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grayton downing

F.D.A. Seeks Tighter Control on Prescriptions for Class of Painkillers - NYTimes.com - 0 views

www.nytimes.com/...-for-class-of-painkillers.html

tighter control prescriptions science medicine

shared by grayton downing on 24 Oct 13 - No Cached
  • The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers.
  • The drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab. Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems.
  • Medical Association and pharmacy organizations, have continued to fight the measure, citing the impact on patients.
  • ...4 more annotations...
  • “These are very difficult tradeoffs that our society has to make,” said Dr. Woodcock. “The reason we approve these drugs is for people in pain. But we can’t ignore the epidemic on the other side.”
  • In 2011, about 131 million prescriptions for hydrocodone-containing medications were written for some 47 million patients, according to government estimates. That volume of prescriptions amounts to about five billion pills.
  • Schedule II drugs are those drugs with the highest potential for abuse that can be legally prescribed.
  • Along with changing how doctors prescribe these drugs, the classification change will also impose added storage and recordkeeping requirements on druggists. In some states, nurse practitioners and other health care professionals who can currently prescribe hydrocodone-containing drugs may no longer be able to do so.
sissij

Flossing and the Art of Scientific Investigation - The New York Times - 1 views

www.nytimes.com/...-scientific-investigation.html

new york times science bias research

shared by sissij on 31 Jan 17 - No Cached
  • the form of definitive randomized controlled trials, the so-called gold standard for scientific research.
  • Yet the notion has taken hold that such expertise is fatally subjective and that only randomized controlled trials provide real knowledge.
  • the evidence-based medicine movement, which placed such trials atop a hierarchy of scientific methods, with expert opinion situated at the bottom.
  • ...2 more annotations...
  • each of these is valuable in its own way.
  • The cult of randomized controlled trials also neglects a rich body of potential hypotheses.
  • sissij on 31 Jan 17
     
    This article talks about the bias within Scientific method. As we learned in TOK, scientific method is very much based on experiments. Definitive randomized controlled trials are the gold standard for scientific research. But as argued in this article, are randomized controlled trials the only source of support that's worth believing? Advise and experience of an expert is also very important. Why can't machine completely replace the role of a doctor? That's because human are able to analysis and evaluate their experience and the patterns they recognize, but machines are only capable to organizing data, they couldn't design a unique prescription that fit with the particular patient. Expert opinion shouldn't be completely neglected and underestimate, since science always needs a leap of imagination that only human, not machines, can generate. --Sissi (1/30/2017)
markfrankel18

Malcolm Gladwell: Do Genetic Advantages Make Sports Unfair? : The New Yorker - 0 views

www.newyorker.com/...130909crat_atlarge_gladwell

gladwell ethics sports

shared by markfrankel18 on 03 Sep 13 - No Cached
  • markfrankel18 on 03 Sep 13
     
    "Eyesight can be improved-in some cases dramatically-through laser surgery or implantable lenses. Should a promising young baseball player cursed with normal vision be allowed to get that kind of corrective surgery? In this instance, Major League Baseball says yes. Major League Baseball also permits pitchers to replace the ulnar collateral ligament in the elbow of their throwing arm with a tendon taken from a cadaver or elsewhere in the athlete's body. Tendon-replacement surgery is similar to laser surgery: it turns the athlete into an improved version of his natural self. But when it comes to drugs Major League Baseball-like most sports-draws the line. An athlete cannot use a drug to become an improved version of his natural self, even if the drug is used in doses that are not harmful, and is something that-like testosterone-is no more than a copy of a naturally occurring hormone, available by prescription to anyone, virtually anywhere in the world."
Javier E

Don't Ask Your Doctor About 'Low T' - NYTimes.com - 0 views

www.nytimes.com/...k-your-doctor-about-low-t.html

testosterone aging

shared by Javier E on 05 Feb 14 - No Cached
  • A FUNNY thing has happened in the United States over the last few decades. Men’s average testosterone levels have been dropping by at least 1 percent a year
  • Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further, especially in obese men. Drugs like steroids and opiates also lower testosterone, and it’s suspected that chemicals like bisphenol A (or BPA, commonly found in plastic food containers) and diseases like Type 2 diabetes play a role as well.
  • Clinical testosterone deficiency, which is variously defined as lower than 220 to 350 nanograms of testosterone per deciliter of blood serum, can cause men to lose sex drive and fertility. Their bone density often declines, and they may feel tired and experience hot flashes and sweats.
  • ...6 more annotations...
  • prescription testosterone doesn’t just give your T level a boost: it may also increase your risk of heart attack. It can add huge numbers of red blood cells to your bloodstream and shrink your testes. In some men, it increases aggression and irritability.
  • a large study published in the journal PLoS ONE found that, within three months, taking the hormone doubled the rate of heart attacks in men 65 and older, as well as in younger men who had heart disease. The Food and Drug Administration has begun an investigation.
  • Used clinically since 1937 and approved by the F.D.A. since 1953, testosterone is now administered in at least five forms, including patches, gels and injections
  • In addition to the cardiac risks, prescription T can mean a permanent shut-off in men’s own, albeit diminished, testosterone production. In other words, once you start, you may well be hooked for life.
  • men should address the leading cause of the problem. Losing weight is a tried and true way to naturally boost testosterone levels. According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. In general, a man’s waist should be half his height.
  • At the end of the day, eating more of the right foods and fewer junk foods improves mood and energy — which may be the only fix many men need.
Javier E

Assessing the Value of Buddhism, for Individuals and for the World - The New York Times - 0 views

www.nytimes.com/...-meditation-robert-wright.html

buddhism psychology research brain science evolution science

shared by Javier E on 24 Mar 18 - No Cached
  • Robert Wright sketches an answer early in “Why Buddhism Is True.” He settles on a credible blend that one might call Western Buddhism, a largely secular approach to life and its problems but not devoid of a spiritual dimension. The centerpiece of the approach is the practice of mindful meditation.
  • The goal of “Why Buddhism Is True” is ambitious: to demonstrate “that Buddhism’s diagnosis of the human predicament is fundamentally correct, and that its prescription is deeply valid and urgently important.”
  • It is reasonable to claim that Buddhism, with its focus on suffering, addresses critical aspects of the human predicament. It is also reasonable to suggest that the prescription it offers may be applicable and useful to resolve that predicament.
  • ...9 more annotations...
  • To produce his demonstrations and to support the idea that Buddhism is “true,” Wright relies on science, especially on evolutionary psychology, cognitive science and neuroscience.
  • Wright is up to the task: He’s a Buddhist who has written about religion and morality from a scientific perspective — he is most famous for his 1994 book, “The Moral Animal.”
  • Second, the mismatch between causes and responses is rooted in evolution. We have inherited from our nonhuman and human forerunners a complex affect apparatus suited to life circumstances very different from ours
  • First, the beneficial powers of meditation come from the possibility of realizing that our emotive reactions and the consequent feelings they engender — which operate in automated fashion, outside our deliberate control — are often inappropriate and even counterproductive relative to the situations that trigger them.
  • Third, meditation allows us to realize that the idea of the self as director of our decisions is an illusion, and that the degree to which we are at the mercy of a weakly controlled system places us at a considerable disadvantage
  • Fourth, the awareness brought on by meditation helps the construction of a truly enlightened humanity and counters the growing tribalism of contemporary societies.
  • when, in modern life, emotions such as fear and anger are incorrectly and unnecessarily engaged — for example, road rage — Wright calls the respective feelings “false” or “illusory.” Such feelings, however, are no less true than the thirst, hunger or pain that Wright accepts and welcomes
  • We can agree that mindful meditation promotes a distancing effect and thus may increase our chances of combining affect and reason advantageously. Meditation can help us glean the especially flawed and dislocated status of humans in modern societies, and help us see how social and political conflicts appear to provoke resentment and anger so easily.
  • How does one scale up, from many single individuals to populations, in time to prevent the social catastrophes that seem to be looming?
Javier E

Climatologist Michael E Mann: 'Good people fall victim to doomism. I do too sometimes' ... - 0 views

www.theguardian.com/...omism-climate-crisis-interview

climate response strategy solutions 2021 personal strategy activism

shared by Javier E on 04 Mar 21 - No Cached
  • the “inactivists”, as I call them, haven’t given up; they have simply shifted from hard denial to a new array of tactics that I describe in the book as the new climate war.
  • Who is the enemy in the new climate war?It is fossil fuel interests, climate change deniers, conservative media tycoons, working together with petrostate actors like Saudi Arabia and Russia. I call this the coalition of the unwilling.
  • Today Russia uses cyberware – bot armies and trolls – to get climate activists to fight one another and to seed arguments on social media. Russian trolls have attempted to undermine carbon pricing in Canada and Australia, and Russian fingerprints have been detected in the yellow-vest protests in France.
  • ...22 more annotations...
  • I am optimistic about a favourable shift in the political wind. The youth climate movement has galvanised attention and re-centred the debate on intergenerational ethics. We are seeing a tipping point in public consciousness. That bodes well. There is still a viable way forward to avoid climate catastrophe.
  • You can see from the talking points of inactivists that they are really in retreat. Republican pollsters like Frank Luntz have advised clients in the fossil fuel industry and the politicians who carry water for them that you can’t get away with denying climate change any more.
  • Let’s dig into deniers’ tactics. One that you mention is deflection. What are the telltale signs?Any time you are told a problem is your fault because you are not behaving responsibly, there is a good chance that you are being deflected from systemic solutions and policies
  • Blaming the individual is a tried and trusted playbook that we have seen in the past with other industries. In the 1970s, Coca Cola and the beverage industry did this very effectively to convince us we don’t need regulations on waste disposal. Because of that we now have a global plastic crisis. The same tactics are evident in the gun lobby’s motto, “guns don’t kill people, people kill people”, which is classic deflection
  • look at BP, which gave us the world’s first individual carbon footprint calculator. Why did they do that? Because BP wanted us looking at our carbon footprint not theirs.
  • Of course lifestyle changes are necessary but they alone won’t get us where we need to be. They make us more healthy, save money and set a good example for others.
  • But we can’t allow the forces of inaction to convince us these actions alone are the solution and that we don’t need systemic changes
  • I don’t eat meat. We get power from renewable energy. I have a plug-in hybrid vehicle. I do those things and encourage others to do them. but i don’t think it is helpful to shame people people who are not as far along as you.
  • Instead, let’s help everybody to move in that direction. That is what policy and system change is about: creating incentives so even those who don’t think about their environmental footprint are still led in that direction.
  • Another new front in the new climate war is what you call “doomism”. What do you mean by that?Doom-mongering has overtaken denial as a threat and as a tactic. Inactivists know that if people believe there is nothing you can do, they are led down a path of disengagement
  • They unwittingly do the bidding of fossil fuel interests by giving up.What is so pernicious about this is that it seeks to weaponise environmental progressives who would otherwise be on the frontline demanding change. These are folk of good intentions and good will, but they become disillusioned or depressed and they fall into despair.
  • Many of the prominent doomist narratives – [Jonathan] Franzen, David Wallace-Wells, the Deep Adaptation movement – can be traced back to a false notion that an Arctic methane bomb will cause runaway warming and extinguish all life on earth within 10 years. This is completely wrong. There is no science to support that.
  • Good people fall victim to doomism. I do too sometimes. It can be enabling and empowering as long as you don’t get stuck there. It is up to others to help ensure that experience can be cathartic.
  • the entry of new participants. Bill Gates is perhaps the most prominent. His new book, How to Prevent a Climate Disaster, offers a systems analyst approach to the problem, a kind of operating system upgrade for the planet. What do you make of his take?I want to thank him for using his platform to raise awareness of the climate crisis
  • I disagree with him quite sharply on the prescription. His view is overly technocratic and premised on an underestimate of the role that renewable energy can play in decarbonising our civilisation
  • If you understate that potential, you are forced to make other risky choices, such as geoengineering and carbon capture and sequestration. Investment in those unproven options would crowd out investment in better solutions.
  • Gates writes that he doesn’t know the political solution to climate change. But the politics are the problem buddy. If you don’t have a prescription of how to solve that, then you don’t have a solution and perhaps your solution might be taking us down the wrong path.
  • What are the prospects for political change with Joe Biden in the White House?Breathtaking. Biden has surprised even the most ardent climate hawks in the boldness of his first 100 day agenda, which goes well beyond any previous president, including Obama when it comes to use of executive actions. He has incorporated climate policy into every single government agency and we have seen massive investments in renewable energy infrastructure, cuts in subsidies for fossil fuels, and the cancellation of the Keystone XL pipeline.
  • On the international front, the appointment of John Kerry, who helped negotiate the Paris Accord, has telegraphed to the rest of the world that the US is back and ready to lead again
  • That is huge and puts pressure on intransigent state actors like [Australian prime minister] Scott Morrison, who has been a friend of the fossil fuel industry in Australia. Morrison has changed his rhetoric dramatically since Biden became president. I think that creates an opportunity like no other.
  • Have the prospects for that been helped or hindered by Covid?I see a perfect storm of climate opportunity. Terrible as the pandemic has been, this tragedy can also provide lessons, particularly on the importance of listening to the word of science when facing risks
  • Out of this crisis can come a collective reconsideration of our priorities. How to live sustainably on a finite planet with finite space, food and water. A year from now, memories and impacts of coronavirus will still feel painful, but the crisis itself will be in the rear-view mirror thanks to vaccines. What will loom larger will be the greater crisis we face – the climate crisis.
anonymous

The Costly, Painful, Lonely Burden of Care - The New York Times - 0 views

www.nytimes.com/...caregiving-burnout.html

shared by anonymous on 27 Mar 21 - No Cached
  • The Costly, Painful, Lonely Burden of Care
  • Health care in the U.S. relies on an “invisible army” of caregivers — mostly women. For many, stunted careers, lost earnings and exhaustion are part of the fallout.
  • “If society wants us to keep caring for others, it’s going to have to show a little more care for us.”
  • ...28 more annotations...
  • Her husband, Brad Buchanan, was late for family dinner. She found him in the bathroom, coughing up blood — a lot of it.
  • Doctors found that a tumor had ruptured in one of his lungs and he urgently needed chemo. As her husband became critically ill, Ms. Washington, a freelance writer, was thrust into the role of nurse.
  • “My hands were shaking,” she said as she remembered apprehensively pushing in the drugs for the first time and feeling the weight of keeping her husband alive.
  • Mr. Buchanan had a stem cell transplant that left him with graft-versus-host disease
  • Depending on the analysis, between 61 and 75 percent of caregivers are women
  • When she explained that she had two children who also had needs, he said, “Well, usually family steps in, and it works out fine.”
  • Ms. Washington felt the burden of responsibility, but also the sting
  • The U.S. health care system relies on and takes for granted the “invisible army” of people — mostly women — who keep the system functioning by performing home care for the many people who are “too well for the hospital” but “too sick for home,” as well as for those on end-of-life care.
  • In 2017, AARP found that about 41 million family caregivers in America perform roughly $470 billion worth of unpaid labor a year.
  • they tend to do more personal care tasks like helping patients bathe and use the toilet than their male counterparts, who are more likely to oversee finances and arrangement of care.
  • The historical roots are complex, but as Evelyn Glenn puts it in “Forced to Care,”
  • emale caregivers put in more hours — 22 to men’s 17
  • they are also more likely to stand by their partner through a serious illness
  • Many people who take on caregiving roles experience negative health impacts, but women are especially at risk of the fallout from caregiver stress.
  • Female caregivers are also 2.5 times more likely to live in poverty as non-caregiver
  • A 2011 study found that women who left their jobs to care for a parent lost an average of $324,000 in wages and benefits over their lifetimes.
  • Ms. Washington was able to dip into savings and a recent inheritance to help pay for supplemental in-home care, but it was still a struggle, causing stress, resentment and lost income.
  • It was hard to have my life put on hold. Everything kind of slipped away.
  • I lost a sense of who I was. I was going to pick up a prescription for myself, the only prescription I had when my husband was sick, and the pharmacist asked for my date of birth, and I gave his date of birth
  • People talk about how it’s the most important job in the world, taking care of our children or taking care of our vulnerable elders, and yet those are some of the worst paid jobs.
  • How much is a quarterback paid versus someone who is doing care for a vulnerable elderly person?
  • How did care work become so undervalued?
  • A doctor told Ms. Washington that her husband would need 24-hour care and “could not be left alone for even a moment.”
  • Western culture has long framed care work done by women as a moral duty or obligation, rather than an economic activity.
  • If your earnings are lower than they would normally be because you’re busy caring for a family member, and you can’t save and pay into social security, it can lock whole families into a cycle of lower wealth and economic instability.
  • And what should someone not do
  • Don’t tell someone to stay positive. For me, there was no staying about it, because I didn’t feel positive to start with. It brought up this feeling
  • My time isn’t my own, but surely my emotions can be
Javier E

I Thought I Was Saving Trans Kids. Now I'm Blowing the Whistle. - 0 views

www.thefp.com/...hought-i-was-saving-trans-kids

trans clinic abuse drug therapy gender dysphoria treatment

shared by Javier E on 11 Feb 23 - No Cached
  • Soon after my arrival at the Transgender Center, I was struck by the lack of formal protocols for treatment. The center’s physician co-directors were essentially the sole authority.
  • At first, the patient population was tipped toward what used to be the “traditional” instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl. 
  • Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone. 
  • ...27 more annotations...
  • The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.
  • This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 
  • I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 
  • There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 
  • The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.
  • To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 
  • When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.
  • Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 
  • Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).
  • Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”
  • Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.
  • How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.
  • when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.
  • Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”
  • There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.
  • Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 
  • Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.
  • no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.
  • Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.
  • We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.
  • During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 
  • I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.
  • Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.
  • Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.
  • For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 
  • The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 
  • All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 
sandrine_h

Can You Get Smarter? - The New York Times - 0 views

www.nytimes.com/...can-you-get-smarter.html

brain science education

shared by sandrine_h on 30 Oct 16 - No Cached
  • Can you get smarter by exercising — or altering — your brain?
  • Americans are a captive market for anything, from supposed smart drugs and supplements to brain training, that promises to boost normal mental functioning or to stem its all-too-common decline.
  • Our brain has remarkable neuroplasticity; that is, it can remodel and change itself in response to various experiences and injuries. So can it be trained to enhance its own cognitive prowess?The multibillion-dollar brain training industry certainly thinks so and claims that you can increase your memory, attention and reasoning just by playing various mental games.
  • ...4 more annotations...
  • Although improvements were observed in every cognitive task that was practiced, there was no evidence that brain training made people smarter.
  • we can clearly enhance learning, even if mental gymnastics won’t make us smarter.
  • Adderall enhanced performance on one of the tests, the embedded image test, which requires subjects to reassemble a whole image from a scrambled one.Still, these are subtle effects, and there is no evidence that any prescription drug or supplement or smart drink is going to raise your I.Q.
  • In the end, you can’t yet exceed your innate intelligence
Megan Flanagan

Hidden Side of the College Dream: Mediocre Graduation Rates - The New York Times - 0 views

www.nytimes.com/...op-out-follow-the-dollars.html

college rates psychology education

shared by Megan Flanagan on 02 Jun 16 - No Cached
  • “go to college” is such a proven prescription
  • college graduates have lower unemployment rates, earn higher wages and even have longer-lasting marriages
  • 7.2 million students who need federal loans to attend college
  • ...12 more annotations...
  • Of the 1,027 private colleges studied, 761 have graduation rates of less than 67 percent.
  • the rate is even lower, 46 percent
  • high schools in which more than a third of students do not graduate on time are labeled to receive special attention by federal standards.
  • a college can have a graduation rate as low as 2 percent and still preserve its accreditation
  • colleges are not fulfilling their promise of upward mobility to students, particularly those who are trying to become the first in their families to earn a degree
  • “Graduation rates are primarily two factors: what the student brings and what the college brings to the experience,”
  • Colleges with lower graduation rates tend to admit a higher percentage of students with Pell grants, which usually go to lower-income students.
  • money is a huge roadblock to graduation.
  • “That is the No. 1 reason our students give when they drop out,”
  • any setback or poor grade can make them question whether they should be in college in the first place
  • “We act as if they’re all the same right now. In K-12 we differentiate.”
  • “It’s not that the low-income students are destined to fail,” Mr. Shireman said. “It’s just that they have more challenges, so it takes a lot more resources to ensure that they succeed.”
Duncan H

Fixing Medicare - NYTimes.com - 0 views

www.nytimes.com/...fixing-medicare.html

medicare economics doctors fixing

shared by Duncan H on 21 Nov 11 - No Cached
  • Medicare is nothing less than a lifeline for 49 million older and disabled Americans. It helps pay for care in a wide range of settings, including hospitals, nursing homes, outpatient clinics, doctors’ offices, hospices and at home, as well as for prescription drugs. It is also hugely costly. The federal government spent about $477 billion in net Medicare outlays in fiscal year 2011 — 13 percent of its total spending. By 2021, it is projected to spend $864 billion — or 16 percent of the total — according to figures derived by the Kaiser Family Foundation. That rate of growth is not sustainable indefinitely.
  • There are three key drivers of Medicare spending: the spiraling cost of all health care as new technologies and treatments are developed; much greater use of medical services by the typical beneficiary; and an aging population. By 2020, the number of enrollees will increase to 64 million.
  • The only way to make Medicare sustainable is to have it grow at the same rate as the economy that provides the tax base to support it. In recent years, Medicare spending has been growing faster than gross domestic product, by roughly 1.7 to 2 percentage points.
  • Duncan H on 21 Nov 11
     
    Will we ever have the political will to fix the problem in the long term?
Javier E

The Poverty of an Idea - NYTimes.com - 1 views

www.nytimes.com/...the-poverty-of-an-idea.html

poverty culture development theory social science

shared by Javier E on 03 Mar 12 - Cached
  • THE libertarian writer Charles Murray has probably done more than any other contemporary thinker to keep alive the idea of a “culture of poverty,” the theory that poor people are trapped by distorted norms and aspirations and not merely material deprivation.
  • Harrington had picked up the idea of a “culture of poverty” from the anthropologist Oscar Lewis, whose 1959 study of Mexican slum dwellers identified a “subculture” of lowered aspirations and short-term gratification. Echoing Lewis, Harrington argued that American poverty constituted “a separate culture, another nation, with its own way of life.” It would not be solved merely by economic expansion or moral exhortation, he contended, but by a “comprehensive assault on poverty.”
  • In his view, these problems were not a judgment on the poor as individuals, but on a society indifferent to their plight. His popularization of the phrase “culture of poverty” has unintended consequences. There was nothing  in the “vicious circle” of pathology he sketched that was culturally determined, but in the hands of others, the idea came to signify an ingrained system of norms passed from generation to generation.
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  • Conservatives took the attitudes and behaviors Harrington saw as symptoms of poverty and portrayed them as its direct causes.
  • In his 1984 book, “Losing Ground,” Mr. Murray argued that welfare programs abet rather than ameliorate poverty. The book dismissed Harrington’s prescription for ending poverty, and Harrington returned the favor. In “The New American Poverty,” published the same year, he called Mr. Murray the right-wing equivalent of a “vulgar Marxist,” a social theorist who believed in a “one-to-one relationship between the economic and the political or the psychological.”
  • Harrington’s culture-of-poverty thesis was at best an ambiguous impediment to understanding — in later books, he made no use of the term. But in its moral clarity, “The Other America” was ultimately optimistic; it was less an indictment and more an appeal to Americans to live up to their better instincts.
Javier E

Summarizing EdTech in One Slide: Market, Open and Dewey - EdTech Researcher - Education... - 0 views

blogs.edweek.org/...ide_market_open_and_dewey.html

educational technology schools approach

shared by Javier E on 14 Jun 12 - No Cached
  • My job is to introduce participants to the diverse landscape of the field of education technology. One of the biggest problems in the ed-tech space right now is that the phrase "education technology" means very different things to different people and organizations. Here's a 2x2 model that summarizes (and, of course, oversimplifies) the entire education technology space:
  • There are two important questions to ask any ed tech organization or advocate: 1) Are you trying to make a billion dollars? and 2) Do you believe that learning occurs primarily through "delivery?" By answering those two questions, we can put everyone in the ed-tech field into one of three groups: Market, Open and Dewey.
  • The "Market" people are those that are trying to make a billion dollars and believe that learning is fundamentally a process of delivery. These people typically believe that free markets are the ultimate tool for optimizing all outcomes in society, and education should be no exception
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  • They view learning as the process of delivering learning objects for the individual consumption of students, and they have great faith that this delivery process can be optimized by algorithms and data mining. It is incredibly important for them that we have quantifiable outcomes of learning (standardized tests), since they can only optimize on quantitative metrics.
  • the biggest players in the Open movement generally believe that learning is a process of algorthmically delivering learning objects to consumers, and they frequently use "supply and demand" models to conceptualize their efforts
  • The difference between Open and Market is that Open folks believe that learning objects are not commodities to be bought and sold, but the public infrastructure of our culture
  • They'd like learning objects and the algorithms distributing those objects to be openly licensed and free for teachers to reuse, remix, and re-publish.
  • The "Dewey" people reject the notion of learning as "delivery" and the free market as the best platform for learning.
  • Dewey is a complex figure, but when most people invoke him, they mean that learning occurs through people's experiences and not through content delivery
  • Learning occurs when teachers and students work together to create or make something with meaning to to people in the real world
  • They tend to believe that the nuanced, contextual, social experiences that lead to the best learning experiences are easiest to facilitate when the curriculum is not overly prescriptive.
Javier E

Which Language and Grammar Rules to Flout - Room for Debate - NYTimes.com - 0 views

www.nytimes.com/...age-and-grammar-rules-to-flout

language grammar rules debate descriptivism prescriptivism

shared by Javier E on 29 Sep 12 - Cached
  • Welcome to another round of the Language Wars. By now we know the battle lines: As a “descriptivist,” I try to describe language as it is used. As a “prescriptivist,” you focus on how language should be used.
  • Your excellent guide, “Garner’s Modern American Usage,” shows you to be, in your words, a “descriptive prescriber.” You give not just “right” or “wrong” rulings on usage, but often a 1-5 score, in which a given usage may be a 1 (definitely a mistake), 3 (common, but …) or 5 (perfectly acceptable). This notion of correctness as a scale, not a binary state, makes you different from many prescriptivists.
  • “There is a set of standard conventions everyone needs for formal writing and speaking. Except under unusual circumstances, you should use the grammar and vocabulary of standard written English for these purposes.”
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  • One could defensibly call me a descriptivist. I just describe something that dogmatic egalitarians don’t want described: the linguistic choices of a fully informed, highly literate but never uptight user of language. It’s a rational construct — rather like the law’s “reasonable person” — and a highly useful one at that
  • But that’s all that the reputable usage experts were ever doing.
  • descriptivists have moderated the indefensible positions they once took. The linguists have switched their position — without, of course, acknowledging that this is what they’ve done.
  • The fact that you and other linguists are now embracing the prescriptive tradition is cause for celebration.
Javier E

Professors, We Need You! - NYTimes.com - 0 views

www.nytimes.com/...of-professors-we-need-you.html

intellectual academia influence scholars debates science public opinion

shared by Javier E on 16 Feb 14 - No Cached
  • to be a scholar is, often, to be irrelevant.
  • One reason is the anti-intellectualism in American life
  • over all, there are, I think, fewer public intellectuals on American university campuses today than a generation ago.
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  • Ph.D. programs have fostered a culture that glorifies arcane unintelligibility while disdaining impact and audience. This culture of exclusivity is then transmitted to the next generation through the publish-or-perish tenure process
  • If the sine qua non for academic success is peer-reviewed publications, then academics who ‘waste their time’ writing for the masses will be penalized.
  • My onetime love, political science, is a particular offender and seems to be trying, in terms of practical impact, to commit suicide.
  • In the late 1930s and early 1940s, one-fifth of articles in The American Political Science Review focused on policy prescriptions; at last count, the share was down to 0.3 percent.
  • Universities have retreated from area studies, so we have specialists in international theory who know little that is practical about the world
  • After the Arab Spring, a study by the Stimson Center looked back at whether various sectors had foreseen the possibility of upheavals. It found that scholars were among the most oblivious — partly because they relied upon quantitative models or theoretical constructs that had been useless in predicting unrest.
  • Many academic disciplines also reduce their influence by neglecting political diversity. Sociology, for example, should be central to so many national issues, but it is so dominated by the left that it is instinctively dismissed by the right.
  • In contrast, economics is a rare academic field with a significant Republican presence, and that helps tether economic debates to real-world debates.
Javier E

Online Medical Advice Can Be a Prescription for Fear - NYTimes.com - 0 views

www.nytimes.com/...06FOB-Medium-t.html

medical advice health websites online

shared by Javier E on 21 Sep 13 - No Cached
  • the medical Web, which is dominated by an enormous and powerful site whose name — oh, what the hay, it’s WebMD — has become a panicky byword among laysurfers for “hypochondria time suck.” In more whistle-blowing quarters, WebMD is synonymous with Big Pharma Shilling.
  • A February 2010 investigation into WebMD’s relationship with drug maker Eli Lilly by Senator Chuck Grassley of Iowa confirmed the suspicions of longtime WebMD users. With the site’s (admitted) connections to pharmaceutical and other companies, WebMD has become permeated with pseudomedicine and subtle misinformation.
  • It’s not only a waste of time, but it’s also a disorder in and of itself — one that preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.
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  • WebMD is a corporation that started as an ad-supported health-alarmism site with revenues of $504 million in 2010
  • the Mayo Clinic is a nonprofit medical-practice-and-research group that started as a clinic. Mayo’s storied past as the country’s premier research hospital, in Rochester, Minn., and its storied present as one of Fortune’s “100 Best Companies to Work For” surface in the integrity of the site itself, which — though not ad-free — is spare and neatly organized, with the measured, learned voice of the best doctors
  • The integrity of the whole institution is on the line with this site, and the Mayo Clinic has every motivation to keep its information authoritative and up to date.
dpittenger

Pharmaceutical pricing: Crippling | The Economist - 0 views

www.economist.com/...pharmaceutical-pricing

pharmaceutical pricing economist

shared by dpittenger on 04 Jun 15 - No Cached
  • insurers low-balled their prices in the early days of the Affordable Care Act in order to gain market share. But there is another reason: higher drug prices. Prescription drug spending increased 13.1% in 2015
  • ASCO dryly remarked that she could find no economic theory to explain how companies price their drugs. 
  • First, pharmaceutical companies can advertise directly to patients in America, which helps ensure demand. Second, price increases have been largely invisible to both patients and their doctors, in part because health-insurance plans often shield buyers from the true costs of their drugs. Third, Medicare, the public-health programme for those aged 65 and older, is the country’s largest drug customer, yet it is not allowed to negotiate prices with drug companies—with predictable results.  The new drugs war
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  • Companies that are forced to pay higher health-insurance premiums for their workers are less inclined to raise salaries, says Steve Miller, the chief medical officer of Express Scripts, a company that manages drug benefits for insurers.
Javier E

Lies, Damned Lies, and Medical Science - Magazine - The Atlantic - 0 views

www.theatlantic.com/...2

medical research bias error science knowledge

shared by Javier E on 04 Nov 10 - No Cached
  • How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.
  • even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you
  • studies report average results that typically represent a vast range of individual outcomes.
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  • studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller
  • The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.
  • nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest.
  • Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.
  • Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.
  • The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.
  • even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested
  • even when a research error is outed, it typically persists for years or even decades.
  • much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s
  • Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right
  • His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work
  • while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”
  • “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line.
  • What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.
  • Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding.
  • We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough
  • Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”
Javier E

Eduardo Galeano Disavows His Book 'The Open Veins' - NYTimes.com - 0 views

www.nytimes.com/...s-his-book-the-open-veins.html

leftist critique capitalism latin america history economy marxist

shared by Javier E on 24 May 14 - No Cached
  • For more than 40 years, Eduardo Galeano’s “The Open Veins of Latin America” has been the canonical anti-colonialist, anti-capitalist and anti-American text in that region
  • now Mr. Galeano, a 73-year-old Uruguayan writer, has disavowed the book, saying that he was not qualified to tackle the subject and that it was badly written. Predictably, his remarks have set off a vigorous regional debate, with the right doing some “we told you so” gloating, and the left clinging to a dogged defensiveness.
  •  ‘Open Veins’ tried to be a book of political economy, but I didn’t yet have the necessary training or preparation,” Mr. Galeano said last month while answering questions at a book fair in Brazil, where he was being honored on the 43rd anniversary of the book’s publication. He added: “I wouldn’t be capable of reading this book again; I’d keel over. For me, this prose of the traditional left is extremely leaden, and my physique can’t tolerate it
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  • “If I were teaching this in a course,” said Merilee Grindle, president of the Latin American Studies Association and director of the David Rockefeller Center for Latin American Studies at Harvard, “I would take his comments, add them in and use them to generate a far more interesting discussion about how we see and interpret events at different points in time.” And that seems to be exactly what many professors plan to do.
  • “Open Veins” has been translated into more than a dozen languages and has sold more than a million copies. In its heyday, its influence extended throughout what was then called the third world, including Africa and Asia, until the economic rise of China and India and Brazil seemed to undercut parts of its thesis.In the United States, “Open Veins” has been widely taught on university campuses since the 1970s, in courses ranging from history and anthropology to economics and geography. But Mr. Galeano’s unexpected takedown of his own work has left scholars wondering how to deal with the book in class.
  • “Reality has changed a lot, and I have changed a lot,” he said in Brazil, adding: “Reality is much more complex precisely because the human condition is diverse. Some political sectors close to me thought such diversity was a heresy. Even today, there are some survivors of this type who think that all diversity is a threat. Fortunately, it is not.”
  • In the mid-1990s, three advocates of free-market policies — the Colombian writer and diplomat Plinio Apuleyo Mendoza, the exiled Cuban author Carlos Alberto Montaner and the Peruvian journalist and author Álvaro Vargas Llosa — reacted to Mr. Galeano with a polemic of their own, “Guide to the Perfect Latin American Idiot.” They dismissed “Open Veins” as “the idiot’s bible,” and reduced its thesis to a single sentence: “We’re poor; it’s their fault.”
  • Mr. Montaner responded to Mr. Galeano’s recent remarks with a blog post titled “Galeano Corrects Himself and the Idiots Lose Their Bible.” In Brazil, Rodrigo Constantino, the author of “The Caviar Left,” took an even harsher tone, blaming Mr. Galeano’s analysis and prescription for many of Latin America’s ills. “He should feel really guilty for the damage he caused,”
Javier E

A Meditation on the Art of Not Trying - NYTimes.com - 0 views

www.nytimes.com/...-on-the-art-of-not-trying.html

spontaneity psychology education natural morality virtue intrinsic Confucius Taoism Mencius authenticity habit

shared by Javier E on 17 Dec 14 - No Cached
  • It’s the default prescription for any tense situation: a blind date, a speech, a job interview, the first dinner with the potential in-laws. Relax. Act natural. Just be yourself. But when you’re nervous, how can you be yourself?
  • Edward Slingerland. He has developed, quite deliberately, a theory of spontaneity based on millenniums of Asian philosophy and decades of research by psychologists and neuroscientists.
  • He calls it the paradox of wu wei, the Chinese term for “effortless action.”
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  • Wu wei is integral to romance, religion, politics and commerce. It’s why some leaders have charisma and why business executives insist on a drunken dinner before sealing a deal.
  • the quest for wu wei has been going on ever since humans began living in groups larger than hunter-gathering clans. Unable to rely on the bonds of kinship, the first urban settlements survived by developing shared values, typically through religion, that enabled people to trust one another’s virtue and to cooperate for the common good.
  • But there was always the danger that someone was faking it and would make a perfectly rational decision to put his own interest first if he had a chance to shirk his duty.
  • To be trusted, it wasn’t enough just to be a sensible, law-abiding citizen, and it wasn’t even enough to dutifully strive to be virtuous. You had to demonstrate that your virtue was so intrinsic that it came to you effortlessly.
  • the discovery in 1993 of bamboo strips in a tomb in the village of Guodian in central China. The texts on the bamboo, composed more than three centuries before Christ, emphasize that following rules and fulfilling obligations are not enough to maintain social order.
  • These texts tell aspiring politicians that they must have an instinctive sense of their duties to their superiors: “If you try to be filial, this not true filiality; if you try to be obedient, this is not true obedience. You cannot try, but you also cannot not try.”
  • is that authentic wu wei? Not according to the rival school of Taoists that arose around the same time as Confucianism, in the fifth century B.C. It was guided by the Tao Te Ching, “The Classic of the Way and Virtue,” which took a direct shot at Confucius: “The worst kind of Virtue never stops striving for Virtue, and so never achieves Virtue.”
  • Through willpower and the rigorous adherence to rules, traditions and rituals, the Confucian “gentleman” was supposed to learn proper behavior so thoroughly that it would eventually become second nature to him.
  • Taoists did not strive. Instead of following the rigid training and rituals required by Confucius, they sought to liberate the natural virtue within. They went with the flow. They disdained traditional music in favor of a funkier new style with a beat. They emphasized personal meditation instead of formal scholarship.
  • Variations of this debate would take place among Zen Buddhist, Hindu and Christian philosophers, and continue today among psychologists and neuroscientists arguing how much of morality and behavior is guided by rational choices or by unconscious feelings.
  • “Psychological science suggests that the ancient Chinese philosophers were genuinely on to something,” says Jonathan Schooler, a psychologist at the University of California, Santa Barbara. “Particularly when one has developed proficiency in an area, it is often better to simply go with the flow. Paralysis through analysis and overthinking are very real pitfalls that the art of wu wei was designed to avoid.”
  • Before signing a big deal, businesspeople often insist on getting to know potential partners at a boozy meal because alcohol makes it difficult to fake feelings.
  • Some people, like politicians and salespeople, can get pretty good at faking spontaneity, but we’re constantly looking for ways to expose them.
  • However wu wei is attained, there’s no debate about the charismatic effect it creates. It conveys an authenticity that makes you attractive, whether you’re addressing a crowd or talking to one person.
  • what’s the best strategy for wu wei — trying or not trying? Dr. Slingerland recommends a combination. Conscious effort is necessary to learn a skill, and the Confucian emphasis on following rituals is in accord with psychological research showing we have a limited amount of willpower. Training yourself to follow rules automatically can be liberating, because it conserves cognitive energy for other tasks.
  • He likes the compromise approach of Mencius, a Chinese philosopher in the fourth century B.C. who combined the Confucian and Taoist approaches: Try, but not too hard.
  • “But in many domains actual success requires the ability to transcend our training and relax completely into what we are doing, or simply forget ourselves as agents.”
  • The sprouts were Mencius’ conception of wu wei: Something natural that requires gentle cultivation. You plant the seeds and water the sprouts, but at some point you need to let nature take its course. Just let the sprouts be themselves.
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