Map of life expectancy at birth from Global Education Project.

Sunday, July 30, 2023

Sunday Sermonette: The king has dementia

 

 In the previous chapter we saw the king completely forget that Mordecai had tipped him off to an assassination plot. Now, the king has completely forgotten that in Ch. 3, he had ordered the murder of the Jews at the behest of Haman. Just in case there's any doubt or confusion, I'll reproduce it here. Obviously, the king has Alzeheimer's disease, because he has no memory of this.

Then Haman said to King Xerxes, “There is a certain people dispersed among the peoples in all the provinces of your kingdom who keep themselves separate. Their customs are different from those of all other people, and they do not obey the king’s laws; it is not in the king’s best interest to tolerate them. If it pleases the king, let a decree be issued to destroy them, and I will give ten thousand talents[b] of silver to the king’s administrators for the royal treasury.”

10 So the king took his signet ring from his finger and gave it to Haman son of Hammedatha, the Agagite, the enemy of the Jews. 11 “Keep the money,” the king said to Haman, “and do with the people as you please.”

12 Then on the thirteenth day of the first month the royal secretaries were summoned. They wrote out in the script of each province and in the language of each people all Haman’s orders to the king’s satraps, the governors of the various provinces and the nobles of the various peoples. These were written in the name of King Xerxes himself and sealed with his own ring. 13 Dispatches were sent by couriers to all the king’s provinces with the order to destroy, kill and annihilate all the Jews—young and old, women and children—on a single day, the thirteenth day of the twelfth month, the month of Adar, and to plunder their goods. 14 A copy of the text of the edict was to be issued as law in every province and made known to the people of every nationality so they would be ready for that day.

15 The couriers went out, spurred on by the king’s command, and the edict was issued in the citadel of Susa. The king and Haman sat down to drink, but the city of Susa was bewildered.

 

So the king and Haman went to Queen Esther’s banquet, and as they were drinking wine on the second day, the king again asked, “Queen Esther, what is your petition? It will be given you. What is your request? Even up to half the kingdom, it will be granted.”

Then Queen Esther answered, “If I have found favor with you, Your Majesty, and if it pleases you, grant me my life—this is my petition. And spare my people—this is my request. For I and my people have been sold to be destroyed, killed and annihilated. If we had merely been sold as male and female slaves, I would have kept quiet, because no such distress would justify disturbing the king.[a]

King Xerxes asked Queen Esther, “Who is he? Where is he—the man who has dared to do such a thing?”

Esther said, “An adversary and enemy! This vile Haman!”

Then Haman was terrified before the king and queen. The king got up in a rage, left his wine and went out into the palace garden. But Haman, realizing that the king had already decided his fate, stayed behind to beg Queen Esther for his life.

Just as the king returned from the palace garden to the banquet hall, Haman was falling on the couch where Esther was reclining.

The king exclaimed, “Will he even molest the queen while she is with me in the house?”

As soon as the word left the king’s mouth, they covered Haman’s face. Then Harbona, one of the eunuchs attending the king, said, “A pole reaching to a height of fifty cubits[b] stands by Haman’s house. He had it set up for Mordecai, who spoke up to help the king.”

The king said, “Impale him on it!” 10 So they impaled Haman on the pole he had set up for Mordecai. Then the king’s fury subsided.

Footnotes

  1. Esther 7:4 Or quiet, but the compensation our adversary offers cannot be compared with the loss the king would suffer
  2. Esther 7:9 That is, about 75 feet or about 23 meters

Saturday, July 29, 2023

The view from nowhere

I commend to your attention this essay from Dan Froomkin on the willful blindness of the corporate media to the reality of right wing politics in the U.S. today. (Even Froomkin doesn't seem to notice that the Republican party generally is driven by dispensationalism,  that most of their voters really do believe in Biblical inerrancy and literalism, and the imminent apocalypse. But that's for another day.)


I was particularly interested in Froomkin's example of opposition to solar farms in rural Ohio. 


Washington Post reporter Jeff Stein really stepped in it with his remarkably na├»ve article headlined “Small-town GOP officials are torn over Biden’s clean energy cash.”

Stein describes a “growing backlash in rural Ohio,” involving “hundreds of activists” who are largely “nonideological.” He describes a county commission meeting “where more than 200 opponents of the solar project showed up in matching red shirts.”

But as climate journalist David Roberts tweeted: “Amazing. Yet another piece about rural opposition to clean energy that does not even *mention* the massive, coordinated, well-funded astroturf campaign of right-wing propaganda that has been marshaled against it….. Like where do you think that roomful of old people *got* those matching red t-shirts?”

Robert has reported on his podcast that “community groups receive organizational help and money from billionaire-funded right-wingers. Across the country and the Internet, there are hundreds of conservative think tanks, groups, and individuals working to stir up community opposition to renewable energy with misinformation and outright lies.”

 

Something like this happened in my town, which owns several currently unused acres of open land. We had a proposal from a solar power company to lease the land from the town for 20 years, pay  us something like $25,000/year and more if they made more profit; and then dismantle the entire project and return the land to grass. The town meeting rejected it. By the way, we're in profound fiscal difficulty and the last thing these people want to do is pay taxes. I'm hoping we can try again, but that's what we're up against.

Thursday, July 27, 2023

Quote of the Day

 From The Madness of Crowds, by William J. Bernstein, describing John Blunt, the mastermind of the South Sea Bubble:


From their earliest histories, commercial societies equate riches with intelligence and rectitude; people of great wealth appreciate hearing of their superior brainpower and moral fiber. The wealth and adulation that accompany financial successes inevitably instill an overweening pride that corrodes self-awareness. worse, great wealth not infrequently arises more from dishonesty [or luck -- C.] than from intelligence and enterprise, in which case the adulation induces a malignancy of the soul, as indeed occurred to Blunt, who by this time had evolved into the archetype of the modern megalomaniacal CEO.

 

Hmm. Who specifically could this refer to?


Wednesday, July 26, 2023

Wednesday Bible Study: Turnabout

In Ch. 6, Haman gets his rude awakening. There is a continuity problem, however, because the king already knew that Mordecai had tipped him off to Bigthana and Teresh, as recounted explicitly in Ch. 2. But we'll take it that he needed reminding -- too much banqueting, I guess.

 

That night the king could not sleep; so he ordered the book of the chronicles, the record of his reign, to be brought in and read to him. It was found recorded there that Mordecai had exposed Bigthana and Teresh, two of the king’s officers who guarded the doorway, who had conspired to assassinate King Xerxes.

“What honor and recognition has Mordecai received for this?” the king asked.

“Nothing has been done for him,” his attendants answered.

The king said, “Who is in the court?” Now Haman had just entered the outer court of the palace to speak to the king about impaling Mordecai on the pole he had set up for him.

His attendants answered, “Haman is standing in the court.”

“Bring him in,” the king ordered.

When Haman entered, the king asked him, “What should be done for the man the king delights to honor?”

Now Haman thought to himself, “Who is there that the king would rather honor than me?” So he answered the king, “For the man the king delights to honor, have them bring a royal robe the king has worn and a horse the king has ridden, one with a royal crest placed on its head. Then let the robe and horse be entrusted to one of the king’s most noble princes. Let them robe the man the king delights to honor, and lead him on the horse through the city streets, proclaiming before him, ‘This is what is done for the man the king delights to honor!’”

10 “Go at once,” the king commanded Haman. “Get the robe and the horse and do just as you have suggested for Mordecai the Jew, who sits at the king’s gate. Do not neglect anything you have recommended.”

11 So Haman got the robe and the horse. He robed Mordecai, and led him on horseback through the city streets, proclaiming before him, “This is what is done for the man the king delights to honor!”

12 Afterward Mordecai returned to the king’s gate. But Haman rushed home, with his head covered in grief, 13 and told Zeresh his wife and all his friends everything that had happened to him.

His advisers and his wife Zeresh said to him, “Since Mordecai, before whom your downfall has started, is of Jewish origin, you cannot stand against him—you will surely come to ruin!” 14 While they were still talking with him, the king’s eunuchs arrived and hurried Haman away to the banquet Esther had prepared.

 

Tuesday, July 25, 2023

Play

I came downstairs yesterday morning and looked out the window, to see a doe and two fawns grazing on my lawn. Evidently they were finding something worth eating among the crabgrass. But the fawns weren't all that interested in breakfast. They'd nibble a bit then gambol -- i.e. jump around -- singly or together. They'd nuzzle the mother briefly, and she might nuzzle them back. At one point they both suddenly ran off into the woods. She just waited patiently until they came running back. They seemed to be testing or teasing her. Of course at some point she's going to have to let them go, but not yet. 


What I find curious about this is that the fawns couldn't possibly have been getting more calories from the occasional nibble at my lawn than they were spending running around and playing. It turns out that all young mammals play. They wrestle, race each other, pretend to hunt a blowing leaf or an insect. (Or, if they live with humans, a toy we give them.) Humans with their complex societies and imaginations engage in more complex play, inventing stories and situations and characters, but as the song goes, even the deer and the antelope play in their own way.


This takes up a lot of energy, and food isn't always in surplus, although it is right now for our deer population in the middle of a long, rainy summer. So any good biologist has to ask why evolution would favor such apparently wasteful behavior. The answer seems to be that mammals, with their complicated brains, don't have all their behaviors wired in from birth. They have to learn how to browse and hunt and escape predators and compete for mates and nurture their young, which means they have to practice before they do the real thing. They have to build the connections between brain and muscle, the patterns of movement and response, the ways of being in the environments in which they find themselves. 


In the end, the deer all learn to live pretty much the same way, depending on where they live. I suppose the white-tailed deer in the southern New England forest learn a somewhat different lifestyle from their cousins in Virginia or Michigan, but within a given setting they're all getting by in pretty much the same way. But we grow up with big differences, going down paths that start diverging from our earliest days. So we can end up in very different places and find it hard to really see each other across the valleys. This occurs to me now because I've been reading about the Civil War, which by the way isn't as much over as we thought. Now is the time for the Union to finally win it.

Sunday, July 23, 2023

Sunday Sermonette: Hang 'em high

I just have two comments about today's passage. The first is that the emperor twice offers Esther half of his kingdom. This seems like quite an impulsive act, especially toward a woman he hasn't even bothered to see for the past month. If I were her I would have taken it -- any Jews in the other half who are in danger can come to her part. The other rather weird detail is that the gallows, that Haman builds in a single day, is 23 meters high. It seems typical in the Tanakh for numbers to be multiplied by at least ten, or  to  even more implausibly large. Anyway, we can see how Esther is setting up Haman for a rude surprise.


On the third day Esther put on her royal robes and stood in the inner court of the palace, in front of the king’s hall. The king was sitting on his royal throne in the hall, facing the entrance. When he saw Queen Esther standing in the court, he was pleased with her and held out to her the gold scepter that was in his hand. So Esther approached and touched the tip of the scepter.

Then the king asked, “What is it, Queen Esther? What is your request? Even up to half the kingdom, it will be given you.”

“If it pleases the king,” replied Esther, “let the king, together with Haman, come today to a banquet I have prepared for him.”

“Bring Haman at once,” the king said, “so that we may do what Esther asks.”

So the king and Haman went to the banquet Esther had prepared. As they were drinking wine, the king again asked Esther, “Now what is your petition? It will be given you. And what is your request? Even up to half the kingdom, it will be granted.”

Esther replied, “My petition and my request is this: If the king regards me with favor and if it pleases the king to grant my petition and fulfill my request, let the king and Haman come tomorrow to the banquet I will prepare for them. Then I will answer the king’s question.”

Haman’s Rage Against Mordecai

Haman went out that day happy and in high spirits. But when he saw Mordecai at the king’s gate and observed that he neither rose nor showed fear in his presence, he was filled with rage against Mordecai. 10 Nevertheless, Haman restrained himself and went home.

Calling together his friends and Zeresh, his wife, 11 Haman boasted to them about his vast wealth, his many sons, and all the ways the king had honored him and how he had elevated him above the other nobles and officials. 12 “And that’s not all,” Haman added. “I’m the only person Queen Esther invited to accompany the king to the banquet she gave. And she has invited me along with the king tomorrow. 13 But all this gives me no satisfaction as long as I see that Jew Mordecai sitting at the king’s gate.”

14 His wife Zeresh and all his friends said to him, “Have a pole set up, reaching to a height of fifty cubits,[a] and ask the king in the morning to have Mordecai impaled on it. Then go with the king to the banquet and enjoy yourself.” This suggestion delighted Haman, and he had the pole set up.

Footnotes

  1. Esther 5:14 That is, about 75 feet or about 23 meters

Friday, July 21, 2023

The corporatization of medicine: Part two

2016 was in fact the first year in which fewer than half of physicians had an ownership stake in their practice, based on a survey by the American Medical Association.[i] The pace of acquisition of practices by hospitals and health systems during this period was astonishing. From 2014-2018, just four years, corporate ownership of practices increased from 24.1% to 45.6% of all physicians in a nationally representative sample. After selling out, physicians actually experienced a reduction in their income.[ii]

The evidence that increasing concentration of medical services is associated with higher prices is consistent and extensive.[iii] This includes horizontal consolidation among hospitals[iv] and physician practices,[v] and vertical consolidation, i.e. purchase of physician practices by hospitals.[vi]

Quality in medical services is difficult to measure, but at least from the standpoint of physicians, the growing corporatization of Medicine is widely experienced as compromising their ability to meet the needs of their patients. It is widely understood that the Covid-19 pandemic imposed enormous stress on the medical workforce.[vii]  However, what is commonly called “burnout” – a psychological state characterized by “overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment”[viii] – was common before the pandemic, and a matter of widespread concern. 

Simon G. Talbot and Wendy Dean argued in 2018[i] that a better term for the problem was not burnout, but moral injury, a concept previously applied to combat veterans who have had experiences such as “Perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. This may entail participating in or witnessing inhumane or cruel actions, failing to prevent the immoral acts of others, as well as engaging in subtle acts or experiencing reactions that, upon reflection, transgress a moral code.” [ii]

As Talbot and Dean put it, “The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.” They argue that the corporatization of medicine, and the evolution of the physician’s role from that of an independent professional to an employee whose services are valued principally for the profit they can produce, has put many physicians in the position of being unable to fulfill what they experience as their ethical obligations to their patients. Dean has since expanded these observations into a book,[iii] which describes many ways in which corporations driven largely or solely by financial gain ill serve both patients and clinicians, and illustrates these with detailed stories about the careers of individual physicians.


[i] Simon G. Talbot and Wendy Dean. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. Stat. July 26 2018. Available at https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/ [Accessed June 27, 2023

[ii] Brett T. Litz, Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, Shira Maguen. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review. 2009. 29:8; 695-706

 

[iii] Wendy Dean (with Simon Talbot). If I Betray These Words: Moral injury in medicine and why it’s so hard for clinicians to put patients first. Steerforth Press, Lebanon, New Hampshire. 2023.

 



[i] Carol K. Kane. Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50 Percent. American Medical Association Policy Research Perspectives, 2017. Available at https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/health-policy/PRP-2016-physician-benchmark-survey.pdf. [Accessed June 19, 2023]

[ii] Christopher M. Whaley, Daniel R. Arnold, Nate Gross, and Anupam B. Jena. Physician compensation in physician-owned and hospital-owned practices. Health Affairs. December 2021 40:12.

[iii] Martin Gaynor. More Than 20 Years of Consolidation Have Led to a Dysfunctional Health Care Market. Promarket, June 2021. The Stigler Center for the Study of the Economy and the State. Available at https://www.promarket.org/2021/06/02/consolidation-dysfunctional-health-care-market-prices-competition/ [Accessed June 21, 2023]

 

[iv] Martin Gaynor and Robert Town. The Impact of Hospital Consolidation: Update. Robert Wood Johnson Foundation, The Synthesis Project. June 2012. Available at file:///C:/Users/ml117/Downloads/rwjf73261.pdf [Accessed June 21, 2023]

[v] Laurence C Baker, M Kate Bundorf, Anne B Royalty, and Zachary Levin. Physician practice competition and prices paid by private insurers for office visits.  JAMA 2014 Oct;312(16):1653-62

[vi] Cory Capps, David Dranove, Christopher Ody. The effect of hospital acquisitions of physician practices on prices and spending. J Health Econ 2018 May;59:139-152.

[vii] Tait D. Shanefelt, Colin P West, Lotte N. Dyrby, Hanhan Wang, Lindsey E. Carlasare, Christine Sinsky,et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings. Sept. 13, 2022.

[viii] Christina Maslach and Michael P. Leiter. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016 Jun; 15(2): 103–111.