Thursday, 18 February 2016

Discredited?

Note: Delays continued, apparently. This post was drafted in March of 2015, it’s now mid-February of 2016 before something else came along to inspire me to get back to work.

Last September I called my doctor’s office to ask about getting a flu shot. I was told that they no longer gave them, that I should just go to the pharmacy instead, but that I should wait because a reformulated vaccine would be available in October. But that was a time during which radiation had sent my brain somewhere else, and I thought no more about it until this past Sunday when a scratchy throat and sore eyes suggested that perhaps I should have been paying more attention last fall.

I think I have a good excuse. The national news tells me, however, that there are a great many people who skip vaccinations for their children without having any such excuse. I can think of numerous words to describe these people, moronic and selfish come to mind.

It seems that in 1998 one Andrew Wakefield wrote a story in the Lancet, a British medical Journal, in which he discussed several cases of children in whom autism first became apparent immediately after receiving the mumps, measles, and rubella vaccine. Many of the recent news stories have mentioned this article, calling it either “discredited” or “debunked” – which I consider appalling.

In science, and we certainly hope that medicine is a subset thereof, an investigator or experimenter observes physical events, conjures up a hypothesis to explain those events, and then devises an experiment or plan of research that will prove or disprove his hypothesis. It has long been noted that it is easy for the experimenter to see the results he seeks even when no clear indication actually exists in the data. This was demonstrated last March by the Background Imaging of Cosmic Extragalactic Polarization 2 (BICEP2) project, a group of astronomers seeking signs of the gravity waves left echoing through the universe from the first microseconds following the big bang. They may have, in fact, seen some such result, but it’s also quite possible that what they saw was the result of cosmic dust and this has been modeled by others and additional work is planned. That’s what “discredited” means. The case of the Wakefield article is nothing like this at all.

Wakefield had a history of attacking vaccination programs, he had a business plan laid out to take it advantage of public fears about the MMR vaccine,and his work was funded by private tort lawyers who would have been able to generate significant fees as a result of any public concern generated. The article suggested that the 12 cases he found were the random result of vaccination, when in fact they had been very carefully chosen. In short, the article was not discredited, it was fraudulent from the start. Wakefield lied. Most of Wakefield’s co-authors asked that their names be removed from the article almost immediately, and after a distressingly long interval, the Lancet formally retracted the entire article. On top of that, the British medical establishment withdrew Wakefield’s credentials as a physician.

Wakefield has subsequently moved to the US where he can stir the pot as the head of his own foundation, and seems to have found favor with some idiots who are willing to help spread his bogus word. I’m sure he continues to present himself as a doctor, but he has never had the privilege of practicing medicine in the US. His history of prevarication probably means that he never will, but the nonsense he has spewed about vaccinations continues to damage the public.

If I were King, journalists who insisted on referring to his articles as discredited rather than fraudulent would be called to the throne room for a good talking to, and “Dr” Wakefield would be banished.

Friday, 20 February 2015

Back at last

It has been far too long since my last entry here. When I started radiation therapy I was told that fatigue would be the most likely side effect. I’m not sure that’s a good term for what I experienced. As expected, I was tired. As some resources warned, sleep did not seem to relieve the exhaustion. Several months afterwards it seems that someone put my brain in a radiation-proof box for safekeeping, it certainly wasn’t available to me.

I was unable to continue reading serious material at the rate that I had maintained during chemo, and completely unable to bear down and capsulize the experience. I got nasty notes from the library about books I had read completely – long overdue. Even though the last several volumes I read made sense, I found myself unable to actually write so much as a coherent paragraph on any of them. Perhaps later. For now they seem too distant.

There is one book review coming up shortly, I’ve started Steven Brill’s America’s Bitter Pill, his magnum opus about the genesis of Obamacare. It starts with him laying in the hospital the night before open-heart surgery, giving him a good perspective on the problems. My last year gives me some similar insights, I trust, so I’ll have no problem getting through this volume, and I’ll certainly have a few things to say about it.

By Thanksgiving Day the fog had mostly lifted and though I could not return to the blog, I was able to revive the Quotes of the Day web server and restart the daily mailings. Other than a two-day absence in December caused by weather-induced power failure, I have mailed the quotes every day since. I don’t believe there has ever been such a consistent stream in the 15 years of the project. For now, I intend to focus on that rather than making a major push here, although I will be back to making cranky observations on the news. Please don’t expect any serious literary efforts soon.

If my year battling cancer is of interest to you, Lord knows there’s no reason why it should, I do have most of it written up here. It should probably suffice that in early December I had an extensive set of CT scans which revealed no metastatic disease, and after Christmas I had a colonoscopy that showed no signs of cancer at the site of resection. So thank God and onward!

Monday, 4 August 2014

Constitutional Right to Farm

Americans have a pretty reasonable set of rights vis a vis the government, I’d prefer the range were a bit broader but there’s no question that we’re well ahead of almost everybody else in the world. China and Russia may not like it, but their protestations that our rights are some “western conspiracy” are absurd, they grew directly from the early days of the Enlightenment. That may have started with English and French philosophes, but every part of that applies to humans in general rather than humans in a particular place.

One right that we are not guaranteed is a right to farm, but then there doesn’t seem to be a lack of farming, and the constraints on that activity are primarily economic rather than governmental, so it’s no surprise that James Madison didn’t include any reference to agriculture in the Bill of Rights, nor has any subsequent amendment. In Missouri, however, Amendment 1 is on the ballot. The heart of this would amend Article I, Section 35 of the Constitution of Missouri to read:

That agriculture which provides food, energy, health benefits, and security is the foundation and stabilizing force of Missouri’s economy. To protect this vital sector of Missouri’s economy, the right of farmers and ranchers to engage in farming and ranching practices shall be forever guaranteed in this state, subject to duly authorized powers, if any, conferred by Article VI of the Constitution of Missouri.

That certainly sounds like something any Chamber of Commerce or state legislature would go along with, clearly a harmless bit of rural boosterism. Except that the organizers see it as a way to prevent regulation of agriculture, such as attempts by the much hated (at least in Missouri farm country) Humane Society of the United States to advocate rules on the amount of space and fresh air that laying hens must be provided. In North Dakota, the only other state with a similar amendment, there haven’t been any real changes as a result. (I learned of this issue from a New York Times article by Julie Bosman, “Missouri Weighs Unusual Addition to Its Constitution: Right to Farm” in today’s issue.)

But if they reject reasonable regulation of their operations, how far do they intend to go? Will they be spraying the wetlands protected for migratory birds with DDT? Allowing unimpeded fertilizer runoff into streams and rivers? Depleting aquifers for thirsty crops and leaving cities to live on Perrier? What about bringing back slavery? All of these are historically-accepted “farming and ranching practices” in the US.

The vote is tomorrow (5 August 2014), and the farm community has spent over a million dollars pushing it. It’s a primary in a non-presidential year so turnout will be low, hordes of angry farmers arriving at polling places on their tractors could put it over, despite the overwhelming opposition by just about every newspaper in the state.

If I Were King I’d just smile, knowing that much of the country’s strength, as the early leaders of the Enlightenment knew, is based on the ability of the citizens to organize and campaign to change the way they are governed. Regardless of who is in charge, or whether this is adopted at the polls, this case may make the farmers feel better but won’t change much.

Update – 6 August 2014 – Amendment 1 passed with a 50.1% yes vote. The Missouri secretary of state has until 26 August to certify the results, at which any person who voted against it can demand a recount based on the slim margin. I’m not sure whether to be appalled or amused at the possible legal antics to follow.

Wednesday, 2 July 2014

Baffled for a bit by Hobby Lobby

I’m sorry, but I just can’t pop out a response to the ruling in Burwell vs Hobby Lobby just yet. I have read a fair amount of the coverage, along with most of the decision, and I’ve started to organize some comments on various aspects of it. But the part that nobody else seems to be talking about is the nature of freedom and, more specifically, the nature of religious freedom. If they aren’t perverting the concept, they certainly are inverting it. I do know this much, If I Were King the concept of freedom would be focused on the individual and his spirituality, on his ability to express his spirituality and to live based on what he learned from it. It would have absolutely nothing to do with businesses, corporations, or families of billionaires who think religious freedom means enforcing their narrow-minded concepts of spirituality on tens of thousands of employees, never mind extending those concepts through the legal system to apply to tens of millions of other citizens. Those supporters of Hobby Lobby who are crowing about this ruling as a victory for religious freedom have the spirituality of Simon Legree and the intelligence of platyhelminthes.

Sunday, 15 December 2013

healthcare.gov

After the 2012 presidential election, I recall reading in some detail about the differences between the Obama and Romney campaigns’ digital efforts. The stories focused on the tablet applications to be used for supervising voter turnout and other details of election day, but also referred to the IT operations throughout the campaign cycle. The Obama campaign had developed all of their efforts in-house, tested with scores of volunteers, hosted with Amazon Web Services for flexibility, and had a great success. The Romney campaign had farmed out their efforts to consultants, done almost no testing at all, and found early on that Tuesday morning that they had laid a big goose egg. I will admit to an unseemly Schadenfreude at that point, but like most, came away with a great confidence that the Obama team “got it” in the digital realm. Apparently not.

In fact, one could almost think that the Romney campaign had designed the Obamacare website, healthcare.gov. The work was farmed out to multiple consultants and supervised by those who had no experience and simply didn’t comprehend the task at hand. Horror stories related by a friend who temped with the developer early this year bore this out.

Could I have done better? Well, the job was too large in scale for me to consider bidding on, but damned straight I could! Not that that’s saying too much, a properly staffed approach would have been far better.

Within hours of approval of the Affordable Care Act, President Obama should have chosen a champion to create the website for those states choosing not to create their own. That champion should have been someone with significant experience in databases, electronic marketplaces, or other-large scale networking projects. (Wikipedia and Google, among others, would know how to build a site that could be scaled from hundreds of simultaneous users to hundreds of thousands.) Most important, that champion should have been an employee of the government, reporting to an appropriate level, not an outside contractor.

A small team should have been assembled to design the flowchart for the site. Within a month the first version of the website should have been online. Not open to the public, and limited in function, but up and running.

A plan should have been established to connect to the IRS or the Social Security Administration to establish eligibility for discounts. At that point this could have covered a very limited population, say single persons in a few states, but something to test against. As the months went by, the interface could gradually include a wider range of users.

At least two insurance companies should have been recruited. One of these should have been chosen because their database was typical of other companies while the other was chosen because it wasn’t. There are several ways the databases could have been deployed. One possibility was to allow the insurance companies to access the database created in the exchange. Another would have been to establish a joint database for each insurance company and use native synchronization. Least useful would be to have a daily batch export from the exchange to the insurance companies, leading to the possibility that when a user made a change to his application the insurance company would end up with a duplicate record. Needless to say, this last approach was chosen. I doubt that this would have been the case if testing had been done at every stage of development.

Commerce sites are built using relational databases, mostly using the Structured Query Language or SQL. The nature of these systems is that the data itself is strongly structured. There are purposes for which nonstructured data is the rule, search engines frequently use tools that do not require an enforced structure. Transactions, inventory, mailing lists, and a host of other common data perfectly fit the traditional relational database. Insurance companies love them. Nonstructured databases are a relatively new development and apparently have some sex appeal or something. Those in charge of healthcare.gov chose a nonstructured database, making it much less likely that experienced developers would be available and that existing database code could be used to rapidly get the site working.

The site wouldn’t have needed to be pretty, just functional so the flow of user interaction with the site could be tested. A properly coded site can be given an entirely new appearance with a new style sheet the night before going public if need be. Because the Affordable Care Act was already law, there should have been no need to keep the site secret. The testing should have expanded as development progressed, first to key members of Congress and the administration, and their aides, then to a wide range of folks from the general public. At some point, truly expert useability experts should have been contracted, someone like Jakob Nielsen of the Nielsen Norman Group. Not to mention people knowledgable about access by the disabled, and not just to tick off the boxes required by law but to actually make it work.

There were things that shouldn’t have needed testing. Most notably, the question of whether or not a user needed to establish an account and verify his identity before shopping for plans. Rudimentary usability testing would have shown that this was a poor approach. On the other hand, having team members familiar with purchasing would have led to the same decision without testing. I’m not talking about complex Defense Department procurement here, merely sufficient experience and wit to go to a deli for a ham sandwich and come out with something involving bread and protein. Despite this low bar, they got this one wrong too.

The site is finally getting fixed, ever since Obama appointed a single person to take control. The vultures are circling, demanding that at least some heads roll from a great height. Before the Senate changed the filibuster rules this wasn’t likely because there was little or no chance of ever getting confirmation for a replacement if Kathleen Sibelius had gotten the axe, now this is possible. But I would say that while there are lessons to be learned and applied, no career-ending blame needs to be laid on anyone.

If I Were King, I would realize that the fault should be charged against “the system”. The structure of government made it unlikely, perhaps impossible, to assemble a staff to build this site on the understanding that most of the team would depart within weeks of the site going live. “The system” says this sort of work needs to be defined in advance so competitive bidding can be used to dole the tasks out to contractors. “The system” is wrong. If nothing else, nobody has ever defined a great website in advance, the best sites evolve over time based on lessons learned building out the initial plan. Obama and his advisors know how to do this kind of work, what they didn’t know was the importance of insisting that this site would be built the same way they built their campaign sites.

Thursday, 28 March 2013

Multiple sclerosis breakthrough!

Or not. Over the period when Congress was debating “health care reform” I had a lot I wanted to say about it but always got too wound up to actually say it. Suffice it to say that, in my judgment, there has not actually been one whit of discussion in Congress about health care reform and altogether too much regarding who to stick with the bill. Perchance I will address some of these issues soon. But a story in today’s New York Times, 3rd Oral Drug to Treat MS Is Approved by the F.D.A. by Andrew Pollack, was too much for me.

It seems that a Massachusetts company called Biogen Idec has just won approval for Tecfidera as an oral treatment for multiple sclerosis, the chemical name is dimethyl fumarate. It seems that analysts are predicting that the price of this will be $51,000 per year. Pollack doesn’t mention an actual dosage but says it will be twice daily, the illustration shows a jar of 240mg capsules. So let’s assume that this capsule size is the adult dose.

Now, based on the cost of aspirin, of which I can buy 500 tablets for about $7.50 or a penny and a half each, let’s assume that if I walk into a modern compounding pharmacy with a drug in hand I can have it made into pills and put in bottles for two cents a pill. So what does this new wonderdrug cost?

Assuming I buy it the most uneconomical way possible, which means buying it in small quantities as a reagent from a chemical company that supplies laboratories, I can buy dimethyl fumarate from Sigma-Aldrich for $56.20 for 100 grams. At 365.25 days per year, 2 pills per day, and 240mg of compound per pill, that’s 175.32 grams per year or $98.53 for the drug and $14.61 for making into pills. Total cost per patient comes to $114.14. Even if they hire exotic dancers to personally deliver each month’s pills to the patient, there’s way too much profit in this at $51,000 per year.

But somehow I don’t think they’re going to be buying the compound in small quantities from Sigma-Aldrich, I think they’re going to buy it in China, from whence so many of our drugs originate. So I went to Alibaba, the great Chinese business-to-business portal where I found lots of sources capable of providing 15 to 2,000 metric tons per month. Most don’t quote prices online, but one source expected it would cost about $5 per kilogram delivered to a west coast port. That’s 87.5 cents for the medication, make it into pills and we’re looking at $15.49.

And what is this marvelous drug, this dimethyl fumarate? It’s a failed biocide. It was originally used in furniture and shoes to prevent the growth of mold when stored in tropical climates. It was packaged in little sachets, like silica gel, until it was noticed that it caused skin rashes. The European Union banned it in consumer products in 1998.

I’ve long felt that many drug patents allowed big pharma to exploit patients, but in this case Biogen Idec doesn’t even hold a patent on the material, merely a patent for a “novel use” of a material which has been mentioned in patents since at least 1978. The very idea of a patent for a novel use is as offensive as a patent for a business process, but then the patent office seems to exist to benefit the rent seekers these days.

The discovery that dimethyl fumarate appears to be efficacious in treatment of MS is a great and wonderful thing. Somebody should make a stunning amount of money by marketing it, a very suitable reward for the effort and expense of identifying the use and testing. In fact, they should charge a buck a pill, $730 per year. If I Were King, I might let them charge even twice that. But not $51,000 for pills that cost $15 to make.

Thursday, 24 January 2013

To my Republican friends

I haven’t spoken with any of my Republican friends since the election, I’m sure that any comments I made would seem like rubbing salt in their wounds. So I’m going to put some comments here for them to see once they’ve recovered:

Mitt Romney was a poor choice of candidates and he ran a poor campaign, but that wasn’t the problem. He got very lucky in that, although Obama ran a good campaign in terms of the nuts and bolts, the “ground game”, he was tired out from four years of fighting with your obstructionist congress critters. You lost a few of those, prepare to lose another raft of them next time out when your opposition doesn’t have to worry about the White House.

You lost by only a few points overall, but you lost huge with Latinos, blacks, women, educated people, gays, and the young. You won fat margins with white males and seniors. Next time out there will be more Latinos, a new crop of young voters, and we’ll lose a similar number of seniors. Moreover, Obama did a truly wretched job of explaining the Affordable Care Act, aka Romneycare, aka Obamacare. In 2016, seniors will fully understand the benefits of the reformed medical system and won’t be voting against it. You’ll be left with your base: white men with high school diplomas, elderly white men, the more docile white wives, and the 1%. Without serious change, you’re toast. It’s time to change your program.

Watching Republican candidates for the past several cycles, it would be easy to get the idea that abortion was a truly difficult political problem. It isn’t. Abortion isn’t a political problem at all. Polities don’t get pregnant, women do. If you really, really, really disapprove of abortion, don’t get one. That should be easy for the majority of Republicans: men and postmenapausal women aren’t at risk of pregnancy. Don’t try to pass bills requiring that your daughters get your permission for an abortion, or even to notify you. If your daughter gets in the kind of bind that makes her choose an abortion and doesn’t talk to you about it, you’ve already failed as a parent. Try to salvage the relationship for the future, but leave this one alone. If you’re a medical professional and feel you can’t be involved in abortions, don’t try to pass laws in the name of your “conscience”. Medical specialties are not mandatory and very few ophthalmologists, trauma specialists, or orthopedic surgeons are asked to perform abortions. In other words, take every reference to abortion and contraception out of your platform. If any candidates bring it up on their own, cut them off.

Marriage isn’t a sacred institution. It can be, but that’s the province of religion. If it really disgusts you, as a Republican man, to have sex with another man, as it does me, you should almost certainly marry a woman. If, however, you are drawn to other men, it’s not fair to marry a woman and expect her to put up with your conflicted soul. It’s not a political issue at all, communities don’t marry. Remember that every year there will be more young voters who know that same-sex marriage is a net positive for the community. Walk away.

You’ve been fixated on documents: birth certificates, passports, green cards. Your community is made up not of the people that carry the same passport as you but the people that live and work and raise families near you. If some of them are criminals, we can take advantage of their lack of documents and deport them instead of paying to put them in prison. Other than that, provide their children with a good education and reward their hard work and you’ll be proud to have them as neighbors. If you’re really lucky they’ll bring you a tray of tamales at Christmas.

And speaking of prisons, we can’t afford to have more people in prison than any other country in the world. We’ve turned our cities into war zones, not to mention the havoc we wreak on Mexico and the rest of Latin America by an irrational prohibition of a few drugs while happily allowing two really dangerous ones. Okay, you can’t come out for having hashish in the bulk section at Whole Foods right away, but this is an area in which your current policies are not only wrong but destructive in every possible way. Work on it. The libertarian elements in your party will be delighted.

Republicans have been taking aim at collective bargaining and the unions. Why? Union members are paid better, have better health benefits, and have more stable jobs. In other words, they’re the kind of people you want for neighbors. Sure, business executives can be good neighbors too, but they’d be just as good to live next door to if they made half the money. And please don’t sing the song about needing million-dollar paychecks to motivate leaders in business and finance. They might work harder if they weren’t showered with so much cash. We don’t want a country with a few billionaires and the rest earning minimum wage or on welfare. Unions were a major part of building the American middle class in the last century, they aren’t your enemies now. So stop being their enemy.

Get a grip on economics. As far as I can tell, every Republican candidate agreed that cutting taxes would immediately stimulate the economy. To get technical for a moment, this depended on the IMF’s calculation that the “multiplier effect” of government spending was 0.5. How they reached that conclusion is beyond me, we’ve had good economic times in this country when the top income tax rate was 91%. In fact, when the top tax rate was 39.6% under Clinton we were doing spectacularly. After having practically destroyed Greece with their austerity prescription, the IMF now thinks that the actual multiplier is between 0.9 and 1.7. In other words, a dollar of government spending might create an additional 90 cents to $1.70. A new electronics company or aircraft company with big export markets might have a multiplier of 3 or 4, so government spending isn’t as beneficial as new primary industry, but it’s still positive and rarely polluting.

Over the last three decades the financial sector has extracted more than twice as much of the national productivity as before, largely as a result of Republican decisions favoring Wall Street. This may make it easier to raise big contributions to Republican campaigns, but it makes for a less healthy America. Your past positions have worked against the personal interests of the great bulk of your party, even if they applauded them.

Basically, I think I’ve just said that you have to take your recent campaign platforms and burn them to the ground. It’s not that you need to work on your “messaging” to better present these ideas, you need to understand that the ideas you have most loudly proclaimed are simply wrong.

If you decide that these are the things that define the Republican party, and therefore can’t be changed, you’re going to lose your place as a major player. I personally don’t believe that the GOP has nothing to contribute, even though recent history suggests otherwise. There is some value in simply being the opposition and acting as a brake for the more exuberant bad ideas that the Democrats might come up with, but I strongly suspect that you can actually help move the United States forward if you’ll only stop trying to move us backwards. If I Were King I’d just go do it myself, but we actually need to be intelligent and act together. I earnestly hope you will.

Monday, 3 September 2012

Who built that?

Last September, Elizabeth Warren included a marvelous tribute to our infrastructure in a campaign speech: “There is nobody in this country who got rich on his own.” In July, President Obama made his parallel comments, from which context Republicans ripped “You didn’t built that”. Never mind the fundamental dishonesty of the way Republican attack ads attempted to take that completely out of context. The most coherent comments on the kerfuffle have addressed the importance of government attending to elements such as police protection and the Interstates as a component of our individual success, which I would have thought was so obvious that it didn’t need expression.

But there’s a definitional point to be made here as well, and both sides are missing it. There’s no surprise that those on the right miss it, because for them to admit it would be nearly fatal. It’s an incredible surprise that the Obama campaign misses it, considering how long their man worked as a community organizer. This point is that what we see as “government” actually has two major components. Some elements of government relate strictly to governing per se, and obviously can only be performed by governments. This is the realm of the police, the criminal justice system, foreign diplomacy, and national defense. But everything else that government does is actually organized community action.

Regardless of what Ayn Rand fantasized, and note that I enjoy reading Atlas Shrugged every few years myself, there comes a point in any community in which some things are done on behalf of the community that require an actual organized structure with administration, an investment in facilities, and paid staff. An Amish community might have the tradition of all pitching in to build one family a barn, and they might build a school the same way, but they actually arrange to have dedicated staff doing the teaching. That school might be in a volunteer-built building or in spare space in someone’s store, and teachers might be motivated by something more than cash payment to teach, but at some scale this ad-hocracy has to be replaced by something more formal. In the case of education, I believe that every single state makes the formal government responsible for funding and delivering the necessary services.

Please note that we don’t have state education because “it’s the law”, it’s the law because “we the people” have chosen to include it in the community action side of government.

The Mormon communities around the country have “welfare farms”. Those without jobs work there, those without income eat the produce. Most of us aren’t Mormons and have chosen to hammer out a system of welfare that is, again, part of the community action side of government.

There are places where men with bulldozers have, in a spirit of community, cut roads through the woods to connect their neighbors. But it’s not common, nor are investor-owned turnpikes. Again, we’ve chosen to create that infrastructure as part of the community action side of government.

Not all of our critical infrastructure is delivered by government. We move goods from creator to consumer over roads that are mostly government built, but private truckers, UPS, and a host of others make the delivery. The government made the internet possible, private companies (including yours truly) invest in facilities and deliver the bits. It would be remarkably dangerous to let government deliver the news, as has been demonstrated countless times.

So the big issue dividing the right and the left is not a question of how big “government” should be on some absolute scale. Fundamentally, it’s a question of what community services should be delivered by government, how well it should be done, and how widely those services should be available.

Note that in most cases, the wealthy don’t need the government to handle many things. They can pay for the best private schools and see doctors at the finest private medical centers. It’s the lower half, or maybe lower three quarters, of the community that lacks the resources to directly arrange these things.

In my mind, the question comes down to this: For what community services is government the most effective tool? Then the question of how big government should be is simply a matter of addition. If I Were King you can be sure that I would express these questions in exactly these terms. Because I definitely want to live in a community where businesses can hire well-educated help, know that they and their staff can affordably maintain their health, that they can procure the materials they need reasonably, that the money they spend and receive will be sound, that the courts will be honest arbiters of disputes, and that all of their transactions are protected by a system of law that allows them to compete on an even playing field.

Wednesday, 22 August 2012

Todd Akin, Redux

What Rep Akin said on Monday regarding his plan to not allow an exception for pregnancies resulting from rape in legislation he would like to see was this, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” For obvious reasons, this has caused a dramatic kerfuffle, most of his own party wanted him to withdraw from the race. Significantly, he could have done just that by close of business on Tuesday and allowed the party to replace him with very little expense or inconvenience.

Apparently his political judgment is as acute as his comprehension of human physiology and he not only failed to withdraw he brazenly committed himself to continuing the race. He apologized for his remarks: “Rape is an evil act. I used the wrong words in the wrong way, and for that I apologize.” No, Congressman, you didn’t use the wrong words in the wrong way, you used very effective words in a brilliant way to demonstrate that you are absolutely clueless.

To my great surprise, much of the published discussion about the case somehow actually revolves around the extreme, if common among social conservatives in the Republican Party, position that there should be no exception for rape in any future ban on abortion. But that seems to dramatically miss the point. Akin is in a position of significant power and believes that he has the moral, theological, and philosophical authority to control the medical decisions of women when he doesn’t understand as much of the process as the average 13-year-old girl. At least where I grew up, girls seemed to have an extremely clear understanding of human reproduction, even if some of us boys were a little slower.

If I Were King I would be grateful that I was not king of Missouri.

Tuesday, 21 August 2012

Medical expertise and Todd Akin

In my youth, most Americans tended to defer to their doctors on questions of diagnosis and treatment. It was father-knows-best, most doctors were men and most patients treated them as demigods. I think it’s a clear improvement that we generally take responsibility for our own health care decisions now.

If my doctor tells me “We’re going to do blah-blah-blah” I am likely to reply “What if we try this <other> first?”. Or if a prescription is mentioned, I’m likely to ask if that’s the most effective solution or if a less-expensive drug might not avail. Or even, on rare occasions, “You’re not listening to me!” before overruling the doc’s initial plan.

On the other hand, my doctor has more training and more experience. I don’t think I’ve ever challenged a choice of antibiotic, I just don’t know all the variations on that theme and primary-care doctors do. Plus, she has the prescription pad, so as with almost every case, we have to agree on a plan before we can pursue it.

There are obvious exceptions. Young children would never choose to have their vaccinations, so parents have to make that decision. Some pathetic souls have been ruled incapable of managing their own affairs and a guardian steps in to the breech. And some simply lack the intellectual horsepower or discipline to make these decisions.

For example, Todd Akin, a Republican representative from Missouri’s second dictrict and now running for the Senate, recently avered that women who had been victims of a “legitimate rape” had physiological responses that prevented conception, so we shouldn’t need to exempt rape victims from a ban on abortions. That’s a two-fer: there should be no ban on abortion that would interfere with a woman’s ability to choose a course of medical treatment in consultation with her doctor, and Todd Akin is clearly among those without the knowledge and intelligence to manage anyone’s health.

If I Were King I would certainly work with my parliament, but I’m certain that a parliament elected by my subjects wouldn’t put an ill-informed cretin like Todd Akin on a committee on science, space, and technology.