The return of choice

by Brian on April 11, 2021

in Covid-19,Health,In the News,Science

Jodi Rudoren doesn’t want to go back to the old normal.

The editor-in-chief of The Forward writes that while “of course I desperately wish that not one more person would die or even suffer a single day from this deadly virus [and while] I cannot wait to hug my friends again,” Rudoren nevertheless worries that we’ll snap back to our old ways without “truly learning the lessons this crisis has brought.” 

Her hope? That “we find yet another new normal rather than returning to the one we used to know.”

What might some of that new normal be for Rudoren? No more five day a week commutes. Continued quality time with her children even when they go back to in-person learning. More virtual meetings, events and conferences. 

“I do not want to return to the habit of spending two hours shlepping across town to meet someone for overpriced salads when we could do our business in 30 minutes” over a video meeting, Rudoren says.

Even Zoom shivas have their benefits, Rudoren notes. Smaller groups online enable a more intimate space between mourner and those coming to provide comfort. Ditto for Zoom weddings and bar mitzvahs which allow a greater number of people to attend virtually. Congregations offering Zoom Shabbat services have seen their numbers swell and are not rushing to shut down their live streams so fast.

“There are so many things I don’t want to go back to,” writes Allison Hope for CNN.com. “Coworkers sneezing in open workspaces. Crowded weekend malls. Obligatory birthday brunches. Or cocktail hours of any kind where we have to mingle and make small talk with strangers.”

Hope quotes Tori Neville, a communications professional, who says she “loves working from home and not having to do things just to ‘show face.’ My life is so calm, my anxiety is way down.” 

Indeed, a recent Pew study found that more than 50% of employees don’t want to return to office life.

The pandemic has also been a blessing for introverts. 

“Some of my patients who struggled with social anxiety began flexing their muscles of communication during Covid-19,” clinical psychologist Judith Zackson told CNN. “Being in their own space [at home] increased theirconfidence, openness and reflective thinking.”

It’s also helped with setting priorities. “We know more than ever that our time on this planet is limited,” writes Hope. Is it really “worth meeting up with that old college friend we never really liked so much anyway?”

On a personal level, I was fortunate that my workload never really changed during the pandemic – if anything, it went up as clients with more time on their hands decided to pursue long-delayed book projects and turned to me for ghostwriting.

Still, the immediate period ahead of us heralds the rapid “return of choice” – what to wear, where to go, who to host – and that can be stressful. There are concerts to attend, restaurants to visit, culture to soak up, friends to see.

When everything could be accessed from the comfort of my home computer, I felt very little FOMO (the fear of missing out). Remember all the free Torah classes, yoga lessons and cooking demonstrations that were the rage in the initial months of the pandemic, many of which were recorded so you could watch at your leisure?

The return of choice is, for me, best exemplified when it comes to planning a trip. Now that my wife, Jody, and I are fully vaccinated, we’re eager to visit our families in California whom we haven’t seen since 2019. 

But there are so many parameters to consider. What’s the fastest and/or least likely to be canceled route to take when flights remain inconsistent? Which airlines adhere to Covid-19 safety standards the best? Where can I go for a PCR test before flying? 

When I get overwhelmed by choice, I start to spin. I try to hold all the options in my mind at once and I get stuck making a decision. 

Swarthmore College professor of psychology Barry Schwartz writes about this “paradox of choice” in his 2005 book of the same name. Schwartz visited his local supermarket and discovered on the shelves some 85 varieties of crackers, 120 different pasta sauces, 285 types of cookies, 175 salad dressings and 22 different types of frozen waffles.

All of this choice increases the pressure to make the “best” or “right” decision. But we are happier, Schwartz asserts, when we have only a smaller number of choices. Not no choice, but fewer.

Schwartz advocates consciously limiting one’s options. In my travel case, if there are 20 ways to fly, pick the three or four best routes and don’t search beyond that. If you’ve decided on basic economy, don’t flirt – even for comparison’s sake – with Comfort Plus. 

As we come to the hoped-for end of the pandemic and choice returns, we don’t have to retreat to the old normal of FOMO and spinning. We can – and we must – learn from the experience of the last year. 

“I don’t want to go back to packing in as much as I can, rushing between three parties on New Year’s Day or from store to store,” Rudoren writes. “I am not eager to return to the fear-of-missing-out days where I feel badly about what event I’m not invited to or why our vacation plans aren’t as interesting as the next family’s. I want to buy less, own less, travel less, do less — because I’ve learned that less is more than enough.”

I first wrote about new and old normals for The Jerusalem Post.

Jodi Rudoren’s picture is from her Twitter profile.

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How is a male peacock strutting his plumage like a devoutly religious person praying? Both are engaged in what scientists studying evolution call “costly signaling.” 

Can understanding the origins of this phenomena help lead us out of the crisis between religious and secular in Israel that Covid-19 has exacerbated? 

Costly signaling is when you put out into the world a hard-to-fake signal which serves as a reliable cue of something you’re trying to demonstrate to your peer group.

The male peacock’s plumage is a sexual display. It’s effective because only the healthiest peacocks can maintain a plumage that is so costly to other aspects of a peacock’s life – it can’t fly fast or run away in a hurry; the feathers make it more visible to predators. 

As a result, if you’re not the strongest of peacocks and you try to flaunt such plumage anyway, you stand a good chance of getting eaten. The message to female peahens is that any peacock with all those gaudy feathers must be good to mate with.

The peacock, of course, is oblivious to the evolutionary basis behind his bravura. He isn’t thinking, “let me grow beautiful feathers because that will send a costly signal to any peahens out there.” 

The same process happens with religion, whether that’s wearing a headscarf in Islam, following the vows of chastity in Catholicism or, in Judaism, strictly observing halacha (Jewish Law). 

To one’s co-religionists, these costly behaviors indicate you are a true believer. If you weren’t, why would you go through the super costly – and irreversible – practice of circumcision, the ultimate hard-to-fake signal?

But, like the peacock and his plumage, religious rituals evolved over thousands of years of trial and error, resulting in religion’s case in a system that ensured the smooth functioning of complex societies.

For most of the history of the human species, explains University of British Columbia professor of psychology Azim Shariff, we lived in small groups, usually no more than 150 people. That’s the limit of how many people we can really know well, Shariff said in an interview for an episode of the podcast Hidden Brain

In a compact group, Shariff notes, if you steal someone’s dinner, you’ll be found out pretty quickly. There’s no way to disappear into the crowd.

But with the advent of the agricultural revolution, people started to live in larger groups. Anonymous strangers in these newfangled communities could cheat with impunity.

That’s when the idea of an omniscient God (or gods) began to sprout up. If God could see all and punish you when your actions weren’t in line with the group’s interests, you’d be more likely to cooperate.

The concept of an all-powerful, often angry God as supernatural policeman eventually morphed into the codification of countless religious laws. However, the original meaning got lost along the way. A modern person of faith doesn’t relate to his or her practices as something that culturally evolved from the needs of an orderly community. Rather, when religious leaders insist that marriage must be between two people of the same creed and sexual orientation, it’s because “that’s what God said.” 

If we consider religion as something that evolved for reasons other than pure piety, though, what happens when religious precepts come in conflict with the needs of the individual – or the overall health of society? 

Does God still demand costly signaling in the modern age? Are we mere peacocks or are we reasoning human beings?

This is, sadly, no longer just a rhetorical point. 

During the Covid-19 crisis, some religious groups adopted an extreme form of costly signaling. Demonstrating fidelity to the group meant refusing to stop communal activities of any kind. 

The deadly consequence: people have been forced to sacrifice their lives for the “good” of the group.

Yet that’s the exact opposite of what religion evolved to do in the first place – to create thriving, living cultures.

If, on the other hand, we embrace the evolutionary history of costly signaling and can separate that from the strict laws that define religions today, there may be space for flexibility when it comes to devotional behavior in general and when confronting a once-in-a-century global pandemic in particular.

Looking honestly at the origins of religion could allow us to chill out on some of the thorniest issues regarding synagogue and state. 

Such a worldview doesn’t mean jettisoning religious tradition – on the contrary, observance still brings great meaning to its adherents. Singing together, for example, can sync up the heartbeats of participants, promoting group cohesion. 

Even the religious institutions we think we understand from the past may not be quite what they seem. 

We know, for example, that the Judaism of the First and Second Temple periods was nothing like the rabbinic Judaism of today. But the discovery by Tel Aviv University researchers of remnants of cannabis on a 2,700-year-old altar unearthed at Tel Arad, suggests that the purpose of ancient religious rituals was not only about adherence to halacha but the enhancement of spirit – quite literally – by providing supplicants a sanctioned way to get stoned. 

It’s a shocking supposition but one that can provide hope for crafting future religious practices more in tune with the times. 

If we can accept that costly signaling was religion’s driving evolutionary force rather than fervent faith, then perhaps we can swap such spiritual signaling for a more inclusive and joyful message, one that doesn’t get twisted into a death-defying, anti-science cult.

Religion should get us high – whether psychedelics are used or not. 

Some food for thought as you pass the charoset this Passover eve.

I first wrote about the evolution of God and halacha for The Jerusalem Post.

Peacock image by Irina Blok

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So, it’s come down to this: bribes – as a way of convincing reluctant Israelis to get their Covid-19 vaccinations. 

Discount coupon for use at. Hadar Mall in Jerusalem

It started in Bnei Brak where officials promised free cholent – the traditional Shabbat meat, beans and potato stew –  for anyone coming in to get their jab.

Soon, the food-for-shots program had expanded to include knafeh, the cheesy sweet Middle Eastern dessert, for those getting vaccinated in Jaffa; blintzes and pirozhki in Petah Tikva; and real shots of alcohol at a pop-up vaccination stand outside a bar on Dizengoff Street in Tel Aviv.

Facebook pundits quickly chimed in with their own suggestions: gefilte fish in Givatayim, biltong in Ra’anana (to cater to the city’s South African population), croissants in Netanya (ditto, for French immigrants).

The exchange reached its economic epitome in Jerusalem where the Hadar Mall advertised it was giving out NIS 20 shopping coupons to those getting vaccinated.

The food-for-shots initiative is an indication that Israel is now firmly in the second phase of its speedy vaccination drive.

While those over 50 have enthusiastically embraced the vaccines – Israeli HMO Maccabi reports that it has inoculated 90% of its members in that age group – now it’s time to convince the more hesitant members of society. 

It’s a global challenge: a Kaiser Family Foundation poll found that 45% of Americans said they would either not get the shot at all or would “wait and see.” With infection rates still steep, though, we don’t have that luxury.

What can the world learn from Israel, the vaccination “beta country,” on how to flip the recalcitrant?

Israel was one of the first countries to roll out a “green pass” that allows only fully vaccinated Israelis entry into restaurants, universities and cultural events. It’s a smart carrot vs. stick approach, but it can only go so far. 

There’s a bigger problem and it’s one that no amount of cholent, cocktails or concerts can fix.

We’re getting the messaging all wrong. 

Listen to public health officials anywhere in the world and what you’ll hear is, “Great you’ve been vaccinated. Nothing changes. You still have to wear your mask and continue to social distance. You can’t hug your grandchildren or get on a plane.”

I understand why the communication is so negative: We don’t know conclusively yet whether vaccinated individuals might still be able to pass the virus to others (although we’re collecting data that indicates that’s likely not the case). 

And then there are all those terrifying variants that may make the vaccines less effective.

But “advising people that they must do nothing differently after vaccination, not even in the privacy of their homes, creates the misimpression that vaccines offer little benefit at all,” writes Julia Marcus in The Atlantic. On the contrary, “vaccines provide a true reduction of risk, not a false sense of security,” even for the most virulent variants. 

Yes, the vaccines are not 100% effective, but they are nearly that good at stopping severe cases, hospitalization and death.

“We’re underselling the vaccine,” University of Pennsylvania infectious-disease specialist Dr. Aaron Richterman told The New York Times.

“It’s going to save your life — that’s where the emphasis has to be right now,” Dr. Peter Hotez of the Baylor College of Medicine adds.

Moreover, continuing to eschew even the lowest-risk changes in behavior “discourages the very thing that will get everyone out of this mess: vaccine uptake,” stresses Marcus. 

Public health officials’ motivations are mostly good. It’s just that, “as academic researchers, they are instinctively cautious, prone to emphasizing any uncertainty,” writes David Leonhardt in the Times.

But if there’s no perceived benefit to getting vaccinated, and with many already worried about long-term effects, negative messaging just feeds the public’s fears – the last thing we need. 

The best way to persuade people to act safely is to tell the truth. 

“I think the tendency of the Health Ministry is to create some form of hysteria, maybe in the attempt to push people to vaccinate,” Hadassah Medical Center director general Zeev Rotstein told The Jerusalem Post.

But “not being completely open because you want to achieve some sort of behavioral public health goal — people will see through that eventually,” Richterman says.

A more positive approach comes from Dr. Robert Wachter, chair of the department of medicine at UC San Francisco, who told the Los Angeles Times that, “I think life can be back to normal when you are talking about what two vaccinated people can do together.” 

Or an entirely vaccinated family – like ours.

Last weekend, with our adult children all fully inoculated and a week past their second dose, we held our first Shabbat meal indoors without masks in nearly a year. It felt familiar, fun and fabulous.

The pièce de résistance – and a tantalizing glimpse of post-pandemic “normal life” – was when my wife, Jody, and I spent two nights at a hotel in Mitzpeh Ramon open only to guests who can present a Green Pass or proof of prior Covid-19 infection. 

Beresheet Hotel in Mitzpeh Ramon

Jody and I will still be wearing our masks in public and taking precautions outside our family circle.

But as Fox News contributor Dr. Nicole Saphier summed up the situation regarding what vaccinated people can do, “We have to stop saying no all the time and get to the answer of yes.”

To arrive at that point, let me offer one last bribe: Give everyone a night at a hotel (not a corona hotel), throw in a portion of cholent and a slice of knafeh and watch how fast any anti-vax sentiment melts away.

I first wrote about convincing the anti-vaxxers for The Jerusalem Post.

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“No, no, you’re doing it all wrong,” Ravit, the cannabis pharmacist, told me.

Ravit was referring to the way I was ingesting my cannabis oil by placing a drop on a cookie and swallowing – my own homemade medical marijuana edible.

“You want to put it on a finger and rub it on your gums,” Ravit continued. “Like you do with coke.”

“Coke?” I replied, confused. “You mean Coca-Cola?”

“No, cocaine,” she replied. “What, you’ve never done cocaine?”

“Um, no,” I sputtered in return. 

“But you’ve seen it in the movies, right?” Ravit pressed on.

“I’ve seen actors snort it up their noses,” I said.

“And then they rub what’s left on their gums.”

“Sure,” I said, although the truth is, I never noticed that second step.

Ravit and I were trying to get the dosage right for my second foray into the world of medical cannabis. I had received my first cannabis license from Israel’s Ministry of Health three years ago when I was diagnosed with cancer and wanted a more natural way to counteract the worst side effects of treatment.

At the time, I was mostly interested in CBD, the part of the cannabis plant that doesn’t get you stoned, and which has been all the rage in recent years, showing up in everything from energy drinks to chocolate chip cookies.

CBD didn’t do much for me and my cancer relapsed while I was taking my nightly drops, so I let my medical license lapse.

But when my chronic insomnia took a turn for the worse at the beginning of the Covid-19 pandemic, I began searching for an alternative to the sleeping medication I’ve been hooked on for the last 20 years. 

When I first started taking the pills, they were a godsend. I’d get seven hours of solid shut-eye and could function again. But the duration of my slumber had been steadily decreasing until, by April of last year, I was on double the recommended dose but getting only a paltry four hours of zzz’s. 

That’s a lot of chemicals for not a lot of benefit.

I decided to see a different doctor for my nocturnal malaise. Maybe there were some pills I still hadn’t tried. I didn’t know when I set up our Zoom appointment that my new doc was also a staunch advocate of psychoactive plant use.

Dr. Cannabis told me that I’d essentially exhausted my sleeping pill options. “What you need is a good Indica with a very high percentage of THC,” he proposed. 

There are two main types of cannabis. Sativas rev you up and give you an energetic, happy high. Indicas are sedating and perfect before bed. There’s a handy mnemonic for the latter: Indica – “in-da-couch,” which is where you’ll want to sink after a few puffs.

Dr. Cannabis recommended I start by smoking or vaping, both of which are faster acting than drops. He punched my information into his computer and sent the request off to the Ministry of Health. 

My official diagnosis: PTSD-induced insomnia, which makes sense: My insomnia kicked in big time in 2001 when the Second Intifada was raging and military helicopters were flying over our apartment on their way to Beit Jalla. I would lay awake at night getting more and more stressed.

Once my license was approved, the next step was to procure my cannabis.  

There are a number of cannabis pharmacies dotted around the country. Some are specialists like Pharm Yarok in Netanya. Others are regular pharmacies such as your neighborhood SuperPharm. Each stocks dozens of strains from multiple manufacturers. These days, they come in professional packaging – a cardboard box with a Ziploc pouch inside. 

Medical cannabis use is still a mostly trial and error process. Every body responds differently to the many varieties available. I started with three 10-gram boxes – one each of “Maple Leaf,” “Og Arsi” and “Neptune.” I’ve never been a pothead, so I didn’t know anything about rolling a joint and keeping it lit. I borrowed a vape pen from a friend and started my journey.

After about a month I had worked up to three puffs before bed while weaning off the pills completely for the first time in decades. To my amazement, I was actually sleeping, albeit not consistently. I wasn’t getting any more rest than I was on the last round of meds.

Discouraged, I called up Dr. Cannabis.

“For PTSD you have to take a lot,” he said. “Three puffs is nowhere near enough. You need three, four times that.”

Twelve tokes is indeed a lot, but after a few nights, it began to have the desired effect. Within about 15 minutes, I was so “in-da-couch” that I would fall asleep nearly immediately. But I would still wake up after a few hours. 

It was Ravit who suggested I add a drop or two of Indica oil to the mix, which I picked up on my next pharmacy run.

The oil didn’t prevent me from waking up, but when I did, I would usually fall back asleep. On a bad night, I’d get four hours of sleep. On my best nights, though, I’d be up to six blissful hours – not ideal, but good enough, all things considered.

Is medical cannabis the answer for everyone’s PTSD-related sleep problems? I’m no professional. All I can say is that it’s succeeding for me. For now. 

Now, if you’ll excuse me, I have to rub some more Coca-Cola on my gums. 

I first documented my adventures in medical cannabis for The Jerusalem Post.

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In 2018, a five-episode miniseries called Autonomies aired on Israeli TV. The show depicts an alternate reality where, 30 years ago, a civil war between haredim (the ultra-Orthodox) and Israel’s secular majority broke out. Intense fighting over lifestyle, education, and draft exemptions led the haredim to essentially secede from the State of Israel, declaring Jerusalem as the capital of a new autonomous zone. 

A high wall with checkpoints was erected and travel documents were required to transit in and out of the autonomy, which was now responsible for its own tax collection, police and social services.

Autonomies, the TV show, is fiction, of course, but haredi autonomy is quite real in today’s Israel. 

Non-haredi Israel, while complaining bitterly, has been willing to tolerate this autonomy because, if you don’t live in certain parts of Jerusalem or Bnei Brak, it could be ignored especially when the economy was booming and the army, despite paying lip service to universal conscription, didn’t really want to draft tens of thousands of recalcitrant ultra-Orthodox men.

Then the pandemic hit. 

The same opposition to the rules that has been mainstreamed by many haredi leaders is now killing the rest of the country – in some cases quite literally.

The alarming statistics at this point are well known: Haredim constitute 12% of Israel’s population but, according to January 2021 data from the Home Front Command, as high as 40% of daily Covid-19 cases. The percent of patients testing positive for Covid-19 in the haredi city of Beitar Ilit was 29% in January, compared with just 4% in Tel Aviv. Haredi elderly are dying at three times the rate of secular Israelis.

This translates into a serious impact on the country’s medical facilities. Hospitals in Jerusalem – which has the highest percentage of haredi Covid patients – are so overwhelmed they are sending anyone who needs treatment for Covid-19 out of the city. Tel Aviv Sourasky Medical Center reports that non-essential procedures have been curtailed as staff are reassigned to the Covid department.

Meanwhile, despite Israel’s repeated lockdowns, in the de facto haredi autonomy, stores, schools and synagogues remain open, as if there was no corona and no law. The dual funerals of Rabbi Meshulam Dovid Soloveitchik and Rabbi Yitzhok Scheiner attracted upwards of 20,000 haredi mourners.

“A lesson of the pandemic that might be hard for the secular public to accept is that, in every sense, they and the haredim are living in different countries, writes Dr. Guy Hoshen, director of the coronavirus department at Sourasky, in Haaretz.

The counter to this dystopian prognosis is that the majority of haredim are following the rules, so why vilify an entire community? That may be true, but it hardly means much when infection rates are soaring. As David Horovitz points out in The Times of Israel, “We are not talking about all in the community, but neither about an insignificant minority.”

Jerusalem Post editor Yaakov Katz puts it more bluntly. “What we are seeing is mass insurrection.”

What can be done to shake up this intolerable situation?

Sending in the police clearly won’t work, as we saw when haredi extremists in Bnei Brak attacked authorities and torched a bus to protest enforcement of coronavirus regulations. 

The key to making changes must come through economic incentives that bring the haredi world closer to the Israeli norm. It’s worked in the past. 

Employment among working age haredi men in the late 1970s was above 80%, Prof. Dan Ben-David, an economist at Tel Aviv University’s Department of Public Policy, told me. That was before the ultra-Orthodox parties became part of Israel’s governing coalitions. Once money started flowing to their institutions, haredi participation in the workforce plummeted to just 40%. 

When the short-lived 2013-2015 government that included no haredi parties cut child subsidies and grants to full-time yeshiva students, yeshiva enrollment plunged by 16%.

The cuts didn’t last long – when the government fell after just a year and a half, the incoming coalition restored the cash. The number of yeshiva students, including married men in kollel, subsequently grew by 37% between 2014 and 2018. 

The pandemic may have triggered a tipping point in non-haredi Israel’s acceptance of this status quo. A poll published at the end of January found that 61% of Israeli voters would prefer that the next coalition exclude the haredi parties. That would, in turn, allow legislating desperately needed economic changes.

I despair that a simple alteration in Knesset arithmetic will be enough, though. It would only be a matter of time before the haredim are back in a future coalition and the autonomy would pick up where it left off.

In this respect, maybe full-scale autonomy, like that depicted in the TV show, is the best approach.

Autonomies co-creator Yehonatan Indursky suggests that what he put on screen is actually “not a dystopia [but] the reality that currently exists in Israel.” 

Why not formalize it?

“The ultra-Orthodox should have a defined territory in which they can live their lives without being imperiled,” writes Carlo Strenger in Haaretz. “A federative structure might relieve Israel’s various cultures from [their] fears of being endangered. We all need spaces to breathe.” 

I’m not convinced that’s an acceptable approach – neither practically (where would the borders be drawn?) nor ethically (isn’t it the Jewish people’s goal to create more unity, not less?)

But whether through economic incentives or radical separation, the haredi autonomy in Israel, as it’s currently formulated, “needs to come to an end,” Katz writes. “No one is above the law. Yes, it is hard. But if we don’t act now, it will only get harder.”

Autonomies is streaming on Amazon Prime.

I first wrote about the haredi-secular civil war for The Jerusalem Post.

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Tuesday tiyulim and Wednesday walks: Prescription for a pandemic

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With international travel off the table for the last year, Jody and I have been exploring what’s closer to home. 8 short treks near Jerusalem.

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Writing about health challenges can be a means of turning a bad break into something more positive. You just need a “commitment device.”

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