Category: Health Care

So You’re Anti-Science if You Don’t Accept Research Posing as Science?

By , March 17, 2013 9:00 am

Apparently, the NRA and all of us Right Wing Gun Nuts are anti-science, according to a post on Lawrence O’Donnell’s MSNBC site, which in turn references a 1993 study published in the New England Journal of Medicine. I guess that’s marginally better than being called racists, homophobes, fascists, deniers (oh wait, deniers by definition are anti-science), and such. But only marginally. Well, of course, there is another side to the story, and I’m simply preserving it here for future reference.

Herewith are links to two articles published on Reason.com. They shed additional–and much needed–light on Mr. Roth’s story (the one on O’Donnell’s site). The first one actually links to the latter one by the way. I recommend you read them. Here is the key quote from both in reference to that 1993 “scientific” study, among others:

Contrary to this picture of dispassionate scientists under assault by the Neanderthal NRA and its know-nothing allies in Congress, serious scholars have been criticizing the CDC’s “public health” approach to gun research for years. In a presentation at the American Society of Criminology’s 1994 meeting, for example, University of Illinois sociologist David Bordua and epidemiologist David Cowan called the public health literature on guns “advocacy based on political beliefs rather than scientific fact.” Bordua and Cowan noted that The New England Journal of Medicine and the Journal of the American Medical Association, the main outlets for CDC-funded studies of firearms, are consistent supporters of strict gun control. They found that “reports with findings not supporting the position of the journal are rarely cited,” “little is cited from the criminological or sociological field,” and the articles that are cited “are almost always by medical or public health researchers.”

Reasonable minds can differ. I recognize that. But in most cases all the reasonable minds aren’t standing on just one side of the issue. That’s especially true when one side is calling the other “anti-science,” “deniers,” “racists,” “homophobes,” “fascists,” and the like.

Edited: added clearer references/links in the first sentence of this post as well as to the sentence that leads into the block quote.

First They Came to Encourage Us to Take Aspirin . . .

By , December 13, 2012 11:39 am

First the good news:

Aspirin is a wonder drug, one that virtually all men over 45 and woman over 55 should take to keep the arteries clear and cancer at bay. So says Dr. David Agus, a professor at USC’s medical school, in an Op-ed in today’s New York Times.

Many high-quality research studies have confirmed that the use of aspirin substantially reduces the risk of cardiovascular disease. Indeed, the evidence for this is so abundant and clear that, in 2009, the United States Preventive Services Task Force strongly recommended that men ages 45 to 79, and women ages 55 to 79, take a low-dose aspirin pill daily, with the exception for those who are already at higher risk for gastrointestinal bleeding or who have certain other health issues. (As an anticoagulant, aspirin can increase the risk of bleeding — a serious and potentially deadly issue for some people.)

New reports about aspirin’s benefits in cancer prevention are just as convincing. In 2011, British researchers, analyzing data from some 25,000 patients in eight long-term studies, found that a small, 75-milligram dose of aspirin taken daily for at least five years reduced the risk of dying from common cancers by 21 percent.

Dr. Agus is so excited about aspirin that he argues, “why not make it public policy to encourage middle-aged people to use aspirin?”

Which leads me to the bad news:

Dr. Agus apparently can see no end to such policy initiatives, at least when his money is at risk because of someone else’s bad health practices:

[W]hen does regulating a person’s habits in the name of good health become our moral and social duty? The answer, I suggest, is a two-parter: first, when the scientific data clearly and overwhelmingly demonstrate that one behavior or another can substantially reduce — or, conversely, raise — a person’s risk of disease; and second, when all of us are stuck paying for one another’s medical bills (which is what we do now, by way of Medicare, Medicaid and other taxpayer-financed health care programs).

Now, who can’t see the benefits of everybody eating better, exercising more, and so on? I can. But I can also see a problem here: one man carrying out his duty can easily become another man’s oppressor. And a woman with one finger on the pulse of America and the power to call out the nannys when that pulse rate increases, is likely a woman with too much power.

In Oral Arguments for the recent Obamacare case, Justice Scalia asked Solicitor General Verrilli whether if the government could mandate that we buy health insurance, it could also mandate that we eat broccoli. Supporters of Obamacare laughed at the idea. As James Stewart wrote in The New York Times, in an article titled “Broccoli Mandates and the Commerce Clause,”

The Supreme Court itself has said: “The principal and basic limit on the federal commerce power is that inherent in all Congressional action — the built-in restraints that our system provides through state participation in federal governmental action. The political process ensures that laws that unduly burden the states will not be promulgated.” And absurd bills like a broccoli mandate are likely to fail other constitutional tests. (emphasis supplied)

All I can say in response to that is, “Mr. Stewart, meet Dr. Agus.”

Another Defense of Niall Ferguson

By , August 21, 2012 1:05 pm

Harvard history professor Niall Ferguson took a shot at President Obama the other day in Newsweek, and in short order Ferguson was taking incoming fire from his own critics, including Paul Krugman, The Atlantic, and Politico, among others. I’m not an expert in either fiscal or foreign policy, so I’ll not comment there. I will say that if Krugman and The Atlantic missed the mark as badly as Politico’s Dylan Byers did, Ferguson’s wounds should heal quickly.

David Frum has come to Ferguson’s defense on the foreign policy front. This is my defense on the English grammar front.

Here is the relevant part of what Byers wrote at Politico:

So, in order to get himself out of that predicament, Ferguson decides to edit the CBO report to satisfy his own conclusions:

If you are wondering how on earth the CBO was able to conclude that the net effect of the ACA as a whole was to reduce the projected 10-year deficit, the answer has to do with a rather heroic assumption about the way the ACA may reduce the cost of Medicare. Here’s the CBO again:

“CBO’s cost estimate for the legislation noted that it will put into effect a number of policies that might be difficult to sustain over a long period of time. The combination of those policies, prior law regarding payment rates for physicians’ services in Medicare, and other information has led CBO to project that the growth rate of Medicare spending (per beneficiary, adjusted for overall inflation) will drop from about 4 percent per year, which it has averaged for the past two decades, to about 2 percent per year on average for the next two decades. It is unclear whether such a reduction can be achieved …”

Indeed, it is, which is why I wrote what I wrote.

But Ferguson cut the CBO excerpt off mid-sentence and changed the meaning entirely. Here is how that last sentence in the excerpt actually reads:

It is unclear whether such a reduction can be achieved through greater efficiencies in the delivery of healthcare or will instead reduce access to care or the quality of care (relative to the situation under prior law.)

So contrary to what Ferguson leads readers to believe, the CBO report does not state that the reduction is “unclear.” What is “unclear” is whether the reduction will come through greater efficiencies in healthcare delivery or reduced access to care.

So, one more time: The Oxford-trained, Harvard-employed, Newsweek contibutor Niall Ferguson just edited the CBO report to change its meaning.

With all due lack of respect: What are you thinking?

Better question: What was Mr. Byers thinking? I responded to him with the following:

Dylan,

With all due respect, Ferguson’s so-called “selective” edit did not change the meaning of the CBO’s sentence. You did, however.

You wrote, “So contrary to what Ferguson leads the reader to believe, the CBO report does not state that the reduction is ‘unclear.’ What is ‘unclear’ is whether the reduction will come through greater efficiencies in healthcare delivery or reduced access to care.”

Both sentences in that statement are incorrect: 1.) Ferguson’s edited version of the CBO report said “It is unclear whether such a reduction can be achieved” not that the reduction is “unclear.” 2.) Even in its unedited form, the CBO report did not say that it was unclear whether the reduction would come from greater efficiencies OR reduced access to healthcare. No, the CBO said that it was unclear whether the reduction would be ACHIEVED through greater efficiencies. If those efficiencies did not materialize, access to healthcare would be reduced.

Look at it this way: The structure of the CBO sentence in question is not parallel. The verb “achieved” applies only to the first clause and NOT to the second. To see what I mean, let’s remove the first clause:

“It is unclear whether such a reduction can be achieved . . . will instead reduce access to care or the quality of care (relative to the situation under prior law).” Pretty silly sentence if you ask me.

The second clause only makes sense if you excise the verb “can be achieved” as follows: “It is unclear whether such a reduction . . . will instead reduce access to care or the quality of care (relative to the situation under prior law).” In other words, the reduced access to healthcare will be the result of the reduction in Medicare spending rather than the reduction in Medicare spending being the result of reduced access to healthcare.

Thus Ferguson’s edit was not selective at all. According to the CBO, IT IS unclear whether such a reduction can be achieved. The words “through greater efficiencies in the delivery of healthcare” only speak to how that reduction might come.

Me thinks you owe Mr. Ferguson an apology–or at least a correction.

I’ll let you know how Mr. Bryers responds.

UPDATE: Mr. Bryers responded via e-mail, writing:

Hi Gregory,

You’re wrong.

The full sentence: “It is unclear whether such a reduction can be achieved through greater efficiencies in the delivery of healthcare or will instead reduce access to care or the quality of care (relative to the situation under prior law.)”

Break it down: It’s unclear whether A can be achieved through B or will instead reduce C.

As in, “It is unclear whether weight-loss can be achieved through exercise alone or will instead reduce food-intake.” It would be ridiculous to make that mean, “It is unclear whether weight-loss can be achieved.”

Thanks,
D.

I responded in kind, well, the short kind: “Sorry, but you’re still wrong.”

To which he responded:

Gregory,

You agree that there is a reduction?

D.

And dutifully, I replied:

Dylan,

I agree that the CBO projects that the growth rate of Medicare spending will drop (or reduce) from 4% to 2% per year.

Do you agree with the following? And if not, why not?

The second clause only makes sense if you excise the verb “can be achieved” as follows: “It is unclear whether such a reduction . . . will instead reduce access to care or the quality of care (relative to the situation under prior law).” In other words, the reduced access to healthcare will be the result of the reduction in Medicare spending, rather than the reduction in Medicare spending being the result of reduced access to healthcare.

Reduced Medicare spending is, after all, the subject of the verb “reduce” in the CBO sentence I quote above.

Thanks,
Greg

And that’s how things stand at 4:16 PM Mountain Time.

UPDATE (Wed. 8.22 10:22 AM):

Yesterday, Dylan asked:

You agree that there is a reduction?

I responded:

I agree that the CBO projects that the growth rate of Medicare spending will drop (or reduce) from 4% to 2% per year.

Do you agree with the following? And if not, why not?

The second clause only makes sense if you excise the verb “can be achieved” as follows: “It is unclear whether such a reduction . . . will instead reduce access to care or the quality of care (relative to the situation under prior law).” In other words, the reduced access to healthcare will be the result of the reduction in Medicare spending, rather than the reduction in Medicare spending being the result of reduced access to healthcare.

Reduced Medicare spending is, after all, the subject of the verb “reduce” in the CBO sentence I quote above.

A bit later, I read a new post by Byers, one that compared a 2009 CBO statement with the 2011 statement at issue. I quickly wrote Byers:

I just read your “ducks, nitpicks” post in which you virtually concede my argument: The CBO is (was?) unclear whether the reduction can be achieved–yes, the CBO said it more clearly in its 2009 letter, but the bolded quote in the 2011 testimony says essentially the same thing, as I’ve pointed out in my previous e-mail. Seems to me that the bone you want to pick is with the CBO because, I repeat, Ferguson’s quote was fair, ellipsis and all. The CBO–in both quotes–was unsure whether the reduction would be achieved through efficiencies. The possible reduction in care or access to care would be **because** of the reduction in spending.

Spin it as you will, that’s that the CBO says in both bolded quotes in your “ducks, nitpicks” post.

He responded:

Ferguson is suggesting the CBO says there might NOT be a reduction.

And followed up with:

In other words, if you are correct, why did the 2009 CBO say “if so” and “whether”

To which I responded:

Dylan,

You accused Mr. Ferguson of editing the CBO report in “a ridiculous, misleading, ethically questionable way that completely misses the mark” of “chang[ing] the meaning entirely.” And yet, here we are in a two-day e-mail exchange, debating the meaning of the very sentence in question. Ironic, no? I’ll repeat my understanding of the sentence in question one more time.

The short story: In both CBO statements, the first clause is about the HOW of the reduction. The second clause is about the possible EFFECT of any reduction. The CBO statements do not present a case of either/or.

Let’s look at CBO 2011 again–grammatically:

It is unclear whether such a reduction [the object of this sentence] can be achieved through greater efficiencies in the delivery of healthcare.

OR

It is unclear whether such a reduction [the subject or actor in this sentence] will instead reduce access to care or the quality of care (relative to the situation under prior law.)

As I read those two sentences, I see two different concerns on the CBO’s mind: 1.) a question of whether greater efficiencies will lead to a reduction of Medicare spending, and 2.) a concern about the effect of a reduction in Medicare spending–however that reduction comes about. The first is a question of HOW. The second is a concern about EFFECT.

That reading is buttressed by the CBO’s 2009 letter

“It is unclear whether such a reduction in the growth rate could be achieved, and if so [that is, IF it is achieved], whether

1.) it [the reduction–the object of this clause] would be accomplished through greater efficiencies in the delivery of health care

OR [however it’s achieved]

2.) [the reduction–the subject of this clause] would reduce access to care or diminish the quality of care.”

To repeat: In both CBO statements, the first clause is about the HOW of the reduction. The second clause is about the possible EFFECT of any reduction. The are separate issues or concerns.

As you said yourself in your “Nitpicks” post, had Ferguson quoted the 2009 letter, he would have been on firm ground. My analysis says that he was also well within the bounds of a fair reading of the 2011 statement to claim that the CBO was unclear that a “reduction in the growth rate could be achieved.”

Again, if you’ve got a bone to pick, go pick it with the CBO person who wrote those statements. They could have been written more clearly. So yes, I can see where you’re coming from, but it’s a stretch–and frankly unfair–to claim that your reading is the only correct reading and therefore Ferguson “misses the mark,” is “unethical,” and that he “changed the meaning entirely” of the CBO’s statement.

I don’t know Ferguson. Though I lean right, this is not a partisan issue for me. I simply feel that your post was unfair and responded accordingly.

Respectfully,

Greg Taggart

(All emphasis and most of the formatting in the last e-mail above is mine, something I point out to the general reader, but that I did not say in my original e-mail to Byers since he was familiar with the actual statements.)

Update:
Ferguson defends himself.

President Obama Is Right

By , August 14, 2012 9:54 am

I agree with what President Obama says in this video, particularly at around the 4:00 – 4:30 mark. Until we–Republicans and Democrats–stop fear mongering, we will not solve our nation’s financial problems.

The question is, does President Obama and his side of the aisle really believe what he says in that video? The evidence from the last few weeks says no. To be fair, does the Republican party?

Follow the Power

By , July 13, 2012 9:07 pm

Why does money always get the bad rap, while power–at least the power coveted by those in government–is almost always benign? You know the mantra: If you want to find out who did the dirty deed, it’s always follow the money, never the power. It’s what Woodward claims Deep Throat told him in that garage in Washington D.C., and it’s been repeated ad nauseam ever since. But let me ask you: wouldn’t a quicker route to solving the Watergate mystery have been to follow the power? Who benefited from the break-in? Well, Nixon, of course. And who ended up resigning because of his abuse of power? Nixon again.

Power in government comes almost inevitably to those who first offer you something. They offer to fix your schools. The say they can clean up the environment. Need healthcare? They’re on your doorstep. The list goes on. And yes, they often come through on their offers. We get cleaner water and a safety net. It’s not all bad. Never is. And in any case, your personal cost for anything the offeror does is often obscured by the good deed. But don’t kid yourself; there is a cost. After the transaction, you have less power, and the government that solved (or tried to solve) your problem has more.

In my mind, power is at least as corrupting as money–and in the wrong hands, much more worrisome. For me, the wrong hands are the hands of people I can’t simply walk away from. Thus, though my church may be powerful in some sense, it’s not power I fear because I can walk away from it. Likewise, I’m not too concerned about the power of a G.E. or an ExxonMobile because I can drive across the street and buy from Sears or Texaco. And it’s not power in the hands of the governor or legislature of my state because it’s pretty easy to move to another state.

No, the power I fear most is power in the hands of the federal government because it’s not so easy to leave the United States of America. That takes more money, a passport, and the proper visas. It takes a dislocation of family and friends, of employment, of language, and so on. Besides, if power in the hands of the federal government has reached a point that I would want to move, it’s likely that I may not be able to move in any case.

Now don’t misunderstand; I don’t think we’re anywhere close to that in the U.S. But I do think it’s time to recognize that every time someone in government offers to help us with something in our lives, be it healthcare or soda, the environment or gun violence, we need to ask who really benefits. In other words, we need to follow the power. Almost inevitably, that offer to help results in a loss of my power and an accretion of the power in the hands of the offeror, power in the hands of people and institutions that I cannot walk away from willy nilly.

Don’t believe me? Ask Milton Friedman.

There Go Those Racist Republi . . . er Democrats Again

By , June 28, 2012 1:13 pm

Apparently, the N-word is only offensive and racist if someone on the Right uses it.

Racist, tax, right, wrong. Words just don’t mean what they used to.

Scalia Hits The Nail — And Hard

By , June 28, 2012 9:50 am

From Scalia’s dissent (at page 190 of the opinion), joined by Kennedy, Alito, and Thomas, in the Affordable Care Act case:

The Court today decides to save a statute Congress did
not write. It rules that what the statute declares to be a
requirement with a penalty is instead an option subject
to a tax. And it changes the intentionally coercive sanction
of a total cut-off of Medicaid funds to a supposedly
noncoercive cut-off of only the incremental funds that the
Act makes available.

The Court regards its strained statutory interpretation
as judicial modesty. It is not. It amounts instead to a vast
judicial overreaching. It creates a debilitated, inoperable
version of health-care regulation that Congress did not
enact and the public does not expect. It makes enactment
of sensible health-care regulation more difficult, since
Congress cannot start afresh but must take as its point of
departure a jumble of now senseless provisions, provisions
that certain interests favored under the Court’s new design
will struggle to retain. And it leaves the public and
the States to expend vast sums of money on requirements
that may or may not survive the necessary congressional
revision.

The Court’s disposition, invented and atextual as it is,
does not even have the merit of avoiding constitutional
difficulties. It creates them. . . .

Hurrah for the limits the Court imposed on the Commerce Clause. Boo because the Court struggled so hard to find a tax. Double boo on a Congress that didn’t have the guts to call it a tax in the first place.

Guess Who?

By , February 20, 2012 11:29 am

Who wrote this:

“. . . farmers are also digging and planting corn and other crops that will be turned into ethanol that can replace gasoline in our cars. Most cars in America can’t run on ethanol, however, so who is going to install ethanol pumps at the gas station without the cars to run on it? At this point I would say to all of my hard-core conservative friends: Hold on to your hats.

“What we need is a government mandate! We need to mandate that all cars sold in the United States, starting with the 2010 model year, be ‘flex-fuel vehicles’ – that is, they should be able to run on a blend that is 85 percent ethanol and 15 percent gasoline (the so-called E85 blend), or even a coal-derived methanol/gas mixture. This mandate would cost a fraction of the new fuel economy standard with the added benefit of saving barrels more oil.”

For the answer, we go to the name under the title of the piece:

So, he’s for “smart” mandates–of course. He’s just against health insurance mandates, especially if they’re mandated in Massachusetts and if Romney’s behind them. Or Obama.

HT Andrew Kacsyinski at BuzzFeed.

I’ll Be Watching This

By , January 31, 2012 4:17 pm

Today on The Corner, Ramesh Ponnuru writes about the move by Republicans in the House and Senate to restore religious liberties abrogated recently by the Obama Administration, which

has decided to require religious institutions that offer insurance to cover contraception, sterilization, and abortifacients, whether or not they object to covering them. Churches would be exempt but not, for example, Catholic universities or hospitals.

My Twitter feed has been alive with conversation about what the Administration has done, but I’ve paid scant attention. I’ll be more attentive from now on because this disturbs me. At one time, I was anti-abortion but pro-choice. No longer. Over the years, I’ve changed my views to anti-abortion, give-the-child-up-for-adoption-if-necessary. To me, if there is any doubt about whether that life begins at conception, then the doubt should favor the possibility of life. Moreover, if Jefferson’s wall separating church and state means anything, it means something here in the domain of all things sacred to religious folk and institutions.

Affordable Care Act: It’s About Power, and It Always Has Been

By , June 8, 2011 3:23 pm

Ilya Shapiro nails it, and apparently, so did the judges of the 11th Circuit Court of Appeals. Obamacare–the Affordable Care Act–is and always has been about power. Washington wants is. The people, at least people like me, don’t want to give it to them.

As the lawyer representing 26 states against the federal government said, “The whole reason we do this is to protect liberty.” With those words, former solicitor general Paul Clement reached the essence of the Obamacare lawsuits. With apologies to Joe Biden, this is a big deal not because we’re dealing with a huge reorganization of the health care industry, but because our most fundamental first principle is at stake: we limit government power so people can live their lives the way they want.

This legal process is not an academic exercise to map the precise contours of the Commerce Clause or Necessary and Proper Clause — or even to vindicate our commitment to federalism or judicial review. No, all of these worthy endeavors are just means to achieve the goal of maximizing human freedom and flourishing. Indeed, that is the very reason the government exists in the first place.

And the 11th Circuit judges saw that. Countless times, Judges Dubina and Marcus demanded that the government articulate constitutional limiting principles to the power it asserted. And countless times they pointed out that never in history has Congress tried to compel people to engage in commerce as a means of regulating commerce.

In case anybody cares, I feel the same way about Climate Change. Even conceding that the globe is warming, I’m not willing to kneel before the would-be climate demigods, certainly not before them move from their Mount Olympus mansions and give up their jets. Yes, Al, I’m talking about you.

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