Map of life expectancy at birth from Global Education Project.

Friday, June 29, 2007

It's Economics 101!

A colleague is returning to China to visit family for the first time in a few years, and of course I wished him a good time, and warned him not to eat, drive or brush his teeth while he is there.

If I had any loyal opposition here, or trolls, they would be falling over each other to point out that China is a communist country, but of course it isn't any more. The problems the Chinese have had lately with poison food and disintegrating tires are the result of capitalism. They decided to try to have rapid economic development by believing the economics textbooks their bright youngsters read at Harvard and Duke, which explain how "free markets" maximize efficiency and how government intervention is inevitably comes at a net cost to social welfare.

Economics professors are paid higher salaries than their colleagues in other disciplines for the express purpose of filling the minds of freshmen with lies. It's pretty clear that econ 101 is the only course the Leader of the Free World remembers, because he talks about it all the time. It has obviously made him a very wise man.

Here's the procedure. Your distinguished professor lays out a set of propositions, and then develops a theory of what would happen assuming the propositions were true. It's beautiful, elegant, astonishing! Everybody acts out pure self interest, and by a mechanism as glorious as the celestial spheres, all the sweeping, lyrical lines intersect to produce the greatest possible good for everyone. This phenomenon has multiple virtues. It means that the best possible outcome for the poor is for the rich to be rich. It means that any politician who tries to interfere with the unfettered conduct of business is stealing bread from the mouths of hungry babies. It proves that our world in which business executives live in mansions with their personal bowling allies and olympic swimming pools, while a million children die every month of starvation and disease is better than a world in which no children starve and no billionaires have bowling allies.

Now, this is indeed a valid proof, but what your professor (who is not a scientist but a theologian) fails to see is that it is a proof of the form called reductio ad absurdum. If the premises produce an absurd result, the premises must be wrong. Indeed they are wrong, and your professor will even throw in some disclaimers. Sometimes, he will aver, there are "market failures" and "externalities," which may justify some tweaking and polishing of the glorious system of the celestial spheres. But this is quickly forgotten, because what really matters is the fundamental perfection of the heavens.

Sadly, no. Market failures and externalities are not exceptions. There is no such thing as a transaction which does not incorporate so-called "market failures." Markets always fail, 100% of the time. The premises on which economic theory is constructed are always false. The falsehood of the assumptions is not a gloss on the theory, or a reservation, or a modification, it is fundamental. The theory is built on false assumptions, therefore it does not describe reality, therefore it is worthless. Economic theory as taught to our children is the equivalent of the Ptolemaic system of astronomy; market failures and externalities are the equivalent of the epicycles added by astrologers to make the Ptolemaic universe correspond to observations. But their project was doomed, because the fact is, the earth is not at the center of the universe.

It is equally true that there is no such thing as a "free market." No such entity has ever existed, or ever can exist. Markets are social constructions, made out of rules created and enforced by humans, for better or for worse. There is no such thing as a transaction in which all of the costs and benefits are felt only by the parties. There is no such thing as perfect information, no such thing as perfect competition, no such thing as rational choice, and most fundamentally damning, the theory does not even predict that outcomes will be fair and just -- a most embarrassing little secret that economics professors and libertarian ideologues pretend away.

As the Chinese are learning the hard way, we need to jettison the Ptolemaic system of economics, pulp all of the textbooks except for a historical archive, send all the professors to reeducation camp, and start basing the discipline of economics on the study of reality. Who will be our new Copernicus?

Thursday, June 28, 2007

Could it finally happen?

Well, Sicko is getting good reviews, even in the corporate media. Arnold Relman has had the audacity to come out with a new book that, instead of asking what is politically feasible in our neanderthal nation, asks what would be right. May I have the envelope, please?

Universal, comprehensive, single payer national health care


In 2009, assuming Dick Cheney doesn't recruit some Young Americans for Freedom to dress up as Iranians and drive a 1969 VW bus into the Jefferson Davis Presidential Library,* we'll have a president and a congressional majority pledged to some form of health care reform. As I noted in an earlier comment thread, about the most radical proposal from the prez contenders (excluding nuisance candidates Kucinich and Gravel) is from John Edwards, who basically wants to give us a Massachusetts/Switzerland style system of mandated private insurance with subsidies for low income people, and an option to buy into expanded Medicare. The (hush hush) hope is that the expanded Medicare option will prove to be the best buy and will gradually eat the rest of the system.

Could this happen? And if it does, will it play out as hoped for? I would say that there's a heckuva lot that can, and will go wrong. There's no way that enough financing will go into the system in the beginning to make good insurance truly affordable for everyone; there will be no mechanism for cost containment or rational allocation of limited resources; and the insurance companies will bribe Congress into giving them bloated rates and all kinds of dodges and loopholes to avoid enrolling sick people. And they know damn well what the competition from a government-run option is all about and where it's supposed to lead. Those bastards weren't born yesterday. So it will be hobbled in some way, you can bet on it.

Still, granted all that, if we can just get a foot in the door and keep pushing, and pushing, and pushing, we might get a shoulder through, and then take a step. Might as well try it.

*A completely real institution, in Biloxi. Currently being restored after extensive damage from Hurricane Katrina, with the help of a $2.5 million federal grant.

Wednesday, June 27, 2007

A Planetary Priority

C. Corax sent in this story about Mexican campesinos defending their land against a planned hydroelectric dam. I have always contended that among the crises facing humanity, making it possible for people to remain sustainably on the land is among the most important.

A future in which the countryside exists only to feed and power the cities and suburbs is one of my worst nightmares.

Tuesday, June 26, 2007

Step Right Up!

One of the (questionable) perks of blogging is that I get all sorts of press releases. This one is worth sharing:

For Immediate Release

Contact:
Neil Shroff, Vice Chairman
ExpressCare No Wait. Feel Great!T

Mobile: (201) 410-3625
Fax Number: (609) 409-3637
Email: Neil@spark-consulting.com
Website: www.expresscarecenter.com

ExpressCare Announces Grand Opening in ShopRite's Neptune, NJ Supermarket
Special Guests to Include Phil Simms and Frank Bisignano
Cranbury, New Jersey, June 22, 2007 -ExpressCare, located in the ShopRite supermarket at 2200 State Highway 66 in Neptune, NJ, will hold its grand opening on June 30, 2007 from 10:00 am-3:00 pm.

The official "ribbon cutting" will take place at 11:00 am and will include local dignitaries, in addition to a special guest appearance by Phil Simms, CBS Sports Commentator, Super Bowl XXI MVP and 15-year NFL veteran. Neil Shroff, Vice Chairman, is pleased to announce that Frank Bisignano, Chief Administrative Officer at JP Morgan Chase, has joined the Executive Advisory Board for ExpressCare.

"Mr. Bisignano, who is well known in the investment community, will provide strategic advice and expertise to the ExpressCare team" states Mr. Shroff. ExpressCare, which has signed agreements with three multi-store ShopRite supermarket store owners, plans to open retail health care centers in as many as 42 locations. ExpressCare will open in six supermarkets in New Jersey and southeast Pennsylvania this summer. Twelve ExpressCare locations in ShopRite supermarkets are expected to be operational by March of 2008.

ExpressCare believes that these health care centers address two health care issues facing most communities - access and affordability. ExpressCare clearly posts its scope of services and prices to make it simple for people to understand. Most services are under $39.00, and all locations will be open seven-days-week including holidays.


It goes on a bit but that's the gist of it. No, it isn't satire. You can visit Express Care's website if you are in doubt. At this point they seem more interested in attracting investors than customers, but it's for real.

Now, you probably think I'm all outraged and bent out of shape and so forth, but actually I'm ambivalent about this. There won't be an M.D. there -- nurse practitioners provide the service. The NPs will only treat simple complaints like rashes and common minor infectious diseases, give you your shots, and do school and sports physicals, that sort of thing. They are trained to act appropriately in more serious cases, whether it be by calling 9-1-1 or referring you to a physician.

We all know that it's next to impossible to get in to see most primary care docs on short notice for minor complaints. This way, you can get your kid's sore throat checked out while you pick up the milk and corn flakes, even on Sunday and Columbus Day. For people without insurance, alas, this is an affordable deal.

In fact, the New England Journal of Medicine recently featured a fairly accepting commentary on this. There are some worries, and there may be unintended or perverse consequences, but supporters argue that these services meet a need and can even help relieve the pressure on primary care providers, who are in increasingly short supply.

Still, a lot of people don't like it. The blatant commercialism of it all doesn't feel quite right, but there are also more substantive issues. There may very well be some value in the serendipitous contact that people have with their physicians when they come in for minor complaints or wellness services. These clinics threaten to disrupt the continuity of care and relationships that people have with primary care providers. And there is always the possibility that a rare condition could be missed by an NP using a rigid protocol intended to identify and treat a minor problem.

Whether these turn out to be legitimate problems, or whether others will emerge, remains to be seen. I don't think I would use one of these clinics, but I'm willing to wait and see what happens with them. I would rather, however, that community health centers and physician practices set up such services, incorporate your visits into your medical record, and alert primary care providers about them. The free standing model is certainly inferior in that regard. But until that happens, it's hard to argue that people shouldn't have access to these services.

By the way, speaking of blatant commercialism, I had to delete a spam comment from a drug company. Yup, I got a comment touting a prescription drug. It met FDA standards for DTC advertising -- including mentioning side effects and giving a link to a web site where you could read the package insert -- and it happened to be for a drug I don't have a particular problem with. Nevertheless, that is not allowed here -- especially if you aren't paying me.

The nerve of these clowns.

Monday, June 25, 2007

Is Malthus rising from the grave?

As you have no doubt noticed, the only substantial measure Congress is likely to pass in the near future to (ostensibly) reduce consumption of fossil fuels in the U.S. is to promote the manufacture of ethanol from corn for fuel -- a plan also enthusiastically embraced by the White House Occupant.

Well, let's not forget that corn is food. In fact, corn isn't just food, it's very nearly all food. Beef, pork and chicken are corn. So are eggs, butter, milk and cheese, and the sugar in soda, breakfast cereal, margarine, frying oil. There's corn meal in pizza and corn products in just about every processed and packaged food in the supermarket.

So what happens when we start turning food into fuel for our automobiles? The price of food goes up. Most of us merkins can afford it, but most of the world's people cannot. Petroleum is also a major input to the growing, processing and shipping of corn and corn products, and all food products for that matter, so we're seeing a double squeeze as oil prices will inevitably continue to rise. Add to that the worldwide depletion of top soil, water shortages, depletion of seafood resources, and continuing population growth, and food is just going to get more and more expensive.

It's happening very fast. In 10 years, we'll live in a different world. I'ts not just the era of cheap oil that's over, it's the era of cheap food. Or so it appears the way we're going.

The likely consequences, and what to do about it, will be another topic here in coming weeks. Meanwhile, for more background on this, the Worldwatch Institute is a good place to go. It won't hurt to eat less meat, and more veggies, grown locally and organically. But this is a vast, global structural problem that isn't going to be dented by voluntary action by a few people in developed countries.

Meanwhile, nix on the fuel ethanol movement.

Sunday, June 24, 2007

Behaviorism

Some readers may have noted the blogsopheric controversy over Glenn Greenwald's new book. Many were hyperventilatingly anxious to insist that the White House resident's putative religious motivations for his crimes against humanity are fraudulent, that he doesn't really believe he's acting out of Christian duty, he's just a psychopath. The point of Greenwald's book was never about Resident Bush's psychology, it was about political discourse, but after a brief resistance he did succumb and join the debate about what's really going on in the Residential wetware. (For the record, he thinks the claimed religious conversion was sincere.)

Many in the His Piety is Bogus school seem particularly concerned that granting him sincere religious convictions might serve to excuse his crimes. I have always said, who cares what George W. Bush really believes? Does he really hear God's voice in his head telling him to invade Iraq and torture muslims, does he truly believe he is on a crusade to purge the world of evil? That seems to me equally apalling, repulsive and dangerous as the theory that it's all an act and he is self-consciously a tool of oil company greed and personal lust for power. What's the difference?

After all, it's hardly a secret that many of histories greatest crimes have been committed in the name of God, and specifically the Christian God -- from the Crusades (and yes, they were crimes that included massacres of Jews as well as Muslims), to the Spanish Inquisition and the torture and burning alive of heretics more generally, to the conquest of the Americas and the dispossession, enslavement and genocide of its population, to slavery in the United States, apartheid in South Africa, and the subjugation of women everywhere, all of them proudly and loudly celebrated by Bible-waving preachers. The schizophrenics who put babies in the microwave are as often as not hearing the voice of Jesus. Whether religious motivation is genuine or feigned has no relationship to the depravity of behavior.

But people naturally temper their moral judgments based on what they think is going on inside people's heads. Hence the insanity defense, and lesser extenuation of the guilty due to impaired capacity or a personal history of abuse.

I would say that a humanist position on moral culpability is that it is practically indispensable but ontologically deficient. No-one is self-created. We become what we are, and do what we do, as a function of our genetically determined bio-psychological potential unfolding in the environment in which it happens to find itself. John Wayne Gacy didn't make himself into what he was any more than Mohandas Ghandi. Bush's warped piety may have saved him from the bottle and inflicted disaster on the world, or it may all be an act, but either way, we can only judge him by his deeds.

If we are to judge people at all, however, it is only if by so doing we can improve human prospects for the future. We tell children they have been bad, and punish them, in the hope that they will internalize the rules in question and behave differently in the future. We ritually sentence criminals as a means of publicly declaring society's expectations for its members and discouraging wrongdoing. The only reason that motives enter into the matter is because they are pertinent to the problem of social control. If someone did not intend to violate the rules, there is little sense in punishing them because their behavior does not need to be so deterred, all they need is better information. If someone is insane, there is little point in punishing them because they can't control their behavior and it won't do any good, even as an example to others who are similarly insane.

But whether wrongdoers are pious or not, whether they think God told them to commit mass murder or they did it for Halliburton, is irrelevant. Evil is as evil does.

Friday, June 22, 2007

What, me worry?

One of the most vexing problems in public health is how to respond to hypothetical events that would be really, really bad if they were to happen, which we think are unlikely, but to which no definite probability can be assigned. Actually, the philosophical underpinnings of the very concept of probability are often pretty shaky in these situations; it isn't even clear what we mean by calling some events unlikely.

Like everybody else, I tend to have opinions even when I don't know anything, so here's what I think about one scenario that tends to worry folks, intended to illustrate how we might think about such problems.

Pandemic flu: The 1918 flu pandemic is still within living memory (though not my own, I'm happy to say). It is not clear, however, whether such deadly strains have emerged in the past. There have been outbreaks of more than usually virulent influenza since 1918, but nothing to rival it. The currently circulating H5N1 bird flu strain worries experts because human immune systems are naive to the H5 form of the hemagglutinin protein, and it may be that the 1918 strain arose in birds, so maybe this is potentially the big one. But nobody knows if this strain will ever become pandemic in humans, or if it does whether the mutated form will be anything like as dangerous as the 1918 strain.

I certainly don't know. Among the portside chattering classes, there is that faction that says the threat is overhyped and it's all a plot to sell Tamiflu or impose martial law; and the opposite faction that says progressive people should be concerned about this as an essential social responsibility and an example of real threats that get ignored in the massive hype over the Global War on Terror.™

Fortunately, however, this one has an answer that should satisfy everybody. It doesn't matter what may happen with H5N1 influenza, the threat of a widespread infectious disease emergency, whether regional, national, or global, involving some virus or possibly another kind of pathogen, is definitely real and in fact, inevitable. Preparation for such events is fairly generic - it isn't specific to H5N1 flu. And that even includes vaccine production. A highly effective vaccine can't be developed until the specific problem strain emerges, so what counts is having vaccine production methods and facilities that can respond quickly and produce enough vaccine for the world within a short enough time to matter. That kind of preparation will benefit us no matter what viruses confront us.

But other kinds of preparation are probably more important, at least to those of us who are deeply concerned about social and political problems. The key response to such emergencies happens locally. Federal agents aren't going to parachute in, we have to be prepared to act in our cities and towns regarding such questions as closing schools and businesses, providing emergency medical care, emergency dispensing and inoculation, communicating with the public, quarantine and isolation, filling in for sick people in essential functions, and so on and so on. Plans and procedures need to be in place to work effectively with special needs populations, people with limited English, cultural minorities, and so forth -- all of which create an opportunity to democratize local government and build stronger communities.

At the national level, we need to have a real debate about responsibility for public health emergencies, and defending open and democratic society in the face of fear and danger. One very concrete way to see this is in the question of whether federal responsibility for a public health emergency belongs with the Department of Homeland Security, or the Department of Health and Human Services. What should be the consequences for civil liberties? What should we ask people to do voluntarily, and what coercion should be used? Do we guarantee to always tell the people the truth? If there are to be any emergency powers granted to any federal agencies, what is the procedure? How long do they last? What mechanisms exist for accountability and review?

And then there are infrastructure questions -- hospital surge capacity; the public health workforce; coordination and collaboration among health care, public health and public safety agencies at the local, state and federal level, with clear collaborative relationships and lines of authority established in advance; planning and training; and so on.

There are many issues touching directly on social justice, democracy, and public priorities embedded in emergency preparedness, as Katrina proved beyond any doubt; and we are woefully unprepared. It doesn't matter whether you believe H5N1 flu is inevitably going to wipe out half the human population before the end of 2008, or you think the whole thing is the biggest crock since the world was going to end on January 1, 2000. Something is going to happen some time, and it makes sense to think in advance about how we will respond. After all, the Cheney Administration used the 9/11 attack to give us Iraq, Guantanamo and the Patriot Act. We should make sure that doesn't happen again.

Thursday, June 21, 2007

Saving babies

I appreciate the comments on the previous post, but I wasn't intending to ask why Karl Rove and other Republican operatives have seized on this issue. My question is, why have a substantial subset of Christians -- specifically the Catholic bishops and evangelical protestants -- passionately embraced such a bizarre definition of what constitutes a morally relevant human life.

There is no basis in the Bible or in traditional Christian theology -- that is, theology prior to the late 19th Century -- for the proposition that an embryo is morally a human being. Furthermore, the proposition seems ridiculous to most people. It is not common in Judaism or Islam, nor is it accepted by most Christians, including I must add most Catholics. And, in fact, even most defenders of this position seem to practice doublethink on the question. As Steven Benen points out on Crooks and Liars, Tony Snow, in defending Bush's veto of the stem cell research bill, said that, on the one hand, Bush believes that embryonic stem cell research is "the taking of human life," i.e. murder; but on the other hand nobody should be too upset because Bush has not advocated banning such research, in fact he's all for it, it's just that he doesn't want to spend federal funds on it.

Weird, huh? For George W. Bush, who is a mass murder and quite probably a psychopath, to stand up and say that there is a moral line he will not cross with respect to a microscopic blob of slime, is beyond grotesque. While Mr. Bush is saving the blastocysts, he has nothing to say about 20 million children under five years of age who currently suffer from severe acute malnutrition, one million of whom will die this year. (PDF) And the same goes for the entire culture of life gang, who obviously don't give a shit about life.

So what do they care about? What is the "right to life" movement all about? Here's your answer. The church came to condemn abortion in the late 19th century not because of any concern about human life -- after all, the Catholic Church used to burn people alive and torture them to death on the rack -- but because of the women's movement of that era. Women began to affirm their sexuality, and to insist that sex could be separated from procreation. That was the claim that troubled the Pope, and it was, and remains, the offensiveness of sexual freedom for women that motivates the right to life movement today, not "life," which in fact they despise.

Embryonic stem cell research just happened to get caught up in the warped logic of this position. If zygotes and blastocysts are human life -- which they have to be to make the anti-abortion position consistent -- then they must be life in or out of the woman's body. If abortion is murder, then embryonic stem cell research must be murder too. But, since that is ridiculous on its face, the culture of life is in a bind; they have been demolished by reductio ad absurdum. So, we get this quantum transposition of ethical positions: it's murder, but it's really okay.

The final proof of my analysis is that the same people who oppose legalized abortion generally oppose contraception as well, which would of course prevent abortion. So it's not about life, it's about sex. Why not cut the crap, and say what you really mean?

Wednesday, June 20, 2007

Moral Values

God's anointed Leader of the Free World is preparing to veto a bill that would have relaxed existing restraints on federal funding of research using embryonic stem cells. So, time once again for me to revist the endlessly fascinating subject of Christian morality. A while back I had occasion to visit Brigham and Women's Hospital in Boston, and there was a guy standing outside with a sandwich board reading, "In the court of God, abortion is murder." This is, of course, by far the most important issue to the people the pollsters call "values voters," and the Christian preachers who tell them what to think, even more important than discriminating against homosexuals.

God's other son has no choice but to veto the bill because it appears to sanction the destruction of human embryos, and that is indistinguishable from the murder of human beings. Now this is a very curious belief for people who claim to base their morality on the Bible, because of course there is not one word about abortion anywhere in the Bible, Old Testament or New. It's rather embarassing for the faithful, in fact, that they can't come up with any Bible verses to demonstrate God's thinking on this. After all, they get their hatred of homos from Leviticus, shouldn't there be something in there somewhere that they can at least twist or torture into a semblance of condemnation of abortion? But there is absolutely nothing. And I should tell you that abortion, and for that matter infanticide, were commonplace in the ancient world.

In fact, Christians did not decide that abortion was sinful until the late 19th Century. And it was impossible for anyone to claim that "human life begins at conception" until people understood what conception was. The ovum was not even discovered until 1827, by Karl Ernst von Baer, cell division was first recognized in 1832 by Dumortier, and the moment of conception was not observed until 1856 by Nathanael Pringsheim, in plants, although he did not understand what he was seeing. In 1883 Edouard van Beneden reported the reduction in chromosome number with the generation of the germ cells and the restoration of the diploid chromosome number upon fertilization. At this point we can say that a small number of human beings -- specialists in the cutting edge of biological science -- had at least a limited understanding of the nature of conception, but even so this understanding unfolded very slowly from then on and did not become in any sense complete until the elucidation of the nature of DNA as the carrier of inheritance in 1953.

Until very recent times, I would venture to say that people in general had a very different understanding of what constitutes a human being with moral status. A human is an entity that can perceive, feel, and behave as a human. We treat humans with respect because we can empathize with them; it troubles us, or at least most of us, when others suffer, and when others are bereaved. Apart from the psychological mechanism of empathy, we also benefit from a social contract. We agree that people should be respected and valued because we wish to benefit from that agreement ourselves.

Now, I agree that there are a lot of fuzzy boundaries and slippery slopes built into this ethical construct. For one thing, people have tended to put whole groups of other people outside of it -- enemies in war, despised castes and races. Only some humans have truly been human. Historically, many if not most cultures did not give full human status to infants, and surplus or defective ones were smothered or left to die. (Viz. Oedipus.) That offends us deeply today, but it did not offend our ancestors -- including the people in the Bible. And it's never been clear what to do about people who are severely debilitated, unconscious, or who don't honor the social contract themselves.

But wherever you want to draw the line on moral agency, embryos clearly don't have it. They can't feel, think, or act, and if nobody is bereaved by their loss, there is nothing left of moral status for them at all. And by the way, if you believe in God, I can tell you right now that he agrees with me about that. As I wrote some time back, "Out of 100 zygotes, about 50 fail to implant in the uterus and uhh, well, there goes a Sacred Human Life down the toilet with the tampax. Of the remaining 50, 30% (that's 15, according to the Satanic Laws of Arithmetic) are simply sloughed off in what appears to be a normal, perhaps late, menstrual cycle and the woman probably will never know that she was preganant. The remaining 35 embryos will last at least 35 days, after which pregnancy may be recognized. Of these, 25% will die in utero, perhaps recognized as a miscarriage. That leaves about 26 of the original 100 zygotes unslain by G. Almighty. Now that is one hell of a prolific baby murderer."

Now, people get a lot queasier about abortion as pregnancy progresses and the embryo becomes a fetus, and over time comes more and more to resemble an infant. I'm not going to argue about that here, since it isn't directly relevant, except to say that there is no specific or definite point or line to be crossed unless you want to make birth the essential event. Probably -- although who really knows? -- fetuses develop some form of sentience and perceptions of relative comfort or discomfort gradually. Given what we know of cerebral anatomy, it seems pretty clear that development of the cerebral cortex, and particularly the frontal lobes, is essential to whatever it is that makes a fetus like a baby, in having conscious awareness. Embryos, for sure, don't have that.

So, from whence do the passionate believers in the so-called "right to life" get their very curious ideas? It is trite to observe that they obviously care far less about people who have actually been born, and who manifestly do feel and suffer and possess moral agency. The same (putative) president who they adore for vetoing embryonic stem cell research doesn't give a damn about sick children (see yesterday's post) or the 29,000 children under five who die every day in poor countries from easily preventable causes such as contaminated water or malaria or starvation. So what the hell, you should pardon the expression, is going on here?

I believe I know the answer, but I'll stop there for now. If anyone cares to supply their own, go for it.

Tuesday, June 19, 2007

This and that

1) Readers may be interested in this from Michael Moore's publicists. No skin off my nose to post it:

To raise awareness of the increasing American healthcare issues and the film, we have created an official SiCKO YouTube group (http://www.youtube.com/group/SiCKOthemovie). Michael wants YouTube members to share your Healthcare Horror Stories and tell us about an experience you had with your insurance companies or healthcare providers. This is the group where you can post your videos to share with Michael, who will be screening them and sharing them with Congress. This is a platform to be heard - so make sure to encourage your readers to upload their own videos today!


2) Our friend Lisa Ann Wright asked me to comment on her post about about the prosecution of Dr. William Hurwitz for what the DA considered to be unlawful prescription of narcotics. I don't know anything about this specific case, but I did offer Lisa Ann these more general thoughts.

Physicians have to make judgments all the time about prescribing narcotics; sometimes these judgments are quite difficult and they get into gray areas of legality as well as ethics. For example, I interviewed a man with HIV who said he had agreed to accept a prescription for antiretroviral medication in exchange for a prescription for morphine. He was a junkie, but was the physician wrong? She was trying to save his life. If she didn't prescribe the morphine, he would have bought heroin on the street. This way, he lived in the YMCA, didn't commit crimes, took his meds, and took his morphine. So what's wrong with that? But a prosecutor might find it indictable.

It is perfectly legal to prescribe opioids to addicts if they happen to be methadone or buprenorphine, although these drugs can be prescribed only under strictly controlled circumstances. Drugs that are in fact more subject to abuse, such as hydromorphone and oxycodone, can be freely prescribed, but as Dr. Hurwitz learned, you can also get in trouble for it. Sometimes patients (like Rush Limbaugh) deceive physicians in order to get multiple prescriptions or continue to get scrips when they are no longer really in pain. Sometimes people with legal prescriptions supplement them with street drugs. Expecting physicians to know everything their patients are doing and to police them is unrealistic. Treating them as criminals for making what some people might construe as errors in judgment, or simply different judgments than some others might make, or being victims of deception is clearly counterproductive.

That said, it is certainly possible for a physician to cross far enough over the line that the issues are no longer ambiguous. I would say there would have to be corruption for money involved, first of all, not an honest judgment about what is in the best interest of a patient. It would have to be ongoing and the physician's guilty knowledge would have to be demonstrable beyond a reasonable doubt, of course.

The situation would be less fraught and easier to make effective policy around if narcotic abuse was decriminalized. By the way, there is a similar and somewhat better known case, that of Dr. Ronald McIver, who is currently serving 30 years in prison for actions which were clearly taken in what he believed to be the best interests of his patients. His case is discussed by Aspazia, here.

This crusade against physicians who are trying to help suffering people is just one more example of how "moral values" in this country have become a synonym for evil.

3)And while we're on the subject of moral values, God's anointed representative on earth wants to provide just $4.8 billion in new funding for the Supplemental Children's Health Insurance Program over the next five years. The CBO calculates that will purge 1.4 million children from the roles -- and 6 million eligible children are already uncovered because the existing money doesn't stretch far enough. That's according to the Congressional Budget Office. Of course, the administration, with its usual disdain for the reality based community, claims the true number is only 794,000. Advocates want to put in $50 billion over the next five years -- $10 billion a year -- and cover all the children. So the difference is $5 billion a year -- enough to fund the occupation of Iraq for a couple of weeks. But we know which of these is a higher priority for Jesus. Just ask the Christian Coalition. (Bob Herbert discusses S-Chip in his column today but the NYT won't let you read it without paying. So no link.)

Update:Lisa Ann hips me that you can get the Herbert column free for 24 hours, here.

Monday, June 18, 2007

A Compound Tragedy

First, apologies for missing a couple of days . . . I was in the country and away from your Internets, which is, from time to time, a good thing. If you really miss me, you can always check out the other blogs I contribute to, Iraq Today, and Dialogue Concerning the Two Chief World Systems.

Meanwhile, back at Stayin' Alive, I came across this today from anonymous ink spillers at the NYT News Service. The mishegos about the vaccine preservative thimerosal being the cause of autism has caused even more damage, estrangement between Bob and Suzanne Wright, the founders of the charity Autism Speaks, which is funding legitimate scientific research, and their daughter Katie, mother of an autistic child, who is convinced that thimerosal caused her family's tragedy. Oprah, to her shame, gave Katie a platform for this claim, leading to a public rift which has damaged the charity.

Reading the description of Katie's faith-based commitment to her lost cause is heartbreaking. She is convinced that her son Christian's condition is due to thimerosal because he developed the symptoms of autism after he had been vaccinated. I shouldn't have to comment on the logic of this position. She could equally well blame solid food, toilet training, or El NiƱo. In fact, the thousands of parents who are absolutely convinced that thimerosal made their children autistic base their unshakable faith on this foundation.

The link between thimerosal and autism has not only not been confirmed by any studies, it has been about as convincingly refuted as any proposition can be. People like Robert Kennedy Jr. who promote this slander are motivated by lust for personal fame and fortune.

Parents like Katie are victims, of course. While I am always careful to avoid blaming victims, in many cases we do make ourselves vulnerable because of our ordinary weaknesses. When people see something absolutely devastating happen to a child, their emotional response inevitably contains an element of anger, and anger needs an object. It may not exactly be comforting to have somebody to blame, but it does meet a need. It helps to make sense of something inexplicable, it creates a path that seems to have some purpose. And, of course, the cynical will note that these parents are engaged in a lawsuit that they hope will win them a whole lot of money. They will say their motive is purely about justice, not greed, but it's kind of hard to separate the two under the circumstances.

If the vaccine court awards them a nickel, that will represent a dereliction of duty and a major miscarriage of justice. I doubt it will happen. And then Katie and her fellow crusaders will feel betrayed once again. They will continue to nurse their anger and now it will extend to the federal government, the judges, the mass media, and the entire scientific community. They will see themselves as double and triple victims of an indifferent and dishonest society.

Of course nothing is further from the truth. People in general care deeply about developmentally disabled children and the families who struggle to nurture them. The National Institutes of Health and private foundations fund autism research, tens of if not hundreds of thousands of people donate to research and family services, hundreds of scientists dedicate their lives to understanding the disorder -- or I should say, disorders, because there is likely more than one etiology behind the autism spectrum -- and many tens of thousands of people work hard for low pay to educate, treat and help care for autistic children and adults. But none of that matters to people who need somebody to blame. It is indescribably sad.

Thursday, June 14, 2007

Doing what's right

Here at Sodom on the Charles in the People's Republic of Massachusetts, today is potentially historic. We'll know soon, but I decided to post this before we get the verdict because what I have to say is the same either way.

As you know, a couple of years ago our state's highest court ruled that the Massachusetts constitution guarantees equality under the law to everybody, and that even includes people who Pat Robertson and Pope Benedict believe will be tortured for all eternity by their benevolent God who made them. I refer, of course, to lesbians and gay men who want to get married. The Catholic Church, after decades spent sponsoring the serial rape of hundreds of children, elected to impose its superior moral virtue against those wretched sinners by sponsoring a constitutional amendment to ban same sex marriage. They collected enough petition signatures during church services to force the state legislature to consider putting the amendment to a referendum.

We have an odd system for amending the state constitution, which requires at least 25% of the members of both houses, meeting as a single conference, to approve the amendment two years in a row. Last year it squeaked by with about 28%31% or so, but many of the legislators who ran for reelection on a platform of banning same sex marriage were defeated, so this year it's too close to call. Yes, the depraved and satanic hordes who elected John Kerry and Ted Kennedy to the Senate, having watched their neighbors get married for the past two years and seeing nothing bad happen, have decided that it's okay after all. Nevertheless, the silk-robed child rapists are brandishing their solid gold candlesticks and sulfurous threats at the people's representatives, and they still may be able to force the voters to consider whether some people just aren't really people after all.

Now, from a public health point of view, this issue is very clear. It's extremely important to eliminate stigma from sexuality, because it's when people are marginalized and driven underground, made to feel filthy and ashamed, are denied self-acceptance, and can't talk openly about their feelings and behaviors, that they behave in dangerous and self-destructive ways. Moral condemnation, shaming, and hatred don't only harm people's spirit, they make it impossible to counsel and support them to protect themselves and others. They directly cause substance abuse, depression and self loathing, undermine responsibility, and kill people.

Acceptance of lesbians and gay men as full citizens, equal and valued members of the community, parents, in-laws, neighbors and friends, makes us a healthy society. If you believe in a God who despises people for being the way he made them, you might think again about offering him praise.

Update: We won big! The amendment went down 151 to 45. Massachusetts is now truly the land of the free.

Wednesday, June 13, 2007

Is this off topic?

I visited my mother last week. We switched on the teevee to catch the news before the Mets game, and it was all about Paris Hilton. So who is this woman anyway, and why is she famous, my mother wanted to know.

I said well, she's heir to the Hilton hotel fortune, but she's famous because one of her boyfriends surreptitiously videotaped them having sex and put it on the Internet, or at least that's the official story but she was probably in on it.

Oh really? said Mom. There was this other woman with two first names who was murdered or something a few months back, who the hell was she?

Well, I explained, that's Anna Nicole Smith. She wasn't murdered as it turned out, she just OD'd. She was a Playboy centerfold who married an 80 year old rich guy, who promptly croaked according to plan. His relatives sued to try to stop her from inheriting the estate but they lost. When she died leaving behind an infant there was a contest among her various sexual partners to see who would win the paternity test and end up controlling the boodle.

That's it. I'm proud of my mother for managing not to know any of that -- it was a difficult achievement. But I've got to say, when you spell it out like that, it raises a vexing question indeed. Why hasn't Wolf Blitzer committed suicide, or at least retired to a monastery? And why the hell do all those people have bumper stickers that say "Proud to be an American"?

Tuesday, June 12, 2007

I got a real bad feeling about this

If you get your information from the corporate media, you probably have a general feeling that things aren't going all that great in Iraq, but on the other hand there are some positive signs. (Of course if your corporate media sources include Fox News, you probably think it's kind of like Palm Springs.)

You know, the "surge" is just getting into place but sectarian violence is down, Anbar province is much less dangerous for U.S. troops, we're trying new tactics, etc. Sure, they keep blowing up bridges and bumping off 3 or 4 Americans every day but that's just background noise by now.

Actually it's much, much, worse than they are telling you. The UN Secretary General says that the surge has already failed. The Green Zone -- the fortified area in central Baghdad where the putative Iraqi government hides from the Iraqi people behind triple blast walls and foreign security forces -- is too dangerous for the UN staff. Civilian casualties are in fact rising, children are not attending school, sectarian militias control the country and violence is rising amid factional fighting in the south. Fifty thousand Iraqis are fleeing the country every month, with many more internally displaced, many of them living in refugee camps. You can read Ban's full report here.

The only reason U.S. troops are taking fewer casualties in Anbar is because they have been arming sectarian militias that promise to confront the most religiously extreme elements known as al Qaeda in Iraq. The problem with this strategy, of course, is that a) these militias also hate the U.S. and the occupation and could easily turn their shiny new weapons on the donors and b) they will ultimately confront the Shiite government and its security forces, in other words we're just fueling the civil war. Remember when the administration was outraged by proposals to grant amnesty to forces that had attacked American troops? Now we're arming them.

The corporate media report on violence form Iraq, but each day your paper or TV news report on only a small fraction of documented incidents, leaving the impression that they have given you the whole story. For a more complete version of daily events, you can visit Iraq Today. It's a completely different universe than the alternate reality of the nightly news.

So, what's the Bush administration plan to salvage the situation? You got it. Bomb Iran. The very pious, God-fearing, morally pure Joe Lieberman is their stalking horse, and he's talking up the attack on Iran big time. The administration is moving naval officers into the top command positions -- not, presumably, to prosecute the guerilla war in the Iraqi desert.

I hope you're ready for a hard winter.

UPDATE: And (posted three hours after this, by the way), Logan Murphy also sees Lieberman as a White House stalking horse and cites Ned Lamont and Michael Hirsh to that effect. (Warning: Disgusting photo of "The Kiss." Click at your own peril.)

Monday, June 11, 2007

Hot tip . . .

You probably won't read this unless I tell you to, because it sounds like it's gonna be really, really boring. It's the NYT supplement called The Business of Health. No, it's not for Absolut-swilling assholes with Gucci briefcases and Republican National Committee donor cards, it's for you.

For the 4 1/2 fans of this site, I particularly recommend "Pinning Down the Money Value of a Person's Life," by Alex Berenson, and "Need a Knee Replaced? Check Your Zip Code" by Stephanie Saul. These are excellent primers that will help you think about the stuff we talk about here just like a Ph.D. - and save you five or six years and 80 grand in the process. So check it out.

Long, slow, ineluctable slide?

I was cleaning out some old files and I found a document from around 1997, a pre-publication draft entitled A Call to Action. It begins:

We are Massachusetts physicians and nurses from across the spectrum of our professions. . . .Mounting shadows darken our calling and threaten to transform healing from a covenant into a business contract. Canons of commerce are displacing dictates of healing, trampling our professions most sacred values. Market medicine treats patients as profit centers. the time we are allowed to spend with the sick shrinks under the pressure to increase throughput, as though we were dealing with industrial commodities rather than afflicted human beings in need of compassion and caring. The right to choose and change one's physician, the foundation of patient autonomy and a central tenet of American medicine, is rapidly eroding. . . "


Among their principals: Pursuit of corporate profit and personal fortune have no place in caregiving. (Funny thing about that - one of the signers of the manifesto, Mitchell Rabkin, at that time received a salary of $1 million per year as president of Beth Israel hospital.)

Anyway, the group, then the Ad Hoc Committee to Defend Health Care, went on to become the Alliance to Defend Health Care, which still exists. Their web site is here. The original manifesto, more or less similar to the draft, is posted there.

So where have we come in ten years? I would say that things are only slightly worse than they were back then. The proportion of the population that is uninsured has grown just slightly; takeovers of non-profit institutions by for-profit corporations have proceeded slowly. More of us are insured by business corporations than by non-profits, and there are more for-profit hospitals and specialty health care providers. However, it isn't really clear that the trend has made patients who are lucky enough to be insured terribly worse off. The main reason is that a physician and consumer rebellion against some of the worst excesses of managed care tempered the restrictions on physician decision making that I believe largely inspired the manifesto.

The fact is that the structural problems that existed then are about the same now: a patchwork of payers that leaves a lot of people out entirely and underinsures many more; and financial incentives that reward high tech, expensive interventions after people get sick, while discouraging adequate preventive care, interpersonal care, and public health programs. We have managed to reduce the death rate from cardiovascular disease by about half, for example, in good part due to drugs and surgery, with a very important boost from reduced rates of smoking, which is a creditable achievement. But we have more and more people living with heart disease and our expenses for treating them have increased dramatically. The obesity epidemic is probably going to exacerbate this trend notably in the near future.

The inequities in health status, access to health care, and health care quality have just gotten worse. The time physicians have to spend with patients is slightly less, although that is more a function of physicians' demands for high incomes than it is of corporate greed. (Hate mailers will find my e-mail address on the side bar.) Granted, if financial incentives shifted to better reward primary care, that would also help, but it doesn't matter whether insurers are for-profit, non-profit, or public, they all have the same incentives.

This is a very sketchy review, given that this is just a quick blog post. An in-depth discussion of where we've come in ten years would require a book, and I haven't been offered the contract yet. But we very definitely have not made any progress.

Friday, June 08, 2007

A sad occasion

It's bad enough that we lost Steven Gilliard this week, now comes the devastating news of the death of a great benefactor of humanity, the inventor of Cheez Wiz and McDonald's french fries.

Just a reminder that this stuff doesn't appear in our alimentary canals through a force of nature. People in laboratories develop the products and the manufacturing processes, and smart kids with Ivy League degrees figure out ways to get us to buy it, and we do, and the companies make money. This happens because the sensory and neurological and hormonal mechanisms that trigger our eating behavior evolved while we were rooting around on the savanna for berries and tubers and chasing down the occasional grass fed antelope. A big blob of carbohydrate or fat or sugar gave our ancestors a big behavioral reward because they were always a few calories short.

Well, not any more. The wiring that enabled us to survive back then is killing us in the toxic food environment created by industrial capitalism. So, what does this suggest about the ideology of market fundamentalism, and specifically its claim that it produces "consumer sovereignty"?

Thursday, June 07, 2007

In case you thought you'd already maxed out your outrage meter . . .

this might make it go up to 11. My friend Sheldon Krimsky and Tania Simoncelli from the ACLU have a commentary in the new JAMA that you can't read because you're just common rabble -- no fault of Shelly's, I assure you, he is probably the one person on earth who is most committed to the democratization of science. But he doesn't make the rules. Anyway, you can read the first 150 words here.

To summarize as best I can, it used to be considered unethical to test pesticides on humans. Now that seems kind of obvious, doesn't it? What I mean is just what I said: it was not considered proper to intentionally feed pesticides to humans in order to find out whether they are safe, for the obvious reason that if the answer turns out to be "no," your volunteers -- or perhaps prisoners -- are shit out of luck. This has been generally accepted since the Neuremberg trials of Nazi doctors.

So, what's the alternative? Studies on animals, obviously. But, people aren't quite the same as rats and mice, so under the Food Quality Protection Act of 1996, the EPA uses additional margins of safety: up to 10 times for the possible difference between human and animal sensitivity, up to 10 times for differences among individual humans, and up to 10 times for the extra protection of children (who are more sensitive than adults to many toxins). So, the EPA could conceivably set a human exposure limit 1,000 times lower than the dose found to be safe in animals.

Pesticide manufacturers would like to be able to get higher exposure limits, so they would like to test pesticides directly on humans in the hope they can show safety at higher levels. And they did so. Shelly and Ms. Simoncelli tell us that they submitted 16 such studies to the EPA between 1992 and 2004, which a House committee found "appear to have inflicted harm on human subjects, failed to obtain informed consent, dismissed adverse outcomes, and lacked scientific validity." Sounds to me like we're talking crimes here -- you know, reckless endangerment, assault and battery -- but as far as I know there were never any prosecutions.

Well, after various regulatory and legal permutations which I don't have room to go into here -- including a moratorium on accepting data from human studies issued by the Clinton Administration, briefly reversed by the administration of you-know-who and then finally overturned by a federal appeals court in 2003, the EPA has issued a new rule allowing the intentional dosing of humans with pesticides. As Krimsky and Simoncelli conclude:

Two statements from the Declaration of Helsinki, as amended in 1983 by the 35th World Medical Assembly, raise serious questions about the morality of intentional human dosing experiments. The first states that “biomedical research involving human subjects cannot legitimately be carried out unless the importance of the objective is in proportion to the inherent risk to the subject.” Pesticides, which are often neurotoxins, endocrine disrupters, or cholinesterase inhibitors, may have acute or long-term chronic effects on those exposed. What system of moral proportionality can possibly weigh the potential of human suffering against the benefits to a company's profit margin? . . .

The presumptive moral position is that the intentional dosing of humans with nontherapeutic agents is unethical. Companies that have an interest in these experiments for minimizing their regulatory burden can, and probably will, purchase these studies and the ethics approvals to support them from private contract research organizations that typically pay members who serve on their institutional review boards. The proposed in-house ethics committee within the EPA cannot be fully insulated from political influences. Because of the complexity of health end points in human toxicology studies and the potential for long-term effects, no reasonable set of human studies will be sufficient to reveal the risks of a person's exposure to pesticides in these experiments or will be able to cover the range of health end points that can be studied using animals and cell culture. Moreover, risk-benefit analysis, 15 in which human research participants bear the risks while pesticide companies acquire the benefits, is an inappropriate criterion for deciding whether it is ethically correct to intentionally expose people to nontherapeutic neurotoxins. . . .

How many human study participants, how many experiments and replications, and how many end points must be studied to obtain the definitive answer to whether a 10-kg infant or a 65-kg adult is more or less sensitive than a 0.5-kg animal to raise pesticide residue levels in food? Is the answer to this question, for the benefit of cost-efficiency, worth the uncertain long-term risks that financially rewarded, usually economically disadvantaged, human subjects will face from intentional exposures to neurotoxins? Is dividing by 10 from mouse to men (and women) too big a burden? The answer is categorically no!


So far, the EPA intends only to permit human testing of pesticides, but it could decide to allow it for industrial chemicals as well. This is absolutely depraved. And why have we heard nothing about this in the corporate media, or from Congress? Are these the "moral values" that Mr. Bush's loyalists claim to uphold? What has become of us?

Wednesday, June 06, 2007

Why I'm almost ready to give up . . .

Because plain, ordinary, simple truth is irrelevant to our political discourse. As Atrios points out, in the Republican "debate" last night the Mittster claimed that the U.S. had no choice but to invade Iraq because Saddam would not admit the UN weapons inspectors. Will anyone in the corporate media, reporter or pundit, bother to point out that the major flaw in this argument is that it is literally false, as in, does not correspond to reality, is made up, is a LIE?

But of course, the Emperor of Mesopotamia has made the same assertion on at least four occasions. I recommend, for those of you who can take it, this attempt to build a comprehensive catalog of the lies of the Bush administration, although the proprietors concede the task is beyond human capacity.

If the news media simply bothered to point out what is true and what is false when politicians speak, we would live in a completely different country. It's that simple. It really is. We live in a gigantic nuthouse, where truth doesn't matter. Large percentages of the public have a whole lot of very important beliefs that are objectively false, which is not surprising since politicians and pundits and even "reporters" tell them these lies every day. It so happens that the so-called "conservative" movement and the Republican party depend entirely on this infrastructure of falsehood for their very existence.

We don't have a divide in this country between political factions with different priorities, values, or intellectually defensible arguments for how to achieve the general welfare or pursue widely held goals. We have a divide between the party of reality and the party of delusion. It really is that simple. Some beliefs are just wrong. But our public discourse does not acnkowledge the fundamental concept of reality.

And one more small point . . .

Alex Beam's column about Conservapedia has gotten quite a lot of play in the blogosphere. But I do have one point to add:

There are 63 different species of kangaroos. Apparently the creation scientists think there is only one.

Tuesday, June 05, 2007

Protecting our Children

Re my most recent post on the Thimerosal hoax, Mr. Gunn asks about the epidemiology of vaccine refusal. I can't find any numbers on how many families refuse vaccination nationwide, but there was a survey of pediatricians done a couple of years ago, which WaPo's Sandra Boodman discussed here. More than half said they'd encountered at least one family in the previous year who refused all vaccinations, and 85% said they'd encountered a family that refused at least one.

Now, that doesn't necessarily translate into a huge problem -- primary care physicians such as pediatricians typically have caseloads of around 1,500 or so (with a lot of variation). Because of herd immunity -- an unvaccinated child is unlikely to be exposed to a pathogen if most of the other children in the community are vaccinated -- we can tolerate a low rate of non-immunization. However, the situation certainly could become dangerous if a lot of families in a particular area opted out. And indeed, Boodman interviews a pediatrician who estimates that he and his partners in northern Virginia each confront vaccine refusers about twice a month. I don't have enough information to do the math, but if enough of those kids are attending the same school or day care center, it certainly could create a dangerous situation for them.

To me it is of equal concern that, as Boodman reports -- and this was a surprise to me as well as the investigators -- "More surprising to the authors were two findings: 39 percent of those surveyed said they would consider turning away a family that refused all shots -- researchers had expected the number to be about 20 percent -- while 28 percent said they'd think about severing a relationship with a family that refused some shots." My gut reaction is that this is not really ethical, and its certainly counterproductive. Doctors should counsel such families and provide them with truthful information and access to resources that will help them make an informed decision. But this is certainly an indication of how frustrating this whole sorry business is to doctors.

What is most frustrating to me, as a non-physician specialist in public health policy, is that the vaccine-autism hoax has become linked in some people's minds with progressive politics and consumer empowerment. For that, of course, we principally have RFK Jr. to blame, which is why I am so contemptuous of him. He has not only deceived and harmed the families who believe his lies, and their children, he has also undermined and discredited everyone who works to empower health care consumers and take back public health and health care from the control of corporate greed. It is just one more extraordinarily offensive consequence of our celebrity-driven media culture.

Here is a trustworthy, accessible source of information about vaccines, for parents and everyone else who cares about children.

Monday, June 04, 2007

Belief

NYT critic Edward Rothstein uses the hook of an exhibition on mythical creatures at the American Museum of Natural History, the opening of the Creation Museum, and the Broadway revival of Inherit the Wind to give us a fair and balanced discussion of evolution vs. creationism. Rothstein doesn't seem to have any opinion about who is correct. He just wants us all to get along:

The questioning of biblical truth, the museum suggests, leads to social and intellectual dissolution. The entire enterprise is fragile, vulnerable to skeptical pressure. That is because it is a faith, not a science.

Unfortunately some Darwinian theorists leave a similar impression about their own enterprise when they bristle at dissent or doubt. But the challenge made by faith to science should actually help science be less like faith, more prepared to scrutinize its own assumptions.

How then can these realms continue to coexist, as the world keeps showing us they will and must? It isn’t always easy to tell when bones are being put together properly and when are we forcing them in place to fit our visions of what the world should or could be.

There are no simple answers, which is why, despite its own simple answers, I liked going to the Creation Museum, if only to try to understand the nature of mythic creatures, even when they still walk the earth.


Sigh. Rothstein, like the majority of people who have been writing about this subject lately, fundamentally misunderstands the nature of science. It is the essence of science that it scrutinizes its own assumptions. Science does not need the ostensible "challenge" from faith to start doing that. Darwinian scientists do not bristle at dissent or doubt, but many of them do bristle at idiocy. The Creation Museum and so-called creation science do not constitute dissent, because they operate entirely outside the framework of reason, and they most certainly do not constitute doubt, because they have none.

Rothstein advocates what is supposed to be the sensible, serious position, that faith and reason will always have to coexist, there is no way to choose between them,it all just depends on which explanatory framework you prefer -- "It isn’t always easy to tell when bones are being put together properly and when are we forcing them in place to fit our visions of what the world should or could be."

Scientists do not force fossil bones in place in order to fit a preconceived vision of what the world ought to be. That is precisely the sort of thing that creationists say, and it is nothing but a slander. Scientists have in fact made mistakes in assembling fossils, and put the wrong heads on dinosaur bodies and so on. But they have corrected these mistakes when better evidence came along.

The reason scientists believe in the antiquity of the earth and the broad outline of evolutionary succession is not because they started out with that story and fit the fossils into it, but because the story revealed itself in the careful fitting together of evidence from many different sources: geologic layering and the distribution of fossils within it, ice cores, radioactive decay, the distribution of species on archipelagoes (among the most compelling kinds of evidence for evolution, by the way, and therefore entirely ignored by creationists), the observation of evolution in historic time, even astronomical observations that place the origin and evolution of the earth in the universal context.

Along the voyage of discovery, we have frequently been surprised, even shocked, by new findings. Old ideas have been overturned. Now we are pretty sure that the dinosaurs are not extinct after all, they are sitting in the trees and singing. That's a whole lot more wonderful than Noah's flood -- but maybe, just maybe, it isn't true after all. And it's okay either way.

Sunday, June 03, 2007

And I'm still beating this horse because it isn't dead yet

I'm sure some of you out there are a bit taken aback by my evident hostility toward liberal icon and Upper Class Twit of the Year Robert Kennedy Jr. Newbies can get the story from these posts: Part One, Part Two, Part Three, and Part Four.

The really bad news is that some trial lawyers have Kennedy's visions of class action sugar plums dancing in their heads and there is indeed going to be a class action suit starting on June 11 against vaccine makers on the grounds that childhood vaccination caused autism in 4,800 children. If this suit is successful, it will be a disaster for children in the United States and the world. And I can assure you, it is utterly without merit. Dr. Paul Offit, who unlike the airhead RFK Jr. did not achieve his prominence because of his parentage, and who actually knows what he is talking about, lays out the potentially very bad news here. Let me give you the money quote, at least as far as the despicable Mr. Kennedy is concerned:

Certainly there is plenty of evidence to refute the notion that vaccines cause autism. Fourteen epidemiological studies have shown that the risk of autism is the same whether children received the MMR vaccine or not, and five have shown that thimerosal-containing vaccines also do not cause autism. Further, although large quantities of mercury are clearly toxic to the brain, autism isn't a consequence of mercury poisoning; large, single-source mercury exposures in Minamata Bay and Iraq have caused seizures, mental retardation, and speech delay, but not autism.

Finally, vaccine makers removed thimerosal from vaccines routinely given to young infants about six years ago; if thimerosal were a cause, the incidence of autism should have declined. Instead, the numbers have continued to increase. All of this evidence should have caused a quick dismissal of these cases. But it didn't, and now the court has turned into a circus. The federal and civil litigation will likely take years to sort out.


RFK Jr. should retire from public life and do something he is qualified for, like work behind the counter at Dunkin' Donuts. If he does that, he'll hurt some children by feeding them empty calories, but that will be far less harm than he's doing now. And, he won't be in over his head, or at least not very far.

Friday, June 01, 2007

Half a peace sign . . .

to the NYT for today's front page headline:

Bush Proposes Goal to Reduce Greenhouse Gases


Uh, he did no such thing. He said that the G-8 nations ought to talk about setting goals and maybe they would come up with something by the time he leaves office. And those "goals" wouldn't include any actual commitments to, you know, actually do anything. As Mr. Bush's environmental advisor James L. Connaughton explained, they would be "aspirational," only binding on individual nations that "chose to bind themselves."

In other words, Bush spouted some meaningless bullshit. This merits the upper right hand corner of the front page of the NYT, which informs the world that he actually proposed to do something, which he did not. Yes, it really is that easy. The editors of the NYT really are that fucking stupid.

In other news, the doctor with the bedside manner of Don Rickles emerges blinking and kvetching into the light of day. I refer of course to Jack Kevorkian, who in spite of having the communication skills of an enraged tarantula managed to keep the support of the majority of Americans for his serial assisted suicide campaign, just because most people happen to think it ought to be allowed. I link to the BBC article because unlike U.S. coverage, it is not dominated by religious fanatics threatening the nation with destruction by burning sulfur for tolerating his kind in our midst. The BBC calmly informs us that physician assisted suicide happens anyway, and that in Oregon, where it is legal, it remains uncommon, evidently free of abuse, and has not led to mass murder of people with disabilities or all the fashionable people shoving grandma out to sea on an ice floe.

I must tell you, however, that many physicians are uncomfortable with legalizing it. They fear that if it's legal, patients will ask for it, and they don't personally want to say yes or have to explain why they are saying no. Other physicians would prefer to have the legal option. The public has consistently strongly favored a legal option for assisted suicide in the case of terminal illness with poor quality of life, but I would say that physicians' opinions do also matter in this.

It certainly gets tricky. Some people who request assisted suicide are not actually terminally ill, but merely in great distress. And any definition of terminal illness is bound to be arbitrary. Contrary to popular belief, physicians are actually very poor at predicting how long a person has to live. You can define terminally ill for legal purposes as having a prognosis of say, 6 months or less, but lots of people who receive that prognosis live for years. Whoever issues the prognosis is really just guessing. I have often said that if I were facing late stage Alzheimer's disease, for example, I would want to take the big pill, but a) I would not be terminally ill at that point and b) I wouldn't be competent to request it. On the other hand, if I were terminally ill and in possession of my faculties, I hope that I would want to live out my life as best I could, assuming I could still do something useful with the time I had left. But all of that is not really relevant to the issue of legalization, which is just to give people the option.

What do you think?