20 replies to this topic

[Lazarus Long]

I am going to post the is article from today's NY Times here as a starter and when someone finds the thread we set up to outline who, how, and why some authors are against longevity like Kass, Fukuyama, and others please merge the two and keep it here in Immortalist Memetics because we should have the cons as well as the pros under one section.

The following issue is at the heart of the coming debate and it outlines a broad area of debate focused upon the costs of specific treatments and more importantly, WHO is going to pay for them. In this case I feel that it is a little bit of a red herring because the cost of the treatment in question will come down as it is made more common and refined.

That said however, the basic point is still a powerful yet subtle aspect of the "cost of diminishing returns as it it applied to the devaluation of human life as we get older. This is an element of what I call Social Capitalism and should not be discounted be cause it overlaps into various areas like Social Security and questions of long term care etc. So rad it and realize that that we are about be to be attacked by the Left AND the Right.

LL/kxs

http://www.nytimes.c.../17LUNG.html?hp

New Therapies Pose Quandary for Medicare
By GINA KOLATA

The federal Medicare program is expected to decide this week whether to pay for an aggressive and expensive lung operation that could offer a lifeline to tens of thousands of elderly patients.

But health economists and medical experts say the treatment, however alluring, is part of an unsettling trend: new and ever pricier treatments for common medical conditions that are part and parcel of aging — procedures that could potentially benefit tens of thousands of patients, at a total cost that would far exceed the kind of prescription drug benefit now being considered by Congress.

The questions, these experts say, are how much Medicare can or should pay, and whether cost-effectiveness should enter into the decisions.

The procedure under consideration this week is an operation for people with severe emphysema, whose lungs are so scarred that they are constantly out of breath. In keeping with its policies, the government's Center for Medicare and Medicaid Services has consulted with medical experts and professional societies and says it expects to issue its decision as early as tomorrow.

The story of the operation, health economists say, is a case study of the troubling and thorny questions that Medicare administrators face as they try to live within the constraints of the $267.8 billion-a-year federal program.

Some say the operation can transform patients' lives.

"If your parents had this condition, you would seek this operation for them," said Dr. Joel Cooper, a lung surgeon at Washington University in St. Louis who developed the operation. Others point to a recent study indicating that its benefits are modest, at best.

But all agree that the patients are severely ill, with no other options. And all agree that the operation is expensive. A recent analysis showed that patients who had the operation had medical bills averaging nearly $63,000 the first year, compared with $13,000 for similar patients who had not had it.

Estimates of the number of potential patients vary from 1 percent to 15 percent of the nation's two million emphysema patients, or as many as 300,000 people, at a total cost of $1 billion to $15 billion.

For now, said Dr. Sean Tunis, the chief medical officer at the Center for Medicare and Medicaid Services, "nobody has a good estimate on how big this population of patients is."

Complicating the issue are other similarly expensive procedures that are on the horizon or have been approved recently. For example, Medicare is to decide next month on devices for patients with congestive heart failure, whose hearts are so damaged they can barely pump.

The devices, known as L.V.A.D.'s, for left ventricular assist devices, can help failing hearts pump. Dr. Annetine Gelijins and Dr. Alan Moscowitz of Columbia University, who did an economic analysis, said they expected about 5,000 Medicare patients a year to get the devices at first, but that as many as 60,000 have heart damage so severe that they might need them.

At $60,000 per device, and with an additional $150,000 in hospitalization charges, the price for L.V.A.D.'s could range from $1.05 billion to $12.6 billion a year.

A recent clinical trial involving very sick people indicated that the devices were effective. But Dr. Alan Garber, a physician and economist at Stanford University, said the question was not whether they worked.

"The big question is, `In whom else does it work?' " he said. "The people in the trial had extraordinarily severe congestive heart failure and were being kept alive in intensive care units. That's the tip of the iceberg in congestive heart failure."

"We seem to be getting new technologies that are effective for common conditions, like congestive heart failure, like emphysema," he went on. "If you are talking about a treatment for a rare genetic disorder that affected 500 or even 1,000 patients a year it would not make much difference. But in the case of L.V.A.D.'s, or with lung volume reduction surgery, the potential number who will get it is quite large so it will force the issue. How are we going to make it available to Medicare beneficiaries without wrecking the Medicare budget?"

Dr. Tunis, of the Medicare services center, says he understood that the costs of new technologies can be staggering. But he adds that cost has traditionally not been a consideration in deciding what to cover.

"If the technology was effective, we would find a way to pay for it," he said. "There is no dollar value per life per year at which Medicare would decline to pay."

But costs are mounting.

The agency just approved implantable defibrillators, which can shock a failing heart, preventing sudden death. They cost $30,000 per patient.

Medicare restricted the devices to patients with specific patterns of disease, denying payment for them to about half of the million or more patients who could benefit, according to a large study. But now it is under intense pressure from doctors, patients and professional societies to expand its coverage to all those who met the study's criteria.

Then there are coated stents, tiny cages coated with drugs to prop open arteries and prevent the blood vessels from closing again. Each costs $3,200, compared with about $1,000 for the older, uncoated stents.

The million patients a year who get stents typically get more than one, with some getting four or five, said Dr. David Hillis, an interventional cardiologist at the University of Texas Southwestern School of Medicine, who called the increased use of defibrillators and coated stents "a good way to bust the budget wide open."

Medical experts say that in addition to the legitimate costs of each of these procedures, they fear technology creep — an increasing use of expensive procedures to wider and wider groups of patients, many of whom may not benefit and may even be harmed.

"I think it is huge, I think it is pervasive. And it is a major driver in Medicare's cost growth," said Dr. Scott Ramsey, a health economist at the University of Washington who analyzed the cost of lung volume reduction surgery. "The reason Medicare is cutting payments to doctors is that its expenses for technology are expanding so fast."

The emphysema operation, lung volume reduction surgery, sneaked up on Medicare about a decade ago. Medicare never agreed to pay for the procedure. But unbeknownst to the agency, pay it did.

"None of the contractors in the Medicare system was aware that the operation was becoming more popular until it began being reported in journals," Dr. Tunis said.

In 1996, Medicare learned that it had paid for 3,000 patients and the numbers were growing fast. But there was a 17 percent mortality rate and no good evidence that the operation worked.

In response, the federal government started a clinical trial involving 1,218 patients. Medicare would pay for the operation only if patients participated in the trial, and if they joined the trial there was a 50 percent chance that they would be assigned to a control group that did not get the operation.

Dr. Tunis says the outcome of the trial will determine whether Medicare will cover the operation. But Dr. Ramsey, the University of Washington health economist, said the agency never stopped to consider "what would happen if the trial came out with uncertain results."

The data, published in May, were not quite the ringing endorsement that many had hoped for.

The study found a subgroup that seemed to benefit — patients with emphysema located mostly in the upper lobes of their lungs and little ability to exercise. They survived longer and could exercise more after they had the operation.

But that is not rigorous evidence, since any set of data will include small subgroups that benefit and others that are harmed. In evaluating trials of new drugs and procedures, the Food and Drug Administration does not accept such subgroup analyses, requiring a second trial for the subgroup that may benefit.

But a second trial of the lung operation is unlikely, many medical experts said. The first one was so controversial that some doctors would not participate, saying it would be unfair to their patients to deny them the surgery if they fell into the control group.

"We felt it was not possible for us to look a patient in the eye and say, `We honestly don't know whether you are better off with this operation or without it,' " said Dr. Cooper of Washington University. He encouraged his Medicare patients to sue. "I went to court 28 times and won 28 cases," he said.

While some, like Dr. Ramsey, say that the clinical trial's results were far from a ringing endorsement of the operation, many lung surgeons disagree, saying that for the 25 percent of patients in the subgroup, the operation was a huge success.

Dr. Barry Make, who directs the emphysema program at the National Jewish Medical and Research Center in Denver, was struck by the survival benefit in the subgroup. "That result is stupendous," Dr. Make said, adding that many patients also felt better.

Dr. Ramsey and others worry that if Medicare approves the operation for the restricted group of patients like those in the subgroup, technology creep may lead to many more having the surgery.

Seventy percent of the nation's estimated two million emphysema patients have upper lobe damage. How will Medicare know whether a particular patient also has poor exercise capacity?

Dr. Cooper says the solution is to restrict the operation to a few centers of excellence where experienced surgeons will assess patients and decide who should have the operation.

Dr. Tunis agreed but said there were limits to how much policing Medicare could do, or wanted to do.

"We don't have a direct way of enforcing compliance with coverage, particularly in patient selection criteria," he said. "It's sort of an honor system. But a lot of these patient characteristics are somewhat subjective or qualitative."

And that, says Dr. Garber, is almost guaranteed to lead to overuse.

There is pressure from patients, doctors and hospitals to cover expensive new procedures, even if their benefits are modest. And that is understandable, Dr. Garber said. "If you the patient are insulated against the cost consequences of your decision, why not get the latest and greatest?" But, he added, there is a price to be paid.

One solution would be to greatly increase Medicare's budget. But that would mean tax increases. Another would be for Medicare to consider cost-effectiveness, rather than just effectiveness. But, Dr. Tunis said, every time that has been proposed, the agency has had to back down.

"This is the fundamental problem hidden behind the broader discussions of health care reform," Dr. Tunis said. "At the end of the day, somebody has to make the decisions one at a time about what people are going to get. But the reality is that we can't afford to pay for absolutely everything that provides some benefit."

So, Dr. Garber said, "Medicare is in a bind."

"The real question," he said, is "how can we inform the public better that, when they want to have access to health care, someone will pay and it will be them?"

[AgentNyder]

Well it seems Medicare will go the way of the dinosaur one way or another...

[Lazarus Long]

I think this article deserves to be here and for a number of reasons. These are the folks we are in competition with and the level of investment they are seeking to protect is demonstrated by some of the photos in the article. If a small percentage of the wealth that is grotesquely invested here were diverted to our cause then major advances would likely be the result and from those advances fewer and fewer people would be needing their products.

On a second more subtle note a serious aspect of the article relates to WHY people are dying and why our society is perceived as grotesque in its opulent self indulgent wealth as well.

http://www.nytimes.c.../28FUNE.html?hp

On the Final Journey, One Size Doesn't Fit All
By WARREN ST. JOHN
Published: September 28, 2003

Perhaps nowhere is the issue of obesity in America more vividly illustrated than at Goliath Casket of Lynn, Ind., specialty manufacturers of oversize coffins.


Mpozi Mshale Tolbert for The New York Times
The owners of Goliath Casket, Julane and Keith Davis, with their 28-inch, 33-inch and newly introduced 49-inch wide coffins. Mrs. Davis sees it at Wal-Mart: "People are getting wider and they're getting thicker."

There one can see a triple-wide coffin — 44 inches across, compared with 24 inches for a standard model. With extra bracing, reinforced hinges and handles, the triple-wide is designed to handle 700 pounds without losing what the euphemism-happy funeral industry calls its "integrity."

When Keith and Julane Davis started Goliath Casket in the late 1980's, they sold just one triple-wide each year. But times, along with waistlines, have changed; the Davises now ship four or five triple-wide models a month, and sales at the company have been increasing around 20 percent annually. The Davises say they base their design specifications not on demographic studies so much as on simple observations of the world around them.

"It's just going to local restaurants or walking in a normal Wal-Mart," Mrs. Davis said. "People are getting wider and they're getting thicker."

Like the airline industry, which was warned in May that passengers were heavier than they used to be, and was asked to adjust weight estimates accordingly, the funeral industry is retooling to make room for ever-larger Americans. The Centers for Disease Control and Prevention estimates that 20 percent of American adults are obese, up from 12.5 percent in 1991. Of those 70 and older — the demographic that most interests the funeral industry — 17 percent are obese. Despite the numbers, nearly every aspect of the funeral industry, from the size of coffins to vaults, graves, hearses and even the standardized scoop on the front-end loaders that cemeteries use for grave-digging (it is called a "grave bucket") is based on outdated estimates about individual size.

"Many people in this country no longer fit in the standard-size casket," said David A. Hazelett, the president of Astral Industries, a coffin builder in Indiana. "The standard-size casket is meant to go in the standard-size vault, and the standard-size vault is meant to go into the standard-size cemetery plot. Everyone in the industry is aware of the problem."
{excerpts}

[Lazarus Long]

All right folks in your collectively informed, intelligent, and concerned opinion whose side are these types on?


Friday, 3 October, 2003, 08:48
Search on for 'suicide band'

Police in Florida are searching for a rock band who are planning to host a live suicide as part of a performance. Hell On Earth, a "death metal" band fronted by Billy Tourtelot, originally planned to help a terminally ill man commit suicide during a gig on Saturday in the city of St Petersburg. But the owner of the venue got cold feet and cancelled the gig, fearing members of the audience may carry out copycat suicides and he may be legally liable.

Mr Tourtelot vowed to go on with the performance and show it live on the band's website. He said the suicide was intended to raise awareness of the right to die. He said "a select few people" would attend the show at an undisclosed location in St Petersburg.

Mr Tourtelot has declined to name the person who wants to commit suicide.

May be an 'illusion'

On Thursday afternoon Judge John Lenderman granted St Petersburg City Council an emergency ordinance forbidding the band from going ahead with the performance, even if it was an "illusion".

Assistant City Attorney, Al Galbraith, said they tried to serve the ordinance on Mr Tourtelot but he had gone to ground.

Mr Galbraith told BBC News Online the city hired bailiffs to serve the injunction on him but have not yet been able to locate him.


Second volunteer

He said he understood that a second volunteer, from Seattle, Washington, had jumped on the bandwagon and planned to come to Florida to commit suicide as well. Mr Galbraith said: "We are not totally sure where the band is. We are trying to locate Mr Tourtelot.

"We had a lead this afternoon but either we missed him by 10 minutes or else it was the wrong person."

He said they were now hoping to get a tip-off about the band's whereabouts. Asked what would happen if the band went ahead with the suicide, Mr Galbraith said: "We may be able to press charges.

"They would be in contempt of the judge's order and the judge has a lot of discretion in that situation. He could jail them or fine them."

Mr Galbraith said he understood the band's website was not working but he denied they had asked the ISP to take it down. The band's stance was condemned as "horrifying" by a UK campaign group.

Julia Millington, of the ProLife Party, said: "It is absurd to equate death in such circumstances with the phrase 'dying with dignity'; it could hardly be less dignified.

"We cannot believe that fans would support this event, during which somebody will end his life. Has life become so cheap that people will actually watch someone die for entertainment?"

[David]

They're not on anybody's side, they're just trying to get ahead in what I believe to be an industry on the point of collapse. You have to hand it to this Billy guy though, his public profile at the moment is f'ing huge! I don't think Elvis would approve...

[imminstmorals]

Publicity appeal has lost its meaning becoz of liaring too much =D
There's internet, no one reads crappy newspaper and watching tele to get biased opinions =D, all reading science and computer mags LOL

[bacopa]

Lazarus these people are ill informed stupid people that simply don't really have a reason probably for even living. I wouldn't equate them to a "side" simply because I doubt they're even knowelgable about what they are doing! they are probably trying to be cool in some stupid way and faking suicide is the desired end.

[Lazarus Long]

Lazarus these people are ill informed stupid people that simply don't really have a reason probably for even living. I wouldn't equate them to a "side" simply because I doubt they're even knowledgeable about what they are doing! they are probably trying to be cool in some stupid way and faking suicide is the desired end.

Our true enemy is ignorance and the fools that protect such "beliefs" as if their right. I understand the true enemy to be the twisted heart of the majority if it is turned to destructive ends. The leaders are but the tools, the catalysts of such mass destruction; it is the people themselves that are the perpetrators. Look at war.

Look close into the eyes of the enemy and you will see ourselves reflected.

Rather than seek sacrifice and villains to be pilloried look instead to the the very process of vilification and understand that there are no innocents. I started this thread with a very logical and pragmatic debate that when followed to its conclusion goes well past euthanasia to genocide but no one identified that aspect. There are times we must learn to look past expediency to fundamental causality.

The same arguments being foisted on us by today's governments to protect the funding for modern medical care by restricting it from progressively more infirmed and elderly is frighteningly parallel to the Nazi's justification for the mass killing of the mentally handicapped and disabled persons in the holocaust.

A failing to understand history will get us all killed and those that seek immortality abrogate any privilege of innocence predicated on ignorance of history as excuse. Ever more so as they become the living memory of the masses.

[Lazarus Long]

BTW, the second example was a subtle multiple entendre, profiting from abuse, obesity as a practical excuse, and complacent acceptance as the final refuge of mass madness and negligent refusal to understand the Grim Reaper's sharpened tools.

The third example is more subtle and I will explain it as the pandering to sensational fads and the willingness to be satiated by the same lust for spectacle that drives religion, politics, sports, war, and mass media alike.

The last is the true wages of sin as the message is "to die for" and is a modern variant on human sacrifice as practiced by theocracy for eons. The audience is turned into glory seeking actors and the self sacrificing victims of their own beliefs, all while the majority stands by and wonders why, or a chosen few quietly take their cut of such blood money profit.

Complicity and complacency skip hand in hand on the path to oblivion leading fools like pied pipers lead children... to their deaths.

[Mind]

Well it seems Medicare will go the way of the dinosaur one way or another...

The quote of the day! I couldn't agree with you more Nyder. The more expensive the treatments covered by medicare the less people will want to support it. It is already dying under its own inefficiency. Politicians only keep it in play because they want power over the people.

[randolfe]

Flip dismissal of medicare would be a grave error. Medical treatments are goods and are in finite supply. Medicare is a public societal mechanism for the rationing that is mandated by demand outrunning supply.
Private wealth is the individual mechanism that also comes into play as a manner of rationing.
With medicare, everyone is entitled to everything. Since this is impossible, waiting lists for treatment are established. Private wealth empowers an indivual to escape rationing systems established by society.
A combination of both makes sense. As a member of society, you should be entitled to at least "the promise of treatment". As an achiever who has accumulated wealth, you should be able to use that reward (wealth) to see "the promise of treatment" is fulfilled more quickly.
This ensures social peace. The ideal is "medical treatment for all". This pacifies everyone. Meanwhile, wealth ensures the strongest and most productive get the benefit of earlier treatment.
If I needed a heart transplant, I'd at least want the "promise of treatment" even if I died waiting for it. Until therapeutic cloning unlocks the secret of cloning new heart cells for all, we'll have to live with this two-tier rationing.

[randolfe]

I think this article deserves to be here and for a number of reasons.  These are the folks we are in competition with ...

On a second more subtle note a serious aspect of the article relates to WHY people are dying and why our society is perceived as grotesque in its opulent self indulgent wealth as well.
(from NYT article):
Perhaps nowhere is the issue of obesity in America more vividly illustrated than at Goliath Casket of Lynn, Ind., specialty manufacturers of oversize coffins.

Lazarus, I have become a fan of most of your postings. However, you have hit a raw nerve with me this time. It just happens that I have this article clipped and on the table by my bed. That is because one of the most wonderful human beings I have ever known is a (i guess) 400 pound black woman, in her late 50s, virtually unable to walk and on disability from her job of thirty years as a public school cleaning woman.

I suspect I may have to buy a coffin for her. I suspect that will be "too soon".

What I really object to is your assumption that obesity is the product of wealth and over induldgence. I can understand why you made that mistake but you are "dead" (to use a politically incorrect word here) WRONG!!

A lot of obesity is caused not only by junk food but by poverty. Cheap pasta dinners, pancakes, etc. are cheap meals for the poor. I know because as child I remember having pancakes on Thursday nights. It was a way to cut the weekly food expenses.

So, you err in equating obesity with over-induldgence and wealth. I suspect that most of those who are truly obese are simply ignorant and poor.

Just for the record, I am a 65-year-old gay "honkie" (forgive the term) without any family nearby. Every Thanksgiving (and Christmas and Easter if I am up to it) me and "mine" (any friends I want to bring) are invited to a wonderful woman's home in Elizabeth, NJ. I always go and pig out (there goes the diet) and come home with platters of sumptous home-cooked food. Every "honkie" should be so lucky.

[Lazarus Long]

What I really object to is your assumption that obesity is the product of wealth and over indulgence. I can understand why you made that mistake but you are "dead" (to use a politically incorrect word here) WRONG!!

Not the cause but a cause. Listen we are driven by evolutionary biology and psychology to store fat, and feel ready to face feast cycling with famine but the famine ain't here anymore. Wealth feeds literally into this both for some individuals and for societies historically. This is not an accident or simply a question of genes, it is the associated behavior that is instigated by genetic driven desire, among many other reasons as well. A person can reach obesity by many contributing causal routes.

It is not the only reason but it sadly is a part.

I am not dead wrong and I apologize if the reference offends but it is an aspect of affluence in our culture, not merely individuals. But we are not by any means the first culture historically to respond thus. We waste and we over eat to satiate, our glands and to satiate our souls. It is vestigial instinct from evolution.

It certainly isn't just about politics but if the whole idea of affluence as addictive is a startling one is because it address issues of wealth, well what a surprise?

The aspects have overlapped like gout and diet. My point is that we must see past mere politics and class issue past the stereotyping, even evolutionary stereotyping but gene work in many different ways but in respect to behavior this is subtle in humans, we barely want to admit instinct anymore in cognitive psych since it is Politically Incorrect science, this is how the lines are drawn and crossed. Like argument on Social Darwinism.

Anyway you cut it as a species humans have a very varied pallet and they fill every way that works. Once there is secure and sufficient food supply the instinct still works psycho biologically as a reaction to stress. As part of any number of different stimuli actuate the lizard brain, it becomes a dominant operative. It doesn't need to react to an ancient feast famine cycle that we evolved through.

This is one way Evolutionary Biology and Psychology come together, let us begin to face ourselves more plainly; this is just not the only way. Food is fuel and fuel is power.

Nothing I have said contradicts what you say here:

A lot of obesity is caused not only by junk food but by poverty. Cheap pasta dinners, pancakes, etc. are cheap meals for the poor. I know because as child I remember having pancakes on Thursday nights. It was a way to cut the weekly food expenses.

So, you err in equating obesity with over-indulgence and wealth. I suspect that most of those who are truly obese are simply ignorant and poor.

These are separate and contributory aspects of the integration of wealth, resources, and distribution with consumption. Aspects of class separately influences choice but also it is the result of how marketing sells an idea.

Madison avenue sells junk food to your fat junkie gene. This isn't some horrific scheme of class warfare either. It is just good marketing to provide pragmatically to the emotions synergistic to many aspects of stress and pleasure, this too "feeds into OCD". Don't blame our ancestors for building markets around what they like and need. They built markets to trade in, not kill one another in. They built them around demand.

Ironic how we are behaving in a growing large scale sociopsychopatic manner because these individual instincts manifest on a "popular scale" and influence large scale cultural interaction when resource distribution is at the core of choice. Maybe affluence doesn't make OCD directly but it sure contributes to its ability to indulge. The trash food is trash because its cheaper to manufacture and distribute too.

I meant nothing personal and if I still offend I am sorry but I must address this issue in my life and am at my wits end with a family member. She blames genes too, and everyone that gave them to her. But I am also trying to get to the core aspects of the problem, not find pretext for blame.

[Bruce Klein]

Within this decade, I predict the invention of an effective diet solution.

Likely by way of digestible pill tailored for each individual to suppress food cravings from within the brain. Just a hunch. We're rapidly advancing in the biosciences and the incentive to find a solution is tremendous.

Hopefully the above tit for tat will seem barbaric soon.

Anyone who wants to alter their body, should be able to do so.

[Lazarus Long]

Hopefully the above tit for tat will seem barbaric soon. 

This was a very reasonable concern raised by Randolfe. I was trying to address it directly, not skirt around it or or make light of it. He is bringing up issues that are "sensitive" precisely because they overlap our many still existing "basic instincts", these instincts influence our psychology, and the individual reflex responses influence mass behavior, particularly as a consequence of large scale choices being made in ever more affluent democratic society.

It isn't just about a cure for obesity, it is about why we think we can cure any ill with a pill. Tweaking the gene to influence each single issue may be possible but as we come to micromanage evolution and clearly have adopted Human Selection as a paradigm, we have done so in a reactionary ad hoc manner rather than by open analysis and comprehension of what "ails us, and why".

I did not feel it was "tit for tat," and I hope randolfe didn't either. His concerns are valid. And Human Selection isn't a single issue with one set of proffered paradigms it is a still evolving set of behaviors that we are in the forefront of establishing.

Within this decade, I predict the invention of an effective diet solution.

Likely by way of digestible pill tailored for each individual to suppress food cravings from within the brain. Just a hunch. We're rapidly advancing in the biosciences and the incentive to find a solution is tremendous.

We are approaching crisis socially because we do have a very emotional component for "human(e)" decision making. We are emotional creatures and for many that is a good thing.

I value emotion, I suspect randolfe does as well, but sooner or later we are going to buy our feelings in a pill and then how real are they?

And if I sell enough pills for a particular set of responses then how real is the social response and how easily controlled?

I look at obesity not as just an individual issue but one that reflects "Social Issues" as it is a problem of the body politic not merely individual's body's. This two sided aspect is not coincidence, what I am suggesting is that there is a disturbing overlap of causal aspects, and not one with specific good guys and bad guys but one where we should take a long hard look at how these processes are interwoven in the fabric we call society.

My initial post on obesity was to point to subtle elements of this and the reality check that being obese is a killer, a killer threatening many we love more and more everyday.

[Bruce Klein]

I value emotion, I suspect randolfe does as well, but sooner or later we are going to buy our feelings in a pill and then how real are they?

I think we already do in the form of Prozac.. and I think the benefits are worth the risks. We already live in an 'artificial' world.. no turning back now.

[Lazarus Long]

think we already do in the form of Prozac.. and I think the benefits are worth the risks. We already live in an 'artificial' world.. no turning back now. 

That is not the issue if the result is one of unintended consequences not foreseen and not outweighing the benefits. I am not advocating "going back anywhere" I am advocating going forward knowingly not through a denial of how we are altering our conscience and making ourselves more easily manipulated en-mass.

There is a direct correlation I am suggesting between trying to fix emotional issues with pills, while ignoring situational problems and the Social Scale OCD that leads to oversize population as both numbers and individual obesity, also leads to large scale suppressed anxiety that manifests as war when trigger stimuli like 9/11 induce a large scale reflexive sense of threat to the "socioeconomic food chain".

The same kind of socio-psychological threat the other sides feels from their perspectives. Cultures are not treatable with Prozac, but as we alter the general conscience of the membership of culture we are essentially treating the culture. For this component to work in a healthy manner requires a volitional and educational component involved in the process as well as demonstrating a "will" (collectively and individually) to succeed.

To define success however is predicated on recognizable goals.

[Lazarus Long]

The point is BTW, about knowing your opponents that one of the opponents may be instinct within ourselves and how we manifest this as a species collectively.

Another was the idea of this opponent resulting in large scale social resistance to change or indulgence in counterproductive destructive behaviors motivated by instinctual reaction to genetic induced fear.

It is how these collective individualized responses manifest and morph into a political process by reflecting desire turned to demand, that unchecked is an obession that decays into compulsion resulting in oppression and excess.

Motivation is still pragmatically at the heart of not just individual human reasoning, but the collective expression of our ability to reason and act in common.

[Lazarus Long]

In the psychological study of addiction there is a phenomenon called "enabling." Basically an enabler is a codependent individual that contributes to the destructive behavior in a parasitic manner. This is a distortion of the positive symbiotic nature of positive "enabling" derivative from loving relationships.

Codependency for alcohol, economic dependency on pushing narcotics, or market dependency on sources of supply for behaviors that might be addressed in many other ways than are rationally explored simply in order to maintain a status quo are behaviors that are parallel due to more than coincidence, they are logically causal for reasons that may reflect mass expression of individual genetics for behavioral choice.

Wealth is an "enabler" aspect of this problem, when symbiotically understood it is derivative of mutually supportive "loving" relationships that lead to hyper-productivity and "progress" when rationalized through exploitive economic dependency it is derivative of the psychology of dependent obsession and falls back upon destructive parasitic models that are predicated on indulgent gratification of a perceived dependency. hat this dependent need is also influenced socio-psychologically and can be distorted to psychotic manifestations should not be overlooked.

Selling addiction is what is done through manipulation of sexual imagery for autos, clothes, numerous products, and even "feel good" drugs. It is "pusher man" memetics made mainstream by Madison Avenue. It is the manipulation of pleasure/pain psycho-biology for marketing products AND ideas and it exploits our ability to fall prey to obsession whether by fear, lust, greed, or self delusion.

Obesity reflects this as both a social and psychology issue and is an important question of:

"Why is this happening?"

Not merely a critical question of:

"How is this happening?

It is not just about globalized yet localized intervention for individual patients; it is about addressing the socio/cultural genetics as it defines the development of memetic structures for humanity as a whole.

Solving the problem requires a vastly more objective assessment and commitment to redefining a healthy socio-economic model than we have inherited through genetics and memetics. More of a commitment to "trans-political" understanding than humanists and transhumanists alike have yet to fully demonstrate.

This requires doing much more than we have been doing to look at the underlying issues and get past the rhetoric of the past because the answer to the "why" question may reflect a "mysterious and godlike graffiti appearing on the walls of the temples of man".

At least we here can claim to have honestly engaged in trying to promote that rational analysis. The journey of this process has begun, the full answer is still beyond our present scope and horizon, but it is becoming more clearly discernible with each day we focus our effort upon the subject.

[kevin]

Laz..

Fundamentally I think our issues stem from the fact that we are on the edge of transformation. We are trying to take old methods of thinking more suited to survival of the individual and tribes, possibly burnt genetically into our character, and apply them to situations which require a much broader and long term perspective. We have evolved to provide for the basics of life and survival and now that we have arrived, at least for some portion of the world, in an era of relative plenty, our genetic 'fear of scarcity' does not easily enable us to switch to a more symbiotic program. This I think, is the challenge. To provide somehow a bridge that enables a shift from 'materialistic accumuation' as an end in itself, to the accumulation of material in a more symbiotic fashion in order that 'we' might continue. This might be compared to how our single celled ancestors managed to develop mechanisms of communicating and interdependence which allowed them to eventually form 'us'. Symbiosis is the next frontier after the basics of survival are met.

That our current obsessions with physical satiation and material possession are being played upon by those who would benefit from that action is merely a reflection of the lack of direction which our species is currently afflicted. This however is changing I think. At least in my contacts with people, I have noticed a distinct shift towards the questioning of the status quo and a skepticism born of experience of the methods that have been used to manipulate us with media and message. People are waking up.. I just hope it isnt' too little too late..

[Lazarus Long]

Thank you for your thoughtful response Kevin and I appreciate greatly your combined optimism and recognition of the real challenges that face us.

The problem of psychological denial is very much an 'Achilles heel' in this process as well as the seemingly mundane and common act of transference. Lastly there is even a subtle aspect of what in the parlor room parlance of psychotherapy is identified as "projection".

The importance of the collective expression of neurosis is that it exposes the manipulable aspects of culture; the "Hot Button Issue," the "Fear Tactic", the "Spin" and the "Hook". It is glossed over because it is like facing our own worts, most people address this by cosmetics, physical surgery, or diverted attention, the smallest minority are those that face the aspect of their own ugliness and incorporate such trivial and annoying aspects into their psyche in a healthy integrated manner.

I am not advocated mere acceptance, but there must be a more balanced concept of self recognition that is functionally more "humane" with respect to flaws of character while still holding up the importance of achievement and excellence, essentially the ideal of individual identification.

Fundamentally I think our issues stem from the fact that we are on the edge of transformation. We are trying to take old methods of thinking more suited to survival of the individual and tribes, possibly burnt genetically into our character, and apply them to situations which require a much broader and long term perspective. We have evolved to provide for the basics of life and survival and now that we have arrived, at least for some portion of the world, in an era of relative plenty, our genetic 'fear of scarcity' does not easily enable us to switch to a more symbiotic program. 

Clearly what you are recognizing here is valid and a core concern. I do not feel it is the only item on the list but it is very near the top, if not at the top. This is at the very least the heart of the struggle between progressive and fundamentalist groups around the world. Many other aspects of this 'conflict of interests' are also in play psycho-culturally, although in a more pragmatic sense with respect to life on our planet and the presence of humans.

We tend to myopically focus upon the paradigmatic aspects of the question in such anthropomorphic terms that the debate over the contrast of 'Old & New' ways of defining say a concept like 'Nature' is an analysis relegated to cloistered philosophers when it is in fact a very personal and common decision embodied by what we eat, where we live, how & who we mate, how we transport ourselves & property, even how we define such concepts as 'property.'

The complexity of the problem on the large scale has caused all too many to lose sight of the very personal and simple behavioral aspects of the problem on an intimate personal level. The very same level that in the "market sense" can determine supply through demand, rather than when vested production interests can manipulate demand to serve the interests of supply. Advertising is designed to accomplish this very fact and is developed around the manipulation of our general psychological makeup. It is designed to exploit our personal vulnerabilities with all the aplomb of con-men.

This same behavior however is also at the heart of much religious and political institutional practice and what we have done essentially is legitimize corruption. These are parts of the problem, so what are the solutions?

This I think, is the challenge. To provide somehow a bridge that enables a shift from 'materialistic accumulation' as an end in itself, to the accumulation of material in a more symbiotic fashion in order that 'we' might continue. This might be compared to how our single celled ancestors managed to develop mechanisms of communicating and interdependence which allowed them to eventually form 'us'. Symbiosis is the next frontier after the basics of survival are met.

Well said because I see this as the very core of the problem and one that is dealt with by many forces through the maintenance of a strategy of "Divide and Conquer." It is clearly a part of the future and the success of many aspects of progressive thinking to make large scale coordination of social and economic "Power" but what happens along the way is that all too many vested interests, whether for 'self serving,' 'corrupt,' or 'bigoted ethnocentric' attempt to redefine the paradigms of the struggles into a form that 'co-opts' the benevolent intent and usurps control redirecting the "Mass Movement" to serve ends that are not understood by the larger collective (for many reasons) or to undermine the ends as actually counter to the goals of what the leadership deems to be relevant and preferable. Also there is the problem of the "Law of Unintended Consequences."

Symbiotic behavioral models are inherently socialistic by the standards of many political theorists yet they are predicated on a healthy family model not in fact a corporate model. They are functionally all about community, not specifically capital.

That our current obsessions with physical satiation and material possession are being played upon by those who would benefit from that action is merely a reflection of the lack of direction which our species is currently afflicted. This however is changing I think. At least in my contacts with people, I have noticed a distinct shift towards the questioning of the status quo and a skepticism born of experience of the methods that have been used to manipulate us with media and message. People are waking up.. I just hope it isn't too little too late..

You have focused upon the core question and the primary dilemma, parallel to our endeavor for seeking a model for life extension are the very real threats facing us like ticking time bombs; small ones distributed through out the process like a mine field and specifically a few very large and destructive ones that are like Weapons of Mass Destruction. We are definitely in a race against time.

This race begins as a very personal struggle we each experience as a life but is extended to all our lives by the memetic development of a collective conscience; one that is perhaps only slightly more 'self' aware at the moment than the currently most advanced artificial intelligence. These two processes are also in a separate parallel developmental competition but are the focal point in many ways of a developmental symbiosis as we who are at the forefront of the 'Human Component' of Web Mind are also in many respects those who are at the forefront of the myriad of aspects behind developmental AI.

This is only one example and outlining the many examples of how this process is evolving are important and also determining whether we are applying symbiotic or parasitic models to the behavioral relationships is primary to maintaining a focus on preserving symbiosis and not decaying into a parasitic archetype.

I am going to include something here that ties many of the previous posts together. This is also about "sin".

Not sin in the religious or cultural use of the word but the pragmatic psychological one that reflects destructive behavior. Sin is the way ancient minds developed memetic limits for destructive developmental consciousness. Behavioral psych from the antediluvian epoch.

You see it is no small irony that at the heart of so many great and global social crises one can find some aspect of the seven deadly sins. The intriguing aspect of these sins is that they are generic and how they are reflected pragmatically in people's lives is very different from those that attempt to apply them parochially in a doctrinaire manner. Nevertheless, as concepts they deserve mention and inclusion as "the Enemy" we face in common.

Pope Gregory the Great (d. 604) described Seven Deadly Sins in his Moralia in Job.

1. Superbia    Pride
2. Invidia        Envy
3. Ira             Anger
4. Avaritia      Avarice (greed)
5. Tristia        Sadness
6. Gula           Gluttony
7. Luxuria       Lust

(Moralia in Job, XXXI cap. xlv).

The sin ‘Tristia’ was later replaced by ‘Accidia’, or Sloth (Wenzel (1967), 38). This sin was taken from earlier catalogues of vice, in particular, the eight evil thoughts listed by Evaagrius (346-99), and the eight principal vices proposed by the mid fourth-century writer Cassian (Wenzel (1967), 14-21). Some of the iconography of the Sins was derived from the descriptions of the Battles between the Virtues and Vices in the Psychomachia by the fourth-century poet Prudentius.

As a sidenote; could the link of 'sadness & sloth' be what today we identify as 'depression'? (this is to say we have a difficult time drawing a distinct line between what is volitional and what is compulsive: not to say that there is no distinction. Think of it perhaps as how 'Intelligence Agencies' manipulate "plausible deniability." Our psyches operate as our own personalized Intelligence Agency. )

Is it mere coincidence that as one looks at global issues facing us almost each major concern can be traced to one or more of the list above?

Is it not also reasonable to suggest that to accomplish our goal for Immortality we must face this challenge?

Is it not also reasonable to suggest that the definition of symbiosis embodies behaviors that are contrary to the exploitive and destructive aspects incorporate in the list of 'sins'?

I am often perplexed by how difficult we can make the simpler tasks and how simplistic our approach to complexity often is. Is not fear mongering for example, simply based on a manipulation of multiple aspects of this list that has been known since time immemorial?