Map of life expectancy at birth from Global Education Project.

Monday, April 30, 2012

Civilization and its Discontents

You have likely heard about a new study that finds that treatment of Type 2 diabetes in juveniles is very likely to fail. Here is the linked editorial in NEJM in which David B. Allen make a succinct statement of our doom:

[T]his is the essential, maddening conundrum of the epidemic of type 2 diabetes — collective failure to adhere to a lifestyle healthy enough to prevent the disease. A critical point is that the participants in the TODAY study were not adults, but youth immersed from a young age in a sedentary, calorie-laden environment that may well have induced and now aggravates their type 2 diabetes. Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier “eat less, move more” environment is created for today's children, lifestyle interventions like that in the TODAY study will fail.

Please note that 20 years ago, nobody had ever heard of Type 2 diabetes in children. As a matter of fact, what we now call Type 2 diabetes used to be called Adult Onset diabetes. Nowadays, however, Type 2 diabetes is just as prevalent in children as Type 1 diabetes (an unrelated autoimmune disease with similar symptoms) which used to be called Juvenile Onset diabetes. This is a public health catastrophe that threatens all the gains we have made in life expectancy and health, and threatens every strategy to contain health care costs.

Yeah yeah, I keep saying it. We keep hearing from conservatives about personal responsibility and how people who develop health problems because of their own bad behavior don't deserve to have the rest of us pay for their health care. But the truth is that our behavior is a function of our social and physical environment.

We evolved to eat whatever food was available because there might not be any tomorrow; and to rest when we could because chances were rare and almost all the time, we had to keep moving if we wanted to keep eating. The human organism is adapted to an environment in which it no longer lives. The result is, many of us get fat. This isn't because we are irresponsible or gluttonous or slothful -- or rather, of course we are gluttonous and slothful, that's how we are made. It's not our fault that we have these faults, it's our nature.

So what is to be done? We can't just target and treat individuals who have this problem. We urgently need to change the cultural, physical and economic environment. There are a lot of ways to do that, first of all by defining junk food and sugary beverages as something other than food, and treating them accordingly. No matter how much the purveyors of this garbage pay corporate think tanks and phony scholars to yell about the Nanny State and personal freedom. What they mean is their freedom to rip us off and kill our children. 

Sunday, April 29, 2012

Stayin' Alive

Yeah, it's not a very imaginative title. Anyway . . .

I live in a small New England town. The town center consists of a general store, a one-woman post office, a Congregational Church, a Catholic Church, the town hall, and an auto/tractor/whatever repair business. That's pretty much what it was 200 years ago, except that the auto/tractor/whatever business would have been the blacksmith. About a mile down the road is the old cemetery, which stopped taking new customers shortly after the Civil War.

Some history and genealogy buffs have made an inventory of the headstones, and the result is very relevant to the main concerns of Stayin' Alive. The list is in alphabetical order, which is almost as good as random, I guess. Here are some excerpts.

Adams, Mary, wife of Captain Thomas Adams, died Sept. 17, 1814, age 76
Allen, infant daughter of Asahel & Desire, died Apr. 23, 1772, age 4 days
Allen, infant son of Ezra & Lydia, died June 11, 1804, age 14 days
Allen, Anna, wife of Levi, died Mar. 5, 1834, age 23 yrs
Allen, Asahel, died Mar. 19, 1825, age 82 yrs
Allen, Charles H., son of Joseph R. & Susan M. Allen, died May 21, 1855, age 9 mos
Allen, Charlotte, wife of Erastus, died Jan. 2, 1875, age 86 yrs
Allen, Deziah, wife of Asahel, died Nov. 2, 1820, age 75, footstone
Allen, Erastus, died Aug. 28, 1856, age 74 yrs
Allen, Ezra, died Aug. 23, 1852, age 77 yrs
Allen, Joseph, died Aug. 28, 1815, age 76 yrs
Allen, Lydia, wife of Ezra Allen, died Mar. 10, 1855, age 70, footstone
Allen, Rebecca, relict of Joseph, died Nov. 17, 1819, age 87, footstone
Avery, infant daughter of Alfred & Fanny, died Oct. 24, 1853, age 2 mos
Avery, infant daughter of Alfred & Fanny S., died Oct. 24, 1853, age 2 mos 4 days

Bass, Betsey, wife of John Bass, died Jan. 9, 1837, age 42
Bass, Captain Ebenezer, Revolutionary War stone, died Mar. 6, 1814, age 67 yrs
Bass, Eunice, wife of John Bass, died Nov. 12, 1820, age 25 yrs
Bass, John, died Sept. 30, 1865, age 78 yrs 11 mos, footstone
Bass, John, son of John & Betsey, died Dec. 24, 1833, age 16 mos
Bass, Nancy, wife of Nathan Bass, died Nov. 23, 1834, age 44 yrs, footstone
Bass, Nathan, born Apr. 15, 1792, died Oct. 8, 1856, footstone
Bass, Ruth, relict of Captain Ebenezer, died Dec. 27, 1834, age 86
Bass, Ruth, daughter of Captain Ebenezer, died Nov. 21, 1794, age 1
Bingham, infant son of Gamaliel, died Nov. 30, 1804, age 3 wks

And it goes on like that. You will, I hope, notice something interesting. Lots of people lived to what we would today consider a respectable age, well into their 80s (there are a few in the 90s which I didn't happen to capture in the cut and paste), mid 70s is a typical age of death. But what is different from today is the many infants and children, and the women of child bearing age. These people were farmers and local artisans, for the most part, and the place was sparsely populated. In the cities, I expect there was more opportunity for infectious disease to carry off young adults and the middle aged. But out here, if you made it past age 4 or so, you could expect to get your three score and ten unless you died in childbirth. (There are a few men killed in the Civil War on the list, but that was a brief interlude in this story.)

This is a point I have made here before, but now we have a very clear and evocative illustration. The tremendous gains in life expectancy we experienced in the past century had little to do with extending old age and almost everything to do with actually getting there. Ruth Bass lived to be 86, but her daughter died at age 1, while her son lived to be nearly 79 and her grandson died at 16 months, while her daughter-in-law died at age 25, quite likely in childbirth. That was life in the good old days.

Thursday, April 26, 2012

A world historical schtick dreck

I have sorta kinda been wanting to write something about John Edwards but what can I say that you haven't already thought yourself? Then I realized that he does sorta kinda make me rethink my political science.

Had you asked me, pre-JE, I would have told you unhesitatingly that a politician's personal behavior and integrity in private affairs should be a minor issue in choosing among candidates. Ultimately, politics is about public policy. The reason it matters who gets elected to office is the extent to which candidates run on policy proposals and priorities; and to what interests they will likely be responsive when in office. Ergo, for example, the serial philandering of JFK and Bill Clinton, as far as I was concerned, was pretty much between them and their wives and children, plus whoever was affected on the side of the partners in philandery. (Am I the only person who has noticed that it is impossible for a man to womanize without a woman who is willing to manize?)

But the Edwards case is different, for a couple of reasons. In the first place, by the time he committed his sleazy affair, the context had changed thanks in large part to the Clenis affair. It didn't matter what Kennedy got up to because the media didn't consider it appropriate to report, even though they actually knew. Until Monica, Clinton's behavior mattered only to the extent that it might have cost him some votes among people who didn't think like me, but basically, he got away with Jennifer Flowers and whatever else he got up to so who cares? (There was an accusation of rape by one woman. If that was true, it would be another matter, but there's no way to know. Paula Jones's story suggests pretty strongly that she was miffed only because she expected him to continue to pay attention to her. But I digress, the point is about consensual behavior not whatever else might have happened.)

However, Edwards knew perfectly well that if he became the nominee, and the truth got out, the Democratic party would be crushed in the election, the party brand severely damaged for a long time, and the country and the struggling people he purported to care about horribly maimed for years to come. On that basis alone, his warped character destroyed any rationale for envisioning him as president based on public policy. His narcissism completely trumped whatever he claimed to stand for.

Beyond that, of course, using campaign funds to keep his paramour on retainer, and to finance an elaborate plot to deny his own child, is so sick you have to wonder what he'd do with an army and a nuclear weapon. All this while making what turns out to have been his fraudulent relationship with his very popular, seriously ill wife, a centerpiece of his self-presentation. This guy is as depraved as they come. So yeah, there is a point at which it does matter, where you don't want to vote for a bastard, even if he's our bastard.

Tuesday, April 24, 2012

A Hard Blow

I've been a football fan my whole life. I remember watching the Houston Oilers beat the Buffalo Bills with a last second field goal on a little black and white TV at my grandparents' house when I was maybe six years old. When I was growing up in Connecticut we were Giants fans - "we" meaning my uncle and grandparents and brother and I. (My father was still hooked on the Philadelphia Eagles.) I've been a passionate follower of the Patriots since I moved to Boston some 25 years ago.

But it looks like I may have to find another way to consume hours of unwanted consciousness. It may be all over for North American football. You have to read a British newspaper to really get this story told forthrightly, but it's now incontrovertible that football players, with a very high prevalence, develop chronic traumatic encephalopathy. That means they become demented, chronically depressed, and die early, often by their own hand. We've always known about the osteoarthritis and other joint and ligament problems, but you can see macho men making a choice to accept that risk in exchange for the money and glory. (Actually the glory for most NFL players is very fleeting, and the money not so much as you think.)

But to lose your mind? That's not so easy to reconcile. Now a lot of these players are suing, claiming that NFL executives knew about this but covered it up. And they have a case. The expert physician panel they employed for many years downplayed the risk based on clearly inadequate research, which they interpreted tendentiously. Now that the truth is out, how many mothers will allow their sons to play football? And no, you don't need an NFL career to suffer this catastrophe, it now appears that it can happen to players who never play past college, quite possibly to some who never play past high school.

Football as we know it can't exist without violent collisions. They are simply essential to the game. And helmet technology seems to be about as good as it's going to get. Hardly anyone seems to be facing up to it yet, but it's hard to see how the game has much of a future. Tell me why I'm wrong.

Monday, April 23, 2012

The Memory Hole

There are plenty of good reasons to despair at the state of our politics. One grows weary at the impunity of lies in public discourse; the continual elevation of trivia, name calling, and faux outrage to the headlines; the systematic exclusion of not only viewpoints, but facts, that do not conform with the elite consensus about what is "serious."

The great Paul Krugman, for one, labors tirelessly to muck out the sewers. (He himself is "unserious" because he thinks European leaders should be more worried about mass unemployment and general economic collapse than they are about this year's budget deficits or the fools who bought Greek bonds. But I digress.) Today he again points out the obvious: That for Romney to win the election people will have to forget that the recession began while George W. Bush was president and that job losses stopped nine months after Obama took office; that private sector employment has done better under Obama than it did under Bush throughout his term; that Obama has been unable to implement most of the economic policies he wanted to anyway because the Republicans in congress prevented it; and that Romney wants to return to the very policies that caused the financial crisis in the first place. But Krugman also figures he will likely get away with it: "Are the American people -- and perhaps more to the point, the news media -- forgetful enough for that attack to work?"

Why yes, they are. Thanks for asking. Larry Siems, writing in Slate, tells us that he has read thousands of classified documents obtained by the ACLU under a Freedom of Information Act Lawsuit. And, as we already basically knew, "Our highest government officials, up to and including President Bush, broke international and U.S. laws banning torture and cruel, inhuman, and degrading treatment. Worse, they made their subordinates in the military and civilian intelligence services break those laws for them." The U.S. tortured people all around the world. The U.S. tortured innocent people. The U.S. tortured people repeatedly even when their torturers had decided it was useless. Senior officials lied, suppressed dissent, and destroyed evidence in order to cover it up. Siems writes, "From emails among FBI agents sharing their shock over scenes they had witnessed in interrogation booths in Guantánamo, to letters and memoranda for the record, to major internal investigations, the documents show that those who ordered and carried out the torture did so despite constant warnings and objections that their actions were ineffective, short-sighted, and wrong. It is no wonder that so many of these documents were suppressed."

Have you heard anything about this on the nightly news, public affairs yack shows, Sunday morning gabfests? Heard anything about it from anybody holding public office, including by the way B. Hussein Obama? Didn't think so. Nor will you, I predict. It would be too unserious to decide that the former president is a criminal.

Sunday, April 22, 2012

The unbearable heaviness of fandom

With specific reference in this case to the Boston Red Sox. Baseball has an aesthetic quality. Just as chess masters can see elegance in a position that tells them it is strong even without close analysis, connoisseurs of baseball can perceive elegance in a team's play that speaks to its prospects. The analogy isn't perfect because there is a random element in baseball, so you need to look at several games before that spiritual sensibility can emerge. We can now proclaim that the Red Sox are a putrid, stinking, excrescence. Yesterday, while Phil Humber was completing the 21st perfect game in major league history on the west coast, the Sox were blowing a 9-0 lead, in Fenway Park, to the New York Yankees, in the nationally televised game of the week. This was just the latest in an unrelieved series of atrocious debacles dating back to the last month of last season. The players have no respect for new manager Bobby Valentine, whose mind is on vacation while his mouth is working overtime at his regular radio show, in New York City, with the New York Yankees play-by-play man. Really. Oh yeah, Valentine, in addition to being manager of the Boston Red Sox and a radio commentator for Yankees fans, is Director of Public Safety for the City of Stamford, Connecticut. Truly. But here's the thing about fandom. The fans have nothing to do with anything that happens. They wear lucky shirts or turn their hats around or leave the room when there's a critical moment on TV because they think they're bad luck or whatever, but really folks, it's not about you. At all. The emotional investment of sports fans in the fate of their team is difficult to explain. Red Sox fans, who are nearly suicidal right now, were euphoric a few years back, but their lives have actually been unaffected by the team's fate. I'm old enough now to have figured this out. (I didn't drop that pass, Wes Welker did. Not my problem.) But many people never do. It's a mystery.

Wednesday, April 18, 2012

Bad News

Coca Cola's earnings jump due to big growth in sales. "Revenue grew 6 percent to $11.14 billion, compared with $10.5 billion in the first quarter last year, propelled by a 5 percent increase in sales volume driven by even larger increases in emerging markets. After India [20% growth!], China experienced the greatest growth, 9 percent, followed by a more modest 4 percent in Brazil."

Good news if you own stock in the company, I suppose, but bad news if you are a human being. The Coca Cola corporation sells poison. That's the business they are in. They make their money by killing people. Kelly Brownell and colleagues explain the benefits of a tax on sugary beverages that would be steep enough to push down sales. But the merchants of obesity and diabetes have more than enough political clout to prevent this from happening. Coca Cola funded the American Legislative Exchange Council to do some of their dirty work, and of course we got Stand Your Ground and other noxious legislation as a side effect.

We have got to stop these evil scum. That is all.

Tuesday, April 17, 2012

Unintelligently designed

That would be us. Frank Bruni is a restaurant critic who for some inexplicable reason was awarded an endowed chair in punditry at the NYT, but today he's writing about food so I guess that's okay. He isn't saying anything we don't already know, or that hasn't already been said right here, but it's good to repeat it and with luck, focus our attention on the real problem and possible right solutions.

The reason we (collectively speaking, not necessarily you or I specifically) keep getting fatter is simply that we're swimming in an ocean of calorie dense food. Bruni could add that we also sit on our butts all day, but that's part of the same picture. For pretty much all of the history of life on earth, but certainly including 2 million years of genus Homo, having too much to eat was pretty much never a problem. If there was abundance, it only lasted a few days, then the elephant started to rot. And the amount of work our ancestors had to do in order to get what food there was burned as many calories as they were able to eat - and that's if they were lucky. So whenever there was extra food around, people would snarf up all they could, trying to put on a couple of extra pounds to get them past the next missed meal.

That wasn't a matter of choice -- it was hard wired into their brains. And it still is. The problem is, obviously, that the situation has completely changed. We weren't designed for the current environment, we evolved in a different one.

The solution to this problem does not lie in gastric bypass surgery, or inventing a miracle diet pill, or switching to a diet of nothing but grapefruit. It lies in changing the food and calorie expenditure environment. There are ways to do this through public policy, but the industries that create the current food environment won't let it happen. Also industries that create the built environment and associated transportation system. This is fundamentally a problem of the political power of vested interests. And it's making us sick and killing us.

I'll have more to say anon.

Monday, April 16, 2012

Revenge turns sour

Quite to my surprise, my home state of Connecticut is in the process of eliminating its death penalty. (At this writing I believe the governor has yet to sign the legislation but he has said he will.)

It may not seem all that surprising that our relatively liberal state would join its neighbors in Massachusetts and Rhode Island in taking this step, but the timing is notable. We have recently endured the second of two death penalty trials in a notorious case that made national headlines. It was even the occasion for one of those New York Times in-depth, four full broadsheet page reports, specifically on the life and family of one of the murderers. (Joshua Komisarjevsky was adopted into a somewhat withered branch of a distinguished clan.)

The surviving victim, Dr. William Petit, whose wife and two daughters hideously tortured and murdered, along with extended family members, demanded the death penalty. Accordingly, prosecutors rejected offers from both perpetrators to plead guilty in exchange for life without parole. Connecticut law requires a trial of guilt, as well as punishment, in capital cases, so the defense could not simply stipulate to the facts. Two juries had to endure the trauma of viewing evidence too horrific to publish, while our community endured the dutiful recitation of its description every evening on the television news, in repeated episodes nearly a year apart. My mother would hit the mute button on he remote whenever the story appeared, as I suspect a lot of people did. Dr. Petit had to testify to his unimaginable experience, twice. No one felt any right to publicly question the ultimate penalty in this case while his ordeal continued.

Neither of these defendants is a poster boy for the injustice of the death penalty. They are both white, both career criminals, well into adulthood, sane and of normal or above average intelligence. And yet, after all this, the legislature chose this moment, to little or no observable public outcry.

Sam Harris discusses the currently most compelling intellectual argument against revenge here. A warning: he very matter-of-factly recites the events of this case. I doubt many legislators or voters are thinking about the illusion of free will as they consider this issue. However, both defendants seemed not so much evil as helpless and almost pathetic, even if it's hard to feel sorry for them. They seemed perplexed by their own actions, lost in their situation. Sure, they're psychopaths and they aren't apparently remorseful, except for the consequences to themselves. But killing them just seems pointless.

The law is not retroactive and they, and the other nine men on Connecticut's death row could, in principle, face execution some day. ("Death row" is metaphorical -- Connecticut doesn't have a dedicated housing unit for the condemned, they are scattered about.) But it takes decades for these cases to wend their way through the courts, and costs the taxpayers millions. By the time anyone is executed, the reasons for it have faded in memory.

Michael Ross, the only person put to death by the state of Connecticut since the Supreme Court allowed executions to go forward, ordered his lawyers to stop defending his life. The judge had to struggle with whether Ross could take it upon himself to embrace his own execution, but finally allowed it. Ross had specifically and horribly traumatized the rural area where I live. People talked about his death with sadness, but no real satisfaction.

So, in the end, I think our people just recognized that capital punishment isn't worth it, doesn't accomplish anything good, and only adds to the trauma and cost of already evil events. Why the folks in Texas and Alabama don't feel the same why, I'm not really sure.

Thursday, April 12, 2012

You know what? Medicine really has come a long way.

I was just hanging out with a couple of physicians around my own age, and they go to reminiscing about the old days when they were interns and such. Their earliest memories of doctoring were of young men showing up with wasting and generalized lymphadenopathy and disseminated cytomegalovirus and dying -- one after another after another, and there was absolutely nothing they could do about it. That was AIDS.

One of them is now a cardiologist. The age adjusted death rate from heart disease in this country has fallen by about 50% since then. (I don't feel like looking up the exact number, but it's in that ballpark.) It's not because we're eating better, or exercising more -- on the contrary. It's because of pills, mostly, and clot busting for people who have just had heart attacks. Childhood leukemia and other cancers of childhood are now largely curable. The death rate from many adult cancers has also fallen sharply. We're living longer and longer.

When I was in graduate school, the general picture was that the huge gains in life expectancy during the 20th Century didn't have a whole lot to do with medicine. They had a lot more to do with public health (e.g. clean water) and higher standards of living, mostly better nutrition. It was even possible for Ivan Illich to write a highly respected book, that everyone had to take seriously, that made the claim that medicine, on balance, did more harm than good. (It's called Medical Nemesis, if you're interested.)

Well, you just can't say that any more. Yes, we'd much prefer for people to exercise and eat right and not smoke and drink only in moderation and practice safe sex and all that good stuff. But the incontrovertible truth is, when we do get sick, we've got a much better chance, and that's now the biggest part of the story of increasing life expectancy.

It's important to remember that this is why universal access to health care, and medical costs and affordability, have become such a crisis. 60 years ago, medical intervention just wasn't as important. Doctors couldn't do nearly as much, there was much less on which to spend money even if you had it, it really was possible to take care of the basic needs of poor people through charity and for country docs to accept chickens from struggling farmers. If you had cancer or heart disease, you were just going to die anyway so que será será.

It isn't like that today. It's important to keep all that in perspective.

Tuesday, April 10, 2012


There seems to be a cornucopia of studies lately finding that conservative political beliefs and attitudes are associated with a paucity of brainpower. The latest of this bounteous harvest is from some folks in the universities of Arkansas, Kansas and Wisconsin, whose home states will not feel flattered. Scott Eidelman and colleagues find that it's not necessarily low IQ, but also essentially cognitive laziness, that generate conservative ideological orientation. They define "conservative" as including presumptive attribution of personal responsibility for individual outcomes; endorsement of hierarchy and status differences; and default preference for the status quo. (Note that logically, the first two tend to conflict with each other. Just a passing observation.)

They find that controlling for education, self-identification as liberal or conservative, and gender, people hanging out in a bar tended to endorse more conservative statements as their blood alcohol level increased. In other words, even if you start out considering yourself a liberal, beer goggles actually make you more conservative.

In other experiments, they got similar results when people were multi-tasking; and when they were given only a short time to formulate their responses. The basic idea is, it's a lot easier to come up with answers and explanations that are consistent with conservative ideology. If you do a little work and think about issues harder, you start to grasp more liberal ideas.

So yeah, it seems more liberal ideas are generally a little more complicated. That person isn't poor because he's a lazy slob, or belongs to an inferior race, it's because the economic order both perpetuates initial disadvantages and fails to provide adequate opportunity for everybody. Slightly more complicated, and also more likely to be a) true and b) potentially ameliorable, which would also of course mean that things would have to change. And this explains the appeal of the moronic ranting of the vulgar pigboy. He speaks to the intellectually lazy, not just the stupid.

Monday, April 09, 2012

Can consequences trump ideology?

I recently had the opportunity to talk with an actual professor of constitutional law at an Ivy League university (not my own, we don't have a law school). He thinks that the Affordable Care Act is constitutionally valid, but that the conservative majority on the SC would just love to find some reason why it isn't because conservative jurisprudence means coming to conclusions that are politically congenial to conservatives.

However, they do confront a difficulty. There is no limit to the sophistry they are willing to employ, viz. Bush v Gore. But in the latter case, the consequence of their action was that GW Bush occupied the office of president, which was fine with them however disastrous it was for the rest of us. However, in this case, here are their alternatives:

They go along with the Scalia plan, i.e., the individual mandate is unconstitutional and it's obviously just too much to ask for them to actually read the bill and decide which parts are inextricably linked to it and which parts aren't, so rather than forcing Justice Scalia to work after 5:00 pm they will just throw the whole thing out.

Since Scalia hasn't read the bill and apparently never will, he doesn't know this, but I'll let y'all in on the secret. There's a whole lot of stuff in there that has already happened. This includes the creation of the Patient Centered Outcomes Research Institute, which already has a funding stream which does not come from the federal budget or from congressional appropriations and which is a private non-profit corporation. It has paid staff and reviewed proposals, for which it will make funding awards in May, presumably before the justices rule. (Disclosure alert: I might even get one.) Similarly, the Center for Medicare and Medicaid Innovation has already spent money and will make substantial awards (maybe a billion clams) before the court rules. (Disclosure alert: They have paid me and several hundred other people $500 as an honorarium for reviewing proposals.) So what happens if the act is struck down? Are these entities dissolved? Do we all have to give the money back? What about people who have been paid salaries by PCORI and CMMI?

Then there are the high risk pools, from which people already have purchased insurance. The people under 26 who are staying on their parents' plans. The grants to states to set up insurance exchanges. What happens to all that? The result would be total chaos.

So let's say Scalia decides he can at least assign his clerk to read the bill and decide what is and is not severable. Is there some consistent, defensible constitutional basis for doing this? What about the medical loss ratio requirement? The insurance exchanges? Guaranteed issue? (Could that survive without the community rating requirement? I don't see why not.) Ban on recissions? If they do sort all this out then, a fortiori (yeah, fancy pointy headed Latin term) they will have to analyze and accurately describe how insurance markets work, which means the whole broccoli analogy and the rest of the right wing blog jive Scalia and the others quoted in oral arguments will blow up like a Pakistani wedding hit by a predator missile. They will have to conclude that the individual mandate is essential to congress's legitimate purpose in regulating interstate commerce in order to fix real problems in the market for health insurance.

As a matter of fact, my friend said that arguments on the third day, regarding severability, suggested to him that Roberts and Kennedy may have had the light bulb go off. They may have seen that the argument for severability essentially unmakes itself; whereas if they don't find severability and strike the whole thing down history will remember them as irresponsible lunatics. The question is whether they care about option B. (Scalia, Thomas and Alito clearly do not.)

Friday, April 06, 2012

A brief moment in history?

Margaret Hostetter, as part of NEJM's 200th anniversary celebration, reviews the history of pediatrics. She tells us that the very concept of pediatrics - of children as a group with particular medical needs - did not exist until the end of the 19th Century.

One reason for this, it seems, is that children in general were not expected to live. The wise approach to the death of children was acceptance. Hostetter writes, "By the middle of the 19th Century, a child's death, far from intolerable, was frequently viewed as blessed, a release from the torment of hectic infection or the lingering complications of diseases . . . " The old graveyard in my home town in Connecticut is full of children's tombstones. Yet the death of a child, once a routine occurrence, is today an unbearable, and rare, tragedy -- in North America and Europe, anyway.

What has changed is not so much living standards -- the children of the wealthy had little more chance in the 19th Century than the children of the poor. It is the conquest, by science, of infectious disease. There are three branches of the militant force which has won this world historic victory: environmental public health, antibiotics, and immunization. By environmental public health I mean such measures as the provision of clean water and safe handling of sewage, pasteurization and other food safety measures, isolation and quarantine (seldom needed today), sterilization of medical instruments, environments, and providers -- that sort of thing. Killing the germs before they get to the people, or keeping them away. The understanding of the nature of infectious disease, and measures such as these based upon it, made a tremendous difference even before there was much in the way of medical intervention against infectious disease.

Antibiotics, in fact, did not become important until after World War II. My mother lost an eye to infection as a child, something that would not happen today. Smallpox immunization was available in the 19th Century, or course, but the ability to immunize against a broad range of infectious diseases also came in the second half of the 20th Century.

So nowadays, for the first time in 2 million years of genus Homo, and 250,000 years or more of Homo sapiens, we expect our children to live. We take it for granted, in fact. But will this be true 30 or 50 years from now? Quite possibly not, if we continue with our present folly. This includes indiscriminate use of antibiotics -- including using them to fatten cattle even while maintaining them in unsanitary conditions. It includes the idiocy of people who refuse, and even campaign against, immunization. And it includes increasingly dangerous underinvestment in public health infrastructure. Maybe people who talk about a right to life should think about this.

Wednesday, April 04, 2012

Some folks may be interested in . . .

Rational Wiki. Quite a lot of useful and generally cool stuff here, although it's all preaching to the choir.

Our purpose here at RationalWiki includes:

Analyzing and refuting pseudoscience and the anti-science movement.
Documenting the full range of crank ideas.
Explorations of authoritarianism and fundamentalism.
Analysis and criticism of how these subjects are handled in the media.

Good for refuting whatever nonsense your Uncle Max comes up with, as well as amusing and enlightening yourself.

Tuesday, April 03, 2012

The scum of the earth

For some mysterious reason I've been getting e-mails from a PR flack for a company called -- no, come to think of it, I won't even name them. A company that sells homeopathic "remedies," i.e. a scheme to defraud the public. The first thing they wanted me to know is that an unnamed "major pharmaceutical company" is in negotiations to buy them, so it can sell their product line in pharmacies. I have no idea whether this is true, but if it is, there will be hell to pay, let me tell you.

Next, they are bragging that the company "has generously offered their product to India's Minister of Health and Family Welfare to help in their H1N1 Flu outbreak. India has stated it is suffering from an outbreak of H1N1, specifically known as the "Swine Flu". To date, the strand of flu has claimed 12 lives. . . .In a gesture of compassion, [company], Inc.'s CEO Kelly Hickel has informed the Indian Minister of Health that he has a modest supply on hand which he will gladly send over immediately, and should more product be necessary they will gladly donate their net profit as a humanitarian effort to aid in their fight against the H1N1 Flu strain."

Kelly Hickel is depraved. He/she/it is a pure, unalloyed evil. That is all.

Monday, April 02, 2012

Guess what? Climate change is bad for business.

And maybe some persons of richness are starting to figure this out. Via Climate Progress, the resort operators in Aspen are wondering why in tarnation they are paying dues to the U.S. Chamber of Commerce, since climate change is, you know, destroying their business and the Chamber denies that it's happening. Which obviously it is. The answer from the Aspen Chamber Resort Association is weirdly lame: "Officials say that while they fundamentally disagree with the U.S. Chamber's stance on climate legislation, they still value the group's administrative services."

Still, I would expect them, and other local chambers suffering from adverse weather, to defect pretty soon. I'm also wondering why we haven't heard from agribusiness and coastal communities. The warming and acidifying ocean is catastrophic for fisheries, and rising sea levels and more severe storms are really bad news for coastal resorts. There are rich people affected by all of this, who could be giving their money to the Sierra Club and Center for American Progress instead of the Chamber of Commerce and the Heartland Institute -- if they had any sense at all. Evidently they do not.

ABC News, at least, has gotten over the false balance fetish, even though the New York Times has not. This story tells it like it is. We'll see if more of the corporate media join them, but I'm not holding my breath.