Astral Codex Ten

Alberta

40 min read

Alberta

Article

Alberta is a recurring place in the Astral Codex Ten archive, appearing 4 times across 4 issues between May 19, 2023 and August 29, 2025. The archive places it in contexts such as “oil-rich Alberta”; “CALGARY, ALBERTA, CANADA and EDMONTON, ALBERTA, CANADA”; “a 27-year-old autistic woman … was granted the right … by an Alberta court”. It most often appears alongside Canada, Netherlands, Astralcodexten Com.

Metadata

  • Category: Places
  • Mention count: 4
  • Issue count: 4
  • First seen: May 19, 2023
  • Last seen: August 29, 2025

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

The Question Of Separatism
May 19, 2023 · Original source
Meanwhile, Montreal never generated a conurbation or significant city region. This is Jacobs’s main hypothesis for why it was overtaken by Toronto, though she doesn’t give a lot of detail on why it happened. In any case, the result was that Montreal lost its status as the economic capital of the country. It became a regional city. The problem is that regional cities tend to do poorly. The nature of nations is to centralize everything in one place (we’ll come back to this). That’s why Paris has a large and rich city region, but Lyon and Marseille don’t. That’s why London looms so large in the UK’s economy while Glasgow or Manchester now contribute very little. There’s nothing wrong per se with being an economically stagnant regional city. Such cities can be fine places. When they’re the center of a supply region, like Calgary and Edmonton in oil-rich Alberta, they can even be wealthy. The complication for Montreal, though, is that its previous status as the main Canadian metropolis made it grow too large for this purpose. Yet, at the same time, Montreal plays an outsized cultural role for French-speaking Canadians — one that Toronto doesn’t even come close to fulfilling. So, Jacobs sees only decline for Montreal. And she thinks this means decline for Quebecois culture generally. Without a strong import-replacing city, Quebec will become a patchwork of supply regions, regions that workers abandon, or transplant economies, like the poverty-stricken Atlantic provinces in eastern Canada already are. Either the Quebecois resign themselves to this fate, she says, or they fight it — and the only true way to fight it is to declare independence. As of the 1980 referendum, she thinks they should go for independence. Generalized Separatism Quebecers did not go for independence, neither then in 1980 nor in 1995 when they voted on the question again. If they had, it would probably have been an example of a peaceful secession. Jacobs points out that there haven’t been many of those, if you exclude the decolonization of overseas imperial possessions (like Canada from Britain). Non-peaceful secessions have been common, but in those cases the destructiveness of war tends to overshadow everything else, economically speaking. In fact that might be the main reason most of us intuitively dislike separatism: we associate it with conflict. But peaceful non-colonial secessions do happen. Since 1980 there have been several more cases, like Czechia and Slovakia. When Jacobs wrote her book, though, the only good example she could think of was the independence of Norway from Sweden in 1905. She tells a great account of the process, noting that the outcome wasn’t predetermined: Sweden didn’t want to lose its western province, and did what it could to contain Norwegian nationalist sentiment. But Norwegian nationalist sentiment won — and importantly, both Norway and Sweden seemingly benefitted. Neither of them was particularly rich in the 19th century, and Norway was in fact dirt poor, which is why so many Norwegians escaped by emigrating to North America. Yet after the dissolution of their union, the two countries developed quickly, and both are now among the wealthiest countries in the world. They certainly didn’t disintegrate. (Of course, in Norway the wealth is due in large part to the oil that they discovered in the late 1960s. But they were pretty advanced by that point already — advanced enough that they could use the oil to develop their own industry, rather than get rich quick by exporting it raw, which is what keeps many countries trapped as supply regions.) When people argue against separatism, they often tout the benefits of being large. A Canada that would be split in two would mean smaller markets, and a weaker political counterweight to the United States. (Not to be mean to Canadian readers, but this argument seems delusional to me — I don’t think Americans currently see Canada as a political counterweight of any significance.) It would certainly be less prestigious. Large size, Jacobs says, is associated with power, and we admire power. We love slogans like “unity makes strength.” But after the medium-sized country of Sweden-Norway became the two smaller countries of Sweden and Norway, they both did well. Small size is less powerful, but it has its own advantages, such as nimbleness and ability to fail non-catastrophically. Small size also allows more diversity in cultural and economic matters, and here Jacobs waxes philosophical, pointing out that favoring diversity over uniformity is a recent, post-Enlightenment idea that has not yet been fully embraced in politics. We can see analogs everywhere. Europe, split into numerous small countries from the Middle Ages onward, became far more advanced than China, which has been unified more often than not. The city-states of ancient Greece and Renaissance Italy are seen as golden ages of Western civilization, even if they weren’t part of larger political units and therefore constantly went to war with one another. In business, large companies are impressive and powerful, but people always complain that Google or Microsoft have become stagnant and that the best place to work is tiny startups of about 2 cofounders and 4 employees. In biology, humans are more successful than numerous larger animals, and in terms of raw numbers, small animals like rats or insects are the most successful of all. Jacobs’s point isn’t that smaller is always better. Her point is that the converse statement, “bigger is always better,” is false — despite how intuitive it feels for political entities. Just like we don’t view a small nation like Switzerland or Singapore as a failure of unity, we (and in particular, Canadians) shouldn’t see the secession of a place like Quebec, if it’s done peacefully and democratically, as a failure either. Still, some people in online reviews of the book complain that this argument is a bit thin, especially considering that it serves as the foundation for the later chapters (which are more directly about late 1970s Quebec politics). Sure, small is beautiful, but large states are great for stability, peace, markets, whatever. If the potential benefits of small national size are Jacobs’s strongest argument, then we can breathe a sigh of relief and go back to agreeing that separatism is bad. Pointing out the widespread bias in favor of unified political entities does seem valuable to me, but okay, fair enough. Does Jacobs have deeper reasons why separatism might be a good idea in general? Yes, and for this we go back to the second half of Cities and the Wealth of Nations. Why Nations and Empires Fail Our breathing rate is regulated through a feedback mechanism. Too much carbon dioxide in the blood, or too little oxygen, and the brain stem commands the diaphragm to accelerate breathing. Once the levels are back to normal, the brain stem receives this feedback and slows breathing down again. Now, Jacobs asks, imagine an impossible creature: ten people, all doing their own thing, but whose breathing is somehow regulated by a single brain stem. The feedback the brain stem receives is a consolidated average of everyone’s carbon dioxide and oxygen levels, and the breathing rate the stem decides on is applied to all ten people, regardless of whether they’re sleeping or playing tennis. This, to put it mildly, wouldn’t work. This creature is an analogy, representing a nation. The ten people are its individual cities, and the breathing rate is the cities’ economies. If it sounds like a stupid analogy, that’s because it is: “I have had to propose a preposterous situation,” writes Jacobs, “because systems as structurally flawed as this don’t exist in nature; they wouldn’t last.” Nor do they exist in machines we design; they wouldn’t work. But “nations, from this point of view, don’t work either, yet do exist.” The feedback mechanism that fails to work properly in a nation is currency. A currency always fluctuates according to the exports and imports of the area where it circulates. Let me use the Republic of Venice and its ducat as a toy example, because the coins look nice: Whenever Venice produces something (like salt) and sells it abroad, foreigners need ducats to buy the exports, so the demand for ducats increases. When Venice buys something from abroad, it needs to use foreign currencies, so the demand for ducats decreases. Add up everything that Venice exports and imports, and you get either a trade surplus (more exports than imports) or a trade deficit (more imports than exports), which determines the value of the ducat relative to other currencies. In both cases, a negative feedback loop restores balance over time, just like our brain stem does with carbon dioxide levels. A trade surplus, and therefore a strong ducat, means that when foreigners want Venetian salt, it’s expensive. So Venice’s exports decrease, while imports increase, since Venetians can use their valuable ducats to buy stuff cheaply from abroad. Conversely, a trade deficit makes exports a bargain for foreigners and imports expensive for Venetians. This feedback loop is great. It’s exactly what a city needs to trigger the crucial import replacement process. When exports decrease and a trade deficit begins (maybe because Constantinople found a cheaper source of salt somewhere else), the weak ducat means that Venice is less able to afford the resources and manufactured goods it used to import. The people of Venice don’t want to have less of those goods, though, so they figure out ways to produce some themselves — that is, they do import replacement. Later they will be able to export the output of the newly expanding industries too, strengthening the ducat and continuing the cycle. Currencies, Jacobs explains, function as automatic tariffs (to protect local industry from foreign imports) and automatic export subsidies (to encourage local industry to export). They are “automatic” because of the feedback mechanism. Just like an accelerated breathing rate, they take effect exactly when they are needed — and no longer. … Or so they should, except that import replacement, as we discussed, is a city process. Whereas most currencies are national or supranational. National currencies work well for city-states, like the Republic of Venice or today’s Singapore. But in large nations, which, remember, are not the fundamental unit of economic life, they mess everything up. Take a city like Detroit. When Detroit’s exports (primarily cars) decrease, Detroit gets no feedback about this, because its currency is the United States dollar, and the United States dollar’s value depends on much more than Detroit. It depends on other cities whose foreign exports might be increasing at the moment. And on rural regions that are selling resources like oil abroad. Also, trade between Detroit and other cities that use the United States dollar — i.e., American cities — is structurally unable to provide any feedback whatsoever. So Detroit doesn’t get the signal that it should buy less stuff from other cities and replace the missing imports with local production. Instead, it just declines. Jacobs hypothesizes that this issue of national currencies is at the root of every large country’s economic troubles. It is why nations and empires always centralize everything into one large city, whether that’s Paris, London, Tokyo, or Toronto, or ancient Rome: that city, being the largest, is simply the only one for which national-level currency feedback works fine. The rest of the nation or empire, then, declines. But of course, nations and empires don’t accept this. They care about the economic well-being of their peripheral regions, sometimes out of genuine concern for the people there, sometimes out of fear that they rebel or hold independence referendums. So nations and empires will embark on every possible solution to reverse the decline. All of their solutions will look like good ideas at first, and yet fail at helping the peripheral regions. Worse, these solutions will weaken the cities, thereby destroying the only real wealth of the country and bringing untold hardship for everyone. Eventually the nation or empire will disintegrate, as nations and empires always do, and always will. Jacobs calls these false solutions transactions of decline. She identifies three types, and, content warning, you might not like some of them depending on your political sensibilities. Sustained military production is a transaction of decline. Permanent military bases and garrison towns are a special kind of settlement: they import a lot and export nothing. Superficially, producing weapons and supplies for the military seems like a good deal for some cities — Jacobs gives the example of Seattle, which, before Microsoft and Amazon were a thing, depended mostly on making military aircraft. But because nobody in a military base ever tries to replace those weapons and supplies with their own production, the trade is sterile in terms of economic development. In a sense, the wealth is slowly “drained” from cities. Large empires are especially prone to this: eventually all of their wealth is destined to the military just to keep the empire together.
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Spring Meetups Everywhere 2024
March 30, 2024 · Original source
CALGARY, ALBERTA, CANADA Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, April 27th, 2:00 PM Location: Side Street Pub: 1167 Kensington Crescent NW. I'll bring an "ACX" sign with red letters. Coordinates: https://plus.codes/95373W26+R8G Notes: Please RSVP on LessWrong
Inline links: https://plus.codes/95373W26+R8G
EDMONTON, ALBERTA, CANADA Contact: Joseph Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, April 18th, 7:00 PM Location: Irrational Brewing Company, 10643 124 St #109, Edmonton, AB T5N 1S5. We will have an ACX sign! More information at https://www.lesswrong.com/events/Fez72WdfeyDZAM796/acx-spring-meetups-everywhere-1 Coordinates: https://plus.codes/9558HF27+7Q Event Link: https://www.lesswrong.com/events/Fez72WdfeyDZAM796/acx-spring-meetups-everywhere-1 Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: Please do your best to RSVP on LessWrong so we know how much food to get
Your Book Review: Two Arms and a Head
August 02, 2024 · Original source
(Source) A diagram of the human spine next to a diagram of the human body, indicating which parts of the body are innervated by which vertebrae in the spinal column. The cervical, thoracic, lumbar, and sacral regions of the spine are highlighted in different colors, with the corresponding body regions highlighted in the same colors. Starting at the top, the cervical (neck) vertebrae control the head, neck, arms, and fingers. The thoracic (torso) vertebrae control the entire torso and abdomen. The lumbar (lower back) vertebrae control the hips and front muscles of the legs. The sacral (tailbone) vertebrae control the back muscles of the legs and the groin area. The very last vertebra, S5, innervates the anus and genitals. Clayton is injured quite high up on the torso at the T5 vertebra. Let's consider the ramifications of having everything below the nipples be completely numb and limp. To start off, that means that he has no use of the muscles that hold him upright. Nothing keeps me sitting up—no hip flexors, erector spinae, hamstrings, or abdominal muscles. I am arms-and-a-head on a column of Jell-O. He can't put both arms out in front of him, lest he fall over. He has to continuously prop himself up with one arm while doing anything at arm's length. After only 1.5 years of being paralyzed, this has already caused significant repetitive strain injuries in his elbows, shoulders, and ulnar nerves. Clayton still has to deal with all the logistics of life, despite two-thirds of his body being a hunk of corpse-flesh. He dedicates huge swaths of the text to all the little time-wasting tasks he now has to do. How much of his life is ticking away with every delay, every piece of effort, every task that is trivial for an able-bodied person but monstrously difficult for him. Something as simple as getting out of a car is an entire production—let alone running errands, cleaning, doing laundry, cooking. Since the lower two-thirds of his body no longer sends pain signals to his brain, he must proactively tend to all of its physical needs. Complications include pressure sores, infections, and a high chance of blood clots. Aside from suicide, the leading causes of death among paraplegics are all related to poor circulation. In addition to the loss of conscious sensation and muscle control, problems with the autonomic nervous system—heart rate, orthostatic blood pressure, temperature regulation—are common. This is even more pronounced in cervical spine (neck) injuries. Some quadriplegics black out or the blood rushes to their head when being moved from lying down into reclining in a wheelchair. A spinal cord injury wreaks havoc on the body's functioning. Go back to that diagram. The groin area is innervated by the very end of the spinal cord, at the S5 vertebra. We tend to think of our legs as being “below” the crotch, but the nerves that control bowel movements and urination are downstream of the ones for the legs. To keep the party rolling I will tell you about piss and shit. [...] To urinate I have to slide a catheter down my urethra. [...] To defecate I finger myself up the ass and root around and around until the shit comes out. Nuggets, smooshy, whatever it is I’m digging in it. He describes the disgusting, nauseating process at length. For the sake of your lunch, I will refrain from quoting it all. In addition to being unable to open and close his sphincters on command, he also receives no signals of needing to go. If he eats the wrong thing and gets a bout of diarrhea, he will have no warning—no abdominal discomfort and no final urge to rush to the bathroom. One afternoon he "has an accident" while lounging on his couch. In trying to move from the couch to the toilet, he subsequently smears feces all over the couch, the carpet, his wheelchair, the toilet seat, and the shower. After he digs the poop out of his anus and washes himself off, he then has to clean all of that up by himself. From a wheelchair. Bending down, stretching, trying not to fall over, trying to reach the floor to scrub feces off the carpet. From a wheelchair. This episode was hardly the first time. He would routinely wake up in the morning to find that he had soiled himself overnight. Imagine struggling to rip dirty sheets off the bed, stuff them in the laundry, and put a clean sheet on the mattress—from a wheelchair. I don't know about you, but I can barely get a fitted sheet on my own mattress, and I get to do it while standing up. And unless I want to piss or shit myself, there can be no rest from this drudgery, ever, for the rest of my life. No relieving stretch of time without piss-dowsing and fingering myself up the asshole. Nobody told Kid Me that Professor X has to dig turds out of his anus every day. The groin dysfunction doesn't stop there. To be redundant once more, I can’t feel my penis. [...] Men, think how losing your penis would make you feel. Ladies, think of having your clit amputated and never having sex again. [...] True, the unfeeling penis attached to the living corpse I drag around can become erect but what has that to do with me? The one time he tries to have intercourse after his injury, it goes about as well as you'd expect: Watching a woman bob up and down on the penis attached to the corpse that used to be my body struck me as macabre and disturbing. It was like necrophilia. It’s like watching a woman get off by rubbing my amputated foot on herself. The disturbing facts just keep on rolling. One final note about the physical symptoms: spinal cord injuries hurt. Everything below the damage is numb, but the injury itself is a massive tear in the central nerve that controls the body. The pain is insistent, nagging, and so sharp it seems to crackle. [...] It’s just as sharp and intense every time, over and over, like it’s mocking you. Sometimes it happens when I’m lying in bed and it’s like trying to fall asleep with someone sticking a needle between my ribs or the bones of my big toe. But, surely, the only real problem is the physical limitations? Clayton is still the same person he'd always been, right? He has the same brain, same personality he did before the accident. Even if he can't walk anymore, he still has his memories. Not so fast. Yes, Even Worse Than That What kind of mental and emotional toll does all of this take on Clayton? The feeling I experience is a frantic, frenzied, desperate distress. [...] I need to move. I need to move. [...] Not only is two-thirds of my body paralyzed, but so is a huge part of my innermost self. It wants more than anything to feel and experience life. To exist. But it exists now only in a place between reality and nothingness with no hope of ever coming back. [...] All it can do is degenerate in the solitary place it has been forever exiled to. A popular heuristic in neuroscience is "use it or lose it." This is usually in the context of memorization, but it also applies to sensory organs and limbs. When Clayton is injured, his brain's connection to everything below his nipples is severed. Lacking any more sensory input from down there, the brain simply overwrites and repurposes the unused neurons. His injury is not limited to his present and future, but also reaches back into his past: Certain of my memories seem to be disappearing. For example, when I try to remember doing things that involved running, jumping, and sex, the memories seem less real or vivid than they used to. [...] If I imagine taking another person’s hand in mine, or kissing someone’s face, or someone touching my face, I feel something similar to sensation in those parts of my body when I imagine it. [...] But my lower body is now just a void, and its death started the creation of a void in my brain. Not only can I not feel it, but my ability to imagine feeling it is disappearing, as is my capacity to remember feeling it, and doing things with it. He likens himself to a Cartesian brain, a part of the world but outside of it, forever locked away, unable to exert his will on the outside world. Not only has he lost his legs; he is beginning to lose the memory of those legs, too. Everything he ever was, any skills that he ever learned related to being able-bodied, are destined to die over the coming years. His mind is doomed to slowly decay as its neurons do what neurons do: rewrite themselves until none of the person he used to be is left. Toxic Positivity Can Clayton actually talk about any of these things with his peers? Not really. He has a small circle of other recently paralyzed friends who understand, but outside of that, no. American culture has an entire social ecosystem that reinforces the idea that disabled people should be upbeat and optimistic about their life prospects. Almost any interview with a paraplegic ends on some upbeat note about how their disability "doesn't stop them from doing all the things they want to do" and that "they can do anything” an able-bodied person can. In fact, Two Arms and a Head opens with one such quote from Stephen Hawking: “I try to lead as normal a life as possible, and not think about my condition, or regret the things it prevents me from doing, which are not that many.” —Stephen Hawking This is patently absurd. Why do they say these things? Do they actually mean it, or are they just being hyperbolic for rhetorical effect? Surely they all know, secretly, that they’re lying to themselves? Clayton argues that no, they mean it, and they’re not lying to themselves. Remember how disability affects the brain? How all those unused neurons get repurposed, and any concepts of using those paralyzed limbs gets overwritten (if they ever existed in the first place)? They [lifelong paraplegics] tend to only see life in terms of the possibilities that exist for them [...] Their view becomes somewhat tautological. “What I can do is all that is possible, therefore I can do all that is possible.” Just as able-bodied people cannot comprehend what it’s like to be a paraplegic, lifelong paraplegics and quadriplegics simply cannot grasp what it is to be able-bodied. I’m not saying that lightly. The difference is biological. They have different brains. [...] They do not understand the experience of being able-bodied—neither the subtleties or much of what, to observers, is overt and glaring. They can try to imagine it, but they don’t even come close to comprehending the potential that exists there. Hence the common refrain that there are “not many” things that they can’t do. Adding to this dynamic is that it is considered impolite in our culture to call them out on it: If I were still able-bodied and a paraplegic told me he could do everything I could, I would just think “Looks like being crippled fucked up his mind too, because that’s insane.” I’m not sure what I’d actually say to him, but I know it wouldn’t be that. [...] So the disabled are basically allowed to go around saying whatever on Earth they want. They acquire a kind of de facto moral infallibility because nobody is going to argue with them. On top of this, humans have a basic need to belong, stay positive, and avoid people who are negative and miserable. If paraplegics were honest about all the body horror and misery, they would quickly find themselves devoid of friends. So what is a newly paraplegic person to do in order to maintain connections during a time in their life when they desperately need comfort and support? Brainwash themselves, of course! Clayton was staring down the prospect of what he would have to do to his mind in order to survive in our current society as a paraplegic. It was bad enough to be mutilated physically; he didn't also want to be mutilated mentally. What happened to my body is frightful, but no less than what happens to the minds of many disabled people. We have to have some kind of integrity to our views of the world and reality, and the more the better. [...] So my unwillingness to adopt certain “attitudes” or whatever people call them is something like a desperate struggle to evade the clutches of madness. It gets worse. This does not just affect their social lives and beliefs. These dynamics ripple out into the medical community’s attitudes about paraplegia. If every interviewee swears that paralysis doesn’t hold them back in life, then why pour resources into finding a cure? I’ve heard people say that spinal cord injury is not a priority for medical research like cancer because “people can live like that”. No, we can’t live like this. This is not “life”. Which raises the question—have there been any breakthroughs since 2008? The State of the Cure Let’s take a short break from the existential horror to look at the science of spinal cord injuries. Clayton killed himself in 2008 because there was no cure at the time. Have there been any new developments in the ~15 years since? The short and upsetting answer is "not yet"—though there are some glimmers of hope. Why are Spinal Cord Injuries So Hard to Fix? The spinal cord consists of multiple concentric layers of nerve fibers, not unlike an electrical cable. Wherever the spinal cord has trauma, the nerve cells die off and form lesions of scar tissue that block all nerve signals from traveling downstream of whichever thread was damaged. Some patients are lucky in that only parts of the spinal cord are damaged, resulting in paralysis on only one side of the body. Nerve cells in the spinal cord do not regenerate themselves. Once damaged and scarred, there’s nothing anyone can do. The good news is that emergency medicine has come a long way in arresting the formation of scar tissue at the moment of injury. Patients coming into the ER today have a much better prognosis than they did a few decades ago. The interventions are straightforward treatments like stabilizing the spine, surgery to release pressure on the pinched nerves, and shots of corticosteroids to reduce swelling and inflammation. But beyond that, there is no clinically-proven, FDA-approved treatment for an existing injury. Clayton describes the challenge of rebuilding his injury as something similar to “reconstructing a crushed strawberry.” No amount of stabilization would have put his smeared spinal cord back together. The Latest Research Treatments fall into two camps: bridging the injury, and encouraging the injured scar tissue nerves to regenerate. Implanted Nerve Cells In 2012, Prof. Geoffrey Raisman's team at University College London successfully treated a paralyzed man in Poland. The treatment involved removing one of the olfactory bulbs in his brain in order to culture olfactory ensheathing cells (OECs), which are the only nerve cells in the human body that continuously regenerate. The surgeons removed a section of nerve from the patient's ankle, then implanted both the ankle nerve and the OECs into his spine at the injury site. The grafted tissue bridged the gap between his brain and the healthy spinal cord just below the injury. After years of rehab and physical therapy, in 2014 the researchers announced their success to impressive fanfare. As of 2016, the patient could walk, ride a tricycle, and had regained bladder, bowel, and sexual function. He was far from his pre-injury self, but his quality of life had improved immensely compared to before the treatment. The call went out to recruit two more volunteers for another study. And then... crickets. This follow-up study has yet to be performed. It could have been delayed for a number of reasons. Perhaps they never found suitable volunteers whose profiles satisfied the demands of European regulators. Perhaps Brexit threw a bureaucratic wrench in the collaboration between UCL and the research center in Poland. Perhaps they ran out of funding. To make matters worse, Prof. Raisman passed away in 2017. In the years since, the team has been making progress in fits and starts. As of 2022, the current focus at UCL has been on figuring out how to culture OECs from the nasal mucosa instead of needing to crack open the skull to get at the olfactory bulbs directly. They’ve also made improvements in the technique for applying these cells to the injury site. Things are certainly happening, albeit at a glacial pace. This treatment strategy may become widespread in the future, but at the moment, it remains experimental. NervGen's "Wiggling Molecules" In 2021, NervGen Pharma announced a drug that encourages damaged spinal tissue to heal without scarring. A bioengineered molecule, NVG-291, is injected into the spinal cord and acts as a scaffold for the nerve cells to attach to as they regrow. The molecules of this scaffold naturally "wiggle” and stimulate nearby nerve cell receptors, promoting healing. Animal models were extremely promising. NVG-291 is currently in Phase 1b/2a clinical trials, which are scheduled to start in August of 2024. I’m cautiously optimistic. The main impediments to finding a cure are the same ones that plague any other field of medical research: lack of funding and unreasonable requirements from regulators. The main problems at this point in time appear to be bureaucratic rather than strictly biological. Will any of this research pan out within the next 5, 10, or even 20 years? Maybe. Only time will tell. (Someone should start a prediction market about this!) Alas, this is all coming too late to have saved Clayton. The Decision to Die I am absolutely and heartbreakingly in love with life. But this is not life. [...] For those who like to say this one: “Suicide is a permanent solution to a temporary problem.” I reply that suicide in my case is a permanent solution to a permanent problem. [...] I have only one serious problem in life and it’s being paralyzed. Clayton does not come to this decision lightly. He considers it exhaustively and systematically. When deciding whether to keep living, he starts from the premise that there is some amount of suffering past which life stops being worth it. He evaluates where that dividing line is by examining the sources of meaning in his life. He starts by asserting that there is nothing wrong with his mental health or his reasoning abilities: I am not depressed, I am tortured, and there is a difference. [...] If they came up with the cure today and I got better instantly, I could win myself a Nobel Prize in medicine for proving that depression was caused not by anything in the brain as previously thought, but by damage to a few cubic centimeters of nervous tissue in the spinal cord. Because I guarantee I’d pop up and be feeling as merry as a lark in about one second. [...] My problem is not depression. [...] There is no problem with my reasoning powers. [...] So if I say, “Paraplegia prevents me running. A life without running is not worth living. Therefore, my life is not worth living.” you might not agree with one of my premises, but there is no question of whether I’m being reasonable. This is similar to Frankl’s argument in Man’s Search for Meaning, and in fact Clayton spends an entire section talking about Frankl. He has a few disagreements with the book, but he has no gripe with the core message. Clayton decides to die because he had meaning in his life—and then the accident took it all away: Probably the life of a deaf man would be good enough for me, or that of a mute or a man missing a leg or an arm. But not the life of a paraplegic. There is not enough left for me. [...] The life I dreamed of and loved with all my heart is gone forever and there is nothing I can do about it. And it’s not just slightly changed, but utterly devastated. [...] My skills as a carpenter, roofer, plumber, gardener, all devastated. My ability to conduct my everyday life with wonderful efficiency, devastated. The wonderful way I was able to relate to other people, devastated. My sex life, devastated. My social life, devastated. [...] I am who I am, I love what I love, and given what I need from life, existence is no longer tenable for me. Some readers may look at that list and call him shallow. Even if that were so, that doesn't change his argument. Maybe most people don't place having sex, controlling one's bowels, and running through the woods as the quintessence of life-affirming values, but I'd be willing to bet that they're still important. Reading this book should prompt a moment of introspection. If you disagree with Clayton’s list above, then reflect on what does give your life meaning. No, seriously, make a list: family, friends, partners, children, hobbies, skills, etc. Write them down. Cross out one entry at random. How would you feel if you lost that entry? Would you still have enough left over to carry on? Probably. Now cross out a few more. Lose your partner. Lose your children. Lose your parents. Your siblings. Your best friend. Your favorite hobby. How do you feel? Still worth it? Add in some physical negatives: chronic pain. Constant nausea every time you eat. Losing feeling and control of your bowels, your legs, your genitals, your diaphragm, your non-dominant hand, your dominant hand, both arms. What about loss of sight? Hearing? Speaking? Communicating at all? What about ending up like the title character in Johnny Got His Gun, where he is left with no legs, no arms, and is rendered blind, deaf, and mute? What would life be like as a disconnected brain in almost complete sensory deprivation? How much would you have to lose before your life stops being worth living? That list—and the dividing line between "worth it" and "not"—is different for everyone. The decision to end one's life is deeply personal. Clayton happened to draw the line at a particular point. Others may agree or disagree, but Clayton’s judgment was his own. Decision in hand, next comes the hard part. The Roadblocks I did not want much from the world in dying. To be able to put my affairs in order without fear of being taken prisoner and treated like I was insane. To say goodbye to those I loved without the same fear. To die a painless death without worrying about leaving behind something gruesome. And to be comforted as I died. When a person has absolutely nothing left and is facing annihilation, all he wants is not to be alone. For Clayton, killing himself is not a simple matter. At the time only one US state, Oregon, had any kind of “Death With Dignity” law on the books. However, this law only allowed assisted suicide for terminally ill patients with less than six months to live, while Clayton’s condition was stable. The slightest whisper of suicidal ideation would have gotten him locked up in the psych ward. He has to write his book in secret, he has to lay his thoughts out for the world in secret, and he has to die in secret. Becoming paralyzed destroys him on two fronts—the disability itself, and the fact that he is completely, utterly, devastatingly alone with his feelings. He writes Two Arms and a Head because he needs to show the world how agonizing it is to face death alone and how important it is for physical-assisted suicide to become—and stay—legal. How empty to exist in this universe and share your feelings and experience with nobody! But that is how you, the world, have left me to die, alone. But what you don’t realize is this: in turning your backs on me, you have turned your backs on yourselves. [...] Someday you will be on your deathbed and maybe you will remember me. What I say to the world is that if you don’t do something about the way death and assisted suicide are dealt with, you may someday find yourselves in an unimaginably horrible situation with no way out. [...] Beware! There could be a horrible fate waiting for you and if you don’t all get together, look each other in the eye, recognize the insanity, and change the laws, you could wake up tomorrow as a head on a corpse with no way out for the next thirty years. A lingering question you might be asking is: if he cared so much about it, then why didn’t he become an activist to get it legalized? The Overton Window was shifting. Washington state would pass a bill a few months after his death, and it would be legalized in Montana by a court case in 2009. Several more states would follow suit in the mid-2010s. He could have shared his experiences far and wide and joined the burgeoning movement that existed back then. He was a law student at Vanderbilt for crying out loud; surely he could have enlisted the help of at least a couple of his colleagues? No one but him could have answered that, though I suspect that the answer is because he didn’t want to. He found his existence to be so ghastly that he didn’t want to stay in it for a second longer than necessary. The only reason he lasted as long as he did was because he wanted to finish the book. He chose to leave Two Arms and a Head as his legacy for the world, and nothing more. We’ve gone over the state of the cure over the last ~15 years. Has there been any progress on amending the laws for physician-assisted suicide? The State of MAiD Medical Assistance in Dying (MAiD) is currently legal in a patchwork of countries and US states. The exact rules, restrictions, and methods vary. In most places that have legalized it, the patient’s condition must be considered terminal (i.e. death is expected within six months) to be eligible for MAiD. The procedure itself is typically either an IV injection administered by a nurse, or a prescription cocktail of benzodiazepines, digoxin, and opioids which patients drink themselves. In Canada and the Netherlands, MAiD is also available to patients with a disability that does not present as immediately terminal. The Netherlands currently includes severe treatment-resistant mental illness as a qualifying condition, and Canada will follow suit in 2027. So it sounds like Clayton got his wish, at least in Canada and parts of Europe. Now, when a Canadian ends up in a terrible accident, they have a choice in the matter of whether they want to spend the next few decades as a quadriplegic head-on-a-corpse. Phew. However, it’s not all smooth sailing. It seems like every few months there’s another horror story in the press coming out of Canada or Europe. Two news stories came out in quick succession in late March/early April 2024—one from Canada, the other from the Netherlands. In Canada, a 27-year-old autistic woman with no disclosed physical symptoms was granted the right to proceed with MAiD by an Alberta court. The story broke after her father sued to try and stop her. In the Netherlands, a 28-year-old woman has decided to pursue MAiD due to her treatment-resistant clinical depression and borderline personality disorder. Her MAiD is scheduled for sometime in May 2024. At the time of this writing, she has yet to undergo it. These stories are nothing new. They certainly sound dreadful. Diving into every big story from the last ten years would be beyond the scope of this review, but let’s return to the one about the 27-year-old autistic Canadian woman who was granted MAiD. Both the Calgary Herald and CBC framed the story as a grieving father desperately trying to prevent his autistic daughter from being led astray by unethical doctors cherry-picked by the Alberta Health Service. The father insists that his adult daughter is physically healthy, albeit “vulnerable and not competent” to make medical decisions due to her autism and ADHD. Despite this, the judge has allowed MAiD to proceed anyway. Meanwhile, reading the actual court decision shows that the legal issue at hand is whether the woman is required to disclose the physical ailment(s) that led to two doctors approving MAiD. The judge ruled that the woman is competent to make her own medical decisions, and that she is not required to disclose her diagnosis to either her family or the court. The father has since filed an appeal. (July 2024 Update: the appeal hearing was subsequently scheduled for October 7, 2024 - six months in the future. Not willing to wait that long, the woman began a voluntary stoppage of eating and drinking (VSED) on May 28. The hearing was rescheduled for June 24. However, the woman continued to refuse food and water going into June. The father withdrew his appeal on June 11. It is unknown whether the woman has undergone MAiD at this time of this update.) She is not choosing MAiD because of autism or ADHD. We don’t know what her physical diagnosis is. We only have the father’s insistence that “her physical symptoms, to the extent that she has any, result from undiagnosed psychological conditions.” That’s the father’s words, not a physician’s, and not the patient’s. Neurodivergence does not bestow immunity against all the nasty ailments that can cut someone down in their twenties. I’m not accusing every news piece about MAiD of being similarly sensationalized, but I’m not not accusing every MAiD story of being similarly sensationalized. Despite so many of these stories not holding up to their headlines, many remain opposed to the expanded rules. There is a massive contingent of activists who want to keep MAiD illegal. Not Dead Yet Clayton had a particular amount of ire directed at one prominent anti-MAiD disability rights org: Not Dead Yet. Not Dead Yet (NDY) was founded in 1996 by the same people who lobbied to get the Americans with Disabilities Act passed a few years prior. As the name implies, they reject the notion that death could ever be an acceptable response to living with a disability. Like any activist org worth their salt, they have a convenient Talking Points page where they lay out all the reasons why they’re opposed to MAiD. They argue that MAiD is deadly discrimination against disabled patients, with current programs having insufficient safeguards to prevent foul play. NDY argues against a medical field that has decided that death is preferable to disability. They insist that they are not against individual autonomy; patients will always be free to commit “un-assisted” suicide if they truly wish to die. The page opens by explaining that MAiD is necessarily a disability issue, even in places where MAiD is only available to the terminally ill. Although people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. When terminally ill patients get polled on why they are choosing MAiD, it turns out that avoiding pain isn’t the primary motivation. In Oregon, where MAiD is only available for the terminally ill, every patient fills out a questionnaire when they apply for the program. Tallying up all the surveys from 1998–2023, to top reasons are: “Losing autonomy” (90%)
Inline links: Source, Prof. Geoffrey Raisman's, As of 2016, As of 2022, NervGen Pharma, Phase 1b/2a clinical trials, Medical Assistance in Dying (MAiD), late March, early April, These stories, are nothing new, CBC, court decision, filed an appeal, May 28, withdrew his appeal on June 11, Not Dead Yet, Talking Points, In Oregon,
Meetups Everywhere 2025: Times and Places
August 29, 2025 · Original source
This year we have meetups planned in over a hundred and eighty cities, from Alberta, Canada to Wellington, New Zealand. Thanks to all the organizers who responded to my request for details, and to Meetups Czar Skyler and the Less Wrong team for making this happen.