Up Hill Both Ways
“It's not a lie if you believe it"
― George Costanza, Seinfeld
“I am not going to lie.” When someone says that to me, I'm fairly confident the next thing coming out of their pie hole will be a lie. How do I prepare you in advance for the things I'm going to say in a manner in which you believe me? When you rail against the system, as I have been doing, it's more common to believe that the normalcy of the system in place, the status quo, is more truthful than what some schmuck might be saying. It's the schmuck who is crazy. And in reality, that person has to be a little bit crazy, just because they are opening their mouth. Something extreme must be happening.
When Joseph presents to Mary the loaf of bread he has baked for her, she makes a simple inquiry on the factual state of the world based on her known context. “Thank you Joseph, but we don't have an oven?” Joseph, who spent the whole day baking that bread replies, “Do you see how that sounds Mary?” His context is one of truth. He was there baking the bread. Her context requires a leap of Faith, she knows they don't have an oven. He must have baked the bread somewhere, perhaps he used the neighbor's oven? We just don't know. We want to believe Joseph but the facts are not in his favor. The system is not in his favor. He is most likely a kook, he certainly is not a cook. He doesn't even have an oven.
In the book, “Escape from Reason”, Francis Schaffer, provides us the proper context for taking a leap of faith. When mountain climbing, it's okay to blindly drop to the ledge beneath you, if you hear a voice coming from that ledge telling you it's okay. You drop into the clouds, your feet hit the ledge beneath you. You let out a sigh of relief.
Recently a friend of mine (a US citizen) returned from a visit to his former home in Uganda. When he was growing up, going to elementary school required that the boys swim across a local river. Girls didn't go to school. On this recent trip, since we had talked about it previously, my friend (we will call him Alfred) swam across this river for old time sake. Turns out there are crocodiles in this river.
Compare and contrast Alfred swimming across a crocodile infested river to go to elementary school in Uganda when he was young. Truth. With your parents telling you that when they went to school they had to walk up hill, in the snow, both ways. Fiction. Maybe we don't lie, but we sometimes exaggerate, even if just a little. Over time, these exaggerations can add up to a lot.
Floyd Landis, after he won the Tour de France, wrote a book, “Positively False”. Raised as a Mennonite, my gut instinct was to believe Floyd. I actually watched this race in real time. His performance was nothing less than extraordinary and his win was for all underdogs everywhere. He is a very good writer…his education in rural Pennsylvania.spoke volumes regarding his believability, for me. I respond well to good writing. I believed Floyd to my core. Years later he came out and said he was lying. This because others had decided it was time to bring down Lance Armstrong, and his seven Yellow Jerseys. Floyd Landis wanted to join the party. Because he knew, as everyone knew, everyone was dirty. Everyone was cheating. Everyone involved in racing at the Tour de France was doing everything they could to gain an edge.
Tyler Hamilton, in his book, “The Secret Race”, tells everyone how it was really done. The best way to do it, is to use your own blood. Impossible to detect. This is the way Lance Armstrong was able to get it done, year after year after year. A month before the race, you have your doctor withdraw a unit of blood. And then you put that unit of blood on ice. Three weeks before the race, you withdraw two units of blood, and you return the one you withdrew the previous week back into your system. Blood only lasts 30 days, and you're only going to keep it on ice, because you can't freeze it. You want all those red blood cells alive and kicking. The next week you do the same thing, two units out, One unit back in. Eventually you have a blood supply, of your own blood, that's going to get you through the 21 stages of this Tour de France.
These are major activities in dishonesty. I'm suggesting however that we get there, through tiny little corruptions in our integrity. My dad, the most ethical man I've ever met, would be the guy looking at his receipt, and returning the item to the store that the clerk had inadvertently missed. Character is built on what happens in the middle of the night, when no one is watching. When you pull up to that red light, and it's 2:00.and there's not a soul in sight…do you wait for the light to turn green? Or do you run that red light? I'm running that red light. I ain't got time for that mess. My dad would wait for it to turn green.
Our country has an integrity crisis on its hands. We have a problem with journalism. We have a problem with science. We have a problem with integrity…across the board. Everybody is lying. Everybody is exaggerating. We believe conspiracy theories. We don't believe what science is telling us. Alfred swam across a crocodile infested river to get to school. That's actually true. But because our parents told us they walked through knee deep snow, we don't believe Alfred. Nobody, including Mary, believes Joseph baked that loaf of bread. Why are you going to believe my account of what's happening to me in this hospital? In particular because pain is subjective. At least the way they measure it. “How's your pain level?” They simply just ask you.
In my former years, I had the opportunity to participate in the Military Operations Research Society, MORS. Science, generally speaking, has ways to keep integrity in our profession at a high level. Transparency is certainly one way. Publishing research in peer-reviewed journals is yet another way. Just talking about your research and inviting critical review is one of the best ways when you're actually engaged in the research. Being on a first name basis with your colleagues and senior members of the community may be an even better way. Remove your rank at the door.
I studied the best methods for keeping an ethical talisman present at all times during research. I was on The Board of Directors at MORS, and was actually Chairman of the Ethics Committee. This is not to say that I have more integrity and then the next guy or gal. I'm still going to run that red light at 2:00 a.m…This is just to say.I spent some time studying the problem.
When you build a house, you have to start with a strong foundation. If you cheat or cut corners, that's going to come back to bite you, eventually.
The great comedian George Carlin, even got into this integrity game. In one of his famous comedy bits he's able to reduce the Ten Commandments from 10 to 2. He found the number 10, of the ten commandments, to be arbitrary. Why was it 10? Why not 11 or 12. Why not 9? The original basis for the argument he found suspect including the necessity to go to the top of the mountain, up hill, both ways, in the snow, just to retrieve them.
Eventually he reduces all ten commandments to these simple two…
“Thou shall always be honest and faithful”
“Thou shalt try real hard not to kill anyone”
In the case of my medical care, the first one is easy. I'm struggling with the second one.