Ethics in medicine

I read something the other day on Medscape that gave me pause and made me reconsider several things about my career as a nurse. After reading the article and reflecting some on it, I came to the conclusion that there’s a bit of an ethical crisis happening in medicine right now.

The article itself was about birth control and teen pregnancy. You can read the article here, and I will of course be pulling out bits and pieces for our discussion. The central premise of the article is this:

“The real goal is to empower women, not to reduce pregnancy,” said Neha Bhardwaj, MD, from the Mount Sinai Health System in New York City. “If someone wants to have children in their teens, you can’t tell them not to, she told Medscape Medical News. “We really have to reframe the conversation,” Dr Bhardwaj stressed in her presentation on contraception and coercion. “You can’t think of teen pregnancy as a disease.”

I can certainly get behind empowering women. And teen pregnancy is not a disease, that I can agree on. But then the article goes on to state:

“Teen pregnancies may contribute to high dropout rates, incarceration rates, and social costs,” but you still have to look at contraception through the lens of choice, she said.

And this is where I started thinking: does choice really trump dropout rates, incarceration rates, and social costs? I think one could make an argument that it doesn’t. But that’s the lens that’s been thrust upon the bulk of medicine: patient autonomy is everything. To the point that really nothing else matters. And to a certain degree patient autonomy certainly is important and does need to be respected. But what kind of position does that put the clinician in? What kind of position does that put society in?

The author admits, readily, that teen pregnancy leads to higher high school drop out rates. And incarceration rates. And that there are substantial societal costs. But there are medical considerations, too. Teen pregnancy is more likely to result in premature birth and low birth weight, which come with a unique set of medical risks and challenges for the baby. Doesn’t that deserve consideration? Is there no argument for waiting to have a child until you’re physically, emotionally, socially, and economically able to? If the argument is that we should empower women, isn’t it imperative that we help women make the best choice, not just the choice they have in a given moment? I am not the same person I was when I was 17. My ideas and values and goals changed significantly.

Now, that isn’t to say you shouldn’t provide pregnant teens with the best possible prenatal care. That isn’t to say you shouldn’t respect a patient’s choices or beliefs. But at some point you have to weigh belief and choice with potential harm. If you don’t, that leaves clinicians in an ethically unsavory position. I’ll give you an example.

In my job I give a lot of vaccines. I encounter a lot of parents who either outright refuse certain vaccines or what to make up their own schedule. Here, I’m hit with two ethical situations that I’m not comfortable with. The first is that the parents are not the patient, the child is. Yes, I realize that an infant or young child doesn’t have decision making capacity, but that means they’re completely at the mercy or their parents’ ignorance and fears. It also reinforces this notion that children are property that parents own. But that’s another blog post.

But, since I have to respect patient choice and autonomy, I have to comply with the parent’s wishes, which brings to situation number two: I have to release a child into the world unprotected against wholly preventable diseases. It’s one thing for parents to have their own set of beliefs, but this push for autonomy over everything else means that suddenly I’m complicit in what’s essentially medical neglect; I’m aiding and abetting parents in the harming of their children by being forced to respect ignorance and misinformation. I don’t like that.

There’s a similar movement with regard to culture in medicine. We’re taught to try and deliver care within the context of the patient’s cultural beliefs. Well, what if their cultural beliefs about health don’t overlap with modern medicine? Letting people wander around thinking that their diabetes was caused by ‘the evil eye’ instead of insulin resistance caused by diet and obesity seems like a bad idea. Isn’t it unethical to let people go through life refusing evidence-based treatments due to some misguided attempt to respect a culture that doesn’t understand or value evidence-based science? Doesn’t that just propagate pseudoscience? Just look at this slide:


“Science is not the highest value to which all other orders of value should be subordinate.” I’m sorry but yes, science should sometimes overrule values. Sometimes the objective really is better than the subjective. The subjective does not need to be protected if it means objective harm is caused simply to maintain some kind of equivalency.  To use a non-medical example here, think of climate change. I don’t care if you think God won’t flood the world again because he promised Noah that he wouldn’t, because that belief doesn’t mesh with objective observations of reality, and thinking that can lead to catastrophic harm for millions of people. Is respecting subjective values really worth losing lives?

In some respect, I see this as an extension of the overly-PC culture we live in. Except that unlike an issue of free speech, where nobody is physically hurt by banning a Halloween costume or renaming a sports team, people really are physically harmed when we compromise care so as not to offend people.

In the end, this really boils down to two classic ethical dilemmas:

  1. Individual rights vs the collective good,
  2. Do your individual rights trump someone else’s individual rights?

I’m personally of the school of thought that in the first scenario, the collective good always outweighs the rights of the individual. The second situation is more tricky. In a situation where there are two parties, how do you decide if one person’s rights are more important than another’s? Think of the medical care of children: is the parent’s right to believe what they want and determine their child’s healthcare equal to or greater than the child’s right to health? Courts would say no, as they’ve ruled in the past that the right of a child to health is greater than a parent’s right to religious or philosophical beliefs.

Yet somehow the conversation in medicine (and science in general) seems to be taking the opposite approach frequently. I’m not arguing that we should be allowed to refuse care to someone simply for believing something different than us or because we don’t agree with them. Not in the slightest, as that comes with it’s own ethical consequences. But there does seem to be an ethical disconnect here. I don’t really know what the solution to that disconnect is, but I think it’s a conversation that medicine needs to have instead of being swept up in identity politics.

The new GOP “healthcare” plan

In case you missed it, republicans are back with a re-vamped version of their failed ACA repeal. The new American Healthcare Act (AHCA) is somehow even worse than before after a new amendment was added by Representative Tom MacArthur (R-NJ). The problem with the last bill was that it apparently didn’t screw enough people over, so the “freedom caucus” (hint: the freedom they want is the freedom for you to die destitute) lifted their noses in disgust and said no. The new amendment by MacArthur aims to bring those ultra-conservative members of the freedom caucus over to their side. How does this amendment do this, you ask?

I am so glad you asked. Here’s a copy of the actual amendment to the bill. The proposed changes are many, but I’d like to focus on one specific part which I think illustrates why this bill isn’t really a healthcare bill at all. One of the main focuses of this amendment is eliminating the mandate that insurance plans offer certain “essential health benefits” as outlined by the ACA. Here’s the actual text of the amendment:

(B) In the case of plan years beginning 2 on or after January 1, 2020, for health insurance coverage offered in the individual or small  group market in such State, to apply, subject to paragraph (5), instead of the essential health benefits specified under subsection (b) of section 1302 of the Patient Protection and Affordable Care Act, essential health benefits as specified by the State.

“Essential health benefits” are things that, by law, insurance is currently REQUIRED to cover. So, what kind of things did the ACA define as “essential” to your heathcare plan?

  1. Ambulatory services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative services
  8. Laboratory services
  9. Preventive services and chronic disease management
  10. Pediatric care, including oral and vision screening

Right off the bat, we can see some major hypocrisy here. I find it truly insulting that the party that claims to be about “family values” and touts how “pro-life” it is says you don’t need newborn care, maternity care, and screw your children’s pediatric care. They don’t give a fuck if your child’s teeth rot out or he can’t get glasses.

Second, whenever the issue of gun control comes up, republicans are the first people to shout, “It’s not a gun problem, it’s a mental health problem!” So naturally their healthcare plan would allow insurance companies to drop mental health coverage.

Third, and also just as disgusting: Trump campaigned on the opiate epidemic. Remember that? He talked about how it’s a tragedy and he feels their pain. So of course now they can just take the whole substance abuse treatment part out of your plan.

So how does this save you money? Well, let’s say your insurance company says, “Sure, we can provide all ten of those benefits for $500/month. But what if we lobbied the state, and now your plan looks like this…”

  1. Ambulatory services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative services
  8. Laboratory services
  9. Preventive services and chronic disease management
  10. Pediatric care, including oral and vision screening

“There. We’ll just provide you with those 4 benefits. You won’t need to visit the hospital, right? And you didn’t want drug coverage, did you? And forget preventive care–you don’t need to waste your money on avoiding illness. If we take all of those things out, we can give you a plan for $50/month.”

The problem with this amendment is that it allows states and insurance companies to decide what’s essential, and let’s them pare down the plans they offer to the point that you aren’t even really receiving healthcare anymore. Of course healthcare will be cheaper if nobody is actually offering you healthcare.

It saves you money in the same way that selling a car without windows, doors,  mirrors, seat belts, airbags, a back seat, and brakes would save you money on a vehicle.

Of course none of this is an issue if you’re rich. If you’re wealthy, you can afford everything that’s essential. But if you’re poor? Screw you, you have to pick and choose from bare-minimum plans that don’t cover everything necessary to keep you healthy.

If you’re middle or lower class, here’s your GOP healthcare plan:


Why do people believe conspiracy theories?

Consider this a companion piece to my last bit on flat earth ‘theories’ (and I use that term very loosely). The idea of a flat earth relies exclusively upon belief in conspiracy, that NASA and countless scientists are not only wrong, but they’re actively lying to you. You’ll see stuff like this all over Facebook, Instagram, etc:


Of course the interesting thing about memes like these is that there’s never a reason given for why NASA and the media would perpetrate such a massive hoax. We can assume that anyone who develops and perpetuates a conspiracy is doing it for some reason. Perhaps unsurprisingly, there is rarely a motivation provided for these conspiracies. We’ll see why that’s not problematic for the believer in a moment.

Of course, the flat earth isn’t the only conspiracy out there. Climate change, vaccines, 9/11, cures for cancer or AIDS, weather control–take your pick. There are people out there who believe it and who disseminate that belief online via social media. The weather control one was a particularly new one for me, but I’ve seen it making the rounds lately:

Haap Patent Weather Modification Chemtails EMF

Well, at least here we have a motivation: military power. However, why would a secret government organization file a public patent for a top-secret weapon? That doesn’t make much sense, does it?

Whenever I look at these kinds of conspiracies, I’m struck by one common thread: they contradict themselves at an incredibly basic level. They set up these shadowy corporations or institutions as entities that are simultaneously both immensely powerful and yet completely incompetent. Take the HAARP example. Here we have a secretive government organization that has all this power and money and knowledge–they can even control the weather!–yet they’re so stupid that they file public patents, let photos of their devices leak onto the internet, etc.

None of that matters to the conspiracy theorist, because these conspiracy theories aren’t meant to appeal to a sense of reason or logic. That’s why they never provide evidence and they rarely provide a motivation. None of that matters, because conspiracy theories are designed to do one thing:

Mollify a perceived lack of control in the believer.  

But don’t take my word for it. There’s been research into why people believe conspiracy theories. This article from Psychology Today has some real gems in it for explaining the conspiracy theory phenomenon:

“Melley proposes that conspiracy thinking arises from a combination of two factors, when someone: 1) holds strong individualist values and 2) lacks a sense of control. The first attribute refers to people who care deeply about an individual’s right to make their own choices and direct their own lives without interference or obligations to a larger system (like the government). But combine this with a sense of powerlessness in one’s own life, and you get what Melley calls agency panic, “intense anxiety about an apparent loss of autonomy” to outside forces or regulators.”

To me, this makes perfect sense. When someone who values their independence see a lack of control or an erosion of that independence in their own life, they manufacture a scapegoat in these conspiracy theories. Research by psychologist Jean Twenge provides some empirical data for this:

“Twenge’s research examines how Americans’ personality traits have been changing over the past several decades, from the 1960s through the end of the century, looking at the personality scores for each year. For example, she finds that trait anxiety (or neuroticism) has been rising dramatically in both children and adults over this period. […] In another study, she shows that people have come to hold an increasingly stronger external “locus of control”; this refers to the feeling that external forces are determining what happens to you, as opposed to an internal locus of control, the feeling that you dictate your own outcomes. […] Individualistic values have also been getting stronger in our culture, with greater importance attached to personal freedoms and self-reliance. […] The rise in anxiety, individualism, and external locus of control may therefore underlie the rise in conspiracy thinking. This is somewhat troubling because these personality trends show no sign of leveling off. In fact, given the current pace of globalization and the “Americanization” of other countries, it seems likely that these personality traits (and conspiracy thinking) will be increasing elsewhere too.

That seems like a succinct and accurate representation of the people who I know that believe in conspiracies. In my last post, I featured a screenshot of a conversation on Instagram. Let’s take a look at it again:


The bit about density is still circled, but this time let’s examine some of the other comments on the thread, starting with the one from mitch_and_tammy: “Who gives a fuck if the earth is flat or round. Either way, I’m still a middle class slave!” This comment doesn’t really tell us if this person believes that the earth is flat. But it does show a predisposition toward not questioning the conspiracy because of a perceived lack of power and control.

Then there’s the comment from bitabites: “I KNOW it looks flat I know about operation paperclip. I know not to trust anyone so I know not to believe anything…” I’m not quite sure what operation paperclip has to do with the flat earth. Nevertheless, let’s examine the other language. This person exhibits a high degree of individualistic values, with much emphasis on “I,” on what the individual “knows.” There’s a strong distrust of that external locus of control– nobody is to be trusted and nothing is to believed.

These two individuals, particularly the second one, exhibit the kind of anxiety and paranoia that psychologists commonly ascribe to conspiracy theorists. Their belief in a flat earth, therefore, are unsurprising.

It’s also unsurprising, therefore, that scientifically trained or inclined people seem less likely to believe in conspiracies. Science relies almost exclusively upon external loci of control–we need other scientists to independently confirm or refute our findings. And because science is a genuinely collaborative effort, there’s less emphasis on “I” and more emphasis on “we.” Science isn’t about the individual, it’s about the scientific community as a whole. Science as a collective body also tends to work toward the same goal, with mutual cooperation and respect. In short, science empowers people, groups of people, whole scientific communities.

So, what do we do to combat this? Well, from the research that’s been done the first and most obvious thing is to make individuals feel more empowered. We can do that on a political, social, and economic level. We can correct the massive income and wealth inequality that exists in this country for starters. We can stop moneyed interests and corporate lobbyists from influencing our political system. Those are probably the biggest causes of anxiety we currently face.

But we also have to do a better job educating people. Basic scientific understanding is floundering in this country. People don’t know how science works, and more importantly don’t know how to critically evaluate evidence or anything they read and see. Sadly, science has become one of those external loci of control, the “other” that’s trying to suppress you. Of course that’s farthest from the truth, but it’s the outcome of a society that doesn’t understand science and feels large amounts of anxiety and paranoia–we have a tendency to fear what we do not understand.

We in the scientific community need to do a better job of engaging with these conspiracy theories and their believers. If people feel a lack of control in their lives, what they really need is power. And I would argue that science is the ultimate provider of knowledge.

How to end the flat earth argument

Apparently people still think that the earth is flat despite an overwhelming amount of evidence to the contrary. This stuff is all over social media, and it infuriates me to no end because we’ve known that the earth was a sphere for thousands of years, and if ancient man could figure that shit out then I would expect that someone who has access to satellite photography would also be able to figure it out. But alas, people are ignorant as fuck and thus we have the flat earth theory. Everyone’s favorite astrophysicist, Neil deGrasse Tyson, recently had to respond to an NBA star commenting that the earth is flat.

I had an exchange with someone on Instagram earlier today. Someone I follow posted something showing how the earth was curved, not flat. Well, cue the “woke” enlightened folk. So I asked how a flat planet could form in the presence of gravity. Well, apparently gravity is also a conspiracy. Here’s the response I got:


See, guys, there’s no such thing as gravity because density! Duh. And no, I’m not blurring anyone’s name out on here because if you’re stupid enough to think the earth is flat and gravity isn’t real you deserve to be called out. And yes, I also realize that you all have my Instagram handle now.

But here’s why I asked about gravity.

I wanted to think of a proof or a thought experiment I could give a flat earther to get them to realize that they’re wrong. And I think I came up with one. And it all hinges on gravity. In order for a flat planet to form, gravity either 1) needs to not exist, or 2) not behave according to our current models. My response to good ol’ Jonathan there was this:

“There’s a very easy way to prove whether or not gravity is real. Pick an object, any old object will do. Next, find a place you can drop it from–a second story window, a tree, a rooftop–it doesn’t matter. Now, if you know the mass of the object and the height from which you’re dropping it from, then it’s a matter of simple math. Calculate the time it would take the object to reach the ground 1) by using the standard model of gravity and the equation time = √(2d/g) and 2) by substituting the value of g for literally anything else–like the formula for density. Then drop the object and compare the times to those given by your two equations.”

That’s really something any middle school student should be able to do. The response I got?

…total crickets. Nobody had a response. None of the flat earth geniuses, to nobody’s surprise, derived a new form of math to describe acceleration and motion that didn’t use gravity.

Because you can believe that the government lies to us about the shape of the earth and the ISS and moon landing are faked by NASA, but there’s one thing that doesn’t lie–GODDAMN MATH.

But just the fact that this needs to be explained to people is incredibly disheartening. It speaks to a broken education system. It speaks to a culture steeped in paranoia. It speaks to a political system wherein people are encouraged to openly deny evidence. People are so quick to latch onto conspiracy, but they can’t see that the way to to truly keep someone ignorant is to make them question observable, measurable, testable, repeatable evidence. THAT’S how you keep someone in ignorance. And the fact that this is happening speaks volumes about our social and political state.

So if you ever run into a flat earther, give them this proof and see what happens. My guess it that cognitive dissonance will be so great that their head will explode.

Democratizing the workplace

I came across this article from the BBC the other day and it absolutely fascinated me. The article focuses on a Swedish software firm , Crisp, and their rather innovative approach to how their business is structured.

Crisp doesn’t have a CEO.

Yassal Sundman, a developer at the firm, explains: “We said, ‘what if we had nobody as our next CEO – what would that look like?’ And then we went through an exercise and listed down the things that the CEO does.” The staff decided that many of the chief executive’s responsibilities overlapped with those of the board, while other roles could be shared among other employees. “When we looked at it we had nothing left in the CEO column, and we said, ‘all right, why don’t we try it out?'” says Ms Sundman.

This is something that I have long suspected about the business world–that in many cases, the boss is completely superfluous. More on that in a bit. So what does a workplace without a designated leader look like?

Crisp holds four-day meetings for all staff two to three times a year. They are used to making decisions on issues that affect everyone, such as an office move, but workers are encouraged to make decisions themselves at other times. It also still has a board – a legal requirement – and this can be used as a last resort to resolve issues if something is not working.

Imagine that, the people who are actually doing the work are making the decisions! Together!

Henrik Kniberg, an organisational coach at the firm, argues that not having to ask a boss for decisions on projects or budgets means the firm can respond faster. “If you want to get something done, you stand up and start driving that,” he says. Yet Mr Kniberg stresses that not having to ask permission does not remove the need for staff to discuss issues or bounce ideas off each other. Because they are all in charge, workers are more motivated, he argues. Crisp regularly measures staff satisfaction, and the average is about 4.1 out of five.

Who would have guessed that giving the worker bees more freedom and self-determination would lead to a happier and more agile workforce? Truly shocking.

What I like about this article is that, for me at least, it dispels some long held myths that people have about business that they apply to their politics. There’s this idea that business is always better at everything than government. I’ve said for years that this patently false for a variety of reasons, but I think this article really drive home on central point:

Businesses can be just as bloated, top-heavy, and overly-administrative as the worst government you can think of. The equivalent of bureaucracy is alive and well in the private sector, and it’s just as detrimental.

I’m not sure how many presidents, vice presidents, junior vice presidents, CFOs and CEOs a company needs, but I’m willing to bet that, as this article from the BBC suggests, the answer is probably “None of them.”

The average CEO in 2014 made $22.6 million dollars per year. That’s a pretty tidy sum for a position, that, if Crisp’s example is any indication of, is essentially worthless. What’s more, that year CEO salaries increased almost 9%–way ahead of the 2.4% that the rest of the economy grew. And a 2000 study found that performance is a weak indicator of CEO compensation. The best predictor of CEO salary was the size of the company–no matter how terrible of a job they did. I’m sure everyone remembers all of those Wall St. folks that gave themselves huge bonuses after they collapsed the economy? The numbers are all here for you to take a look at.

And then there’s the lovely ‘golden parachute’ that we all hear about so much, which sounds like something Donald Trump would pay Russian hookers for, but is really just a giant check they give the top brass upon retirement. Here’s a list of the top 20 golden parachutes according to Bloomberg. I’ll recreate the top five for you here:

  1. Steve Wynn (Wynn Resorts): $358,134,747
  2. David Simon (Simon Property Group): $302,425,834
  3. John Hammergren (McKesson): $198,150,788
  4. David Zaslav (Discovery Communications): $161,119,864
  5. Brent Saunders (Allergan): $140,672,343

Man, what a great deal: getting paid tens of millions of dollars a year no matter how poorly you perform…and then they give you HUNDREDS OF MILLIONS when you retire!

What a fucking joke.

How many billions of dollars are wasted every year on executives that don’t do shit? Billions that could be reinvested in the company or the employees. While everyone else’s hours and benefits are slashed because of taxes or Obamacare or whatever bullshit line they throw out, the CEO gets to retire with hundreds of millions of dollars in his pocket. Notice how it’s never the top earners that are asked to tighten their belts during the lean times?


But why is it this bad? How do these salaries get set? Well, in many companies, executive compensation is set by the board of directors. And who’s on the board? You guessed it–all of the executives. Executive salaries are out of control and keep going up despite poor job performance because they’re the ones giving themselves the raises and the golden parachutes. Pretty convenient, huh? This article in Forbes covers some of the insane catch-22s that allow this kind of unfettered greed and inefficiency to continue.

And then people wonder why a candidate like Bernie Sanders is so popular with people. Because people are tired of being bullshitted by business leaders and conservative politicians about how dire everything is while they keep making more and more money. They tell us all that they’ll need to get rid of social security and medicare while lowering the tax rates on the guy who just made $358,134,747 simply for retiring.

Because for all the ways they paint the private sector as noble, something for government to aspire to, the same bullshit happens there, too. The same bloating, the same excess, the same waste, the same frivolity. The same lack of accountability for the people at the top. Human greed and ignorance permeates all aspects of society, something that is often lost on conservatives. 

But it doesn’t have to be that way. Companies like Crisp are showing that. They’re just starting to show that there’s a different way to do things. You can essentially democratize the workplace–give the employees the reigns. Give the employees more of a stake in things. Give the employees the freedom they don’t get with a top-down organizational structure.

Because the same is is true in the workplace as it is in politics: the people have the power. Unions used to be how workers flexed that muscle. And then the bullshit started. “Well, you know, those unions, they just ensure that bad workers can’t be fired.” You hear this bullshit all the time, like with teachers. The teachers union just protects bad teachers!

An argument that seems especially ironic given that of the top 25 paid CEOs in ANY GIVEN YEAR from 1993-2012, one quarter of them worked for firms that took federal bailout money. In other words, these incompetent assholes fucked up, then used your tax money to stay in business and continue to give themselves a massive raise and an even more massive golden parachute. But hey, it’s the unions that are greedy, right?

It’s all bullshit, folks. Did you know that there are countries that don’t have a minimum wage? Doesn’t the sounds like a conservative republican’s idea of paradise!? Well, not so fast. Places like Iceland and Sweden have no minimum wage because workers have the right to collectively bargain. A lot of those evil socialist countries follow that model.

Oh, I get it: when the CEO gets to determine their own outrageous salary, it’s capitalism and moxie, but when the workers try to have a say in how much they’re paid it’s evil socialism. Again, how convenient.

So the next time someone tries to tell you that the government is wasteful and stupid, count for them the many ways the the private sector is also full of corrupt hypocrites.


What happened to those bootstraps?

Does anyone else find it supremely ironic that republican and conservative voters elected Donald Trump on the promise that his government would bring jobs back? Because I certainly find this sentiment to be the epitome of hypocrisy.

For decades now, all we’ve heard from the GOP and other conservatives is that the government is horrible and meddlesome, and everything would be better if there was less government interference and everyone took more personal responsibility for their lives.

Conservatives 2008/2012: “The government just makes things worse. Get rid of the government and everything will be fine–it’s not the function of government to create jobs, you libtards.”


It’s galling to me that the party of moxie and rugged individualism is now the party that applauds a government that directly gets involved in business and trade negotiations–the very things conservatives were crying the government should stay out of for the past 30 years.

How many times have we seen conservative politicians and voters say the following about welfare or the minimum wage: “We don’t believe in handouts. If you want to make more money, improve your situation, work harder, etc. Pull yourself up by your bootstraps like a real American.”

Well apparently conservatives in 2016 have thrown out their old bootstraps.

This article on CNN interviews people in a Kentucky town, “the poorest city in America,” that overwhelmingly voted for Donald Trump. Here are some snippets:

Beattyville residents want jobs, especially ones that pay more than the minimum wage of $7.25 an hour. They think if anyone can bring jobs back, it’s Trump.

Yeah, of course. The guy whose Trump brand suits and ties are made in Chinese factories is going to bring your job back. The same guy who immediately nominated the CEO of a fast food company who hates the minimum wage, Andy Puzder, as labor secretary.

Here’s what one of the men Kentucky elected to the senate, Mitch McConnell, had to say about the minimum wage: He cited a Congressional Budget Office study that he claimed said raising the minimum wage to $10.10 an hour would “destroy half a million to 1 million jobs. […] That’s not the way to grow our economy,” he added.

And here’s what Kentucky’s other senator, Rand Paul, had to say about raising the minimum wage: ‘The minimum wage is a temporary’ thing, Paul said. ‘It’s a chance to get started. I see my son come home with his tips. And he’s got cash in his hand and he’s proud of himself. I don’t want him to stop there. But he’s working and he’s understanding the value of work. We shouldn’t disparage that.’”

Good luck getting jobs that pay beyond the minimum wage, Beattyville. You elected people who propose the very opposite of that, who think, in Paul’s case, that trying to raise a family on a minimum wage job is great because it’ll build your character and teach you the value of hard work!

“If you got a job here in Beattyville, you’re lucky,” says Amber Hayes, a bubbly 25-year-old mom of two, who also voted for Trump. She works at the county courthouse, but is paid by the Kentucky Transitional Assistance Program (K-TAP), a form of welfare.
The vast majority of Beattyville residents get some form of government aid — 57% of households receive food stamps and 58% get disability payments from Social Security.

But I thought that welfare was just for the takers? Isn’t that what all the conservative politicians campaign on? Haven’t we all heard some iteration of that from conservative friends and relatives? Isn’t that what Mitt Romney said just 4 years ago, that 47% of the country votes to just get free stuff?

Here’s what Kentucky’s own Mitch McConnell said about food stamps as recently as last September: Asked about the improving economy, McConnell scoffed: Business leaders tell him they have “a hard time finding people to do the work because they’re doing too good with food stamps, Social Security and all the rest.”


Residents of Beatyville would apparently beg to differ with Mr. McConnell.

From the outside, it’s easy to wonder why people in Beattyville don’t just move somewhere else. But out of all the people CNNMoney met in Beattyville, only one wanted to leave. The rest are drawn to the beauty of the place and the friendly community. “I’m country to the core,” laughs Puckett. He husband of 39 years nods beside her. Judge executive Mays puts it this way: “We’re perceived as a hillbilly, backwoods, all this and that. But we’re a good people.”

Again, whatever happened to those bootstraps, hmm? That’s what Paul Ryan or Rand Paul would tell you to do–work to improve your own situation and don’t depend on the government to save you. If you lose your job, find another, even if it means moving. Retrain yourself. Oh, you can’t pay for that? Well, you just need more gumption and definitely less of that darned government in your life, always making things worse.

Look, I have lots of sympathy for the people of Beatyville. They’re certainly in a bad place. Yet at the same time, they and the rest of their state have repeatedly voted for people who have told them that the government will make their life worse. That getting rid of food stamps will create an incentive for people to get a real job. That social security and medicaid should be cut or outright privatized. That the problem with America in general is too much reliance on the government.

In the end, Beatyville and other red cities in red states that are suffering are the victims of their own voting. It’s particularly tragic that they now expect the same government that believes that the government shouldn’t be engaged in safety net programs or other forms of public assistance to save them. If the democrats were smart, they’d get out grassroots campaigns to go to towns like Beatyville and help explain this to residents.


I guess we’ll see what happens in 2018.

Litigation nation

Liability. It’s fancy legal talk for “Whose at fault?” Blame is big in our culture when something goes wrong, and we’ve taken to using the legal system as a way of obtaining closure.

Case in point: I recently came across this story about a family in Texas who is suing Apple because a driver who struck their car, killing their daughter, was using FaceTime at the time of the accident. In their lawsuit, the couple alleges that it was incumbent upon Apple to warn everyone that their app could be dangerous when misused, and that they should have designed a safer app.

Folks who read this blog know that I’m not usually a fan of corporations, but I have to side with Apple here. It’s unreasonable, both in legal terms and in common sense, to expect a company to clairvoyantly predict all the ways in which a product can be misused or abused. And speaking of common sense, it should be painfully obvious to everyone that a video chatting app shouldn’t be used while driving.

There is definitely someone at fault here, but it isn’t Apple. It’s the man who was driving the car that hit them. He’s the one at fault because he’s the one who made the decision to use the app while driving. It was his actions that lead to the accident, not Apple’s.

What this appears to be is simply a grab for money. Why else sue Apple instead of, you know, the man who killed your daughter? Probably because the guy who hit your car isn’t worth billions of dollars. But more importantly, suing Apple doesn’t speak to justice–turning tragedy into financial gain is not justice.

But this case brings to light several important questions.

First, should companies be held responsible when their products are used incorrectly or abused? The answer to that, I should think, is a resounding NO. There was a similar debate about this issue during the democratic primary. Hillary Clinton supported a law that held gun manufacturers liable for incidents involving their products. Bernie Sanders did not support such legislation. I have to side with Bernie on this one (shocking, I know, me agreeing with Bernie). The fact that someone used a gun to commit a murder isn’t the manufacturers fault; that individual chose to use a gun for murder instead of self-defense or sport.

Where would this sort of thing end, holding manufacturer’s liable for the actions of individuals who use their products? Suing the brewery for a drunk driving accident? Suing the waitress who served the alcohol? Charging the gun shop owner who sold the weapon used in a crime as an accomplice or an accessory? Holding manufacturers liable is a very, very dangerous precedent.

Second, are companies obligated to warn people about the potential dangers of their products? This is a slippery slope. How much hand-holding do we expect these companies to do? This is why we have labels that say things like, “Do not stick hand in while lawnmower is running” or “caution: this hot drink is hot.” At some point, individuals have to exercise common sense and personal responsibility.

The fact that we have to tell people this is sad

Third, is litigation the best way to get closure? Suing Apple isn’t going to bring the family’s daughter back. Even if they did win, say, a billion dollars, that still isn’t going to change the fact that their daughter died. But I think more importantly, we as a culture have to realize that getting money isn’t the same thing as grieving. We have a tendency in this country to throw money at problems.

But sometimes that simply doesn’t work. In the case of losing a loved one this is particularly true. Money does not replace loved ones and it isn’t a substitute for grief. Sorry. But I expect that our cultural solution to intense emotional angst would involve money somehow, because everything in this country revolves around money.

Perhaps what disturbs me the most about cases that seek to hold a manufacturer liable is that they absolve individuals of the need or expectation that they use common sense, critical thinking, and have a little personal responsibility for their actions. We’re becoming a nation where everything is always someone else’s fault, we’re never the ones in the wrong. We always try to point the finger at others when we screw up. “How was I supposed to know that my child could choke on tiny toy parts if he wasn’t supervised?! Give me money!” Maybe you could try, I don’t know, parenting your child. I don’t think it’s too much to expect people to know that hot coffee is hot or that you shouldn’t stick your hand in a lawnmower while it’s running. It’s dangerous to me to allow people to use the law to obviate their own lack of foresight, responsibility, or common sense.

Now, all of this doesn’t mean that people who experience what the family in that article went through don’t deserve closure. After all, the accident was not due to a lack of vigilance on their part; someone else’s poor choices directly affected them. But that person wasn’t Apple. It was the man driving the car. Who can and will be prosecuted for his crime–manslaughter. That’s where the legal system is supposed to provide closure to grieving people. In the fact that the person was caught, held responsible for their actions, and won’t be allowed to do it again. That they’ll be punished for their poor choices. That’s justice.