[VISION] [Asperger-friendly] The underpinnings of a visionary conversation

[John Harvey]

The underpinnings of a visionary conversation

[Asperger-friendly version]
Different experiences, different beliefs
Different people have different experiences of important things. Those important things include things we learn. Learning about things in different ways sometimes leads us to differing ideas about the same things. Because we all learn about the same things in different ways and come to different ideas about them, some of us can arrive at beliefs that conflict with others' beliefs about the same things.
Some people experience, once they come to believe something, that it can be difficult to change that belief even when new evidence comes to us that justifies a change in belief. Many people belonging to an organisation calling itself the Skeptics, who commonly have Asperger's syndrome or other cognitive deficits, find themselves in such difficulties every day.
Without tolerance, true skepticism is impossible
People who are able to change their beliefs in accordance with the evidence are usually able to discuss beliefs that they do not hold without having to believe that those beliefs are wrong. They simply accept that they do not know. This ability is a requirement of true skepticism (scepticism). Another requirement of true skepticism is that until there is incontrovertible evidence that answers a question one way or another, the skeptic (sceptic) does not hold any belief at all in answer to that question but simply accepts that he or she does not know the answer to that question. For many in the organisation called the Skeptics, tolerating uncertainty is simply impossible. But for others, it can pose no difficulty at all.
People affected by the cognitive difficulties that are common among Skeptics might continue to believe answers to many questions in relation to which there is new evidence that conflicts with that belief.
Two important questions of this nature are the effectiveness of various medicines (which medicines are effective and which are not), and the safety of various medicines (which medicines we can be sure are safe and which we can't be sure are safe).
Some of those medicines of which beliefs about effectiveness and safety can remain very strong despite conflicting evidence are vaccines, because of the stories we hear about them from childhood, and homoeopathic medicines, because of the stories we hear about them from vaccine manufacturers.
Pseudoskepticism and fundamentalism
Many people are able to change their beliefs in accordance with the evidence.

But people who continue to believe something despite evidence clearly contradicting that belief find such an ability difficult to understand. Although true skeptics (or sceptics) try to not believe anything that they have no evidence about, and to change their beliefs to accord with the evidence, others, whom we might call false skeptics, evade evidence that conflicts with their beliefs, or misrepresent such evidence to accord with their beliefs. True skeptics regard the inability to change beliefs in accord with evidence as irrational; false skeptics regard inability to change beliefs in accord with their own beliefs as irrational. True skeptics tolerate differences in viewpoint; false skeptics (whom from here on I'll refer to as pseudoskeptics) do not.
Partly for these reasons and partly due to emotional immaturity, those affected by the cognitive deficits that lead to false skepticism often also wish to force true skeptics to act in accordance with pseudoskeptics' beliefs rather than in accordance with their own wishes. In general, this wish to force others to do what one wants is known as fundamentalism; those who support such force are known as fundamentalists.
Fundamentalist pseudoskeptics believe that their own belief in the rightness of their beliefs is more important than any ethics concerning truth, tolerance, or liberty. It is for that reason that their campaigns against those who present evidence they dislike fail to limit themselves to making relevant claims, instead insulting those presenting the evidence and even going as far as to threaten them and their supporters, to attempt to exclude them from conversation, and to attempt to destroy their reputations and businesses.
A treaty of rationality
People with rational abilities recognise many things that certain cognitive deficits prevent others from recognising. One of the things they recognise is that if everybody were to act as fundamentalist pseudoskeptics do, there could be no real conversation on the topics under discussion and no real progress.
What people with rational abilities therefore choose to do is to agree that anybody in the conversation who violates certain requirements shall be treated as not contributing to that conversation. This is a kind of treaty, an agreement on the limits of what is a useful contribution, and we may call it a treaty of rationality. The requirements are fairly simple:
• to make your contributions wholly relevant to the question under discussion;
• to keep your contributions accurate; and
• to acknowledge any contributions to discussion of the question that add something new and relevant to its consideration.
These requirements generally mean:
• avoiding needless repetition, as it does not advance the conversation;
• presenting evidence, or references to evidence, rather than hearsay, as far as possible;
• acknowledging the implications of evidence that contradicts your previous statements;
• refraining from denigrating people's character and from threatening them;
• treating others able to respect these requirements as you wish to be treated.
A treaty of liberties
People with rational abilities and a sense of the inherent equality of all human beings recognise the fairness and wisdom of ensuring that everybody be able to do certain things that nobody is entitled to interfere with, and pluralist democracies are based on that recognition. Those things, which we call inalienable rights, include most obviously such things as having access to the basic necessities of life; marrying somebody (of sex and sufficient age) willing to marry you; believing whatever you like, even about gods and politicians, and expressing your beliefs in ways that do not interfere with others' similar rights; freely assembling with others willing to assemble with you; and refusing interference with your person, either in whole or in part, such as incarceration or assault.
We might regard these recognitions as jointly constituting a treaty of liberties. Most such liberties are guaranteed by law in western liberal democracies. And those engaged in conversations concerning the delivery of medical services in such places as the U.S., Canada, Britain, Australia, and the European Community, as members of a society based on the priority of personal liberties, expect such liberties to remain uncompromised by the ideals of commerce and the promises of better delivery.
Such expectations are built into the fabric of rational conversations between people without fundamentalist persuasions, and participants in all conversations of merit who attempt to undermine them undermine their own credibility as rational pluralist supporters of democratic principles and liberties.
Anybody expecting to be attended seriously by all intelligent readers, then, is obliged to respect certain courtesies, which I may sum up as:
• the courtesy to acknowledge anybody's freedom to hold any opinion, to express it, and to act on it in a way that does not limit others' comparable freedoms.
Making the underpinnings explicit
The underpinning priorities that appear in bullet points above are some that it seems to me underlie any conversation that rational people hold in a pluralist democracy. It seems to me also that it's worth making them explicit, in order to enable identification of the underlying conflict of priorities between those who continue to support them and anybody who seeks to undermine them (and thus to change the basis of the conversation).
The topic of the conversation I propose to have is: a vision of how health care may best sustain our health.
The assumptions that I foresee underpinning the conversation are:
(1) the inalienability of the human rights to dignity, informed consent, and informed choice -- meaning that these human rights may not be taken away from anybody;
(2) the undesirability of commercial monopoly -- meaning that it is better to have a range of providers, rather than a single provider, of any saleable good or service;
(3) the necessity of regulatory transparency -- meaning that the way in which industry is regulated should be accessible by the public;
(4) the importance of scientific openness, pluralism, and tentativeness -- meaning that evidence is more important than hearsay and opinion, accessibility of information is more important than protection of secrets, tolerance is more important than comfort, and acknowledgement of uncertainty is preferable to acting on false conclusions;
(5) the desirability of social pluralism, tolerance, and reciprocity -- meaning that it is good to let others be as they wish to be, to accept their choices for themselves and their children as being as important to them as your choices for yourself and your children are to you, and to minimise the power of one person to do to another what the latter is not empowered to do to the former; and
(6) the necessity of vigilance and engagement to the ascendancy of equity, access, and liberty over corruption, distortion, and disenfranchisement -- meaning that the prevention of some from taking unfair advantage of their own positions or of others' positions or from placing people in unfair positions necessitates that we look after each other.
I don't have a particularly clear view of these matters, and we can all contribute to making the conversation constructive and robust as well as dear to our hearts. What I would like to do is to ask any reader interested in such a conversation on such a topic to help refine the underpinning assumptions.
We might also refine the topic or create several topics. But, over all, I would like us to be able to hold a conversation with the fundamentals firmly in place:
• a conversation inherently balanced, reasonable, credible, and safe;
• one in which scientific scrutiny is not submerged in disinformation and hearsay, in which neither the lessons of personal stories nor the lessons of statistical evidence are ignored in favour of baseless assertions;
• one that, rather than experience as ratty and debilitating, we can find meaningful and rich even as it contributes to the social, cultural, political, and scientific advancement of the study and practice of matters affecting health.
I see no compelling need to restrict such a conversation from discussing anything relevant to a robust vision of broad health, including all those matters that detract from it. Recognition and treatment of acts destructive of our health need discussion at least as urgently as does the prevention of further such destruction and the building of new visions, methods, and institutions.
Dealing with such matters is not in itself debilitating to our wellbeing; rather, what debilitates us is frustration of our great capacity to deal with them. Therefore, our conversation could implement the three great arches of important change: analysis, vision, and strategy.
But let those of us interested in initiating it discuss first what its underpinning assumptions shall be -- and later let the topics flow.
To keep communication on this topic clear and distinct, we could precede any subject line with "[VISION]", as I have done above. In order to help our Skeptic friends to identify attempts, such as this one, to enable them to understand the concepts involved in, and participate in, a particular conversation, we could perhaps label them with "[Asperger-friendly]", or perhaps "[Asp-Fr]" or "[A-F]", in the subject line.
Kind regards,
John
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"The most successful tyranny is not the one that uses force to assure uniformity but the one that removes the awareness of other possibilities, that makes it seem inconceivable that other ways are viable, that removes the sense that there is an outside."

-- Allan Bloom, Closing of the American Mind, p. 249.