Falling 24 miles

The difference is that Graham Spanier is doing it without a parachute. The president of Penn State University for 16 years, pulling down more than half a million a year in salary, traveling in the most rarefied of elite circles, and now he faces charges of perjury, obstruction of justice, and endangering the welfare of children. Whatever the outcome of the criminal case, Spanier's reputation in his own field -- family sociology and therapy -- is forever ruined. How could he possibly not have understood the likely implications of the reports he got -- on two occasions years apart -- about behavior by Jerry Sandusky that obviously, even to a layperson, raised very disturbing probabilities?

Well, the answer is, he did understand, and it seems to me quite evident from the smoking gun e-mail in which he approves a decision not to report the allegations against Sandusky to the authorities, but only to raise them with the executive director of Sandusky's charity, the Second Mile, and let him follow up.

The only downside for us is if the message isn't `heard' and acted upon, and we then become vulnerable for not having reported it. The approach you outline is humane and a reasonable way to proceed.

Penn State is a "mandated reporter," legally required to bring credible suspicions of child abuse to the attention of authorities.

The Catholic Church, PSU, the Boy Scouts, and now the BBC with the Jimmy Savile scandal -- all of these stories are eerily parallel. The Catholic Church's history of covering up child abuse was no surprise. It was pretty much common knowledge my entire life. People told jokes about it long before the Boston Globe's expose. I personally knew a guy who was viciously abused by monks at a Catholic boarding school, and another who grew up in a Catholic orphanage and, while he was not victimized himself, knew all about what was happening to other kids.

But having the same sort of tale emerge about one powerful institution after another is, I confess, a revelation to me. It seems more the norm than the exception for people in charge of organizations that are built on image and reputation to instinctively respond to this particular crime by ignoring the victims and protecting the perpetrators.

I'm still trying to parse out exactly what this tells us about the culture. Of course the people responsible are all men, and that includes the BBC which seems to have a very male dominated power structure. I can't prove that women in charge would have acted differently. So far we don't have any evidence about that, but I think most people will consider it a factor. However, it is certainly not my instinct, as a male heterosexual, to protect men who rape children. And I would like to think that my instinct as an organizational leader would be to put the organization's virtue ahead of its reputation . And even if I were entirely cynical, I hope I would be sensible enough to realize that the damage to reputation would be far worse if I got caught out  after the cover up.

So I do find this puzzling. Raping children is, to most people, the most revolting of crimes. Yet it seems also to be the one crime that powerful men are least inclined to do anything about, if it might inconvenience the institutions that give them their power. I mean, if these people were stealing from the parishioners, scouts, Second Mile participants or kiddie show audience members, I'm pretty sure there would not have been a cover up. What gives?

Speaking of evil scum . . .

We can always whip up an evil scum post by taking a look over at the pharmaceutical industry. Two pieces in the new BMJ (I think you'll just get the first 150 words or something but the Blog Oversight Organization requires that I provide links) skim the scum for us.

First, Medtronic corporation, a name you will find familiar should you be a totebagger. The Senate finance committee has found that they paid -- get this, it's not a typo or an extra zero -- hundreds of millions of dollars to doctors to pretend to be the authors of articles they drafted, edited and approved praising its product InFuse. Senator Max Baucus says, "Medical journal articles should convey an accurate picture of the risks and benefits of drugs and medical devices, but patients are at serious risk when companies distort the facts the way Medtronic has." Indeed. The editors of Spine Journal weigh in: "If surgeons had known that the lead authors of the 13 original studies on InFuse had received payments ranging from $1.7 million to $64 million [sic!] from Medtronic and that its marketing employees were co-authors and co-editors, would they have been as eager to use InFuse on their patients?"

That's all well and good but BMJ fails to name the names of those "physicians." They are all cruising along with high powered appointments and continuing to publish.

Along a somewhat different pathway of scummery, BMJ editor Fiona Godlee writes an open letter to Roche board member John Bell, "regius professor of medicine at Oxford University." Since it's open, presumably she doesn't mind if I quote it at length.

Dear John

I am writing to you in your capacity as a member of the board of Roche. As you may be aware, the BMJ has been working with the Cochrane Collaboration in its efforts to get Roche to release the raw data on the effects of oseltamivir (Tamiflu) so that Cochrane can properly fulfil the UK government’s commission for a systematic review of neuraminidase inhibitors based on clinical study reports.

To remind you of the background to this, in 2009 the BMJ published the updated Cochrane review of neuraminidase inhibitors in healthy adults.1 This took the view that, since eight of the 10 randomised controlled trials on which effectiveness claims were based were never published and because the only two that had been published were funded by Roche and authored by Roche employees and external experts paid by Roche, the evidence could not be relied on. The BMJ also published an article summarising the Cochrane team’s efforts to obtain the data from these randomised controlled trials and a feature investigation exploring the underlying issues.2 3

After these articles were published, we and the Cochrane Collaboration received public assurances from Roche that the data from these 10 trials would be made available to physicians and scientists.4 Although some further data have been released to the Cochrane reviewers, the data that were promised (“full study reports”) have not been made available. . . .

The Cochrane reviewers now know that there are at least 123 trials of oseltamivir and that most (60%) of the patient data from Roche’s phase III completed treatment trials remain unpublished. We have concerns on a number of fronts: the likely overstating of effectiveness and the apparent under-reporting of potentially serious adverse effects. Meanwhile, oseltamivir has just been added to the World Health Organization’s List of Essential Medicines, alongside aspirin and β blockers.

On behalf of the Cochrane collaborators and public health decision makers around the world, I ask Roche to honour its publicly stated promise to make available the full clinical study reports. In order for the Cochrane collaborators to properly analyse these data they will need individual patient data in electronic format.

Oseltamivir has been a great commercial success for Roche. Billions of pounds of public money have been spent on it, and yet the evidence on its effectiveness and safety remains hidden from appropriate and necessary independent scrutiny. I am appealing to you, as an internationally respected scientist and clinician and a leader of clinical research in the United Kingdom, to bring your influence to bear on your colleagues on Roche’s board. As company directors, responsibility for Roche’s behaviour rests with you, as individuals and collectively. In refusing to release these data of enormous public interest, you put Roche outside the circle of responsible pharmaceutical companies. Releasing the data would do a great deal to restore confidence in the company and its board of directors.

As you may recall, during the Great Flu Pandemic Hoax of three years back, the World Health Organization and many national governments paid megabucks to stockpile the stuff. That's your money. It's you who got ripped off.

Personal note: I'm still without electrical power but I think of it as a kind of penance. My neighborhood wasn't burned to the ground or washed into the ocean, my children didn't disappear into the raging waters, I didn't lose my business and I'm not freezing or starving. I'm blogging from work where I can also take a shower and get a good meal. Not so for millions of people.

Res Ipsa Loquitur

I get a lot of e-mail. Should I go for this?

Dear Michael,

I’m getting in touch to introduce you to our client Vault Couture. Vault Couture is an innovative, luxury membership service designed for those seeking the ultimate wardrobe-management solutions. Founded last year, the idea of Vault Couture came about when the Founder, businesswoman Mounissa Chodieva, realised that there was to date no service which would provide her with the very best assistance in managing her wardrobe needs.

These needs, shared by the majority of her time poor, professional friends, included lack of storage in her London home – which simply didn’t offer enough cupboard space for her ever increasing wardrobe! She found, like many women, finding an outfit to wear in the morning from her vast wardrobe was a stressful affair, coupled with the fact she was fed up of having to take lots of luggage whenever she travelled on business in order to ensure she had the right outfit for all the occasions on the trip. Mounissa noticed there was a gap in the market for a service which could manage her wardrobe as well as assisting her with styling what she already owned and getting rid of garments which she found she never wore any more.

And so, the idea for Vault Couture was born, a membership service which offers an easy way to find an outfit from your wardrobe in the morning as well as style looks for the day/week/month ahead - eliminating that ‘panic dressing’ we all suffer from due to lack of time. In addition she created a state-of-the-art storage facility in London for her clients without enough space in their home wardrobes or who didn’t have a home in London and only come to the city on business. Vault Couture now offers a fast and reliable collection and delivery service of garments to any worldwide destination – all at the click of a button.

I would love to tell you more about the company and hear if this is could be of interest for your readers, please find attached more details on the services offered by Vault Couture along with a few images.

I look forward to hearing from you.

Best wishes

Valeria

I'm sure all my readers will be very interested.

It does make me sad

My grandmother's sister lived in Ventnor, New Jersey, the town next to Atlantic City. As a matter of fact they lived on Ventnor Avenue, with which you are familiar if you have played Monopoly. When I was a kid, we used to visit in the summer. Aunt Mary and Uncle Oby didn't have kids so they shamelessly spoiled us. Uncle Oby was a local macher so he had free passes to all the rides on the Steeplechase Pier. They took us -- me, my siblings and cousins -- to all the shows on the Steel Pier: Herman's Hermits, Dave Clark Five, Wilson Pickett. We'd go to watch the diving horse and walk along the boardwalk scarfing up the salt water taffy, cotton candy, Planters Peanuts (they had a guy in a giant Mr. Peanut costume) and Taylor fried pork roll (basically a Spam competitor but a greasy treat for a kid). It was the greatest!

Atlantic City hasn't been all about the wholesome family entertainment since they sold out to Donald Trump and the Mafia and brought in casino gambling in the '70s. But the Boardwalk and the Steel Pier were still there. Until Monday, that is. The Atlantic City boardwalk has been destroyed, and judging from the pictures, the Steel Pier is history.  At least half of it is gone and I'm guessing they won't rebuild it.

I don't know whether the ocean made it as far as Ventnor Avenue, which is the second avenue paralleling the ocean behind Atlantic Avenue. I don't know whether Aunt Mary and Uncle Oby's house is still standing. Of course they died a long time ago and I haven't been to Atlantic City since I was maybe thirteen. I did visit Avalon, further south on the Jersey Shore, when I was in college. But anyway that whole area is deep in my family lore and my fondest childhood memories.* Now it's gone, just gone. Gone. The governor has said the Jersey shore will never be the same, and I'm sure he is right.

Was this a natural disaster? Partly. But it was also one of the greatest monuments to human folly of my lifetime. Yes of course war is a great folly and we've had plenty of wars that have been even more destructive and killed far more people. But these events will just keep happening, all around the globe. Good luck to us all.

* Don't know what to make of it, but of course Bruce Springsteen's famous ode to Asbury Park is subtitled "Sandy." According to the narrative of the song Sandy was his goodbye girl as he prepared to set out to make his fortune. "For me this boardwalk life's through, you ought to quit this scene too." The Asbury Park boardwalk is gone too, but I expect they'll rebuild that one. Haven't heard what happened to the Stone Pony.

Update:  Friend Steph says the section of the AC Boardwalk with the main attractions is in decent shape. That's good to know. Of course the social and economic decline of the old Atlantic City was only accelerated by casino gambling, not arrested.

LBTA- part 3

My power went out last night so I'm blogging on batteries. The power company gives no estimate of when I'll get the juice back, no blame there I'm sure there's just starting to get an idea of what they are facing. The political future just got even more critical, it seems to me.

There is some tragedy here, and a lot of pain and a whole lot more inconvenience and economic cost. But it's also an opportunity, potentially a wake up call. We'll have to do a whole lot differently from now on, from improving Manhattan's defenses against the rising ocean to stringing power lines that can withstand a twig falling on them to moving development away from the coast, and a whole lot more of that mitigation and adaptation. That means a huge amount of public investment.

Most important, of course, we need to stop spewing so much CO2 into the atmosphere.

Electing Mitt Romney, who wants to drastically cut the budget for disaster aid and reduce FEMA to block grants because nobody likes FEMA anyway, and who says he doesn't believe that humans are causing climate change, and who says that the way to create jobs is to cut government spending, will destroy this one chance. Make sure it doesn't happen.

Live blogging the apocalypse -- Part two

So far (8:00 am eastern time) I'm cool. It's getting a bit breezy but not so as to bring down any timber. I've got my 'lectric, just had my morning cup of joe, and . .. whoops, there goes a big gust. The National Weather Service is promising me tropical storm force winds soon enough, so I'm staying home.

I hereby command you to read Joe Romm on this situation. He very much likes the term Frankenstorm. My grandfather was a professor of English literature, who had a wide range of interests from Chaucer to Faulkner. Along the way he wrote about Mary Shelly's Frankenstein. The novel's central metaphor is taken to represent the ways in which scientific and technological advances can unleash unforeseeable consequences. (It's subtitle, in case you didn't know, is The New Prometheus. The Gods punished Prometheus for giving fire to humanity but we're all getting it on the chin for our collective folly in this world.)

Romm explains why this unprecedented event is happening now. What is unprecedented about it? It starts out as the largest hurricane in known history. That means, not the hurricane with the most powerful central winds, but the hurricane with the largest extent of tropical force winds, hundreds of miles in width. It could form as late in the season as it did, and retain its power as a hurricane, because the ocean is much warmer than it has been previously -- some 5 degrees Fahrenheit off the mid-Atlantic coast. At the same time, the disappearance of arctic sea ice and the reduced arctic temperature gradient causes the jet stream to develop deep southerly loops. An unprecedented blocking high off of Greenland and a powerful winter storm with its central low pressure moving into the central U.S. are causing the hurricane to make a highly unusual west turn into New Jersey, where it is colliding with the winter storm to create a hybrid which has never been seen before.

We'll see how extensive the wind damage, including power outages, really turn out to be, and whether Manhattan is inundated by the surge. Meanwhile, I'll be catching up on my reading. I'll let you know what Habermas says about Lifeworld and System. And I'll try to get back to you once the woods start crashing down around me, if the technology holds up well enough.

Live blogging the apocalypse

I expect to lose electricity some time tomorrow, there's no telling how long the computer battery will last or whether Verizon will be able to get me to your Intertubes anyway. So I might as well get it while I can.

I have a five gallon can of potable water in the kitchen, a bucket in the bathroom for toilet flushing and two big tubs on the porch to scoop more out of. I'm building up the ice supply, have non-perishable food laid in and plenty of candles. The wood rack is full so I don't have to brave the elements. I'll just sit here and listen to the trees crashing down. Should be fun.

My aunt owns a beachfront house in Clinton, CT. No, she's not rich. She's the widow of a preacher, they had a bachelor friend who left the house to them. Fortunately her property is on a bluff about 20 feet above sea level. Her house should be okay but I expect the surge will overtop her seawall and possibly wash out her stairs and take away a chunk of front yard. Anyway she and my mother are going to stay at my cousin's house, well inland. They have a generator. Don't want to think about all the old folks who are going to have to ride it out alone. If you know any such people, check on them please.

What's really annoying about this is that we're getting used to it. I didn't get a generator after last year's serial collapses of civilization because I figured, what's the chance of it happening again? Well I'm a fool. We're all fools, who brought this on ourselves. Maybe we'll wake up.

First thing to do, when you do awake: take a solemn vow never, ever, to vote for any Republican candidate, for any office, under any circumstances. Republican=Koch=death.

We don't give medical advice . . .

. . . but, you might want to know that this pretty good study finds that taking benzodiazapines -- i.e. tranquilizers like Valium -- increases the risk of dementia by about 50%.

Guidelines call for these drugs to be used only on a short-term basis, but they are very widely prescribed, they are addictive, and many people take them for years on end. As a matter of fact many people doctor shop to get excessive benzo prescriptions just as others seek opioids.

This study doesn't absolutely drive the final nail into the coffin. It's difficult to correct for confounding by indication in this situation because symptoms that may foreshadow dementia could also be reasons for prescribing and taking these drugs. However, this study is carefully designed to account for that problem as much as possible, and it adds a more powerful and robust finding to a growing body of evidence.

As far as I'm concerned, dementia is the worst thing that can happen to you. It's also really unfortunate for your family and friends, and for society. Now we actually have a way of avoiding a substantial number of cases, by not taking tranquilizers. This is personal, by the way. My father died after a long, horrific journey with dementia. At one point, when he had a crisis, my mother's doctor gave her a big box of Valium. I'm happy to report that I advised her not to take it, and she threw it away.

Unfortunately, it's very difficult to get from findings such as this to real changes in clinical practice.

Theodicy

Indiana senatorial candidate Richard Mourdock has actually done us all a favor by forcing a public discussion about theology. That is a realm that has heretofore been off limits in politics. I'll bet a  lot of people might be interested to know more about the Mormon religion, but we aren't allowed to talk about it. Now we at least get to talk about Christianity.

In order to be a Christian, you absolutely must compartmentalize your thinking, so as to wall off what would be fatal conflicts if the wrong pieces ever came in contact with each other. Think about natural disasters. The reporters will go to a town that has been devastated by a tornado, and the survivors will all be giving thanks to God for protecting them. Of course, the people next door, maybe including your aunt and your cousins, are all dead or maimed. Hmm.

The miners are trapped underground.. A crew of 100 shows up with drilling equipment and works without sleep for five days, and gets them out, except for the guys who died in the initial collapse. Everybody thanks God for saving the miners. Hmm.

Your daughter is raped. Amazingly, even though it's a legitimate rape, the normal means the female body has to "shut all that down" fail in this case, and she's pregnant. God is all powerful, all knowing, and therefore one can only conclude that God intended for that to happen.

As a matter of fact, God knew at the beginning of time that after he got Mary pregnant, king Herod would get wind of it and murder all the babies in town. He intended for that to happen. God knew that Hitler was going to try to murder all the Jews in Europe. He intended for that to happen. God intended for me to lose my hair, for that matter, and he intended for you to get poison ivy. He intended it all. Hmm.

If it isn't on TV, it isn't happening

I was almost afraid to look at Climate Progress because I figured Joe Romm would be apoplectic over the "debate" last night. (I put the word in quotation marks because Romneybot 4.1 seemed to agree with Obama on everything except the quality of his rhetoric. But I digress.) Yes, it seems that "foreign policy" consists of vague conversations about the Middle East including whether we will do everything Bibi Netanyahu wants us to, whether we're gonna call China names, and how many navy ships we need for unstated purposes. I know Bob Schieffer is a much more serious person than me, but I would have asked about:

Anthropogenic climate change

Resource depletion

The global threat of communicable diseases including the faltering effort to eradicate polio, drug resistant TB, malaria, and other pathogens

The Mexican drug wars and the deleterious effects generally of the illicit drug trade in much of Latin America. (We, of course, being the consumers. Not that decriminalization could have come up as part of the solution. Sigh.)

The European financial crisis, granted not much for the U.S. to do about it but maybe there's a lesson there for the austerions? (Note that the candidates did manage to work in the U.S.  federal budget deficit as the greatest threat facing our children. Feh.)

The poverty killing children and crushing their lives in sub-Saharan Africa, Afghanistan, Pakistan (no, they can't eat bullets or hellfire missiles), parts of India and elsewhere in the world

International cooperation on science and technology

Russia is looking increasingly authoritarian and crony capitalistic, but is this a problem we need to worry about? Why or why not? How about continued nuclear arms reduction and other measures to achieve mutual reductions in military expenditures and increase security?

Global nuclear arms control, reduction, and eventual de-nuclearization of the planet? Nahhh, that's silly.

We really need to extract our collective heads from our collective posteriors.

"Doping"

The last time I wrote about Lance Armstrong, I was in essence responding to a friend who was a fan, who believed Armstrong was being persecuted. Now, on the one hand, having seen the USADA report, there seems no room for doubt that Armstrong was essentially the ringleader in a continual conspiracy by his team to get away with using banned performance enhancing drugs and autologous blood transfusions. There also can be no doubt that he has been a habitual, remorseless liar throughout his career.

Could there be an "on the other hand"? Well, yes, sorta kinda. The fact is it's a more than fair bet that every elite cyclist in that era broke the rules, or at least the majority of them. The TdF will be very reluctant, I expect, to declare the second place finishers in Armstrong's races the victors. Note that baseball, faced with a similar situation, has not invalidated any records or games from its own era of pervasive PED use. That was just the reality at the time, and it cannot be undone.

That said, every elite athlete's extreme capabilities depend on all sorts of scientifically tested artificial interventions, from diet and training routines finely tuned by biological measurements, to surgery, high altitude training, computer enhanced rehearsal techniques, you name it. The authorities don't necessarily get around to banning some substances until after they've been in use for a while -- the rules can change. So the question is, why exactly are some methods of enhancing performance allowed, while others are banned?

Some people argue that performance enhancing drugs can be harmful to health over the long term, so we don't want to encourage young people to use them. Maybe so, although the evidence in the case of some methods is weak. It is true, for example, that excessive use of EPO over the long term is harmful to cancer or dialysis patients -- you want the right amount of red blood cells, not too many. However, there is no evidence I'm aware of that episodic use by fit young people is dangerous. I haven't heard of cyclists having strokes or heart attacks.

And the fact is, while it's good to exercise and be physically fit, the extreme training routines and competition of elite athletes are actually detrimental in the long term. When they get older, athletes develop osteoarthritis at a very high rate, and of course they may have sequelae of concussions or other injuries, depending on the sport. American football is just starting to make some efforts to reduce this toll but it cannot be eliminated. Heck, we even allow boxing and mixed martial arts -- just participating in those sports is far more dangerous than using steroids or EPO.

So there is something arbitrary about this. Many people have proposed relaxing the rules for professional athletes, perhaps banning only those methods that have good evidence for long-term harm. I'm not taking a strong position here, but the fact is, athletes take physical risks and make physical sacrifices knowingly, all the time. It's in the nature of being an elite athlete. In fact, that's part of what thrills us about them. We know they are courting danger and paying a price.

Yes, the rules are the rules and Armstrong broke them. But as long as the rewards for championships are so great, people will keep looking for a way.

Update: A commenter points out that apparently, there were indeed some deaths of cyclists linked with EPO use back in the 90s. So I erred about that. Apparently the reason it stopped is that they did start monitoring hematocrit levels (i.e. the red blood cell count). So if EPO use were to be allowed, that would certainly have to be strictly enforced.

Epic take down

Two of my colleagues here at what is actually the World's Greatest University, and my old friend John McDonough at the institution which only pretends to the honor, fillet Mitt Romney like a salmon on health care policy.

Props to NEJM for letting you read it yourself, but I feel I should contribute some value  added so a couple of highlights:

"Though Romney has offered many opinions and comments as a presidential candidate, he has not provided any detailed blueprint of his plans for U.S. health system reform, and his proposals provoke more questions than they provide answers."

That's one of the great things about Romney -- you could cut and paste that statement onto a discussion of just about any of his policy proposals. Anyhow, they do manage to find, after combing through his various statements, five "essential elements of his policy intentions."

1. Repeal much of the Affordable Care Act, especially the parts having to do with expanding insurance coverage.
2. Convert Medicare into a "defined contribution," i.e. voucher program.
3. Make individually purchased insurance tax deductible [hey wait a minute -- I thought he wanted to eliminate tax deductions and simplify the tax code].
4. Take away states' power to regulate health insurance markets [hey wait a minute, I thought -- oh never mind].
5. Massively reduce federal spending on all health programs.

Does that sound good? Are you for it?

He says he'll repeal the $716 billion in Medicare savings that are part of the ACA, which he goes around falsely implying that represent a cut in benefits. (It does not.) Sayeth our informants: "Rescinding these savings would advance the insolvency of the Medicare Part A Hospital Insurance Trust Fund from 2024 to 2026 and trigger a $323 increase in premiums for most Medicare beneficiaries . . . "  Does that sound good? Are you for it?

Converting Medicare to a defined contribution program would shift growing costs to beneficiaries starting in 2023.

Turning Medicaid into a block grant and capping the federal contribution would swell the ranks of the uninsured by something on the order of 20 million people and cut benefits for those who were left, along with payments to providers.

He believes that "health care goods and services should be traded in an open market, where competition drives choice, efficiency, quality and price." That would not explain why choice, efficiency, quality and price are best in countries that have the most tightly regulated markets and socialized insurance, and why we, who in fact already have the least regulated market do the worst on those measures.

Finally, "If his proposals for a balanced budget, defense spending hikes, and non-defense spending reductions are achieved, all non-defense programs except Social Security would require cuts averaging 29% in 2016 and 59% in 2022. Included would be Medicare, Medicaid, the National Institutes of Health, Centers for Disease Control and Prevention, the Veterans Health Administration, and every other federal health program."

So all you doctors out there, who want to hold on to your sailboats. Are you for this?

Chalk one up for the nanny state

I think you're going to be stuck with the abstract only but that's okay. Here's all you need to know. From 1988 to 2010, data from the National Health and Nutrition Examination Survey (NHANES), show that the average level of "bad cholesterol" (Low Density Lipoprotein, LDL-C ) in U.S. adults declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend). 

First of all, I should point out that NHANES is a socialist government plot to obtain information about the health of the American people, presumably so they can nefariously use it to find ways of making us healthier. 

The well-known liberal bias of reality is fully on display here as well. The question is, why did this happen? It's not just because more people are taking statins - the trend was also observed in people who are not. It's obviously not because people are exercising more and losing weight, or generally eating a better diet, because, well, they aren't. Au contraire.

But what did happen, and what appears to be the only plausible explanation (not proved, of course, just a sensible conclusion) is that this results from the purging of trans fats from the American diet. This happened partly because of public information campaigns in conjunction with requirements for nutritional labeling; and partly because of local governments imposing regulations on  fast food restaurants; and in general because CDC and USDA put out so much information about the evils of trans fats that food manufacturers started to brag about taking it out of their products. Check out the potato chip aisle if you haven't already noticed that.

This doesn't just make you healthier, even if you're a Republican. It saves you money on your health insurance and your taxes, because you aren't paying for as many heart attacks and strokes. I remember when regulations on fast food restaurants were happening getting into fights with commenters here (I used to have more of them, including trolls; those were the days) who thought they were being ruthlessly deprived of their personal freedom to eat french fries cooked in trans fats. They seemed unimpressed by the argument that they wouldn't be able to tell the difference but would live longer. Well suck on this, pal: you weren't able to tell the difference, and you're alive.

Stayin' Alive

Have I used that title before? Anyhow, I've been remarking lately on the astonishingly unique times in which we live. Here's another contribution to the wonderment from an international group of scholars writing in the Proceedings of the National Academy of Sciences. (Yes, you can read it.)

We just take it for granted, but in the wealthy countries, human life expectancy at birth has increased by about 3 months per year since 1840. This means that until the late 1800s, the human life expectancy everywhere was about the same as that of hunter-gatherers, in other words probably about what it had been since the emergence of anatomically modern humans more than a quarter million years ago. A 30 year old hunter-gatherer has about the same probability of death as a 72 year old Japanese. Life span at birth for a hunter-gatherer is about 31. For Swedes, it was 32 in 1900, and it's 82 today.

We don't know exactly how to explain this -- no doubt it's a combination of everything you can think of -- better nutrition, housing, sanitation, medicine, probably lower rates of violence (at least that's what Stephen Pinker thinks, WWII notwithstanding). But it's absolutely astonishing.

The authors' main point is that our assumptions about senescence -- that genetic patterns that are beneficial at young ages, and particularly in the highest reproductive years, are not necessarily beneficial at older ages, so we just fall apart and die -- can't exactly be true. The reductions in death rates have occurred at all ages, and are actually greater past reproductive age.

Keep in mind, we're talking about Sweden and Japan here -- in the U.S. by the way we haven't done nearly as well, but well enough I suppose. But this has completely revolutionized society, culture, the economy, in ways we scarcely notice. I recently embarked on a new and demanding career at the age of 55, and I have complete confidence that I'll hang in long enough to leave a good legacy of accomplishment. As Tom Lehrer put it, "It is a sobering thought, for example, that when Mozart was my age, he had been dead for two years." But that was no great tragedy in Mozart's day, it was typical.

Will this last? Stay tuned.

A couple of minor issues nobody's talking about . .

. . . in the presidential campaign. Like, none of this is happening.

1. Anthropogenic global climate change and everything having to do with it.
2. Resource depletion and unsustainability generally -- water, soil, phosphorous, feeding the world's people
3. Major public health challenges -- drug resistant pathogens including TB, malaria, MRSA, and other really scary stuff; lack of potable water and sanitation; obesity and type 2 diabetes; others I could name
4. The real problem with our health care non-system: unsustainable waste and inefficiency. That is also our real fiscal challenge, not discretionary domestic spending
5. The president acting as judge, jury and executioner and secretly ordering robot planes to blow people up in distant lands, often blowing up people who are innocently attending weddings and funerals.
6. The outrageous inequality of incomes and the hollowing out of the middle class. And no, raising top marginal tax rates a couple of percent isn't getting at the problem. 
7. Racism

I'm sure you have a couple of your own. But really, what does any of this matter?

Debate This

Folks on the port-side are feeling pretty good about the Vice Presidential debate last night, just as people to starboard were all excited over the first presidential debate. Me, I care how the election turns out but this debate schtick just frosts my pumpkin.

My idea of a debate is that people marshal facts, logical arguments and, if applicable to the question, values on behalf of a controversial proposition. The winner is the person who makes the most compelling argument. The elements of a compelling argument are:

1. True facts
2. Correct logic
3. Values I happen to agree with

So why did Mitt Romney and Joe Biden "win" their respective debates?

You could go through the transcript of the first presidential debate with a microscope and I doubt you'd find Mitt Romney saying anything factually true or logically correct. I was more inclined to find Joe Biden's arguments, to the extent he actually made any, compelling, but that's not why he "won" his debate.

The fact is the voters they are trying to win over don't have a clue what's true or not or how to decide that, and couldn't tell a logical argument from doubletalk. The winner, in both cases, was the guy with the most impressive swagger, the one who gave the beat down, the guy who swung the biggest stick. And that's what the press coverage says too. Sure, Romney was more full of shit than a port-o-potty but that's irrelevant. Biden was large and in charge although he laughed too much. On the other hand Ryan drank too much water.

This is a totally idiotic way to to choose a president. These "debates" are worthless.

Separated at birth?

Reason vs. Madness

That would be Barack Obama and WM Romney, arguing for their health care policies side-by-side, which you can read right here in the new NEJM. (And yes, they have kindly invited to masses to read it.)

I hereby assert the privilege of the chair to make the following comments:

Obama provides a coherent, focused, spirited defense of the Affordable Care Act, and proudly claims the label of Obamacare. He also directly, cogently and unabashedly criticizes the claims of his opponent. My conclusion? He didn't write this himself, because he sure as hell never talks this way.

Here's a taste:

My opponent in this election, Mitt Romney, has a radically different vision for the future of our health care system — even if it means running from his past as the architect of health reform in Massachusetts. He would begin by repealing Obamacare on day 1. Your patients would once again be charged excessive copays for preventive care, and millions of Americans would be one illness or injury away from bankruptcy. He would undo the progress we are making toward a more coordinated delivery system. Romney and his running mate, Congressman Paul Ryan, have proposed a budget that could force drastic cuts to investment in medical research, eliminating 1600 National Institutes of Health grants and slowing our progress on scientific and medical breakthroughs. They have pledged to turn Medicaid into a block grant and slash its funding by a third — plunging tens of millions more Americans into the ranks of the uninsured and leaving our hospitals and health care providers to grapple with an increasing burden of uncompensated care. And they are committed to ending Medicare as we know it by turning it into a voucher program, with insurance companies set to make millions while seniors and people with disabilities are forced to pay thousands more every year.

Romney, as usual, is long on rhetoric, short on specifics, and wrong when he does offer any up. He claims the PPACA increases taxes by $1 trillion, which will "hit the middle class hard and drive medical innovation overseas." This is of course utter nonsense. The major revenue sources in the bill are an added tax of 3.8% on unearned income for high-income taxpayers, which I suppose does include people who Romney thinks are the "middle class"; an annual fee paid by insurance providers, which fund the Patient Centered Outcomes Research Institute; and a  40% excise tax on health insurance annual premiums in excess of $10,200 for an individual or $27,500 for a family, which is not designed to actually raise revenue but to discourage employers from providing such "cadillac" plans. There are various smaller taxes on medical device makers and odds and ends, but the total of new revenues over ten years is $392.1 billion, which is less than 2/5 of $1 trillion. So he's just flat out lying -- in the pages of the New England Journal of Medicine. If his article were peer reviewed, it would have been rejected.

The Act doe raise the Medicare tax by .9%, which makes it more reflective of reality. I kind of wish it didn't do that, since the tax is regressive. However, the poor and middle class will save money as a result of the act, and get affordable health care, more than offsetting anything they have to pay.

Romney repeats the lie about $716 in cuts to Medicare, which I don't think I have to re-debunk here.

Then he says:

If elected President, I will repeal Obamacare and replace it — not with another massive federal bill that purports to solve all our problems from Washington, but with common-sense, patient-centered reforms suited to the challenges we face.
In the health care system that I envision, costs will be brought under control not because a board of bureaucrats decrees it but because everyone — providers, insurers, and patients — has incentives to do it. Families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans. As a result, they will be price-sensitive, quality-conscious, and able to seek out the features they want. Insurers will have to compete for their business. And providers will find themselves operating in a context where cost and price finally matter. Competition among providers and choice among consumers has always been the formula for better quality at lower cost, and it can succeed in health care as well.

If people decide not to take their employer's health insurance, but to go out on their own and try to buy insurance on the non-group market, it will cost them vastly more, and if they have any pre-existing conditions, they won't be covered. They'll also face life-time caps, and the possibility that their policy will be canceled if they get sick -- in other words, all the problems the PPACA was designed to solve. These "competitive markets" Romney talks about have always existed, and they exist today, and they do not have the results he claims they do. He is not proposing anything specifically that would change that. So it's nothing but BS.

Will Obama be able to articulate that in next televised debate? Stay tuned.

System and Lifeworld, and electoral democracy

Or republic, or whatever you want to call it. As some readers may know, "system" and "lifeworld" are key terms in the philosophy of Jurgen Habermas. (It's a long story, but his theory of communicative action and in particular his development of speech act theory are important in my own work. Here I will go off on a different application.)

For most people, the forces that create the high-level context of their lives are largely inscrutable. Somehow human society produces the built environment of roads and sidewalks and corner stores; the job market in which they struggle to provide for themselves; the commercial products which are available and affordable or not; war and peace; and the mass media content that is constantly drilling into their brains.

People obviously have various theories about all this. To a large extent, they get those theories from their lifeworlds -- the interacting, communicative environments in which they do have competence and some degree of control. Together with our family, friends, coworkers, and to some extent people with whom we interact in a formal capacity such as teachers and health care providers, we mutually create our lifeworld. If, in our lifeworld, the earth is 6,000 years old and the reason we can't find a job is because rich people pay too much in taxes, well, that's how it is.

But the lifeworld is obviously not autonomous. At the system level, people are working to shape it through what Habermas calls strategic (as opposed to communicative) action. Vast forces contend for influence over our lifeworlds, whether it's Coke or Pepsi or God wants you to vote Republican. Ultimately, the processes that produce an electoral outcome owe only a passing and usually non-dispositive accountability to verifiable reality.

Yes, people's values differ and they decide what is in their own self-interest, so if they don't want gay people to get married they really don't want that. That's a component of their lifeworld, or it isn't, and strategic action has more capacity to mobilize it than to create it. (Although scare tactics are certainly employed. [The passive voice is chosen deliberately.]) A champion of democracy has to accept that voters will act on such feelings, and if you don't like it, that's the price you have to pay for democracy.

But the question of whether further cutting millionaires' taxes, as opposed to spending more on mass transit and public education, will do more to reduce unemployment is what Habermas calls a "first world" criticizable validity claim. It's a claim about intersubjective reality, that has a particular kind of truth which is independent of your values or feelings. The same goes for Saddam Hussein's weapons of mass destruction and the effect of carbon dioxide emissions on the climate. And it turns out that in U.S. politics, right now, such truths don't matter very much. And that's a disaster for us all.

Talking points

A couple of completely meaningless events happened in the past couple of weeks, both of them courtesy of the Bureau of Labor Statistics. Despite being completely meaningless, they are very meaningful, because they force the Romneybot to produce different text outputs.

Last week (IIRC, doesn't matter exactly) the BLS did its routine revision of quarterly employment numbers and concluded that more people are employed today than were employed when Obama took office. Again, this is meaningless. The job market was plummeting like a meteorite when Obama took office. It stabilized after a couple of years and began a slow recovery. I'm not going to argue here about the effect of federal policy on this or who did what to make federal policy what it has been -- that's beside the point. Whatever you may think about that, at some point the number of employed people was going to exceed the number on January 20, 2008.

Today, the BLS announced that the unemployment rate fell to 7.8%. Again, I won't go into how the unemployment rate is calculated, what it really means, or who or what is or is not responsible for the number now being below 8%.

The point is, Romneybot has been outputting the message that there are fewer Americans working today than when Obama took office. Again, a completely meaningless fact but it registers in people's frontal cortices as a failure on the part of Obama. Romneybot can no longer output that text. Similarly, the bot has been outputting that unemployment has been above 8% the whole time Obama has been in office. That output also ceases. Is there some reason why the difference between 8.1 and 7.8 is greater than the difference between, say, 8.5 and 8.2? Okay, it is actually proportionally more, but that's not what people hear -- it's the first digit  that matters. The same reason stuff costs 99 cents, or $99.98. That's a lot cheaper than $1.01, or $100.27.

So while Eric Fehrnstrom figures out how to re-write the stump speech, we should all contemplate the absurdities of our minds. Yes, it's good news for Obama, whether or not it should be and whether or not it means you personally have a job yet. But as I always say, history turns on the arbitrary and the illusory.

More on scientific fraud

It turns out I'm not just imagining things, it seems there is more of it lately -- or at least it's being caught out more. According to this study, the rate at which scientific papers are retracted has increased ten times since 1975. And contrary to the conventional wisdom, 2/3 of retractions are due to fraud, plagiarism, or duplicate publication, not unintentional error.

The rate went up noticeably after 2005, when Congress flatlined NIH. This is unfortunate but not unsurprising. The dynamic is that a period of increased funding for research increases the supply of Ph.D. students, post-docs and junior faculty who are looking to make it as scientists. When funding gets tight, some of them get desperate. Right now NIH is funding less than 10% of proposals, and if you can't get yours into that very lucky category, you can't have a career.

There's more to it than that, or course. For instance, there is also institutional culture. The report says that 43% of retractions came from just 38 labs. That means thousands of labs and research centers had none. (Mine included, I'm happy to say. Indeed, as far as I know, my entire university remains pure as the Antarctic snow.)

A commitment to stable federal support for research, growing with inflation and GDP, would help a lot. Then we'd have a world in which the number of people who make it onto the first rung of the scientific career ladder is reasonably matched to the number who can look forward to having a decent career, allowing for the appropriate level of attrition and people who just don't cut the mustard. But that's my selfish, parochial point of view. More important, we would continue to make steady progress in basic and clinical sciences with less wasted effort and investment, and maybe some day we'd have effective treatments or prevention for Alzheimer's disease or diabetes or cancer or MS, and people would get the right care that met their particular needs, at lower cost.

Wouldn't that be nice.

Am I missing something here?

A tragic and bizarre story has dominated the local news in Connecticut for the past few days. A woman in the affluent town of New Fairfield heard somebody trying to break into her house in the middle of the night, so she called her brother, who lived next door. The brother grabbed his hand gun and came on over, where he found a man dressed all in black, wearing a ski mask, and holding a shiny object in his hand. The brother shot the intruder dead. The intruder turned out to have been his 15 year old son, who was carrying a knife.

Nobody knows what the heck the kid was up to, so yeah, it's weird. The police will not charge the shooter -- self defense, home is your castle, stand your ground and all that.

But what nobody has said, as far as I have discovered, is this:

If you think somebody is trying to break into your house, should you call your brother, and have him come over and shoot the guy? Or should you call the police --  you know, 9-1-1? They work nights, and they'll come over right away. And they're specially trained for this sort of thing.

I know, that's socialism and communism and the NRA will make sure I can never run for public office. But I mean come on! What the hell is wrong with us?

Like I always say . . .

. . . we don't really have a federal spending problem or a long-term structural deficit problem in this country. Well yeah, we have a ridiculously bloated military and rich people don't pay enough taxes, but getting past those obvious facts, what we really have is a health care spending problem. Medicaid is the biggest problem for state budgets right now, and Medicare + Medicaid is the long-term problem for the federal budget. Get our health care spending down to that of the rest of the civilized world and everything else is much more tractable.

And, as I have also said, the Affordable Care Act is not the solution, but it's a start -- it gives us  a framework to build on. The Urban Institute agrees with me. The problem is, this won't fit on a bumper sticker. In fact, the prospects of actually getting more than 5% of voters to understand anything about this, or even to want to, are dismal.

Basically, the Act lays down the following foundations:

It restrains growth in Medicare payment to providers, mostly hospitals and nursing homes. Republicans, of course, portray this as "cuts" to Medicare, but it doesn't cut benefits at all. The idea is that the providers will become more efficient, reduce useless and unnecessary services -- and that can indeed happen. There's plenty of room for it and they've already started. (BTW, yesterday a provision kicked in that essentially fines hospitals for excessive short-term readmissions for people with heart failure and some other conditions. We'll see how it goes but they aren't really complaining -- they're already figuring out how to do this.)

It sets up greater competition among insurance companies and makes it easier for consumers to comparison shop through the "exchanges." And it already requires them to return more of their premiums for actual health care and spend less on marketing and profits. Soon, it will eliminate medical underwriting. All this cuts administrative expenses.

It taxes "Cadillac" health plans, correcting one of the perverse incentives resulting from the tax exemption for employer-provided health insurance.

It sets up the Patient Centered Outcomes Research Institute. Even though Medicare isn't allowed to actually use the information for coverage decisions (death panels and all that) one hopes that doctors will use it to deliver care more wisely.

How much will all this save? It remains to be seen, but growth in health care spending has already slowed. And as I say, it's just a start. Like all new legislation, it will require fixing and improving down the road. Hey, maybe we can even add a public option!

But it all depends on the election. Yes, it really matters.

The politics of Nowhere Land

Maybe it's too much to ask that voters, politicians and stenographers journalists have some grasp of history, but it would be so much better if political discourse was rooted in some idea of what the past has been, how we got to where we are, and oh yeah, where we are at.

I've noticed quite a lot of interest among the pointy-headed intellectual set lately in the broad sweep of economic history. The latest nugget is from Brad DeLong, who on the occasion of the death of historian Eric Hobsbawm has reprinted this review from 1995 of the lapsed Communist historian's Age of Extremes. I'm not particularly interested in Hobsbawm's ideologically induced brain damage as I am in the history DeLong reviews. I've come across several other essays on the general subject of what exactly it was that happened from the late 19th through late 20th Century that made our world.

And what a world it is. As DeLong says, it is not clear that people in say, 18th Century France or Virginia were materially any better off than Athenians. But today, Americans are arguably 20 times wealthier than they were in 1900. You can't really quantify it because a whole lot of our stuff didn't even exist then. Take it back to 1850 and you can't even make sense of the question. People spent a good many hours every day hauling water and firewood into the house and hauling out excrement. Bedrooms were unheated. There was no refrigeration, or even canning. You had to either eat produce within a couple of days or somehow preserve it by drying or pickling. If you wanted to communicate with someone in your own town, you had to physically go to their house and, if they weren't home, leave a message.  Agricultural techniques hadn't changed substantially since Roman times. If you wanted to hear music, you needed a village band or to wait for a traveling performer to come through town. Chances are you had never been more than a few miles from the place you were born. If you did move -- say from the east coast to the frontier -- it was a once in a lifetime journey filled with great peril. Now people of modest means fly back and forth from the west to east coast in a few hours, for the sake of a brief vacation or a one-day business meeting.

The political developments of the 19th and particularly the 20th Centuries were possible only in the context of this astonishing material transformation; and they were necessary in order to sustain it. But now many intersecting crises threaten the good life people have come to take for granted and assume must last forever. To take just a few of the most important, we have to begin with the fundamental dependence of the transformation on fossil fuel energy, which is not sustainable. Many other essential resources are being depleted, from water to soil to phosphorus.

That aside, industrial capitalism must grow or contract -- it cannot stand still. One could quite credibly argue that we have enough already, we just need to distribute it properly and turn our energies from creating more and more stuff to contemplating art and cultivating the virtues. But we have no mechanism of organizing society so as to make that happen. But fueling continued growth requires continuing technological innovation. You probably have central heating and indoor plumbing and major appliances and an automobile. The next generation of smartphone isn't gong to get you to spend more than a fraction of what you spent on that stuff. The Chinese and Indians have managed to find a way to grow and more of their people will be able to buy those things, or at least so it seems. But it's not clear they will be made in the U.S.A., and anyway that will top out in due course.

We haven't figured out how to allocate investment without creating both repeated financial crises and gross inequality. The prospect of the whole house of cards collapsing is quite real, though not for the reasons Ron Paul thinks. The threat is not the national debt, but the claim on non-existent assets represented by the immense accumulation of monetary wealth. That's what's driving Europe into depression -- the creditors demand to be paid money lent on bogus collateral, and the ordinary people, who had nothing to do with the whole scam, are being made to pay. This promises a downward spiral of misery with no clear end in sight.

We aren't having any sort of a discussion about the problems we actually face. The marginal tax rate on the wealthy does matter, but even that discussion is happening on nonsensical terms. It's time we all got real, folks.

Dare to hope?

With the Rombot cratering in the polls, most people started to look forward to the era of divided government, dangerous brinksmanship, and policy paralysis continuing. That would at least be better than what we had been dreading: full control of federal power by a coalition of psychopathic plutocrats and delusional religious fanatics.

But now the real possibility arises of a complete reversal of the 2010 election. Democratic control of the Senate appears likely, and now we are seeing well informed conclusions that the House may go Democratic. If this does happen, it will force me and like-minded people to file the sharp corners off of our cynicism. It will mean after all that reality and logic have enough of an intrinsic advantage in public discourse to overcome billions of dollars deployed in the service of lies and obfuscation at least some of the time.

Not that I'm expecting Democratic control to usher in a golden era, but at least it will delay utter disaster.

But consider also the importance of random events in history. A storm destroys the Spanish armada; Lieutenant Colonel Stanislov Petrov chooses to ignore an alarm and therefore, human civilization has survived. (Yes, this really happened. Do follow the link.)

Romney was already trailing and looking like a bad candidate, but it took an anonymous waiter or bartender and a reporter who happened to get on the trail, to destroy his candidacy with a (probably illegally recorded) video. More than Romney's candidacy got walloped of course, so did the entire right-wing narrative. I am quite sure that the tale of the 47% has done real harm to Republican congressional candidates and is very much behind the turning tide in down-ticket polling.

What if Petrov had pushed that button? What if we had never seen that video? It really does come down to "shit happens."

Medical Nemesis

I'll largely outsource today to Marshall Allen, who reviews the evidence that some unknown hundreds of thousands of people are harmed each year in the United States by medical errors. He bemoans that we don't keep track of all these errors, ergo it's hard to know how to fix them.

Okay, but his main premise is that people who are harmed by medical errors don't take advantage of the systems that are available to report them. That's just ridiculous. In the first place, most people have never heard of these systems. (Basically, you can complain to your state medical licensing board, and if you're a Medicare beneficiary, your state has what's called a Medicare Quality Improvement Organization.) Even if they have, most of the time they have no idea that they were harmed by a medical error, unless the doctor told them, which obviously isn't likely to happen.

If they do know it, or believe it, they might sue, but just making a mistake isn't enough to get a doctor successfully sued -- they have to be negligent, which is a whole other level. And who's going to go to the trouble of tracking down how to complain to the state licensing board? Especially since the truth of the matter is, the board won't do anything with your complaint anyway.

Hospitals are supposed to report certain categories of errors, but they don't. And how are you going to make them do it?

This is really a problem of the culture of medicine. Doctors make mistakes, they're human, and so do nurses and pharmacists. But we have had fewer and fewer plane crashes over time and now flying is safer than hanging out at home. We got there through a concerted effort by regulators and yes, the airline industry, which doesn't like plane crashes any more than you do. Of course, we don't have to worry about crashes being reportable, but the industry also documents errors that don't actually lead to crashes, as well as reverse engineering every crash that does happen and, at least eventually, fixing the problems that led to it on a systems level. Medicine can do that too.

Science Marches On

The 2012 IgNobel Awards are out, and I trust you will join me in a rousing round of applause for the winners.

I particularly commend to your attention this study, in which the investigators used functional magnetic resonance imaging (fMRI) to show that a dead salmon can determine the emotional experiences of humans depicted in photographs.

The point is that there is currently an avalanche of these studies, mostly funded by you through the National Institutes of Health, in which the investigators claim that they can detect which regions of the brain are active when carrying out certain cognitive tasks, reacting to particular stimuli, or having certain internal experiences. Here is a reasonably accessible explanation of how they have very often gotten it wrong. I'll try to fit it into a pistachio shell for you and just say that the method divides the brain into thousands of "voxels" -- small regions equivalent to 3-dimensional pixels -- and obviously, some of the same ones will happen to light up on the fMRI image of several subjects exposed to the same stimulus, purely by coincidence. There may be a very low p value for these correlations, which the investigators interpret to mean they are not coincidental after all, but that logic is spurious because they fail to account for having made thousands of comparisons.

This misuse of statistics is actually surprisingly common and manages to get past peer review in other fields as well. It just drives me nuts that it continues. Yeah yeah, the spurious findings eventually get forgotten because they don't lead anywhere. Once in a while somebody might even try to replicate them and fail, but that doesn't happen often because it is very difficult to get a study published that only replicates, or refutes, a previous finding. Editors are much more interested in original stuff, and they also don't like to be embarrassed by findings that call into question previous peer review and editorial judgment. (Viz my earlier post about the experiences of Russell Lyons.) We really need to shake up this culture.

Obamacare is not actually unpopular

I have been saying all along that people know they're supposed to hate it, but they don't know why. Michael Saks on the Health Affairs blog has a lot of interesting observations.

The first is that when people are asked what they actually want to happen with the ACA, 28 percent want it expanded. They disapprove of it because it doesn't go far enough, i.e. no public option or they are single payer advocates. Only 38 percent actually want it repealed or replaced with a Republican plan -- and since the Republicans haven't come up with any, I guess that also just means repealed. So it isn't unpopular after all.

But what about the people who really do think it "creates too much government involvement in health care," which is what a bare majority of people who disapprove do think. As Saks points out, it creates much less government involvement than does Medicare, and Medicare is overwhelmingly popular. So what's the disconnect? Easy. They don't know what is actually in the act. As we already know. More than a third think it contains death panels or other provisions it does not. Basically, people are just reflexively against government, or at least against Democrats.

When read lists of actual provisions that are in the act, overwhelming majorities are favorable. And, although majorities say they don't like the individual mandate, once it is actually explained to people, they end up supporting it.

So here's my question: Why won't Democratic candidates for office, including Mr. Obama, stand up and publicly mount a full-throated defense? It's a winning issue. The radio silence on this was devastating in 2010, and it's not helping now. Take credit for it, help people understand it, and promise to make it even better. That's the way to a House majority.

A series of unfortunate events

John Auerbach, Massachusetts Commissioner of Public Health, has resigned. I have known John for at least 15years, since he was Commissioner of Health for the City of Boston. He is one of the most effective, progressive and selfless public servants there ever could be.

The news of the reason for this tragic turn of affairs is disturbing and perplexing. The Department of Public Health operates a laboratory in Jamaica Plain where they do the usual public health stuff: test mosquitoes for West Nile Virus, test bats for rabies, nasal swabs for influenza, identify the culprit in outbreaks of food-borne illness, yadda yadda yadda.

Presumably because it was convenient, the legislature gave the DPH laboratory the job of testing samples of suspected illicit drugs for law enforcement. (Hey, they already have a laboratory, let them do it.)  This has nothing to do with the Mission of the Department of Public Health, so it would not be terribly surprising if the Commissioner and other high-level functionaries in DPH didn't spend their days paying a whole lot of attention to what was going on there.

Now it turns out that since 2003, a chemist working in that laboratory was apparently faking it. The full details of what she was doing have not been made public, but apparently she was not following test protocols, would do things like add drugs from another case to make amounts large enough to qualify for a more severe charge, and possibly just flat reporting negative results as positive. Nobody has said why she might have done this, but one has to suppose that she thought her job was to help the cops get convictions, rather than determine the truth.

Anyhow, now that this has been discovered, it's the biggest mess since the Harlem wastewater treatment plant caught fire. (Bet you didn't remember that one.) Bigger. Much bigger. She worked on something like 34,000 cases, and now the defense attorneys are lining up to get tens of thousands of convictions overturned. Nobody has even started to imagine the lawsuits yet, the mind cannot encompass it.

Now, I don't happen to think that non-violent drug offenders should be criminally prosecuted in the first place. What's actually most disturbing about this, to me, is that there were 34,000 cases for her to work on. What a catastrophic waste of public resources and destruction of people's lives. Drug enforcement is fundamentally racist and socially counterproductive. But it is happening, and now the Commonwealth is going to be snarled in litigation and paying out damages that will drown the courts and drain the public coffers for a decade.

Actually it will be all for the good if they have to empty out the jails of people whose only offense was to be caught with pot or pills. But the political consequences will be appalling.

The most appalling thing . . .

about Romney's no longer secret fundraiser? A whole bunch of rich people paid $50,000 apiece to have a malignant narcissist babble offensive nonsense at them.

The rich are not like you and me. Evidently they are a lot stupider.

Fat Chance

JAMA this week is  a theme issue on obesity. You pitiful rabble are not allowed to read most of it, but they will let you in on this:

 

 

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I have to tell you, that's a very shocking picture -- more than 1/3 of adult Americans are classified as obese by BMI. It's not a perfect measure -- a few of these people may be very muscular, but most of them are just plain fat. Yes yes, it's starting to look like people on the lower end of the official obesity index may be okay, if they have good cardiovascular fitness, but most of these people are not at that lower bound.

Now listen up. This didn't happen because our gene pool suddenly changed, or people suddenly because lazy and gluttonous. Yelping mindlessly about "personal responsibility" isn't going to fix it. And it isn't just tough luck for all these folks, it's tough luck for all of us, because they are at increased risk for disability, and for costing the health care system -- which means all of us who pay insurance premiums and/or taxes -- a whole lot of money.

This happened for a combination of reasons. Fewer people do physically demanding work. When not at work, people spend more time in front of various kinds of electronic screens. High calorie, low nutritional density food is everywhere, comparatively cheap, and aggressively marketed. Humans evolved mostly under conditions of caloric scarcity, so we're wired to eat too much when food is easily available.

The solution, if one is to be found, has to be in public policy. Mayor Bloomberg wants to restrict sale of gigantic tubs of sugar water, which people are seeing as a violation of their personal freedom and the first step down the slippery slope to communo-fascism. It does seem like kind of a crude measure that largely misses the point.

But there are potential approaches that get at the problem at a deeper level. Obviously it doesn't help that we've been cutting phys-ed in schools, and we can certainly make school lunches more nutritious. Safer neighborhoods with more physical recreational opportunities, better mass transit, subsidies for vegetable farmers rather than corn farmers, programs to help neighborhood store owners carry healthier foods, limitations on marketing junk food to children (good luck with that) -- there's a lot we can do. But it requires an activist government that's looking out for the common welfare -- in smart ways that increase our freedom rather than limiting it.

Yep, that's right. Liberty doesn't grow up naturally when government gets out of the way. It has to be protected, and nurtured, by democratic government. That's one way that Paul Ryan and his sidekick are completely wrong. 

Words are inadequate

My mother is 80 years old. She lives on a schoolteacher's pension, which is not in addition to Social Security, it's in lieu of it. Her savings were wiped out by my father's long, terminal illness with frontotemporal dementia. She pays no federal income taxes.

Willard M. Romney, who wants to be president of the United States, says "My job is not to worry about those people. I'll never convince them they should take personal responsibility and care for their lives."

I'm going to take personal responsibility and say that W.M. Romney is evil, ugly, ignorant, and has the morals of a tapeworm. He is worthless. Money cannot make him human.

Deep thoughts

The escape hatch for free market fundamentalism in the face of resource depletion and environmental degradation is the faith-based premise that technological developments will always come along to solve the problems. Too bad that cold fusion thing didn't pan out.

Quite a few people have noticed that the Mittbot seems to think he's still running in Republican primaries -- the Etch-a-Sketch never shook after all. The reason is obvious: the Christian religious fanatics, racist ultra-nationalists and ignoratti who constitute the Republican primary electorate couldn't be counted on to hold their noses and vote for him after all. He has to continually prove and re-prove his allegiance to them, and that is not a formula for winning in November. Hopefully that's true regardless of Sheldon Adelson's Chinese money.

How in tarnation can 15 guys carrying RPGs just walk onto a U.S.-run military base in Afghanistan and start blowing up $20 million jets? Don't they even have a perimeter? Meanwhile the Afghan police and military the U.S. is spending $4 billion a year to pay, support logistically, and train, seem equally as interested in killing Americans as in killing Taliban. Even after we supposedly "leave" in 2014 -- which actually means staying -- we're going to be spending that money to pay the Afghan forces because the Afghan government has absolutely no way of finding a fraction of that much dough. It might be helpful if someone would explain the reason for this.

The Republican position on Medicare is that we absolutely must cut Medicare spending drastically, but anybody who proposes to cut Medicare spending wants to put Granny on an ice floe.

Economics is a branch of theology, not science.

Spin Doctors

This page has from time to time opined about the pervasive overhyping of medical research by the corporate media. Every experiment on mice or Phase II trial gets reported as promising to eliminate cancer or make the blind see.

I have mostly assigned the blame to journalistic credulity or the commercial value of sensationalism, but this study in PLoS Medicine puts the blame elsewhere -- in the actual abstracts of the published studies. In my view, that doesn't let the reporters off the hook -- if they're going to write about medical science, they should be competent enough to read the whole paper, understand it critically, and interview the authors with perspicacity. (Look it up when you get home.)

But, there is something to this. I cannot tell you how many times I've downloaded a bunch of abstracts, gotten the articles that looked relevant for whatever I was thinking about, and found out that half of them don't deliver what the abstract promises. This is a big problem for several reasons, not the least of which is that few practicing physicians have time (or for that matter, the technical knowledge of research methods and statistics) to read research reports. They just read the abstracts. The presence of research results in the world is 99% just the abstract; hardly anybody actually reads the papers.

This happens because peer reviewers and journal editors, in my experience at least, pay no attention to the abstract. Journals usually have a required outline -- something like background, methods, results, and discussion -- but they have no standards about how the abstract should reflect what's in the paper. Abstracts often announce results on endpoints that weren't specified in advance, with p values. Without bothering your beautiful mind once again with Bayes, this is totally inappropriate. They basically never discuss limitations, alternate interpretations, adverse effects, or prior plausibility. They exist to sell the study, not to summarize it.

It seems to me there need to be standards about this in medical publishing. It's long overdue.

Vile, repulsive, and small

That would be WM Romney. He has always creeped me out, but it does bring me up a bit short to have to reconcile his basic incompetence with his success at accumulating vast wealth. It just proves that intelligence -- whether cognitive, social or emotional -- is largely unrelated to success at finance capitalism. The only qualities that really matter are greed, the luck to get an opportunity, and utter lack of conscience.

Now that we have that out of the way, some of the discussion of his latest mendacious assault on Barack Obama, in the midst of a very dangerous international crisis, by the way, makes a couple of category errors.

1) As I have said here many times, I think that all religions are equally ridiculous and I am not personally offended by mockery of religion as a general principle.

2) Yes, we have in this country both a constitutional protection against government suppressing political speech (although it has been inappropriately extended to commercial advertising), and a cultural norm in general against private suppression of speech, as by employers, schoolmasters, boycotts and so on.

3) However, that does not mean that some specific instance of mockery of religion cannot be legitimately called objectionable. Satire is ethical when it enlightens more than it wounds. Pious people do have sensitivities which compassionate people must respect, and we certainly won't get anywhere in the cause of persuasion by ignoring them.

Those principles aside, the film The Innocence of Muslims, as PZ tells us, happens to be offensive, false, and inane in many ways. It is deliberately offensive, in fact, and intended to provoke just the reaction it has gotten. U.S. diplomats everywhere, and particularly in predominantly Muslim countries, are doing the job of diplomats by condemning it and trying to make clear to people that the U.S. government does not condone it.

Romney is rightly taken to task for falsely implying that the Cairo embassy issued it's denunciation of the film after the attacks on that embassy and the consulate in Benghazi; and for falsely claiming that this constituted Obama's first response to the violence. It wasn't a response to the violence at all, nor was it in any way a statement by the administration, but only by local diplomats. However, that is actually all tangential. It would be completely appropriate -- indeed called for, in my view -- for the administration to condemn the film now. Not censor it, obviously, but just say that it's ugly and stupid and wrong -- just like Mitt Romney.

To my sibling Christians . . .

For I was hungry, and you gave Me nothing to eat; I was thirsty, and you gave Me nothing to drink; I was a stranger, and you did not invite Me in; naked, and you did not clothe Me; sick, and in prison, and you did not visit Me.’ “Then they themselves also will answer, ‘Lord, when did we see You hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not take care of You?’ “Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’

Perhaps this should have some bearing on how Christians vote, but from all I hear nowadays, it does not.

Can the people get clear on the concept?

As you may have heard, Mitt has been furiously flip-flopping on health care reform, telling Press the Meat that of course there are provisions of Obamacare that he wants to preserve, such as guaranteeing coverage for people with pre-existing conditions. Then a couple of hours later his campaign said he didn't exactly mean that, he meant this:

His campaign later told TPM he wasn’t signaling a shift in policy and was instead referring to his existing stance in favor of protections on preexisting conditions only for those with continuous insurance coverage — not for first-time or returning buyers. 

Do you see what is wrong with that statement? If you already have insurance, then by definition you have already not been denied insurance for a pre-existing condition. Any medical conditions that you develop after you have acquired your current insurance policy are, a fortiori, not pre-existing. 

Even Romney's critics, including TPM and Paul Krugman, have apparently failed to notice this basic semantic problem. Why is Mitt trying to have it both ways? Because a) guaranteeing coverage for people with pre-existing conditions is popular and b) it is impossible without the individual mandate, which is not popular and which he claims -- even though it's at the heart of his own Massachusetts reform which is otherwise essentially identical to Obamacare -- is a tool of the Antichrist.

What we need to get through the heads of the casually informed public is the following True Fact:

• If you require coverage for pre-existing conditions without requiring that everybody have health insurance  ->
• healthy people will not buy insurance because they know they can buy it if they get sick -> 
• only sick people will have insurance which means it will be too expensive for most people -> 
• ergo, you haven't really required coverage for pre-existing conditions because it won't be affordable and furthermore you will have destroyed the market for health insurance.

That's the reason for the individual mandate. There's no other way to do it. Good, affordable insurance requires universal buy-in. That's how the world works. Even if you're a Republican.

What really matters

It's great that the president at least mentioned global climate change in his acceptance speech -- specifically, he said it is not a hoax. But that was about all he had to say about it, and as far as policy, he introduced nothing new, just his previously stated intentions to support development of sustainable energy while also supporting more fossil fuel extraction.

Naturally he focused on the issues, largely of self-interest, that are likely to win over persuadable voters, and that means more and better jobs, and you'll still get Medicare and Social Security when you're old. Fine, but that's not going to happen if, say, agricultural production collapses or major coastal cities end up under water, and wars over dwindling resources engulf the planet.

The very unpleasant fact is that climate change is happening faster than just about anybody predicted even a couple of years ago. The scientists who study the arctic are completely gobsmacked. It's starting to look more and more compelling that positive feedbacks are driving an accelerated rate of change and that we could very easily undergo an abrupt transition to a very different state, with unforeseeable consequences.

There are plenty of Cassandras out there, my little voice won't much matter. But I will add my two cents. We have entered a peculiar age of apathy. I grew up in the midst of the Civil Rights Movement and the Anti-War Movement and the energized, grassroots left that flourished around them. The Great Depression generated an immense wave of progressive activism that powerfully shaped the government response to the economic disaster.

We have just as much -- indeed, hard as it is to encompass, even more -- to be worried and angry about today. But the response of  much of the broad public has been self-centered, tribal and divisive. Other than the very brief and apparently now entirely spent paroxysm of the Occupy movement, political activism has largely been limited to the feckless activities of blogging and tweeting and commenting on blogs. That's a fine thing to do, but it's only going to reach the people who already want to read what you have to say. We have got to find a way to build a real movement, and soon.

The strange case of Marc Hauser

As you may recall, Hauser was the well-known Harvard psychology professor and author of several popular books who resigned after he was accused of research misconduct. The National Institutes of Health has now completed its investigation, and yep, he did it.

In fact, it sounds worse than the accusations which have previously been made public. What we knew about was that he coded observations of monkeys without establishing intercoder reliability, and without being blinded to the stimulus, and that the results were not replicable when others viewed the videotapes. That is definitely unacceptably sloppy research, but may not have constituted deliberate fraud -- he could have been fooling himself. The investigation finds that he also outright fabricated some findings.

(I'll digress for a brief comment on research methods. In social psychology, sociolinguistics, and sociological research, we often want to classify behaviors, such as categories of speech acts, orienting toward a stimulus, categories of gesture or body language. Identifying these requires human judgment. In order for us to believe that the coding decisions really do reflect some underlying reality, and not just the idiosyncratic or possibly biased, we want to see the same data coded by multiple people and that there is a high level of agreement. That's called intercoder or interrater reliability. Second, if the point of the study is to show that a particular behavior results from a particular stimulus, we want the coder not to know what the stimulus condition is, to prevent conscious or unconscious influence on the results. Without both of those conditions, nobody should believe the findings.)

Okay, he's not the first person to commit scientific fraud, that's for sure. But what is, as far as I know unique about this case, and also strange, is the apparent lack of motive. Usually these sorts of cases involve post-doctoral fellows or junior investigators trying to win grants or out-compete their peers and get ahead. Hauser already had a large body of apparently sound work and he was a tenured professor at Harvard. And his prior work, reputation, and program of research certainly did not depend on a specific species of monkey being able to parse syllables or syntax, or whatever it was he was specifically looking at. A negative finding in this particular experiment would not have somehow caused him any major problems.

Why risk everything for so little, really nothing at all? People are hard to figure.

A confusing day at the Gray Lady

Reading the Paper of Record™, I learn that organic meat and produce is no safer than conventionally grown food, according to a meta-analysis. Turning to the science section, I learn that feeding antibiotics to farm animals is causing an alarming rise in contamination of meat with antibiotic resistant bacteria, and more presence of such superbugs around generally.

What's a pointy-headed east coast liberal to think? I think what we have here is a serious case of missing the point. While it is probably true that the nutritional value of conventional and organic meat and produce is generally similar, and that the amount of pesticide contamination of conventional produce is small enough that it doesn't cause demonstrable problems for the typical consumer, that isn't really what organic farming is all about.

It's about the relationship of farming to the social and biological environment as a whole, not just to your individual biology over the next 24 hours. Aside from antibiotic resistant bacteria, we're talking about broad ecological impacts of pesticide use, soil quality, erosion and runoff, eutrophication of bodies of water, social and economic consequences of the scale of farming, fossil fuel consumption, air pollution, substitution of capital for labor -- a whole lot worth worrying about and arguing about. Whether that particular head of lettuce has as many vitamins as the next one is not the issue.

Got it?

By the way, on a personal note, yesterday I made dinner for my family -- my mother, aunt and cousins -- mostly using stuff I grew myself. It tasted fantastic -- fresh pesto made with home grown garlic and basil, home grown sweet corn, home grown salad. All of it 100% organically grown of course. Everybody went home very happy. Economics and the nutritional value of a given hunk of biomass don't begin to tell the story. It's the story of how we live, in our entirety.

The answer to one puzzle

Last night I had a chance to catch up with my farmer friend Festus at a party. I haven't seen him for quite a while -- Festus and his wife just work when they aren't sleeping. 

He only has a high school education but I've found him pretty savvy about politics and policy, fully aware of the plutocracy that's out to screw hard working basically poor people like himself. But last night a Glenn Beckish streak emerged that I hadn't noticed before.

It started with his foaming at the mouth outrage that he would be forced to buy health insurance or pay money not to. He has no intention of buying it, which he assumes means the government is just going to come along and grab some of the little money he has. By the way he has an eight year old daughter. I asked him, "Well Festus, suppose you're hit by a bus or your girl gets sick, and you can't afford the health care you need. Who do you think is going to pay for that?"

Try as I might, I could not get him to think through the idea that everybody -- people who pay insurance premiums, and taxpayers including him, pay for critical care of people who are uninsured, because the hospitals jack up their prices to cover it. They charge more to people who pay out of pocket than they do to insurance companies, he said. That's true -- because insurance companies have bargaining power, I explained. But a lot of those people who pay out of pocket never do pay -- and the hospitals write off the debt. And if the person isn't going to die in the ER, they won't get the cancer treatment or other expensive care they need, and they'll just die. I told him he'd get a big subsidy and the insurance would be cheap for him, maybe even free.

That didn't work either. Now he's complaining that insurance doesn't cover "alternative" medicine, just doctors who are all about poisoning people. He's an organic farmer and he's convinced that the earth is being poisoned by air pollution and it's ruining the biology of the soil he depends on. He considers medicine to be unnatural and pharmaceuticals just another form of industrial toxin. Then he starts ranting about how regulation is destroying small business. He sells peppers to a hot sauce maker who has to get a sanitary inspection every year. I said well, I don't want to get food poisoning. But, says Festus, they make him sterilize the factory with toxic chemicals, and that ends up in the food.

There was no arguing with him. I don't think he's going to vote at all, and I doubt he would ever consider voting for Republicans, but his hot sauce making friend is obviously planning on it. He doesn't want the government telling him he has to produce a safe product. Festus is really worried about pollution, but it doesn't occur to him that government could do something about it, by you know, regulating business. And he doesn't want health insurance, even cheaply, because it infringes on his freedom to get ripped off by quacks and die.

The fact is there are a lot of people whose thinking goes around in those sorts of circles and there is nothing anybody can do about it.