Month: September 2008

According to RCP’s poll of polls, McCain’s post-convention bounce peaked at a 2.9 percent national lead over Obama on September 8. Six days later, it’s now at 1.3 percent. Obama’s post convention bounce gave him a peak of 6.4 percent on September 2. It was gone by September 6. Pollster’s poll of polls gives McCain a national lead of 1.8 percent. Pollster’s electoral college prediction still shows a small Obama advantage. RCP’s electoral college tally records a small advantage for Obama-Biden in the electoral college. But 538 shows a clear McCain lead in the electoral college.

Now’s the time to begin to see the fundamentals emerge after both conventions and the soap opera of Palin temporarily dies down. Basically: it’s tied with a tiny edge to McCain in the national vote and a tiny edge to Obama in the electoral college. Gallup’s tracking shows the race closing again. My own view is that Palin has all but killed the McCain candidacy. And her real advantage was novelty. Once people realize she has no record of even interest in foreign policy and is a serial liar, her unfavorables will continue to rise.

Yglesias wants someone to take on the corn industry as a whole. Ezra chimes in here and explains that pretty much every ingredient you can’t pronounce is made of corn.

Palin’s popularity tanks as voters get to see more of her:

The Research 2000 poll for Daily Kos now has Palin’s favorability-unfavorability scores at 45-44 — just a +1.  Six days ago, when the poll launched, she was at a 52-35, a +17.

A loss of 16 points in six days. You can fool some of the people …

A reader writes:

Interestingly, I started to write you about this very question a few days ago, and figured there were bigger fish to fry. My background: I’m a board-certified OB/GYN, full professor at a major medical school, with an additional degree in epidemiology. Most of my work involves using the tools of decision analysis and cost-effectiveness analysis to address questions in women’s health, both at the level of individual decision making and for policy (for example, looking at the cost-effectiveness of vaccination for HPV in combination with cancer screening). Screening for Down syndrome is something I’m very familiar with, from both a personal clinical perspective as well as a classic teaching tool. 

Most pregnant women don’t get an amniocentesis.  They are offered a combination of ultrasound and blood tests which quantify the risk of Down syndrome (and a few other chromosomal anomalies, some of which are much more severe). If the risk of an anomaly is greater than the risk of a loss from the amniocentesis (about 1 in 200-1 in 300), then an amniocentesis is offered. As women age, the risk increases–for a 35 year old, it’s about 1 in 200, which is why amnio is routinely offered.   For a 44 year old, the risk is about 1 in 50. In order to be optimal, the ultrasound/blood testing needs to be done in the first trimester–it’s possible this pregnancy was diagnosed too late to have it done. 

Notice, from a classical decision analysis perspective, this recommendation assumes that the utility of a loss of a healthy infant from the amnio is equivalent to having a child born with Down syndrome. My colleague Miriam Kuppermann has done some very elegant studies which demonstrate that, for most women, this is not the case. 

Most obstetricians don’t have the training, or the time, to really go through these probabilities with patients, but most do go through the options with patients. As you suggest, many who would not undergo abortion choose not to have the test. For others, there are some benefits to knowing the diagnosis in advance–emotional and perhaps financial preparation, the chance to become familiar with the challenges of raising a Down syndrome child (including the highly increased risk of certain childhood cancers), etc. It’s also possible that some women, while not having an abortion, might decide to be less aggressive in the setting of certain pregnancy complications (like very preterm labor).    

 

In terms of maternal complications, I’m not aware of any specific complications relating to mother of children with Down syndrome, although women in their 40s are clearly at increased risk for a wide range of complications, including hypertension during pregnancy, growth problems in the baby (even normal babies), and the need for c-sections; Down syndrome increases the risk for fetal distress during labor, increasing the need for c-sections. In addition, having had 4 previous children, the risk for a precipitous labor (a very quick labor and delivery) was certainly increased with Gov. Pailn.

As I suspected, the Palin decision remains befuddling and contradicts her resolutely pro-life stance. I also find it bizarre that a woman whose contractions have started and who is at risk for a very precipitous labor and birth would choose to delay seeing a doctor for over 24 hours after her contractions began and take a trans-continental plane trip. But those are questions to be explored in a subsequent post.

A new record. Give the drug warriors four more years and I’m sure they can break a new one. Remember: McCain opposes medical marijuana even for the terminally ill with cancer. Palin smoked pot when it was legal in Alaska.

In an excellent and prescient piece, Hitchens takes on Pakistan. He’s right, I think, to acknowledge that an Afghan-Pakistan war is now a de facto reality and that the Bush administration has just followed Barack Obama’s advice and started fighting the core al Qaeda now given refuge by Islamabad. Hitch:

…[Obama] is committed in advance to a serious projection of American power into the heartland of our deadliest enemy. And that, I think, is another reason why so many people are reluctant to employ truthful descriptions for the emerging Afghan-Pakistan confrontation: American liberals can’t quite face the fact that if their man does win in November, and if he has meant a single serious word he’s ever said, it means more war, and more bitter and protracted war at that—not less.

Yes, it could. The difference is: it would be a war against the real enemy, not one we partly created with the security vacuum we opened up in Iraq. Since I’m not a liberal on these things – despite what today’s "conservatives" claim – I can face the idea of a president Obama taking on and finally defeating Osama. In fact, that’s the major reason why I favor his candidacy. I want to win the war on terror we are currently losing. And I want all of us in this war – Democrat and Republican. Getting a Democratic president to take responsibility for a war we will have to fight for generations is critical to our long-term success. If it remains a partisan enterprise, used for domestic political points on the Cheney and Rove model, al Qaeda will win.

Obama will try to correct the massive strategic error of the Iraq invasion and pivot Western allies toward a greater focus on Afghanistan and Pakistan. I believe that Obama will be able to do this with much less global p.r. blowback than McCain and that the support president Obama will get from our European allies will dwarf McCain’s. McCain’s seriousness as a potential president has been undermined abroad by his crude and unintelligent response to Russia’s aggression, his captivity to the most extreme neocon factions in Washington, and his unserious selection of Sarah Palin as his veep. Obama will begin with a massive wave of good will. 

Obama goes after McCain’s "the fundamentals of the economy are strong" gaffe:

This strategy strikes me as overly reactive. Where is the Obama ad explaining what he would do about this crisis?

Richard Cohen airs his disappointment with McCain.

So far, I’ve learned nothing from my readers that resolves the conundrum of a fervently pro-life woman risking the life of her child even in a small way by an amniocentesis. Here’s one of the more succinct first-person testimonies from a pro-life couple I have received so far:

You’ve made some good observations in your post. My wife and I were discussing this last night. When she was pregnant with our third child, certain tests (blood or urine, I think) suggested that the baby had Down syndrome.  So the doc recommended ultrasound.  The ultrasound was inconclusive, so the doc recommended amnio.  We declined.  In our view, there is only one reason to do amnio, and (as you note) there is risk involved in doing it.  Therefore, we chose not to do amnio.

So we went forward, knowing that there was some chance our child would have Down syndrome.  We told no one, and just worked out the issue in our own hearts.  We were at peace and ready for anything.  When the child was born, the nurse quickly checked him and whispered in my wife’s ear ("He doesn’t have it"). As opponents of abortion, that was how we dealt with the situation.  I think we are pretty typical.

Palin’s decision was atypical for a pro-life mother. Here are some possible explanations:

As a retired military person, I can think of one possibility where this would make sense for a pro-life person to consider amniocentesis.

A person who is due for a military career-related household move might want to know about the health of the fetus and if any abnormalities are present before moving. We had amniocentesis done when my spouse was pregnant with our youngest child.

My spouse was over age 35 and we wanted to have this information to better help us with deciding our next military duty station (I was stationed at a military base that closing in a few months).

But that doesn’t apply to Palin. Another reader writes:

At age 42, Ms. Palin was at risk for both Down’s and a neural tube defect, and while the first is not a big issue for delivery concerns, the second is.  So the question is not just to terminate or not, but how to prepare for delivery of a challenged infant. There is risk in ANY procedure — this is the nature of informed consent.  A well-informed pregnant woman can look at the risk profile, see clearly whether there’s a greater risk from amniocentesis or from a potentially serious delivery complication, and choose.  It’s her decision, but at her age Palin taking the slight risk of complications from amniocentesis in order to prepare for what could be a difficult birth seems responsible to me.

But if you’re preparing for a possibly difficult labor and birth, why would you then wing it for a speech and airplane flights from Texas to Wasilla after your water has broken or your amniotic fluid is already leaking and you are having contractions? If the point of the amniocentesis was to take every precaution to avoid a dangerous birth, then the decision to fly from Alaska to Texas and back, after contractions and leakage of amniotic fluid, is bizarre. One more small thing from the NYT piece – which is well worth reading and re-reading. Palin may have agreed to the amniocentesis to prepare herself. But she didn’t prepare her own children in any way for the condition of their new brother:

Inside Ms. Palin’s room, her daughter Willow, 14, immediately noticed her new brother’s condition, according to People magazine. “He looks like he has Down syndrome,” Willow said. “Why didn’t you tell us?”

Another reader suggests:

I am not a women, but I am a father, so I thought I would take a shot at replying to your questions regarding amniocentesis.  While my wife was pregnant with our first child she had a positive result on her triple screen blood test (which tests for Down Syndrome among other things).  Based on that result my wife was presented with the option of undergoing amniocentesis, which she chose to do. I can’t say that we were strongly pro-life at the time, but, in any case, prior to opting to undergo the procedure, we had decided that we would not terminate the pregnancy based on the results. 

The problem we faced was that there is a very high false positive rate for the triple screen blood test, so a positive result from that alone really leaves you in limbo. Amnio was presented as the only option available to provide a more definitive result. Without undergoing amnio we would have been faced with months of wondering and fearing the worst (again we weren’t informed of any other options other than waiting for an ultrasound much later in the pregnancy). We felt that the stress of not knowing would pose similar risks to the pregnancy as would undergoing amnio.

I have no idea if the stress caused by expecting a child with DS is greater than the demonstrated risk of an amnio to an unborn child. But I do think it’s worth asking Palin herself to elucidate her reasons, and how she balanced those reasons against her pro-life principles. Is that deferent enough?

Keep emailing me and if I get any information casting more light in this, I will post it.

Jonathan Rauch imagines the next turn in the absurd McCain-Palin campaign. He imagines a McCain-Shcmidt conversation that goes something like this:

"Our tracking polls show age is the public’s biggest remaining concern about you, sir. People love Sarah as running mate or VP. But when we test the words ‘President Palin’ … "

"So? What are you suggesting?

"We need to go on offense. Our theme is that Barack Obama is too old for the job and that the public needs a younger, more vigorous brand of leadership …

"Steve, April Fool’s Day is seven months off. You want me to say Obama is too old to be president and I’m not?"

"Yes."

"I’m younger than Obama?"

"Not younger, exactly. More youthful. You have more, um, youthiness. What is 72? That’s just a numeral. Same two digits as 27. It’s ink on a driver’s license. You have the adventurous spirit of youth. You’re the innovator, the reformer. You may be older in years. You’re older technically. But you’re younger in qualifications. That’s the age that really matters. Qualificationswise, you’re entering your prime, and you have the experience to prove it. You’re like Reagan, although you’re even younger, though not technically.

When the truth is for fools and poseurs, why not? It goes on. And if this was the message, Jonah Goldberg would be echoing it.