It's so strange sometimes watching tv shows and movies from the 90's where you see characters smoking indoors in public places.
Like in Seinfeld you will have episodes where Kramer is smoking in offices....and even in the doctor's clinic! There was an episode where Kramer took out a cigar and smoked in a doctor's waiting room. I thought he would immediately get in trouble but none of the other characters cared.
And then you got movies from back then like Jackie Brown (which is a great movie by the way) where you see character's smoking in a mall cafeteria. A mall! A family friendly environment! And it's considered normal!?!?!? Blows my mind.
It is hard to overstate how common that was in the nineties, at least here in Spain.
Clouds would come out of family bars and diners when you opened the door. Movie theaters and art galleries would have people smoking inside as it was part of their intellectual aesthetic. During weddings giving out Cuban style cigars as a present was assumed. Schools would not allow it officially, but every bathroom and teacher lounge would clearly smell from the people hiding for a smoke. Same for hospital waiting areas and bathrooms. Trains had smoking and non smoking wagons, which people complained about, feeling smokers were being ostracized. Beaches were full of cigarette buts to the point that accidentally stepping on a not yet cold one was a common concern. Not "going for a smoke" at work was considered socially isolating, and particularly for men saying you don't smoke would lead to others questioning your heterosexuality in a non PC manner. Teenagers would start smoking around the family as a "proof of adulthood" as soon as they had their first part time job to pay for it.
Same in Greece, that came last in banning smoking in closed spaces since the last 5-6 years! Funny thing, now our clothes in taverns don't smell smoke anymore, but meat and garlic.
I remember visiting a friend in California which I think was the first place to ban smoking in bars. Anyhow we want to some jazz club and no one was smoking. So weird. And I didn't and don't smoke.
If you had asked me I would have said, nah I don't smoke and I don't like the smell but I get used to it. When I got out of that place I suddenly realized that it I didn't "not like it" it really bugged me. And no, I never really got used to it.
In college, we had two bars that still had smoking despite it being banned in our state. The exception was it had to have doors and a completely separate HVAC. One bar had a smoking second story that had most of the pool tables and TVs while downstairs was a more relaxed area. Another bar bought out the building directly behind them and put a door connecting the two buildings.
Hookah bars got wrapped up in the smoking ban too which I think was an overreach. You go to a hookah bar to smoke, you don't go there to watch a game, shoot pool, and have a beer. The one hookah bar in town actually sued the state over it. Because they also sold hookah supplies, they were exempted.
Smoking on airplanes is the one that just seemed like an accident waiting to happen. And yet there were (relatively) few incidents caused by cigarettes.
I heard that air quality on planes was better back then (maybe someone who was alive then can confirm). Because of smoking they had to ventilate the whole aircraft much better. While these days I feel like they are just starving us for oxygen so as to not have to heat up fresh air.
Old person here. I think it's really hard to convey the extent to which smoke literally permeated everything. It's not just the immediate air quality aspects of it, but there was just a residue on all the surfaces, every cushion and fabric held onto the stuff.
I can recall the week that no-smoking indoors at restaurants/bars passed and it was literally shocking to walk into a place and not have it be hazy. It really felt weird.
Anyway, air quality + quality of life was much worse. Sometimes the future does get better.
Another old person here. At an office in Zurich I saw a layer of smoke filling the upper reaches of the atrium. I wondered how many working (i.e. smoking) hours it would take before it reached the balcony on which I was standing.
except for the dance bars. Dear lord the sweat smell during the transition was bizarre. It as always masked thanks to the smell of smoke. I think a lot places had to start thinking about adding nice parfumes, because almost at the end of that first year of zero tolerance inside bars, it was 'solved'.
The airplanes were awful, usually with silly little signs stuck in some seats to designate the switchover which the smoke didn't seem to respect. I was in a train brought back to service from smoking times a few years ago and the stench still emanating from the fabric seats brought back those memories right away.
Turns out using less engine bleed air is good for fuel economy, so now it's 50% recirculated HEPA filtered (which does nothing for the co2 contents) air.
Lol. I was 14 when I took a long distance international flight on a 747 in 1979. The family was sitting in the “non-smoking section”. I can tell you for a fact that the air quality in that plane was terrible. Possibly because a number of passengers in the non-smoking section still deigned to smoke. Whaddaya do eh?
It's an addiction, they're compelled to smoke, and so at the edges of the area they'll light up.
That's how the Kings Cross Fire started. Escalator full of potential fuel, smoker drops a used match, it falls inside the machine, fire. It wasn't legal technically to be smoking on that escalator, but it would have been legal in a few paces so "everybody" did it. The investigators found signs that such fires had likely started or almost started many times before, the disaster was just that this time it burned for long enough to create a pool of extremely hot gas flowing up the inclined ceiling for the escalator, and we got to discover the Trench Effect in the least fun way possible.
I flew to Japan from US in the "non smoking section" and which the smoking section started in the row immediately behind me... A woman smoked in the seat behind me most of the trip.
Or smoking a cigar in an oxygen rich spacecraft cabin, as per the opening scene of the original Planet of the Apes (released in Feb 1968, after the Apollo 1 fire in Jan 1967).
I like how they still have the ash trays in the bathroom. I get it, throwing the heater into the paper towel trash is a recipe for disaster. But still, the idea of taking a poop in this tiny little uncomfortable bathroom with 5 people waiting for you and sitting there demolishing an entire cigarette while you do it is sort of hilarious in its desperation.
You don't have to go back 30 years to see it. Just take a shared taxi in Sumatra. Most of the men and some women will be smoking. Inside the car. With the windows closed. Sitting next to babies and young children.
I was recently watching some TV show and there was this one scene in maternity hospital. The doctor(!) was smoking while talking to the main character. Insane for today's standards.
The last hold out in the UK was the offices of BAT (British American Tobacco). They had ashtrays, spittoons and untold free cigarettes for their staff to help themselves to.
To spice it up a bit, they had lots of cigarettes to try from developing markets. Sometimes these had extra flavour that appealed to the smoker, so more nicotine and tar.
They had this 70s style going on in the early 2000s, at a time when smoking had been outlawed from enclosed public spaces plus lots of outdoor spaces such as sports grounds and train platforms.
Out of the 70s context, the dedication to normalising smoking in the BAT offices made the place sound like more of a cult. I did not work there myself but I had a friend that did. He didn't smoke once he left the 'cult'.
The day they introduced non smoking (late nineties?) a friend of mine found out as the aeroport. He made a big stink, canceled his ticket and booked a new flight for Amsterdam - NYC with the only company still allowing smoking: Aeroflot.
He spent the better part of a day, flying via Moscow.
The next time he had to fly he grudgingly accepted it.
Sometimes even Shaw's unreasonable man has to come to terms with defeat.
100 years from now the descendants of the engineers who work at Big Tech will be looked upon by their descendants with the same shame that people nowadays look at ancestors who were involved in tobacco.
As someone who had a brief stint consulting for Big Tobacco, I can assure you that people care a lot.
RJ Reynolds does not have their pick of the most elite graduates. Most of them would be ashamed to tell their friends and family, no matter the salary.
Yeah I don't know why people are downvoting. Not for one second would I or anybody I know care about someone in the family having been a tobacco farmer any more than they would care about someone growing alfalfa.
This is an outrageously dumb thing to say. BIg Tobacco knowingly sold a product that physically addicted (the only real form of addiction) its users and killed them.
Facebook ran experiments on on unknowing teenage girls to study how being shown negative content leads to negative mental health outcomes, which has lead to suicide.
> Contrary to the earlier notion that addiction is predominantly a substance dependency, research now suggests that any source or experience capable of stimulating an individual has addictive potential. This has led to a paradigm shift in the psychiatric understanding of behavioural addictions.
dopamine, the little “hit” you get on social media sites or when you get a “ping”, has a massive role to play in behavioural addictions. and with behavioural addiction it basically causes the same stuff in the brain that cocaine etc does (very simplified explanation).
also, i’m a recovering drug addict. and i can tell you for sure from my lived experience that addiction is definitely not limited to physical stuff like drugs. xD
> Problem gambling (PG), also known as pathological gambling, gambling disorder, gambling addiction or ludomania, is repetitive gambling behavior despite harm and negative consequences. [0]
Addiction isn't just [chemical in blood stream] -> [addiction]. Addiction involves many steps, many of them in the brain, and many of those reactive to non-physical events.
Gambling is conventionally considered addictive, but the user isn't ingesting chemicals. I don't think a physical/non-physical binary really stands up under scrutiny. I mean, aren't all addictions physical insofar as they stimulate the body to produce neurotransmitters?
Plus, smoking doesn't kill people; its pathological outcomes do. Similarly, looking at a phone screen might hurt a user's eyes, but it won't kill them; however, the decisions that user makes over time due to the effects of the subject matter they interact with might definitely put them at risk. And if aspects of that subject matter are deliberately amplified for their addictive properties, should platforms be regulated to control this?
Not the OP but I get it. We don’t produce anymore.
What we do is produce ideas, then sell the idea to a few wealthy groups; which has lead to a very distorted economy.
It’s also no secret that “wealth extraction” has been an ongoing best practice for the past decade or two by those in this circle, and the financiers are eyeing ways to get to the retirement accounts legally.
We already see this with cryptocurrency “normalizing” as investments and SpaceX bundling itself with questionable AI companies pre-IPO (index fund manipulation).
Saying this about a compute rental service is hilarious
They have the power to do what exactly? Sell you some EC2 instances at reasonable prices? lol
There’s organizations that have the power to openly kidnap and execute people and we’re being melodramatic about a few buildings with computers in them
That's not an ideal tone for here. From my perspective the most incredible thing is the concentration of IO. I might like at some point for elements of my computer usage to remain private, it would be nice if that ability were preserved. A bit hard to accomplish when 1 out of 4 bits processed globally all run through the same network
Wasn’t it just a few months ago that a big tech CEO used his powers to gain access to all the US government data he wanted? Did you forget that already?
Did you see any clips from Trumps inauguration? Weren’t the CEOs of these big tech companies sitting right behind him?
Shall we even talk about Palantir?
I think it’s pretty obvious what the power of these companies are. You have to have your head pretty deep in the tech hole to think this is just about fair ec2 pricing. What I’d do to have that kind of ignorance again.
I see. So your brilliant logic is to reduce the actions and impact of multi billion dollar institutions down to simplified versions of the technical solutions they offer.
“You don’t need to worry bout them Palantir boys, they just make simple harmless dashboards. Don’t worry about the deep involvement in government surveillance, military targeting, and immigration enforcement.”
“Amazon just provides simple VMs. Ain’t no need to be concerned about worker treatment, anti-competitive practices, tax avoidance, and environmental impact.”
When their customers start using those buildings with computers in them to autonomously determine who to kidnap and execute, I suspect you might understand their point. I’d also note we are one refusal away from the US president declaring DPA control over frontier model providers and their infrastructure a national defense necessity and under his personal control.
Governments are companies that have accountability to the public, wherein the public has direct influence over their decisionmaking, unlike regular corporations where people have no influence whatsoever (without lobbying the government to regulate them, anyways).
To the extent that governments work against the people, it is largely because people in some countries are collectively very stupid and willingly support such governments.
He is politically accountable. The majority of the voting populace voted him back in and also voted for a majority of legislators whose central policy was worshipping the ground on which he stands. America is getting exactly what its people voted for, if you have a problem with that you have a problem with democracy itself.
To be clear, political accountability doesn't mean "you, one person out of over 300 million, get your desired outcome". It means the over 300 million people collectively decide what he is accountable for and what happens to him.
He can be removed from office by Congress after the midterms if the population shows up to vote for that happening. They won't, of course, because the American people as a whole do not want him removed from office, but the mechanism is there.
He will also probably stand for re-election, and if he does he probably will win despite it being in violation of the constitution, because by all accounts the American people collectively prefer the concept of Supreme Leader Trump to the scrap of toilet paper that is their constitution. That is the nature of democracy. It gives the people what they want, even if what they want is very stupid and harmful to themselves.
Maybe worry more about the organizations that actually have the power to do bad things rather than speculating about something that might happen at some point lol
AdSense is the one that people underestimate. It's a piranha pool of liquid cash, billions-scale impressions and near global outreach. Any sane nation would have banned it decades ago, unless it was propping up a global influence campaign for their government.
AdSense uses a sealed-bid auction system with arbitrary number of lots that Google controls. It's a FOMO market driven by artificial scarcity, and since Google contractually forbids AdSense-enabled websites from using competing services, it forces ad buyers to go through their closed, controlled system.
But in practice, nobody (well, nobody making lots of ad revenue from their website) uses AdSense exclusively. Most don't even use it at all - AdX is better as a header bidding fallback than AdSense. But those who do use AdSense as a fallback are using it in competition with many other ad networks.
They forbid those websites from using competitors? Isn’t that blatantly illegal? I guess it’s not actually illegal until they lose a court case for antitrust.
Every brand or product has to competitively bid for its own identity in a monopoly competitive bidding market.
It's downright evil.
Look at Google's AI rivals having to spend hundreds of millions just so customers can find them. Google Anthropic or OpenAI and see what you get.
The next admin needs to break Google up horizontally (not vertically) into competing browsers, clouds, and search products. They all need to fight. Healthy capitalism is fiercely competitive. Not whatever this invasive species that preys on everything else is.
They also need to make it illegal to place ads for registered trademarks. The EU should get in on that too.
>The next admin needs to break Google up horizontally (not vertically) into competing browsers, clouds, and search products. They all need to fight. Healthy capitalism is fiercely competitive. Not whatever this invasive species that preys on everything else is.
That sounds great if you're rich and can afford to pay for all the million subscriptions that will pop up to replace what Google offers.
Google offers an insane amount of value to people for free: YouTube, Android, Google Search, Trends, Scholar, Maps, Chrome, Translate, Gmail. These would all be paid subscription products without adsense (or some equivalent). And as paid products they would get the typical subscription enshittification over time.
Also, on the topic of AI: didn't the transformers research paper come from Google? In an alternate world that would've been a trade secret locked away inside Google.
> Google offers an insane amount of value to people for free: YouTube, Android, Google Search, Trends, Scholar, Maps, Chrome, Translate, Gmail. These would all be paid subscription products without adsense (or some equivalent). And as paid products they would get the typical subscription enshittification over time.
That's false.
There are hundreds of free offerings in this and many other spaces offered by lots of other companies.
There does not have to be one monopoly controlling all of it for the freemium model and advertising to work.
What are the great phone OSes that aren't Android based? Can you run Android-specific apps on then?
There definitely isn't a YouTube replacement. You might say that there are video sites and that's true, but there aren't any that also offer 55% of the revenue to the creator, let alone that being enough to really have a creator economy.
Most browsers these days are Chromium based or are essentially funded by these big tech companies (eg Mozilla).
Google search and translate do have alternatives, especially these days with LLMs doing a lot of the latter.
What are some of the free email providers? I'm genuinely curious, because I know some exist, but I'm unfamiliar with most of them.
> What are the great phone OSes that aren't Android based? Can you run Android-specific apps on then?
Make Google give up Android (which is Linux based) and watch an entire industry pop up.
> There definitely isn't a YouTube replacement. You might say that there are video sites and that's true, but there aren't any that also offer 55% of the revenue to the creator, let alone that being enough to really have a creator economy.
TikTok creators earn 70-90%
Twitch creators make 50-70%.
Split YouTube into ten video websites and watch a robust, de-consolidated economy sprout.
> Most browsers these days are Chromium based or are essentially funded by these big tech companies (eg Mozilla).
This is the most heinous of all because it's the insidious linchpin behind Google's evil empire. It's the starting point of the funnel Google makes all of its "search" revenue from. (I say "search" because when I type in "openai", I know what I want, but Google gives me something different and forces that player into an expensive bidding war.)
Google didn't build the browser. That was originally KHTML and then taken over by Apple. They lifted it, used Embrace-Extend-Extinguish, and launched a tracking/search ad funnel/anti-adblock empire.
Every google search result compels you to download Chrome if you aren't using it. It's the default on Android. They warn you if you're using Firefox.
When you can spend billions to dump on the browser market you can do things like this. It's especially heinous since they reinvested their ill-gotten ad dragnet gains back into the engine that powered their empire.
Google needs to have Chrome stripped from them. Period. They cannot have a browser now or ever.
Firefox is their antitrust litigation sponge. They happily pay the stooges there to chug along and waste money.
Brave can and will easily fill this void when Google is forced out.
> What are some of the free email providers? I'm genuinely curious, because I know some exist, but I'm unfamiliar with most of them.
Microsoft, Yahoo. You used to be able to run your own before Google platformized email.
> Are the free Maps alternatives good?
Yes. Apple Maps is shockingly good. Turns out competition is good.
If Google is forced out, there will be lots of competition.
I don't expect consumers to understand this, but I do expect regulators to get it. And I want more regulators to take up the mantle against Google.
Google is highly anti-competitive and drastic measures need to be taken to restore a cutthroat capitalist environment that is maximally beneficial to the economy.
>Make Google give up Android (which is Linux based) and watch an entire industry pop up.
I guess that would be when Apple takes over smartphones entirely.
>TikTok creators earn 70-90%
>Twitch creators make 50-70%.
They don't get that revenue split from ads. They either match YouTube or give less depending on the size of the channel.
>Split YouTube into ten video websites and watch a robust, de-consolidated economy sprout.
We had 10+ video websites simultaneously before YouTube. The videos were all lower quality, limited in length, and obviously no revenue share. Only YouTube grew out of them to become YouTube and it was because of a superior product.
>This is the most heinous of all because it's the insidious linchpin behind Google's evil empire.
Google didn't make me switch to Chrome, Mozilla did. One day they decided to rework the UI, which broke my add-ons. And then they decided that I'm not allowed to use my own add-ons without permission from Mozilla.
Using my own add-ons with Chrome (or chromium-based browsers) was no problem.
Also, Mozilla mucked up the mobile browser thing themselves. Their scroll felt extremely wrong to use for years. Every other application on my phone scrolled in one way, but somehow Firefox did not. Eventually they fixed it, but that took a long time.
I'm not opposed to using Firefox, but they themselves pushed me away.
>Brave can and will easily fill this void when Google is forced out.
You think Google is going to continue building Chromium if they can't have Chrome?
???
>Microsoft, Yahoo. You used to be able to run your own before Google platformized email.
So one tech giant instead of the other? What's the difference?
>Yes. Apple Maps is shockingly good. Turns out competition is good.
Great if you're in the apple ecosystem, I guess, but that's, again, switching from one tech giant to another. In this case it would be switching into a company known for building walled-gardens. I don't see how this would improve the situation at all.
>I don't expect consumers to understand this, but I do expect regulators to get it. And I want more regulators to take up the mantle against Google.
Get what? That regulators should go after one tech giant so that their customers are forced to swap to the products of... other tech giants?
I'm not here to defend Google, but I feel like you might want to think about this some more. Your answers basically just suggested other tech giants or Brave (which relies on Google still contributing to chromium). Being stuck in Apple's walled garden doesn't sound great to me considering how expensive all their stuff is.
"Possibility for abuse" seems like the right reason here. Does the benefiting of reducing a specific possibility of abuse outweigh the cost of an intervention? And here in particular, is there much cost to the intervention other than just shifting the money distribution from a zero-sum advertising arms race from one player to several?
I frequently see calls to not intervene if there's not bulletproof evidence of existing abuse, but why wait? Would you want Google to own a bunch of nuclear missiles just because they might not have misused them yet?
Yep. They can make every mistake imaginable and not work as hard but still win. It’s the power of concentrated capital and monopolistic behavior and what people call “moats” but really is just an unfair advantage. Why should Google or Apple be allowed to copy everyone’s AI tech and just win because of distribution through Chrome or iPhones?
We need new antitrust laws and heavy taxes just on the megacorps worth $500B or more. And aggressive enforcement.
Gemini is a copy of ChatGPT. And ChatGPT was a product invented on top of many previous ideas. The fact that one paper among many was written at Google isn’t relevant to my point.
Google entered the competition in AI products late. And now they will use their power unfairly to try and make it win. When they bundle an AI Chatbot into their existing contracts for Google workspace, they are competing unfairly. When the Chrome browser steers you towards Google properties by default, they are competing unfairly. Etc. Those unfair monopolistic actions let them come into the market years late with a viable competitor to ChatGPT or other products.
And let’s not give them too much credit for transformers. A handful of researchers were paid by Google while they came up with that paper. Google didn’t really do anything to push for it and neither Google leaders nor shareholders cared much about it at the time. Not to mention, transformers themselves were just a continuation of other prior steps in ML, from what I’ve read.
Not that I'm opposed to new laws, but just having enforcement of the laws we already have would go a long way to fixing the problems.
The problem is how to get to the point where there is enforcement.
It definitely isn't going to happen with Republicans in power, and it also isn't a sure thing with Democrats in power either.
Lina Khan was a good start for a bit there, but she certainly didn't have universal Dem support. Establishment Democrats are going to have to grow a spine and tell the Reid Hoffmanesque donor class to get fucked.
The current set of laws lead to the current situation in my opinion. Enforcement within the current laws means a court case that will take years and span multiple administrations, which gives it a lot of time to be killed. It doesn’t provide enough authority to immediately bring enforcement actions.
I will preface by saying that someone with Lina Khan is sorely needed; Big Tech and other monopolies have gotten way too Big and seriously need to be reined in.
That said, from all the informed takes I've seen, Lina Khan was seriously... flawed (putting it charitably) in her strategy and tactics. To the extent that some observers wondered if she was deliberately sabotaging the agency just to highlight the need for new, more effective laws. She did have a novel theory of consumer harm, but that requires new legislation to enforce. Instead the way she went about it -- including by flouting due process -- was extremely counter-productive.
That was a big reason she was neither very effective in her goals (other than creating a lot of noise) nor have high political support from any side.
Her lack of political support from certain factions on the Democratic side was obviously because the big donors involved in the VC world want the option to continue to unload the startups they've invested in off as acquisitions to google, microsoft, et al.
Nothing noble about that stance, that's continuing to feed the Big Tech monster.
They are very much part of the problem that needs to be solved and they didn't like that she was starting to push for the solutions.
If you look into how she ran the agency, there were a lot of parallels with how the current US adminstration is being run. (Ask any AI for an overview and see the parallels pop up.) Regardless of your political leaning, I think generally we agree that is not how government institutions should be run. Even if the donor class hadn't made any noise, the Democrats were right in not supporting her tactics.
Everything it’s building now - Gemini in its various forms, and all the other AI products - are copies of other products. If they weren’t Google but another startup with the same products, they would be irrelevant and ignored. It’s their capital and anticompetitive practices that let them get away with missteps that no one else can survive.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there.
I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.
I'm a doctor who used to be an engineer. Deriving things from first principles in medicine is a lie we doctors tell ourselves.the truth is this.we have some really good understanding of syne things at molecular levels that we then correlates to things that happen clinically at a macro level, that correlation is very very handwavy. But we teach it as if we know for sure. We don't.
The few things that we think we have a somwhat good correlation for, we often test on our exams, but even for most of those things, it's some handwavy link
I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there
Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.
I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.
I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.
The hospital my wife first gave birth at were very accommodating with her request. I think education of the individuals is a bigger issue than the hospitals (who have probably send and done all different ways.)
Hospitals are starting to bring midwives and doulas back. Of course, educating women and families about their options and pushing back on inducing labor and c sections would help as well.
They already tried pushing back against c-sections, turns out giving overly opinionated options to women that discourages things that are medically beneficial in a large portion of cases is not helpful and caused a lot of unnecessary suffering and some deaths, now that policy is thankfully long gone, though the opinionated attitude it generated in some continues on sadly.
my wife had a particularly large first baby, natural birth might have worked, but would have been risky, rather than being given unbiased options, she was pressured towards induction over c-section since it was “more natural” (I suspect mostly because it would have looked better in the hospitals stats to keep the c-sections down). The early induction failed after days of suffering (as early inductions usually do, turns out), and then she had a c-section anyway (which having reviewed the options was her original preference, but was pressured out by the doctor), the c-section was vastly more successful, as you’d expect from the statistics (and a lot less suffering, which doesn’t show up in the stats but is obvious once you concider the process).
Im willing to agree neither should be recommended in most cases, natural births are safer in most births, but the best thing anyone can do is give the facts as they apply to the person giving birth (and keep their opinions well out of it).
I fully admit that personal experience has biased me strongly in favour of c-sections, but only when the stats support them, which they often do.
Dr. Atul Gawande† reported 20 years ago how obstetricians standardized on c-sections because the suppposedly-better alternative, forceps, (i) was very difficult to teach and supervise, and (ii) used incorrectly, could result in horrible injuries to both baby and mother:
<QUOTE>
The question facing obstetrics was this: Is medicine a craft or an industry?
If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills—the Woods corkscrew maneuver for the baby with a shoulder stuck, the Lovset maneuver for the breech baby, the feel of a forceps for a baby whose head is too big.
You do research to find new techniques.
You accept that things will not always work out in everyone’s hands.
But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts.
You seek reliability.
You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques.
You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received.
After Apgar, obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble.
They found it in the Cesarean section. [0]
</QUOTE>
(Formatting edited.)
† Surgeon, Rhodes scholar, MacArthur Foundation "genius grant" recipient, professor at Harvard Medical School, author of The Checklist Manifesto among many other things.
If the water actually broke, inducing labor can be important to reduce the risk of infection though, since bacteria can easily get into the amniotic fluid. If the water didn’t break yet, then at least where I live they don’t induce unless you go so much over the expected birth date that there is a high risk you’ll need C-section if you wait more (in Northern Europe they generally don’t offer C-sections unless medically required).
Midwives provide most of the care for most births in hospitals in the UK AFAIK and have done so for decades (certainly where my older daughter was born).
In the U.S. at least the incentives are perverse. Probably what would actually move the needle is a test trial with results showing it's more cost and resource effective
I wonder how different things would have been if Germany had increased rather than decreased the reliance on nuclear energy.
After all so much of Germany’s energy now comes from natural gas which is bad for climate change and, in the case of Germany, the natural gas comes from Russia. Helps feed the war machine, etc.
Germany, and the rest of Europe, nowadays would have been less reliant on Russia and have contributed less to climate change if they had used more nuclear energy.
Like in Seinfeld you will have episodes where Kramer is smoking in offices....and even in the doctor's clinic! There was an episode where Kramer took out a cigar and smoked in a doctor's waiting room. I thought he would immediately get in trouble but none of the other characters cared.
And then you got movies from back then like Jackie Brown (which is a great movie by the way) where you see character's smoking in a mall cafeteria. A mall! A family friendly environment! And it's considered normal!?!?!? Blows my mind.
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