Quotulatiousness

September 15, 2013

Why “Breaking Bad: Canada” is a ludicrous meme

Filed under: Government, Health, Media, USA — Tags: , , , , , — Nicholas @ 09:57

Megan McArdle is a fan of the TV show Breaking Bad, but she also is fairly well informed about the US healthcare system. This means that the idea that the TV show’s Canadian counterpart would look like this…

Breaking Bad Canada

…depends on the audience for the real TV show not actually knowing much about the US system.

The series starts with Walter White, a high school chemistry teacher in Albuquerque, New Mexico, who is diagnosed with lung cancer. His lousy health maintenance organization won’t cover a decent doctor, or treatment. So Walter is forced to turn to crime just to pay his medical bills and … whoa, wait a minute. You know who has excellent benefits, compared with basically everyone else in the country? Teachers, firefighters and cops. Maybe they’re overworked and underpaid, but the one thing that you cannot say about them is that they’re forced to endure shoestring health-care plans. According to the Internet, Albuquerque school district employees are eligible for

    Medical, Dental, Vision, Basic and Additional Life Insurance, Long Term Disability, Pre-tax Insurance Premium Plan (PIPP), Flexible Spending Accounts, Long Term Care Insurance, 403(b) and the 457(b) Deferred Compensation Plans.

That’s a generous package. Moreover, the Albuquerque school district self-insures, so any complaints about benefit levels should be directed at the city government, not your “lousy HMO.”

Later, after Walt’s actions accidentally result in the shooting of his brother-in-law, a Drug Enforcement Agency agent, Walt’s wife takes a bunch of the meth money to pay for Hank’s treatment. On his government salary, Hank can’t possibly afford the treatment he needs, because, of course, his lousy insurance policy won’t cover more than a few visits to the physical therapist … and whoa, we just went from “unrealistic” to “ludicrous.” You know who has even better benefits than employees enjoying a compensation package collectively bargained with a local government? Federal employees in a low-cost state such as New Mexico. Moreover, extra benefits are available to people injured in the line of duty.

In short, a number of key plot points hinge on the improbable assertion that people who actually enjoy some of the best health insurance in the country actually suffer some of the worst — so bad that we are expected to believe that Walt had no choice but to cook meth to cover the gaps. For an otherwise great show, this is incredibly silly.

September 13, 2013

Medicare costs as seen by the public

Filed under: Government, Health, USA — Tags: , , — Nicholas @ 07:58

The Harvard School of Public Health released a summary of public opinion on various issues surrounding the Medicare system:

As debate over the national debt and the federal budget deficit begins to heat up again, an analysis of national polls conducted in 2013 shows that, compared with recent government reports prepared by experts, the public has different views about the need to reduce future Medicare spending to deal with the federal budget deficit. Many experts believe that future Medicare spending will have to be reduced in order to lower the federal budget deficit [1] but polls show little support (10% to 36%) for major reductions in Medicare spending for this purpose. In fact, many Americans feel so strongly that they say they would vote against candidates who favor such reductions. Many experts see Medicare as a major contributor to the federal budget deficit today, but only about one-third (31%) of the public agrees.

This analysis appears as a Special Report in the September 12, 2013, issue of New England Journal of Medicine.

One reason that many Americans believe Medicare does not contribute to the deficit is that the majority thinks Medicare recipients pay or have prepaid the cost of their health care. Medicare beneficiaries on average pay about $1 for every $3 in benefits they receive. [2] However, about two-thirds of the public believe that most Medicare recipients get benefits worth about the same (27%) or less (41%) than what they have paid in payroll taxes during their working lives and in premiums for their current coverage.

Differences between experts on the financial condition of Medicare and the public can also be seen when examining the reasons for rising Medicare costs and ways to reduce future Medicare spending. Unlike many experts, the public does not see overuse of medical care and the cost of new medical technologies as among the most important reasons for rising Medicare costs. Only one in six Americans (17%) believes that “people receiving drugs and medical treatments they don’t need” is one of the most important reasons why Medicare care costs are rising, and only 6% see “new drugs, tests and treatments being offered to the elderly” as one of the most important reasons. The three reasons cited most often by the public are poor management of Medicare by government (30%), fraud and abuse in the health sector (24%), and excessive charges by hospitals (23%).

Many experts believe that one of the most important reasons for rising Medicare costs is unnecessary care provided to patients. The public, however, sees the bigger problem for people on Medicare as not getting the health care they need (61%), rather than receiving unnecessary care (21%). Many experts see capitated payments (doctors getting paid a fixed amount of money so they can manage all of a patient’s health care for the year) as a preferred way of reducing future Medicare spending. However, a majority of the public favors continuing fee-for-service payments (65%) rather than changing to capitated health care arrangements (30%). This resistance to change may be related to the fact that a majority of the public sees Medicare in some cases already withholding treatments and prescription drugs to save money, including 63% who believe this happens very or somewhat often.

September 12, 2013

This is rather sinister

Filed under: Health, Science — Tags: , , , — Nicholas @ 10:46

At Marginal Revolution, Alex Tabarrok talks about a statistical study which concluded that being left-handed had serious impact on your lifespan:

In 1991 Halpern and Coren published a famous study in the New England Journal of Medicine which appears to show that left handed people die at much younger ages than right-handed people. Halpern and Coren had obtained records on 987 deaths in Southern California — we can stipulate that this was a random sample of deaths in that time period — and had then asked family members whether the deceased was right or left-handed. What they found was stunning, left handers in their sample had died at an average age of 66 compared to 75 for right handers. If true, left handedness would be on the same order of deadliness as a lifetime of smoking. Halpern and Coren argued that this was due mostly to unnatural deaths such as industrial and driving accidents caused by left-handers living in a right-handed world. The study was widely reported at the time and continues to be regularly cited in popular accounts of left handedness (e.g. Buzzfeed, Cracked).

What is less well known is that the conclusions of the Halpern-Coren study are almost certainly wrong, left-handedness is not a major cause of death. Rather than dramatically lower life expectancy, a more plausible explanation of the HC findings is a subtle and interesting statistical artifact. The problem was pointed out as early as the letters to the editor in the next issue of the NEJM (see Strang letter) and was also recently pointed out in an article by Hannah Barnes in the BBC News (kudos to the BBC!) but is much less well known.

The statistical issue is that at a given moment in time a random sample of deaths is not necessarily a random sample of people. I will explain.

August 21, 2013

Obesity – it’s not just for humans any more

Filed under: Food, Health, Science — Tags: , — Nicholas @ 09:01

We’re constantly being barraged with public service announcements from public figures that we all eat too much, exercise too little, and as a result society has a (sorry) growing obesity problem. However, as David Berreby points out, it’s not as simple as that:

Consider, for example, this troublesome fact, reported in 2010 by the biostatistician David B Allison and his co-authors at the University of Alabama in Birmingham: over the past 20 years or more, as the American people were getting fatter, so were America’s marmosets. As were laboratory macaques, chimpanzees, vervet monkeys and mice, as well as domestic dogs, domestic cats, and domestic and feral rats from both rural and urban areas. In fact, the researchers examined records on those eight species and found that average weight for every one had increased. The marmosets gained an average of nine per cent per decade. Lab mice gained about 11 per cent per decade. Chimps, for some reason, are doing especially badly: their average body weight had risen 35 per cent per decade. Allison, who had been hearing about an unexplained rise in the average weight of lab animals, was nonetheless surprised by the consistency across so many species. ‘Virtually in every population of animals we looked at, that met our criteria, there was the same upward trend,’ he told me.

It isn’t hard to imagine that people who are eating more themselves are giving more to their spoiled pets, or leaving sweeter, fattier garbage for street cats and rodents. But such results don’t explain why the weight gain is also occurring in species that human beings don’t pamper, such as animals in labs, whose diets are strictly controlled. In fact, lab animals’ lives are so precisely watched and measured that the researchers can rule out accidental human influence: records show those creatures gained weight over decades without any significant change in their diet or activities. Obviously, if animals are getting heavier along with us, it can’t just be that they’re eating more Snickers bars and driving to work most days. On the contrary, the trend suggests some widely shared cause, beyond the control of individuals, which is contributing to obesity across many species.

Such a global hidden factor (or factors) might help to explain why most people gain weight gradually, over decades, in seeming contradiction of Bloomberg’s thermodynamics. This slow increase in fat stores would suggest that they are eating only a tiny bit more each month than they use in fuel. But if that were so, as Jonathan C K Wells, professor of child nutrition at University College London, has pointed out, it would be easy to lose weight. One recent model estimated that eating a mere 30 calories a day more than you use is enough to lead to serious weight gain. Given what each person consumes in a day (1,500 to 2,000 calories in poorer nations; 2,500 to 4,000 in wealthy ones), 30 calories is a trivial amount: by my calculations, that’s just two or three peanut M&Ms. If eliminating that little from the daily diet were enough to prevent weight gain, then people should have no trouble losing a few pounds. Instead, as we know, they find it extremely hard.

Many other aspects of the worldwide weight gain are also difficult to square with the ‘it’s-just-thermodynamics’ model. In rich nations, obesity is more prevalent in people with less money, education and status. Even in some poor countries, according to a survey published last year in the International Journal of Obesity, increases in weight over time have been concentrated among the least well-off. And the extra weight is unevenly distributed among the sexes, too. In a study published in the Social Science and Medicine journal last year, Wells and his co-authors found that, in a sample that spanned 68 nations, for every two obese men there were three obese women. Moreover, the researchers found that higher levels of female obesity correlated with higher levels of gender inequality in each nation. Why, if body weight is a matter of individual decisions about what to eat, should it be affected by differences in wealth or by relations between the sexes?

August 18, 2013

Down with the “nudgers”

Filed under: Food, Government, Health, Liberty — Tags: , — Nicholas @ 10:13

In Reason, Baylen Linnekin discusses the so-called libertarian paternalists:

Even if I were to concede that point, there are plenty of programs that might be called soft or libertarian paternalism and that yield negative outcomes.

For example, federal farm subsidies quietly influence the choices made by farmers and consumers and lead many in both groups to believe they’re better off — a key precept of libertarian paternalism.

Subsidies influence farmers to produce some foods (like corn, soy, dairy, and sugar) to the exclusion of other foods (like arugula, bok choy, and yams). It’s no surprise that the former foods are the ones most farmers grow, and that they’re much more frequent choices among eaters.

The noodgy allure of farm subsidies is that farmers get money and certainty, while consumers get abundant and cheaper food at the grocery.

Another example of libertarian paternalism around food is menu labeling. Its proponents refer to laws mandating calorie counts on fast food and other restaurant menus as a gentle nudge that requires businesses to provide us with information the government thinks we need but still allows us to make our own choices. The hope by government is that we’ll choose items with fewer calories and be better off for exercising that choice. But studies have shown mandatory restaurant menu labeling does not work in practice. Worse, a recent study showed mandated menu labeling can actually cause consumers to choose foods with more calories.

So both farm subsidies and mandatory menu labeling present firm empirical evidence that libertarian paternalism doesn’t work, right?

You might think so. But Sunstein’s Nudge writing partner, Richard Thaler, would likely argue that these failures simply call for more testing on the part of government.

“No one knows the answers to every problem, and not every idea works, so it is vital to test,” Thaler said earlier this month.

Of course. Who else but a cadre of bureaucrats who’ve never met you could possibly through trial and error determine what’s best for you to eat?

August 8, 2013

Medical marijuana – “We have been terribly and systematically misled for nearly 70 years”

Filed under: Health, Media — Tags: , , , — Nicholas @ 10:29

ThinkProgress reports that CNN’s Dr. Sanjay Gupta has changed his position on the medical use of marijuana:

CNN’s Chief Medical Correspondent Dr. Sanjay Gupta reversed his position on marijuana’s health benefits and apologized for his previous stand against it in an article Thursday for CNN. In 2009, Gupta penned an op-ed advocating against marijuana, where he advised as a doctor that “marijuana isn’t really very good for you.” At the time, he was in the running for an appointment to Surgeon General.

Since then, additional research and his work on a documentary have convinced him otherwise.

“I apologize because I didn’t look hard enough, until now,” he said. “I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.”

[…]

“We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.”

August 2, 2013

First it was bulemia, then anorexia, now it might be “orthorexia”

Filed under: Food, Health, Media — Tags: , , — Nicholas @ 07:59

It’s nice to know that people in the richest culture in world history can still manage to make themselves utterly miserable by obsessing about things:

Picture this: After spending the summer indulging in ice cream and cocktails, you decide to embrace healthy eating. You cut out refined sugar and packaged food-the kind of nutrient-free junk on any doctor’s warning list. Wheat and dairy are the next to go.

People compliment you on your weight loss; your energy levels rival those of Jillian Michaels. But soon your innocent health kick takes a strange turn. Certain foods – even fruits and veggies – begin to seem dangerous, even unclean.

Within months, you’ve whittled your list of “acceptable” foods down to almost nothing.

This unhealthy fixation with eating healthfully is called “orthorexia nervosa,” a term coined by Dr. Steven Bratman, a Colorado-based physician, in 1997. Since then, orthorexia rates have spiralled in tandem with society’s insistence upon knowing every last detail about its food.

Orthorexia (derived from the Greek “ortho,” which means “correct”) often begins with a noble impulse – to get fit or eat organic – that grows into a self-destructive obsession where fewer and fewer foods meet the orthorexic’s increasingly high standards.

The result is everything from malnutrition to social anxiety as orthorexics avoid restaurants and their friends’ kitchens. At its most extreme, orthorexia can even act as a gateway to anorexia, says Merryl Bear, director of Toronto’s National Eating Disorder Information Centre.

“The gateway possibility is very real because the principles are so similar,” she explains. “Like anorexics, orthorexics prize being pure and in control above all else.” (Orthorexia is currently classified as a form of disordered eating, not a clinical eating disorder, in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.)

Since orthorexics value purity, not weight loss, eating becomes a moral act. “A day filled with wheat grass juice, tofu and quinoa biscuits may come to feel as holy as one spent serving the destitute and homeless,” writes Bratman in his book Health Food Junkies: Overcoming the Obsession With Healthful Eating (2004).

H/T to Nicholas Packwood for the link.

Update: Colby Cosh was quick to send me a link to a piece he did on this topic more than a decade ago:

Since becoming a physician, Dr. Bratman has seen many people like his own young self — and some who are worse off — flirting with disaster by depriving their body of vital nutrients. The fads of his youth, far from disappearing, have survived and grown in number: there are even “Breatharians” who believe food to be wholly unnecessary. A few years ago Dr. Bratman coined the phrase “orthorexia” — merging Greek ortho-, meaning righteous, with the stem familiar from “anorexia” — to describe a pathological attachment to dietary theories.

“I never intended the term to be a serious diagnostic entity; you wouldn’t go to a hospital with ‘orthorexia,'” he says. “It’s informal, like ‘workaholic.'” The idea has nonetheless stirred controversy: a Yale University physician sniffed in one critique that “We’ve never had anybody come to our clinic with orthorexia.” Yet fanatical attachment to dietary theories can indeed be hazardous. Macrobiotic diets caused a string of deaths in the 1960s and had to be modified; “metabolic” treatments for cancer, usually involving fasting, occasionally turn disastrous; and vegetarians and vegans must monitor themselves for certain vitamin and mineral deficiencies. In September, an Armenian couple in Surrey, England, were convicted of starving their nine-month-old daughter to death on a “Fruitarian” fruit-only diet.

“People become orthorexic by falling in love with a dietary theory,” says Dr. Bratman. “They run across an idea like macrobiotics or raw-foodism, and embrace it like a religion. We’re not talking about common-sense rules of healthy eating, but theories which reject whole classes of foods and make spontaneous eating [impossible]…There’s a personality type, an obsessive type of person who is prone to embrace them in a quasi-religious way.” This can result in an enticing sense of moral superiority, sometimes coupled with the euphoria associated with partial starvation. But orthorexia also brings crippling feelings of unworthiness after the inevitable slip-ups, when the true believer succumbs to a cookie or a pizza. “There are similarities with anorexia,” he says. “An important one is that anorexics feel like they’ve done something evil when they gain weight, something morally wrong rather than merely unhealthy.” Similarly, the sure sign of an orthorexic is that he associates unhealthy eating with a sense of sin.

July 29, 2013

“Junk food costs as little as $1.76 per 1,000 calories, whereas fresh veggies … cost more than 10 times as much”

Filed under: Economics, Food, Health, USA — Tags: , , , , — Nicholas @ 10:35

Making a case for the McDonald’s McDouble as the greatest food in human history:

What is “the cheapest, most nutritious and bountiful food that has ever existed in human history” Hint: It has 390 calories. It contains 23g, or half a daily serving, of protein, plus 7% of daily fiber, 20% of daily calcium and so on.

Also, you can get it in 14,000 locations in the US and it usually costs $1. Presenting one of the unsung wonders of modern life, the McDonald’s McDouble cheeseburger.

The argument above was made by a commenter on the Freakonomics blog run by economics writer Stephen Dubner and professor Steven Leavitt, who co-wrote the million-selling books on the hidden side of everything.

Dubner mischievously built an episode of his highly amusing weekly podcast around the debate. Many huffy back-to-the-earth types wrote in to suggest the alternative meal of boiled lentils. Great idea. Now go open a restaurant called McBoiled Lentils and see how many customers line up.

But we all know fast food makes us fat, right? Not necessarily. People who eat out tend to eat less at home that day in partial compensation; the net gain, according to a 2008 study out of Berkeley and Northwestern, is only about 24 calories a day.

The outraged replies to the notion of McDouble supremacy — if it’s not the cheapest, most nutritious and most bountiful food in human history, it has to be pretty close — comes from the usual coalition of class snobs, locavore foodies and militant anti-corporate types. I say usual because these people are forever proclaiming their support for the poor and for higher minimum wages that would supposedly benefit McDonald’s workers. But they’re completely heartless when it comes to the other side of the equation: cost.

Update, 30 July: Stephen Dubner notes that the Kyle Smith story has triggered “about one zillion” media requests for more comment on the original post, but that he’s too busy writing to take time out to respond.

July 22, 2013

Examining post-traumatic stress disorder

Filed under: Health, Military, USA — Tags: , , , — Nicholas @ 08:23

In the New Yorker, David J. Morris looks at the psychological chameleon we call PTSD:

As it is understood today, post-traumatic stress disorder is a grab bag of symptoms that emerges after experiencing trauma, like nearly dying or having one’s bodily integrity violated. It includes a persistent sense of hypervigilance and recurrent, intrusive memories of past traumatic events. In the worst cases, veterans with P.T.S.D. may hallucinate the voices of dead comrades, enemy combatants, or their commanding officers. A 1995 study of combat veterans with P.T.S.D. published in Traumatology found that sixty-five per cent of subjects reported hearing voices, including command hallucinations that they felt compelled to obey. As the psychiatrist Jonathan Shay, the author of Achilles in Vietnam: Combat Trauma and the Undoing of Character, put it, “P.T.S.D. can unfortunately mimic virtually any condition in psychiatry.”

But there are a growing number of psychiatrists and researchers who are challenging our understanding of P.T.S.D. — even its very nature as an ailment. Modern psychiatry, they argue, is locked into a mindset that systematically overdiagnoses P.T.S.D. without nurturing veterans’ ability to heal themselves. American culture, meanwhile, vacillates between elevated ideas of hero worship and victimhood in its conception of veterans, which can be destructive to the veterans themselves. One of the chief proponents of this school of thought is Ben Shephard, a leading British historian of military psychiatry. In his provocative book, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, he describes a historical cycle that governs the treatment of war stress: “the problem is at first denied, then exaggerated, then understood, and finally, forgotten.” Shephard claims that the West, and America in particular, are deeply mired in the exaggeration phase of that cycle. These skeptics of the prevailing model of P.T.S.D. were described in Scientific American as a “broad array of experts indeed, giants of psychology, psychiatry and epidemiology.” One of the major tenets of this argument is a fact that, on its face, suggests that P.T.S.D. is a culturally determined phenomenon as well as a medical one: American veterans are 2.5 to four times more likely to be diagnosed with P.T.S.D. than British veterans.

[…]

As Jonathan Shay, the author of Achilles in Vietnam, shows in his follow-up, Odysseus in America: Combat Trauma and the Trials of Homecoming, while the problem of returning from war is one of humanity’s oldest struggles, the use of P.T.S.D. to frame a wide variety of traumatic experiences is a relatively recent development. The growing criticism of our current understanding of P.T.S.D. suggests that what was once ignored or treated as a failure of character — the soldier’s weakness — has now been medicalized to the exclusion of discussing its moral and spiritual dimensions. “It feels to me as if the U.S. civilian population has pathologized the veteran experience,” Elliott Woods, an Iraq veteran-turned-reporter, told me not long ago. “One well-intentioned person said to me the other day, ‘I can’t see how anyone could go to Iraq and not come back with P.T.S.D.’

H/T to Tim Harford for the link.

July 13, 2013

The state’s constant interest in what’s in your kid’s lunchbag

Filed under: Britain, Education, Health — Tags: , , — Nicholas @ 09:13

James Delingpole on the most recent “Nanny knows best” appointee hoping to dictate what the kids are going to eat for lunch:

“Mr Dimbleby”, it seems to me, is coming perilously close to suggesting that the decision as to what children eat at school should be a matter for the State rather than parents. Can he really believe this? Is there nothing about saying this sort of thing that makes him uneasy?

I mean sure, I agree with him on the principle that a good, well-prepared hot meal at lunchtime is probably more filling and nourishing than a packet-bread sandwich and a packet of crisps. Problem is, not all school canteens offer quite the same range and quality you might find in — oh, I don’t know, let’s pluck a random example from the air, shall we? — Bekynton.

Having put children through the state system myself I know whereof I speak. A new caterer arrived at my daughter’s primary school to much fanfare and for a while the food was great and most parents gratefully abandoned packed lunches (which, let me tell you, are a real hassle for a parent to prepare because they have to be done fresh in the morning when you’re already in a rush having breakfast and getting ready for the school run) and welcomed the new regime. But then standards began slipping to the point where my daughter (who, like a lot of children whose staple diet is gastro-porn TV programmes from the Great British Bake Off to Masterchef, genuinely cares about food) couldn’t eat the stuff any more. Again: is “Mr Dimbleby” seriously suggesting that schools should force children to go on eating in the canteen regardless of how disgusting they find the food?

You hear similar arguments from well-heeled progressive types on the school system generally. “If only public schools were abolished and all those pushy middle-class strivers were forced to put their children through the state system, standards would rise across the board.” Well, possibly. What would more likely happen is that all those scrubbed, diligent, nicely spoken, polite young poshos would be dragged down to the level of the lowest common denominator. And in any case it’s not an experiment which has any right being attempted anywhere in a Western notionally free-market economy. Why not? Because it’s illiberal bordering on the totalitarian, is why.

This is hardly a new topic … last year I said:

I remember what kind of crap my middle and high school cafeterias offered … and if I’d forgotten to bring a sandwich with me that day, going hungry always seemed like the better choice. The food on offer always seemed to manage the difficult stunt of being visually unappealing (sometimes being actually disgusting to look at), nutritionally inadequate, and either utterly flavourless (the better choice) or actively nasty. No wonder the best sellers in the cafeteria were the milk cartons (especially the chocolate milk), pop cans, potato chips, chocolate bars, and Vachon cakes (all of which were pre-packaged and relatively invulnerable to further processing).

July 3, 2013

US public opinion on abortion has been stable for decades

Filed under: Health, Law, Media, Politics, USA — Tags: , , , , — Nicholas @ 10:31

Nick Gillespie says the stability of beliefs on the topic of abortion is one of the most striking things about the whole debate:

So despite decades of polling data showing that large majorities of Americans believe abortion should be legal under some circumstances, you could be excused for thinking there are only two possible positions when it comes to terminating pregnancies: either all abortions should be allowed, or none should be.

Yet the most striking thing about attitudes toward abortion is how stable they’ve been over the 40 years since Roe v. Wade. Gallup has been tracking public sentiment on the matter since 1975, when 22 percent of Americans agreed that abortion should be illegal under any circumstances and 21 percent believed it should be legal under any circumstances. Those numbers are now 18 percent and 28 percent respectively. In 1975 54 percent believed abortion “should be legal only under certain circumstances.” The number is now 52 percent and has never gone above 61 percent or below 48 percent. Over the past 15 years, the number of Americans calling themselves “pro-life” and “pro-choice” has narrowed to a few points, with 48 percent identifying as pro-choice and 44 percent as pro-life (in 2011, those figures were basically flipped).

Official political stances on abortion are absolutely Manichaean, however, with the Republican Party and most of its leading figures stressing that life begins at conception, a belief that would outlaw virtually all abortions except those necessary to protect the health of the mother. The Democratic Party platform — and most of its highest-profile members, including President Barack Obama — “strongly and unequivocally supports” abortion at any time and for any reason during a pregnancy.

Most Americans reject such categorical, extreme views and instead offer conditional support for abortion depending on when it’s performed. Gallup found that while 61 percent of Americans think abortion for should mostly be legal in the first three months of pregnancy and 27 percent felt it should be legal in the second trimester, just 14 percent agreed it should be allowed on demand in the final three months.

Unlike their political representatives, then, Americans hold a far more nuanced view of abortion, and one that comports with the reality of the procedure. Of the roughly 1 million abortions performed a year in America, about 90 percent take place within the first 12 weeks of pregnancy and only 1 percent take place after 20 weeks (in fact, over the past decade, there has been a marked trend toward earlier abortions). That helps explain why 62 percent of Texans supported S.B. 5, the bill that Wendy Davis filibustered.

Update: You went full Satanist. Never go full Satanist:

Not that invoking Satan isn’t serious, but the response on Twitter included some great humor. A few of my favorites:


The Blaze noted:

Obviously, it is much more likely that the abortion supporters were chanting “Hail Satan!” to mock pro-lifers rather than actually hailing Lucifer, but anything is possible.

Ed Morrissey responded:

I’m certain that the intent was mockery. The overall effect of chanting “Hail Satan”? That’s another story, but one of those effects is surely clarity.

Right. Having been to Texas, I can assure you that the defense of “We were mocking Christians by invoking Satan,” might actually make things worse.

We’re just trying to raise your awareness…

Filed under: Health, Media, Politics — Tags: , , , , — Nicholas @ 09:44

… because we’re morally and ethically superior to you unwashed plebs:

Last Thursday was Post-Traumatic Stress Disorder Awareness Day. If you missed it, that’s probably because every week there are awareness days. We’re swamped by them. There are literally thousands of organisations whose mission is to raise our awareness. There is also a vast number of politicians, policymakers, experts, professionals, academics and earnest volunteers who are all devoted to the cause of raising awareness.

Those who set themselves up to raise the public’s awareness are not just providing information; they’re also making a statement about themselves, about who they are. They, unlike those who require their support, are aware. Awareness is presented as a state of being all of us should aspire to attain. In its common usage today, the term awareness resists any clear definitions. It is not simply about knowing or understanding. [. . .]

Campaigns designed to raise awareness are as much about advertising the status of the campaigners as they are about changing the outlook of a target audience. For example, advocates of breastfeeding produce literature that affirms the virtuous nature of their own lifestyles while also inviting those who have not seen the light to become aware. The very term ‘raising awareness’ involves drawing a distinction between those who are enlightened, who are aware of something, and those who are not. It draws attention to the fundamental contrast between those who know and those who are ignorant, between the morally superior and the morally inferior. So someone who allows his children to eat junk food is not only unaware and ignorant; he’s also morally questionable.

Awareness-raising campaigns impute to their advocates the values of intelligence, sensitivity, broadmindedness, sophistication and enlightenment. For that reason, the mission of raising awareness has become a key cultural resource for those who want to distinguish themselves from others. Awareness-raisers are invariably drawn towards inflating the behavioural and cultural distinctions between themselves and the rest of society; they are preoccupied with constructing a lifestyle that contrasts as sharply as possible to the lifestyles of their moral inferiors. What is really important about their lifestyles is not so much the values they exhort, but that they are different, in every detail, from the lives led by obese, junk-food eating, gas-guzzling, xenophobic and fundamentalist consumers of the tabloid press and junk culture.

Sociologically speaking, the act of raising awareness is really a claim for moral respect, and more importantly moral authority. The possession of awareness is a marker of superiority — and the absence of awareness is taken as a sign of inferiority. Those who refuse to ‘be aware’ are frequently morally condemned

June 27, 2013

Progress and regress in the pursuit of care for the mentally ill

Filed under: Government, Health, History, USA — Tags: , , — Nicholas @ 13:32

In City Journal, James Panero looks at the history of treatment of the mentally ill in America:

If it’s true that “men moralise among ruins,” as Benjamin Disraeli wrote, the ruins of America’s nineteenth-century mental institutions should invite some serious reflection. Built between 1850 and 1900, these crumbling edifices speak to our onetime dedication to caring for the mentally ill. Almost all were designed on the Kirkbride Plan, named for Pennsylvania physician Thomas Story Kirkbride, author of an influential treatise on the role of architecture and landscape in treating mental disorders. Even in their dilapidated state, it’s possible to see how the buildings, which followed a method of care called the “moral treatment,” gave the mentally ill a calming refuge from the gutters, jails, and almshouses that had been the default custodians of society’s “lunatics.”

Unfortunately, in the middle of the twentieth century, as asylums became grossly overcrowded and invasive treatments aroused public concern, the moral treatment came to seem immoral. The eventual result was the process known as deinstitutionalization, which steadily ejected patients from the asylums. Instead of liberating the mentally ill, however, deinstitutionalization left them — like the asylums that once sheltered them — in ruins. Many of today’s mentally ill have returned to pre-Kirkbride conditions and live on society’s margins, either sleeping on the streets or drifting among prisons, jails, welfare hotels, and outpatient facilities. As their diseases go untreated, they do significant harm to themselves and their families. Some go further, terrorizing communities with disorder and violence. Our failure to care for them recalls the inhumane era that preceded the rise of the state institutions. The time has come for new facilities and a new moral treatment.

[. . .]

At a time when the medical science of mental illness was in its infancy, the Kirkbride Plan created alternative, protected worlds for patients. It echoed many of today’s more holistic approaches to treatment by encouraging patients to participate in social activities, games, and crafts. Kirkbride institutions often sported their own baseball diamonds, golf courses, bakeries, bowling alleys, ice cream shops, dairy farms, gardens, and stages for plays and other performances.

But in the twentieth century, a shadow fell over the Kirkbride asylums, as doctors there began using more invasive procedures. The Austrian psychiatrist Manfred Sakel introduced insulin shock therapy, now known as insulin coma therapy, in the 1930s. Electroshock therapy arrived from Italy soon after. Both treatments induced seizures to alter brain chemistry in patients with depression and schizophrenia. In 1949, the Portuguese neuropsychiatrist Egas Moniz won a Nobel Prize for developing the frontal lobotomy, which he had invented in 1935. Walter Freeman, a clinical neurologist in Washington, D.C., further popularized the treatment through his own outpatient procedure, which came to be known as the transorbital, or “ice-pick,” lobotomy.

June 25, 2013

Portugal’s experience with drug decriminalization

Filed under: Europe, Health, Law, Liberty — Tags: , , , — Nicholas @ 14:38

The Cato Institute sent out a Twitter update, reminding everyone about the 2009 White Paper by Glenn Greenwald on how the Portuguese drug experiment played out after 2001:

On July 1, 2001, a nationwide law in Portugal took effect that decriminalized all drugs, including cocaine and heroin. Under the new legal framework, all drugs were “decriminalized,” not “legalized.” Thus, drug possession for personal use and drug usage itself are still legally prohibited, but violations of those prohibitions are deemed to be exclusively administrative violations and are removed completely from the criminal realm. Drug trafficking continues to be prosecuted as a criminal offense.

While other states in the European Union have developed various forms of de facto decriminalization — whereby substances perceived to be less serious (such as cannabis) rarely lead to criminal prosecution — Portugal remains the only EU member state with a law explicitly declaring drugs to be “decriminalized.” Because more than seven years have now elapsed since enactment of Portugal’s decriminalization system, there are ample data enabling its effects to be assessed.

Notably, decriminalization has become increasingly popular in Portugal since 2001. Except for some far-right politicians, very few domestic political factions are agitating for a repeal of the 2001 law. And while there is a widespread perception that bureaucratic changes need to be made to Portugal’s decriminalization framework to make it more efficient and effective, there is no real debate about whether drugs should once again be criminalized. More significantly, none of the nightmare scenarios touted by preenactment decriminalization opponents — from rampant increases in drug usage among the young to the transformation of Lisbon into a haven for “drug tourists” — has occurred.

The political consensus in favor of decriminalization is unsurprising in light of the relevant empirical data. Those data indicate that decriminalization has had no adverse effect on drug usage rates in Portugal, which, in numerous categories, are now among the lowest in the EU, particularly when compared with states with stringent criminalization regimes. Although postdecriminalization usage rates have remained roughly the same or even decreased slightly when compared with other EU states, drug-related pathologies — such as sexually transmitted diseases and deaths due to drug usage — have decreased dramatically. Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens — enhancements made possible, for numerous reasons, by decriminalization.

June 24, 2013

Finally, a semi-rational explanation for the slow adoption of deodorant in Britain

Filed under: Britain, Health, History, Media — Tags: , , — Nicholas @ 11:57

Richard Smith talks about the British Medical Association’s “official” stance on heterosexual and homosexual “indulgences” from the 1950s on, and also explains why British use of deodorant always lagged the rest of the western world:

I was once responsible for Family Doctor Publications, which were a series of booklets owned by the BMA, had titles like You and Your Bowels, and sold in huge numbers in the 1950s because they were almost the only information on health available to the public. I was much amused that in the 50s the BMA agreed that the booklets could include advertising for cigarettes and alcohol, but under no circumstances could they advertise contraceptives. And at about the same time thousands of copies of one booklet had to be pulped because it seemed to accept the possibility of sex before marriage. Now I’ve learnt more about the prudishness and “severe, restrictive morality” of the BMA.

[. . .]

The BMA was also happy to ignore science and evidence when it launched into explanations of what at the time was perceived as “an epidemic of homosexuality.” “Many men see in homosexual practices as a way of satisfying their sexual desires without running the risks of sequelae of heterosexual intercourse. They believe, for example, that there is no danger of contracting venereal disease in homosexual activity. Other men adopt homosexual practices as a substitute for extramarital heterosexual intercourse because there is no fear of causing pregnancy or emotional complications as in the life of a woman.” The idea that “women” equals “emotional complications” was a very 50s idea.

It was unsurprising, thought the BMA, that the public would be hostile to homosexuals because of the propensity of its practitioners in “positions of authority to give preferential treatment to homosexuals or to require homosexual subjection as an expedient for promotion. The existence of practising homosexuals in the Church, Parliament, Civil Service, Armed Forces, Press, radio, stage and other institutions constitutes a special problem.” Medicine is conspicuously absent from that list. God (heterosexual, of course, even though capable of insemination without intercourse) forbid that the BMA would have homosexuals in its membership.

The BMA found sexual acts between men “repulsive” and that “homosexuals congregating blatantly in public houses, streets, and restaurants are an outrage to public decency. Effeminate men wearing make-up and using scent are objectionable to everybody.” Born in 1952 I was infused with this kind of thinking and didn’t use a deodorant until I was 45 for fear of what people might think. My father, born in 1922, didn’t like me to buy half a pint rather than a pint of beer in case I be thought homosexual.

Having made its position clear, the BMA concluded that “if degenerate sodomists” persist then “it would be in the public interest to deal with them in the same way as mentally deranged offenders.” In other words, commit them to state lunatic asylums.

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