Wednesday, 7 June 2017

vote

Once more, though it is no doubt pointless:

1. Economy.
If you are tempted to believe the economy is in safer hands with the Tories than others, seriously, ask yourself why you believe that?! I'm tired of repeating myself, but here goes: We've had six recessions since the Great Depression in the 1930s and FIVE of those were under Tory governments and attributable to Tory policy. The one that happened under a Labour government (2008) was caused by a global banking crisis and was exacerbated by domestic economic policies which were wholly backed by the Conservatives (bank deregulation) and which would have been implemented by them if they had been in power at the time (go on, find me any statement made by a Tory which is critical of bank deregulation prior to the banking crisis in 2008). Moreover, it is highly unlikely that a Corbyn-led Labour party would have pursued a policy of bank deregulation.

2. Renationalisation.
I keep hearing people asking "how are we going to pay for all this renationalisation?" What the hell is so hard to understand about this? Those industries which the Labour party propose to renationalise are highly profitable, and right now the profits are, by and large, not being reinvested adequately, are not being used to bring down prices for financially pressed consumers, and are in many cases leaving the country and going untaxed. Bringing highly profitable industries back under the control of the people means that the profits belong to the people and the people get better and more affordable services. This doesn't cost, it is a way of generating income.

3. Security.
Yes Corbyn spoke to Irish Republican political leaders in the 1980s. He did so at the same time as Tory ministers were speaking to the same Republican political leaders. This is a matter of historical record. It is such dialogue that paved the way for the peace process and saved lives. If you think peace in Northern Ireland is a good thing then surely you believe that those who sought dialogue in the 1980s did the right thing? The goal has to be to prevent death and violence. Not to generate more.
Corbyn also campaigned for an end to Apartheid in South Africa and for the freeing of political prisoners there, such as Nelson Mandela. Go look up what many leading Tories were doing back then. You might not like Corbyn, but he was on the right side of history on those two issues, unless, of course, you are some kind of democracyphobe and preferred Belfast as a war zone and apartheid in South Africa.

4. Health.
Objectively there is NO funding crisis in the NHS. One has been created by the present government but there are no grounds for believing we cannot fully fund an effective NHS through taxation. That is the cheapest, most efficient way. We pay less than half (actually close to one third, by some measures) of what Americans pay as a proportion of Gross Domestic Product (GDP) for our health provision. Americans die when they have no health insurance and no cash to pay for the meds they require AND their system is over twice as expensive as ours. Explain to me then why anyone might want to vote for a party which wants to move us to a US style system of health provision? Let's be clear, moving to such a system is nothing to do with affordability or a funding crisis or an ageing population or efficiency, because the system they propose to move us to is MORE expensive and less efficient. Health systems funded by insurance, whether private insurance (as in the US) or state insurance systems (like France) are significantly more expensive because less efficient. It is a myth that we cannot afford the NHS. It is a myth that marketisation will make health more affordable. Marketisation of health makes it vastly more expensive. This is not ideological it is factual. One can find the data on this in such market-friendly magazines as The Economist. This isn't socialism it is economic reality.

5. (And do not get me started on) Shoot to Kill!
There is a distinction between "shoot to kill policies" and allowing police to shoot to kill when the situation demands it (i.e. there is a person trying to kill people and the most operationally effective way to prevent more deaths is to kill that person).
A "shoot to kill policy" is a policy of extra-judicial killing, which doesn't sit too well with claims to uphold the rule of law. When there seemed to be evidence that the Thatcher government had approved a covert policy of shoot to kill in the 1980s it was a huge political scandal, which rumbled on for decades. The same Tories who now sit by and watch Corbyn criticised for refusing to endorse a shoot to kill policy were and still are very keen to deny there was such a policy enacted by the state in the 1980s? Why is this important? Well because no politician who values, or wants to appear to value, the rule of law and due process believes that that is compatible with a shoot to kill policy. If those politicians had integrity they would be defending Corbyn from these blatant smears.
The BBC have already admitted that they misrepresented Corbyn on this last year. What is happening here today and yesterday is that people are being misled by often deliberate equivocation on the term "shoot to kill". A shoot to kill policy is a policy of extra-judicial killing and has no place in a state which claims to uphold the rule of law and due process. Shooting dead terrorists when it is judged essential by trained officers so as to save lives is something different and Corbyn has NEVER claimed this should not be allowed.

6. First strike Armageddon MADness.
WTF?! Has no-one heard of Mutually Assured Destruction? So, Corbyn is to be criticised for refusing to be the one to initiate Mutually Assured Destruction. Some things don’t need rebutting because they’re so obviously mad.

Is there anything else I should cover?

Thursday, 20 April 2017

A Little Note on Placebo and Meaning


What are placebo effects?


There is a common misconception that "placebo effect" is the label given to cases of people believing they've recovered or perceiving their symptoms to have decreased or gone, when those people have received no medically active intervention: so, they've received a sugar pill perhaps, or a sham surgical intervention of some kind and in response perceive their symptoms to have improved or believe themselves to have recovered. However, this is not what we mean by "placebo effect", it's actually far more mind-blowing than that! 

It is not simply that people believe or perceive themselves to have recovered or believe that the condition has gone into remission, it is that they HAVE, as a matter of clinically verifiable fact, recovered as if having received a pharmaceutically active or surgical intervention. Daniel E. Moerman’s book Meaning, Medicine and the "Placebo Effect" is replete with examples, as are many other papers and books on placebos. This much about placebos is uncontroversial, even though it is, as noted above, pretty mind-blowing.

When Randomised Controlled Trials of drugs or surgical interventions are carried-out, there are two phenomena that have to be controlled for, in addition to existing treatments, so that we might ascertain whether the intervention under scrutiny has genuine medical efficacy: these are "placebo effects" and regression to the mean.

Regression to the mean is basically the statistically significant fact that some people just get better over time anyway, so we need to control for these people and not confuse measurement of this phenomenon in our trial data with a response to the intervention on trial.

What is referred to as the "placebo effect" is something else: people respond as if they have been treated with a medically active treatment when we know they have not received such (they’ve been given a sugar pill or sham surgery, for example). As I noted above, this isn’t merely about them believing themselves to be better, nor is it about them perceiving their symptoms to have gone; it is that they have recovered in ways physiologically comparable to those who have recovered in response to receiving treatment, and they have done so in ways that cannot be accounted for by regression to the mean.

So, an RCT will have a control group which receives no treatment at all (the regression to the mean control group) and one or more control groups who are administered sham treatments (the placebo control(s)), in addition to the groups who receive the intervention being trialled and groups receiving the competing intervention(s), such as, perhaps, the current market leading drug for that condition.

Explaining Placebo


So, what is the explanation for the placebo response? What is the explanation, for example, for why the person (the body) actually produces dopamine when administered a sham treatment, what is called endogenous dopamine release, and which mimics the dopamine that would have been introduced had that person received the medically active intervention? For, putting this another way: the person's biochemistry endogenously mimics the introduction of clinically administered exogenous dopamine. Indeed, there are many many more examples of such biochemical and physiological changes which come about through the administering of what have been called "placebos", which have been shown to mimic or replicate the changes that the active medical interventions are designed to introduce or cause. Such interventions can take the form of surgical or pharmaceutical interventions.

Well, the standard folk explanation for this has perhaps been to assume this is a n example of a conditioned response: i.e. to assume that there is something akin to classic Pavlovian conditioning taking place.

However, there are a number of reasons not to accept this: first, there are a wealth of arguments which show that actually there is no such thing as Pavlovian conditioning, as traditionally conceived and as it takes hold in the folk imagination; rather, there is the learning of associations.  Second, even if there were such a thing as the 'conditioning of popular psychological mythology', the necessary conditions for such conditioning in many cases of placebo responses just are not present. And third, such conditioning cannot account for the cultural indexicality/variance widely observed in studies of placebo responses, because cultural differences often generate different responses in people who might otherwise be depicted as having had the same conditioning or learning.

So, in the 1980s Irving Kirsch (the guy who is probably better known to those outside placebo studies for his critique of antidepressants: I.e. he demonstrated that FDA approved and widely prescribed antidepressants were no more effective than placebos) proposed the response-expectancy explanation for placebo responses. This explains placebo responses as responses to expectations: for example, you expect to find it difficult to sleep having had a double espresso late at night, and your expectation is based on your beliefs that caffeine is a stimulant and that a double espresso gives you a strong shot of caffeine. In response to this expectation you do indeed suffer disrupted sleep. However, unbeknownst to you, your host last night had run out of your favoured Java blend and, so as to avoid the shame which would inevitably follow from such a social faux pas, had elected to give you a Swiss water decaffeinated double espresso, without informing you. So, your poor sleep was a placebo response, based on our expectation, which in turn was based on your (false) belief that the coffee was caffeinated.

The response-expectancy explanation is the dominant explanation to date. In fact, when I attended the big placebo conference in Leiden earlier this month (April 2017 - the inaugural conference of the Society for Interdisciplinary Placebo Studies - SIPS) the vast majority of those speaking at the conference proceeded as if this was the explanation: placebos are expectancy responses. I was one of only two dissenting voices (of which I was aware) among the speakers, the other being  the cognitive psychologist, Jan De Houwer (...I found common intellectual ground with a cognitive psychologist.)

For my part, I just don't think the response-expectancy explanation works. Here are the problems, as I see them.

To expect something one has to represent, in the form of a belief, the putative state of affairs one is expecting and the problem is that in many documented cases of placebo responses there is simply no evidence that those responding to the sham treatment have such a belief (unlike in the coffee example). However, and this is the more telling point, there are many cases of placebo responses where those responding to sham treatments in placebo-type ways do not have the epistemic resources, or even access to them, such that they might form the required belief. So, it is not merely that there are cases of "placebo responses" where those who respond do not appear to have the beliefs that would be required in order to form the expectation, it is that they don't have access to the data that would be required to serve as the 'building blocks' for such an expectation.  

So, what of expectation now? If, as the response-expectancy crowd want to do, we hold on to expectancy as an explanation for "placebo responses", then we need to provide warrant for our having extended the grammar of “to expect”, such that in this use it is not internally related to, it does not invoke, a propositionally structured belief, a representation of a state of affairs. This, in turn entails having access to the epistemic resources, which, recall, we have seen are simply unavailable in many cases of placebo responses.

We can put the argument of the last paragraph less abstractly: if you want to stick with expectancy, you owe us an explanation as to how someone can expect something while not being in a position to know what it is they are expecting, i.e. how can one expect something without being able to specify or represent the something they are expecting?

Alternatively, we can leave the grammar of 'to expect' as it is, stop trying to square this particular circle, and instead drop the overly restrictive reliance on response-expectancy as a global explanation for "placebo responses". Then, instead, we might talk more broadly about meaning responses (as Dan Moerman does), and set about, via ethnographic investigations of people responding in medically significant ways to pharmaceutically and surgically inert interventions, gaining better understanding of medically significant meaning responses.

Here we are talking about the world having meaning in a way that does not demand that we first have the resources to form beliefs about (possible) states of affairs in the world, for we don't need to expect something to cure us for us to be cured when we have received a sham treatment. Rather, we move beyond such a representationalist picture of cognition, to more enactive or even ethnomethodologically-informed accounts.

That’s the issue, and that is why I’m so preoccupied with this right now.


Tuesday, 18 April 2017

General Election - Second Referendum

Identify the anti-Brexit candidate in your constituency and vote for them. (If there is more than one anti-Brexit candidate, identify the one with the best chance of winning and influencing their party policy)

Persuade all anti-Brexit friends to do the same. Hold your nose if you have to, and do it.

Treat this general election as a second referendum.

If you are motivated by anti-establishment sentiment, then whatever you believed that amounted to last summer, you have a second stab at it now. Clue: Johnson, Gove, Fox, May etc. _are_ the establishment (and those of them who campaigned for Brexit lied about NHS funding and much, much more)

May is being opportunistic in calling the election now, after repeatedly stating she would not do so. Moreover, recall the Fixed Term Parliament Act, designed to stop opportunistically-called snap elections..? Is this someone to trust? (Ans. NO)

May has called this election for no other reason than the lead in the opinion polls indicates to her that she is guaranteed another five years and an increased majority. HOWEVER, if we reframe this election successfully as a SECOND REFERENDUM and as a vote on whether we want a small minded racist Britain with rising inequality and a dismantled health service (now servicing the pockets of Tory cronies) or an open, progressive and increasingly egalitarian Britain with good health provision for all (serving the health of the nation) she might well turn out to have been mistaken.

Let's reframe this election to be a second referendum and not about what we feel about Corbyn, or what the media tell us about Corbyn. If we do so, then those opinion poll figures will be rendered irrelevant.

Tuesday, 22 November 2016

Lessons

About 16 years ago, as part of the work I was doing for my Ph.D. thesis, I visited the Fortunoff video archive for Holocaust testimonies at Yale university. I was interested in the phenomenon of survivor shame.

After 10 days of watching video recordings of interviews with Holocaust survivors a number of things stuck with me and remain prominent in my thoughts to this day. I'll list two here.

1. Many of those interviewed who were survivors had lived silent for three decades or more. Many of them were speaking now either because they had been persuaded it was important for them to do so or because they had been moved to break their silence because of the emergence of the denialist movement. In short, testifying to what happened then was a deeply distressing experience and often had psychological consequences. They did it because they felt it was important that the truth be known and not doubted.

2. I watched a number of interviews with those who had managed to escape Germany, Poland and so on in the 1930s, and made it to the US. What came up several times was the following: they would receive letters from friends and family back in Europe which would make light of the changed circumstances, which would play down the horrors of forced removal to ghettos and so forth. While there are a number of possible explanations for this, what seemed to emerge from the interviews was that those writing the letters simply couldn't comprehend the magnitude of what was happening or that the psychological burden of comprehension was simply too much, particularly if you had a family to hold together. So people downplayed the hardship and the horror as a way of seeking to convince themselves things would be alright, that it wasn't as bad as it seemed (and would become).

From this I take these lessons (among others): 

re 1. Testifying to crimes, calling out and documenting injustice, is not whining, it's not a personality flaw, it's not something people want to do or do because they think it makes them look good. It is something that is very difficult to do, that takes courage. People lived for 30 years and more without telling a soul what they'd witnessed and experienced. There is little pride in identifying oneself as a victim, particularly if the crimes perpetrated against you involved all-out attack on your dignity. 
The right wing attacks on people calling out injustice which depict those people as whiners, and as weak, are the reverse of the truth. Fascists are the weak who bully in an attempt to hide from themselves their own weakness. Those who stand for justice when it would be easier to stay silent are the drivers of all that is good in humanity.

re 2.when catastrophic political change is happening history shows us that it invariably creeps up on us, it happens not with a dramatic bang, not with the sudden horrific entrance of obviously evil people, but incrementally, so we just don't see it for what it is until later, much later. We don't see it for what it is for numerous psychological reasons and because bad people rarely do bad things in the name of badness. Be aware of this tendency and try to find the courage to see things for what they are, don't seek to explain away the alt-right as jesters because that helps frame them as less of a threat. It is important to see these people for who they are.

Thursday, 10 November 2016

Failure of a Research Programme

Liberal political philosophy has failed. It has failed not because of its politics, but because of its epistemology. Its politics of toleration and justice is still as important as it ever was, all progressive political projects must aspire to defending and promoting these virtues. I am not here dismissing the liberal virtues. But liberal political philosophy as a research programme is in a terminally degenerative state because it never saw these things as virtues in need of nurturing, but saw them as principles to be applied.

Liberal political philosophers often simply dismissed the communitarian critique, advanced by philosophers such as Charles Taylor and Alasdair MacIntyre, as conservative critiques and thereby missed the more important philosophical point of those critiques: that social change does not come from jurisprudence.

Bush to Trump or How to Respond to Disappointment and Failure

Since G.W. Bush came to power in 2001 things happened from which the left, reasonably, assumed they'd benefit. 

The disasters of the illegal wars, Abu Ghraib, etc. 
(with associated anti-war movement); 

the financial crisis 
(with associated Occupy movement)

the increasing disillusionment with career politicians 
(remember the expenses scandal here in the UK, and the duck house?) 

and

the continuing unfolding global catastrophe that is human created climate change
(policies of economic growth based on carbon economies are clearly, and unequivocally, unsustainable)


The left naturally expected to benefit from a decade of political crises and failures, but if anything these have translated, as of now, into failings for the left while the populist right have benefited. 

I guess in the face of this one has a choice to either reckon with one's failings, regroup, learn and transform with a view to building an effective left alternative or one enters into some kind of denialism, which allows you to convince yourself, at great cost to your integrity and potentially to humanity, that the failings can be decoded as successes.

Apportioning Blame

Let's say you got two TV shows. One of those shows, made and broadcast by Network A, incites racial hatred and is watched by 60% of the viewing public. The other, made and broadcast by Network B, is watched by 30% and was kinda dull, middle of the road, conservative television. (the other 10% of those with TVs were reading books, playing video games or writing shit on Facebook, I guess).

Do we really blame the writers and broadcasters of the dull show on Network B for the crimes which result from people having watched the show that incited racial hatred on Network A?


Sure, it would be better had network B put something on against Network A's show, which was both more attractive to viewers and had a more radically progressive message for those viewers. But really, you cannot blame Network B for the crimes perpetrated by Network A.

*****************

DNC shouldn't have selected HRC, but if we're ranking responsibility for the racist and sexist violence that will emerge from Trump's victory then it doesn't fall at the door of the DNC. While they take their place in the list of those bearing responsibility, they're well down that list below Trump himself, the GOP, those who voted for Trump, the people who actually go out an perpetrate the violence, a racist US media, a me first selfish culture, and so on.