very efficient to take a rapist, robber and assailant off the streets in one fell swoop

A musician has created a never-before attempted woodwind instrument that produces bone-rattling low notes and stands taller than the average adult: the subcontrabassoon.

When Richard Bobo was learning to play the bassoon in 8th grade, he read about a mythical instrument called the subcontrabassoon in a Guinness Book of World Records, made by a 19th century musician. It would be able to produce sounds similar to that of a large pipe organ, at two octaves below the regular bassoon, and one octave below the contrabassoon. Prototyping such an instrument had never been attempted before.

It turned out that the Guinness Book of World Records was wrong, he said, and such an instrument didn’t actually exist. “However, just because a true subcontrabassoon didn't exist historically did not mean it could not exist,” Bobo told Motherboard. “As I began my career as a professional contrabassoonist (with a tangent as a machinist/CAD designer at my dad's shop), I held out hope that someone would come along and make this myth real. Eventually, I realized that no one else was rushing at the opportunity, and that my background might make me the best (or, at least, most willing) choice.” 

Bobo presented his creation at the International Double Reed Society in Boulder, Colorado in July. It weighs almost 32 pounds (not including metal keywork) and stands at around six feet tall—even taller depending on how the player needs to adjust the endpin for their own height. Wood is lighter than plastic, but he made this prototype using a 3D-printer and ABS plastic, with a support frame of welded stainless steel.

3D printing pieces of an instrument of this size and complexity is a feat in itself. Bobo’s Prusa MK3S printer limits prints to 200mm, this meant that the initial prototype was made of printed pieces that composed the subcontrabassoon’s multiple segments, which he then bonded together. The bonding process wasn’t robust enough for Bobo, however, so he designed his own custom 3D printer, a 200x200x600mm modification of the RatRig Vcore 3.

“With this, I am able to make the majority of the pieces for the next prototype in one solid piece, with no need for bonding,” Bobo said. He’s also switching to ASA plastic that’s less susceptible to warping and UV rays (just in case he needs to drag this thing outside for a plein air concert) and plans to switch to an aluminum frame to cut down on the weight. 

Bobo’s big bassoon won’t be stuck in a hypothetical setting for long. In January—if all goes according to plan with further prototyping—the subcontrabassoon will be used in a live performance of the Symphony of Northwest Arkansas. “The part is small,” Bobo said, “but if everything works out it will be the live premiere of an instrument that was, until just a few years ago, firmly in the realm of unicorns or the philosopher's stone.”

Beyond that, he’s trying to keep an open mind about where the project will go. “Maybe there will come a day when every serious symphony orchestra has a subcontrabassoon on hand, and maybe I'll even live to see it,” Bobo said. “But that's a high bar; even 180 years after its invention, the saxophone is not yet a regular member of the orchestra. But perhaps, like the saxophone, the subcontrabassoon will find a niche in other genres of music. Perhaps, like the contrabass clarinet and contrabass flute, it will have a home in chamber music written for instruments of the same family.”

Ten years ago this week I thought I would write a piece to offer a useful metaphor for straight white male privilege without using the word “privilege,” because when you use the word “privilege,” straight white men freak out, like, I said then, “vampires being fed a garlic tart.” Since I play video games, I wrote the piece using them as a metaphor. And thus “Straight White Male: The Lowest Difficulty Setting There Is” was born and posted.

And blew up: First here on Whatever, where it became the most-visited single post in the history of the site (more than 1.2 million visits to date), and then when it was posted on video gaming site Kotaku, where I suspect it was visited a multiple number of times more than it was visited here, because Kotaku has more visitors generally, and because the piece was heavily promoted and linked there. 

The piece received both praise and condemnation, in what felt like almost equal amounts (it wasn’t; it’s just the complainers were very loud, as they often are). To this day the piece is still referred and linked to, taught in schools and universities, and “living on the lowest difficulty setting” is used as a shorthand for the straight white male experience, including by people who don’t know where the phrase had come from.

(I will note here, as I often do when discussing this piece, that my own use of the metaphor was an expansion on a similar metaphor that writer Luke McKinney used in a piece on Cracked.com, when he noted that “straight male” was the lowest difficulty setting in sexuality. Always credit sources and inspirations, folks!)

In the ten years since I’ve written the piece, I’ve had a lot of time to think about it, the response to it, and whether the metaphor still applies. And so for this anniversary, here are some further thoughts on the matter.

1. First off: Was the piece successful? In retrospect, I think it largely was. One measure of its success, as noted above, is its persistence; it’s still read and talked about and taught and used. Anecdotally, I have hundreds of emails from people who used it to explain privilege to others and/or had it used to explain privilege to them, and who say that it did what it was meant to do: Get through the already-erected defenses against the word “privilege” and convey the concept in an interesting and novel manner. So: Hooray for that. It is always good to be useful.

2. That said, Upton Sinclair once wrote that “It is difficult to get a man to understand something when his salary depends upon his not understanding it.” In almost exactly the same manner, it is difficult to get a straight white man to acknowledge his privileges when his self-image depends on him not doing so. Which is to say there is a very large number of straight white men who absolutely do not wish to acknowledge just how thoroughly and deeply their privileges are systemically embedded into day-to-day life. A fair number of this sort of dude read the piece (or more perhaps more accurately, read the headline, since a lot of their specific complaints about the piece were in fact addressed in the piece itself) and refused to entertain the notion there might be something to it. Which is their privilege (heh), but doesn’t make them right.

But, I mean, as a straight white dude, I totally get it! I also work hard and make an effort to get by, and in my life not all the breaks have gone my way. I too have suffered disappointment and failure and exclusion and difficulty. In the context of a life where people who are not straight white men are perhaps not in your day-to-day world view, except as abstractions mediated by television or radio or web sites, one’s own struggles loom large. It’s harder to conceive of, or sympathize with, the idea that one’s own struggles and disappointments are resting atop of a pile of systemic privilege — not in the least because that implicitly seems to suggest that if you can still have troubles even with those many systemic advantages, you might be bad at this game called life.

But here’s the thing about that. One, just because you can’t or won’t see the systemic advantages you have, it doesn’t mean you don’t still have them, relative to others. Two, it’s a reflection of how immensely fucked up the system is that even with all those systemic advantages, lots of straight white men feel like they’re just treading water. Yes! It’s not just you! This game of life is difficult! Like Elden Ring with a laggy wireless mouse and a five-year-old graphics card! And yet, you are indeed still playing life on the lowest difficulty setting! 

Maybe rather than refusing to accept that other people are playing on higher difficulty settings, one should ask who the hell decided to make the game so difficult for everyone right out of the box (hint: they’re largely in the same demographic as straight white men), and how that might be changed. But of course it’s simply just easy to deny that anyone else might have a more challenging life experience than you have, systemically speaking. 

3. Speaking of “easy,” one of the problems that the piece had is that when I wrote the phrase “lowest difficulty,” lots of people translated that to “easy.” The two concepts are not the same, and the difference between the two is real and significant. Which is, mind you, why I used the phrase “lowest difficulty” and not “easy.” But if you intentionally or unintentionally equate the two, then clearly there’s an issue to be had with the piece. I do suspect a number of dudes intentionally equated the two, even when it was made clear (by me, and others) they were not the same. I can’t do much for those dudes, then or now.

4. When I wrote the piece, some folks chimed in to say that other factors deserved to be part of a “lowest difficulty setting,” with “wealth” being primary among them. At the time I said I didn’t think wealth should have been; it’s a stat in my formulation — hugely influential, but not an inherent feature of identity like being white, or straight, or male. This got a lot of pushback, in no small part because (and relating to point two above) I think a lot of straight white dudes believed that if wealth was in there, it would somehow swamp the privileges that being white and straight and male provide, and that would mean that everyone else’s difficulty setting was no more difficult than their own.

It’s ten years on now, and I continue to call bullshit on this. I’ve been rich and I’ve been poor and I’ve been in the middle, and in all of those economic states I still had and have systemic advantages that came with being white and straight and male. Yes, being wealthy does make life less difficult! But on the other hand being wealthy (and an Oscar winner) didn’t keep Forest Whitaker from being frisked in a bodega for alleged shoplifting, whereas I have never once been asked to empty my pockets at a store, even when (as a kid, and poor as hell) I was actually shoplifting. This is an anecdotal observation! Also, systemically, wealth insulates people who are not straight and white and male less than it does those who are. Which means, to me, I put it in the right place in my formulation.

5. What would I add into the inherent formulation ten years on? I would add “cis” to “straight” and “white” and “male.” One, because I understand the concept better than than I did in 2012 and how it works within the matrix of privilege, and two, in the last decade, more of the people I know and like and love have come out as being outside of standard-issue cis-ness (or were already outside of it when I met them during this period), and I’ve seen directly how the world works on and with them. 

So, yes: Were I writing that piece for the first time in 2022, I would have written “Cis Straight White Male: The Lowest Difficulty Setting There Is.” 

6. Ten years of time has not mitigated the observation about who is on the Lowest Difficulty Setting, especially here in the United States. Indeed, if anything, 2022 in the US has been about (mostly) straight white men nerfing the fuck out of everyone else in the land in order to maintain their own systemic advantages. Oh, you’re not white? Let’s pass laws to make sure an accurate picture of your historical treatment is punted out of schools and libraries, and the excuse we’ll give is that learning these things would be mean to white kids. You’re LGBTQ+? Let’s pass laws so that a teacher even mentioning you exist could get them fired. Trans? Let’s take away your rights for gender-affirming medical treatment. Have functional ovaries? We’re planning to let your rapist have more say in what happens to your body than you! Have a blessed day!

And of course hashtag not all straight white men, but on the other hand let’s not pretend we don’t know who is largely responsible for this bullshit. The Republican party of the United States is overwhelmingly straight, overwhelmingly white, and substantially male, and here in 2022 it is also an unabashedly white supremacist political party, an authoritarian party and a patriarchal party: mainstream GOP politicians talk openly about the unspeakably racist and anti-Semitic “Great Replacement Theory,” and about sending people who have abortions to prison, and are actively making it more difficult for minorities to vote. It’s largely assumed that once the conservative supermajority of the Supreme Court (very likely as of this writing) throws out Roe v. Wade, it’ll go after Obergefell (same-sex marriage) as soon as a challenge gets to them, and then possibly Griswold (contraception) and Loving (mixed-race marriage) after that. Because, after all, why stop at Roe when you can roll civil rights back to the 1950s at least?

What makes this especially and terribly ironic is that when game designers nerf characters, they’re usually doing it to bring balance to the game — to put all the characters on something closer to an even playing field. What’s happening here in 2022 isn’t about evening up the playing field. It’s to keep the playing field as uneven as possible, for as long as possible, for the benefit of a particular group of people who already has most of the advantages. 2022 is straight white men employing code injection to change the rules of the game, while it’s in process, to make it more difficult for everyone else. 

So yes, ten years on, the Lowest Difficulty Setting still applies. It’s as relevant as ever. And I’m sure, even now, a bunch of straight white men will still maintain it’s still not accurate. As they would have been in 2012, they’re entirely wrong about that. 

And what a privilege that is: To be completely wrong, and yet suffer no consequences for it. 

— JS

In a racist society, science and technology and medicine automatically becomes racist in practice. It’s not just the Tuskegee Experiments either. Here is a grotesque and horrifying example of this right now.

Jordan Crowley was born with only one shrunken kidney to clean his blood. As he gets older, his one kidney gets sicker.

Jordan is now 18, loves dogs, and is more interested in telling me about his college classes than the fact that he was recently hospitalized for seizures, a complication of his illness. He’ll need a kidney transplant soon. He would be closer to getting that kidney transplant, if only he were categorized as white.

A patient’s level of kidney disease is judged by an estimation of glomerular filtration rate, or eGFR, which normally sits between 90 and 120 in a patient with two healthy kidneys. In the United States, patients can’t be listed for a kidney transplant until they’re deemed sick enough—until their eGFR dips below a threshold of 20.

Jordan is biracial, with one Black grandparent and three white ones. His estimated GFR depends on how you interpret this fact: A white Jordan has a GFR of 17—low enough to secure him a spot on the organ waitlist. A Black Jordan has a GFR of 21.

Jordan’s doctors decided he is Black, meaning he doesn’t qualify. So now, he has to wait.

Huh?

Knowing how well a patient’s kidneys can clean their blood is important for countless medical decisions, from diagnosis of kidney disease to proper medication dosing. It’s difficult to calculate kidney function quickly—doing so once required patients to store a full day’s worth of urine in their refrigerators so physicians could look at what the kidneys had successfully filtered out of the body. In 1999, a major study in the Annals of Internal Medicinepainstakingly measured the GFR of more than 1,500 patients to develop a model that could more easily predict how well the kidneys were working using just a rapid blood test and some math; the resulting number is known as the estimated GFR, or eGFR. The equation—which has been formally cited more than 15,000 times in the literature—was quickly folded into medical practice and remains a standard of care today.

The formula focuses on creatinine, a byproduct of muscle activity and one of the many things that the kidney is supposed to remove from blood. Generally, when creatinine levels in a patient’s blood are high, it signals that the kidneys are struggling to do their job of filtering toxins; this makes creatinine levels something of a proxy for overall kidney health. But things get more complicated when you consider that people vary in shape and size, have different muscle mass in their bodies, and therefore have different amounts of creatinine in their blood to start with.

Indeed, during development of the mathematical model, authors found that overall, the population of Black patients in their study had higher levels of creatinine in their blood compared with the group of white patients. The authors reasoned this was likely because “on average, black persons have higher muscle mass than white persons.” They added a race-based coefficient to correct for what they assumed must be naturally high levels of creatinine in Black patients, recommending that doctors inflate the eGFR of patients by 21 percent “if Black.”

This eGFR multiplier can make Black patients with kidney disease appear healthier than they are. It means that Black patients have to reach higher levels of kidney disease before they are considered sick enough to qualify for certain treatments or interventions. The adjustment is the reason Jordan wasn’t able to register on the kidney waitlist after his first transplant evaluation years ago.

And what does Black in America mean?

Jordan’s grandmother Joyce Kaufman is a white woman who has spent her life as a nursery school teacher and mother to biracial foster children, including Jordan’s mom, Jessica. Jordan is her buddy. Because his health issues made it impossible to enroll him in day care, Jordan has been at Joyce’s side since the day he was born.

Joyce remembers finding out about the GFR race adjustment at a transplant evaluation appointment in 2016. After asking about her grandson’s lab results, a nurse practitioner told her the computer was having a “difficult time” because it didn’t know whether to evaluate Jordan as Black or white.

Kidneys are not white or Black; there are, in fact, no genes, physiologic traits, or biological characteristics that distinguish one race from another. “If you know anything about human genetic diversity and the commonality of human physiology, it just doesn’t make any sense that the simple equation could involve a binary race variable,” says Jay Kaufman. “It’s so illogical that it has to be false.”

Yet, race-based adjustments alter reality for patients like Jordan. A patient’s eGFR determines not just whether he is allowed on the transplant list, but what stage of care he can get: Medicare-covered nutritional therapy and reimbursed kidney disease education kick in at an eGFR of 50; referral to a doctor that specializes in kidney disease is guarded by an eGFR threshold of 30, as is referral to formal transplant evaluation, with the threshold of 20. Again and again, the race-based inflation can delay when Black patients meet cutoffs for resources that offer real survival benefits: Kidney disease patients who have been cared for by kidney specialists, for example, have lower rates of hospitalization and death.

If the race adjustment were eliminated from medical practice, a third of Black patients with kidney disease would be reclassified to a more severe stage, and thousands of Black Americans would receive a diagnosis of kidney disease for the first time, according to a study completed by researchers at Harvard University published in the Journal of General Internal Medicinein October. This increases opportunity for preventive medicine and early treatment, which is important because kidney disease is often silent until the damage is already done.

Because he was born sick, Jordan has been monitored with monthly blood tests for years. But those who don’t receive diagnosis of kidney injury in a timely manner lose out on this extra care, which can increase the risk of “crash” dialysis, wherein patients with no previous preparation suffer severe kidney failure complications like heart arrhythmias, bleeding issues, strokes, or seizures and are urgently placed on dialysis for survival. I’ve seen this done in the emergency department several times. It’s shocking to everyone involved when a patient first learns about their kidney disease the day they are rushed to the hospital for kidney failure.

Now, an old assumption about Black bodies is preventing Black people from receiving timely diagnosis and access to treatment. When authors of the 1999 study added the race adjustment, they didn’t prove the idea that Black patients have higher levels of creatinine due to higher muscle mass. In fact, they never actually measured muscle mass. What’s more, they made this conclusion about fundamental racial difference without controlling for socioeconomic status, education, geography, or other diseases that affect kidney function, like diabetes and high blood pressure.

Our country has been filled with racial inequality from the start, and it’s unsurprising that racism gets under the skin to jeopardize the health and well-being of Black bodies. Racial inequities that limit where people of color live, eat, pray, and breathe can all influence how effectively the kidneys churn urine, producing health disparities in kidney disease and beyond. Other factors, like the amount of protein in a patient’s diet, athletic activity, and dehydration can all directly affect the level of creatinine in someone’s blood. But the authors didn’t look into any of those things and assumed the heightened creatinine had a simple explanation, in increased muscle mass. The authors stopped their inquiry and conclusions short.

Again, this is why there is no “pure science” or “pure medicine.” It’s all impacted by race, even the unquestioned racial assumptions of doctors or scientists or tech guys who may even be well-meaning. So you create ridiculous standards that might make sense to the researchers, but in fact are complete nonsense, combine them with the one-drop rule of race going back to American slavery (the question of what “Black” means of course not relevant to the researchers who probably never took a history course or anything else about race since they were college freshmen when they were “wasting their time in classes that don’t matter to my career”), and then mix them all up in the racist reality of contemporary America.

What does that equation lead to? A lot of dead Black people.

Welcome to America, where race matters for every single question we ask.