It's an epidemic!

OMG! The incidence of thyroid cancer has tripled in the U.S. in the past 30 years, from 3.6 cases/100,000 to 11.6. Is it radioactive fallout? Pesticides? Vaccination? Fluoridation?

Nope. It's CT scans. And you can relax. They aren't causing thyroid cancer, they're finding abnormal cells which in the past, nobody would have detected. But, as Brito, Morris and Montori tell us at the linked article (which I don't think you can read but that's okay, I'll tell you what's in it), they aren't actually cancer after all.

There are four different kinds of thyroid "cancer," the most common of which is called papillary carcinoma. Guess what? 99% of people with papillary nodules less than 20 mm in diameter will be alive after 20 years. It turns out that at least 1/3 of people who die of other causes have these lesions, which were never detected.

It used to be that thyroid cancer would be diagnosed when a person presented with symptoms or palpable nodules. Now, when people get CT or MRI scans to investigate coughing or neck pain, 16% of the time they find nodules in the thyroid, most of which are less than 15 mm in size.

Then what do you think happens? The doctor says, "You have thyroid cancer," and the person has surgery to remove part or all of the thyroid, which cost $416 million in 2006. They have to take thyroid replacement pills for the rest of their lives, and it's difficult to adjust the dose properly. Some have more severe complications. And, contrary to recommendations, 2/5 of people get radioactive iodine which makes it easier to do follow-up imaging but, er, causes cancer.

Well, at least we're saving lives, right? You already guessed the answer. The death rate from thyroid cancer in the past 30 years has stayed exactly the same. Rarely, people have opted not to have surgery and to just be followed carefully. In an observational study, of 340 people who made this choice, none died. That would be zero. In 31 patients, the nodules did enlarge, and 18 of them ultimately chose surgery. Thirteen did not, and in 7 of them, the tumors subsequently shrank.

Draw your own conclusions.

Facts are Stupid Things

Those are the immortal words of Ronald Reagan. (He meant to say stubborn, not stupid.) Anyway . . .

Many people have been noting lately that people know they're supposed to hate Obamacare, but they don't know why. The popular prediction now is that as the Affordable Care Act is actually implemented, and people find that either a) nothing happens, because the insurance they already have just goes on as before or b) they couldn't get insurance before, but now they can, and they can afford it; and there aren't any death panels and their Medicare benefits don't get cut and they can keep their doctor or pick one they want (assuming the doctor will take them, of course), and there aren't any government bureaucrats telling their doctor what to do, and everything is just fine, well then, they'll like it after all.

I am very reluctant to get into the prediction game, but that seems a reasonable expectation. However, we do have some problems. People in the Massively Resistant red states won't get the Medicaid expansion, and the federally run exchanges are likely to be kludgy and buggy. It is also essential that lots of young healthy people sign up, and I can't 100% guarantee that will happen in states with massive disinformation campaigns. Whether the wildly misinformed citizens of those states will correctly figure out who to blame for their problems is unclear.

There are also many technical defects in the Act which will need fixing, which an uncooperative congress won't do. And, in the long run, it will need more major surgery to achieve cost containment, which will be politically very difficult because your wasted money is profit for Merck and Hospital Corporation of America.

We may get this Rube Goldberg contraption to work for a while, and maybe that means a Democratically controlled congress sometime soon. But there's still only one way to have a sustainable health care system that can continue to cover everybody into the future, and that's universal, comprehensive, single payer national health care. There's no other way.

Weapons of Mass Distraction

No, sorry, but nerve gas is not a Weapon of Mass Destruction™. It is a battlefield weapon, which is not inherently any more massively destructive than bullets or bombs. It kills people over a limited area for a short time, then it blows away. The people are no more or less dead than people who get blown up by bombs or shot with bullets.

Now, it so happens that there are international conventions against use of chemical weapons, but there are also international conventions against bombing and shooting civilians. Something like 100,000 people have already died in the Syrian conflict, an accomplishment credited entirely to guns and bombs. The United States has not seen any need to blow up stuff and people in Syria throughout this carnage.

So now, apparently, for reasons that admittedly are a bit hard to see, the Syrian military has used organophosphate gas to kill a lot of people in a Damascus suburb. If they had just dropped bombs on the people, that would have been fine. But, since the people were poisoned rather than pulverized, the U.S. is compelled to do some bombing of its own.

The amount of bombing proposed is insufficient to change the course of the conflict, which we don't want to do anyway because we would probably like the new Syrian regime no more, and quite possibly rather less, than we like Bashar Assad. It might discourage Assad from further chemical attacks, but it won't discourage him from blowing people up because the message is precisely that blowing people up is perfectly okay. Cruise missiles cost $1 million each, which goes to Raytheon, so I'm sure they're happy.

Oh yeah. This will really piss off the Russians, who are just as capable of blowing up stuff and people as the U.S. This is not smart.

Oh yeah, the conference

Since I had my Baselian adventure at the expense of the U.S. taxpayers, I suppose I owe y'all something in return. To remind you, I was there to attend the annual international meeting sponsored by the International Society for Environmental Epidemiology and the International Society of Exposure Science. The latter is not about exhibitionism but what happens to your body when you swallow, inhale or have contact with various chemicals, mostly, and some other stuff like really hot weather or obnoxious noise or whatever.

So. On the one hand the environmental movement has had some great successes over the decades. They finally managed to convince political leaders to get the lead out of gasoline and paint, for one very good example. We've also reduced other nasty tailpipe emissions, banned many pesticides and restricted others, improved our drinking water, and reduced workers' exposure to many harmful agents, thanks to the scientists who attend these meetings. Environmental epidemiology is really the discipline that first established the link between tobacco smoking and all the nasty stuff it does, although lots of people still smoke.

Now that we're not dying so much of infectious diseases and us folks from the rich countries, at least, are well nourished and otherwise healthier and longer lived than ever, the relatively subtle effects of remaining hazards -- many of them created by ourselves -- loom larger. The overwhelming challenges of climate change and resource depletion may seem to relegate endocrine disruptors and ultrafine particles to minor league status, but that's really missing the point. It's all one fabric.

The problem of endocrine disruptors is increasingly recognized by scientists, but barely on the public radar. Innumerable pervasive chemicals, notably constituents of plastics, have chemical structures similar to hormones. A common effect is to raise estrogen levels. Fish and amphibians are very sensitive to these effects in their developmental phases, and the presence of these chemicals in water is likely contributing to the catastrophic decline in amphibian populations and also affecting many aquatic fish. So this has a great deal to do with the stability of ecosystems and the mass extinction now underway.

These exposures also seem to affect human children. Children now endure a very complex suite of low-level exposures. Yes, plenty of hazardous chemicals occur in nature but we're getting most of our exposures nowadays from manufactured goods and processed food. We just don't have adequate information on the safety of the vast majority of substances to which we heedlessly expose ourselves every day. They are affecting long-term cancer risk, neuro-development, sexual maturation, and many other biological processes, in ways we little understand.

The problem is, the good folks I met in Basel are largely talking to each other. The vast majority of folks, had they been able to come up with $250 for a conference badge, would barely have understood a word that was said. The societies worry about how to communicate with policymakers, but not with the public in general. They seem to think that these "policymakers" will do what is wise and good if only they are made to understand the science.

That's not how it works, obviously. Reason and truth have little to do with the making of public policy, until and unless the people rise up and make it happen.

I came away more convinced than ever that the democratization of science is our greatest imperative. We are the only species capable of understanding that we are destroying the planet even as we go ahead and keep doing it. There is a contradiction there that we must resolve, and fast.

Thought experiment

You might have noticed that the response of the U.S. and U.K. governments to the antics (is that the right word?) of Edward Snowden has been astonishingly clumsy and has only gone to reinforce the narrative he wanted to tell -- of governments out of control, undemocratic, and arrogating power. Forcing down the plane of the democratically elected president of a member state of the Organization of American States, with which we are and always have been at peace, based on a completely false assumption, was really, really stupid. Detaining a Brazilian subject who is merely transiting through your airport, for nine hours, on no relevant suspicion, aggressively interrogating him and stealing all his electronic gear, knowing that whatever information it contains already exists in multiple copies all over the world, is totally idiotic.

There's actually more but you get the idea. Why are they doing this? The spookmasters, including Msrs. Obama and Cameron and their underlings, are red in the face with frustration. The whole point of the secret "national security" apparatus is the unaccountable exercise of power. Here are a couple of nobodies who are openly taunting them and laughing in their faces, and they can do nothing about it. Gen. Clapper lies awake at night dreaming of droning Snowden, Assange and Greenwald.

But he can't. They are citizens of anglophone countries, and of European descent. Well okay, Greenwald is a homosexual Jew, but that's not the same thing as an Arab, you can't just murder him at will.

Try this. Change Snowden's name from Edward to Mohammed, put a beard on him, and move him from Russia to Yemen.

3-2-1 Blam! Am I wrong?

A bit more about Basel

As I said, the bikes are more prevalent than cars. People park their bikes everywhere. Most people put a bike lock on so you can't just ride off on it, but they don't bother to secure them to anything. Some people don't lock them at all. You'll see big patches of parked bikes and scooters in all sorts of nooks and crannies. The drivers -- those relatively few that there are -- are surprised if a pedestrian waves them on. They expect to stop. The trams go by constantly. It's completely unlike a U.S. city where people pile up in large groups for 15 or 20 minutes waiting for a bus or a trolley. You're supposed to buy a ticket or a pass, but it's on the honor system. People board by the back door and the driver never checks.

All of the cafes -- and as I say, there are three or four on every block -- have outdoor seating, and hardly anybody sits indoors. Of course the weather is paradisical right now, I can't say if that's always the case. And there are people there all day, often with beer or wine, but maybe coffee, a plate of cheese or cured meets, talking and laughing and interacting with passersby, half of whom, it seems, are their friends. That's where they live, on the street, in the cafes. Everybody seems relaxed and friendly and trusting. Yes, the service is slow and the construction workers are taking it easy, but there isn't a single piece of litter on the street, anywhere. I haven't seen a single cigarette butt or paper cup. Not one.

I was walking around in the early evening and I came to one block, just like all the others with the people out on the sidewalks having their beer and wurst, three hairdressers on the block (mysteriously, as always), and this happened to be where the ladies of easy virtue were. They were all young and lively and bantering with the cafe sitters but their reason for being there was obvious, and of course they all walked up to me and made what were evidently very friendly remarks in German. I just said Hi how yah doin' and walked on and everybody laughed. As I left the block a police car (they're Mercedes!) came around the corner but I expect they were just making sure everything was peaceful, it didn't seem like they were going to broom the young ladies. But don't hold me to that.

Update:  I looked it up. Prostitution is legal in licensed brothels. Street prostitution is confined to designated areas only. I am guessing that the young ladies I saw were actually the equivalent of carnival barkers for one or more indoor establishments on the block. They were there to advertise the business and invite customers inside, which is why everybody took them for granted. Maybe somebody who knows the city can confirm whether this is a plausible interpretation.

I asked somebody why there are so many hairdressers and he was nonplussed. It had never occurred to him that this is abnormal. I've mentioned it to my fellow American visitors and they confirm, I'm not crazy, they noticed it too. I should probably get a haircut before I leave, just to check it out, but . .. see below.

So yes, this is definitely a nice place to visit but save up for it. In case you think the Yankee dollar has clout, get over it. Swiss francs are very dear in dollars. A haircut would set me back 40 bucks. I just blew seventy bucks on two drinks and a cheese plate. But the cheese was good. And yes, it had holes in it.

Swiss movement

Well, it's been a bit difficult getting this post out. First of all, it's in italics because for some mysterious reason blogger in Helvetia insists on displaying postss this way. (Atrios looks like this here as well.) (Okay, it's only in italics in the editing pane.) The hotel wifi doesn't work with my computer so I'm using the hotel guest computer which has a German keyboard. They don't use the letter Y, or the apostrophe, so they''re in weird places, along with some other peculiarities. It was a real struggle signing into this account as well, because blogger doesn't like me being in such a weird location. Among other problems, including terminal jet lag.

Anyway -- more about the conference later. But, a bit about Basel. There is far less automobile traffic here than any large U.S. city. The streets are not congested at all. Pedestrians can pretty much cross at will, there's unlikely to be a car coming and there are hardly any stoplights. Why is this? First, the city is completely knitted together by a dense network of street cars -- electric trolleys similar to Boson's Green Line, if you happen to be familiar with that, but going absolutely everywhere. At just about any block, you can get on anywhere from 2 to 5 different trolleys, that come every 2 to 6 minutes, going just about anywhere.

Second, there are more bicycles on the streets than there are cars, and at least as many scooters as cars. Such cars as there are are small. I have yet to see an SUV, a pickup truck, or a hummer. There are bicycle racks everywhere. Why can't Americans be half this smart?

Yes, the city is older than American cities and it has a lot of very old buildings. That doesn't always mean charming, some of the old stuff is drab and even run down -- the city isn't richer than New York, but on the other hand it's more egalitarian, as far as I can tell. The charming and elegant are all mixed together with the ordinary, but on the whole, it's pleasant to contemplate. There are two or three bars on every block downtown here near the Rhine, and also, for some bizarre reason, two or three hairdressers. The people don't seem particularly well coiffed, but they definitely have the opportunity. I can't explain that. They don't eat vegetables here, as far as I can tell. Cured meats, potatoes, a bit of fish, and pizza. That seems to be the diet. Also beer.,

Contrary to what you have been told, they don't all speak English. In fact, even the waiters in the hotel restaurants don't necessarily speak more than a few words. The language here is German, but the look is multi-ethnic. There are lots of black people and women in hijabs yacking away in Deutsch. So that may upset some of your mental pictures. On the other hand, everybody '-- well, not everybody, but a lot of the young men, smoke. They recently banned smoking in restaurants and bars, but a lot of the bars have banded together into a kind of civil disobedience association. We'll see how that plays out.

The river is of course long-since canalized, but it very much has that old world charm. It is lined solidly with lovekly old restaurants and hotels, taking advantage of the setting for outdoor dining and cafe sitting. The weather this time of year is paradisical. Generally, there's no AC, which is not a problem right now but I have to wonder about the future.

If I spoke the language, I could get a much less superficial view, but that,s about what I can see as an ignorant tourist. Something about the conference will come later.

A new peril for travelers

I'm off to Switzerland in a short while. (I just hope the constant yodeling and playing of giant wooden trumpets doesn't keep me up at night.)

The bad news is I have to change planes at Heathrow, and it turns out the British police, if they are so inclined, can at a whim, for no stated reason and indeed for no reason at all, hold me incommunicado for 9 hours and confiscate all my electronic equipment.

Back at the height of the Iraq war, when I was writing the Today in Iraq blog, I was marked for extra security screening. (True!) Every time I flew they'd take me aside and hand search my luggage. That seems to have stopped now but I haven't been abroad for a few years. Last time, coming back from Mexico, I got the full shakedown. So we'll see.

It turns out that once you're on the list, it's very hard to get off. Unfortunately, Harper's hasn't made the article available to non-subscribers, but there is a chilling tale this month by the writer William T. Vollman (link leads to the paywall, sorry), who discovered via FOIA that he has been on a watch list for decades in large part because he was suspected of being the Unabomber. The reason for the suspicion is that some of his novels seem to take the part of native peoples against the European invasion. True! Once the Unabomber was captured, he obviously was no longer under suspicion of that, but it didn't matter! He got detained and grilled for hours every time he crossed an international border.

The really ugly secret about the immense, secret national security establishment is that it is utterly inept. They're spending hundreds of billions of dollars of your money to pay idiots to violate your civil rights and your privacy for no good purpose whatsoever. The point of keeping it all a secret is that it gives them more secrets to keep, which is what they do. It's an end in itself.

Missing the obvious

A couple of nights back John Oliver had Rand Paul on the show. The good doctor seemed oh so calm and reasonable. He too, wants everybody to get health care and for it to be more affordable. But Obamacare isn't the way to achieve that.

No, the way to achieve universal, affordable health care is to make the patients pay for it. Dr. Paul has observed that procedures that aren't generally covered by insurance, such as laser vision correction, have come down in price. So if we just make everybody pay for everything, it will all get cheap, and we can all afford it!

Now, I could explain why this is complete bullshit, but I'm tired of doing that. The biggest challenge of blogging is that you keep writing the same post, over and over. So instead I'll just ask, WTF is wrong with John Oliver?

Having grown up in the land of the bowler and bumbershoot, Oliver presumably noticed some surprising facts about his surroundings:

1) Nobody has to pay one penny for health care, ever. (Some well-off people do pay for extra stuff they happen to want. That's allowed! Libertarian paradise!)

2) It costs half as much as it does in the U.S.

3) Everybody gets it, not a problem.

4) The people live longer, and they are healthier, than they are in the United States.

Now, one could go to the trouble of explaining this, but failing that, one could simply point it out. Nahh, not worth it. It's not a joke.

A reluctant, sad judgment on PZ Myers

As many people who may read this no doubt already know, there has lately been a raging controversy within the organized skeptical/atheist/secular humanist community -- whatever you want to call it -- about rampant sexism among leadership and misbehavior by loutish male conference-goers. I subscribe to Free Inquiry,  the publication of the Center for Inquiry which is among the accused institutions. I have long followed the Pharyngula blog of PZ Myers, who has championed the aggrieved women in this brouhaha.

That's as close as I get to the movement -- I'm a practitioner of rationalism and an avowed atheist, but I'm not an activist. So I don't have any firsthand knowledge about this. I must say however, that the torrents of crude, sexist and misogynist comments that appear on blog posts about this issue seem to powerfully vindicate the complainants.

Now, however, PZ has, in my view, screwed up. Rather than link to his original post, which may or may not stay up much longer anyway, I'll send you to this post by Jack Vance which summarizes the story and links out to further news and discussion. Briefly, PZ says he received communication from a woman who wishes to remain anonymous claiming that celebrity skeptic Michael Shermer got her drunk and raped her at a conference. He reprinted some of her allegations along with her assertion that she knows other women who have had similar experiences.

The Pharyngula commenters overwhelming back Myers -- there really isn't much of a discussion going on over there. Shermer, not surprisingly, has had his lawyer write a sternly worded letter demanding the post be taken down and seeming to imply further legal action. PZ Myers has largely kept silent on the matter since his original post, other than some cryptic remarks. Not that anybody is likely to care, but here's my take on this matter.

First of all, PZ already doesn't much like Shermer, who has has made some unseemly remarks of his own about the "feminism in skepticism" cause. I haven't thought all that much of Shermer as a skeptic since he started making claims to the effect that science proves the ideology of economic libertarianism to be correct. But not liking somebody is an excellent reason not to make yourself the instrument of questionable vengeance. So when in doubt, that should give you a presumption.

In this particular case, I don't think there's much doubt. The problem is that the accuser is anonymous, and refuses to specify even the time or place. The remaining accusations are pure hearsay, coming from the same anonymous accuser. Therefore, it is impossible for Shermer to defend himself. Anybody, anywhere, anytime, could completely fabricate such an accusation and post it on the Internet. While I trust PZ Myers and he says he trusts the accuser, that's obviously not good enough, because you might not happen to agree. PZ should not have done it.

Off to the land of Holey Cheese

As I have mentioned before, next week I will be in Basel for the international environmental health conference, sponsored by the International Society of Environmental Epidemiology ISEE, International Society of Exposure Sciences ISES, and International Society of Indoor Air Quality ISIAQ.

I will be presenting on Thursday, one of several presentations and posters coming out of the Community Assessment of Freeway Exposure and Health (CAFEH) study (Doug Brugge, PI). This is a "big science" community based participatory research project funded by the National Institute of Environmental Health Sciences. The study included detailed assessment of air quality near I-93 in Boston and Somerville, and in comparison urban areas, using a mobile laboratory, to create a detailed model of exposure for individual locations; a survey of residents in the study area; and collection of actual biological information including blood samples from a sub-set of survey respondents.

My piece is a social science sub-study of risk perception. We asked people how concerned they were about air pollution in their neighborhood, and about pollution specifically from the highway; and whether they supported more or less government action to control pollution. We gave them various psychological and attitudinal scales that have been though to be related to risk perception, and we have a lot of other information about them including demographics, education, and even how much physical activity they engage in, smoking history, and you name it.

I'm basically supposed to wait till the conference presentation before I spill the beans on the results, but I will say a couple of things about the context. First of all, in case you didn't know it, living near a major highway or otherwise spending time near one is very bad for you. The principal danger is ultra-fine particle pollution -- unburned hydrocarbons come out of the tail pipes and condense, essentially forming hydrocarbon steam. The most numerous particles are extremely small -- much smaller in diameter than a human hair. If you breathe these in, they go right through your lungs into your bloodstream, and they can enter cells. They cause general inflammation, seem to contribute to atherosclerosis, and are an acute risk factor for myocardial infarction as well as chronic vascular disease.

And guess who lives near the highway? Disproportionately, low income and non-white people. It's a favorite place to build public housing projects, as a matter of fact, but private housing is obviously cheap there too. And this basic fact has been underappreciated, I think, in previous studies of risk perception. More in due course.

Any friends in Helvetia who want to do lunch or something, you have my e-mail.

The ability to think is not a requirement

to enter the journalistic profession.

Headline: Near-death experiences aren't figment of imagination, study shows

Actual study: Rats' brains remain active after cardiac arrest.

This doesn't actually "show" anything about near death experiences, but it is consistent with what we already know: Near-death experiences are a figment of imagination.

Apparently there's an intelligence test, and if you pass it, they won't hire you at CBS news.

True Crime

The good people of Boston are experiencing a surfeit of big time crime stories, from the historical -- the Bulger trial and definitive identification of the Boston strangler -- to the immediate -- the Marathon bombing, the murderous Patriots tight end, and now a young woman who came to the city to make her fortune and was brutally murdered by a wacko who had been serially attacking women in South Boston over the recent week. The cops could have brought him in, too, but the detective assigned to the case dropped the ball. (The police commissioner, who says "lawr enfawcement," busted him back to flatfoot.)

Lurid crime stories pretty much dominate my memory of local news in my 25 years living in that town. One of the earliest was a 15 year old kid who murdered a neighbor woman, about his mother's age, for no particular reason. Back in 1989, a young woman was murdered after a birthing class at Brigham and Women's Hospital and her husband told the cops a drug-crazed negro did it. The police jacked up ever young black man in Mission Hill. They even arrested one of them and publicly announced that they had their man. Then it more or less accidentally came out that the husband did it himself. He jumped off the Tobin Bridge.

Then we had John Salvi, who shot up two abortion clinics in Brookline; a guy in the leafy suburb of Newton who murdered his wife and two children in the marital bed and then fled to England (not sure why that one got the OJ treatment from the media, but it did); a couple of young girls who were killed in gang crossfire, a couple of workplace mass murders, the sexually motivated murder of a ten year old boy that led, briefly, to restoration of the death penalty in Massachusetts until the boy's father changed his mind and came out against it (really, that one man's original wishes, followed by his change of heart, was dispositive in swaying the legislature); and of course the pedophile priests. I could go on and on. The point is that my memories of all this are more vivid, and detailed, than my memories of public policy disputes or elections, even though I was a political activist most of the time, and for a while a professional social policy analyst. They are even more vivid and detailed than my memories of my own life (such as it was).

My point is that the narrative of community life stitched together by the news media, and particularly television with its evocative and memorable images, is dominated by crime news. To be sure, although only a small percentage of people are directly affected by serious crime, it's a public responsibility of journalists to document it, and also to make the criminal justice system transparent. But they don't do either very well -- they are not consistent in their decisions about what to make into a big story, they do a terrible job of holding police and prosecutors accountable, and they don't put all this in its proper place or context.

I would prefer to have a somewhat different headful of memories from my years in that town.

The Olympics Problem

Sorry for not posting yesterday, insanely busy. (I don't know how academics like PZ Myers and Brad DeLong do it every day.) Anyhow . . .

I am going to speak about a current difficult issue from the sagacious perspective of advanced age. Yes, V. Putin's new anti-gay law is a putrid, stinking excrescence. It is deeply galling to think that the winter Olympics will happen in Russia in a few months and give Czar Vladimir a chance to strut around on the world stage. Equally galling has been the tepid response of the IOC and for that matter the USOC, and yes, we do have to worry about participating athletes who might run afoul of the law and also any gay athletes who may feel threatened or forced to deny who they are for the duration.

However, a boycott of the Sochi games would be, in my view, a really bad idea. Jimmy Carter boycotted the 1980 Moscow Olympics to protest the Soviet invasion of Afghanistan, and here's what happened. Only a few countries went along, so the games happened anyway. Athletes who had spent the entirety of their young lives preparing for their single chance lost it. Americans were deprived of a spectacle many people look forward to -- the boycott was unpopular with the public and cost Carter politically. The Russians stayed in Afghanistan, if anything they dug in deeper. And the Soviet bloc turned around and boycotted the next Olympic games in the U.S.

Positive accomplishments? Zero. And we'd have exactly the same result this time.

Obviously, the IOC, USOC, and U.S. State Department have to make it absolutely clear that the law will not be enforced in Sochi for the duration of the time that international visitors are there for the games -- and that's at least a week before and after the opening and closing ceremonies. If the Russians can't make, and keep, that commitment, we can specify diplomatic and economic consequences.

Next, the Obama administration has to move this higher on its list of beefs with Czar Vlad. They should stop giving a fecal bolus about Mr. Snowden, which I know is not going to happen, but at least they can elevate this to the same level. It's not about meddling in Russia's internal affairs -- we can't do business in Russia under the circumstances, just as if they discriminated against African American businesspeople or diplomats. Putin needs to understand that we can't have a normal relationship under the circumstances.

But the Olympics are not the right lever to pull. IMHO.

The Republican Party

I recently commented (elsewhere) that the Republican party is a Ménage à trois among racists, plutocrats and religious fanatics. On reflection, I left out an element, which is hard to define, or at least to name.

Let's call it ultra-nationalist anarchism. This overlaps to a considerable extent with the racists and religious fanatics, but it has a distinct -- and distinctly American -- flavor.

These are people who on the one hand consider themselves the only True Patriots, and who hold the idea of the United States in quasi-religious awe. They believe that the United States should dominate the planet and that it enjoys moral exceptionalism; that the U.S. is not bound by the norms and expectations of international behavior that apply to other nations, and that to criticize the U.S. for actions which U.S. officials routinely condemn in other nations is treasonous "moral relativism." They glorify the military and are cheerleaders for U.S. military action whenever some global actor annoys us.

On the other hand, they view government as inherently oppressive and the federal government in particular as fundamentally illegitimate. They have an unexamined assumption that government is the only entity that can constrain their freedom, apparently unaware of the ocean of private coercion in which they swim. The subculture of firearm worship is an essential component of this philosophy. With a gun, a man makes himself free, protects his own interest, without having to rely on the oppressive state.

I need hardly point out the multiple intersecting and cross-cutting contradictions in this world view. Its historical roots are evident in the bitter defeat of Southern slave culture and white racial resentment generally, the anarchistic conditions of the frontier and the continuing urban/rural divide, and Christian dominionism which delegitimizes the secular state. But it is a very dangerous combination because it includes all of the ingredients of fascism. 

The plutocrats, of course, merely exploit it to convince people to vote against their own interests. But that so many of them are willing to do so today is very worrisome.

A couple of drive-by insights from the Global Burden of Disease

The GBD is a project of the World Health Organization, started in 1991. It's a massive effort to put together comparable morbidity and mortality statistics for all the nations of the world. The numbers are more reliable in some places than in others, and have all sorts of conceptual and systematic weaknesses, but they're the best we've got and they do tell us quite a lot that's interesting and important.

http://www.nejm.org/doi/full/10.1056/NEJMra1201534, review the changes in the U.S. and the world from 1990 to 2010. It's a complicated story, which they perhaps could have made more clear than they do in some ways. Read it if you're interested in understanding what's going on with the good ole human population, but I'll pick out a couple of noteworthy points.

They use a metric called Disability Adjusted Life Years, which is an attempt to measure loss of functionality and death in a common currency. You may or may not think that's morally correct, or even possible, but people who study public health think that something like it is necessary in order to compare the harm caused by various diseases or risk factors, and the value of competing investments in treatment or prevention. (I have covered this concept in the past.)  They make it a bit confusing by using the term DALY to mean its opposite, that is DALYs lost -- the sum of premature deaths and years spent living with disability. As far as I know this is not conventional, and they don't explain it. That seems to be an editorial oversight. But anyway . . .

Ranked by DALYs, the most costly disease in the U.S. is ischemic heart disease, which also happens to be the leading cause of death. The second leading cause of death, stroke, is number 7 on the DALY list. Since these are in considerable part manifestations of the same underlying disease, atherosclerosis, that's pretty impressive. Cancer of the respiratory tract is number 4 on the DALY list and number 3 on causes of death. That is mostly caused by smoking, which also contributes heavily to heart disease and stroke. So the major fact that we could have an enormous public health impact by getting tobacco out of our lives hasn't changed.

Something new is that dementia is now listed as the 4th leading cause of death, and its 12 on the DALY list. That's not exactly because we're having an epidemic of dementia, obviously, it's because we're living longer. Right now, there's exactly nothing we can do about it.

Globally, ischemic heart disease is now number 1 on the DALY list, and that's a measure of how deaths from infectious disease have fallen globally while life spans have increased, even in the poor countries. (Lower respiratory tract infections were number 1 in 1990, and heart disease was number 4.) This is true in spite of the HIV epidemic, and it's largely due to a decline in deaths of children from diarrhea. That's actually something of a global success story.

Compared to the rest of the world, we're much more likely to die from dementia -- because we live a long time and don't die from other stuff -- but also from lung cancer, because the tobacco epidemic started here. (Don't worry, the world is catching up.) So, obesity and physical activity are indeed major challenges, but tobacco is still with us. Now is not the time to stop fighting it.