One of the fun gross-out facts of natural science a couple of decades back was the observation that in some preying mantis species, insufficiently careful males would die for love. You remember. The male would carefully, hesitantly approach the female. When he got close enough she’d pull off his head and eat it while his decapitated body jumped her bones. To the ....... spine tingling delight of many and, one suspects, the erectile dysfunction of some, the ways of nature were revealed to an avid public. I recall hearing it mentioned in some bit of nervous, male, anti-feminist bluster somewhere or other. Maybe it explains the rise of Rush Limbaugh.
You get used to filtering out commercials during the evening news but once in a while one breaks through your defenses. At the tail end of a Levitra commercial Sunday they included sudden deafness as a reported side effect. Sudden deafness now joins the list of announced effects of taking whoopie pills, which already include seeing blue and inconvenient, hours long, priapus. To anyone aspiring to enjoy the erectile state of a 16-year-old, the last one should come as no surprise. That is if their long-term memory of one of the more embarrassing parts of being an adolescent male is still intact.
There are so many sides to this, the lax standards of drug approval in the aftermath of neo-classical economics, the direct promotion of dangerous drugs to the public - thanks to the idiocy of a Supreme Court more wedded to legal theory than observation of real life, etc. But the most interesting question is how far geezers, themselves, are willing to go to achieve rock hard erections into their late senescence. Would they accept having their head fall off, one wonders? Would they miss it? I’ve got to listen more closely tonight to hear if death is a reported side effect of aphro-geeziacs, by name or not. The answer may have already been reported.
I won’t extend this parallel to the mating habits of the Mantidae and risk adding to the performance anxiety which is the root of the issue. And some readers of this blog might still have to get through breakfast.
Tuesday, August 19, 2008
Monday, August 18, 2008
Remember. And, If You Cannot Remember, Invent
Hurrah! I can post!
Max Daschu explains how women have been left out of history.
We can, of course, either remember our history or, in Monique Witting's words, invent our history. Daschu opts for "remembering." And expanding our vision of power helps.
Max Daschu explains how women have been left out of history.
We can, of course, either remember our history or, in Monique Witting's words, invent our history. Daschu opts for "remembering." And expanding our vision of power helps.
Safety, racism and guilt (by Suzie)
Davis told the teenager that his grandmother was correct to feel scared because she understood African-Americans "have a reason to hate."In Obama’s speech on race, he said his grandmother “once confessed her fear of black men who passed by her on the street.”
Did she fear any black man who passed her on the street? Is it possible that she would have been wary of any man, no matter his race, who pursued her for money?
First Obama, then others, have discussed his grandmother’s fears to illustrate attitudes about race. But her fears also speak to the harassment women (of all colors) face on the street and in public transportation.
I understand that it’s incendiary to talk about white women and black men. I’m not saying white women should fear black men more than white men. In regard to violence, women are more likely to be victims of men of their own race whom they know than they are of a stranger of another race. Nevertheless, if a woman (of any color) is afraid of a guy on the street, I think she has the right to be heard. Also, if a woman (of any color) has no problem taking precautions against a strange white guy, she should feel free to do the same when confronted by a man of color.
This dovetails with a fascinating series I’ve mentioned before in which a writer for the Cleveland Plain Dealer talks about many issues connected to her rape, including race. Joanna Connors is white; the rapist was black. She encountered him in a theater, and he was the only other person there.
I ignored my instinct not to trust a stranger, because the stranger was young and black, and I did not want to look like a racist white woman who automatically does not trust young black men. If he had been white? I'm not sure -- but I think I would have left.In another situation, a white woman might have trusted a white man, and still gotten raped. Or, a woman of color might have trusted a man of color. Or, she might not have wanted to look afraid in front of a white man. You can complicate the scenario with different ethnicities or different rationales, such as a woman needing to do her job. No matter what, women who get raped may still feel shame in a society that second-guesses their decisions. Connors continues:
The rape made me fear black men I did not know, especially young black men. I hated this fear. I tried to reason my way out of it, and I spent a lot of my time in therapy trying to overcome it.As in the previous post, I’m not saying women have to live in fear of, or distrust, all men all the time. Nor am I saying that whites should not examine their feelings about race. What I’m saying is: As progressives, let’s not forget women when we talk about civil liberties.
Finally, a psychologist asked me the obvious, common-sense question: "But do you also fear and avoid strange white men?"
My answer was yes, of course. The difference was that fearing white men did not make me feel bad about myself. It did not make me feel like a closet racist. It did not bring me shame.
Fifteen days of blogging for health care reform: Unfunded mandates
Guest post by Skylanda.
The arrival of my intern class at the university hospital was occasioned by the opening of the brand spanking new emergency department. I never had the pleasure - or the horror - of seeing the old department, though its mythology remains. Occupied beds lining the hallways, bleeding patients begging as you passed anonymously on your way to find the one you were assigned to admit, and dingy, always dingy in those old war stories. No, by the time I arrived and rotated through there on the first month of the academic year, the old one was shut and gutted, and the sparkling new ED was up and open and running at such a constipated pace that most nights we had half a dozen beds moving patients, a dozen or so beds in each wing housing admitted patients waiting for real rooms upstairs, and nothing to do but twiddle our thumbs while some forty to sixty patients lay triaged but unseen in the waiting room. Except for a few Friday nights when the frenetic shuffle between the ambulance docks, the resuscitation bays, and the trauma-surgery ICU kept the whole lot of us running, it made for an eerily quiet month in the busiest emergency department in the state.
On one of the quieter nights, I got an earful out of one of the ED attendings. The topic was universal health care; the tone was at a low yell. I didn’t ask about it because I know better than to talk politics at work - someone else set off the spark, I was just in the line of sight when he started to breath fire.
“What do you think,” some poor, unsuspecting resident rotating from another department asked, “are you for or against universal health care?”
“We already HAVE a system of socialized medicine in this damn country,” the attending snarled back, all afire all of a sudden, “people just refuse to f’ing admit it.”
I thought for a moment before contributing anything to a clearly sensitive topic, then I ventured forth. “You mean things like Medicare?” I asked and then ducked back. People over 65 and enrolled tribe members under the Indian Health Service are often cited as the only two demographics in the US with entitled access to health care - that is, they have it and cannot lose it through change in circumstance; the former was the first one into my head and out of my mouth.
“No,” he said tightly. “The emergency room. Look around you. How many of these people can pay? How many will pay? How many handed you a fake name and a social security number that doesn't exist because they can't afford to have this bill coming to their residence, if they even have a place they call a residence? But we take care of them anyway. Not that we wouldn't if we did have the choice, but we are mandated to. The great unfunded - and unspoken - mandate of the American health care system. Anyone who cannot pay comes to us. You primary care people can turn them away, but we cannot. No one pays for this, no one reimburses us for this, we eat most of these bills, if we‘re lucky the billable visits covers the write-offs in any given year. And if something goes wrong, they can sue us even though no one has paid us a dime for the time and effort spent on their care. We already HAVE socialized medicine in the US. We just need to start acting like we have it, and start f’ing paying for it.”
We digested this for a moment while he went back to scribbling orders. But he wasn‘t done just yet.
“You know about EMTALA, right?”
Oh yes, EMTALA: The Emergency Medical Treatment and Active Labor Act. This is the law that mandates that anyone who is hurt or in labor can show up to almost any ED and has the right to be seen by a provider, no matter if they can pay or not (not that this stops private hospitals from owning ambulance companies and directing their fleet to triage their cargo to various hospital, including or not including their own, based on their gestalt assessment of the patient's ability to pay). It always seemed to me - as it probably seems to most - that emergency departments, merely by their nature, have some kind of cosmic obligation to treat emergencies. But this is not the case. There is actually an American law that states that all emergency departments - at least all those who receive any reimbursement from the Medicare/Medicaid axis - must triage, stabilize, and at least transfer to an appropriate facility (if not treat in house) anyone who presents ill, injured, or in labor. Without this law, you can bet that certain emergency departments would not accept certain patients…of that you can be certain.
EMTALA, it turns out, is a mixed blessing for the uninsured and underinsured folks of America. On one hand, it provides the final and definitive safety net for those without any other means of access to health care. You can be undocumented, on the lam from a felony charge, hopped up on meth, without a cent to your name (and believe me, this constellation of demographic niceties is not a rare story at the university ED), and if you walk into any almost emergency department in America, they have to address your chest pain, your diabetes, your stab wound, your disease du jour. EMTALA is what stands between care and disaster for a large number of American citizens and others living and working inside our borders.
EMTALA is also - in my opinion - one of the primary stumbling blocks between America and concrete health care reform. However noble in intent, it is entirely possible that without EMTALA, pressure would have mounted so high on the health care system from so many quarters by now (from so many people dying, being turned away from the ER doors with no insurance) that something would have had to give. The stitching on real safety nets might have begun. No one can say for sure, of course - Americans are breath-taking in our ability to bury heads in sands when tough but feasible answers are available to nasty problems - but EMTALA has become both a curse and godsend to every uninsured person in the country. If worst comes to worst, the ER always has to take you. It makes us all sleep a little better at night. And because we all sleep a little better at night, we don't bother to get up the next morning and do something concrete to solve the problem of lack of health care access.
Would I revoke EMTALA now? No, of course not - the ferrets are already loose in the chicken house, it would do far more harm than good. But if I could go back two decades to the year that EMTALA was passed - to a time when the health care crisis was just peaking around the corner and not brewing in forty million-plus American homes - I might have thought twice and hard about whether it was such a good idea. By providing half a safety net full of holes, we have put off the weaving of a strong social fabric to take care of the nation‘s health.
The arrival of my intern class at the university hospital was occasioned by the opening of the brand spanking new emergency department. I never had the pleasure - or the horror - of seeing the old department, though its mythology remains. Occupied beds lining the hallways, bleeding patients begging as you passed anonymously on your way to find the one you were assigned to admit, and dingy, always dingy in those old war stories. No, by the time I arrived and rotated through there on the first month of the academic year, the old one was shut and gutted, and the sparkling new ED was up and open and running at such a constipated pace that most nights we had half a dozen beds moving patients, a dozen or so beds in each wing housing admitted patients waiting for real rooms upstairs, and nothing to do but twiddle our thumbs while some forty to sixty patients lay triaged but unseen in the waiting room. Except for a few Friday nights when the frenetic shuffle between the ambulance docks, the resuscitation bays, and the trauma-surgery ICU kept the whole lot of us running, it made for an eerily quiet month in the busiest emergency department in the state.
On one of the quieter nights, I got an earful out of one of the ED attendings. The topic was universal health care; the tone was at a low yell. I didn’t ask about it because I know better than to talk politics at work - someone else set off the spark, I was just in the line of sight when he started to breath fire.
“What do you think,” some poor, unsuspecting resident rotating from another department asked, “are you for or against universal health care?”
“We already HAVE a system of socialized medicine in this damn country,” the attending snarled back, all afire all of a sudden, “people just refuse to f’ing admit it.”
I thought for a moment before contributing anything to a clearly sensitive topic, then I ventured forth. “You mean things like Medicare?” I asked and then ducked back. People over 65 and enrolled tribe members under the Indian Health Service are often cited as the only two demographics in the US with entitled access to health care - that is, they have it and cannot lose it through change in circumstance; the former was the first one into my head and out of my mouth.
“No,” he said tightly. “The emergency room. Look around you. How many of these people can pay? How many will pay? How many handed you a fake name and a social security number that doesn't exist because they can't afford to have this bill coming to their residence, if they even have a place they call a residence? But we take care of them anyway. Not that we wouldn't if we did have the choice, but we are mandated to. The great unfunded - and unspoken - mandate of the American health care system. Anyone who cannot pay comes to us. You primary care people can turn them away, but we cannot. No one pays for this, no one reimburses us for this, we eat most of these bills, if we‘re lucky the billable visits covers the write-offs in any given year. And if something goes wrong, they can sue us even though no one has paid us a dime for the time and effort spent on their care. We already HAVE socialized medicine in the US. We just need to start acting like we have it, and start f’ing paying for it.”
We digested this for a moment while he went back to scribbling orders. But he wasn‘t done just yet.
“You know about EMTALA, right?”
Oh yes, EMTALA: The Emergency Medical Treatment and Active Labor Act. This is the law that mandates that anyone who is hurt or in labor can show up to almost any ED and has the right to be seen by a provider, no matter if they can pay or not (not that this stops private hospitals from owning ambulance companies and directing their fleet to triage their cargo to various hospital, including or not including their own, based on their gestalt assessment of the patient's ability to pay). It always seemed to me - as it probably seems to most - that emergency departments, merely by their nature, have some kind of cosmic obligation to treat emergencies. But this is not the case. There is actually an American law that states that all emergency departments - at least all those who receive any reimbursement from the Medicare/Medicaid axis - must triage, stabilize, and at least transfer to an appropriate facility (if not treat in house) anyone who presents ill, injured, or in labor. Without this law, you can bet that certain emergency departments would not accept certain patients…of that you can be certain.
EMTALA, it turns out, is a mixed blessing for the uninsured and underinsured folks of America. On one hand, it provides the final and definitive safety net for those without any other means of access to health care. You can be undocumented, on the lam from a felony charge, hopped up on meth, without a cent to your name (and believe me, this constellation of demographic niceties is not a rare story at the university ED), and if you walk into any almost emergency department in America, they have to address your chest pain, your diabetes, your stab wound, your disease du jour. EMTALA is what stands between care and disaster for a large number of American citizens and others living and working inside our borders.
EMTALA is also - in my opinion - one of the primary stumbling blocks between America and concrete health care reform. However noble in intent, it is entirely possible that without EMTALA, pressure would have mounted so high on the health care system from so many quarters by now (from so many people dying, being turned away from the ER doors with no insurance) that something would have had to give. The stitching on real safety nets might have begun. No one can say for sure, of course - Americans are breath-taking in our ability to bury heads in sands when tough but feasible answers are available to nasty problems - but EMTALA has become both a curse and godsend to every uninsured person in the country. If worst comes to worst, the ER always has to take you. It makes us all sleep a little better at night. And because we all sleep a little better at night, we don't bother to get up the next morning and do something concrete to solve the problem of lack of health care access.
Would I revoke EMTALA now? No, of course not - the ferrets are already loose in the chicken house, it would do far more harm than good. But if I could go back two decades to the year that EMTALA was passed - to a time when the health care crisis was just peaking around the corner and not brewing in forty million-plus American homes - I might have thought twice and hard about whether it was such a good idea. By providing half a safety net full of holes, we have put off the weaving of a strong social fabric to take care of the nation‘s health.
The attending’s diatribe ended with a declaration that he already provides universal health coverage, and that it is just up to America to start ponying up the cash for the services we demand of his profession. Moreover, wider coverage would prevent the sort of drain-clogging ER crowds that drive doctors trained in the medical heroics of trauma and resuscitation to spend their time fixing primary care issues that cost a pennies on the dollar to treat in clinic versus the emergency department. Universal coverage would empty the ERs of the earaches and the bellyaches and the headaches and leave way for the car crashes and the heart attacks and the knife wounds - the things that ERs were built to handle, the things that ER docs were born to revel in.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
Sunday, August 17, 2008
Fifteen days of blogging for health care reform: OHP - a bold experiment in systematic reform
Guest post by Skylanda.
Local newspapers are a funny thing - half pulpy fiber ready-made for the recycling bin, half pure insight into the local ways and goods. When I first moved to Oregon several years back, I picked up the local rag one day, intending to peruse the real estate and rentals section. The front page caught my eye; on it was a lengthy list of medical conditions, some five hundred or so altogether. Somewhere on the list - probably around number three hundred or so - was a line break. I scrutinized it for some time, but couldn’t discern the connotation even behind the accompanying article. It took me several years of pre-clinical and then clinical experience to fully appreciate what I saw on the front page of the paper that day.
The list of medical conditions was the condensed essence of the state Medicaid program, known about town as the Oregon Health Plan (OHP). There is much myth - and much detail - about OHP that is somewhat lost on me, so any Oregonians out there who care to correct me are invited up front to do so. But the gist of it, as I understand it, goes like this.
Years back - before the lean years, when Oregon was still enjoying the spill-over of the tech boom in California - a group of reform-minded physicians and other supporters started a bold experiment in health care reform. The charge was led a lanky, cowboy boot-clad, bolo tie-wearing governor who goes by the name of Kitzhaber. Kitzhaber was an ER doctor in his first incarnation, before he got into politics. This crowd got federal exemption from the standard Medicaid rules, and went about creating a new system on which a model of universal coverage could be built. It was built on a series of assumptions, something like this:
The first premise is that the coverage offered should occur in a hierarchy, and that that hierarchy should be 100% transparent. These folks claimed - boldly, I emphasize again - that all available medical treatments could be given numerical value based on a set of parameters that come down to, essentially, health bang per health buck. There are, for example, cheap treatments that result in major health gained - things like vaccinations and drugs to control diabetes; these things top the list. Then there are cheap treatments for only marginal health gain (oh, let‘s say, acupuncture), and expensive treatments for large health gain (how about: chemotherapy for cancer); these get mixed up in the middle. Finally, there are expensive treatments for little health gain, and these go at the bottom of the list (the most notorious of these was treatment for pancreatic cancer - expensive, painful, almost useless, most people die of the disease no matter what you do for them). You can use health surveillance data to then multiply each list entry by a) the number of people who get that condition each year, and b) how much it costs to treat each one of those people. You can keep a running total in the next column, and if you know your total Medicaid budget for the year, you can draw a line through the list where your running total equals your Medicaid budget. You cover the conditions above the line, deny the conditions below the line, and voila, you have achieved maximum health available per dollars you have to spend.
Although I suspect it involved a little more math than I give credit for, perhaps.
The genius of this tactic is the transparency - that the list was run in the paper every year (maybe still is, I don’t know…Oregonians, want to chime in on that?). Don’t like it? Think it’s heinous that coverage is denied to little Susie just because her condition fell two notches below the line? Fine. Pressure your representatives for more dedicated Medicaid funding from the state and federal pools next year. It’s the opposite of the CIA’s black-line discretionary budget: you know exactly what your tax dollars are buying, and if you don‘t like it, you‘re welcome to involve your own bad self in the political process and push to change it.
The second premise - which you may have already noted above - is that the decisions on which to base the list are to be based in clinically sound data and guidelines. In the parlance of modern medicine, they are to be “evidence based.” This tactic means that the ranking of the list was based on available data, not on what is popular at the moment, what the pharmaceutical reps are pushing, or what is the hottest new experimental procedure. This also caused some consternation - partly because not everything medical people do is evidence-based under the best of circumstance, and partly because no kind of experimental treatment is covered at all (though this is not atypical of any insurance plan). Nevertheless, there it is.
This also leads to the third premise: that the medication formulary associated with this plan should also be evidence based, with a firm emphasis on cost control. Functionally, this means that if two drugs perform the same in trials, the cheaper one goes on the formulary and the more expensive is not covered unless there is some compelling reason why the patient cannot tolerate the cheap one (formularies are usually based on which drug company cut which deal with which insurance company and/or hospital, making them profoundless useless outside of their immediate context). This was among the most useful tools produced by the OHP folks, and doctors here and there around the nation picked up the OHP formulary for informal use in their own practice because it was so pointed and effective in weeding out pharmaceutical advertising from actual evidence. I used it not because I had many OHP patients (by the time I came around, OHP was flailing badly, and most my patients were either privately insured or uninsured), but because it was the easiest way to find a drug in a given class that a poor patient was most likely going to be able to pay for.
The final premise that made OHP such a unique experiment in medical coverage was the role of the list itself. Medicaid is designed to cover poor people (Medicare, remember, is designed to cover retired people); the definition of “poor” often moves to accommodate a given state’s Medicaid budget. In some states, you have to be so dirt poor that if you work so much as a few hours a week, you’re off the Medicaid rolls. The crux of the OHP experiment was to shift the mode of cost control from trimming people from the rolls to trimming the health care package itself. The standard metaphor they used went like this: when your local county elementary education budget gets cut by 10%, no one throws 10% of the kids out of school - they merely cut 10% of services: teachers, aides, school lunches, whatever. It’s not ideal, but even in the worst of circumstances, as a society we agree that you do not cut people out of that particular service; you can cut the service package, but you cut it the same for all parties. And so should be health care: when the inevitable budget crisis comes reaming through your front door, you do not cut people off the Medicaid rolls; you cut services, you cut the package offered, so that the total group of people is still covered.
And this is the place where revolutions happen. Though this is the norm in every other industrialized nation, it is an alien concept here, one that needs metaphors and explanations and justifications. But the crux is this: we take care of ours. Even in lean times, when they’ve trimmed the fat and are now cutting down to bone, we’re all in this equally, together, getting the same goods, receiving the same package, facing the same limitations, even if we‘re just talking about the subset of us on Medicaid. It’s just that little tweak of this thing called justice. It ain’t perfect, but wow, it’s a bold shot, isn’t it?
That was then, back in the mid-1990s or so. I moved to Oregon a couple years after the tech bust, when state budgets on the west coast were doing the rough equivalent of the gymnastics that the mortgage industry is performing now. Whereas providers rushed to sign on OHP patients in the early days, reimbursement for services had fallen so sharply that it had become hard to find providers who weren’t refusing patients at the door. This doesn’t speak well of all providers, but you can’t entirely blame them: you cannot maintain a business pulling in less cash per patient than it costs to rent the building you house your office in for that chunk of time; the world just doesn’t work like that. When I left the state, the program was sinking rapidly and no one was quite sure how to fix it, short of a mass infusion of cash that didn’t seem to be materializing.
Meanwhile, Kitzhaber’s term limits ended his governorship and he left office the year I moved up there; he and his cadre went on to found the Center for Evidence-Based Policy, a think-tank dedicated to continuing the pursuit of the basic values of OHP: cost-effective, health-effective medicine. Medicine, that is, that buys health.
Far from a requiem, the precepts of the OHP should serve as a model for nation-wide reform. Transparency, evidence-based practice, cost-effective choices mandated first when all other parameters are equal. And the move toward policy that gives at least a tiny little nod to that stubborn, hard-to-kill beast we call justice.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
Local newspapers are a funny thing - half pulpy fiber ready-made for the recycling bin, half pure insight into the local ways and goods. When I first moved to Oregon several years back, I picked up the local rag one day, intending to peruse the real estate and rentals section. The front page caught my eye; on it was a lengthy list of medical conditions, some five hundred or so altogether. Somewhere on the list - probably around number three hundred or so - was a line break. I scrutinized it for some time, but couldn’t discern the connotation even behind the accompanying article. It took me several years of pre-clinical and then clinical experience to fully appreciate what I saw on the front page of the paper that day.
The list of medical conditions was the condensed essence of the state Medicaid program, known about town as the Oregon Health Plan (OHP). There is much myth - and much detail - about OHP that is somewhat lost on me, so any Oregonians out there who care to correct me are invited up front to do so. But the gist of it, as I understand it, goes like this.
Years back - before the lean years, when Oregon was still enjoying the spill-over of the tech boom in California - a group of reform-minded physicians and other supporters started a bold experiment in health care reform. The charge was led a lanky, cowboy boot-clad, bolo tie-wearing governor who goes by the name of Kitzhaber. Kitzhaber was an ER doctor in his first incarnation, before he got into politics. This crowd got federal exemption from the standard Medicaid rules, and went about creating a new system on which a model of universal coverage could be built. It was built on a series of assumptions, something like this:
The first premise is that the coverage offered should occur in a hierarchy, and that that hierarchy should be 100% transparent. These folks claimed - boldly, I emphasize again - that all available medical treatments could be given numerical value based on a set of parameters that come down to, essentially, health bang per health buck. There are, for example, cheap treatments that result in major health gained - things like vaccinations and drugs to control diabetes; these things top the list. Then there are cheap treatments for only marginal health gain (oh, let‘s say, acupuncture), and expensive treatments for large health gain (how about: chemotherapy for cancer); these get mixed up in the middle. Finally, there are expensive treatments for little health gain, and these go at the bottom of the list (the most notorious of these was treatment for pancreatic cancer - expensive, painful, almost useless, most people die of the disease no matter what you do for them). You can use health surveillance data to then multiply each list entry by a) the number of people who get that condition each year, and b) how much it costs to treat each one of those people. You can keep a running total in the next column, and if you know your total Medicaid budget for the year, you can draw a line through the list where your running total equals your Medicaid budget. You cover the conditions above the line, deny the conditions below the line, and voila, you have achieved maximum health available per dollars you have to spend.
Although I suspect it involved a little more math than I give credit for, perhaps.
The genius of this tactic is the transparency - that the list was run in the paper every year (maybe still is, I don’t know…Oregonians, want to chime in on that?). Don’t like it? Think it’s heinous that coverage is denied to little Susie just because her condition fell two notches below the line? Fine. Pressure your representatives for more dedicated Medicaid funding from the state and federal pools next year. It’s the opposite of the CIA’s black-line discretionary budget: you know exactly what your tax dollars are buying, and if you don‘t like it, you‘re welcome to involve your own bad self in the political process and push to change it.
The second premise - which you may have already noted above - is that the decisions on which to base the list are to be based in clinically sound data and guidelines. In the parlance of modern medicine, they are to be “evidence based.” This tactic means that the ranking of the list was based on available data, not on what is popular at the moment, what the pharmaceutical reps are pushing, or what is the hottest new experimental procedure. This also caused some consternation - partly because not everything medical people do is evidence-based under the best of circumstance, and partly because no kind of experimental treatment is covered at all (though this is not atypical of any insurance plan). Nevertheless, there it is.
This also leads to the third premise: that the medication formulary associated with this plan should also be evidence based, with a firm emphasis on cost control. Functionally, this means that if two drugs perform the same in trials, the cheaper one goes on the formulary and the more expensive is not covered unless there is some compelling reason why the patient cannot tolerate the cheap one (formularies are usually based on which drug company cut which deal with which insurance company and/or hospital, making them profoundless useless outside of their immediate context). This was among the most useful tools produced by the OHP folks, and doctors here and there around the nation picked up the OHP formulary for informal use in their own practice because it was so pointed and effective in weeding out pharmaceutical advertising from actual evidence. I used it not because I had many OHP patients (by the time I came around, OHP was flailing badly, and most my patients were either privately insured or uninsured), but because it was the easiest way to find a drug in a given class that a poor patient was most likely going to be able to pay for.
The final premise that made OHP such a unique experiment in medical coverage was the role of the list itself. Medicaid is designed to cover poor people (Medicare, remember, is designed to cover retired people); the definition of “poor” often moves to accommodate a given state’s Medicaid budget. In some states, you have to be so dirt poor that if you work so much as a few hours a week, you’re off the Medicaid rolls. The crux of the OHP experiment was to shift the mode of cost control from trimming people from the rolls to trimming the health care package itself. The standard metaphor they used went like this: when your local county elementary education budget gets cut by 10%, no one throws 10% of the kids out of school - they merely cut 10% of services: teachers, aides, school lunches, whatever. It’s not ideal, but even in the worst of circumstances, as a society we agree that you do not cut people out of that particular service; you can cut the service package, but you cut it the same for all parties. And so should be health care: when the inevitable budget crisis comes reaming through your front door, you do not cut people off the Medicaid rolls; you cut services, you cut the package offered, so that the total group of people is still covered.
And this is the place where revolutions happen. Though this is the norm in every other industrialized nation, it is an alien concept here, one that needs metaphors and explanations and justifications. But the crux is this: we take care of ours. Even in lean times, when they’ve trimmed the fat and are now cutting down to bone, we’re all in this equally, together, getting the same goods, receiving the same package, facing the same limitations, even if we‘re just talking about the subset of us on Medicaid. It’s just that little tweak of this thing called justice. It ain’t perfect, but wow, it’s a bold shot, isn’t it?
That was then, back in the mid-1990s or so. I moved to Oregon a couple years after the tech bust, when state budgets on the west coast were doing the rough equivalent of the gymnastics that the mortgage industry is performing now. Whereas providers rushed to sign on OHP patients in the early days, reimbursement for services had fallen so sharply that it had become hard to find providers who weren’t refusing patients at the door. This doesn’t speak well of all providers, but you can’t entirely blame them: you cannot maintain a business pulling in less cash per patient than it costs to rent the building you house your office in for that chunk of time; the world just doesn’t work like that. When I left the state, the program was sinking rapidly and no one was quite sure how to fix it, short of a mass infusion of cash that didn’t seem to be materializing.
Meanwhile, Kitzhaber’s term limits ended his governorship and he left office the year I moved up there; he and his cadre went on to found the Center for Evidence-Based Policy, a think-tank dedicated to continuing the pursuit of the basic values of OHP: cost-effective, health-effective medicine. Medicine, that is, that buys health.
Far from a requiem, the precepts of the OHP should serve as a model for nation-wide reform. Transparency, evidence-based practice, cost-effective choices mandated first when all other parameters are equal. And the move toward policy that gives at least a tiny little nod to that stubborn, hard-to-kill beast we call justice.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
What Do You Know, You Can Get People To Agree With Themselves by Anthony McCarthy
Or, Do these guys ever listen to themselves?
In this mornings Boston Globe in yet another psych-ridden look at a story in the news, the “Clark Rockefeller” riddle, is this piece of vital information:
These subtle cues, Pentland emphasizes, are difficult to fake - he calls them "honest signals." But Bailenson and Yee's work suggests that the cues don't have to be subtle to work: most of their subjects didn't notice that they were being mimicked, even as they were proceeding to bond with the digital figure on the screen in front of them.
To earn someone's trust, in other words, even rather blatant aping can do the trick. One of the landmark studies on influence was done in 1965 by the Ohio State psychologist Timothy Brock. In it, shoppers at a paint store were approached by a research assistant who offered them advice on what type of paint to choose. He told half of the shoppers he approached that he had recently bought the same amount of paint that they were looking to buy, he told the other half he had bought a different amount.
By and large, the first group took his advice, and the second did not. Something as trivial as buying the same-sized bucket of paint, Brock argued, can forge a bond with a total stranger.
I had to read this at least four times to believe I was really reading this in the masthead article in a prestigious section of a major newspaper. I thought it was incipient dementia at first.
Apparently it takes a “landmark study” for psychology to understand that if a store clerk tells you he did what you wanted to do you’re likely to do what you wanted to do. And if he tells you he didn’t do what you wanted to do, you’re likely to do what you wanted to do. In short, people tend to do what they want to do.
Apparently this piece of obviously counterintuitive wisdom is impressive enough to be used in the Boston Globe Ideas Section forty-three years after it was published.
I’m tempted to look it up the ancient study to check to look if they controlled for:
- people who tried to estimate how much paint they would need and the methods they used,
- how many of the buyers just went into the store and guessed,
- whether or not they were trying to cover a darker color with a lighter color,
you know, the kinds of things real people think about when they’re painting something. In the small samples typical of studies of this type, even a few people taking these kinds of things into account might give entirely different results. But I’m on a very tight schedule. If you know the study, please tell us.
I’ve got a hunch that too much dependence on psychology is a sure sign of a lazy reporter, the Boston Globe Ideas section would be a good place to look for evidence.
II. No Joke
You might also read the letter by the executive director of public and member communications of the American Psychological Association, denying that it has done little to keep its members from actively participating in the Bush regime’s use of torture. Contrast it with this news article by Tania deLuzuriaga in another place in today’s Globe.
This issue, brought to new prominence by Jane Mayer and especially her reporting on the role of Martin Seligman in relation to the torture scandal. It’s tempting to be sarcastic about his protestations that his lecture to the incipient torture team was turned on its head and that his torturing dogs was for the greater good but that might risk turning this into a joke. It’s no joke.
What did Seligman think they were asking him for? I don’t believe he couldn’t have guessed that his lecture and the dog torturing experiment was very likely to be used to plan a program of torture in the year after 9-11. If he’s that naive you wonder what his lifetime in psychology has taught him about the way people think. A highschool history student looking at the darker side of the 20th century for a term paper would likely have guessed better. But then, I think history has a better track record for getting that kind of thing right, than psychology has. I also don’t trust people who torture animals for the greater good.
III.
And finally, a very rare and skeptical look at the use of imaging in studying behavior by Jonah Lehrer.
"There are so many bad brain imaging studies, it's hard to believe," says Nikos K. Logothetis, director of the Max Planck Institute for Biological Cybernetics in Germany. "Too many of these experiments are being done by people who, unfortunately, don't really understand what the technology can and cannot do."
Logothetis and others believe that much of the misuse stems from the visual nature of the data. One study, by researchers at Colorado State University, showed that simply giving neuroscience students images from an fMRI machine, even if the images were redundant or irrelevant, made the students significantly more likely to find the data credible. According to Paul Bloom, a psychologist at Yale, this is because fMRI "has all the trappings of work with great lab-cred: big, expensive, and potentially dangerous machines, hospitals and medical centers, and a lot of people in white coats."
The data looks rigorous - it has the veneer of cutting-edge science - and people assume it's valid, even when the reasoning is shoddy.
"You can't just put people in a scanner and ask them whatever question you want," Logothetis says. "Many of these [fMRI] papers are such oversimplifications of what's happening in the brain as to be worthless."
Update:
An e-mail objects most strenuously by to my jibe about the vintage psych study above.
First, what is there about being deceived by the accused con-man “Clark Rockefeller” and the experience of being psychologically manipulated by a psych student posing as a store clerk in an Ohio paint store in 1965 which makes the latter intuitively relevant to the former? What does the study of 1965 authoritatively add to the intellectual investigation of the bizarre news story? Please forgive me if I assert that the more rational assumption is that the study has nothing to tell us about it.
The two attempts at deception are insufficiently similar, to start with. The possible motives would seem to be entirely unlike. The people attempting the manipulation are hardly alike and the subjects almost certainly as unlike, though that would be an entirely undefined variable in the comparison. The fact is that “Rockefeller” is suspected of a decades long, geographically vast and complex range of deceptions, perhaps, including killing. The “clerks” in the paint store were certainly not doing it for the same reasons. They probably just wanted to get their degree.
We know the subjects in the study wanted to buy some paint, we have no idea of what range of motives the people who fell for “Rockefeller” under his various names and guises may have had or if those deceived by him shared anything else in common. There is no reasonable reason to suspect that the situations have any real life similarities that would make resulting claims linking them to have sufficient reliability to be considered science or journalism.
About the paint store study, let me pose just two possible scenarios to you.
You are a woman who has painted a heck of a lot of things. You are a very experienced painter who has taken the time and made the effort to come up with what experience leads you to believe is a good estimate of what you need to buy. You go into a store and see a younger man (somehow I’ve got the feeling that all the psych students were probably males, though I don’t know that*) who says that he bought a similar amount of paint. He proposes a brand of paint you have had good results with in the past, so you buy it. It might have been one you were considering buying anyway.
Another scenario. Assume you are an experienced painter who has made an estimate and the kid says he bought twice as much paint. You might be on your guard for being sold too much paint, maybe someone did that to you in the past. You know the kind of paint he tells you is not what you need. You might think the kid doesn’t know what he’s talking about. You don’t take his “advice”. If he tells you he bought less than you know you’ll need, you would also think he doesn’t know what he’s talking about. Maybe you decide to shop for paint elsewhere.
The ages of the customers and the “clerks” would have just about certainly been an issue for many of the customers. At least the ages could be objectively verified, many of the other issues couldn’t.
The people who walked into that paint store might have represented any range and combination of variations on the two scenarios proposed above, and there could have been other issues relevant to the choice that was made. Maybe the kid looked like a favorite nephew or one you think is a snot nosed brat. I wonder if there is any reason to believe that the customers were all sufficiently alike to assume they would have belonged in the set conceived of in the study other than the convenience of the researcher.
Would the motivations of two people either buying (or not buying) what the clerk recommended be the same action, representing the same motivation? I doubt it. I believe their motives would have been vastly different, perhaps no two truly alike.
How large a sample would you need to take all the possible relevant issues into account? What kinds of equations would have covered all these possible issues? How would they tabulate the results?
If these are problems of sufficient complexity so as to be a insurmountable problem for psychological researchers that might be unfortunate. It doesn’t make them irrelevant. Not if discovering reality is the goal. As seen in the rest of my morning post, decades old studies can have horrible real life impacts.
People working in journalism who make the improbable assumption that these “studies” are relevant to their reporting of the news are guilty of multiple journalistic sins. Just the facts. The verified facts, supported by two independent sources. Anything else isn’t news.
* You wonder what the possible effect of having a female “clerk” advising a customer on paint would have had on the choices made in 1965. I don’t know about Ohio but do suspect that it would have been very unusual in most places in 1965 to have a female clerk in most hardware departments. You wonder at the difference in gender between “clerk” and customer. And you wonder about the various responses to that among customers of the same gender. How can you account for those contributors to the ultimate choice. And you wonder what the relevant social changes would do to the applicability of the “findings” four decades later.
I can’t tell you, just that I think they’re probably important.
In this mornings Boston Globe in yet another psych-ridden look at a story in the news, the “Clark Rockefeller” riddle, is this piece of vital information:
These subtle cues, Pentland emphasizes, are difficult to fake - he calls them "honest signals." But Bailenson and Yee's work suggests that the cues don't have to be subtle to work: most of their subjects didn't notice that they were being mimicked, even as they were proceeding to bond with the digital figure on the screen in front of them.
To earn someone's trust, in other words, even rather blatant aping can do the trick. One of the landmark studies on influence was done in 1965 by the Ohio State psychologist Timothy Brock. In it, shoppers at a paint store were approached by a research assistant who offered them advice on what type of paint to choose. He told half of the shoppers he approached that he had recently bought the same amount of paint that they were looking to buy, he told the other half he had bought a different amount.
By and large, the first group took his advice, and the second did not. Something as trivial as buying the same-sized bucket of paint, Brock argued, can forge a bond with a total stranger.
I had to read this at least four times to believe I was really reading this in the masthead article in a prestigious section of a major newspaper. I thought it was incipient dementia at first.
Apparently it takes a “landmark study” for psychology to understand that if a store clerk tells you he did what you wanted to do you’re likely to do what you wanted to do. And if he tells you he didn’t do what you wanted to do, you’re likely to do what you wanted to do. In short, people tend to do what they want to do.
Apparently this piece of obviously counterintuitive wisdom is impressive enough to be used in the Boston Globe Ideas Section forty-three years after it was published.
I’m tempted to look it up the ancient study to check to look if they controlled for:
- people who tried to estimate how much paint they would need and the methods they used,
- how many of the buyers just went into the store and guessed,
- whether or not they were trying to cover a darker color with a lighter color,
you know, the kinds of things real people think about when they’re painting something. In the small samples typical of studies of this type, even a few people taking these kinds of things into account might give entirely different results. But I’m on a very tight schedule. If you know the study, please tell us.
I’ve got a hunch that too much dependence on psychology is a sure sign of a lazy reporter, the Boston Globe Ideas section would be a good place to look for evidence.
II. No Joke
You might also read the letter by the executive director of public and member communications of the American Psychological Association, denying that it has done little to keep its members from actively participating in the Bush regime’s use of torture. Contrast it with this news article by Tania deLuzuriaga in another place in today’s Globe.
This issue, brought to new prominence by Jane Mayer and especially her reporting on the role of Martin Seligman in relation to the torture scandal. It’s tempting to be sarcastic about his protestations that his lecture to the incipient torture team was turned on its head and that his torturing dogs was for the greater good but that might risk turning this into a joke. It’s no joke.
What did Seligman think they were asking him for? I don’t believe he couldn’t have guessed that his lecture and the dog torturing experiment was very likely to be used to plan a program of torture in the year after 9-11. If he’s that naive you wonder what his lifetime in psychology has taught him about the way people think. A highschool history student looking at the darker side of the 20th century for a term paper would likely have guessed better. But then, I think history has a better track record for getting that kind of thing right, than psychology has. I also don’t trust people who torture animals for the greater good.
III.
And finally, a very rare and skeptical look at the use of imaging in studying behavior by Jonah Lehrer.
"There are so many bad brain imaging studies, it's hard to believe," says Nikos K. Logothetis, director of the Max Planck Institute for Biological Cybernetics in Germany. "Too many of these experiments are being done by people who, unfortunately, don't really understand what the technology can and cannot do."
Logothetis and others believe that much of the misuse stems from the visual nature of the data. One study, by researchers at Colorado State University, showed that simply giving neuroscience students images from an fMRI machine, even if the images were redundant or irrelevant, made the students significantly more likely to find the data credible. According to Paul Bloom, a psychologist at Yale, this is because fMRI "has all the trappings of work with great lab-cred: big, expensive, and potentially dangerous machines, hospitals and medical centers, and a lot of people in white coats."
The data looks rigorous - it has the veneer of cutting-edge science - and people assume it's valid, even when the reasoning is shoddy.
"You can't just put people in a scanner and ask them whatever question you want," Logothetis says. "Many of these [fMRI] papers are such oversimplifications of what's happening in the brain as to be worthless."
Update:
An e-mail objects most strenuously by to my jibe about the vintage psych study above.
First, what is there about being deceived by the accused con-man “Clark Rockefeller” and the experience of being psychologically manipulated by a psych student posing as a store clerk in an Ohio paint store in 1965 which makes the latter intuitively relevant to the former? What does the study of 1965 authoritatively add to the intellectual investigation of the bizarre news story? Please forgive me if I assert that the more rational assumption is that the study has nothing to tell us about it.
The two attempts at deception are insufficiently similar, to start with. The possible motives would seem to be entirely unlike. The people attempting the manipulation are hardly alike and the subjects almost certainly as unlike, though that would be an entirely undefined variable in the comparison. The fact is that “Rockefeller” is suspected of a decades long, geographically vast and complex range of deceptions, perhaps, including killing. The “clerks” in the paint store were certainly not doing it for the same reasons. They probably just wanted to get their degree.
We know the subjects in the study wanted to buy some paint, we have no idea of what range of motives the people who fell for “Rockefeller” under his various names and guises may have had or if those deceived by him shared anything else in common. There is no reasonable reason to suspect that the situations have any real life similarities that would make resulting claims linking them to have sufficient reliability to be considered science or journalism.
About the paint store study, let me pose just two possible scenarios to you.
You are a woman who has painted a heck of a lot of things. You are a very experienced painter who has taken the time and made the effort to come up with what experience leads you to believe is a good estimate of what you need to buy. You go into a store and see a younger man (somehow I’ve got the feeling that all the psych students were probably males, though I don’t know that*) who says that he bought a similar amount of paint. He proposes a brand of paint you have had good results with in the past, so you buy it. It might have been one you were considering buying anyway.
Another scenario. Assume you are an experienced painter who has made an estimate and the kid says he bought twice as much paint. You might be on your guard for being sold too much paint, maybe someone did that to you in the past. You know the kind of paint he tells you is not what you need. You might think the kid doesn’t know what he’s talking about. You don’t take his “advice”. If he tells you he bought less than you know you’ll need, you would also think he doesn’t know what he’s talking about. Maybe you decide to shop for paint elsewhere.
The ages of the customers and the “clerks” would have just about certainly been an issue for many of the customers. At least the ages could be objectively verified, many of the other issues couldn’t.
The people who walked into that paint store might have represented any range and combination of variations on the two scenarios proposed above, and there could have been other issues relevant to the choice that was made. Maybe the kid looked like a favorite nephew or one you think is a snot nosed brat. I wonder if there is any reason to believe that the customers were all sufficiently alike to assume they would have belonged in the set conceived of in the study other than the convenience of the researcher.
Would the motivations of two people either buying (or not buying) what the clerk recommended be the same action, representing the same motivation? I doubt it. I believe their motives would have been vastly different, perhaps no two truly alike.
How large a sample would you need to take all the possible relevant issues into account? What kinds of equations would have covered all these possible issues? How would they tabulate the results?
If these are problems of sufficient complexity so as to be a insurmountable problem for psychological researchers that might be unfortunate. It doesn’t make them irrelevant. Not if discovering reality is the goal. As seen in the rest of my morning post, decades old studies can have horrible real life impacts.
People working in journalism who make the improbable assumption that these “studies” are relevant to their reporting of the news are guilty of multiple journalistic sins. Just the facts. The verified facts, supported by two independent sources. Anything else isn’t news.
* You wonder what the possible effect of having a female “clerk” advising a customer on paint would have had on the choices made in 1965. I don’t know about Ohio but do suspect that it would have been very unusual in most places in 1965 to have a female clerk in most hardware departments. You wonder at the difference in gender between “clerk” and customer. And you wonder about the various responses to that among customers of the same gender. How can you account for those contributors to the ultimate choice. And you wonder what the relevant social changes would do to the applicability of the “findings” four decades later.
I can’t tell you, just that I think they’re probably important.
Saturday, August 16, 2008
Get Who’s Calling Obama “Exotic” By Anthony McCarthy
You aren’t surprised. The Republican Party is going for the racist vote, as they always do. The effort of their soundboard, the media, to make Obama’s vacation trip to Hawaii an “exotic” location is clearly part of a campaign to whip up white racists. Visiting his infirm grandmother in the one of the 50 great states she lives apparently ranks lower in strangeness levels than The Bush Crime Family buying a massive estate in Paraguay*. Visiting an old grandmother is more sinister than buying a large chunk of a country famous as a haven for WWII era war criminals. Our media seem to be populated by folk too innocent of modern life to notice that Crawford del Sud would make a good refuge from indictments crimes against humanity or to shelter from those who might, someday, try to recover the billions plundered from the taxpayers of the United States.
Hearing the “exotic” line recited by Cokie Roberts last Mondy has to rank up there with Sally Quinn on marital propriety. There is no one more exotic than Cokie Roberts, whose family left New Orleans, a perfectly normal city, to morph into the most alien life form, the DC insider. Her brother’s a DC lobbyist, her husband, another DC media pod person. The talking heads are service droid mannequins more believable as Sci-fi Channel filler than as sources of information about life in the United States.
One of the more important aspects of this campaign of racism is whether or not white people, especially those in “the heartland”, will be played for chumps as the Republican racial strategy wishes them to be. You would think that people who live in the mid-west would be tired of that role, especially as many of them are fully as progressive and sophisticated as anyone who works on either coast. I’ve known many people from states that start with an I who are more enlightened than any member of insider Washington and New York City. I’d be hard pressed to think of a mid-westerner I’ve known who isn’t more aware of real life than anyone who gets asked to yack on the cabloids. People in the mid-west aren’t consigned by fate to assume roles in perpetual I-Hop commercials. They should punch anyone who tries to force them into that square in the mush and in the only way they will stop it, by overturning the corporate establishment that creates these roles for them.
Obama’s campaign must point out how insulting and condescending those Republican campaigns are to the people who live in the fabled “heartland”. I’ll bet there are millions of white mid-westerners who are just waiting for evidence that they are not eternally consigned to the role constructed for them by snobs in the media and publishing elites over the past century*.
The announcement by the Census Bureau that the United States will be white minority about the middle of the century makes me wonder if it isn’t part of the effort by the Bush Regime to scare white people. But that’s one of the problems with this kind of thing, once you get used to seeing it used, you get suspicious of everything. Doesn’t mean your suspicions are wrong, unfortunately.
* The first elected government in Paraguay in about sixty years is in serious trouble with next to no notice given by those obsessing about Georgia’s defacto partition. The timing in Paraguay seems a bit too convenient to me. We will know after the election if the Bush compound there was conceived as a continuation of that dark history. Call me suspicious if you want to. More about the situation in Georgia later in the week.
** The real history of the “heartlands” reveals a much more sophisticated and complex reality that is never told in the corporate media. Mid-western progressives, progressive populists and radicals have a rich history to reference and promote. I’d be proud if New England had a record to match it.
Hearing the “exotic” line recited by Cokie Roberts last Mondy has to rank up there with Sally Quinn on marital propriety. There is no one more exotic than Cokie Roberts, whose family left New Orleans, a perfectly normal city, to morph into the most alien life form, the DC insider. Her brother’s a DC lobbyist, her husband, another DC media pod person. The talking heads are service droid mannequins more believable as Sci-fi Channel filler than as sources of information about life in the United States.
One of the more important aspects of this campaign of racism is whether or not white people, especially those in “the heartland”, will be played for chumps as the Republican racial strategy wishes them to be. You would think that people who live in the mid-west would be tired of that role, especially as many of them are fully as progressive and sophisticated as anyone who works on either coast. I’ve known many people from states that start with an I who are more enlightened than any member of insider Washington and New York City. I’d be hard pressed to think of a mid-westerner I’ve known who isn’t more aware of real life than anyone who gets asked to yack on the cabloids. People in the mid-west aren’t consigned by fate to assume roles in perpetual I-Hop commercials. They should punch anyone who tries to force them into that square in the mush and in the only way they will stop it, by overturning the corporate establishment that creates these roles for them.
Obama’s campaign must point out how insulting and condescending those Republican campaigns are to the people who live in the fabled “heartland”. I’ll bet there are millions of white mid-westerners who are just waiting for evidence that they are not eternally consigned to the role constructed for them by snobs in the media and publishing elites over the past century*.
The announcement by the Census Bureau that the United States will be white minority about the middle of the century makes me wonder if it isn’t part of the effort by the Bush Regime to scare white people. But that’s one of the problems with this kind of thing, once you get used to seeing it used, you get suspicious of everything. Doesn’t mean your suspicions are wrong, unfortunately.
* The first elected government in Paraguay in about sixty years is in serious trouble with next to no notice given by those obsessing about Georgia’s defacto partition. The timing in Paraguay seems a bit too convenient to me. We will know after the election if the Bush compound there was conceived as a continuation of that dark history. Call me suspicious if you want to. More about the situation in Georgia later in the week.
** The real history of the “heartlands” reveals a much more sophisticated and complex reality that is never told in the corporate media. Mid-western progressives, progressive populists and radicals have a rich history to reference and promote. I’d be proud if New England had a record to match it.
The Soporific Values of PBS by Anthony McCarthy
Sitting with a convalescent a number of evenings, I was reminded just how god-awful PBS entertainment programming has become. Foyles War? Inspector Lindley*? On our local affiliate they’re showing Miss Marple. If there have been more than two series of Miss Marple made to please what they condescendingly believe the American audience wants, please point it out so it can be avoided.
Is there Brit kitsch so bad that they won’t show it on some Yank public TV station? And where is the American produced stuff they were promising us a while ago? Has anyone seen anything produced in America for PBS in fresh memory? Wait. Cancel that. Do we need a clone of CSI dressed in tweed and elbow patches?
While sitting through one piece of Brit trash recently, I was reminded of a tiresome joke repeated on one of the blogs a few months back about Canadian TV shows and their superior quality. It’s supposed to be ironic, trouble is, its not. Living where I do, I’ve seen a bit of Canadian stuff over the years, a lot of it back when I used to get the French language station out of Quebec. Some of it is garbage, but some is better than what you’re going to see here unless you buy it. Omerta, for example, or the wonderful English language series, Slings and Arrows**.
Slings and Arrows would be especially appropriate since its theme is a theater company that went through the motions for years, producing correct and boring productions of Shakespear and a bloated and incompetent bureaucracy more interested in sucking after funding than in fulfilling their stated purpose. You get the feeling that PBS and its affiliates wouldn’t be especially eager to explore that theme. Maybe they should notice that the incompetent financial manager has an easier job of selling the stuff when the hack-work artistic director dies and the content of their production gets shaken up.
Theater - including film, however shown - has the chance to tell about life. They have the words and actions to do that. An instrumental musician who deals mostly in abstractions, can get blown away when hearing what a single singer and piano player can do during a recital. It can change the way you see life. It rarely happens, though when it does it makes you certain that it is a useful activity. But it has to be the right singer, the right pianist and the right program of songs. Luckily, the songs, like the plays and scripts, already exist. There are writers and composers who aren’t just going through the motions, they’re generally the ones with a small audience. There are writers who are doing their part against all odds.
With the luxury of using the medium of reality, you wonder why anyone would settle on doing absolutely nothing with it at such great cost for so many years. You can understand people paying for junk if it has some novelty value or spectacle, though nothing gets older faster. That’s what fads are all about. But when a public TV system depends on those who will pay to see the same old junk and new junk of rapidly deteriorating quality, it’s already down the drain. Other than Moyers in the news and less than a handful of other news and history relates shows, PBS and public TV works against its purpose to exist.
Note: By the way, anyone else who is tempted to produce yet another mini-series glorifying Elizabeth I or the rest of her blood thirsty family should read William Cobbett’s THE HISTORY OF THE PROTESTANT REFORMATION IN ENGLAND AND IRELAND first. But for the rest of us, Cobbett’s History is a good antidote to that mildewed line of docu-drama. Note that Cobbett was, himself, a protestant.
When you cut through the establishment propaganda, the Tudor’s destruction of the medieval social support network in order to plunder it and buy support might go a long way to understanding what’s been so rotten about the Anglo-American system. They come off as sort of like the Bush Crime Family with a somewhat better record in arts patronage.
His defense of Mary as the least blood soaked and most beneficent of the Tudors and Stuarts are an interesting change from the line of lies and propaganda that started during her family’s reign and which will probably continue in the fall line up on PBS. Cobbett’s list of the hypocrisies and crimes of “That prince of hypocrites” Thomas Cranmer will come as a real shock to a lot of people brought up to their knowledge of history by PBS. Loved Glenda Jackson but Elizabeth I was no Glenda Jackson.
* That how it’s spelled? I was tempted to look it up but the effort isn’t worth it.
** The writing was great, the actors great. The three major roles played by Martha Burns, Paul Gross and Stephen Ouimette are especially good. Movies and plays about theater people are usually terrible but this series was great.
I probably shouldn’t mention it, but someone has posted the first season on You Tube.
Is there Brit kitsch so bad that they won’t show it on some Yank public TV station? And where is the American produced stuff they were promising us a while ago? Has anyone seen anything produced in America for PBS in fresh memory? Wait. Cancel that. Do we need a clone of CSI dressed in tweed and elbow patches?
While sitting through one piece of Brit trash recently, I was reminded of a tiresome joke repeated on one of the blogs a few months back about Canadian TV shows and their superior quality. It’s supposed to be ironic, trouble is, its not. Living where I do, I’ve seen a bit of Canadian stuff over the years, a lot of it back when I used to get the French language station out of Quebec. Some of it is garbage, but some is better than what you’re going to see here unless you buy it. Omerta, for example, or the wonderful English language series, Slings and Arrows**.
Slings and Arrows would be especially appropriate since its theme is a theater company that went through the motions for years, producing correct and boring productions of Shakespear and a bloated and incompetent bureaucracy more interested in sucking after funding than in fulfilling their stated purpose. You get the feeling that PBS and its affiliates wouldn’t be especially eager to explore that theme. Maybe they should notice that the incompetent financial manager has an easier job of selling the stuff when the hack-work artistic director dies and the content of their production gets shaken up.
Theater - including film, however shown - has the chance to tell about life. They have the words and actions to do that. An instrumental musician who deals mostly in abstractions, can get blown away when hearing what a single singer and piano player can do during a recital. It can change the way you see life. It rarely happens, though when it does it makes you certain that it is a useful activity. But it has to be the right singer, the right pianist and the right program of songs. Luckily, the songs, like the plays and scripts, already exist. There are writers and composers who aren’t just going through the motions, they’re generally the ones with a small audience. There are writers who are doing their part against all odds.
With the luxury of using the medium of reality, you wonder why anyone would settle on doing absolutely nothing with it at such great cost for so many years. You can understand people paying for junk if it has some novelty value or spectacle, though nothing gets older faster. That’s what fads are all about. But when a public TV system depends on those who will pay to see the same old junk and new junk of rapidly deteriorating quality, it’s already down the drain. Other than Moyers in the news and less than a handful of other news and history relates shows, PBS and public TV works against its purpose to exist.
Note: By the way, anyone else who is tempted to produce yet another mini-series glorifying Elizabeth I or the rest of her blood thirsty family should read William Cobbett’s THE HISTORY OF THE PROTESTANT REFORMATION IN ENGLAND AND IRELAND first. But for the rest of us, Cobbett’s History is a good antidote to that mildewed line of docu-drama. Note that Cobbett was, himself, a protestant.
When you cut through the establishment propaganda, the Tudor’s destruction of the medieval social support network in order to plunder it and buy support might go a long way to understanding what’s been so rotten about the Anglo-American system. They come off as sort of like the Bush Crime Family with a somewhat better record in arts patronage.
His defense of Mary as the least blood soaked and most beneficent of the Tudors and Stuarts are an interesting change from the line of lies and propaganda that started during her family’s reign and which will probably continue in the fall line up on PBS. Cobbett’s list of the hypocrisies and crimes of “That prince of hypocrites” Thomas Cranmer will come as a real shock to a lot of people brought up to their knowledge of history by PBS. Loved Glenda Jackson but Elizabeth I was no Glenda Jackson.
* That how it’s spelled? I was tempted to look it up but the effort isn’t worth it.
** The writing was great, the actors great. The three major roles played by Martha Burns, Paul Gross and Stephen Ouimette are especially good. Movies and plays about theater people are usually terrible but this series was great.
I probably shouldn’t mention it, but someone has posted the first season on You Tube.
Friday, August 15, 2008
Guest post by Skylanda: Fifteen days of blogging for health care reform
I am a physician. To be more specific, I am a resident, in my second year of training in a rural family practice track. I live and breath health care, more hours than I live any other part of my life. Ask any resident, they will quite likely tell you something very similar.
Doctors battle out the flaws and foibles of the American health care system every day. No matter what their opinion on the solution, few will disagree that we indeed have a problem in this country. Some will tell you we need more free marketeering, less government interference; others lean to the far opposite side, demanding reform toward single payer coverage or even a government-run health care system that directly manages health care workers as its own employees. But find me a doctor in this country who thinks there is nothing direly wrong with health care in America today, and I will find you a chicken who hatches pink bunnies out of its eggs - that is, a rare bird indeed.
At the same time, few physicians are immune to some personal ensnarement of the health care crisis in America. We straddle two sides of the fence - we are providers, but we are also consumers, and our relative wealth provides only thin insulation from the same traps and pitfalls that plague the rest of the nation. Just out of college, in the midst of the turn-of-the-millennium tech bust, I took a job that required heavy manual labor on offshore construction rigs; I was uninsured, working on subcontracts among union crews of merchant marines, and I was without a hint of worker’s comp coverage - it was simply understood among us contractors that if we were ever injured offshore, the first call would be made to lawyers to start talking settlements, because there would be no other way to pay a medical bill proportionate to the risks to life and limb we took on those rigs. My older sister, meanwhile, waited out ten years without health insurance, during which time a minor (and treatable) skin condition blossomed into inflammation and scarring so severe that it impairs her ability to walk, write, even provide fingerprints required by new employers; by the time she obtained insurance, the condition had become entrenched and largely irreversible. Two years ago, my brother’s school-age child came down with a complicated case of leukemia less than a month after he returned from a year-long tour in Iraq with the National Guard; though her epic hospital stay was graciously covered by the combined taxpayer efforts of Tricare and Medicaid, he now has to closely balance his potential income with Medicaid limits lest his chronically ill and entirely uninsurable daughter lose her only source of insurance eligibility.
These are not sob stories and they are not meant to gain any particular sympathy for a few rough years in my family tree; these are entirely typical stories in America in 2008 (and I don‘t doubt that readers here could share a litany just like them). Few families outside of the shrinking and ever-more-distant elite cannot tell similar stories: grandparents hospitalized for conditions that could have been prevented by medications they were prescribed but could not afford, bankruptcies filed as a last-resort means of coping with unpayable medical bills, choices made between health care and food, health care and education, health care and mortgage payments.
Nor can one pretend any longer that the crisis in health care coverage and access is at all limited to the poorest corners of the social strata. There is nothing acceptable - morally, economically, or otherwise - about a wealthy, industrialized nation leaving any portion of the populace without access to care, but when such problems are limited to the most marginalized people, we can at least pretend that we are on our way to vanquishing the problem, chasing it into darker and darker corners, moving toward something better and brighter. This pretense has no business existing any longer. Extinguish the notion, right now, that we are not losing a fight, in this nation, in this very moment, to the burden of ever-growing numbers of the uninsured, the under-insured, the improperly insured, and people simply pushed so far to the margins that access to care comes only at the door of the emergency room - a door exponentially more expensive than that of your local five-star hotel. Some forty-something million of the former, some uncountable number of the latter, growing every day.
Echidne has graciously provided several of us guest bloggers a platform on which to speak during these next two weeks, and this is auspicious timing indeed. In my adopted state of New Mexico, the governor has called a special session to force the legislature to start addressing this issue of broadening health coverage; at the end of the month, Barak Obama will accept the nomination for the democratic presidential ticket, bringing new hope - and renewed cynicism - to the health care reform table and the litany of other progressive issues. During these two weeks, my contribution to Echidne’s blog will be a series of posts from this one insider’s perspective - and there are as many insider’s perspectives as there are doctors, nurses, hospital administrators, biotech developers, patients, and the like - on some of the key issues and developments that shape and hinder health care reform in America today.
Times are ripe indeed for a profound push toward reform, as they have been ripe and then fallen short before, time and again. But like an addict who quits their cigarettes fourteen times before the quitting takes, one of these times, reform will take hold. The shape of that reform, the effect it will have on the diversity of issues that shape health in America, its inclusive or exclusive nature - those remain to be seen. Stay tuned.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
Doctors battle out the flaws and foibles of the American health care system every day. No matter what their opinion on the solution, few will disagree that we indeed have a problem in this country. Some will tell you we need more free marketeering, less government interference; others lean to the far opposite side, demanding reform toward single payer coverage or even a government-run health care system that directly manages health care workers as its own employees. But find me a doctor in this country who thinks there is nothing direly wrong with health care in America today, and I will find you a chicken who hatches pink bunnies out of its eggs - that is, a rare bird indeed.
At the same time, few physicians are immune to some personal ensnarement of the health care crisis in America. We straddle two sides of the fence - we are providers, but we are also consumers, and our relative wealth provides only thin insulation from the same traps and pitfalls that plague the rest of the nation. Just out of college, in the midst of the turn-of-the-millennium tech bust, I took a job that required heavy manual labor on offshore construction rigs; I was uninsured, working on subcontracts among union crews of merchant marines, and I was without a hint of worker’s comp coverage - it was simply understood among us contractors that if we were ever injured offshore, the first call would be made to lawyers to start talking settlements, because there would be no other way to pay a medical bill proportionate to the risks to life and limb we took on those rigs. My older sister, meanwhile, waited out ten years without health insurance, during which time a minor (and treatable) skin condition blossomed into inflammation and scarring so severe that it impairs her ability to walk, write, even provide fingerprints required by new employers; by the time she obtained insurance, the condition had become entrenched and largely irreversible. Two years ago, my brother’s school-age child came down with a complicated case of leukemia less than a month after he returned from a year-long tour in Iraq with the National Guard; though her epic hospital stay was graciously covered by the combined taxpayer efforts of Tricare and Medicaid, he now has to closely balance his potential income with Medicaid limits lest his chronically ill and entirely uninsurable daughter lose her only source of insurance eligibility.
These are not sob stories and they are not meant to gain any particular sympathy for a few rough years in my family tree; these are entirely typical stories in America in 2008 (and I don‘t doubt that readers here could share a litany just like them). Few families outside of the shrinking and ever-more-distant elite cannot tell similar stories: grandparents hospitalized for conditions that could have been prevented by medications they were prescribed but could not afford, bankruptcies filed as a last-resort means of coping with unpayable medical bills, choices made between health care and food, health care and education, health care and mortgage payments.
Nor can one pretend any longer that the crisis in health care coverage and access is at all limited to the poorest corners of the social strata. There is nothing acceptable - morally, economically, or otherwise - about a wealthy, industrialized nation leaving any portion of the populace without access to care, but when such problems are limited to the most marginalized people, we can at least pretend that we are on our way to vanquishing the problem, chasing it into darker and darker corners, moving toward something better and brighter. This pretense has no business existing any longer. Extinguish the notion, right now, that we are not losing a fight, in this nation, in this very moment, to the burden of ever-growing numbers of the uninsured, the under-insured, the improperly insured, and people simply pushed so far to the margins that access to care comes only at the door of the emergency room - a door exponentially more expensive than that of your local five-star hotel. Some forty-something million of the former, some uncountable number of the latter, growing every day.
Echidne has graciously provided several of us guest bloggers a platform on which to speak during these next two weeks, and this is auspicious timing indeed. In my adopted state of New Mexico, the governor has called a special session to force the legislature to start addressing this issue of broadening health coverage; at the end of the month, Barak Obama will accept the nomination for the democratic presidential ticket, bringing new hope - and renewed cynicism - to the health care reform table and the litany of other progressive issues. During these two weeks, my contribution to Echidne’s blog will be a series of posts from this one insider’s perspective - and there are as many insider’s perspectives as there are doctors, nurses, hospital administrators, biotech developers, patients, and the like - on some of the key issues and developments that shape and hinder health care reform in America today.
Times are ripe indeed for a profound push toward reform, as they have been ripe and then fallen short before, time and again. But like an addict who quits their cigarettes fourteen times before the quitting takes, one of these times, reform will take hold. The shape of that reform, the effect it will have on the diversity of issues that shape health in America, its inclusive or exclusive nature - those remain to be seen. Stay tuned.
Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.
The United States of Feminists (by Suzie)
I just wanted to clear that up, after last Friday’s lengthy arguments. One argument was that feminists who cannot imagine forgiving an alleged ally who abused a woman were akin to Stalinists who held trials with no chance of acquittal. If I choose not to forgive a man, he can still have a fine life. I have restricted him only in his dealings with me. I haven’t executed him or sent him to Siberia.
This argument is related to the use of “feminazis,” in which we're compared to Nazis because we’re … what? extreme and militant? Not militant in the sense of being violent, of course, but too aggressive. In case anyone is confused, feminist armies have not invaded other countries, nor are we committing genocide against men.
Some feminists talk of a war on women, or women living in occupied territory. If it’s false to compare feminists to the state, isn’t it equally wrong to compare men to the state? I don’t think so because men predominate in the top rungs of the government, military, media, religion, etc. Men do have much more control over state policy and actions.
Another argument from last week's post was that some feminists presume men to be guilty until proven innocent, which flies in the face of our jurisprudence. False. The presumption of innocence is a right in U.S. criminal trials, but it doesn’t apply throughout the criminal justice system. If police presumed everyone to be innocent, they’d never make any arrests.
A related argument is that feminists are stereotyping men if they distrust a man until he proves to be OK. Although I’m sure they exist, I can’t name a feminist who thinks all men are intrinsically bad. We understand some men are great, but we know men disproportionately commit crimes against women, and we cannot always predict who will do what. We have a right to try to lessen our personal risk. Of course, this isn't just feminists. A conservative woman might not open the door to a man she doesn't know.
Our society sends mixed messages. Some men are hurt and angry if they aren’t trusted. On the other hand, women can be blamed if they trust a man who then abuses them. People may ask: "Why did you go over to his house if you hardly knew him?" "Why did you get in his car?" “Why did you open your door?” These attitudes have a long history in which women are expected to guard themselves from men, or to allow other men, such as their fathers or husbands, to guard them.
Another argument is that women are gender profiling, like racial profiling. But we're not the police, pulling over drivers, or transportation officials, keeping people from boarding planes, just because they're men. By not opening my front door, or by locking my car door, or by meeting a man I don’t know in a public place, I’m not curtailing anyone’s rights. I'm a person in a less-powerful group protecting myself against the group with more privileges.
Another argument is that women are gender profiling, like racial profiling. But we're not the police, pulling over drivers, or transportation officials, keeping people from boarding planes, just because they're men. By not opening my front door, or by locking my car door, or by meeting a man I don’t know in a public place, I’m not curtailing anyone’s rights. I'm a person in a less-powerful group protecting myself against the group with more privileges.
The bottom line on all of these arguments is that men’s feelings are more important than women’s rights.
Thursday, August 14, 2008
Vacation!
Ah. Blessed vacation. For me, anyway. I'm going to be on vacation from today until the end of August. In the meantime you will be entertained and educated by my gracious and charming and smart guest bloggers: Anthony McCarthy, Bleustocking, Hecate, Phila, Skylanda and Suzie (in alphabetical order). My sincere and heartfelt thanks to all of you guest bloggers.
Now, where are those flippers and that beach ball?
Never Again Going to Give The “News” The Benefit of the Doubt by Anthony McCarthy
During this personal hiatus, I’ve been trying to do something about the old writing style. Again. One of the things stressed by those who have thought about the form of effective advocacy is how to place information in a written story for maximum persuasive effect. Not burring the lead idea is high among those. Putting the most important information in the very beginning of the piece is just about universally advocated for written material.
But what about other parts of structuring information to inform? How can you decide when they are doing that and not, in fact, advocating a subjective opinion? And what about the different opportunities and requirements for effective view point promotion on the radio or TV? You can assume a much smaller number of words, to start with, but you probably can count on them all being audible, if not heard. People don’t change the page when listening to the news as opposed to reading the paper.
I got interested in this last week when, during its alleged hard new headlines, I heard a story on NPR that started out to be about Obama’s position on an issue but during which his voice wasn’t heard and none of his words were quoted. However, they did manage to quote McCain and to have a clip of a Republican STATE SENATOR(!) opining on what was alleged to be Obama’s position. You’d think the least they could do was use Obama’s own words or even a position paper, but that was held to be less important in a story about Obama’s stand on an issue than what a Republican State Senator had to say about it.
Funny, once you notice it, you hear that kind of clear bias practice all over the place. Characterizations of Obama’s positions are given, motives ascribed to him based on those characterizations, even alleged campaign strategies “reported” (without verification from the campaign) but the actual quotes and voices are those of Republicans. And, mind you, this is in the alleged reporting sections of alleged news programs, not the vastly longer time given to “analysis” during which are mired all manner of speculation and dispund. Hey, if the venerable NPR gets away with that kind of practice, why should the seamier organs of the media be expected to remain chaste?
And yet they wonder why people are abandoning the traditional news in favor of online sources. At least people on the blogs don’t pretend to be practicing objective reporting while they are advocating a side, certainly not pretending it’s news. At least not in such large numbers.
They want people to trust them, they can cut this kind of crap to start with.
But what about other parts of structuring information to inform? How can you decide when they are doing that and not, in fact, advocating a subjective opinion? And what about the different opportunities and requirements for effective view point promotion on the radio or TV? You can assume a much smaller number of words, to start with, but you probably can count on them all being audible, if not heard. People don’t change the page when listening to the news as opposed to reading the paper.
I got interested in this last week when, during its alleged hard new headlines, I heard a story on NPR that started out to be about Obama’s position on an issue but during which his voice wasn’t heard and none of his words were quoted. However, they did manage to quote McCain and to have a clip of a Republican STATE SENATOR(!) opining on what was alleged to be Obama’s position. You’d think the least they could do was use Obama’s own words or even a position paper, but that was held to be less important in a story about Obama’s stand on an issue than what a Republican State Senator had to say about it.
Funny, once you notice it, you hear that kind of clear bias practice all over the place. Characterizations of Obama’s positions are given, motives ascribed to him based on those characterizations, even alleged campaign strategies “reported” (without verification from the campaign) but the actual quotes and voices are those of Republicans. And, mind you, this is in the alleged reporting sections of alleged news programs, not the vastly longer time given to “analysis” during which are mired all manner of speculation and dispund. Hey, if the venerable NPR gets away with that kind of practice, why should the seamier organs of the media be expected to remain chaste?
And yet they wonder why people are abandoning the traditional news in favor of online sources. At least people on the blogs don’t pretend to be practicing objective reporting while they are advocating a side, certainly not pretending it’s news. At least not in such large numbers.
They want people to trust them, they can cut this kind of crap to start with.
Weight & health (by Suzie)
I count fat as a feminist issue because there are so many messages in society that pressure girls and women to be as skinny as possible. That’s why I was happy to see this article, which says:
A new study suggests that a surprising number of overweight people - about half - have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity.Unfortunately, the article began with the idea that only “trim people” “can look great in a swimsuit.”
My mother, who was “trim” into her 80s, had high cholesterol and died of a heart attack. Thanks to genetics, I had high cholesterol even when I was thin. I wish more people understood that thinness does not guarantee health.
In the 21st Century
Nations don't invade other nations. That's what John McCain said about the Russian invasion of Georgia. Now, he could have meant the statement as a positive one, meaning that nations don't indeed invade other nations now that the time stamp starts the century with a "2". If so, he was wrong, and a simple counterexample is the U.S. invasion of Iraq.
Or he could have meant it as a normative statement, arguing that nations shouldn't invade other nations in our current era. If so, was he as outspoken against the earlier U.S. invasion of Iraq? I don't recall that.
Yes, all this is boring and about something trivial. I'm just trying to fill the enormous gap that exists in the media triviality account balances when it comes to McCain. Obama we get a lot about, from Maureen Dowd onwards. But poor McCain? Isn't he interesting enough for some trivia scandals?
Wednesday, August 13, 2008
Two Takes
On the new Democratic platform about reproductive choice. First, Digby sees a fundie touch in the developments. Second, Linda Hirshman sees the development as good for women's reproductive rights.
I'm too tired to chime in but some of you are probably not.
What Is That Smell?
Here we go again:
While several factors can send a woman swooning, including big brains and brawn, body odor can be critical in the final decision, the researchers say. That's because beneath a woman's flowery fragrance or a guy's musk the body sends out aromatic molecules that indicate genetic compatibility.
Major histocompatibility complex (MHC) genes are involved in immune response and other functions, and the best mates are those that have different MHC smells than you. The new study reveals, however, that when women are on the pill they prefer guys with matching MHC odors.
Best mates? What sort of research is this based on? What is the frequency distribution of these smells in the general population?
And do the guys prefer different MHC smells from their own? Do the parents apply these rules in societies where marriages are arranged? What about those cultures which favored cousin marriages? How often have women had the chance to pick their own mates?
Here's more on the study:
Past studies have suggested couples with dissimilar MHC genes are more satisfied and more likely to be faithful to a mate. And the opposite is also true with matchng-MHC couples showing less satisfaction and more wandering eyes.
"Not only could MHC-similarity in couples lead to fertility problems," said lead researcher Stewart Craig Roberts, an evolutionary psychologist at the University of Newcastle in England, "but it could ultimately lead to the breakdown of relationships when women stop using the contraceptive pill, as odor perception plays a significant role in maintaining attraction to partners."
Sexy scents
The study involved about 100 women, aged 18 to 35, who chose which of six male body-odor samples they preferred. They were tested at the start of the study when none of the participants were taking contraceptive pills and three months later after 40 of the women had started taking the pill more than two months prior.
For the non-pill users, results didn't show a significant preference for similar or dissimilar MHC odors. When women started taking birth control, their odor preferences changed. These women were much more likely than non-pill users to prefer MHC-similar odors.
Well, it could be interesting that the smell preferences of some of the women on the pill changed. But note that the women not on the pill apparently didn't express a preference for dissimilar MHC odors. Doesn't that sorta affect the basic thesis and all the speculation that follows?
And what is "much more likely" in that study? How many of the pill users changed their preferences?
Pardon me for sounding suspicious, but it's hard to take the evidence of "past studies" completely seriously because those studies were in this same field of evolutionary psychology, looking for the same kind of stuff, and often popularized with the same extreme language.
----
Via feministpeacenetwork.org.
Oh My! You People are Exotic!
Most of the presidential campaign coverage makes me vomit. The part which is all about Barack Obama somehow being too uppity or too foreign or a secret mole for the Islamofascists. If the so-called liberal media in fact was at all liberal it would also cover similar silly stories about John McCain. About his famous temper (well, those stories might even be legitimate), for instance and about the eight houses he owns. Having eight houses sounds really exotic, uppity and foreign to me.
But nope. All we get is up-close-and-personal stories about only one of the candidates. I'm really tired of them. Tell us at least if Obama used to collect stamps.
All this is in honor of Cokie Roberts who criticized Obama taking a vacation in Hawaii as exotic. Even though Obama's granny lives there and even though Hawaii is part of the United States of America. It's so utterly silly a statement that it must be a feed from the secret wingnut headquarters. Pick your role, Cokie: Either you are silly or you are a secret mole of the Wingnutofascists.
Well, the Hawaiians didn't take well to being called exotic (via Eschaton).
This gives me an excellent opportunity to point out that all you American readers look and sound exotic to me. I remember those wolf-teeth in early television programs (every American guy in the shows had them). And jello desserts! Heh.
Tuesday, August 12, 2008
What Women Have Mouths For
Not for speaking or eating, according to Rush Limbaugh. Those mouths are for blowjobs.
And women should shut up and suck. If that sounds gross, don't blame me. Blame our little friend Rush, because that's what this long ramble means when translated into plain language:
LIMBAUGH: Well, it's -- I mean, at some point, at some point, you gotta exhibit maturity and restraint. You know, and I do that constantly. But -- well, I don't -- look, let me see if I can run you through this and get you to think what I'm thinking without my actually saying it. That might be a pretty big talent if I could do that -- make you think what I'm going to say without my having to say it, therefore if anybody gets in trouble for saying it, you say it.
We know -- we've been told that Elizabeth Edwards is smarter than John Edwards. That's part of the puff pieces on them that we've seen. Ergo, if Elizabeth Edwards is smarter than John Edwards, is it likely that she thinks she knows better than he does what his speeches ought to contain and what kind of things he ought to be doing strategy-wise in the campaign? If she is smarter than he is, could it have been her decision to keep going with the campaign? In other words, could it be that she doesn't shut up? Now, that's as far as I'm going to go.
Well, you're -- Snerdley says he's missing something. If you're missing it, you're going to have to provide it. What are you missing? Mm-hmm, mm-hmm.
I can't close the loop on it. I can't close the loop on it. I'm on -- you know, I'm in a little quicksand already today talking about how the chicks are giving us boring pictures of the female athletes from the Olympics. Because I know -- you -- the diversity crowd's going to be upset. They're going to -- "Ooh, do you mean the Olympics are just so you guys can ogle wom--" Yes, because we do not care to watch 'em compete. But back to Elizabeth and the Breck Girl.
I'm sorry, my friends, I just -- I can't. It just seems to me that Edwards might be attracted to a woman whose mouth did something other than talk.
[...]
LIMBAUGH: OK, we're back. Ladies and gentleman, my theory that I just explained to you about why -- you know, what could have John Edwards' motivations been to have the affair with Rielle Hunter, given his wife is smarter than he is and probably nagging him a lot about doing this, and he found somebody that did something with her mouth other than talk. I think I can back this up from her.
We have a sound bite. This is February 2007. She was on the tabloid show Extra. And this is what she said. Listen very carefully.
HUNTER [audio clip]: The whole experience was life-altering for me. One of the great things about John Edwards is that he's so open and willing to try new things and do things in new ways.
LIMBAUGH: "Open to new things." Folks, it is what it is. You get mad at me for bringing the truth to you, but it is what it is.
Note that the premise of his whole thesis is missing, because he has no information about the blowjob habits of the two women discussed here. He's simply assuming those, because our little Rush really, really hates smart women who are something more than animated sex aids.
Life Imitating Art?
Well, sort of. The events at the Olympic opening ceremonies in China appear to have imitated Terry Pratchett's fantasy book Maskerade:
A 7-year-old Chinese girl was not good-looking enough for the Olympics opening ceremony, so another little girl with a pixie smile lip-synched "Ode to the Motherland," a ceremony official said — the latest example of the lengths Beijing took for a perfect start to the Summer Games.
If you are unfamiliar with Pratchett's funny science-fiction-cum-fantasy books you are in for a treat. The Maskerade might not be a bad one to begin with. It's a story about the opera (and, as usual for Pratchett, also a story about us ridiculous human beings). A young witch (never mind that part for the purposes of this post) called Agnes has a wonderful voice and wants to become an opera singer. Her voice qualifies her but her body does not, being too hefty. Thus, Perdita (as Agnes wishes to be called) sings from the wings while a pretty little thing lip-syncs on the stage.
Of course neither role is much fun. One woman doesn't sing well enough, the other doesn't look cute enough. Now apply that storyline to reality and replace grown women with little girls. Two of them got their dreams squashed there.
But of course the final result was fantastic. In both senses of the term.
Writing About Medical Research Findings
Here's an odd thing: Two reports about the same breast cancer recurrence study were published today. One of them begins like this:
Even early-stage breast cancer patients who complete five years of drug treatment have a significant risk for relapsing, new research shows.
The study included patients treated at Houston's M.D. Anderson Cancer Center between 1985 and 2001 who were cancer-free five years after initial treatment with surgery or surgery and radiation.
The other one, discussing the very same study, begins like this:
WASHINGTON (Reuters) - Women who survive breast cancer for five years after treatment have a relatively low risk of the disease recurring, according to a U.S. study published on Tuesday.
Is the glass half empty or half full? What is it about these write-ups that chose to go either positive or negative? The actual information in the stories is roughly the same, except for the selected emotional tilt.
More generally, I'm not sure what "recurrence" means in the sense of a lot of time passing after breast cancer treatment. Couldn't the new cancer be a totally new one? I doubt that surviving breast cancer means that the woman is then somehow guaranteed a zero risk of it in the future, but I may be confused about that issue.
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