Quotulatiousness

April 12, 2023

Institutional Review Boards … trying to balance harm vs health, allegedly

Filed under: Books, Bureaucracy, Health, USA — Tags: , , , , , — Nicholas @ 06:00

At Astral Codex Ten Scott Alexander reviews From Oversight to Overkill by Simon N. Whitley, in light of his own experience with an Institutional Review Board’s demands:

Dr. Rob Knight studies how skin bacteria jump from person to person. In one 2009 study, meant to simulate human contact, he used a Q-tip to cotton swab first one subject’s mouth (or skin), then another’s, to see how many bacteria traveled over. On the consent forms, he said risks were near zero — it was the equivalent of kissing another person’s hand.

His IRB — ie Institutional Review Board, the committee charged with keeping experiments ethical — disagreed. They worried the study would give patients AIDS. Dr. Knight tried to explain that you can’t get AIDS from skin contact. The IRB refused to listen. Finally Dr. Knight found some kind of diversity coordinator person who offered to explain that claiming you can get AIDS from skin contact is offensive. The IRB backed down, and Dr. Knight completed his study successfully.

Just kidding! The IRB demanded that he give his patients consent forms warning that they could get smallpox. Dr. Knight tried to explain that smallpox had been extinct in the wild since the 1970s, the only remaining samples in US and Russian biosecurity labs. Here there was no diversity coordinator to swoop in and save him, although after months of delay and argument he did eventually get his study approved.

Most IRB experiences aren’t this bad, right? Mine was worse. When I worked in a psych ward, we used to use a short questionnaire to screen for bipolar disorder. I suspected the questionnaire didn’t work, and wanted to record how often the questionnaire’s opinion matched that of expert doctors. This didn’t require doing anything different — it just required keeping records of what we were already doing. “Of people who the questionnaire said had bipolar, 25%/50%/whatever later got full bipolar diagnoses” — that kind of thing. But because we were recording data, it qualified as a study; because it qualified as a study, we needed to go through the IRB. After about fifty hours of training, paperwork, and back and forth arguments — including one where the IRB demanded patients sign consent forms in pen (not pencil) but the psychiatric ward would only allow patients to have pencils (not pen) — what had originally been intended as a quick record-keeping had expanded into an additional part-time job for a team of ~4 doctors. We made a tiny bit of progress over a few months before the IRB decided to re-evaluate all projects including ours and told us to change twenty-seven things, including re-litigating the pen vs. pencil issue (they also told us that our project was unusually good; most got >27 demands). Our team of four doctors considered the hundreds of hours it would take to document compliance and agreed to give up. As far as I know that hospital is still using the same bipolar questionnaire. They still don’t know if it works.

Most IRB experiences can’t be that bad, right? Maybe not, but a lot of people have horror stories. A survey of how researchers feel about IRBs did include one person who said “I hope all those at OHRP [the bureaucracy in charge of IRBs] and the ethicists die of diseases that we could have made significant progress on if we had [the research materials IRBs are banning us from using]”.

Dr. Simon Whitney, author of From Oversight To Overkill, doesn’t wish death upon IRBs. He’s a former Stanford IRB member himself, with impeccable research-ethicist credentials — MD + JD, bioethics fellowship, served on the Stanford IRB for two years. He thought he was doing good work at Stanford; he did do good work. Still, his worldview gradually started to crack:

    In 1999, I moved to Houston and joined the faculty at Baylor College of Medicine, where my new colleagues were scientists. I began going to medical conferences, where people in the hallways told stories about IRBs they considered arrogant that were abusing scientists who were powerless. As I listened, I knew the defenses the IRBs themselves would offer: Scientists cannot judge their own research objectively, and there is no better second opinion than a thoughtful committee of their peers. But these rationales began to feel flimsy as I gradually discovered how often IRB review hobbles low-risk research. I saw how IRBs inflate the hazards of research in bizarre ways, and how they insist on consent processes that appear designed to help the institution dodge liability or litigation. The committees’ admirable goals, in short, have become disconnected from their actual operations. A system that began as a noble defense of the vulnerable is now an ignoble defense of the powerful.

So Oversight is a mix of attacking and defending IRBs. It attacks them insofar as it admits they do a bad job; the stricter IRB system in place since the ‘90s probably only prevents a single-digit number of deaths per decade, but causes tens of thousands more by preventing life-saving studies. It defends them insofar as it argues this isn’t the fault of the board members themselves. They’re caught up in a network of lawyers, regulators, cynical Congressmen, sensationalist reporters, and hospital administrators gone out of control. Oversight is Whitney’s attempt to demystify this network, explain how we got here, and plan our escape.

Omnipolitization, the scourge of the western world

Filed under: Bureaucracy, Government, Media, Politics, USA — Tags: , , , , — Nicholas @ 03:00

Theophilus Chilton, reposting from 2018 (!), explains why the inexorable spread of government everywhere in the west has led us to a situation where every election is “the most important election in history”, and every government decision can infringe upon or even ruin the lives of millions of people as mere side-effect:

The western front of the United States Capitol. The Neoclassical style building is located in Washington, D.C., on top of Capitol Hill at the east end of the National Mall. The Capitol was designated a National Historic Landmark in 1960.
Photo via Wikimedia Commons.

Politics in the United States have become an all-encompassing nightmare from which the average American cannot hope to escape. As American democracy (you know, the “freedom” form of government) expands the reach of the managerial state into every area of modern life, the stakes involved in the political process have mushroomed, with control over the lives of hundreds of millions of people hanging in the balance. It’s little surprise that each election season stretches out over a year, and (as Florida and Georgia recently showed us) doesn’t end once the voting is “officially” over.

It’s reached the point where literally everything is involved in some way with politics. Your choice of restaurant now signals your political inclinations, and thus who will harass you while eating there. Businesses themselves feel compelled to virtue signal, usually in a leftward direction, lest they bring upon themselves threats of boycott, bad publicity, or worse. It has escalated to the point where being the public face of the “wrong” side earns you harassment and menace to your physical health, as Tucker Carlson and several Republican members of Congress have found out. Expressing the “wrong” opinions in the workplace or online can get you reprimanded or fired.

How did we reach that point?

It hearkens back to something I wrote about earlier concerning the tyranny of the technical society. In our particular case, we are seeing a situation playing out in real time whereby “political techniques” first pioneered by Lenin in establishing and maintaining Soviet control over Russia are being used to bring every facet of modern life into the political realm. Every action and attitude has a political ramification which can affect your employment, your access to social amenities, and even (eventually) your freedom from the gulag.

This omnipolitisation leads inevitably into a dichotomy between formal and informal power in the US governing system. Formal power is exactly as it sounds – the “constitutional” (written or otherwise) distribution of decision and policy-making authority in a government, i.e. which entity or body gets to legally do what. This usually involves theoretical limits on the roles or extent of governing authority, which sets it in opposition to the principle of omnipolitics. Conversely, informal power is also exactly as it sounds – it is power wielded extra-constitutionally (yet in a very real sense) by those who “shouldn’t” be exercising it, but nevertheless are.

April 10, 2023

It’s totally normal for a country to send troops overseas and neglect paying to feed them, right?

Filed under: Bureaucracy, Cancon, Military — Tags: , , , , , — Nicholas @ 06:00

This week’s Dispatch post from The Line includes some commentary on the story I linked to last week from the Ottawa Citizen, reporting that Canadian soldiers sent to Poland to train Ukrainian troops are being stiffed by the Department of National Defence on their food bills:

Operation Unifier shoulder patch for Canadian troops in Ukraine.
Detail from a photo in the Operation Unifier image gallery

Here’s a totally normal story from a well-functioning country that isn’t at all broken: it turns out that processing per diems for a hundred or so folks is now beyond the capability of the federal government.

This story came to us courtesy the Ottawa Citizen, where David Pugliese reported that the company sized unit of Canadian military personnel operating in Poland has seen months worth of expense filings go unpaid. In some situations, a military unit sent abroad would include its own logistical support team, including cooks. In other situations, a relatively small unit sent to a place with functioning civilian infrastructure is told to feed themselves and keep the receipts for reimbursement. For our troops in Poland, there to provide logistical and training support to Ukrainian forces since October, the government went the latter route.

And that’s fine. Really. Frankly, we’re sure the troops are happier eating out at local places and enjoying delicious Polish food — really, it’s amazing — than getting three servings of military slop a day. The problem, though, as these poor troops discovered, is that the military and national defence bureaucracy no longer has the ability to process the expense payments. So these balances are just sitting on their personal credit cards. For months.

[…]

The mission began in October.

It seems almost pointless to add much actual insight and analysis here. This kind of dysfunction speaks for itself. We’ll limit ourselves to two comments: operational deployments are incredible stressful on military personnel and their families on the homefront. That’s uncontroversial, and unavoidable. That’s why military service is recognized as a sacrifice even during peacetime deployments. The basic bargain we make with our servicemembers is while they are serving their country abroad, their country will take care of their families at home. Leaving these families with high-interest credit-card balances they can’t pay off because the Canadian government is too broken to reimburse soldiers for expenses they were told to incur is an on-the-nose failure of Canada to honour its debt to the the military parents, spouses and children who have been, in effect, ordered to advance the Canadian government money to subsidize military deployments.

The second comment we’ll make, is that this isn’t just further evidence in support of the Canada-is-broken thesis — it’s a very specific kind of break. We’ve all known that Canadian governments, at all levels, have struggled to turn new policies into new programs. That’s not new. But even granting that failure, we’ve generally been able to keep doing the things we already do. There seemed to be enough residual muscle memory in our governments. Can we do new things? No, not really. But we’ll keep doing the stuff we already do.

This military fiasco is alarming because it’s a sign that our state-capacity issues are now extending into areas that previously worked. Not only are we struggling to do new things, we’re forgetting how to do things we used to be able to do. This goes beyond what our typical gripes about state capacity. This is something else. This is state atrophy, or rot.

Now that the public is paying attention, we suspect we’ll see some reasonably rapid progress. The government will throw bureaucrats and maybe consultants at the problem until it goes away. This is how they have reacted to similar issues: we hurled ground staff at airport delays until they cleared, and bureaucrats at passport offices until the backlogs eased.

But we have to ask why we now require exceptional redeployments of staff to maintain typical levels of service. And we don’t like the answers we can come up with. Ottawa has added tens of thousands of civil servants, at an annual cost of tens of billions, in recent years. During that time Ottawa has also sharply ramped up spending on consultants; the annual cost now surpasses $20 billion.

And yet.

What the hell is going on?

I’ve been saying for literally years now, the more the government tries to do the less well it does everything, and this fiasco is a perfect example of that sclerosis spreading further.

April 6, 2023

Japan is weird, example MCMLXIII

Filed under: Books, Bureaucracy, Business, Government, History, Japan — Tags: , , — Nicholas @ 03:00

John Psmith reviews MITI and the Japanese Miracle by Chalmers Johnson:

I’ve been interested in East Asian economic planning bureaucracies ever since reading Joe Studwell’s How Asia Works (briefly glossed in my review of Flying Blind). But even among those elite organizations, Japan’s Ministry of International Trade and Industry (MITI) stands out. For starters, Japanese people watch soap operas about the lives of the bureaucrats, and they’re apparently really popular! Not just TV dramas; huge numbers of popular paperback novels are churned out about the men (almost entirely men) who decide what the optimal level of steel production for next year will be. As I understand it, these books are mostly not about economics, and not even about savage interoffice warfare and intraoffice politics, but rather focus on the bureaucrats themselves and their dashing conduct, quick wit, and passionate romances … How did this happen?

It all becomes clearer when you learn that when the Meiji period got rolling, Japan’s rulers had a problem: namely, a vast, unruly army of now-unemployed warrior aristocrats. Samurai demobilization was the hot political problem of the 1870s, and the solution was, well … in many cases it was to give the ex-samurai a sinecure as an economic planning bureaucrat. Since positions in the bureaucracy were often quasi-hereditary, what this means is that in some sense the samurai never really went away, they just hung up their swords — frequently literally hung them up on the walls of their offices — and started attacking the problem of optimal industrial allocation with all the focus and fury that they’d once unleashed on each other. According to Johnson, to this day the internal jargon of many Japanese government agencies is clearly and directly descended from the dialects and battle-codes of the samurai clans that seeded them.

This book is about one such organization, MITI, whose responsibilities originally were limited to wartime rationing and grew to encompass, depending who you ask, the entire functioning of the Japanese government. Because this is the buried lede and the true subject of this book: you thought you were here to read about development economics and a successful implementation of the ideas of Friedrich List, but you’re actually here to read about how the entire modern Japanese political system is a sham. This suggestion is less outrageous than it may sound at first blush. By this point most are familiar with the concept of “managed democracy,” wherein there are notionally competitive popular elections, culminating in the selection of a prime minister or president who’s notionally in charge, but in reality some other locus of power secretly runs things behind the scenes.

There are many flavors of managed democracy. The classic one is the “single-party democracy”, which arises when for whatever reason an electoral constituency becomes uncompetitive and returns the same party to power again and again. Traditional democratic theory holds that in this situation the party will split, or a new party will form which triangulates the electorate in just such a way that the elections are competitive again. But sometimes the dominant party is disciplined enough to prevent schisms and to crush potential rivals before they get started. The key insight is that there’s a natural tipping-point where anybody seeking political change will get a better return from working inside the party than from challenging it. This leads to an interesting situation where political competition remains, but moves up a level in abstraction. Now the only contests that matter are the ones between rival factions of party insiders, or powerful interest groups within the party. The system is still competitive, but it is no longer democratic. This story ought to be familiar to inhabitants of Russia, South Africa, or California.

The trouble with single-party democracies is that it’s pretty clear to everybody what’s going on. Yes, there are still elections happening, there may even be fair elections happening, and inevitably there are journalists who will point to those elections as evidence of the totally-democratic nature of the regime, but nobody is really fooled. The single-party state has a PR problem, and one solution to it is a more postmodern form of managed democracy, the “surface democracy”.

Surface democracies are wildly, raucously competitive. Two or more parties wage an all-out cinematic slugfest over hot-button issues with big, beautiful ratings. There may be a kaleidoscopic cast of quixotic minor parties with unusual obsessions filling the role of comic relief, usually only lasting for a season or two of the hit show Democracy. The spectacle is gripping, everybody is awed by how high the stakes are and agonizes over how to cast their precious vote. Meanwhile, in a bland gray building far away from the action, all of the real decisions are being made by some entirely separate organ of government that rolls onwards largely unaffected by the show.

April 5, 2023

The modern Canadian Army – go on deployment to Poland, train Ukraine troops … and have to buy your own rations

Filed under: Bureaucracy, Cancon, Military — Tags: , , — Nicholas @ 05:00

Is it hard to figure out why the Canadian Armed Forces are having recruiting shortfalls when they can’t even manage to feed the troops they send overseas to train Ukrainian soldiers?

Operation Unifier shoulder patch for Canadian troops in Ukraine.
Detail from a photo in the Operation Unifier image gallery – https://www.canada.ca/en/department-national-defence/services/operations/military-operations/current-operations/operation-unifier.html

The Canadian soldiers are in Poland to train Ukrainian military personnel but since Canada did not send military cooks on the mission, the troops were told to eat at local restaurants.

But there is a massive backlog with the Canadian Forces reimbursing the soldiers for those costs, sending some of them thousands of dollars into debt. Their families contacted this newspaper to complain about the situation they say is causing financial stress at home.

After this newspaper [the Ottawa Citizen] inquired about the situation, the Canadian Forces confirmed Monday that there are problems with payments of per diems and the reimbursement of other expenses. The Canadian Forces is now promising to speed up the process.

“We apologize to the members and their families for the distress this has caused, and thank them for their patience,” said Capt. Nicolas Plourde-Fleury, spokesman for Canadian Joint Operations Command (CJOC). “We want them to know we have implemented measures to better support them moving forward.”

Approximately 100 Canadian military personnel are currently serving in Poland as part of a contingent to train Ukraine troops. The first arrived in October 2022 but the mission added more personnel in February and March.

As part of Operation Unifier, the Canadian soldiers are providing training in basic and advanced engineering skills, the use of explosives for demolition work, demining and skills relating to the use and operation of the Leopard 2 tanks in combat.

The Canadian Forces usually has its own cooks to provide troops with food. But in this situation, the Canadians initially received their meals from the Polish military. Later, the Canadian soldiers were told to eat in local restaurants and they would be reimbursed by the Canadian Forces.

Justin Trudeau chooses the Argentinian model over the Canadian model

Filed under: Americas, Bureaucracy, Cancon, Economics, Government, History, Politics — Tags: , , , , — Nicholas @ 03:00

In The Line, Matt Gurney considers the proposition that “Canada is broken”:

To the growing list of articles grappling with the issue of whether Canada is broken — and how it’s broken, if it is — we can add this one, by the Globe and Mail‘s Tony Keller. I can say with all sincerity that Keller’s is one of the better, more thoughtful examples in this expanding ouevre. Keller takes the issue seriously, which is more than can be said of some Canadian thought leaders, whose response to the question is often akin to the Bruce Ismay character from Titanic after being told the ship is doomed.

(Spoiler: it sank.)

But back to the Globe article. Specifically, Keller writes about how once upon a time, just over a century ago, Canada and Argentina seemed to be on about the same trajectory toward prosperity and stability. If anything, Argentina may have had the edge. Those with much grasp of 20th-century history will recall that that isn’t exactly how things panned out. I hope readers will indulge me a long quote from Keller’s piece, which summarizes the key points:

    By the last third of the 20th century, [Argentina] had performed a rare feat: it had gone backward, from one of the most developed countries to what the International Monetary Fund now classifies as a developing country. Argentina’s economic output is today far below Canada’s, and consequently the average Argentinian’s income is far below that of the average Canadian.

    Argentina was not flattened by a meteor or depopulated by a plague. It was not ground into rubble by warring armies. What happened to Argentina were bad choices, bad policies and bad government.

    It made no difference that these were often politically popular. If anything, it made things worse since the bad decisions – from protectionism to resources wasted on misguided industrial policies to meddling in markets to control prices – were all the more difficult to unwind. Over time the mistakes added up, or rather subtracted down. It was like compound interest in reverse.

And this, Keller warns, might be Canada’s future. As for the claim made by Pierre Poilievre that “Canada is broken”, Keller says this: “It’s not quite right, but it isn’t entirely wrong.”

I disagree with Keller on that, but I suspect that’s because we define “broken” differently. We at The Line have tried to make this point before, and it’s worth repeating here: we think a lot of the pushback against the suggestion that Canada might be broken is because Canada is still prosperous, comfy, generally safe, and all the rest. Many, old enough to live in paid-off homes that are suddenly worth a fortune, may be enjoying the best years of their lives, at least financially speaking. Suggesting that this is “broken” sometimes seems absurd.

But it’s not: it’s possible we are broken but enjoying a lag period, spared from feeling the full effects of the breakdown by our accumulated wealth and social capital. The engines have stopped, so to speak, but we still have enough momentum to keep sailing for a bit. Put more bluntly, “broken” isn’t a synonym for “destroyed”. A country can still be prosperous and stable and also be broken — especially if it was prosperous and stable for long enough before it broke. The question then becomes how long the prosperity and stability will last. Canada is probably rich enough to get away with being broken for a good long while. What’s already in the pantry will keep us fed and happy for years to come.

But not indefinitely.

March 31, 2023

QotD: The education racket

Filed under: Bureaucracy, Education, Quotations — Tags: , , , , — Nicholas @ 01:00

… one of “capitalism’s” great ironies is that it creates several different breeding grounds for the ideology-addled idiot parasites that eventually destroy it. Politics is the most obvious example, but there are lots of others. The “education” business, for instance, is little more than make-work for idiots. You’ll never get rich as a teacher, of course, but a nice middle-class salary, great bennies, a nuclear-armed union, guaranteed lifetime employment, and fucking summers off is a very sweet gig indeed. The red tape and routines and meetings, endless meetings, are infuriating to anyone with more than two brain cells to rub together, but for a certain type of person — the kind of dull, vapid, lazily malicious person who would volunteer to be a Block Warden in the USSR — it’s heaven.

Indeed, it’s not going too far to say that these types of institutions are designed to chase off anyone brighter, more honest, or more hardworking than the average member. If you haven’t had any experience with teachers or school boards lately (you lucky bastards), think back to your last encounter with Human Resources, or your neighborhood’s Homeowners’ Association. The only person who can stand to work for HR or be part of the HOA is … well, is the kind of person who works in HR or is part of the HOA — dull, vapid, lazily malicious busybodies. They’re as lazy as they are dumb, as dumb as they are malicious. The key to dealing with them, like the Sovietologist’s key to predicting the Politburo, is figuring out which of their lovely personality traits is likely to come to the fore in a given situation.

Severian, “How Dumb Are Liberals?”, Rotten Chestnuts, 2020-07-31.

March 30, 2023

“Food insecurity” – one of the neat new benefits of our over-regulated economy

Filed under: Bureaucracy, Cancon, Environment, Food, Government, Politics — Tags: , , , , , , — Nicholas @ 04:00

Elizabeth Nickson on how western governments (in her case, the provincial government of British Columbia) are working hand-in-glove with environmental non-governmental organizations to create “food insecurity”:

Original image from www.marpat.co.uk

In Canada, the British Columbia government in order to increase “food security” is handing out $200,000,000 to farmers in the province. Food insecurity, which means crazy high food prices, comes to us courtesy of the sequestration of the vast amounts of oil and gas in the province and the ever increasing carbon tax, which (like a VAT in Europe), as you probably know, is levied at every single step in food production. Add the hand-over-fist borrowing in which the government has indulged for the last 20 years, and you have created your own mini-disaster.

Ever since multinational environmental non-governmental organizations (ENGOs) took over public opinion in the province, our economy has been wrenched from resource extraction to tourism. Tourism is, supposedly, low-impact. The fact that it pays $15 an hour instead of $50 an hour and contributes very much less to the public purse than forestry, mining, farming, ranching, oil and gas, means we have had borrow to pay for health care and schooling. This madness spiked during Covid, and, as in every “post-industrial” state, has contributed to making food very, very much more expensive, despite the fact that British Columbia where I live, is anything but a food desert. We could feed all of Canada and throw in Washington State.

Inflation comes from a real place, it has a source, it is not mysterious and arcane. Regionally, it comes from “green” government decisions. I pay almost 70 percent more for food now than I did five years ago. Of course one cannot know with any confidence how much the real increase is. The Canadian government was caught last week hiding food price statistics and well they might. The Liberal government leads with its “compassion”, blandishing the weak and foolish, hiding the fact that in this vast freezing country they are trying to make it even colder by starving and freezing the lower 50 percent of the population.

Even the Wasp hegemony that ran this country pre-Pierre Elliot Trudeau knew not to try that. But not this crew! It doesn’t touch them. They don’t see and wouldn’t care if they did, about the single mother working in a truck stop on the Trans-Canada Highway, who steals food for her kids because all her money is going towards keeping them warm.

[…]

The region in which I live used to grow all the fruit for the province, now, well good luck with that buddy. Last year under the U.N. 2050 Plan, local government tried to ban farming and even horticulture. That was defeated so hard that the planner who introduced it was fired and the plan scrubbed from the website. Inevitably it will come again in the hopes that citizens or subjects, as we in Canada properly are, have gone back to sleep. U.N. 2050, an advance on 2030, locks down every living organism, and all the other elements that make up life, assigns those elements to multinationals, advised by ENGOs, which can “best decide” how to use them.

If the only tool you have is a hammer, it’s tempting to treat everything as if it were a nail. It is only the most arcane and numerate think tanks who bang on and on about over-regulation and how destructive it is. Regulation is so complex that most people would rather do anything than think about it, much less deconstruct it.

“Nothing is as permanent as a temporary government program” … except those few that make your life easier

Filed under: Bureaucracy, Government, Health, Technology, USA — Tags: , , , — Nicholas @ 03:00

At Astral Codex Ten, Scott Alexander reacts to the US government’s new moves to make telehealth less useful for as many people as possible:

“Live telehealth demonstration” by CiscoANZ is licensed under CC BY 2.0 .

Telemedicine is when you see a doctor (or nurse, PA, etc) over a video call. Medical regulators hate new things, so for its first decade they ensured telemedicine was hard and inconvenient.

Then came COVID-19. Suddenly important politicians were paying attention to questions about whether people could get medical care without leaving their homes. They yelled at the regulators, and the regulators grudgingly agreed to temporarily make telemedicine easy and convenient.

They say “nothing is as permanent as a temporary government program”, but this only applies to government programs that make your life worse. Government programs that make your life better are ephemeral and can disappear at any moment. So a few months ago, the medical regulators woke up, realized the pandemic was over, and started plotting ways to make telemedicine hard and inconvenient again.

The first fruit of their labor is DEA-407, which makes it hard for telemedicine doctors to prescribe controlled substances. Controlled substances are drugs like Adderall, Ritalin, Xanax, or Ambien that the government has declared to be potentially addictive. The new rules say that telemedicine doctors can no longer prescribe these (or, in some cases, can prescribe them one time in an emergency).

Why don’t I like this decision? I am a telepsychiatrist. I work with about a hundred psychiatric patients who, for one reason or another, prefer online to physical appointments:

  • Some live in small towns that don’t have psychiatrists of their own
  • Some have agoraphobia, chronic pain, or some other condition that makes it hard for them to go to an office.
  • Some move around a lot and like to be able to see their psychiatrist whether they’re in LA or SF.
  • Some live hundreds of miles away from me, but know and trust me for some reason, and would rather see me than someone closer to them.
  • Some appreciate the fact that I charge lower rates than psychiatrists who have offices, because I don’t have to pay for Bay Area commercial real estate and pass those costs on to my patients.
  • Some work during work hours, and like being able to see me from their office instead of taking half the day off to travel to my location.
  • Some like convenience and dislike inconvenience

As a psychiatrist, a big part of my job is prescribing controlled substances. For example, most guidelines agrees that the first-line treatment for severe ADHD is stimulant medications (eg Adderall or Ritalin). And although psychiatrists hate to admit it, the first-line treatment for temporary crisis anxiety, especially when it’s so bad that the patient isn’t able to listen to your clever plans to solve it with therapy, is benzodiazepines (eg Valium or Klonopin). You can’t be a good well-rounded psychiatrist without the option to sometimes prescribe these drugs.

“Well, your patients will have to find a different psychiatrist, or transition off of them”. Nobody ever finds different psychiatrists. Some of my patients are a bad match for my style or areas of expertise, and I’ve tried very hard to find them different psychiatrists, and it never works. Maybe there are no other psychiatrists in their area. Maybe the psychiatrists in their area don’t take the right insurance, or are too far away from mass transit. Maybe the psychiatrists have six month long wait lists. Sometimes it’s just that my ADHD patients get distracted and forget they were supposed to find new psychiatrists, and I can’t hold their hand literally all the time. As for transitioning off the medications, some patients absolutely cannot function at all without them. Did I mention that if you come off of some of them too quickly, you can literally die?

March 21, 2023

The reason there are no EV charging facilities along the Interstate Highway System

Filed under: Bureaucracy, Government, USA — Tags: , , , — Nicholas @ 04:00

Jon Miltimore explains why a 1956 law prohibits the installation of EV charging bays anywhere on the Interstate:

Nissan Leaf electric vehicle charging.
Photo by Nissan UK

In 1956, Ike signed into law a bill — the Federal-Aid Highway Act — that paved the way (pun intended) for the interstate highway system, which included rest areas at convenient locations.

While there were numerous problems with the legislation, a relatively minor one was that it created strict limits on what could be sold at these rest stops. Today, federal law limits commercial sales to only a few items (including lottery tickets), the Verify team found. When President Joe Biden rolled out a $5 billion funding plan for states to create EV charging stations, he neglected to carve out a commercial exemption for EVs.

“You would be paying for that energy”, Natalie Dale of the Georgia Department of Transportation told WXIA-TV Atlanta. “That would count as commercialized use of the right-of-way and therefore not allowed under current federal regulations.”

If you think this sounds like an inauspicious roll out to the massive federal EV program, you’re not wrong.

Allowing drivers to charge their EVs at convenient, familiar locations that already exist along interstate highways is a no-brainer — yet this simple idea eluded lawmakers in Washington, DC.

Unfortunately, it illustrates a much larger problem with the top-down blueprint central planners are using to create their EV charging station network.

“We have approved plans for all 50 States, Puerto Rico and the District of Columbia to help ensure that Americans in every part of the country … can be positioned to unlock the savings and benefits of electric vehicles”, Transportation Secretary Pete Buttigieg said in a 2022 statement.

While it’s good the DOT isn’t trying to single-handedly map out the locations of thousands of EV charging stations across the country, there’s little reason to believe that state bureaucrats will be much more efficient. A review of state plans reveals a labyrinth of rules, regulations, and stakeholders dictating everything from the maximum distance of EV stations from highways and interstates to the types of charging equipment stations can use to the types of power capabilities charging stations must have.

The primary reason drivers enjoy the great convenience of gasoline stations across the country — there are some 145,000 of them today — is that they rely on market forces, not central planning. Each year hundreds of new filling stations are created, not because a bureaucrat identified the right location but because an entrepreneur saw an opportunity for profit.

March 13, 2023

Good “peacetime” generals versus good “wartime” generals

Filed under: Britain, Bureaucracy, Military, USA, WW2 — Tags: , , — Nicholas @ 04:00

“Shady Maples“, a serving Canadian Army officer, explains why the skills and talents that allow an officer to rise to general rank in peacetime have no direct relationship with how that officer will perform in a shooting war:

Field Marshal Sir William Slim (1891-1970), during his time as GOC XIVth Army in Burma.
Portrait by No. 9 Army Film & Photographic Unit via Wikimedia Commons.

I am not the first person to make these kinds of observations. Jim Storr has written about peacetime promotion culture in the British Army and Thomas E. Ricks did the same with U.S. Army. Here is an excerpt from Storr:

    It appears that many of those whom the British Army promoted in peacetime during the twentieth century were found wanting on the outbreak of war. Promotion to high command in peacetime very much reflects the values of existing senior commanders, themselves largely the products of a peacetime promotion system. To that extent it reflects deeply held values, and has an obvious impact on operational effectiveness in war.

    Roughly two-thirds of those who commanded formations in the BEF [British Expeditionary Force] of 1940 were either sacked, retired immediately, or were never given another formation to command in the field.

Ricks describes a similar phenomenon occurring in the U.S. Army during the Second World War. Many senior leaders who had risen during peacetime couldn’t perform under real-world conditions. Under the stern hand of George C. Marshall, then Chief of Staff of the U.S. Army, generals were removed from command at a rate that is unheard of today. Many of those who were fired had glowing records and some went on to redeem their reputations in later commands, which suggests that they had been promoted too soon or too high above their level of competence.

More recently, Russia has been churning through general officers in Ukraine, seemingly desperate to find someone who can achieve Putin’s war aims. If an army systematically promotes its officers above their level of competence in peacetime, then clearly their selection and assessment criteria are not aligned with the actual job requirements.

To illustrate the point, Storr compares careers of Second World War British Field Marshals. The first, Field Marshal John Verreker a.k.a. Lord Gort, was Commander-in-Chief (C.-in-C.) of the BEF during its disastrous efforts in France in 1940.

    [Gort] was the epitome of the system: young, highly decorated, charismatic, promoted through and entirely within the system. He was only 51 when appointed CIGS [Chief of Imperial General Staff] … As C.-in-C. of the BEF, he “fussed over details and things of comparatively little consequence” and had a “constant preoccupation with things of small detail”.

After he oversaw the evacuation of British troops from Dunkirk, Gort was removed from command and served out the rest of the war in non-combatant posts. It should be noted that Gort was not a bad soldier. During the First World War, he rose from the rank of captain to acting lieutenant-colonel and in the process earned the Distinguished Service Order (with bar) and the Victoria Cross. It was during the interwar years that Gort ascended from the substantive rank of Major to Field Marshal. Battles may be won with good-enough tactics and a lot of chutzpah, but Gort was unprepared for the complexities of wartime command at the strategic level. He did, however, excel at playing politics.

For contrast, here is Storr’s description of Field Marshal William “Bill” Slim:

    [The] 47-year-old Bill Slim was promoted to lieutenant-colonel in 1938, perhaps at the last possible opportunity. Slim had not been to Sandhurst; he had gained his commission “through the back door” and had come from a modest background. The outbreak of the Second World War saw him commanding a brigade in East Africa. Within four years he was commanding the Fourteenth Army in Burma … Slim was obviously not the product of a stable heirarchy in peacetime. His rise to fame came entirely during wartime. He was arguably one of the greatest British generals of the twentieth century. The contrast with Gort could not be more marked.

For his part, Ricks has a takes a wider view of how the post-war U.S. Army made some officers too big to fail:

    Korea, Vietnam, and Iraq were all small, ambiguous, increasingly unpopular wars, and in each, success was harder to define than it was in World War II. Firing generals seemed to send a signal to the public that the war was going poorly.

    But that is only a partial explanation. Changes in our broader society are also to blame. During the 1950s, the military, like much of the nation, became more “corporate” — less tolerant of the maverick and more likely to favor conformist “organization men”. As a large, bureaucratized national-security establishment developed to wage the Cold War, the nation’s generals also began acting less like stewards of a profession, responsible to the public at large, and more like members of a guild, looking out primarily for their own interests.

It seems like loyalty up became more important than loyalty out.

March 6, 2023

How the powers-that-be got drunk on (practically unlimited) power with the pandemic lockdowns

Filed under: Britain, Bureaucracy, Government, Health, Liberty — Tags: , , , , , , — Nicholas @ 04:00

Brendan O’Neill on the revelations from the release of British government officials’ informal chats on WhatsApp as the initial lockdowns were imposed:

“Covid 19 Masks” by baldeaglebluff is licensed under CC BY-SA 2.0

They were laughing at us. They didn’t only lock us down. They didn’t only suspend virtually every one of our civil liberties, including a right none of us ever expected to lose: the right to leave our own homes. They didn’t only spy on us with drones, and encourage us to snitch on that neighbour going for a sneaky second jog, and fine teenagers life-ruining sums of money for holding house parties. They also chuckled about it. It was funny to them. In one of the most startling WhatsApp chats revealed in the Daily Telegraph‘s Lockdown Files, a senior civil servant says the following about Brits returning from trips abroad who were forced to quarantine in a stuffy hotel room for 10 days: “Hilarious“.

It was Simon Case, the UK’s top mandarin. In February 2021 he had a breezy virtual chat with Matt Hancock, the then health secretary. A policy had just been introduced stipulating that any Briton returning from a “red list” country – which eventually included 50 states around the world, including India and vast swathes of Africa – would have to quarantine in a hotel at a cost of £1,750 per person, later rising to £2,285. A total of 200,000 British citizens and residents endured this painful, expensive quarantine. To Hancock and his civil-service pals it was all a big laugh. “I just want to see some of the faces of people coming out of first class and into a premier inn shoe box”, chortled Mr Case. He later asked Hancock: “Any idea how many people we locked up in hotels yesterday?” Locked up in hotels. Hancock replied that 149 people “are now in Quarantine Hotels due to their own free will!”. “Hilarious”, said Case.

Hilarious? Tell that to the people whose lives were ruined by this policy. The idea that it was just reckless rich folk jetting off to exotic destinations that were on the “red list” is ridiculous, as academic Aleksandra Jolkina has explained. Consider the NHS worker who travelled to Ethiopia to visit his dying uncle and look after his sick mother. While he was there Ethiopia was added to the “red list”, meaning he could not return to the UK; he couldn’t afford to. Or the Briton who travelled to Pakistan to visit his terminally ill father. He was forced to raid the family savings to pay the return quarantine fee. As a result, his “family’s ability to survive financially” was put “at risk”. Or think about the many Brits who did not go abroad, to one of those supposedly toxic countries, because they didn’t have the funds for that stay in a “premier inn shoe box”. People who, as Jolkina describes it, could not “visit their ill relatives or wish them a final farewell”. Hilarious, right?

The sinister cruelty of lockdown is laid bare in this grotesque vision of officials laughing over a policy that caused so much heartache and hardship among often low-earning Brits whose only crime is that their families live overseas. You couldn’t have asked for a better snapshot of the feudalistic authoritarianism that underpinned the ideology of lockdown. Civil servants working from their plush homes having a giggle about a policy that inflicted severe financial pain on the diverse working classes. A health secretary breaking his own guidelines to snog his mistress while sending snide WhatsApp messages about a policy that prevented poorer citizens from kissing the cheek of a dying relative. For me, this is the most important thing about the Lockdown Files – their revelation of just how morally cavalier and even inhuman the political elites can become when they are drunk on power, when they are liberated from democratic accountability to pursue whatever extreme policies they like.

The Telegraph‘s Lockdown Files are based on more than 100,000 WhatsApp messages sent and received by Matt Hancock in the pandemic years. Hancock gave the messages to Isabel Oakeshott when she was co-writing his book, Pandemic Diaries, and now Ms Oakeshott has given them to the Telegraph. They provide only a partial insight into the machinations of lockdown, of course. Hancock is not the centre of the universe, whatever he might think to the contrary. And he says some of the messages are being taken out of context. Perhaps. Nonetheless, the Lockdown Files represent our first serious reckoning with lockdown, our first glimpse at what was happening behind the scenes of this unprecedented exercise in social control. And it’s not a pretty picture.

March 2, 2023

QotD: The rise of the overeducated mediocrity

Filed under: Bureaucracy, Business, Education, Quotations — Tags: , , , — Nicholas @ 01:00

Of recent months, several children of friends of mine have asked my help in preparing what they call a personal statement in their application for a job or place at university. Why they should ask me to help them is a bit of a mystery; I am glad to say that I made my career, such as it was, before these invitations to unctuous self-advertisement were even heard of.

The son of a friend of mine applied for a place at medical school and was turned down on the grounds that his personal statement was inadequate. I don’t know what was wrong with it; perhaps he employed incorrect old clichés rather than the correct new ones. Having the means to do so, my friend sent his son to a tutor who specialized in personal statements (every bureaucratic requirement is an economic opportunity for an ex-bureaucrat wanting to strike out for himself). No doubt the tutor in personal statements advised him to put in more about his passion for social justice and equality. At any rate, it worked and he was accepted.

In these statements — apparently as much a requirement in the private sector as in the public — you have to not only explain why you have dreamt all your life of this position in the marketing department (selling the unnecessary to the insolvent) and why you, of all the 7,000,000,000 people in the world, are the most suited to it, but also proclaim your deep sense of social responsibility, which you will bring to whatever task you are told to perform. People have never been entirely straightforward, thank goodness (what need of art and literature if they had been?), but we do seem to be breeding up a generation of Pecksniffs and Uriah Heeps.

I don’t want to indulge in what has been called the hermeneutics of suspicion, the habit of finding the supposedly real, occult, and sinister explanation behind perfectly straightforward social phenomena, but nevertheless I cannot help but wonder what the true purpose is of mission statements and their cognates, such as annual declarations of probity and the like. I think (though of course I cannot indubitably prove) that it is to make the world safe for overeducated mediocrities.

Theodore Dalrymple, “In Defense of Mediocrity”, Taki’s Magazine, 2018-02-17.

March 1, 2023

If the Freedom Convoy “actually was what it has often been portrayed as on social media — a horde of thousands of literal Nazis and Confederates set on violently overthrowing our democratically elected government — then [we’d] be living in the Confederate Republic of Nazi Canada by now”

Filed under: Bureaucracy, Cancon, Government, Liberty, Media, Politics — Tags: , , , , , , , — Nicholas @ 03:00

In The Line, Matt Gurney explains how going through Justice Paul Rouleau’s Public Order Emergency Commission report in detail leads to some uncomfortable realizations about Canadian goverment and policing — at all three levels — failed to meet minimal expectations of competency and capacity:

A screenshot from a YouTube video showing the protest in front of Parliament in Ottawa on 30 January, 2022.
Photo via Wikimedia Commons.

The convoy crisis — and I’m mostly speaking here about the events in Ottawa, though the situation at the border crossings fit the same general pattern — forced Canadian police and political leaders to respond quickly to evolving circumstances. And Rouleau’s report is just a relentlessly brutal catalogue of the ways they failed.

Is it really necessary at this point to recap the failure of the Ottawa police? We at The Line have long maintained that the complete failure of the Ottawa police to plan for and control the protest not only allowed the convoy to entrench itself, but also established the psychological paradigm that would define the crisis for weeks: the convoyers held the initiative (not to mention the capital) and the Canadian state was befuddled and adrift. From that, a national crisis was born. Rouleau is just devastating. “The OPS [Ottawa Police Service]’s planning challenges,” he notes on page 56 of the first volume, “were compounded by a general breakdown of command and control.” Super.

He’s even more brutal on page 185 of the second volume: “The influx of Freedom Convoy vehicles and the disruptive behaviour by some protesters threw the OPS operational command at the NCRCC [a command centre] into a state of dysfunction. OPS Inspector Lucas described the atmosphere at the NCRCC as chaotic and explained that he and his team had neither the capacity to process the incoming information nor the resources to respond to the needs it was facing. In the late afternoon of January 29, the OPP’s [Ontario Provincial Police] representative at the NCRCC, Inspector Dawn Ferguson, reported to OPP Superintendent Abrams that OPS members in the NCRCC were panicked and were swearing and yelling orders at each other and at partner agencies.”

Huh.

Moving up a level of government, much has already been written about the cowardice of the Ford government. If any agency performed semi-well, it was the Ontario Provincial Police. The OPP was the force that was generating most of the critical intelligence used (or ignored) during the crisis. It was quick to realize that command-and-control had collapsed in Ottawa (see above), and to begin working with the RCMP on a plan — eventually a series of plans — to restore order. You can’t read POEC and conclude the OPP performed perfectly. Far from it. It was probably the best we had, though, but because Ford took a gander at the mess in Ottawa and decided to mosey on off to the cottage, it couldn’t do much.

Huh.

And that leaves us with the feds. I have maintained since last year that the federal government hasn’t received nearly enough attention in our understanding of what the hell went wrong last year. This has caused a fair degree of pushback, especially from Liberal supporters who read any reference to the “federal government” as “our beloved prime minister”. But no — while I don’t think the prime minister or the federal cabinet did particularly well during the crisis, the real federal failures were in the officials that supported the PM and his ministers.

Among the many other failures, the inability of the various government and police organizations to organize and properly share the information they were handling is perhaps the most disturbing:

If you want to see it yourself, check out pages 38 and 39 of the third volume. For those in a hurry, though, it turns out that even within the government, the flow of information was so bad that the clerk of the privy council, and the prime minister, noted that staff were learning about the convoy not via internal reports, but social media. The federal government had, as Juneau and Rigby have noted, “intelligence gaps” that “hampered the government’s ability to understand, anticipate, and respond to the situation, and to reconcile conflicting information such as contradictory reports about the size of the convoy”. The federal government didn’t have the software to process and analyze online posts, even public ones.

And then there was this (my emphasis added):

    [National Security and Intelligence Advisor] Thomas also described an information-sharing gap between law enforcement and government. Assistant Secretary to the Cabinet, Security and Intelligence, Michael MacDonald recalled a significant delay in receiving updates from the RCMP, due to the RCMP’s obligation to consult with each intelligence agency that has provided the RCMP with information prior to sharing that information further (known as the “third party rule”). The NSIA’s office did not receive situation reports, project reports, or other forms of information, such as Project Hendon reports, that the RCMP obtained from other law enforcement agencies. Prior to the events of the convoy, the NSIA was not aware of Project Hendon. …

    NSIA Thomas further stated that it was sometimes difficult to know how to interact with law enforcement agencies. She recognized that government must not interfere in operational matters, but thought that there was nonetheless useful information that could have been provided to decision makers without encroaching upon police independence. However, senior officials were uncertain how to obtain that information, and were concerned about “crossing the line” both in requesting information and in discussing solutions.

… huh.

And that doesn’t even cover our now-outgoing national commissioner of the RCMP being so clueless she decided to just not mention germane information during a critical meeting because … well, we never really got a good explanation for that one. Oh well. Enjoy your retirement, Commissioner Lucki!

February 25, 2023

Buttigieg isn’t covering himself in glory over his belated East Palestine train derailment response

Filed under: Bureaucracy, Government, Media, Politics, Railways, USA — Tags: , , , , , — Nicholas @ 03:00

Jim Treacher is clearly trying to at least pretend some sympathy for Transportation Secretary Pete Buttigieg, but it’s a tough assignment:

Pete Buttigieg is the type of guy who walks into a job interview and says his biggest weakness is his perfectionism. As a kid he always had an apple for the teacher, and if she forgot to assign homework that day, he was the first with his hand up. He’s a repulsive little hall monitor, so all the other repulsive little hall monitors think he’s simply divine.

Mayor Pete and his fan club are having a really bad time right now, because for once he’s expected to actually do something. Producing results simply isn’t his specialty. After spending three weeks hoping the East Palestine, Ohio rail disaster would stop bothering him if he just ignored it, he finally showed up there yesterday.

And I’m starting to understand his reluctance:

What a visual, huh? He looks like a little kid playing Bob the Builder. It’s not quite Dukakis in the tank, but it’s close.

And then it got worse: He started talking.

He’s just so gosh-darn dedicated to his job, you see. His only mistake was listening to you people. He followed the norm. This is your fault!

And then he blurted out this instant classic:

Now, which of those words should you try to avoid when you’re talking about a disastrous train derailment? I’m starting to suspect this guy isn’t the unparalleled megagenius the libs keep telling us he is.

[…]

Team Pete is more concerned about reporters asking about East Palestine than about the disaster itself. The rest of us are just an abstraction to them. If they accidentally manage to help some of us, that’s fine. If not, that’s also fine. Either way, we cannot be allowed to stand in the way of their political aspirations.

Mayor Pete really did think this gig would be a cinch, didn’t he? Like, he could just do all the reading the night before the final and ace it. He’s positively resentful at being expected to do what we’re paying him to do. He thinks he’s too good for this job, which is why he’s very bad at this job.

Will Buttigieg’s tenure as transportation secretary ruin his presidential prospects? After all, that’s what this is all about for him. Maybe, maybe not. It’s not as if politics is about solving problems. All you have to do is claim you solved the problems, and your team will cheer for you no matter what.

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