Map of life expectancy at birth from Global Education Project.

Wednesday, April 30, 2014

Could reality possibly matter in the end?

It seems Rick Scott went looking to rile up some seniors about the horrors of Obamacare and it turns out they're fine with it, nothing bad has happened to Medicare after all and isn't it nice that their younger friends can get insurance?

And now a story the likes of which we'll be bearing more and more of, about a rugged individualist who wouldn't have no truck with that soshulist Obamacare until he did, and it saved his life:

He's a self-employed, self-sufficient logger who has cleared his own path for most of his 57 years, never expecting help from anyone. And even though he'd been uninsured since 2009, he especially wanted nothing to do with the Affordable Care Act. "I don't read what the Democrats have to say about it because I think they're full of it," he told his friend Bob Leinhauser, who suggested he sign up. . . . "We argued about it for months," Angstadt said. "I didn't trust this Obamacare. One of the big reasons is it sounded too good to be true." January came, and Angstadt's health continued to decline. His doctor made it clear he urgently needed valve-replacement surgery. Leinhauser had seen enough and insisted his friend get insured. . . . Angstadt's plan kicked in on March 1. It was just in time. Surgery couldn't be put off any longer. On March 31, Angstadt had life-saving valve-replacement surgery. "I probably would have ended up falling over dead" without the surgery, Angstadt said. "Not only did it save my life, it's going to give me a better quality of life."

I don't see how it's possible that between now and November people will fail to notice that there aren't any death panels, there aren't any government bureaucrats sitting in the doctor's office, and more people are getting the health care that they need. No trainwreck. But apparently they're still going to vote for Republicans. Please tell me why.

Monday, April 28, 2014

Taking time off from the blog has helped me appreciate . . .

why Tom Lehrer retired from public life. The goings on lately are beyond the power of commentary. A guy becomes a conservative hero by refusing to pay his bills, on the grounds that "the federal government does not exist," while his armed supporters ostentatiously wave the flag of the non-existent United States. That he's an ignorant racist lunatic is pretty much beside the point. But everybody expects the Republicans to gain control of the Senate in November.  I'm baffled.

Anyway, my personal update is that I'm still in the cast and it's hard to type, but the pain is much less and I'm off the ibuprofen. Cast comes off May 6, I'm counting the days. Meanwhile, back at the ranch, I got one of the rare e-mails from a publicist I actually want, a report by a coalition of progressive groups on the National Restaurant Association. No, it isn't the corner diner, it's Coca Cola and McDonald's and  KFC and the like. They spend huge bucks on lobbying and political contributions, and they're major opponents of minimum wage laws, other labor protections, and public health regulation. Selling junk food to children is one of their biggest priorities. Coca Cola, by the way, is not food, it's poison. How we can organize to fight and beat these scum is not clear to me, but it should be a top priority for progressives and everybody who cares about their children.

Monday, April 21, 2014

Sorry, typing is still a real pain . . .

and probably will be for the next two weeks till I get the cast off. So if I'm light on blogging, you know why.

Anyhow, the first anniversary of the Boston marathon bombing has pretty much displaced recognition of other anniversaries this week, perhaps mercifully including Columbine. What most people probably still haven't caught up with is that it wasn't about bullying or jocks and nerds or anything to do with high school culture or politics. Eric Harris was a psychopath who just wanted to kill as many people as possible for the fun of it, and Dylan Klebold was a tool. That's all. it doesn't really mean a whole lot except that such people exist.

And they could easily get guns, I suppose, although their main intention was to kill people with propane bombs, which fortunately did not go off. But they could have with better wiring skills.

I think this is more or less true of the marathon bombing as well. It doesn't have much to do with Jihad or radical Islam. Tamerlan was a violent lunatic, probably schizophrenic, and Islam was just the particular fantasy around which his violence coalesced. And his brother was also a tool, like Klebold. Don't look for more meaning than there really is, I say.

Thursday, April 17, 2014

Medicine Triumphs

You know that a lot of my thinking revolves around the proposition that we spend too much on medical intervention and it really doesn't do all that much good. Type 2 diabetes is one of my best examples. If we could all just skip the processed food and sugar water, and get some exercise, we'd never need the doctor in the first place.

Maybe so, but we haven't been doing that. So, doc to the rescue. CDC investigators have found that even though the prevalence of diabetes has gone up, complications are way down. Why? Because we've figured out that we need to concentrate on preventing the cardiovascular and kidney complications that maim and kill most diabetics, and we have better drugs. I'd feel better if people were losing weight and eating whole grains and legumes instead  of white bread and soda, but they aren't.

In spite of fraud by pharmaceutical companies, underinvestment in public health, overtreatment and all the other constant complaints you read here, medicine does gradually get better. So let's have universal access, as a fundamental right.

Monday, April 14, 2014

I'm baaaaaack . . .

It was just too painful to type for a few days so I decided not to bite the bullet. People ask me what I do for a living and I say I'm a medical sociologist, but now I realize that a better job description is typist. Anyway . . .

Millions of people are locked up for shoplifting and smoking pot and shooting dope, but if you steal $20 billion you're cool. I don't know how much of this you can read, but the new BMJ has a theme issue on the latest fraud of the century. The story is that in 2006, one Tom Jefferson led a Cochrane review* of neuraminidase inhibitors -- these are drugs to treat influenza, most notably oseltamavir (brand name Tamiflu, manufactured by Roche).  He concluded that it can prevent hospitalizations, shorten the course of influenza, and save lives. Accordingly, during the flu pandemic hoax of 2010-2011,** governments stockpiled huge amounts of the drug and doctors handed it out like lollipops.

Then Jefferson got a heads up from a Japanese researcher that there was a lot of unpublished data that might change these conclusions. He fought for years to get the drug companies to cough it up. They resisted every step of the way, but backed up by BMJ and powerful (mostly British) physicians, he finally got the data. What do you know? The full clinical trial data finds that the benefits of the drugs don't outweigh harms. Says BMJ International Editor Kamran Abassi:

Worryingly, the welfare of patients seems a secondary consideration for all stakeholders. Drug company executives champion their work for the benefit of patients. Regulatory authorities are responsible for protecting patients. Politicians make decisions for the public good. Yet, when faced with the sudden threat of pandemic H1N1 flu, a threat that ultimately did not materialise, each party behaved opportunistically and irresponsibly. Drug companies exploited a window for rapid sales. Regulators approved drugs with insufficient scrutiny, exposed now by the forensic approach of the Cochrane researchers. And politicians were desperate to act, to do something in the face of a perceived crisis, whether it was based on evidence or not. Patient welfare didn’t matter, although it
was the excuse for these decisions.

Hey indeedy.

*The Cochrane Collaborative is an international non-profit that publishes systematic reviews of medical treatments. It's used a gold standard reference for what works and when and with whom.

** In order to find that there was a pandemic, the WHO was forced to change the definition of pandemic flu such that we actually have one every year. 2010-2011 was a milder than usual flu season.

Thursday, April 10, 2014

Just so you know . . .

I'm as well as can be expected, under the circumstances. Still kind of hard to type, which slows down blogging. but . . .

This is kind of disturbing, but while driving me home my brother, who is no fool, said that he knows what happened to that Malaysian airliner. Since 2007, Boeing commercial aircraft have been equipped with a supposedly anti-hijacking system that allows a ground facility to seize control of the aircraft. Yesterday, I did some Googling and found numerous references to this. Today, only this, the patent information. Yes, it's real. Great if you really are hijacked, not so great at all if somebody hacks into it. And no, they obviously wouldn't talk about that possibility.

We'll see if men in black show up at my door.

Tuesday, April 08, 2014


That would be on me. I'm getting surgery today on my left hand. Specifically, they are going to remove the bone at the base of the thumb, called the trapezium, and stuff the space with tissue harvested from a wrist tendon. Grotesque, isn't it?

The reason is osteoarthritis. I have no cartilage left between the trapezium and the metacarpal bone, that is the shaft of the thumb. It hurts all the time - it hurts to take money out of my wallet, it hurts to button my shirt, it hurts to take a paper cup off the shelf. The proximate stimulus for taking this step is that my cousin-in-law talked me into buying a guitar, and I just can't play for more than a few minutes. I studied up on it carefully, and this surgery has an excellent record of long-term outcomes. However, it will be an ordeal. I'll be in a cast for six weeks, I'll need weeks of physical therapy, and it will be months before it's fully normal. But, then I'll have the rest of my life to be glad I did it.

I don't blame evolution -- we weren't supposed to live this long. But most of the world's people, obviously, have no access to this kind of intervention. If they develop osteoarthritis, they just have to live with it. It's the price of stayin' alive. So just think about it -- being in your fifties or sixties, and taking it for granted that you have many productive years left and shouldn't be, and don't have to be, disabled, is a very recent, very unusual version of the human condition. And maybe it won't last much longer.

Monday, April 07, 2014

Art Criticism

It seems war criminal George W. Bush is taking advantage of his impunity to exhibit his portraits of world leaders at his "presidential" library.

I think it would be more appropriate for him to paint mangled and burned corpses, disfigured children, shattered cities, and maimed veterans. Those are subjects much more relevant to Mr. Bush than world leaders.

Sunday, April 06, 2014

Excitement in Mudville

As far as I know, the University of Connecticut is the only school to have won the men's and women's NCAA basketball championship in the same year, which I believe was 2004. (I'm not going to look it up because it isn't that important.) This year, UCONN can do it again.

The women's team, which won last year, was rated number one all season and was expected to be the team to beat. They play their semifinal match tonight, against Stanford, who they already beat easily earlier in the season. The men's team, however, is a surprise. They went into the tournament as a 7th seed, having been trounced by Louisville in the American Conference final. They survived and overtime scare to get through the first round. Then they went on to beat number 4, 3, 2, and finally 1 seeds, the latter being Florida, the consensus pick to win it all, who they trounced to make the championship game on Monday.

So, I have some fandom in the game when it comes to the controversies about the NCAA. As a matter of fact, long-time UCONN men's coach retired under a cloud last year with the program on probation over poor academic performance. The men's team has always had a poor graduation rate, and it's not because they are going on to riches in the NBA, for the most part. (The women, on the other hand, do really go to college and graduate.) This year, however, under new coach Kevin Ollie, things seem to have changed. In fact their superstar point guard Shabazz Napier is expected to graduate in May, fulfilling a promise to his mother, after a solid academic career. And yes, NBA riches await him, but he deferred for the full four years.

But we've seen situations like Kentucky, in which playing on the basketball team obviously has nothing to do with going to college and nothing particularly to do with the University of Kentucky. The players do one season and it's on to the pros. I suppose if that's your chosen career path you don't have a strong argument to be paid, but you don't have much of an argument for an athletic scholarship either. Much worse, of course, are the kids who play on the team, help the coach and the athletic director earn millions, never get an education and never make it to the pros either. The ratio is even worse in football, and they risk traumatic encephalopathy in the process.

At my place of employment, in contrast, athletics has its place and we even produce the occasional NFL player. But the Ivy League does not give athletic scholarships. You get an edge on admission if you're a talented athlete but you still have to fulfill the academic requirements to stay on the team and stay enrolled. We don't offer a Rocks for Jocks course or a phys-ed major. I won't say that the top athletes don't get a break or that none of them suffers from the entitled jerk complex associated with male athleticism. I don't know about that. But college sports as a community building exercise for the university, fun and good exercise and character building for the participants -- that isn't entirely mythological, at Brown or at the other colleges and universities I've been associated with.

What I think we need to do is create two separate categories of college athletics. Top division football and basketball programs a) should pay their players and b) should give athletes the opportunity to get a college education but they can also take a pure athletic track in which their official career ambition is to be a professional athlete or coach and that's what they're studying to do. And yes, if they aren't meeting requirements to credibly stay on that track, they're off the team and out of the program. That's only fair to them, as a matter of fact. And if they have a career-ending injury, they get a full scholarship, tuition and room and board, to get a degree in something else. And if they can't cut it at the university, the university will pay for vocational training.

So no, there won't be a level playing field, any more than there is for the New York Yankees and the Milwaukee Brewers. Colleges that want to sponsor a pro sports team should do just that. There can be a limit on salaries, but the athletes should be paid. Colleges that want to have collegiate athletics should play in a completely different league, and should not provide scholarships to people just to play games. Take our pick, but don't pretend that one thing is the other.

Friday, April 04, 2014

A reflection on the climate change problem

Specifically, not climate change itself, but the failure of the political system to respond to it. Eric Chivian, one of the founders of International Physicians for the Prevention of Nuclear War, has some thoughts about this in BMJ. (Not sure if this is open access.)

He makes the usual points: scientists are always cautious and hedge their conclusions -- "high degree of confidence," that sort of thing -- whereas the denialists speak with what sounds to lay people like greater clarity; the media finds that controversy sells so they give the denialists equal time and stature; and there's big money behind denial.

But he embeds the deepest point in another -- burying the lede, I would say:

We were, and are, up against the richest, most powerful, most rapacious adversaries on the planet, who since the industrial revolution began have controlled what powers almost everything we do, whose products are the engine for the economies of all industrialized countries and the fuel for the rapid growth of developed countries.
The real issue is not the powerful, rapacious adversaries. They are a by-product of the fundamental reality. Our world, our entire civilization, exists only because of fossil fuels. The human life span, the conditions of life for the overwhelming majority of the world's people, the accumulation of wealth and the pace of technological change were essentially stagnant since the first ape that spoke. Then came James Watts steam engine in 1781, fueled by coal. Everything since then would have been impossible without it. The human population would be maybe 1/50th as large. Maybe. We'd still need more pasture for our horses than farmland, which would absorb the daily, grinding labor of 90% of us. It would take two months to cross the Atlantic, and the only way to get a message across would be to carry it.

We can't undo this world, but finding acceptable ways of fueling it is the hardest thing we will ever do. It's like chewing your own leg off to get out of a trap. But, chew we must.  

Thursday, April 03, 2014

A couple of bookmarks

Do check out:

Democracy: A Journal of Ideas

and uh

The Baffler.

Without a doubt, both offer some of the best free content (or any content, for that matter) out there.

Can't figure out how they pay for it, these are well-known professional writers, but you might as well take advantage.

Tuesday, April 01, 2014

While they ignore the IPCC report . . .

the corporate media are getting all excited about Ebola virus, which ABC news is now telling us may come to the U.S.

Puh-leeze. People contract Ebola virus from wild animals in remote places in Africa. It is highly unlikely any of those people are going to get on an airplane, and if one of them were to do so, even more unlikely that she or he would be headed for Kennedy Airport. Ebola virus is a problem for people who live where it is likely to be encountered, but it doesn't have to be our problem for that to be true.

Here are the true facts, from the WHO.

Yes, it's a really awful disease. The case fatality rate is 90% and there is no effective treatment or vaccine. And people can be contagious during the incubation period in which they are not symptomatic. But . . .

The virus is transmitted only through direct contact with bodily fluids. If somebody sitting next to you on the plane happened to be infected asymptomatically, you would be very unlikely to contract it. The virus spreads when health care workers take insufficient precautions -- gloves and gowns and masks and all that -- and through funerary practices in which people come into contact with the corpses of victims. People in the acute phase of the illness bleed through every orifice, so yes, there are plenty of bodily fluids to avoid, but they aren't walking around and they definitely aren't flying on airplanes! (And, it is present in semen.)

What all that means is that we will continue to see these isolated outbreaks, but unless it somehow mutates to become more contagious, this is not going to become the next Black Death. And don't worry about it coming to the U.S.

Why the "journalists" just can't avoid these temptations is beyond me.