The View From Your Obamacare: Women’s Health, Ctd

A reader quotes another:

I am very frustrated with this comment:

Access to medical, dental, and mental care are true human needs. Obamacare should have focused on meeting all those needs, including the mental and dental coverage that too many employers had failed to make available, instead of opting to cover the pill. Except for its palliative uses, the pill is not a form of healthcare.

President Obama Visits Boston To Talk About Health CareFirst, I would ask, why is this an either/or situation? Why pit this one benefit against other benefits? Physical, mental, dental, and reproductive health are all essential human needs. In fact, I would also add vision coverage, as those of us with very bad vision know we cannot operate in the world without the help of optometrists. Shouldn’t we be advocating for a more holistic approach to healthcare and not elevating one type of care over another?

Secondly, I must strongly disagree with the claim that “The pill is not a form of health care.” This is simply erroneous. I know a number of women who take birth control for reasons unrelated to preventing pregnancy.  Most of them use it to treat very painful periods or endometriosis. I know one person who uses it as estrogen therapy to treat Turner Syndrome, a genetic condition resulting from a missing X chromosome. In fact, only 42 percent of women use the pill only for contraceptive purposes, according to a 2011 study by the Guttmacher Institute. Maybe your reader does not consider those uses to be a form of healthcare, but most doctors would.

Finally, even preventing pregnancy is healthcare.

Pregnancy is not an illness, but it is a condition that affects a woman’s health. Pregnancy can put some women at great risk, because they have other health problems. For the rest of us who do not currently want to be pregnant, it is a relatively safe and easy method for us to prevent pregnancy – a method that does not require us to rely on a partner’s willingness to wear a condom. Of course, in theory we should all be having sex with partners who are willing to participate in safe sex, but we know that relationship are very imperfect and sometimes dysfunctional or even abusive. The pill is a way for a woman to have autonomous control over their reproductive health. It is a way to prevent a change in one’s health.

Another speaks from personal experience:

Did you notice that health-insurance companies made not a peep about covering birth control? And that they very quickly figured out a way to cover employees of religious hospitals, universities, and other religious employers with separate birth-control policies that would allow the institutions to save face? It is long-run cost savings for them.

I am prescribed “birth control,” which costs $100 a month and does prevent pregnancy – which, as I am 48 years old, is a good thing for me and for all my fellow policyholders. A pregnancy at this point in my life would surely be a very expensive prospect. But more than that, my “birth control” prescription ended the debilitating deluge of menstrual blood that began in my mid-40s, likely caused by the same condition that required my mother to have a hysterectomy at age 48. So my insurance company and fellow policyholders are shelling out $1,200 a year to prevent pregnancy and to prevent an expensive hysterectomy and the subsequent recovery time, which would cost many thousands more.

I expect to be taking this preventive “hysterectomy control” prescription into my early 50s, when my body should end the deluge on its own, thus avoiding an expensive surgical procedure for my insurance company and fellow policyholders, as well as keeping me on the job rather than suffering through the monthly challenge or the surgery that would have been required to stop it. Those savings can eventually be used to pay for expanded coverage of things like dental care – or at least they should.

Another ties the personal issue to a political one:

If Hobby Lobby prevails, their female employees with menorrhagia would have no choices for treatment except surgery – which leaves you unable to later get pregnant and comes with risks not present with the other medical options. “Birth control” is not just birth control. Would a male legislator who had lived one week out of every month bleeding uncontrollably still think it reasonable to deny women access to this treatment?

(Photo by Yoon S. Byun/The Boston Globe via Getty Images)

Vampire Science Discovers The Protein Of Youth

New studies out of Harvard and Stanford, in which researchers used blood transfusions to reverse the effects of aging in mice, are being heralded as bringing us one step closer to immortality:

Scientists previously demonstrated that the process of aging did not rid tissue of its stem cells. Therefore, these researchers set out to identify the signals, potentially carried in the blood, that could reinvigorate the dormant stem cells of elderly mice. … Evidence from a number of studies pointed to a protein called GDF11. Researchers found much more GDF11 in young mice blood and determined that treatment with this protein alone recapitulated some of the effects of the transfusions.

Scientists demonstrated the benefits of these “young blood infusions” in reversing aging effects in three different body systems. In muscles, young blood revived strength and endurance in old mice. In the heart, it reversed age-induced cardiac hypertrophy (enlargement of the heart). Recent findings now point to rejuvenating effects in the brain.

John Timmer explains why GDF11 is so promising for future research:

It should also be clear that a variety of evidence is building in favor of GDF11 being a general factor that promotes youthful behavior in a variety of tissues. None of the findings on their own would be earth-shattering, but there’s now a large collection of incremental results that paint a pretty compelling picture.

That picture is generally good news, too. GDF11 is part of a large family of signaling molecules (the TGF-ß superfamily) that is extremely well studied. (It’s so well studied that you can order a tiny batch of 98 percent pure human GDF11 that was made in bacteria for as little as $80.) So following up on this work won’t mean starting from scratch with a mystery molecule that no one understands.

If it’s so easy to make GDF11, could places offering injections be far off in the future? Probably not, but we’re a long way from the sort of evidence that would make that a safe, approved therapy for the declines of aging. It’s possible for GDF11 to have both positive and negative effects on a variety of tissues.

Jesus Diaz notes that there really doesn’t appear to be much of a catch to this good news:

There’s only two caveats. The first is that these are experiments with mice. They still have to be tested in humans, who have their own version of GDF11. It will probably work in the same way, but we don’t know for sure yet. The second one is cancer. The moment you start awakening stem cells and telling them to start creating new cells, you may increase the possibilities of cancer. Honestly, I would rather take the chance of cancer than the certainty of dementia or early death because of some heart disease.

That’s why scientists are so excited. The results are clear and there are no conflicts between the two studies, so this is wonderful news so far, they say.

Michael Byrne meditates on how discoveries like these may change the way we think about old age:

If a whole range of diseases are the result of declining GDF11 levels in the body, then it’s not really hard to imagine a disease that just is the decline itself. It’d be one big package of pathologies under one generalized roof, like, say, hypothyroidism, an illness sometimes known as the “great imitator” because it encompasses symptoms and syndromes associated with about every illness ever. Treating it, meanwhile, is just a matter of upping the levels of one hormone in the blood. You might imagine GDF11 deficiency in a similar light, except of course that age happens to everyone.

Society hasn’t really found an “OK” way to die. “Old age” is about the closest we have, and there’s not actually such a thing as dying of old age. People die of aging-related diseases, like the two mentioned above, but also cancer and even just getting the flu as an old person. Bodies get worn down by time because that’s what time does; GDF11 would seem like a way of not buying extra time, but of resetting the clock in general, erasing age and, most strangely, erasing time. Which is where it gets ominous, if vaguely so: the clock itself as the disease.

Walter Russell Mead quips:

Over the years boomers have sucked millennials dry financially in all sorts of ways: by promoting policies that shifted wealth towards them and away from the young; by resisting reform to entitlement programs; by hogging all the job growth; and by supporting reductions in spending that benefits the young (like aid to public colleges).

Now they could be out for millennials’ blood. Young people don’t expect to be looking up the local blood bank instead of the local job bank. But since they’ve got nothing in the bank, maybe it’s worth considering a new way to pay off those college loans.

How Many Atheist Kids Convert To Belief? Ctd

A reader cries foul:

The headline of this post is badly misleading. It states that only 46 percent of the non-affiliateds’ kids remain unaffiliated, but the survey on which the data was based breaks down the “unaffiliated” demographic as follows:

Unaffiliated: 16.1% of the total US population

– Atheist: 1.6% of the total US population
– Agnostic: 2.4% of the population
– Nothing in particular: 12.1% of the population

– Secular unaffiliated: 6.3% of the population
– Religious unaffiliated 5.8% of the population

In other words, more than one-third of the unaffiliated in question are actually religious, and another one-third-plus are sufficiently noncommittal to eschew both religious and non-religious identification. As an atheist contemplating reproduction, I’m deeply interested in what happens to the children of the committed nonreligious (atheists and agnostics). But generalizations about the “unaffiliated” don’t really address that question at all.

A few more readers sound off:

The thing about the “nothing in particular” group is that they tend to believe in a god or universal spirit while being skeptical that organized religion has any special knowledge about that god or universal spirit. So you’re not looking at how many atheist kids convert to belief; you are looking at a group that mostly consists of mostly of disenfranchised theists.

All of that being said, the retention issue is one of the reasons I support the creation of atheist community centers: places where atheist parents can bring their children to be indoctrinated in reason, logic, evidence, and science in the same way that religious children are indoctrinated into the beliefs of their parents’ religion.

Another:

I’m an atheist, and my husband is on the belief fence. We are not raising our kids in any religious tradition (we were both raised Catholics – he much more traditionally than me). A kid from across the street who does go to church told my six-year-old that all she has to do is believe and then she won’t go to hell. Nice. So we talked about it. She is a thinking type of kid and says she doesn’t know if she believes or not. And at six years of age, I think that is the perfectly correct answer.

A Better Answer To “Where Ya From?”

Geneticists Eran Elhaik and Tatiana Tatarinova have developed a fascinating new tool, which they call the Geographic Population Structure (GPS), that allows anyone to identify where their ancestors came from as far back as 1,000 years ago. The technology has a much greater degree of accuracy than previous methods:

Previously, scientists have only been able to locate where your DNA was formed to within 700km, which in Europe could be two countries away; however this pioneering technique has been 98 per cent successful in locating worldwide populations to their right geographic regions, and down to their village and island of origin. The breakthrough of knowing where the gene pools that created your DNA were last mixed has massive implications for life-saving personalised medicine, advancing forensic science and for the study of populations whose ancestral origins are under debate, such as African Americans, Roma gypsies and European Jews.

Jordan Pearson explains why the GPS is so precise:

The increased accuracy of the new model is based on a simple, if controversial, assumption made by the study authors: that race doesn’t exist.

“The model of races is incorrect and should be dismissed,” Elhaik told me in an email. Up until now, tracing genetic origins assumed that people could be typified as a mix of two to three defined races, presupposing a homogenous “European” identity, Elhaik said. “By contrast, GPS represents a paradigm shift in population genetics whereby all populations are considered admixed to various degrees.”

Admixing occurs when one gene pool mixes with another to create a whole new one. You can think of it like how primary colours mix to create new palettes and shades—“red” people from region A breed with “blue” people from region B, creating a new group of “purple” people, genetically speaking. What the study assumed, if you’ll forgive the analogy a moment longer, is that there aren’t purely “red,” “yellow,” or “blue” people in terms of genetic makeup; we’re all somewhere in between, and every population worldwide displays a certain amount of admixing.

Update from a reader:

I’m always keen to see new ideas and methods in human evolution and genetics, so checked out the clip from Elhaik.  It pinged my bullshit sensors pretty hard, so I asked a friend and PhD student in the Graham Coop lab (much more an expert on this sort of thing than I) his take.  He says “it’s plausibly a decent genetic clustering algorithm, and they present evidence that they do better than SPA, which is probably the best existing method for this kind of thing, but the hype is way over the top.”

He also sent me a blog review from an editor on the paper, a summary of some questionable reviews of the analysis service, and an allegation of intellectual theft including a response from Elhaik himself.

Briefly, there are a few big issues with this paper.  First, the concept of a single ancestral origin for an individual is obviously ridiculous.  We all have thousands of ancestors who lived 1000 years ago, geographically spread to varying degrees; this method at best finds an average between all of these, so their prediction for a lot of folks ends up in the middle of an ocean.  Second, the authors claim no competing financial interests yet started a for-profit company offering this analysis on the same day the paper was released.  Third, the paper uses methods first suggested several years ago on a popular genomics blog, but makes no effort to credit the source.

Finally, the idea that race has been considered a useful concept by any serious human population geneticist in the last decade is absurd.  The notion that this method is superior because it eschews racial divisions is a straw man.

The Legacy Of Gary Becker

Justin Wolfers eulogizes the University of Chicago economist-cum-sociologist, who passed away last weekend at the age of 83:

To Gary, who died on Saturday, economics was not a field of inquiry, but rather a method of analysis. He saw the power of the economic method to illuminate issues well beyond the pecuniary domain. Along the way, he transformed our understanding of discrimination, education, labor markets, crime, the family, social interactions and the law.

Before Professor Becker, these topics were considered noneconomic. Today, they’re central. Whether they are aware of it or not, whenever policy makers debate these issues today, they do so in the shadow of an analytic framework that he developed. Grandiose as it may sound, no economist since Marx has had such a profound impact across the social sciences, transforming not just economics, but also sociology, political science, criminology, demography and legal scholarship.

The heart of the Beckerian approach is that people make decisions with purpose. His approach grants agency to everyone from the love-struck teen to the potential addict who is trying to decide whether to shoot up for the first time. In his telling, they’re considering the likely consequences of their actions, and so they’re responsive to incentives.

Yglesias lists Becker’s major contributions to his field:

Becker pioneered the concept of “human capital” — the idea that individuals could and did act to deliberately increase the value of their labor by investing time and effort in gaining more skills. This was, at the time, a new way of bringing the traditional process of education into the framework of economic life. In the human capital view, people pursue schooling not merely for love of learning but because effort expended in learning is rewarded in the labor market.

Becker, like several of his colleagues at the University of Chicago economics department, was also an active popularizer of pro-market political ideas, including both standard right-of-center economic policies and more exotic ideas like auctioning permits to immigrate to the United States. But much of his influence can be seen in work that has little direct relationship to politics.

He also brought economics to bear on the issue of racism, Edward Glaeser notes:

Economists didn’t study discrimination in the 1950s, unless it was the price discrimination practiced by railroads. Gunnar Myrdal’s 1944 An American Dilemma: The Negro Problem and Modern Democracy may have later won the author the Nobel Prize in Economics, but he was seen by Americans as more of a sociologist than an economist, and he was a Swedish Social Democrat to boot. Becker emerged from a citadel of American economics, using the increasingly mathematical tools that would come to define economics.

The Economics of Discrimination noted that firms led by racist leaders should earn less money than firms that just try to maximize profits. This insight countered those who saw an intrinsic link between capitalism and racism, but Becker’s logic is inescapable: Maximization subject to a constraint (racism) does less well than unconstrained maximization. The same logic also implies that racist workers will earn less money, and racist homebuyers will pay more for housing. It does not imply that whites cannot benefit, however, if they collectively rig the system against African-Americans. Becker’s subversive message was that, in the right circumstances, the quest for profits can be a force for tolerance.

Cass Sunstein remembers Becker for his belatedly appreciated insights into odd subjects like restaurant pricing:

Behavioral economists like to emphasize fairness. People tend to think that it’s unfair to raise prices, and maybe popular restaurants don’t want to make their customers angry. But Becker didn’t have a lot of enthusiasm for behavioral economics, so he went in a different direction.

His key point was that people’s demand for some goods depends on the demand from other people. For some goods, the pleasure is greater when many people want to consume it – “perhaps because a person does not wish to be out of step with what is popular, or because confidence in the quality of the food, writing, or performance is greater when a restaurant, book, or theater is more popular.”

Becker’s argument helps to explain why some books, movies, restaurants, magazines, political campaigns, technologies and ideas turn out to be spectacularly successful, while very similar ones fail. If at some point people begin to think that your product is popular, you can get a huge boost.

Kathleen Geier, who respected Becker even as she disagreed with him profoundly, reviews the criticism of his ideas from the left, particularly on the notion of “human capital”:

Human capital was a conveniently optimistic theory that told us that our economic success was merit-based and within our control. It detracted attention from the growing power of the other kind of capital, and the attendant spiraling economic inequality it was creating.

Yet underneath its sunny facade, human capital theory has a dark side. As Philip Mirowski notes, Foucault pointed out that Becker’s concept of “human capital” brilliantly flipped our self-identification as economic actors from laborers to capitalists, “investing” in ourselves like we’re a piece of run-down property that needs some sprucing up. That’s a profoundly creepy and alienating self-concept. And it’s certainly of a piece with Becker’s hard-right politics.

Lastly, John Cassidy points out that Becker correctly doubted that the financial crisis would fundamentally alter the field of economics:

When Becker, Milton Friedman, and other members of the Chicago School reminded other economists that price systems convey valuable information, and that incentives matter, they were imparting important truths. But they took the laissez-faire arguments too far, and many of their followers went even further, denying the very possibility of market failure and pillorying virtually any form of government intervention as counterproductive.

That was ideology rather than sound economics. Compared to ten or fifteen years ago, some progress has been made. Even at economics conferences, you can’t get very far these days by saying that markets, particularly financial markets, are invariably “efficient,” and that we can’t hope to improve on their results. The passage of the Affordable Care Act was an acknowledgement that the health-care market wasn’t working in the interests of the uninsured. The current debate about inequality reflects a widespread belief that compensation and rewards aren’t wholly correlated with productivity, which is what orthodox economics would tell us; it also underscores the lopsided distribution of power and access.

These are encouraging signs. But, over all, Becker was right: the revolution in economics didn’t happen. Or, at least, it hasn’t happened yet.

An Effort To Eradicate Education, Ctd

Zack Beauchamp warns that if Boko Haram wants to sell the over 200 Nigerian schoolgirls it kidnapped last month into slavery – as its leader claims in the video above – it would be terribly easy for them to do so:

According to Walk Free, nine of these countries [in the West Africa region] —Mauritania, Benin, Cote d’Ivoire, Gambia, Gabon, Senegal, Sierra Leone, Togo, and Cape Verde — are in the 16 countries globally where people are most likely to be enslaved and trafficked across international borders as property. That means over half of the world’s worst slaving countries are in the same neighborhood as Nigeria. While Nigeria itself isn’t on that list, it has an arguably more dubious distinction. Nigeria is enormous: it has about 168 million people, over half of West Africa’s total population. This means it has the largest enslaved population in the region — roughly 700,000, by Walk Free’s estimate. That’s the fourth largest slave population in  the world, surpassed only by those in India, China, and Pakistan.

The prevalence of slavery in Nigeria and around it makes it terribly easy for Boko Haram to sell the kidnapped girls if it so chooses. Human traffickers coexist alongside other criminals around the region — drug smugglers, arms dealers, and Islamic militant groups. Each of these groups, in their own ways, weaken and corrupt local police and border enforcement so they can ply their trades. These weakened institutions are part of why West African countries have had so little success cracking down on the local slave trade.

Terrence McCoy reports on the Nigerian protest movement, which is frustrated with the Nigerian government’s slow and inept response to the kidnapping:

Nigerian President [Goodluck] Jonathan, who has taken sweeping criticism for what some have perceived as disregard for the crisis, addressed concerns on Sunday. “Wherever these girls are, we’ll get them out,” Jonathan said, adding that officials had no idea where they were. Then he proceeded to criticize parents for not being forthright with police. ”What we request is maximum cooperation from the guardians and the parents of these girls. Because up to this time, they have not been able to come clearly, to give the police clear identity of the girls that have yet to return,” he said.

The events illustrated an escalating clash between a protest movement and a government many say has been feckless in its pursuit of the children. Adding to that tension is dismay that the government seems to have no idea where the girls are — because Village elder Pogo Bitrus told The Washington Post it’s clear to locals.

“Some of them have been taken to the northern part of the state, and these are the ones with the bad experiences in the mass marriages,” Bitrus explained on Monday morning while waiting for a protester at an Abuja police station, who he claims was “detained for no reason.”

Nina Strochlic gets the sense that the government is trying to pretend nothing is wrong:

Indeed the government’s entire approach has been one of denial bordering on fantasy. “They don’t believe that this is real; they live in a different world,” says Nigerian journalist and activist Omoyele Sowore. The country has seen a rapid, spectacular escalation of violence in the past few weeks, with 19 people killed in a bombing in the capital late last week, following on 70 killed in a blast the day before the abductions.

Yet, while bombs are going off in Abuja and girls are being kidnapped and sold into slavery by the hundreds, the government is desperate to put on a confident face as it welcomes a thousand dignitaries to the World Economic Forum summit for Africa on Thursday. “They just want to do the WEF in Nigeria, like ‘Nothing is wrong with us, come to Nigeria and invest!’” says Sowore.

Last week, Kema Chikwe, a leading figure in Nigeria’s ruling party, raised the question of whether the kidnapping even occurred. “How did it happen? Who saw it happen? Who did not see it happen? Who is behind this?” she asked.

Though she is glad the Western press is finally paying attention, Karen Attiah remains uncomfortable with our “gendered notions of African children that deserve protection from African conflict”:

African boys seem to have received the lion’s share of western preoccupation when it comes to conflicts on the continent. A google image search for the words “child”, “conflict” and “Africa” are mostly images of male child soldiers holding semi-automatic weapons. Many people familiar with conflict know of the “Lost Boys of Sudan”, or the boy soldiers of “Invisible Children” of Uganda. Perhaps boy child soldiers invoke a western fascination with the myth of African males, who naturally brutish and violent and are easily coerced into killing one another because, “primordial hatred”. But do many people know that in 1996 in Aboke, Uganda, more than 100 school girls between the ages of 13 and 16 were kidnapped by the Lord’s Resistance Army? That many of them were rescued by their school mistress? That it took almost ten years to get most of them back? I have not heard much mention of the Aboke girls at all in coverage of the missing Chibok girls.

Beyond lack of coverage, I questioned on Twitter the language we use to talk about girls who are abducted in conflict situations. News media reports said that a number of the girls have been “sold as brides to Islamic militants for $12” Is it appropriate to call these girls “brides” or “wives” in our reporting just because the militants may refer to them as such? In scanning the Nigerian media, I did not see the words “brides” or “wives” feature as heavily as I did in Western reporting.

Meanwhile, eight more girls were reportedly kidnapped last night:

Villagers said the men arrived in trucks and started shooting. “Many people tried to run behind the mountain but when they heard gunshots, they came back,” one villager told Reuters. “The Boko Haram men were entering houses, ordering people out of their houses.” A police source told the news agency that a truck had taken the girls away. The abducted girls were aged 12-15.

Previous Dish on the kidnapping and the Nigerian insurgency here, here, and here.

Mankind’s Deadliest Natural Enemy, Ctd

Jonathan Eisen takes issue with this chart, which claims that mosquitoes kill more humans annually than any other animal. He notes that many “of the animals, including mosquitoes, are on the list are there because of the diseases they transmit:”

If we follow that logic, which I am fine with, then we need to add a whole lot of deaths to the “human” column.  After all, humans transmit a whole heck of a lot of diseases that kill humans.  One source I found has the following #s

  • HIV/AIDS: 1.78 million per year
  • Tuberculosis: 1.34 million per year
  • Flu: 250-500,000 per year
  • HAIs: >100,000
  • Syphilis: 100,000
  • Measles: 600,000

and many many many more.   The totals are probably greater than 5 million per year that are killed by infectious diseases where it was humans who transmitted the agent to other humans.  Way more than the mosquitoes.

Brad Plumer adds:

[T]he broader thrust of Bill Gates’ post was still correct — and vitally important.

Diseases transmitted by mosquitoes are a major public-health crisis that don’t get nearly enough attention. (Shark attacks, by contrast, often dominate headlines but only kill about 10 people per year.) Gates is doing invaluable work calling attention to the situation. And my colleague Dylan Matthews has a great list of cheap, cost-effective ways to tamp down on mosquito-borne diseases. But deadlier than humans? Not quite.

Relatedly, Ed Yong worries about the spread of drug-resistant malaria, which is spread by mosquitos:

Over the last century, almost every frontline antimalarial drug—chloroquine, sulfadoxine, pyrimethamine—has become obsolete because of defiant parasites that emerged from western Cambodia. From this cradle of resistance, the parasites gradually spread west to Africa, causing the deaths of millions. Malaria already kills around 660,000 people every year, and most of them are African kids. If artemisinin resistance reached that continent, it would be catastrophic, especially since there are no good replacement drugs on the immediate horizon.

[Malaria expert François] Nosten thinks that without radical measures, resistance will spread to India and Bangladesh. Once that happens, it will be too late. Those countries are too big, too populous, too uneven in their health services to even dream about containing the resistant parasites. Once there, they will inevitably spread further. He thinks it will happen in three years, maybe four. “Look at the speed of change on this border. It’s exponential. It’s not going to take 10 or 15 years to reach Bangladesh. It’ll take just a few. We have to do something before it’s too late.”

What’s At Stake In Ukraine?

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An awful lot, or so Kim R. Holmes believes, including the European order itself:

Putin’s larger goal appears to be to change the nature of the international system, particularly with respect to Europe. … If successful Putin will have succeeded in changing how Westerners view power and influence. The normal indices of national power — military and economic, for example — will have been shown to be far less important. Asymmetrical warfare will not be merely a thing waged by jihadists huddling in caves but by emerging great power leaders occupying palaces in Moscow and Beijing. That war will be fought at the strategic level, not to conquer one another’s territory or to destroy each other’s populations, but to alter the values and rules of the international system. All methods can and will be used (from cyber-warfare to “lawfare” to psychological warfare) in this type of conflict; the side that better understands the game will have the best chance of prevailing.

Far from the 19th- or 20th-century mentality he’s accused of harboring, Peter Pomerantsev argues that Putin’s strategy is responding cannily to – and in turn reshaping – the geopolitics of the present day:

The Kremlin’s approach might be called “non-linear war,” a term used in a short story written by one of Putin’s closest political advisors, Vladislav Surkov, which was published under his pseudonym, Nathan Dubovitsky, just a few days before the annexation of Crimea. Surkov is credited with inventing the system of “managed democracy” that has dominated Russia in the 21st century, and his new portfolio focuses on foreign policy. This time, he sets his new story in a dystopian future, after the “fifth world war.” …

This is a world where the old geo-political paradigms no longer hold.

As the Kremlin faces down the West, it is indeed gambling that old alliances like the EU and NATO mean less in the 21st century than the new commercial ties it has established with nominally “Western” companies, such as BP, Exxon, Mercedes, and BASF. Meanwhile, many Western countries welcome corrupt financial flows from the post-Soviet space; it is part of their economic models, and not one many want disturbed. So far, the Kremlin’s gamble seems to be paying off, with financial considerations helping to curb sanctions. Part of the rationale for fast-tracking Russia’s inclusion into the global economy was that interconnection would be a check on aggression. But the Kremlin has figured out that this can be flipped: Interconnection also means that Russia can get away with aggression.

Speaking of the European order, Max Fisher passes along the satirical map seen above, which he says is actually pretty accurate:

Ukraine is divided between the “Old New Russia” east, where Russia is backing the pro-Moscow separatists, and the “Eurofascists” west, the pro-European government of which has been portrayed by Russian media as a crypto-fascist conspiracy. The Baltic countries of Estonia, Latvia, and Lithuania are labeled “Nervous?” in reference to fears that Russia might invade there next; they were formerly part of the Soviet Union and still have significant ethnic Russian populations. And Poland is labeled “drama queens” as a play on the pro-European government’s tough rhetoric on Russia’s recent aggression.

There’s more good stuff going on in this map. Cyprus (the island nation south of Turkey, in the eastern Mediterranean) is labeled “Piggy-Bank” because the country is a huge offshore banking haven for Russians. The Russian city labeled “Sankt Putinburg” is Sochi, location of the recent winter Olympics. Georgia is labeled “SHH!” in reference to the country’s disastrous 2008 war with Russia — the little country is also portrayed with some of its breakaway territories as part of Russia.

Evaluating the West’s response thus far, James Goldgeier and Andrew Weiss conclude that a different approach is needed:

Isolating Russia politically and economically was an important step in the immediate aftermath of the annexation of Crimea to make clear to Putin that his actions were unwarranted, illegal, and strongly opposed by the international community. But our paramount goal now has to be different—saving Ukraine as a country. If Kiev cannot hope to hold meaningful elections on May 25 or reassert control over key parts of the country, what can the West do?

First and foremost, we need to find a way to get beyond the West versus Russia narrative. The sad truth is that neither side in this geopolitical tug of war is going to be able secure its goals all by itself or without serious bloodshed. Any attempt to “win” Ukraine will almost certainly lead to the country’s collapse and de facto partition.

What Ukraine really needs is an Afghan-style loya jirga, a grand assembly, ideally under the auspices of the United Nations or Organization for Security and Cooperation in Europe (OSCE), with the full backing of all outside powers. Participation in the loya jirga by representatives of all political, regional, and economic stakeholders from inside Ukraine would have to be mandatory.

The Bloomberg editors, on the other hand, want tougher sanctions now now now:

The events in Odessa also give the lie to Merkel’s argument, in her joint news conference with Obama last week, that it’s fine to wait to impose broader, so-called stage-three sanctions to see whether or not Ukraine stabilizes in time to hold elections. May 25, she said, was “not all that far away.” In fact, it’s hard to imagine a legitimate election being conducted in eastern Ukraine today, let alone after the turmoil is given three weeks to worsen, failing determined intervention from both Russia and the West to pull the two sides back.

Only Merkel can make Putin believe in the threat of comprehensive economic sanctions, and Germany’s push since Friday for another round of talks in Geneva, after the abject failure of the last, makes sense only if that threat is imminent, detailed and on the table. This is the West’s chosen tool for influencing Putin, and it must be used now if it is to be used at all.

Previous Dish on Putin’s novel approach to conflict here and here, and on his worldview here.