Map of life expectancy at birth from Global Education Project.

Wednesday, June 29, 2011

Then they came for the magnetohydrodynamicists .. .

It's not just biomedical investigators who put up with harassment and death threats, of course. Biologists get them from creationists (I even had a very creepy visitor here once after I posted something evolutionistic), but one of the toughest kind of scientists to be these days is a climate scientist.

It's gotten so bad the American Association for the Advancement of Science has issued a statement, something they don't often do. They begin:

We are deeply concerned by the extent and nature of personal attacks on climate scientists. Reports of harassment, death threats, and legal challenges have created a hostile environment that inhibits the free exchange of scientific findings and ideas and makes it difficult for factual information and scientific analyses to reach policymakers and the public. This both impedes the progress of science and interferes with the application of science to the solution of global problems. AAAS vigorously opposes attacks on researchers that question their personal and professional integrity or threaten their safety based on displeasure with their scientific conclusions. . . .

If anything it's even worse in Australia, which happens to be one of the places on earth that will suffer the most -- indeed is already suffering greatly -- from climate change. (And how do they manage, being upside down all the time? Answer that, round-earthists!) Also this.

Australians also know who gets a big fat chunk of the of the blame for promulgating denialist lies and stirring up the dangerous fanatics -- that would be the Australian expatriate Rupert Murdoch and his evil empire. Can we please stop pretending they are in any way a legitimate journalistic enterprise? Is that too much to ask?

Tuesday, June 28, 2011

True believers

I can't remember the last time I touched on the problem of so-called Chronic Fatigue Syndrome (sometimes called myalgic encephalomyeltis even though there is no real evidence that it is actually associated with encephalomyeltis, which means an inflammation of the brain). It is called a "syndrome" because it is defined by a cluster of syndromes rather than any known etiology (i.e., causal process). The symptoms overlap with those definitive of fibromyalgia, another syndrome of unknown etiology. I would say that the difference is an emphasis in the latter case on pain, and in the former on overwhelming fatigue, but sufferers tend to have some of both. Some people with similar symptoms are convinced they have chronic Lyme disease, but doctors are convinced that there is no such thing, that Lyme disease can be definitively cured by antibiotics.

It is very often the case that when syndromes are identified, it eventually turns out that they don't always have the same cause, that two or more different diseases are behind similar presentations. For example, the same diagnostic label used to be given to tertiary syphilis and to schizophrenia. We now know that syphilis is an infectious disease, but schizophrenia to this day is of unknown etiology and may indeed represent more than one disease.

Psychiatrists and psychologists have found that some people with symptoms of this nature can benefit from cognitive behavioral therapy and from graded exercise -- gradually increasing physical activity levels. Not everyone benefits, but some are ultimately freed of the condition. Weirdly, the mere suggestion that CFS can in some cases be effectively treated through psychotherapy, and publication of these findings, has enraged many people living with the condition to the point where they vilify and threaten physicians and scientists who work in the field. The link is to a subscription-only article in BMJ, but Professor Wessely is quoted as saying, "It's a relentless, vicious, vile campaign designed to hurt and humiliate. for some years now all my mail has been x-rayed. I have speed dial phones and panic buttons at police request and receive a regular briefing on my safety and specific threats."

As the Quackwatch article on chronic Lyme disease reports, the true believers in that disease can be equally vitriolic:

Internet newsgroups also have posted violent polemics against physicians and researchers who disagree with their claims and concerns. Research reports that run counter to the claims of Lyme activists are denounced and their authors accused of incompetence and financial conflicts of interest. Magazines and news organizations whose stories on Lyme disease are not sufficiently hysterical are barraged with e-mail complaints and urged to contact certain organizations for "the truth." Protests have been organized to denounce Yale University because, according to the protesters, Yale "ridicules people with Lyme disease, presents misleading information, minimizes the severity of the illness, endorses inadequate, outdated treatment protocols, excludes opposing viewpoints, and ignores conflicts of interest."

Researchers have been harassed, threatened, and stalked. A petition circulated on the Web called for changes in the way the disease is routinely treated and the way insurance companies cover those treatments. Less radical groups have had their meetings invaded and disrupted by militant Lyme protesters. In October 2006, the New Jersey-based Lyme Disease Association (LDA) led a series of protests at NY Medical College to denounce the updated Lyme disease treatment guidelines published by the IDSA. The LDA organized another online petition against the guidelines, and a related LLMD organization demanded the treatment guidelines be retracted. Evidently, they were worried the guidelines would be accepted by insurance companies and therefore cut into their private practice profits.

Part of this turmoil is raised up by purveyors of snake oil, but they cultivate the fertile ground of people who feel their very real suffering is denigrated by doctors who seem to be saying that "it's all in their heads."

Not at all. Of course it's in their heads, that is where all suffering resides, after all. The brain is an organ and it is possible for it to go awry and be the ultimate cause of all sorts of problems. That does not mean the problems are not real, or don't count, or that the sufferer is responsible for them. Furthermore, some people with these symptoms may have a dynamical process in the brain at the root of it all which can be fixed by CBT and graded exercise, whereas others have some other cause. No-one should feel threatened by this.

The non-existent chronic Lyme disease, like a recent, evidently erroneous claim that a virus called XMRV might be responsible, were seized on by sufferers as proof that it wasn't "all in their heads" after all, that they have a "real" disease. The debunkers of the XMRV claim have faced similar vituperation.

The unreasonableness and virulence of this debate has at its root the Cartesian dualism that still infects our culture -- the deeply rooted assumption of a "ghost in the machine," that mind is an ethereal stuff separate from the body, which is self-responsible for everything it does. Not so. Mind is a product of the brain, and the brain is just as real as the pancreas. Once we get that straight we'll have a lot more clarity on many issues.

Monday, June 27, 2011

All your private property . . .

Changes in the Land is about the ecological changes in New England following the invasion of English settlers, but the protagonist is actually a social construct: the concept of property rights peculiar to European capitalism, which was just emerging at the same time as the colonization of the Americas.

At the heart of the conservative philosophy which predominates in the United States today is this concept of property, somewhat further developed from the 17th and 18th Centuries but essentially similar. Conservatism elevates this concept of property from a social convention particular to time and culture, to a natural law, and more than that, a sacred principle.

New England as the English found it in the 1600s was already shaped greatly by human activity, although the English didn't realize this. But the Indians had a very different way of understanding their relationship to land and the biota than the English. They did not own land, nor did individuals have any particular rights pertaining to territory. Rather, communities negotiated for rights of particular uses of tracts of land, which were tied to seasons and which could change as the land and community needs changed over time.

The Indians also did not accumulate possessions or exploit land its resources to generate a growing commerce. They traded with their neighbors when each had a surplus of something that was scarce to the other, but maintained a steady state of wealth. People owned, in a sense recognizable to us, their personal tools and their mobile housing -- they moved constantly with the seasons -- but their attachment even to these was less than we are accustomed to.

Consequently, and to their ultimate destruction, when they sold land to the English they thought they were doing something very different from what the English understood to be happening. They thought they were exchanging limited rights of usufruct. Instead the land was ultimately cleared of forest, enclosed by fences, and everyone who did not "own" it excluded from trespass. Over three centuries, the forest, along with most of its wildlife and of course the Indians themselves, disappeared from most of New England. Ultimately, it was the European conception of property, of accumulation, and of gain from commerce, that brought this result.

Today we confront the fate of the Indians: the basis of our way of life will soon be exhausted. As Karl Polanyi wrote in The Great Transformation, of the political and economic crisis of the 1930s that led to the Great War and the new international system of the latter half of the 20th Century, "[T]he idea of a self-adjusting market implied a stark utopia. Such an institution could not exist for any length of time without annihilating the human and natural substance of society; it would have physically destroyed man and transformed his surrounding into a wilderness."

We have forgotten this already. There are other ways of living, and we must learn from them, to discover a new way forward.

Friday, June 24, 2011

Don't worry, I'm just thinking

I've been stealing a little time from the cockroach race to do some reading and reflecting. As a matter of fact I'm reading William Cronon's Changes in the Land, which is actually about a lot more than its subtitle says it is. Yes, it's directly personal because it's helping me figure out where I live, but it's also about where we all live and who we are.

Meanwhile, as you wait for my profound return, in case you're still baffled why the Democratic leadership tossed Weiner, here's your answer and it doesn't make them look so toolish after all. (That's right, I wrote "toolish" not "foolish." They're looking less and less like either. Keep in mind, Vitter is a much, much bigger fish than Weiner.)

Wednesday, June 22, 2011

It ain't over while the fat man still sings

At least I hope it isn't. President Gore's* problem, as he makes clear, is not so much that nearly all of our political leadership either flat out denies the very existence of the greatest crisis humanity has faced since we were reduced to a single small band a quarter million years ago, or at best pays almost no attention to it.

Nope. While the linked essay is getting headlines for putting Barack Obama in the latter category, the corporate media is, naturally enough, ignoring its main target which is (drum roll please) the corporate media. The only balance that a sane journalist could bring to this debate is to truthfully call James Inhofe and the rest of the Republicans in congress evil fools, the Koch brothers psychopathic enemies of humanity, Rush Limbaugh a pathological liar motivated entirely by greed, and the people in general blissful idiots sleepwalking through our final days in fool's paradise.

I find it very difficult to keep up this blog because after all, what else really matters when human civilization and the health of the planetary biosphere are in peril? What have we come to when I must, in all seriousness, type the preceding sentence? Yo, Scott Pelley, Wolf Blitzer, Diane Sawyer -- are you awake? Come to think of it, I can't even remember the last time Rachel Maddow mentioned this little problem -- she spent more time on Weiner^2gate than anybody.


*He was in fact elected president of the United States in 2000.

Tuesday, June 21, 2011

The proletarianization of science

This essay in Miller-McCune by Beryl Lieff Benderly is a year old, but I just came across it. She tells a story which is important to me personally, and important to the nation's future.

We often hear that the U.S. is falling behind other nations in science, and the blame is generally placed on our educational system. We are purported to have a shortage of scientists -- and the prove is that tens of thousands of foreign Ph.D.s, most of them Chinese, are filling postdoctoral positions in U.S. universities.

It turns out this is the wrong diagnosis. In fact the number of Ph.D.s awarded in the sciences in the U.S. has been increasing steadily over the past two decades. The problem is that we are producing 3 times as many of them as there are faculty positions. Post doctoral fellowships, which were once prestigious awards to a small number of the most promising young scientists, are now the required gateway to have any hope of a faculty appointment, and people often get stuck in the for many years, working long hours at low pay, and never getting a tenure track job. The reason Chinese people take these jobs is the same reason Mexicans pick lettuce -- it looks like a better deal to them than it does to similarly situated Americans. As Benderly writes:

Starting about three decades ago . . . placing students in desirable faculty jobs became more and more difficult, and several years of postdoctoral “training” gradually became the norm for nearly everyone rather than, as formerly, a mark of special distinction. It was, in fact, a form of disguised unemployment. “Simply put, there are not enough tenure-track academic positions for the available pool of … researchers,” according to the Bridges report.

Whereas new Ph.D.s had formerly spent a year or so applying for perhaps three or four faculty openings before accepting a job, they now spent multiple years sending out scores of applications, often without success. Graduate students and postdoctoral “trainees” were less and less the protégés of mentors morally responsible for their futures . . . . They morphed instead into highly skilled, highly motivated and invitingly inexpensive labor, doing the bench work needed for professors to keep their grants. Winning those grants gradually came to outweigh placing their students in good jobs as a major mark of professional stature.

So we have a situation in which getting a science Ph.D. and trying to become a scientist means accepting the likelihood of many years of penury and toil with a low probability of ever becoming an independent scientist, or getting the security and prestige that comes with a professorship. Indeed, the ultimate outcome may be driving a taxi, or going back to school to get certified as a high school teacher. We really need to fix this.

Monday, June 20, 2011

Well, nobody can accuse me of chasing traffic

Not if I refer you to a highly technical essay that will make your head hurt. Russell Lyons of Indiana University is annoyed -- so annoyed in fact, that he transgresses the boundaries normally expected of academic writing to trash both some highly respected and widely touted investigators, the world's leading medical journals, and peer review in general -- the latter two categories of trashee coming in for extra trashing in part because he couldn't get this particular essay published in high impact journals. So he's uppity, shrill, rude and obnoxious.

He's also probably right. In order to save you from a headache, I'll just explain this very simply. You may remember that the popular media a few years back got all excited by research based on data from the Framingham Heart Study which found that fatness is contagious. Basically, if your friends get fat, you are likely to get fat too. These investigators -- principally N.A. Christakis and J.H. Fowler -- followed up with similar findings for quitting smoking, being happy, and being lonely. These findings were all published in very high impact, prestigious journals.

Lyons calls bullshit. Without going into all the arcana, his main points are:

1) Their claims of statistical significance for many findings are bogus. In fact, the confidence intervals overlap, by a lot, but they conjure of the confidence intervals away by pretending it is really the number zero. (I kid you not.)

2) The logic by which they conclude that obesity is contagious, rather than the alternative explanation that obese people are more likely to name other obese people as friends, is bo-o-o-o-gus.

3) The statistical methods they use to try to control for potentially confounding variables do no such thing.

But the main point of this rant -- which is what it really is in spite of the venue -- is that a lot of investigators who use statistics don't really understand what they are doing, and neither do the peer reviewers who decide where they get their stuff published. This is true, I think. I have written before about the almost universal misinterpretation of the p value, and that is indeed part of what is going on with these social network analyses. It is a major reason why, as John Ioannidis has found, most published findings are false.

Now get a grip. This doesn't mean that global warming is a hoax or HIV doesn't cause AIDS. We're talking about specific, new findings right where the mining machine of science cuts into the rock face of ignorance. After a while we get the basic story right. But physicians and yes, scientists; reporters; and average people are just too quick to accept the latest weird and unlikely discovery as an important scientific breakthrough, whereas most of them are just noise. And as Lyons suggests, scientific journals should be a lot more interested in replication and criticism of prior findings, rather than relegating them to the lowest impact venues.

Friday, June 17, 2011

Here's a righteous rant . . .

on the Health Affairs blog. As I have said here many times, real health care reform -- the kind that can make Medicare and all health care more affordable, while actually improving patient outcomes -- requires putting more resources into primary care and less into high-priced specialty care. One institution that stands in the way is the Relative Value Scale Update Committee (RUC), which advises Medicare on the reimbursement rates for various procedures. The RUC is dominated by high-priced specialists, and you can guess what the result is.

The American Academy of Family Physicians is standing up for its members, yes, but also for you. They are supporting legislation introduced by Rep. Jim McDermott that would require CMS to hire independent contractors to review the values placed on medical procedures. As McDermott note:

"Most people don't know this, but there is this small panel that decides behind closed doors what the reimbursement rates will be for certain medical procedures," McDermott said in the news release. "For two decades now, this panel has been dominated by (sub)specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services. The result of this is clear -- there is a shortage of family doctors, patients don't necessarily get the services they need and medical costs are increasingly driven higher."

McDermott also pointed out that "since the creation of the RUC in 1991, the income disparity between primary care versus procedure-heavy (sub)specialists has grown from 61 to 89 percent."

I don't want to see a civil war in the medical profession but maybe that's what it's going to take to fix this.

Thursday, June 16, 2011

A busy day in the medical journals

First, another open door crashed through, but sometimes you need to prove the obvious to get people to pay attention. (Props to NEJM for making this open access, BTW.) Joanna Bisgaier, M.S.W., and Karin V. Rhodes, M.D., had women call pediatric specialty clinics pretending (yeah yeah, deception) to be parents of sick kids and trying to get an appointment. In 54% of cases, the first question asked was what kind of insurance the kid had. If it was Medicaid or CHIP, the child was refused an appointment 66% of the time. If it was private insurance, only 11% of kids didn't get an appointment. Waiting times for kids purportedly on Medicaid, if they did get an appointment, were also much longer. This is because Medicaid doesn't pay as well as private insurance.

If you're worried about the safety of nuclear power, a review article on the health consequences of nuclear power accidents (also open access) will help inform your thinking. If you ask me, you really ought to compare this to the health risks from fossil fuel burning, which don't just happen occasionally when there's a catastrophic accident, but all the time.

After a period of considerable pessimism, we may be getting close once more to eradicating polio from the planet. It's going to be tricky, however, because once we're confident we've cleaned out an area, we have to stop giving live attenuated virus vaccine, which can occasionally escape and cause an outbreak. So it has to be played juuuuussssst right.

Over in JAMA, where more of the good stuff is behind the prescription wall, there are a few mildly interesting items but the one I'm going to highlight is the TV Kills epidemiological meta-analysis by Grøntved and Hu. "The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100 000 individuals per year, 38 cases of fatal cardiovascular disease per 100 000 individuals per year, and 104 deaths for all-cause mortality per 100 000 individuals per year." As with all epidemiological studies, there are reasons for doubt. Maybe people who have other risk factors are more likely to watch more TV. Investigators try to control for that but they can't do it completely. And maybe these don't seem like huge numbers but they add up over time and re-runs of Jersey Shore. Watch 4 hours a day for 15 years and you've got maybe a 3 or 4 percent chance of dying prematurely. If we're talking about kids getting zombified in front of the TV from age 4, they've got the potential for 50 years of exposure time and by then we're saving on not having to pay out Social Security and Medicare.

I'm less worried about that than I am about brain rot, however.

Tuesday, June 14, 2011

This is what drives me nuts

Completely nucking futz, as a matter of fact. The "reporter" Julie Rovner on Morning Edition today committed what I would call an egregious act of journalistic malpractice except that it's an absolutely typical, conventional, standard example of the current practice of journalism.

In Rovner's vision, the future of Medicare is not a policy problem, to be understood and explained, but a political weapon wielded with equal legitimacy or illegitimacy -- she doesn't seem sure which it is -- by both parties. The audio is actually worse than the written version. In the written version, the Affordable Care Act "would reduce Medicare spending by a half trillion dollars over 10 years." In the actual radio bit, it "cut Medicare" by half a trillion dollars. Then she played the Republican radio ad in which old folks accused Democratic representatives of betraying them.

What she didn't bother to explain is what the act actually did. It reduced overpayments to insurance companies in the Medicare Advantage program. It didn't cut, reduce, restrict, or affect the benefits of Medicare recipients in any way. In fact it saved money in order to protect the program. In other words, the Republican accusation was a canard -- objectively false and misleading. So her "reporting" merely magnifies the Republican lie and gives it renewed life.

Then she goes on to Democratic attempts to turn the tables in response to the Paul Ryan proposal, which she deems dishonest because "That plan's major Medicare changes wouldn't affect current seniors, but you wouldn't know that to listen to Democrats and their advocates." She pivots immediately to Paul Ryan, who is allowed to defend his proposal, not by explaining its content, but simply by saying that "I would do it just like this if I had to do it all over again . . . I really believe people are ready for these kinds of solutions; they want to see leaders tackle these challenges, and they are sick of the political demagoguery, and I think people are becoming more desensitized to all these attack things."

Then she turns to Nancy Pelosi who is quoted and framed selectively to appear to be endorsing the idea of using Medicare as a political weapon, even though she knows that "Medicare is not financially sound enough to sustain the retirement of 78 million baby boomers who are beginning to join the program this year. And that Medicare costs are a major drag on the nation's debt and deficit problem." Then she pivots to a political scientist who says that "fear beats hope" in politics, so that's why we get these fear based attacks instead of solutions.

So it's all about those evil Democrats trying to scare people instead of seeking solutions, like Paul Ryan. What Rovner completely ignores is that the Democrats do in fact propose ways of constraining the cost of Medicare, which Republicans block at every turn by using dishonest scare tactics. They refused to allow a vote on the confirmation of Donald Berwick to head the Center for Medicare and Medicaid services because he's a "socialist" who is in favor of "rationing." They won't allow Medicare to consider comparative effectiveness research or cost effectiveness analysis in making spending decisions. They refuse to allow funding for counseling about end of life care. They won't allow Medicare to negotiate prices with drug companies. They scream about "death panels" and "socialism" every time anybody tries to propose an honest solution to the problem of rising health care costs.

But explaining all that requires actually understanding, and explaining, something about public policy. Rovner won't do that, probably because she's too ignorant but possibly because telling the truth would look like taking sides. Either way, she's a disgrace.

Monday, June 13, 2011

Hello again

I've had some serious writer's block -- at least in this venue, not so much elsewhere -- and now I have George Soros to to explain it for me. This is from his essay in the New York Review of Books called "My philanthropy." The first part is what the title says it is, and more -- an explanation not only of what he's been doing with his considerable charitable donations, but how he is structuring the foundation he will leave behind. It seems an honorable gesture. But then he more or less jumps the rails, and much for the better, I would say, and talks about current U.S. politics:

[My mentor Karl] Popper had argued that free speech and critical thinking would lead to better laws and a better understanding of reality than any dogma. I came to realize that there was an unspoken assumption embedded in his argument, namely that the purpose of democratic discourse is to gain a better understanding of reality. It dawned on me that my own concept of reflexivity brings Popper’s hidden assumption into question. If thinking has a manipulative function as well as a cognitive one, then it may not be necessary to gain a better understanding of reality in order to obtain the laws one wants. There is a shortcut: “spinning” arguments and manipulating public opinion to get the desired results. Today our political discourse is primarily concerned with getting elected and staying in power. Popper’s hidden assumption that freedom of speech and thought will produce a better understanding of reality is valid only for the study of natural phenomena. Extending it to human affairs is part of what I have called the “Enlightenment fallacy.”

As it happened, the political operatives of the Bush administration became aware of the Enlightenment fallacy long before I did. People like me, misguided by that fallacy, believed that the propaganda methods described in George Orwell’s 1984 could prevail only in a dictatorship. They knew better. Frank Luntz, the well-known right-wing political consultant, proudly acknowledged that he used 1984 as his textbook in designing his catchy slogans. And Karl Rove reportedly claimed that he didn’t have to study reality; he could create it. The adoption of Orwellian techniques gave the Republican propaganda machine a competitive advantage in electoral politics. The other side has tried to catch up with them but has been hampered by a lingering attachment to the pursuit of truth.

And that's why it has been difficult for me to keep up the energy and quality here. In a society where truth has no power and no honor, it just feels futile. Well, don't fear for me, I'll be over it by tomorrow morning. I just thought I'd let y'all know.

Thursday, June 09, 2011

Decline and fall

EJ Dionne ruminates on the current circus (and they aren't even bothering with the bread):

[T]he Weiner episode marked the culmination of several months during which other sideshows involving outrageous male behavior — John Ensign and John Edwards come to mind — dominated news coverage at a moment when our country’s future really is on the line. . . .

Britney Spears, appropriately enough I suppose, has a catchy song out with the refrain “Keep on dancin’ till the world ends.” Forgive me for wondering whether her song will provide the soundtrack for some future documentary on our national decline if we don’t get very serious, very soon.

I don't really have much to add to that. I'm blogged out until tomorrow, anyway.

Wednesday, June 08, 2011

Perhaps I repeat myself

As you have no doubt heard, Medicare is "unsustainable," so we're just going to have to make old people pay for their own damn health care, and if they can't afford it, there's nothing we can do about it, we're tired of all these freeloaders. But one thing we absolutely cannot allow is rationing of health care, because life is infinitely precious.

For example, it would be an offense against God to ration use of Sipuleucel-T, brand name Provenge. As you can see from this FDA summary explaining why they approved the drug, in a clinical trial it was found to increase overall survival in men with prostate cancer from 21.7 months to 25.8 months. A second trial got very similar results.

So the typical patient gets 4 months of life. (Not healthy life, mind you, sick and dying life made even less pleasant by "chills, fatigue, fever, back pain, nausea, joint ache, and headache.") Still, if you really need that 4 months to finish your bucket list I suppose you'll go for it.

But, it costs $93,000. Not to worry, the Affordable Care Act includes explicit language that the Independent Payment Advisory Board (yep, the Death Panel) "shall not include any recommendation to ration health care." If it offers any discernible benefit, cost is allowed to be no object.

Except, of course, for people who don't have any health insurance at all because it is too expensive and they can't afford it, which right now doesn't include anybody over age 65 but will if the Republicans get their way. For people under 65, it includes a lot of folks, obviously, but denying them health care isn't "rationing," it's the sacred invisible hand of God. Whereas deciding that Medicare won't routinely pay for Sipuleucel-T because we have better things to do with $93,000 is the work of the devil. And by the way, Randians (Ayn, Paul, or Paul Ryan) there would still be nothing stopping you from buying it yourself, if you happen to have $93,000 -- we're just talking about not forcing the rest of us to buy it for you. Which, exactly, is the libertarian position? I'm all confused.

Now, Barack Obama and Harry Reid could explain this to the people, if they wanted to. But they do not. They just let Sarah Palin explain it. Please explain that to me.

Tuesday, June 07, 2011

The most significant event in human history

That would of course be Weinerweinergate, or Weinersquaredgate, or the gate of Weiner's weiner or whatever you want to call it. In between acts of sadistic psychopathy in the Boston Bruins game, I clicked over to Lawrence O'Donnell to see if he really was devoting his entire program to the most world-changing event since human mastery of fire. Not quite -- only 40 minutes, or 2/3. I gather from Digby that Tweety did almost the entire program on Weiner^2. The ABC news site this morning had four separate articles on Weiner^2 at the top of the page.

Now, I understand that sex sells, but I mean come on, this isn't even sex. At least Vitter, Ensign, Haggard, Craig and Clinton etc. actually had physical contact with other human beings. I'm sure Weiner's wife is hurt and disappointed and his lies certainly don't speak well of him but that's all there is to say about it. After all he's one of 435 members of the House.

What defines a void is the stuff around it. While ABC was building up a mighty evidence of Weiner^2, they also mentioned in passing a record shattering heat wave gripping most of the country and record shattering floods along the Missouri River. But these events have nothing to do with anything else, and they don't call for urgent action of any kind, unlike Weiner^2 which is the most urgent political problem facing our nation.

I'm happy to say that I am not even tempted to any of the foibles that seem to be the epidemic downfall of great men these days, but I am pretty sure that most people have some secret bizarreness about them. It's all very titillating but we have real problems. It's time to get our heads out of the sand.

Monday, June 06, 2011

Talk about blaming the victim

As I believe I have mentioned, I'm stuck with a long commute these days (and I feel guilty about the carbon footprint, believe me) so I'm ODing on NPR. Last week I heard a long story about how report by the National Bureau of Economic Research finds that nearly half of Americans say they either could not, or weren't confident that they could raise $2,000 in 30 days in case of an emergency. That means they have no meaningful savings and can't even borrow $2,000 on a credit card, and also don't think they could borrow the money from a relative or friend.

I'm ashamed to admit it, but having been gainfully employed at a decent salary for many years I just hadn't stopped to imagine what life is like for most people. The disembodied radio voices seemed equally impressed by this news. So today I had a chance to look up the original report. It's by one Annamaria Lusardi, here you go.

They also find that almost half the people say they have trouble keeping up with monthly expenses -- which more or less means the same thing, I guess, since it implies they can't save anything -- and that only half of people 45-59 years old have tried to figure out how much they need to save for retirement. Most of these people do not have any retirement accounts.

Now, this is all very depressing but perhaps even more depressing is that Lusardi essentially interprets this as meaning that Americans are financially illiterate and irresponsible. As she puts it in the abstract:

Financial capability is measured in terms of how well people make ends meet, plan ahead, choose and manage financial products, and possess the skills and knowledge to make financial decisions. The findings reported in this work paint a troubling picture of the state of financial capability in the United States. The majority of Americans do not plan for predictable events such as retirement or children’s college education. Most importantly, people do not make provisions for unexpected events and emergencies, leaving themselves and the economy exposed to shocks.

Well okay, but maybe it's because they cannot do so. Their income just isn't sufficient for them to have anything left over after they pay the rent and buy the groceries. They could take the time to bone up on finance and make all the elaborate plans you can imagine, but they don't have any money so it would be pointless. They aren't planning for their children's college education, or for retirement, because they can't afford it.

I'm planning to become the quarterback for the New England Patriots and marry Gwyneth Paltrow. That shows how smart I am.

Friday, June 03, 2011

And we might have fewer no-shows

British GP Des Spence, writing in the new BMJ (off limits to commoners, alas), suggests that doctors can stop doing the dread Digital Rectal Examination (DRE).

"Logically it has two purposes: to detect rectal tumors and palpate the prostate. It has no obvious logical diagnostic value in appendicitis or acute abdominal pain, which were once traditional indications."

Tell me about it. As I have revealed here previously, I was admitted to the hospital many years ago with acute abdominal pain. Doctors in training lined up to stick their fingers up my ass. None could elicit any pain, but they all decided I had acute appendicitis anyway, which I didn't. (I had a solitary cecal diverticulum.) So what was the point?

As for detecting rectal tumors, as a screening test the DRE is too nonspecific to have any value. In older people with symptoms suggesting a tumor, either endoscopy is indicated or it isn't. The DRE isn't going to change that opinion either way. Ditto with prostate cancer -- annual DREs don't reduce mortality but do result in overdiagnosis and associated harm.

Spence says, "Rectal examination is unpleasant, invasive, and as an investigation has unknown sensitivity and specificity. In a young patient [DRE] has almost no value, and in older patients may have very occasional and limited indication."

So just don't do it, okay?

Thursday, June 02, 2011

Well duhh . . .

But if former presidents of Colombia and Mexico, along with Reagan BFF George Schultz, former European presidents and major capitalists all say it, along with various well-respected famous writers and intellectuals and whatnot, maybe, just maybe people will start to believe it. Says the Global Commission on Drug Policy:

The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched
the US government’s war on drugs, fundamental reforms in national and global drug control policies are urgently needed.

Vast expenditures on criminalization and repressive measures directed at producers, traffickers and consumers of illegal drugs have clearly failed to effectively curtail supply or consumption. Apparent victories in eliminating one source or trafficking organization are negated almost instantly by the emergence of other sources and traffickers. Repressive efforts directed at consumers impede public health measures to reduce HIV/AIDS, overdose fatalities and other harmful consequences of drug use. Government expenditures on futile supply reduction strategies and incarceration displace more cost-effective and evidence-based investments in demand and harm reduction.

Okay, you could have read that on CNN. But it so happens that this week in NEJM (sorry, full article is unavailable to the riffraff) Josiah D. Rich, Sarah E. Wakeman and Samuel L. Dickman review the consequences for the United States. We have 5% of the world's population and 25% of the world's prisoners. Most of those prisoners are non-violent drug offenders. And most of them are Black or Hispanic even though Black and Hispanic people are not more likely to use illicit drugs than white people. (Probably less likely, actually, according to the survey data I've seen.) Not only that, but more than half of prisoners have diagnosable psychiatric disorders -- major depression and psychosis are 4 to 8 times as prevalent as in the general population -- but most of them aren't getting treatment. (Illicit drug use is often associated with psychiatric disorders, in part because people are trying to medicate themselves.)

Most of them, however, are not getting treatment. On the contrary, obviously, conditions in prison are likely to exacerbate mental disorders. Maybe a third of all injection drug users, and a quarter of people with HIV spend time in a prison or jail each year. In low income minority communities, high incarceration rates are devastating socially and economically.

The authors note that in Rhode Island, where I work, it costs more than $40,000 a year to incarcerate a person, and that five states now spend more on prisons than they do on higher education. This is utterly insane. State and local governments are broke and they are engaged in cruel reductions in social services to the most vulnerable people. And yet we keep on locking up people who have addictive diseases and psychiatric illnesses, mostly if they also happen not to be white, to absolutely no discernible beneficial end.

Stop it.

Wednesday, June 01, 2011

We are in trouble. Big time.

Calculated risk has it all: GM says year-to-year car sales likely down; Institute for Supply Management manufacturing index down; Private employment increased by only 38,000 in May. (With public sector employment still likely declining, probably a net decrease in employment.) Mortgate applications down; Home prices hit a new low.

And all they're talking about in DC is cutting federal spending. Oh yeah, the Democrats are going along with it; Obama is even taking credit for spending cuts. Welcome to nineteen thirty two, but Herbert Hoover is still president.

This is likely to get very, very ugly.