Program Archive

Jacob Appel is a physician, lawyer, psychiatrist, bioethicist, and author, with more masters degrees than you can count on one hand, even if you've got six fingers.

His talk was about rethinking resource allocation in this time of pandemic, highlighting all the ethical conundrums. He posited three categories of scarce resources: 1) "hard scarcity" (like organs for transplant); 2) "soft scarcity" (with some wiggle room, like funds for health care); and 3) "evaporating or conservable" resources (like antibiotics, where too much use impairs effectiveness).

The big picture, which he called "macro-allocation," concerns how overall societal resources get allocated — Appel pointed to our nation spending 17-18% of GDP on health care, versus about 6% on education. Our health spending is considerably higher than in other advanced countries, with different systems. Appel noted that ours, dominated by employer-provided insurance, grew out of WWII wage controls, preventing companies from competing for workers on salary, so they competed instead on fringe benefits. [Which are deductible as businesses expenses, and constitute non-taxable income to employees — FSR.]

Also at issue is what specific things we choose to fund. For example, work on HIV/AIDS and cancer is over-funded in comparison to mental health. Appel noted that sickle cell disease (associated with Blacks) is under-funded compared to Cystic Fibrosis (associated with whites). And he said we've way underfunded pandemic preparation, undermining what might have been our response to Covid-19.

The health care funding realm presents fundamental ethical dilemmas. We don't like the idea of "rationing" health care, but resources are never infinite, so we have to make choices. Appel illustrated this with the Slim Watson case — this guy had a rare condition treatable only at great expense. The question being whether to keep him alive and thus effectively deny funding for other things that could actually save many more lives. We have trouble with such issues because they pit "visible victims" (like Watson) against "invisible victims."

It's a really acute issue because about 30% of total Medicare spending goes on patients in the last year of life; a third of that in the final month. Is this worth it, compared with what health improvements that money could buy if spent on other people? Appel also pointed to the 1983 "Orphan Drug Act," incentivizing work on rare diseases. Seemingly altruistic, but there are numerous such illnesses affecting small populations, and treating them all would cost trillions.

Mentioned too was an Oregon attempt at rationally allocating health care, aimed at saving the most lives for a given sum of money. Thus not spending it on cancer patients deemed to have a small chance of recovery. Another example here was the allocation of limited dialysis machines, with a committee established to vet applications from patients seeking their use. Appel presented an actual transcript from the committee's deliberations, trying to figure out which patients best merited the limited dialysis capability. The excruciating ethical conundrums were obvious.

Of course similar issues can apply regarding ventilators in this time of covid, and who makes the decisions. It may be unethical to put them in the laps of health care workers on the spot. Another option is a "blinded committee" like the one described above (with all the problems that entails). Appel also noted that standards vary greatly from state to state, so identically situated patients can get treated very differently.

Vaccination presents such issues too. Development can be speeded by trials with volunteers exposed to covid after getting a trial vaccine. Is that ethical? Then, who gets a vaccine first? The most vulnerable versus frontline health workers, for example? And should government make vaccination compulsory? Appel suggested that winning public "buy-in" would work better.

Cheryl Roberts spoke about electing New York State Supreme Court Justices — and why your vote hardly matters. She lost out in a 2019 bid for one of those judgeships.

Despite its name, the State Supreme Court is not New York's highest court, but actually the lowest, the trial level. Next up is the Appellate Division, and the highest panel is the Court of Appeals. There are almost 400 Supreme Court judges divided among 13 multi-county judicial districts. Albany is in the seven-county 3rd Judicial District.

Roberts explained that the State Supreme Court handles cases like divorces, mortgages, foreclosures, and felony crimes (most of which though, upstate, are heard in county courts). Another key jurisdiction is Article 78 proceedings, challenging governmental actions.*

New York is one of only a few states electing (rather than appointing) such judges. Roberts characterized our system as very political and "incredibly unfair." The party nominees in judgeship elections are chosen in judicial conventions, by delegates elected in primaries. In practice, because of the large numbers of delegates, and those primaries being under the radar, there are never contested ones, the delegates being simply picked by party leaders.

Our Third Judicial District used to go both ways politically, and Democratic and Republican leaders would often agree on bipartisan endorsements. Nowadays Democrats typically prevail. At some point the district's seven Democratic county chairmen came to a deal divvying up the judgeships among themselves. In 2019 it was seemingly Columbia County's turn, and the county backed Roberts. However, Albany — the most populous and hence most powerful county in the district, with the most delegates — backed Justin Corcoran. He had been (after a big fight) the party's nominee in 2014, but had lost the election. This time Corcoran did win both the nomination and election.

Though knowing her bid was doomed, Roberts says she stayed in the race, to highlight a need for more diversity among the the judges (one might remember a bunch of letters-to-the-editor at the time so arguing for her candidacy). She also wanted to throw a spotlight on the system's undemocratic cronyism. Though changing it would require a constitutional amendment — which in turn would require the initiative of the state legislature. Good luck with that, in the People's Democratic Republic of New York.

Dr. Abby Hafer has her doctorate in zoology from Oxford University and currently teaches at Curry College. She has authored the book Unintelligent Design, among others, and claims to be famous for testicles. (Not her own; see below.) Her talk was about what today's fighters against fake news can learn from Darwin's apostles.

She started by suggesting that pre-Trump we could not have imagined an American president establishing a bizarre, counter-factual, evidence-free narrative, yet succeeding in gulling much of the population. But "Welcome to my world," Hafer said — every evolutionary biologist has always had to deal with such an environment of factual denialism. "Objective reality exists"; she insisted, steadfastly disregarding all the evidence to the contrary.

The Darwin apostles Hafer discussed were scientists who fought, against powerful entrenched interests,  to gain acceptance for his theory of evolution by natural selection. After a long hard campaign they succeeded to a great degree (despite pockets of resistance, notably including a high proportion of Americans). But meantime Hafer noted publication, in 1889, of a book, Lux Mundi, in which notables in the Church of England dilated upon reconciling their faith with evolution — which they already assumed was true.

John William Draper was a scientist who authored History of the Conflict Between Religion and Science in 1874. The lesson Hafer took from his efforts: don't quail from battling fundamentalist religion, but work with religious people wherever it's possible.

Alfred Russel Wallace was of course the guy who figured out evolution at about the same time as Darwin. Darwin had been afraid publishing would cause a big backlash. But Wallace, Hafer said, struck a different kind of terror into Darwin: not getting credit. So he finally got his book finished quickly enough to pip Wallace.

Joseph Hooker was one scientist who had long actually fought against the idea of biological evolution. But ultimately, he said, the conviction was "forced upon an unwilling convert." He couldn't fight the facts. That was intellectual integrity.

Darwin's greatest proponent was Thomas Henry Huxley. Hafer discussed his lengthy battle with Richard Owen, who maintained that brain differences ruled out any close connection between humans and apes. Huxley showed Owen was just wrong on the anatomical facts: "Before I have done with that mendacious humbug I will nail him out like a kite to a barn door, an example to all evil doers."

Huxley was indefatigable, working the "social media of his day" — newspapers. Letters to the editor, and replies, were a very big thing.

One audience member remarked that many people who most need to hear such messages refuse to listen. Hafer acknowledged this, and how a lot of these issues have become politicized. But she held that persistent efforts to debate such issues, vigorously battling error, in the public sphere, can have an effect. And Americans are actually leaving evangelical Christianity in droves, indeed angry because they feel they've been lied to.

A point she emphasized was that to overcome biases you have to tailor the message to engage people. Mention was made of Galileo's experiments with the motions of balls, illustrating his points in a visually unarguable way. Hafer also pointed to her own work on how the human body actually shows un-intelligent design. A prime example is testicles, hanging vulnerably outside the body cavity, whereas many other animals have them safely inside. It's because human testicles have to be kept cooler. (I asked whether there was any connection between testicles and Galileo's balls and she gave me a straight-faced answer.) Anyhow, the point was that when you start talking about testicles, people sit up and listen.

She also said the current pandemic is a golden opportunity to make people grasp the importance of being serious toward science. A further point was that the virus, of course, evolved.  If it weren't for evolution, there'd never be any new diseases.

Hafer avowed that we are struggling today not only for the soul of this nation — but for its brain. Its integrity. Scientists are on the front lines of this battle. And their latter-day apostles are us.

She paraphrased Martin Niemoller: First they came for the evolutionary biologists . . . .

Cheryl Roberts is an ex-Judge, currently serving as Executive Director of the Greenburger Center for Social and Criminal Justice, as well as corporation counsel for the City of Hudson.

Her topic was mass incarceration — the criminalization of mental illness and substance disorders. America has the highest incarceration rate of any country. That's right, of any country. We have less than 5% of the world's population, but 25% of its prisoners. Our incarceration rate is five to ten times higher than for other democracies.

Is it because we have that much more crime? Of course not [although we do have way more gun crime because of our insane gun culture — FSR]. Roberts noted that U.S. incarceration numbers rose from about 200,000 in 1973 to 2.2 million in 2009. Since then they've stayed at about that level. [But during that interval crime rates actually fell dramatically. Imprisonment of dangerous people probably contributed somewhat to that decline. Nevertheless, an eleven-fold increase in incarceration obviously can't be justified on the basis of crime rates. — FSR]

What it does represent, Roberts said, is not a response to rising crime, but rather a policy choice to use prison as a response to crime; and it's that policy that's criminal.

The policy disproportionately affects mainly minority men under 40, who are already disadvantaged, educationally and economically, etc. For all Americans, the lifetime chance of being imprisoned is 6% [a scary enough figure]; for black men it's 32%. And meantime, over half of the prisoner population suffers from some kind of mental illness. Such people are ten times likelier to see the inside of a prison cell than a psychiatric facility.

For those with untreated mental illness, the risk of dying in interactions with police is 16 times greater than for people not so afflicted. And it's not because the mentally ill are more likely to be engaged in criminality. Actually, according to Roberts, they are more likely to be victims of crime.

And prison, she said, is the last place they should be, suffering horribly there. [Hard enough to cope with imprisonment even for "normal" people.] Roberts cited a Virginia study of 400 prison deaths, finding 41% associated with solitary confinement, 44% were suicides, 18% were tasered, etc.

How did we get here? Roberts quoted John Ehrlichman (a Nixon confidante, speaking decades later) saying that the Nixon administration wanted to hit two "enemies" — blacks and anti-war leftist protesters. Launching a "war on drugs" with harsh penalties was a way to kill two birds with one stone. It's the war on drugs that still accounts for the bulk of America's over-incarceration. [Treating drugs as a public health issue rather than a criminal justice one would go far toward solving the whole problem — FSR.]

Mentally ill people used to be put in asylums; one such gave us the word "bedlam." They were not indeed pleasant places. Thus a big societal push to get folks out of them. One impetus was adoption of a Medicaid rule prohibiting payment for most hospital care for the mentally ill.

Roberts noted that in the 1960s we had about 560,000 psychiatric hospital beds; four decades later it was down to about 50,000, for a national population double the size. Those beds came to be used for people coming out of the criminal justice system, deemed incompetent to stand trial. While perhaps incongruously, what was originally the psychiatric hospital population was largely shifted into prisons. (And into homelessness.)

Roberts concluded by discussing Hope House on Crotona Park, a North Bronx project of the Greenburger Center to serve as an alternative to incarceration for people charged with crimes who have serious mental illness, which will include treatment for drug problems and other issues.

Dr. Ricki Lewis is an Adjunct Professor at the Alden March Biocenter; author of numerous textbooks, scientific books and papers. Her topic was the Biology of the 2020 Pandemic.

She began with a Joshua Lederberg quote saying humanity's biggest threat is viruses; and by harking back to the great past fear over polio (another virus); as well as the once-common childhood illnesses Measles, Mumps and Chicken Pox; all now defeated by vaccines [at least until the anti-vax movement came along — FSR.]

SARS-CoV-2 is the name of this virus. Covid-19 is the illness it causes. It's common for viruses to jump to humans from other animals. Particularly bats; they're a quarter of all mammals, can harbor viruses without dying, and spew them all over. This is a natural enough explanation for  Covid-19. Lewis noted that no part of its genome matches anything in labs, though she couldn't rule out its originating in a lab without human intentionality.

A virus is not a living thing, being much simpler than a bacterium or other kind of cell. It straddles the boundary between the biological and the chemical. Now, our genetic material is DNA; DNA is a molecular template for making RNA; and then RNA makes proteins. The genetic material for a virus can be either DNA or RNA. That genetic core, in a virus, is encased in a capsule of fatty stuff. "Coronavirus" gets its name from its crownlike exterior of spikes that lock into what are called ACE2 receptors on the outsides of our living cells. That enables the virus to inject its genetic material into a cell, and grab its chemical innards to make copies of itself. Then the cell bursts, spewing out more viruses.

We have a hierarchy of defenses. First are simply physical barriers, like skin. Then there's "innate immunity," mainly white blood cells tasked with combating invaders in general, through what we call "inflammation." The third level is "adaptive" immunity, when the body manufactures antibodies specific to a particular invader. But that takes a while. Lewis noted that Blood Type O seems to block the covid virus better than other types; whereas Type A is overrepresented among the victims. She also said that Africans may be suffering less than us from covid because their immune systems are already revved up due to all the various illnesses they're exposed to.

We get infected mainly by taking in viruses in droplets spewed out in coughs or sneezes, or just breathing, by infected people. Lewis discussed the possibility of getting viruses from touching surfaces where they've come to rest. While this can happen, she didn't think it's much of a factor.

Most who get infected with the covid virus suffer only mild symptoms, or none. It's actually better from the virus's point of view if it can do its thing without killing the host; hence Lewis saw some possibility that covid could mutate its way into such relative benignity. Meantime, however, it does make a minority of victims very sick, in ways she described. A lot in the body goes wrong. We have endothelial cells that kind of hold things together; and they "come apart at the seams." The alveoli in our lungs, which transfer oxygen into our blood, fill up with "stuff," and blood oxygen plummets. The blood clots, you get heart attacks, strokes, and organ failure. Your own immune system goes haywire trying to fight this, resulting in a "cytokine storm" with nasty positive feedback loops.

As for treatment, the drug remdesivir seems to inhibit virus replication, somewhat hastening recovery. But Lewis was skeptical about a vaccine, saying we don't actually know if that's even possible, and anyhow it would take a lot longer to deploy safely than optimists currently contemplate. Meantime "herd immunity" would deprive the virus of enough potential victims to keep itself going; that would happen once about 70% of the population has been infected and are presumably immune; though we don't yet actually know they actually are immune from reinfection. And we're a long way from herd immunity levels. Reopening economies could accelerate that, with a "second wave" of infections. Lewis said she initially expected that in the fall, but now thinks it could come within weeks due to the George Floyd protests likely having spread the virus.

Paul F. Cole is a former Secretary-Treasurer of the New York State AFL-CIO in addition to other prominent labor and public policy posts. His topic was "The decline of the middle class: how it happened and what to do about it."

After a long history of labor conflict, the 1935 Wagner Act enshrined some key rights for unions, which introduced a flourishing of the U.S. union movement. Cole considers this a key factor in building a strong American middle class in the three decades or so following WWII. He showed charts indicating a correlation between unionization and higher wages. But the last several decades have seen a considerable ebbing of union membership and political clout. Cole says this was in considerable part due to pushback by right-wing Republicans, aiming to use political power to re-assert power over the economy. Cole calls this a "revolt of the bosses," and a "vicious, no-holds-barred ongoing war against organized labor." Today the U.S. has one of the lowest union membership rates among rich countries.

Cole also pointed to a fundamental shift from a "stakeholder capitalism" model to one emphasizing maximization of shareholder value. The former sought to balance the interests of shareholders, employees, customers, and the public at large. But that, argued economist Milton Friedman among others, misconceived a corporation's proper role. Arguing the other side was a book by Lynne Stout, The Shareholder Value Myth, which Cole cited.

Cole acknowledged that shareholders are actually the owners of corporations. But he said the idea of maximizing shareholder value has led to a focus on short term profits. Over recent decades, the compensation of corporate CEOs has become heavily tied to profit performance. During 2008-17, Cole said, 466 of the companies in the S&P 500 spent $4 trillion on stock buybacks, equal to 53% of their profits. This boosts stock prices; as opposed, Cole said, to reinvesting those profits in their products or workers.

He presented various charts showing a resulting rise in inequality. Until about 1980, productivity and wages grew in tandem; afterwards, productivity continued rising, while wages have been pretty much flat. [Note, this chart showed "hourly wages," omitting the increasingly large importance of fringe benefits, especially health care, as a part of worker compensation. — FSR] Others showed increasing percentages of wealth and income garnered by the top 1%; the earnings of the top 0.1% grew 15 times faster than those of the bottom 90%. Gates, Bezos, and Buffett between them have more wealth than the nation's bottom half.

That's because the bottom half, in fact has very little wealth stored up. This includes half of Americans approaching retirement. A key reason is a long-term shift away from "defined benefit" pension plans to "defined contribution" models, like 401K accounts. This helps corporations reduce unaffordable pension burdens. [Indeed, the impossibility of meeting looming pension obligations is a growing problem not only for businesses but for governments at all levels. — FSR]

The trends Cole discussed are, of course, exacerbated by the current economic disaster, with levels of unemployment not seen in generations. It is lower-income Americans bearing the brunt, obviously increasing inequality.

As for the "what to do about it" part of his talk, Cole said to rebuild the labor movement. And to be active politically.

By Frank S. Robinson

Frank Wind (pronounced as in "gust of" rather than "wind up") is a retired geologist, professional storyteller, and longtime CDHS stalwart. His presentation on the dinosaur extinction was done over the zoom internet platform, with over 30 participants. This worked quite well.

Frank started by saying Darwin is his patron saint. He also cited a book by journalist Elizabeth Kolbert, The Sixth Extinction (concerning the one currently underway), and a New Yorker article by Douglas Preston, The Day the Dinosaurs Died. That was actually the fifth and (until now) last mass extinction of species on this planet, 66 million years ago (mya); the first occurred about 440 mya. The most severe was the Permian Extinction, about 250 mya, killing over 95% of marine species and 70% of terrestrial ones.

Those creatures must have really pissed off God. Except, of course, that he only created the whole shebang only 0.006 mya. To be exact, in 4004 BCE. On October 2. At 6 PM. That was the calculation of Bishop Ussher, by parsing the Bible's chronology, in 1650. Which Biblical literalists today still take as gospel. They place Noah's flood at 2348 BCE, which did for the dinosaurs. But even that theory is a bit problematical, unless you suppose every dinosaur species literally missed the boat. Indeed, Frank showed a cartoon with the ark departing, two dinos standing ashore, one saying to the other, "Oh crap, was that today?"

And the dinosaurs could not have died out much earlier because, of course, death itself was introduced into the world in consequence of Adam's "sin." But actually, the Bible has nothing at all to say about dinos, which were not even discovered until the 19th century.

The whole concept of extinction wasn't really a thing till then, most people (well, Christians) believing life on Earth unchanging. Discovering dinos threw them for a loop. And even science was kind of stumped to explain how such a whole big range of creatures could have more or less abruptly vanished from the scene.

Not until recent decades was a good theory offered, by Luis and Walter Alvarez, father-and-son scientists. They ascribed dino extinction to a huge asteroid smashing into the Earth. There is evidence of such impacts happening periodically, in the form of 190 craters. And the Alvarezes pinpointed remains of the gigantic 66-mya Chicxulub crater in the Yucatan peninsula and coast. They also found much evidence in the geologic record, identifying a distinct boundary between sedimentary layers at just that time, with the in-between layer being notably different, showing a very high iridium content, which could only have come from an extraterrestrial source. Such evidence is found as far away as New Zealand (can't get much farther), proving how dramatically the planet's environment was affected. Frank also showed some fossils discovered in the U.S., showing directly how animal life suffered.

He also described in vivid detail what a global cataclysm that asteroid hit would have caused. (I missed most of this part because I had to reboot my internet connection, which itself fell victim to a small asteroid strike. But you can use your imagination, based on various disaster movies you've seen, to envision the event.)

Not all scientists buy this asteroid theory. They don't deny the impact, but don't think it alone can account for the extent of the extinction. Pointing instead to a spate of big volcanic eruptions that seem to have occurred shortly before. But they accept that the asteroid didn't help.

We may miss having dinosaurs around (though we do have birds, which are their descendants). However, Frank pointed out, it was the demise of the dinos that cleared the way for the flourishing of mammals, which in turn led to the evolution of you-know-who. Though some misanthropic cynics would say this was not such a blessing.

By Frank S. Robinson