Map of life expectancy at birth from Global Education Project.

Friday, December 30, 2011

Donning the Turban

Okay, I promised I'd get around to looking ahead to 2012 in the U.S. and I guess it's now or never. I've been procrastinating because it seems an unpleasing prospect.

I try to avoid the pundit's occupational hazard of presuming magical predictive powers. But I do hereby declare there is a 95% chance that our national conversation will completely miss the point on just about every important subject. That's the basis of my gloom. It's not that we can't make real progress toward solving our problems, it's that we won't even recognize them or talk about them. We'll talk about other problems that we don't have.

Everybody has noticed that we have extreme economic inequality in the U.S., the kind we used to deplore in what were once called Third World dictatorships. Some people on the right don't think this is a problem - those folks with the loot are the "job creators" and if you want a job, you want them to have even more money. Apparently there's a guy who only has $5 billion right now, and once he gets $6 billion, he'll give you a job. The way to achieve this is to stop making rich people pay taxes and to eliminate environmental, worker safety, food and other consumer safety regulations, and allow banks and investment management companies to steal from you.

On the other side we have people who want to increase marginal tax rates on income over a million dollars a year by 2%, and slash federal spending on stuff like health and other scientific research; technology investment; infrastructure maintenance, repair and construction; health care for the poor and elderly; education; and basic needs for poor children, in order to reduce the federal budget deficit in 2030. Oh yeah, meanwhile they want to give you a break by underfunding Social Security. Those are the liberals.

What we won't talk about is the absolutely critical need to invest everything we can right now, while we still have the resource and time, in a post-fossil fuel energy regime; to dismantle our globe girdling military empire; to prepare our young people for the demands of the knowledge-based economy; to save the ecosystem services of forest, grassland and ocean; and to destroy the power of the psychopathic, soulless corporations that are running the world right now. Because we won't even talk about any of the above . . .

We will continue our national decline. Our economy is controlled by people who have no loyalty to the United States or its citizens, who will extract whatever they can from the public infrastructure without paying for it, and send the proceeds wherever in the world they can loot at an even higher profit.

Our remaining national strength is squandered on a useless military behemoth designed to fight World War III on its own against the rest of the planet combined, but unable to defeat a few hundred men with homemade bombs. (Why we want to defeat them in the first place is a profound mystery.)

More and more of our children will go hungry. People who have worked and saved all their lives suddenly find themselves with their savings and careers destroyed, architects and engineers taking the jobs their teenage children would have had ten years ago. Higher education will be impossibly out of reach for more and more of those kids even as their elementary and secondary schools deteriorate.

And almost in the background, noticed only to be denied, the weather will grow more and more destructive, whole regions of the country will become essentially uninhabitable, agriculture will decline, mass extinctions of plants and animals will continue, and the ecology of the world ocean will collapse.

What do you expect the political campaigns next year will be all about?

Wednesday, December 28, 2011

Odd thoughts

I came into work today, even though the university is closed, because of some pressing duties. Providence is a college town, so downtown seems to have been hit by a neutron bomb. I was the only person in the restaurant where I ate lunch. This week generally has a slow, subdued, and slightly lonely quality, a suspension of normal time.

In fact there is a great deal of consequence going on in nation and the world right now, but for whatever reason, the TV news focuses on a disconcerting polarity of heartwarming holiday tales and horrific tragedies. I don't expect there are more deadly house fires and auto crashes this time of year, but we certainly hear a lot more about them. One such was a fire in a Victorian mansion in the tony New York suburb of Stamford CT that killed three children and their grandparents.

It turns out that before retiring for the night, somebody removed the hot coals from the fireplace and put them out in the mudroom in a bag. This behavior is so daft that I thought there must be some deeper meaning to it. The proper place for hot coals, of course, is the fireplace. It is built to contain fires. Just leave them there.

Could it be that the Martha Stewartian perfection of the home seemed impaired by the thought of -- shudder -- ashes in the fireplace? Whatever the case, the fireplace was once as essential to the functionality of a house as indoor plumbing and electricity are today. I grew up in a farmhouse built in 1835, which had two big stone fireplaces on either side of a central chimney. The fireplace in what is today the dining room has a steel rod on a swivel built into one wall, which was used to hang cooking pots over the fire; and a dutch oven on the side. You put coals in the bottom half of the oven and baked in the top half. That room was both kitchen and dining room. The room that is today the kitchen was a transitional room, an unheated anteroom which undoubtedly held firewood and whatever tools and gear were needed to venture out of doors, and probably a well pump. (The only surviving well from those days is out of doors, so I'm not sure about that.) Beyond that, fully attached to the house, was a stable where animals spent the winter.

Imagine, not just the utility, but the meaning of that fireplace. In winter, obviously, it would have burned continually, as not just the focus but the essential source of family life. Here was the one truly warm place in winter, where food was prepared and consumed, water was heated for cleaning and bathing, illumination was available in the evening for reading, the bedwarmers were filled before everyone retired for the night, and everyone huddled together continually in the cold and lean months.

Nowadays, fireplaces are just toys -- dangerous toys, as it turns out, for people who don't understand them. I suppose they are more than toys. They retain symbolic power from the old days, as a symbol of the household community, which is still captured in the word hearth. We have sat around fires for a million years, so the appeal must be built into our nature. But it's just for old time's sake.

Tuesday, December 27, 2011

People are Stupid

That was the opening line of a talk I heard by Isaac Asimov back when I was in college. He was predicting the kind of world we would have in the 21st Century and no, it wasn't about intelligent robots and space travel. It was about how we would have equality for women and limits on population and resource depletion and stuff because if we didn't, we'd be well and truly screwed.

He was right of course but unfortunately we're leaning more toward the latter alternative. "People are stupid" is also what I take to be the core message of this useful handbook on debunking BS from Skeptical Science. (It's a PDF but not huge.)

The basic problem we face in going up against the Limbaughs and Hannitys of this world and their devil-spawn in the Republican primary field is that you don't beat liars by trying to stuff people's heads with more and better facts. If your headline is "It's a myth that climate scientists don't agree about human-caused global warming," the phrase "climate scientists don't agree about human caused global warming" actually has a more powerful effect than the phrase "it's a myth." If you provide 7 arguments as to why you should believe that burning fossil fuels does cause global warming, that's too many, because people don't want to think that hard. If you tell them that the Vulgar Pigboy doesn't know what he's talking about, that's just going to make them hate you because they know and trust the Vulgar Pigboy. (VP=Rush, BTW.) Also, words - too hard to follow. Show them a picture.

And so on. It's well worth a read if a bit depressing, not least because the liars already know all of the above and are highly skilled in implementing it. But the authors hope that if real experts can learn these lessons, the truth can win on a more level field. I hope so.

Saturday, December 24, 2011

It's been a decent interval . ..

So I can repost this, which I wrote a few years back.

Christopher Hitchens, like Lyndon Larouche, used to present himself as a leftist. For many years he had a column in The Nation in which he vied with Alexander Cockburn for the “Most Acerbic” award (a magnificent scarlet inkwell filled with sulphuric acid). Things started to get a little weird in the 1990s when he developed an obsessive hatred of the Clintons. His reasons were partly respectable (triangulating, Dick-Morris-employing betrayers of the revolutionary vanguard) and partly insane (Bill’s serial sex crimes made Ted Bundy look like a boy scout; Whitewater [in which they were guilty, Guilty, GUILTY!) was the financial scandal of the century; Hillary not only murdered Vincent Foster, but conspired with her lesbian lover to seduce, rob and kill dozens of wealthy young fops whose mutilated bodies turned up in seedy alleys all over the DC metro area . .. well, maybe I made up that last one but it’s in the spirit of the thing.) Once he could no longer demonstrate his superiority to the bleating herd of liberal sheep by cheering on Ken Starr, the Iraq war became his next opportunity. His bellicose rantings were enough to drive Dick Cheney to the Quaker meetinghouse. He finally resigned from The Nation, claiming that the refusal of the magazine’s other writers and editors to fall to their knees in grateful acknowledgment of his intellectual and moral superiority on the question of war was proof of their bigotry and hatefulness. He wrote a final hissy fit essay in which he burned every bridge from London to Lompoc.

As some people have noticed, the Iraq war has not turned out the way it was supposed to. Some of the war’s portside chickenhawk supporters have since issued mealy mouthed retractions; others have concentrated on giving Chimpoleon and his pals unsolicited advice about how to do it better. Hitchens, however, has devoted himself to escalatingly vicious and absurd attacks on the war’s opponents. It’s not unusual for polemicists to turn against their own comrades but Hitchens’s case is particularly disgusting and bizarre. I think that chronic alcoholism destroyed brain cells in his cerebral cortex that normally inhibit irrational emotional responses in the limbic system. Something ticked him off around 1994, and the anger just fed into a positive feedback loop that slowly and steadily grows more intense. Eventually, he’ll lose one too many neurons and lapse into a vegetative state.

In his last couple of years, his public face was mostly about atheism, which is fine by me. But people shouldn't forget the rest of it. The guy went seriously off the rails.

Friday, December 23, 2011

Lies, damn lies, and un-lies

I'm sure I don't have to draw readers' attention to the preposterous selection by the self-styled "fact checking" organization Politifact of the "Lie of the Year." This was the claim by many Democrats that Republicans voted to end Medicare, specifically when the House voted to endorse Paul Ryan's long-term fiscal austerity plan. As many a blogger has pointedout, this is not a lie, therefore it cannot be the Lie of the Year. And it wasn't even Democrats who first said it, it was Naftali Bendavid in, of all places, the Wall Street Journal.

PolitFact is defending itself, seeming almost proud to have provoked such a firestorm among liberal bloggers and analysts. They claim that conservatives get all their info from Fox News, while liberals get all their info from Rachel Maddow, so of course we're unable to see that our treasured memes are actually lies.

Well now. Rachel Maddow is highly opinionated, but unlike Fox News, she has respect for actual true facts. That aside, I don't get my information about health policy from Rachel Maddow or anyplace else on TV. I get it from scholarly journals because, unlike the clowns at PolitiFact, I happen to be a genuine, bona fide expert on the subject. I even have a fancy degree in it and everything and I am a professor at one of those pointy headed elitist fancy pants east coast universities.

So here's the genuine information, unfiltered by Rachel Maddow. Medicare is a government sponsored health care plan which covers everybody in the U.S. over 65, and some other folks as well. It's essentially a single payer plan -- Medicare pays for health care services, giving everyone who is eligible a bundle of guaranteed benefits with very low, subsidized premiums and copayments. (People who can't even afford those get extra help from Medicaid.) (Now, you can choose to have Medicare use the funds otherwise allocated to you to buy private insurance. It's called Medicare Advantage. But it turns out to be no advantage at all, because it actually costs the government more.)

That's Medicare. That's what the word means.

The Republicans would instead give you a voucher that you could use to buy private health insurance, but it would not be enough money for most elders to actually afford the same level of benefits they get from Medicare. And it would just get worse and worse over time. And it would be much less cost effective because those private insurance companies would spend a big chunk of the money on marketing, profits, executive salaries, and trying to find ways to stop older and sicker people from doing business with them. (There are plenty of sleazy ways to do that, even if it's supposedly illegal.)

That's not Medicare. It's something else.

There are many other implications of this difference that I won't go into here, mostly having to do with all the ways that Medicare could be even better and would be if the insurance, pharmaceutical and hospital industries didn't own Congress.

The people who run PolitiFact don't understand all that because they are not experts. They have been bamboozled in the name of "balance." They are useless.

Wednesday, December 21, 2011


I have a probably unfortunate habit of looking ahead to the new year here. As far as I can remember I have tended to be mostly right but I don't claim any special powers of prognostication. Anyway, in case anybody cares, here's what I'm worried about, which, alas, is plenty.

Starting in Europe and moving generally eastward:

Don't look now (and few people are) but Greece is already in the midst of a total economic collapse. I mean the kind where refugees flood into the rest of Europe, civil order disintegrates, food rioters break into warehouses, and the country's hard won democracy founders. Really. It's that bad. Greece has long had a dysfunctional economy and political culture, it's a special case and economically, it's basically a minor appendage to Europe, but Europe as a whole is heading into a less dramatic, but still painful recession and its leaders seem collectively insane. They're doing the best they can to make matters worse, while squabbling with each other like schoolchildren who didn't get lunch. In the past -- i.e., for the better part of 2,000 years -- their squabbles have tended to get extremely ugly. I'm not expecting World War III but I do know that the experiment of European unity is in peril. Meanwhile this can't be good for their biggest trading partner, that would be us.

Meanwhile, and again Americans long ago lost interest, but Iraq is skating perilously close to breaking into three pieces -- which will not happen peacefully. The brewing civil war in Syria just exacerbates sectarian tensions in Iraq, since the Shiite government is much more sympathetic to Assad than the Sunni Arabs who are increasingly feeling oppressed and have lost faith in Iraq's democracy. If Iraq does fall apart then it won't be a surprise to see Iranian and Saudi forces enter the country and then, hoo boy. Oh yeah, Iran is hurting big time from the sanctions regime and its own population is simmering while it's elites are increasingly fractious. There is no limit to the amount of shit that might hit the fan in the whole region, and uhh, oh yeah, oil.

Proceeding on to Pakistan, it is very likely that the pretense of civilian rule will dissolve. Pakistan's military and security services are riddled with highly ideological religio-nationalists who have shown themselves perfectly capable of creating irrational provocations to India and which have designs on wielding influence in Afghanistan through precisely the people who we now call the insurgency and who are blowing up our fine young soldiers. Oh yeah, they have a large nuclear arsenal.

I'm actually not particularly worried about North Korea but I don't like to see millions of people starve. China will probably see some economic difficulties but they'll muddle through.

Before I cross the Pacific, I'll just say that Africa, for all its troubles, is actually doing okay compared to previous decades. And, proceeding to Latin America, they're doing quite well these days. The big players, Argentina and Brazil, are actually doing jes' fine, with stable democracies, strong economies, and steady progress against their long standing problems. (Not so much the Amazon rain forest, however.)

Now, proceeding north from Brazil . ..

To be continued

Tuesday, December 20, 2011


I'm sorry for not posting for a few days. As I may have mentioned before, I'm selling my home of more than 20 years in Boston and finally have an imminent closing, so that's made me very busy, not least of all with getting the last of my stuff out of there. In the process of closing down the old homestead and moving, I think I've gotten rid of about 50% by volume of all the crap I had. As much as possible, I talked the thrift store into taking stuff or found a way to give it to someone directly, but the piles of trash are still immense.

How did this happen? How did I end up with mass quantities that I don't need, don't want, don't even want to store? And why, since I actually have more crap than I want, do family members insist on giving me yet more crap that I probably don't want every December 25? For years now I've been trying to break them of this habit. I make a contribution to charity -- specifically Oxfam but it could be any charity that gives to people who actually need it. I send everybody a card saying I did that. They all seem happy with that and not offended by it, but they still just have to give me something.

I asked my mother what she wants for Christmas and it turns out she's as sensible as I am -- she said she wants people to come to her house and take stuff away. But even the combined influence of the two of us can't overcome the deeply felt need to have a mass celebration of buying and having stuff, more and more stuff, more and more useless and superfluous stuff, every December.

With the planet in peril from overconsumption, and literally billions of people who actually could stand a little of your generosity, this makes no sense at all. Including if you are a Christian. Lillies of the field and all that, remember?

So let's win the war on Christmas. Enough stuff.

Update: Almost forgot to share Tom Lehrer's Christmas Carol. (Full lyrics here.) Final verses:

Relations, sparing no expense'll
Send some useless old utensil,
Or a matching pen and pencil.
"just the thing I need! how nice!"
It doesn't matter how sincere it
Is, nor how heartfelt the spirit,
Sentiment will not endear it,
What's important is the price.

Hark the herald tribune sings,
Advertising wondrous things.
God rest ye merry, merchants,
May you make the yuletide pay.
Angels we have heard on high
Tell us to go out and buy!

So let the raucous sleigh bells jingle,
Hail our dear old friend kris kringle,
Driving his reindeer across the sky.
Don't stand underneath when they fly by.

Friday, December 16, 2011

End of an era

As those of you who have checked out the sidebar know, I have for many years contributed to the blog Iraq Today. When I first started, it was called Today in Iraq (it's a long story why we had to change) and it was one of the most heavily trafficked blogs on foreign affairs. We were linked from Atrios and Riverbend and I regularly got e-mails from everyone from Iraqi officials to U.S. army publicists to reporters and pundits complaining about stuff I had said about them. We also heard from military, military spouses and war widows, usually to thank us but sometimes to accuse us of disloyalty because they didn't think it was possible to simultaneously support the troops and oppose the war.

As Iraq faded from the consciousness of Americans, so did the attention people paid to Today in Iraq. But we kept it going, because we felt it still ought to matter to English speaking readers, particularly Americans (although we have had contributors from Europe and readers from all over the world).

Today, the U.S. handed over its last remaining base to Iraqi control and ended its military operations in the country. I still care as much as ever about the long-suffering people of Iraq, and I still believe that the United States bears some responsibility for their future, but our armed forces will no longer be involved. That's what we've been advocating for from the beginning. I am very glad about it, although I look to the future in Iraq with great concern. There's not much good news these days so I'll take what I can get.

So this marks a bit of a change in my life as well. The blog will become Today in Afghanistan, and I will henceforth spend more time studying that country and its troubles. I am not abandoning Iraq -- I'll check in on it every Sunday -- but it will be a weaker tie, something like a friend who has moved out of town, I suppose. Anyway, I hope you'll look in on Today in Afghanistan as Whisker and I develop the site and our style of aggregating and commenting on the news from that country.

Thursday, December 15, 2011

This should be obvious . . .

But it still bears repeating because it doesn't seem to live comfortably in the political consciousness. A major point of Lawrence Lessig's new book is that as important as the corrupting influence of money in politics is to determining the outcome of the political process, it's just as important in determining what we talk about. One of his big examples is the major focus by Congress this past winter on whether banks could charge transaction fees on debit cards -- while spending less time on unemployment, global warming, health care, the various wars in which the country was engaged, or the deficit. I would add that we wouldn't be talking about further cutting wealthy people's taxes either, and we never would have cut them in the first place back in 2002.

I would also add that while all of the above is important, the simple fact is, as Tom Murphy explains so even a historian can understand it, civilization as we know it is doomed. It will not be possible to produce enough liquid fuel to sustain the existing society, let alone the growth anticipated in India, China and elsewhere, within a very short time. Even if we want to do shale oil and tar sands and coal liquification, climate be damned, those resources cannot be developed fast enough. and we face the Energy Trap no matter what we do -- it takes energy to develop renewables or unconventional oil sources or infrastructure that promotes conservation such as mass transit. No matter what direction you want to go, we need to use the fossil fuels we have no in order to get there, but if we don't start investing now, if not yesterday, those fuels will get more and more expensive and will be in too short supply to support that development.

So we need to deal with this immediately, radically, and with full commitment. But all we're talking about is financial deregulation, repealing the Affordable Care Act, and lower taxes for billionaires. See you 'round the apocalypse.

Ooooghh: Tangential but, Revealed: huge increase in executive pay for America's top bosses. From The Guardian:

Exclusive survey shows America's CEOs enjoyed pay hikes of up to 40% last year – with one chief executive earning $145m. Chief executive pay has roared back after two years of stagnation and decline. America's top bosses enjoyed pay hikes of between 27 and 40% last year, according to the largest survey of US CEO pay. The dramatic bounceback comes as the latest government figures show wages for the majority of Americans are failing to keep up with inflation.

The guy who scooped up $145 million? That would be John Hammergren of McKesson, which is a pharmaceutical and medical supply distributor. Now you know why we can't have single payer national health care.

Wednesday, December 14, 2011

Hillbilly heroin

I've kinda changed my mind -- kinda -- about opioid prescribing. I used to lean toward emphasizing that doctors are often too reluctant to prescribe opioid analgesics, that they can be a tremendous boon to people in chronic pain, and that a) short term use for pain relief seldom leads to addiction and b) if people who need them basically forever technically become addicted, who cares? Biologically, maintenance on a steady level of opioids can have some side effects, such as constipation, but people can function perfectly well and in fact better than they would in chronic pain.

But, as CDC reports here, we have a large and growing problem with prescription opioid abuse and the ultimate manifestation, that we can't look away from, is death by overdose. It turns out that by 2008, death from prescription drug overdose rivaled death from motor vehicle crashes, the leading cause of unintentional injury death (36,450 vs. 39,973). Since motor vehicle deaths are declining (due to socialist fascist nanny state regulations such as air bags, antilock brakes, etc.), and prescription opioid ODs are increasing, those lines will probably cross soon if they haven't already. (By the way, it's non-Hispanic whites who are at by far the highest risk. African Americans and Hispanics have much lower rates of death from misuse of opioid pain relievers. They're much more likely to end up in jail for drug offenses, but they commit them less often. This is another national scandal.)

However, I've only kinda changed my mind. As the linked report also states, it has been found that 3% of physicians account for 64% of opioid prescriptions, and there's plenty of evidence that most of this epidemic is linked to "Pill Mills" -- unscrupulous operations that hand out scrips without appropriate medical indication, evaluation, or follow up. Astonishingly, the governor of Florida, the state with the highest concentration of these operations, long resisted efforts to crack down. It's still likely that many physicians are withholding relief from some people who ought to get it. But we need to stop these criminals.

Tuesday, December 13, 2011


Bissinger that is. He was Buzzy in prep school but he's dropped the diminuitive now that he's all grown up and he's just Buzz. (I was acquainted with him but didn't know him well. His real given name is Harry BTW.) He's very well known for documenting the culture of sports in the U.S. so Tweetie* has been having him on the program regularly to discuss the Jerry Sandusky/Penn State child rape mess.

Buzz is the veritable paradigm of repressed fury. I keep expecting his hair to burst into flames. And I can understand why, it's how a lot of people feel. Mr. Sandusky is of course entitled to due process, but the disposition of his personal case is not really the point in all this. Whatever the underlying facts, many people in positions of authority, with weighty responsibilities, failed to act appropriately and adequately when presented with credible information that required that they do whatever was necessary to be sure that children were safe. We already know this.

So what do I have to add to the maelstrom of mostly fairly obvious reflections? Just that if we view the sexual exploitation of children as a public health problem, we can think about etiology and epidemiology instead of just foaming at the mouth and having our hair burst into flames. Yes, moral condemnation and righteous fury are essential to reinforcing the social consensus, not to mention they're human nature, and I don't begrudge indulgence in them, but it's even more useful to understand why this happens and how it manages to continue.

I'm not a psychologist so I can't offer any particular expertise in the psychological roots of sexual attraction to children or sexually exploitative behavior. I do know that there is a risk of people who are abused as children becoming abusive themselves, although most of course react in the opposite way and become fiercely angry toward people who do this. (Joshua Komisarjevsky, who was recently sentenced to death in Connecticut, put on a defense based on his having been repeatedly sexually assaulted as a child. It didn't convince the jury but there is undoubtedly something to it.) While many children are resilient and overcome such traumas, others do not and, in one way or another, the consequences ripple out through society and down through time, unto generations. So preventing one incident can have multiplying benefits, while failure is a catastrophe that can extend far beyond a single child.

What is uniquely interesting in the Penn State case, as in the case of the Catholic church, is the sociological dimension. Whatever the reason that many priests and (allegedly) Jerry Sandusky engaged in this behavior, powerful cultural forces protected them. The church is an insular society unto itself, whose transcendent value is institutional aggrandizement. Football is a more complicated phenomenon. Yes, there are little subsocieties of team and university, but they are much more fluid and diffuse than the church -- people come and go, with the exception of Joe Paterno Penn State football and Pennsylvania State University are not life-long commitments, nor are they singular identities. And this scandal leaked well beyond those two institutions to include not only the campus police but also the police of the town of State College, apparently (from what we are starting to hear) a high school principal, charity executives and social workers, and probably many other people who were overawed by the charisma of the football team. Unlike the bishops, they weren't part of the institution they were protecting.

So this story also has resonance pertaining to the role of athletes and sports in our society. Athletes have an expectation of entitlement, which they get from the same wellspring as coach Sandusky. Sports are a public spectacle that stands for accomplishment and virtue. That symbolism largely obscures the reality that what you are watching and passionately adoring is just a bunch of ordinary, flawed people who happen to be skilled at a fundamentally useless enterprise. Many sports, including football, in fact institutionalize and glorify violence, which seems a wrong thing to worship, although I grant it is fun and exciting. (I wrestled in college -- there's nothing more essentially violent than that. The whole object is to physically force your will on the opponent.) But we are strongly committed to the illusion and just can't stand to shatter it.

*For those who are not aware of all Internet traditions, that's Chris Matthews. Some people feel he resembles the cartoon canary. (I tawt I taw a puddy tat!)

Friday, December 09, 2011

Another window into the libertarian paradise

Jerry Avorn, in NEJM (and mad props to them for continuing to make their public affairs material open access) looks back on the thalidomide disaster. The younguns may not know about this (I'm often befuddled when I discover you whippersnappers don't now what Vietnam was all about) so to review briefly:

Fifty years ago, drug manufacturers didn't have to prove that their products were safe and effective in order to sell and market them. Sen. Estes Kefauver introduced legislation to require that they do so but, as Avorn tells us, "Kefauver was accused of trying to unnecessarily expand the power of government, threatening the viability of the pharmaceutical industry, and inserting Washington bureaucrats between patients and their doctors, limiting the freedom of both. His legislation seemed doomed."

Damn right and Don't Tread on Me! I will give up my unstudied drugs when they pry my cold dead fingers from the pillbox.

So it turns out that at about the same time, there was a mysterious epidemic in Europe and Australia of babies being born with their hands and feet attached directly to their torsos. It took some freelancing investigators to figure out that their mothers had been prescribed a drug, marketed heavily for morning sickness (not to mention insomnia, premature ejaculation, menopause, alcoholism, depression . ..) sold under various brand names. Because it was called by so many different names in so many different places, it took a while to get it off the market. In the end, more than 10,000 children were born with devastating birth defects.

But . . .

The drug, generically called thalidomide, was never sold in the U.S. because an FDA employee named Frances Kelsey took it upon herself to conclude that evidence of safety was inadequate. Once this story came out, Kefauver's legislation passed. We still have a long way to go -- the deficiencies in the FDA approval process, even today, have been well-covered here. But, after a few more disasters in recent years, we've made some progress.

Listen up Dr. Paul. The drug companies, if left to their own devices, would be selling us arsenic. Liberty does not emerge from the mist if you take away government. On the contrary, we will find ourselves at the mercy of ruthless, greedy, powerful forces that we have no way to resist or even understand. Freedom is a product of democratic government, there is no other way for it to exist.

Wednesday, December 07, 2011

In case anybody wanted to know what I do for a living . . .

Right now I have funding to do a study called Explanatory Models if Illness and Decision Heuristics in HIV Care. What I'm doing in this first stage is having semi-structured interviews (that means essentially a guided conversation, no check boxes or fill in the blanks) with people living with HIV, in which I ask them what their concept is of HIV, HIV disease, and treatments, and how they work, and why they should or should not take the pills, etc. This is actually very important because over the years I've found that a lot of people have theories about all of the above which don't correspond to the theories their doctors have, and which cause them not to take the pills regularly, which their doctors think is a really bad idea.

I am also involved in a project where we are training physicians in a counseling technique called Motivational Interviewing, to see if they can't learn how to do a better of job of counseling their patients about taking pills and other health related behaviors. Mostly, before we train them, they just scold people, which doesn't work.

I have also developed methods for coding and analyzing clinical communication. We're steadily publishing papers from that work, and they tend to prove what I said in the preceding paragraph.

I'm curious, in case anybody wants to play this game. How would you explain what a virus is? How does it reproduce? How does it make people sick? That's in general. How about HIV? (Hint: It's different from most viruses. Do you know why?) Why can't your body get rid of it, as it does with a cold or flu? How do the drugs work to control it? Why do you have to take them right on schedule?

If you don't have a clue, that's okay too. If you think your idea is probably wrong or dumb, don't worry about it -- believe me, most people don't know the technical details, it's just interesting how folks think about it given that they weren't biology majors.

Tuesday, December 06, 2011

Knowledge is good?

You may not have caught the news about a Dutch virologist who has cooked up a genetically engineered strain of influenza which he claims could kill half of humanity. I was tempted to say that how I feel about that depends on which half, but on second thought, I'd call that a bad idea regardless.

What he has done, as I understand it, is to marry the lethal properties of the H5N1 avian flu virus that has been bouncing around Eurasia for a while with properties that make the virus highly contagious among humans. He's just guessing what the consequences would be of letting it loose but nobody wants to find out for sure.

He thinks he should publish his work so that people who want to come up with defenses against bioterrorism will have a heads up. Others think that would be not smart. I tend to agree with Others. We already grok the concept, which is about all you need to know to think about preparing. Publishing the details would make it easier for the Gingrich administration to actually make the stuff to use in the War on Terror, as any smart historian would do.

All that said, there are too many people in the world, and there will be way too many more in due course. For the past 20 or 30 years, it has been unfashionable for environmentalists to focus on the size of the human population. This is because it was considered more philosophically correct to worry about the other factor, the net negative environmental impact per person. Supposedly if we could make that low enough it would be cool for there to be zillions of people.

I say pish tosh. Of course we need to live more sustainably, but you have to multiply the burden each of represents by how many of us there are to get to the total problem and frankly, we're heading in the wrong direction on the first factor. The International Family Planning Conference just concluded, to exactly zero interest on the part of the U.S. corporate media. The truly bizarre, ugly and evil religious fanaticism that says giving people, notably women, control over their own reproduction is immoral must be relegated to the netherworld of ideas where racism and fascism now reside.

Otherwise, we will indeed experience a major reduction in the human population, the hard way.

Monday, December 05, 2011

This really frosts my pumpkin

Let there be no doubt whatsoever. Donald Berwick was, is and ever more shalt be the best person to head CMS. He is the most qualified, has the best ideas, and has the strongest resume to be in charge of making medical care in this country better for patients, cheaper for payers -- including the taxpayers -- and more satisfying for providers. If you don't understand why, or what the man is all about, please do read the linked article.

As Harris Meyer writes, "[I]t's difficult to find any health care stakeholder groups that express anything less than glowing praise for Dr. Berwick's performance at CMS." But, president Obama had to put him in office through a recess appointment because the brain dead Republicans in the Senate threatened to filibuster his confirmation on account a he's a soshulist and he's for rashuning. Then they wrote a letter saying don't even come back and try for a regular appointment.

Evil idiots. That's all they are. Why anyone would even contemplate voting for Republicans candidates, who all hate America, I cannot begin to fathom.

Friday, December 02, 2011

Yeah, it's personal

An important twist in my long and winding road was when I resigned from my job at United Way in Boston, at the same time as my friend Wayne S. Wright, and for basically the same reasons. (No reason to go into that, it's a good organization that's worthy of your support.) I set up a consulting practice to work my way through grad school, and Wayne became the first real executive director of the Multicultural AIDS Coalition in Boston. (I say "real" because there was a caretaker exec appointed to guide the nascent organization while they sought a permanent incumbent.) Wayne started referring me to various community based organizations involved with HIV prevention and services.

At that time -- the early 1990s -- there was no effective treatment. HIV meant you eventually get AIDS and then you die, in a very unpleasant way. And that was happening to a whole lot of people including, ultimately, Wayne. Unfortunately, I can't find his full obituary free on line but but this is the lede and it should give you a pretty good idea of what a great fellow he was. I was luckier than many people, I just had a few friends die of AIDS, but I've talked with a lot of gay men for whom the plague years meant one funeral after another and the destruction of entire communities -- very much like the Black Death and other plagues must have been before real medical science came along.

Effective treatment for HIV became available just the year after he died, and everything changed. One of the most prominent AIDS-related service organizations, the Hospice at Mission Hill, closed because HIV was no longer about death. In its place rose the Boston Living Center, where people go to help themselves do just what the name says. As a matter of fact, people who were in the hospice, weighing 80 pounds and ready to die the next day, rose from their beds and their bodies astonishingly reconstituted and they suddenly had to contemplate the sorrows of life as vigorous and healthy young men once more. We call this the Lazarus syndrome.

So when I read that the Global Fund to Fight AIDS, Tuberculosis and Malaria is too broke to make any new grants for three years my blood boils. We've given up on the goal of treating everybody because, well, we just can't afford it apparently. There's something else we need to do, although I'm not clear what that is. And in case you hadn't heard, people who get treatment and have suppressed viral loads are not infectious. That means, if we treat everybody, we can end AIDS forever. We can eradicate it. But it just isn't worth it.

Thursday, December 01, 2011

Hey indeedy

James Michael Crotty discusses the Republicans' elevation of ignorance and stupidity to a virtue. His basic explanation is that it's the only way to preserve ideological purity, especially when your ideology is entirely counterfactual. Fair enough, but obviously it begs the question.

Why are so many Americans passionately committed to absurd beliefs? Obviously they are continually exposed to propaganda, but wealthy greedheads and religious con artists have the same opportunities in Europe Canada that they do here -- Fox News is huge in the UK BTW -- but the worship of idiocy is much less common elsewhere. If I tried to engage a Republican primary voter in a discussion about health care policy, it would be a big mistake for me to mention that I have a Ph.D. in the subject, and study it for a living. It's even worse -- I do that at an Ivy League university and I got the doctorate from Brandeis which is, well, you know. (It rhymes with U.) All that means is that I have no standing on the subject whatsoever, because I'm a pointy headed elitist.

I don't know the full explanation, but one hypothesis is that it's partly because higher education in this country is a luxury good largely reserved for the children of the affluent. The reason Scott Brown can attack Elizabeth Warren for her association with Harvard is that Harvard really is a marker of privilege. It makes sense intuitively for non-privileged people to doubt that people associated with ruling class institutions are actually on their side.

(So how do you explain George W. Bush? Well, he did go to Harvard (and Yale) but it obviously didn't rub off on him. He had a phony cowboy accent, had difficulty producing syntactically well formed sentences, and didn't believe in that ungodly science baloney.)

It would help a lot if higher education was free to everyone, with admission based on credible measures of people's prior preparation and potential to make good use of their education, and no account whatsoever for their parentage or financial resources. That would do a lot, I think, to change the cultural dynamic.

On another note, I should say something about World AIDS Day, even though it's basically a marketing tactic like National Pickle Week. It's still an occasion to reflect and take stock. I'll probably get around to it a day late.

Wednesday, November 30, 2011

Ezekiel Emanuel is half right . . .

But there's a bit more to the story. He points out that 10% of the population account for almost two thirds of health care costs. As a matter of fact, based on data from the Medical Expenditure Panel Survey, the top 5% account for more than half, while the bottom 50% account for 5%. (Abstract only for the unwashed. This data is 10 years old but it had been stable since 1970. It doesn't change.)

Dr. Zeke wants to make the care of those people more efficient using bundled payment instead of fee for service and care coordination strategies. That's fine, it might save a few percent and make those folks lives a little better. I'll let his argument about that speak for itself if you care to read the article.

But here are some points he doesn't make.

First, you've heard all that yackety yack from conservatives about how if we had to pay for more of our health care out of pocket, people would choose more wisely and we'd save a lot of money. Pish tosh. These people are soaking up tens of thousands of dollars a year in health care expenditures because it's free to them so why not go for it. They are seriously, chronically sick. They have kidney failure, heart failure, complications of diabetes, cancer, or serious congenital diseases. (No, they aren't all elderly, only about half.) People don't get kidney dialysis because they feel like it, they do it as the only available alternative to dying. Making the rest of the people pay fifty bucks to see the doctor isn't going to save diddly, but it is going to make them more likely to end up in the top 5% where they are costing real money.

Second, suppose we could save a few percent on the care of these really sick people. That's better than nothing but it's still only a dent -- and the underlying trend of increasing costs would continue, it would just be set back a couple of years. The problem would not be solved.

Unlike Ron Paul, I am not in favor of abandoning the unfortunate. So what do I propose? A few things that Emanuel doesn't want to talk about because of politics.

First, we need to do cost effectiveness analysis and we need to set limits. This doesn't actually have to hurt people. Do people really benefit if they get three or four weeks of extra life semi-conscious in a hospital bed? I don't think so. That's not where most of this money is going, but it's a chunk. A bigger chunk can come from just knowing what's most effective and setting up enforceable guidelines that prohibit wasting money on useless or harmful treatments, such as angioplasty for people who haven't had heart attacks. People are making money off of this stuff, which is why Republicans won't let us even study the question. Well screw 'em.

Second, we need to invest much more in public health. We'd have a lot fewer people in this situation if we really made the effort to combat obesity, tobacco addiction, and other preventable harms. There's net social benefit from reducing particulate pollution from motor vehicle exhaust, chemical contamination of food (such as BPA from can liners), mercury in fish, food-borne infectious diseases. And a lot more. But that requires spending government money to improve the social and physical environment, and regulating powerful industries. Again, Republicans think that infringes on the freedom of rich people to rob us. See final comment above.

Third, we need to use the buying power of Medicare, Medicaid and public employee health care -- and eventually the buying power of the single payer program that will cover everyone -- to reduce the incomes of overpaid medical specialists and the price of drugs and medical devices. And no, using the promise of obscene profits as the basic mechanism to finance drug development is grossly inefficient. Yes, that costs a lot of money, but it would be cheaper for the government to finance the research directly, which would direct the research in the most socially beneficial, as opposed to the most profitable direction; and then buy the drugs cheaply, instead of having most of the money go to profits, executive salaries, and marketing costs.

In other words, we can't get there by mucking around on the edges. We need fundamental reform.

We need universal, comprehensive, single payer national health care. Nothing else. That's what we need.

Tuesday, November 29, 2011

Dr. Murray

I don't think I need to provide a link, but in case you haven't heard, Dr. Conrad Murray, physician to the late Michael Jackson, has been sentenced to four years in prison for involuntary manslaughter. I certainly agree that his actions were egregious, and that in principle, bad doctoring can constitute criminal behavior. But, it's always a tough call and it seems like a very slippery slope.

The essence of the problem is that physicians have a license to take actions that are ordinarily crimes. They can slice us open, remove body parts, and feed or inject us with powerful toxins that might just end up killing us. If we aren't conscious or competent, they don't even need our permission. Although you may have heard that it's a principle of medical ethics dating to Hippocrates to "First, do no harm," it is not. Just about anything substantial that doctors do carries a risk of harm -- all medical interventions represent a tradeoff of uncertain benefits, predictable harms, and serious risks. Not only that, but a medical degree does not confer superpowers -- doctors make mistakes, even the best of them, and those mistakes harm people.

I once made the acquaintance of Gilbert "Punky" Mudge, the cardiologist who treated Reggie Lewis, who told him it was okay to play basketball. It wasn't. Lewis had a cardiomyopathy that caused him to die of cardiac arrest when he took to the practice floor. Lewis's widow sued, but ultimately Dr. Mudge was found by a jury not to be responsible for Lewis's death. In a sense, of course, he was -- his advice was wrong. But that's the tough thing about being a physician. If most people make a mistake in their work, it's not a big deal, or it's correctable. But we can't start making physicians criminally responsible for their human frailties or, obviously, nobody will do the job. In Dr. Mudge's case, his judgment may have been affected by some personal history which I won't go into because that wouldn't be fair, but in any case, he wanted very much to save Reggie Lewis's career and give such a promising, talented, and likeable young man a chance to realize his dreams. After Reggie Lewis and his widow, I doubt anyone was more damaged by the matter than Dr. Mudge.

So what are the factors that ought to make bad doctoring criminal? Malicious intent is presumably one. For example, doctors who operate opioid prescription mills are intentionally working against their "patients'" interests out of purely venal motives. On the other hand, whether somebody legitimately ought to get a prescription for opioids is a matter of judgment and there have been prosecutions that seem inappropriate. Addicts are often very skilled at deceiving doctors, and not only that, but some of them are also genuinely in pain and maybe it's just as well for them to get the drugs.

Dr. Murray appears to have been trying to serve what he understood to be his patient's best interest. Jackson was a tormented soul who could not sleep, and evidently Murray kept resorting to stronger and stronger measures until he finally started anesthetizing his patient. That seems like very poor judgment already but doctors can legally prescribe off label and again, poor medical judgment is not a crime. He apparently left his patient unattended while he was in a propofol-induced coma. That is the sort of negligence that would support a malpractice suit but is not ordinarily prosecuted. (We had a surgeon in the Boston area who left a patient on the operating table so he could cash a check and buy drugs. He lost his license and got sued, but he was not prosecuted for that specific act.) Finally, Murray apparently did not immediately call for an ambulance when he discovered his patient in respiratory arrest, and that could be what pushes this over the line. I suppose if I were a juror it would be the fact upon which I would focus, although in fact it was probably too late anyway.

So what I'm saying is that I suspect most physicians, not out of self interest since few imagine themselves behaving so inappropriately, but out of a general interest in protecting professional judgment from unseemly second guessing, would prefer to see this situation handled in civil court. Murray would no longer be able to practice, he would be ruined professionally and financially, the world would be safe from his professional poor judgment, and either way, Michael Jackson is already dead. But it's a tough call.

Monday, November 28, 2011

Credit where it's due

Every morning and evening, I am strapped into a chair and forced to listen to NPR against my will. (Well okay, maybe I could listen to something else . . . ) I am not often kind to them here -- lately they've featured a fairly steady diet of long, sycophantic interviews with insane Republican power brokers, apparently in a craven and obviously futile attempt to save their federal funding -- but they finally give us a piece on climate change, occasioned by the hopeless Durban conference, in which they do not feel compelled to "balance" truth with ideological hallucinations.

As Richard Harris reports, "The United States is second only to China in emitting gases that cause global warming." Yep, he said it. Also, he quotes Kevin Kennedy of the World Resources Institute: "'Nowhere else in the world do you see a political debate about whether climate science is real, whether or not the climate is actually changing,' Kennedy says. 'That political climate makes it very difficult to move forward in a comprehensive way. And that is something we need to address in this country.'" And he doesn't make room for a rebuttal from climate science experts such as James Inhofe or Rick Perry.

The Durban conference is hopeless, of course, precisely because the United States will not support any effective action on climate change. And that is because the corporate media, in general -- and that includes the New York Times, by the way -- continues to treat the question of how much it matters, whether it's worth doing anything about, and even whether it is even happening, as a political controversy rather than a question of scientific fact; and because public discourse is largely controlled by wealthy psychopaths who are perfectly happy to destroy civilization in order to keep a few more millions in their pockets.

I don't write about this much because it terrifies me too much and I really don't know what I can add. I will, however, add Climate Progress to my sidebar, and I hope you all will visit and educate yourselves. Then take action -- no politician who won't commit to making this a priority deserves your vote.

Friday, November 25, 2011

Donald Berwick

Just a quick note that, to no-one's surprise, the corporate media has pretty much ignored the Republican filibuster which prevented the appointment of Donald Berwick to head the Centers for Medicare and Medicaid Services (known for historical reasons as CMS) from becoming permanent.

They claim it's because he once praised the British National Health Service, which makes him a commie, but Brian Beutler does an excellent job of explaining what's really going on. Berwick is a proponent of comparative effectiveness research and cost effectiveness analysis -- as well as being darn right radical in his advocacy for patient centered care and the empowerment of patients as the decision makers in their own health. But the Republicans ignore the part of the previous sentence after the dash and focus on the first part, which of course makes him a death panelist.

What they are really afraid of is that he can prove that public insurance, and especially a single payer system like Medicare, can deliver better health care with happier customers for less money than private insurance. If they let him get away with proving that, their corporate owners won't be happy.

Tuesday, November 22, 2011

Repealing the Enlightenment

I have said it before, but Naomi Klein says it at greater length, and maybe even a bit better. Climate change denialism is an example of thinking backwards. Since we already know that unregulated markets maximize human welfare, it is impossible for carbon dioxide emissions from burning fossil fuels to cause any serious problems. That would imply a need for some sort of intervention by government to reduce those emissions, and that conclusion is logically impossible, right?

Klein goes on to show how anthropogenic climate change implies many other conclusions which are not permitted in conservative ideology, but that's the basic idea. Anyway it's worth reading so go ahead. (I get the dead trees Nation so I got to read it sitting on the sofa and then do the puzzle.)

Tom Levenson at Balloon Juice is generally taken aback, nonplussed and aghast at what appears to be a growing global rejection of science as in any way authoritative. It's antivaxers trying to get their kids infected with chickenpox that sets him off, but then he broadens out. "The tyranny of facts undermines privilege . . ." The Republican War on Science is motivated by greed -- tobacco industry greed, coal and power generation industry greed, oil company greed.

And it's not just environmental catastrophe and selling people addictive poison. Have you been wondering why the heck Newt Gingrich has suddenly called the Congressional Budget Office a "reactionary socialist institution? It's because the CBO won't agree that gigantic tax cuts for wealthy people increase government revenue. (What the heck is a reactionary socialist, anyway?) Economics isn't really a science, but if we're living in this universe we can agree that the Obama stimulus did save millions of jobs and that the reason we have these big federal deficits stretching over the horizon is because of the Bush tax cuts and wars. If we're Republicans, however, we can't agree with those propositions, because they conflict with our axioms. Adam and Eve must be real historical characters because without original sin, Christ's sacrifice couldn't redeem us. (Not that the whole thing makes any sense in the first place.)

Thinking forward means observing what is out there in the real world and then trying to explain it. Thinking backwards means deciding what we already believe and then trying to force reality to look that way, which means ignoring evidence and making stuff up. Thinking backwards is what conservatives do. We need to laugh them off the stage, but if we don't, what happens won't be funny.

Monday, November 21, 2011

The NYT gets maybe half way there

The Editors, glorying in their anonymous collectivity, take on Medicare spending. They frame the issue correctly -- we need to rein in the growth in the cost of Medicare because we need to keep it universal and comprehensive. If the cost of Medicare continues to grow faster than the economy, it will grow harder and harder to convince the public to continue to pay for it. (Of course, this is a matter of degree. The Editors point with alarm to the projection that Medicare will account for 16% of federal spending by 2021, which Is Just Unpossible! Well no, it isn't, we could do that. But maybe we won't.)

So, The Editors think we should carefully examine proposals to raise the eligibility age, make higher income seniors pay higher premiums, and introduce more "cost-sharing by beneficiaries to deter unnecessary use of medical care." They think all that might be good but they are cautious. Wrong, wrong, and wrong.

Raising the eligibility age would not save any money at all. It would mean that people age, say, 65-67 would still be paying for their health care some other way, or not at all. Since a lot of people are out of the labor force by then, not at all would be a very popular option. But what happens when people that age don't get any medical care is that as soon as they hit Medicare eligibility, they come right in and now Medicare has to pay for all the bad stuff that wouldn't have happened if their health care hadn't been on hold for a few years -- heart disease and kidney disease due to uncontrolled hypertension and diabetes, for example. Baad idea.

Making higher income people pay for their Medicare sounds reasonable, but it would be politically suicidal. The appeal of Medicare is that it's universal. If it becomes a program for low and moderate income seniors only, wealthy people will turn against it -- it will just be "welfare," and we know that's evil.

Cost sharing is an even worse idea because your average senior citizen obviously does not know which medical interventions are worth it and which are not. They'll consume less medical care and medications, but at least half the time, they'll make the wrong choices. Which could end up costing more in the long run.

Then The Editors say that "So-called premium-support or voucher plans come in many flavors — some good, some bad — and would need to be carefully vetted." What all of these plans mean is abolishing Medicare and giving people money to buy private health insurance. Exactly none of the flavors of this disgusting idea are good. Medicare -- a single payer system -- is much more efficient than private health insurance and costs far less to deliver the same benefits. It always will, because it doesn't make a profit for shareholders or multi-millions for its executives, doesn't have to market itself to compete with other payers, and has the market power (should it ever care to use it) to make the medical system behave more efficiently and deliver the goods for even less.

Having tepidly endorsed or at least tolerated all of the really awful proposals that are out there, they are all for payment reform to the extent of moving away from fee-for-service to some form of capitated payment. That's okay although we have a long way to go to prove that it can work well. But, here's what they don't say.

We need to support cost effectiveness analysis and we need to direct resources away from doing stuff that just isn't worth it. Nobody wants to touch that because a former half-term governor of a state with a smaller population than metropolitan Boston will scream about death panels. That's a really stupid reason not to tell the people the truth.

Friday, November 18, 2011

Communicative action

For those not familiar with the philosophy of Jurgen Habermas (Stanford Encylopedia of Philosophy article is here), one of his central interests is in how we go about constructing knowledge together, through discourse.

To crudely summarize (and these conventional English translations of the terms may not be the best) we can engage in either communicative action, or strategic action. The latter is basically when I'm trying to get over on you -- I have a desired outcome, I want you to do something or believe something that's going to get you to do what I want, and I engage in speech or other forms of communication to bring about that end. Communicative action is when we talk with each other, openly and transparently, to discover how we might come to agree. Any one of us may engage in strategic action at one time or another, but it is pretty much impossible for the institutional interests labeled by Habermas as "the system" to do anything else. Corporations try to sell you stuff, political action committees try to get you to vote for the interests of their donors -- you're never going to have a dialogue with them.

I expect Habermas must love the Occupy movement -- they are totally committed to communicative action, at least internally. It does have the downside that they can't state exactly what they want to happen, but then again, maybe we'll all get there together some day.

But, if I may abruptly change the subject, what about doctors and patients? You might think, since the whole point is that the doctor is looking out for your well being, that you and your doctor would be having a lot of conversations about what, exactly, you think that is, and sharing thoughts about how to get there. Well, you may not have thought about this much, but you probably aren't really doing that. I could go on about this at great length, but here's a quick story.

I met the other day with some people who are living with HIV. I was interested in how they would explain what a virus is, and basically, none of them could say much about it. A virus is something that causes disease, that's about all they knew. Now, all of these people thought their doctors were the greatest thing since oxygen, and had been living with HIV and getting treatment for it for years. But the doctor had never bothered to say how she understood the nature of a virus and the way the drugs work to control it.

So, in about two minutes, I explained it, like this. As you know, your body is made up of billions of cells, and in the center of each cell -- the nucleus -- there's a molecule called DNA. That consists of very long strings of smaller molecules which spell out the instructions for making the proteins that carry out the functions of the cell and make up the tissues of your body. The instructions are carried from the DNA into the cell by a molecule called RNA, which directly controls the assembly of the proteins.

Well, most viruses are just little pieces of DNA that contain the instructions to make more of the virus. One way or another, the viral DNA gets into a cell and its instructions take over, turning the cell into a factory that just makes more and more of the virus. HIV is a little bit different because it consists of RNA instead of DNA. Same instructions, just in a different form. You have cells circulating in your blood called T-cells, that are part of the immune system that combats viruses. Some of these T-cells have a so-called receptor -- a channel for getting stuff in and out of the cell -- called a CD4 receptor, and when HIV bumps into one of those, it injects its RNA into the cell. The RNA immediately causes a protein to be made which causes the cell to write the instructions for making HIV into the cell's DNA. At some point, that DNA will be activated and the cell will turn into an HIV factory. Over time, as more and more of these CD4+ cells are destroyed, your immune system becomes less and less effective and you start getting weird infections.

That was it. They got it. They were all astonished. It's really that simple, they understood it, and we went on to understand drug resistance and how the various drugs work, among other things. Oh yeah, exactly what those T-cells do when they're working correctly. Other stuff. In about 5 minutes. So why, in maybe 10 years, had their doctors never told them this?

Wednesday, November 16, 2011

Some disorganized chatter

Yesterday I was in Boston all day for meetings, slept in my old house for what I hope will be the last time -- it's under agreement, just waiting to close -- then drove back to CT, didn't have a chance to blog. So . . .

The main point of my last post is really that we don't know what the consequences will be of technological developments. They often have huge effects that no-one foresees. The automobile wasn't just a faster horse that didn't need farmland to feed it -- it created the suburbs and a whole lot else, including becoming one of the leading causes of death, particularly for young people, and making the world warmer and stormier. We can try to imagine a world with on-the-spot manufacturing and driverless cars, but we'll probably get it wrong. Whatever happens, almost nobody will spend any time worrying about possible bad effects, however. If it's possible, we'll do it, pretty much mindlessly, because it is by definition progress.

Another completely unrelated issue that is on my mind is the prevalence of insane lawyers. To be sure, I'm not one, and I don't know what I would do if I were handed the assignment of defending somebody who doesn't have a chance in hell and probably doesn't deserve one. However, when I was a kid I read Clarence Darrow's "Attorney for the Damned," and he managed to find a way.

I have commented before -- not here I think -- about the lawyer for Joshua Komisarjevsky, whose particular acts of depravity we don't need to mention again. The guy's pretrial strategy was to relentless attack the sole surviving victim, whose family his client murdered; and along the way to hold a press conference on the courthouse steps in which he recited specific details of how his client had raped an 11 year old girl, which he apparently considered somehow exculpatory. Komisarjevsky has now been convicted of 6 capital offenses and his trial is in the penalty phase. The lawyer is trying to convince the judge to allow him to call his client's daughter, who is about the same age as the girl his client raped and murdered. I'm sure that will engage the jury's sympathy. Sheesh.

Now we have the almost equally popular Jerry Sandusky, whose lawyer let's him give a prime time interview to the sportscaster Bob Costas. Mr. Costas is not to be underestimated just because he covers fun and games. He's a smart guy, which Sandusky and his lawyer clearly are not. In the process of denying the allegations against him, Sandusky proved beyond a reasonable doubt that he is El Creepo, and should never be allowed within sight or sound of any boys. All prospective jurors will have a pretty good idea of the most effective way to achieve that.

There is a substantive point to take from this. If our culture did not view the criminal justice system principally as an instrument of retribution, we wouldn't be subjecting the public to these repulsive sideshows. Komisarjevsky was not allowed to plead guilty to a capital offense, so we had to endure a trial, and now this. If the deal had been life in prison to begin with, his lawyer would have haggled over the terms of his confinement and that would have been all there was to it. As for Sandusky, he probably would have been dealt with more appropriately a long time ago, but he wouldn't be resorting to such preposterous and desperate tactics if he wasn't looking at spending the rest of his life in so-called administrative segregation, which is the only place he's headed with a guilty verdict. He wouldn't last ten minutes in a prison population, obviously.

Most people probably think that's just fine, and I know I'm not going to talk anybody out of it. But in both of these cases, subjecting the public, the victims, and the jurors to trials is a major evil. By the way, the TV news stations in Connecticut and the Hartford Courant posted Komisarjevsky's confession on their web sites, accompanied by disclaimers to the effect that you really don't want to hear this. No, you don't.

Monday, November 14, 2011

Tea, Earl Grey, Hot

Prediction is very hard, particularly about the future. But I've been hearing a lot of low-key buzz lately about astonishingly transformative technologies that are not far off. 3-D printers are already not so uncommon. In fact the elementary school where my sister teaches has one. They can make any object you like out of metal, plastic or ceramics, and no doubt we'll soon have more sophisticated models that can use combinations of even more materials, such as made-to-order clothing on the spot. (Books can already be made and sold this way.) Cars that drive themselves are also on the horizon. As a matter of fact, they exist today. When it will be legal to let the car drive you to Grandma's house on the public roads I don't know, but it may well be the case very soon that robocars are safer than human drivers.

While we are oohing and ahhing over cool stuff, we often don't stop to think that technology drives major social transformations. When I was a youngster, my grandfather was a college professor and my grandmother was the secretary to a college professor. My grandfather's job still exists but my grandmother's doesn't. My secretary is Microsoft Office. Even low-level corporate managers who didn't rate their own secretaries would write their letters with a pen on yellow legal sheets or dictate into a tape recorder and send them to the typing pool, then they'd proofread the result and send it back for a final product. No more.

And in case you're agonizing over the decline of U.S. manufacturing, don't. The U.S. still has a robust manufacturing sector, but what we don't have is a robust manufacturing jobs sector, because the way to stay competitive in manufacturing in the U.S. is to replace labor with machinery as fast as possible. Of course people have to make the machinery and write the software, but that requires far fewer jobs than the products displace.

So imagine a world in which, instead of walking into a store and selecting from among the available coffee mugs or dinner plates, you look at samples on a touch screen, pick the one you want, and a machine makes a set for you while you wait. And no, you didn't get in your jalopy and drive to the store. You entered your destination into your smartphone, and the computer (which already knows where you are, obviously) dispatched the nearest car to pick you up and take you there.

Living that way is much cheaper than owning your own car. Cars are constantly in service so the world needs many fewer of them. They just about never crash, and they always know when they need maintenance and get it on time. Everyday manufactured goods are also much cheaper because they don't have to be shipped -- the materials to make them are shipped in bulk instead, which is a lot less expensive. Also you don't have to pay a truck driver. And there are no unsold surpluses -- every object that is made is sold, immediately.

Sounds great, huh? Could even have environmental benefits -- saves energy and waste. Or so it seems. Can anyone think of a downside?

Friday, November 11, 2011

Follow up on psychology research

We had a guest who is planning to get a graduate degree in psychology inquiring about my drive-by comment that some people consider the whole field of social psychology to be "dodgy." This isn't my specialty and I don't know a whole lot about it, but here's Benedict Carey in the NYT reviewing the issue:

In recent years, psychologists have reported a raft of findings on race biases, brain imaging and even extrasensory perception that have not stood up to scrutiny. Outright fraud may be rare, these experts say, but they contend that Dr. Stapel took advantage of a system that allows researchers to operate in near secrecy and massage data to find what they want to find, without much fear of being challenged.

“The big problem is that the culture is such that researchers spin their work in a way that tells a prettier story than what they really found,” said Jonathan Schooler, a psychologist at the University of California, Santa Barbara. “It’s almost like everyone is on steroids, and to compete you have to take steroids as well.”

I'm afraid I'm not getting the distinction between "outright fraud" and telling a "prettier story than what they really found." When you publish research findings, the only story you are permitted to tell is what you really found. It is true that research reports normally end with a "Discussion" section in which the authors often speculate, going beyond the findings to adduce possible implications or further hypotheses. These can be tendentious, to be sure, but at least an alert reader will be able to spot that, if the "Results" section is accurate and presents the information needed to correctly interpret the observations. Abstracts are often misleading, as are titles, and that's a problem because many readers never look beyond them.

But Schooler obviously understands that using steroids is against the rules in athletics, and telling a prettier story than what you really found is against the rules in science. The analogy is imperfect, not least because the consequence of using performance enhancing drugs is that somebody wins a game, which doesn't actually matter; whereas the consequence of falsely reporting on research is that the world is misled, careers and money are spent chasing down the wrong path, and quite often, people -- likely in their role as patients -- are directly harmed. I don't know whether this is available to the public -- I don't think so, but unfortunately I'm using a computer that has privileges to read BMJ whether I log in or not -- but they have much more this week on the Andrew Wakefield fraud. It turns out that a) not only did the kids not have autism, they didn't have inflammatory bowel disease either; b) the pathologist whose name was on the paper as a co-author had in fact found them not to have bowel disease but signed onto the paper anyway; and c) the institution - University College London -- has refused to do any investigation of the whole matter.

Although I have never seen anything but integrity among my own colleagues, recent publicly reported scandals are making me wonder how widespread the corruption of science may be. It's disconcerting, to say the least.

Thursday, November 10, 2011

These kids today . . .

Oh my God, am I becoming a curmudgeon? No, I really don't think so. The NYT sent a reporter to State College, who had a front row seat as students set fires, trashed a TV van, attacked police, and otherwise vandalized their campus in their outrage over the firing of the football coach. I don't know if reporter Nate Schweber went out of his way to find morons, but he evidently didn't have much trouble.

“I think the point people are trying to make is the media is responsible for JoePa going down,” said a freshman, Mike Clark, 18

Demonstrators tore down two lamp posts, one falling into a crowd. They also threw rocks and fireworks at the police, who responded with pepper spray. The crowd undulated like an accordion, with the students crowding the police and the officers pushing them back. “We got rowdy, and we got maced,” Jeff Heim, 19, said rubbing his red, teary eyes. “But make no mistake, the board started this riot by firing our coach. They tarnished a legend.”

Justin Muir, 20, a junior studying hotel and restaurant management, threw rolls of toilet paper into the trees. “It’s not fair,” Mr. Muir said hurling a white ribbon. “The board is an embarrassment to our school and a disservice to the student population.”

Paul Howard, 24, an aerospace engineering student, jeered the police. “Of course we’re going to riot,” he said. “What do they expect when they tell us at 10 o’clock that they fired our football coach?”

Now listen up. Yeah I'm old now but I went to college. We even had a football team, and it almost became famous. Swarthmore was at one point poised to break the all-time NCAA record for consecutive losses. CBS even sent a crew to cover the historic event. The student body was behind them 100%. The stands were packed and the roar deafening. Well, you could hear something, anyway. The Swarthmore College marching band (which featured an amplified cello) performed its famous amoeba formation at half time for the benefit of national television. But our heroes blew it. They scored a touchdown as time expired to win the game. We were all really bummed out, even more so because it was a bad call. The ball never made it over the goal line.

So yeah, we were 100% behind the coach and players. But in spite of our passionate loyalty, if it turned out that one of the assistant coaches had been raping boys in the locker room and the head coach, athletic director, and college president all covered it up and merely told the guy to do his child raping elsewhere, I'm pretty sure we'd have started the rioting before they all got fired and only would have stopped once they were fully and unceremoniously canned.

Does this signal the decline of the West? Or am I overinterpreting?

Wednesday, November 09, 2011

Too much going on at once

Well, you can't call this a boring week in the news, that's for sure. Let me get the obligatory comments out of the way on a few of the stories that are trying to drive each other off the front page.

I think the religious fanatics actually made a big mistake with the Mississippi "personhood" amendment. I understand they're trying to do this in a few other states and it ain't over (officially) yet but if you can't do it in the country's most benighted state (sorry to our fans from the land that gave us the blues but you know it's true) where can you do it? Their mistake was to confront the public with the logical conclusion of their claim that "human life begins at conception," that an embryo is morally indistinguishable from a baby. It turns out that lots of people who define themselves as "pro-life" can't actually go there when they have to take it literally. It's a reductio ad absurdum of the anti-abortion position, which they deliberately presented. If people are careful and wise, they can build on this moment to fundamentally shift the terms of the debate.

Next, Joe Pa.(It turns out there's a distant and meaningless connection -- he's an alumnus of Brown University.) Lots of people are pointing out that this is similar to the Catholic Church. Not so much, I think. They have in common the moral failing of putting the perceived good of the institution ahead of the child victims, but the context is otherwise quite different. Penn State and its football program weren't involved in the lives of the victims and weren't actually perpetrating the rapes. And it's pretty clear to me that the culture of the Catholic priesthood is deeply imbued with repressed and twisted sexuality. The guys at Penn State didn't actively protect Sandusky or enable his actions, they just couldn't be bothered to stop him. You may not agree, but it seems to me that along one dimension, anyway, that's even worse, because the cost of acting, and the potential damage to the institution, were far less in the Penn State case. It would have been easy to turn Sandusky in, and while people would have been shocked, it would not have reflected poorly on Penn State or Penn State football. So their actions are not only inexcusable, but rather inexplicable, in my view.

Next, I'm sure you're at least as sick as I am of hearing about Herman Cain, but I'll make one last comment. It's just plain weird that Vulgar Pigboy and the rest of wingnuttery are rallying around him and blaming the liberal media. It would cost them next to nothing to dump him, but it's costing them a whole lot to keep loving him. They're just pathologically incapable of admitting error, I guess.

Finally, as coastal Alaska gets wiped out by a snow hurricane, I wonder if it will have any impact on the climate change denialism that rules in a state where the oil industry mails a check to everybody once a year? We'll see. But no, I don't care what a former half-term governor has to say about it, and neither does anyone else.

Tuesday, November 08, 2011

The Bernie Madoff of Social Psychology

That would of course be Diederik Stapel of Tilburg University in the Netherlands. I compare him to Bernie because he committed an astonishingly bold, massive fraud over many years that included gross betrayal of friends and colleagues. Oh yeah, he should have been caught many times but his prestige and power protected him. If you want the full story from the university investigating committee, it's here.

In case you haven't read about this and don't want to bother, basically the guy would chat up post docs and faculty colleagues to find out what research questions and hypotheses they were thinking about. Sometimes he would then work with them to design a study, write questionnaires, get funding, etc. He claimed to have relationships with high schools and universities that allowed him to recruit their students, or in a couple of cases faculty, as subjects. He'd go off to ostensibly collect the data, come back with it in a couple of months, and whaddya know, the hypothesis would be confirmed. Sometimes he didn't even bother with all that, he just said he had an old data set that was suitable, which he hadn't gotten around to analyzing, here it is. Only, he never collected any data. At all. He made it all up. Oh yeah, he also supervised dissertations based on phony data.

The really strange question is why? Bernie could have invested the money, and Stapel could have actually done the experiments. Madoff wouldn't have made 12% a year come hell or high water, and Stapel wouldn't always have found what he was looking for, but they still could have been perfectly successful. In Stapel's case, in fact, probably equally successful -- there's nothing stopping us from publishing findings we don't expect.

Just as Bernie brought about financial ruin for his customers, Stapel has brought career ruin on his students and collaborators. Even though they were perfectly innocent of the fraud, their programs of research are now destroyed and their publications will have to be retracted. Although the university says his students can keep their degrees, they are forever tainted and will no doubt find it very difficult to advance their careers. Everyone's CV will shrivel up like bacon.

He has also damaged the university, and the entire field of social psychology, which some people already consider to be a bit dodgy. (Think Marc Hauser.) The psychopathology here is really inscrutable. Yeah, the guy is some version of a psychopath but he seems to have been generally empathic and reliable in other contexts. This is just weird.

Monday, November 07, 2011

Sometimes it is worth proving the obvious . . .

Or at least I'll concede it might be. It's big national news, it seems, that a survey of 7-12 graders finds sexual harassment is pervasive.

Well duhh. Did the majority of adults somehow skip adolescence? We were there, remember? Well, okay, we probably don't, unless somebody gets our attention and makes us think about it. The world of children and adolescents is often cruel, even depraved. Kids can do a pretty good job of keeping their secrets from adults and within their own world, to the extent it manages to evade oversight, they're in the struggle of all against all, nasty and brutish -- also short since it ends, at least for most of us, with adulthood.

But we have a cognitive bias toward seeing the past with a rosy glow, remembering the good parts much more than the bad. That's good, in that it helps us feel better, but it isn't helpful if we want to look out for young people, really appreciate what they go through, and help to shape their worlds for the better. So I'm very glad that we're seeing a real trend now toward paying attention to bullying -- of which this is a subset, obviously, maybe the biggest piece.

I think it's happening in large part because of real changes in cultural norms about gender, sexuality, and the associated dynamics of power and vulnerability. We're talking about boys who are gay or perceived to be gay being targets of relentless abuse; boys who feel entitled to take what they want from girls, whether physically or symbolically; masculinity defined as cruelty and domination.

It does get better, unless you happen to be a libertarian, in which case Lord of the Flies is your paradise.

Saturday, November 05, 2011

Never speak ill of the dead

Hi, I'm Randy Ooney.

Here's a random collection of banal objects. This is a box of cereal. Why can't cereal come in a canister? Who made that rule?

This is a roll of toilet paper. Who invented toilet paper, anyway? We know who invented the telephone and the light bulb, but what's more important? Was it Scott? I don't know.

These are double A batteries, and triple A batteries, and D batteries. What ever happened to B and C?

Somebody sent me this eyebrow trimmer. Who ever trims their eyebrows? I certainly don't.

For CBS News, this is Randy Ooney, good night. And why the heck is anybody sitting and watching this inanity? That's what I'd really like to know.


Last night Rachel Maddow posited -- nay, all but concluded -- that the ever more bizarre Herman Cain presidential campaign is in fact a clever work of performance art. She pointed to various sly allusions and other clues that reveal the true intention.

Okay, that seems the most sensible explanation to a sane outside observer. But why would the Koch brothers sponsor a satiric performance that aims at revealing the absurdity and ignorance of the very constituency they manipulate for their nefarious purposes? Conceivably, their hubris is so great they believe they can simply enjoy the joke and get away with it. Maybe this is a message to current and future Republican candidates to respect the depravity of the Republican primary electorate.

Whatever it is, I'm impressed.

Friday, November 04, 2011

Human life ends at birth

Apparently. The Governor of Mississippi has come out in favor of the so-called "personhood" amendment, which will amend the constitution of the nation's most poorly educated and least healthy state to declare that "every human being from the moment of fertilization, cloning or the functional equivalent thereof" is a "person" with full legal rights. So, apparently, has former abortion rights champion Multiple Choice Mitt. (In some of what follows, I plagiarize myself, which I believe is legal.)

Of course, these people despise human life. They couldn't give a stale communion wafer about sick and dying children in poor countries, or right here in the US of A, where their leading domestic priority is to repeal legislation to provide health care to kids whose families can't afford it.

The entities to which they impute "sanctity" are not human beings, but anything that's kind of like a human being, in having human DNA, but is otherwise unlike what most of us think of us being human in having no ability to survive independently, and no consciousness. And where do they get the idea that lives of microscopic balls of cells, fetuses with unformed cerebral cortexes, and former humans whose cortexes have been destroyed, are somehow "sacred"? They obviously don't get it from the Bible. There is not one word about abortion anywhere in the Bible, Old Testament or New, even though abortion, and for that matter infanticide, were widely practiced in the Biblical world.

For that matter, the Bible certainly does not put forth any concept of the "sanctity of life." The Hebrews are commanded at various times to slaughter people, steal their land, rape their women, and enslave their children. God himself massacres innocent children in Egypt and elsewhere. God commands the Hebrews to stone a man to death for gathering sticks on the sabbath.

And of course, the Bible could not possibly assert that "life begins at conception" because people in Biblical times didn't have the slightest idea what conception was or how fetuses developed. In fact, if you believe in God, then you also have to believe that God is the most prolific abortionist in history, by many orders of magnitude, because something like 2/3 of "human lives" -- the zygotes created at the moment of conception -- never successfully develop. Most of the time, the woman is not even aware that she was ever pregnant. If abortion is murder, this is the death of tens of millions of innocent children every year. Should it not be the absolutely highest priority of medical research to save those babies' lives? But you never hear a peep from these people about it, because they know it's completely illogical.

Christian prohibition of abortion is an entirely modern phenomenon, dating at its very earliest to the 19th Century. And what happened at that time to suddenly provoke the concern of the Pope? It wasn't any scientific discovery -- understanding of the nature of conception and the zygote did not come until about until considerably later. No, what got the Christian fathers riled up was the women's movement. The idea that sex could be uncoupled from reproduction, or that women could choose not to become mothers, was appalling to the (putatively) celibate old men who ran the Catholic Church, and later to the Evangelical "Christian" conservatives who share their views on the semi-human status of women, although they otherwise think Catholics are heretics who God intends to torture for all eternity. And vice versa.

The reason I bring all this up, although you already know it, is because nobody in public life seems willing to take this issue on at the fundamental level of morality and logic. The most assertive anyone is willing to be about it, including NARAL, is to say that people differ in their views of the morality of abortion and that the law should not impose one view on everyone. I say it's time to get serious about this and expose the hypocrisy and fundamentally nonsensical basis of "pro-life" activism. Answer these lying bigots who would lead the world back into darkness. Explain to people why their views and public discourse makes no sense. Reveal their true agenda, to oppress women and for that matter all of humankind. To rule the world through terror and deceit.

Not a damn thing Christian about them.

Thursday, November 03, 2011

Speaking of denialism

Henry Aaron - not Hammerin' Hank, but the Brookings Institution economist -- makes it so clear even a Republican could understand it. Whatever savings may be available from making Medicare and Medicaid more efficient, or squeezing providers and beneficiaries, aren't going to cut it:

Whichever approach is followed — repeated modest reductions or a single huge one — if all cuts come exclusively from spending, it will be impossible to sustain anything approximating current commitments under Medicare and Medicaid (and under Social Security) as we know them. Resistance to defense cuts, beyond those already included in the legislation to boost the debt ceiling, is already hardening. A concern about undermining the nation's capacity to meet its international obligations may prevent the repeated allocation of half of spending cuts to national defense. Interest spending will inevitably grow sharply as today's recession-induced, near-zero real interest rates return to normal levels. Outlays other than those for defense, interest, Medicare, Medicaid, and Social Security today constitute only one third of the budget and have been cut deeply already. Following the Willie Sutton principle, Congress would have to “go where the money is” and slash the major social insurance programs, including Medicaid and Medicare.

To avoid this outcome, tax increases must account for a sizable fraction — perhaps most — of any deficit-reduction plan.

That's it. If we want to keep the promise made long ago that elderly people will not have to fear dying uncared for in the cold and dark, the Koch brothers will have to pay more taxes. There's no way around it. That's the cold truth.