"There is always a philosophy for lack of courage."—Albert Camus

Friday, December 28, 2007

Faith, Religion and Atheists

Two articles last week had me thinking how easy it’s been for prominent blowhard atheists of late to control the terms of the debate. The first was in the Chicago Tribune, “Of books, faith and cathedrals: The mystery at the heart of religion is individual belief.” Notice how the author compares religious faith to that of the atheist:

Without question, the New Atheism sells. Even with what seems to me to be a smug, hip, self-congratulatory tone, these books do quite well. Hitchens' "God Is Not Great" is a best seller . . . . And unlike Hitchens and his fellow nonbelievers, I'm willing -- to employ the phrase of the great singer and songwriter Iris DeMent -- to let the mystery be.

Mystery. That's really the point, isn't it? The mystery at the heart of religious faith isn't about syllogisms or axioms. It's not about logic. It's not about what I think about your beliefs; it's about what you believe. Faith baffles. It's supposed to. It's as puzzling and inscrutable as the emotion one feels when strolling through a Swiss cathedral on a cold afternoon in mid-December, holding a book, minding one's footsteps on the chipped and craggy stone floor but dreaming, all the while, of sky.
Faith is in effect a synonym for religion, while the atheists get the logic, the syllogisms and axioms. Are you kidding me? As if Hitchens doesn’t have faith! We can say it is not religious faith, but it is faith nonetheless. In fact the leap of faith it takes to be an atheist is incomprehensible, because they have to believe that everything came from nothing. I would say that is impossible, but then that would be a self-evident truth that requires no proof, or yes, an axiom.

It is not religious faith that baffles, or puzzles, and it is certainly not inscrutable (i.e. incapable of being investigated, analyzed, or scrutinized; impenetrable). What is incapable of being investigated or proved is the philosophical pre-commitment of the atheist that nothing is responsible for everything. That truly baffles. There is much mystery in religion, and Christianity in particular, but it is not incoherent or illogical. People embrace it for many reasons, but not because it makes no sense. To allow the atheists to traipse around proudly wearing the unchallenged assumption that they are the logical ones with no need of faith is absurd. It is also not accurate or true.

The other article was a wonderful piece wishing Mr. Hitchens a Merry Christmas while making fun of the blowhard atheists. But it also gives them a pass on the faith issue. Here it is:

But for those of us who don’t need a God Helmet, who intuit a Presence all on our own, what Hitchens writes doesn’t matter. Here is a man who admits he has no faith, nor capacity for it, but presumes to write volumes on the topic.
Why do we allow the atheists to determine that faith is a synonym for religion? That’s what in effect is happening here. So we let these little blowhards think that we, the religious folk, we’re the ones who need the faith, we weak minded souls looking for a crutch before a threatening and uncertain universe. In fact, not only do atheists have faith, they have a gargantuan capacity for faith bigger than a black hole. How else could one believe (there’s the word, friends, they must believe, i.e. have faith) that, I say again, everything came from nothing? The only capacity they have bigger than faith is the capacity for self-delusion. It is we, the faithful, yes the religious, who inhabit the rhetorical high ground. Let us stop ceding it to the leapers.

Tuesday, December 25, 2007

Merry Christmas from the Moon

(This was our blog's message in 2005 and 2006. Another year has passed, but do the important things ever change?

Remembering the important things, as these men did, seems longer ago and even farther away with each passing year, and to some, even more silly. But Merry Christmas and Happy Hanukkah to all those here gathered anyway, and may we smile today, give thanks, and be inspired in the coming year to perpetuate their silliness...)

It was on Christmas Eve 1968 that the astronauts of Apollo 8, Frank Borman, Jim Lovell, and Bill Anders, became the first of mankind to see an earthrise from the orbit of the moon, and looking back on us, they spoke these words:

Anders: "We are now approaching lunar sunrise. And, for all the people back on earth, the crew of Apollo 8 have a message that we would like to send to you...

"In the beginning, God created the Heaven and the Earth. And the Earth was without form, and void; and darkness was upon the face of the deep. And the Spirit of God moved upon the face of the waters. And God said, Let there be light; and there was light. And God saw the light, that it was good; and God divided the light from the darkness."

Lovell: "And God called the light Day, and the darkness He called Night. And the evening and the morning were the first day. And God said, Let there be a firmament in the midst of the waters, and let it divide the waters from the waters. And God made the firmament, and divided the waters which were under the firmament from the waters which were above the firmament; and it was so. And God called the firmament Heaven. And the evening and the morning were the second day."

Borman: "And God said, Let the waters under the Heaven be gathered together unto one place, and let the dry land appear; and it was so. And God called the dry land Earth; and the gathering together of the waters He called Seas: and God saw that it was good."

And from the crew of Apollo 8, we close with good night, good luck, a Merry Christmas, and God bless all of you, all of you on the good earth."

It is good. God bless us, every one.

Monday, December 24, 2007

Darwin Goes Fishing

The above title was the one I gave to the following article that was rejected back in '04 or so by a magazine whose editor's eye amazes me in retrospect. Some months later, I took all of this and wrapped it into a slightly longer, much quoted and celebrated, article at Jewish World Review entitled Dare To Win. That ran on Jan. 26, 2005. In recently organizing my archives, I came upon this original version and was pleased to see how well this stood up in hindsight. See if you agree:

It was announced recently that the American Civil Liberties Union is suing the school district in Harrisburg, Pennsylvania, that has incorporated into its curriculum the idea that the evolution of the natural world is believed by some to be so complex as to have required intelligent design. Bring ‘em on, I say, this may be a blessing in disguise. There might be a chance to turn things around and gain some ground.

Although the theist view always wins vastly more adherents in the countryside than does its counterpart, the normative intellectual or academic view for over a century has favored Darwinism. The fireworks of the Scopes Trial, with Clarence Darrow besting William Jennings Bryan in feisty public exchanges, heralded the conquest of the classroom by the forces of evolution. This is what we like to call the origin of the specious notion that the question of creation has been debated and settled for all time.

Yet the courtroom has never been a venue suited to the rigors of scientific colloquy; it lends itself to the moods and tides of rhetoric. Mastery of the rip-roaring riposte serves one better here than the measured tones of the academy and the laboratory.

That very climate can be turned to favor any underdog, even when Bryan and Darrow have their roles reversed. When I lived in Cincinnati, the old-timers described to me how Rabbi Eliezer Silver, confidante of President Taft and many Republican politicians, won the right to build a Jewish ritual bath despite being sued by the Zoning Commission. Former Senator Taft, son of the President, was his defense counsel, and Silver took the stand on behalf of his cause.

The plaintiff’s attorney must have had visions of Darrow and Bryan dancing in his head when he stood up to cross-examine. He used a similar approach, asking if the rabbi believed that all the events described in the Bible were literal, such as the splitting of the Reed Sea and manna raining from the sky. He acknowledged that he did.

“And do you mean to tell this court and the learned gallery that you believe the story of Balaam in the Book of Numbers, that an ass could actually speak?”

“Sure I do. I’m seeing it with my own eyes.”

The courtroom exploded in laughter and the case was essentially won by a single well-timed witticism.

This Harrisburg case needs to be joined and fought with slogans and sound bites, both inside and outside the courthouse. Especially potent will be one key phrase, one key image, namely that this is the “Scopes Trial in reverse”. The public can be, must be, made to see this battle as the mirror image of the Scopes Trial. It is not a tussle between science and religion so much as it is a power grab by one view of science over another. This needs to be pounded over and over. It is a bullet point that needs to be reloaded into the chambers again and again.


Most importantly, one prime insight can frame this battle in terms that are amenable to the position espoused by the school district and have the added advantage of being true. It will not only have a decisive impact in the courtroom, it has the capacity to transform the popular debate as well. This simple idea, if promoted relentlessly and sold, is a nuclear bomb that will ramify in the culture for generations.

Namely, that there are essentially two separate theories advanced by Darwin. The first is that the process of the world attaining its current form was characterized by evolutionary transitions in its phasing, which built themselves into permanence by providing in each instance a fitter form or functionality. The second is the idea that this could have happened by itself without a conscious design.

In the past, this distinction was obliterated by the fact that most of the religionistic resistance to Darwin overreached by challenging elements of the evolutionary science as well. This led to their being diverted from the fundamental epistemological division between these two components of Darwin’s larger presentation. It is urgent that this wedge be driven into his work, driven now and driven hard. We are not debating evolution. We are challenging the separate theory that evolution could have happened without someone turning on the switch.

This approach would be devastating in the courtroom. If an attorney won early on from the judge the right to refer to Darwin One and Darwin Two as a shorthand for the two theories, the plaintiff’s case would be literally decimated. As pedestrian as this linguistic affectation may seem, it literally divides and conquers the opposition.

Once the battleground has thus been narrowed, the absurdity of the ACLU’s position is highlighted. In what way is it more scientific to say that evolution could happen by itself? Why is it unscientific to maintain that much information had to be encoded, in individual cells and in the stuff of matter itself, to facilitate evolutionary tendencies? The truth is that Darwin Two is an intellectual choice engineered not by logic but by a distaste for the idea of being beholden to a Creator.

Tuesday, December 18, 2007

Free Lunch for Lefties!

Michael Simpson writes below that for whatever reason, university professors tend to lean left.


In fact, one of my correspondents, who's a philosophy prof, tells me that as a self-defined liberal, he's far outnumbered by committed leftists on his own faculty.

And I consider my philosophy prof friend more a leftist that a "liberal," if a liberal has anything in common with FDR, Harry Truman, JFK, or Bill Clinton, which he doesn't, so go figure.

I could live with all that if only a leftist educator could educate.

But as sorta-right-leaning Robert Maranto, who actually worked for the Clinton Administration, recently wrote in the Washington Post:

At many of the colleges I've taught at or consulted for, a perusal of the speakers list and the required readings in the campus bookstore convinced me that a student could probably go through four years without ever encountering a right-of-center view portrayed in a positive light.

The problem isn't that the lefties in "higher education" attempt to influence their students toward their point of view. They do, and that's understandable---we're all human, and very few of us are truly neutral.

The problem is that these university professors seem incapable of educating about other points of view. I've yet to meet a lefty who could explain my righty point of view fairly, without making me into Hitler or Satan. That's the rub, and that's what Maranto's saying here.

Now, as a conservative, it's well-known that I dig war and imperialism and torture, no taxes, huge deficits, and pushing Grandma down the stairs after her wheelchair gets a flat. I mean, now she can't even fix me the breakfast I need to go out and exploit the American working man and the undocumented immigrant. So who could blame me for getting sick of her whining as her wretched, broken body crawls to the stove every morning, lest I be forced to have her put out on the streets to fend for her own miserable self?

Gran, I love you and all, but life is a business. Take a loan for that tire or something. Pull yourself together here.

In the real world, of course, I meself drive a 1991 Honda Civic that only has 3 cylinders left firing, and I couldn't exploit anyone even if I wanted to. Here in Los Angeles, the going rate for exploited undocumented day laborers is 10 bucks an hour, plus lunch if you're going to exploit them for more than 4 hours. I can't even afford to buy 'em lunch, let alone exploit them for the rest of the day.

So, I wish that the university could teach its young fetuses something, anything, about me, a lousy conservative whose yearly salary is often below the cost of a decent college's yearly tuition. I'd volunteer to host a student exchange program, except that the studentry would be repulsed. The dorm has cleaner floors and more regular meals.

But I'd pay to get yer typical college prof to come live how I live, oh yeah, even though I can't afford his hourly rate either. He'd learn a lot more than he teaches, and hey, I'd even make us lunch, or get Gran to do it, if she's still around here somewheres.


Monday, December 17, 2007

Right and Left in Academe

The disparity between the political affiliations of America's professoriate and the wider population is, well, a bit more than statistically significant. Something like 90% of the faculty ID as Dems and/or liberals. But don't worry, it's not bias in hiring, it's just the natural outcome of what liberals and conservatives choose to do. Libs like learning and conservatives like money. Or something like that.

Righty-o. Suppose that women were pretty much on level with men in their secondary and college educational achievements and then suppose that there was, nonetheless, something like a 9-1 male-female faculty imbalance. Just what folks choose to do, right? Oh, wait, no, THAT's an occasion for numerous conferences, subsidies for women hires, and an almost obligatory sentence at the end of every job ad that women (as well as "minorities") are "especially encouraged to apply." But conservatives? They're just greedy or stupid or whatever. Righty-o, dude.

Now, I'm not much in the conspiracy business and while I have *no doubt* that there is a liberal hiring bias in the academy, that's not the whole story. I mean, you can be as crazy Marxist/postmodernist/whatever-the-left's-flavor-of-the-month-is as you want to be and you can still get hired just about anywhere. Write a dissertation defending traditional marriage as normatively preferable and see how many places drop that application into the "it'll be a cold day in Hades" pile. But it's also the case that the grad students who are earning PhDs tend to be liberal and that is itself, I think, a product of a self-perpetuating cycle. Smart students who think that maybe they'd like to be a prof look around and see that, well, most of the profs are liberals. This has, I think, a rather natural selective effect on conservative students, some of whom (perhaps rather reasonably) think that academia must not be for them. And so you get a winnowing-out process.

The biggest problem with that explanation is that it leaves untouched the original "liberalization" - why are the professors more liberal in the first place? Patrick Deneen, a prof at Georgetown, has what seems to me a pretty good answer: the changed nature of the university. Whereas the university used to be about (generally speaking) the preservation and transmission of knowledge and intellectual capacities, it is now about (generally speaking) about the production of research and promoting change in society. That is, the university has become the citadel of scientistic progressivism (e.g. we can "solve" any problem - and will solve any problem - merely by applying the proper scientific research techniques). There's not much of a place in the academia for conservatives of an older stripe, then, perhaps helping explain the wide disparities in political temperament and identification. Go read all of Deneen's post.

Fred08.com? Fred Dead? Only in My Head

OK, OK, I admit it. I'm weak.

Although I unilaterally fired his ass from thenewswalk.com news ticker, Fred Thompson just got 50 bucks out of me. Anyone who's lazy, hates people, and is the only true conservative running for president can't be all bad, and that makes him 3 for 3 with me. Plus, he never says anything genuinely stupid.

Do not, under any circumstances, go to his website and contribute yourself. Just don't. You ain't lazy, you love people, and you're not even all that conservative.

Plus, you dig candidates who say stupid stuff all the time. Here's your man. Or maybe this one. Not Fred, though.

Friday, December 14, 2007

Huckabee, Schmuckabee, Fred's Dead: Is Mitt a Twit?

Like Fred Thompson before him, Mike Huckabee is about to squander thenewswalk.com bump that comes with the honor of being the subject of our news ticker in the right column.

Huck has leapt to near the top of the polls, but you just don't accuse your opponent of believing that Satan is Jesus' brother. Even if it were true, which it apparently ain't, that's just bad form.

Neither do I, a putative Christian, want a president who advertises himself as a "Christian Leader." I'm also putatively a Catholic, and I don't want any "Catholic Leaders" as my president either. I prefer my sectarianism in this republic mellow and understated, invisible even, just like the Founders did. "Christian Leader" means Pat Robertson, and the Republican Party didn't like that noise the first time around after he finished second in the 1988 Iowa Caucuses.

The general electorate liked it even less. Huck, you're out. I like Christians. I'm married to one. But too much is way too much.

National Review, which founded modern conservatism, and which historically has been more Catholic and Jewish than Protestant, has endorsed Mitt Romney, who is none of the above, Mormonism being its own thing.

Harkening back to Abraham Lincoln, who said he'd fight to preserve the Union even if it meant not freeing a single slave, National Review endorses Romney to preserve the unity of the conservative movement, even if it means not electing a Republican to the presidency in '08.

[Well, they didn't admit the last part, but that's what's going on here.]

So, OK. I can dig that. Mitt Romney gets thenewswalk.com ticker now. Me, I think Mitt's a plastic man and genuinely weird, like Gore and Kerry before him, who deserved to lose. Weird like he put his family dog on the roof of his car for 10 hours on a trip, and then insisted the doggie liked it, even though the car was covered in doggie poo.

I mean, that's weird, I don't care how cleancut His Mittness looks.

I don't want a weird president. If Romney's the GOP nominee, I can't guarantee he gets my conservative vote, just because I happen to be a conservative. But Brother Mitt, you have our news ticker now, with all the perks and responsibilities it entails.

Prove to us that you ain't weird, please? I wanna believe.

Wednesday, December 12, 2007

A Word About "Authorized" Generics

Patents are valuable, often enough, and economic value attracts the sort of attention that honey elicits from bugs. And so whole industries evolve around legal challenges to patents, and the more valuable a given patent, the stronger the incentive to use the courts to redistribute wealth. Moreover, litigation is expensive, and the risk of losing a pharmaceutical patent to a challenger---to a generic drug producer in this context---analytically is equivalent to a shortening of the patent period expectationally. The process, therefore, reduces the expected returns to investment in the research and development of new medicines, and reduces as well the development of me-too drugs, that is, competition in the pharamceutical market.

And that is why the geniuses in Congress who want to limit the ability of innovative pharmaceutical producers to settle such lawsuits with payments to the challengers are utterly myopic in their view that such limits would increase (generic) competition and thus lower prices. In the very short run, maybe. But the increased challenges to patents would have the longer-run effect of reducing the flow of new medicines, and thus competitive pressures from them with respect to older, more-established drugs. That this is so obvious is the central reason that many in Congress cannot understand it.

[cross-posted from www.medicalprogresstoday.com/blog/]

Tuesday, December 11, 2007

The View From the Top...

... is always top-down, particularly in that city of the exalted, Washington D.C. So what is it this time? "A Food and Drug Administration medical reviewer said it wasn't clear if consumers could safely and effectively use a proposed Merck & Co. cholesterol-lowering drug without a prescription." (Wall Street Journal, December 11)

And that just about sums it all up, doesn't it? Forget consultations between doctors and their patients. Forget the heterogeneous characteristics and needs of millions of individual patients. Forget the huge informational advantage engendered by ongoing experience, modern mass communication, and individual trial and error. Forget the reality that some very substantial proportion of prescriptions are for off-label uses. Sorry: The Beltway knows best, children---because it says so---and "safety and effectiveness" is one-size-fits-all.

It is not only inside the Beltway that this sort of arrogance is to be found, but it is the Beltway in which it is rewarded so consistently and in which it simply is more than a way of life. It is a mindset.

[cross-posted from www.medicalprogresstoday.com/blog/]

What Is a Mandate?

A good fight is always fun to watch, particularly if it is only political blood that is being spilled, and it is flowing freely in the Democratic free-for-all in the context of health care reform. Senators Clinton, Edwards, and Obama are united in their policy preferences for "reforms" that inexorably will lead to a single-payer system of health care insurance and to all of the perversities attendant upon it. Anyway, one way to reduce the taxpayer cost---not the true economic cost---of such a system is to force those who otherwise would find health insurance not worth its cost to buy it anyway. They would pay more than the benefits they receive, and so would subsidize others.

Such an "individual mandate" for all is part of the Clinton and Edwards proposals, and for children in the Obama plan. So: How would the government enforce this requirement? Edwards is quite clear: He would require proof of insurance with the annual filing of income-tax returns, and in the absence of such documentation the IRS would automatically enroll the scofflaws in a plan. And if the freeloaders refuse to pay the premiums? Wages will be garnished! The IRS becomes ever friendlier!

Hillary, after having blasted Obama for not having a mandate, and thus not "covering" everyone, finally has been forced to admit, sort of, that a mandate is meaningless without enforcement, and that she too might consider garnishment of wages and the like. Obama, more honest than the other two---not an exacting challenge---has not responded with a proposal for expanded coercion, and indeed has not explained even how the mandate for kids is to be enforced.

So let us be very clear: Mandates will be hard to enforce, and so the cost estimates in the respective plans---for this reason and host of others---will come a cropper. Which illustrates an eternal truth: Government planning cannot work, never has worked, and always yields unexpected effects less than salutary. Will our crack journalists covering this issue understand any of this? Not a safe bet. Not at all.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, December 10, 2007

Super-Sized Stupidity, Beltway-Style

Well, not exactly the Beltway this time, but instead a member of the D.C. Council, David A. Catania, who without any doubt at all looks in the mirror and sees Senator Catania. After all, they all drink the same water. Anyway, Comrade Catania now proposes to license pharmaceutical sales representatives, in an effort to rein in "disreputable agents who drive up the costs of prescription drugs."

Got that? Restricting the supply of reps through licensing will reduce costs! And how will this bit of alchemy be achieved? Elementary, Watson: No longer will we have pharmaceutical representatives who can "mislead doctors and patients into buying the most expensive drugs on the market, shunning reasonably priced generics or drugs that could be just as effective." After all, sayeth the deep-thinking Catania, "the agents' salaries are dependent on sales, [so that] they sometimes give the wrong impressions about drugs and present themselves as medical professionals."

So there we have it. Doctors who are licensed are fools, but pharmaceutical representatives who are licensed are wise and scrupulous. Oh, by the way, since Comrade Catania seems not to propose a change in the way that "the agents' salaries" are determined, it is not quite clear how licensing would change their incentives. And speaking of which, incentives for deception are far weaker than Catania assumes, given that the reps and the pharmaceutical producers have ongoing relationships with the medical providers, so that deception now carries a real risk of damaged business tomorrow. After all, do the representatives not place some value on their credibility? And, of course, there is the FDA: Is Catania oblivious to the fact that the reps are not allowed to make claims not approved by the FDA? Perhaps Catania is generalizing from the record of dishonesty observed eternally in the world of politics---the D.C. government is not exactly a model of good-government progress---a possibility magnified by the view of reality shaped by a lifetime outside the real world.

More wisdom from Comrade Catania: "If [licensing] is good enough for cosmetologists, it ought to be good enough for the pharamceutical company." Catania, naturally, has this precisely backward: Just as market forces are quite sufficient to lead cosmetologists toward honest behavior, so the same is true for pharamceutical representatives, who have to deal with physicians and others who are not idiots. But Catania must truly believe that they are idiots, just as the political class believes that the rest of us are children rather than citizens. That we have to pay their salaries is a monument to the perversities of that sausage factory known as lawmaking.

[cross-posted from www.medicalprogresstoday.com/blog/]

Saturday, December 08, 2007

Democrats Love Sausage, Too [or at least they did...]

One of my favorite quotes is from Otto von Bismarck:

God has Special Providence for drunks, fools, and the United States of America.

Words to live by, and we Americans surely do.

Uncle Otto is also known for

There are two things you will never wish to watch: the making of sausage and the making of legislation.

Now, it was well-known by key members of congress, including leading Democrats---not to mention the papers---that certain members of al-Qaeda were captured and then subjected to "harsh" interrogation, including waterboarding. Putatively, as a result, these monsters gave up the goods, and innocent lives were saved from their nefarious plans.

Sausage was made.

Nobody felt very good about it, but everybody---everybody---knew what was what.

Tapes of the process were made. Since no good could come of them being revealed to the world except to show how horrible sausage-making is, and how awful the United States of America must be to make it, somebody at the CIA had the tapes destroyed.

The fellow's name seems to be Jose A. Rodriguez, Jr., who was in charge of such things. Perhaps they'll throw him in jail, if they can find something to charge him with. He is presently unavailable for comment.

Now some of us are looking for someone to blame for doing what was necessary to save innocent lives, but Mr. Rodriguez took it upon himself to make sure that couldn't happen. Did he break some law? I have no idea.

But make no mistake, we all wanted the sausage. And if now they pass some legislation against making it, I don't want to watch that either.


Thursday, December 06, 2007

Hearken Sinners: The End Is Near

The Wall Street Journal today has a front-page article on the "grim prognosis" facing Big Pharma, as a number of big-selling drugs soon will lose patent protection even as the companies have fewer new products in the pipeline, as the FDA has become ever-more averse to purported safety risks, and as the costs of drug development rise sharply, in particular for late-stage safety-and-effectiveness trials. This article is certain to engender a lot of discussion and commentary: The firms are shrinking, and the article implies that fewer cures are in the offing, although the heavier implicit focus is on the issue of investment in pharmaceutical stocks and the like.

Yes, there are important problems facing the pharmaceutical industry, but color me far less pessimistic than the article implies. To begin, note what the article does not say, to wit, that research budgets are shrinking. That suggests that the capital market still views pharmaceutical R&D as profitable endeavors prospectively, regardless of what Moody's and the other rating bureaucracies say, green-eyeshade institutions that almost always look backward rather than forward.

Note as well that the recent decline in new drug introductions has a lot to do with the fact that PDUFA was passed in 1992, which had the effect of speeding the approval process significantly (for awhile, anyway), and a bow-wave of drugs was approved in the late-90s to early 2000s period. To some nontrivial degree, the more-recent slowdown has to do with an approval cycle driven by that early PDUFA experience.

The real news, which really is not news at all, is that the FDA and the rest of the relevant part of the Beltway are driven more than ever by powerful political incentives to avoid negative headlines. And so drugs are too safe and are approved too slowly, which means that more death and suffering occurs because beneficial medicines are held off the market too long. Perhaps more important, the industry is changing significantly because pharmacological science is changing: The era of individualized medicines is looming as a direct effect of advances in biological and genetic science. That may be bad for the bureaucrats, and in the short term for the firms forced to deal with them; but in the larger sense this technological advance will yield a huge advance in our ability to reduce human suffering, and no newspaper article can tell me that such a scientific revolution will not prove salutary in spades for Pharma's bottom line.

[cross-posted from www.medicalprogresstoday.com/blog/]

Tuesday, December 04, 2007

Sue the FDA!

Well, now, surprise: Dennis and Kimberly Quaid have sued Baxter Healthcare, the producers of heparin, after their newborn twins were given large overdoses of the drug at Cedars Sinai Hospital in Los Angeles. The suit claims that Baxter was negligent in packaging because both the small and large dosage vials had labels with blue backgrounds, when the vials "should have been completely distinguishable [by] size and shape."

Of course, that might have engendered confusion with some other medicine(s), but, anyway, all pharmaceutical packaging, warnings, etc. must be approved by the FDA. So why aren't the happy parents suing the FDA? And, by the way, why have the Quaids decided not to sue Cedars Sinai, the staff of which made the error? Baxter had sent a letter warning health-care workers to to read the heparin labels carefully, but the suit argues that an "urgent" warning should have been sent. Anyone want to guess the likely outcome if everyone starts using "urgent" warnings so as to keep the lawyers at bay? Hint: Remember the boy crying "Wolf!"

The twins "appear to be doing well." But the lawsuit proceeds so as "to save other children from this fate. [The Quaids are] not looking for money." Right.

What is clear is that "similar" vials are not identical, and that if "blue backgrounds" are the only similarity, then the culpability of Baxter is far from obvious under any definition. But the litigation lottery proceeds apace, and shouldn't the rich and famous get to play too? That all of us ultimately will be the losers is not something that we can sue over.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, December 03, 2007

The Road To Serfdom

And so it continues: "Policy advisers for Clinton on Saturday said she would consider a proposal to garnish the wages of some U.S. residents who can afford health insurance but do not obtain coverage"---Long Island Newsday, 12/1.

So if we take the Democratic proposals and combine them---a rather crude approach, but not without predictive value---we will have mandatory enrollment in insurance plans, mandatory acceptance by insurance plans, mandatory checkups and other preventive care, mandatory employer-sponsored plans, and, of course, mandatory taxes to pay for all of this government compassion. Is anyone in the press paying attention to the implications of all this coercion?

Fred Fired, Huck Hired

We put Fred Thompson on our news ticker in the right column back before he declared his candidacy. He was the most interesting thing going.

Me, I still dig Fred---he's the most solid conservative in my view---certainly the most thoughtful---but I think he's not in it to win it, but to hang around and pick up the pieces if the other candidates crash and burn. [See the previous "I, Freddie."]

The latest numbers are out, and there's a new candidate for Mr. Interesting---

The Rasmussen Reports daily Presidential Tracking Poll for Monday shows Giuliani with 20% support nationwide while Huckabee attracts 17%. Fred Thompson is at 14%, John McCain at 13% and Mitt Romney at 11%. Ron Paul attracts 7% of Likely Republican Primary voters nationwide and no other Republican candidate reaches 2%...

Now, I'm skeptical that a tax-loving creationist can win nomination, but we need to keep our eye on Arkansas governor Mike Huckabee, for good or ill.

Welcome, Governor, and good luck. Please don't make us look like idiots.


Saturday, December 01, 2007

CNN: The Corrupt News Network?

I woke up this morning to fire alarms in my house (fortunately no fire), which will certainly get the sleep out of your eyes really fast. I almost felt the same way when I made my typical morning trek to the LA Times website when what do I see? A headline that I still don’t believe I read: “CNN: Corrupt News Network: A self-serving agenda was set for the Republican presidential debates.” Can this be? Objective news from the LA Times? I wonder if it showed up in the print version, but maybe not, because next to it was a little red “Discuss.” Oh boy, I’ll discuss.

In case you are not familiar with the disgrace CNN heaped upon itself this week at the so-called Republican debate, you can read about it here or here. One of those two is Howard Kurtz of the Washington Post. That amazed me of course, but what’s next, the New York Times? I believe in miracles, but that would actually be irrefutable proof of the existence of God.

So here is some of what that LA Times media guy, Tim Rutten, had to say:

The United States is at war in the Middle East and Central Asia, the economy is writhing like a snake with a broken back, oil prices are relentlessly climbing toward $100 a barrel and an increasing number of Americans just can't afford to be sick with anything that won't be treated with aspirin and bed rest.

So, when CNN brought the Republican presidential candidates together this week for what is loosely termed a "debate," what did the country get but a discussion of immigration, Biblical inerrancy and the propriety of flying the Confederate flag?

In fact, this most recent debacle masquerading as a presidential debate raises serious questions about whether CNN is ethically or professionally suitable to play the political role the Democratic and Republican parties recently have conceded it.

Selecting a president is, more than ever, a life and death business, and a news organization that consciously injects itself into the process, as CNN did by hosting Wednesday's debate, incurs a special responsibility to conduct itself in a dispassionate and, most of all, disinterested fashion. When one considers CNN's performance, however, the adjectives that leap to mind are corrupt and incompetent.
This could have come right out of the mouth of Rush Limbaugh! In fact, much of it did! I grew up politically in the era BR (before Rush), which means before talk radio, cable news, and the blogosphere, and this story is indicative of just how much the playing field has changed since Reagan was in office. Then CBS, NBC, ABC, Public television and radio, and the big dailies ruled the roost. When they determined what the reigning paradigm would be on a story it was very difficult to challenge and get heard. Hey CNN, it’s a new day!

Friday, November 30, 2007

The Silly Season Arrives

The holidays approach and the elves are busy, and not only at the North Pole. A friend who works at the UCLA Medical Center forwarded to me the following paean to silliness, distributed to all employees:

THE GREAT PEN EXCHANGE! Once again, UCLA is leading the way. This time in adopting new guidelines for our relationship with industry. To start, we're asking everyone to bring any pens (as well as mugs or other items) that bear the imprint of a medical company or product, to exchange for a brand new, spiffy UCLA Health system pen. Don't be left out! Starbucks $5 gift certificates to the first 100 participants at each location!

So, let's see here. Quite apart from their poor grammar, the august administrators of the UCLA Medical Center---world renowned for reasons that remain curiously obscure---apparently believe that their staff will sell out the interests of their patients for... a ballpoint pen. And how, precisely, would such perfidy proceed? Well, that is far from clear; presumably, the doctors will prescribe drugs ineffective for a given patient rather than an effective alternative because their morning coffee (not from Starbucks) was consumed from a mug bearing the logo of the producer of the former. Can the UCLA bureaucrats actually believe anything so stupid?

Well, the obvious answer is "Yes." Emphatically. Notice that this corruption on the part of the doctors would be observed not in the case of new gifts---shiny pens and the like---but also for such goodies already received and presumably with the removable pen caps already chewed. Why would an old gift yield continuing corruption? The UCLA bureaucrats offer no clue. And notice as well that the mere presence of a gift is not enough; no indeed, it is the gifts that "bear the imprint of a medical company or product" that raise the concerns of the UCLA green-eyeshade types. Someone might see it! And, by the way, did UCLA buy the Starbucks gift certificates? Or were they donated? In either case, the potential for corruption is immense---after all, five dollars would buy only a small latte, but a whole packet of pens---and the only difference is the identity of those to whom the doctors will have prostituted themselves.

So there we have it. Gifts not bearing logos are kosher; so, how about some cash in an envelope? Obviously---obviously---it is not actual corruption that concerns the UCLA bureaucrats; it is instead the potential appearance of corruption in a form so trivial that only modern journalists---political science majors who failed to be admitted to law school---could actually believe it. Along with, of course, the deep thinkers among the UCLA administrators, spineless, stupid, and self-satisfied in their moral superiority.

[cross-posted from www.medicalprogresstoday.com/blog/]

Thursday, November 29, 2007

Is it Heroic or Not?

An article by John Hulsman today at OpinionJournal takes on Michael Gerson’s “heroic conservatism.” It is by far the most concise and most devastating critique of compassionate/big government/heroic conservatism I’ve yet seen. I’m convinced that the big split in conservatism is not between social/religious conservatives and whatever we call the other side, but between limited and big government conservatives. To give you some indication of where I come down on this; it is very difficult for me to type the words “big government” next to the word conservative. In my mind they are mutually exclusive, oxymoronic and inherently at war with one another.

I love the way Hulsman draws the distinctions, which are incredibly important and need to be made over and over again. I'll take out a few paragraphs for your rumination.

What about the longtime conservative belief that limited, accountable government works best--that it is the form of government least likely to squander resources, thwart private initiative, impinge on freedom and avoid harmful, unintended consequences? Unheroic, says Mr. Gerson. What about the quaint notion that government should live within its means? Short-sighted when people are suffering, says Mr. Gerson. Little wonder that Mr. Gerson's co-workers in the White House (from which he retired earlier this year) called him, only half-jokingly, "the Christian Socialist." As it happens, Christian socialism--going back to R.H. Tawney and Tolstoy--has an honorable intellectual tradition. But its tenets are an awkward fit for America in general and for the Republican Party in particular.

The U.S. government has been pouring billions and billions of dollars into the welfare state since Lyndon Johnson's Great Society, with results so wayward that, for decades now, a cottage industry has grown up among policy intellectuals to document all the disappointing results and ill effects. The welfare reform of Bill Clinton's first term grew out of such a critique. Still, Mr. Gerson equates "caring" with government spending, as though, self-evidently, yet more "visionary" programs are the best way of dealing with poverty, addiction and children at risk.

To the traditional conservative, it is more heroic--that is, more honest and realistic--to acknowledge that such problems are too deeply ingrained to be solved by a far-away Washington bureaucracy. Traditional conservatives since Edmund Burke have put their faith in the organic forces of society--family, community, civic institutions. In America, such faith has made common cause with commercial dynamism and the opportunities it creates for upward mobility.

Mr. Gerson will have none of it. Siding with FDR and Woodrow Wilson, his acknowledged heroes, he assumes that traditional conservatives do not care about American society's problems. He never stops to ponder whether traditional conservatives disagree with his statist prescriptions precisely because they do care.
Spot on! The self-righteousness of these big government types is a perfect contrast with the inefficacy of their supposed solutions. Yet it’s we limited government types who are heard hearted Scrooges who don’t care about the poor. Clearly we have a more difficult time making the case for limited government, because it’s easier to demonize and spew platitudes, as big government types tend to do. Americans are also more easily persuaded that big government isn’t a threat to our way of life. Of course that is only true until it's too late. And self-government and personal responsibility are just tougher sells, but sell we must.

The Nanny State Looms Ever More Obese

"FDA Contemplating Crackdown On Salt"---Los Angeles Times, November 29, 2007.

So there it is: Bureaucrats, do-gooders, politicans, and the morally superior have their eyes on salt in processed foods, and next week the ingredients in cookies, and then the recipes for pies made at home from scratch. Talk about an obesity crisis: There is no limit---none whatever---to the meddling in individual choices available to those who believe profoundly in the infinite perfectibility of man; can an exercise requirement be far behind?

And let us not forget that the central justification for such nanny-statism is the public budget for health care: The government (actually, the taxpayers) pays for health care, and so the government has a regulatory interest in individual health. Forget for the moment the fact that the bureaucrats often enough get even the scientific questions wrong, or the larger reality that such judgments inevitably must be politicized. Will this dynamic be reduced if the U.S. moves ever closer to a system of government single-payer health care? Don't bet on it.

[cross-posted from www.medicalprogresstoday.com/blog/]

Wednesday, November 28, 2007

This Is Entertainment

The New York Times, aka the Journal of Record, published an editorial on Sunday entitled "The High Cost of Health Care," eliciting from readers a stream of letters to the editor published today.

One Reno DiScala makes the crucial point that health care reform faces "true complexities," and will never be achieved until "there is fundamental compromise," which faces obstacles from those "guided only by their political ambitions." Thank you, Reno!

Mr. Peter Hanauer weighs in with a plea for "Medicare for all," justified by the fictoid that "the administrative costs of Medicare are approximately 20 percent of [those] of private insurance," an utter non sequitur, and utterly incorrect anyway, as demonstrated in recent Manhattan Institute research located here. Please forgive me, Peter.

Melvin H Kirschner, M.D. finds single-payer government-run health care to be a panacea. No, I am not kidding: Dr. Kirschner likes "one form to file, one payer, one set of rules... and the assurance that everyone has health care coverage..." Why, then, are so many doctors fleeing Medicare and Medicaid? Alas, Dr. Kirschner is unavailable to comment further.

Professor Jan Warren-Findlow believes that the U.S. should "allocate our economic, medical, and research resources to provide good health to every American; then we can figure out how to do it cost-effectively." All right, then!

Mr. Allan Ostergren believes that we should raise taxes, and then allow patients to choose between a Canadian-style system and private insurance operating under a guaranteed-issue, community-rating system. He seems not to realize that only the sick would buy private coverage, and the government would get all the healthy people. A bonanza for the Beltway!

The ineffable Marcia Angell, M.D.---not economics Ph.D---opines that "some sort of single-payer system will be necessary to control costs, even if not sufficient," an observation utterly clueless about the difference between reported and hidden costs. That's our Marcia!

Joshua U. Klein, M.D., reminds us that "there's no such thing as a free lunch." Truer words were never spoken.

Mr. John A Rowland supports federalism: "The federal government should not develop a one-size-fits-all national program." (Applause track here.) Uh, will the states pay for this themselves? Or will they demand Uncle Sam's dollars? The question answers itself, but seems not to have occurred to Mr. Rowland. But he gets a B+ for class participation.

Mr. William L. Burge points out that "health care costs cannot be contained without addressing the legal issues," to wit, the tort system. Mr. Burge goes to the head of the class with Dr. Klein.

And finally, Kenneth A. Fisher, M.D. complains that too many die in costly intensive-care facilities. True enough; that is one outcome when patients spend other people's money.

And so remember: All this wisdom was published on one day in the NYT! Proving, of course, that it all was fit to print.

[cross-posted from www.medicalprogresstoday.com/blog/]

Tuesday, November 27, 2007

The New England Journal of Political Ideology

Well, I don't know about that "on loan from God" stuff---methinks that Comrade Van Dyke has been hitting the schnapps a bit too hard---"rejected by God" might be far more accurate; but, anyway, Mr. John K. Iglehart is a national correspondent for the august New England Journal of Political Ideology, oops, Medicine. Why the NEJM needs a "national correspondent" is a question to which the answer is less than immediately obvious, but, in any event, Mr. Iglehart has an editorial---sorry, article---in the November 22 issue entitled "The Fate of SCHIP---Surrogate Marker for Health Care Ideology," the central theme of which is captured wonderfully in this priceless passage:

President George W. Bush vetoed [a reauthorization of SCHIP despite the fact that] many legislators, a large majority of the public, major private stakeholders, and 43 governors strongly support expansion of the program. By contrast, in an effort to appeal to the conservative base of their party, the leading Republican presidential candidates agreed with Bush's veto---despite the fact that the program, though signed into law by a Democratic president, originated in a bipartisan compromise and was enacted by a Republican-controlled Congress.

It really, truly, absolutely does not get any better than that. Supporters are bipartisan, and have a large majority of the public on their side, not to mention major private stakeholders, whatever that means, and 43---count 'em---governors who absolutely, positively are not influenced by the prospect of getting their snouts ever deeper into the federal trough. And the opponents? They are craven ideologues, pandering to their political base, and dismissive of the fact that SCHIP began as a great compromise passed by a Republican Congress.

Is Iglehart actually this stupid? Or is he merely dishonest? He glosses over the problem of substitution of public coverage in place of private insurance with the assertion that "the compromise would have required states to prepare a plan to prevent families from enrolling children in SCHIP if private insurance was available to them." A requirement to prepare a plan! And if "available" private insurance is deemed by someone to be unaffordable? Can anyone possibly believe that this requirement would have reduced the crowd-out problem by even one family?

Iglehart simply repeats the budget numbers without any acknowlegement at all that the fiscal 2012 figures were fraudulent, as a means of reducing the official five-year budget projections. He ignores the longer-term problem of weak incentives on the part of public policymakers to feel constrained by the preferences of patients. Ad infinitum.

Anyway, you get the idea. Everyone wants their few minutes of fame, and so the NEJM simply cannot limit itself to medical science. Does this mean that the scientific articles also are politicized? It is hard to see how an editorial process fixated on politics can avoid that outcome.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, November 26, 2007

A War on Christmas Question

Now that it's officially the "silly season," when all sorts of mostly inconsequential disputes break out over what to call that tree in the airport lounge or how close the Santa has to be to the manger in order for the creche to stay in the town square, I have a question, dear readers.

My mailbox is being assaulted by scads of catalogs, all urging me to "buy! buy! buy!" if I really love my wife and children. (And I do mean assaulted - I noticed yesterday that my mailbox post has a large crack in it - I'm sure it was the 50th LL Bean catalog that did it). Now, of course, they all want me to buy presents for "the Holidays," but just as surely they swathe the catalogs in red and green and cram in as much "Christmas" imagery as they can. More generally, we might say they trade on the idea of Christmas in order to get you to buy without mentioning it as a way of avoiding offense to those who don't celebrate Christmas.

Fine and dandy. I find the whole image/word thing pretty ironic, but kind of humorous as well. My question is this: would people who don't celebrate Christmas be particularly offended if, say, Toy Company X just switched out "Christmas" for "Holiday"? Would it be a problem? My sense is that it wouldn't and that the companies are being, well, prematurely non-offensive, but I'm not really in a good position to say, since we're pretty big on keeping the "Christ" in Christ-mas around our household. Any thoughts?

Friday, November 23, 2007

Michael Gerson, Christian? Idolator!

The libertarian-minded Cato blog endorses Kara Hopkins' swipe at Michael Gerson's new book, Heroic Conservatism:

[None of this is] to say that social justice isn’t a Christian concern. But Gerson is more stirred by abolitionists and activists like William Wilberforce and Martin Luther King Jr., and the sweeping social change they wrought, than he is by Christ’s own model, which was conspicuously short on political impact and long on individual acts of mercy. He implies that his giants—--poverty, AIDS, illiteracy, genocide—are too big for hand-to-hand combat. Thus the Biblical call to “do unto the least of these”—--the hallmark of which is personal sacrifice—--must be replaced by government programs—the wellspring of which is coercion. If this constitutes an act of worship, it honors a failed god.

Now hold on here. Me, I like Gerson. He speaks to a void in the GOP that many in the party feel. It’s important to know who Gerson’s target audience is.

Quite so that it’s impolite to invoke God to someone who doesn’t believe in Him. [Which is why arguing from “natural law” is becoming a favored method by believers: both Suarez and Grotius submit that the natural law exists independently of deity.]

The fact remains that a certain acceptance of the New Deal and even the Great Society is entirely within the center, the mainstream, of American politics, and to ignore that fact is to lose elections. So too, we’ll find enough in Adam Smith himself to justify concern for the poor. It’s a human thing, not just religious, not to mention prudent for the cohesion of a society:

How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it…That we often derive sorrow from the sorrows of others, is a matter of fact too obvious to require any instances to prove it; for this sentiment, like all the other original passions of human nature, is by no means confined to the virtuous or the humane…the greatest ruffian, the most hardened violator of the laws of society, is not altogether without it.
—--Smith, The Theory of Moral Sentiments

Now it’s true that Jesus didn’t order his minions to go rip off the rich man’s house and give the goods to the downtrodden. But as citizen-rulers in this here republic, just rule requires we look out for the little guy. One need not be a Christian to embrace that duty.

Gerson is simply speaking the language of many Republicans, the language of God, and that seems entirely proper since that’s where the Godites tend to hang out these days. It may be so that he makes the libertarian wing uncomfortable with such talk, but they should heed Gerson if only for practical reasons, and in response to him, perhaps should try natural law arguments themselves.

But compassion is part of the natural law, of man’s nature, so there’s a structural problem here, and the libertarian-minded must tread lightly in making their practical [and sound] arguments. As Smith notes elsewhere about how man is wired, unless we admire the other fellow’s motives, we cannot hear his arguments or respect his deeds, no matter how much they accrue to the unfortunate man’s good.

Or as GK Chesterton put it, "Reason is always a kind of brute force; those who appeal to the head rather than the heart, however pallid and polite, are necessarily men of violence. We speak of 'touching' a man's heart, but we can do nothing to his head but hit it."

Easy with that libertarian bludgeon, Ms. Hopkins. People vote with their hearts and not their heads. It's in our nature, and it's not an entirely bad thing.


Wednesday, November 21, 2007

Health, Justice, Mercy, & The Beast

Our Benjamin Zycher [on loan from God] writes judiciously about a recent Los Angeles Times article: Cancer survivors Rudy Giuliani, John McCain and Fred Thompson all note that the current US health system gave them a better chance of beating the Big C than the socialized medicine found in most of the developed Western world. True fact.

Also true is Dr. Zycher's identification of Ricardo Alonso-Zaldivar's "news" story as an op-ed. The "reporter's" sympathies are clear. We've learned to expect that from the newspapers, but it should always be noted.

However, Alonso-Zaldivar is correct when he states:

All three have offered proposals with the stated aim of helping the 47 million people in the U.S. who have no health insurance, including those with preexisting medical conditions. But under the plans all three have put forward, cancer survivors such as themselves could not be sure of getting coverage — especially if they were not already covered by a government or job-related plan and had to seek insurance as individuals.
“Unless it’s in a state that has very strong consumer protections, they would likely be denied coverage,” said economist Paul Fronstin of the Employee Benefit Research Institute, who has reviewed the candidates’ proposals. “People with preexisting conditions would not be able to get coverage or would not be able to afford it.”

Dr. Zycher responds:

Perhaps [uninsurable cancer victims and survivors] are worthy of compassion and even subsidies; but that is not a very powerful argument for socialism in health insurance.

Quite so, but the GOP ignores the unfortunate reality of such folks at its own peril, and leaves the door open to the progressivists.

Better a bad system where all suffer equally than leaving the unfortunates to die. Them's the rules of the lifeboat, and they are fair.

Conservatives have got to be creative and yes, compassionate, or they---we---do not deserve to govern. It's conservatism's position, and the correct one, that ordering a society under lifeboat rules guarantees only eternal misery and privation. The genius of the free market is that it creates plenty for all. The moral question becomes not if the rich have too much, but whether the poor have enough.

Now, the collectivists have seized on health insurance as the barometer of our society's well-being, and use some people's lack of it to propose a state takeover of health. But the question is one of health care.

My UK friends are surprised to learn, contrary to their news reports, that we Americans don't exactly let the indigent die in the streets. Our safety net of last resort is the county health care system. Dare I suggest the words that make the liberal heart go atwitter, and the conservative heart turn black---that we make sure the county systems are "fully funded?"

For if the right doesn't get health care to all Americans somehow some way, the left will give them health insurance, creating the great statist beast whose hunger can never be satisfied, and whose mercilessness in the name of the public good [as Dr. Zycher documents here] is not a whit more compassionate.

Or moral. As Ben notes, first, they came for the fat people. Soon, some cancers will be less moral than others. Next, each man and woman's body will stand in judgment of the state. Such a brave new world that "progress" offers us. Conservatism is all that stands in its way, and so far, it's doing a lousy job of it.

The Future Is Now

In New Zealand anyway. A British man who moved to New Zealand has been told by officials that his wife is too fat to join him.---www.Telegraph.co.uk, 11/21/07.

Yes, you read that correctly. Mr. Richie Trezise "lost weight to gain entry to New Zealand after initially being rejected for being overweight and a potential burden on the health care system... [while] his wife... has so far been unable to overcome New Zealand's weight regulations."

Can anyone actually believe that the "burden on the health care system" criterion will be limited to aspiring immigrants? Or to New Zealand? No, my friends, with the expansion of government power comes the expansion of government control, and for health care it is inevitable that the politically unpopular will bear the brunt of rationing when demands exceed resources, as they inevitably must. The overweight. Smokers. The elderly. Those with conditions expensive and incurable. The unborn with, say, Downs syndrome.

Societies utterly humane and civilized can be driven toward perversity and worse in baby steps, and do not for a moment believe that it cannot happen here. As demands exceed resources under government health care, choices will have to be made, and there is no particular reason to believe that political processes will be constrained by a bias in favor of compassion, because more compassion for one must mean less for others. Such is the path toward which political appeals on behalf of "The Children" inexorably will lead.

[cross-posted from www.medicalprogresstoday.com/blog/]

The Silliness All Around Us

The august Los Angeles Times does it again: Yesterday's edition features a front-page op-ed by Ricardo Alonso-Zaldivar in which the glaring gap in the Republican candidates' health-care plans is revealed. To wit: The reliance on private insurance yields no guarantee that those without coverage will be able to obtain it, particularly in the case of those with pre-existing conditions, since insurers purportedly have obvious incentives not to cover such individuals.

And so the utter ignorance of the journalists is revealed yet again. It is government policies---in particular, constraints or proscriptions on underwriting (allocation of premiums in accordance with expected costs)---that lead insurers to avoid those with pre-existing conditions. In the absence of such regulations, premiums would be driven by competitive pressures to reflect actuarial reality, and there would be no reason not to cover people whatever their health status, except in the case of those with conditions so expensive to treat that they would not be willing to pay the actuarily-fair premiums. Perhaps such individuals are worthy of compassion and even subsidies; but that is not a very powerful argument for socialism in health insurance.

Such regulations are exacerbated by legal/regulatory mandates for coverage of a broad set of medical services, the effect of which is higher costs for coverage, particularly given the absence of interstate competition in health insurance. And the tax subsidy for employer-provided insurance makes it easier for legislatures to pass such mandates, as the attendant costs are hidden from the employees buying the coverage indirectly.

And so Mr. Alonso-Zaldivar's central argument, in this waste of fine newsprint, is the need for government regulation to ensure the availability of coverage. That it is government regulation that has yielded this problem in the first place is a reality with respect to which Alonso-Zaldivar is utterly oblivious.

[cross-posted from www.medicalprogresstoday.com/blog/]

A Nash Wednesday

Though Ogden denies writing it:

One ought not to creye
With that jaundiced y
At milk spilled so nie
To a warm piece of pigh.

Tuesday, November 20, 2007

Attention Genesis Fans

I have to believe that some of the folks that visit this esteemed website are fans of the band Genesis, that is fans of the pre-Abacab Genesis (when they were great). If that is you, I've come across something you need to hear. If you know the album “The Lamb Lies Down on Broadway” you are probably familiar with a song called “The Colony Of Slippermen.” Classic album, wonderful song.

My brother, who is a professional musician and did some recording with a later version of Genesis, reworked the Slipperman song with a bunch of country musicians from Nashville. These guys had never heard "The Lamb" and were not at all familiar with Genesis, let alone the older stuff. They listened to it, charted it all out for a totally different sound, and the result is spectacular. Here’s some information from the Spocksbeard website:

Nick has teamed up with Nashville Engineer/Producer Mark Hornsby to record a truly unique version of an early Genesis song: "The Colony of Slippermen". Recorded at Java Jive Studio in Nashville, TN, the song features some of Nashville's best musicians, taking the song in a whole new direction. "We wanted to see what would happen if we exposed the song to a different climate of musicians," says D'Virgilio, "The early Genesis recordings are so musical and very bluesy when you get right down to it. They really lend themselves to some different interpretations." Although all of the original elements of the song are still there (drums, bass, guitar, and piano), it now takes on a more "acoustic" vibe. This, coupled with accordion, electric sitar, and a fantastic horn arrangement, takes the song to an entirely different place. "We had talked about doing something like this for awhile," says Hornsby, "With the recent success of the Genesis reunion tour and the re-release of the Genesis catalogue in 5.1, the time seemed right to see what we could come up with." "The Colony of Slippermen" is part of a larger project that has yet to be announced. The song is currently available as a free download at Nick D'Virgilio's Myspace page: myspace.com/ndvmusic.
Check it out. I promise you’ll dig it. I certainly hope they find a way to do the rest of the album.

Sunday, November 18, 2007

A Spell of In(s)anity

As Ogden Nash never wrote:

One ought not to laffe
At the poor old giraugh
He is infected with stalf
Cutting his neck in haph.

Friday, November 16, 2007

Conservatives in Academe

Inside Higher Ed reports on a new study arguing that part of the explanation for the political imbalance among college faculty (lots of liberals, very few conservatives) rests in students' preferences regarding career and family desires. Conservative students are more likely to value financial security and raising a family while liberal students want to write something "original." What's striking about the charts at the end of the study (pp 18-22) are some things that seem to be statistically significant (though perhaps don't have as much explanatory power): satisfaction with classes and visits to profs outside of office hours. Student satisfaction with humanities and social science classes drops pretty dramatically as you move from students on the "far left" to students on the "far right" and same with visits to profs. This suggests something else I've long thought (hey - a study that confirms my views - it must be right!) and that is part of the lack of conservatives going into academics is the sense that many have that it's not a place for conservatives, something they learn while as undergrads when they see all of their profs as liberal - something that would be especially obvious in...humanities and social science classes.

Thursday, November 15, 2007

The Importance of the 'net...

John Leo is entirely right: if it weren't for blogs, talk radio, and other non-MSM elements of our media culture, things like Delaware's obnoxious residential life indoctrination program would continue on under the radar.

Sure, some group might file a lawsuit, but how do you think the NYT or WashPo would report it, if they deigned take notice at all?

People pay lots of attention to what professors say or write - and they should - but mostly, I suspect, because such writings are relatively easy to find. But the truth of the matter is that colleges' and universities' residential life programs can have much more pervasive effects, as they tend to really set the tone for the whole campus (or perhaps reflect and amplify one portion of it).

And it's striking in an era when universities have largely eschewed their role acting in parents' place that they have nonetheless settled on what can only really be described as a kind of proto-totalitarian mindset. It reminds me of Vaclav Havel's classic essay "Power of the Powerless," where he talks about a greengrocer in communist Czechoslovakia who puts up posters in his shop with slogans like "Workers of the World Unite!" He knows, Havel says, that these are lies (in the sense that the state is not at all interested in the welfare of workers, united or otherwise) but puts them up anyway as a quite reasonable attempt to keep his job and protect his family. But in participating in the lies, he becomes implicated in his own oppression and, indeed, becomes a part of the oppression.

Wednesday, November 14, 2007

I, Freddie

His birthname was Freddie Dalton Thompson. You could look it up.

L to R: Ron Paul, John McCain, Fred Thompson.

Thenewswalk.com hath awarded Fred née Freddie our news ticker over in the right column because he's been the X-factor, the most interesting proposition.

But Fred's been blowing it bigtime because he's boring, and is a mouse click or two away from getting replaced by somebody worthier. [Nominations are now being taken from the floor.]

Even as an actor, His Fredness was even more boring on Law & Order than Ronald Reagan was in Bedtime for Bonzo, and at least Reagan was the star. And so far, although he's a creditable thinker in his writings here and there, Fred's about 1/100th of the politician that the Great Communicator was, and that ain't gonna cut it.

Because leaders aren't boring---even the Great Miscommunicator Dubya W. Bush's Texas sass turned C3PO [Gore] and R2D2 I'm-a-Rebel-Too [John Kerry] into robotic roadkill.

Ex-Sen. Fred has always got by on his avuncular charm. (I never quite knew what "avuncular" meant precisely until I looked it up just now---it means uncle-like, "especially in benevolence or tolerance," and ain't that Uncle Fred to a T?) But he just got handed the biggest gift of his political career.

For some odd reason, The National Right to Life Committee has just handed Federalist Fred (status quo ante Roe v. Wade, or in other words, "one by one, each to their own, let the states decide") its endorsement.

As a non-absolutist on the issue---at least on the political level---I myself am OK with Fred, although I don't see how his position differs much from Rudy Giuliani's.

Fred has a golden chance---his only real Golden Chance here. Mostly it looks like he's positioned himself to pick up the pieces if and when the all the other leading candidates get trashed by their skeletons, and rest assured, they have them. (The press so far is keeping their powder dry for the eventual GOP nominee. Even the MSM have standards---no sliming unless the Republican has an actual chance of getting elected.)

If Fred actually wants to show some leadership, he could do it right now, on the late-term abortion issue, even if only rhetorically. Most Americans are appalled at abortions---except to save the mother's life---at the point after the baby could live with all the resources of modern science supporting him. Her.

We're not much or many, just a little sliver of the American electorate I suppose, but we feel deeply about this, and love our country a little or even a lot less when it doesn't look out for him.

Or her.

Of such acorns presidents are elected. Word up, Uncle Fred---speak out. The eagle just dropped the cub into your grasp, and the auspices are good---you could look it up. Lead, follow, or go hide behind the curtains in case we need you. On a scale from one to ten, this is a ten.

Saturday, November 10, 2007

Friday, November 09, 2007

A Moment of Honesty From Krugman!

The ineffable Paul Krugman today (NY Times) critiques the arguments against single-payer "reform" of the U.S. health-care system, by summarizing those arguments as such caricatures that his discussion itself truly is a caricature of itself. How does he summarize the arguments against single-payer socialism in health care? "No insurance, no problem." "It's the cheeseburgers." "2007 is better than 1950." "Socialized medicine! Socialized medicine!"

So there we have it: It's all eyewash. But now let us defer to the observations made not long ago by a prominent economist and observer of health-care reform policies: Under a single-payer system of health insurance, "the public sector... sooner or later [would] have to make key decisions about medical treatment... [and] health care---including the decision about what treatment is provided---[would become] a public responsibility."

And who wrote those words? None other than our friend Krugman, in an exceedingly rare moment of honesty (New York Times, December 26, 2005).

So: Once we agree that under a single-payer system health care services inevitably would be rationed, and that government bureaucrats would do the rationing, and that a number of other not-very-attractive effects inexorably would emerge, the arguments against health-care socialism begin to look a bit less trivial, don't they? What say you now, Professor Krugman?

Thursday, November 08, 2007

The People vs. the Beltway

ABC News, USA Today, and the Kaiser Family Foundation conduct a periodic poll on health care issues, and the findings in the most recent (September 2006) are fascinating. In particular, there is a question on satisfaction with the quality of the health care received by the respondents, of whom 87 percent have health-care insurance coverage, while 13 percent do not. Among all respondents, 89 percent are either very satisfied (52 percent) or somewhat satisfied (37 percent) with their health care. For those with coverage, the respective figures are 56 percent and 37 percent, totaling 93 percent; about 6 percent are dissatisfied.

This means that satisfaction with the quality of health care services actually received among the uninsured can be imputed to be 62 percent. Accordingly, about 37 percent of those without coverage are dissatisfied with their health care.

So: About two-thirds more of the uninsured are satisfied with their health care than are dissatisfied. And bear in mind that even the dissatisfied have access through emergency rooms and other facilities to health care services that are, to be blunt, world class. It may not be very efficient or convenient, but inhumane it is not.

Would someone please tell me why health care coverage for the uninsured in America purportedly is a crisis? Or is the real crisis the difficulty some face in terms of using this issue as a vehicle for wealth redistribution?

[cross-posted from www.medicalprogresstoday.com/blog/]

Wednesday, November 07, 2007

The Panacea goes Up In Smoke

The voters in Oregon rejected a ballot measure to increase tobacco taxes by 84.5 cents per pack to fund health care coverage for uninsured kids. The vote, in incomplete returns, was about 3:2 against. That's landslide country, folks. I wonder if the Beltway is watching in the context of SCHIP.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, November 05, 2007

And So The Decay Begins

The Centers for Medicare and Medicaid Services announced last week a final rule that will reduce Medicare physician reimbursements by 10.1% on Jan. 1, 2008, unless Congress acts to reverse the reductions, as reported by Congressional Quarterly HealthBeat (November 2). Under the rule, Medicare will pay $58.9 billion to about 900,000 physicians in 2008. CMS officials said that the agency "has no choice but to implement" the rule under current law.

And so just as with Medicaid, the single-payer squeeze on the providers now proceeds apace under Medicare, as politicians and bureaucrats respond to their powerful incentives to reduce budget expenditures at the expense of patients. The longer-run effect of this process is not difficult to predict: Physicians will retire earlier than otherwise would have been the case, fewer will enter medical school and generalized practice, more foreign and fewer experienced doctors will come to characterize medical practice; in short, quality will suffer. Medicare beneficiaries will find it increasingly difficult to find physicians willing to serve them. And so yet again we will come to experience the fruits of government compassion.

[cross-posted from www.medicalprogresstoday.com/blog/]

One Size Does Not Fit All

The august Los Angeles Times ran an article Sunday by Charles Ornstein on his efforts to help his Mom pick a plan for her Medicare health care and prescription drug benefits, from among the thousands of Medicare Advantage plans and Medigap plans and Part D options and combinations available. The plans are characterized by significant differences in coverages, premiums, co-payments, and all the other attributes that collectively make up health insurance products for seniors.

Ornstein's exasperation is clear given the task of sorting through all the options to find the best one for his Mom. What is clear as well is the utter failure of both him and, as usual, the LA Times to see the forest for the trees: Thousands of options are available because the market---unlike the Beltway---understands and has incentives to respond to the myriad differences in preferences and conditions shaping the health-care choices of millions of American seniors. Would Ornstein be happier with one choice? Well, perhaps, if that choice just happened to be the one fulfilling his Mom's needs most fully. But what are the odds of that?

Ornstein is not alone in his failure to understand that the hassle of sorting through the offerings of the market are nothing compared with the hassle of dealing with government policies and agency bureaucrats who do not have customers to satisfy, and so whose central incentive is to cut budget costs. Would Ornstein be more pleased with a bureaucracy that simply will not spend dollars on given medical services for people older than, say, 75? Don't bet on it. But do bet on that very kind of outcome as a result of socialized health-care finance, if the U.S. ever is sufficiently misguided to adopt such a monstrosity.

[cross-posted from www.medicalprogresstoday.com/blog/]

Friday, November 02, 2007

Rudy Is Right and Krugman Is Wrong

From the Manhattan Institute City Journal website:

Malignant Rumor

On cancer survival rates, Rudy’s right and his critics are wrong.
David Gratzer
31 October 2007

This week, Rudy Giuliani’s presidential campaign released a radio ad in which the candidate praised American health care for curing him of prostate cancer and wondered what might have happened to him under the socialized medicine practiced in the United Kingdom, where survival rates for that condition are far lower. In the ad, now running in New Hampshire, Giuliani says: “I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.” He drew those statistics from an article that I wrote for the Summer 2007 issue of City Journal.

The ad has already aroused intense criticism, most of it claiming that survival rates in Britain aren’t nearly so low. ABC News’s Rick Klein, in a blog entry entitled “Rudy’s Fuzzy Healthcare Math,” writes: “To hear Rudy Giuliani describe it in his new radio ad, the British medical system is a scary place. . . . But the data Giuliani cites comes from a single study published eight years ago by a not-for-profit group, and is contradicted by official data from the British government.” Kevin Drum, blogging at CBS News, declares simply: “Giuliani is full of shit.” Ezra Klein of American Prospect agrees on his blog: “It’s—no pun intended—crap. England and America have vritually [sic] the same mortality rates from prostate cancer.”

Let me be very clear about why the Giuliani campaign is correct: the percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. The Organisation for Economic Co-operation and Development reports on both the incidence of prostate cancer in member nations and the number of resultant deaths. According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived. Economist John Goodman, in Lives at Risk, arrives at precisely the same conclusion: “In the United States, slightly less than one in five people diagnosed with prostate cancer dies of the disease. In the United Kingdom, 57 percent die.” None of this is surprising: in the UK, only about 40 percent of cancer patients see an oncologist, and historically, the government has been reluctant to fund new (and often better) cancer drugs.

So why do the critics think that Britain’s survival rates are as high as America’s? The main reason is that they are citing overall mortality rates, which are indeed, as Ezra Klein writes, similar across various countries. That is, the percentage of all Americans who die from prostate cancer is similar to the percentage of all Britons who do. But this misses the point, since a much higher percentage of Americans than Britons are diagnosed with prostate cancer in the first place. If you are a patient already diagnosed with prostate cancer, like Rudy Giuliani, your chances of survival—as Giuliani correctly said—are far higher in the United States.

Likewise, though Rick Klein is right that official UK data differ from mine, those data look at five-year survival rates—that is, they track cancer patients for five years and report on their survival. Their approach is different from mine. They don’t examine what we might call a “snapshot,” as my data do: that is, examining how many people with a particular disease die during a given interval of time—say, a year.

True, the OECD data are seven years old, as Rick Klein also points out. However, newer studies show a similar trend: Americans do better when diagnosed with cancer than their European counterparts do. Since the publication of my City Journal essay, the prestigious journal Lancet Oncology has released a landmark study on cancer survival rates. Its findings:

  • The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rate is close to 71 percent. (English data were incomplete.)
  • For the 16 different types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
  • American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.

These data, recently released, are now the best available. They too confirm Giuliani’s point: he was fortunate to be treated here.

I’m not denying that American health care has its problems. On the contrary, I’ve just written a book advocating reform. And the Giuliani campaign isn’t denying it, either—the mayor has advocated reforms of his own. But as Americans consider how to improve our health care system, we should understand what we do well and what other countries do poorly. Failing to do so would be the public policy equivalent of malpractice.

Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book is The Cure: How Capitalism Can Save American Health Care. He advises the Giuliani campaign.

Let the Violins and Tears Begin

Well, now, some unions and other pressure groups have started running ads targeting Republicans who voted against the new, improved, improved and new, old-wine-in-new-bottles version of SCHIP. "What if your daughter didn't have health coverage...? What if you had to work two jobs to make ends meet, but still couldn't afford insurance? Would you still back George Bush's vetoes?" (New York Times, November 2)

Sniff. Why, oh defenders of compassion with other people's money, is it the case that some working people cannot afford insurance? Could it be because of the regulatory mandates for this and that coverage that you have supported for years? Could it be because of the absence of interstate competition in health insurance plans, a barrier that exists because of your allies in the various state insurance regulatory commissions? Could it be because of the restrictions on underwriting and rating---the allocation of premiums in accordance with expected costs---in the absence of which insurance for most kids would be very cheap? Could it be because of "guaranteed issue" regulations---don't buy insurance until you get sick---engendering the worst kind of adverse selection problem?

Or could it be... all of the above? Well, yes. Emphatically. And have the unions and pressure groups supported all this meddling in the competitive market for health insurance? Ditto. And now they're blaming others for resisting another long step toward a system in which government pays for "coverage," squeezes the doctors and hospitals for "savings," and then squeezes patients as well with rationing, underinvestment in technologies, and restrictions on the services that patients may obtain. Anyone who actually believes that this political balderdash is for "the children" shouldn't worry too much about vetoes. The Tooth Fairy will come to the rescue.

[cross-posted from www.medicalprogresstoday.com/blog/]

Thursday, November 01, 2007

Are You Feelin' Lucky, Punk?

The august NY Times reported yesterday that the Chinese chemical firm "Honor International Pharmtech was accused of shipping counterfeit drugs into the United States" even as it "was openly marketing its products in October to thousands of buyers [in Milan] at the world's biggest trade show for pharmaceutical ingredients."

Yeah, yeah, but so what? After all, the prices are low, and isn't that what really counts? So what's the problem? Actually, there isn't one, in the context of the long-running debate over the importation of foreign drugs subject to price controls overseas, except in the case of contagious diseases. If someone takes a fake or adulterated drug because the price looked good, well, isn't that really their problem, the issue of infecting others aside? The proponents of parallel trade in pharmaceuticals---again, importation of "cheap" drugs from overseas---fail even to consider that problem, in their rush to subsidize their constituencies at the expense of others.

More generally, they are keen to ignore all the problems---contagion, the dilution of brand-name capital and the resulting implications for trust in the health-care system, the inevitable horror stories for individual patients given adulterated drugs without any warning at all, the bonanza for the lawyers---as they pursue price "discounts" with no consideration of any adverse implications at all. And they are the ones demanding truth in advertising from everyone else. Have they no shame? That question answers itself.

[cross-posted from medicalprogresstoday.com/blog/]

Wednesday, October 31, 2007

Trust Me

There's a rather silly article in the October 1 issue of Pharmaceutical Executive in which twelve "brandmeisters" weigh in on the issue of how Big Pharma can restore "trust" where it now is lacking or weak. The various commentaries offer the usual war-on-insomnia platitudes about not overpromising, whatever that means, constant communication, putting the customer/doctor/patient first, and blah blah blah.

Actually, competitive markets solved this problem ages ago: Investment in such assets as brand-name capital, the value of which collapses if the firm fails to live up to its promises, sends a clear signal to the market that the firm makes more money by behaving in a trustworthy fashion than the opposite. Advertising is the most obvious example, even given the constraints and mandates enforced by the FDA; that is why virtually all consumers, given a choice between a brand-name drug and its generic equivalent at the same price, would choose the former. Other examples are a long-term commitment to charitable endeavors, indicating that the firm is not a fly-by-night, construction of specialized facilities not easily transferable to other firms, etc.

And so yet again we find a reason that the political attacks on pharmaceutical marketing are mindless, even as we can be amused in supreme fashion by accusations of "misleading advertising" hurled by the permanent Beltway establishment.

[cross-posted from www.medicalprogresstoday.com/blog/]