Planned remarks before Houston City Council

Below are my planned remarks for the speech I gave at Houston City Hall on Tuesday, July 29, 2014. Unfortunately, due to the number of speakers, I was only allowed one minute instead of the three that I had planned, so I said something a bit different than planned. My remarks are inspired by a transportation ordinance to be issued regulating Uber and Lyft that affects people with disabilities (as ride-sharing companies tend not to provide accessible service to people in wheelchairs).

The whole hearing is online: I am in part three of four beginning around 23:45.

Before I begin, let me just take a few moments to introduce myself. My name is Michael Zoorob, and I am a student at Vanderbilt University. The views I am expressing today are my own.

This summer I had the opportunity to work at the Southwest ADA Center, a disability non-profit organization. Through my work at the Center, and also through the conversations I have had with many who work there, I think I’ve learned a lot about disability. Today I’d just like to share some of what I’ve learned.

The first thing I learned is that disability is real and prevalent
I’m 20 years old, I like to lift weights a few times a week, and disability is not something I think about as affecting me. But consider this: In Oct 2012, the NYT wrote that a 20 year old has a 30% chance of becoming disabled for more than six months before he retires. Cancer is the second biggest cause of disability – and consider how often – and how randomly – it strikes.

In fact, more than 50 million people have a disability – a number that will increase as the population ages. This isn’t something which just affects somebody else. It affects our parents and grandparents. It affects all of us. And it matters.

Disability is, like race or sex or sexual orientation, a characteristic which you cannot wake up one morning and decide to change. It is also, unfortunately, a characteristic which is often used to deny a person work or service or respect. But discrimination is just as wrong when it is done because a person is blind and uses a guide dog or paraplegic and uses wheelchair as when it is done because of a person’s skin color.

This is a civil rights issue. But it is also an invisible civil rights issue. People with disabilities are much more likely to have difficulty leaving the home – to have difficulty accessing transportation. It can be hard to realize that discrimination is happening when it traps a person within his home. But when buildings or sidewalks or cars are designed in a way which excludes some people from using them, that’s discrimination too.

The city council is to vote tomorrow on a new transportation ordinance. I hope they send the message that while equality isn’t free, civil rights are priceless.

Thank you for giving me the opportunity to speak today.

Why do so few medical students become Psychiatrists?

Today one of my coworkers and I got in an interesting discussion (or maybe an argument) about why relatively few medical students become psychiatrists. She just finished her first year at a pretty prestigious medical school.

I claimed that it boiled down to stigma against mental illness, while she argued that the difference is explained by other fields of medicine being “cooler,” “more interesting at least to some people,” and “more hands-on” (which I pointed out does not at all contradict the stigma explanation).

 I (like most people I imagine) am not very good at faithfully and fairly recounting how arguments played out, especially when they get a bit heated. So I’ll from here on try to make this objective (by which I mean independent of my conversation with my co-worker) and just flesh out a few interesting points that came up.

Psychiatrists are paid less and research is funded less than for other specialties

As New York Times writes, “Psychiatrists rarely earn enough to compensate for their additional training. Most would have been better off financially choosing other medical specialties.” Psychiatry is among the least paid medical specialties, though it looks like the pay is increasing faster than in most other areas. Interestingly, HIV/Aids specialists receive the lowest salary of all, and they also treat a stigmatized population.

Psychiatrists are least likely to accept insurance plans, possibly because they are systematically under-reimbursed, even for the same procedures  (that article also says that half of counties lack a regular psychiatrist!). Research on mental illness is significantly underfunded relative to the disease burden it creates.

Are other specialties more interesting, hands on?

Surely for some people and not others – like everything else. Maybe some people really like feet or skin or hearts or reading x-rays.  But for this to make sense in explaining the shortage of psychiatrists, it has to take the stronger form that psychiatry is systematically less interesting than other forms of medicine. And that sounds a little difficult to believe to me. (I am also inclined to think that if the average psychiatrist made $340,000 a year like the average orthopedic surgeon, interest wouldn’t matter much).

 The brain is an incredibly complex organ. Mental pathologies are extremely powerful and disruptive forces – they ruin lives and cause all kinds of bizarre behaviors. Additionally, considering that the lifetime prevalence of mental illness is one in two, and depression and substance abuse are higher among medical students than the general population (discussed later), it is fairly likely that a medical student has personally experienced a mental illness or observed its effects. It seems to me that, all else equal, you would be more likely to go into a field of medicine which has affected you or someone you know than not.

Anyhow, psychiatry sounds a lot more interesting to me than Orthopedics, for example (the highest paid specialty by far) or Plastic Surgery (another high payer). Surgery is a lot sexier than psychiatry (in addition to being much better paid) and I think this is a product of the stigma.

Are future doctors too sophisticated for stigma?

The hypothesis for this line of thinking is pretty intuitive: stigma comes from misunderstanding and misperception of mental illness. Medical students and doctors, who know a lot about mental illness, don’t make these mistakes, so they are less likely to stigmatize mental illness.

Unfortunately, it’s not true. Not at all.

According to an Journal of the American Medical Association study (specifically of med students at UMichigan), mental illness stigma may actually be higher among medical students, who, in addition to being more likely to be depressed than average, are more likely to attribute depression to “weak coping skills” and more ashamed about revealing their negative emotions. This sort of makes sense to me, as medical students strike me as the kind of people who endorse a very strong “protestant work ethic”, “internal locus of control” type of outlook. One that says if you want something, work hard and you get it; if you have a problem, work hard and you’ll solve it.

The implication is, unfortunately, that if you can’t solve a problem, you aren’t working hard enough. It’s your fault, something to be ashamed of.  It’s not hard to see how this attitude, coupled with a high-stress, hypercompetitive environment, would be ripe for high levels of depression and self-stigmatization. After graduating, doctors tend to avoid seeking mental health care.

And in the population at large, while more people attribute mental illness to neurobiological factors than in the past, stigma is actually higher, according to an American Journal of Psychiatry report. Being able to attribute illness to neurobiology doesn’t make people more accepting of illness; in fact, it may make it seem intractable, a rigid characteristic about a person that will never go away.

Mental illness stigma deters people from Psychiatry

Furthermore, there are plenty of published anecdotes (eg here, here, here) of psychiatrists describing the stigma they received for choosing their profession. A Columbia Professor of Psychiatry writing for Scientific American describes this comment made by another faculty member: “Tell all students who get low scores on their board exams not to worry, they just need to change their career plans and go into psychiatry.”

Psychiatry is also, as far as I know, the only branch of medicine with a dedicated movement opposed to its existence.  Ever heard of anti-cardiology?

Incoherent or Masterfully Erratic? Putin’s Six Contradictions in Ukraine

Russia’s involvement in Ukraine has been riddled with contradictions, including statements, actions, alleged motivations, and poll results that jar with one another. For example, officials first denied involvement in Crimea while justifying involvement in Crimea; then Putin admitted troops were involved. Putin said Russian troops would withdraw from Ukraine’s border but had until then denied there was a troop buildup at the border. And so on. It’s difficult to make sense of these things. Maybe it is part of Putin’s strategy to be unpredictable; or maybe the Russian strategy really isn’t as coherent as it appears (viewed this way, Russia’s success would have more to do with Ukrainian weakness than Russian aptitude).

Anyhow, here are Six Contradictions regarding Russian intervention in Ukraine:

  1. Celebrations in Sochi and Soldiers in Crimea: The juxtaposition between an international ceremony celebrating peaceful competition among states and an invasion upending the international order as we know it could hardly be more striking. As Henry Kissinger points out in an interview with Fareed Zakaria, “He [Putin] spent $60 billion on the Olympics. They had opening and closing ceremonies, trying to show Russia as a normal progressive state. So it isn’t possible that he, three days later, would voluntarily start an assault on Ukraine.” Rather than being a long-conceived assault, the Crimean takeover was much more likely to have been an “emergency response” to events in Ukraine pushing it away from Russian orbit.
  2. Why intervene? In the 1990s Russia signed a treaty affirming the integrity of Ukrainian sovereignty throughout its borders in exchange for Ukraine giving up its nuclear weapons. To justify breaking this promise, Russian officials have pointed to two things: 1) Protecting Russian speakers from “ultra-nationalist” violence, a problem deemed “overblown” by Putin’s own human rights advisory council, which urged against the deployment of Russian troops in Ukraine. 2) A letter written to the Russian minister to the UN by deposed Ukrainian President Yanukovych, who was recommended to the ICC by the Ukrainian Parliament on charges of mass murder and crimes against humanity. A day before writing the letter, on Feb 28 2014, Yanukovych told reporters he had no intention of inviting Russia to intervene. In April, he told reporters that he regrets that decision and will press Putin to return Crimea to Russia.
  3. Whose troops? On March 5, Russia’s foreign minister and defense minister called various reports and evidence of Russian troops in Crimea “complete nonsense” and “provocation.” Russia’s state-owned RT network blamed the mainstream media for fabrication and maintained that gunmen in Crimea were local self-defense forces. Putin contended the same. Then, on April 17th, he admitted that Russian troops had deployed to Crimea after all. (What I think is really odd about this is that Russia was simultaneously providing reasons for why it was right to intervene while denying it had intervened).
  4. Pull back of non-existent troops on border? In early May, Putin announced that the 40,000 Russian troops deployed to the border with Ukraine would pull back, though a NATO official said nothing had changed. Until then, Russia had denied any buildup was occurring, even in the face of satellite images provided by NATO showing helicopters, troops, tanks, and artillery on the border.
  5. Crimea poll numbers fudged: Business Insider puts it succinctly: “Official Kremlin results: 97% for annexation, turnout of 83%, and 82% of all Crimeans voting in favor. Putin’s Human Rights Council Report: 50-60% for annexation, turnout 30-50%, and 15-30% of all Crimeans voting in favor.”
  6. Donetsk and Luhansk polls: Separatists report that 80% of voters in Donetsk and 96% in Luhansk supported independence. There are a variety of reasons to think these numbers are bogus. Here is one of them: Independent polls paint a far different picture of opinion in these regions: According to the Kiev International Institute of Sociology, about 60% of those in Luhansk and 70% in Donetsk disagreed with the statement that Ukraine violated the rights of Russian speakers. Less than 30% wanted their country to secede from Ukraine and join Russia, and less than 20% in these regions supported Russian troops in Ukraine. Most people in Donetsk and Luhansk wanted greater decentralization or a federation within the Ukrainian state. Very few said they supported armed groups seizing buildings or endorsed taking up arms to fight for unification with Russia. Other independent polls echo these results – for example, just 37% of Ukrainians in the Donetsk, Luhansk, and Kharkiv regions support an alliance with Russia, compared to 49% who supported an alliance with the EU, according to a CNN poll. According to Pew, “A majority of east Ukraine also wants to be one country (70%), including nearly six-in-ten Russian-only speakers (58%).” Meanwhile, Russian-backed separatists push for joining Russia, in clear contrast to all the evidence of independent pollsters. 

Musical Transformations: Word to sound and sound to kaleidoscopic color

I stumbled on some cool artistic transformations involving music and technology lately, and I thought I’d share / document them.

1. “Music Worth Watching.” I stumbled on a series of “animated graphical visualizations” of various songs in classical music. Different shapes represent different instruments, colors represent tones, and spatial orientation shows pitch, among other elements. The result is a really neat visualization; pyramids of sound cascading across the screen, creating a kaleidoscopic of swirling voices. Check out a video of Stravinsky’s Rite of Spring (notes here). Looks like it’s called the Music Animation Project created by a guy named named Stephen Malinowski – and the whole idea started as a hallucination in the 1970s.

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2. “Transprose” – Novels transformed into piano music. This project involves assigning words to particular tempos, keys, and tones according to their emotional content (ex. joy, sadness, trust, happiness);  The full list of songs is here. It’s a little simple right now, but the idea is so cool, and some of the songs sound pretty neat (my favorite is Heart of Darkness). Time did a short write-up about it: “By picking out emotion-related words and translating those into tempos and keys, two researchers found a way to connect music and literature.” A programmer/artist from NY named Hannah Davis and Saif Mohammad of the Canada’s National Research Council created it.

3. “Listen to the Sound of Wikipedia.” This project takes real-time activity on the different Wikipedia sites (English, French Punjabi, Wikidata… you choose the ones you want) and generates tones. The result is continuous ambient music. I think this is especially neat because it creates art out of something obviously not intended for art – the big data of Wikipedia edits – How cool is that! Here’s the description: “Bells indicate additions and string plucks indicate subtractions. Pitch changes according to the size of the edit; the larger the edit, the deeper the note. Green circles show edits from unregistered contributors, and purple circles mark edits performed by automated bots.”  It was built by Stephen LaPorte and Mahmoud Hashemi and apparently was inspired by a similar idea for Bitcoin.

I think it’s clear that increasingly sophisticated technology is not the bane of aesthetics. Rather, technological innovations magnify the space for artistic expression by unveiling new modes through which art can proliferate. All three of these projects are powered by recent software and involve coding of some kind. All the more reason to learn to program, I think.