Adventures in Dentistry and Neurology

I forget if I mentioned it, but I had nerve damage from the first dental surgery, way back in June.  Everything else healed up more or less all right, but that one kept hurting.  Actually it felt like two damages- one that was healing, albeit slowly, and one that was staying static or getting worse.  The prospect of living with that pain for the rest of my life was really daunting.  Medical marijuana, which had been so helpful at first, was having more side effects with fewer desirable effects every day.  It eventually became clear my surgeon had no idea what was going on or how to fix it so I went to a neuroendodontist, a subspeciality I really wish I wasn’t already familiar with.

A toenailectomy looks awful but feels like nothing at all.  A neuroendodontal exam is the exact opposite.  It looks like some guy very gingerly touching around your mouth, but he is not only deliberately provoking pain, he needs you to pay attention to the pain and report on in it excruciating detail, while you remind yourself that inaccurate reporting leads to inaccurate diagnoses.

For all that pain, I actually got very good news.  Even though it feels like I have two distinct damages, it’s actually only one, and it is healing.  Nothing is guaranteed in neurology but existing data is consistent with this eventually healing itself.  And in the meantime, he gave me new and different medicines.  We’ll see what the side effects are, but at the very least I have options to rotate through.

Adventures in Podiatry and Neurology

WARNING: THIS ONE IS GRAPHIC EVEN BY MY STANDARDS.  NEEDLES, PAIN, AND TOENAILS.

Recently I learned toenails aren’t supposed to be under the skin of your foot and hurt constantly; this is an ingrown toenail and it’s a solvable problem.  By “recently” I mean a year and a half ago, but a little pain when I flexed my toes in a shoe did not seem as important as the pain in my mouth or my inability to digest food, so I only got around to seeing a podiatrist now.  If you develop an ingrown toenail there are home treatments to coax it better, but if you’ve always had it the cure is a little more drastic: they cut off the bit of the nail that has grown under the skin and cauterize the nail bed so it never grows back. If you are curious, here’s a video of the actual medical procedure:

The worst part is the lidocaine injection. There’s a topical anesthetic, but they root the extremely thin nail around under your skin in order to find the nerves and inject directly over them. The podiatrist will describe it as slightly painful, but they are lying, and it will make you doubt them when they promise the rest of the procedure is painless. That part turned out to be true: with enough lidocaine you genuinely can’t feel them slip the scissors/pliers under the nail bed, or the burny stuff*, unless you are a freak who processes -cain very quickly, in which case they will give you more and it will stop hurting.  But the anesthetic injection was pretty brutal.

That is not actually the interesting part. In between the lidocaine and the scissors/pliers, they test your numbness with what looked like a large blunt toothpick. My podiatrist, which more flourish then was strictly necessary, brought it down from a great height onto my toe.

I screamed.

Then I realized it didn’t hurt at all. My brain had combined the memory of the painful needles and the visual information about incoming sensation and preemptively sent a scream response before it noticed I couldn’t feel anything. I never had quite that strong a reaction again, but there was an extremely weird dissonance as I watched something I knew should hurt, yet got only vague reports of pressure from the area.

This works in reverse too.  Phantom limb syndrome is a condition in which people missing a limb (even one they never had) experience excruciating pain where their brain thinks that limb should be.  One of the only effective treatments is mirror therapy, where a mirror is used to simulate the appearance of the missing limb, and somehow the brain goes “oh, I guess it’s fine.”  This clip from House is not quite as accurate as the matrixectomy one (mirror therapy rarely involves kidnapping), but the science is sound.

The lesson here is that even something that feels incredibly simple and real, like pain, is in fact an artifact of post-processing on several different inputs.

*Dr. Internet says phenol but I could have sworn it started with an M. In my defense, he gave me the proper name after the needles bit and I was fuzzy.

Depression as a false negative

Slate Star Codex points out that rates of suicide and depression are weirdly terrible metrics for how good a society is.  I wonder if some of that is a definitional effect.  Depression is more or less defined as occurring for no reason.  If you have a reason for sleeping poorly and feeling unable to do everyday things (e.g. fibromyalgia), you’re diagnosed with that instead.  As society gets worse, people who were chemically destined to be depressed are given reasons to be sad, and so stop contributing to the depression statistics.

This is related to but slightly distinct from the idea that depressed people are less likely to commit suicide when conditions are objectively miserable than when they are good because bad conditions leave room for hope in a way good conditions don’t.  That is about individuals specific reaction to their depression.  My hypothesis is about how the number “% depressed” is measured.

Of course, my suggestion doesn’t account for increased suicide rate.  The expectations hypothesis does account for that.  One other factor I think may be in the mix is coping mechanisms.  Before the AIDS cocktail, someone noticed AIDS patients actually got better when co-infected with another virus.  The reason turned out to be interferon, an intercellular signal to ramp up anti-viral defenses.  HIV didn’t trigger it, or didn’t trigger it enough, but when another virus did the resulting interferon protected from HIV as well as the original virus.  Maybe external bad events trigger coping mechanisms in a way depression doesn’t, and they incidentally fight depression.  This could be true even if  “coping mechanism” just means disassociating until things get better.

The FDA strikes a blow for HIV virus everywhere

Part of the FDAs job is making sure the pill you swallow is the pill you think you are swallowing.  It would be very bad if you thought you were taking penicillin and instead took sugar, or Prozac.  This is a government task even a libertarian could love.

But.

Sometimes enforcing a definition is harder than penicillin vs. Prozac.  For example, condoms.  The FDA has definition of a condom, and if your product doesn’t meet it, you can’t sell it, or at least you can’t call it a condom.  Some of this is good.  You want condoms tested for structural integrity, and you don’t want flat pieces of latex being sold as sexual health devices.

But.

The FDAs definition of a condom does not appear to account for human variation.  Condoms must be at least 160 mm in length.   Condoms are not allowed to be wider than 54 mm (-> diameter of 170 mm).   I’m not sure exactly how closely condom dimensions need to match penis dimensions, but that is longer than ~70% of penises and (using a condom width to girth conversion I don’t understand) narrow than ~18% of penises (source).  Yes, condoms are stretchy and will fit over your leg if you try- but they’re more prone to break, and your leg isn’t kept rigid via blood flow.  A too loose condom will just fall off, but a too long condom bunches, which also causes breaks and reduces blood flow.

I understand why we had to put up with this 100 years ago, but condoms used to be custom made, and some genuises in England are bringing that back.  But thanks to our FDA and its scrupulous definition of condoms, it is illegal to sell them in the states.  And it would definitely be illegal to use the cheap package forwarding service they link to, unless you are an EU citizen.

Why I donated to the EFF this year

I applied for a patent this year.  While I sincerely believe my invention is patentable under the current definition applied by the US Patent Office, I also believe the US Patent Office’s current definition is bullshit, and is stifling innovation by giving exclusive rights to obvious ideas and creating a culture of fear that hurts start ups more than big companies.

The incremental effect of my patent in reinforcing this bullshit system is very small.  Even if you internalized all the negative externalities, I believe the cost is trivial next to the benefits of applying (shiny resume line and a $5,000 bonus).  But no single snowflake believes it’s to blame for the avalanche, and I was really not comfortable justifying material gain because everyone else was doing it.  My compromise was to donate half the bonus to the Electronic Frontier Foundation, which fights for a variety of pro-individual and pro-start-up positions, including patent reform.  There’s no way my patent did $2500 worth of damage to society, so everyone comes out ahead except the patent trolls.

One friend asked if I thought patent reform was truly the most important cause in the entire world, and if not, why not donate to the more important one?  I have a few explanations, but I must acknowledge I made the decision first and then looked for why I made it.  The easy answer is that the world is complicated, and when the developing world catches up with us, I want what they catch up with to be not just materially comfortable, but… well honestly I want some sort of Star Trek utopia where all material needs are sated and people do things for sheer love of learning.  But failing that, I at least want a world where individuals can invent things that improve the world.  I don’t want us getting stuck at any particular rung on the ladder.

The other reason is that donating to the EFF isn’t supposed to be penance or an indulgence, it’s supposed to undo a specific harm I did.  I am deeply uncomfortable with justifying unethical behavior by helping some greater good.  For one, humans are bad at math, so it’s easy to see that doing net harm.  But even if all the trades are strictly advantageous it complicates the system, which ultimately makes it harder to get my Star Trek utopia.  Sometimes that complication is necessary and moral, but if you are in a situation where that is necessary you should probably find someone else to do it.  My talents lie in simplifying.

Problems in need of generalizable solutions

What to do if you have some intrinsic motivation but not enough?

Sometimes I spontaneously feel like exercising.  Sometimes I don’t, but I prod myself a bit and am really glad I did.  Sometimes I prod myself a bit and am not glad I did.  Sometimes I didn’t want to be because of important but subconscious reasons, and doing the Healthy Thing makes me feel actively worse.  I worry that every time I push without getting a reward at the end I’m making myself ultimately worse off by eroding my intrinsic motivation.  That worry is itself a negative reinforcement that makes the outcome more likely.  If someone could send me a general solution that works for regular exercise, physical therapy exercise, cooking, eating well, cleaning, work, and extroverting I would super appreciate it.

What to do with an initial burst of enthusiasm?

I assume we’ve all had the experience of getting an initial burst of enthusiasm for something (e.g. clean all the things), only to overdo it and burn out.  Then we are sad, because our hopes have been dashed.  I assume many of us have learned from this to scale back our initial efforts and channel that enthusiasm into long term sustainable action, only to discover the enthusiasm has an expiration date either way, so now our hopes are dashed *and* we had the unpleasant feeling of bridling ourselves *and* we accomplished strictly less than we would have if we’d run with the initial enthusiasm.  Is there a third way that would let me accomplish all the things without every feeling burnt out or overextended several of the things with a minimal amount of overextension or artificially holding myself back?

Reason to believe maybe this year will be better than the last

This has been a hard year, and I thought it would be done by now, but it’s not.  Objectively I’m in a much better state than I was in June, but I got really bad news at the surgeon’s yesterday.  I’m not dying, it’s fixable, but my new projections fr when it is fixed are much worse than my old projections and that feels terrible.

One good thing about this year is that my observer-self has gotten much stronger, especially when measured in real time.  This translates to being more aware and more able to acknowledge outside events and how I feel about them.  I would like to do more of this in the coming year.

This isn’t a New Years Resolution so much as the type of experiment I try all the time, and now happens to be New Years.  But: I’ve had trouble getting to sleep.  Could be pain, could be low exertion during the day, could be screen usage (h/t: Iodine).  I don’t find a study of 12 that had people read for 4 hours before bed particularly compelling, nor do I consider a 10 minute delay in sleep statistically significant, but…  I’m going to try no screens after midnight.  Even if the blue light effect is bullshit, I think there’s a good chance limiting myself to a few modes of entertainment, as opposed to infinite and instantaneous variety, will lead to more thoughtfulness and more sleep. If it goes well I may push the deadline up or put a cap on total screen time.

Complication: I’m not sure reading counts as a calming activity if you read things like The Child Catchers and The New Jim Crow.  I have trouble finding books that are both interesting and calming.  That may also be a thing to work on.

Why I donated to the ACLU and Planned Parenthood

Neither is a neglected cause.  I mean, I wish they had more money, but in the scope of finite resources to billions of worthy causes, they’re relatively unneglected.  Certainly they have non-EA movements supporting them.  Which is why I didn’t give them much money.  But they both also politically tenuous, and benefit from donations not just with what they buy, but with evidence of a supporter they can brandish threateningly to politicians.  That’s a pretty cheap way for me to influence policy.

Donations in 2014

I have been trying to figure out how much money I want to donate, and where I want to donate to.  As I described before, my past habit has been maximizing employer matching plus a bit.  That no longer felt sufficient to me, but as I upped the number I started feeling a lot of anxiety.  It’s not about giving up luxury consumption, or having a smaller home, or anything material.  It’s the worry that $15k worth of dental surgery and 4.5 months without any income will not be the worst thing that happens to me, and I’ll need the money for that.  Or that I will have enough money to be okay, but will cut it close enough that I become miserable and miserly.  I like who I am a lot more when I have enough cushion to feel safe.  That’s why I get to the airport much earlier than necessary: so can walk at a leisurely pace and let stressed people ahead of me instead of racing old ladies in walkers to the security line.

Trying to pick a particular number just wasn’t working- it was either too low to satisfy my moral needs or too high to satisfy my safety needs.  So I decided to come up with a formula first, and then abide by what it said.  In that same post I described a severe preference for consumption taxes over income taxes, so I picked a number (20%), and calculated my spending.  This took a little bit of doing- I have several credit cards, plus a few expenses paid out of checking directly, plus I did not feel like medical expenses should be taxed, and of course previous donations shouldn’t be counted as consumption.  But I made a pretty good estimate rounded up to the nearest 10k, and got: exactly my employer matching cap.

I could have upped the percent more, but that’s basically me choosing a number, which is what I was trying to avoid.  So I began really digging in to why income based obligations bothered me so much.  Some of it was that I felt like I had more control over consumption than income.  I have low fixed expenses so that’s in some ways true, but if I am low on money, the correct thing to do is spend less and earn more regardless of whether I’m taxed on consumption or earnings.  But it went deeper than that.   I make enough money that any extra goes into savings, not spending (I am aware both that this is incredibly fortunate and that I lack the life experience to appreciate just how fortunate).  Savings are good and they brought me a lot of security this year, but since they happen automatically my internal sense of wealth doesn’t particularly go up when I have more.  Whereas writing large checks definitely makes me feel poorer.  So I was correctly predicting my irrational feeling that giving away 10% of my income would mean increases in real income would make me feel poorer, and balking.  While I have to commend myself for accurately anticipating something that weird, it was also a fixable problem.  I spent some time sitting down and figuring out exactly how my savings had grown this year, and suddenly any argument I couldn’t afford 10% seemed awful.  So while I’m not ready to sign the pledge just yet, I decided to give the GWWC recommended percentage.  Scott Alexander’s argument that if everyone gave 10% we would literally have more money than we knew what to do with was prominent in my mind here.

Then I needed to define “10% of what, exactly?”  John suggests the income line on my W2, but that includes stock grants (which for tax reasons I really shouldn’t sell right now) and excludes health insurance.  My health insurance has been way too useful this year for it to not count as income.  Plus I won’t know the W2 number until I get all my W2 forms, and that will be tricky this year because I did eventually get disability payments, some of which are taxed and some aren’t.  And hey, given that they’re not taxed (because the premiums were paid with post-tax money), does that mean they shouldn’t count towards my income?

Finally, I hit on a solution: use last year’s income.*  I spent 10 minutes on the IRS’s ridiculous new efile system, got roughly my income for last year, and used this year’s COBRA costs to estimate the value of my insurance last year.  I didn’t get any equity or disability last year, so I can figure it out later.  The W2 income isn’t exactly right (For the benefit of the IRS: this is a 401k issue, not tax fraud), but I was done investigating this, so I rounded up, divided by 10, and got A Number.  It may not be the exactly correct number, but it is most certainly close enough that the correct thing to do is stop fiddling.

Except.

All this donation is done partially because helping people live better lives is awesome, and partially because my ability to make so much money is dependent on a number of things I didn’t earn.  My genetics, the time and place of my birth, a feminist movement that opened up lucrative work to me,  a substantial investment in my education made by my parents.    This doesn’t mean I didn’t work very hard or make excellent choices, it just means that I would not have had the same results if I worked this hard and made this quality of choices after being born in Ethiopia, or in 1900.  10% of my income to discharge that debt is actually a pretty good deal.  But there are certain choices I make that incur additional debt.  One is eating animals.  And then there’s high-fixed-cost low-marginal-cost goods I could free ride on, like wikipedia.

Then there’s the question of where to send the money the bulk of the money.  The goal is to have the highest marginal impact, which means picking not strictly the most useful thing, or the most neglected thing, but some combination thereof.  Against Malaria Foundation’s math is very compelling, but so is their story, so they should have an easier time getting funding from non-EAs than GiveDirectly.  I think the research determining what the next Next Big Thing is important, less likely to be funded, and just more interesting to me personally.  So I funded some of that by giving GiveWell an unrestricted donation.

[To be fair, GiveDirectly invests an enormous amount in trying new things and checking their own work.  That is why I gave them some money.  But they are are never going to work in American criminal justice or chronic pain, so they don’t get all the money.]

I also donated to Social Justice Northwest Fund (full disclosure: a fellow EA member is on the board), which is in many ways a (much, much) fuzzier GiveWell.  Their goal is to fund small grassroots organizations working for social/economic/criminal justice and racial/gender/queer equality.  These are important communities to help, they’re often not tapped in to the regular funding machine, and the history of people (usually whiter and richer) who are tapped in to them coming in to help is not good.  SJN gives them money so they can get started.  Many of these organizations are not as efficient or effective as the top GiveWell organizations, but they will not get better unless they are given money and room to fail.  Absent a convenient measure of “utility founder/community knowledge gained”, I have to make my best guess and accept that there will be some inefficiencies.

With all that said, here are my total donations for the year.  I’ll be writing more posts with explanations for specific charities, check the comments for links.

St Stephen’s Protestant Episcopal Church (runs a food bank in Ferguson): $500
Modest Needs: $1544 (this was before I was so strongly into EA)
GiveDirectly: $4547
Planned Parenthood: $10
ACLU: $10
Mercy for Animals: $500
Ocean Conservancy: $250
GiveWell (unrestricted): $3000
Social Justice Fund Northwest: $2500
Electronic Frontier Foundation: $2500 (half my patent bonus)

From this you can approximately derive my income last year.  I’m not thrilled about this, but I think the social norms that make me uncomfortable hurt employees to the benefit of employers, so I am trying to fight them.  Apart from the tens of thousands of dollars we donated, one of the best parts of Seattle Effective Altruists Donation Decision day was when a subgroup of us (with comparable jobs) shared our salaries with each other.  It was really informative.

*When I brought this up at my EA group, people were evenly split as to whether this was brilliant or cheating, by which I mean Brian thought it was brilliant and Stephanie thought it was cheating and no one else cared.

Review: Surprisingly Vegan Waffle Mix

Before I was tested for food sensitivity my diet was incredibly reliant on eggs, dairy, and wheat, so you can imagine my dismay when I tested sensitive to all three things and was told to give them up.*  When I did so, I decided to shift to eating foods that naturally didn’t contain any of those things, rather than search out substitutes for my old staples.  My theory was that vegetables can be really awesome at tasting like vegetables, and meat can be… well at the time eating any meat was a huge struggle, but it was one I eventually expected to pay commensurate dividends.  But the vegan milks just remind me of how much better actual milk is, and the thing that makes gluten-containing food delicious is gluten.  Plus the imitation food tends to be incredibly processed in order to more closely approximate their originals.  If I was going to put a ton of work into learning to cook and enjoy different foods, I might as well pick the healthier of the two.

But everyone needs easy carbs some times, and more than one thai restaurant in my neighborhood now recognizes me on sight, so I needed some new options.  John served this vegan, gluten free waffle mix (referral link: Charity Science) at an EA event and I have to say: it’s pretty good.  Not good enough you’d choose it over regular waffles for taste alone, but pretty good.  The ingredient list is short and full of actual foods.

I seriously doubt this will apply to anyone else, but it’s interesting in light of my recent deep dive into appetite hormones.  When I eat waffles + syrup and nothing else, there is an obvious disconnect between different parts of my brain as to how full I am.  Each bite of waffle is ridiculously rewarding (indicating high ghrelin?), and yet I never seem to feel satiated, even as my stomach reports it is uncomfortably full.  I solved this problem by putting chia seeds in my syrup and interspersing waffles with swigs of protein powder (also mixed with chia seeds).  This seemed to get me the good parts of waffles while ensuring I also eventually stopped eating them.

One warning: they are not kidding about the cooking time for this mix.  It takes much, much longer than you are used to.  It is theoretically possible to turn this into pancake mix by watering it down, but I could never manage to give them enough time to fully cook.  Putting them in the waffle iron and walking away was easier.  The good news is they’re not as temperamental as regular waffles either, a few extra minutes doesn’t ruin them.  But do give them that extra time, or you will be eating batter.

*Many professionals believe that the test is purely a measure of what you’ve eaten, and that the immune reaction does not present a problem.  My personal experience is that I do much better when I avoid these foods.