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We push ourselves toward the highest-paying, most prestigious jobs, seeking promotions and public recognition. As Adam Gopnik points out, the result is not so much a rat race as a rat maze, with no way out. Except one: to choose accomplishment over achievement.

Achievement is the completion of the task imposed from outside.

Accomplishment, by contrast, is the end point of an engulfing activity one engages in for its own sake.

Shermer and Gopnik discuss:

• mastering the secrets of stage magic (Gopnik’s son worked with David Blaine and Jamy Ian Swiss)
• accomplishment in music
• family and mentors
• the concept of the 10,000-hour rule vs. natural talent
• Adam’s new book All That Happiness Is, which offers timeless wisdom against the grain.

Adam Gopnik has been a staff writer at The New Yorker since 1986. He is the author of numerous best-selling books, including Paris to the Moon and The Real Work: On the Mystery of Mastery.

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Every generation, a journalist has looked deep into the heart of the nuclear military establishment: the technologies, the safeguards, the plans, and the risks. These investigations are vital to how we understand the world we really live in—where one nuclear missile will beget one in return, and where the choreography of the world’s end requires massive decisions made on seconds’ notice with information that is only as good as the intelligence we have.

Pulitzer Prize finalist Annie Jacobsen’s Nuclear War: A Scenario explores this ticking-clock scenario, based on dozens of exclusive new interviews with military and civilian experts who have built the weapons, have been privy to the response plans, and have been responsible for those decisions should they have needed to be made. Nuclear War: A Scenario examines the handful of minutes after a nuclear missile launch. It is essential reading, and unlike any other book in its depth and urgency.

Annie Jacobsen is an investigative journals, Pulitzer Prize finalist, and New York Times bestselling author. Her books include: Area 51, Operation Paperclip, The Pentagon’s Brain, Phenomena, First Platoon, and Surprise, Kill, Vanish. Her book Nuclear War: A Scenario, has been optioned to be made into a dramatic film.

Shermer and Jacobsen discuss:

• So much has been written on this subject…what is new? (Richard Rhodes’s nuclear tetraology (The Making of the Atomic Bomb, Dark Sun, Arsenals of Folly, Twilight of the Bombs, Eric Schlosser’s Command and Control, Fred Kaplan’s The Bomb, Martin Sherwin’s Gambling with Armageddon, Daniel Ellsberg’s The Doomsday Machine, Carl Sagan’s and Richard Turco’s A Path Where No Man Thought)
• How much more is classified that we still do not know?
• Why we have a nuclear triad (land missiles, submarine missiles, bombers)
• Competition among military forces and increasing budgets for more weapons
• How many types of nuclear weapons are there now, and how many total?
• Why humans engage in aggression, violence and war
• The Prisoner’s dilemma, Hobbesian trap, Security Dilemma, the “other guy” problem
• Balance of Terror, Mutual Assured Destruction, Logic of Deterrence
• Close calls: Cuban Missile Crisis, Nuclear sub/Vasily Arkipov (1962), Damascus Titan missile explosion (1980), Able Archer 83 war exercise in Europe, Stanislav Petrov, etc.
• Surviving a nuclear explosion/war
• What happens in a nuclear bomb explosion
• Short terms and long term consequences of a nuclear exchange
• Nuclear Winter
• Nuclear protests & films (On the Beach, Fail Safe, Dr. Strangelove, War Games, The Day After)
• Getting to Nuclear Zero: Stockpile reduction, No First Use, No Launch on Warning, shift taboo from not using them to not owning them,
• Reagan and Gorbachev and arms reductions
• North Korea, China/Taiwan
• Göbekli Tepe and post-apocalyptic world.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

On October 17, 2005 the talk show host and comedian Stephen Colbert introduced the word “truthiness” in the premier episode of his show The Colbert Report:1 “We’re not talking about truth, we’re talking about something that seems like truth— the truth we want to exist.”2 Since then the word has become entrenched in our everyday vocabulary but we’ve largely lost Colbert’s satirical critique of “living in a post-truth world.” Truthiness has become our truth. Kellyanne Conway opened the door to “alternative facts”3 while Oprah Winfrey exhorted you to “speak your truth.”4 And the co-founder of Skeptic magazine, Michael Shermer, has begun to regularly talk to his podcast guests about objective external truths and subjective internal truths, inside of which are historical truths, political truths, religious truths, literary truths, mythical truths, scientific truths, empirical truths, narrative truths, and cultural truths.5 It is an often-heard complaint to say that we live in a post-truth world, but what we really have is far too many claims for it. Instead, we propose that the vital search for truth is actually best continued when we drop our assertions that we have something like an absolute Truth with a capital T.

Why is that? Consider one of our friends who is a Young Earth creationist. He believes the Bible is inerrant. He is convinced that every word it contains, including the six days of creation story of the universe, is Truth (spelled with a capital T because it is unquestionably, eternally true). From this position, he has rejected evidence brought to him from multiple disciplines that all converge on a much older Earth and universe. He has rejected evidence from fields such as biology, paleontology, astronomy, glaciology, and archeology, all of which should reduce his confidence in the claim that the formation of the Earth and every living thing on it, together with the creation of the sun, moon, and stars, all took place in literally six Earth days. Even when it was pointed out to him that the first chapter of Genesis mentions liquid water, light, and every kind of vegetation before there was a sun or any kind of star whatsoever, he claimed not to see a problem. His reply to such doubts is to simply say, “with God, all things are possible.”6

Lacking any uncertainty about the claim that “the Bible is Truth,” this creationist has only been able to conclude two things when faced with tough questions: (1) we are interpreting the Bible incorrectly, or (2) the evidence that appears to undermine a six-day creation is being interpreted incorrectly. These are inappropriately skeptical responses, but they are the only options left to someone who has decided beforehand that their belief is Truth. And, importantly, we have to admit that this observation could be turned back on us too. As soon as we become absolutely certain about a belief—as soon as we start calling something a capital “T” Truth—then we too become resistant to any evidence that could be interpreted as challenging it. After all, we are not absolutely certain that the account in Genesis is false. Instead, we simply consider it very, very unlikely, given all of the evidence at hand. We must keep in mind that we sample a tiny sliver of reality, with limited senses that only have access to a few of possibly many dimensions, in but one of quite likely multiple universes. Given this situation, intellectual humility is required.

Some history and definitions from philosophy are useful to examine all of this more precisely. Of particular relevance is the field of epistemology, which studies what knowledge is or can be. A common starting point is Plato’s definition of knowledge as justified true belief (JTB).7 According to this JTB formulation, all three of those components are necessary for our notions or ideas to rise to the level of being accepted as genuine knowledge as opposed to being dismissible as mere opinion. And in an effort to make this distinction clear, definitions for all three of these components have been developed over the ensuing millennia. For epistemologists, beliefs are “what we take to be the case or regard as true.”8 For a belief to be true, it doesn’t just need to seem correct now; “most philosophers add the further constraint that a proposition never changes its truth-value in space or time.”9 And we can’t just stumble on these truths; our beliefs require some reason or evidence to justify them.10

Readers of Skeptic will likely be familiar with skeptical arguments from Agrippa (the problem of infinite regress11), David Hume (the problem of induction12), Rene Descartes (the problem of the evil demon13), and others that have chipped away at the possibility of ever attaining absolute knowledge. In 1963, however, Edmund Gettier fully upended the JTB theory of knowledge by demonstrating—in what has come to be called “Gettier problems”14—that even if we managed to actually have a justified true belief, we may have just gotten there by a stroke of good luck. And the last 60 years of epistemology have shown that we can seemingly never be certain that we are in receipt of such good fortune.

This philosophical work has been an effort to identify an essential and unchanging feature of the universe—a perfectly justified truth that we can absolutely believe in and know. This Holy Grail of philosophy surely would be nice to have, but it makes sense that we don’t. Ever since Darwin demonstrated that all of life could be traced back to the simplest of origins, it has slowly become obvious that all knowledge is evolving and changing as well. We don’t know what the future will reveal and even our most unquestioned assumptions could be upended if, say, we’ve actually been living in a simulation all this time, or Descartes’ evil demon really has been viciously deluding us. It only makes sense that Daniel Dennett titled one of his recent papers, “Darwin and the Overdue Demise of Essentialism.”15

So, what is to be done after this demise of our cherished notions of truth, belief, and knowledge? Hold onto them and claim them anyway, as does the creationist? No. That path leads to error and intractable conflict. Instead, we should keep our minds open, and adjust and adapt to evidence as it becomes available. This style of thinking has become formalized and is known as Bayesian reasoning. Central to Bayesian reasoning is a conditional probability formula that helps us revise our beliefs to be better aligned with the available evidence. The formula is known as Bayes’ theorem. It is used to work out how likely something is, taking into account both what we already know as well as any new evidence. As a demonstration, consider a disease diagnosis, derived from a paper titled, “How to Train Novices in Bayesian Reasoning:”

10 percent of adults who participate in a study have a particular medical condition. 60 percent of participants with this condition will test positive for the condition. 20 percent of participants without the condition will also test positive. Calculate the probability of having the medical condition given a positive test result.16

Most people, including medical students, get the answer to this type of question wrong. Some would say the accuracy of the test is 60 percent. However, the answer must be understood in the broader context of false positives and the relative rarity of the disease.

Simply putting actual numbers on the face of these percentages will help you visualize this. For example, since the rate of the disease is only 10 percent, that would mean 10 in 100 people have the condition, and the test would correctly identify six of these people. But since 90 of the 100 people don’t have the condition, yet 20 percent of them would also receive a positive test result, that would mean 18 people would be incorrectly flagged. Therefore, 24 total people would get positive test results, but only six of those would actually have the disease. And that means the answer to the question is only 25 percent. (And, by the way, a negative result would only give you about 95 percent likelihood that you were in the clear. Four of the 76 negatives would actually have the disease.)

Now, most usages of Bayesian reasoning won’t come with such detailed and precise statistics. We will very rarely be able to calculate the probability that an assertion is correct by using known weights of positive evidence, negative evidence, false positives, and false negatives. However, now that we are aware of these factors, we can try to weigh them roughly in our minds, starting with the two core norms of Bayesian epistemology: thinking about beliefs in terms of probability and updating one’s beliefs as conditions change.17 We propose it may be easier to think in this Bayesian way using a modified version of a concept put forward by the philosopher Andy Norman, called Reason’s Fulcrum.18

Figure 1. A Simple Lever. Balancing a simple lever can be achieved by moving the fulcrum so that the ratio of the beam is the inverse of the ratio of mass. Here, an adult who is three times heavier than the child is balanced by giving the child three times the length of beam. The mass of the beam is ignored. Illustrations in this article by Jim W.W. Smith

Like Bayes, Norman asserts that our beliefs ought to change in response to reason and evidence, or as David Hume said, “a wise man proportions his belief to the evidence.”19 These changes could be seen as the movement of the fulcrum lying under a simple lever. Picture a beam or a plank (the lever) with a balancing point (the fulcrum) somewhere in the middle, such as a playground teeter-totter. As in Figure 1, you can balance a large adult with a small child just by positioning the fulcrum closer to the adult. And if you know their weight, then the location of that fulcrum can be calculated ahead of time because the ratio of the beam length on either side of the fulcrum is the inverse of the ratio of mass between the adult and child (e.g., a three times heavier person is balanced by a distance having a ratio of 1:3 units of distance).

If we now move to the realm of reason, we can imagine substituting the ratio of mass between an adult and child by the ratio of how likely the evidence is to be observed between a claim and its counterclaim. Note how the term in italics captures not just the absolute quantity of evidence but the relative quality of that evidence as well. Once this is considered, then the balancing point at the fulcrum gives us our level of credence in each of our two competing claims.

Figure 2. Ratio of 90–10 for People Without–With the Condition. A 10 percent chance of having a condition gives a beam ratio of 1:9. The location of the fulcrum shows the credence that a random person should have about their medical status.

To see how this works for the example previously given about a test for a medical condition, we start by looking at the balance point in the general population (Figure 2). Not having the disease is represented by 90 people on the left side of the lever, and having the disease is represented by 10 people on the right side. This is a ratio of 9:1. So, to get our lever to balance, we must move the fulcrum so that the length of the beam on either side of the balancing point has the inverse ratio of 1:9. This, then, is the physical depiction of a 10 percent likelihood of having the medical condition in the general population. There are 10 units of distance between the two populations and the fulcrum is on the far left, 1 unit away from all the negatives.

Figure 3. Ratio of 18 False Positives to 6 True Positives. A 1 to 3 beam ratio illustrates a 25 percent chance of truly having this condition. The location of the fulcrum shows the proper level of credence for someone if they receive a positive test.

Next, we want to see the balance point after a positive result (Figure 3). On the left: the test has a 20 percent false positive rate, so 18 of the 90 people stay on our giant seesaw even though they don’t actually have the condition. On the right: 60 percent of the 10 people who have the condition would test positive, so this leaves six people. Therefore, the new ratio after the test is 18:6, or 3:1. This means that in order to restore balance, the fulcrum must be shifted to the inverse ratio of 1:3. There are now four total units of distance between the left and right, and the fulcrum is 1 unit from the left. So, after receiving a positive test result, the probability of having the condition (being in the group on the right) is one in four or 25 percent (the portion of beam on the left). This confirms the answer we derived earlier using abstract mathematical formulas, but many may find the concepts easier to grasp based on the visual representation.

To recap, the position of the fulcrum under the beam is the balancing point of the likelihood of observing the available evidence for two competing claims. This position is called our credence. As we become aware of new evidence, our credence must move to restore a balanced position. In the example above, the average person in the population would have been right to hold a credence of 10 percent that they had a particular condition. And after getting a positive test, this new evidence would shift their credence, but only to a likelihood of 25 percent. That’s worse for the person, but actually still pretty unlikely. Of course, more relevant evidence in the future may shift the fulcrum further in one direction or another. That is the way Bayesian reasoning attempts to wisely proportion one’s credence to the evidence.

Figure 4. Breaking Reason’s Fulcrum. Absolute certainty makes Bayes’ theorem unresponsive to evidence in the same way that a simple lever is unresponsive to mass when it becomes a ramp.

What about our Young Earth creationist friend? When using Bayes’ theorem, the absolute certainty he holds starts with a credence of zero percent or 100 percent and always results in an end credence of zero percent or 100 percent, regardless of what any possible evidence might show. To guard against this, the statistician Dennis Lindley proposed “Cromwell’s Rule,” based on Oliver Cromwell’s famous 1650 quip: “I beseech you, in the bowels of Christ, think it possible that you may be mistaken.”20 This rule simply states that you should never assign a probability of zero percent or 100 percent to any proposition. Once we frame our friend’s certainty in the Truth of biblical inerrancy as setting his fulcrum to the extreme end of the beam, we get a clear model for why he is so resistant to counterevidence. Absolute certainty breaks Reason’s Fulcrum. It removes any chance for leverage to change a mind. When beliefs reach the status of “certain truth” they simply build ramps on which any future evidence effortlessly slides off (Figure 4).

So far, this is the standard way of treating evidence in Bayesian epistemology to arrive at a credence. The lever and fulcrum depictions provide a tangible way of seeing this, which may be helpful to some readers. However, we also propose that this physical model might help with a common criticism of Bayesian epistemology. In the relevant academic literature, Bayesians are said to “hardly mention” sources of knowledge, the justification for one’s credence is “seldom discussed,” and “Bayesians have hardly opened their ‘black box’, E, of evidence.”21 We propose to address this by first noting it should be obvious from the explanations above that not all evidence deserves to be placed directly onto the lever. In the medical diagnosis example, we were told exactly how many false negatives and false positives we could expect, but this is rarely known. Yet, if ten drunken campers over the course of a few decades swear they saw something that looked like Bigfoot, we would treat that body of evidence differently than if it were nine drunken campers and footage from one high-definition camera of documentarians working for the BBC. How should we depict this difference between the quality of evidence versus the quantity of evidence?

We don’t yet have firm rules or “Bayesian coefficients” for how to precisely treat all types of evidence, but we can take some guidance from the history of the development of the scientific method. Evidential claims can start with something very small, such as one observation under suspect conditions given by an unreliable observer. In some cases, perhaps that’s the best we’ve got for informing our credences. Such evidence might feel fragile, but…who knows? The content could turn out to be robust. How do we strengthen it? Slowly, step by step, we progress to observations with better tools and conditions by more reliable observers. Eventually, we’re off and running with the growing list of reasons why we trust science: replication, verification, inductive hypotheses, deductive predictions, falsifiability, experimentation, theory development, peer review, social paradigms, incorporating a diversity of opinions, and broad consensus.22

We can also bracket these various knowledgegenerating activities into three separate categories for theories. The simplest type of theory we have explains previous evidence. This is called retrodiction. All good theories can explain the past, but we have to be aware that this is also what “just-so stories” do, as in Rudyard Kipling’s entertaining theory for how Indian rhinoceroses got their skin—cake crumbs made them so itchy they rubbed their skin until it became raw, stretched, and all folded up.23

Even better than simply explaining what we already know, good theories should make predictions. Newton’s theories predicted that a comet would appear around Christmastime in 1758. When this unusual sight appeared in the sky on Christmas day, the comet (named for Newton’s close friend Edmund Halley) was taken as very strong evidence for Newtonian physics. Theories such as this can become stronger the more they explain and predict further evidence.

This article appeared in Skeptic magazine 28.4
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Finally, beyond predictive theories, there are ones that can bring forth what William Whewell called consilience.24 Whewell coined the term scientist and he described consilience as what occurs when a theory that is designed to account for one type of phenomenon turns out to also account for another completely different type. The clearest example is Darwin’s theory of evolution. It accounts for biodiversity, fossil evidence, geographical population distribution, and a huge range of other mysteries that previous theories could not make sense of. And this consilience is no accident—Darwin was a student of Whewell’s and he was nervous about sharing his theory until he had made it as robust as possible.

Figure 5. The Bayesian Balance. Evidence is sorted by sieves of theories that provide retrodiction, prediction, and consilience. Better and better theories have lower rates of false positives and require a greater movement of the fulcrum to represent our increased credence. Evidence that does not yet conform to any theories at all merely contributes to an overall skepticism about the knowledge we thought we had.

Combining all of these ideas, we propose a new way (Figure 5) of sifting through the mountains of evidence the world is constantly bombarding us with. We think it is useful to consider the three different categories of theories, each dealing with different strengths of evidence, as a set of sieves by which we can first filter the data to be weighed in our minds. In this view, some types of evidence might be rather low quality, acting like a medical test with false positives near 50 percent. Such poor evidence goes equally on each side of the beam and never really moves the fulcrum. However, other evidence is much more likely to be reliable and can be counted on one side of the beam at a much higher rate than the other (although never with 100 percent certainty). And evidence that does not fit with any theory whatsoever really just ought to make us feel more skeptical about what we think we know until and unless we figure out a way to incorporate it into a new theory.

We submit that this mental model of a Bayesian Balance allows us to adjust our credences more easily and intuitively. Also, it never tips the lever all the way over into unreasonable certainty. To use it, you don’t have to delve into the history of philosophy, epistemology, skepticism, knowledge, justified true beliefs, Bayesian inferences, or difficult calculations using probability notation and unknown coefficients. You simply need to keep weighing the evidence and paying attention to which kinds of evidence are more or less likely to count. Remember that observations can sometimes be misleading, so a good guiding principle is, “Could my evidence be observed even if I’m wrong?” Doing so fosters a properly skeptical mindset. It frees us from the truth trap, yet enables us to move forward, wisely proportioning our credences as best as the evidence allows us.

About the Author

Zafir Ivanov is a writer and public speaker focusing on why we believe and why it’s best we believe as little as possible. His lifelong interests include how we form beliefs and why people seem immune to counterevidence. He collaborated with the Cognitive Immunology Research Initiative and The Evolutionary Philosophy Circle. Watch his TED talk.

Ed Gibney writes fiction and philosophy while trying to bring an evolutionary perspective to both of those pursuits. He has previously worked in the federal government trying to make it more effective and efficient. He started a Special Advisor program at the U.S. Secret Service to assist their director with this goal, and he worked in similar programs at the FBI and DHS after business school and a stint in the Peace Corps. His work can be found at evphil.com.

References

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13. Gillespie, M. A. (1995). Nihilism Before Nietzsche. University of Chicago Press.
14. https://rb.gy/4iavf
15. https://rb.gy/crv9j
16. https://rb.gy/zb862
17. https://rb.gy/dm5qc
18. Norman, A. (2021). Mental Immunity: Infectious Ideas, Mind-Parasites, and the Search for a Better Way to Think. Harper Wave.
19. https://rb.gy/2k9xa
20. Jackman, S. (2009). The Foundations of Bayesian Inference. In Bayesian Analysis for the Social Sciences. John Wiley & Sons.
21. Hajek, A., & Lin, H. (2017). A Tale of Two Epistemologies? Res Philosophica, 94(2), 207–232.
22. Oreskes, N. (2019). Why Trust Science? Princeton University Press.
23. https://rb.gy/2us27
24. Whewell, W. (1847). The Philosophy of the Inductive Sciences, Founded Upon Their History. London J.W. Parker.

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Nick Bostrom’s previous book, Superintelligence: Paths, Dangers, Strategies, changed the global conversation on AI and became a New York Times bestseller. It focused on what might happen if AI development goes wrong. But what if things go right? Suppose that we develop superintelligence safely, govern it well, and make good use of the cornucopian wealth and near magical technological powers that this technology can unlock. If this transition to the machine intelligence era goes well, human labor becomes obsolete. We would thus enter a condition of “post-instrumentality” in which our efforts are not needed for any practical purpose. Furthermore, at technological maturity, human nature becomes entirely malleable. Here we confront a challenge that is not technological but philosophical and spiritual. In such a solved world, what is the point of human existence? What gives meaning to life? What do we do all day?

Bostrom’s new book, Deep Utopia, shines new light on these old questions and gives us glimpses of a different kind of existence, which might be ours in the future.

Nick Bostrom is a Professor at Oxford University, where he is the founding director of the Future of Humanity Institute. Bostrom is the world’s most cited philosopher aged 50 or under. He is the author of more than 200 publications, including Anthropic Bias (2002), Global Catastrophic Risks (2008), Human Enhancement (2009), and Superintelligence: Paths, Dangers, Strategies (2014), a New York Times bestseller which sparked a global conversation about the future of AI. His work has pioneered many of the ideas that frame current thinking about humanity’s future (such as the concept of an existential risk, the simulation argument, the vulnerable world hypothesis, the unilateralist’s curse, etc.), while some of his recent work concerns the moral status of digital minds. His writings have been translated into more than 30 languages; he is a repeat main-stage TED speaker; and he has been interviewed more than 1,000 times by media outlets around the world. He has been on Foreign Policy’s Top 100 Global Thinkers list twice and was included in Prospect’s World Thinkers list, the youngest person in the top 15. He has an academic background in theoretical physics, AI, and computational neuroscience as well as philosophy.

Bostrom and Shermer discuss:

• The Future of Life Institute’s Open Letter calling for a pause on “giant AI experiments”
• Eliezer Yudkowsky Time OpEd: “Shut It All Down” — “Many researchers steeped in these issues, including myself, expect that the most likely result of building a superhumanly smart AI, under anything remotely like the current circumstances, is that literally everyone on Earth will die. Not as in ‘maybe possibly some remote chance,’ but as in ‘that is the obvious thing that would happen.’ If somebody builds a too-powerful AI, under present conditions, I expect that every single member of the human species and all biological life on Earth dies shortly thereafter.”
• Utopia, Dystopia, Protopia
• Would it be boring to live in a perfect world?
• If we lived forever with everything we need, what would be the purpose of life?
• Trekonomics, post-scarcity economics
• The hedonic treadmill and positional wealth values—will people never be satisfied with “enough”?
• Overpopulation of the 1960s and today’s birth dearth
• Colonizing the galaxy (von Neumann probes, O’Neill cylinders, Dyson spheres)
• The Fermi paradox: where is everyone?
• Mind uploading and immortality
• Examples of Technological Maturity
• Google’s Gemini AI debacle
• Large Language Models
• ChatGPT, GPT-4, GPT-5 and beyond
• The alignment problem
• What set of values should AI be aligned with, and what legal and ethical status should it have?
• The hard problem of consciousness
• How would we know if an AI system was sentient?
• Can AI systems be conscious?

On Mind Uploading and Replicating / Resurrecting Everyone Who Ever Lived

(An excerpt from Michael Shermer’s 2018 book Heavens on Earth.)

The sums involved in achieving immortality through the duplication or resurrection scenarios are not to be underestimated. There are around 85 billion neurons in a human brain, each with about a thousand synaptic links, for a total of 100 trillion connections to be accurately preserved and replicated. This is a staggering level of complexity made all the more so by the additional glial cells in the brain, which provide support and insulation for neurons and can change the actions of firing neurons, so these cells better be preserved as well in any duplication or resurrection scenario, just in case. Estimates of the ratio of glial cells to neurons in a brain vary from 1:1 to 10:1. If you’re not a lightning calculator, that computes to a total brain cell count of somewhere between 170 billion and 850 billion. Then factor in the hundreds or thousands of synaptic connections between each of the 85 billion neurons, adding approximately 100 trillion synaptic connections total for each brain. That’s not all. There are around ten billion proteins per neuron, which effect how memories are stored, plus the countless extracellular molecules in between those tens of billions of brain cells.

These estimates are just for the brain and do not even include the rest of the nervous system outside of the skull—what neuroscientists call the “embodied brain” or the “extended mind” and which many philosophers of mind believe is necessary for normal cognition. So you might want to have this extended mind resurrected or uploaded along with your mind. After all, you are not just your internal thoughts and emotions disconnected from your body. Many of your thoughts and emotions are intimately entwined with how your body interacts with its environment, so any preserved connectome, to be fully operational as recreating the experience of what it is like to be a sentient being, would also need to be housed in a body. So we would need a warehouse of brainless clones or very sophisticated robots prepared to have these uploaded mind neural units installed. How many? Well, to avoid the charge of elitism, it’s only fair that everyone who ever lived be resurrected, so that means multiplying the staggering data package for one person by 108 billion.

Then there’s the relationship between memory and life history. Our memory is not like a videotape that can be played back on the viewing screen of our minds. When an event happens to us, a selective impression of it is made on the brain through the senses. As that sense impression wends its way through different neural networks, where it ends up depends on what type of memory it is. As a memory is processed and prepared for long-term storage we rehearse it and in the process it is changed. This editing process depends on previous memories, subsequent events and memories, and emotions. This process recurs trillions of times in the course of a lifetime, to the point where we have to wonder if we have memories of actual events, or memories of the memories of those events, or even memories of memories of memories…. What’s the “true” memory? There is no such thing. Our memories are the product of trillions of synaptic neuronal connections that are constantly being edited, redacted, reinforced, and extinguished, such that a resurrection of a human with memories intact will depend on when in the individual’s life history the replication or resurrection is implemented.

In his book The Physics of Immortality the physicist Frank Tipler calculates that an Omega Point computer in the far future will contain 10 to the power of 10 to the power of 123 bits (a 1 followed by 10123 zeros), powerful enough, he says, to resurrect everyone who ever lived. That may be—it is a staggeringly large number—but is even an Omega Point computer powerful enough to reconstruct all of the historical contingencies and necessities in which a person lived, such as the weather, climate, geography, economic cycles, recessions and depressions, social trends, religious movements, wars, political revolutions, paradigm shifts, ideological revolutions, and the like, on top of duplicating our genome and connectome? It seems unlikely, but if so GOSH would also need to duplicate all of the individual conjunctures and interactions between that person and all other persons as they intersect with and influence each other in each of those lifetimes. Then multiply all that by the 108 billion people who ever lived or are currently living. Whatever the number, it would have to be even larger than the famed Googolplex (10 to the power of a googol, with a googol being 10100, or 1010100) from which Google and its Googleplex headquarters derived its name. Even a googol of googolplexes would not suffice. In essence, it would require the resurrection of the entire universe and its many billions of years of history. Inconceivable.

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When Robert Zubrin published his classic book The Case for Mars a quarter century ago, setting foot on the Red Planet seemed a fantasy. Today, manned exploration is certain, and as Zubrin affirms in The New World on Mars, so too is colonization. From the astronautical engineer venerated by NASA and today’s space entrepreneurs, here is what we will achieve on Mars and how.

SpaceX, Blue Origin, and Virgin Galactic are building fleets of space vehicles to make interplanetary travel as affordable as Old-World passages to America. We will settle on Mars, and with our knowledge of the planet, analyzed in depth by Dr. Zubrin, we will utilize the resources and tackle the challenges that await us. What we will we build? Populous Martian city-states producing air, water, food, power, and more. Zubrin’s Martian economy will pay for necessary imports and generate income from varied enterprises, such as real estate sales—homes that are airtight and protect against cosmic space radiation, with fish-farm aquariums positioned overhead, letting in sunlight and blocking cosmic rays while providing fascinating views. Zubrin even predicts the Red Planet customs, social relations, and government—of the people, by the people, for the people, with inalienable individual rights—that will overcome traditional forms of oppression to draw Earth immigrants. After all, Mars needs talent.

With all of this in place, Zubrin’s Red Planet will become a pressure cooker for invention in bioengineering, synthetic biology, robotics, medicine, nuclear energy, and more, benefiting humans on Earth, Mars, and beyond. We can create this magnificent future, making life better, less fatalistic. The New World on Mars proves that there is no point killing each other over provinces and limited resources when, together, we can create planets.

Robert Zubrin is former president of the aerospace R&D company Pioneer Astronautics, which performs advanced space research for NASA, the US Air Force, the US Department of Energy, and private companies. He is the founder and president of the Mars Society, an international organization dedicated to furthering the exploration and settlement of Mars, leading the Society’s successful effort to build the first simulated human Mars exploration base in the Canadian Arctic and growing the organization to include 7,000 members in 40 countries. A nuclear and astronautical engineer, Zubrin began his career with Martin Marietta (later Lockheed Martin) as a Senior Engineer involved in the design of advanced interplanetary missions. His “Mars Direct” plan for near-term human exploration of Mars was commended by NASA Administrator Dan Goldin and covered in The Economist, Fortune, Air and Space Smithsonian, Newsweek (cover story), Time, The New York Times, The Boston Globe, as well as on BBC, PBS TV, CNN, the Discovery Channel, and National Public Radio. Zubrin is also the author of twelve books, including The Case for Mars: The Plan to Settle the Red Planet and Why We Must, with more than 100,000 copies in print in America alone and now in its 25th Anniversary Edition. He lives with his wife, Hope, a science teacher, in Golden, Colorado. His latest book is: The New World on Mars: What We Can Create on the Red Planet. The next big Mars Society conference in Seattle August 8-11.

Read Zubrin’s discussion of his paper on panspermia for seeding like on Earth.

Shermer and Zubrin discuss:

• Why not start with the moon?
• What’s it like on Mars? Like the top of Mt. Everest?
• Was Mars ever like Earth? Water, life, etc.?
• How much will it cost to go to Mars?
• How to get people to Mars: food, water, radiation, boredom?
• Where on Mars should people settle?
• What are “natural resources”?
• Resources on Mars already there vs. need to be produced
• Analogies with Europeans colonizing North America
• Public vs. private enterprise for space exploration
• Economics on Mars
• Politics on Mars
• Lessons from the Red Planet for the Blue Planet
• Ingersoll’s insight: free speech & thought > science & technology > machines as our slaves > moon landing. “This is something that free people can do.”
• Liberty in space: won’t the most powerful people on Mars threaten to shut off your air if you don’t obey?
• Independent City-States on Mars
• Direct vs. representative democracy
• America as a model for what we can create on Mars
• Are new frontiers needed for civilization to continue?
• The worst idea ever: that the total amount of potential resources is fixed.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

In 2021 the CDC issued a grim statistic: more than one million Americans had died from overdoses since 1999 when it started tracking an opioid epidemic that began with prescription painkillers and is now dominated by fentanyl.1 Since that sobering milestone, another 300,000 have died.2 That is roughly the same number of Americans who died in all wars the United States has entered (1.3 million) combined, including the First and Second World Wars and the Civil War.3 The opioid epidemic is, aside possibly from obesity, the biggest health crisis of our time.

Most know about the frenzy of finger pointing, lawsuits, bankruptcy filings among pharmaceutical companies, drug distributors, national pharmacy chains, medical associations, and the Federal Drug Administration. There is plenty of blame to go around. What is not often discussed in the extensive media coverage about the epidemic is how we got here.

The story of how the opioid crisis got underway and who is responsible is a tale of greed, poor government regulation, and many missed opportunities. It began with good intentions based on bad data and later became a movement in which profits took precedence over morals. It is a tragedy that was largely preventable and, as such, one of the most infuriating chapters in modern U.S. history.

History of Pain

Chronic pain affects 50 million Americans, more than those with high blood pressure, diabetes, or depression.4 Developing a medication that alleviates pain without too many side effects has been one of the drug industry’s holy grails. The market is enormous, and most people are long-term patients. Opiates were isolated as effective pain killers in the 1800s. At the turn of the 20th century—the drug industry’s Wild West days—they were dispensed over the counter. Over time, opiates earned a notorious and deserved reputation for addiction. German giant Bayer patented and marketed Heroin as, incredible as it now sounds, a cure for morphine addiction.

Congress did not pass a law requiring prescriptions for narcotic-based medications until 1938.5 It took another 33 years before the federal government created the Controlled Substances Act in 1971, listing oxycodone, fentanyl (along with cocaine and methamphetamine) as Schedule II drugs. That meant they had a risk of “severe psychological or physical dependence” but had medical and therapeutic uses. Doctors were supposed to balance the risks of opioids against the needs of patients who required them for short-term use after surgery or an accident, or longer treatment for disabling chronic pain.

Throughout the 1970s and early 1980s, drug companies spent a lot of money searching for a nonaddictive painkiller. Every effort ended in failure. In a Science article, a pharmacologist and a chemist at the National Institutes of Health concluded that it was unlikely such a medication was possible.

This was the same time, however, when a few physicians were about to upend traditional medical views about pain and how to treat it. Until the early 1980s, medical schools taught that pain was only a symptom of some underlying physical condition. Physicians did not treat it as a stand-alone ailment but instead searched for what caused it. The specialty of “pain management” did not exist. An anesthesiologist, John Bonica, whom Time dubbed “pain relief’s founding father,” questioned the conventional wisdom. Bonica suffered chronic shoulder and hip pain from his pre-medical career, first as a professional wrestler, then a carnival strongman, and finally the light heavyweight world wrestling champion.6 Bonica contended that underdiagnosing pain meant millions of patients suffered needlessly. He cofounded the International Association for the Study of Pain (its journal, Pain, is the field’s leading publication) in 1974, and three years later the American Pain Society (APS).7

The incipient movement to prioritize pain was not long underway when a five-sentence “letter to the editor” in the January 10, 1980, New England Journal of Medicine (NEJM) kicked off a parallel revolution in reconsidering established medical views about the risks of opioids. A doctor, Hershel Jick, and a grad student, Jane Porter, had examined 39,946 records of Boston University Hospital patients to determine adverse reactions and potential abuse for widely used medications. Almost a third (11,882) had “received at least one narcotic preparation” but they found only “four cases of reasonably well-documented addiction in patients who had no history of addiction.” Their conclusion was as unorthodox as it was decisive: “Despite widespread use of narcotic drugs in hospitals, the development of addiction is rare.”8

The letter cited two previous studies, both of which involved only hospitalized patients given small doses of opioids in a controlled setting. Very few had had them dispensed for more than five days. None were given painkillers after they were discharged from the hospital.

No one could have predicted the impact that letter had on the reassessment of using opioids to treat pain. During the next two decades it was cited over 1,600 times in textbooks, medical journals, and other publications. More than 80 percent of those who mentioned it left out that it only studied hospitalized patients who took opioids for a few days. Instead, that 99-word letter was widely cited to support far broader conclusions about the safety profile of opioids.9 (In 2017 the NEJM published a rare “Editor’s Note,” adding it to its webpage with the original Jick-Porter letter: “For reasons of public health, readers should be aware that this letter has been ‘heavily and uncritically’ cited as evidence that addiction is rare with opioid therapy.”)

The twin themes—that not treating pain was negligent and that opioids were safe for almost everyone—reinforced one another.

The World Health Organization (WHO) cited the Jick- Porter letter in 1986 as a cornerstone for challenging decades of medical dogma that “the risks of widely prescribing opioids far outweighed any benefits.” Six weeks after the WHO publication, Pain published a startling report, the “Chronic Use of Opioid Analgesics in Non-Malignant Pain.” The lead author was Russell Portenoy, a 31-year-old Memorial Sloan Kettering physician specializing in anesthesiology, neurology, pain control, and pharmacology. His coauthor was Kathleen Foley, a top pain management specialist.

Portenoy and Foley had studied 38 patients who had been administered narcotic analgesics—a third took oxycodone—for up to seven years. Two thirds reported significant or total pain relief. There was “no toxicity,” the two doctors reported, and only two patients had a problem with addiction, both of whom had “a history of prior drug abuse.” They concluded that “opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.”10

Pain as the Fifth Vital Sign

That paper kicked off a contentious and at times rancorous debate over whether opioids had been unfairly branded for decades and underutilized in pain management. The charismatic Portenoy emerged as the unofficial spokesman for the embryonic movement to reassess opioids. He saw himself as a pioneer in reexamining outdated views about opioids. If he could convince doctors not to fear dispensing opioids, it could help millions of patients suffering from chronic pain.

A diverse, informal network of physicians contributed to the emerging reevaluation. Doctors specializing in pain management formed The American Academy of Pain Medicine and the American Society of Addiction Medicine (its slogan is “Addiction is a chronic brain disease”). They in turn encouraged patients suffering from chronic pain to form advocacy groups and petition the FDA to loosen opioid dispensing restrictions.

In 1990, American Pain Society president, Dr. Mitchell Max, wrote a widely read editorial lamenting how little progress had been made in treating pain. “Unlike ‘vital signs,’ pain isn’t displayed in a prominent place on the chart or at the bedside or nursing station,” he wrote.”11 Max’s fix was to have physicians ask patients on every visit about whether they were in pain. Doctors had for decades kept watch of four vital signs when examining patients: blood pressure, pulse, temperature, and breathing. The American Pain Society suggested “Pain as the 5th Vital Sign.”

There was no reliable diagnostic test, as there was for blood pressure or cholesterol. Pain was a subjective assessment based on the doctor’s observations and the patient’s descriptions of symptoms. What one patient described as moderate pain that restricted mobility might be excruciating and disabling for someone else. The first rudimentary measurements were developed around this time. One of them, the McGill Pain Index, had 78 words related to pain divided into 20 sections. Patients picked the words that best described their pain. Another, called the Memorial Pain Assessment Card, had eight simplified descriptions and patients selected the one that best matched their pain’s intensity. Yet another was developed by a pediatric nurse and child life specialist in Oklahoma—a chart for children with 10 handdrawn faces ranging from happy and laughing to angry and crying. Variations of that scale soon became a 1 to 10 rating for adults, 1 being “very mild, barely noticeable,” and 10 signifying “unspeakable pain.”

Those tools meant that differing pain tolerances among patients were no longer important. What mattered was tracking whether a patient’s pain was getting better or worse. The Joint Commission, an independent, not-for-profit organization responsible for accrediting 96 percent of all U.S. hospitals and clinics, became the first major group to endorse pain as the fifth vital sign. After the Veterans Administration embraced it, it was adopted quickly in the private sector.12

Over the next few years, a series of other small trials published in medical journals reinforced Portnoy’s 1986 study. They uniformly concluded that opioids did not deserve their terrible reputation and that they were extremely “effective in treating long-term chronic pain.” Buried in scientific footnotes was that “long-term” usually meant 12 to 16 weeks and “effective in treating” meant “superior to placebo.”13

An anesthesiologist and dentist, J. David Haddox, pushed the limits of the reevaluation movement. Haddox, who later became the American Academy of Pain Medicine president and went to work for Purdue Pharma, reported in Pain about the failure to treat the pain of a 17-year-old leukemia patient. That failure, wrote Haddox, had “led to changes similar to those seen with idiopathic opioid psychologic dependence (addiction).” “Pseudoaddiction” was a syndrome, he theorized, that doctors unintentionally caused when they failed to provide their patients with sufficient opioid painkillers. The “behavioral changes” that many doctors concluded constituted addiction, argued Haddox, was only evidence of how undertreated the patient was in terms of narcotic painkillers.14

America’s three major pain associations embraced pseudoaddiction.15 (It took a quarter century before a comprehensive study revealed that in the 224 scientific articles that cited pseudoaddiction, only 18 provided even the sketchiest anecdotal data to support the theory. The study concluded that pseudoaddiction was itself “fake addiction.”)

The same month that Haddox introduced pseudoaddiction, a dozen prominent doctors published “The Physician’s Responsibility Toward Hopelessly Ill Patients” in the New England Journal of Medicine. Although the study was limited to terminally ill patients, pain management advocates enthusiastically applied its conclusion to all patients: “The proper dose of pain medication is the dose that is sufficient to relieve pain and suffering.… To allow a patient to experience unbearable pain or suffering is unethical medical practice.”16

New Jersey became the first state to adopt an “intractable pain treatment” law that recognized patients had a right to treat their pain. The statute shielded doctors from criminal or civil liability if the narcotics dispensed caused an addiction; 18 other states soon followed.

Enter Big Pharma

Portenoy and colleagues contended that opioids should be the first treatment option for chronic nonmalignant pain if the patient had no history of addiction. Instead of setting a maximum dose, the emerging standard of care was that opioids should be dispensed until the patient’s pain was relieved. The twin themes—that not treating pain was negligent and that opioids were safe for almost everyone—reinforced one another. The Sackler family, owners of a small drug company, Purdue Pharma, would have been hard pressed to plan a better lead-in to their release a decade later of OxyContin, their blockbuster opioid-based painkiller.

Purdue used a Wizard of Oz analogy to promise the reps who sold the most oxycontin that “A pot of gold awaits you ‘Over the Rainbow.’”

When the pain reevaluation movement had begun in the mid-1980s, OxyContin was not even on the drawing board. It was in early development when pain was on its way to becoming the fifth vital sign. In the following decade, Purdue did what every other drug company with an opioid-based product did: spent millions underwriting and subsidizing the doctors, advocacy organizations, and pain societies who were at the vanguard of the reevaluation movement. Many pioneering doctors reaped big fees as company lecturers. Purdue and other drug firms subsidized courses at medical schools, professional conferences and conventions, and continuing education classes. And, similar to what happened with the launch of other major drugs, some government officials (even a few key FDA officials) eventually went to work for Purdue and other firms selling opioids. Purdue and its competitors spent lots of money on the pain advocates precisely because they were promoting ideas about pain treatment that the drug manufacturers enthusiastically embraced.

The opioids reevaluation movement might not have had such an impact if it was not for the development of a time-release opioid painkiller, OxyContin. Purdue, and its aggressive marketing of OxyContin, came at a time when doctors were more willing to believe that opioids could be safely prescribed.

Three psychiatrist brothers, Arthur, Mortimer, and Raymond Sackler had bought Purdue in 1952. It was then a tiny New York drug company whose product line consisted mostly of natural laxatives, earwax removers, and tonics that claimed to boost brain function and metabolism. A decade after purchasing Purdue, the Sacklers added a distressed British manufacturer, Napp Pharmaceuticals. The Sacklers had not thought about developing a painkiller until Napp took advantage of an opportunity in the United Kingdom.

Cicely Saunders, a British nurse-turned physician, had opened the world’s first hospice in London in 1967. Her biggest obstacle in alleviating patient’s terminal discomfort was the need to dose painkillers intravenously every few hours. The patients got little sleep and it was not possible to send them home to spend their last days surrounded by friends and family.

Morphine, Saunders found, was not as effective in alleviating pain as diamorphine (a brand name for heroin). Heroin’s biggest drawback, she concluded, was that “it may be rather short in action.”17 She experimented by adding sedatives and tranquilizers to extend the time pain was relieved, but she was stymied at every turn by intolerable side effects.

Still, Saunders had a permissive view of opioids and their addictive power. She did not think heroin had a “greater tendency to cause addiction than any other similar drug.… We have several patients in the wards at the moment who have come off completely without any withdrawal symptoms.”18

What she wanted was a revolutionary narcotic painkiller. In a single dose, it had to provide long relief from intense pain without causing sleepiness, motor coordination problems, and memory lapses. Several independent British pharmaceutical companies accepted her challenge. Smith & Nephew developed Narphen, a synthetic opioid it claimed was 10 times more powerful than morphine, quicker acting, and had a milder side effects profile. Although Saunders acknowledged that Narphen was a better end-of-life drug, it was not her holy grail for terminal cancer pain.

Smith & Nephew’s stumble handed the Sacklers an opportunity. Napp launched a significant research effort to find the new painkiller. When the breakthrough came in 1980, it promised not only to revolutionize pain care for the terminally ill, but it unwittingly provided the technology that would later fuel America’s opioid crisis. Napp introduced a morphine painkiller with a revolutionary, invisible- to-the-human-eye, sustained-release coating. That chemical layer consisted of a dual-action polymer mix that turned to a gel when exposed to stomach acid. Napp claimed the drug, MST Continus (continuous), released pure morphine at a steady rate over 12 hours. They could adjust the release rate by fine-tuning the density of the coating’s water-based polymer. It was the breakthrough painkiller for which Cicely Saunders had been searching since the late-1960s.

MST Continus carved out a market in the UK, but it was limited for end-of-life cancer and hospice patients. It took the Sacklers seven years (until 1987) to get FDA approval for that drug in the U.S. (which they renamed MS-Contin). The FDA had slowed the approval process since its active ingredient, morphine, was a Schedule II controlled substance. By the time it went on sale in America, Portnoy had published the first of his studies concluding that opioids were not as addictive as previously thought and that they should be prescribed liberally to treat pain.

Purdue, now run by two of the surviving Sackler brothers, Mortimer and Raymond, and some of their children, took note of the burgeoning pain management movement. Raymond’s son, Richard Sackler, also a doctor, led a company effort to find an improved painkiller, or at least one with much broader commercial appeal than MS-Contin. Richard Sackler thought that any new painkiller should not use morphine since it had a notorious reputation as an end-of-life medication. Purdue’s science team picked oxycodone, a chemical cousin of heroin. While there were some oxycodone-based painkillers on the market—Percodan (oxycodone and aspirin) and Percocet (oxycodone and acetaminophen)—they were immediate-release pills. If Purdue could master an extended-release oxycodone pill, it would be the first of its kind.

Their oxycodone-based drug was still an unnamed product. Its first clinical trial was only completed in 1989. It took until 1992 for Purdue to apply for a patent. In 1995, the company finally got FDA approval. And it also won an extraordinary concession from the government regulator. Although Purdue had not conducted clinical trials to determine whether OxyContin was less likely to be addictive or abused than other opioid painkillers, the FDA had approved wording requested by the company: “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.”19 (Curtis Wright, the FDA officer who oversaw the OxyContin label approval, soon left the agency to work at Purdue as its medical officer for risk assessment).

Marketing Pain

Purdue’s sales team highlighted that extraordinary sentence to convince physicians that it was a safer narcotic than its rivals. Purdue prepared an unprecedented marketing launch for OxyContin. The late Arthur Sackler was a marketing genius, widely acknowledged as having introduced aggressive Madison Avenue advertising tactics to selling pharmaceuticals. Arthur had handled the promotion for Hoffman LaRoche’s 1960s blockbuster drugs, Librium and Valium, and had made them the biggest-selling drugs in the world for a record 17 years.

Purdue laid out a sales strategy for OxyContin straight from Arthur’s playbook. Its twin sales pitches were that OxyContin relieved pain longer than any other opioid painkiller, and because it was a time-release product, it was less likely to be addictive.

Purdue sales reps raised “concerns about addiction” before physicians did. It was, they said, understandable that no matter how wonderful a drug, “a small minority” of patients “may not be reliable or trustworthy” for narcotic painkillers. If the doctors were still skeptical at that stage, the reps showed them the FDA-approved label that stated if OxyContin was used as prescribed for treating moderate to serious pain, addiction was “very rare.” What constitutes “very rare”? Less than one percent, according to the sales reps. To tilt the odds in favor of its “low risk of addiction” sales strategy, Purdue underwrote several studies that reported addiction rates from long-term opioid treatment between only 0.2 percent and 3.27 percent. However, those company-sponsored reports were never confirmed by independent studies.

Purdue also got help in promoting the “low risk of addiction” from the American Pain Society and the American Academy of Pain Medicine. Purdue and other opioid drug manufacturers were generous funders of both organizations. The groups issued a consensus statement emphasizing that opioids were effective for treating nonmalignant chronic pain and reiterating that it was “established” that there was a “less than 1 percent” probability of addiction.

Purdue sales reps hammered home that OxyContin released oxycodone into the bloodstream at a steady rate over 12 hours. That, Purdue claimed, made it impossible for addicts to get the rush they chased. Without a high, patients would not want more of the drug as it wore off. The company knew that was not true—its own clinical trials demonstrated that for some patients up to 40 percent of oxycodone was released into the bloodstream in the first hour or two. That was fast enough to cause a high and a resulting crash that required another pill in order to feel better.

Dispensing physicians had no idea what Oxy cost, nor did most care. Since they did not pay for the drugs, they let patients and their insurance companies worry about that.

Purdue revised its compensation packages for its sales team, especially top performers, in time for the OxyContin launch. Large bonuses could double a sales rep’s salary. In an internal memo to the “Entire Field Force,” Purdue used a Wizard of Oz analogy to promise the reps who sold the most that “A pot of gold awaits you ‘Over the Rainbow.’” Two months later after Oxy went on sale, another memo titled, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!”, urged the sales team to push doctors to prescribe the higher-dose pills.

There was far greater profit for Purdue, and more money for the sales team, by pushing higher doses. There were three strengths when it went on sale: 10, 20, and 40 milligrams. An 80 mg tablet was released a month later (15, 30, 60, and 160 mg pills would arrive in a few years). Purdue’s production costs were virtually the same for each since oxycodone, the active ingredient, was inexpensive to manufacture. However, Purdue charged more for each additional strength. On average, a bottle of 20 mg pills cost twice as much as the 10 mg variety, and 80 mg pills were about seven times more expensive. If a patient took 20 mg pills twice a week, Purdue made less than $40 in profit. The same patient prescribed 80 mg pills twice a week returned $200 to Purdue, a 450 percent increase (that profit exceeded $600 a bottle in another five years).

Dispensing physicians had no idea what Oxy cost, nor did most care. Since they did not pay for the drugs, they let patients and their insurance companies worry about that.

Purdue created “Individualize the Dose,” a campaign designed to push the strongest doses. Sales reps told doctors that the company’s studies showed it was best to start patients on a medium to higher dose. The stronger doses, Purdue assured physicians, could be dispensed even to people who had never used opioids, all without adverse effects. The field reps contended that the higher-dose pills were no more likely to cause addiction. That was not true. Internal documents later revealed that Purdue’s sales team knew that stronger doses carried a significantly higher likelihood of dependence, addiction, and even potentially lethal respiratory suppression. While the company’s press releases claimed “dose was not a risk factor for opioid overdose,” internal communications are replete with references to the dangers of “dose-related overdose.”

OxyContin was instantly the most successful drug Purdue ever released. By 2001, only five years after it had gone on the market, its cumulative sales had passed a billion dollars, a first for Purdue. Although a lucrative hit for the Sacklers, OxyContin was less than ten percent of the opioid market. Johnson & Johnson, Janssen, Cephalon, and Endo Pharmaceuticals had their own narcotic painkillers. Their sales teams pitched them as aggressively as Purdue pushed Oxy, and all the companies subsidized the same nonprofits and patient advocacy groups. Janssen managed to get FDA approval in 1990 for the first fentanyl patch to treat severe pain. Fentanyl was then the most potent synthetic opioid, one hundred times stronger than morphine and 1.5 times more powerful than oxycodone. Two years after the FDA had given a green light to OxyContin, it approved Cephalon’s Actiq, a fentanyl “lollipop,” for cancer patients whose intense pain did not respond to other narcotics. Fentanyl patches and Actiq pops were diverted illicitly for big profits and sometimes with lethal side effects. There were widespread industry rumors that Cephalon’s sales team pushed its lollipops off-label as “ER on a stick” for chronic pain.

Still, by 2001, it was OxyContin that was in the crosshairs of some angry patients, the media, and the DEA. Small towns throughout Appalachia seemed overrun by a deluge of OxyContin, locally called “Hillbilly Heroin.” The DEA, meanwhile, was investigating diversion of the drug from the manufacturing plant Purdue used in New Jersey. It was also compiling evidence that Oxy contributed to overdose deaths by examining autopsy reports from across the country. The DEA wanted the FDA to put strict restrictions on the number of refills allowed for the painkiller.

In February 2001, OxyContin appeared for the first time in the New York Times, a front-page story—“Cancer Painkillers Pose New Abuse Threat”—about how it had become an abused drug in at least seven states.20 The Times raised the issue of whether Purdue’s hard-hitting marketing was partially responsible for the growing problems.

Purdue went all out to battle the bad press and its regulatory headaches. It hired big name legal talent. Rudy Giuliani, fresh off being America’s Mayor after his handling of the city in the aftermath of the 9/11 attacks, had just opened a private office and he began lobbying government officials on Purdue’s behalf. The company dispatched its medical officers and top executives to meet with the FDA and DEA. It assured both that it was working to control any abuse and diversion and it contested the findings about Oxy’s role in overdoses by pointing to the cocktail of illicit drugs in most of the autopsy reports. At that stage, the DEA could not find a death in which the victim had only Oxy, without alcohol, benzos, heroin, cocaine, cannabis, or some other drug. In the same month as the Times story, Richard Sackler sent an internal Purdue email that said, “We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”

Purdue emerged mostly unscathed from all the extra scrutiny. Although the FDA did require changes to OxyContin’s label, it was far less than what activists wanted. The FDA ordered the addition of a so-called black box warning. The bold-font warning was a reminder to doctors that OxyContin was “a Schedule II controlled substance with an abuse liability similar to morphine.” No drug company liked having a black box warning on its label, but as I learned in my reporting, Purdue was not upset since it considered the language a good compromise. One marketing executive remarked later, “It is black box lite.” It merely reiterated what most physicians knew already about OxyContin.

In 2004, OxyContin officially earned the dubious distinction as the most abused drug in America.21 Parents who had lost children to OxyContin were trying to raise awareness about the drug’s dangers. The biggest concern for Purdue, however, was an ongoing investigation into Oxy’s marketing by the West Virginia U.S. Attorney, John Brownlee, who started his probe in 2002. West Virginia was one of states hardest hit by OxyContin. In 2006,

Brownlee was ready to bring a case. He forwarded a six-page memo to the DOJ’s Criminal Division to get authorization to file felony charges against Purdue and its top executives for money laundering, wire and mail fraud, and conspiracy.22 Brownlee got bad news from headquarters. The Criminal Division vetoed all the serious felony counts and instead gave him permission only to bring less serious charges around misbranding the drug. That was a clean and straightforward prosecution.

In May 2007, Purdue and three non-Sackler executives accepted a plea agreement. The company and officers pled guilty to a scheme “to defraud or mislead, marketed and promoted OxyContin as less addictive, less subject to abuse and diversion, and less likely to cause tolerance and withdrawal than other pain medications.”23 Purdue’s fine was $634.5 million, and the three executives paid a combined $34.5 million.

Purdue signed both Consent and Corporate Integrity agreements. It agreed not to make “any written or oral claim that is false, misleading, or deceptive” in marketing OxyContin and to report immediately any signs of false or deceptive marketing. The strict terms of those agreements should have been the end of Oxy’s nationwide trail of devastation. Instead, the ink was barely dry before Purdue started flagrantly disregarding the rules. The deadliest years and record abuse with OxyContin came after the 2007 guilty pleas.

And Then It Got Even Worse

Purdue went on a hiring binge that eventually doubled its sales force. It unleashed them to push Oxy with a renewed vigor. The company also paid millions to the “key physician opinion leaders” so they would convince doctors that OxyContin should be their first choice whenever a patient presented with serious pain. The results were impressive. In the year that Purdue pled guilty, sales passed $1 billion annually and profits exceeded $600 million. OxyContin provided 90 percent of Purdue’s profits.

The opioid crisis is a tragedy that was largely preventable and, as such, one of the most infuriating chapters in modern U.S. history.

When Purdue faced the possibility of generic competition in 2010, the company devised a “new and improved” coating that it said was more difficult to crush, snort or inject. Although Purdue’s two small studies showed the new version had “no effect” in reducing the addiction and overdose potential, the FDA still approved tamper-resistant OxyContin. (It took ten years before an FDA advisory panel ruled that the tamper-resistant Oxy had failed to reduce opioid overdoses).

With the FDA approval, Purdue spent millions on a splashy ad campaign directed to physicians. Titled “Opioids with Abuse Deterrent Properties,” Purdue touted its crush-resistant formulation as the first ever narcotic pain reliever that reduced the chances for abuse and slashed the addiction rate. The campaign worked. Many doctors believed it and increased their prescribing pace.

In 2011, four years after Purdue’s criminal guilty plea, OxyContin surpassed heroin and cocaine to become the nation’s most deadly drug. Sales were also at a record, each year breaking the previous year’s record. When there was a slowdown in 2013, the Sacklers brought in McKinsey & Company consultants, who laid out a plan to “supercharge” sales. The results were almost immediate. In 2015, Forbes listed the Sackler family on its “Richest Families” list for the first time. The Sacklers, with an estimated net worth of $14 billion, had jumped ahead of the Rockefellers, Mellons, and Busches, among many others. Forbes titled the family “the OxyContin Clan.”24

The news about the Sacklers great fortune was lost under a deluge of news about the national toll from OxyContin. By 2015, for the first time, opioids killed more people than guns and car crashes combined, and lethal overdoses even surpassed the peak year of HIV/AIDS deaths. Statisticians blamed OxyContin for the first decline in two decades in the life expectancy of Americans. And a CDC report confirmed what some doctors suspected: prescription opioid users were 40 times more likely to become heroin addicts, making Oxy the most effective gateway drug into heroin. The CDC urged doctors either to “carefully justify” or “avoid” prescribing more than 60 mg daily. Still, the guidelines were voluntary. Only seven states passed legislation to limit the number of prescriptions.

In 2016, OxyContin and the opioid epidemic became a presidential campaign issue. The Joint Commission, responsible for accrediting hospitals and clinics, reversed its 2001 position that pain should be the fifth vital sign. Even the FDA was slowly recognizing the extent of the problem. Parents who lost children to opioids had submitted a citizen’s petition to the FDA, pleading with the regulators to classify Oxy for severe pain only. After eight years on the back burner, the agency was seriously considering it.

It’s Only Money

Suddenly, the Sacklers and Purdue, and their competitors, were on the defensive. The Trump administration declared the opioid epidemic a public health emergency in 2017. That action freed up extra federal resources for treatment. A few months later, forty-one state attorneys general subpoenaed internal Purdue marketing and promotion documents. Purdue announced plans to slash its sales force by half and that it would no longer market Oxy directly to individual physicians, instead concentrating on hospitals and clinics.

In 2019, a judicial panel decided to streamline the more than 2,500 pending lawsuits under the jurisdiction of a single federal judge in Ohio. The consolidated lawsuit was called the National Prescription Opiate Litigation. The following month, the Massachusetts Attorney General filed an amended complaint that was different from all others. It relied on Purdue’s internal records to conclude that eight of the Sackler-family directors had “created the epidemic and profited from it through a web of illegal deceit.” The New York Attorney General filed a similar action a few weeks later and added that the Sacklers had personally transferred hundreds of millions in assets to offshore tax havens.

To drive home how much the Sacklers had profited from OxyContin, court documents filed by the attorneys general revealed that the family directors had voted payments of $12 to $13 billion in profits since OxyContin went on sale. By the end of 2019, OxyContin had $35 billion in sales from its launch, while America recorded its 200,000 death since the government had begun tracking them.25

In the end, it was lawyers, state prosecutors, and the nation’s top class action litigators, who pried some financial justice from the many parties that shared responsibility for the national tragedy. Purdue filed for bankruptcy protection in late 2019 and the Sacklers sought protection from all the civil litigation so long as they contributed a lot of money to an overall settlement. In 2022, the family agreed to pay $6 billion toward a settlement and a bankruptcy judge signed off on a plan that freed them from civil litigation.26 (I co-wrote two New York Times opinion pieces that argued the judge had exceeded his bankruptcy court authority by discharging all actions pending against the Sacklers, who had not themselves filed bankruptcy. That issue and the complex bankruptcy plan are now pending before the Supreme Court.) Under the bankruptcy plan, Purdue became a public entity that continued to sell OxyContin, with any proceeds going to treatment and public health.

This article appeared in Skeptic magazine 28.4
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In 2022, Johnson and Johnson paid $5 billion to settle the litigation pending against it. J&J also announced it was quitting the opioid painkiller business. The country’s three largest wholesale drug distributors—AmerisourceBergen, Cardinal Health, and McKesson—reached a settlement in the tsunami of litigation pending against them by paying a combined $21 billion.27 Another $13.8 billion came from the big three pharmacy chains, Walmart, Walgreens, and CVS. Rite Aid filed for bankruptcy protection. The litigation has produced about $55 billion in total settlements.28

Still none of that matters to many families who lost loved ones to the overzealous marketing of prescription painkillers. And, with the many families I have interviewed, they note that no one has gone to prison for having made such enormous profits off the deaths of several hundred thousand Americans. Many who helped fuel the epidemic, such as overprescribing doctors, owners of pill mills, and lax regulators at the FDA and in state health agencies, got away without so much as a slap on the wrist.

An unnamed plaintiff’s lawyer told The Guardian in 2018 that the Sacklers were “essentially a crime family… drug dealers in nice suits and dresses.” No prosecutors, however, had the courage to bring a criminal action against the Sacklers and other opioid kingpins.

What a shame.

About the Author

Gerald Posner is an award-winning journalist and author of thirteen books, including New York Times nonfiction bestsellers Why America Slept (about 9/11) and God’s Bankers (about the Vatican), and the Pulitzer Prize finalist Case Closed (about the JFK assassination). His latest, Pharma, is a withering and encyclopedic indictment of a drug industry that often seems to prioritize profits over patients. A graduate of the University of California at Berkeley, he was a litigation associate at a Wall Street law firm. Before turning to journalism, he spent several years providing pro bono legal representation on behalf of survivors of Nazi experiments at Auschwitz.

References

1. https://rb.gy/6a7hv
2. https://rb.gy/8pyh2
3. https://rb.gy/h7pop
4. https://rb.gy/lviuy; https://rb.gy/wrekp
5. Cavers, D.F. (1939). The Food, Drug, and Cosmetic Act of 1938: Its Legislative History and Its Substantive Provisions. Law & Contemp. Probs., 6, 2.
6. “John Bonica, Pain’s Champion and the Multidisciplinary Pain Clinic,” Relief of Pain and Suffering, John C. Liebeskind History of Pain Collection, Box 951798, History & Special Collections, UCLA Louise M. Darling Biomedical Library, Los Angeles, CA.
7. Brennan, F. (2015). The U.S. Congressional “Decade on Pain Control and Research” 2001– 2011: A Review. Journal of Pain & Palliative Care Pharmacotherapy, 29(3), 212–227.; https://rb.gy/zmifj
8. Porter, J., & Jick, H. (1980). Addiction Rare in Patients Treated With Narcotics. New England Journal of Medicine, 302(2), 123.
9. https://rb.gy/zmg4c; https://rb.gy/leawh. In 2017, six researchers published in the NEJM the results of their review of all subsequent citations to the 1980 letter. “In conclusion, we found that a fivesentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy.” Dr. Jick told the Associated Press in 2017: “I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did.”
10. Portenoy, R.K., & Foley, K.M. (1986). Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases. Pain, 25(2), 171–186.
11. Max quoted in Schottenfeld, J.R., Waldman, S.A., Gluck, A.R., & Tobin, D.G. (2018). Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis. Journal of Law, Medicine & Ethics, 46(2), 220–237.
12. Morone, N.E., & Weiner, D.K. (2013). Pain as the Fifth Vital Sign: Exposing the Vital Need for Pain Education. Clinical Therapeutics, 35(11), 1728–1732.
13. Sullivan, M.D., & Howe, C.Q. (2013). Opioid Therapy for Chronic Pain in the United States: Promises and Perils. Pain, 154, S94–S100.
14. Weissman, D.E., & Haddox, J.D. (1989). Opioid Pseudoaddiction—an Iatrogenic Syndrome. Pain, 36(3), 363–366.
15. “Definitions Related to the Use of Opioids for the Treatment of Pain,” Consensus Statement of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine, approved by the American Academy of Pain Medicine Board of Directors on February 13, 2001, the American Pain Society Board of Directors on February 14, 2001, and the American Society of Addiction Medicine Board of Directors on February 21, 2001 (replacing the original ASAM Statement of April 1997), published 2001.
16. Wanzer, S.H., Federman, D.D., Adelstein, S.J., Cassel, C.K., Cassem, E.H., Cranford, R.E., … & Van Eys, J. (1989). The Physician’s Responsibility Toward Hopelessly Ill Patients. A Second Look.
17. Saunders, C. (1965). The Last Stages of Life. The American Journal of Nursing, 70–75.
18. Saunders, C. (1963). The Treatment of Intractable Pain in Terminal Cancer. Proceedings of the Royal Society of Medicine, 56, 195–197.
19. https://rb.gy/l7kvh
20. https://rb.gy/tzwla
21. Cicero, T. J., Inciardi, J. A., & Muñoz, A. (2005). Trends in Abuse of OxyContin and Other Opioid Analgesics in the United States: 2002–2004. The Journal of Pain, 6(10), 662–672.
22. https://rb.gy/xdv0m
23. 2007-05-09 Agreed Statement of Facts, Para 20.
24. https://rb.gy/qi6ph
25. https://rb.gy/67baw
26. https://rb.gy/580po
27. https://rb.gy/hz79m
28. https://rb.gy/ma2m8

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If there’s one universal trait among humans, it’s our social nature. The craving to connect is universal, compelling, and frequently irresistible. This concept is central to Robots and the People Who Love Them. Socially interactive robots will soon transform friendship, work, home life, love, healthcare, warfare, education, and nearly every nook and cranny of modern life. This book is an exploration of how we, the most gregarious creatures in the food chain, could be changed by social robots. On the other hand, it considers how we will remain the same, and asks how human nature will express itself when confronted by a new class of beings created in our own image.

Drawing upon recent research in the development of social robots, including how people react to them, how in our minds the boundaries between the real and the unreal are routinely blurred when we interact with them, and how their feigned emotions evoke our real ones, science writer Eve Herold takes readers through the gamut of what it will be like to live with social robots and still hold on to our humanity. This is the perfect book for anyone interested in the latest developments in social robots and the intersection of human nature and artificial intelligence and robotics, and what it means for our future.

Eve Herold is an award-winning science writer and consultant in the scientific and medical nonprofit space. A longtime communications and policy executive for scientific organizations, she currently serves as Director of Policy Research and Education for the Healthspan Action Coalition. She has written extensively about issues at the crossroads of science and society, including stem cell research and regenerative medicine, aging and longevity, medical implants, transhumanism, robotics and AI and bioethical issues in leading-edge medicine. Previous books include Stem Cell Wars and Beyond Human, and her work has appeared in the Wall Street Journal, Vice, the Washington Post and the Boston Globe, among others. She’s a frequent contributor to the online science magazine, Leaps, and is the recipient of the 2019 Arlene Eisenberg Award from the American Society of Journalists and Authors.

Shermer and Herold discuss:

• What happened to our flying cars and jetpacks from The Jetsons?
• What is a robot, anyway? And what are social robots?
• Oskar Kokoschka, Alma Mahler, and the female doll
• Robot nannies, friends, therapists, caregivers, and lovers
• Sex robots
• The uncanny valley: roboticist Masahiro Mori in 1970
• Robots in science fiction
• Psychological states: anthropomorphism, effectance (the need to interact effectively with one’s environment), theory of mind (onto robots), social connectedness
• “Personal, social, emotional, home robots”
• Emotions, animism, mind
• Emotional intelligence
• Turing Test
• Artificial intelligence and natural intelligence
• What is AI and AGI?
• The alignment problem
• Large Language Models
• ChatGPT, GPT-4, GPT-5 and beyond
• Robopocalypse
• Robo soldiers
• What is “mind”, “thinking”, and “consciousness”, and how do molecules and matter give rise to such nonmaterial processes?
• Westworld: Robot sentience?
• The hard problem of consciousness
• The self and other minds
• How would we know if an AI system was sentient?
• Can AI systems be conscious?
• Does Watson know that it beat the great Ken Jennings in Jeopardy!?
• Self-driving cars
• What set of values should AI be aligned with, and what legal and ethical status should it.

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Thousands of religions have adherents today, and countless more have existed throughout history. What accounts for this astonishing diversity?

This extraordinarily ambitious and comprehensive book demonstrates how evolutionary systematics and philosophy can yield new insight into the development of organized religion. Lance Grande―a leading evolutionary systematist―examines the growth and diversification of hundreds of religions over time, highlighting their historical interrelationships. Combining evolutionary theory with a wealth of cultural records, he explores the formation, extinction, and diversification of different world religions, including the many branches of Asian cyclicism, polytheism, and monotheism.

Grande deploys an illuminating graphic system of evolutionary trees to illustrate historical interrelationships among the world’s major religious traditions, rejecting colonialist and hierarchical “ladder of progress” views of evolution. Extensive and informative illustrations clearly and vividly indicate complex historical developments and help readers grasp the breadth of interconnections across eras and cultures.

The Evolution of Religions marshals compelling evidence, starting far back in time, that all major belief systems are related, despite the many conflicts that have taken place among them. By emphasizing these broad historical interconnections, this book promotes the need for greater tolerance and deeper, unbiased understanding of cultural diversity. Such traits may be necessary for the future survival of humanity.

Lance Grande is the Negaunee Distinguished Service Curator, Emeritus, of the Field Museum of Natural and Cultural History in Chicago. He is a specialist in evolutionary systematics, paleontology, and biology who has a deep interest in the interdisciplinary applications of scientific method and philosophy. His many books include Curators: Behind the Scenes of Natural History Museums (2017) and The Lost World of Fossil Lake: Snapshots from Deep Time (2013). His new book is The Evolution of Religions: A History of Related Traditions.

Shermer and Grande discuss:

• Why is a paleontologist and evolutionary theorist interested in religion?
• Evolutionary systematics and comparativism in evolutionary biology, linguistics, and the history of religion
• What is a comparative systematicist?
• E. O. Wilson’s consilience approach
• Agnostic approach: not addressing the truth value of any one religion
• What is religion?
• Variety: 10,000 different religions: Christianity (33%), Islam (23%), Hinduism/Buddhism (23%), Judaism (0.2%), Other (10%), Agnosticism (10%), Atheism (2%)
• Evolutionary trees of religion
• Biological vs. cultural evolution & diversification: Lamarkian vs. Darwinian
• Historical colonialist progressivism and social Darwinism
• Frans Boaz, Margaret Meade, historical particularism
• Rather than focusing on differences, focus on similarities
• Nature/Nurture & The Blank Slate in anthropology & the social sciences
• Early evolutionary origins of religion: the cognitive revolution, agenticity, patternicity, theory of mind, animism, spiritism, polytheism
• Gobekli Tepe as the earliest religious ceremonial structure
• Machu Picchu and Inca religion
• Human sacrifice and religion
• Apocalypto
• Pizzaro, Atahualpa, and Spanism/European colonialism & eradication of New World religions
• Time’s arrow and Time’s cycle: Asian Cyclicism
• Dharmic religion (India), Taoism, Buddhism, Jainism, Sikhism, Shinoism (Hirohito)
• Old World Hard Polytheism (vs. Soft?) & New World Hard Polytheism (Mesopotamian, Egyptian, Celtic, Greek, Old Norse, Siberian totemism, Alaskan totemism
• Colonialism and missionaries extinguished many polytheistic religions
• Linear Monotheism: Atenism, Zoroastrianism, El, Yahweh, Jehovah, Monad, Allah (linear time: one birth, one life, one death, one eternal afterlife; dualistic cosmology: good vs. evil, light vs. dark, heaven vs. hell); proselytic: conversion efforts
• Abrahamic Monotheism 6th century BCE Second Temple Judaism and Samaritanism
• Included prophets: Noah, Abraham, Moses (60% of all religious people today)
• Tanakh sacred scripture 6th century BCE: Hebrew Bible, Old Testament, Quran
• Jesu-venerationism (1st century CE): Ebionism (Jesus as prophet but not divine), Traditional Christianity, Biblical Demiurgism (primal good god Monad, evil creator spirit Demiurge; saw Jesus as the spiritual emanation of the Monad), Islam
• Reformation: Catholicism split into Protestantism, Anglicanism
• Islam: revered 25 prophets from Adam to Jesus, ending with Muhammad
• Expansion of Islam through conquests in the 7th and 8th centuries CE
• 4 Generalizations:
  • Organized Religions are historically related at one ideological level or another (illustrated by trees);
  • Largest major branches today were historically intertwined with major political powers;
  • Authority of women declined with the rise of male dominated pantheons, empires, clergies, caliphates;
  • Religion played a role in our species’ early ability to adapt to its social and physical environment: tribalism was a competitive advantage for early humans in which communal societies that developed agriculture, commerce, educational facilities, and armies out-competed less communitarian groups.

Show Notes
How We Believe

In my 2000 book How We Believe: Science, Skepticism, and the Search for God, I defined religion as “a social institution that evolved as an integral mechanism of human culture to create and promote myths, to encourage altruism and reciprocal altruism, and to reveal the level of commitment to cooperate and reciprocate among members of the community.” That is, there are two primary purposes of religion:

1. The creation of stories and myths that address the deepest questions we can ask ourselves: Where did we come from? Why are we here? What does our ultimate future hold?
2. The production of moral systems to provide social cohesion for the most social of all the social primates. God figures prominently in both these modes as the ultimate subject of mythmaking and the final arbiter of moral dilemmas and enforcer of ethical precepts.

From Shermer’s book Truth

“Jesus was a great spiritual teacher who had a profound effect on many people,” writes Lance Grande in his magisterial The Evolution of Religions, admitting that “he became what is probably the most influential person in history.” But this says nothing about the verisimilitude of the miracle claims made in Jesus’ name. In fact, as Grande notes, neither during his own lifetime (4BC-30 CE), nor in the earliest writings of the New Testament by Paul, were miracle claims made in Jesus’s name. Even Paul’s mention of the resurrection of Christ was described in 1 Corinthians (15:44) as a spiritual event rather than a literal one: “It is sown a natural body; it is raised a spiritual body. There is a natural body, and there is a spiritual body.” In Paul’s writings about Christ, says Grande, “he speaks of him in a mystical sense, as a spiritual entity of human consciousness.” Many contemporary groups, in fact, “saw Christ as a spirit that possessed the man Jesus at his baptism and left him before his death at the crucifixion” (called “separationism”). But since political monarchs in the first century CE were treated as divine, Christian proselytizers began to refer to Jesus as the “King of Kings,” and so came to pass the deification of an otherwise mortal man. Here is how Grande recaps the transformation:

Reports of specific miracles only began to appear several decades after the death of Jesus, in the Gospel of Mark (65-70 CE) and in later gospels (80-100CE). This suggests that stories of miracles (e.g., controlling the weather, creating loaves and fishes out of nothing, turning water into wine, healing the sick, and raising the physical dead) were layered into the story of Jesus as expressions of an ultimate God experience.

And as is typical of myths in the making, in the retelling across peoples, spaces, and generations, layers of improbability are added as a test of faith:

Once the stories of miracles began to appear in early Christianity, they were retold repeatedly, until they became ingrained beliefs. More stories were added, such as miracles about singing angels, stars announcing earthly happenings, and even a fetus (that of John the Baptist in his mother Elizabeth’s womb) leaping to acknowledge the anticipated power of another fetus (that of Jesus in his mother Mary’s womb). These details, many of which probably began as metaphorical lessons, gradually became accepted by many followers as literal historic truths. It is probable that some of these stories were never intended as documents of historical fact.

From metaphorical lessons to historic truths. Perhaps this is what the author of the Gospel of John meant when he wrote (John 20:31): “But these are written, that ye might believe that Jesus is the Christ, the Son of God; and that believing ye might have life through his name.”

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In an era of terrifying unpredictability, we race to address complex crises with quick, sure algorithms, bullet points, and tweets. How could we find the clarity and vision so urgently needed today by being unsure? Uncertain is about the triumph of doing just that. A scientific adventure tale set on the front lines of a volatile era, this epiphany of a book by award-winning author Maggie Jackson shows us how to skillfully confront the unexpected and the unknown, and how to harness not-knowing in the service of wisdom, invention, mutual understanding, and resilience.

Long neglected as a topic of study and widely treated as a shameful flaw, uncertainty is revealed to be a crucial gadfly of the mind, jolting us from the routine and the assumed into a space for exploring unseen meaning. Far from luring us into inertia, uncertainty is the mindset most needed in times of flux and a remarkable antidote to the narrow-mindedness of our day. In laboratories, political campaigns, and on the frontiers of artificial intelligence, Jackson meets the pioneers decoding the surprising gifts of being unsure. Each chapter examines a mode of uncertainty-in-action, from creative reverie to the dissent that spurs team success. Step by step, the art and science of uncertainty reveal being unsure as a skill set for incisive thinking and day-to-day flourishing.

Maggie Jackson is an award-winning author and journalist known for her pioneering writings on social trends, particularly technology’s impact on humanity. Winner of the 2020 Dorothy Lee Book Award for excellence in technology criticism, her book Distracted was compared by FastCompany.com to Silent Spring for its prescient critique of technology’s excesses, named a Best Summer Book by the Seattle Post-Intelligencer, and was a prime inspiration for Google’s 2018 global initiative to promote digital well-being. Jackson is also the author of Living with Robots and The State of the American Mind. Her expertise has been featured in The New York Times, Business Week, Vanity Fair, Wired.com, O Magazine, and The Times of London; on MSNBC, NPR’s All Things Considered, Oprah Radio, The Takeaway, and on the Diane Rehm Show and the Brian Lehrer Show; and in multiple TV segments and film documentaries worldwide. Her speaking career includes appearances at Google, Harvard Business School, and the Chautauqua Institute. Jackson lives with her family in New York and Rhode Island.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

In a special double segment that is reminiscent of The National Enquirer in its heyday, 60 Minutes has aired another dramatic story on Havana Syndrome. If it had been a sporting event, the score would have been 8-0: eight people interviewed and not a single skeptic.

Billed by CBS News as a “breakthrough” in their five-year-long investigation, the episode that aired Sunday night, March 31, 2024, raises many important questions—not about the existence of Havana Syndrome, but the present state of journalistic integrity. As someone who has followed this saga from the beginning, the new 60 Minutes report was a case study in fearmongering and selective omission. The program was filled with misleading statements and circumstantial evidence that were used to gin up a story that is on life support after the U.S. intelligence community concluded last year that “Havana Syndrome” is likely a condition that never existed.

In the leadup to the broadcast, CBS News teased the segment with the headlines “Targeting Americans” and “Breakthrough in Havana Syndrome Investigation.” Yet in the report it was described as “a possible breakthrough” and there was no conclusive proof that Americans, or anyone else, have been targeted.1

60 Minutes reporter Scott Pelley featured an interview with Gregory Edgreen, a former American military intelligence officer who oversaw the Pentagon investigation into “Havana Syndrome.” He told Pelley that the present situation is dire for American security as “the intelligence officers and our diplomats working abroad are being removed from their posts with traumatic brain injuries—they’re being neutralized.”2

Edgreen disagreed with last year’s intelligence community consensus, left his position and has founded Advanced Echelon, a company devoted to caring for “Havana Syndrome survivors.”3 His interview is reminiscent of recent attempts by some media outlets to support the unfound claim the U.S. Government is covering up information on the existence of recovered alien bodies and crashed saucers. This is the opinion of one man who was involved in an investigation, yet he does not represent the intelligence community, which has deemed the purported attacks to be “highly unlikely” and the existence of the condition itself as dubious.

Enter David Relman

Predictably, Stanford microbiologist David Relman made an appearance and told Pelley that his panel found “clear evidence of an injury to the auditory and vestibular system of the brain.” This is not supported by the evidence. Relman failed to mention that not only have recent studies found no such damage, many Havana Syndrome patients have been diagnosed with psychosomatic disorders that are commonly triggered by stress.

Pelley also claimed that a senior Department of Defense official was attacked during last year’s NATO Summit in Lithuania. His source: multiple unnamed people. He said that the official involved—also unnamed—“was struck by the symptoms and sought medical treatment.” We are told nothing more. The trouble with this claim is that Havana Syndrome has been associated with a laundry list of common health complaints ranging from fatigue and forgetfulness to nausea, nosebleeds, headache, tinnitus, ear pain and difficulty sleeping. Throughout the broadcast there were also assertions that victims were suffering from brain injury—something that has never been demonstrated. These symptoms are also features of countless other medical conditions.

Also interviewed was an FBI agent identified only as “Carrie,” who said she had been attacked by a directed energy weapon and while she had been given permission to discuss her condition by her employer, “she wasn’t allowed to discuss the cases she was on when she was hit.” Appearing in disguise to protect her identity she described how one day in 2021 at her Florida home she felt “pressure and pain” in her head that radiated down her jaw and neck and into her chest before she passed out. Since then, she says she has experienced problems with long and short-term memory and difficulty with sensing spatial awareness: “If I turn too fast, my gyroscope is off… it’s like I’m a step behind where I’m supposed to be, so I’ll turn too fast and I will literally walk right into the wall.”

Pelley then claimed that “other sources”—anonymous of course—told 60 Minutes that one of the cases involved a suspected Russian spy who was caught speeding on a Florida highway in 2020. The man had apparently been interviewed by Carrie on several occasions. He was identified as a former Russian military officer with an electrical engineering background. While serving a sentence for reckless driving and evading police, “Carrie” said she was hit two more times—about a year apart—once in Florida, once in California. The “attacks” left her disoriented and a feeling that her body was pulsating.

The Russians Are Coming!

Who is behind these attacks? The Russians, of course. Pelley casts suspicion for the “attacks” on a Russian military unit known as 29155. He also claims to have found the smoking gun—a document sourced online showing that one the unit’s officers had been paid for working on “nonlethal acoustic weapons.” This is not the dramatic find that it is made out to be. Acoustic weapons are in common use by governments around the world. The use of sound cannons—commonly known as Long-Range Acoustic Devices—have long been employed to control crowds. Beyond this they have shown little practical value as the waves rapidly disperse.

It was then claimed that unit 29155 may have been in the city of Tbilisi in the former Soviet Republic of Georgia, when several Americans experienced mysterious health incidents there. An unnamed 40-year-old wife of a Justice Department official told Pelley that she was struck by an energy weapon when her husband was working at the U.S. Embassy in Tbilisi in October 2021. She said she was suddenly overcome by a piercing sound in her left ear, felt “a fullness” in her head, developed a headache, and began vomiting. What happened next reads like a spy novel. She looked outside and spotted a car near the front gate and a man nearby. Pelley then showed her a photo of a member of unit 29155 who was thought to have been in the city at the time of the “attack.” When asked if it looked like the man in the photo, she unhesitatingly pronounced, “it absolutely does.” Shortly after, however, she grew hesitant: “I cannot absolutely say for certain that it is this man…” But after a few more seconds elapsed she proclaimed: “I can absolutely say that this looks like the man….” This is not exactly an icon-clad identification.

The woman says she continues to suffer balance problems, headaches and “brain fog,” the latter term being a common description of people experiencing anxiety. She also said that her symptoms typically worsen at night. These are common features of vestibular dysfunction. Pelley dramatically noted that the woman has also been treated for “holes in her inner ear canals.” While this could have been from a mysterious weapon, there is a more mundane explanation: perilymphatic fistula that can be caused by barotrauma from changes in air or water pressure, such as from flying or scuba diving. Strenuous physical exercise can also trigger the condition, as well as head trauma.

A Story with Nine Lives

Havana Syndrome has become a cottage industry for podcasters, bloggers, and the news media because it’s a dramatic story that reads like a spy novel and is guaranteed to get clicks and views. It has also turned into the ultimate game of whack-a-mole. Like the cat with nine lives, it just won’t die. I cannot help but think that when enough people become aware of the full story—where key facts have not been omitted, Havana Syndrome will finally fade from the headlines. If I had watched this story with only a superficial knowledge of Havana Syndrome, I probably would have finished watching the episode convinced that there really have been Russian attacks on Americans using a secret weapon. But the facts point to a far more mundane explanation.

What happened to journalistic integrity? For years many journalists have reported that American citizens have been hit with a mysterious energy weapon. Scott Pelley has filed no less than three such reports for 60 Minutes.4 At the very least, viewers are entitled to hear from prominent skeptics whose voices were silenced. A news program that interviews eight believers and no skeptics isn’t a news program—it’s propaganda.

About the Author

Robert E. Bartholomew is an Honorary Senior Lecturer in the Department of Psychological Medicine at the University of Auckland in New Zealand. He is a Fellow of the Committee for Skeptical Inquiry and the co-author of Havana Syndrome: Mass Psychogenic Illness and the Real Story Behind the Embassy Mystery and Hysteria (Copernicus, 2020) with neurologist Robert Baloh.

References

1. Costa, Robert (2024). The CBS Evening News, March 29, 2024, at 10:00 sec. and accessed at: https://www.cbsnews.com/evening-news/; See also https://www.cbsnews.com/video/targeting-americans-sunday-on-60-minutes/
2. Pelley, Scott (2024). “Foreign adversaries may be involved in Havana Syndrome, sources say.” 60 Minutes (CBS News, NY). March 31.
3. See the Advanced Echelon homepage at: https://www.advancedechelon.net/about
4. See also: Pelley, Scott (2022). “Havana Syndrome: High-level national security officials stricken with unexplained illness on White House grounds.” 60 Minutes (CBS News, NY). February 20, accessed at: https://cbsn.ws/3MfZaLR; Pelley, Scott (2019). “Brain damage suffered by U.S. diplomats abroad could be work of hostile foreign government.” 60 Minutes (CBS News, NY). March 17.

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As one of the few black students in his philosophy program at Columbia University years ago, Coleman Hughes wondered why his peers seemed more pessimistic about the state of American race relations than his own grandparents–who lived through segregation. The End of Race Politics is the culmination of his years-long search for an answer.

Contemplative yet audacious, The End of Race Politics is necessary reading for anyone who questions the race orthodoxies of our time. Hughes argues for a return to the ideals that inspired the American Civil Rights movement, showing how our departure from the colorblind ideal has ushered in a new era of fear, paranoia, and resentment marked by draconian interpersonal etiquette, failed corporate diversity and inclusion efforts, and poisonous race-based policies that hurt the very people they intend to help. Hughes exposes the harmful side effects of Kendi-DiAngelo style antiracism, from programs that distribute emergency aid on the basis of race to revisionist versions of American history that hide the truth from the public.

Through careful argument, Hughes dismantles harmful beliefs about race, proving that reverse racism will not atone for past wrongs and showing why race-based policies will lead only to the illusion of racial equity. By fixating on race, we lose sight of what it really means to be anti-racist. A racially just, colorblind society is possible. Hughes gives us the intellectual tools to make it happen.

Coleman Hughes is a writer, podcaster and opinion columnist who specializes in issues related to race, public policy and applied ethics. Coleman’s writing has been featured in the New York Times, the Wall Street Journal, National Review, Quillette, The City Journal and The Spectator. He appeared on Forbes’ 30 Under 30 list in 2021.

Shermer and Hughes discuss:

• If he is “half-black, half-Hispanic” why is he considered “black”?
• What is race biologically and culturally?
• Race as a social construction
• Population genetics and race differences: sports, I.Q., crime, etc.
• Base Rate Neglect, Base Rate Taboos
• The real state of race relations in America: surveys, call-back studies, search data, etc.
• George Floyd, BLM, Ibram X Kendi, Robin DiAngelo, Isabella Wilkinson, Ta-Nehisi Coates and the neo-racists
• Institutionalized neo-racism: the academy and business
• What it means to be “colorblind”
• Viewpoint epistemology and race
• Affirmative action and correcting for past wrongs
• Lyndon Johnson’s famous quote, June 4, 1965, Howard University: “You do not take a person who, for years, has been hobbled by chains and liberate him, bring him up to the starting line of a race and then say, “you are free to compete with all the others,” and still justly believe that you have been completely fair. Thus it is not enough just to open the gates of opportunity. All our citizens must have the ability to walk through those gates. This is the next and the more profound stage of the battle for civil rights. We seek not just freedom but opportunity. We seek not just legal equity but human ability, not just equality as a right and a theory but equality as a fact and equality as a result.”
• Why are there still big gaps in income, wealth, home ownership, CEO representation, Congressional representation, etc.?
• Myth of Black Weakness
• Myth of No Progress
• Myth of Undoing the Past
• The Fall of Minneapolis
• Reparations
• The future of colorblindness.

Read Michael H. Bernstein’s review of Coleman Hughes book, The End of Race Politics: Arguments for a Colorblind America.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

Several years ago, I came across an imaginative essay entitled “Explaining Affirmative Action to a Martian.”1 The author, who I had never heard of, described a fictious interaction where a human explains the rationale of affirmative action to an alien. Among its gems is the following interaction:

Earthling: Black people were enslaved and subjugated for centuries, so, sometimes they get special dispensations. It’s only fair…

Visitor: So those black kids…were enslaved and subjugated, so they get to score 450 [standardized test] points lower than Asians?

Earthling: Well these particular black students didn’t experience slavery or Jim Crow themselves… But their grandparents might have experienced Jim Crow.

Visitor: Might have?

Earthling: Well, around half of black students at elite colleges are actually the children of black immigrants so they have no ancestral connection to American slavery or Jim Crow…

Visitor: … I’m utterly confused by you creatures.

The author of this essay was Coleman Hughes, a Columbia University undergraduate at the time. In the intervening years, Hughes has been one of the leading voices on race. As a long-time listener and fan of Hughes, I was eager to read his first book, The End of Race Politics: Arguments for a Colorblind America. It did not disappoint.

Hughes has a gift for clearly and dispassionately evaluating one of our most explosive social topics. Oftentimes in today’s world, the political left exaggerates the prevalence of racism while the political right a priori assumes that all such accusations lack merit. What we so desperately need is a middle ground: An analysis that deals honestly with the racism which does exist without inflating it. This is what Coleman Hughes does.

What makes his book excellent is, ironically, the mundane manner in which he evaluates race. Hughes carefully dissects the arguments of neoracism, an ideology he defines as “discrimination in favor of non-whites…justified on account of the hardships they endure—and hardships their ancestors endured—at the hands of whites.” Reading Hughes is a breath of fresh air. He gives neoracism the long overdue hearing it deserves, one that is fair but critical.

Hughes forces readers to think in terms of counterfactuals. This is typically missing from public discourse but is essential for evaluating double-standards and identifying what philosophers call the “special pleading” fallacy where rules are inconsistently applied. For example, the author points out that Yale University did not denounce the racism of a psychiatrist who gave a talk saying, “I had fantasies of unloading a revolver into the head of any white person that got in my way, burying their body and wiping my bloody hands as I walked away relatively guiltless.” Yet, as Hughes puts it, “Suppose [the speaker] had described fantasies about shooting black people in the head, burying them, and walking away… Is there any doubt that the Yale administration would have condemned her racism?”

In chapter five, Hughes delves into seven central tenants of neoracism, such as “Racial disparities provide direct evidence of systemic racism” and “White people have power in society, but Black people don’t.” Reading the book, and this chapter in particular, felt like following the author on a tour of three-legged stools. Each claim seems believable on its face but Hughes raises compelling arguments against them. For instance, consider the racial disparity tenant mentioned above which includes the claim that “there would be no racial disparities, or at least large ones, in a fair society.” It is easy to see the appeal: Blacks have been historically discriminated against and are on the short end of many troubling disparities. However, Hughes discusses factors other than racism that could explain group differences. Perhaps most critical is the age gap, such that the median White person is 10 years older than the median Black person. Wilfred Reilly points out that the age gap is even more striking (31 years) when comparing the modal (most common) age.2 Might that play a role in some disparities, such as wealth or incarceration rates?

One of the joys of reading Hughes’ book, at least for myself as a research psychologist, is the way key psychological concepts are infused throughout—even if not explicitly named (and since the author has no formal background this is not surprising). The notion of tribalism, something my colleagues and I have studied in the context of politics,3 is depicted as key to the neoracist ideology “because it casts every event as an instance of us versus them, good versus evil, black versus white.” Sadly, one of the most important lessons4 from social psychology—the subfield largely devoted to understanding how humans interact with each other—of the past 50 years is the ease with which people separate into groups and develop preference for in-group members.

Elsewhere, in critiquing what he calls “chronic victimhood,” Hughes writes, “A wise therapist wouldn’t tell you to accept chronic victim status…and think of yourself as forever trapped in your experience of trauma. The wise therapist would instead help you develop strategies for moving past the trauma you’d suffered, empowering you to escape the trauma’s gravitational pull.” Here, the author is getting at the idea of mindset, a concept developed by Stanford Psychology Professor Carol Dweck. Hughes is correctly pointing out that victimhood and its downstream difficulties should be viewed in the context of a growth mindset—something that is malleable—rather than in the context of a fixed mindset, which is not changeable. Growth mindsets suggest that people have agency to change; unsurprisingly, research generally supports the idea that it leads to better outcomes. A study by Jessica Schleider, for example, found that a single 20–30 minute computer-based session focused on enhancing a growth mindset reduced depression among adolescents when evaluated nine months later.5

There was one observation Hughes made in passing that clearly reveals his status as a gifted intellectual with a keen eye towards understanding how people think and behave. He starts by critiquing the position that America has failed to “acknowledge and atone for its past [racism]” by pointing out several facts which seem to contradict this assertion, including the adoption of Juneteenth and Martin Luther King Day as federal holidays, affirmative action programs, and most critically, Congress issuing apologies for slavery. Hughes argues that “none of this paints a picture of a general public, or a government, that is resistant to historical soul-searching.” Several paragraphs later he continues, “To this day, it remains a talking point among media pundits that America has ‘never’ issued a formal apology for slavery.” And this is where he makes his insight:

We must realize that a game is being played here. Normally when someone demands an apology, they actually want one. But sometimes they don’t. Sometimes the ability to continue demanding the apology is worth more than the apology itself. Sometimes the debt is worth more unpaid than paid… This is why every new apology, program, or holiday that they demand is forgotten as soon as it’s achieved… It’s not clear to me whether neoracists play this game consciously or whether there is self-deception involved. But either way, we are indeed playing a game, and if we don’t realize it, then everyone loses.

If you took out the word “neoracist” and told me this passage was from Eric Berne’s seminal 1964 book, Games People Play, I would have believed you. Hughes is arguing that a game of shifting goalposts is occurring. One could argue another instance of this happened in the aftermath of George Floyd’s death. First, there were demands for Chauvin to be convicted. After he was convicted, the guilty verdict was seen as insufficient. For instance, Bernie Sanders tweeted the common sentiment “The jury’s verdict delivers accountability for Derek Chauvin, but not justice for George Floyd.”6 If no game were occurring, which is to say that opinion was also held before the conviction, then it seems to suggest courts are unable to administer justice for victims. This raises challenging questions about how justice would be administered (if possible) and who would decide what constitutes justice.

My only substantiative critique of the book is that, while it functions as a highly effective counter to ideas presented by radical neoracists, Hughes could have bolstered his argument in favor of colorblindness by also speaking more explicitly to moderates. I think many left-of-center people are put off by the ideas of activists such as Ibram X. Kendi and Robin DiAngelo, and are disturbed by the way race is discussed in elite circles. However, I also think most would still favor mild affirmative action programs that they believe are appropriately calibrated. People who fall into this camp might agree with 90 percent of the book and even agree that colorblindness is a better approach to race than our current one. Yet, they might also argue that the best solution is to reduce, yet not eliminate, the consideration of race.

Overall, I found The End of Race Politics to be an excellent read from a superb up-and-coming author. Those teaching classes on race who include Kendi’s How to Be an Antiracist on their syllabus should seriously consider adding this book to the reading list for a diversity of viewpoints. Students could then engage with scholars who hold diametrically opposing positions and debate the merits of each.

I doubt that will happen anytime soon, but will be delighted if proven wrong.

A review of The End of Race Politics: Arguments for a Colorblind America by Coleman Hughes

About the Author

Michael H. Bernstein is an experimental psychologist and an Assistant Professor at Brown University. His research is focused on the overlap of cognitive science with medicine. He is Director of the Brown Medical Expectations Lab and co-editor of The Nocebo Effect: When Words Make You Sick. For more information, visit michaelhbernstein.com.

References

1. https://bit.ly/3Vi24Xv
2. https://bit.ly/48UG3Be
3. https://bit.ly/498cmNi
4. https://bit.ly/4amn181
5. https://bit.ly/4cddOR0
6. https://bit.ly/3TuKcGu

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Order the Artificial Intelligence issue of Skeptic magazine (in print or digital format).

Looking ahead to the 2024 election, most Americans sense that something is deeply wrong with our democracy. We face extreme polarization, increasingly problematic candidates, and a government that can barely function, let alone address urgent challenges. Maxwell Stearns has been a constitutional law professor for over 30 years. He argues that our politics are not merely dysfunctional. Our constitutional system is broken. And without radical reform, the U.S. risks collapse or dictatorship.

In Parliamentary America: The Least Radical Means of Radically Repairing Our Broken Democracy, Stearns argues that we are in the midst of the biggest constitutional crisis since the Civil War, and that the roots of the crisis are in the U.S. Constitution itself. The Framers never intended a two-party system. In fact, they feared entrenched political parties and mistakenly believed they had designed a scheme that avoided them. And yet the structures they created paved the way for our entrenched two-party system.

From the start, our systems of elections and executive accountability thwarted the Framers’ expectations. In the information age, it has spun out of control, and the result is a hyperpolarized Republican-Democratic duopoly that has poisoned our politics and society and threatens to end our democracy. The two-party system now undermines our basic constitutional structures, with separation of powers and checks and balances yielding to hyper-partisan loyalties. Rather than compromises arising from shifting coalitions, we experience ever-widening policy swings based on which party takes control of the White House in increasingly combative elections. The restrictive nature of the choices voters face in each election cycle encourages battles for the souls of the Democratic and Republican Parties, with more moderate voices on one side and more ideologically strident ones on the other. This two-party stranglehold on our politics is exactly what the Framers feared.

To survive as a democracy, we must end the two-party deadlock and introduce more political parties. But viable third parties are a pipe dream in our system given the current rules of the game. Stearns argues that we must change the rules, amend the Constitution, and transform America into a parliamentary democracy. Unlike our two-party presidential system, well-functioning parliamentary systems have multiple political parties that represent an array of perspectives, giving voters more choices that better align with their views. In such systems, parties compete in elections and then, based on the results, form a majority governing coalition. In contrast with the endless hyper-partisanship that pushes Democrats and Republicans further and further apart, coalitions represent the nation’s ideological core, capturing views of multiple parties, accommodating competing positions, and moderating the most extreme ideologies or partisan commitments. This improves the outcomes for citizens, which helps to explain why surveys have found that voters derive greater satisfaction and the governments are more responsive in parliamentary systems.

Achieving a robust parliamentary democracy in the U.S. requires amending the Constitution. Although this is difficult to do, Stearns explains why his specific set of proposals is more politically viable than other increasingly prominent reform proposals, which cannot be enacted, will not end our constitutional crisis, or both. What does he propose doing?

1. Double the size of the House of Representatives, with half continuing to be elected by district, a new cohort elected by party, and the entire chamber based on proportional representation. This reform will allow us to end the two-party duopoly and create space for thriving third-, fourth- and fifth-parties that better align with voters’ values/worldviews.
2. Transform how we choose the president and vice president. Power to choose the president will shift from individual votes processed through the Electoral College to party coalitions within the House of Representatives. They will select the president and vice president from party slates by inviting up to five party leaders, in descending order of representation, to negotiate a majority coalition.
3. Provide a new mechanism for ending a failing presidency. The House can remove the president with a 60 percent no confidence vote based on “maladministration.” This standard is lower than the requirements for impeachment, and the amendments leave the impeachment clause intact. These reforms infuse parliamentary selection, proportional representation, and coalition building into the U.S. constitutional system while retaining and preserving our most essential institutional structures. The proposal would end the two-party system, create space for multiple parties, end partisan gerrymandering, moderate the most extreme ideologies, reduce polarization, and incentivize negotiation and compromise.

Maxwell L. Stearns is the Venable, Baetjer & Howard Professor of Law at the University of Maryland Carey School of Law. He has authored dozens of articles and several books on the Constitution, the Supreme Court, and the economic analysis of law.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” —Sherlock Holmes

The “game” of my title refers to the one played by media outlets and podcasters for the past seven years interviewing rogue scientists and conspiracy theorists to spin tales of Americans being zapped by nefarious foreign actors with sonic or microwave weapons. This includes the authors of studies suggesting that there were brain and inner ear injuries suffered by many victims of Havana Syndrome when those studies were clearly flawed and any competent mainstream scientist who read them would have seen these shortcomings. Indeed, they did—there were at least two classified studies that found no evidence of such attacks, instead emphasizing the likely role of stress.1, 2, 3, 4 Publicly, these politicians and pundits were referring to the events in Cuba as attacks, yet gave no hint of the findings of U.S. intelligence agencies.5

On March 18, 2024, the National Institutes of Health released two studies that failed to find any evidence of brain or inner ear damage in victims of Havana Syndrome—a mysterious array of ailments that have befallen U.S. Government personnel in Havana, Cuba, since 2016.6, 7 The results were published in the prestigious Journal of the American Medical Association (JAMA) and are in stark contrast with two earlier studies published in the same journal in 2018 and 2019 that purported to uncover brain anomalies in American diplomats and intelligence officers who served in Havana.8, 9 While some media outlets are portraying this discrepancy as a deepening mystery, it is nothing of the sort.

The earlier publications were riddled with flaws.10 In fact, the editorial board of the European journal Cortex called for the authors of the 2018 study to clarify their methods or retract the article.11 Their attempt at clarification did little to quell the controversy.12 The NIH study was more comprehensive and took great pains to have a well-matched group of control subjects. The studies were conducted over a five-year period beginning in 2018. Sophisticated MRI scans were taken of the brains of Havana Syndrome participants and compared to a healthy control group of government workers in similar jobs. Some of the control subjects even worked at the American Embassy in Havana.

The Havana Cohort: A Group Under Stress

A major finding of the new study was that 41 percent of those who reported Anomalous Health Incidents (AHIs) “from nearly every geographic area, met the criteria for Functional Neurological Disorders” (FND) or exhibited symptoms indicative of underlying psychological distress.13 It is noteworthy that mass psychogenic illness, which some skeptics have long tied to the episode, is a form of FND. The presence of functional disorders is not surprising because they are commonly triggered by stress and the American staff in Havana were, by any definition, under exceptional stress. They had been counselled that they would be under surveillance 24/7 once they arrived in Havana and later told that they may be targets of a mysterious weapon and to be vigilant for strange sounds and symptoms. They were even warned not to stand or sleep near windows as it could render them vulnerable to an attack. In FNDs the brain structure and hardware are unaffected, but the sending and receiving of messages is disrupted, hence neurologists often refer to it as a software issue.

Havana Syndrome participants also reported more symptoms of depression, fatigue, and post-traumatic stress. The lead author of one of the studies, Dr. Leighton Chan, emphasized that the symptoms in Havana Syndrome patients were “very real, cause significant disruption in the lives of those affected and can be quite prolonged, disabling and difficult to treat.”14 Another member of the research team, neuropsychologist Louis French, noted that the presence of mood symptoms and post-traumatic stress were not unexpected. “Often these individuals have had significant disruption to their lives and continue to have concerns about their health and their future. This level of stress can have significant negative impacts on the recovery process,” he said.15

No Evidence of Attacks

As for the role of a directed energy weapon that has long been proposed as the cause behind the events, Dr. Chan said if an “external phenomenon” such as “a directed energy ‘attack’ is truly involved it seems to create symptoms without persistent or detectable physiologic changes.”16 While the researchers found no evidence of an external source for the symptoms, this does not prove that there wasn’t one, leading one media outlet, the Daily Mail, to suggest that a weapon was likely involved but its presence was undetectable. The newspaper interviewed Georgetown University Neurologist Dr. James Giordano, a persistent critic of the possible role of psychogenic illness in Havana Syndrome victims, who was quick to dispute the findings of FNDs. “Let me be very definitive, we’re not talking about a functional neurological disorder, which is a psychosomatic disorder,” Dr. Giordano said. “We’re talking about a disruption of neurological function, that then created a host of effects, including downstream physiological effects that manifested themselves cognitively, motorically, and behaviorally.”17

Giordano’s position lacks supporting evidence. One could also argue that there was no evidence of extraterrestrial involvement, but that doesn’t prove space aliens weren’t targeting victims with a ray gun. On the weight of evidence, stress appears to have played a major role in the outbreak. While critics like Giordano have jumped on the statement that the symptoms were real and severe as evidence that they were not functional, psychosomatic symptoms are real and can be as severe as any other symptoms and often involve the same brain pathways.18

After release of the NIH reports, one of the world’s leading experts on FNDs, British neurologist Jon Stone, told The Guardian science podcast that this condition was a plausible explanation as many of the patient’s symptoms “got worse over time,” which is typical of a functional disorder. Brain injuries, on the other hand, are typically “worse at the time of the injury, then they slowly improve,” he said. The paper’s world affairs editor Julian Borger was then asked to weigh in. He said that while a “secret weapon” seemed far-fetched, it was equally unlikely that so many diplomats and spies would be affected by psychogenic illness. This response highlights a common misconception of psychogenic disorders: the symptoms are real and can happen to anyone regardless of education level or training.19

The Extraordinary Claims of David Relman

In 1953, Nobel laureate Irving Langmuir devised the term “pathological science” to refer to instances “where there is no dishonesty involved but where people are tricked into false results by a lack of understanding about what human beings can do to themselves in the way of being led astray by subjective effects, wishful thinking” and the like.20 The history of science is rife with examples of extraordinary claims that were eventually discredited. During the late 19th and early 20th centuries several astronomers, most notably Percival Lowell, claimed to discern through their telescopes a network of canals on Mars. This turned out to be an exercise in the subjective nature of human perception involving Martian geology where people saw what they expected to see. In 1903, French physicist Prosper-René Blondlot claimed to have discovered N-rays, a new form of radiation that turned out to be a product of experimenter bias and self-deception.21, 22 In 1989, chemists Stanley Pons and Martin Fleischmann created international headlines amid claims they had achieved cold fusion—a limitless source of clean energy. Their experiment turned out to be flawed and could not be reproduced. To this list we should add the name of Stanford microbiologist David Relman.

Media coverage of the NIH studies has been dominated by the lack of evidence for brain damage and the findings of significant stress-related disorders in many of the subjects who reported anomalous health incidents. Considerable attention has been given to Dr. Relman, who was chosen by the Journal of the American Medical Association (JAMA) editors to deliver an accompanying editorial. Relman oversaw two panels that studied the claims of people reporting AHIs and the circumstances surrounding them.23, 24 He contends there is still a mystery surrounding some of the victims and holds the door ajar to the possible involvement of “pulsed radiofrequency energy.” The problem is, the two panels he oversaw showed bias by failing to interview prominent skeptics, ignoring evidence for mundane explanations, and giving considerable weight to unproven claims that supported his pet energy weapon theory. I have previously documented these and other shortcomings in Skeptic, including how one of his panels botched the diagnostic criteria for the presence of psychogenic illness.25, 26, 27 Neither panel conducted a single physical examination of a patient or engaged in any directed testing.28 The decision to choose Relman to write the commentary may be an attempt by the JAMA editorial board to mitigate the damage to their reputation after they published two poorly designed studies that have received much criticism by the scientific community.29, 30, 31, 32, 33, 34, 35, 36, 37

A bugaboo of Relman is the appearance of “abrupt-onset sensory phenomena” in a subset of patients on which he places great significance.38 In his commentary he mentions these cases while discussing “Havana Syndrome” reports from around the world. He writes: “Most strikingly, these phenomena often displayed strong location dependence, in that they quickly dissipated when the individuals vacated their initial location, and then returned when the location was revisited.” These incidents were followed by such conditions as “vertigo, dizziness, imbalance, blurry vision, tinnitus, headache, nausea, and cognitive dysfunction, sometimes leading to chronic disability.”39 The implication is that they may have been targeted by a directed energy weapon.40

In the press briefing, Dr. Chan said that his team looked at these reports that Relman had flagged as “cases of concern” for intelligence agencies—people who reported an acute onset coinciding with a “strong sense of locality or directionality.” But Chan said he was unable to study them as Relman had not provided the name of a single person involved, and that his definition of “locality or directionality” was not well-defined. Dr. Chan also noted that “cases of concern” were confined to “a really small group of individuals” who were affected very early in the outbreak in Cuba because early on U.S. Embassy personnel were counselled to move away from where they initially experienced symptoms. “If you’re on the X, get off the X,” they were told.41 Cases of concern were first noted in the National Academies of Sciences study that was conducted between 2019 and 2020, and only looked at reports in Cuba and China. If there were later cases of concern identified globally in Relman’s second panel that convened between 2021 and 2022, it was not conveyed to Dr. Chan.42

Why is it that the two panels headed by David Relman uncovered patterns that the American intelligence community—including the CIA and FBI—failed to find? This is a red flag. It is noteworthy that Relman’s panels had limited resources and access to government documents. For instance, in discussing the National Academy of Sciences committee and the attempt to examine cases of concern, he observed: “We did not really have the means to do our own investigation of these cases. We simply collected all that we could from those that had done various and sundry investigations and tried to make the most sense out of it we could.”43

While Relman claims to have found a small group of outliers, why weren’t the names of these victims given to the NIH study authors so they could be examined more closely? If these cases are deemed to be of such significance, why haven’t detailed interviews with these victims been released so others can read the descriptions? How many people are we talking about? The true test of the scientific method is to open your data to outside scrutiny, and in this instance, there is little to scrutinize. The ECREE Principle—extraordinary claims require extraordinary evidence—was never more apropos. There are just too many questions surrounding these cases to make the claims that are being asserted. The symptoms in abrupt onset cases can be caused by an array of common conditions. While a sound may appear to be targeted, there is a considerable body of literature on ear-witness testimony, which is notoriously unreliable and subject to error.44 An energy weapon could theoretically produce what is discerned to be a concentrated beam of sound, but so can a cricket rubbing its wings or legs together. We know that some of the reports involving a beam of sound that accompanied early Havana Syndrome victims were recorded during the “attacks,” and later identified as crickets.45, 46 Curiously, Dr. Relman’s commentary was crickets when it came to this alternative explanation.

Occam’s Razor

Some media commentators and rogue scientists continue to speculate that a small number of cases in U.S. personnel in both Cuba and later around the world, may have involved a directed energy weapon. Yet, Occam’s razor fits well here. Given two competing explanations, the simplest is the most likely. The entire episode is explainable using conventional psychology, and without recourse to foreign actors and secret weapons. It is noteworthy that the NIH findings are consistent with the conclusions of a report issued in March 2023 by the Director of National Intelligence that found no evidence of sonic or microwave weapons or the involvement of state actors. Instead, intelligence agencies traced the health complaints to an array of pre-existing conditions, environmental factors, and anxiety reactions.47

The appearance of Functional Neurological Disorders in the NIH studies is consistent with the early events in Havana, which suggest a psychological origin. A 2022 interview with CIA officer Fulton Armstrong is revealing. Armstrong was in Havana during the initial “attacks” and says that the man who first reported the mysterious sounds and became known as “patient zero,” had engaged in a zealous campaign to get embassy officials to take the sounds seriously. “He was lobbying, if not coercing, people to report symptoms and connect the dots,” he said.48 This lobbying could have primed other staff to frame future sounds and states of unwellness as an attack by a nefarious state actor. It is also notable that when other staff believed they were under attack from a sonic weapon, they recorded the sounds accompanying them. These sounds were consistent with the mating call of the Indies short-tailed cricket.49

By 2017, the State Department began counselling new staff being posted to Cuba to be vigilant for mysterious sounds and health incidents.50 This counselling created an expectation of illness and provided the frame through which sounds and symptoms were interpreted. Suddenly, mundane events such as a headache, fatigue, insomnia, or tinnitus were perceived as symptoms of a possible attack—a classic setup for psychogenic illness.51 “Patient zero” was pivotal in laying the foundation for the mysterious sounds that were noticed to coincide with subsequent “attacks”—the sounds of crickets. While cricket sounds cannot cause physical sensations such as head pressure and tingling, hearing a cricket sound and fearing it may be emanating from a neuroweapon can trigger anxiety reactions. It is well-known that panic attacks often occur when people visit the same location associated with anxiety or previous attacks.

The Importance of Timing

Dr. Relman’s “cases of concern” raise many questions. As Dr. Chan observed, they were poorly defined, small in number, and not a single person was identified or further studied. Relman should release the information on each of these cases so their testimony can be scrutinized. The timing is also important. Relman contends that some of the early victims in Cuba were unaware that their colleagues were suffering from Anomalous Health Incidents.52 This claim is not consistent with the known timeline, which begins with so-called patient zero. This early series of events in Havana have been meticulously pieced together using interviews with over three dozen American and foreign officials and confidential government documents.53, 54

Scrutinizing these cases could help clarify the possible role of what psychologists refer to as “retrospective interpretation.” It is plausible that once alerted to their possible targeting by an energy weapon, staff would have thought back to when they arrived in Havana and identified any unusual sounds or medical events. While at the time these incidents were not deemed to have been worthy of seeking medical attention or reporting to their superiors, later, in light of the energy weapon scare, these ambiguous events could have easily been redefined as “attacks.”55

For years Relman has asserted that there was “clear evidence of an injury to the auditory and vestibular system of the brain” in some Havana Syndrome patients.56 This is a reference to a study conducted by University of Miami neurologist Michael Hoffer.57 The vestibular system deals with the workings of the inner ear, spatial awareness, and balance. Neurologist Robert Baloh, who created some of the tests that were used to assess the patients and has written the standard textbook in the field, has steadfastly maintained that Hoffer’s study was riddled with flaws and failed to demonstrate inner ear damage. Among the study flaws was the mystifying decision not to use housemates as a control group, and the notion that a directed energy attack could cause inner ear or brain damage without affecting hearing, which makes no sense.58 That the NIH studies failed to corroborate Hoffer’s findings comes as no surprise. David Relman is an acclaimed microbiologist, but he is not an expert in vestibular medicine. This is a classic example of someone outside of their field of expertise being led astray.

Relman’s attempt to take a small number of cases that are vaguely defined and discussed in passing in both his commentary and in his two panel reports, are essentially lipstick on a pig. No matter how hard you try to alter its appearance, at the end of the day, it’s still a pig. Like Bigfoot, chupacabras, and alien abductions, the evidence is lacking and there are alternative plausible explanations which are firmly grounded in established science.

About the Author

Robert E. Bartholomew is an Honorary Senior Lecturer in the Department of Psychological Medicine at the University of Auckland in New Zealand. He has written numerous books on the margins of science covering UFOs, haunted houses, Bigfoot, lake monsters—all from a perspective of mainstream science. He has lived with the Malay people in Malaysia, and Aborigines in Central Australia. He is the co-author of two seminal books: Outbreak! The Encyclopedia of Extraordinary Social Behavior with Hilary Evans, and Havana Syndrome with Robert Baloh.

References

1. Acoustic Signals and Physiological Effects on U.S. Diplomats in Cuba, November 2018. Declassified United States Government study.
2. Kirk, J. M. (2019). The strange case of the Havana ‘Sonic Attacks’. International Journal of Cuban Studies, 11(1), 24—42. See p. 27
3. https://bit.ly/4a7JvJY
4. https://bit.ly/49qjQeJ
5. One of the most vocal has been U.S. Senator Marco Rubio.
6. https://bit.ly/43ESTm3
7. https://bit.ly/3VyUDeK
8. https://bit.ly/3TPzPhx
9. https://bit.ly/4cwQM80
10. https://bit.ly/43ziVav
11. https://bit.ly/3PBMoKO
12. https://bit.ly/43uri77
13. https://bit.ly/3VyfKh9
14. ibid.
15. ibid.
16. Chan et al., 2024, op cit., pp. E10—E11.
17. https://bit.ly/3TpaiKE
18. Personal communication with Professor Robert Baloh, Department of Neurology, UCLA Medical School, March 23, 2024. For an excellent overview of FNDs see https://bit.ly/3VBqLyb
19. https://bit.ly/3vpmdAo
20. https://bit.ly/4aaO8mS, quotation on p. 16 reproduced from the original 1953 article with commentary by R.N. Hall.
21. Klotz, Irving M. (1980). “The N-Ray Affair.” Scientific American 242(5):168—175
22. Nye, Mary Jo (1980). N-rays: An Episode in the History and Psychology of Science. Historical Studies in the Physical Sciences 11(1):125—156.
23. https://bit.ly/3xdTnne
24. Declassified United States Government Commissioned Report (2022). Anomalous Health Incidents: Analysis of Potential Causal Mechanisms, IC Experts Panel.
25. https://bit.ly/43uvCTP
26. https://bit.ly/4aaQ6ng
27. https://bit.ly/49fvmcy
28. https://bit.ly/3TzPxfH
29. https://bit.ly/43ziVav
30. https://bit.ly/3PCKbiu
31. https://bit.ly/3IY7gbr
32. https://bit.ly/3PyQT8Y
33. https://bit.ly/3PAXnUU
34. Baloh, R.W., and Bartholomew, R.E. (2020). Havana Syndrome: Mass Psychogenic Illness and the Real Story Behind the Embassy Mystery and Hysteria. Copernicus Books.
35. https://bit.ly/3vpoz2c
36. https://bit.ly/498CQhC
37. https://bit.ly/3PBajdI
38. Relman, 2024, op cit., p. E1.
39. Relman, 2024, op cit., p. E1.
40. While Relman writes about the plausibility of the possible role of microwave radiation in his commentary, he has not always been so confident. After the National Academies of Sciences report appeared, he was asked by National Public Radio reporter Sarah McCammon, “How confident are you that microwaves are what’s behind these symptoms?” His response: “We were not confident…we didn’t have any direct evidence that this could explain the entire story for sure or even parts of it…[and] we were not familiar with or read into the exact circumstances of these cases, so we couldn’t comment on the situational information that might have either supported or refuted this idea.” See: https://bit.ly/3x7kTma
41. Myles, R., moderator (2024). “NIH Telebriefing on Publication of Study Findings on Federal Employees with reported Anomalous Health Incidents (AHIs) in JAMA.” This embargoed media briefing featured Dr. Leighton Chan, Dr. Carlo Pierpaoli, and Dr. Louis French who answered questions from journalists.
42. Myles, 2024, op cit.
43. https://bit.ly/3TNskaW
44. Öhman, L. (2013). All Ears: Adults’ and Children’s Earwitness Testimony. University of Gothenburg.
45. Acoustic Signals and Physiological Effects on U.S. Diplomats in Cuba, November 2018. Declassified U.S. Government study
46. https://bit.ly/3VwwOUC
47. Office of the Director of National Intelligence. Unclassified: National Intelligence Council Updated Assessment on Anomalous Health Incidents, 2023.
48. https://bit.ly/3Tp6PvO
49. Acoustic Signals and Physiological Effects on U.S. Diplomats in Cuba, November 2018. Declassified U.S. Government study. An updated analysis with similar results was published on October 16, 2021 and titled, An Analysis of Data and Hypotheses Related to the Embassy Incidents, JSR-21-01, McLean, Virginia, 143 pp.
50. Oppmann, P., and Labott, E. (2017). “U.S. Diplomats, Families in Cuba Targeted Nearly 50 Times by Sonic Attacks, says U.S. Official.” CNN News, September 23.
51. One Embassy staffer told me: “The Embassy was a tightly-knit community with a very active rumor mill; many people were buzzing about the incidents’ and the related ailments starting as far back as December 2016. We knew as far back as March or April [2017] that doctors were comparing the symptoms to Traumatic Brain Injury. We were absolutely primed to know what the symptoms were. Additionally, many of us *were* experiencing headaches, mental fog, irritability, etc. —completely understandable given the high stress environment and the fact that we went asleep every night wondering whether we’d be zapped in our beds, and consequently lay awake for hours at a time, days on end, stretching into weeks and months.”
52. Merchant, 2021, op cit.
53. https://bit.ly/3TNFkNU
54. Baloh and Bartholomew (2020). pp. 29—37. These are highly respected journalists and Golden has won two Pulitzer Prizes for his reporting prowess.
55. The NIH study found that the first reported AHI occurred in 2015. All previous investigations had placed the date as late 2016. But this does not mean we should push back the start of ‘Havana Syndrome’ to 2015. Once American staff were interviewed about their AHIs, they would have been asked to recount any unusual health incidents or sounds that they experienced since arriving in Havana. As the U.S. Embassy was reopened under Obama in 2015, it is conceivable that any mysterious sounds or health complaints that were recalled during this period, could have easily been relabelled after the fact as an incident or ‘attack.’ That at least one person reported an AHI in 2015 should receive no great significance.
56. See, for example: https://bit.ly/4aaRIxk; see also, Merchant, 2021, op cit.
57. https://bit.ly/3TP84pv
58. Baloh and Bartholomew (2020). op cit.

In the Political Accuracy and Divisions Study (PADS), we conducted an extensive survey of over 3,000 American adults to assess their accuracy about a variety of controversial topics including, abortion, immigration, gender, race, crime, and the economy. So much of our political discourse revolves around these topics—but how much do we really know about these issues and the views of our fellow Americans? How informed are the loudest, most politically confident voices? We will examine the prevalence of misconceptions across the political continuum, and in doing so, we hope to offer a means by which to improve the quality of our national discourse.

For additional information, please feel free to contact the Skeptic Research Center by email: research@skeptic.com.

DATA BRIEFS

Additional data briefs that were shared on Twitter (X)

1. Do Hispanic Americans Identify with “Latinx”?
2. Are Voter ID Laws Racist?

REPORT (PADS-011)
Younger Generations are Least Accurate About Police Shootings and Least Trusting of Police

Eleventh report in the Political Accuracy & Divisions Study (PADS)

Amidst the George Floyd anti-police riots, the Skeptic Research Center showed that Americans’ anti-police attitudes were influenced to a significant degree by their ignorance about the number of unarmed Black men shot by police (McCaffree & Saide, 2021; Saide, McCaffree & McCready, 2021). Probably due in part to mainstream media’s constant portrayals of police as bloodthirsty racist killers (e.g., Balko, 2022; Thompson, 2021), we found that Americans identifying as “very liberal” were extremely misinformed, with nearly 54% believing 1,000 or more unarmed black men were shot by police in 2019, and with over 22% of “very liberals” believing the number was 10,000 or more (the actual number is around 10). Given Americans’ continued fledgling trust in police–64% of Americans reported high levels of trust in police in 2004 compared to 43% in 2023 (Gallup Polling, 2023)—in this report we ask: how does Americans’ accuracy about policing vary by generation, and how does being inaccurate about policing relate to trust of police?

Download Report (PADS-011)

Suggested Citation: McCaffree, K., & Saide, A. (2024). Younger Generations are Least Accurate About Police Shootings and Least Trusting of Police. Skeptic Research Center, PADS-011.

REPORT (PADS-010)
Are Americans Losing Their Trust?

Tenth report in the Political Accuracy & Divisions Study (PADS)

Public opinion polling has revealed unprecedented drops in Americans’ institutional trust for several years now, and institutional trust reached a new low in 2023 (Jones, 2022; Saad, 2023). Americans’ trust in government, for example, is hovering at its lowest point since Pew polling began measuring it in 1958 (Pew Research Center, 2023). In 1973, 58% of Americans had “a great deal”/“quite a lot” of confidence in public schools—by 2023, this had fallen to 26%. Also in 1973, 42% of Americans had “a great deal”/“quite a lot” of confidence in Congress—by 2023, this had fallen to 8%. In 1975, 80% of people had “a great deal”/ “quite a lot” of confidence in the medical system, but by 2023, this number had fallen to 33% (the decline began long before COVID). And also across many other American institutions (see Gallup Polling, 2023). Some polling also suggests Americans have been losing trust in each other (not just in abstract institutional “systems”). For example, Pew polling found that 64% of Americans felt that trust in one another has “been shrinking,” (Rainie et al., 2019). In light of these concerning trends, we looked back through two of our own polls (one conducted in 2021, the other in 2022) and asked: how have Americans’ trust in institutions and each other changed?

Download Report (PADS-010)

Suggested Citation: McCaffree, K., & Saide, A. (2024). Americans Are Losing Their Trust. Skeptic Research Center, PADS-010.

REPORT (PADS-009)
Being “Liberal” in America

Ninth report in the Political Accuracy & Divisions Study (PADS)

Analysts have recognized for decades now that the world is becoming more liberal. It seems that the more removed people are from basic survival concerns, the more liberal their worldviews become, in the sense of being more accepting of cultural differences and more protective of civil rights. Some analysts have noted how paradoxically intolerant and dogmatic this trend has become in Western societies (i.e., the societies most removed from basic survival concerns): amongst many Western progressives, for example, all group disadvantages are assumed to always be a result of oppression, with oppression always being driven by white people (and usually men). Thus, it would seem that at the extremes, liberalism and the human tendency towards tribalism interact to produce both a demand for equality and justice as well as an insistence that one demographic group (white/European people) is accountable for most or all of the oppression and corruption in the world. In light of the controversies and nuances inherent in identifying as a modern liberal, in this report we ask: how do rates of identifying as “liberal” vary in the United States according to peoples’ generation, sex and race?

Download Report (PADS-009)

Suggested Citation: McCaffree, K., & Saide, A. (2024). Being “Liberal” in America. Skeptic Research Center. Political Accuracy and Divisions Study, PADS-009.

REPORT (PADS-008) The Essence of Americans

Eighth report in the Political Accuracy & Divisions Study (PADS)

Part of human reasoning involves reducing people, animals, and things to their core essence, a tendency beginning in childhood (Ahn et al., 2001; Gelman, 2003). We define dogs and cats by different essences, for example, and we do the same for people when we define them by their sex, race, age, and the like. Though helpful as a crude way of categorizing things in the world, essentialism makes us prone to error. Believing, for example, that water is defined by the essential element of “wetness” will fail to recognize ice as water; or, believing that those with recent European ancestry are defined by the essential element of “whiteness” will fail to recognize variations in cultural background or individual experience (Roth et al., 2023). While essentialism feels useful in its simplifying of an otherwise complex reality, it can lead to negative stereotyping. Given that essentialist reasoning typically produces rigid categorizations of people, and that rigid categorizations of people might be conducive to political misinformation, conspiracism, or extremism (e.g., Buhagiar et al., 2018; Kurzwelly et al., 2020), in this report we ask: how common is the tendency to essentialize amongst the American public?

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Suggested Citation: McCaffree, K., & Saide, A. (2023). How Commonly Do Americans Essentialize Each Other?. Skeptic Research Center, PADS-008.

REPORT (PADS-007) How Accurate Are Americans About Economic Mobility?

Seventh report in the Political Accuracy & Divisions Study (PADS)

According to economists at Stanford University, economic mobility is a “fading American dream.” Richard Delgado, a founder of critical race theory, calls upward mobility a “myth” and suggests that, “the myth of upward mobility enables the wealthy to justify favorable treatment for themselves and cutbacks for the rest,” while reminding us that, “study after study shows that class membership in our society is relatively fixed.” In agreement, the Huffington Post regards economic class in America as “suffocating,” Mother Jones insists that America is a “thriving aristocracy” maintained by “powerful-yet-obscure entities,” and the New York Times informs us that class in America is a “caste system,” and that “the hierarchy of caste is… about power — which groups have it and which do not. It is about resources — which groups are seen as worthy of them, and which are not.” These claims are not new. As far back as 1897, Carrol D. Wright, the first commissioner of the United States Bureau of Labor Statistics, noted that, “the assertion that the rich are growing richer and the poor poorer has…taken more complete possession of the popular mind than any other.” Yet, Wright went on to say that this assertion “is a false one, false in its premises and misleading in its influence.” Is poverty ubiquitous in America? Do people have any chance of improving their economic circumstances? To assess these claims and what Americans think about them, in this report we ask: how accurate are Americans about economic mobility?

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Suggested Citation: McCaffree, K., & Saide, A. (2023). How Accurate Are Americans About Economic Mobility?. Skeptic Research Center, PADS-007.

REPORT (PADS-006) Depression and Political Ideology

Sixth report in the Political Accuracy & Divisions Study (PADS)

Is life in America hopeless? In a peer-reviewed article entitled “Fuck the patriarchy: Towards an intersectional politics of irreverent rage,” sociologist Helen Wood suggests that, “with climate change [and] widening inequality… we are truly fucked” (Wood, 2019). In 2020, Chad Wolf, acting U.S. Department of Homeland Security Secretary, declared white supremacy to be the most persistent and lethal domestic threat to the United States (Behrmann, 2020). A recent New York Times feature article described one professor’s struggle to remove “whiteness” from universities given that the study of classic literature, “has been instrumental to the invention of ‘whiteness’ and its continued domination” (Poser, 2021). Some popular academic theories even doubt the possibility of moral progress (Seamster & Ray, 2018). But in 2021, a Manhattan Institute report found, among other things, that reading social justice scholarship significantly reduced Black Americans’ hopefulness and motivation (Kaufmann, 2021). The author of the report speculated that, though intended to empower women and racial minorities, misleading characterizations of America as a white supremacist patriarchy may do the exact opposite. In light of this possibility, in this report we asked: “How is mental health related to believing this popular political rhetoric?”

Download Report (PADS-006)

Suggested Citation: McCaffree, K., & Saide, A. (2023). Depression and Political Ideology Skeptic Research Center, PADS-006.

Follow-up to PADS-006

Posted on Twitter on August 3, 2023

Download “Depression and Political Ideology” (PADS-006F)

REPORT (PADS-005) How Informed Are Americans About Women’s Opportunities?

Fifth report in the Political Accuracy & Divisions Study (PADS)

Feminist academics argue that “patriarchy,” or the oppression of women in society by men, affects both public and private life. They argue, for example, that male managers exploit their female colleagues in the workplace, male script writers perpetuate demeaning views of women and girls on television, husbands force their wives into near-constant subservience in the home, and that patriarchy not only prevents women from succeeding in society but also causes numerous other problems (Bates, 2021). One activist wrote, “We need…to deconstruct and exorcise patriarchy – which is the root of so many other forms of oppression, from imperialism to racism, from transphobia to the denigration of the Earth” (Ensler, 2021). In apparent agreement, the American Psychological Association now regards masculinity as “harmful” (APA, 2018). Additionally, according to leading sociologist Barbara Risman and others, “challenging men’s dominance is [also] a necessary condition of ending the subordination of lesbians and gay men,” and that, “If as feminists, we believe that gender is socially constructed and used to create inequality, our political goal must be to move to a post-gender society” (Risman, 2004; 2009). Due to the alarming nature of these claims, in this report we ask: “How informed are Americans about women’s achievements and opportunities?”
Download Report (PADS-005)

Suggested Citation: McCaffree, K., & Saide, A. (2023). How Informed Are Americans About Women’s Opportunities? Skeptic Research Center, PADS-005.

REPORT (PADS-004) Are “White People” Morally Deviant?

Fourth report in the Political Accuracy & Divisions Study (PADS)

For decades in the U.S., and particularly in the last few years, journalists and intellectuals have suggested that “white people” are socially or morally deviant. Time magazine, for example, published the claim that white supremacy is the “foundational principle” of culture in the U.S., preventing non-whites from having “perfect hair, perfect clothes, perfect grades…[or regarded as a] perfect employee and colleague.” In 2020, the Smithsonian National Museum of African American History and Culture claimed “rational thinking” and “hard work” are white supremacist ideals that oppress non-whites. In a recent opinion editorial, Savala Nolan, the Executive Director of the Center for Social Justice at UC Berkeley School of Law, said “white people…disappoint me. They frustrate me. They make me sad.” Meanwhile, books describing the immorality of white people, such as Caste, How to be an Anti-Racist, and White Fragility have all soared to the top of the New York Times Bestseller List. Given these strong opinions, in this report we ask: what does the public really think about the (apparent) immorality of white people?
Download Report (PADS-004)

Suggested Citation: McCaffree, K., & Saide, A. (2023). Are “White People” Morally Deviant? Skeptic Research Center, PADS-004.

Follow-up to PADS-004

Posted on Twitter on June 13, 2023

Download “Noble Savage Myth and Education” (PADS-004F)

REPORT (PADS-003) Update: How Informed are Americans about Race and Policing?

Third report in the Political Accuracy & Divisions Study (PADS)

“Defund the police” was the rallying cry of liberals in the Summer of 2020, motivating “mostly peaceful” protests that led to property damage in excess of two billion dollars across at least 20 US states (Johansmeyer, 2021). To better understand the motivation behind these protests, in 2020, we surveyed people about their estimates of the number of unarmed black men shot by police in 2019 and found a shocking degree of inaccuracy, particularly amongst progressives. In this report, we present an update on these data and ask: have people become more knowledgeable when it comes to the available data on fatal police shootings of unarmed black Americans?
Download Report (PADS-003)

Suggested Citation: McCaffree, K., & Saide, A. (2023). Update: How Informed are Americans about Race and Policing? Skeptic Research Center, PADS-003.

REPORT (PADS-002) Trans, Identity and Institutional Controversies

Second report in the Political Accuracy & Divisions Study (PADS)

A particularly salient culture-war issue in contemporary American society concerns the relationship between gender identity and biological sex. While some insist that peoples’ subjective interpretation of their sex is paramount, others insist objective markers (like chromosomes) are practically more relevant. Most recently, this issue has been enflamed by two central institutional controversies: biological males identifying as women competing in women’s sports leagues and sex/gender-oriented material being taught to young children in schools. Disagreement abounds, with liberals sometimes downplaying the severity of these controversies, and conservatives doing the opposite. In this report, we ask: what do Americans really think about these issues?

Download Report (PADS-002)

Suggested Citation: McCaffree, K., & Saide, A. (2023). Trans, Identity and Institutional Controversies. Skeptic Research Center, PADS-002.

REPORT (PADS-001) What Do Americans Believe About Abortion and How Accurate Are They?

First report in the Political Accuracy & Divisions Study (PADS)

In this report, one of a series of reports on controversial topics in American culture, we investigated the degree to which partisans in the United States hold accurate beliefs about abortion and about each other. Herein, we covered three central questions in the American abortion debate:

1. What abortion policies do Americans really prefer?
2. How accurate are Americans’ beliefs about the prevalence of abortion and the recent Supreme Court ruling, and what variables influence their accuracy?
3. How accurate are Americans regarding the abortion beliefs of other people?

The over-arching goal of this report was thus to contribute to our collective understanding of what Americans really believe, as well as how accurate they are about the topic of abortion and about one another.

Download Report (PADS-001)

Suggested Citation: McCaffree, K. & Saide, A. (2023). What Do Americans Believe About Abortion and How Accurate Are We? Skeptic Research Center, PADS-001.

https://traffic.libsyn.com/secure/sciencesalon/mss416_Abigail_Shrier_2024_03_23.mp3 Download MP3

In virtually every way that can be measured, Gen Z’s mental health is worse than that of previous generations. Youth suicide rates are climbing, antidepressant prescriptions for children are common, and the proliferation of mental health diagnoses has not helped the staggering number of kids who are lonely, lost, sad and fearful of growing up. What’s gone wrong with America’s youth?

In Bad Therapy, bestselling investigative journalist Abigail Shrier argues that the problem isn’t the kids—it’s the mental health experts. Drawing on hundreds of interviews with child psychologists, parents, teachers, and young people, Shrier explores the ways the mental health industry has transformed the way we teach, treat, discipline, and even talk to our kids. She reveals that most of the therapeutic approaches have serious side effects and few proven benefits. Among her unsettling findings:

• talk therapy can induce rumination, trapping children in cycles of anxiety and depression
• social Emotional Learning handicaps our most vulnerable children, in both public schools and private
• “gentle parenting” can encourage emotional turbulence – even violence – in children as they lash out, desperate for an adult in charge.

Mental health care can be lifesaving when properly applied to children with severe needs, but for the typical child, the cure can be worse than the disease. Bad Therapy is a must – read for anyone questioning why our efforts to bolster America’s kids have backfired – and what it will take for parents to lead a turnaround.

Abigail Shrier received the Barbara Olson Award for Excellence and Independence in Journalism in 2021. Her bestselling book, Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020), was named a “Best Book” by the Economist and the Times. It has been translated into ten languages. Her new book is Bad Therapy: Why the Kids Aren’t Growing Up.

Shermer and Shrier discuss:

• Irreversible Damage redux: WPATH Files
• Darwin’s Dictim: “all observation must be for or against some view if it is to be of any service.” What view is this book for or against?
• What’s the problem to be solved? Anecdotes vs. Statistics
• Theories: coddling, social media, screen time, generations/life history theory
• Good and bad therapists and therapies
• Does it work?
• Bad therapists or bad parents or bad schools?
• Parenting styles
• As with trans, social contagion vs. real phenomena now acceptable?
• Iatrogenesis: “originating with the healer” (a healer harming a patient)
• Anxiety, depression, suicidal ideation, autism
• ACE (Adverse Childhood Experience): Physical abuse, Sexual abuse, Emotional abuse, Physical neglect, Emotional neglect, Mental illness, Divorce or parental breakup, Substance abuse in the home, Violence against the mother, Incarcerated household member
• Trauma, stress, PTSD, The Body Knows the Score
• Punishment and spanking (corporeal punishment) vs. time outs etc.
• Anti-fragility and resilience
• Diagnosis self-fulfillment: placebo / nocebo effect
• “Doing the work” of therapy
• Goodwill Hunting view of therapy
• Previous quack therapies and psychological pseudoscience:
• The Subliminal Messages scare, the Satanic Panic, the Recovered Memory mania, the Self-Esteem movement, the Multiple Personality craze, the Left-Brain/Right-Brain fad, the Mozart Effect mania, the Vaccine-Autism furor, the Super-predators fear, Attachment Therapy, the Drug Abuse Resistance Education (DARE) program that increased teen drug use, the Scared Straight program that made adolescents more likely to offend, the Critical Incident Stress Debriefing (CISD) program that worsened anxiety and symptoms of post-traumatic stress disorder (PTSD), and many more that have plagued psychology and psychiatry.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

“Nothing in biology makes sense except in the light of evolution.” —Theodosius Dobzhansky

Why can one person smoke and drink heavily into their 90s while another dies from cancer in their 40s? Why are we fat? Why does a suntan look and feel so good if it is bad for us? Why is alternative medicine so popular? Do vaccines work and are they safe? Do toxins in our food cause cancer?

In this article I outline the emerging field of Evolutionary Medicine, looking at how our Stone Age ancestors lived, got sick, and got well over millions of years, and pointing to how we can live longer, healthier, and happier lives today.

As a skeptic, I have learned to often question ideas that are accepted as “common knowledge.” As a physician, I know that some of the drugs and treatments that we are encouraged to use today are only marginally useful at times and sometimes even toxic. Where does evolution come in? I have found that applying evolutionary thinking to common medical knowledge can provide us with fresh insight into the cause and cure of common diseases.

Evolutionary medicine draws insights from three areas of scientific research: (1) archaeologists’ ongoing discoveries about the lives of our paleolithic ancestors; (2) anthropologists’ observations of modern humans living in cultures that have changed little since the Stone Age; and (3) findings of molecular geneticists that have unraveled the story told by our DNA.

These studies have led to fundamental changes in our understanding of what it means to be healthy. We now know that many problems we experience today are, in fact, understandable in terms of the natural capacities that helped us survive in earlier times. Evolutionary medicine can expose many fallacies behind commonly accepted medical practices and the quackery that fosters popular health fads.

What is Evolutionary Medicine?

Some time ago I was invited to co-teach a course in Evolutionary Medicine at the University of California, Santa Barbara. Professors of parasitology and evolutionary biology, Armand Kuris and Bob Warner, explained that they needed a “real doctor” in the class because their knowledge of human disease and medical treatment was understandably limited. Since inviting a practicing physician to join the mix aligns with the interdisciplinary approach for which UCSB has become known, how could I refuse?

We were fortunate to use the just-published Why We Get Sick as the course text. In it, evolutionary theorist George Williams and psychiatrist Randolph Nesse merged their knowledge of health and disease with emerging archaeology and evolutionary biology to begin answering questions about why rather than simply how we get sick.

It soon became impossible to avoid seeing my own patients as the not-so-distant descendants of our Stone Age forbears. From allergies to the most terrifying cancer, from the ravages of mental illness to the most mysterious autoimmune disease, Darwinian evolution was no longer simply an elegant theory. I was seeing its consequences daily: in the diseases from which my patients suffered but also in how they could be healed.

When I began to share these evolutionary insights with my patients—for example, how we heal from a sprained ankle or why so many people struggle with diabetes— it didn’t take long to see positive effects. These conversations often helped patients develop an entirely new approach to problems from which they’d long suffered as significant improvements in their health soon followed.

The Primal Diet

Consider your teeth. Many of the best-preserved fossils we have found are teeth. That’s because tooth enamel is the hardest, longest lasting substance in the body. These fossils reveal that Stone Age teeth had a rough time of it, undergoing wear and tear as tools for cutting and grinding and chewing many hours a day. Remarkably, however, they had few cavities, the number one dental problem we have today! Since cavemen didn’t have toothbrushes, fluoridated water, dental floss, or dentists, why were their teeth so healthy?

The answer is diet. The bacteria that rot teeth feed mainly on sugars. Unlike proteins and fats, sugars are tiny and sticky. Streptococcus mutans, the main bacterial culprit in tooth decay, lives in the crevices around our teeth and turns sugar into lactic acid that then erodes the surrounding dental enamel, leaving holes—or cavities—in which more bacteria can live. We know from genetic studies that S. mutans has existed in its current form for several million years. It has found a good niche, so why mutate?

When fibrous roots, sour fruits, and occasional honey were the only scarce carbohydrates in a paleolithic person’s diet, these bacteria found very little to feed on. In contrast, our modern diet, overloaded as it is with simple carbs and sugary sodas, offers a bacterial paradise. It’s no surprise, then, that dental cavities are the most widespread chronic disease of childhood in the world today.

This understanding about dental hygiene leads to one of the most frequent and important questions I hear in my practice. What should I eat? Our early human ancestors spent several million years gathering and chasing down every bite of food they ate. The reason we covet sweet, salty, and greasy foods today is that they are important for survival and were rare. Not so today. Simply by reaching into the refrigerator, in a few minutes we can snag all the calories we need to get through the day. We know that eating too much is bad for us, but we seem powerless to stop.

The problem is not just a lack of willpower. We spend billions of dollars a year on foods low in carbohydrates, fats, and sugars or high in vitamins, antioxidants, or omega-3 fatty acids—hoping they will help us lose weight. We dish out billions more on diets, unused gym memberships, surgery, and appetite suppressing injections. Meanwhile, our healthcare system is burdened with hundreds of billions spent on obesity-related illnesses. Gluttony may be a vice, but overeating is an epidemic fed by wholly modern myths about food.

In the past 50 years, we’ve witnessed a tidal wave of obesity as nutritionists, doctors and food manufacturers promoted a fear of fatty foods. But low fat doesn’t mean low in calories. And calories count. Making food with less fat often means packing in more carbohydrates to make it appealing. A low-fat label gives us the false impression that we can eat as much of these “harmless, healthy” foods as we want. But if there were an easy diet that really worked, we’d all know about it. We’d all be thin. The fact that so many diet books sell each year is all the evidence we need that none of them is universally effective.

What did our ancestors eat? We can calculate that to get enough calories our earliest primate ancestors spent up to 12 hours a day finding, chewing, and grinding mostly plant-based foods, much as gorillas do today. As they evolved, their diet expanded to include berries, grubs, fruits, eggs, mushrooms, and the occasional small animal when they could catch one. They were omnivores. We estimate that our ancestors consumed up to 300 different foods in a typical week; today we average about 30.

Many of the roots and vegetables on which ancestral humans thrived were loaded with what your mom might call roughage. Stone Age fruit bore little resemblance to today’s plump, sweet, and juicy produce. An apple then looked and tasted more like today’s hard crabapple. Berries were small, and archaic citrus fruits would make a sour lime taste sweet in comparison. Along with honey and later primitive grains, these fruits were the main source of carbohydrates. Before the advent of agriculture barely 12,000 years ago, most foods contained very few starchy carbs. Before people began cultivating wheat, corn, and rice, the wild versions of these grains grew sparsely, had thick husks, and produced few kernels containing little starch. Root crops were tough and required a lot of chewing. Nuts were tiny and bitter, more like today’s acorns. Fruits were scrawny, fibrous, and none too sweet.

Evolutionary Prescription for a Healthy Diet

• Forget about a low-fat diet. Go low-carb instead. Minimize bread, cereal, pasta, potatoes, rice, beans, and other grains. None were on the menu in the Paleolithic.
• Maintain a healthy weight and avoid obesity by restricting the number of calories you’re ingesting to what you burn.
• Be omnivorous. Eat a wide variety of foods to ensure you get all the vitamins and minerals you need—without taking vitamin pills or supplements.
• In the absence of gnawing on bones like a caveman, include dairy products and root vegetables for calcium.
• If you are vegetarian for ethical reasons, you have to be very careful to avoid nutritional deficiencies, especially in children.
• Throw all rules out the window on your birthday and other special occasions. Eat whatever you want and enjoy it.

Since fruit and grains appeared for only a few weeks each year, it was vital for our ancestors to eat as much of them as possible when available, before the birds, insects, and other animals could get to them. When fruit ripened, early humans gorged themselves until they were stuffed—then ate again an hour or two later. As a result, our ancestors evolved a nearly insatiable craving for carbohydrates. The only limit was the size of their stomachs, and those could stretch to accommodate the seasonal abundance.

During times of plenty, Stone Age people ate a whole lot more each day than they needed. Those whose bodies were better at storing up those extra calories as fat, bought some insurance for any lean times ahead and passed on their genes for getting fat on to the next generation. This cycle of abundance and want lasted for millions of years. We are its inheritors.

Paleoanthropologists love to debate, “Which came first, bigger brains or more protein in the diet?” We do know that as our ancestors became cleverer, they became better hunters. (Hunting and tracking may indeed be the evolutionary basis for our ability to think scientifically, but that is another, long story.) Eating animals added protein and fat to their diets, providing more calories often for less effort than eating plants. Before farming changed everything, abundant meat was the main course for hundreds of thousands of years.

Taming fire, roughly one million years ago, was a key evolutionary event. Cooking breaks down starch and proteins, making them easier to chew and digest. More energy became available from every bite. Quickly, time spent chewing dropped from 12 to 3 hours a day. This may have been the advent of leisure; time to sit around the fire and tell stories, sing, and pass along knowledge.

Only a few hundred thousand years after harnessing fire, early hominids set out on their first great migrations around the globe. Humans loved meat. In areas where game was abundant, some settled for tens of thousands of years. When meat became scarce, because of a changing climate, overhunting, or just bad luck, it was time to pick up stakes and search for happier hunting grounds. The disappearance of many species of large animals such as massive marsupials in Australia, ground sloths in North America, and bison, elk, and aurochs in Europe, followed the spread of modern humans.

By the late Stone Age, around 50,000 years ago, Homo sapiens emerged as accomplished and resourceful hunters. Studies show they got around half their calories from meat and fat, 40 percent from roots and vegetables, and 10 percent from fruits and berries. These humans, with bodies and brains similar to yours and mine, ate very well. It is from this time that we have evidence of the first obese people. There probably weren’t many of them, but a few were able to lead pampered, sedentary lives, supported by the advancing skills of the growing tribe. Sculpted images of enormously obese women, known as “Venus” figurines, are among the earliest surviving works of art, carved more than 30,000 years ago. Of course, we don’t know the exact meaning these images held for their late Stone Age makers, but it is likely that they were expressions of beauty, or at least attractiveness. Fat women have been cherished for their fertility in most cultures until very recently. “Survival of the fittest” might be better expressed as “reproduction of the fattest.”

Some hormones evolved to shut down our appetites when we had eaten enough fats and proteins. That is why fatty foods are so “satisfying.” However, others, such as GLP-1—the hormone that the new weight loss drugs Wegovy and Ozempic mimic so effectively—are released by sugar and carbs in our diet. They trigger the production of insulin and in our past helped us to pack away those excess carb calories as fat. In higher doses (mimicked by the weight loss injections) they slow down movement of food through the gut, making us feel “full” and thus suppressing our appetite.

Germ Warfare

Drop the word infection into any conversation and watch ears prick up. Mention diarrhea or COVID, and people will begin to edge away. Measles, mumps, or mononucleosis get little reaction any longer. However, up the ante with herpes, tuberculosis, or syphilis, and you can sense people starting to squirm. Invoke pus, bleeding, or plague, and you are edging beyond the bounds of polite conversation.

Most of us have a primal fear of infectious diseases, for good reason. Alongside medicine’s stellar achievements of the past few centuries—hygiene, antibiotics, vaccines, and vastly safer childbirth—many microbes have battled humans to a draw, and some are even gaining ground. As soon as we conquer one infectious disease, another seems to take its place. We defeat smallpox, arm-by-inoculated-arm, and HIV comes out swinging. COVID-19, a more lethal cousin of the common cold, caused us to apply dampers to the world economy for months. We are in an evolutionary arms race with no end in sight. As the human population rises, there are more hosts for our microscopic enemies to attack.

Even with the discovery of antibiotics less than a century ago, bacteria, parasites, and viruses have not retreated. Within a year of the first use of penicillin, some germs were found to resist it. And while vaccines have loosened the stranglehold once held on us by measles, mumps, hepatitis, and polio, as yet we have no shots to prevent HIV, herpes, West Nile, or a horde of other viruses. In the tropics, new strains of influenza emerge annually from animal hosts and spread at jet speed onto the wider world stage.

On the home front, patients come to me every day sneezing and coughing, aching and fevered, hoping an antibiotic will provide a quick fix. Sadly, these drugs have no effect against viral infections and, when used inappropriately, breed drug-resistant bacteria in our bodies. At the same time, some people worry that vaccines against the killer diseases of childhood actually damage their children. They resist immunizations, depending on others to get the shots that derail an epidemic.

Fighting infections has never been easy. Microbes invade our bodies and evade our immune systems in clever ways that science is still deciphering. In the past, they jumped from person to person, while today they leapfrog from city to city. They are nimble adversaries. Evolution happens when genes mutate and spread to the next generation—and many bacteria produce a new generation every 90 minutes!

Nevertheless, working in our favor are the very Stone Age defenses we often misunderstand. Our healthy skin, thick mucus, fever, inflammation, and antibodies are the body’s first responders on the front lines of the fight against infections. We suppress them at our peril. Understanding how our cave-dwelling forebears survived such onslaughts, long before they could reach for a bottle of pills, can teach us how to respond better to infections today.

A Few Paleolithic Symptoms That Have Lingered On

Coughing evolved to clear our airway of foreign particles—dust blown by the wind, smoke from a fire, and food inhaled when we meant to swallow. By forcefully expelling air from our lungs, coughing gets the grime out. A sneeze serves a slightly higher purpose.

Mucus, or phlegm, is also a defense mechanism. This complex and wonderful concoction of proteins and other gooey stuff entraps and disarms germs, helping us to swallow them into our stomachs where powerful acids wait to destroy them.

Evolutionary Prescription for Weight Loss

• Eat fewer calories.
• Eat fatty foods and proteins to satisfy your hunger, rather than starchy, sugary ones. Fats and proteins trigger satiety hormones and take more time to digest.
• Fool your Stone Age appetite by filling up on bulky, low-calorie vegetables such as celery, radishes, and salads. Also, drinking warm liquids such as chicken broth can trick your body into feeling full for a while.
• Watch out for fruit juice and sodas. They are mostly sugar and water.
• Exercise because it’s enjoyable and healthy, but don’t rely on it to shed weight. You’d have to exercise for hours to work off a single sugary soda.
• Eat meals whatever time of day you want to. A calorie is a calorie no matter when you eat it.

What happens when we are confronted with a cold virus? A virus is really very simple. It’s just a bundle of genes, wrapped in a protein coat. All it needs is to find a good place, i.e., you, in which to set up housekeeping, make a few million copies of itself, and then move on. For contagious diseases, it’s the moving on that matters. If they can’t get out of us to a new victim, they die out. Cold viruses such as COVID are spread on airborne droplets of moisture when we cough. Making us cough, by irritating our airways, is the evolutionary tactic a virus uses to spread itself. Diarrhea is a similar strategy of gut viruses, the “stomach bug.”

Well-meaning parents often encourage their sick children to “cough it up” to clear phlegm out of their airways. However, coughing actually irritates our airways. It’s like scratching an itch. The more you scratch, the more irritated it gets. Coughing actually makes a sore throat worse and spreads the virus to others. We are playing right into the virus’s hands.

Sneezing is even worse. Have you ever seen the famous photo of a sneeze, spraying droplets ten feet across a room? Sneezing serves the virus’s purpose by loading them on an express flight to the next victim—our children, coworkers, spouses, or strangers. This is why masks are useful in stopping the spread of airborne viruses. To really be helpful, however, you need a really good mask, such as an N95, made of multiple layers of hydrophobic filters that stop the droplets from ever reaching your nose.

When you feel the need to cough, don’t let the virus win. Suppress it. By drinking a small amount of liquid, you can help your body eliminate the germs by ingesting them. At the same time, you will prevent the irritation and swelling that coughing brings. Sometimes you can’t help but cough. In those cases, your mom had it right: Cover your mouth. Not just a polite hand in front of the face— really press your hand or inner elbow over your mouth to seal off any air from coming out. (And then be sure to wash your hand—thoroughly). This decreases the rapid flow that irritates your airway as well as stops the spread of germs. This was common advice 50 years ago when coughing around others was considered impolite at best.

Unfortunately, all the over-the-counter cough remedies containing dextromethorphan (the DM in Robitussin-DM) and other ingredients don’t do much. They coat your throat, but they don’t help suppress coughing. Without any evidence they are effective, we spend billions a year on cold remedies such as Echinacea, Airborne, vitamin C, Dayquil, Nyquil, antihistamines, decongestants, cough suppressants, and fever reducers that do nothing to shorten the infection and have minimal effect on the symptoms. Some even work against the healing process.

When we take an antihistamine to dry up the sniffles, it limits the mucus available to help engulf the virus. The sole over-the-counter expectorant used in the United States, guaifenesin, thins mucus, which makes it less effective at trapping bacteria. Codeine-based cough suppressants, now very hard to come by, can help and are useful when simply making an effort to suppress the cough fails, especially at night when we need to sleep.

The most effective way to defeat a cold virus is to recognize that we are all in this together. Once we’re infected, washing our hands and covering up when sneezing or coughing is the kindest thing we can do for others. Rest, stay hydrated, and let your immune system do what it evolved to do. When a true cure for the common cold comes along, it won’t need to be advertised or sold in alluring packages at the checkout counter. It will be obvious to all of us because of how well it works, every time. And then, like polio and smallpox, colds will be history.

You Give Me Fever

If evolution is a long war between us and germs, then a cold is a daily skirmish on the front line. While viruses reproduce quickly, our bodies react more slowly. It can take days for our immune system to mobilize specific antibodies to fight a virus.

Over millennia, we evolved a quicker response. Germs are adapted to infect us when our body temperature is normal. By turning up our internal thermostat when we first detect an infection, our bodies make it harder for the virus to grow. Shivering probably evolved to warm us when we got cold. A shaking “chill” making us hot—called a rigor in medicine—is often our first line of defense. When we feel a chill, we want to take to our beds because that is exactly what we should do. If we take a fever reducer, such as aspirin or Tylenol, we can suppress the fever and may feel well enough to be up and around. This can divert energy our body needs to fight off the infection—and affords the virus many more opportunities to spread to others.

Increasing our temperature also speeds up the activity and circulation of disease-fighting white blood cells. In early mammals, those who responded to microbe invasion by developing a fever and limiting their activity would have survived better and passed on these defenses to their descendants. It makes evolutionary sense that children get hotter faster than adults. Kids are more likely to run into germs they have never encountered before and to which they have no immunity. They need the quick general defense a fever can muster.

If a fever provides an evolutionary advantage for a near naked primate, what happens when we bundle up in blankets? We can cause our temperature to rise higher than it naturally would and so overshoot the safety mark. Exceeding 103F (39.5C) degrees can do more harm than good. Extreme temperatures can lead to seizures in children and dehydration and worse in adults. Taking a fever reducer such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil and Motrin), or naproxen (Aleve) is entirely appropriate in these conditions. These medications all short-circuit our body’s natural ability to raise a fever.

Is there any sense in the old saying, “feed a cold and starve a fever”? When we have a simple cold, eating has been shown to quadruple the production of the virus-fighting hormone interferon. When we start to get hot, however, it’s not food we need but fluids. It’s no coincidence that a fever kills our appetite. Fluids trigger the production of interleukin-4, which works particularly well against many of the bacteria that cause fevers. The return of hunger is usually a sign that you are getting better.

A Paradox of Prevention

Polio offers a good example of how “progress” can inadvertently help a virus to spread in a way that evolution couldn’t. Polio is a virus that usually grows in our guts. When excreted, it survives for weeks in freshwater pools and stagnant ponds.

Throughout history, infants who were exposed to the virus early in life while they were still protected by antibodies in their mothers’ milk, usually experienced only a mild infection. Fewer than one in a thousand had the paralytic form associated with the epidemics of the last century.

Paradoxically, modern hygiene in the late nineteenth century prevented infants from ingesting water contaminated with the virus while still breastfeeding. Coming in contact with that virus later in life in swimming pools or ponds, at a time when they were no longer protected by maternal antibodies, caused them to contract the much more serious paralytic form of the disease. By 1900, small epidemics of paralytic polio began to appear throughout the industrialized world. By 1952, with breastfeeding at a minimum and better sanitation more widely practiced, polio infected thousands of children who had failed to acquire immunity in infancy. At its peak in 1950, the epidemic paralyzed 60,000 people a year.

A vaccine developed in 1952 by Jonas Salk arrested the spread of the disease within a few years. Polio is now almost wiped out. However, certain religious and political objections still hamper universal use of the vaccine.

Other diseases that could be eradicated, linger on—mumps, measles, chickenpox, and hepatitis. As vaccination has made certain childhood infections so uncommon in Western countries, some people have become comfortable with not vaccinating their children. These parents are counting on the immunity of those who do get vaccinated (herd immunity) to prevent the spread of these childhood illnesses to their own kids.

Evolutionary Prescription for Toxins

• Be very careful with the dose of all drugs—prescription, over-the-counter and recreational. All can be toxic.
• Unfortunately, alcohol is a toxin. Newer evidence suggests the less the better.
• Get all the vitamins you need from sunshine and a healthy diet, not pills or supplements. Vitamins are essential but can be toxic in large doses.
• Don’t worry about toxins in peanut butter.
• Don’t obsess about buying “organic.” As far as your health is concerned, there is no difference between organic and nonorganic.

Remember measles? Measles ranks high on the list of all-time lethal diseases. By some estimates, measles wiped out up to a third of all the people along the trade routes of the Middle Ages—and that was even before the European Age of Exploration opened vast new territories for the virus. In the past 150 years it has killed 200 million people—including 128,000 in 2021, most under the age of five.

The measles virus evolves very slowly. With so many innocent immune systems to infect in the past, it didn’t need to change much to find plenty of hosts. Luckily, it’s easier to make vaccines for slower-changing viruses because they are so stable. Faster-changing viruses, such as COVID, HIV, and influenza, form more elusive moving targets.

Today, many of us have forgotten how dangerous many formerly common infections were. Measles was a worldwide scourge. Mumps can make men sterile. Rubella can cause birth defects when it infects a pregnant woman. One vaccine, MMR, prevents all three. Diphtheria and Whooping Cough (Pertussis) were once dread diseases of childhood. Tetanus kills. Here too a single vaccine, DPT, prevents all three. Smallpox, which killed 300 million people in the last century, has now been eradicated by a worldwide vaccine campaign.

By skipping vaccination, some parents hope their children will dodge a risk. However, serious side effects of the vaccine occur at a much lower frequency than serious complications of the disease. Fears once raised that measles vaccine causes autism have been thoroughly debunked.

If enough people avoid vaccination, those once serious diseases will continue to evolve and come roaring back. Mumps and whooping cough are returning to the United States. Polio is still making its crippling rounds. Skipping vaccination is a terrible gamble. When these viruses strike, unvaccinated children are the first to fall.

During the COVID-19 pandemic, the science of vaccination became even more politicized. This is unfortunate because priming our immune systems to recognize and fight off infections is one of the most effective and least harmful methods of protection we have. In the Stone Age, every infection set off a race between the “bugs” and our defenses. Vaccines activate this age-old system by injecting tiny amounts of weakened strains of these germs, allowing us to be forearmed.

The Not So Common Cold

Colds are caused by viruses—not by being out in cold weather or getting tired or soaked with rain. Understanding the evolutionary origins of viruses can help us stop them in their tracks. Most cold viruses evolved in enormous prehistoric populations of migrating birds and beasts. Because there were millions of animals in these flocks and herds, viruses could spread from one individual to another, never needing to infect the same creature twice—much like a wave spreading across the water.

By contrast, our paleolithic ancestors lived in isolated bands of a few dozen people. Archaeologists estimate that as recently as 70,000 years ago there were only 10,000 humans alive on the entire planet. Each family or clan clung together as closely as possible, seldom interacting with other groups. Stealing food or mates posed too great a risk to encourage much contact. So even if an animal virus managed to infect a person, it was very difficult for it to spread beyond the group it first entered. The common cold was not so common back in the Stone Age. Clearly, we aren’t going to solve the problem of colds by going back to living in isolated tribes. However, the insights of evolutionary medicine can help in arresting the rapid spread of these and other viruses in our modern world.

Under the Influenza

Influenza, the “flu,” kills around 400,000 people worldwide, and 36,000 people in North America—most years. In flu pandemics, which occur every 20 years or so, tens of millions die.

As with the common cold viruses, the earliest humans didn’t have enough contact with other groups to allow the flu to spread. Yoshiyuki Suzuki (Oxford University), who studies the evolution of influenza, estimates the first flu epidemics in humans occurred no earlier than 8,000 years ago. This coincided with the development of farming and village life, when people, fowl, and pigs first began living cheek by beak by jowl.

Unlike the more stable measles, mumps, and chickenpox viruses, the flu virus changes its outward appearance (that is, it evolves) rapidly. Shrouded in an ever-varying coat of proteins, like a shape-shifter in a science fiction novel, it cloaks itself in order to hide from our immune systems. However, once it gets past our defenses, it always causes the same miserable symptoms—high fever for days, severe body aches, a racking cough, and nasal congestion. It’s like a cold, only much worse.

Flu’s ability to change its surface coat so rapidly forces us to come up with a revised flu vaccine every year. Modern medicine maintains a constant watch for emerging strains in order to predict which to include in the following year’s vaccine. Before the advent of annual flu vaccines, many more people got sick and died of the flu every year, especially those over 60.

Occasionally, farmers and food handlers are infected with a strain of flu derived from another animal at the same time they have a human flu virus in them. When this happens, the two kinds of flu can merge to become an entirely new strain. The combined virus is often better at infecting us because we have no antibodies that recognize its novel appearance. This is how the avian flu pandemics of 1918, 1957, 1968 and the swine flu pandemic of 2009 occurred, and also why some people think COVID-19 originated in a live animal food market in China. (Doing justice to the debate between the “wet market” and the alternative “lab leak” theory of the origin of COVID-19 requires a separate article).

Quarantine, an early scientific method for halting the spread of disease, yields excellent results—if it is done quickly enough. That’s how SARS, the first well-known Coronavirus, was stopped in 2003. With proper public health policies in place, and enough people who take them seriously, we could likely contain any newly emerging virus within weeks, even a novel strain of the flu, without relying on vaccines. However, quarantine is expensive, inconvenient, and may even deprive people of some rights or even their livelihood for a short period. Still, that price would be minuscule compared to the devastation of a full-blown pandemic such as we have recently experienced.

On the home front, the best way to protect ourselves is to be clear about how such germs spread. Not being “part of the herd” and not going out in public when we are sick can go a long way toward stopping the spread. Covering our mouths when we cough or wearing effective masks helps a lot, as does thoroughly washing with plain old soap and water. Washing is a lot more effective than hand sanitizer, which doesn’t kill all types of viruses or even fully remove them from our hands.

Toxins and Cancer

Many things in our world are toxic. Radium, benzene, arsenic, and asbestos are widely known to cause cancer, but most of us are rarely exposed to them. On the other hand, smoking, drinking, obesity, and excess sun exposure together account for about 50 percent of all cancers.

The most significant food toxin known to cause cancer in humans is Aflatoxin, a fungal byproduct found in moldy peanuts. It contributes to the occurrence of liver cancer, mostly in parts of Africa and Asia where the hepatitis B virus, a cofactor for this cancer, is prevalent and moldy food is common. Yet, if you search online, you will find a long list of alleged cancer-causing culprits, including soda, hydrogenated oils, microwave popcorn, farmed fish, refined sugar, white flour, pickled, salted or smoked foods, and grilled red meat. We frequently hear that some common chemical such as the sweetener we use in our coffee “causes cancer.” None of these claims is backed by scientific evidence.

Evolutionary Prescription for Cancer

• Watch your weight. Obesity hikes the odds of several cancers.
• Exercise at least 30 minutes a day, three times a week, to lower your general risk of cancer by about 10 percent.
• Keep vitamin D levels up to snuff by getting 30 minutes of sun three days a week on parts of your body not usually exposed.
• Don’t smoke. You’ll decrease your lifetime risk of lung cancer by 90 percent and your overall risk of dying of any cancer by 25 percent.
• Get a colonoscopy after age 50. You’ll decrease the risk of dying from colon cancer by 80 percent.
• Lower your chance of getting some cancers by a third by saying no to antioxidant and vitamin supplements—particularly A, C and E.
• Girls and young women: Say yes to the new HPV vaccine. It reduces the risk of cervical cancer by 95 percent.

When scientists say a chemical “may cause cancer,” it usually means it was tested and found to damage the DNA of a bacteria or cause tumors in rats. However, such research uses doses hundreds or thousands of times what a person would ingest, pound-for-pound. And rats are genetically different from you and me. They get cancer very easily and that’s why we use them for tests. Just showing that a toxin causes cancer in rats, or abnormal changes in bacteria or cells in a Petri dish, doesn’t come close to demonstrating it will do so in humans. Our livers are three times the size of the whole rat and work hard to protect us. Please don’t misunderstand what I’m saying. I am a scientist. I trust good evidence. However, not all research is done well and we must remain skeptical—though not cynical—especially of fear-inducing claims.

Since we can’t ethically test toxins on humans, we look for “natural experiments”—groups of people exposed to a chemical at work or by accident. We then compare them against a similar but unexposed group to see what effects these toxins have. Beyond a few well-studied carcinogens—and Erin Brockovich’s cinematic arguments about a cancer cluster—there is scant linkage between trace toxins in our environment or food and cancer or other illnesses.

Your plastic water bottle, for example, won’t give you cancer. If it did, we would have detected thousands, indeed millions, of cancer cases already. The same is true for tap water. There’s no credible evidence that food preservatives, deodorant, stress, aluminum, processed foods, aspartame (Equal), or saccharin (Sweet’N Low) cause cancer. If you examine the reports carefully you will see that they are usually based on extrapolating from experiments on cells or animals given huge relative doses and always contain qualifiers such as “can” or “may” cause cancer.

We have always lived in a world chock full of poisons, and we have evolved potent defenses against the natural threats we’ve encountered in our long ascent from the primordial swamp. Our not so fragile forebears thrived among greater toxic threats than we might imagine. Why do some things smell and taste “bad”? Often it’s because they were bad for us. Our tough skin, hardy livers, and purifying kidneys evolved to neutralize many toxins that passed the nose test to make their way past this first line of defense.

Meanwhile, there is no shortage of products being offered to help our bodies “cleanse” ourselves of toxins by using homeopathy, chelation, or colonics. We can buy “probiotics” to counter the antibiotic we took when we had a cold. (The marketers don’t mention that all yogurts have these bacteria—it’s what makes them yogurt in the first place.) We can sweat in saunas, chill in ice baths, soak in spas, or spend money on supplements—all in the name of “cleansing.”

Is there any real evidence that people who make such efforts are healthier than the rest of us? Not one bit. Contrary to countless celebrity testimonials, decades of research provide zero evidence that using any detoxifying products actually improves health or prevents cancer.

Dodging Cancer

There’s a good evolutionary reason why we heal so well from wounds and infections but have trouble fending off cancer. Natural selection, the weeding out of harmful traits, has a hard time acting on illnesses that occur later in life. By the time most cancers appear, people have usually finished having children. A cancer predisposition that appears only after our reproductive years gets a free pass to the next generation.

Children do get cancers, of course. Terrible as these cases are, fortunately they are rare compared to other causes of death. Most cancers occur in older people. The single most important reason cancer is increasing in the developed world is because we are living longer, not because of toxins in our food and environment.

Cancer still kills one in six people worldwide, but that means 84 percent of us will die of something else. In less-developed countries where life expectancy is shorter, most people die of infections and accidents, as in times past. In those places, cancers don’t even make it into the top ten causes of death.

While research has made significant progress against certain cancers, our fear leaves plenty of openings for a Pandora’s box of alternative therapies. This has always been the case with poorly understood diseases. In the days before the discovery of the poliovirus, rumor attributed polio to everything from fleabites to airborne toxins, insecticides, and poverty. When the vaccine came along, some people thought it was the cause. Many of these same suspects are blamed for cancer today.

One popular theory suggests that a diet low in fiber causes colon cancer. This idea arose from a 1979 book that reported a lower rate of colon cancer in men in Africa than in the West. The author attributed this to their high-fiber diet and using a squatting posture during defecation. He forgot to take into account that men in Africa die younger than men in the West, and the rate of colon cancer increases as we age. A meta-analysis of more than 80,000 participants demonstrated that fiber doesn’t prevent colon cancer. Still the myth lives on in health food stores and breakfast cereal ads.

Antioxidants are now popularly claimed to prevent cancer (as well as aging, heart disease, and “inflammation”). These molecules do limit oxidation, a kind of cell damage that can contribute to cancer—in the lab. Remember, however, oxidants and free radicals are part of how our cells fight off infection and clear damaged cells from our bodies! When tested in people, there is no evidence that antioxidants—including beta carotene, lycopene, acai berries, cumin, turmeric, or vitamins A, C or E—can prevent cancer. Vitamin A in excess can cause liver damage, osteoporosis, hair loss, dry skin, and birth defects. It seems our bodies make all the antioxidants we need, so supplementing them can make matters worse. Studies done in actual people, not Petri dishes, show that excess vitamin E, folic acid, and beta-carotene can actually increase the risk of cancer.

Vitamin Supplements

Our Stone (and Iron, Bronze, Middle, and Steam) Age ancestors survived without ever taking vitamin pills, but it wasn’t always easy. In hard times, especially when they roamed into new territory, experienced harsh winters, droughts, and floods, food could be hard to find. Their bodies evolved to be very good at absorbing whatever vitamins they needed, especially when they were in short supply. We inherited this ability to store most vitamins for times of scarcity.

Today, of course, we can buy a plethora of vitamins and minerals off the shelf, mixed in myriad combinations. Some of us gulp down enough to choke a horse. This is a high-risk endeavor because an excess of certain vitamins (A, D, E, and K) can be toxic. Some of our legislators are enthusiastic supporters (read: on the payroll) of the vitamin industry. Vitamins are sold as “dietary supplements,” not as drugs, and are largely unregulated. There are no safety inspections or uniform requirements for those who manufacture or market them, and therefore no guarantee you are getting what you pay for.

This article appeared in Skeptic magazine 28.4
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The only real proof we need for the benefit of vitamin pills should be that taking them makes us healthier. However, people who take them, in small or mega doses, are sick just as often and have just as many other illnesses as those who don’t. Of the 13 known vitamins, six can be taken in overdose. Every year more than 60,000 people in the United States overdose on vitamins—80 percent of them are children under the age of six.

If you eat a variety of unprocessed food you get all the vitamins, minerals, and antioxidants you need. Let your body do all it evolved to do, and you will get just the amounts you need.

Alternative Medicine

Many “alternative” therapies, such as acupuncture, massage, Reiki, homeopathy, aromatherapy, naturopathy, and ayurveda promise to make us well while causing less harm than medicine. Do they work?

As most doctors and some alternative practitioners know, most people who seek medical attention get better on their own, no matter what we do to them. This is because most illnesses are mild and self-limiting. Still, many of us are not content with letting nature take its course. When we feel a sniffle, we reach for some over the counter medicine. None can make us better. When we get better, we want to believe it was because of what we took.

We spend billions each year on brand named pills and folk remedies that have lingered from earlier times. They became popular in the same manner as do all superstitions. One person tried them, got better, and believes the treatment worked. They pass this along through retelling and retailing, and so a so-called cure is born.

Alternative medicine practitioners now use TikTok, YouTube, Facebook and X (Twitter) to speed the spread of their “cures.” Although some of these practices are actually harmful, the false hope they offer to the seriously ill is misleading at best and criminal at worst. Sadly, modern medicine has sometimes been little better, pushing marginally useful pills or physical therapy on us when time and a better understanding of the natural process of healing would accomplish just as much—and at less risk and a lower cost.

What’s Next?

If you find this approach intriguing, I urge you to look further into what evolution has to say about how we heal from injuries, why allergies are more common today than in earlier times, how much sleep we really need, who we find sexually attractive, the benefits of grandparents, how many periods should a woman have in her lifetime, why morning sickness was good for us, why we get depressed, the advantages of Attention Deficit Disorder, what use are emotions, the origins of anxiety, whether cholesterol is really bad for us, why do so many people need glasses, how does sickle cell disease protect some people from malaria, and what can we do to live longer healthier lives. These topics and dozens more are the subject of the fascinating new science of Evolutionary Medicine.

About the Author

William Meller, M.D., is a board-certified internist who runs a medical practice and clinic in Santa Barbara, CA, where he also coordinates three busy medical centers. He has been published in The Journal of the American Medical Association and has been featured in the Wall Street Journal, among other publications. He is the author of the book Evolution Rx: A Practical Guide to Harnessing Our Innate Capacity for Health and Healing.

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The Holocaust is much discussed, much memorialized, and much portrayed. But there are major aspects of its history that have been overlooked.

Spanning the entirety of the Holocaust, this sweeping history deepens our understanding. Dan Stone—Director of the Holocaust Research Institute at Royal Holloway, University of London—reveals how the idea of “industrial murder” is incomplete: many were killed where they lived in the most brutal of ways. He outlines the depth of collaboration across Europe, arguing persuasively that we need to stop thinking of the Holocaust as an exclusively German project. He also considers the nature of trauma the Holocaust engendered, and why Jewish suffering has yet to be fully reckoned with. And he makes clear that the kernel to understanding Nazi thinking and action is genocidal ideology, providing a deep analysis of its origins.

Drawing on decades of research, The Holocaust: An Unfinished History upends much of what we think we know about the Holocaust. Stone draws on Nazi documents, but also on diaries, post-war testimonies, and even fiction, urging that, in our age of increasing nationalism and xenophobia, it is vital that we understand the true history of the Holocaust.

Dan Stone is Professor of Modern History and Director of the Holocaust Research Institute at Royal Holloway, University of London. He is the author or editor of numerous articles and books, including: Histories of the Holocaust (Oxford University Press); The Liberation of the Camps: The End of the Holocaust and its Aftermath (Yale University Press); and Concentration Camps: A Very Short Introduction (Oxford University Press). His new book is The Holocaust: An Unfinished History.

Shermer and Stone discuss:

• Why this book now? What is unfinished in the history of the Shoah?
• Holocaust denial: 20% of Americans under 30 who, according to a poll by The Economist, believe the Holocaust is a myth. Another 20% believe it is exaggerated
• Just as “Nazism was the most extreme manifestation of sentiments that were quite common, and for which Hitler acted as a kind of rainmaker or shaman”, suggests Stone, the defeat of his regime has left us with “a dark legacy, a deep psychology of fascist fascination and genocidal fantasy that people turn to instinctively in moments of crisis – we see it most clearly in the alt-right and the online world, spreading into the mainstream, of conspiracy theory”
• What was the Holocaust and why did it happen: intentionalism vs. functionalism
• Ideological roots of Nazism and German anti-Semitism
• “ideology, understood as a kind of phantasmagorical conspiracy theory, as the kernel of Nazi thinking and action”
• From ideas to genocide: magical thinking
• Blood and soil
• Hitler’s willing executioners
• The Holocaust as a continent-wide crime
• Motivations of the executioners
• Polish law prohibiting the accusation of Poles complicit in the Holocaust
• Industrial genocide vs. low-tech mass murder
• The banality of evil
• Nearly half of the Holocaust’s six million victims died of starvation in the ghettos or in “face-to-face” shootings in the east.
• Jews were constrained by a profusion of demeaning legislation. They were forbidden to keep typewriters, musical instruments, bicycles and even pets. The sheer variety of persecution was bewildering. It was also chillingly deceptive, persuading some law-abiding Jews that survival was a matter of falling into line. Stone quotes the wrenching letter of a woman reassuring her loved one that getting transported to Theresienstadt, in German-occupied Czechoslovakia, might be better than living in Germany. “My future place of residence represents a sort of ghetto,” she explained. “It has the advantage that, if one obeys all the rules, one lives in some ways without the restrictions one has here.”
• Wannsee Conference of Jan. 20, 1942
• In March 1942, “75 to 80 percent of the Holocaust’s victims were still alive.” Eleven months later, “80 percent of the Holocaust’s victims were dead.”

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

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Do we live inside a simulated reality or a pocket universe embedded in a larger structure about which we know virtually nothing? Is consciousness a purely physical matter, or might it require something extra, something nonphysical? According to the philosopher Eric Schwitzgebel, it’s hard to say. In The Weirdness of the World, Schwitzgebel argues that the answers to these fundamental questions lie beyond our powers of comprehension. We can be certain only that the truth—whatever it is—is weird. Philosophy, he proposes, can aim to open—to reveal possibilities we had not previously appreciated—or to close, to narrow down to the one correct theory of the phenomenon in question. Schwitzgebel argues for a philosophy that opens.

According to Schwitzgebel’s “Universal Bizarreness” thesis, every possible theory of the relation of mind and cosmos defies common sense. According to his complementary “Universal Dubiety” thesis, no general theory of the relationship between mind and cosmos compels rational belief. Might the United States be a conscious organism—a conscious group mind with approximately the intelligence of a rabbit? Might virtually every action we perform cause virtually every possible type of future event, echoing down through the infinite future of an infinite universe? What, if anything, is it like to be a garden snail? Schwitzgebel makes a persuasive case for the thrill of considering the most bizarre philosophical possibilities.

Eric Schwitzgebel is professor of philosophy at the University of California, Riverside. He is the author of A Theory of Jerks and Other Philosophical Misadventures; Perplexities of Consciousness; and Describing Inner Experience?

Schwitzgebel has studied the behavior of philosophers, particularly ethicists, using empirical methods. The articles he has published investigate whether ethicists behave more ethically than other populations. In a 2009 study, Schwitzgebel investigated the rate at which ethics books were missing from academic libraries compared to similar philosophy books. The study found that ethics books were in fact missing at higher rates than comparable texts in other disciplines. Subsequent research has measured the behavior of ethicists at conferences, the perceptions of other philosophers about ethicists, and the self-reported behavior of ethicists. Schwitzgebel’s research did not find that the ethical behavior of ethicists differed from the behavior of professors in other disciplines. In addition, his research found that the moral beliefs of professional philosophers were just as susceptible to being influenced by irrelevant factors as those of non-philosophers. Schwitzgebel has concluded that, “Professional ethicists appear to behave no differently than do non-ethicists of similar social background.”

Shermer and Schwitzgebel discuss:

• bizarreness
• skepticism
• consciousness and sentience
• AI, Turing Test, sentience, existential threat
• idealism, materialism and the ultimate nature of reality
• solipsism and experimental evidence for the existence of an external world
• Are we living in a computer simulation?
• mind-body problem
• truths: external, internal, objective, subjective, and mind-altering drugs
• anthropic principles and fine-tuning of the universe
• theism, atheism, agnosticism, deism, pantheism, panpsychism
• free will, determinism, compatibilism
• Is the universe predetermined?
• entropy, the arrow of time, and causality
• infinity
• souls and immortality, mind uploading
• multiverse, parallel universes, and many worlds hypothesis
• why there is something rather than nothing.

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While not going so far as arguing, as some have, that psychotherapy is always effective, I’d like to present some data and offer some contrasting considerations to Harriet Hall’s article: “Psychotherapy Reconsidered” (in Skeptic 28.1). Probably no other area within social science practice has been so inordinately and unfortunately praised and damned. Many of us working in the field have long been acutely aware of the difficulties to which Hall and others point, as well as other problems. However, we also regularly observe the positive changes in clients’ lives that psychotherapy—properly practiced—has produced, and in many cases, the lives it has saved.

In her article, the late Harriet Hall, whose work I and all skeptics admire and now miss, stated that no-one can provide an objective report about the field, indeed, that there “…aren’t even any basic numbers,” that we don’t know whether psychotherapy works, that it is not based on solid science, and that there is “…no rational basis for choosing a therapy or therapist.”

Hall and other sources she quotes are quite correct in saying that there is much we still don’t know about human psychology, and much that we don’t understand about how the mind and psychotherapy work. Yet it’s also necessary to look at the data and analyses which demonstrate that psychotherapy does work. The case for the defense is made in detail in The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work by Bruce Wampold and Zac Imel, and also in Psychotherapy Relationships That Work by Wampold and John Norcross, both of which present decades of meta-analyses. They review conclusions from an impressive number of psychotherapy studies and show how humans heal in a social context, as well as offer a compelling alternative to the conventional approach to psychotherapy research, which typically concentrates on identifying the most effective treatment for specific disorders by placing an emphasis on the particular components of treatment.

This is a misguided point in Hall’s argument, as she was looking at the differences between treatments rather than between therapists. Studies that previously claimed superiority over one method to another ignored who the treatment provider was.1 We know that these wrong research questions arise from using the medical model where it is imperative to know which treatment is the most effective for a particular disorder. In psychotherapy, and to some extent in medicine generally, the person administering the treatment is absolutely critical. Indeed, in psychotherapy the most important factor is the skill, confidence, and interpersonal flexibility of the therapist delivering the treatment, not the model, method, or “school” they use, their number of years in practice, or even the amount of professional development they’ve had. How we train and supervise therapists largely has little impact on the outcomes of psychotherapy, unless each therapist routinely collects outcome data in every session and adjusts their approach to accommodate each client’s feedback.

The Bad News About Psychotherapy

Hall is right on the point that psychotherapy outcomes have not improved much over the last 50 years. Hans Eysenck’s classic study debunking psychotherapy was performed in 1952.2 His view was not challenged until 1977, when a meta-analysis showed that psychotherapy was effective, and that Eysenck was wrong.3 It found the effect size (ES) for psychotherapy was .8 above the mean of the untreated sample. Recent meta-analyses show that this ES has remained the same over the intervening 50 years, despite the proliferation of diagnoses and treatment models.4

Hall was also accurate in saying that much conflicting data exists from studies about the efficacy of the hundreds of types of psychotherapy. Yet she was incorrect in saying that we don’t even have basic numbers. We now have decades of meta-analyses showing what works and what doesn’t work in psychotherapy.5, 6, 7, 8, 9, 10

Hall was also mostly on-target when she stated, “…proponents of each modality of psychotherapy give us their…impressions about the success of their chosen method.” Decades of clinical trials comparing treatment A to treatment B point to the conclusion that all bona fide psychotherapy models work equally well. This is consistently replicated in trials comparing therapists who use two different yet coherent, convincing, and structured treatments, as long as these treatments provide an explanation for what’s bothering the client in addition to discussing a treatment plan for the client to work hard at overcoming their difficulties. Psychotherapy research clearly shows that all models contribute 0–1 percent towards the outcomes of psychotherapy.11 This means that proponents of Cognitive Behavioral Therapy—or any model—claiming its superiority to other treatments, are not basing their claims on the available evidence.

Another correct statement of Hall’s is that most therapists have no evidence to show that what they’re doing is effective. This lack of evidence led others to conclude that, “Beyond personal impressions and informal feedback, the majority of therapists have no hard, verifiable evidence that anything they do makes a difference…Absent a valid and reliable assessment of their performance, it also stands to reason they cannot possibly know what kind of instruction or guidance would help them improve.”12

For decades, free pen-and-paper measures by which therapists can track their outcomes have been available,13 recently superseded by online versions.14 These Feedback Informed Treatment (FIT) online platforms are easy to use and have been utilized by thousands of therapists around the world to get routine feedback from every client on each session. The result: Data from hundreds of thousands of clients is continually being updated. Regrettably, those of us who use these methods are still a small minority of therapists practicing around the world compared to the unknown numbers who, as Hall rightly pointed out, provide psychotherapy in its manifold (and perhaps unregulated) forms.

The online outcome measurement platforms mentioned above are recommended by the International Center for Clinical Excellence (ICCE).15 For decades, the ICCE has been aggregating data from therapists around the world and so providing evidence that corroborates some of Hall’s critical claims about psychotherapy. Current data show that dropout rates, defined as clients unilaterally stopping treatment without experiencing reliable clinical improvement, are between 20–22 percent among adult populations (even when therapists use FIT).16 Dropout rates are typically higher (40–60 percent) for child and adolescent populations. This raises the unfortunate possibility that dropout rates for therapists who don’t get routine feedback from clients are probably higher still.

Hall was, however, incorrect in stating that we don’t know about the harms of psychotherapy. There are many examples of discussions and analyses of what doesn’t work in psychotherapy and what can cause harm.17 One study of aggregated data shows that the percentage of people who are reliably worse while in treatment is 5–10 percent.18

Regrettably, the data indicate that the average clinician’s outcomes plateau relatively early in their career, despite their thinking they are improving. One review found no evidence that therapists improve beyond their first 50 hours of training in terms of their effectiveness, and a number of studies have found that paraprofessionals with perhaps six weeks of training achieve outcomes on par with psychologists holding a PhD, which is equal to five years of training.19 These data support Hall’s statement that unless they are measuring their outcomes, no therapist knows whether their method is more (or less) effective than the methods used by others. Even then, it leads to a conflation that it’s due to the method instead of the therapist. Studies also show that students often achieve outcomes that are on par or better than their instructors. These facts are amply demonstrated in Witkowski’s discussion with Vikram H. Patel,20 whose mental health care manual Where There Is No Psychiatrist is used primarily in developing countries by non-specialist health workers and volunteers.21

Further, there is now evidence that psychotherapists who have been in practice for a few years see themselves as improving even though the data show no such improvement.22 Psychotherapists are not immune either to cognitive biases or to the Dunning-Kruger effect, and a majority rate themselves as being above average. In other words, psychotherapists generally overestimate their abilities. Finally, meta-analyses show that there is a large variation in effectiveness between clinicians, with a small minority of top performing therapists routinely getting superior outcomes with a wide range of clients. Unfortunately, these “supershrinks” are a rare breed.23

To balance the bad news above, following is some of the data which shows that psychotherapy works.

The Good News About Psychotherapy

Psychotherapy works. It does help people. Since Eysenck’s time and in response to the numerous sources cited by Hall, many studies have demonstrated that the average treated client is better off than eighty percent of the untreated sample.24 That doesn’t mean that psychotherapy is eighty percent effective, but it does mean that if you take the average treated person and you compare them to those in an untreated sample, that average treated person is doing better than eighty percent of people in the untreated sample. This effect size means that psychotherapy outcomes are equivalent to those for coronary artery bypass surgery and four times greater than those for the use of fluoride in preventing tooth decay. As discussed earlier, this has remained constant for 50 years, regardless of the problem being tested or the method being employed.

Just as in surgery, the tools that psychotherapists use are only as effective as the hands that use them. How effective are psychotherapists? Real world studies have looked at this question, asking clinicians to measure their outcomes on a routine basis with each client in every session. They’ve compared these outcomes against those in randomized clinical trials (RCTs). It must be noted that in RCTs researchers have many advantages that real world practitioners do not. These include: (a) a highly select clientele, in that many published studies have a single unitary diagnosis while clinicians routinely deal with clients with two or more comorbidities; (b) they have a lower caseload; and (c) they have ongoing supervision and consultation with some of the world’s leading experts on psychotherapy. Despite all this, the data documents that psychotherapy outcomes are equivalent with those of RCTs.25

Therapists around the world, including me, have been using Feedback Informed Treatment (FIT) for decades. I have been seeing clients since 1981 and my clinical outcomes started to improve when I started incorporating FIT into my practice nearly 20 years ago. Those of us who use FIT routinely get quantitative feedback from every client at the beginning of every session. We ask about the client’s view of the outcomes of therapy in four areas of their life: (1) their individual wellbeing; (2) their close personal relationships; (3) their social interactions; and (4) their overall functioning. This measure is termed the Outcome Rating Scale or ORS.26 At the end of every session, we also get quantitative feedback about four items to gauge the client’s experience of: (1) whether they felt heard, understood, and respected by us in that session; (2) whether we talked about what the client wanted to discuss; (3) whether the therapist’s approach/method was a good fit for the client; and (4) an overall rating for the session, also asking if there was anything missing in that session. This measure is termed the Session Rating Scale or SRS.27 The resulting feedback is successively incorporated into the therapy, ensuring that the client’s voice and preferences are privileged.

Research shows that individual therapists vary widely in their ability to achieve positive outcomes in therapy, so which therapist a client sees is a big factor in determining the outcome of their therapy. Data gathered over a 2.5-year period from nearly 2,000 clients and 91 therapists documented significant variation in effectiveness among the clinicians in the study and found certain high-performing therapists were 10 times more effective than the average clinician.28 One variable that strongly accounted for this difference in outcome effectiveness was the amount of time these therapists devoted outside of therapy to deliberately practicing objectives which were just beyond their level of proficiency.29

What these studies show is that we’ve been looking in the wrong place for the answers as to why the outcomes of psychotherapy have not improved over the last 50 years. We’ve been studying the effects within the therapy room rather than what happens outside of the therapy room, i.e., what clients bring into their therapy and what therapists do before and after they see their clients.

Indeed, clients and their extra-therapeutic factors contribute 87 percent to outcomes of psychotherapy!30 Extra-therapeutic factors comprise the client’s personality, their daily environment, their friends, family, work, good relationships, and community support. On average clients spend less than one hour per week with a therapist. The extra-therapeutic factors are the components of the client’s life to which they return, and which make up the other 167 hours of their week. This begs the question “does this mean that there’s nothing we can do about it?” The key is for therapists to a) attune to these outside factors and resources, and b) tap into them. The remaining 13 percent of treatment effects which accounts for positive outcomes in therapy is made up of: the individual therapist, between 4–9 percent; the working alliance (relationship) between therapist and client, 4.9–8 percent; the expectancy/placebo and rationale for treatment, 4 percent; while the model of therapy contributes an insignificant 0–1 percent. This highlights that who the therapist is and how they relate to their clients is the main variable accounting for positive outcomes outside of the client’s extra-therapeutic factors.

So, how should you choose a therapist?

There is now a movement led by eminent researchers, educators, policymakers, and supervisors in the psychotherapy field to ensure that after graduation therapists consciously and intentionally engage in ongoing Deliberate Practice—critically analyzing their own skills and therapy session performance, continuously practicing their skillset (particularly training their in-the-moment responses to emotionally challenging clients and situations), and seeking expert feedback. Deliberate Practice is based on K. Anders Ericsson’s (who made a name for himself as “the expert on expertise”) three decades of research on the components of expertise in many domains of activity, including in sport, medicine, music, mathematics, business, education, computer programming, and other fields. Building on research in other professional domains such as sports, music, and medicine, a 2015 study was conducted to understand what differentiated top performing therapists from average ones.31 It found that top performing therapists spent 2.5 times more time in Deliberate Practice before and after their client sessions than did average therapists, and 14 times more time in Deliberate Practice than the least effective therapists!

This article appeared in Skeptic magazine 28.4
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Experts in the field encourage therapists, supervisors, educators, and licensing bodies to “change the rules” about how psychotherapists are trained and how psychotherapy is practiced.32 The research reviewed here highlights that we can do this in two main ways: first, by making our clients’ voices the central focus of psychotherapy by routinely engaging in Feedback Informed Treatment with every client in every session to create a culture of feedback; and second, by each therapist receiving guidance from a coach who uses Deliberate Practice. To ensure accountability to clients, health insurance companies, and the psychotherapy field itself, this should be the basis for all practice, training, accreditation, and ongoing licensing of therapists.

In summary, psychotherapy does work. For readers who are curious to explore why psychotherapy works and which factors contribute to it doing so, I’d highly recommend Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness33 and its accompanying Field Guide to Better Results.34

About the Author

Vivian Baruch is a relationship coach, counselor, psychotherapist, and clinical supervisor specializing in relationship issues for singles and couples. She has been practicing since 1981, has been a psychotherapy educator at the Australian College of Applied Psychology, and taught supervision to psychotherapists at the University of Canberra. In 2004, she trained with Scott D. Miller, and has been using Feedback Informed Treatment (FIT) for 20 years to routinely incorporate her clients’ feedback into her psychotherapy and supervision work.

References

1. https://rb.gy/iw4yb
2. https://rb.gy/4y3su
3. https://rb.gy/bc9u9
4. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
5. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
6. Norcross, J. C., & Lambert, M. J. (Eds.). (2019). Psychotherapy Relationships That Work: Volume 2: Evidence-Based Therapist Responsiveness. Oxford University Press.
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8. https://rb.gy/x7bm9
9. https://rb.gy/rfq74
10. https://rb.gy/rz91t
11. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
12. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
13. https://rb.gy/edpb6
14. https://rb.gy/ktioc
15. https://rb.gy/2bjuy
16. https://rb.gy/6f55y
17. https://rb.gy/tpuo2
18. https://rb.gy/uqp3k
19. https://rb.gy/obhfg
20. Witkowski, T. (2020). Shaping Psychology: Perspectives on Legacy, Controversy and the Future of the Field. Springer Nature.
21. Patel, V. (2003). Where There Is No Psychiatrist: A Mental Health Care Manual. RCPsych publications.
22. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
23. Ricks, D. F. (1974). Supershrink: Methods of a Therapist Judged Successful on the Basis of Adult Outcomes of Adolescent Patients. In D.F. Ricks, A. Thomas, & M. Roff (Eds.), Life History Research in Psychopathology: III. University of Minnesota Press.
24. https://rb.gy/obhfg
25. https://rb.gy/uulpw
26. https://rb.gy/d5mbx
27. Ibid.
28. https://rb.gy/0hvy3
29. https://rb.gy/rkr85
30. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
31. https://rb.gy/ye406
32. https://rb.gy/r2jb8
33. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
34. https://rb.gy/f3c3e