Job and free will

Do human beings have free will? Volumes have been written on this subject from every conceivable angle, and Christianity is no exception. Numerous Bible verses address, appear to address, or are claimed to address the question of whether or not we have free will. And yet broad consensus remains elusive (perhaps because people are all too mindful that stripped of proper context, the Bible can be made to support or oppose nearly everything; as a result they are unwilling to allow it to say anything at all). In any event, I humbly offer my view on the subject.

The book of Job offers a compelling argument in favor of free will. At the outset of the book, God praises Job to Satan as "A man who fears God and shuns evil" (Job 1:8). Satan, however, accuses God of "stacking the deck." He asserts that God protects and favors Job, so that there is no reason for Job to be anything but obedient. But take away Job's material comfort and blessings, Satan says, and Job will soon enough turn against God. And so God permits Satan to put his theory to the test.

Simply depriving Job of his many possessions proves insufficient, though, and Satan returns to God unsatisfied. "A man will give all he has for his own life," he complains. "But now stretch out your hand and strike his flesh and bones, and he will surely curse you to your face" (Job 2: 4-5). Once again, God consents to Satan testing Job, although He stipulates that Satan's torments may not extend to the deadly.

Satan's central premise is that Job's love for God is really love of self. Job loves God because God makes his, Job's, life comfortable and pleasant. If God were to withdraw the comfort, Job would turn against God. But this is only possible if Job is free to choose whether to praise or curse God. If Job did not have free will, God could simply dictate his responses, thereby invalidating the whole enterprise. Satan knows this but pushed for the contest anyway. The only conclusion, therefore, is that Satan knew that Job possessed the free will necessary to make this decision for himself.

Why the new pope is good for all of Christianity

Two weeks ago Jorge Mario Bergoglio was elected the 266th Pope. Bergoglio, who will be called Francis, was selected on just the second day of deliberations. More than a billion people worldwide identify themselves as Roman Catholic. That alone qualifies Francis's selection as noteworthy, but the importance of this moment transcends denominational lines. This is a pregnant moment for Christianity as a whole.

Like Easter and Christmas, the selection of a new pope offers Christianity a unique moment in the mainstream spotlight. This is a golden opportunity for an energetic discussion of all manner of subjects. Homosexuality and gay marriage, the role of women in the vocational ministry, and even the necessity of faith in Jesus for salvation, to name just three, are culturally relevant topics that can have eternal implications. Christians everywhere should embrace the chance to spark conversation and critical thinking about some of the biggest questions facing Christianity today.

New honor for Dartmouth

Earlier this month the Orozco Murals at Dartmouth College were recently designated a National Historic Landmark by the National Park Service (you can read more about it here). Officially titled "The Epic of American Civilization," the mural was completed after two years of effort by Mexican artist Jose Clemente Orozco. Located in the Reserve Reading Corridor in Baker-Berry Library, the mural has impressed and inspired (and thoroughly creeped out) students since its completion in 1934. It is a must-see for any first-time visitors to campus!

Dartmouth has commissioned a number of peculiar pieces of artwork in recent years (the large rectangles adorning the side of the Hopkins Center spring to mind). Nevertheless, it is gratifying to see a culturally and artistically significant piece of art be recognized by the National Park Service. What's more, the mural was recently renovated, so it is in impeccable condition to receive what will hopefully be even greater public and student interest.

Staying in Hanover, the Dartmouth baseball team has gotten off to a torrid start this spring. Their record is currently 11-1, which is the best twelve-game start they've ever had. Not only that but they began the season 8-0 before losing to Slippery Rock on March 20. That made them the final unbeaten team in Division I this year. Go Big Green!

The double-edged sword of evidence-based medicine

EMS has gotten swept up in the evidence-based medicine craze in recent years. This is not at all a bad thing; on the contrary, it is probably the clearest path forward for a field that is continually locked in a struggle to carve out and maintain an identity within the healthcare community. There lurks danger, though, in becoming too dependent on only one mode of analysis and progressive impetus. This danger is primarily one of methodology and not of substance, but EMS leaders would nevertheless be wise to understand the limitations of evidence-based medicine. Like any other tool at the EMS provider's disposal, its capabilities must be exploited without losing sight of its shortcomings.

Years ago, a paramedic coworker loudly declared, "There has never been a single study that demonstrated any benefit to taking people to the hospital." This individual was particularly fond of loud declarations, but in this case he was spot on. It stands to reason that you should go to the hospital if you get sick or injured. but can you use statistics to demonstrate its superiority? That is, after all, the essence of evidence-based medical practice.

A popular anecdote among EMS providers is the 1998 study that tracked the outcomes of two groups of patients, one in New Mexico and one in Malaysia, who were transported after suffering spinal injuries. The patients in New Mexico were all placed in cervical collars and secured to backboards by EMS whereas the Malaysian group was not given the benefit of such "advanced" treatment. Guess which group had a lower incidence of permanent neurological deficits?

The spinal immobilization study is very much a success story for evidence-based medicine; selective spinal immobilization protocols have since been developed and promulgated widely. In my view, and that of more than a few training officers and medical directors, this is a huge step forward for EMS providers and the patients we treat. Score one for research.

But let's get back to the fact that we transport people to the hospital at all. There will never be a study that proves the benefit of transporting patients to the hospital because there will never be a study that even considers whether or not we should transport patients. Who would volunteer for the control group? "Well, Mrs. Smith, it appears you're suffering from acute pulmonary edema secondary to a CHF exacerbation. Unfortunately, you've been placed in the 'control group,' so we're not going to take you to the hospital today. Just keep gurgling away when you inhale and maybe some air will get in there. Have a nice day!" Common sense dictates that we transport patients to the hospital, and we will continue to do so--at least for high-acuity patients--as long as there is such a thing as EMS.

So does that mean that we should rely on reason and intuition to guide treatment protocols? Of course not. Just look at the evolution of cardiac arrest protocols: I've been in EMS for the better part of a decade now, and I've already seen several sea changes in the way cardiac arrests are managed (the changes in compression-to-ventilation ratios and the introduction of prehospital therapeutically-induced hypothermia leap to mind). There are providers out there with four times my level of experience who could describe countless more steps in the evolution of cardiac arrest management. The point is that as research sheds additional light on the pathophysiology of cardiac arrest, our treatment protocols are updated to match current understanding. And rinse and repeat. There is simply no other way to advance our understanding and treatment of that condition or many others.

How do we resolve the tension between letting research guide us forward while not getting paralyzed by the obsessive need to gather research to prove the unprovable? Fortunately the answer is simple: This is not a tension that needs resolving. Use research to gather as much information about as many pathologies and treatments as possible. Embrace whatever benefit can be gleaned from such study. But don't forget a liberal application of common sense to know what can and cannot be improved through scientific research. If we get too caught up in worshiping at the altar of evidence-based medicine, we lose sight of the fact that research is supposed to serve us, not the other way around.

Good books with bad endings?

A few months ago, Joan Acocella posted to The New Yorker's website a blog post lamenting the disappointing endings of otherwise (and nevertheless) classic works of literature. Notwithstanding her ludicrous assertion that "Our country's greatest novel" is Huckleberry Finn--obviously Acocella has never read The Great Gatsby--she raises an interesting question about the effect of an unworthy ending on the value of a novel as a whole. She singles out Huckleberry Finn, David Copperfield, Wuthering Heights, and Song of the Lark for particular scorn, with special focus on the first of these, averring that the endings are not worthy of the body of writing they conclude.

One of Acocella's most astute points is to distinguish between endings that are "inartistic" and those that are simply disappointing. No one wants Islands in the Stream to end the way it does, but it's hard to argue that Hemingway crafts a masterful ending for the story of Thomas Hudson. David Copperfield's happily-ever-after, at least in Acocella's opinion, induces the reader to "Die of boredom." It is the latter category of ending that incurs Acocella's wrath because she feels they are "A betrayal of what came before."

One notable weakness in Acocella's article is that she doesn't embrace the question of "What might have been." The books she names are major, even seminal works by household-name authors. They have stood the test of time, bad endings and all. If they had been given endings commensurate to their erstwhile grandeur, what then? Would there be a new category of super-book where excellent beginnings and middles are completed by excellent endings?

Thus we have the fundamental problem with Acocella's mode of analysis. It's impossible to divorce the ending of a book from the novel as a whole. The quality of a book encompasses the value of all its constituent parts. There's nothing wrong with criticizing the end of a book--or any other part for that matter--but the creation of a sub-class of novel, the Great Book With a Really Bad Ending, is going too far.

On a separate but related note, a long-overdue congratulations to Louise Erdrich '76 for winning the 2012 National Book Award for Fiction for her novel The Round House. That makes two Dartmouth alumna to be honored with a National Book Award in the last five years (Annette Gordon-Reed '81 received the Nonfiction award in 2008 for The Hemingses of Monticello, which I had the great privilege to help work on when I was an editorial intern). Way to go!