Consumerist Care

It is true that the medical services Wesley J. Smith defines as “consumerist””such as cosmetic surgery, in vitro fertilization, and Viagra prescriptions”should not be considered basic health care (“Careless Consumerism,” December). But even if coverage included only essential health care, under our current third-party reimbursement system, American health care costs would continue to spiral out of control. The author misses the crucial point: The concept of health “insurance” is fundamentally flawed.

We insure our cars in case of a serious accident, but we don’t expect auto insurance to pay for gasoline and maintenance. Yet this is what we expect from health “insurance” provided by employers and the government. Under this system, there is little incentive for patients or providers to limit overutilization of resources.

The author states that “we will have to draw proper boundaries between the basics that insurance should provide and the extras that people should pay for themselves.” Given the ever-increasing involvement of the federal government in health care, we all know who will be the “we.”

The adjustment that would be most helpful for improving the current health care system would involve shifting to high-deductible policies that combine catastrophic health insurance with health savings accounts (HSAs). The true cost of care would not be concealed from patients, patients would become true consumers of medical services, and market forces would eventually compel providers to lower fees. For example, the price of the Lasik eye procedure, usually not covered by insurance, has decreased 70 percent.

In 2006, Indiana added an HSA option for state employees. By August 2012, 90 percent had signed up. Consequently, employee premiums are much lower, and the state has achieved a 35 percent reduction in the cost of providing medical care for its workers.

Governor Mitch Daniels explained in a 2010 Wall Street Journal article that “what seems free will always be overconsumed, compared to the choices a normal consumer would make . . . . A system built on ‘cost-plus’ reimbursement (i.e., the more a physician does, the more he or she gets paid) coupled with ‘free’ to the purchaser consumption, is a machine perfectly designed to overconsume and overspend. It will never be controlled by top-down balloon-squeezing by insurance companies or the government.”

In a distinctly American (and Catholic”remember the concept of subsidiarity) resolution to the health care crisis, the truly indigent could still be covered by a greatly shrunken Medicaid-type program or by private charities. The vast majority of the population would receive comprehensive and truly cost-effective medical services.

Michael Wulfers, M.D.
Cape Girardeau, Missouri


While one may argue that the prevalence of “consumerist” procedures ranging from Botox to IVF for lesbians is a function of a more liberal, tolerant society, another (unexamined) reason is the balkanized, opaque health care system that legally eschews the use of economic analysis in treatment decisions. The main threshold for insurance approval is if a procedure is “experimental.” The consequence of this emphasis on outcome rather than cost is clear: Any procedure supported by enough data, or that fulfills a broad societal need, is likely to be approved.

Wesley J. Smith’s proposed solution to this problem would be to exclude obvious “consumerist” services from “basic health care.” However, ambiguity reigns: Botox, which for one individual may be consumerist, may for another be a key treatment for depression or Parkinson’s disease. A treatment system based on a priori definitions would lead to a far more centralized and byzantine health care system than even that proposed under the ACA.

Ironically, NICE (England’s National Institute for Health and Clinical Excellence), the target of Smith’s rhetorical vitriol, presents the most tractable solution. NICE has arguably developed the world’s most transparent and comprehensive cost-effectiveness framework analysis to judge what treatments will be paid for by taxes. Each analysis includes an explicit definition of the treatment’s target subpopulation, assessment of the treatment’s clinical effectiveness, and its contribution to an individual’s quality of life vis- -vis the cost of the actual therapy.

When Smith predicts that health care reform will lead to more “consumerist” procedures, he fails to take heed of NICE’s constructive role. Although the U.K. currently approves some of the procedures, it also has denied coverage for many “consumerist” treatments not deemed cost-effective, and perhaps more important, it has led a societal debate on whether taxpayer money should be used for these procedures. Either of these actions would be a pipe dream in the current or future American health care system.

Erik Tollefson
Washington, D.C.


Wesley J. Smith rightly notes that the distinction between medical and consumerist procedures is often difficult to discern. Yet he mischaracterizes in vitro fertilization (IVF), a distinctly consumerist procedure, as a possible medical procedure. He gives examples of excessive uses of the procedure but states that “[IVF] started as a medical procedure intended to help infertile married couples bear children” and that one could argue that such use is medical.

But one could argue that IVF, in itself, is a medical procedure only to the same extent that any of the other consumptive procedures mentioned in the article are medical treatments. Boston College’s Tim Muldoon argues that one cannot accurately call IVF a medical treatment because the procedure treats none of the pathologies that may cause a couple’s infertility. Infertility is “the result of other medical conditions” rather than a medical condition or pathology itself. IVF diverts attention, and therefore resources, away from the real underlying causes of infertility. Such a funneling of resources is especially unjustifiable considering the procedure’s low (30 percent) success rate (evidenced in Centers for Disease Control research).

Andrew Favata
Yonkers, New York

Wesley J. Smith replies:

I thank the correspondents for their letters. Michael Wulfers’ proposal to improve the competitive nature of the American health care system is certainly worth discussing. But the point of my article wasn’t to suggest an alternative to our current mess. It was merely to note that what many call “basic health care” these days is neither. Until and unless we make that elementary distinction, we have no hope of controlling health care costs.

I agree with Erik Tollefson that it is often difficult to distinguish between consumerist and medical procedures. But perhaps not as hard as he implies with the Botox example. It isn’t the type of medication or procedure that should be the prime determinate, but the purpose for its provision. Thus, a medication approved as an efficacious treatment for Parkinson’s could be covered for that use but not for a consumerist use, such as temporarily erasing wrinkles.

As for NICE, it is the kind of “death panel,” the polemical term coined by Sarah Palin, that Americans rightly fear could take hold
under the Affordable Care Act. NICE bases many of its recommendations on the Quality Adjusted Life Year (QALY), which creates invidious distinctions that it uses to justify medical discrimination against certain patients, based on issues such as disability, frailty, age, life expectancy, etc.

The last thing Americans should accept is bureaucrats imposing these kinds of value judgments on patients and families. Moreover, some of NICE’s priorities aren’t based on costs and medical benefits at all but on politics, as my article clearly demonstrates.

Finally, I am not going to argue with Andrew Favata. I think that reasonable people can differ on the medical or consumerist nature of IVF as a treatment for infertility. Moreover, even if IVF is “medical,” that doesn’t mean it should ever qualify as “basic health care.” But, as I wrote at the close of my article, that is a discussion for another day.



Loyalty

A lifetime of experience across cultural lines, including time in the kind of European villages Jean Bethke Elshtain described in her Erasmus Lecture, tells me that regardless of how the relationship between narrow parochialism and loyalty is spun, R. R. Reno’s conclusions may need further expansion (“The Virtue of Loyalty,” December).

It might be that individual experiences during our maturing process are what really set us up to respond favorably to someone in perilous need. The Jews Reno referred to were not necessarily strangers to those sheltering them in Le Chambon-sur-Lignon, and I don’t know anyone who equates loyalty with parochialism.

Across the generations, those in small villages like Le Chambon are more likely to have good interpersonal relationships established between diverse groups based on need via mercenary and human services (the butcher, the baker, the candlestick maker, or even romantic partner) than they are out here in the big city. In light of that and a mature Judeo-Christianity expected at that late date in the twentieth century, the real wonder is how few places there were like Le Chambon-sur-Lignon.

Henry Elden
St. Clair Shores, Michigan

R. R. Reno replies:

Many people are suspicious of religious, ethnic, family, and other forms of particular loyalty, seeing them as signs of condemnable parochialism. Plato worried that the ideal city would be corrupted by the loyalty of parents to their children, which is why he thought that the ruling elite shouldn’t form families. Kant has lots of nasty things to say about the Old Testament, in large part because covenant loyalty works against his ideal of a universal ethic.

To this day it’s taken for granted by most liberals that a strong religious commitment leads to divisive conflict in society. They suppose that we’ll be more cooperative and kind if we carry our loyalties lightly.

Henry Elden observes that congenial pluralism tends to make diverse groups less antagonistic and conduces to friendship. That’s very likely true. But Le Chambon-sur-Lignon was not unique in that regard. So we’re left to wonder: Why did that compact group of obscure villagers remain so courageously loyal to our common humanity when so many during the Nazi occupation were not?

Leadership mattered, of course. Their pastor, Andre Trocmé, was a cosmopolitan man, a pacifist, and in many important ways a liberal. But it was not an abstract universalism that allowed the villagers to unite and undertake their extraordinary conspiracy of goodness. Their loyalty to the truth of Christianity”and to their own collective memory as a persecuted Huguenot minority”seems to have given them the conviction necessary to act courageously.

This, it seems to me, is a paradox of loyalty. It can blind us to the needs of strangers, but it trains our souls for courageous self-sacrifice. We can’t have the one without the other, and in dark times it’s the latter we need most.



Chance and Evolution

Stephen M. Barr is logically and theologically correct in “Chance, by Design” (December). However, like the great majority of Christian commentators, Barr ignores the gorilla in the room. That is, “Did an original first man and an original first woman, from whom all mankind has descended, exist?”

Based upon the traditional teaching of the Catholic Church codified in Pius XII’s encyclical Humani Generis , the existence of a historical first man and woman, which pair committed the original sin, is at the core of Christian theology (Romans 5:12“21). However, if one removes the blinders of received wisdom and examines the evidence from a scientific point of view, that gorilla is only as threatening as a Macy’s Thanksgiving Day balloon. The major difference between human and all other creatures, including extinct near-human ancestors, is the gift of language, which is a manifestation of the spiritual soul.

A number of establishment scientists maintain that the genetic mutation that led to language occurred only once (i.e., in the original “Adam and Eve”). When descendants of the original pair mated with non-language relatives, the offspring with language skills would be more likely to survive. Therefore, even though we have sundry genes from some ten thousand or so ancestors, the one series of genes that comes from Adam and Eve (the genes that make us humans with souls) are the genes for language.

William M. Selenke
Cincinnati, Ohio


After reading the article “Chance, by Design,” I still do not understand what is preventing Christians, and especially Catholics, from adhering to the Intelligent Design theory. Stephen Barr argues that the scientific concept of randomness is consistent with divine providence because we may not comprehend the horizontal causality. But he recognizes that there is always a vertical causality. This means that there was always a design, although we might not have apprehended it while looking at the horizontal causality.

Apparent randomness in statistics seems consistent with our limited capacity of understanding. If we could calculate all the aspects of the movement of tossing a coin, including the precise strength applied by the finger, the angle of the coin, the air resistance, etc., we would be able to know the result in a precise way and not need recourse to statistics. We would know the concrete result from each tossing from the finger. The same would apply to the matter that was spread after the Big Bang.

Stephen Barr’s clarification on the vertical and horizontal causality can help a lot of people to reconcile scientific language with their beliefs. But so does the Intelligent Design theory.

Bernardo Cunha
Washington, D.C.


Stephen M. Barr accurately reported the mainstream view that the mutations that drive evolution are random, i.e., uncorrelated with the adaptational needs of the organism. This has been the Neo-Darwinian synthesis since the 1930s. It is the view held by the majority of scientists, propagated by nearly all textbooks. But it is demonstrably wrong. In fact, it may be the biggest mistake in science.

In the 1940s, Barbara McClintock discovered mobile genetic elements and the phenomenon of transposition. Mobile genetic elements are segments of DNA that nonrandomly move to other parts of the genome, changing the expression of genes and adapting the organism to its environment based on hundreds of chemical signals related to nutrients, environmental threats, chemicals, temperature, salinity, and predators.

At first her discoveries were largely met with derision. But in 1968 James Shapiro of the University of Chicago demonstrated that bacteria have the same capability (see his book Evolution: A View from the 21st Century ). Transposition became widely known in the 1970s, and in 1983 McClintock won the Nobel Prize for her discovery.

David Prescott showed that a protozoan under stress can splice its DNA into 100,000 pieces and reassemble them, making major adaptations in real time. Transposition is how bacteria learn to digest nutrients that they were previously unable to metabolize.

This is akin to a self-modifying computer program that edits its own code and rewrites its own software while the machine is running . There is no known cell type that cannot do this.

Bacteria develop resistance to antibiotics by exchanging DNA with each other and using the same editing capabilities used by transposition to insert new pieces of DNA into their own genomes. A bug can become a superbug in twenty minutes by acquiring resistance. It then begins sharing its newly discovered code with other bacteria. Bacteria adapt faster than antibiotics can kill them. That’s why antibiotic resistance is such a significant problem today.

This too is an utterly nonrandom process. It is demonstrably targeted and teleological behavior, much as seeking food and evading predators is teleological. The only thing that’s not clear is exactly how teleological these adaptations are and to what degree the cell is making predictions when it adapts.

Genetic mutations might follow some sort of structure, perhaps obeying linguistic rules. These mechanisms exhibit well-documented, nonrandom, somewhat predictable patterns. Under extreme stress, organisms massively restructure their genomes. None of these functions are “random” in the sense that any engineer or physicist would use the term.

Perry S. Marshall
Oak Park, Illinois

Stephen Barr, Darwinists, Creationists, and Intelligent Design advocates all seem to miss the point that evolution is inherently nonrandom. A population of self-replicating molecules together with its environment constitute a computer with memory seeking to maximize the population. This is true whether the molecules live in a collective soup or acquire cells and whole organisms as packaging. The 3-D stereochemistry of the self-replicating molecules creates energy barriers that favor some mutations over others, whether they are stimulated by cosmic rays or transcription errors during replication.

Moreover, some transcription errors will be more likely than others for the same reason. Evolution thus proceeds faster than is indicated by calculations assuming strictly random mutations that are then selected or eliminated by interaction between the organism and its environment. In other words, there is inherent in evolution an intelligence that must be acknowledged, regardless of one’s religious beliefs.

John Futterman
Pleasanton, California

An omnipotent God has the power to utilize an evolutionary process characterized in part by “natural selection” and mutation, random or otherwise, to accomplish the same purpose. This, however, is not of any great comfort to the consistently scriptural Christian theist.

Evolution, no matter how it is characterized in detail, involves long ages of animal suffering and death as the “survival of the fittest” process works its wonders during the long ages preceding the advent of mankind. Since it is impossible to invoke animal sin (or the consequences of human sin) as a justifying rationale for this suffering, one who accepts evolution as a historical reality is committed to the proposition that God chose this means of “creation” while having the power to accomplish the same ends without involving any suffering of innocent creatures at all.

This is, plainly, gratuitous suffering, and worthy of the various pagan gods, but not of the God of the Christian faith who declared himself to be Love and his creation to be “very good.” If I believed in the god of the evolutionists, I could tremble before his power and might well seek to placate him for self-interested reasons, but I could never love or truly worship him. He would be, to me, ultimately morally abhorrent.

Barr’s lengthy discussion of randomness presupposes evolution and thus does not involve him in any argument for this thesis. If one assumes that only naturalistic explanations may be sought, then one would indeed be hard pressed to come up with an alternative, and this abductive argument would appear to be quite powerful.

However, this assumption cavalierly begs the question against a teleological explanation, and such an explanation is easily provided: The creator designed the genetic features to perform (or not perform) analogous functions in different organisms, just as an engineer may use a strut or other feature in very different circumstances with different contrivances to serve similar purposes. There is thus no need to posit common ancestry, with the consequence that common ancestry provides no basis for postulating evolution.

Paul Sauer
Lindenhurst, New York

Stephen M. Barr shows that the statistically uncorrelated random processes associated with Darwinian evolution are consistent with the spiritual concept of a divine providence who guides, plans, and thus controls evolutionary events, events such as random mutations that promote survival.

However, the key unanswered question his otherwise excellent article raised in my mind is why these random evolutionary processes are also consistent with the total absence of divine providence. As Barr admits, there is no scientific test for an event planned by God. However, is there neither any empirical evidence of such events? Barr’s metaphor of God as playwright could as easily apply to actors speaking spontaneously without a playwright or script. The “horizontal causality” of nature may be consistent with the “vertical causality” of a Creator, but it does not require it.

Barr’s analysis thus finds divine providence only a possibility consistent with evolution, but not a probability contributing to evolution. But where in our evolving world might empirical evidence of either an impersonal providence or a personal creator be found in evolutionary processes, even if one admits with Barr that such evidence would never be conclusive?

Biologist Martin Nowak of Harvard is showing how evolutionary processes involving cooperation may have been instrumental in propelling our species to its prominence, primarily by encouraging a complexity that provides a robust, unplanned adaptability to unforeseen environmental change or unanticipated challenges to survival. This evolving complexity seems to violate nature’s law of entropy and presents at least some evidence for the unseen hand of a divine (but impersonal ) providence.

Moreover, continuing past the idea of evidence for an impersonal divine providence, is there any empirical evidence of a personal creator? Ironically, if we look at the writings of atheist Arthur Schopenhauer, we find him categorizing human behavior as egoistic, sadistic, and empathetic. He defines virtue as empathy without egoism ; that is, as justice and loving-kindness given freely without expected reward, either in this life or another. When asked the source of this empathetic virtue, he said the source was a mystery.

Is it not amazing that the conclusions of a pessimist and atheist like Schopenhauer align with the main message of Jesus in the Beatitudes? Science seems to be telling us to test the hypothesis: “Other-interest is self-interest.” Martin Nowak has taken up this challenge at Harvard. Considering the work of Barr, Nowak, and Schopenhauer all together, I believe that, eventually, science will not only allow the existence of divine providence, but will provide evidence for that existence that will interest believers and nonbelievers alike.

Dan Biezad
San Luis Obispo, California

Stephen M. Barr replies:

I thank my correspondents for their responses. William M. Selenke makes some interesting suggestions, though I doubt that syntactical language involved just one genetic mutation. The origin of syntactical language remains deeply mysterious. But one certainly does not want to say that there are genes that make us humans with souls. As Pius XII noted in the very encyclical Selenke mentions, the human spiritual soul, with its powers of rationality and free will, cannot be explained merely in biological terms. The Catholic view is that our spiritual nature is supernaturally conferred in a way that supervenes on biological developments but cannot be reduced to them.

Bernardo Cunha thinks that the appearance of randomness is due only to our “limited capacity of understanding,” which makes it hard for us to trace all the natural causes of events, and he attributes the same view to me. A central point of my article, however, was that “randomness and ‘chance’ events occur in our world not because . . . we cannot trace their causes” but because there are many chains of causality that are independent of each other. So even if we traced out the causes of each coin toss (force applied by the finger, movements of the air, air resistance, etc.), there would remain randomness to the extent that the causes of different coin tosses were independent of each other.

He also asks what is preventing so many Christians from “adhering to the Intelligent Design theory.” One “adheres” to a theory (as opposed to considering it seriously) only to the extent that it has been solidly supported by positive evidence.

Perry S. Marshall argues against “the mainstream view that the mutations that drive evolution are random, i.e., uncorrelated with the adaptational needs of the organism.” He thinks it “demonstrably wrong” and adduces Barbara McClintock’s discovery as evidence of this. (The “mainstream” must have overlooked the implications of her work when it awarded her the Nobel Prize.)

But surely Marshall cannot be saying that all mutations in evolutionary history have been tightly correlated with the adaptational needs of organisms. For how then would one explain that most mutations are harmful or neutral and that most species eventually fail to adapt and go extinct?

John Futterman argues that “evolution is inherently nonrandom.” Evolutionary biologists do not claim that evolution is random but that genetic mutations are. Certainly, there are systematic patterns discernible in evolution. For example, the evolutionary process seems to favor the emergence of certain kinds of structure, as shown by the phenomenon of “convergent evolution,” a point that has been strongly emphasized by Simon Conway Morris.

Paul Sauer could never worship a God who created a world in which there is the gratuitous suffering and death of innocent animals. I would think, then, that special creation would be more disturbing to his faith than evolution. For, if all the various types of living things were specially created, what need was there for God to create nonhuman animals capable of suffering in the first place? He could just as well have created only human beings, plants, and animals that were too neurologically simple to experience significant pain and suffering.

Given evolution, on the other hand, animals with highly developed nervous systems are prerequisites for the appearance of man and thus essential to the divine plan. As for the idea that there is “no need to posit common ancestry,” that could be true only if there were not overwhelming empirical evidence for it.

I agree with Dan Biezad that the mere fact of randomness in nature, while consistent with divine providence (which is all I wanted to argue), is also quite consistent with a lack of it. With reference to the analogy of God as playwright, he asks why an atheist couldn’t say that the actors of the play were “speaking spontaneously without a playwright or script.” This reveals an ambiguity in my analogy.

Perhaps matters are made clearer by comparing God to the author of a novel. For a novel, there are no “actors” over and apart from the story itself. The author “thinks up” the whole story, the characters as well as the events in which they are involved. While it is true that one can understand much that happens in a novel with reference only to the horizontal causality operating within it, and can choose to read the novel without giving any thought to its author, it would be absurd to suppose that there could be a novel without an author. And given the existence of an author, his “providential” control over the novel follows.

In other words, the doctrine of providence is a corollary of the doctrine of creation. And the chief evidence for creation is not this or that thing or event, whether it seems providential or not, but the remarkable fact that there are any things and events at all, as well as the equally remarkable fact that these things and events are governed by laws.

Nevertheless, there are specific features of the world in which we live that give added credibility to the idea of providence”for example, the “anthropic coincidences” in the laws of nature, without which we wouldn’t be here. While evolving complexity might be another example, it does not (despite appearances) violate “nature’s law of entropy.”



Islam’s God

David Mills in “While We’re At It” (December) mentions that there is a lot of Islamophobia out there and brings home Richard John Neuhaus’ comment that “Christians, Jews, and Muslims agree that the God we are disagreeing about is the God of Abraham.”

Nevertheless, as Sidney H. Griffith argued in a review in the October 2011 issue, “the Qur’an rejects the entire doctrine of the Trinity, root and branch. Rather than glossing over this difference, the more sound position is to admit the incommensurability of Christian and Muslim views of this radical article of the Christian creed.”

“Does this incommensurability mean that Christians and Muslims worship different Gods?” he continued. “The answer has to be both yes and no. On the one hand, in terms of identity, both Christians and Muslims worship the one God of Abraham, Isaac (Ishmael), and Jacob, the creator of all that is. On the other hand, the Christian confession that the one God of the patriarchs is Father, Son, and Holy Spirit accepts an affirmation about God’s identity that is explicitly denied by Muslims.”

Let’s also note that the Second Vatican Council, highlighting common ground in an effort to extend a friendly hand, carefully states that Muslims “profess” to hold the faith of Abraham, while leaving open the matter of whether Islam actually does. It certainly does not mean that Muslims and Christians regard God in the same way.

Something similar regarding the Trinity could, of course, be said of Jews, as they also reject the Incarnation and the divinity of Christ. But in spite of that, Christians and Jews do worship the same God: Christianity began as an extension of Judaism, affirming faith in the same Scriptures, the same prophets, and many other points of belief. These things cannot be fully affirmed about Islam, which considers itself a correction of Christianity and Judaism, rejecting the Bible as corrupted.

Muslims accept as true that their one and merciful God is the God whom Jews and Christians worship, because that is what is written in the Qur’an (29:46), a book that depicts God and his commands in a very different way from that in which the Bible does, a difference large enough to require of Christian charity that it urgently further missionary efforts among Islam’s followers. As the God of the Bible is the only one there to hear the prayers of the Muslim people, Christians have a duty to share the revelation of the real nature of God with those beloved brothers and sisters.

Alejandro Delaney
Buenos Aires, Argentina



David Mills replies:

All good points. My purpose in conveying the view of the founder was to counter the surprising intensity and frequency of attacks on Islam as Islam, and on Muslims as Muslims. As, for example, another letter received in response to that item, in which the writer declared that Muslims “do the works of their father, the devil” and that Islam “is a religion of force, war, violence, fear, prejudice, hate, murder, slavery, and deception,” and finished by saying he was dropping his subscription.

Alejandro Delaney mentions the careful wording of the Second Vatican Council’s Nostra Aetete , but not the whole statement. The council says that “the plan of salvation also includes those who acknowledge the Creator, in the first place among whom are the Muslims: these profess to hold the faith of Abraham, and together with us they adore the one, merciful God, mankind’s judge on the last day.” Earlier in the statement, the council says (invoking St. Gregory VII), “They worship God, who is one, living and subsistent, merciful and almighty, the Creator of heaven and earth, who has spoken to men.”

Essentially, in other words, what Richard John Neuhaus wrote.



Mics at Mass

When, in his thoughtful essay (“Drop the Mic,” December), Kevin White contrasts the current, microphone-dominated liturgy with the tradition, his point of comparison is the preconciliar low Mass. But the norm was the high Mass”the Mass in which all the parts to be pronounced out loud were sung. The singing of the Mass is actually a hedge against the abuses White recounts. It projects a sacred text throughout a large church in an elevated style suitable to the sacred, without a microphone; with a microphone, the style slips into the chatty, which does not suit the sacred.

White complains that over the microphone, the purposeful distinction in style between the various texts of the Mass is homogenized. But in the sung Mass, these are highlighted by the various melodies to which they are sung. Even the lessons receive a definite distinction of tone: the Old Testament receiving a slightly harsh declamatory tone, the Epistle a highly rhetorical one, and the Gospel a simple but elevated one. Each part of the Mass receives a melody that characterizes its unique function within the whole, purposefully distinguishing it from the others in a way that makes the whole liturgy shine forth as beautiful”not art for art’s sake, but art in the service of the liturgy.

In this kind of high Mass, congregations can participate in singing, especially the ordinary of the Mass, but they can also experience the purposeful recollection elicited by parts sung by the choir or cantor. This is a higher kind of active participation.

The celebrant’s singing of the Mass sets his role apart from that of the others, but also integrates the service and draws the other musical elements into the whole. Indeed, the American bishops’ recent document Sing to the Lord makes a strong exhortation for the priest to sing his parts.

Moreover, when he does so, it is unambiguous that he is doing something quite distinct from the magnified hubbub of microphoned secular activity. Not only is it distinct, but it is also elevated, suited to addressing the most high God. It conveys the sacredness of the liturgy, something we are now beginning to recover with the new translations, with the movement for the singing of the propers of the Mass, and with the singing of the priest.

William Mahrt
Stanford University
Stanford, California


Realism Revisited


On his way to making some good points about Thomas Nagel’s critique of naturalism in Mind and Cosmos (“A Tale of Two Thomases,” December), John Haldane writes that the debate between realists and antirealists “reflects the broad opposition between ‘progressive liberals’ and ‘social conservatives.’” That way of characterizing the debate is misleading.

It is no doubt true that most antirealists are to be found on the left, and that most, if not all, social conservatives are realists, but it is not true that realists are generally social conservatives. Whatever their views about controversial social issues, most scientists are realists of a kind”that is, they believe the principles of logic and mathematics are more than just social constructions or products of human psychology. They believe the discoverable truth about gravity or evolution would be true whether or not anyone discovered it.

Many philosophers who would never describe themselves as social conservatives think the same is true of ethics. Derek Parfit’s On What Matters is just one of many recent efforts to work out a nontheistic ethical realism. In short, Richard Rorty does not speak for most people on the left, nor the pope for most realists. Whether, and why, the mind has any natural symmetry with the cosmos are not questions that can be symmetrically related to ideological categories.

Matthew Boudway
Commonweal
New York, New York


John Haldane replies:


Matthew Boudway is right to point to the fact that the relationship between (a) metaphysical realism and antirealism (views regarding the issue as to whether the structure of the “world” is independent of human thought), (b) objectivism and subjectivism about ethical values, and (c) social conservatism and liberalism is not one of identity. As he observes, one may be a scientific realist and/or a moral objectivist while being a social progressive.

It does not follow, however, that most realists are not social conservatives. One might think of positions with regard to a, b, and c as being points on one and the same rod visible through three windows; or regard them as entirely independent, or”and this is where the interest lies”as being connected not determinatively but in ways that tend to be mutually constraining.

It would take another essay to explore these relationships, and it would have to range across relations of psychological and social influence as well as of reasoned inference. He himself notes that “most antirealists are to be found on the left, and that most, if not all, social conservatives are realists.” It is an interesting question to reflect upon why this should be so.

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