Month: December 2013

Reviewing a number of new books on Machiavelli, Michael Ignatieff argues that the author of The Prince was “hardly the first theorist to maintain that politics is a ruthless business, requiring leaders to do things their private conscience might abhor.” So what set him apart?

He believed not only that politicians must do evil in the name of the public good, but also that they shouldn’t worry about it. He was unconcerned, in other words, with what modern thinkers call the problem of dirty hands. The great Princeton philosopher Michael Walzer, borrowing from Jean-Paul Sartre, describes the feeling of having dirty hands in politics as the guilty conscience that political actors must live with when they authorize acts that public necessity requires but private morality rejects. “Here is the moral politician,” Walzer says: “it is by his dirty hands that we know him.”

Walzer thinks that we want our politicians to be suffering servants, lying awake at night, wrestling with the conflict between private morality and the public good. Machiavelli simply didn’t believe that politicians should be bothered about their dirty hands. He didn’t believe they deserve praise for moral scruple or the pangs of conscience. He would have agreed with The Sopranos: sometimes you do what you have to do.

But The Prince would hardly have survived this long if it was nothing more than an apologia for gangsters.

With gangsters, gratuitous cruelty is often efficient, while in politics, Machiavelli clearly understood, it is worse than a crime. It is a mistake. Ragion di stato [reason of state] ought to discipline each politician’s descent into morally questionable realms. A leader guided by public necessity is less likely to be cruel and vicious than one guided by religious moralizing. Machiavelli’s ethics, it should be said, were scathingly indifferent to Christian principle, and for good reason. After all, someone who believes he has God on his side is capable of anything.

In other words, Machiavelli’s innovation was not to teach evil, but to remind us that agonizing over it was the real mistake:

He insisted that when tough or risky political decisions have to be made, Christian charity or private empathy simply will not serve. In politics, the polestar must be the health of the republic alone. Following the querulous inner voice or tacking to and fro when moralizers on the sidelines object is just weakness, and if your hesitations put the republic at risk, it is contemptible weakness. Machiavelli’s ethics valued judicious decisiveness in politics over the anguished search for rectitude.

He was the original person who regarded torture, for example, the same way that Dick Cheney did: as “a no-brainer.” Previous Dish on Machiavelli here, here, and here. A reader adds:

I’ve always loved this statue of Machiavelli in Florence, and it’s the very first thing that came to mind when I saw your FOTD of Putin [seen above, via Getty].

Beutler compares Obamacare to abortion:

An astute friend remarked to me on Tuesday that the GOP’s position on Obamacare is coming to resemble its position on abortion in one key way: loudly, consistently, uniformly opposed, but ultimately not really driven to eliminate it. The backlash they’d face would be brutal, but they might stand to gain by fighting it on the margins and keeping the issue alive.

The comparison holds at a state level too. The most effective Obamacare saboteurs have been GOP governors and legislatures who resisted the opportunity to create their own exchanges and have refused to expand Medicaid with federal dollars, as the law allows.

More generally, conservatives are wielding Obamacare the way they wielded culture war issues in the 1990s. The particulars are enormously different, but the political objectives are similar: pick an issue that both unites conservative voters and appeals to the discontent of moderates and use it first and foremost to fracture the Democratic coalition.

I don’t think they’re going to fracture the Democratic coalition. But I can imagine the issue remaining an effective mobilizing tool for an otherwise agenda-less party through the end of Obama’s presidency.

Theresa Brown points out that “every drug with two names — and that means practically every drug in use — is a medication error waiting to happen”:

[W]e have recently seen a proliferation of look-alike, sound-alike meds. For example: Zantac is used to treat heartburn, while Xanax is an anti-anxiety medication. A list of these sound-alikes fills a full eight pages on the Institute of Safe Medication Practices website. Data on medication errors is not collected systematically in the United States, so it is impossible to say accurately how many errors result from such confusion. Whatever the number, and the attendant misery the most serious mistakes generate, it seems undeniable that the potential for error is increased by the dual naming of all drugs.

Her suggestion:

All drugs now being sold could use either their brand name or the generic name. That name, and the manufacture of that medication, would be patent-protected for 20 years. Thereafter, any other producer of that drug would append it with a “-G,” indicating that it is a generic formulation. Acetaminophen sold as a generic would become Acetaminophen-G, and Plavix, a brand name blood thinner, would be sold as Plavix-G in its generic form. Combination drugs like the brand name inhaler Duoneb might have to use generic names (albuterol and ipratropium) to avoid confusion.

A reader writes:

I wonder how many folks, like me, had thought about buying the 23andme kit, hadn’t gotten around to it, and now, because of all the recent FDA publicity and worried they might miss the opportunity, went ahead and submitted their order. My kit should arrive in the mail today, and I plan to get it back to them ASAP, because I suspect they have received a flood of orders, thanks to the FDA. Because the genealogy part of the results are also those of my three sisters, they will be receiving those results from me as their belated Christmas gift.

Another gets an uneasy feeling:

I want to bring up another angle that I think has been under-appreciated. Anne Wojcicki, a co-founder of 23andMe, is married to Sergey Brin of Google (although they are now separated). Her sister Susan is Google’s director of marketing, and was also the person who rented her garage to Larry and Sergey when they started the company. Why is this important? Because 23andMe collects genetic data from people, along with their family and medical histories.

In a recent interview, Wojcicki said they hoped to reach a million customers by next year. Their stated business plan includes using this genetic data to find associations between genes and diseases. To my knowledge, no other entity can come close to amassing this amount of data, and people are voluntarily giving it to them as part of the service. To me, the $99 testing service is almost an inconsequential part of their business. It simply allows them to collect the data and turn it into biomedical discoveries. Despite the recent Supreme Court ruling that genes cannot be patented, there is still plenty of room to monetize therapies using this approach. All they need is a partner with the ability to process huge amounts of data and extract relevant gene/disease associations, and with Google they would have that. Presumably customers’ identities are kept private, and the data are analyzed anonymously. But of course there is always the concern that with big data, nothing is truly anonymous.

Update from another:

One thing that most people probably don’t realize is that the genetic information that 23andMe collects is not covered by federal healthcare privacy laws (HIPAA) because 23andMe’s customers pay out of pocket. For HIPAA to apply, the healthcare provider has to bill for reimbursement electronically. There are probably state laws that apply, but there is not federal protection for that information.

Matthieu Aikins investigates the “all-out, very expensive effort to eliminate the last few problem areas in some of the most troubled and undeveloped parts of the final three countries where polio is endemic: Afghanistan, Pakistan, and Nigeria”:

The poliomyelitis virus has likely been living with humans for millennia. Archaeological excavations of prehistoric burial grounds, as well as paintings in ancient Egyptian monuments, show limb paralysis that is probably the result of polio. The virus, part of the enterovirus genus, is extremely contagious and spreads through two routes—oral-oral, through saliva, or more commonly fecal-oral, like when an infected person’s feces contaminate the water supply. In the crowded, unsanitary cities of antiquity and medieval times, this meant that virtually everyone would have been exposed to the virus in childhood. For most people, this wasn’t a problem:

The virus typically infects only the mucosal tissues of the gastrointestinal system for a few weeks, where the immune system clears it before any harm is done. After that, the infected person would be immune to future infections from the same strain. However, in less than 1 percent of infections, the virus attacks the central nervous system and causes paralysis. Typically this affects just the legs. But in 5 to 10 percent of paralytic cases (that is, 0.05 percent of total infections), polio paralyzes the breathing muscles, meaning that without artificial respiration the patient will suffocate.

All this explains why polio is so difficult to annihilate. For every one person who actually gets sick, nearly 200 are carrying the virus and infecting others.

(Photo: Fawad Rahmani, 11, makes his way home using his crutches and special braces fitted from the ICRC Orthopedic clinic in Kabul, Afghanistan on September 26, 2009. Fawad has had polio since he was two years old. Health care is one of many problems facing Afghanistan, eight years after the war began to oust the Taliban regime, even as the country receives billions of dollars in international aid. Afghanistan is still fighting to eradicate polio to which they are one of the few countries still dealing with the disease. Earlier this month UNICEF launched an immunization campaign targeting 1.2 million children with an aim is to immunize every child under five. By Paula Bronstein/Getty Images)