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The American Way of Death

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This ProPublica expose on the hospice-industry-trending-toward-nationwide-racket is fascinating and depressing. A couple of excerpts:

It might be counterintuitive to run an enterprise that is wholly dependent on clients who aren’t long for this world, but companies in the hospice business can expect some of the biggest returns for the least amount of effort of any sector in American health care. Medicare pays providers a set rate per patient per day, regardless of how much help they deliver. Since most hospice care takes place at home and nurses aren’t required to visit more than twice a month, it’s not difficult to keep overhead low and to outsource the bulk of the labor to unpaid family members — assuming that willing family members are at hand.

Up to a point, the way Medicare has designed the hospice benefit rewards providers for recruiting patients who aren’t imminently dying. Long hospice stays translate into larger margins, and stable patients require fewer expensive medications and supplies than those in the final throes of illness. Although two doctors must initially certify that a patient is terminally ill, she can be recertified as such again and again.

Almost immediately after the AseraCare takeover, Farmer’s supervisors set steep targets for the number of patients marketers had to sign up and presented those who met admissions quotas with cash bonuses and perks, including popcorn machines and massage chairs. Employees who couldn’t hit their numbers were fired. Farmer prided herself on being competitive and liked to say, “I can sell ice to an Eskimo.” But as her remit expanded to include the management of AseraCare outposts in Foley and Mobile, she began to resent the demand to bring in more bodies. Before one meeting with her supervisor, Jeff Boling, she stayed up late crunching data on car wrecks, cancer and heart disease to figure out how many people in her territories might be expected to die that year. When she showed Boling that the numbers didn’t match what she called his “ungodly quotas,” he was unmoved. “If you can’t do it,” she recalled him telling her, “we’ll find someone who can.”

Farmer’s bigger problem was that her patients weren’t dying fast enough. Some fished, drove tractors and babysat grandchildren. Their longevity prompted concern around the office because of a complicated formula that governs the Medicare benefit. The federal government, recognizing that an individual patient might not die within the predicted six months, effectively demands repayment from hospices when the average length of stay of all patients exceeds six months.

But Farmer’s company, like many of its competitors, had found ways to game the system and keep its money. One tactic was to “dump,” or discharge, patients with overly long stays. The industry euphemism is “graduated” from hospice, though the patient experience is often more akin to getting expelled: losing diapers, pain medications, wheelchairs, nursing care and a hospital-grade bed that a person might not otherwise be able to afford. In 2007, according to Farmer’s calculations around the time, 70% of the patients served by her Mobile office left hospice alive.

Another way to hold on to Medicare money was to consistently pad the roster with new patients. One day in 2008, facing the possibility of a repayment, AseraCare asked some of its executive directors to “get double digit admits” and to “have the kind of day that will go down in the record books.” A follow-up email, just an hour later, urged staff to “go around the barriers and make this happen now, your families need you.”

You may be able to guess where this is going:

Forty years on, half of all Americans die in hospice care. Most of these deaths take place at home. When done right, the program allows people to experience as little pain as possible and to spend meaningful time with their loved ones. Nurses stop by to manage symptoms. Aides assist with bathing, medications and housekeeping. Social workers help families over bureaucratic hurdles. Clergy offer what comfort they can, and bereavement counselors provide support in the aftermath. This year, I spoke about hospice with more than 150 patients, families, hospice employees, regulators, attorneys, fraud investigators and end-of-life researchers, and all of them praised its vital mission. But many were concerned about how easy money and a lack of regulation had given rise to an industry rife with exploitation. In the decades since Saunders and her followers spread her radical concept across the country, hospice has evolved from a constellation of charities, mostly reliant on volunteers, into a $22 billion juggernaut funded almost entirely by taxpayers.

For-profit providers made up 30% of the field at the start of this century. Today, they represent more than 70%, and between 2011 and 2019, research shows, the number of hospices owned by private-equity firms tripled. The aggregate Medicare margins of for-profit providers are three times that of their nonprofit counterparts. Under the daily-payment structure, a small hospice that bills for just 20 patients at the basic rate can take in more than a million dollars a year. A large hospice billing for thousands of patients can take in hundreds of millions. Those federal payments are distributed in what is essentially an honor system. Although the government occasionally requests more information from billers, it generally trusts that providers will submit accurate claims for payment — a model that critics deride as “pay and chase.”

Jean Stone, who worked for years as a program-integrity senior specialist at the Centers for Medicare and Medicaid Services, said that hospice was a particularly thorny sector to police for three reasons: “No one wants to be seen as limiting an important service”; it’s difficult to retrospectively judge a patient’s eligibility; and “no one wants to talk about the end of life.” Although a quarter of all people in hospice enter it only in their final five days, most of the Medicare spending on hospice is for patients whose stays exceed six months. In 2018, the Office of Inspector General at the Department of Health and Human Services estimated that inappropriate billing by hospice providers had cost taxpayers “hundreds of millions of dollars.” Stone and others I spoke to believe the figure to be far higher.

Some hospice firms bribe physicians to bring them new patients by offering all-expenses-paid trips to Las Vegas nightclubs, complete with bottle service and private security details. (The former mayor of Rio Bravo, Texas, who was also a doctor, received outright kickbacks.) Other audacious for-profit players enlist family and friends to act as make-believe clients, lure addicts with the promise of free painkillers, dupe people into the program by claiming that it’s free home health care or steal personal information to enroll “phantom patients.” A 29-year-old pregnant woman learned that she’d been enrolled in Revelation Hospice, in the Mississippi Delta (which at one time discharged 93% of its patients alive), only when she visited her doctor for a blood test. In Frisco, Texas, according to the FBI, a hospice owner tried to evade the Medicare-repayment problem by instructing staff to overdose patients who were staying on the service too long. He texted a nurse about one patient: “He better not make it tomorrow. Or I will blame u.” The owner was sentenced to more than 13 years in prison for fraud, in a plea deal that made no allegations about patient deaths.

A medical background is not required to enter the business. I’ve come across hospices owned by accountants; vacation-rental superhosts; a criminal-defense attorney who represented a hospice employee convicted of fraud and was later investigated for hospice fraud himself; and a man convicted of drug distribution who went on to fraudulently bill Medicare more than $5 million for an end-of-life-care business that involved handling large quantities of narcotics.

Once a hospice is up and running, oversight is scarce. Regulations require surveyors to inspect hospice operations once every three years, even though complaints about quality of care are widespread. A government review of inspection reports from 2012 to 2016 found that the majority of all hospices had serious deficiencies, such as failures to train staff, manage pain and treat bedsores. Still, regulators rarely punish bad actors. Between 2014 and 2017, according to the Government Accountability Office, only 19 of the more than 4,000 U.S. hospices were cut off from Medicare funding.

Because patients who enroll in the service forgo curative care, hospice may harm patients who aren’t actually dying. Sandy Morales, who until recently was a case manager at the California Senior Medicare Patrol hotline, told me about a cancer patient who’d lost access to his chemotherapy treatment after being put in hospice without his knowledge. Other unwitting recruits were denied kidney dialysis, mammograms, coverage for lifesaving medications or a place on the waiting list for a liver transplant. In response to concerns from families, Morales and her community partners recently posted warnings in Spanish and English in senior apartment buildings, libraries and doughnut shops across the state. “Have you suddenly lost access to your doctor?” the notices read. “Can’t get your medications at the pharmacy? Beware! You may have been tricked into signing up for a program that is medically unnecessary for you.”

Some providers capitalize on the fact that most hospice care takes place behind closed doors, and that those who might protest poor treatment are often too sick or stressed to do so. One way of increasing company returns is to ghost the dying. A 2016 study in JAMA Internal Medicine of more than 600,000 patients found that 12% received no visits from hospice workers in the last two days of life. (Patients who died on a Sunday had some of the worst luck.) For-profit hospices have been found to have higher rates of no-shows and substantiated complaints than their nonprofit counterparts, and to disproportionately discharge patients alive when they approach Medicare’s reimbursement limit.

A huge factor here is that long-term care for chronically ill elderly people is so poorly managed in this country that lots of families have to go broke just to become eligible for government-funded programs. And naturally the line between “the chronically ill” and “the terminally ill” is often very fuzzy — quite profitably so, this being America and all. And when it becomes profitable to move people back and forth between these categories, well we’re good at that too, even if it sometimes requires “nudging” some recalcitrant “terminally ill” patients that aren’t cooperating with their diagnosis.

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diannemharris
4 days ago
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Capitalists against the free market, an endless series

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“I’m not just the CEO, I’m also a member!”

Elon explaining why he decided to ditch his Moderation Star Chamber or whatever and just make the decision to unilaterally restore the account of every fascist who asked for it is revealingly stupid, dishonest, and incoherent:

Shorter Elon: “I must accept every Nazi’s request to be on this website because activists broke an imaginary deal by forcing corporations to not want to advertise on a site I took over for the sole purpose of putting more Nazis on it.”

Seriously, this is the kind of shit Elon thought it was so important to platform he overpaid at least $20 billion for a social media site [TW: justifications of hate crimes present and future from massive dorks]:

To make an unoriginal observation, you can make a point out of hosting people who will say that victims of hate crimes had it coming for the offense of being human beings in public around children, or you can run a site that makes money by selling lots of advertising to Fortune 500 corporations, but you can’t do both. WOKE activists aren’t the reason (some) major corporations don’t want to be associated with hatred and fascism. If you were too deeply immersed in a bubble of reactionary twaddle about a version of “free speech” that has no relationship to any remotely defensible definition of the concept to understand that it’s on you.

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diannemharris
13 days ago
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fxer
14 days ago
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> the revenue left because elon musk is an absolute dipshit who doesn’t know how to run a company that isn’t larded up with government subsidy money
Bend, Oregon
fancycwabs
7 days ago
My man should totally make up the advertising shortfall of his Free Speech Machine out of his own pocket until advertisers see how great it is and return of their own volition.

A thought experiment: what if we talked about the over-60s’ screen time the way we talk about young people’s screen time? – Hi, I'm Heather Burns

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Yesterday’s news cycle gave me a chance to tease out an idea that’s been in my head for quite a while. The news in question was the revelation that

Young people now watch almost seven times less broadcast television than people aged over 65, according to a report from regulator Ofcom. It said 16 to 24-year-olds spend just 53 minutes watching TV each day, a two-thirds decrease in the past 10 years. Meanwhile, those aged 65 and over spend just under six hours on average watching TV daily.
-Source: https://www.bbc.co.uk/news/technology-62506041

I teased out that thought in a thread, which follows below. But first:

I’ve long been troubled by the hypocrisy of the UK’s obsession – moral panic, really – about young people, screen time on mobiles and devices, and the content they consume there; a hypocrisy born of the fact that as anyone knows, that statistic showing six hours of average TV viewing by the older generations is a generous underestimate, and one which does not even address the content they are taking in.

I’ve never understood the sanctimony about the need to “protect” young people from excessive screen time, when almost literal all-day TV viewing isn’t just central to older people’s daily lives: it’s a subsidised benefit, via free TV licenses, which is held to be something of a sacrament. This country wants them to live that way. And twelve years of Tory austerity cuts mean there’s very little else for them to do, and not much they can afford to.

And yet. It’s always about young people and mobiles; that other cohort remains sainted and untouchable.

They shouldn’t be.

This is, in fact, something I feel very strongly about, personally. I’ll tell you why; scroll down to the line if you just want to get to the policy thought experiment.

I watch very little TV. In fact, there are weeks when I might turn it on once or twice to watch live news. That’s partially because TV is just not my thing; it’s partially because I have tons of other ways I’d rather spend my time; and it’s partially what I’ve come to call my postmarital therapy, and the taking back control of my own life.

I wasted what should have been the best years of my life being a part of a family whose life, like so many British families, revolved around the television. The goddamn thing had to be on every waking minute, no exceptions, tuned into the most banal programming possible. This was not a family that got deep into box sets which pushed the boundaries of the craft of film and television. This was a family that stared at 40’s derring-do war films, 50s melodramas, 60s nostalgia, 70s cop shows, 80s murder mysteries, 90s game shows, and 00’s property and antiques porn – so much fucking property and antiques porn – plus a topsoil layer of nonstop WWII documentaries.

All day. All week. All month. All year. All the time. All there was.

And all devoured with the rapturous attention of religious penitents. Anything that interrupted that rapture, such as my rude attempts at conversation, or the suggestion of hobbies which did not involve the TV, were regarded as if I’d just slapped them in the face.

Let me tell you how deep the TV obsession ran in that family: we did not eat family meals around a table. We did not have a table. That family had never owned a table. There was no table. There were plastic trays, on your lap, in front of the TV. Family dialogue around the table? Ha. They’d shout answers at the game show, between taking slurps of their food off their laps like farm animals taking a feed. No other conversation was respected.

My suggestions to eat shared family meals at a table, the way I was raised – which quickly but briefly turned into desperate pleas, immediately abandoned – were met with a mix of mockery and xenophobia by the family I’d married into. Whodye hink you are? That’s no how we do things here hen. No, this was a family which did things exactly the way they have always been done, and exactly the way they were raised, and that meant eating off trays in front of the TV, engaging in the day’s worship of motherfucking Pointless.

“Pointless” indeed.

And so it came to pass that my own child was raised by her proper British family in the proper British way too: eating plastic meals off a plastic tray in front of the television. My say in my own child’s life, that is, my wish to raise her according to my unacceptable immigrant customs of making home-cooked meals that we could eat together at a table, was not even considered. In this democracy, I was outvoted by the natives.

I acquired a disgusting, nicotine-stained 70s folding table, which I used in a brief and desperate attempt to create family table mealtimes. That lasted about a week. It ended up being used once a year, for about 45 minutes, on Christmas day, while (you guessed it) staring at the television. The table served, rather symbolically, as an ashtray the other 364 days.

I did all that while forging a new career in the world of tech policy, where there is a hell of a lot of legislation being crafted around the idea that what young people see on a screen, and how long they look at that screen, is somehow the greatest moral risk to our society; and I did that all the while engaging in the emotional trench warfare of trying to create any sort of family life with people in their 50s, 60s, and 70s that did not involve staring zombie-eyed and slack-jawed at cock-sucking Flog It.

I failed, at that, but fortunately I failed upwards.

I eat meals, in the life I live now, at a table. I eat them alone, because my marital family – as you can tell – imploded up their own backsides. But in many ways, I was always eating alone, even when I was in that family, perching a plastic tray on my lap while they stared at the glowing box like they’d dropped acid.

So it’s not at all bad, in fact.

Because a life where you have to fight for your family’s respect against A Place In The Sun isn’t a life worth living. And a family which regards you as being in the way of the telly, rather than being a reason to turn it off, isn’t a family that’s worthy of you.

But please, yes, tell me again about young people and screen time and content and moral decay, and how the mobiles they’re engaging with are somehow a greater risk to their character than their own parents and their own grandparents and the family traditions they hold so dear, such as laughing in your face when you suggest shared family mealtimes around a table, a suggestion which might lead to talking to each other, listening to each other, and being present in that shared moment with each other. Tell me all about it.

Because I have all the time in this world, alone in this world, after the only family I had left in this world self-immolated in the bright glow of the TV screen, to hear it.

Here’s a padded-out version of a thread I posted on Twitter in response to the Ofcom story about screen time consumption and the generation gap. For the slow people at the back, the thread is actually about the UK’s online harms framework, and the Online Safety Bill, but also touches on other issues such as school device monitoring, the tagging of asylum seekers, and employer surveillance. In fact, everything I’ve included here is something I have heard said in these debates, either in public or behind a closed door.

This is a thought experiment built around the idea, as I’ve titled this blog post, exploring what would happen if we talked about older people, their screen time, and their content consumption with the same hand-wringing sanctimony we use to discuss young people, their screen time, and their content consumption. If the mere existence of that experiment offends you – perhaps, like the family I wrote about above, you’ve been culturally conditioned to regard any questioning of the older generations as something between blasphemy and first-degree murder – should you really be working in this field?

Right then.

Given how the over-65s are devoting more than six hours a day to screen time, which anecdotally is a LOT of subjectively harmful content about Nazis and (property) porn, shouldn’t we be looking after them – and their wellbeing – with safety tech, in-home monitoring, and a duty of care?

Surely if they have a telly box anyway, those tech wizards can wizard up a way to know the age and identity of the viewer, what they’re watching, and at what time? And to give family members the ability to see that granddad is watching that 18-hour-long documentary about Rommel again?

And surely the companies can report this to the necessary authorities, to keep people safe?

And surely, all that big data about viewers and the content they’re consuming can be used to do good things, like map the percentage of under-40s in a community who do not own a home against the percentage of over-65s in that community who spend at least five hours a day consuming Bargain Cash Property Grand Makeover In The Sun?

And surely that data from the tellybox duty of care scheme, correlating low home ownership with high property porn consumption, would be used by the Secretary of State for Digital, Culture, Media, and Sport to declare property porn a form of legal but harmful content, and restrict it as if it is actual porn; because if the lack of access to affordable homes isn’t the greatest existential threat facing our young people today, then what is?

Now surely the tech wizards can just activate the camera on the magic device tellybox thingmy to take a screen shot of the room every 60 seconds, to check on the over-65s? To see who else is in the room and if they’re alone and such? It’s for statutory safeguarding purposes.

And the wizards should also activate the microphone thingmy on the box, so that companies and families can listen in to who the over-65 is talking to, in case it’s a scammy scammer trying to do a scam. That Big Tellybox refuses to perform this duty of care is nothing short of intransigence.

Big Tellybox must also be forced to pay a levy which will fund a deradicalisation programme for vulnerable, lonely men over the age of 60 who have been radicalised by endless playlists of harmful content glorifying fascism, racism, and war, and who now pose a risk to their societies and local communities. To prevent further radicalisation, the further dissemination of any televised content on WWII would be strictly limited by the Secretary of State.

Given the hunger winter ahead, it would also make great sense to require the over-65s to “check in” by being in front of the tellybox – say, five times a day, at specific times – or else the authorities are alerted. The check-ins are facial scans, to monitor their wellbeing.

The tellybox monitoring can also be used to monitor the home help care, in order to punish them for being four hours late because they’re covering two other people’s shifts because the others are off with covid.

Now surely the data collected from the tellybox duty of care scheme should influence fiscal policy decisions, to wit, staring at a non-interactive screen for over six hours a day is clearly both a leisure activity and a lifestyle choice, which can and should create a furious policy debate on why young workers who will never know pensions or retirement are being forced to subsidise the leisure lifestyles of people who, by definition, can afford not to work?

And surely the over-75s’ protests in defence of their leisure lifestyles would be swiftly shut down with patronising advice reminding them to cut out Netflix, takeaway coffees, smartphones, and cheap holidays in order to save up that £13 per month?

And surely in addition to the smart data from the tellybox duty of care scheme bringing a short, swift, and sharp end to free TV licenses for leisure lifestyles, that data can be used to bring payments for TV licenses onto a far fairer footing, as with utilities: to wit, surely an over-60 who can afford not to work and who watches five times as much TV as a young worker should be paying five times as much for the license?

This experiment could (and should) run on, but for now I hope I’ve made the point clear:

if legislation grounded in sanctimonious moral panic about young people and their screen time cannot stand up to those very same rules being applied to old people and their screen time, then it cannot stand up at all.

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diannemharris
26 days ago
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acdha
27 days ago
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Washington, DC
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God’s big money cheaters

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Make AiG’s nightmare a reality!

Churches already have so many unwarranted privileges that it’s simply being greedy when they also flout the few laws that constrain them. ProPublica exposes what we already knew was happening everywhere: churches ignoring the law to meddle in politics.

ProPublica and The Texas Tribune have found 20 apparent violations in the past two years of the Johnson Amendment, a law that prohibits church leaders from intervening in political campaigns. Two occurred in the last two weeks as candidates crisscross Texas vying for votes. The number of potential violations found by the news outlets is greater than the total number of churches the IRS has investigated for intervening in political campaigns in the past decade, according to documents obtained through the Freedom of Information Act.

Under the law, pastors can endorse candidates in their personal capacities outside of church and weigh in on political issues from the pulpit as long as they don’t veer into support or condemnation of a particular candidate. But the law prohibits pastors from endorsing candidates during official church functions such as sermons.

Violations can lead to the revocation of a church’s tax-exempt status.

Oooh, what a terrifying punishment.

Since the IRS has been unable to enforce the law, I suggest cutting through all the hesitations and simply revoke the tax-exempt status of all churches. There’s no legitimate reason that setting up a panhandling shop and calling it a god’s house should make its owners free of property and income taxes. Start rendering unto Caesar what is Caesar’s, you know.

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diannemharris
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Therapy Isn’t for Everyone. Let’s talk about the people harmed by… | by Devon Price | Human Parts

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diannemharris
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iridesce
39 days ago
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DC
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"Eden in the East" - Southeast Asia as the epicenter of prehistory

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I suppose everyone is startled when they first encounter these passges in the Epic of Gilgamesh:
"What I had loaded thereon, the whole harvest of life I caused to embark upon the vessel; all my family and all my relations, The beasts of the field, the cattle of the field, the craftsmen, I made them all embark.  I entered the vessel and closed the door...

For six days and nights Wind and flood marched on, the hurricane subdued the land.  When the seventh day dawned, the hurricane was abated, the flood which had waged war like an army; the sea was stilled, the ill wind was calmed, the flood ceased. I beheld the sea, its voice was silent, And all mankind was turned into mud! As high as the roofs reached the swamp;...

I beheld the world, the horizon of sea; Twelve measures away an island emerged; Unto Mount Nitsir came the vessel, Mount Nitsir held the vessel and let it not budge... When the seventh day came, I sent forth a dove...
These words [more at the link] were inscribed onto clay tables in Ninevah centuries before the Bible was assembled.

What I didn't realize until reading Eden in the East is that there are some 500 flood myths from around the world - not just from the Middle East, but also in northern Europe, North America, China and the far East.  This book undertakes the immense task of collating the flood myths in search of a unifying hypothesis.   

I'll offer just a bare-bones thumbnail sketch.  Everyone agrees that the world has experienced marked changes in sea level since the appearance of Homo Sapiens, the most dramatic of them occurring when changes in the global climate resulted in melting of the glaciers:


The time scale in Figure 1 above goes back to 18,000 years before the present - about the time that early humans were traversing Beringia (on land or via near-shore vessels) from Asia to the Americas.  Note that early in human prehistory (10-15,000 years ago), sea levels around the world were 50-100 meters lower than their present levels.


Figure 3 above "zooms in" on the third world-wide flood about 8,000 years ago, and shows geologic evidence of that rise in regions as far apart as the Arabian Gulf, the Caribbean, and Southeast Asia.

Those glacial melts flooded continental shelves around the world - as for example Doggerland:


That land between GB and Europe was above water and inhabited by modern humans, and if you dredge the bottom of the North Sea, you can haul up artifacts from that era.

I bookmarked Doggerland years ago as blogworthy material, but for now I'm going to shift back to Eden in the East.  Oppenheimer notes that there was an immense low-lying coastal landmass between what is now Thailand/Cambodia/Vietnam and what is now Borneo/Mayasia - the undersea area now referred to as "Sundaland."


Oppenheimer uses this area as the focus of his book, and postulates that cultural diffusion from this Sundaland may have spread to Austronesia, the Indian subcontinent, Mesopotamia, and then worldwide.

That's the big picture.  Here's a smattering of excerpted tidbits - starting with the science of the megafloods:
"Around 12,500 years ago, not long after the first flood, pottery appeared for the first time in southern Japan.  Some 1500 years later there is evidence of pots being made in China and Indo-China.  These examples of pottery making antedate any from Mesopotamia, India or the Mediterranean region by 2500-3500 years.  Stones for grinding wild cereal grains appeared in the Solomon Islands... as early as 26,000 years ago, whereas they were not apparently used in Upper Egypt and Nubia until about 14,000 years ago..." [p. 18-19]

"The third dry cold period was interrupted suddenly around 8000 years ago by an event which, although only discovered in the last decade, has been described as 'possibly the single largest flood of the [past two million years]'.  The melting Laurentide ice cap had dammed up vast volumes of fresh water in glacial lakes occupying a third of the land area of eastern Canada...  Geologists have calculated that the combined surface area of these glacial lakes... exceeded 700,000 square kilometres... Calculations of the total unfrozen water volume discharged instantly vary between 75,000 and 150,000 cubic kilometres - enough to raise the global sea-level by 20-40 centimetres instantaneously...  The centre of the ice cap that was also flushed out through the Hudson Strait, however, would have rapidly added another 5-10 metres to the sea-level..." [33-35]

"This last rapid rise in global sea-levels was presumably also responsible for breaching the Hellespont and flooding the partially desiccated Black Sea... Bill Ryan and Walt Pitman... who discovered this flood, suggest that this may  have given rise to the legend of Noah's flood.  This is possible for the Middle East, but it does not explain all the other 500 flood stories from around the rest of the world." [38]

"Southeast Asia has the highest concentration of flood myths in the world.  It is an area with few large river deltas and no recent reputation for flooding, but it lost more than 50 per cent of its landmass after the Ice Age." [62]

"... the strong likelihood of superwaves arising from the crustal strains when the Laurentide ice sheet of Canada collapsed and melted around 8000 years ago... The release of energy from the Earth's crust would have produced waves rolling across the Pacific and inundating all shores and flat hinterlands in direct line..." [107]
The excerpts above are from Part I of the book, which details the geologic events that would have produced widespread flooding. Part II shifts the focus to how the displacement of large coastal populations by the floods could have led to the diffusion of knowledge/customs/technologies from southeast Asia to other parts of the world, using new information from linguistics, anthropology, and genetics.
"I believe that Southeast Asia was the centre of innovations after the Ice Age and long-distance seeding of ideas from the region led to technological breakthroughs elsewhere.  The Austronesians may have contributed sailing technology, magic, religion, astronomy, hierarchy and concepts of kingship.  The Austro-Asiatic speaking people may have contributed the more down-to-earth skills of cereal farming, and even bronze.   A combination of all these traits was necessary for the first city-builders of Mesopotamia..." [221]

"If there were so many bad riverine floods in Mesopotamia, as the sedimentary record shows, one very bad one would not be remembered so long.  Instead the recurrent aspects would be recalled.  The myths from around the world do not usually refer to periodic river floods.  In any case most flood myths come from island Southeast Asia, which, unlike Mesopotamia, lost most of its alluvial flood-plains after the great melt when the Ice Age ended." [227]

"After 200 pages of concentrated flood myths he [Sir James Frazer] concluded that such ancient myths were widespread on every continent except Africa...  A large proportion of the Earth's surface was permanently lost to settlement and agriculture somewhere between 18,000 and 5000 years ago as a result of the sea-level rising...  Africa, with narrow continental shelves, would have been relatively spared... " [230-232]

"There is now general agreement that the stories of Noah's Flood and the floods of the Sumerians, Babylonians and Assyrians are related, although there is no agreement on the original source... There are now at least eleven related Ancient Near Eastern versions, including the two in Genesis and Berossus's account of Xisuthros.  The three Assyrian versions were committed to tablet in the seventh century BC.  This was perhaps a hundred years before the writing of the Priestly account in Genesis, but probably well after the Jehovistic account, for which a date is still under discussion.  The two surviving Babylonian accounts were written thousands of years earlier, somewhere between 1850 and 1500 BC..." [242-8]

"Frazer lists fifteen Greek flood stories in his Folklore in the Old Testament, twelve of which record a mountain landing." [258]

"A number of the Moon stories I have sketched contain the number seven.  I have suggested the lunar week as a possible origin for the use of this numeral... After one, two, and three, the number seven appears more frequently in Old World sacred texts than any other number.  This applies particularly for the Bible, the Koran, Babylonian texts and the Egyptian Book of the Dead...  Although five is a prime... the number of fingers on a hand and a half unit in the decimal system it is not more common in sacred texts than expected... [345-6]

"And did God first mould a model from blood and clay and blow into it to give it life?  Did he take the bone, Ivi, from man's side among the dark rainforest trees of Southeast Asia?.. Stories of the creation of humanity are universal.  They can be divided into two main varieties, people evolving from a totem, such as a tree or animal, and the creator fashioning man from clay.  These two archetypes have distinct distributions which overlap most dramatically in eastern Indonesia.  The merging of these two themes in that location eventually resulted in the beautiful and mysterious story of the Garden of Eden... In this chapter we trace the origin of the Genesis version of the clay-man myth from Southeast Asia... Polynesian informants insisted on the antiquity of stories stating that the first woman, who came from a bone in the man's side, was called Eevee/Ivi (the word for a bone in many eastern Polynesian languages).  Yet most of the Christian ethnographers assumed a missionary source for these stories rather than the disturbing possibility of a more ancient origin... It is likely that they were unaware of the widespread ancient distribution of the story elsewhere and thus could simply not believe their informants.  This selective bias is discussed at length by Sir James Frazer." [355-9]

"The Garden of Eden story holds a cherished place in Western literature... Yet the Genesis writers assembled this story less than three thousand years ago from a selection of fertility and immortality myths that were in common circulation at the time.  The separate elements of these myths are still to be found today in Southeast Asia and Melanesia."  [382]

"The tree of knowledge played centre stage throughout the snake's temptation of Eve.  The tree of life, however, remained in the wings unnoticed until it was nearly too late and Jehovah realised that Adam and Eve could eat from that too, and become immortal like Him.  He therefore shooed them out of the garden before they could gain immortality as well as knowledge... Frazer's view was that there were originally two trees, but that the tree of knowledge of good and evil had really been the tree of death contrasting with the tree of life.  This hypothesis may explain the verses:
'But of the tree of the knowledge of good and evil thou shalt not eat of it: for in the day that thou eatest thereof thou shalt surely  die.' (Genesis 2:16-17)
Clearly, humankind did not die on that day of the Fall, but instead became mortal." [384]

"In certain Aboriginal cultures, the Moon was regarded as a deity with the secret of immortality because it 'died' for three days every month, subsequently renewing itself during the first half of the next month." [386]

"The location of paradise has always worried Bible scholars, particularly since the lush forest description given in Genesis fits so poorly with anything we know about the environment of ancient Mesopotamia.  Rainfall may have been better 6000-7000 years ago, but nothing fits the picture of paradise as well as tropical jungles such as in Southeast Asia.  Both ancient Mesopotamians and Egyptians described their respective sites as far across the water towards the rising Sun, that is in the East." [405]
This is an impressive book, extensively annotated with relevant references from the literature.  I first encountered it shortly after its publication about 20 years ago, and after being duly impressed by the scholarly writing I set it aside for a re-read "sometime in the future" (that future having arrived this year).  I think it is sometimes erroneously grouped with the fantasy books about Atlantis or ancient aliens, but the existence of the "drowned continent" of Southeast Asia is factual, and the hypotheses presented here are eminently logical.

The book has probably "too much information" for the casual reader, so for the TL;DR crowd I can recommend the final ten-page "Epilogue" as a reasonably concise summary.  I've already created a mega-post here and I'm tired of typing, but I'll close by adding several excerpts from the Epilogue:
"In their partial rejection of diffusion as the reason for these links [between diverse cultures], folklorists of the twentieth century have had to propose the only two other possible causes of similarity: chance and the inner workings of the human mind.  While chance may operate for single obvious motifs, such as the worship of the Sun, I have shown that it is statistically extremely unlikely that complex story-types, sharing from three to ten distinct motifs, could have occurred more than once.  Yet this is what would have to happen for the distribution of myths in a diagonal band across Eurasia - with Polynesia at one end and Finland at the other - to have all occurred independently.  That these were the core myths that were preserved so carefully by the Mesopotamian, Middle Eastern and Egyptian civilisations can also be no coincidence.  All the main stories in the first ten chapters of Genesis are found in this cultural band and all occur in the Far East: the watery creation, the separation of skies and earth, the creation of man from red earth, and Eve from his side, the Fall, Cain and Abel, and, of course, the flood.  With the exception of the flood, the relative paucity of evidence for these complex story-types elsewhere in the Americas and Africa not only supports diffusion as a reason for the distribution, but also argues against both chance and the 'inner workings of man's brain' for their similarities."

"If we can accept the statistical evidence of trans-continental relationships in myths, then the dating of the first written versions of the Eurasian myths becomes crucial.  We are lucky here, since the Sumerians and Babylonians were so assiduous in recording the motifs on tablets and cylinder seals.  The date bracket that comes out of such an enquiry reveals that the myths, with their religious connotations, were among the first of all written records in the third millennium BC.  Since in the majority of cases the structure and content of the Mesopotamian myths show them to be derived from earlier Eastern versions, we may suppose that the direction of diffusion was East-to-West, and that the date of diffusion may be been earlier than the beginning of the third millennium.  This means that East-West cultural links may be older than 5000 years.  Such cultural links could only have occurred if there were people in Southeast Asia to hold the stories, and that they were capable of traveling to India and Mesopotamia to transmit them... The Sumerians and Egyptians themselves wrote about the skilled wise men from the East, a fact often dismissed as the embellishment of a fertile imagination."

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diannemharris
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hannahdraper
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mareino
36 days ago
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"the first woman, who came from a bone in the man's side, was called Eevee/Ivi (the word for a bone in many eastern Polynesian languages)."
Washington, District of Columbia
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