Remember Dr. Kevorkian?

For those of you who are too young, he was a retired pathologist back in the 1990s who helped terminally ill people end their lives as a sort of crusade. This was completely illegal at the time, everywhere in the country. He was prosecuted a couple of times, but juries would not convict -- apparently you couldn't find 12 people who thought that what he did deserved criminal sanction. This was despite his notably abrasive personality. He wasn't a persuasive person, but his actions spoke for themselves and most people evidently supported them.

He finally was convicted. The basic difference was that in the previous cases, he had set up his "suicide machine" -- a gas delivery system -- and let his customers (I don't know if you should call them patients) push the button themselves. In the case for which he was convicted, the client was paralyzed and unable to initiate the process, so the good doctor did it himself. This seems a trivial moral distinction to me -- the guy very clearly articulated his desire -- but it does seem to matter to many people.

Anyway, so-called Physician Assisted Dying (PAD) is now legal in Oregon, Washington, Vermont, Colorado and the District of Columbia, by law; and in Montana, by court decision. (A law in California was recently overturned on a technicality before it could take effect. We'll see where that goes.) Here's a summary history.

 I expect that PAD sounds better than physician assisted suicide, and I'll grant that there is a bit of a difference in that the person has to be dying already and we're just talking about hurrying it along. On the other hand we're all dying so it's only a matter of degree. The relevant laws have clear eligibility and procedural restrictions, and they try to guard against commonly evoked dangers such as people taking the option because they're afraid they'll be a burden to others, and possible attendant pressure; failure to provide adequate palliative care; and people who aren't really dying but only disabled using the option. By all accounts there are few if any abuses but of course there are gray areas and matters of degree involved here.

Physicians differ in whether they approve of this at all; and whether they would personally consider participating. Here Dr. Bernard Lo tries to offer ethical guidance. As far as I can tell this all comes out of his own head, based on extensive acquaintance with what people have written and argued about it. There hasn't been any high level committee. There also haven't been any studies about the best way to do it -- what drugs to use. I'm not sure how an Institutional Review Board would view a randomized controlled trial of procedures intended to cause death. This is a new ethical frontier which we have crossed without a whole lot of deep reflection, and surprisingly little public debate. I don't recall it being a big issue in electoral campaigns. I expect we'll see considerably more pronounced controversy at some point.

Update: In response to a comment, here is a compendium of relevant policies around the world. I haven't made any particular study of this myself. It's still illegal in most countries but a few have legalized it in recent years, particularly in northern Europe.

Unencumbered by the thought process

Politics is in some respect a debating society. Of course money and other sources of power and privilege affect what voices get amplified, and tribal loyalties can trump facts and logic in how they are heard. Still, those of us who are rational empiricists can make an effort to judge the quality of arguments. Rep. Diane Black of Tennessee says that pornography is the cause of school shootings.

There is no evidence that I know of, and certainly none adduced by Rep Black, that any school shooter in history has even been exposed to pornography, let alone that it has anything to do with their actions. Of course they likely have, depending on your definition. When I was an adolescent my classmates got their hands on Playboy Magazine and so on. Nowadays, anybody with a telephone can see any kind of porn they want, so sure, these kids might have checked it out. Funny thing though, there's porno in Canada, Sweden, the UK, France -- oh, actually, just about everywhere that there have not so far been 23 school shootings this year, or in fact any at all. Also, the shooters aren't acting out soulless sexual fantasies, they're, you know, shooting people, which is not generally a feature in pornography.

School shootings, and mass shootings in general, are a small proportion of all gun violence. The linked piece in the Puffington Host says that "poor social, economic and cultural conditions are primary drivers of gun violence." That statement is too vague to be fact checked, but at least it isn't ridiculous. We really need to have honest discussion of our problems. Black is spouting nonsense based on her presumption that her voters don't like porno, so they'll be open to hearing it blamed for something else they don't like. (I won't bother to tell her that statistics show there is more on-line viewing of pornography in socially conservative parts of the country.) That isn't how logic works.

Sunday Sermonette: A painful day in Canaan

This chapter is sort of a weird interlude between episodes of depravity. It is of interest in that it exemplifies two sharp differences between the Old Testament and the New.

 When Abram was ninety-nine years old, the Lord appeared to him and said, “I am God Almighty; walk before me faithfully and be blameless. ² Then I will make my covenant between me and you and will greatly increase your numbers.”
³ Abram fell facedown, and God said to him, ⁴ “As for me, this is my covenant with you: You will be the father of many nations. ⁵ No longer will you be called Abram; your name will be Abraham, for I have made you a father of many nations. ⁶ I will make you very fruitful; I will make nations of you, and kings will come from you. ⁷ I will establish my covenant as an everlasting covenant between me and you and your descendants after you for the generations to come, to be your God and the God of your descendants after you. ⁸ The whole land of Canaan, where you now reside as a foreigner, I will give as an everlasting possession to you and your descendants after you; and I will be their God.”

In the Tanakh, many people are said to see God as a physical manifestation. Or I should say many men saw him, the only woman I can find who saw God was the wife of Manoah, i.e. Samson's mother. What he looks like is usually not described, although sometimes he is said to speak to men "face to face." Moses saw God face to face a few times, and of course once as a burning bush. In Exodus, however, we are told that "There shall no man see me, and live." And the Gospel of John states repeatedly that God cannot be seen, and has never been seen. Colossians and Timothy also describe him as invisible.

As for the name change, it is not entirely clear what it's all about. Abraham may mean "Father of Many."

⁹ Then God said to Abraham, “As for you, you must keep my covenant, you and your descendants after you for the generations to come. ¹⁰ This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. ¹¹ You are to undergo circumcision, and it will be the sign of the covenant between me and you. ¹² For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. ¹³ Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. ¹⁴ Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”

One must wonder at the origin of this barbarous custom. One might think that it served to mark the Jews as a distinct people, but actually the custom was widespread among other peoples of the region, including the Egyptians. Note that slaves are to be circumcised.

¹⁵ God also said to Abraham, “As for Sarai your wife, you are no longer to call her Sarai; her name will be Sarah. ¹⁶ I will bless her and will surely give you a son by her. I will bless her so that she will be the mother of nations; kings of peoples will come from her.”
¹⁷ Abraham fell facedown; he laughed and said to himself, “Will a son be born to a man a hundred years old? Will Sarah bear a child at the age of ninety?” ¹⁸ And Abraham said to God, “If only Ishmael might live under your blessing!”
¹⁹ Then God said, “Yes, but your wife Sarah will bear you a son, and you will call him Isaac. I will establish my covenant with him as an everlasting covenant for his descendants after him. ²⁰ And as for Ishmael, I have heard you: I will surely bless him; I will make him fruitful and will greatly increase his numbers. He will be the father of twelve rulers, and I will make him into a great nation. ²¹ But my covenant I will establish with Isaac, whom Sarah will bear to you by this time next year.” ²² When he had finished speaking with Abraham, God went up from him.
²³ On that very day Abraham took his son Ishmael and all those born in his household or bought with his money, every male in his household, and circumcised them, as God told him. ²⁴ Abraham was ninety-nine years old when he was circumcised, ²⁵ and his son Ishmael was thirteen; ²⁶ Abraham and his son Ishmael were both circumcised on that very day. ²⁷ And every male in Abraham’s household, including those born in his household or bought from a foreigner, was circumcised with him.

No explanation for Sarai's name change, sorry. Remember, by the way, that the marriage is incestuous. Sarah and Abraham have the same father. Anyway, if you remember back a couple of chapters Abraham has 318 adult male slaves. He must have had some boy slaves as well, so we're talking at least maybe 400 circumcisions in a single day. Since they had presumably never done it before and didn't have any local experts, I can imagine there may have been some problems.

Anyway, while circumcision remains a requirement for Jews, the apostle Paul repudiated the practice. In fact he outright forbade it in Galatians:

Behold, I Paul say unto you, that if ye be circumcised, Christ shall profit you nothing. For I testify again to every man that is circumcised, that he is a debtor to do the whole law. Christ is become of no effect unto you, whosoever of you are justified by the law; ye are fallen from grace.  

Obviously Christians have chosen to ignore this passage as most of them are today circumcised shortly after birth, although only because it is a secular custom, not for religious reasons. This is starting to change, however, as some medical authorities have come to doubt that it has significant hygienic value. This is a matter of controversy.

Chicxulub

Chicxulub is a small town on the Yucatan peninsula.  It's worth periodically reminding ourselves that a little more than 66 million years ago an asteroid about 15 kilometers in diameter smashed into the earth near there, releasing the energy of about 10 billion Hiroshima bombs. The fireball sterilized the earth for thousands of miles, ferocious wildfires were ignited across the planet, and debris partially blocked sunlight for years. Within a short time, something like 75 to 80% of terrestrial species were extinct. After the short-term cooling, the attendant relase of C02 caused global warming that lasted for 100,000 years.

You are probably thinking, "I hate it when that happens," but maybe you shouldn't be. The extermination of the dinosaurs (with the exception of the birds), allowed mammals to radiate into the vacant ecological niches, and become the dominant order of large terrestrial animals. That, after 66 million years, made you possible. So keep that in mind. We just happen to be here, and we might not be around much longer. There isn't any plan beyond the one we are able to make for ourselves.

So wise up.

Economic Anxiety?

Eduardo Porter in the NYT reviews the latest research on the motivations of Trump voters. It's clear and supported by multiple lines of evidence: their anxiety isn't economic, it's about losing white status privilege. Referring to work by pollster Stanley Greenberg Porter writes:

The research zeroed in on white Trump voters without a bachelor’s degree who were either Democrats or independents and had voted for Mr. Obama at least once. Focus groups detected the same underlying theme that had motivated the Reagan Democrats more than 30 years before: a view of America as divided between “us” — white, struggling and aggrieved — and a nonwhite “them.”

So yes, Republicans are engaged in identity politics It's just that we are trained not to think of white, non-Hispanic as an "identity." Some years ago I was at a conference where I attended a meeting of people interested in behavioral health services for Latinos. We went around and introduced ourselves and this old white guy said - really - "I always wished I had a culture. When I was growing up I'd see the Hispanic kids and the Asian kids and I'd think, 'Why can't I have a culture like them?'" I told him, "I assure you sir, you do have a culture."

Trump voters, in fact, had median incomes above the population as a whole. A few of them no doubt had lost income since the steel mill or the coal mine closed down, but most of them are doing fine.

In a place that is more than 80 percent white, Mr. Trump’s Democrats share “pretty powerful feelings about race, foreignness and Islam that lead them to see white people as victims in a country feeling increasingly foreign to many of them,” the study noted.

The single strongest predictor of support for Vladimir Putin's candidate is racism, broadly construed. This is what causes conservative white voters to oppose policies that will actually benefit them, such as universal health care and expanded educational opportunity: they think that more of it will go to people of other tribes, and they are more interested in retaining their relative privilege than in their absolute well being. Of course they feel other threats to their traditional concepts of community, including growing acceptance of diversity in gender, sexuality and religion.

But here's what I think folks. Open your minds. Don't identify narrowly as a straight white male. Try on a broader self-definition, as, say, a proud citizen of a dynamic, diverse, and inclusive nation. We will all do better when we try to do well together. The divisive politics of the current Resident are not just retrograde and repulsive. They are downright dangerous. 

With all the turmoil and craziness, too much is flying under the radar

I didn't even know that it appears a truly horrible version of so-called "right to try" is about to become federal law. I have written about this before, but when legislation was only being passed at the state level it didn't really matter. The FDA still controls access to experimental drugs and state law can't preempt it, so state legislation was purely symbolic.

The link is to an essay by the notoriously long-winded David Gorski. Do read it if you want all the details, but I'll try to give a succinct version.

For background, the drug approval process has several stages. First, trials in animals have to show some evidence that a chemical may be promising to treat human disease and establish evidence about safety. People are not mice, however, and unfortunately most agents that show promise in animals turn out not to be useful for human health care, due to lack of efficacy, safety, or both.

So, the next step is a so-called Phase One trial. This involves giving the agent to a small number of human volunteers, starting with very small doses and increasing them until adverse effects are observed. This is not intended to show anything about efficacy, just to get an idea of how much of the drug can be administered safely in a larger study.

Phase Two trials are relatively small trials which are not powered (i.e. do not have a large enough sample size) to really prove efficacy, but do have at least one control arm (a placebo or existing standard treatment) and produce more information about safety (at least in the short term) and enough of an indication of treatment effect to establish the sample size needed for a large scale Phase Three randomized controlled trial. A lot of agents flunk out at this stage, and never make it to Phase Three.

So, in order to get access to an experimental drug you need to enroll in a clinical trial. And of course, you might end up in a control arm and not actually get the experimental drug. Which is at least 50% likely to be good news for you, because the experimental drug might not work and might not be safe. If there already is an established treatment and you have a somewhat serious condition, in the control arm you'll get the standard treatment because placebo control would be unethical. Got that?

The FDA has licensed drugs based on safety and efficacy since the thalidomide catastrophe. But so-called right to try means that terminally ill people will be allowed access to drugs that have only passed Phase One. People intuitively think, "What's wrong with that? Freedom!" Well, there's a lot wrong with it, but it might not be an absolutely terrible idea under some conditions. Unfortunately the legislation that's teed up now is in fact an absolutely terrible idea.

Note the following. Insurance companies will not pay for experimental treatments. People who want them outside of clinical trials will have to pay out of pocket. The drug companies can charge whatever they want. Note also that it is not only the case that evidence for effectiveness is not compelling: there is no evidence of effectiveness whatsoever based on a Phase One trial. The treatment is as likely to make people worse off as it is to help them. Okay, they're dying, what have they got to lose? Other than their children's inheritance, that is. Take it away, Dr. Gorski:

Consistent with their libertarian origin, right-to-try laws also strip away many protections from patients. First, there is no requirement that companies provide the drugs for free or at a reduced price. Indeed, these laws explicitly state that insurance companies are under no obligation to pay, even though such a statement is unnecessary given that insurance companies don’t reimburse for experimental therapies. As a result, the only people who would potentially be able to access right-to-try are the rich or people who are very good at fundraising. A terminally ill person trying to access right-to-try can easily spend away his estate or even go bankrupt before dying. It’s even worse than that. The language in many of these laws can be interpreted to mean not just that insurance companies don’t have to pay for right-to-try but that they don’t have to pay for medical care as a result of complications suffered from using a drug under right-to-try.

Another aspect of these bills is, as Jann Bellamy and I have described many times, how, compared to existing expanded access programs, they strip patient protections away from patients who access them. One way to see this is by comparing what happens when a patient accesses an experimental therapeutic under the FDA expanded access program to what happens when another patient accesses one under a right-to-try law. Under FDA expanded access, patients retain full protections under federal and state laws. They can sue for malpractice if there is any, and their care is still monitored by an institutional review board (IRB), with any adverse events recorded and considered by the FDA. Moreover, the FDA approves nearly all such requests (99%). In contrast, under right-to-try, there is no IRB oversight. It’s all between the company and the patient, a libertarian paradise!

These laws also immunize companies providing right-to-try drugs and physicians overseeing their administration from liability. Right-to-try laws also limit what patients can do in the event of malpractice or negligence. All of them broadly immunize physicians advising or administering right-to-try medications or using right-to-try devices against malpractice suits or actions against their medical license by the state medical board related to their participation in right-to-try. All of them also immunize companies providing experimental therapeutics under right-to-try from liability. All of them contain provisions stating that state employees can’t interfere with a patient seeking right-to-try, which could be interpreted to mean that a doctor at an academic medical center at a state university couldn’t counsel a patient not to seek right-to-try without running afoul of the law. As Jann notes, even if state authorities believe, for example, that an elderly person is being exploited for financial gain by a physician, presumably this provision would prohibit their acting.

Finally, this creates a situation in which legitimate clinical trials may be compromised.  If it isn't possible to recruit enough people who are willing to undergo randomization, because too many people are already clamoring for the experimental drug, we will never know if it really works and is really safe. I will finally note that if a drug shows what appear to be truly miraculous results in Phase One trials, then even a relatively small scale Phase Two trial may who strong evidence of effectiveness, in which case movement toward approval will proceed quickly and expanded access may be offered under existing regulations. This seldom happens. Of course the Koch brothers are behind this particular outrage.

Sunday Sermonette: Just when you think it couldn't get more depraved

As we have seen, whatever the Bible may be it is not a manual for morality. Genesis 16 takes it to 11. (But don't worry, it gets worse.)

Now Sarai, Abram’s wife, had borne him no children. But she had an Egyptian slave named Hagar; ² so she said to Abram, “The Lord has kept me from having children. Go, sleep with my slave; perhaps I can build a family through her.”
Abram agreed to what Sarai said. ³ So after Abram had been living in Canaan ten years, Sarai his wife took her Egyptian slave Hagar and gave her to her husband to be his wife. ⁴ He slept with Hagar, and she conceived.

Credit to the NIV for calling a slave a slave. For some reason they haven't been willing to do it up until now. It's interesting that in this situation Hagar becomes Abram's "wife." Later, we will meet the institution of concubinage, in which the sex slaves don't get to be called wives.

When she knew she was pregnant, she began to despise her mistress. ⁵ Then Sarai said to Abram, “You are responsible for the wrong I am suffering. I put my slave in your arms, and now that she knows she is pregnant, she despises me. May the Lord judge between you and me.”
⁶ “Your slave is in your hands,” Abram said. “Do with her whatever you think best.” Then Sarai mistreated Hagar; so she fled from her.
⁷ The angel of the Lord found Hagar near a spring in the desert; it was the spring that is beside the road to Shur. ⁸ And he said, “Hagar, slave of Sarai, where have you come from, and where are you going?”
“I’m running away from my mistress Sarai,” she answered.
⁹ Then the angel of the Lord told her, “Go back to your mistress and submit to her.” ¹⁰ The angel added, “I will increase your descendants so much that they will be too numerous to count.”

It's obviously hard for us to get inside the head of someone in Hagar's situation. But it does make sense that if you're a slave, and you're bearing the owner's child, you get some improved status. No doubt this was true of Sally Hemmings, though Thomas Jefferson's wife had died when Jefferson started having sex with her. In any case, Abram doesn't want Sarai to be jealous so he lets her mistreat Hagar. God evidently has a plan, however, which requires Hagar to submit to an abusive slavemaster, so tough shit. Then we get another prophecy:

¹¹ The angel of the Lord also said to her:

“You are now pregnant
    and you will give birth to a son.
You shall name him Ishmael,
    for the Lord has heard of your misery.
¹² He will be a wild donkey of a man;
    his hand will be against everyone
    and everyone’s hand against him,
and he will live in hostility
    toward all his brothers.”

"Ishmael" means God hears.  That seems scant consolation. God has heard of your misery, and insists that you remain in it. And here we have yet another prophecy, which, like the curse upon Cain, doesn't actually happen.

¹³ She gave this name to the Lord who spoke to her: “You are the God who sees me,” for she said, “I have now seeⁿ the One who sees me.” ¹⁴ That is why the well was called Beer Lahai Roi; it is still there, between Kadesh and Bered.

¹⁵ So Hagar bore Abram a son, and Abram gave the name Ishmael to the son she had borne. ¹⁶ Abram was eighty-six years old when Hagar bore him Ishmael.

The name of the well could be one of those stupid Jeopardy! questions. It  means "well of the living one who sees me." Later, Abe (whose name will have been changed by then for no apparent reason, to Abraham) will have a second son, Isaac, who will thenceforth be referred to as his only son. This may be true in a sense because Abraham will  eventually kick Ishmael out of the house and disown him. I know I'm getting ahead of myself here but we're trying to keep track of what it would really mean to "live biblically." If there is one thing God does not know, it's right from wrong. 

Royal Heinie

I suppose it's just harmless fun, but the obsession of the American public with British royalty seems bizarre to me. That a B-list American celebrity is about to marry a parasite on British society (who by the way, is not in the line of succession to the throne unless his brother and his family are wiped out, not that it matters) is the biggest consumer of TV time and column inches even as, well, certain other stuff is happening, seems disconcerting..

If I am correctly informed, the colonies who have since become the United States fought a war to get out from under the British throne. Since then, the rest of Europe has eliminated or privatized their monarchies. But the Brits squander massive taxpayer cash on allowances, horse drawn carriages and ceremonial officials whose only function is to wave around ritual objects, soldiers in medieval garb who practice human statue routines, and the maintenance of massive, impractical ancient structures. All this makes the useless twits who constitute the Windsor family the most fascinating people in the world, it seems.

In case you didn't know it, the pet cause of the Prince of Wales is the promotion of homeopathy.

But at least the symbolism of the wedding may be positive. Although it won't produce a monarch of African or common descent, it does signify that British culture has changed. Nobody wants to mention that subtext, however. I suppose it would be unseemly to point it out. What would really be a step forward, however, would be for Britain to become a republic and make these people get real jobs. I'm not holding my breath.

Wow, how did this get by me?

The new director of the CDC is named Robert Redfield. The U.S. Centers for Disease Control and Prevention (still abbreviated CDC because "prevention" was added later) is the country's public health agency. Here are some fun facts about Redfield.

He was in charge of the armed forces' response to the HIV epidemic in  the 1980s. Among his policies:

• Mandatory HIV testing of all troops, without confidentiality. Positive tests were revealed to the entire chain of command.
• HIV+ troops were kept in isolation and dishonorably discharged when they developed AIDS. . .
• Which meant they were dumped on the street without health insurance and died in poverty. Many committed suicide.

He was associated with a Christian extremist organization called Americans for a Sound AIDS Policy, which called for mandatory testing of the entire population and isolation of people who were infected. He wrote the introduction to a book by the organization's leader, in which he said:

It is time to reject the temptation of denial of the AIDS/HIV crisis; to reject false prophets who preach the quick-fix strategies of condoms and free needles; to reject those who preach prejudice; and to reject those who try to replace God as judge. The time has come for the Christian community — members and leaders alike — to confront the epidemic.

The book, by W. Shepherd Smith, Jr., asserted that AIDS was God's judgment against homosexuals.

He fraudulently promoted a worthless HIV vaccine, and got congress to appropriate $20 million to study it. As the linked FP article informs:

The VaxSyn product never worked, and its elevation to top dog status, despite lack of scientific support, was denounced in the Washington Post as “pork-barrel research.” The “MicroGeneSys soap opera,” as Science reporter Jon Cohen dubbed it, dragged on through investigations and scandal into 1994. Eventually, the Army tried the concoction on more than 600 HIV-positive military personnel, concluding they showed “no clinical improvement.” In his 2001 book, Shots in the Dark, Cohen detailed the Redfield saga and showed that he continued promoting VaxSyn and using it on human volunteers with the financial support of Smith’s ASAP long after the Army had concluded it didn’t work.

Our health, and our very lives, depend on sound, science based public health policy. This dishonest, bigoted, thieving, religious fanatic lunatic is probably not the right person for the job.

God as con artist

For some reason we don't hear much preaching about Genesis 15, even though it seems pretty juicy. Here it is.

After this, the word of the Lord came to Abram in a vision:

“Do not be afraid, Abram.
    I am your shield,
    your very great reward.”

² But Abram said, “Sovereign Lord, what can you give me since I remain childless and the one who will inherit my estate is Eliezer of Damascus?” ³ And Abram said, “You have given me no children; so a servant in my household will be my heir.”

⁴ Then the word of the Lord came to him: “This man will not be your heir, but a son who is your own flesh and blood will be your heir.” ⁵ He took him outside and said, “Look up at the sky and count the stars—if indeed you can count them.” Then he said to him, “So shall your offspring be.”
⁶ Abram believed the Lord, and he credited it to him as righteousness.

You may recall that previously, Abram was going to have as many descendants as there are motes of dust in the world. That's a lot! But actually, there are only about 5,000 stars visible to the nude eyeball, of which half are in the hemisphere you can't see. So even under the best of circumstances, Abram is going to have no more than 2,500 descendants. Of course, including stars that can't be seen without a telescope, there are more than 100 billion in our galaxy alone.

⁷ He also said to him, “I am the Lord, who brought you out of Ur of the Chaldeans to give you this land to take possession of it.”
⁸ But Abram said, “Sovereign Lord, how can I know that I will gain possession of it?”
⁹ So the Lord said to him, “Bring me a heifer, a goat and a ram, each three years old, along with a dove and a young pigeon.”
¹⁰ Abram brought all these to him, cut them in two and arranged the halves opposite each other; the birds, however, he did not cut in half. ¹¹ Then birds of prey came down on the carcasses, but Abram drove them away.

In the Torah we learn that God really digs it when people kill animals and burn them. In this particular case, for some reason, as we will see momentarily,  God actually sets them on fire himself. This is abnormal, however. Usually the people are expected to do it. Later on we'll see all sorts of elaborate instructions for how to go about killing and burning the animals. One is hard pressed to understand why God wants people to do this, and as it turns out later, ha ha! He didn't really mean it. Starting with Psalms, and later prophets, God does not want animal sacrifices, are you kidding me? E.g.

Sacrifice and offering thou didst not desire. Psalm 40:6
Will I eat of the flesh of bulls, or drink the blood of goats? Psalm 50:13
For thou desirest not sacrifice ... thou delightest not in burnt offerings. Psalm 51:16

¹² As the sun was setting, Abram fell into a deep sleep, and a thick and dreadful darkness came over him. ¹³ Then the Lord said to him, “Know for certain that for four hundred years your descendants will be strangers in a country not their own and that they will be enslaved and mistreated there. ¹⁴ But I will punish the nation they serve as slaves, and afterward they will come out with great possessions. ¹⁵ You, however, will go to your ancestors in peace and be buried at a good old age. ¹⁶ In the fourth generation your descendants will come back here, for the sin of the Amorites has not yet reached its full measure.”

So the Jews are God's chosen people, but he's going to enslave them for 400 years? Why? (As it turns out it was actually 430 years but who's counting. Oh yeah -- there were not 4 generations between Abram and Moses, there were six. But again, who's counting?

¹⁷ When the sun had set and darkness had fallen, a smoking firepot with a blazing torch appeared and passed between the pieces. ¹⁸ On that day the Lord made a covenant with Abram and said, “To your descendants I give this land, from the Wadi^[e] of Egypt to the great river, the Euphrates— ¹⁹ the land of the Kenites, Kenizzites, Kadmonites, ²⁰ Hittites, Perizzites, Rephaites, ²¹ Amorites, Canaanites, Girgashites and Jebusites.”

This promise God definitely did not keep. The land between the Nile and the Euphrates would include what is today Syria, Jordan, and most of Iraq. The Jews never got a fraction of that. Bullshit artist.

The corporate media is taking a long time to wake up from its slumber

Here is Jonathan Chait saying fairly succinctly what we know to be true. It is now a confirmed fact that a Russian oligarch -- which ipso facto means a crony of Vladimir Putin -- paid $500,000 to a shell company set up by Donald Trump's bag man, a firm with no employees that had no apparent function other than making secret payments on Trump's behalf. We have learned this thanks to the lawyer for a porn star who received one such payment. (Really. We are talking about the president of the United States here.) Chait notes:

For all the speculation about the existence of the pee tape, the latest revelations prove what is tantamount to the same thing. Russia could leverage the president and his fixer — who, recall, hand-delivered a pro-Russian “peace plan” with Ukraine to Trump’s national-security adviser in January 2017 — by threatening to expose secrets they were desperate to keep hidden. Whether those secrets were limited to legally questionable payments, or included knowledge of sexual affairs, is a question of degree but not of kind.

 Chait goes on to tell the sordid tale of the chair of the House Intelligence Committee making every effort to undermine and obstruct the investigation, including trying to expose a secret intelligence source who would likely pay the price of his life:

Think for a moment what this report tells us. The chairman of the House Intelligence Committee, who enjoys the full backing of his party’s leadership, is willing to risk what his own government describes as the betrayal and potential loss of life of an intelligence source. And officials within this government believe the president would do the same, all in order to obstruct an investigation into the president’s secretive ties to a foreign power. They are acting as though Trump is compromised by Russia, or at the very least, that he cannot be trusted to defend his own country’s security against it. The sordid Russia scandal has already brought some version of a very dark nightmare scenario to life.

This is where we stand. The president is a tool of a foreign adversary, the president's party in congress knows this full well and is trying to protect him rather than expose him, and the corporate media are covering their eyes and plugging up their ears. This is treason.

PS: There are obviously dozens of good reasons to give hundreds of thousands of dollars to Michael Cohen that have nothing to do with Donald Trump. I invite y'all to list them.

My friend Mel

Here is the rest of Genesis 14.

¹⁷ After Abram returned from defeating Kedorlaomer and the kings allied with him, the king of Sodom came out to meet him in the Valley of Shaveh (that is, the King’s Valley).
¹⁸ Then Melchizedek king of Salem brought out bread and wine. He was priest of God Most High, ¹⁹ and he blessed Abram, saying,

“Blessed be Abram by God Most High,
    Creator of heaven and earth.
²⁰ And praise be to God Most High,
    who delivered your enemies into your hand.”

Then Abram gave him a tenth of everything.

²¹ The king of Sodom said to Abram, “Give me the people and keep the goods for yourself.”
²² But Abram said to the king of Sodom, “With raised hand I have sworn an oath to the Lord, God Most High, Creator of heaven and earth, ²³ that I will accept nothing belonging to you, not even a thread or the strap of a sandal, so that you will never be able to say, ‘I made Abram rich.’ ²⁴ I will accept nothing but what my men have eaten and the share that belongs to the men who went with me—to Aner, Eshkol and Mamre. Let them have their share.”

First of all, I must point out that the translators of the NIV have cleaned up an embarrassment. In the original Hebrew, it is completely ambiguous whether Abram gives the tithe to Melchizedek, or Melchizedek gives it to Abram. Many commonly used translations preserve this ambiguity, but the NIV just adopts the more common understanding. The literal translation of the phrase is just "He gave him tithe of all," with no clarity as to who "He" is. The idea appears to be that since Melchizedek is the "priest of God Most High," he gets to collect a fee in exchange for Abram's victory. Thus we have the prototype for hucksters everywhere, from Jim Bakker to Reverend Ike.

In the New Testament book Hebrews, we learn that:

7:1 For this Melchisedec, king of Salem, priest of the most high God, who met Abraham returning from the slaughter of the kings, and blessed him;

7:2 To whom also Abraham gave a tenth part of all; first being by interpretation King of righteousness, and after that also King of Salem, which is, King of peace;

7:3 Without father, without mother, without descent, having neither beginning of days, nor end of life; but made like unto the Son of God; abideth a priest continually.

7:4 Now consider how great this man was, unto whom even the patriarch Abraham gave the tenth of the spoils.

So he was never born, God just conjured him up for the occasion. And apparently he's still around. The idea is supposed to be that he somehow prefigures Jesus. A psalm also suggests that Mel is a prototype for the Messiah. But here he is still hogging a tenth of Abram's loot.

The Afterlife

British physician and commentator Margaret McCartney discusses the Alfie Evans and Charlie Gard cases in this week's BMJ. She touches upon, but doesn't try to go too deeply, into the role of religion in these disputes.

Systematic studies have found that deeply religious people -- or at least Christians, since the studies I am aware of were done in the U.S. where that's the predominant sect -- are more likely to insist on continued medical intervention with family members after doctors have concluded that further treatment is futile. And indeed, it is Catholic and right wing evangelical Christians who show up as political activists when one of these cases is highly publicized. Catholic clergy organized demonstrations to keep Terry Schiavo on life support, and the pope always seems compelled to weigh in on these situations.

Superficially, this seems odd. One of the evident functions of Christian doctrine is to facilitate acceptance of death. You get to go to heaven and hang out with your ancestors, and bask in the glory of God. Or you go to the lake of fire. Either way, you have it coming to you.

But this doesn't seem to work. Devout Christians actually seem to fear and deny the reality of death more than less religious and non-religious people. A glib explanation is reverse causation: people who have a harder time accepting death are more prone to seize on religious denial of its reality, but at heart they don't really believe that so they still insist on futile measure to prolong even the appearance of life.

The leaders of these sects need to stop promoting irrationality. Until recent decades, obviously, it was impossible to keep the tissues of brain dead people perfused with oxygen so we didn't have this problem. Whatever Jesus may have thought about death in 30 A.D. still pretty much applied. But now we need to decide when the time has come to pull the plug, and we need to decide as a society. We can't make it an individual family decision because that would give some people an unlimited claim on societal resources and take needed care away from people who could actually benefit.

Somebody needs to have a conversation with the pope.