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David Frum: What is the future of the conservative movement?

Question: What is the future of the conservative movement? 

David Frum: To understand the future of the conservative movement, you have to begin with the past. The conservative movement that I grew up with, that I’m a creature of, coalesced out of old, old pieces. They coalesced as a governing philosophy in the late 1970s and early 1980s in response to a crisis in American and world society that happened at that time.

The 1970s were a period of tremendous economic strain, social disarray, a loss of a sense of national identity in many countries; crises of so many and so different types it's almost impossible to summarize them. And in this mood of crisis, a lot of the governing ideas that had been in place since the Second World War, and before, suddenly seemed obsolete.

The conservatives stepped forward with a series of answers that called for opening up the micro-economy, making transactions easier, reducing the role of government in the economy, restoring some older notions of how you dealt with social problems and they had, not only in the United States, but around the world, tremendous success.

And that led to faster economic growth in the 1980s and 1990s, it led to a restabilization of a lot of societies; above all, it led to the triumph in the Cold War.

But one of the things that happens with political ideas is when an idea succeeds it also makes itself obsolete, almost as obsolete as an idea that has failed.

Question: Do you see parallels to today?

David Frum: Well, that's where we are today. Where we are today is that we are at the end of a long political cycle that started in the 1970s. And the answers offered by conservatives have become largely exhausted and we're at a moment where advanced societies face a whole series of new problems to which traditional conservatism doesn't offer answers.

Traditional liberalism, of course, doesn’t offer answers either, but that's a different topic.

For example, we had this tremendous acceleration of economic growth; that faster economic growth has created a lot of wealth but it's distributed more unequally than anything we've been used to in almost a hundred years. So that's something that no one really has answers to.

At the same time, in this new and more unequal society, we've had a tremendous restabilization and remoralization of life at the top of society. Elite Americans lead very stable lives, they work harder, they don't abuse drugs, their marriages last, their fertility rates are going up.

But at the bottom of society there is increasing social breakdown and social disarray. It's not universal the way we thought it was in the 1970s, it's confined to the bottom third; but that's a special problem.

We have new environmental problems. We have new problems of migration to challenge all the advances of society, to test both their stability and their tolerance. We have a tremendous problem with fertility, of collapsing birth rates, societies that are no longer replacing themselves. We have new problems of fusing security with new technological possibilities and we have coming on a terrible set of moral problems that arise from our new control over human biology. How far can we go in tampering with human beings?

These are questions that are going to call forth a new kind of politics and they're going to leave a lot of the politics of the 20th century behind.

Question: Who are the leaders of the conservative movement right now?

David Frum: I think we are only at the very beginning of formulating answers to these questions. So I can go on issue by issue, and I can point to some people who have some interesting things to say.

On issues of demography-- I mentioned the problem with birth rates-- my brilliant colleague at the American Enterprise, Nicholas Eberstadt, is one of the great experts on population and its problems. I think, on the environment, we are in the middle of a free-for-all trying to measure the seriousness of our environmental problems and what should be done with them.

I don't know that there are people who are as yet grappling seriously enough with the problems of morality raised by new biological technology. Again, an AE colleague of mine, Leon Kass, has thought very hard about this, but I don't know that we're arriving at answers.

The problems of how do you cope with income inequality, what do we do for national security in a world in which the power of our traditional allies is ebbing--these are ideas we are just so much in the infancy of.

 

Recorded on: May 5, 2008

Frum talks about where conservatives will be after George W. Bush, who the leaders of the movement are and why the 1970s were so important.

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The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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