Map of life expectancy at birth from Global Education Project.

Wednesday, June 29, 2016

Now this is just nuts

According to the new Quinnipiac University poll, the presidential race is currently a virtual tie. If you think that's bad, respondents see Donald Trump as more honest and trustworthy than Hillary Clinton.

Honest. And trustworthy.

Friday, June 24, 2016

Just take a pill!

I've written quite a bit here about chronic pain. As your humble correspondent has written many times, long-term opioid use is not just dangerous, it is ineffective. And most people don't benefit from other pharmaceutical treatments. They might be worth a try, but if you do have chronic pain of neurogenic origin, you will probably need what we call a bio-psycho-social approach. That means learning how not to let pain get the better of you. Physical therapy, graded exercise, cognitive behavioral therapy, all can help.

I don't buy the full menu of non-pharmaceutical options listed by NYT reporters Meier and Goodnough -- acupuncture and chiropractic are bunk -- but I do draw your attention to the basic point. Insurers will pay for pills, but they won't pay for a comprehensive bio-psycho-social approach to chronic pain. I would add that doctors don't really know how to do it either, all they know how to do is write prescriptions.

This is a fundamental problem in our culture. We expect a pill to make everything better, whether we are anxious, or sad, or in pain. But they really don't work for those problems and the idea that what your problem is really bad chemicals that can be fixed by other chemicals is a basic misreading of your situation.

What you suffer from is the human condition. We can work hard to make that better, but there isn't any pill for it.

Wednesday, June 22, 2016

House Republicans roll out plan to screw you

Paul Ryan and his co-conspirators have been talking for years now about their plan to repeal and replace the Affordable Care Act, as soon as they get around to figuring out what that will be. They couldn't figure that out, however, because the ACA is actually working quite well and health care spending has actually grown more slowly than predicted even as the uninsured population has been cut in half. People have discovered that there has not, in fact, been a government takeover of health care and that there aren't any death panels either.

So now Ryan has issued a document which he claims is his replacement plan although it doesn't have any cost estimates or legislative language. Here's how he proposes to make the world better.

Medicare would be replaced by "premium support," meaning old folks would get money with which to buy private health insurance. Note that right now, Medicare is much more cost-effective than private insurance, because it spends far less on administrative costs and marketing, and nothing on profits for shareholders or multi-million dollar compensation packages for executives. So the insurance would be more expensive and presumably the amount government would spend would be less. So if Granny doesn't have big bucks in her 403B, she won't be able to afford comprehensive insurance.

They'll repeal the Medicaid expansion and turn Medicaid into a block grant rather than an entitlement. "Reforming Medicaid’s financing with a per-capita allotment certainly will reduce federal spending," the document says. Right. In other words fewer people will be covered and their benefits will be reduced. Or, as they explicitly say, "Under the House Republican plan, states could also “charge reasonable enforceable premiums or offer a limited benefit package” and use “waiting lists and enrollment caps” for certain groups of Medicaid beneficiaries."

There will no longer be a requirement that people have health insurance. This means, of course, that young and health people won't be in the risk pool and insurance will get more expensive for everybody else.

Insurers won't have to cover pre-existing conditions if you haven't been continuously insured. That pretty much leaves us where we were before.

There's more, but the basic idea is to make things worse for everybody who isn't well to do. Exactly why this is supposed to be better than what we have now they do not explain, but I will tell you: it will enable tax cuts for rich people.

Friday, June 17, 2016

Ho Lee-Fuq

I have seen no mention of this whatsoever in the New York Times, any of the major news networks, or for that matter the liberal blogs and on-line magazines. Only at Climate Progress did I learn that the temperature in Greenland's capital of Nuuk last week hit 75 degrees Fahrenheit, which is the warmest temperature ever recorded there in June. The percentage of the Greenland ice sheet surface that has melted is now 2 standard deviations above normal for June. The arctic sea ice is also on track for a record low.

May was the hottest ever recorded globally, and we're on track for the hottest year ever for the third year in a row. This is serious folks.

To be fair, The Guardian is covering this, even while the Brits are in shock over the murder of a Labor MP by a neo-Nazi. But here in the U.S. of A.? Crickets. Their piece is, if anything, scarier than Joe Romm's. Excerpt:

May was the 13th month in a row to break temperature records according to figures published this week that are the latest in 2016’s string of incredible climate records which scientists have described as a bombshell and an emergency.
The series of smashed global records, particularly the extraordinary heat in February and March, has provoked a stunned reaction from climate scientists, who are warning that climate change has reached unprecedented levels and is no longer only a threat for the future.
Alongside the soaring temperatures, other records have tumbled around the world, from vanishing Arctic sea ice to a searing drought in India and the vast bleaching of the Great Barrier Reef. The UK has experienced record flooding that has devastated communities across the country and scientists predict that the flash floods seen by parts of the country in recent days will increase in future.


Thursday, June 16, 2016

Betting Pool

The weeks leading up to the Republican National Convention are bound to be very interesting. Do buy your popcorn now before the shelves are stripped bare! One of the most intriguing questions is who will be the Vice Presidential nominee.

The first, essential criterion is that the person be willing to accept the honor. A desirable quality would be that the individual not be a maniac. The overlap in the Venn diagram for that proposition is very small, so we may have to relax the second criterion. Here is my take on some of the prospects, but I'm not setting odds.

1. Chris Christie. A major advantage is that he has already been thoroughly humiliated and subjugated, so that process can be skipped. He broadens the ticket's appeal to include people who are attracted to vulgar bullies and simplistic world views. Oh wait . . .

2. Ben Carson. The narcoleptic nutcase has pre-humiliated himself, a substantial service to the cause. He might alienate the white supremacist faction of T. Rump supporters. On the other hand, they may be okay with the idea of a house negro.

3. Sarah Palin. An early endorser, she also broadens the appeal to include people who are attracted to incoherent rants and preposterous conspiracy theories. Oh wait . . . . The only candidate who reads all the newspapers. Brings foreign policy gravitas from her nightly examination of Vladimir Putin's head through a small telescope.

4. Louie Gohmert. Stupid enough to think this would be a good idea.

5. Paul LePage.  Could be kept in a simulated campaign environment throughout, so that he thinks he's campaigning but is actually interacting only with actors on a sound stage in between fake flights on a convincing mock up of a private jet that produces sound effects and shows projections on the windows but never actually leaves the ground.

Perhaps you have other candidates to propose.

Friday, June 10, 2016

Legalize Marijuana

There are as we know many unintended effects of prohibiting things that people want. Sure, it's often a balance. Whether we're talking about prostitution, methamphetamine, or 32 ounce sodas there are costs of both legalization and prohibition. It's more complicated than that because various prohibition and legalization regimes are possible. Evidence of the effects of one regime vs. another is generally largely lacking, so a lot of the debate consists of speculation and moral judgments disguised as factual claims.

In the case of cannabis, however, I am fully convinced and I have been for a long time. What we know about alcohol prohibition ought to convince us. I should make it clear that there is evidence -- not definitive but worthy of concern -- that there are long-term risks of heavy use for people under 18 or so. But blanket legal prohibition isn't keeping pot out of the hands of teenagers, and furthermore the causal associations are still impossible to sort out from the evidence. A legal regime that treats cannabis like alcohol -- sold only in licensed outlets and only to adults -- and also regulates potency and labeling (which current regimes in the U.S. don't do effectively, BTW) would do a better job of protecting young people.

We already know about the damaging - and racially discriminatory - effects of law enforcement and punishment. I won't go on about that. But just as outlawing prostitution makes it less safe, outlawing cannabis drives people to alternatives that don't subject them to legal sanctions, but are far more damaging.

Specifically, we have an epidemic of products based on synthetic chemicals that interact with the same neurotransmitter system that THC does, but with far greater potency and unpredictable effects. As the linked NYT magazine article explains, people turn to these specifically because they are readily available in ordinary retail outlets, and won't cause them to fail a drug test. And they can make people batshit crazy, paranoid and violent, as well just plain kill them. Here's a shorter version of the story from Forbes if you don't want to take the time to read the long-form piece.

Here's the thing. It is impossible to suppress these drugs -- spice, spike, "synthetic marijuana" (not), whatever they are called -- because they're easy to formulate in illicit laboratories and the exact chemicals keep changing. But, nobody would want them who could easily and legally obtain real marijuana. The market would disappear. It's that simple.

Wednesday, June 08, 2016

We're Number One!

It turns out that Brown is tied with UConn for the highest number of reported sexual assaults on campus in 2014. Since I work at one and pay taxes to support the other you may think I should be upset, but it's a bit more complicated than that.

We can't say for sure, but this is probably to the credit of both universities. From what I know of the efforts of the administration and faculty here, I think it is. This represents what we call ascertainment bias. At Brown, people are willing to come forward when they experience an assault. (The headline on the story says "rape" but the category is broader.) A university of this size that had few reports would be the one with the bigger problem.

On the other hand, just because we know we have a problem while others don't know it is obviously not where the story ends. We still need to fix our problem, as best we can. It's actually a few different problems.

One is sexual harassment and coercion of students and more junior personnel (such as post-docs, research assistants and junior faculty) by powerful faculty members. That's not pervasive -- and I actually haven't heard of any specific incidents here -- but in many stories from other universities that have become public recently, what we see is that prominent, tenured faculty have enjoyed years of impunity. That must end.

Second is the general male culture. I actually think, as do many others, that women are probably safer at most colleges than they are in most other settings, but that is obviously not safe enough. Students don't magically change when they cross the invisible borders of the campus. The young men bring with them the attitudes of objectification of women, of conquest as a mark of male accomplishment, of sexuality as predation. They are also immature and can't easily resist peer culture. So the peer culture has to change.

Third is the tendency of most institutions to support their hierarchies, suppress negative news, and avoid disruption. There are perceived costs ranging from bad publicity to loss of otherwise valuable human resources that come with acknowledging inappropriate behavior and it's just easier to sweep it under the rug. So that value equation has to be rebalanced.

Fourth, it takes a substantial investment to establish and maintain rules, guidelines, policies and systems to properly address fraught and contested interpersonal disputes. Universities are not historically well equipped to adjudicate sexual crimes; but they can't just refer these problems to the courts for many reasons. The criminal justice system does a terrible job of prosecuting them, and often puts victims on trial. Violations of appropriate norms, that seriously harm people, are not necessarily legal crimes. So there have to be internal mechanisms to deal with accusations, but we're still figuring out how to do it. Expelling students and firing employees are major injuries to those individuals and the accused have rights that must be protected. So it isn't easy.

So I want people to believe that we are sincerely trying. But keep up the pressure, it's necessary.

Tuesday, June 07, 2016

Not Stayin' Alive

You probably noticed the recent announcement by CDC that the U.S. death rate increased last year for the first time since 2005, and even that was just a blip. This may not mean anything -- sometimes numbers bounce around a bit seemingly at random -- but researchers have actually been predicting it.

First, a couple of clarifications. This is the age adjusted death rate, so it's not a function of the aging population. Second, this is not principally explained by the recently observed bump in deaths among middle aged white women, widely attributed to addiction other social problems. That's too small a group to move the whole population numbers like this.

I'm not sure if this is available to the un-academic rabble, but as David Ludwig explains, what we appear to be seeing is the long-predicted decrease in life expectancy due to obesity. The culprits are heart disease, diabetes, liver disease, stroke and Alzheimer. These are all associated with obesity. (Not so clear why the Alzheimer number went up but it is often associated with stroke and cerebral ischemia so obesity may be at least a partial explanation.) 

Of course we've been Fat Nation for a long time but  Ludwig's argument is that improvements in medical prevention and treatment -- e.g. statins and blood pressure meds, heart surgery, dialysis, etc. -- have masked the deadly effects of fatness, but now medical intervention can't keep up.

All this is so far somewhat speculative but it certainly wouldn't come as a surprise. We'll need to see what happens next year, and as people take a deeper dive into this data, but let this be a wake up call as if we needed one.

And yes, there are culprits and there are important political issues here. Food marketing, walkable neighborhoods, city planning, lots of questions that president Trump could address. We'll keep talking about it.

Friday, June 03, 2016

Not sure what to think about this . . .

I don't recommend that you do this, but if you take a look at the Republican National Committee home page, (and you don't have to because I did it for you) you will see they have a lot to say about Clinton "scandals,"  they're selling George H.W. Bush socks (really!), and they have a section on faith and sections on GOP Hispanics, African Americans, and Asians (nothing about lesbians and gay men, it seems). But they have absolutely not mention and no hint of a presence of their candidate for president.