Courage is rightly esteemed the first of human qualities because it is the quality which guarantees all others.—W. Churchill

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.

D'oh.

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?