Map of life expectancy at birth from Global Education Project.

Friday, January 18, 2013

People is puzzling


The news is dominated today by the chemically enhanced cyclist and the linebacker with the imaginarily dead imaginary girlfriend. Both stories have a certain amount of intrinsic weirdness but it got me to thinking that all the world over, people are obsessed with sports. The popularity of particular games is as definitive of cultures as religion and cuisine; and the civic unity of cities and nations is as much about sporting teams and iconic athletes as it is about political institutions and nationalist mythology.

I don't have any deep explanation of this. It's like music -- nobody really knows why we like it so much or what it really means. I'm as much a fan as anybody, looking forward to the AFC championship game on Sunday even knowing the awful truth about what it's doing to my heroes' cerebrums. Oh well.

Thursday, January 17, 2013

American Exceptionalism


All this is old, old news to readers of this blog, but we might as well keep chopping away. The National Academies of Science commissioned yet another panel on the health of the U.S. population compared to civilized countries, and they reach the same depressing conclusion: we're not the Greatest Country on Earth; God doesn't bless America; we aren't a Shining City on the Hill; we aren't Number One. We are the uttermost piece of crap. E.g.

  • For many years, Americans have had a shorter life expectancy than people in almost all of the peer countries. For example, as of 2007, U.S. males lived 3.7 fewer years than Swiss males and U.S. females lived 5.2 fewer years than Japanese females.
  • For the past three decades, this difference in life expectancy has been growing, especially among women.
  • The health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.

    The wise people don't know exactly why, or they kind of do but they're coy about it. We have much more gun violence, we die more in car crashes mostly because we drive more, we have more people who are depressed and addicted and oh yeah -- lots of people don't have access to health care and the health care they do get isn't as good even though it costs 2 or 3 times as much.

    A funny thing happens when we turn 65 though -- the life expectancy gap stars to shrink and it goes away by age 75. What else happens at age 65? Oh yeah -- you get, for the first time, universal, comprehensive, single payer national health care.

    By the way -- it's also a lot cheaper. Even though it's better.

Monday, January 14, 2013

Aaron Swartz


I've written before about open access, perhaps to a degree obsessively, and I try not to repeat myself too much here (which is getting difficult as the years go on, to be sure). But I do have to take this occasion to once again say how very important is this issue, how very fundamental to what ought to be the ethic of science.

Some readers may be fully involved in this issue, may completely understand what was at stake for this young man who took his own life this weekend, and why he did the deed that had MIT and the U.S. attorney pursuing him like the furies, trying to destroy his life and career by imprisoning him for 35 years. Here's his manifesto.

In my own words, subscriptions to scientific journals cost hundreds of dollars a year -- or more. In fact, the library at my own elite Ivy League university has cancelled many of them recently because we can't afford it. Nevertheless, we still have thousands of journal subscriptions and I get to read them all because I have the magical powers of a college professor in a wealthy country at a wealthy university. You, however -- be you the common rabble in our wealthy country, or an academic department chair in Kenya or the Dominican Republic, do not get to read them. Most of the research that they publish was paid for by taxpayers, but it does not belong to the taxpayers. It belongs to people who own for-profit academic publishing companies, that in turn sell it -- for their own profit -- only to those institutions that can afford the exorbitant prices their monopoly power enables them to charge.

This is wrong. Scientific knowledge is the common property of humanity. The right way to do this is to include the cost of publication in the original grant that funds the research. That's how the Public Library of Science, BMJ Open Access, Dove Press, Biomed Central, and other completely legitimate open access scientific publishers work. Yes, we pay them to publish our stuff, but they still have rigorous peer review and high editorial standards -- higher, in fact, than the subscription model publishers in many cases. The reason for that is obvious: they have to spend the money on editorial costs instead of lining their owners' pockets; they have to compete for the best research because the people who do that excellent research are paying for publication; and they have to prove their quality and integrity every day. Best of all, everybody in the world with an Internet connection can read the work.

Mr. Swartz downloaded thousands of copyrighted academic publications from an archive called JStor. But he didn't try to sell them, he just tried to make a point. Knowledge belongs to humanity. For this, the U.S. Attorney and the Massachusetts Institute of Technology hounded him to death. Rapists and murderers don't get 35 years.

Update:  In response to an anonymous commenter, I should also add that I, like almost all researchers, freely share my own work with anyone who asks for it. You can go to my academic web page, see my publications, and if you send me an e-mail, you'll get the PDF. That's just one more thing that's ridiculous about this entire issue.

Thursday, January 10, 2013

What Bernie Says


Right here. It's been hard for me to post lately because it feels like biting granite. Our political debates are all completely phony, and the corporate media are making us all live in that phony world. For whatever reason (and I'm not going to get into the Obama mental telepathy game that so many people like to play) the president is not puncturing the fake scenery, he's playing right along.

Yes, we have a spending problem. Specifically, the more than $700 billion a year we're spending on the military, which is more than we spend on Medicare.

Yes, we have a tax problem. Specifically, as Bernie says, federal revenue is a lower percentage of GDP today than it was 60 years ago, and it's somewhere around half of what the rest of the wealthy countries raise -- you know, totalitarian dungeons like Canada and Sweden. We have the most unequal distribution of wealth and income of any developed country, and in fact we're back to where we were in the Gilded Age, just before the Great Depression.

No, privatizing everything and turning it over to profit-making corporations doesn't make it efficient, competition doesn't make the consumer sovereign, and it doesn't make us freer. As Eduardo Porter convincingly demonstrates, in the case of health care it leaves us ripped off, ill served, and unhealthy. You know what does work really well? Universal, comprehensive, single payer national health care. Ask any country where they spend half of what we do, and have healthier people.

Right now, we don't have a deficit problem, we have a problem of insufficient aggregate demand, which means we have a lot of unemployed people. We need to spend money to put them to work. Then, if we want to eliminate the federal deficit long term (not that we particularly need to do that), all we need to do pay taxes the way we did under Ronald Reagan, eliminate the cap on social security taxes, and create a Medicare for All system that is funded by the money people are paying in health insurance premiums now, that pays for results, and not for doing unnecessary, useless and harmful procedures.

If we want to be affluent in 2025, we need to spend money on good quality education and universal access to vocational training and higher education, for everybody; renewable energy, mass transit, a smart electrical grid, and energy efficiency and conservation; and scientific research and development; and less money on the military.

Who the hell is talking about this -- what we absolutely must do. Not Barack Obama, that's for sure.

Tuesday, January 08, 2013

Money money money


I presume y'all have encountered the tidal wave of blather about the trillion dollar platinum coin. Paul Krugman is for it, in case you need an intro, so it can't be all bad. Most people are having a very hard time grasping this concept, and it I guess it does seem kind of ridiculous. But that's because most people don't know what money is.

It's fairy dust. It's fiction. It's purely symbolic. And that is true, by the way, whether it's made out of gold, or paper, or nothing. The proof? There's a society that already uses money which, like the trillion dollar platinum coin, never leaves the vault. The people of Yap, a real fantasy island, have two-ton rocks, mined from a distant island, which are money. But they never move. They just change ownership. One of them, in fact, lies at the bottom of the ocean, due to a transportation accident, but it still counts. Somebody owns it, and they are accordingly affluent.

The little pieces of paper with dead presidents are just an accounting convenience, as you have learned since you started paying for everything with a credit card. In fact, if you didn't have your wallet on you, or you were between paychecks, in the old days you might write an IOU to your friend or your grocer. Guess what? You printed money, just as surely as the government does. That's all money is -- a symbol.

One of the enduring, and mysterious quirks of conservative ideology is that they just can't grasp this idea. It offends something deep in their psyche, that money isn't actually worth anything but a promise. They somehow believe that gold and silver have "real" value and therefore should be money. But think about it for a second: the value of all the stuff that people buy and sell, all the debt they owe, is far more than the ostensible value of all the gold and silver in the world. All money is backed by real assets, it just doesn't happen to be gold. If I can buy a car or a house or lunch with a sum of money, the sum of money is worth that much, identically as it's worth whatever amount of gold it can buy. There is no difference.

Once Ron Paul gets his tiny brain around that idea, the rest of his nonsensical worldview will melt away like the snows of March.

Monday, January 07, 2013

Ozymandias


That is the famous poem by Shelley, of course. I thought of it when I read this essay by Bill McKibben, which has been reposted just about everywhere in a coordinated cyber-bomb. So if you haven't come across it yet, go check it out.

Now you're back. Let me tell you why neither Barack Obama or anybody else in power is doing anything meaningful about the existential threat facing our civilization. I have a writer friend who got an assignment from Harper's to write about climate change as a kind of eschatology. He kept asking me what it was like to live in the End Times and he got a little bit miffed when I wouldn't buy into the concept. It's not the end times. Civilizations come and go. The world goes on. So far, as a matter of fact, so has Homo sapiens. The collapse of classical Greece, the Roman Empire, feudal Europe and the Kingdom of Ouagadougou haven't even slowed us down.

Industrial civilization is built on fossil fuel, just as Mesopotamia was built on its irrigation system and the Holy Roman Empire on the Catholic religion and steel swords, spears and armor. If some scientist had come along and told them those bases for their civilizations were doomed, and they just had to try something else, what do you think would have happened? I don't know about Mesopotamia, but in Europe, you got burned at the stake.

To say that we have to give up fossil fuel is to say that our civilization must go the way of Ozymandias. It's just not clear to me that it can happen until it all comes crashing down. We are Homo petroleus. Eventually, we won't be any more. The times will be very trying, filled with catastrophe and pain. Then we'll be something else.

Thursday, January 03, 2013

Another of those competing liberty things . . .


For what are to me quite mysterious reasons, every year we have these whoop dee doos about health care workers refusing to get flu shots. This particular nurse -- who got fired from a long-time hospital job -- claims it's for "religious" reasons but apparently, at least from what her lawyer seems to be saying, the only religion in question is that it's her religion not to get the flu vaccine. Beyond that, she offers no explanation for her refusal.

Okay. I may get some pushback on this but here's the whole story as far as I'm concerned. Yes, the flu pandemic hoax of three years ago had me foaming at the mouth, and particularly got me up in the face of Daily Kos's Greg Dworkin. Influenza is not, in fact, all that big of a public health issue. Most of the 36,000 people or so in the U.S. who are are officially tagged as dying of flu are already debilitated and it just finishes them off. There is a much smaller number of unlucky folks whose lives are definitely cut short by it, including some children, but it's a far smaller number than are killed from car crashes, or even homicide. Most of the so-called Flu Like Illnesses (FLIs) that people get aren't flu at all, they're other viruses. Also, the flu vaccine isn't as effective as it's been touted to be, maybe about 60% effective, i.e. you can still get the flu even if you've been vaccinated.

All true. On the other hand . . .

The risk of any serious complications from flu vaccine is as close to zero as it can possibly be. It may even be zero. Possibly there is a 1 in a million risk of Guillan-Barre syndrome, or possibly there isn't. Virus for flu vaccines is grown in eggs, so people with allergies used to have a problem, but now there is egg free vaccine. So the worst you can get is a sore arm. Getting the vaccine benefits you personally, because it might let you avoid a case of the flu or have a more mild one if you do get it. That's not all . . .

It benefits everybody else, particularly people who are immunocompromised, pregnant women, and old folks, who are at high risk for flu complications, because by weakening the chain of transmission, it helps prevent other people from being exposed. (That's called "herd immunity," and maybe you don't like that term as applied to people but it's accurate.) So . . .

Obviously there's a basic interest in not forcing people to do what they want, in general, but if you work for a hospital you are obliged to act in the interest of the patients. You aren't allowed to smoke in the workplace, you aren't allowed to come to work while you're sick and know you are contagious, you aren't allowed to slack off and not pay attention to your duties, you may be required to do regular tests to establish that you retain the skills to do your job, you may have to get certain physical examinations -- as pilots and school bus drivers, for example, must do. Flu may not be the biggest problem in the world but it's a big problem for somebody who is already sick and in the hospital. So, if the administrators of the hospital require you to get a flu shot, they are well within their rights. Refusal is irrational, irresponsible, and nonsensical.

I feel no sympathy for this woman whatsoever. Zip. Zilch. Zero. Fire away.

Wednesday, January 02, 2013

Pleasingly Plump


Sorry for the long hiatus, I was distracted by a (very wonderful) personal matter. It turns out blogging isn't necessarily the most important thing in the world after all.

Anyway, despite the new year and all the ongoing political sturm und drang, I'm going to re-enter the blogosphere with a conventional Stayin' Alive post. Flegal and colleagues in the new JAMA present a very careful meta-analysis of studies linking body mass index with mortality. Their findings confirm what has been the general trend in observations over recent years: the categories of overweight and obesity set by NIH consensus panels may define healthy weight a little too stringently. People in the current "overweight" category (BMI between 25 and 29) actually seem to have slightly lower all-cause mortality than people of ostensibly "normal" weight, and people in the lowest category of "obesity" (BMI 30-34) do not appear to have higher mortality rates. Above that, however, obesity is most definitely associated with sharply higher risk of mortality.

But . . .

It's complicated. Underweight individuals have elevated mortality, probably mostly because the reason they are underweight is that they are already sick. Mildly overweight people may have good cardiovascular fitness and good muscle mass, or not: being both overweight and unfit is probably bad. Also, staying svelte in youth is probably a good omen for your later years. People tend to gain weight with age, but very few young people die, so when we're talking about mortality risk, we're talking about older folks who are naturally a little bit more zaftig than their younger selves.

Anyway, the point of all this is, if I were a real doctor, I'd tell you to pay more attention to being physically active and fit, and eating a well-balanced diet, than whether you're five pounds overweight by the standard measure. However, if you're much more overweight than that, you should try to trim down. And how can you do that?

Well, this one is abstract only for the rabble, but: the high fructose corn syrup and table sugar thing is probably real. It turns out that fructose -- of which there are similar amounts in both of the above-named products -- is the worst form of calories. Not only does it have a high glycemic index, it doesn't satisfy hunger, in fact it appears to make you hungrier. That's the crap in soda and supermarket sweets and the sugar bowl on your table. It's increasing prevalence in the American diet may have a lot to do with the obesity epidemic. Do not eat it! Have a piece of fruit.

Back to a normal schedule now, I hope.

Wednesday, December 26, 2012

Riiiiiiggghht!


As Noah says to the Lord in the famous Bill Cosby routine. As I may have mentioned before, I'm a lifelong -- well, since age 13 -- subscriber to Scientific American, which is probably why I'm such a know-it-all, even though they've been assiduously dumbing it down for the past few years.

Anyhow . . .

Michael Dettinger and Lynn Ingram this month tell us that once every couple of hundred years, California has been visited by the real, diluvean deal. Starting on Christmas eve in 1861 it rained not for 40 days and 40 nights, but for 43, after which the Central Valley was "an inland sea 300 miles long and 20 miles wide." Sacramento was 10 feet under. It took 6 months for the water to drain.

The most incredible fact about all that is that I had never heard of it before. Cal was relatively sparsely populated at that time, nevertheless thousands of people died. If that were to happen today . . .

Guess what. It will. They've been able to trace the record of such events in the sediment going back to 1150 or so, and they have convincing evidence of 5 of them. It turns out that great rivers of water vapor form in the atmosphere and west coasts generally are vulnerable to these events. And of course you know the kicker . . .

Global climate change should make them more frequent, by increasing the amount of water vapor in the atmosphere. If you thought Katrina and Sandy were exciting, well now. Words fail. A simulation of a lesser event -- only 23 days of rain -- found that 1.5 million people might need to be evacuated, with total economic costs of $700 billion. Given that nobody's getting 1.5 million people to high ground very quickly, again, well now. You figure it out.

That's why I'm not making any predictions for the New Year. Shit will happen.

Monday, December 24, 2012

Merry Christmas


Really. I believe I posted many moons ago about Richard Dawkins's idea to make "Atheists for Jesus" T-shirts.

I was just talking to a friend yesterday about the ascendancy of I-got-mineism in our politics, and the delusions that come with it -- that everything you have you deserve, nobody and nothing outside of yourself contributed to your deserved fortune, and every penny you pay in taxes is stolen to give to lazy parasites. That's not so weird in itself, but the alliance of this philosophy with the predominant form of Christianity in the U.S. is pretty strange.

My uncle was a preacher -- the pastor of Trinity Church on the Green in Branford, Ct, which is a national historical landmark. My mother was a Sunday school teacher. I got several perfect attendance medals for Sunday school, and I was talking about getting confirmed when I got old enough to figure out for myself that religion is bunk, i.e. thirteen years old.

But, the Christianity they taught me was the exact opposite of Rich Warren and Pat Robertson and Franklin Graham. They claim to interpret the Bible literally, and live by it. So how do they interpret this?

Matthew 25:31

31 “When the Son of Man comes in his glory, and all the angels with him, he will sit on his glorious throne. 32 All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. 33 He will put the sheep on his right and the goats on his left.
34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’
40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’
41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’
44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’
45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’
46 “Then they will go away to eternal punishment, but the righteous to eternal life.”

Or this?



Mark 12

13 Later they sent some of the Pharisees and Herodians to Jesus to catch him in his words. 14 They came to him and said, “Teacher, we know that you are a man of integrity. You aren’t swayed by others, because you pay no attention to who they are; but you teach the way of God in accordance with the truth. Is it right to pay the imperial tax[b] to Caesar or not? 15 Should we pay or shouldn’t we?”
But Jesus knew their hypocrisy. “Why are you trying to trap me?” he asked. “Bring me a denarius and let me look at it.” 16 They brought the coin, and he asked them, “Whose image is this? And whose inscription?”
“Caesar’s,” they replied.
17 Then Jesus said to them, “Give back to Caesar what is Caesar’s and to God what is God’s.”
And they were amazed at him.

Or this:

Matthew 19

16 Just then a man came up to Jesus and asked, “Teacher, what good thing must I do to get eternal life?”
17 “Why do you ask me about what is good?” Jesus replied. “There is only One who is good. If you want to enter life, keep the commandments.”
18 “Which ones?” he inquired.
Jesus replied, “‘You shall not murder, you shall not commit adultery, you shall not steal, you shall not give false testimony, 19 honor your father and mother,’[c] and ‘love your neighbor as yourself.’[d]”
20 “All these I have kept,” the young man said. “What do I still lack?”
21 Jesus answered, “If you want to be perfect, go, sell your possessions and give to the poor, and you will have treasure in heaven. Then come, follow me.”
22 When the young man heard this, he went away sad, because he had great wealth.
23 Then Jesus said to his disciples, “Truly I tell you, it is hard for someone who is rich to enter the kingdom of heaven. 24 Again I tell you, it is easier for a camel to go through the eye of a needle than for someone who is rich to enter the kingdom of God.”

Now, I know that the scammers have all sorts of arguments as to why these passages don't actually mean what they appear to mean. But why don't we ever hear from other Christians who do believe in the words attributed to Jesus in the Gospels? Why do they cower under the pews? Just askin'. 



Thursday, December 20, 2012

Not all massacres are alike


Via Balloon Juice, I came across this essay by Mark Ames, who apparently is something of an expert on rampage murder. His main focus in the linked piece is on the NRA, and I recommend it for that reason.  Basically, he argues that by being batshit crazy, the NRA actually insures intense loyalty and passion on the part of its members, because it reinforces their tribalism and paranoia.

That's worth thinking about, but the point I want to make for this post is that the Newtown tragedy was not typical, in that the perpetrator had no evident connection to his targets. I have mentioned previously the socially isolated men who shoot up their workplaces when they are in one way or another robbed of their only source of dignity through their employment. The kids who attack their own schools also typically, in one way or another, feel humiliated or socially excluded.

Now we find the question of access to mental health services entering prominently into the post-Newtown debate. I'm afraid that while I agree we have problems with mental health services, that's largely an irrelevant distraction. The typical workplace or school shooter would not have contemplated getting mental health services. Workplace shooters often erupt after being fired, or disciplined, or having a conflict with their supervisors. There is seldom any indication in advance that they ought to get mental health treatment, and even if somebody thinks there is, there's no way to make them do it. Similarly, the school shooters are generally entirely unpredictable.

Now, it just so happens that Jared Loughner and James Holmes were recognized in advance as having serious mental illness, in both cases as it happens by school authorities. And their respective institutions reacted by expelling them and washing their hands of the matter. Loughner already has an official diagnosis of schizophrenia and obviously, Holmes will get one too. The Newtown shooter was also manifestly somehow wrong in the head, although we'll never get to slap a specific label on him. It's this run of bad luck which has apparently made mental health a big player in the current debate.

However. None of these people sought treatment. Putting a free psychiatry kiosk on every street corner would not have helped. The only thing that would have helped is making it impossible for them to acquire large capacity ammunition clips.

QED

Update: An armed society  is a polite society, right Mr. LaPierre?

Tuesday, December 18, 2012

About that Second Amendment


Jeffrey Sachs is of course correct. The amendment has to do with an archaic debate about federalism. It protects the state militias, not some bozo who wants to walk around the shopping mall with a gat on his hip so he can shoot any black kid who looks threatening, or a bunch of louts who think they can resist "tyranny" by taking on the United States army. The state militias are now the National Guard. That's the well-regulated militia. Back in the day, the militia members owned their own muskets, and kept them at home, which is why the amendment reads as it does.

The Supreme Court, in decreeing that a) this has anything to do with a "right" that pertains to individuals and b) has any application at all in the United States post about 1800, is legislating from the bench. This "interpretation" has nothing to do with conservatism or "original intent" or even jurisprudence. It's just a fraud. There is no such thing as gun rights, or gun owners rights, or a right to bear arms, deriving from the Constitution of the United States.

None. It's all nonsense.


Monday, December 17, 2012

On Liberty


It's not exactly a revelation that you get a huge political advantage from attaching a label with positive associations to your cause. Rights, liberty, life, freedom,choice -- who could be against any of those? Respecting the right to bear arms gives us more liberty, more freedom, more choice, and we can defend our lives and our property. If you want to restrict that right, you want to take away my freedom. Obviously.

What's wrong with this picture? I shouldn't even have to point it out, yet somehow our public discourse can't arrive at the obvious.

People walking around with guns on their hips may feel that they have liberty and freedom, but they diminish the freedom of others. Who would dare to offend a belligerent character with a gun in his hand? Are the people of Newtown, and every other school district in this country, freer because their neighbors own high powered rifles with 30 round magazines? Of course not. They are forced to take all sorts of measures that restrict freedom in order to protect themselves. They have to make their schools, libraries, town halls and court houses less accessible. They have to tax themselves more to pay for police and security systems. Even so, sometimes their children get murdered.

I could play this argument out at greater length but others have done so better. The point is, liberty is always a problem of balance. Whatever liberty is granted to one person may take away from the liberty of another. Your liberty to dump your waste in the river deprives me of the liberty to swim in it.

Here's another powerful example. Banning smoking in public places turns out to have a huge effect on the incidence of heart attacks and acute respiratory distress. Huge. A twenty-one percent decrease in hospital admissions for acute myocardial infarction. That means smokers aren't poisoning other people, and the rest of us don't have to pay as much to take care of people who have heart attacks.

Libertarianism is sophomoric nonsense. Rand Paul and Ron Paul and everybody associated with the Cato institute are mindless. We must root this delusional thinking from our political discourse. 

Sunday, December 16, 2012

Why?


Connecticut is a relatively small state in geographic extent, but Newtown is pretty far from me in Connecticut terms. I have never been there, and I had to look it up on a map. As it turns out, though, my brother-in-law's niece attended Sandy Hook, and her baby sitter's daughter was killed. And seeing my governor and senator on TV talking about it makes it seem somewhat close to home anyway.

As for why the guy did it, the answer to that is easy: he was batshit crazy. Nobody is worried about asking Jared Loughner, for example, why he shot the congresswoman and all those other people, because we know he can't give a meaningful answer. As this story by AP's Helen O'Neil discusses, we can't say there has been an increase in these rampage killings recently. The first one I remember was Charles Whitman, who climbed a tower at the University of Texas in 1966 and shot 45 people, killing 13. I was 12 years old at the time. When I was in college, a woman in combat fatigues shot up a nearby shopping mall, and 16 year old Brenda Spencer shot up a school yard in San Diego in the "I don't like Mondays" assault. Usually they're men of course: the Luby's cafeteria massacre, the McDonald's in San Diego, that Vietnam vet who attacked children in a schoolyard, the epidemic of postal service massacres, and more recently Columbine, Virginia Tech  . . .

(As I write this, my neighbor is emptying a 12 round magazine. He needs to do that every morning.)

So these keep happening. The distribution in time may not show any obvious pattern, but the distribution in space does. The U.S. seems to be where it happens most often. Sure, there have been massacres in New Zealand, Scotland, and Canada in my memory, but each of them is unique in its particular country. (I'm leaving politically and economically motivated crimes, such as the Mexican drug cartel massacres, for another day. I'm just talking about rampage killings by unconnected individuals.)

Is it something in the culture? I don't really see any evidence of that. Charles Whitman, on autopsy, was found to have a brain tumor. Many of the perpetrators, including Loughner and James Holmes, are manifestly psychotic. We don't understand psychosis well at all; it isn't clear how the zeitgeist influences psychotic fantasies. Obviously you have to know that the CIA exists to believe it has implanted a chip in your brain, or to have heard of Alpha Centauri to believe that extraterrestrials are beaming messages at you from that particular location, but otherwise the form of the delusion is probably sui generis, in other words you could believe you were possessed by a demon. Same idea. So whether violent movies or video games actually make psychotic people violent is far from proven.

There is a pattern of workplace rampages by socially isolated men whose work is their only claim to dignity and who react when something goes wrong there, but I don't know that that is unique to the U.S.

But we all know what is unique to the U.S. The only time I have fired a rifle was at boy scout camp. The weapon had a bolt that you pushed up and pulled back to open the chamber. Then you inserted a single cartridge, pushed the bolt forward and down, and took your one shot. Guess what? If you're hunting deer, that's just as good as a semi-automatic Bushmaster with a 30 round magazine. You only get one shot and if you miss, and try shooting again at the fleeing animal, you are an irresponsible idiot. There is absolutely no reason for people to own semi-automatic weapons or large capacity magazines. They have nothing whatsoever to do with hunting or sport of any kind. They are designed for exactly one purpose, and that is to kill humans. That is the only purpose they are good for.

The arms which the well-regulated militia had the right to keep and bear were muzzle loading muskets. You'd pour black powder down the barrel from your powder horn, then shove a wad of paper down the barrel with a rod, then drop in a ball. Then you could aim and fire, once.

If I want to shoot the chuck that's eating my garden, or bag a turkey for dinner, the most I need is a double barreled shotgun. Break it at the breech, put in two shells, and you're good to go. If I had one, and I lost my marbles, I could maybe shoot two people. Not 26. It's that simple.

Thursday, December 13, 2012

You might want to play with this


An on-line app from the Guardian that let's you look at death rates globally or regionally, by age, from various causes, in 1990 and 2010.

Worldwide, heart disease and circulatory disease are by far the leading cause of death. No surprise there, but you might be surprised by the importance of chronic respiratory diseases in carrying off the old folks. Unintentional injuries -- falls -- aren't way up there in the rankings but they're pretty important. A broken hip is very often the beginning of the end.

There have also been some big changes since 1990. HIV of course has jumped way up, while other communicable diseases have tended to go down in rank.

Anyway, you get to visualize it all sorts of different ways -- try it, it's very informative.

Big Gummint


Jonathan Chait has justly won a wanker of the day award or two, but I'll give him props for this. (No endorsement of the Puffington Host implied or intended.)

I'll put a slightly different spin on it, but the basic idea is correct. The reason the weeping orange man won't specify the spending cuts he's demanding in return for the revenue increases he also won't specify is that he cannot. The United States has a far less generous social safety net than other wealthy countries, our infrastructure is crumbling, our regulatory agencies are underfunded (and they spend little money anyway) -- the one place where we can actually find substantial savings is in the bloated military, while the Republicans have been running around screaming that it's dangerously underfunded since Obama took office. They also campaigned against Obama for cutting Medicare, and now they're complaining that he doesn't want to cut it enough. Not that simple logic ever mattered in political discourse but . . .

The fact is that at some point, Congress is going to have to sit down and pass appropriations bills, and reauthorize the major entitlement programs. Fiscal cliff or not, debt ceiling or not, Orange Julius's House of Representatives is going to have to specify how much the federal government will spend on each and every one of its functions. They can cut funding for stuff they don't like, such as the EPA, but that will have a trivial impact on the budget deficit. They can cut spending on Medicare, but there are only two ways to do that:

  1. Payment reform and cost-effectiveness guidelines. They claim that is equal to "death panels," so they won't do that.
  2. Reducing benefits. That's not going to win them any love in 2014. 
 They could try cutting Medicaid benefits and tightening eligibility standards. That won't pass the Senate and if they did it, they would get the blame for horrendous consequences. At some level, the sane among them know that.

And they can cut the military budget, but they won't do that.

So they're stuck. The low IQ members may not understand that, but Boehner does. He knows it perfectly well.

Wednesday, December 12, 2012

When everything changes


Our new article in Patient Preference and Adherence is now available open access. (I try to publish open access when I can, but don't always have the funding.)

I really like this piece because we gave voice to people who have been through really tough times and in most cases, overcome. But it required fundamentally changing how they thought of themselves and how they related to the world.

This is one of the consequences of a chronic disease diagnosis -- in this case HIV, but it happens to some extent with heart disease, chronic kidney disease, cancer. The doctor pronounces the word and the world changes. You are still the same person, but in a sense your identity is altered, where you are in the world is different.

Most of these folks, ultimately, made the most of it. But I don't know what the magic pixie dust is that can get people to successfully incorporate the new reality and move ahead courageously. Nor can they say what it was. At some point, it just happened.

Monday, December 10, 2012

Not really the end of the world


While it is true that only a few people are convinced that the apocalypse will occur on a specific, known date, it is tragically also true that there are a lot of people -- I don't specifically remember the polling on this and maybe somebody can come up with a number, but it's close to half of Americans -- believe that it will happen sometime soon, they just can't say exactly when.

You may be old enough to remember that Ronald Reagan's Secretary of the Interior, James Watt, believed that, and said so publicly. He said that environmental conservation was pointless because the environment wasn't going to be around much longer anyway. Yes, that really happened. And maybe that's one reason among several that the looming catastrophe of climate change is largely ignored.

The failure of the Doha climate conference ought to be the top headline in every media outlet. It was buried in a small item inside the NYT this morning and is basically nowhere to be seen on the web sites of the major news networks. But the Reuters story (linked above) gets it right.

At the end of another lavishly-funded U.N. conference that yielded no progress on curbing greenhouse emissions, many of those most concerned about climate change are close to despair. . . .


The conference held in Qatar - the country that produces the largest per-capita volume of greenhouse gases in the world - agreed to extend the emissions-limiting Kyoto Protocol, which would have run out within weeks. But Canada, Russia and Japan - where the protocol was signed 15 years ago - all abandoned the agreement. The United States never ratified it in the first place, and it excludes developing countries where emissions are growing most quickly.

Delegates flew home from Doha without securing a single new pledge to cut pollution from a major emitter. . . . A series of reports released during the Doha talks said the world faced the prospect of 4 degrees Celsius (7.2F) of warming, rather than the 2 degree (3.6F) limit that nations adopted in 2010 as a maximum to avoid dangerous changes. According to the World Bank, that would mean food and water shortages, habitats wiped out, coastal communities wrecked by rising seas, deserts spreading, and droughts both more frequent and severe. Most impact would be borne by the world's poorest.

No, this is not the end of the world. It's not the end times. The universe will go on. But it will be hard times indeed, harder than we have ever known, and that includes World War II and the Dark Ages. Wake the fuck up.
 

Saturday, December 08, 2012

What with the end of the world approaching . . .


. . . in just a couple of weeks, my curiosity has again been awakened about why so many people believe in this particular category of balderdash, continually through the ages. This story about the followers of Harold Camping casts a bit of what little light there is to be found, but leaves me unsatisfied. (The on-line magazine Religion Dispatches, from which this is taken, is a good resource, BTW. They write about religion from the outside, without hostility but with appropriately critical thinking.)

As you may recall, Camping was the radio preacher who convinced thousands of people that the apocalypse would occur on May 21, 2011. They quit their jobs, spent their savings promoting the truth to the world, left their kids without college funds, abandoned their homes . . .

Spoiler alert: It didn't happen. The universe sailed on as serenely or tumultuously as ever. But why did they believe this? They weren't just betting on it. They were absolutely certain, as certain as the sun would rise on that day, the earth would be devastated by massive earthquakes, and then the rapture and the end of the universe would occur in October. Which also didn't happen, by the way.

It turns out that many of them are engineers or otherwise mathematically trained. They figured it out, by elaborate reconciliation of scriptural passages. The numerological and textual relationships they found in the Bible could not possibly have been coincidences, they were irrefutable evidence of the truth of the prophecy. Well, okay, but you really have to try very hard to get to that conclusion. Confirmation bias can't happen until you already believe. There's still a piece missing here.

But come to think of it, the same can be said of all religious belief. It's just that much of it doesn't smash to pieces against observable reality quite as hard. Anyway, I'm puzzled.

Thursday, December 06, 2012

Unpopular Legislation


As you have no doubt heard, while Americans tell pollsters they like various specific provisions of the Affordable Care Act, the act as a whole still gets less than 50% approval.

Maybe this is why. (PDF -- scroll down to page 8.)

Two and a half years after the law’s passage, six in ten Americans either believe that the health care law establishes a government panel to make decisions about end‐of‐life care for Medicare beneficiaries (39 percent) or are not sure whether or not this is a provision of the ACA (22 percent). The numbers among seniors are very similar: 32 percent of seniors believe the law sets up such panels, 28 percent are not sure. Two in three seniors say the law cuts benefits for people in the traditional Medicare program. In fact, there are no actual cuts in benefits for beneficiaries in the traditional Medicare program, though those enrolled in Medicare Advantage plans may see fewer supplemental benefits once reimbursements to those plans are reduced.

A lie is half way around the world before the truth gets its boots on. The Republicans have succeeded in lying to people, and the corporate media have enabled their lies. This must end, or there is no hope for us.