Month: April 2011

San Francisco, California, 4.45 pm

Freddie Deboer rejects the notion that college campuses are indoctrination centers:

[T]he constant conservative complaints about liberal bias in the university … reflects such an insulting and wrong vision of students, that they are this amoral jelly upon which anyone with authority can project their political positions. Trust me: these kids will tell you what they think, if you just prompt them a little and show them that they are in a safe space. Whenever I read someone like David Horowitz talking about this generation of innocent youth being indoctrinated into radical politics, all I can think is “you’ve never tried to sneak a line of bullshit by a college class.” Because they will call you on that. Forcefully.

A remarkable moment for science:

Many readers are already sounding off on the subject. One writes:

I read your post and I can provide an example of how anti-vaccination beliefs can go awry.

Earlier this month, Blue Mountain School, a private school in Floyd, Virginia, had an outbreak of pertussis, or whopping cough. Twenty-three of a total of forty-five students became infected, as well as seven other adults. That's 51% of the student population. The school had to close a number of days.

Floyd County is known for its hippie-all-natural-granola-semi-commune population. I, myself, infer that these folks tend to lean towards leftist, semi-libertarian, politics. When the story broke out on April 5, I emailed my friend the story. Her response back to me more or less summarized the situation: "It is all those damn hippies in Floyd who won't vaccinate their kids."

The director of the New River Health District stated that the outbreak was attributed to "lax vaccinations." "The outbreak was caused by not properly vaccinating people against the disease, O'Dell said, noting that a subset of the population does not follow vaccination recommendations."

Another writes:

I am a member of a parenting website, and it's actually disturbing the number of people who deny that vaccines prevent serious disease. Vaccines are an underappreciated science. You don't get to physically "see" the effects of vaccination (but, strangely, it doesn't seem to sway the vaccine denialists when you see the effects of not vaccinating), and many of the vaccine denialists that I've spoken with seem to think that vaccinations risks outweigh the benefits because the diseases they prevent have largely been eradicated.

The biggest scientific misunderstanding by denialists is the concept of "herd immunity". Vaccines aren't meant to simply help the individual, it's meant to stop the disease from spreading to those who can't yet (or ever) receive the vaccine. I'm allergic to the pertussis (whooping cough) vaccine, and therefore, I am not immune to whooping cough. I rely on others to be vaccinated.

Another:

One of the most prominent proponents of vaccination conspiracy theories is probably Don Imus. (I haven't followed him since he got booted from MSNBC, so I don't know if he's still pushing the theory that vaccines cause autism.) Imus is a pretty good representative of American populism, niether on the political left nor right in the conventional sense of those terms.

Frum is right, moreover, that the "organic," whole foods, New Agey mindset transcends political ideology. While we tend to associate it more closely with the left, I do recall many years ago visiting my step brother in Arizona. He had some friends over to his place and at one point one of them said something about quartz having good harmonic properties. I replied that, indeed, it does which is why the crystal is used in digital watches. When an electric current is applied to quartz it vibrates at a constant frequency which can be used for timing purposes. At which point the guest interjected, "It's why I keep a quartz crystal next to my gun." The comment threw me off balance and I replied somewhat clumsily "Oh, you mean those sorts of harmonic properties …"

Another:

I find this topic fascinating, so I've been tracking media coverage of vaccines and autism at AutismNewsBeat.com for about three years. Mooney is essentially right – vaccine denialism is more comfortable on the left, where it meshes with new age beliefs and antipathy to corporate America, in this case "Big Pharma". If I had to guess, I'd say two-thirds of the hard core anti-vaccine activists are left of center, but only because political beliefs correlate with education, and vaccine deniers tend to have more years of schooling and have higher incomes than people who trust their pediatricians. It has more to do with how parents see themselves than with children's health.

That said, the last great US smallpox outbreak (1898-1902) was hardest to stamp out in the south, where vaccination was stubbornly opposed by God-fearin' country folk who saw public health initiatives as a violation of states rights. That anti-government strain infects today's anti-vaccine movement, where antipathy to the CDC, NIH, FDA, and of course Congress creates more suspicion that Big Guvmint is in cahoots with Big Pharm to make us all sick.

Right-wing fever dreams about the United Nations also  morph into anti-vaccine delusions. There is a widely held belief that the Gates Foundation, the Rockefellers, and the World Health Organization foist vaccines upon the Third World as part of a conspiracy to sterilize poor women, in order to depopulate the world. A Springfield, IL radiologist named David Ayoub is at the center of this nonsense. Here is a Radio Liberty video, complete with patriotic music intro, where Ayoub explains the "science" of how vaccines prevent women from conceiving. Oddly enough, Islamists in Africa spread versions of the same story to prevent vaccination for polio, mealses, rotavirus and other killers.

Another:

A lot of ardent pro-lifers are on the vaccine denialsm bandwagon too. Apparently, making vaccines kills babies. Or something. And let's not even start on the HPV vaccine nutters.

On that note, according to a new report, "HPV, the same STD that causes genital warts and cervical cancer in women, is now the top cause of oral cancer in men, responsible for more cases than either smoking or drinking."

Michelle Goldberg stamps out rumors that the left is encouraging Obama Birtherism:

[I]t was the Drudge Report, not liberal cable stations, that was hyping [Jerome] Corsi’s work Thursday  with an “exclusive” titled, “Book to Reveal Obama’s True Identity?” Nor was it liberals who’ve made Corsi a star of the Tea Party circuit. And it certainly wasn’t the left that made the Arizona legislature pass a bill requiring presidential candidates to produce long-form birth certificates, or, failing that, two or more other documents such as hospital birth records and circumcision papers. While Republican Gov. Jan Brewer vetoed it, Louisiana Gov. Bobby Jindal says he’ll sign similar legislation if it gets to him. Birther bills are pending in a number of other states, including Oklahoma, Texas and Indiana.

Amazingly, Drudge touting Corsi's book rocketed it to the top of Amazon's bestseller list.

Brian Whitaker digests an AJE report on Assad's lifting of the emergency law and comes to an unsurprising conclusion – "it will make little or no difference":

According to a former judge, all 15 branches of the security services will retain their immunity from prosecution, even after the emergency is lifted. Their immunity derives from a decree issued by President Assad in 2008. As an example of how the police state will be unaffected by lifting the emergency, the article points out that dissidents who signed the Damascus Declaration were jailed in 2005 on charges of "weakening national sentiment", "belonging to a secret society" and "spreading false news" – all of which will continue to be crimes under the penal code, regardless of the state of emergency.

Whitaker also analyzes a new decree that "allows the authorities to prevent any demonstration they disapprove of." Meanwhile, today was an especially bloody day in Syria:

At least 20 people have reportedly been killed in Syria, as mass protests are being held across the country. Deaths were reported in the central city of Homs, Douma and the southern city of Azraa. … Thousands of people have taken to the streets for rallies on what activists have dubbed "Great Friday", in what they say could become the biggest protests against the government to date. …

From Beirut, Robert Fisk, a leading correspondant with decades of experience in the region, told Al Jazeera that Assad appeared to be "stepping backwards". "Once you start giving these concessions, the crowds on the streets want more and it'll always end at the same demand: end of the dictator," Fisk said.

AJE updates here. Enduring America has compiled many clips from the day.

Krugman today has a column making the empirically powerful case that there is no clear market consumer-based way to rein in healthcare costs. This simple point is perhaps more graphically made by this actual ER doctor:

HALF of all health care costs in the US is concentrated in only 5% of the population, and 80% of costs are accounted for by the top quintile! (source: Kaiser Foundation PDF)

So the effect here is that with such a concentration of costs in such a small segment of the population, the ability of the larger population to move the market is highly restricted. You can make 80% of consumers highly price sensitive, but they can only affect a tiny fraction of healthcare spending. And for the generally well, their costs are probably those which are least responsible for the spiraling inflation. They're not getting $30,000 stents or prolonged ICU stays, or needing complex chronic disease management.

Conversely, those who are high consumers of health care simply cannot be made more price sensitive, since their costs are probably well beyond what they could pay in any event, and for most are well beyond the limits of even a catastrophic health insurance policy.

Once you are told that you need a bypass/chemo/stent/dialysis/NICU etc, etc, etc, the costs are so overwhelming that a consumer cannot possibly pay them out of pocket. Since, by definition, these catastrophic costs are paid by some form of insurance, the consumer cannot have much financial interest in cost containment. For most, when they are confronted with a major or life-threatening illness, their entire focus shifts to survival, and they could care less about the cost.

I don't want to believe this, but its logic is hard to counter. Any offers? The conflict comes home to me in an acute way. I'm a fiscal conservative with HIV. It's little wonder that this question stumps me.

A reader writes:

Why not just require people applying for public or private insurance to complete an advance medical directive and power of attorney as part of the application process? You'd be perfectly free to state the terms and conditions you want, but you'd be required to state your intentions (rather than punt the decision to someone else). Besides the obvious cost of life support in the final days, there's also the issue of liability. Absent instruction, medical personnel will opt for the kitchen sink to avoid being accused of negligence down the line. In any case, I think you're right. It should generate immediate and lasting savings.

Another writes:

Your modest proposal is a wonderful idea, but did you know it's already been tried? 

HR 3200  (the House bill that preceded the Affordable Care Act) contained a provision that would have made it easier for patients to create living wills and limit end of life care voluntarily .  It was very similar to your modest proposal.  See Sec. 1233. Advance Care Planning Consultation here. Of course, this is the provision that came under  heavy fire from Republicans who described it as "government death panels"…

Yes, and I acknowledged this in the post. It is just one of many Republican inconsistencies that they want drastic cuts in collective healthcare spending but cannot countenance anything but maximalist individual healthcare spending. At some point, all those individuals become a collective, especially since we're bound together in insurance pools. Another:

I very much like your idea, though I find fallacy in your presumption about how Christians should approach the subject.  To be certain, it only makes sense that they'd want to be in the arms of their maker sooner (at least it makes sense to me), yet to my knowledge, especially amongst the most devote and evangelical Christians, I fear they'd amount this sort of pre-death decision equivalent to suicide, which in their eyes is seen as disrespectful.  So I doubt they'd ever buy this idea.

They have that right. But it can be framed so this simply allows another to exercise power of attorney on your behalf. You can appoint someone who actually insists on keeping you in animated suspension for years. Or someone who sees nothing wrong with letting go when the time comes, and something almost blasphemous about clinging to life when it has stopped clinging to you. Another:

"Christians, of all people, it seems to me, have nothing to fear from death, and a great deal to gain from giving a few of their own unconscious final days…" And yet, surveys show that it is Evangelical Christians who most want (and demand?) heroic measures to save their loved ones.

Another:

After the Terri Schiavo debacle, my wife and I immediately sought out a lawyer to implement a plan similar to your proposal.

Another:

I have another modest proposal that is so simple and logical I can’t figure out why it isn’t happening now. Require an office visit co-pay for Medicare and Medicaid patients. I know most people with employer based healthcare have co-pays for office visits. They are an accepted part of health care costs.  Even a small amount like $5 or $10 for seniors and a dollar or two for Medicaid when you figure in the hundreds of millions of visits every year has to add up to billions.

It seems to me that Good Friday is the right moment to get this email:

You wrote:

In one of the most tragic ironies in recent social history, this greater knowledge of gay people was accelerated by the AIDS epidemic. Our deaths remade our lives. I wonder if, without such a catastrophe – three times as many young Americans died of AIDS than died in Vietnam over a similar period of time – we would still be decades behind where we are.

My partner George first got sick in 1986. He died in 1990.

Yes, it totally remade our lives. It changed everything. I will never forget hospital staff who wouldn't even bring food trays into the room, but would leave them on the floor outside the door. So many of us came out and demanded action and change. We demanded that the good people we knew or worked with acknowledge what was going on.

I'll never forget a meeting with my boss, telling him that I needed to be home to mix and administer IVs to my partner, and that I didn't know when I would be back to work. I think he was totally blindsided and was totally lost as to what to say or do. It was clear that I wasn't asking for any approval – I had to do it, and to be honest, I was so focused on what I needed to do for George, I hadn't really thought through the fact that I could be fired.  You do what you have to do, and then you deal with the results.

I was very lucky. He totally covered for me. I'm pretty sure I was (suddenly) the first openly gay person he had ever dealt with. Multiply that by thousands.

I think we all just felt that we had to be open about it – then and forever. We had to do what we had to do for the people we loved. And people needed to know what was happening.

And, yes, the world changed enormously. Bit by bit. Marriage? No one I knew then would have ever thought that was coming. And yet, here we are. Amazing and hard to believe, sometimes.

It's so very painfully sad that so many people had to die for the rest of us to get here.

I think of the Leonard Cohen lyric:

It's coming through a hole in the air,
from those nights in Tiananmen Square.
It's coming from the feel
that this ain't exactly real,
or it's real, but it ain't exactly there.
From the wars against disorder,
from the sirens night and day,
from the fires of the homeless,
from the ashes of the gay:
Democracy is coming to the U.S.A.

My italics.

(Photo: Thousands of people gather to view the AIDS Memorial Quilt on display on the Washington Monument grounds 10 October, 1992 in Washington, DC. The Quilt contains more than 20,000 panels with the names of people who have died of AIDS. By Renaud Giroux/AFP/Getty Images.)

Thoreau wonders:

It is true that most establishment Republicans know better than to openly advocate Birtherism, but how many are openly denouncing it? Yes, I’m running the risk of sounding like the ones who say “Well, why haven’t I heard more liberal Imams denouncing it?” but we aren’t talking about a minority group that bears the brunt of public distrust and then gets told that they need to somehow prove their loyalty. We’re talking about a group that is powerful and mainstream, and that could probably widen its appeal among independents if one of them would just speak openly, loudly, and sanely on this topic.

Well, we now have Jan Brewer and Michele Bachmann. Palin whiffed on this one. Conor is in related territory with Thoreau:

Some of us have long insisted that the conservative movement was going to pay for its embrace of demagoguery, anti-intellectualism, bombast in place of substance, and shameless pandering. For our trouble, we've been dismissed by talk radio hosts and conservative bloggers, who took an ends-justify-the-means approach to the 2010 primaries and opposition to President Obama generally. Lo and behold, the conservative movement is now paying a price, exactly as predicted. The GOP has a weak field for 2012, and although Donald Trump isn't going to win the nomination, his early status as a front-runner is an unwelcome distraction and may end up pulling other candidates toward the sort of absurd populism that will hurt them in a general election.