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Advil relieves headaches, unless everyone at work takes it, which raises the bar for taking sick days, thus creating another headache

PTO, or paid time off, is a progress trap created by the invention of personal palliatives such as Advil and DayQuil. These medicines were supposed to make life easier, but since everybody takes them, everybody is expected to show up to work all the time. Before the existence of these elixirs, you just had to white-knuckle through the day or stay home. Now, unless you are god-awfully sick or bed-ridden, you can find enough palliatives at the convenience store to help you sit at your desk and simulate a fully-engaged worker. Coffee doesn't make you more alert; It just jitters you into seeming awake. Advil doesn't stop you from being sick; rather it masks ill feelings. Sick people show up to work just to save their PTO, likely infecting co-workers and thus feeding the cycle.

There's now a trend for companies to bundle sick and vacation days into a bank of hours that represents a general, "Don't show up to work because you don't feel like it"-day. To Europeans, PTO would seem absurd, but Americans see it differently. To some, it's a godsend because it gives them control over vacation time. For them, it rewards healthy and sturdy workers who "earn" buckets of vacation they can use all at once. In theory, PTO offers flexibility benefits, but it is an invention with rotten origins. Managers just want "good" employees with perfect attendance who reach their limit of accumulated PTO and then stop earning hours. When these so-called "rock stars" leave after three years, management can cut them a check for the PTO balance which they can vaguely pretend is severance.

While it's hard to say if Advil makes us weaker since strength versus weakness is often a false dichotomy in these matters, a fairer analogy is that of a treadmill: The more we make things easier for ourselves as individuals, the standard of difficulty for us as a group rises along with it. Advil relieves headaches, unless everyone at work takes it, which raises the bar for taking sick days, thus creating another headache.

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Expected-Value in Life-or-Death Decisions

The problem with cancer is not so much the physical struggle, but the mental struggle to make a rational decision about treatments. We can withstand nearly any adversity so long as we believe it's rational. And to believe something is rational, we have to believe in its value. But how do you measure the value of a life-or-death decision? Expected-value calculations are undefined when the costs and benefits are unlimited. Death is an infinite loss. Prolonged life is an infinite benefit.

We have some capacity to deal with expected-value in life-or-death situations. For example, when we swerve out of the way to avoid a car accident, we take on some risk. But the probability of success is close to one, which practically removes it as a factor for consideration. There is no expected-value, just value. One action to save one life. That's easy.

In the case of cancer, treatment may have a 100% chance of six months of suffering for a 20% chance of prolonging your life another ten years. 20% multiplied by ten years is two years, but you can't tell a patient, "this choice is worth two years." While there is some research on maximizing QALYs or quality-adjusted life years, they require a battery of thought experiments. Patients have to consider various trade-offs, gambles, and preference-ranks to get to the bottom of what they "truly want." But even if such tests could approximate the rational choice 95% of the time, the patient would have to undergo significant duress to comply. It takes an insane amount of guts to refuse treatment that has a 20% of success, even if it's supposedly worth two QALYs. A 20% chance is high enough to activate hope, but not low enough to activate resignation.

Our ancestors rarely encountered these kinds of probabilistic scenarios. Our default approach is always to grasp for survival. If there is famine, strive for success. If you're sick, try to fight it. If you fail, well, it was a good two-week battle, and then you're done. Not a bad way to go out. There were no decades-long quests to cling onto life. In a way, modernity is worse, because we spend our golden years maximizing the number of last-ditch efforts to extend an increasingly poor quality-of-life.

medicine rationalism

Psychosomatic Lurch

If there were no cure for headaches, we might not suffer them as much. When we reach for painkillers, the order of events seems like it goes from vexation to question to answer. We feel tense, then we ask, "What can be done about this?" to which the response is, "Use this." But the existence of a possible answer draws the question out of us, and in tandem the knowledge of the vexation.

For example, a mother is driving her son to school and notices he is quiet. She asks, "What's wrong?" to which he replies, "My head hurts." (In the past, he might have said, "My tummy hurts," or "I don't feel good.") Suddenly a Children's Tylenol appears in his mouth, which creates an entry for "headache" in his database of fixable things.

Perhaps even the question, "What's wrong?" wouldn't have been asked a couple of generations earlier because parents didn't have video games and pills in their panacea toolbox.

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The Limits of Collective Research and Reasoning

According to the Internet's best guess, everything causes cancer, and everything doesn't cause cancer. If you search, "Does such-and-such cause cancer?" you can find plenty of articles from supposedly reliable sources, such as WebMD, to confirm the carcinogenic properties of almost anything. The same confusion is true for the side effects of drugs. Everything causes headaches, nausea, etc. Or, if you follow the consensus advice on what to eat and what not to eat, you will be left with only five possible foods in your diet.

There is a medical truth out there, but our current quality of research and the current collective reasoning skills of the Internet are insufficient to answer a broad swath of common questions today.

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