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Archive for the month “January, 2013”

Assimilation or Acculturation, One Lesson from the Talmud: Thinking in Jewish IX

Between the [holy] books on one hand and the tefilin and mezuzot on the other, this is the only difference: the books are written in all languages, whereas the tefilin and the mezuzot only in Hebrew. Rabbi Shimon ben Gamliel said: “Even for the [holy] books, they [the masters] have only authorized [by way of another language] their being written in Greek.”
Tractate Megillah, 8b

Assimilation or Acculturation, One Lesson from the Talmud: Thinking in Jewish IX

Assimilation or Acculturation, One Lesson from the Talmud: Thinking in Jewish IX

In the Souls of Black Folks, W. E. B. DuBois argued persuasively that an important issue facing African-Americans in the post-slavery United States was whether or not to assimilate into the culture of the majority. DuBois argued that assimilation would effectively destroy that which defined the souls of Black people, arguing that rather than submit to a reduction into the same (not DuBois’ term) and engage in the culture of the normative society, rather than seek to assimilate, Black people should concentrate on acculturation as a meaningful alternative. Acculturation meant that learning to navigate through the White man’s world, adopting speech patterns, clothing and accepted manners while dealing with White people did not mean that one had to accept total reduction to the same, rather, one could continue to maintain cultural and linguistic roots while working and living within one’s own community.

Nearly 2,000 years before DuBois wrote Souls of Black Folks the sages of the Mishnah, and 700 years later the sages of the Talmud in commenting and clarifying the Mishnah addressed the same issue; just what is one’s obligation to conform to the normative society and what are the options open to maintaining one’s roots as Jews in the diaspora. The quote from the Mishnah above, found in Tractate Megillah of the Talmud Bavli is focused on the same question that DuBois raised. In essence the Mishnah allows for all sacred texts from Scriptures through commentaries to be translatable into the language of the people with two exceptions, the tefilin and the mezuzot. A minority opinion is included that points out that translation into Greek is the only one expressly authorized by the masters, the sages of the Sanhedrin.

Why is this so important? By making the claim that translating sacred texts into the language spoken by people, the rabbis are making it clear that it is more important to be able to understand what is written than to simply adhere to the original textual form. While there is implicit in their ruling, for that is what the Mishnah is, a compilation of Jewish Law, that translations are interpretations of the texts, translation leads to clarity and visceral understanding as well. It is also clear, through the minority opinion, that the masters understood the need to translate at least into one language but had no ability to extend to any other language as the Sanhedrin no longer existed.

Why the exception for tefilin and mezuzot? The most important prayer for Jews is the Shema, the prayer that affirms the oneness of God, one that is repeated three times each and every day and when Torah is read, more often. It is also repeated with greater frequency on some special holidays. Translated into English it reads: Listen up Israel! The Lord is God, God is one. Directly following the recitation of the Shema is a prayer called the V’ahavtah, a prayer that tells devout Jews to bind these words as a sign upon your hand and between your eyes (tefilin) and they shall be inscribed upon the doorposts of your house and gates (mezuzot). Inside the tefilin and mezuzot are hand written prayers that include the V’ahavtah and other verses from Torah. These verses are not to be translated into any other language, rather they are to be held in their original linguistic form for all ages; a clear connection to one’s roots. To do otherwise would be to become just like those of the other nations, the gentiles, and would lead to a complete absorption into the broader, normative culture.

The Rabbis were being careful to preserve the essential quality of what it means to be Jewish. They were saying, through the metaphor of translation, that it is more important to preserve the core of one’s cultural belief system than to turn the whole over to those in a strange land. They were fully aware that if one allows the other to define the self then the self is destined to be reduced to the other without recourse to that which underpins one’s attitude toward life, ethics, and morality. By creating an exception to the translation rule, the Rabbis preserved a specific hook upon which to hang one’s hat, a specific bit of Torah that cannot be changed, no matter how hard others may try to reduce it to the ashes.

If the sages of the Talmud lived today, I am certain they would side with DuBois, arguing that acculturation is preferable, in fact is the positive choice for Jews, rather than attempting to assimilate into gentile society. Acculturation provides one with a dualistic approach to society, being comfortable in two worlds, without having to sacrifice one’s ethical convictions to one or the other.

Am I learning to read between the lines? Indeed, I think so.

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Drawing Conclusions: Thinking in Jewish VIII

What happens when one dies?
Rabbi Mendel, in conversation

Drawing Conclusions: Thinking in Jewish VIII

Drawing Conclusions: Thinking in Jewish VIII

After the Parsha class last evening, several of us were talking about some of the problematics raised during the discussion of mutton Torah (the gift of the Torah and not the revelation at Sinai because tradition holds that the Torah was already known to the Jewish people having been taught to Abraham and then passed down through all subsequent generations). One of those problematics was the notion that every Jewish soul was present at Sinai, even those unborn souls, at the exact point when God descended from his heavens and Moses ascended to God’s mountain. The very idea of a soul became the point of the after class discussion. Rabbi Mendel was making the point that a creator God created the soul in order for there to be a ‘spark’ of life infused into every living creature, great or small; that that ‘spark’ or soul ascends to a different level of existence when the body dies. He was questioned vigorously by a member of the group (not me) trying to come to grips with the very idea of the existence (even pre-existence if the idea that all souls living, dead and yet unborn were present at Sinai) of the soul. It was at that point the question quoted above was raised. I’m sorry in advance, but Rabbi Mendel’s argument is what is famously known as one of those false logical arguments that philosophers call the argument from incredulity; that argument goes basically like this: I cannot even imagine something different therefore what I believe must be true. Let me explore this for a few moments.

Let me first assume there is a creator God for the sake of argument. Let me also assume that this creator God is at once omnipotent, omniscient and benevolent (all powerful, all knowing and loving/merciful). If, and only if (iff) this is true does the very existence of a soul begin to make any sense at all but the jury remains out on the truth of this kind of a creator God. If God is all these things then how is it the God cannot build a mountain that God itself cannot move? The very idea that this is possible, even in the face of countless described miracles where God alters nature described in Scripture, then the creator God cannot be omnipotent. Strike one! If the creator God is all knowing how is it possible for man to have choices, to exercise free will? This questions both the omniscience and omnipotence of the creator God. If the creator God knows all possible outcomes then man can only have the illusion of free will, the simulacrum of moral and ethical choice because both the choice and the outcome are already known by the omniscient creator God. If, as theologians argue, the creator God gives mankind free will it surrenders some of its power rendering itself no longer omnipotent and some of its knowledge rendering itself no longer omniscient. Strike two! As to benevolence, the creator God is responsible for the commonplace as well as the extraordinary suffering of all life on earth. In the face of massive genocides of the 19th and 20th Centuries, where was this benevolent creator God. Either the creator God was unable to stop the genocides in which case the creator God was impotent not omnipotent or the creator God was unwilling to stop the genocides in which case the creator God is unmerciful at best and a sadist at the very worst. Strike Three.

Simply on the basis of the evidence briefly described above, the question of a creator God remains a moot point. Perhaps there is a force that is something akin to Aristotle’s Prime Mover, but even that is a circular argument that ends only because, incredulously, Aristotle himself, after circling back in time comes to a point where he cannot imagine that there was creation ex nihilo (creating something from nothing), hence he concludes that there must have been something that lit the flame of the universe and all creation, else why would anything at all exist. But just because one cannot imagine creato ex nihilo doesn’t mean that there aren’t alternative solutions to creation. Two come to mind. First there is the idea of creato ex materia or creation from some pre-existing, eternal material force that has not yet been identified. Then, of course, the theological favorite, creato ex deo or the creation out of the very voice of God. These are three competing voices to explain the creation of the universe, none of which are inevitable but perhaps only one of which is supported by cosmologists; the idea of the Big Bang is, in fact, an argument for creato ex nihilo. By isolating one of the other two possible explanations for the creation of the universe and all that is within it and suggesting that it is the only reasonable explanation is to argue from incredulity. The failure to address competing arguments is, at the very least, an argument that leaves reasonable doubt in my mind.

So if the question of the existence of a creator God can be called into doubt, which is not to say that there is no creator God, merely that there is not enough positive evidence extant to support such a God and more than enough evidence extant to deny such a God, then to base the existence of the divine soul on the idea of creato ex deo to the exclusion of all other possibilities is not persuasive. The internal argument for creato ex deo in Judaism is based exclusively in Scripture. It is a theological argument based in a mythological explanation for that which was thought to be completely outside the ken of human understanding. As an ethical story the whole idea of creation arising from the spoken word of the creator God may have ethical and moral lessons to be learned about the genesis of everything but given the state of scientific knowledge it is a story that can only be understood as metaphor and not as revealed truth. If that is the case, the argument for the existence of a soul, even a repository for all souls dead, living and yet unborn, makes little sense except teleologically. If there is, however, real evidence to show my analysis to be wrong, then I am obligated to explore that evidence for its credulity and either accept it or reject it as warranted or not warranted. I would reject as unwarranted any assertions that are only based on Scriptural writings or commentaries on Scriptural writing, not because it is incredulous, rather because it is steeped in that which it purports to prove leaving no room for alternatives.

As I told Rabbi Mendel last night, it would take an awful lot of persuasion to get me to accept the existence of an eternal soul leaving the door open to being persuaded.

Paradigm Shifts and Higher Authority: A Brief Encounter

With scientific observation…the scientist can have no recourse above or beyond what he sees with his eyes and instruments. If there were some higher authority by recourse to which his vision might be shown to have to have shifted, then that authority would itself become the source of his data and the behavior of his vision would become a source of problems.
Thomas S Kuhn, “The Structure of Scientific Revolutions, 3rd edition”

Paradigm Shifts and Higher Authority: A Brief Encounter

Paradigm Shifts and Higher Authority: A Brief Encounter

Thomas Kuhn, in his brilliant work, The Structure of Scientific Revolutions, suggests that in general the world is governed by one’s paradigmatic understanding of the world itself. A paradigm is essentially what Richard Rorty described as normative discourse, a discourse in which the rules of the game are clearly established governing the very questions one is allowed to ask. To a lesser extent, normative discourse governs the answers one receives as well.

For Kuhn, the problem with paradigmatic thinking comes when the questions being asked provide answers that conflict with that which is thought to be normative, to be normal. When that happens, scientists begin to seek new questions that help to explain the anomalies found in their answers. Perhaps the greatest example is the shift from Newtonian physics to the ideas of Einstein and relativity and Boor and quantum physics. Physicists are now trying to develop the tools to respond to the problems posed by the polar differences between relativity and the breakdown of what appears to occur at the smallest of quantum levels of being. When scientists are puzzled by the world they observe they engage in work that seeks to respond to the puzzle. This is what Kuhn describes as a scientific revolution or what Rorty calls abnormal discourse. This neo-pragmatic view of knowledge both in terms of understanding of and developing new clarity is underpinned by the idea that solutions arise from problems and problems are best expressed as questions.

Not all questions are equal. Some questions lead nowhere. Some lead to dead ends. Some are pure speculation without a basis in the real world. Even some of the questions that appear to be on the right path to new understanding turn out not to be supported by evidence based on observation and instrumental data. In short, in order to engage in science, evidence trumps speculation and bombast.

The second sentence in the quotation from Kuhn, “If there were some higher authority by recourse to which his vision might be shown to have to have shifted, then that authority would itself become the source of his data and the behavior of his vision would become a source of problems,” is, it seems to me, to be a perfect definition of blind faith; a reliance on a higher authority outside of observable facts and appropriate data collection. The problem that arises is that the higher authority in general is a compilation of ideas and writings, stories and myths, designed to explain that which is unexplained or appears unexplainable. The higher authority is deemed to be generally speaking the final authority disabusing itself of questions that are not contained within the canon. Often the preservers of higher authority discount science as not being in accord with the canon that authority brings to the table. Believers are, then, stuck in whatever time the canon was developed without hope of a more reasoned understanding.

For me, the world is a wondrous place. It is filled with many things I fail to understand, not because my ability to understand is limited, rather, because I have not taken up the study that might lead to understanding. I am in awe of the universe and its grandeur but that doesn’t lead me to posit that the universe is anything more than a very large, violent, random number generator that, in all probability will simply run out of steam some day in the very far distant future. Our own solar system is a microcosmic representation of the absurdity of the universe itself in that sometime in the future it will cease to exist as the sun burns out of its source of fuel. Absurdity in extinction leads me to the conclusion that there is nothing other than probability guiding the very furnace of the universe itself. No need to explain creation unless one is also willing to explain the demise of everything. The eternal universe is simply not an acceptable answer if one explores even the barest surface of current scientific knowledge.

It is Raining Outside Chicago In January

It is Raining Outside Chicago In January

It is Raining Outside Chicago In January

It is raining, well not quite rain, rather a mixture of rain and sleet, freezing rain I suppose. This means that the electrical grid will be stressed to its limits this evening as temperatures drop into the mid-twenties. Tomorrow, however, the forecast calls for temperatures in the mid to high forties and it is still January. Something is awfully wrong with the weather. Of course, I live in the United States, the land of denial (that’s right the Untied States not Egypt). Global climate change is only a mythological story told by liberals in order that they might spend more money and grow the size of our government or so goes the tale told by the denial group. But temperatures in the high forties and low fifties in January in Northern Illinois are simply not normal. Perhaps it is time to wake up and smell the roses (that may bloom in February if this keeps up) before the world my grandchildren inherit from us is destroyed.

That being said, after all it is good to rant once in a while, I spent an interesting weekend at the Chabad of Elgin, where the Rabbi and his wife hosted a Friday night dinner. The evening included both a Shabbat service, a dinner and Shabbat games played by a raucous group of folks attending this event. The food served featured the seven native fruits of Israel including: dates, figs, pomegranates, sesame seeds, olives, apples and oranges (if memory serves me correctly). The food was simply outstanding, rich in tradition with a modern presentation that left everyone there satisfied. The hit of the evening for me was a potato kuggel, a baked potato pudding, that swept me back nearly 60 years to my grandmother’s table and her outstanding potato kuggel. I even asked for the recipe it was that good.

Part of the evening was spent talking to one of the regular attendes at our weekly torah study group. We see each other on a week to week basis but never really get a chance to talk much. Spending time building this relationship was both interesting and enjoyable. It turns out that he is a “Jew by Choice” having converted to the religion I was born to. Because we come to the table with such different perspectives our conversation explored nuanced belief; how, for example, I could be so interested in religious texts while I simply do not believe in a God (or gods for that matter) and while no conclusion was reached, I found myself thinking more clearly than ever about the differences between belief and non-belief, between faith and rationality. I suppose that is a good thing but I cannot yet draw any conclusions about the conversation we engaged in.

At one point in the evening Rabbi Mendel told us an interesting tidbit of information. We were celebrating the holiday of Tu Bish’Vat, the festival of trees, a holiday in which Jews traditionally eat fruit. The holiday that celebrates the harvest and, by implication, fruit, Sukkot, doesn’t have a tradition of eating fruit at all. Curious. But, needless to say, he found a lesson in all that. Eating of fruit on Tu Bish’Vat symbolizes the potential in the fruit tree, the very reason for the existence of the trees in the first place. Celebrating by eating fruit on this holiday reminds us of all of the work to nurture the trees, to pull the weeds, water the orchard and so on. It reminds us of the purpose of nature harnessed. The harvest, on the other hand, the picking of the fruit, represents a period of dormancy that doesn’t require a special food to remind us that the seasons turn in order. Now these are stories I can understand. They are simple, almost folksy, reminders of an ethical life lived encapsulated by infinity. The stories lend purpose to an otherwise absurd life, a life in which purpose often eludes us.

One last thing, I am actually feeling quite giddy today. I spent the last two nights sleeping through the night, the first time since my prostatectomy. Not only that, but in the morning the only thing in my Depends for Men was the baby powder I put in before I went to bed. I take this as a sign that things are actually improving. I am pleased to report this progress as it gives me something to look forward to. Yea!!!

To the Pain…

To the Pain...

To the Pain…

At the end of June, 2012, I had a total knee replacement performed on my left knee. For three months I was in so much pain, a pain that simply didn’t seem to be getting any better, that I regretted having undergone this surgery. I was shocked and, frankly, surprised that the pain was so intense. After all, I have two total hip replacements and a titanium back from a laminectomy to deal with a stenosis caused by my severe osteoarthritis. I expected recovery to mirror my prior orthopedic surgeries. Then, one day about three months after surgery, the pain simply disappeared; while I was left with some discomfort, it was getting better from my commitment to physical therapy. But my healthcare nightmare of 2012 was not quite over. In October I was diagnosed with prostate cancer and, because of the biopsy, the bone and CAT scans, it was decided that surgery was the most appropriate option. So in late November I underwent a radical prostatectomy. So far, this is nothing new for those following this blog. Here is where it gets a bit dicy. Because of the surgery and the post-operative restriction on lifting, I was unable to continue the exercise program that my PT laid out for me. Three weeks ago I was granted a lifting of all restrictions on lifting and exercise. Ten days later I was in my orthopedic surgeon’s office for my six month evaluation. I was complaining about a stiffness developing in my left knee. He suggested that I go to physical therapy just to make sure that I didn’t do any serious damage to the knee as I worked my way back into some kind of shape.

Yesterday was my first serious day in physical therapy and man do I hurt today. There isn’t a muscle in my lower body that is not feeling the effects of having been sedentary for the past two months. Things that I did with ease prior to the prostate surgery were not only difficult, they were painful as well. When I rolled out of bed this morning I could feel the pain everywhere. I have a whole regimin of exercises to do at home and I will not return to PT until Tuesday. With enough effort on my part, perhaps I will rejoin the ranks of the reasonably fit but right at this very moment that doesn’t seem like a reasonable outcome. What I’ll have to do is shelve my pessimism and visualize the end result as I go down to my basement to push myself harder but within the limits laid out by my PT.

Okay, I know this is a short post, but I am out of the house to meet with the orthopod about another issue, nothing I am terribly worried about, and then to see Zero Dark Thirty. Exercise will wait until I return.

Thinking In Jewish Is Harder than I Thought: Thinking In Jewish VII

Thinking In Jewish Is Harder than I Thought: Thinking In Jewish VII

Thinking In Jewish Is Harder than I Thought: Thinking In Jewish VII

It all falls on what counts as evidence. In my Western way of thinking, evidence cannot be accepted on faith alone. In fact, faith and what counts as evidence are contradictions. In my approach, evidence must be both reliable and verifiable; it must originate in fact and it must be replicable in multiple contexts. Faith, on the other hand, accepts as fact that which is often absurdly beyond the knowledge, what is knowable, and what is verifiable outside of the limitations of faith itself. Faith, then, presents fundamental problems to rationality. Here is where I am struggling to break from the mold of the Greeks and integrate Jerusalem into my thought process. I am finding it more difficult that I had imagined because much of what I am reading and learning relies on faith based evidence and not on reliable and verifiable evidence.

Let me cite a simple example. Yesterday I was reading a commentary on the current parsha (weekly Torah portion open for study for the week and read in synagogue on Monday, Thursday and Saturday mornings) that, among other teachings focuses on the splitting of the Sea of Reeds (the Red Sea) by God. In the Torah there is a single line that reads as follows: “And Moses stretched forth his hand over the sea and the sea returned to its strength.” (Exodus 14:27)  The commentary I read focused only on the four words (one Hebrew word) in the English translation, “returned to its strength.” The first part of the commentary focused on the vocalization of the Hebrew word that could have two pronunciations depending on which vowels are used in vocalizing the word (Hebrew is a language written with no vowels; vowels are added as an afterthought in more modern times in order to simplify correct pronunciation but the Torah is written with no vowels at all). In one vocalization the word means “returned to its strength” while another vocalization of the same letter combination means “returned to normal.” So with no vowels to guide a translator, a choice was made to translate using the phrase, “returned to its strength.” In recent translations made within the past 50 years, the English translation reads “returned to normal” or “returned to its normal state” while leaving the Hebrew of the Tanakh (the Bible) unchanged.

Using the older translation, “returned to its strength” posed a problem for sages of the Talmud and for commentators on the Torah itself. The phrase as translated makes no sense. Pronouncing the Hebrew  in the accepted manner makes no sense. But since every word in Torah is transmitted to Moses by God, and the pronunciation itself must have been, therefore, taught to the Jewish people by Moses himself, the pronunciation must be accepted as the correct pronunciation as well. Occam’s Razor posits that the simplest solution to a problem is generally regarded as the best solution. In this case, accepting a pronunciation that makes little sense over a pronunciation and vocalization that makes clear the language being used doesn’t comply with the principle of Occam’s Razor. Newer translations correct this problem yet there are hundreds, perhaps even thousands of pages of commentary stretching over 3,000 years that have to deal with the problem of what appears to be a mispronunciation of the Hebrew of the Torah; a Hebrew that is sans vowels.

To this commentary, the Lubavitcher Rebbe complicates the problem even more. While admitting to the vocalization problem, the Rebbe focuses on the accepted version and tries to explain it. In order to do this, he must jump through at least three hoops and still can only sound convincing to those who accept the Torah as sacrosanct, as infallible, as the word of God transmitted to Moses, through Joshua, to the Judges, Prophets, Sages of the Mishnah, the Sages of the Gemara, to the rabbis and then to the people. The first hoop the Rebbe must traverse is why God would choose such a word to convey a simple idea that once a miracle is over the natural world could return to some kind of normalcy. To this the Rebbe goes through a complex argument that boils down to the fact that the parting of the Sea of Reeds took two miracles, the first was the parting of the sea and the second was the restoration of the sea to normal. The second miracle was made necessary to confirm the fact that the Sea of Reeds was created with the potential for the first miracle and once the condition of that miracle was met and the Israelites crossed the sea on dry land, that without the second miracle the sea would have ceased to exist for ever and all times. God, therefore, needed to restore the sea with miracle number two. This is one reason that the language seems awkward, to make this very point.

Then the Rebbe admits that this is not a completely satisfactory answer to the problem posed by two vocalizations; by two possible meanings. Rather than look for the simplest solution, the Rebbe argues that in order to understand God one must give up the idea that time for God is the same as time for human beings. For us, time is linear but for God time doesn’t exist as God can travel backwards in time, forwards in time and simply be in the present simultaneously. Therefore, one must think of miracles as coming in two varieties. One form of miracle disrupts the flow of the natural world while the other restores the natural world from the discord of the first variety of miracles. This is likened to a conditional contract where the contract would be null and void if the condition for executing the contract is never met. Once the condition is met, the contract is fulfilled (a miracle occurs) but unless the miracle to restore is undertaken the world will be forever altered by the scar left by the first miracle.

There is more but I think you get my point. The evidence the Rebbe relies on is based in the faith that the Torah was given to Moses by God and transmitted across a long line of prophets and sages to the rabbis and then to the people. I find this form of evidence failing to meet either the standard of reliability or validity. The evidence used here requires one to create complex scenarios in order to explain that which cannot be verified and is, therefore, unreliable and cannot be repeated except as a story and is therefore not valid. In order to make sense of this faith based evidence, complicated arguments must trump the simpler answer. None of this analysis, none of this exegesis would be necessary if the vocalization of the Hebrew word itself made sense in the context of the sentence. Occam’s Razor pushes one toward the solution the the sea was returned to its normal state, a state in which the world is restored. Of course, that still leaves us with the problem of the existence of miracles in the first place but that, too, is a function of reliable and valid evidence and will be saved for a different post perhaps.

Treating Disease and Not Risk Factors: A Holistic Approach

Treating Disease and Not Risk Factors: A Holistic Approach

Treating Disease and Not Risk Factors: A Holistic Approach

I spent the day yesterday with my wife as she went for a baseline heart assessment. She worries because her father and mother as well as her brother all had significant heart disease diagnosed in their late fifties. She is in her early sixties with some risk factors for heart disease so her goal was to establish a baseline as a way to measure changes in her risk for heart disease. That is all well and good. I am a firm believer in understanding risks and probabilities, I play poker after all. What I am most worried about is the desire of physicians, especially cardiologists in my experience, to treat risk factors in the absence of actual disease. When I was in graduate school we were encouraged to ask two questions as we began to investivate research reports. First, who funded the research; is there a funding agent that has a significant dog in the fight because if there is the results of the research are significantly less valuable than if the research was conducted objectively. Secondly, we were encouraged to ask just who actually benefits from the results of the research; understanding the relationship between beneficiaries of research and those upon whom the research is actually intended to benefit along with the divergency in ultimate beneficiaries is important in evaluating the results of the research itself.

Take Lipitor, as an example. According to Wikipedia, “Atorvastatin [Lipitor] was first synthesized in 1985 by Bruce Roth of Parke-Davis Warner-Lambert Company (now Pfizer). The best selling drug in pharmaceutical history, sales of Lipitor since it was approved in 1996 exceed US$125 billion, and the drug has topped the list of best-selling branded pharmaceuticals in the world for nearly a decade.When Pfizer’s patent on Lipitor expired on November 30, 2011,generic atorvastatin became available in the United States.” (emphasis added) While I am not looking at specific studies, I can imagine a reasonable scenario in which the vast majority of research done on Lipitor was funded by Pfizer or their predecessor company, studies that showed the benefits of Lipitor in preventing fatal heart disease. I immediately am skeptical of research that is funded by the company that benefits in terms of manufacture and sales when the drug goes on the market. In the case of Lipitor, the drug was the best selling pharmaceutical for over ten years; a patented drug the profits from which flowed into the coffers of Pfizer’s treasury. Clearly, Pfizer was a major beneficiary of the drug Lipitor.

The question of patient benefits are a bit more sketchy. Side effects from Lipitor (and other statin drugs) are many and some are even deadly. Again according to Wikipedia:

As stated earlier, myopathy with elevation of creatinine kinase (CK)] and rhabdomyolysis are the most serious side effects, although rare at <1%. Headache is the most common side effect, occurring in more than 10% of patients. Side effects that occur in 1–10% of patients taking atorvastatin include:

  • Weakness
  • Insomnia and dizziness
  • Chest pain and peripheral edema
  • Rash
  • Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, nausea
  • Urinary tract infection
  • Arthralgia, myalgia, back pain, arthritis
  • Sinusitis, pharyngitis, bronchitis, rhinitis
  • Infection, flu-like syndrome, allergic reaction

Atorvastatin and other statins are associated with anecdotal reports of memory loss by consumers, which have been seen in clinical practice in a tiny percentage of users, particularly women. Evidence is conflicting with anecdotal reports contrasting with a well-established association of high cholesterol with dementia. However, it is known that cholesterol synthesis is necessary for normal neuron functioning. According to Pfizer, the manufacturer of Lipitor, clinical trials “do not establish a causal link between Lipitor and memory loss.”

Elevation of alaninetransaminase (ALT) and aspartate transaminase (AST) has been described in a few cases.

High-dose atorvastatin had also been associated with worsening glycemic control in the Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) substudy.

Side effects occur in up to 10 percent of all patients taking Lipitor, or now generic Atorvastatin; one in nine people will experience some side effect from this drug. What is even more interesting is the list of side effects does not include potential damage to one’s liver, neuropathy, or other conditions that may occur when using Lipitor. What is even more unsettling is that the drug is designed to treat “Secondary prevention in people with coronary heart disease and multiple risk factors for myocardial infarction, stroke, unstable angina, and revascularization.” The first part of this sentence shows a use for treating disease while the second half of the sentence specifically treats risk factors for, or the probability of being affected by, something that has not yet occurred. I wonder just how much profit Pfizer made from treating risk and not treating actual disease? My guess it that it amounted to over 75% of all profits earned from the sale of this drug.

Risk factors are just that, factors that may or may not contribute to an individual’s chances for developing a particular disease. With regular doctor’s visits, a solid program of reasonable weight control, exercise and a baseline from which to assess risk, clearly one need not spend untold thousands of dollars popping pills. A personal example, from the time that Prostate Specific Antigin (PSA) testing was available I had mine checked at least once a year. I had significant risks for prostate disease, especially prostate cancer so establishing a baseline that was particular to me, not to some generality of statistical risk, became a guide post for my own awareness of the changing risk factors. When my PSA suddenly spiked to 23 the time had come to actively pursue treatment options. Until that time, however, taking prevention pills was not a personal option. Treating risks is something like carrying an umbrella on a sunny day thinking that there is a potential for rain albeit an unlikely chance that rain will occur at all. When there are potentially deadly side effects in taking a drug aimed at prevention, when the drug is known to destroy one’s liver, the risks of taking the drug are perhaps greater than the risk of disease itself.

I am ranting here because my wife was prescribed Lipitor by a new cardiologist, had to undergo a stress-echo test in which her skin was sandpapered raw, and she was told that she could only eat chicken, fish, veggies, and fruit and she had to eat all this food without seasoning the food. Seriously? If it were me, I’d simply run the other way. I avoid doctors that prescribe medication on a first visit and surgeons who do not offer non-surgical treatment before they recommend surgery. I am disturbed by the practice of medicine that throws the patient under the bus in order to benefit pharmaceutical purveyors and themselves first and the patient second. I am not sure what she intends to do but I will do all within my power to encourage a second opinion, one from a cardiologist who doesn’t reach for the prescription pad first and alternatives second. For me it is a matter of medical ethics and holistic treatment of a patient and not a risk factor.

Always Already Being In The Material World

Always Already Being In The Material World

Always Already Being In The Material World

To borrow a phrase from Martin Heidegger without necessarily committing to its meaning, being-in-the-world adequately represents the notion of the existential moment. If I could phrase it differently than Heidegger I would strip it of its ontological references while incorporating the notion of representing an illusory phantom of the trace of memory and a projection into the future. In Levinas’ terms, this is represented better by the notion of hypostasis, the question of the infinitely brief moment of existential time while merging the idea of the trace remembered and the future desired, both of which are measured by ever fading memory or ever more fantastic dreamt of futures. In brief, existential time is a simulacrum of the conjoining of past/future, while cleverly disguising both within a true sense of security of past events and a desired sense of future certainty. Nothing, however, exists outside of this very moment of existential time; all the rest is merely a ghost or a projection on a screen of hope; something like Plato’s images on the cave wall without the reference to forms.

Going beyond the ontic nature of Heidegger’s being-in-the-world, Levinas focuses on the idea that hypostasis focuses on the interiority of solitude in which one experiences existential time; the trace of memory and those projections for the future are clearly personal, not able to be shared with any other human being. If left to its own resources, Heidegger insists, the self would be so consumed with its own interiority that it could not relate to the exterior world other than to evaluate the entirety of that world as objects of the self with being incorporated in the objective relationship with the objects, including the human objects, in the world. Levinas is critical of this position arguing that one can only understand being by and through the social interaction with the other, by responding to the call of the other without reservation or expectation of reciprocation; to make oneself present in the world in order to be responsible for the welfare of the other without reservation or expectation of reciprocation. In this sense, being-in-the-world turns Heidegger on his head by proclaiming that ethics trumps ontology; that response-ability, the ability to respond to the call of the other from wherever it originates is a fundamental obligation of the ethical human being, denying the interiority of the self as more important than the self existing as a social being evidenced by its commitment to the exteriority of the world one encounters in this very moment of existential time.

I exist in this world in order to be of service to the other, to extend my hand whenever and wherever I hear the call of the other asking for help. Must I answer each and every call from the other? No, but I must answer the calls for which I am best equipped. For me, as a personal being existing in the world, I have two major callings. I will answer the call of anyone with a desire to stop drinking by extending my hand and offering the support I can and must offer. I do this because I am a recovering alcoholic with over two decades of not drinking. Recently, because of my diagnosis of prostate cancer I announced my presense to any and all who have the same or similar diagnosis; I will answer the call of anyone with prostate cancer by extending my hand and sharing my experience, strength and hope. The choice of these two ‘causes’ does not preclude my being responsible in other situations; it simply means that I have chosen to priortize my personal sense of responsibility in these two arenas at this very moment. It seems that I recognize my existence within the bounds of the spirit of Alcoholics Anonymous and the community of men diagnosed with prostate cancer as well as those men who desire to end prostate cancer as the second leading killer of men in the United States.

 

Reflections on Life and Death or Living with Prostate Cancer

I do not fear death. I had been dead for billions and billions of years before I was born, and had not suffered the slightest inconvenience from it.
Mark Twain

Reflections on Life and Death or Living with Prostate Cancer

Reflections on Life and Death or Living with Prostate Cancer

I agree with Mark Twain’s assessment with one exception, that he was dead before he was born, but I understand the inference quite well. One cannot be ‘dead’ prior to birth; one can merely be said to not exist. The transition to death is only a function of having been alive in the first place. But this is a minor quibble and doesn’t take anything away from the idea that life itself is a transitory journey that exists between the bookends of infinity. If I could only remember the infinity prior to birth, the non-existence of nothingness, I could accurately predict what the transition to death might be. In truth, however, as an existing sentient being, imagining that transition is impossible albeit many have tried to do just that. From reincarnation to heaven and hell, and all things in between, images of the ‘afterlife’ abound both culturally and in religious dogma. I choose to deny all of these mythological answers to the question of “What is next,” and concentrate on this very moment of existence.

There is no reason to believe that there is something other than the material world in which I reside at this very moment. In the past several months I have been placed in a situation in which I had to contemplate my own mortality, a fragile and precious thing. Given the choice between life and death I choose life. But that is not unlike the choice between good and evil, to chose anything but good is outrageous. What I came to realize was that, in the final analysis, at some time in the future, later than sooner I hope, I will be presented with no choice at all; that the only choice is the intimacy of the transition from life to death, a journey only I can take, there are no substitutes, no proxies from which to choose. Just as there are no substitutes, there are no coaches, no guides; the transition from life to death, from finite existence to infinity, is mine and mine alone.

Yet, my personal mark on this material world does not die when I die. Throughout my life I have listened to the platitude voiced at services of mourning that, “The good men do lives after them,” a stunning sentiment indeed since it fails to mention evil in the same sentence. Designed to placate that profound sadness attached to the loss of a friend or loved one, it is, I suppose, a compromise for the sake of those in mourning. That platitude, however, never rang true until I was forced to contemplate my own death. Then I began to assess my contributions to this world, the only world I know. To my surprise, those contributions were many. As a teacher I touched lives, and through my students that became teachers themselves, my influence continues to be felt a hundred fold every single day. I raised two interesting children, so different from each other it is surprising that they were products of the same parents, and they now have children of their own, and that is a continuing presence on this earth that cannot be denied by death.

The fact of the matter is simply this; I am very much alive and doing well. My cancer is in remission with a 15% probability of recurrence. The side effect of incontinence shows signs of being under control most of the time. Life is adjusting back to a sense of normalcy that I have not known for the past six or seven months. Clearly, however, cancer is a life altering experience; one that forces one to assess the quality of one’s lived-experience while adjusting one’s approach to future events not yet anticipated. Cancer forded me to face my own mortality, lifted the threat with early detection and radical treatment, yet, even with the threat lifted I have come to understand that life itself is a terminal disease so I should make the most of the only one I will ever know.

Ethics and Bare Life; Another Aporia of Modern Democracy

Ethics and Bare Life; Another Aporia of Modern Democracy

Ethics and Bare Life; Another Aporia of Modern Democracy

Ethics, according to Emmanuel Levinas, is the first philosophy, elevated above ontology or epistemology. On Levinas’s view, as nicely summarized by Hillary Putnam, the fundamental ethical obligation is to become response-able (responsible) for the welfare of the other without reservation or expectation of reciprocation. Ethical behavior is fundamentally interpersonal, non-judgmental, face-to-face and established without external imperatives. Bare life, according to the view of Giorgio Agamben, focuses on the excluded, the marginalized, the non-members of society who, through external imperatives by a governing authority are disenfranchised, separated from and isolated from the rest of normative society. Bare life is externally mandated by the sovereign power to eek out an apartheid existence. Sometimes, the isolation is limited applying to a single aspect of life, for example, an unwarranted fear of the other because of skin color, religious beliefs (or non-beliefs), sexual orientation, social class (yes we have social classes in the United States that are not formal but that, nevertheless, exist), politics, or other generalized group membership. We also have examples where bare life, because of a vacuum in political opposition and a well-organized bureaucracy, takes bare life to unthinkable limits where genocide is a political function of the government and is carried out in exquisitely efficient ways so well described by Zygmunt Bauman.

The aporia, the double bind is that of self-directed ethics motivated by the interiority of the self to extend outward to the exteriority and absolute uniqueness of the other and the authoritative imperative motivated by the exteriority of the other and extended inward to invade the interiority of the self in an attempt to reduce the individual into the same, to homogenize the external world into a flat, featureless normality while excluding the uniqueness of the self. Linguistically we might think in terms of the oppositions of diversity/uniformity as representative of the aporia of modernity.

The double bind that is at work here is that one must engage in both worlds, one may choose an ethical stance even in the most horrific exercise of the authority of the sovereign, the one standing outside (not above) the law or one may choose the uniformity of enforcement of separation and isolation. There are, for example, countless stories of people choosing ethics over authority in the death camps of Nazi Germany (read the works of Primo Levy for a few examples). There are examples of those feigning uniformity who, rather than comply, chose to practice an ethical life (think of Schindler’s List as a prime example). And there are also those choosing to comply, even among the victims of the unimaginable homogenization of the death camps (those Jews who chose to do the work of their Nazi guards, to cooperate with their enemy if only to stave off the inevitable for themselves).

While these are extreme examples, we can see the same thing happening in modern democratic societies where the aim of exclusion is not as well defined nor is it as final as the consequences of the Shoah (the Holocaust). Police acting to curb protests, where the police are literally the uniform(ed) arm of the sovereign power, even while the police belong to the same class as those protesting. We see the leaders of religious institutions arguing for the exclusion of others who do not believe in the same specific tenants as they and it is all done in the name of their God or gods while their congregants uniformly accept the preachings of the hate mongers. I witness teachers willingly entering the classroom with the idea of creating a climate of compliance among their students in order to infuse the desire to score well on an imposed standardized test.

In the final analysis, however, the choice of the fundamental ethical obligation trumps uniformity, although that choice is always more dangerous than the choice of compliance, of sinking into the plain vanilla of uniformity. In making the ethical choice, one must constantly confront one’s taken-for-granteds, one’s prejudices and one’s biases in favor of the admission of bias and working to embrace that which one finds different. I recall a personal story as an example here. I was called for jury duty and while my panel was being questioned, one of the attorneys doing the questioning asked something like, ‘Is there anyone who cannot set aside their personal bias and examine the evidence presented to come to a verdict based solely on the evidence presented?’ I found the question a bit strange. I raised my hand and asked. ‘What do you mean by setting aside personal bias?’ The attorney responded, ‘That your verdict be based solely on the evidence presented and that you leave your personal beliefs at home.’ I responded, ‘Then I would have to answer that I cannot set my personal beliefs or bias aside but could only examine evidence in the context of those beliefs. I cannot simply turn off my bias and sink into a uniformity of fair-arbiter. I can listen to all the evidence but I cannot evaluate that evidence unless I evaluate it in light of my core ethical obligations.’ The judge dismissed me from the panel. In order to embrace the other’s diversity, one must also embrace one’s own values as uniquely their own.

The point of this ramble is that the line between diversity/uniformity is one in which we all find ourselves from time to time. The forces of the ethical self are at odds with the forces of uniformity and compliance.

 

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