locke in the 17th century, and were then developed further, expanding from religion to more general morality, with the ideas of John Stuart Mill:

The experience of Hitler affected many people, and by no means only Liberals, by making them more aware of the need to tolerate differences of race and creed, and to put a taboo on any violent expression of the dislike of difference.
Today, in the world of Drumcree, the murder of Stephen Lawrence and the nail-bomb in the Admiral Duncan pub, it is much easier to say that enforcing at least an outward respect for diversity is part of the state’s duties. It is among those who have grown up since Hitler that the views of Mill On Liberty have become, for the first time, part of the essence of the Liberal creed.

Russell is at his strongest and most instinctively liberal in this section, asserting that ‘We believe there is no one right way to live, and, provided that they do no harm to others, people are normally best left alone to make such decisions for themselves.’ He covers a whole range of social and ‘moral’ issues and one section makes it clear that had he lived, he would have welcomed equal marriage as he points out that it causes no harm to others. He discusses the harm principle, and looks at how to determine when an activity causes meaningful harm to others, and can thus be prevented or limited, but also acknowledges the complexity of the issue and its inability to be completely resolved in the space he has available. However, he rejects the idea that morality can be enforced upon others without their consent: ‘Our purpose in politics is not to get people to live in some single right way, but to help them to live in the way they think is right.’

Finally, Russell looks at Green Liberalism and other ideas that may come to be a fuller part of liberalism in years to come. Reading this section was a strong reminder of how far we’ve come in the past fifteen years in the recognition of global climate change as a threat, but also how little work has been done to marry together green and liberal philosophies. Russell rests on sustainability as the liberal watchword in environmental issues, harking back to the idea that power is a trust granted by the people, and one of the key duties of a trustee ‘is to hand on the inheritance to the next generation in as good a shape as he can leave it.’ However, sustainability cannot just be a simple term to plaster on to anything and everything, and Russell invokes the liberal traditions of controlling power and internationalism to assert the need for joint action to confront those powers that may damage our environment.

He also looks at the power of globalisation, and wonders what the liberal position on this should be. It’s perhaps one area where this book has become quite dated in just fifteen years, as there’s no consideration of the effects of the internet and the communications revolution, but he does sketch out some interesting challenges for liberalism in the face of the rise of unaccountable global powers, and how challenges to that power need to be built on consent.

This has turned into a much longer post than I expected it to be, but I could have (and still may) written much more on each of the subjects Russell explores in his exploration of liberalism. However, in the way he constructs his vision of liberalism as a combination of history and philiosophy, building from the initial core of controlling executive power, I think he sets out one of the best explorations of and arguments for liberalism. It’s a shame that this book has fallen out of print, as I think it deserves a much wider audience, and still today provides a great basis for discussing the past and future of liberalism.

Writing about Russell’s An Intelligent Person’s Guide To Liberalism the other day prompted me to think more about the version of liberalism he describes. One of the things I appreciated in his book was the way he placed liberalism, and particularly British liberalism, in a historical context. This isn’t surprising as he was a historian rather than a philosopher or political scientist, but it does feel sometimes that people present liberalism as something that only emerged in the nineteenth century, ignoring the important of Locke and the debates of the seventeenth century in its emergence. There are important liberal thinkers before and after John Stuart Mill, and Russell’s historical account reflects that.

It’s also interesting to note how Russell’s account downplays the role of economics in liberalism. Again, this contrasts with the current vogue for claiming the existence of ‘classical liberalism’ based around Millian ideas of liberty and laissez-faire economics. Russell’s vision of liberalism is one that has the control of power and the promotion of the individual at its heart, with economics a tool to be used to achieve those ends, not an end in itself. For me, that’s a much more interesting vision of liberalism than one which places economics at the heart of everything and embraces the fetishisation of work (especially ‘hard work’) that’s such a feature of modern political discourse.

Russell’s exploration of liberalism takes works through a few distinct areas:

Challenging power

Pluralism: Multiple locations of power

Pluralism: the ‘cult of diversity’

The underdog and the economy

Internationalism

Individual liberty

Green liberalism

Rather than writing another post that tries to cover all of those issues in one, what I’m planning is to do a series of posts over the next week or two that looks at each of these in turn. The idea will be to use Russell’s thoughts on the subject as a springboard for some more thoughts of my own, to look at where this kind of vision of liberalism can take us. Hopefully, they’ll be interesting enough to spark off a bit of debate in the comments and elsewhere, and even if they don’t, it’ll be an interesting process for me to think and write about those ideas.

The Milgram experiment: a troubling feature of people who seem nice all the time.

I’ve been in two minds about publishing this for a while, but friends in the party have expressed a desire for me to do so, and I’ve finally decided to go ahead. This is the speech I wrote, and delivered, at the special general meeting of the Cambridge Liberal Democrat party, called to determine if we wanted to vote for a leadership election. The vote was lost on the basis that now was decided not to be the right time to call for an election. You can imagine that wasn’t the way I voted.

Here’s the speech:

When someone votes, they vote with their head, but they also vote with their heart. People vote for aspirations, for dreams. They vote for an ideal.

Consider the ideals people have in mind when they vote:

UKIP	I want my country back from some unspecified thing, so it can resemble some rose tinted past that never existed.
Labour	Up the working classes, even if the reality is that Labour routinely screws them over.
Tories	Land of hope and glory, good old blighty, steady hand at the tiller, captain of industry, never mind the poor because poor people bring it on themselves, right?
Green	Save the planet! Social justice!

Regardless of how the reality differs from the perception, people at least feel they’re voting for something when they vote for these parties.

Liberals – What do people think we stand for?

Well, what image are we putting out? Is it an image of liberalism? Of staunch defenders of civil liberties? Of a party that wasn’t part of the stale old discourse? This was ostensibly who we were in 2010.

Have we been liberals in government? Really? I don’t think we have.

Liberal should mean something. It should mean something to the people who vote for us. It should mean that they can vote for us and expect us to govern with liberal values.

People do not have that confidence because we, our party, have betrayed them.

As a liberal I believe that the weak should be protected from the strong. That the preservation of freedom is paramount. That people should not be coerced or forced into living in ways they do not want to. That taking away a person’s freedom to live as they will, especially when it is done by the strong against the weak, is a most serious and egregious business.

As a liberal, the reason I want to participate in the process of government is because government is strong. Government possesses tremendous power to shape and affect and constrain the lives of the individual. Liberal government should be a facilitator; liberal government should help ensure that people are free to live their lives without undue restrictions on their conduct, the exercise of their beliefs, and that in a rich country such as ours, people should be free to live their lives, regardless of the circumstances of their birth, free from poverty.

Where the state, or any other strong entity, such as a large corporation, acts to constrain the freedom of the individual, or take it away, that is a very grave matter indeed. It must be subject to due process. It must be seen as a last resort. It must be done in a way that allows the individual in question every opportunity to defend themselves, and when that opportunity is inconvenient to the state, it is more important than ever to stand firm as liberals and ensure it is available.

We need a strong liberal voice in government precisely because, in the difficult cases, when the government finds it really hard to give those it would seek to deprive of their liberty due process, we need to stand up and tell the government, “tough, you can’t deprive this person of their rights just because you find it too hard to grant them”.

It is offensive and intolerable, as a liberal, to have a government rescind that right in my name. There are lines in the sand which we must defend to the last, and not having secret justice, where the accused is not afforded every opportunity to defend themselves, simply because the state finds it hard, is one of them.

I was at Spring Conference in 2013, when one of our MEPs spoke out against secret courts, as illiberal instruments of a state with a cavalier attitude towards exercising its own powers. I was sat only a few rows away when Nick Clegg verbally slapped her down.

It’s not just secret courts, egregious as they are. We have sat on our hands while the Tories waged an idealogical war against the poor, the disabled, the dispossessed, in the name of deficit reduction, when we know that benefit fraud and trying to help people who are otherwise deprived a decent life, through no fault of their own, to live with some self respect has nothing to do with why our economy is in the state it’s in. We, our party, have stayed silent while people have awoken to the disgusting spectacle of one of the richest countries in the world putting spikes outside buildings to deter the homeless, as if they’re vermin.

We should be screaming about these things, and we are not.

We, and by we, I mean our leadership, have sat on our hands while the Tories enslaved people through poverty. We, and by we, I mean our leadership, have sat on our hands while they have removed the opportunity for people to defend themselves through secret courts and legal aid cuts. We, and by we, I mean our leadership, have sat on our hands while the Tories took away one public safety net after another, in health, in education, in privacy, and subcontracted it to the lowest bidder. We, and by we, I mean our leadership, have sat on our hands while the Tories gleefully censored the Internet – the great library of the modern world.

Enough is enough. As a liberal, these things are intolerable. That they are done in my name is unbearable.

At the time of the secret courts debacle, some of us in this room, and plenty of people in other local parties, came to the brink of doing something similar to what we are doing now. However, we were persuaded not to at the last minute, with an assurance that our grievances would be listened to; that our leadership would grow a spine and start defending liberal values.

But nothing has changed. Nick Clegg has surrounded himself with people who, I now believe, do not share our values, or at least do not consider them important to draw lines in the sand over, or even advertise them as our values.

We desperately need a leadership who will show people what it means when they put an X next to a Liberal on the ballot paper.

I want to be a Liberal again. I want that word to stand for an assurance that we will not stand silently by and let the strong steamroll over the weak.

I no longer believe that Nick Clegg has any intention of being someone who will do that, and it is with a heavy heart that I say he has to go.

And if that doesn’t convince you, allow me to share a picture that loads of my friends are spreading around social media at the moment.

Enough said?

The No-IP takedown: Microsoft doesn't understand DNS.

And now, some thoughts on subjects pertaining to publishing. I’ll use myself as an example for much of this.

1. I am in business with Amazon, though its Audible.com subsidiary. As you might be able to tell by my post yesterday, I am deeply happy with my experience working with Audible (and thus, by extension, Amazon). They’ve been a very good business partner to me.

2. I am also in business with Hachette, via its Gollancz imprint in the UK. I think what Amazon’s doing to US Hachette authors at the moment well and truly sucks. I heartily remind people that just because Amazon has been screwing these authors by making it impossible to buy their books there, doesn’t mean you can’t get those books — pretty much immediately — from all sorts of other retailers, including local bookstores. This might also be a fine time to install a Kobo or Nook or iBook app on your tablet or smartphone and diversify your eBook retailers.

3. I am in business with Random House, through its Heyne imprint in Germany. I have had an excellent business relationship with Heyne and think very highly of the people who work there. You may also recall that last year, when Random House attempted egregious bullshit with the contracts for their digital imprints Hydra and Alibi, I was happy to punch them in the throat for it, because they were trying to screw authors, no two ways about it.

4. I am in business with Macmillan, through Tor Books. As most of you know, I have been very happy with Tor, who treats me very well and who is very supportive of my career; I have the career I have because Tor has done well by me. What most of you may not know is that one major reason there was a three-year gap between Zoe’s Tale and Fuzzy Nation was because Tor and I had a substantial business disagreement, and I chose not to write new work for Tor for a while. The details of that disagreement are not important now — water under the bridge — but it was significant enough that I walked away from the company and worked on other things. Then it was done, we came to an understanding, and now we are working together again, quite happily.

What’s the point to all of the above?

Publishing is a business. As a writer, you are enaging in business with others, sometimes including large corporations. It’s not a team sport. It’s not an arena where there are “sides.” There’s no “either/or” choice one has to make, either with the businesses one works with or how one publishes one’s work. Anyone who simplifies it down to that sort of construct either doesn’t understand the business or is actively disingenuous, and isn’t doing you any favors regardless. The “side” you should be on is your own (and, if you choose, that of other authors).

These businesses and corporations are not your friends. They will seek to extract the maximum benefit from you that they can, and from others with whom they engage in business, consistent with their current set of business goals. This does not make them evil — it makes them business entities (they might also be evil, or might not be, but that’s a different thing). If you’re treating these businesses as friends, you’re likely to get screwed.

(And for God’s sake, don’t confuse being friends with people at those businesses with being friends with the business. I have very good friends at Tor. It didn’t stop me from having a substantial business disagreement with the company. Businesses aren’t your friends, even when they employ friends.)

Sometimes the goals of these businesses will align with yours. Sometimes they will not. And often a company that you’ve found yourself in alignment with previously will tack off on a different course, leaving you behind. Maybe you’ll realign at some later point. Maybe you won’t. If you’re under the impression that any business will always align with your own set of business goals, you are likely missing something. Expecting businesses that are not your own to act in a manner other than their own self-interest is likely to end in disappointment for you.

You’re allowed to think more than one thing about a company at the same time. I like what Amazon’s doing in the audiobook space, especially as it involves me. I think what it’s doing to Hachette authors sucks, in no small part because it happened to me, a few years back, when Amazon had a similar fight with Macmillan. Amazon has helped my career; it’s also made it clear to me that it doesn’t give a shit about my career when its interests are elsewhere. Amazon isn’t the only business partner I have that I can say that about. It’s clarifying, I will say.

Your business relationships are allowed to be complex, entangled and even contradictory. How do I feel about being in business with Hachette and Amazon? I feel fine about it, obviously. Likewise, I feel fine about being in business with, for example, Macmillan and Subterranean Press, both of whom have published the same work of mine, in different formats. I’m in business with a lot of businesses. I’m going to keep doing that, because I like to eat and I know where my ethical lines are. You can do this too. The person to decide what limits you choose to place on your business should be you.

Publishing is a business. I said that already. Guess what? I’m saying it again. If you’re not approaching it as a business, with the same eye toward your own business goals as those you’re in business with undoubtedly have on theirs, then when you find yourself completely at a loss and utterly dependent on the business choices of a company that fundamentally doesn’t care about you outside of a ledger entry, the amount of sympathy you’ll get — from me, anyway, and I suspect from other authors who tend to the business of their writing — will be smaller than you might hope.

Like a lot of people, I excitedly downloaded the Retro Hugo Voter Packet when it became available this week; and like a lot of people, I was sorry that it didn't include more of the finalists in the fiction categories. Unlike a lot of people, I'm aware of the hard work and immense difficulties faced by the Hugo team in assembling it, and shared some of their frustration in tracking down permissions and reproducible copies. One can make a case to the publishers and authors of today that including their work in the Hugo voter packet is a gain for them in terms of future sales; it's rather more difficult to make that case convincingly for work that has been on sale since 1938 (or not, in a couple of cases), and whose authors are no longer in a state to care about future sales.

Thanks to ISFDB, I have compiled this list of all of the publications including the finalists in the short fiction categories, including the ISBN numbers where they exist. You may well find, as I did, that you already have some of the relevant anthologies on the shelves - particularly for the much-collected "Who Goes There", "Pigeons from Hell" and "Helen O'Loy". A couple of the stories can also be found online; I haven't dug very deeply (the links to "Hollywood on the Moon" are copied from the Retro Hugo voter packet). Myself, I was able to acquire Science Fiction: The Great Years, eds. Carol Pohl and Frederik Pohl, Sleepers of Mars, by John Wyndham, and The Autumn Land and Other Stories, by Clifford D. Simak, without too much difficulty or cost. I do hope that my making this post doesn't suddenly drive prices up!

Anyway, here you are. Пожалуйста!

Best Novella

Anthem by Ayn Rand
In voter packet
In print: ISBNs 0452281253, 0451191137, 1434100359 and many others
Online at Project Gutenberg: http://www.gutenberg.org/ebooks/1250

“A Matter of Form” by H. L. Gold
Big Book of Science Fiction, ed. Groff Conklin
Assignment in Tomorrow, ed. Frederik Pohl (044778699125)
Science Fiction: The Great Years, eds. Carol and Frederik Pohl (0575017848, 0722169248)
The Classic Book of Science Fiction, ed. Groff Conklin
The Mammoth Book of Classic Science Fiction Short Stories of the 1930s, eds. Waugh, Greenberg, Asimov (0948164727)
Great Tales of Classic Science Fiction, eds. Asimov, Greenberg, Waugh (0883657554)
Perfect Murders (coll) by H.L. Gold (0895561301, 978080323359)

“Sleepers of Mars” by John Beynon [John Wyndham]
Sleepers of Mars (coll) by John Wyndham (0340173262, 045042023X)

“The Time Trap” by Henry Kuttner
In voter packet
Evil Earths, ed. Brian Aldiss (0297770055, 0860078892, 0380446367)
Girls for the Slime God, ed. Mike Resnick (0965956903)
Thunder in the Void (coll), by Henry Kuttner (9781893887534)
Armchair Fiction Double with The Lunar Lichen, by Hal Clement (9781612871424)

“Who Goes There?” by Don A Stuart [John W. Campbell]
Adventures in Time and Space, eds. Healy & McComas (0345253744, 0395254965, 0345277473, 0345289250, 0739422146)
Towards Infinity, ed. Damon Knight (0575003723, 0330234315)
The Science Fiction Hall of Fame, vol 2A, ed. Ben Bova (038504576X, 0765305348, 038000385)
Starstreak, ed. Betty M. Owen (0590312642)
13 Short Science Fiction Novels, eds. Asimov, Greenberg, Waugh (0517476460)
The Mammoth Book of Short Science Fiction Novels, eds. Asimov, Greenberg, Waugh (0948164220)
Cinemonsters, eds, McSherry, Greenberg, Waugh (0880385049)
Movie Monsters, ed. Peter Haining (0727815466)
The Mammoth Book of Classic Science Fiction Short Stories of the 1930s, eds. Waugh, Greenberg, Asimov (0948164727)
Great Tales of Classic Science Fiction, eds. Asimov, Greenberg, Waugh (0883657554)
Between Time and Terror, eds. Weinberg, Dziemanowicz, Greenberg (0451454529)
Science Fiction Classics, ed. Forrest J. Ackerman (1575000407)
Toward Infinity, ed. Damon Knight (0671650934)
The Science Fiction Roll of Honour, ed. Frederik Pohl (0394486773)
The Best of John W. Campbell (0345249607)
Foundations of Fear, ed. David G. Hartwell (0312850743)
Worlds of Fear, ed. David G. Hartwell (0812550021)
The World Turned Upside Down, eds Flint, Baen, Drake (0743498747, 9781416520689)
Who Goes There? (coll), by John W. Campbell (0883553651, 088355450X, 0899667341, 9780575091030, 9780575129023)
The Mammoth Book of Body Horror, eds. Kane & O'Regan (9780762444328)


Best Novelette

“Dead Knowledge” by Don A. Stuart [John W. Campbell]
Who Goes There? (coll), by John W. Campbell Jr (0883553651, 088355450X, 0899667341, 9780575091030, 9780575129023)
The Thing and Other Stories (coll), by John W. Campbell
A New Dawn (coll), by John W. Campbell (1886778159)

“Hollywood on the Moon” by Henry Kuttner
Online at http://www.unz.org/Pub/ThrillingWonder-1938apr-00012, continued at http://www.unz.org/Pub/ThrillingWonder-1938apr-00027 and http://www.unz.org/Pub/ThrillingWonder-1938apr-00029

“Pigeons From Hell” by Robert E. Howard
In voter packet
The Weird Writings of Robert E. Howard, vol. 2
The Dark Man and Others (coll), by Robert E. Howard (044775265095, 0586042938)
Weird Tales, ed. Leo Margulies (0515048771)
The Book of Robert E. Howard (0890831637, 0425044491)
Pigeons from Hell (coll), by Robert E. Howard (0890831890, 0441663206)
Cthulhu: The Mythos and Kindred Horrors (coll), by Robert E. Howard (0671656414)
The Horror Hall of Fame, eds. Silverberg & Greenberg (0709049021, 0881848808)
Young Blood, ed. Mike Baker (0821744984)
The Black Stranger and Other American Tales (coll), by Robert E. Howard (0803273533, 0803224214)
The Robert E. Howard Omnibus (11588739422)
The Haunter of the Rings and Other Tales (coll), by Robert E. Howard (9781840220858, 9781447407683)
The Best of Robert E. Howard vol 2 (0345490209)
The Day They Hanged My Best Friend Jimmy, ed. Barry J. Gillis (9780968593776)
Heroes in the Wind (coll), by Robert E. Howard (9780141189437)
A Thunder of Trumpets (coll), by Robert E. Howard (9780809571703)
The Horror Stories of Robert E. Howard (978159063327)
Zombies! Zombies! Zombies! ed Otto Penzler (9780307740892)
The Century's Best Horror Fiction 1901-1950, ed. John Pelan (9781587670800)
Blessings from the Condemned, ed. Robert Friedrich (9781499609264)

“Rule 18” by Clifford D. Simak
The Autumn Land and Other Stories (coll) by Clifford D. Simak (0749301856)

“Werewoman” by C. L. Moore
In voter packet
Horrors Unknown, ed. Sam Moskowitz (0802755348, 0425030636)
The Edge of Never, ed. Robert Hoskins
Dark Imaginings, eds. Boyer & Zahorski (0440531187)
Echoes of Valor II, ed. Karl Edward Wagner (0312931891, 0812557522)
Northwest of Earth (coll), by C.L. Moore (9781601250810, 9781607518594, 9780575119369)


Best Short Story

“The Faithful” by Lester del Rey
In voter packet
...And Some Were Human (coll) by Lester del Rey
First Flight, ed. Damon Knight
Now Begins Tomorrow, ed. Damon Knight
Early Del Rey (0385027400)
The Early Del Rey vol 1 (0345 25063X)
The Road to Science Fiction #2, ed. James Gunn (0451617363, 0810844397, 0451618599)
First Voyages, eds. Knight, Greenberg, Olander (0380775867)
Isaac Asimov Presents The Best Science Fiction Firsts, eds. Asimov, Greenberg, Waugh (0760702543)
The SFWA Grand Masters, vol 3 (0312868774, 0312868766)
War and Space (coll) by Lester del Rey (9781886778764)

“Helen O’Loy” by Lester del Rey
In voter packet
...And Some Were Human (coll) by Lester del Rey
Beyond Human Ken, ed. Judith Merril
Assignment in Tomorrow, ed. Frederik Pohl (044778699125)
The Coming of the Robots, ed. Sam Moskowitz
Master's Choice, ed. Laurence M. Janifer
The Science Fiction Hall of Fame, vol 1, ed. Robert Silverberg (0722178298, 0380007959, 1568658788, 0765305364, 0765305372, 0380449331, 0980007959)
18 Greatest Science Fiction Stories, ed. Laurence M. Janifer (0448053756, 044812128X)
Assignment in Tomorrow, ed. Frederik Pohl (044778699125)
3000 Years of Fantasy and Science Fiction, eds de Camp and Crook de Camp (068840006X)
Modern Science Fiction, ed. Norman Spinrad (0385022638, 0839823398)
In Dreams Awake, ed. Leslie A. Fiedler
Science Fiction and Fantasy, ed. Fred Olbrecht (0812006518)
Souls in Metal, ed. Mike Ashley (0709158912, 0515045462)
Robots Robots Robots, eds. Geduld & Gottesman (0821206885)
The Best of Lester del Rey (0345273362, 0345329333, 034543949X)
Science Fiction: Masters of Today, ed. Arthur Liebman (0823905373)
The Analog Anthology #2, ed. Stanley Schmidt
Analog Readser's Choice, ed. Stanley Schmidt (0385276818)
Robots and Magic (coll), by Lester del Rey (9781886778887)

“Hollerbochen’s Dilemma” by Ray Bradbury
In voter packet
Horrors Unseen, ed. Sam Moskowitz (0425025837)
Collected Stories of Ray Bradbury, vol 1 (9781606350713)

“How We Went to Mars” by Arthur C. Clarke
The Collected Stories of Arthur C. Clarke (057507065X, 0312878214, 1857983238, 0312878605, 0312878214, 1857983238, 0312878605)

“Hyperpilousity” by L. Sprague de Camp
In voter packet
Omnibus of Science Fiction, ed. Groff Conklin (0517453703)
Science Fiction of the Thirties, ed. Damon Knight (0380009048)
The Best of L. Sprague de Camp (0345254740, 0345329309)
The Road to Science Fiction #2, ed. James Gunn (0451617363, 0810844397, 0451618599)

Yesterday I blogged about the new "right to be forgotten" established by the European courts.

As that post has proved so popular - and as I appear still to be the only Liberal Democrat concerned by the issues it raises - here is a round up of others' comment about it.

On the Guardian website James Ball writes about that paper's experiences so far:

Stark evidence of this fact, the result of a European court ruling that individuals had the right to remove material about themselves from search engine results, arrived in the Guardian's inbox this morning, in the form of an automated notification that six Guardian articles have been scrubbed from search results. 

The first six articles down the memory hole – there will likely be many more as the rich and powerful look to scrub up their online images, doubtless with the help of a new wave of "reputation management" firms – are a strange bunch. 

Three of the articles, dating from 2010, relate to a now-retired Scottish Premier League referee, Dougie McDonald, who was found to have lied about his reasons for granting a penalty in a Celtic v Dundee United match, the backlash to which prompted his resignation. ... 

The other disappeared articles – the Guardian isn't given any reason for the deletions – are a 2011 piece on French office workers making post-it art, a 2002 piece about a solicitor facing a fraud trial standing for a seat on the Law Society's ruling body and an index of an entire week of pieces by Guardian media commentator Roy Greenslade.

As Ball goes on to say:

The Guardian, like the rest of the media, regularly writes about things people have done which might not be illegal but raise serious political, moral or ethical questions – tax avoidance, for example. These should not be allowed to disappear: to do so is a huge, if indirect, challenge to press freedom. The ruling has created a stopwatch on free expression – our journalism can be found only until someone asks for it to be hidden.

Xindex, a blog run by Index on Censorship, says the court ruling that has brought this right into being s deeply problematic, and needs to be challenged on many fronts:

We need policymakers to recognise this flabby ruling needs to be tightened up fast with proper checks and balances – clear guidelines on what can and should be removed (not leaving it to Google and others to define their own standards of ‘relevance’), demands for transparency from search engines on who and how they make decisions, and an appeals process. 

If search engines really believe this is a poor ruling then they should make a clear stand against it by kicking all right to be forgotten requests to data protection authorities to make decisions. The flood of requests that would be driven to these already stretched national organisations might help to focus minds on how to prevent a ruling intended to protect personal privacy from becoming a blanket invitation to censorship.

And even setting aside questions of censorship, Panopticon points out that there are all sorts of problems raised by that ruling:

Suppose, for example, that I am an investigative journalist with substantial reputational and career investment in articles about a particular individual who then persuades Google to ensure that my articles do not surface in EU Google searches for his name? Those articles also contain my name, work and opinions, i.e. they also contain my personal data. In acceding to the ‘please forget me’ request without seeking my input, could Google be said to have processed my personal data unfairly, whittling away my online personal and professional output (at least to the extent that the relevant EU Google searches are curtailed)? Could this be said to cause me damage or distress? If so, can I plausibly issue a notice under s. 10 of the DPA, seek damages under s. 13, or ask the ICO to take enforcement action under s. 40? 

The same questions could arise, for example, if my personal backstory is heavily entwined with that of another person who persuades Google to remove from its EU search results articles discussing both of us – that may be beneficial for the requester, but detrimental to me in terms of the adequacy of personal data about me which Google makes available to the interested searcher.

Back on the Guardian site, James Ball has ideas for getting round the ruling:

Publishers can and should do more to fight back. One route may be legal action. Others may be looking for search tools and engines outside the EU. Quicker than that is a direct innovation: how about any time a news outlet gets a notification, it tweets a link to the article that's just been disappeared. Would you follow @GdnVanished?

I would follow it, but there are more fundamental problems for Liberals here.

We instinctively support freedom of information, but many of us want to support privacy too - I was happy to publish a guest post in support of European privacy legislation by Paul Bradwell on this blog.

This week's events have shown that these two instincts can come into conflict and that we have hard choices to make.

But for Liberals this is really not a hard choice. As John Stuart Mill and Karl Popper have shown, freed discussion and free criticism lie at the heart of our creed and we should not compromise our belief in them.

Our latest week at Bonkers Hall ends with a bang.

Friday

A bright morning on my gunnery range, which occupies a remote corner of the Estate frequented only by sheep and ramblers. My companion is my old friend and fellow peer Matthew “Knuckles” Oakeshott, who rang earlier in the week asking for personal tuition in the deployment of the Bonkers Patent Exploding Focus (for use in marginal wards).

I give him my usual lecture: “The key thing after you have pulled out the pin is to get it through the letterbox, leg it down the garden path and dive behind the hedge before it goes off.” I then invite him to try it out for himself on a mock-up of a front door that I have had erected for just such occasions.

He pulls out the pin with gusto, but then spends an age fiddling with the letterbox, with the result that the Focus goes off while he is still holding it. Fortunately, he is unharmed (though rather black in the face).

“I am afraid, Knuckles, that This Sort of Thing may not be for you,” I tell him gently. “And I’d stay away from Ukip activists until I have had a good wash.”

Lord Bonkers was Liberal MP for Rutland South-West 1906-10.

Earlier this week...

• On the roof of St Asquith's
• Introducing Freddie and Fiona
• No time to worry about Japanese food
• Nick Clegg and Vince Cable at the Bonkers' Arms
• Send for the Well-Behaved Orphans
• Steve Webb visits the Hall

Alfred Smith got fired from his job as a counselor in an alcohol rehab clinic because he went to church on Sunday and drank wine during communion.

That’s not exactly what happened. But it is exactly parallel to what happened.

Smith, who is Native American, got fired from his job as a counselor at a drug rehab clinic because he participated in Native American religious rituals involving peyote. Then he got turned down for unemployment benefits because peyote is an illegal substance in Oregon.

That seems wildly unjust. Even during Prohibition, sacramental wine was never illegal. How could Oregon’s ban on peyote — even in religious rituals — be viewed as anything other than a clear violation of Alfred Smith’s free exercise rights guaranteed by the First Amendment?

The case went all the way to the Supreme Court. The majority opinion, written by Justice Antonin Scalia in 1990, said “Tough luck, Mr. Smith.”

The court ruled that Oregon’s law prohibiting all use of peyote was a reasonable and generally applicable law. It wasn’t intended to target Native American religions specifically — they were just collateral damage. If a generally applicable law just so happened to have unfortunate side effects for religious minorities, well, then it sucks to be them, I guess.

That struck a lot of us as outrageous. A big messy trans-partisan coalition — the ACLU, everyone mentioned anywhere in the Handbook of American Religions — raised holy hell about this for the next three years. That produced two tangible results.

First was Hialeah — or, more formally, Church of Lukumi Babalu Ay v. City of Hialeah. The Florida city didn’t like having a Santeria congregation around and so, walking through the door that Justice Scalia had opened for them in the peyote ruling, they passed a generally applicable law involving the slaughter of animals that just so happened to also have the side effect of outlawing the religious practices of an unwanted religious minority.

To Hialeah’s dismay, the high court flip-flopped. Lower courts had all upheld the city’s anti-slaughter statute citing the clear precedent Scalia had provided in Employment Division v. Smith (the peyote case). But the Supreme Court blinked and balked and reversed itself, pulling a 180 with a unanimous ruling that the city’s statute was an unconstitutional violation of the First Amendment rights of religious minorities.

The fig-leaf excuse for this reversal was that such discrimination was the transparent intent of Hialeah’s law. That was distinct from the peyote case, the court said, because Oregon’s law hadn’t been specifically intended to burden the free exercise of Native Americans.

As though the link between peyote and Native Americans is supposedly too obscure to have occurred to anyone. As though the history of the western United States were pristine of any hint of bias toward Native Americans.

But it’s churlish to focus on the flimsiness of the pretext. The good news was that the court reversed itself — three years of very loud, very public argumentation had rendered its previous position indefensible. That can happen. It happens a lot, actually.

Later that same year, 1993, Congress passed RFRA — the Religious Freedom Restoration Act — a short, specific legislative response to correct the injustice established by Employment Division v. Smith.

In 1993, no one who supported RFRA believed that it said or meant what Justice Alito and the majority of the Supreme Court creatively discovered it to newly mean in the Hobby Lobby ruling. This inelastic law, tailored to remedy a specific ruling — one the court itself later repudiated (without quite admitting it) in Hialeah — has now been stretched beyond the breaking point.

This is a law that says, clearly, that the rights of religious minorities cannot be erased by “generally applicable laws” that just so happen to make their religious practices illegal. It defends the right of Native American religious groups to use peyote in their religious rituals. It defends the right of Santeria congregations to sacrifice chickens.

Or, rather, it used to do those things. Now it does the opposite.

Now, Alito says, RFRA defends the religious liberty of states who seek to outlaw peyote, and it defends the “religious liberty” of nice little Florida cities who just want the religious freedom to not have those weird Santeros hanging around.

The City of Hialeah should go back to court. Justice Alito has just made it clear that this time they’d win.

After a brief spurt of debate over the claim that “97% of relevant published papers support anthropogenic climate change”, I think the picture has mostly settled to an agreement that – although we can contest the methodology of that particular study – there are multiple lines of evidence that the number is somewhere in the nineties.

So if any doubt at all is to remain about climate change, it has to come from the worry that sometimes entire scientific fields can get things near-unanimously wrong, especially for political or conformity-related reasons.

In fact, I’d go so far as to say that if we are not climatologists ourselves, our prior on climate change should be based upon how frequently entire scientific fields get things terribly wrong for political or conformity-related reasons.

Skeptics mock the claim that science was wrong before, but skeptics mock everything. A better plan might be to try to quantify the frequency of scientific failures so we can see how good (or bad) the chances are for any given field.

Before we investigate, we should define our reference class properly. I think a scientific mistake only counts as a reason for doubting climate change (or any other commonly-accepted scientific paradigm) if:

1. It was made sometime in the recent past. Aristotle was wrong about all sorts of things, and so were those doctors who thought everything had to do with black bile, but the scientific community back then was a lot less rigorous than our own. Let’s say it counts if it’s after 1900.

2. It was part of a really important theory, one of the fundamental paradigms of an entire field. I’m sure some tiny group of biologists have been wrong about how many chromosomes a shrew has, but that’s probably an easier mistake to wander into than all of climatology screwing up simultaneously.

3. It was a stubborn resistance to the truth, rather than just a failure to have come up with the correct theory immediately. People were geocentrists before they were heliocentrists, but this wasn’t because the field of astronomy became overly politicized and self-assured, it was because (aside from one ancient Greek guy nobody really read) heliocentrism wasn’t invented until the 1500s, and after that it took people a couple of generations to catch on. In the same way, Newton’s theory of gravity wasn’t quite as good as Einstein’s, but this would not shame physicists in the same way climate change being wrong would shame climatologists. Let’s say that in order to count, the correct theory has to be very well known (the correct theory is allowed to be “this phenomenon doesn’t exist at all and you are wasting your time”) and there is a large group of people mostly outside the mainstream scientific establishment pushing it (for approximately correct reasons) whom scientists just refuse to listen to.

4. We now know that the past scientific establishment was definitely, definitely wrong and everyone agrees about this and it is not seriously in doubt. This criterion isn’t to be fair to the climatologists, this is to be fair to me when I have to read the comments to this post and get a bunch of “Nutritionists have yet to sign on to my pet theory of diet, that proves some scientific fields are hopelessly corrupt!”

Do any such scientific failures exist?

If we want to play this game on Easy Mode, our first target will be Lysenkoism, the completely bonkers theory of agriculture and genetics adopted by the Soviet Union. A low-level agricultural biologist, Lysenko, came up with questionable ways of increasing agricultural output through something kind of like Lamarckian evolution. The Soviet government wanted to inspire people in the middle of a famine, didn’t really like real scientists because they seemed kind of bourgeois, and wanted to discredit genetics because heritability seemed contrary to the idea of New Soviet Man. So they promoted Lysenko enough times that everyone got the message that Lysenkoism was the road to getting good positions. All the careerists switched over to the new paradigm, and the holdouts who continued to believe in genetics were denounced as fascists. According to Wikipedia, “in 1948, genetics was officially declared “a bourgeois pseudoscience”; all geneticists were fired from their jobs (some were also arrested), and all genetic research was discontinued.”

About twenty years later the Soviets quietly came to their senses and covered up the whole thing.

I would argue that Stalinist Russia, where the government was very clearly intervening in science and killing the people it didn’t like, isn’t a fair test case for a theory today. But climate change opponents would probably respond that the liberal world order is unfairly promoting scientists who support climate change and persecuting those who oppose it. And Lysenkoism at least proves that is the sort of thing which can in theory sometimes happen. So let’s grumble a little but give it to them.

Now we turn the dial up to Hard Mode. Are there any cases of failure on a similar level within a scientific community in a country not actively being ruled by Stalin?

I can think of two: Freudian psychoanalysis and behaviorist psychology.

Freudian psychoanalysis needs no introduction. It dominated psychiatry – not at all a small field – from about 1930 to 1980. As far as anyone can tell, the entire gigantic edifice has no redeeming qualities. I mean, it correctly describes the existence of a subconscious, and it may have some insightful things to say on childhood trauma, but as far as a decent model of the brain or of psychological treatment goes, it was a giant mistake.

I got a little better idea just how big a mistake doing some research for the Anti-Reactionary FAQ. I wanted to see how homosexuals were viewed back in the 1950s and ran across two New York Times articles about them (1, 2). It’s really creepy to see them explaining how instead of holding on to folk beliefs about how homosexuals are normal people just like you or me, people need to start listening to the psychoanalytic experts, who know the real story behind why some people are homosexual. The interviews with the experts in the article are a little surreal.

Psychoanalysis wasn’t an honest mistake. The field already had a perfectly good alternative – denouncing the whole thing as bunk – and sensible non-psychoanalysts seemed to do exactly that. On the other hand, the more you got “educated” about psychiatry in psychoanalytic institutions, and the more you wanted to become a psychiatrist yourself, the more you got biased into think psychoanalysis was obviously correct and dismissing the doubters as science denalists or whatever it was they said back then.

So this seems like a genuine example of a scientific field failing.

Behaviorism in psychology was…well, this part will be controversial. A weak version is “psychologists should not study thoughts or emotions because these are unknowable by scientific methods; instead they should limit themselves to behaviors”. A strong version is “thoughts and emotions don’t exist; they are post hoc explanations invented by people to rationalize their behaviors”. People are going to tell me that real psychologists only believed the weak version, but having read more than a little 1950s psychology, I’m going to tell them they’re wrong. I think a lot of people believed the strong version and that in fact it was the dominant paradigm in the field.

And of course common people said this was stupid, of course we have thoughts and emotions, and the experts just said that kind of drivel was exactly what common people would think. Then came the cognitive revolution and people realized thoughts and emotions were actually kind of easy to study. And then we got MRI machines and are now a good chunk of the way to seeing them.

So this too I will count as a scientific failure.

But – and this seems important – I can’t think of any others.

Suppose there are about fifty scientific fields approximately as important as genetics or psychiatry or psychology. And suppose within the past century, each of them had room for about five paradigms as important as psychoanalysis or behaviorism or Lysenkoism.

That would mean there are about 250 possibilities for science failure, of which three were actually science failures – for a failure rate of 1.2%.

This doesn’t seem much more encouraging for the anti-global-warming cause than the 3% of papers that support them.

I think I’m being pretty fair here – after all, Lysenkoism was limited to one extremely-screwed-up country, and people are going to yell that behaviorism wasn’t as bad as I made it sound. And two of the three failures are in psychology, a social science much fuzzier than climatology where we can expect far more errors. A cynic might say if we include psychology we might as well go all the way and include economics, sociology, and anthropology, raising our error count to over nine thousand.

But if we want to be even fairer, we can admit that there are probably some science failures that haven’t been detected yet. I can think of three that I very strongly suspect are in that category, although I won’t tell you what they are so as to not distract from the meta-level debate. That brings us to 2.4%. Admit that maybe I’ve only caught half of the impending science failures out there, and we get to 3.6%. Still not much of an improvement for the anti-AGW crowd over having 3% of the literature.

Unless of course I am missing a whole load of well-known science failures which you will remind me about in the comments.

[Edit: Wow, people are really bad at following criteria 3 and 4, even going so far as to post the exact examples I said not to. Don't let that be you.]

Thursday 

From time to time I invite one of our Liberal Democrat ministers down to the Hall to hear how they are getting on and give them the benefit of my experience.

My latest guest is Professor Steve Webb, whom all agree is Terribly Clever. He tells me all about his plans to reform the pension system so that a chap can get his hands on his nest egg and use it as he sees fit rather than be forced to buy an annuity from the insurance companies.

“Of course,” he goes on, “the important thing is how long someone is going to live after retirement, but these days they can work that out. Here, I’ll do it for you.”

He begins to pound the keys of his pocket calculator, but grows steadily more puzzled as he does so. I even hear him mumble, with that pleasant Birmingham lilt of his, something to the effect that I “should have died years ago”.

“What you are failing to take into account, Professor,” I tell him, “is the Spring of Eternal Life that bursts from the hillside above what used to be the headquarters of the Association of Liberal Councillors in Hebden Bridge. I make an annual pilgrimage to bathe in it – I've checked the small print on all of my insurance policies and nowhere is it mentioned.”

All in all, a pleasant afternoon and I end it by giving Webb a lift back to the station in my Lamborghini.

Lord Bonkers was Liberal MP for Rutland South-West 1906-10.

Earlier this week...

• On the roof of St Asquith's
• Introducing Freddie and Fiona
• No time to worry about Japanese food
• Nick Clegg and Vince Cable at the Bonkers' Arms
• Send for the Well-Behaved Orphans

"YOU SUCK! GET OFF THE STAGE!"

Sandman is a difficult comic to discuss in any sort of critical fashion if only because it’s generated a fan base which defends the series far in excess of its virtues. By and large, it’s a strong, laudable run of some 75+ comics with a great deal of merit – of those stories, a solid third (typically the ones which, ironically, feature the book’s title characters and his clan little, if at all) are impeccable and practically beyond criticism. Another third are stories which can conceivably be described, at worst, as “capable but literate”, and then there’s that last third which is, you know, A Game of You.

It’s also fair to say that the book often seemed to lack direction, that – claims to the contrary notwithstanding – the first dozen or so issues seem to indicate that Gaiman didn’t truly know where the comic was ultimately going, it relied on character sketches at the cost of world-building, dragged its feet, was a smidgey-widge pretentious,  and so on.

The hell you say.

Really, you don’t have to go much further than the title’s second coherent arc, The Doll’s House, to see all of its strengths and weaknesses on display in a single story:  While it simultaneously introduces the series’ most intriguing single idea (the serial killer convention) and crafts a brace of well-conceived characters in the midst of a compelling, human storyline (Rose and her recently reunited family),  it then proceeds to gad it up with imprecise and ambiguous threats (oh no, it’s a “dream vortex”, should we … call the cops?), “colorful” background characters who tread water and appear to be weird for weird’s sake, indulgent interstitial stories which are admittedly exceptional but which completely fubar the pacing of the main narrative, and then let’s not forget the Little Nemo-inspired scenes of escapism which may have seemed shocking once but become increasingly goofy as the story proceeds AND the fact that the main female protagonist is TWICE in the same story threatened with rape and murder and then TWICE is saved by a magical man from dreamland …

In lieu of actual criticism, though, you tend to get relentlessly forgiving and barely-qualified praise where even the failings are celebrated as successes, such as with the AV Club’s recent review of the series which, if you don’t have time to read it, you can summarize by picturing the sound of an enthusiastic but inexpert blowjob OR, if imagination fails you completely, you can just feed a jar of mayonnaise to a bulldog.

For my part, though, the story which has always stood out as the series’ weakest point was early on, Sandman No.4 (April 1989), “A Hope in Hell” – or, as I like to call it, literally the dumbest comic I’ve ever read.

In the inconceivable event that you’ve never read Sandman before now, here’s the skinny: The Sandman is “Morpheus”, the King of Dreams, a nearly-immortal and occasionally (when the script calls for it) functionally omnipotent figure who is a member of some supernatural race of beings called The Endless and who has dominion over the world of dreams in some occasionally indistinct capacity – he either makes them, rules over them, or is the embodiment of them, or some mix thereof.

Whatever the case, dreams certainly happen when he’s otherwise occupied, such as early in his first issue where it’s revealed that Morpheus has been the captive of a Crowley-esque cult of spiritualists since the early part of the century. Escaping from his captors, the early issues of Sandman’s comic involve him retrieving the symbols of his office – a pouch of magic sand, a ruby, and his magic hat, which is in Hell.

Of course he's got a fedora.

To be fair, it’s not a magic hat, it’s a ♫ magic hel-met ♫, which I defy you not to hear in Elmer Fudd’s voice every time it’s mentioned. Spear and ♫ magic hel-met ♫.

The story in A Hope in Hell doesn’t kick in until almost halfway through the book, as first we’re introduced to the topography of Hell and some story-seeding for later issues. After an intro to the demonic host of Hell, entertainingly drawn by Sam Kieth, we’re in the ridiculous main story.

So Hell has Sandman’s ♫ magic hel-met ♫ and Lucifer, feeling  friendly, invites the Sandman to choose from among Hell’s gathered masses of messed-up looking demon dudes to find the guy who has it in his possession– and he does, it’s Choronozon, a magenta nitwit with a wide catalog of castoff costumes from touring productions of the Rocky Horror Show. Unwilling to return the ♫ magic hel-met ♫, Choronozon challenges the Sandman to – A RAP BATTLE!

It’s the rap battle for a ♫ magic hel-met ♫ to beat all rap battles for a ♫ magic hel-met ♫! Again, to be fair, it’s not exactly a scene from 8 Mile, in fact it’s slightly more contrived than a demonic rap battle – it’s an infernal poetry slam (aren’t they all). The game is allegedly called “reality” and what it involves is for both players to (A) dress up like extras from a Michael Jackson video and (B) to talk utter nonsense at each other.

Each contestant describes themselves as some sort of thing which destroys the last thing, so like Choronozon starts by being a wolf, Morpheus replies by being a guy who kills wolves, Choronozon replies by being a thing that kills guys – it’s not exactly Settlers of Cataan, although I’d fully expect to see guys in fedoras and photographers vests playing it at a card table in back of a comic shop.

The dumbest part of the battle – and remember this, it’s important – is that Choronozon decides he’s the death of the universe and Sandman replies “Oh, but I’m hope!” and everyone’s like WHAT and Satan’s record player scratches and then you hear a cat yowl and like a planter crashes to the ground or something. Hope, can you believe this guy, HOPE! Fans are rushing the field, tearing down the goalposts now.  No one knows how to crush hope, even though hopes are literally dashed every second of every day plus that one guy just said that the universe is dead so there is no hope to be had, anyway, this game is O-VER *dumps Gatorade on Sandman*

So, already this would be frustrating enough, because this is one of those situations where the characters in a story are supposed to be more clever than the readers but they act like morons and there’s nothing you can do, they ain’t real! You can’t phone ‘em up or nothing. They just gotta be dumb, and then the story ends – but it doesn’t.

Now in possession of his ♫ magic hel-met ♫, Sandman is preparing to leave Hell, but the demons of the underworld gather to stop him, even though he’s won his freedom by playing the most important game of Apples to Apples the universe has ever seen. He engineers his escape by explaining that, hey, he’s Dream and even demons gotta dream of a better place, right? Okay, peace out.

I am a Nineties alterna-comic, over-written, pretension-bolstering.

So here’s what happened, in short order – keeping in mind that the stakes of the magic rap battle was that, if he lost, demons would kill him, the Sandman manages to get out of both situations by iterating the same idea – that he represents “hope”. Both times. Literally, the book staged the same threat with the same resolution within the span of six pages. It went like this:

Demons: All right Sandman, we are going to hell of kill you now.

Sandman: But you can’t kill me, because I represent **HOPE**

Demons: OHHHH SHIIIIT SONN I guess you’re right okay see you (pause) but not before we KILL YOU!

Sandman: But you can’t kill me, because I represent **HOPE** still

Demons: OHHHH SHIIIIIIT SONN WE FORGOTTTT you mentioned that like just now, all right see ya for reals this time, bye!

Dumb as fuck, but at least the Prez issue was still forthcoming.

Brendan Totten writes…

I enjoyed reading your recent pieces on Bob Kane and Bill Finger. It set me thinking about another major comic character.

I have often been curious as to why Wonder Woman has always been credited solely to William Moulton Marston with no mention of Harry G. Peter as co-creator. He did the original concept sketch which has since become the "iconic" image of Wonder Woman as well as a great body of excellent and charming artwork for the original series. I can't help feeling he is another forgotten hero from the Golden Age who has not achieved the credit he deserves.

Maybe you have some information or theories that would be new to me?

Well, credits like that in comics have always been the result of negotiation. William Moulton Marston made a deal that gave him credit. Harry G. Peter did not. I would guess — this is speculation — that Marston secured a contract that gave him sole credit and then Peter had the option of creating what he created without a creator credit…or not getting the job. Back then, I don't think most folks in comics dreamed of how important that creator credit might someday be. Peter probably didn't even dream of how important Wonder Woman would be.

In television, the Writers Guild of America has set up rules as to what you have to do to have it say "Created by" you on a TV show and the producers have agreed to abide by those rules. There are not and have never been any such rules in comics, which is why the guy who owned the company could sometimes slap his name in that position or deny it to those who actually did the work. There have been writers who have felt that by writing the first script, they'd created the comic and that the artist who drew that script and devised what everyone looked like were not entitled to be referred to as co-creators. Others disagree.

It's possible that this is one of those injustices that no one ever notices or campaigns about. I dunno. I don't think a lot of folks think Peter did excellent and charming artwork for those comics. I sure don't…but that's not relevant to whether he deserves the credit.

I also don't think many people today know much about Harry G. Peter, whereas you had friends of Bill Finger's like Jerry Robinson and Arnold Drake going around decrying his lack of recognition. Some of the things Bob Kane said seemed to cry out for correction, whereas Dr. Marston was not making the rounds claiming he did the whole comic by himself.

But you know, I have to admit: I've seen Marston get sole credit on Wonder Woman for years…on the Lynda Carter TV show, for instance. I don't recall anyone ever asking, "What about Harry G. Peter?" Maybe someone should.

No, I didn't misspell "dessert" in the subject line. This is a post about deserting (as in, "abandoning") most toppings on hamburgers.

The New York Times, when it isn't quietly retracting every story they ran about the Iraq War during its first year, has been covering some pretty important topics…like how to make a great hamburger. I like the part of this story where they say…

Finally, there are condiments. You pull your burgers off the skillet, place them on the buns and then offer them to guests to dress. Ripe tomatoes and cold lettuce should be offered ("Only bibb lettuce," Mr. Zakarian said, "for its crispness and ability to hold the juices of the meat") along with ketchup, mustard and, for a hardy few, mayonnaise or mayonnaise mixtures. Onions excite some. Pickles, others. But do not overdress. "People really overcomplicate hamburgers," Mr. Zakarian said. "They substitute complication for proper cooking technique."

Exactly. I find that the more someone aspires to reinvent the form and offer "gourmet" hamburgers, the more I'm likely to be served something inedible. Call me a peasant if you like but what I want was is a properly-cooked piece of ground beef with a little fat content, served to me on a traditional white bun with some onions and an adjacent bottle of ketchup. I do not want cheese, lettuce, mustard, tomato, bacon, arugula, thousand island dressing, dressing of any kind, chili, a fried egg, an unfried egg, pineapple, sprouts, your sister's Barbie doll, teriyaki sauce, kale, truffle glaze, green chiles, oobleck, avocado, pickled ginger, secret sauce, non-secret sauce, flubber, wasabi flakes, frosted flakes, etc.

I have no problem with all that stuff being available for those who like it. Fine. But if you can't make a great hamburger out of just meat and a bun, you have no right calling yourself a chef. And that's what I want: Meat on a bun. With some onions and ketchup.

And we're talking basic meat here. Last week, I found myself at a fancy restaurant where their "signature burger" (the only one they had) was a cheeseburger that was — and I quote right from the menu — "A delicious blend of Chopped Sirloin, Smoked Bacon and Sweet Onions." That description of items they mix into their meat says to me, first of all, "We're going to charge a lot for this." Secondly, it says they're using too good a grade of beef to make a hamburger so they have to add extra ingredients to give it flavor.

I'm fine with bacon and onions outside the burger…but those things inside plus unidentified seasonings made this hamburger, to me, not very good. One of the spices seems to have triggered one of my food allergies but, that aside, it was three times the price of a Five Guys burger and about a third as pleasing.  And I came to that conclusion before I began to get the unpleasant feeling that a mild reaction from one of my food allergies was kicking in.  (I'd asked, by the way.  They had no hamburger meat on the premises that wasn't mixed with all those extra components.)

A few years ago, a trend started. Restaurants began opening that not only served a hamburger with all sorts of special condiments but which also had a policy of not allowing modifications of their items. You couldn't not get it with the arugula on it, you couldn't have ketchup, etc. This, from my point of view, was a trend of opening restaurants I would never visit.

That's their right, of course. All I want to say here is that I think there's something to be said for hamburgers that don't need a lot of add-ons. I have eaten in places where to get what I wanted — meat, bun, ketchup and onions — I had to tell the waiter to give me a #1 and to leave off about eight toppings that come standard on it. There is, of course, no price reduction for declining about half of the product.

I've also learned in some pretty fancy places that when you leave off everything except the ketchup and onions, you discover that the burger itself — the meat patty that is, after all, the central component of what you're buying — just plain isn't very good.

Tuesday

Who should telephone but Freddie and Fiona? “We’ve been told to organise a press event in a pub this morning so that Mr Clegg and Vince Cable can have a drink together and show they are really best friends despite what everyone says,” they explain. “But the trouble is, we don’t know how to do it.” “Why ever not?” I ask. “Because we are too young to go into pubs.”

Cometh the hour and all that, so I step in and organise things for them. “There’s a pint of Smithson & Greaves Northern Bitter each for Clegg and Cable,” I tell them when they arrive at the Bonkers’ Arms, “and that dreadful, gassy Dahrendorf lager for the journalists.” “Oh no,” they say quickly, “we can’t have journalists at a press event. What happens if they write something nasty about Mr Clegg?”

I talk some sense into them, thought I must admit the press pack does get rather frisky when the lager starts to flow. I show Clegg a loose window in the Gents that he can climb through, before leading Vince Cable along the secret passage that leads from the cellar of the pub to the Hall, where we enjoy a hearty luncheon.

Lord Bonkers was Liberal MP for Rutland South-West 1906-10.

Earlier this week...

• On the roof of St Asquith's
• Introducing Freddie and Fiona
• No time to worry about Japanese food

We ask judges to interpret the law — to adjudicate between different possible meanings of civil statutes. We don’t ask them, or want them, to settle religious questions. That’s not their jurisdiction.

So there’s a sense in which the majority opinion of the Supreme Court in the Hobby Lobby case was correct in those parts of the ruling that ignored the factual content of the purported religious beliefs of the billionaire Green family. The Greens’ claim that certain forms of contraception are “abortifacient” is not factually accurate. It contradicts observable reality — it is not true.

But again, it’s not the courts’ job to weigh in on whether or not religious claims are true — even when those claims are patently falsifiable. The Hobby Lobby ruling demonstrates the wisdom of that principle from both sides. The bits of that ruling that refuse to consider the factual validity the Greens’ claims make some sense. But then the ruling reverses itself, endorsing the factual validity of those claims without ever evaluating them, and thereafter it goes off the rails into lawlessness and incoherenece.

We’ll get to the ruling and its inconsistency on this point later. Here I want to discuss the factual “dispute” at the heart of the Greens’ bogus “abortifacient” claim.

The Greens and their supporters (many of whom are, or were shaped by, their support-ees) frame this dispute in a dishonest and self-serving way. They believe that IUDs and emergency contraception are “abortifacients,” they say, because of their religious belief that “life begins at conception.”

But that’s a dodge. This dispute is not about the belief that life begins at the moment of conception. It’s about the belief that conception occurs at the moment of ejaculation.

That’s not a matter of theological or philosophical debate. It’s just wrong.

That’s not how sex works.

But this, um, misconception fuels a lot of the opposition to emergency contraception in the US. If you mistakenly believe that conception occurs at the instant of ejaculation, then you’re going to assume that something called a “morning after pill” must be an abortifacient. You’ll be sure that if a pregnancy was going to occur, it would have occurred during the intercourse of the night before and, therefore, by the “morning after” it must be too late for contraception and this pill must really be inducing an abortion.

This is primarily a misunderstanding of the timeline — of how long it takes between the moment of Ohgodohgodohgodyes and the moment of fertilization. Those are not the same moment. They’re quite often not the same day.

It is possible for this to happen within the same hour, but that requires the Michael Phelps of sperm, ideal conditions, and the wind blowing out at Wrigley Field. But even with supersonic sperm, it’s never going to happen in less than at least half an hour. More often it takes a day or more — up to five days.

Ah, yes, but what if it did only take an hour or two? That’s possible, right? Intercourse at, say, 11:45 p.m.,* fertilized egg by 2 a.m. The “morning after” it’d be too late for contraception, wouldn’t it? So then it’s possible the morning-after pill could become an abortifacient if taken the next day, right?

Well, no.

Here’s what the morning after pill does if you take it after you’re already pregnant: nothing.

But isn’t it still maybe possibly conceivable that, in some rare cases, emergency contraception could possibly maybe interfere with a fertilized egg?

Scientists will answer yes. It’s not probable. It’s not likely. All the evidence strongly suggests that can’t and won’t happen. But scientists, being scientists, will always answer “yes” when you frame a question that way.

Ask Neal DeGrasse Tyson if a radical increase in atmospheric CO2 will result in climate change and he will answer, unequivocally, Yes. But if you ask him whether it’s possible — not likely, just possible — to imagine that some other unforeseen factor could possibly alter that result, and he’ll say that, yes, that’s technically possible. Tyson is a scientist — ask him to disregard likelihood and spin out possible imaginable scenarios and he could go on forever.

But it would be either foolish or dishonest to conclude therefore that Tyson doubts the link between CO2 and climate change.

And it’s just as foolish and/or dishonest to grasp at the slender straw of imaginable possibility as “evidence” that emergency contraception is an abortifacient.

That claim requires you to misrepresent “Medical science cannot with 100-percent positivist certainty rule out the rare and remote possibility of X” as “Medical science says X.”

And when you misrepresent things in that way, it tells the rest of us that you cannot be trusted.

But look, I get it. Those folks don’t trust me either. I do not share their belief that full human personhood begins at the moment of conception (and/or incorporation). And since I don’t share their belief about that, they’re not likely to listen to me when I try to explain that the instant of conception does not occur at the same instant as ejaculation — or even shortly thereafter.

And therefore they’re not likely to trust me when I try to explain that the “morning after” acts is a contraceptive and not an “abortifacient” — that it is, in fact, almost certainly useless as an abortifacient.

Fine. Don’t listen to me, or to the Mayo Clinic, or to your doctor.

Listen to Roman Catholic Cardinal Joachim Meisner of Cologne, a conservative Catholic who — with the approval of his friend, then-Pope Benedict XVI — ordered Catholic hospitals in his archdiocese to permit the use of emergency contraception.

Meisner is a conservative Catholic who believes that “life begins at conception.” But he does not oppose emergency contraception because he does not believe that conception begins at ejaculation. He does not believe that because that is not true.

- – - – - – - – - – - -

* I say 11:45 because my first apartment had a central, acoustically perfect “breezeway” and everybody kept their windows open all winter due to the overactive 1930s steam radiators. So everybody heard everybody else’s TV, the clank of dishes in their sinks, and any other … domestic noises.

My upstairs neighbors were like clockwork. Action News. Carson’s monologue. Squeak, squeak, squeak. Loud cry. Every night.

And good for them. Here’s hoping they kept at it all through the Leno years and they’re still keeping the same schedule in the Jimmy Fallon era.

Since I was twelve years old, my life has taken place in a series of Four Year Intervals.

Four years of high school. Four years of college. Four years of medical school. Four years of residency. Four times four, nice and symbolic.

This comes to mind now because I finished my first year of residency today.

I went into it raised on a steady diet of medical TV dramas like Scrubs and House, the legends passed down by other doctors in my family, and the ideas inculcated into me in medical school. It turned out to be nothing like any of those.

I’ve written a few posts about my experiences at work: The Hospital Orientation, I Aten’t Dead, Who By Very Slow Decay, and Evening Doc. I’ve tried to avoid writing anything more specific in order to protect patient confidentiality and my confidentiality.

But I thought this would be a good time to record – for my future self as much as for anyone else – what surprised me in my first year of medical practice.

To start with, forget about diagnostic mysteries. If you’ve ever seen House or anything else remotely like it, you imagine doctors as constantly presented with weird and wonderful symptoms, then racing against the clock to figure out what rare and deadly disease it is.

In real life, patients are more like the elderly lady I got last month. She had three hospital admissions for urinary tract infections in the past two years. Now she comes in with urinary symptoms. Before I even know the patient exists, the emergency room doctor has run a urine test which reveals that it’s a urinary tract infection. He has helpfully started her on the correct antibiotic for urinary tract infections. WHAT COULD THIS DIAGNOSTIC MYSTERY POSSIBLY BE?

Yeah, it was a urinary tract infection.

Or the guy who comes in shaking and sweating. I ask him what happened. He said he has been drinking alcohol for thirty years, and two days ago he tried to stop cold turkey. Have you ever had these sorts of symptoms before? Yes, every time I go off alcohol I get them. Does anything relieve the symptoms? Yes, drinking more alcohol. SOMEBODY PAGE DOCTOR HOUSE TO FIGURE OUT WHAT’S GOING ON?

Yeah, it was alcohol withdrawal.

Not all the patients I got were like this. But probably ninety-five percent of them were. Most people come into hospital for flare-ups of chronic problems they have had for, at minimum, ten years. Most of the time they have been to their primary care doctor first, who has made the diagnosis and sent the patient to the hospital for treatment. Or if not, they go to the emergency room, where the emergency room doctors do the same standard blood test they do on everybody and which usually gives you a really good idea what’s up. Oh, you’re feeling sick and tired and thirsty and nauseous? Hmm, your blood glucose is five hundred. Are you a diabetic? Did you take your insulin? Why didn’t you take your insulin? “Being on vacation” is not a good reason to stop taking your insulin! Do you promise to take your insulin in the future? Okay, well let’s admit you to the hospital and send you to Dr. Alexander so he can clear up this massive medical mystery we have on our hands.

But okay, five percent of cases we’re not entirely sure what’s going on. Now we can page Dr. House, right?

Wellll, in reality we “stabilize” them. A lot of the time “stabilize” means “put them in a bed and give them IV fluids and they get better on their own”. Sometimes the problem looks vaguely infectious and so we give empiric antibiotics, where empiric means “let’s give them an antibiotic that works for lots of stuff, and maybe it’ll work for this”. Sometimes the problem looks vaguely autoimmune and we give them steroids.

It’s pretty funny, because in medical school you spend a lot of time learning about maybe two dozen very rare autoimmune diseases, and how to differentiate Wegner’s granulomatosis from Takayasu arteritis, and the very subtle differences in the aetiology of each. And in real life, my attending says “Huh, this looks vaguely autoimmune, let’s throw steroids at it.” And it always works.

Now I understand that when the patient leaves hospital, they go to a rheumatologist or other specialist, and the specialist probably does lots of complicated tests and then comes up with a treatment regimen perfectly suited to that patient. But at the level I’m working at, it’s more “Hey, it responded to steroids! I guess it really was autoimmune! Or maybe the patient just got better on her own. Or something. Anyway, who cares, patient’s better, let’s discharge before something goes wrong.”

Because something else always goes wrong. You may be wondering: if doctors don’t spend their time solving diagnostic mysteries, what do they do in all those long hours they work? The answer is: deal with the avalanche of disasters that inevitably begin the second a patient walks through the door into a hospital.

I want to make it very clear I’m not criticizing my own hospital here. They make an amazing effort to do everything possible to avoid dangerous complications. All the hospitals I’ve worked at do. And all of them are death-traps. God just has a particular hatred for hospital patients, which He expresses by inflicting random diseases upon them for so long as they make the mistake of staying within the four walls and ceiling of a hospital building.

Like, you can be a perfectly healthy person, who lives forty years without anything worse than a sniffle. And then one day you’re playing sports, and you break your leg and you think “What’s the worst that can happen, I’ll spend a day or two in the hospital?” and by the time you come out you’ve got two artificial legs and a transplanted kidney and a rare bunyavirus from the African tropics and you have to inject yourself with insulin every three hours or else you die.

There are some good reasons for this. Obviously hospitals are full of sick people which means the potential for contagious infectious is high. People in hospitals are always getting lines stuck into them and surgeries performed and otherwise having foreign objects stuck in the body, and of course that’s a risk factor for all kinds of stuff. People in hospitals are often taking medications, which often have side effects. People in hospitals are often having tests, which sometimes involve injecting large amounts of radioactive material into the body and hoping it doesn’t fry anything important.

Then there are reasons you never expect until someone teaches you about them. If you don’t move your legs enough – maybe because you’re lying in a hospital bed all day – the blood in your legs settles and clots, and then the blood clots travel to your lungs, and then you can’t get any oxygen and potentially die. If you don’t fidget enough – maybe because you’re lying in a hospital bed unconscious – the constant pressure on a single patch of skin produces an ulcer, which gets infected and you potentially die. If you take five different recreational drugs every day, and your dealer doesn’t visit you in the hospital, then you go into withdrawal, and if you don’t want to admit what’s going on to your doctor maybe they miss it and – yeah, you potentially die.

But probably the biggest reason – and one you never think of – is that the hospital is where they’re finally doing tests on you, which means all those diseases that were lying dormant before and which you put down to normal old age finally get detected. You come in for a kidney stone, but your doctor does a blood test and finds you have diabetes. Also your calcium is a little off, we’re going to need to give you calcium pills and set up an appointment to get your parathyroid checked. And also when they did the CT of the kidneys they found a suspicious-looking mass in the colon, so you’re going to have to get that checked out. Uh, the gastroenterologist pulled the joystick controlling the colonoscope a little too hard and now you have a perforated colon, you need surgery. Uh, the surgeon put on her gloves the wrong way, now the surgical site is infected, guess you need antibiotics. Uh, guess you’re allergic to that antibiotic, let’s use a different one. Wow, allergic to four antibiotics in a row, guess this isn’t your day!

While Dr. House is diagnosing Chikungunya fever, the rest of us are treating the person who came in with a nosebleed (final diagnosis: blew nose too hard) but now has a DVT, hyperkalaemia, Sundowner’s syndrome, and a line infection.

Well, sort of treating.

John Searle came up with this really interesting philosophy-of-consciousness thought experiment. Suppose that a man were put in a room with a bunch of books, each of which contained a set of rules about Chinese characters. Sometimes, a paper with Chinese characters would come in through a slot in the door. The man would apply the rules in his book, which told him to write certain Chinese characters if certain conditions about the characters on the paper held true, and slip the output back through the slot in the door. The man does this faithfully, although he doesn’t know any Chinese and has no idea what any of it is saying.

On the other side of the door is a Chinese person. In her mind, she’s writing questions to the man, and he is responding back in fluent Chinese. She thinks they’re having a very productive conversation, and is starting to get a crush on him.

And the question is, in what sense can the man in the room be said to “understand” Chinese? If the answer is “not at all”, then in what sense can the brain – which presumably takes inputs from the environment, applies certain algorithms to them, and then sends forth appropriate outputs – be said to understand anything?

Daniel Dennett and various other materialist philosophers have a response to this challenge, which is that the man does not understand Chinese, but the man, his books, and the room can be conceptualized as an emergent system that does possess the property of Chinese-understanding and which may or may not be conscious.

I bring this up, because I understand what’s going on with patient care about as well as the man understands Chinese. I feel like maybe the hospital is an emergent system that has the property of patient-healing, but I’d be surprised if any one part of it does.

Suppose I see an unusual result on my patient. I don’t know what it means, so I mention it to a specialist. The specialist, who doesn’t know anything about the patient beyond what I’ve told him, says to order a technetium scan. He has no idea what a technetium scan is or how it is performed, except that it’s the proper thing to do in this situation. A nurse is called to bring the patient to the scanner, but has no idea why. The scanning technician, who has only a vague idea why the scan is being done, does the scan and spits out a number, which ends up with me. I bring it to the specialist, who gives me a diagnosis and tells me to ask another specialist what the right medicine for that is. I ask the other specialist – who has only the sketchiest idea of the events leading up to the diagnosis – about the correct medicine, and she gives me a name and tells me to ask the pharmacist how to dose it. The pharmacist – who has only the vague outline of an idea who the patient is, what test he got, or what the diagnosis is – doses the medication. Then a nurse, who has no idea about any of this, gives the medication to the patient. Somehow, the system works and the patient improves.

The patient thinks “My doctor must be very smart”. Meantime, the girl outside that room in the thought-experiment is thinking “This man must be a brilliant Confucian scholar.”

Part of being an intern is adjusting to all of this, losing some of your delusions of heroism, getting used to the fact that you’re not going to be Dr. House, that you are at best going to be a very well-functioning gear in a vast machine that does often tedious but always valuable work.

Well, other people are. I plan to go into outpatient.

Starting tomorrow, I abandon this exciting world of urinary tract infections and broken legs and go into psychiatry full time. I’m looking forward to it, especially since psychiatry is a little slower-paced and more focused. But this year was meant to teach me some appreciation for the wider world of medicine.

And boy have I got it.

[Good luck to SSC commenters Athrelon and Laura and everyone else starting an internship or residency tomorrow, and congratulations to everyone finishing one up]

Today, in a 5-4 decision, the Supreme Court stated that religious belief (backed with a lot of cash) is more important than actual scientific and medical fact.

Hobby Lobby, a chain of craft stores, decided it didn’t want to cover birth control in its mandated employee health insurance because its owners oppose abortion and felt that birth control pills were an abortifacient. These beliefs are wrong — that is, factually incorrect — but nevertheless we had to let the Supreme Court decide just how important actual facts are.

Turns out, if the facts can be ignored in favor of wealthy corporations and against women, they aren’t that big of a deal. So Hobby Lobby is now free to execute its religious freedom in denying health care to women.

Some other facts that need to be ignored:

1) Hobby Lobby does the bulk of its business with China, where abortion is mandated by the state, but that doesn’t seem to compromise their beliefs.

2) Hobby Lobby invests, as part of its pension plan, in companies that manufacture birth control pills, but that doesn’t seem to compromise their beliefs.

3) Hobby Lobby’s employee health insurance covers vasectomies, as that doesn’t seem to compromise their beliefs.

These firmly held religious beliefs only seem to matter when they both affect women and make instead of cost money.

Now, I know what you’re thinking. “What if the boss is a Jehovah’s Witness? Are they exempt from paying for blood transfusions? Scientologist and psychiatrists? Christian Scientist and any health care at all?” You’re right to wonder that, but don’t worry; the ruling specifically says those don’t apply here. Why? I don’t know, but I can guess. For one thing, religious beliefs are varied, and there are differing opinions on what is and isn’t permitted, but one thing they all seem to agree on is that women are filthy whores whose slut-holes must be vigilantly monitored by their male superiors. Also, and this is a sort of by-the-by, but I guess the Supreme Court can now decide which religion is true and right (conservative Christianity) and which are bullshit nonsense we don’t have to acknowledge (all others). No big deal there.

We know that Corporations have Freedom of Speech. And they’re people. Now they have Religious Beliefs. It seems like they can do just about anything these days except go to jail when they break the law.

This was a golden opportunity for the right wing. It simultaneously got to help a corporation do whatever the hell it wanted to do AND state how unclean and wanton women are for thinking about non-procreative sex. It came as no surprise to anyone who has had to make herself content in the knowledge that Corporatism and Corporate-friendly Christianity get the last word on anything in this country anymore. We don’t need facts, we don’t even need common sense, we just need whatever Milton Friedman and Wall Street Jesus tell us they deeply believe.

It’s hard to find any winner other than Corporatism in this ruling. Even the evangelicals who have been fooled into thinking the GOP gives a damn about their sincere religious beliefs don’t win, because let me assure you, if you sincerely believed that Jesus would have wanted capital gains taxed at a higher rate you’d find out in a second what your allies think of you.

It’s am embarrassing mess of nonsense, this ruling. It follows the trend of corporate entities gaining more rights and actual human beings losing them. And I don’t see how we’ll ever retreat from this “progress”.

Now if you’ll excuse me, I have to fill out my What I Did With My Genitals This Weekend report and get it onto my boss’ desk.