http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
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Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

Put your money where your mouth is. Sponsor a striker. They take a small transaction fee ($1.75 or so?) but help out these folks that take a huge hit when striking.

>> ^L0cky:
I looked at a lot of sources, including CDC. They have a helpful compilation of their stats in the form of their CDC's 2007 chart book. It shows that firearm related deaths and poisoning are always less than motor vehicles; firearms are more likely to cause an early death; while death from poison is more likely to get you in middle age (possbily this includes long term effects of poisoning, ie working with hazardous materials when they were younger?).
It also doesn't show non death injuries; nor can the stats reflect the fact that every household has potential poisons while around half of households have firearms.
I took a look at the pdf, and while the charts are nice, they cover various date ranges and present their results in different formats, and I think you're misinterpreting them. What I did was use the search feature and look at the raw data. You can also search for non death injuries, but gun related non deadly injuries, accidental or intentional, doesn't even make the top 20, and it doesn't show anything below that.

>> ^L0cky:
In absolute terms it's inarguable that there are a lot of gun related deaths and injury in the US (around 31,000 deaths and 70,000 injuries per year give or take). This doesn't change simply because there are other causes of death and injury.
You just said that your source doesn't show non death injuries, yet now you're claiming 30,000 deaths and 70,000 injuries per year. You claim to be getting your sources from the same place, but the data from the CDC shows that between 1999 and 2010 the average homicide by firearm is 12,807 deaths per year. If you add accidental deaths involving firearms the total comes to 21,146 which accounts for 9.6% of all accidental and intentional deaths (this does not include suicide, illness and disease related deaths).

>> ^L0cky:
Let me be clear, my argument is that non sport firearms don't add anything positive to society that justifies the resulting gun related injury, death and crime. The granting of firearm licenses for hunting and sport should require strict licensing that's based on a requirement of training and testing. Gun control laws should be purposefully strict.
We already have plenty of gun control laws. More laws are not going to stop someone that has no intention of obeying them. You obviously did not read the whole article I linked to as it points out that "93 percent of the guns obtained by violent criminals are not obtained through lawful transactions that are the focus of most gun control legislation.

>> ^L0cky:
I haven't objected to this. My objection is to the suggestion that a societal need to teach children how to use firearms can be used to justify their existence. It's circular logic; and I'd prefer not to live in a society where learning to use firearms is a requirement of safety.
No one said that you need to teach children to use guns to justify their existence. You were a kid once (or still are), and at a certain age didn't you do the opposite of everything your parents said? If there is going to be a gun in a house, even if they are told it's dangerous and not to be played with and you do your best to lock it up and keep it away from them, if they do get their hands on it wouldn't it be better that they knew how to properly handle it so they don't end up adding to the accidental death by firearm statistic? Cars are dangerous too, but we teach our kids how to be safe in and around cars (wear your seat belt, look both ways before crossing street, etc.), why are you so freaked out about teaching a kid gun safety?

Your philosophy that kids shouldn't be taught how to use guns because guns are bad is basically the same as abstinence only sex education, AKA teaching ignorance.

>> ^L0cky:
I'm not stating this, I'm questioning it. You yourself said you own them for self defense.
I said I own guns for many reasons, self defense being one of them. You still seem to be confused about why someone chooses to carry a gun for self defense. It looks to me based on what you've written is that you assume someone carries a gun only to protect themselves from other gun owners. As I already pointed out, only 10% of violent crimes involve the use of a gun. I carry to protect myself from 100% of crimes.

>> ^L0cky:
That has zero effect on the number violent crimes that DO involve the use of a gun.
You can't pick out a small portion of a larger statistic to base your argument on, you need to take into account the whole picture. That's like saying 2001 was a slow year for terrorism, if you don't count the World Trade Center attacks.

>> ^L0cky:
This isn't a useful number unless you can show that those crimes would not have been prevented without guns; and would still have occurred without guns.
I don't know what more you expect, a crime was in progress, a lawfully armed citizen stopped it and it was reported to the police. What your asking isn't possible as the only way to know what would have happened in the other situations is to invent a time machine.

>> ^L0cky:
I guess your point is that gun ownership reduces crime. I'm open to that - if it can be shown more clearly.
What is clear from comparing to other countries, particularly those with comparative gun ownership is that the lack of gun control in the US correlates to an increase in gun related death and injury by an order of magnitude. The problem isn't gun ownership in and of itself; it's gun ownership without lack of appropriate gun control laws.
If guns don't reduce crime, then why do we give them to the police? Once more back to that article you didn't read:

"In 13 states citizens who wish to carry arms may do so, having met certain requirements. Consider Florida, which in 1987 enacted a concealed-carry law guaranteeing a gun permit to any resident who is at least 21, has no record of crime, mental illness or drug or alcohol abuse, and who has completed a firearms safety course. Florida's homicide rate fell following the enactment of this law, as did the rate in Oregon after the enactment of a similar law. Through June 1993, there had been 160,823 permits issued in Florida. Only 530, or 0.33 percent, of the applicants have been denied permits. This indicates that the law is serving the law abiding. Only l6 permits, less than 1/100th of 1 percent, have been rescinded because of the commission, after issuance, of a crime involving a firearm."

>> ^L0cky:
You're right, if guns suddenly vanished tomorrow there would still be crime and violence. However, it would be crime and violence without guns; and I think, that (of itself) is preferable. How could it not be?
Are you fucking serous? Why is a murder with a gun any worse than a knife, baseball bat or even bare hands? A murder is a murder no matter what tool is used to commit it. Other crimes besides murder would be better off without guns, but what part of 90% of violent crimes do not involve the use of a gun did you not understand? If you take away guns from everyone, you're only removing 10% of the tools used by violent criminals, and that doesn't guarantee that violent crime will drop by 10%? In reality you wouldn't be removing anything from criminals because "93 percent of the guns obtained by violent criminals are not obtained through lawful transactions that are the focus of most gun control legislation. So you essentially want to take away every law abiding citizen's right to defend themselves with a gun without doing anything to stop criminals from committing crimes with guns.

>> ^L0cky:
Crime in the UK has reduced dramatically according to The Office for National Statistics between before then (1999/2001) and now, including firearm offences. In Australia assault is up, robbery is down and sexual assault is about the same according to the Australian Institute of Criminology. Homicides involving firearms have continued to decline to their lowest on record.
From your source: "Provisional figures for the year ending June 2012 show that 5,507 firearm offences were recorded in England and Wales, an 18 per cent decrease on the previous year (6,694)." In 1997 when the ban was enacted only 2,648 crimes were reported involving guns. It looks like that ban has worked well.


>> ^L0cky:
I pulled it from the same source you are correcting me with
The CDC - Injury in the United States: 2007 Chart Book, page 24.
Statisticslol
This is where you have misinterpreted the graphs. The vertical portion of that graph is in deaths per 100,000 population. If you dig up the raw numbers from the search engine this is what you'll find:

Motor Vehicle Accident = 22%
Homicide by Firearm = 13%
Accident by Firearm = 0.5%

I find it interesting that every presidential contest is 'close', convenient isn't it? Toss in a few so-called voting anomalies or quirky machines behaving one way in key areas, and just fine everywhere else. Software isn't emotional. It either works, or it doesn't. It is either well tested, or it isn't. It is either secure, or it isn't. If it isn't tested, if it isn't secure, if it doesn't work, then that means someone intentionally gave it the green light for release. Your bank machines? Super secure. Do you realize those who make voting machines also make bank machines? Why can't they make voting machines as reliable for transactions as banking machines?

>> ^Kalle:

One serious question that bothers me is.. why isnt it possible to use gravity as an energy source?
Would such a machine be a perpetual motion machine?

There is a bottom to a gravity well (apart from Black Holes? I don't know ). Say you drop an object and harvest some of its kinetic energy as it falls...what do you do once it reaches the bottom of the well? You must exert energy to pull it back out of the well, and that energy is greater than what you gained from dropping it. In a sense a pendulum makes this transaction with every swing. It does it very efficiently, only losing a fraction of its energy with each exchange but none the less it does lose energy. In a sense we never truly generate energy, we simply move it around. We break chemical bonds and withdraw a portion of the energy that was needed to make those bonds. Whenever we put an object with any mass on a high shelf we use some our energy and give it potential energy. Should it fall from the shelf this potential is converted to kinetic. The most plentiful supply of locked away energy? Probably mass. The speed of light squared is a big number, as GeesussFreek says, the future is probably fusion. If we can convert just a tiny fraction of this planets mass to energy cheaply and safely then our energy problems are more or less solved.

Anyway, I hope that somewhat answered your question. Its one of those questions that on the face of it seems simply to answer but once I tried I realised it wasn't so easy

To me this object looks like an extremely efficient pendulum. I actually love its design. The fact the ball "orbits" is actually very apt. I don't think its perpetual motion, but if it really had been going at near constant speed for that long then it is still a very impressive piece of engineering. He should patent and start making more. I'd bet people would pay a pretty sum for a scaled down version sitting on their desk. I would. Even better, put a lightbulb in the centre, surround it with 8 concentric rings for each planet and tweak the weights/magnets so the balls orbit at approximately the right speed...that would be fucking sweet.

So, If I mow my neighbor's lawn and in turn he fixes my fence in return, do we need to send the government some tax money?
A transaction has been completed,so...

@renatojj Apologies for the late reply, have been running for work and it doesnt look like that will stop

True that some countries may have less cooperation, though is that dependent on the economic system used or something else? For instance, East Germany had 100% employment and a very active economy, more so then west Germany in some regards. It was ofc run top down with little choice and politically biased, but I am not sure if that lessons the amount of economic transactions, ie cooperation. I guess it comes down to what you define as cooperation.

BTW "those criticisms of the depletion of finite natural resources consists of the economic Law of Diminishing Returns, opportunity cost, and scarcity in economics" -- I never understood what they mean with that. Even if the resource cost goes up strongly due to scarcity it doesnt mean that that resource can be replaced by something else, or that the higher cost (than the original cost of the scarce resource) of the replacement can be born by its consumers.

Now you say something very interesting: I agree with you that capitalism isnt always about ever-increasing competitiveness, in practice. In cases where you have competition, you get ever-increasing competitiveness. (This is in theory what all capitalism strives for) In cases where you do not have competition you dont. That is exactly what we are talking about. Free market philosophy assumes there is always near perfect competition right? How else would the market balance itself if there is no competition? Would you agree that free markets only work where there is competition?

Lets see when we have competition:

"competition is proportional to the difference between supply and demand" That doesnt sound right. If there is large demand and little supply (the difference is big), there is little competition as all suppliers will overcharge like hell as they will be able to sell anything they can manufacturer anyway. If there is large supply and little demand there can be competition, though usually this results in companies leaving the market until you have: If the supply and demand are about equal, you SOMETIMES have competition that keeps things in balance. Or you can have a monopoly for whatever reason and that market has again little to no competition. In other words, in no single scenario is competition guaranteed. Actually, there is good reason to assume markets move to monopolies naturally in all cases. In a market that is turning from early adopters to mass market, there is always focus on economies of scale. Companies need to get bigger to make sure they have the lowest cost price (best competitive edge) and to keep their shareholders happy as they demand growth to make their investments worth more. Bigger companies means fewer companies on the long run, as the market is always limited. This means companies will take over other companies until only a handful remain. Voila. Actually, if it werent for (anti-free market) anti-monopoly rules lots of markets would only have 1 company left. That company would be so big it would be impossible for a new entry to push them out of the market or even get a foothold unless the market itself crumbles because a newer range of products exist that make the old one obsolete. Again, without rules governing economies, things just go bust.

Which was what happened in the derivatives market. It was a completely deregulated market that was exploding itself as there were no rules governing it. When it did explode (ie when the free market failed) there were 2 options left: Let all banks fail or bail them out. Think of the consequences of following your recommendation: If 1 bank fails, it will pull the others down with it as they are all strongly interconnected. As banks are key in the economical world, the entire system would collapse. The amount of devastation would be huge, would probably kill the entire system. Now, you can argue that would be good for us, as we could build a fully new system. But before we would get there, there would be years if not decades of nightmares.
I agree with you that the fall of the derivatives market should never have happened in the first place which is exactly the reason to not follow free markets.

Above clarifies a bit my way of thinking: for many of these markets (be it banks or utilities or employment) the consequences of letting that market fail are just too big. If you have the guts to follow free markets to the end, it might work (isnt proven though) but you come to a point where you destabilize your country in such a manner that things like revolts and all kind of nastiness are highly possible and even likely. That is not progress, that is barbarianism.

You mention yourself that there are practically no free markets anywhere. You say that is because they havent been tried. I say that they have been tried again and again but never last.

@rbar I didn't call you a socialist, I don't know you that well! It was about your portrayal of capitalism. Also, I apologize for referring to free market capitalism, subject of this topic, as just "capitalism", that caused understandable confusion. I completely agree with you that some of those "isms" fall under a broader definition of capitalism, as they're social orders dependent on private property rights. Those who advocate free markets like me, however, really tend to consider free market capitalism as the only real one, while variations are just "less capitalistic" or not capitalism at all.

Any economic system is as cooperative as the next? Hmm... I don't know, rbar. Would you say there's as much cooperation inside North Korea as there is in South Korea? The old East and West Germanies? Surely any country with a lesser economy enjoys much less cooperation of their citizens among themselves (or with other countries) than a country where policy favors economic growth, no? Very common in North Korea, the "do what I tell or you'll starve in a concentration camp" approach, just isn't my favorite definition of cooperation. Coincidence or not, their economy is shit.

You raise a very important issue of limited resources, that wikipedia article on Capitalism explains better than I ever could, that counter-arguments to "those criticisms of the depletion of finite natural resources consists of the economic Law of Diminishing Returns, opportunity cost, and scarcity in economics". Interesting stuff.

My issue is with you portrayal of capitalism as ever-increasing competitiveness, because it's kind of biased and overlooks the abundance of cooperation. Imagine looking at a crowded night club and describing it simplistically as "a bunch of people struggling for the attention of the opposite sex". Seems pretty accurate if one hates night clubs. There is competition going on, specially for the most popular people, but what about all the other people enjoying each other's company over drinks, talking, flirting, and laughing, couples making out and enjoying the music on the dance floor? Who would describe those activities as purely competitive?

There is a lot of supply and demand in a capitalistic economy, not trying to sound like an economist, but competition is proportional to the difference between supply and demand. So what about where supply is meeting demand, should we just overlook the huge amount of cooperation happening there?

I find it amusing that you ask "What? What policy?", then, at the end of the same paragraph, write "The way the bailout happened is ... utter crap, but that is a different story all together." No, it's not a different story, the bailouts are government/central bank policy, partly the answer to your important question. Stepping in and handing out money to bankers who should have been punished by their excessive risk-taking with bankruptcy, is the exact opposite of letting free markets work.

To try to answer your persistent request for examples of free markets, if you didn't realize it yet, free markets are not very compatible with central banks, institutions that have a legal monopoly over what happens to half of a country's economy (usually half of all economic transactions involve money). Now, do you know how many countries have central banks today? Except for Monaco and Andorra, all of them.

Centuries ago, there wasn't a single country in the world where people enjoyed freedom of expression. That fact could be considered an obstacle to its adoption, but never a testament to its impracticality.

@renatojj Ah, its nice to be called a socialist for once. Where I come from, they call me a right wing capitalist
Any economic system is as cooperative as the next. That is the definition of an economic system, a system where economic transactions take place, ie cooperation. So capitalism is NOT more (or less) cooperative than other isms. (And mercantilism and corporate capitalism (corporatism right?) are forms of capitalism ;-) http://en.wikipedia.org/wiki/Capitalism)

Definition of capitalism:
"an economic and political system in which a country’s trade and industry are controlled by private owners for profit, rather than by the state" - oxford dictionary
Emphasis is on "for profit". So yes, all capitalist are per definition profit seeking. Relentless is something that follows Darwin. Those who are more relentless get higher profits and have more money to grow, invest, invent, etc. They eventually push out less relentless profit seekers so the relentless ones are the only ones left.
And remember you said them first, not me. I just said that capitalism tries to achieve profit and as competition drives prices down one way to do so is to minimize cost, ie become more efficient. So there is always a drive for efficiency in capitalism.
I am not against profit seeking, I believe that capitalism is the system that pushes the most growth in most regions, be it economic growth, technological progress, etc. That also makes it a rat race, where you continually need to go faster to keep up. As I am getting older I see that running is not the only game in town. And in most cases it detracts from happiness more then other methods in the long run (though it brings more wealth). Given also the finite resource problem and it is a good discussion to have if capitalism is the best and only economic system we should have on this planet. Like I said, for another time.

"The Libor and derivatives markets scandals, are not examples of free markets at all, they're abuses where the bad behavior was encouraged by policy"

What? What policy? The entire idea of over-the-counter (OTT, the largest amount by far) derivatives was that they are traded without any supervision or visibility. Complete free market! That and the inability to value and understand the risk per unit made for instance the Credit Default Swaps so dangerous. These were perfectly legal, and are still in most cases. The market is still unregulated today. You can argue that in the end it wasnt a free market because they got bailed out. Bullshit. They got bailed out because the other option was to let the entire economic system collapse. Letting the system collapse is not free markets, its stupid. The damage would have been catastrophic. The markets wouldnt repair that, they wouldnt exist anymore. That is why people call the derivatives market an example of a free market that should have been more regulated, because they had the power to destroy everything and the incentive to take the risk (for profit).
The way the bailout happened (and is still happening) is total and utter crap, but that is a different story all together.

Which leads again to the same question: if not the (IMHO obvious) derivatives market, name me an example of a free market?

The Washington initiative--I-502--has problems. In order to get it passed they have placed a tax of 25% on every transaction. This means that the grower pays 25%--the distributor pays 25%--the dispensary pays 25%. By the time the cannabis gets to consumers it will be--at least--as expensive as black market pot (IMO). Practically guaranteeing that the black market will still flourish.

It has been said that this is necessary to get the bill passed--but I worry that seeing a booming black market will be used as an excuse to crack down on legal cannabis.

We'll see.

@renatojj I agree with you! Coerced into transactions they dont want is indeed the only definition important. I just dont agree free market policies are about making transactions as voluntary as possible. Free market policies only do that in some cases, namely where you have optimal competition. In most markets that is not the case. That is what I mean with right.

I live in Europe. Spain currently has an official unemployment of 25%, 50% for those under 25. Do you think in that situation the unemployed have a choice? You will and do get coercion. People dont want to work for wages that are so low they cannot afford their homes and barely have enough to eat. But the other option is starvation, so they have to. I know the free market people argue that that is still a choice. It is not. If it where up to companies, they would pay even less. Thats why you need for instance minimum wages. If companies would be allowed to go below that minimum all kinds of nastyness would happen. Not for the companies, but for the country, which is bad also for the companies in the end.

Free markets rules are set to minimize government intervention. In some cases that also leads to maximum choices, which you call economic freedom. The issue here is that if all the choices are bad, you are still better off with more rules as lots of bad choices is another form of coercion. The entire idea is to maximize economic freedom while making sure there are good choices. I am not advocating government take full control, which would be the other side of the spectrum. I am advocating a middle road. Use free markets when you can, regulate when you need to.

@rbar the only definition of exploitation that really matters is when people are coerced into transactions they don't want to participate. Whenever you adopt any broader definition to fight against, you end up with more of that first kind of exploitation.

In a free market, the policy is to make transactions as voluntary as possible, maximizing options, which makes exploitation less likely.

When you argue that an environment is not right for a free market, what do you mean by "right"? Isn't that just passing judgement, just you implying force should be used to achieve whatever it is you consider to be "right" for a bunch of people, instead of letting them work it out without force? Wouldn't imposing by force your definition of "right" be likely more unfair?

What you said about unions not being involved with government any more than businesses are, I completely agree, because they both are very much involved, they both use force, laws, and taxpayer money to gain an unfair advantage. That would be unacceptable in a free market.

There is nothing arbitrary about the rules of a free market, they're defined on principle to maximize economic freedom for the individual. The only analogy I make with freedom of expression is that they're both freedoms, they have the same dynamic.

@gorillaman, ok, so people should be free to express their ideas, but not free to have different ideas or ideologies from each other. How does that work?

I love how you apply the word "anarchy" to the economy, as if the natural state of things is not people independently trading with each other, but government ownership and control of all the world's resources, when in fact most of what happens in the world's economy is in such a tremendously vast and complex scale that I can't imagine a single entity keeping track of all that, let alone coordinating it.

I can only imagine, though, how incredibly immoral and oppressive such a world would be. Something like Soviet Russia? I'm sure they had their own standards of efficiency, and hell yeah, the soviets were pretty efficient at sending a man into orbit, making nuclear bombs, nuclear submarines... not so much at erradicating poverty though, or not completely enslaving and slowly starving millions of people, or avoiding the total collapse of their economy.

If you're so worried about harm to third parties, how about the catastrophe of having a third party meddling with every economic transaction? That's TWO parties being directly harmed right there, for every single transaction. Is that a catastrophe worth mentioning?

@renatojj

Your claim is that economic anarchy is more efficient than any system of rational control, and I say this must be false.

It's naive to presume that mutually beneficial agreements between individuals necessarily prove beneficial on a wider social scale; many economic transactions will benefit all directly involved parties while catastrophically harming others.

Ethically, it is appropriate to intervene in these transactions between free individuals where harm will come to a third party, especially where that third party is your whole society. Social harm is caused by production of frivolous luxuries like sports cars, both in terms of squandered labour that could have been used to enrich mankind and depletion of finite resources that belong to everybody. Everything from oil to aluminium is communal property; we all have equal claim to what's in our earth.

Even assuming their ability to do so, it ought to be obvious that wherever each individual has to make their own social benefit analysis of a transaction instead of referring to an authority; that is an immense, inefficient, duplication of effort. In such cases, the cost of servicing ones responsibilities may outweigh the gain in freedoms.

Freedom to hurt others is not a desirable condition. There is a school of thought that suggests preventing a murder is a violation of the rights of the murderer; I would hope you don't subscribe to that view.

Regarding ideological freedom, from which freedom of expression is quite distinct and unequivocally desirable - Yes, I oppose it for the same reasons.

I don't think I would go as far as saying to steal is morally the best choice, but rationally the stronger choice. If 2 gods incapable of lying were on staged, and promised to share, that is the most moral position. Well actually, IMO, 2 people that CAN choose to lie deciding not to is more morally pretty, so 2 humans choosing share because they want to do the right thing is the best moral outcome, and also the hardest to achieve. And to that end, your suggesting that stealing becomes more moral starts to gain a little traction in real world human transactions, but it only works if you can get people to act in a certain way...so it is morally dependent on the actions of other people, which is not a good place for your morality. All it takes is a type person Rorschach, a moral high grounder whom wants to punish injustice to ruin the plan, as in the movie version of watchmen. The conflict of justice with fairness makes a TRUE solution imposible to have. This is one of the moral problems that lead me away from my faith, Justice and Goodness being incompatible in the way they cary themselves out. For instace, a person whom wants to not do the "right" thing (share) but make sure a person that does the wrong thing get screwed (push for stealing by stealing ensuring that both get nothing) is incompatible with the Goodness version where share is the only option. The conflict between "Love" and "Justice" meant, to me, that there is no way to be loyal to both at the same time, and anyone who says they are is a lier. Anyway, didn't want to drag the conversation here per say, but this was a key kind of conversation I had with myself in a very similar chain of events as to this gameshow...a showdown of ideas, ideals, and morals.

>> ^RedSky:

Lol, last time this show got posted I suggested the exact same idea.
>> ^RedSky:
Stealing is both rationally and morally the best choice because:
1 - If they steal, you would have been screwed picking the other option.
2 - If they share, you can always voluntarily give them half after, thereby forcing a share scenario.


>> ^RedSky:
@direpickle
I admit the idea does hinge on being able to convince the other fully of your actions, but if you can, then you'll effectively have changed their payoff to steal = nothing, share = possibility of something. If you can see you've evidently convinced them, you could even pull a fast one and instead choose to share thus saving you time and effort! I guess it's kind of contradictory to effectively act benevolent through authority but in a limited case like this, where you can reduce the uncertainty of an undesirable outcome considerably, I think it's fully worth it.