Crisp New York

I spent yesterday in New York for a day of Terri Schiavo Life & Hope Network-related meetings. It was a beautiful nearly autumn-feeling day, one with that slight chill in the air that suggests that the summer season is ending. Sharing some photos from the day’s travels that I snapped, starting from the Flatiron to Morningside Heights to St. John the Divine to Hudson Yards/Hell’s Kitchen—this last area has changed substantially (for the better) in the past two years.

Being minimally conscious

Dr. Joseph J. Fins writes about our habit of segregating patients who are minimally conscious from receiving meaningful rehabilitation, and the scandal that is our mis-diagnosis rate for patients like Terri Schiavo, wherein patients are classified as functionally brain-dead when in fact more than 40 percent are likely conscious:

Maggie was found to be in the “minimally conscious state” — a term medically formalized in 2002. Unlike vegetative patients, those in MCS areconscious. They demonstrate intention, attention and memory. They may reach for a cup, say their name and notice you when you walk into their room. The problem is that these actions may be rare and intermittent, so when family members who witnessed them share their observations with staff members, they are often attributed to a family’s wishful thinking.

This may be true in individual cases. But often it is just part and parcel of the biology of MCS. Indeed, at least one study indicated an alarming rate of misdiagnosis: it found that 41 percent of patients with traumatic brain injury who were in chronic care and thought to be in the vegetative state were in fact in MCS.

If not for the astute observations of her Boston neurologist, Maggie, too, would have been misdiagnosed in perpetuity. But instead, she was expressing herself one blink at a time. For a young woman who had been thought permanently unconscious, this was truly a heroic accomplishment. …

Maggie’s case — her “small life” — became very consequential when my colleagues at Weill Cornell Medicine published a paper last December in the journal Science Translational Medicine revealing what had happened within her brain following her injury. During the recovery of her ability to communicate, Maggie’s brain essentially rewired over a period of years.

Using magnetic resonance imaging, Daniel J. Thengone, a graduate student, and colleagues in the Laboratory of Cognitive Neuromodulation, led by Dr. Nicholas D. Schiff, were able to demonstrate a strengthening of structural and functional reconnections across the two hemispheres emanating from Broca’s area, the region in the frontal lobe responsible for speech. It showed, remarkably, that even a grievously injured brain could heal itself. It appeared to do so by a process bearing a strong resemblance to typical brain development. The ongoing reorganization of connections among neurons is a reprise of how the developing brain gets its start. …

Yet, access to care is strained for this population. Utilization reviewers, and insurance benefit companies will deny access to rehabilitation to many individuals when they leave the hospital because they are deemed not yet ready for rehabilitation. But when nearly half of those who could participate are misdiagnosed as vegetative when they are actually minimally conscious, this vulnerable group is further marginalized. Organizations like the American College of Rehabilitation Medicine have been calling for a comprehensive evaluation of patients after hospital discharge so that misdiagnosis can be prevented and those who might be helped can get the rehabilitation they need.

Even those lucky few who do get rehabilitation and are not shunted off to what is euphemistically called “custodial care” get too little time. Most rehab stays are six weeks or less. But if the brain recovers through a slow process similar to development, why do we provide — and only to those lucky enough to receive it — just a few hours of rehabilitation a week for six weeks? It would be akin to sending your third grader to school for half-days of classes for a month or two and telling them that they are now on their own. Now that we know that it takes years for the developing brain to learn and mature, a similar commitment to the recovering injured brain now seems indicated.

If we reconceived rehabilitation as education, no one would graduate after a six-week course of care. Instead, we would promote lifelong learning as a means to achieve a recovered life. If there is a legal obligation to educate the developing brain, should there not be a correlative responsibility to those whose brain are in a process of redevelopment and recovery?

Dr. Fins’s entire op-ed is worth reading if you care about whats of medical care is provided to America’s most vulnerable patients.

‘Big plans’

I met Wesley J. Smith at 30th Street Station the other day for his visit as the Terri Schiavo Life & Hope Network’s newest board member. As I walked into 30th Street as his train was arriving from Alexandria, I noticed Penn State World Campus’s monumental ad. I found it to be both touching and tragic that its message—”I have BIG plans for my career and my life.”—was placed as a sort of backdrop to Angel of the Resurrection, the monumental statue commemorating the Pennsylvania Railroad’s World War II servicemen who fell in the war.

Michael, the Archangel (Quis ut Deus?) his lifting up the body of a man who has fallen asleep, as Christians say, in the hope of the resurrection.

Like all men and women, he undoubtedly had big plans for his life.

Domestic militaries

Sen. Rand Paul writes on a practice that’s as problematic as civil asset forfeiture, which is the problem of creating military-style forces out of local law enforcement:

Speaking to the Fraternal Order of Police in Tennessee this morning, Attorney General Jeff Sessions formally announced that the Trump administration will restart giving surplus military weapons and equipment to state and local law enforcement.

That’s a mistake.

What kind of equipment are we talking about? Well, Haverhill, Mass., a town of fewer than 65,000, got a nearly 20-ton Mine-Resistant Ambush Protected vehicle. Keene, N.H., a town of fewer than 30,000, got an 8-ton armored BearCat. Over 10,000 bayonets have been handed out. Yes, bayonets.

Police work is unquestionably difficult — and often thankless. I have nothing but the utmost respect and admiration for those who put it all on the line to protect our communities, and I saw their bravery firsthand this summer when Capitol Police officers made all the difference during the attack on our congressional baseball-game practice.

To support our local police, we must first realize they aren’t soldiers. But today the line between the two is being eroded.

It’s no surprise you can find big government right at the heart of this problem. Washington has incentivized the militarization of local police precincts by using federal dollars to help municipal governments build what are essentially small armies — where police departments compete to acquire military gear.

Plus, over a third of the “surplus” equipment is new, so it’s disingenuous to portray it as banged-up old stuff lying around the garage.

When we couple militarizing law enforcement with the erosion of civil liberties and due process that allows the police to become judge and jury — national-security letters, no-knock searches, broad general warrants, pre-conviction asset forfeiture — we see the magnitude of the problem.

National Review’s John Fund has observed: “The proliferation of paramilitary federal SWAT teams inevitably brings abuses that have nothing to do with either drugs or terrorism. Many of the raids they conduct are against harmless, often innocent, Americans who typically are accused of nonviolent civil or administrative violations.”

Fund also notes: “By 2005, at least 80 percent of towns with a population between 25,000 and 50,000 people had their own SWAT team,” and that “the number of raids conducted by local police SWAT teams has gone from 3,000 a year in the 1980s to over 50,000 a year [in 2014].”

Given these developments, it’s natural for many Americans — especially minorities, given the racial disparities in policing — to feel like their government is targeting them. Anyone who thinks that race does not still, even if inadvertently, skew the application of criminal justice isn’t paying close enough attention. Our prisons are full of black and brown men and women who are serving inappropriately long and harsh sentences for nonviolent mistakes in their youth.

Our Justice Department should be leading the conversation on reforming the system, not setting it back further.

Americans must never sacrifice their liberty for an elusive and dangerous — or false — security. The militarization of our law enforcement is just another symptom of an overall problem that stems from an unprecedented expansion of government power — where we are repeatedly asked to make such “liberty for what we tell you is security” tradeoffs.

Ultimately, if we sacrifice the very nature of the institutions we have set up to enforce the law, what kind of law will we end up enforcing?

It has been our tradition that the U.S. military cannot be deployed domestically, but if we continue going down this path I think it’s inevitable that it eventually will be, either in fact or in essence through police officers who are indistinguishable from our armed forces. None of this is compatible with the idea of liberty.

Sister Cities Park

Center City District redeveloped the old concrete Sister Cities Plaza into the incredible Sister Cities Park five or so years ago. This is a tiny little park on the edge of Logan Circle, right in front of the Cathedral Basilica of Sts. Peter and Paul. I can look out onto Sister Cities Park from the Terri Schiavo Life & Hope Network offices.

It’s a beautiful little space, and especially in summertime when the fountains are on and people of all ages are out. I snapped this photo earlier this week when I was sitting with Bobby Schindler having lunch. Ashley Hahn on Sister Cities Park after its recreation:

The design team wanted to bring elements of Fairmount Park onto the Parkway, and the discovery garden is meant evoke a child-sized Wissahickon. The rocky hill at the northern end – a surprising change in grade– has a trail, logs, and a stream winding its way down to the pool below. The plantings and decorative fence are also expicit nods to the flora and fauna of the Wissahickon.

After being inside the Academy of Natural Sciences or Franklin Institute for part of the day, the discovery garden is “about finding a way for kids to engage… get a little bit wet, a little bit dirty,” said Hanes. Kids can amble along the hill or push rented toy boats around in the pool.

Bridging the formality of the Sister Cities Fountain plaza and the charmingly rustic children’s garden is an inviting, modern pavilion. Digsau’s Jules Dingle described the pavilion as a threshold space, designed to create a “seamless transition from city to garden.”

Dingle explained that the pavilion’s form deliberately echoes “rock forms that might loom overhead and create shelter” somewhere deep in the Wissahickon. The texture and tone of the pavilion’s natural materials soften the design’s sharp angles, and create a critical visual link in the park’s landscape. From inside, the glassy walls provide a 260° vista of Sister Cities Park, Swann Fountain, and the Parkway beyond.

Little spots like this contribute to the “specialness of place” that residents and visitors alike feel about the day-to-day experience of being someplace. It’s often in the “little things” that the big changes find their initial momentum.

Tappan Zee Bridge

I snapped a photo of the New York Times in Starbucks yesterday because the news of the new Tappan Zee Bridge, just north of New York City, caught my attention:

Its opening comes at a time of skyrocketing construction costs, diminished resources devoted to infrastructure, and deteriorating subways and airports in New York.

“We built the longest bridges, the most sophisticated tunnels,” Mr. Cuomo said. “But we lost that daring, we lost that competence.”

In talking about the factors that have hampered big projects, the governor sounded like a possible candidate for the Democratic nomination for president in 2020, as some have suggested he is. “A more litigious society” got in the way, he said, as did a “NIMBY factor” and politicians allergic to conflict and risk. With troubled projects like Boston’s “Big Dig” highway tunnel, which was plagued by cost overruns, shoddy work, scandals and one death, the United States, he said, is falling behind in the competition with countries that build sleek new airports and railway systems.

The governor boasted that the state has $100 billion in infrastructure projects in progress or planning, including renovations of LaGuardia and Kennedy Airports and Penn Station.

“What the New Tappan Zee says is we can still do great things,” Mr. Cuomo said.

In a ceremony on Thursday, Mr. Cuomo drove across the bridge in a 1955 Corvette with a noteworthy passenger: Armando Galella, a 96-year-old veteran of the attack on Pearl Harbor who had driven across the original Tappan Zee Bridge on its opening day in 1955.

Robert Moses, one of the fathers of New York as we know it, possessed the sort of daring and competenace Cuomo says we’ve lost. But Moses’s decades-long presence at the head of New York planning agencies came at terrible social cost. Is that the trade-off? Either do great and visionary things at great social cost, or do good little things that maintain what you already have?

The new Tappan Zee looks a lot more beautiful than the one that opened in 1955, but it’s not doing anything new. It’s just replacing a bridge that had come to the end of its life.

We can’t get the Hyperloop soon enough.

Afghanistan

We’re living through a time when serious political breakthroughs in America seem to require a sort of civic/political suicide. In order to have a serious debate about encryption as a means to preserve Fourth Amendment Constitutional protections, and in order to expose the government’s abuse of the public trust, Edward Snowden has functionally had to forfeit his citizenship, for example.

On another front in the category of “reckless government behavior,” President “Chaos” Trump suggested he would bring our Afghanistan war to an end. Instead, we’re re-upping on our longest war. What will it take to end this war? Kevin Williamson writes:

What is it we are doing in Afghanistan? What do we think we are doing in Afghanistan? All we can say with any confidence is that the former and the latter bear only a theoretical relationship.

The United States invaded Afghanistan in 2001 in the aftermath of the terrorist attacks of September 11. Al-Qaeda leader Osama bin Laden and many of his associates were thought to be holed up there under the protection and the patronage of the Taliban, the jihadist militia cum narcotics syndicate that controlled Afghanistan at the time. U.S. forces marched in, toppled the Taliban, and installed a client regime under Hamid Karzai, a wildly corrupt and borderline incompetent leader who was, all things considered, probably the best we could do at the time. We eventually had a falling out with Karzai and his government, and Afghan democracy — “democracy” — moved on. The country has remained in a slow-motion civil war, with the Taliban waxing and waning conversely with U.S. interest in this unhappy little corner of the world.

“Killing terrorists,” Trump says. Afghanistan has its share of terrorists, but what it mostly has is an endless civil war being fought among rival tribal interests in a rugged and empty part of the world that mostly has served only to get in the way when you’re marching your Macedonian army toward India. “Killing terrorists” in Afghanistan is not a national military goal with a defined set of conclusory conditions and a working definition of victory — it’s an eternal game of Whac-a-Mole using U.S. forces as the toy mallet. If concluding our efforts in Afghanistan before Islamic radicalism has been exterminated there means handing a victory to the ghost of Osama bin Laden — who is, let’s keep in mind, dead — then we are never leaving Afghanistan.

One doesn’t expect Donald Trump to sort this out on his own, or to figure out how to match his socks.

Congress should step in here. The Authorization for Use of Military Force passed nearly unanimously by Congress and signed into law by President Bush on September 18, 2001, served its purpose in the immediate aftermath of the shocking events of September 11, 2001. The only member of Congress to vote against the AUMF, Barbara Lee of California, predicted that it would end up being a deathless “blank check” for worldwide military operations without the explicit and specific authorization of Congress, and in that she was correct. The AUMF should be repealed and funding for operations in Afghanistan cut off unless and until the United States can define exactly what it is that its military is to accomplish in Afghanistan, at which time a new, specific, and limited AUMF may be drawn up. If the answer ends up being “killing bad guys,” then maybe the current leadership in Washington should retire with a six-pack and some old Chuck Norris movies and turn this over to the adults.

They don’t know what it is they are doing, but they are sure that we should keep doing it — forever.

It’s a scandal that Congress refuses to force the president’s hand on this—and it was as great a scandal under the previous two administrations, too.

Better college football playoffs

Penn State kicks off its season against Akron in State College next Saturday; I’m debating whether to head to the game. In the meantime, I wanted to highlight Urban Meyer’s recent off-the-cuff comment to ESPN’s Chris Low:

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We started down the path toward a better college championship model when the bowl championship series was replaced with the College Football Playoff, but as I wrote last December after Penn State beat Wisconsin its still subjective in the same way that made the old bowl system frustrating:

Penn State’s 38-31 win second half over Wisconsin last night has put them in the Rose Bowl on January 2nd against USC. Penn State’s #5, USC’s #9.

This means Penn State won’t be competing in the College Football Playoff, despite its Big Ten Championship win last night and despite beating Ohio State, which will be in the playoffs. There are lots of layers to this conversation, and I don’t mean to disrespect the value of different schools of thought entirely out of hand. I understand, for instance, the idea that Ohio State’s overall season record (one fewer loss than Penn State) should hypothetically count for something. At the same time, I discount that. …

The value of division champions is what, exactly, in a world where selectors pick the final semifinalists for playoffs anyway? I saw Paul Clifford, Penn State Alumni Association CEO, share Urban Meyer’s 2006 comment: “If you don’t win your conference, you shouldn’t be playing for a national championship.” I think that’s right—and not just because it would mean Penn State would compete for the national championship this year, but because the current system devalues the division championships.

We’re moving toward a playoff model. In a playoff model, overall wins matter less than performance at key points in the season. The playoff model should allow for the rise of magical and unexpected teams like Penn State has proven to be this year, and who knows who’ll be next year.

I think we should probably move toward a system where the national champion is the result of division-victor playoffs.

Money and belief

A worthwhile conversation with Philip Goodchild (author of Capitalism and Religion and Theology of Money) on economics and money, and what these things mean in a world where trust in the objective value of money seems perilous. He asks: “What can we put our faith in that gives us confidence in one another?”

“People talk about the law of comparative advantage, as though it were like the law of gravity and always applies. But it might be a principle that different countries are better at doing certain things, and would be better served if they did their different things. But that doesn’t mean that at all times and in all places and in every case, it’s best to keep to what you’re good at and not do a full range of other things.

“It’s one thing to take a principle, or talk about a tendency, or say ‘In general there is this economic force or phenomenon.’ It’s another thing to understand how that has a bearing on each individual situation, and [judge] whatever other forces are at work.

“In general, I would say that most economic laws are simply tendencies. But they become ideological when people call them laws, and they become belief systems that [people] live by and reconstruct their lives by. So the idea that markets are efficient is one that’s structured a lot of economic behavior over the past decades.”

A problem in thinking of laws as “simply tendencies” is that so much of quantum physics seems to suggest the same thing about laws of nature—that these things are “tendencies” too. But if things work as expected in most cases, they’re as good as law. The same may turn out to be true of capitalism—that these tendencies are the closest thing to law as we can get this side of heaven.

Men without work

Brian Rottkamp writes on Nicholas Eberstadt’s latest book “Men Without Work: America’s Invisible Crisis”:

For centuries, philosophers, theologians, and social scientists have contemplated the distinction between leisure (the basis of culture as per Josef Pieper) and idleness as defined by the cardinal sin of acedia. Modernity tends to blur the difference between spending time in a way that elevates the individual and society and a way which is unproductive and/or harmful. By utilizing various research conducted by the Census Bureau and the Bureau of Labor statistics annual American Time Use survey, Eberstadt is able to show how prime-age men not in the labor force (NILF), unemployed men, employed men, and employed women spend their time. What comes to fore is that prime-age NILF men with their free-time dividend of over 2000 hours/year spend no more time assisting with household care than employed women and less time than unemployed men. Out of the four groups, these men spend the least amount of time in religious and volunteer activities—despite the much greater amount of free time they possess. Instead, this time is spent engaging in “personal care” which includes sleeping and grooming, and most notably, a huge amount of time spent in “socializing, relaxing, and leisure.” Especially telling is the fact that prime-age NILF men watch nearly five-and-a-half hours of television and movies each day which far surpasses all of the other sub-categories and is a full two hours per day more than unemployed men. Seeing as NILF men are much more likely to use illicit drugs and visit gambling establishments, while less likely to attend religious services, read the newspaper, or vote in a presidential election, the parallel of entertainment media to the soma of Aldous Huxley’s Brave New World is unavoidable and deeply troubling. It is a crisis for the individual, the family, and society at-large.

The macroeconomic changes which can be deemed responsible for this male flight from work in the United States are varied. Increasingly, the influence of innovation, automation, and globalization is seen causing a fundamental shift in the nature of work. The large-scale incarceration of men—especially black men following the “war on crime”—unquestionably plays a major role, given not only the time each prisoner spends in jail but also the scarlet letter of a previous conviction that marks him when attempting to re-enter the labor market. Interestingly, Eberstadt also references a rapid increase in disability and social welfare claims which is perceived as inhibiting gainful employment. As Eberstadt makes clear, his intent is to create awareness of this crisis and open the discussion rather than providing all of the possible solutions. Without question, this book and the subsequent surprise victory of Donald Trump in the U.S. presidential election has led to an increased awareness of the plight of these “forgotten men.” The social reformers of Riis’ era clearly understood the effect that housing had on the individual and the family. One can only hope that we can be as wise to value the many benefits that work provides for men and society and develop the economy accordingly. The tenements are long gone but the challenge to develop virtue and character remains.

Nicholas Eberstadt writes: “Today’s received wisdom holds that the United States is now at or near “full employment.” An alternative view would hold that, by not-so-distant historic standards, the nation today is short of full employment by nearly 10 million male workers (to say nothing of the additional current “jobs deficit” for women). Unlike the dead soldiers in Roman antiquity, our decimated men still live and walk among us, though in an existence without productive economic purpose. We might say those many millions of men without work constitute a sort of invisible army, ghost soldiers lost in an overlooked, modern-day depression.”

Like J.D. Vance’s “Hillbilly Elegy,” Eberstadt speaks to a serious issue that’s seriously under-addressed…