Saturday, September 29, 2012

The Psych Approach to David Brooks

My mother and I tend to agree about most political issues, but we have a long running dispute about the wisdom of one political pundit, New York Times columnist David Brooks. The role Brooks occupies is a relatively new entry in the NYT columnist lineup, not really replacing the true "House Conservative" position of William Safire, one which was adopted by Bill Kristol and is currently held by the ever-fascinating Ross Douthat. No, he's more of a living, breathing embodiment of what George Bush 43 referred to as the "compassionate conservative"; he's a man who believes in the policies of the Republican party--at least the economic and tax-regulatory ones--while showing an interest in social issues related to the quality of how people live and what can be done to make people's lives better. Also unlike the Saffire/Kristol/Douthat crew, Brooks's rhetoric is milder and more gentle. Not that someone like Douthat is in the same camp as, say, Mark Levin, but you get the point.

Momma calls this "centrism" and thinks he's nifty; I call it "inherently contradictory for the most part" and think he's shallow but coated with a thin patina of gravitas...which fools people like Momma, bless her soul. "Nitwit" seems too strong a word, especially as he has such a fine command of the English language, but his analytical mind doesn't seem to far off that description from where I stand.

Comes this week's entry: The Psych Approach, a column devoted to taking a look at the social science research known as the Adverse Child Experiences, or "ACE", study. ACE is a survey of about 17,000 people, and looks at particular formative experiences (such as alcoholism in a parent) and current life/health issues (self-reported alcoholism, stress, depression, smoking) in an attempt to look for correlations. For instance, this report demonstrates a significant correlation between alcohol use in a parent and current drinking problems. Further, they go so far as to say in this flyer that "[adverse child experiences] account for one-half to two-thirds of drug use."

I haven't seen the academic data, and while it looks a little slippery--for instance, it's never made clear what constitutes "alcohol problems" so different responders may have wildly varying definitions, making absolute comparisons tricky--it nevertheless seems like a solid piece of epidemiologic research, one that not only documents the importance of formative experiences on current social and health issues, but quantifies it as well. Thus a useful body of data for someone interested in thinking about public policy, like, say, a politician...or at least his or her staff that have the time to read such stuff and think about how government policy can have an impact on such issues.

And here's where Brooks takes his cue. He starts off by noting that maybe government has been looking at fixing the wrong thing:

In the past several decades, policy makers have focused on the material and bureaucratic things that correlate to school failure, like poor neighborhoods, bad nutrition, schools that are too big or too small. But, more recently, attention has shifted to the psychological reactions that impede learning — the ones that flow from insecure relationships, constant movement and economic anxiety. 

And the fix for this? Well, in short, get everyone on the same page to work creatively and for the common good in a "failure is not an option" mode:

When you look over the domestic policy landscape, you see all these different people in different policy silos with different budgets: in health care, education, crime, poverty, social mobility and labor force issues. But, in their disjointed ways, they are all dealing with the same problem — that across vast stretches of America, economic, social and family breakdowns are producing enormous amounts of stress and unregulated behavior, which dulls motivation, undermines self-control and distorts lives.

Maybe it’s time for people in all these different fields to get together in a room and make a concerted push against the psychological barriers to success.

It's a provocative thought. It also is exactly the kind of thought that someone who believes that government policy can make a difference in people's lives would express.

Now, once upon a time, it was a thought that could have been expressed out loud by a member of the Republican party. The disagreement, the Republican would insist, is not whether government can affect change but simply how the government should go about doing so. But that Republican party is long gone, and what appears to be an interesting observation from Hypothetical Presidential Candidate David Brooks would have been derided by his opponents for being "socialist"--which, in the language of modern Republicanspeak, means "anything with which I disagree".

It's a sentiment that would have been expressed by the kind of Republican who, twenty years ago, would have endorsed a public/private solution to the problem of tens of millions of Americans lacking health insurance. In fact, such a solution was proposed and became known as "Obamacare" and was met with fanatical opposition by the current Republican party. Yet the law is thoroughly Republican in its philosophy and was a disappointment to people who a generation ago would have been considered "centrist Democrats". Though now, through the magic of political alchemy, they somehow have been branded "far-left radicals" (and, of course, "socialists").

In short, it's a habit of looking at the world that is not welcome by the modern, Tea Party-dominated Republican party. For David Brooks to find himself fascinated by such research--sponsored as it was by the US Federal Government via the CDC--and to think that such research might somehow lead to the world being a better place is nice. For him to think that the tail-wagging-the-dog Republican party which he so often lauds gives a damn is naivete in the extreme. Which we're used to from him by now.

Monday, September 17, 2012

Why Romney Failed...Wait, You Say the Campaign's Not Over?!

In the immortal words of Brad DeLong, why oh why can't we have a better press corps?

Even casual political readers this week can feast themselves on any number of Romney campaign obituaries and detailed post-hoc analyses of how the campaign stumbled--in past tense, no less!

Except the game ain't over. Yes, it's late in the third and Obama's up by 8 with the ball. But as the Arizona Cardinals discovered yesterday to their near-horror, even seemingly sure things can evaporate with an unfortunate error. An interception pick-six from Team Romney (a memorable one-liner zinger during the debates a-la "there you go again"--even though Carter's point was correct) and a two-point conversion (hundreds of millions of dollars of TV ads complements of Karl Rove & Co.) and you are headed down to the wire. This game ain't over, folks--but you might get a different impression from reading news analysis this week.

If you were reading all the political stories this week from Politico to Wall Street Journal (well, the op-eds anyway) to TPM you would have been reading story after story obsessed with the horse race rather than the underlying substance of the campaign. As political junkies, we don't mind a little bit of horse race analysis with our news, but the POTUS campaign coverage is alas mostly devoted to who's-ahead-other-campaign-in-chaos topics. As Sahil Kapur trenchantly observes, "once the 'Romney in disarray' narrative gets stale, it'll probably shift to 'Romney's comeback." And neither "narrative" should have any bearing on why someone should or shouldn't vote for Governor Romney or President Obama.

The central problem is that these stories crowd out much more important news. A little noted item in early September involved Romney saying that global warming is real and caused in part by humans. This is a policy statement of tremendous importance and should have been major news since it indicated a Romney policy shift away from one of the more insane anti-scientific tenets of the Republican base. (Although given Romney's previous slippery, contradictory statements on the subject, it might have simply been another "Etch-a-Sketch" moment in his say-anything-to-please-everyone campaign.) We should note that we think President O's response to on this and other topics makes much more sense. However, either way, Romney's statement was important--really important--and hardly anyone noticed it.

The Billy Rubin Blog is contemplating what to write in the event of a Romney loss: suffice it to say that we agree with the central premise of this article by Charlie Pierce. But before the media calls the game, maybe they should spend as much time and effort as possible to get actual news out about what the campaigns are saying. Yes, we thought the Clint Eastwood stuff was amusing, and maybe says something about whether Romney is qualified to be President...but not that much. Analyzing his statements on the middle class, however, really is important.

Wednesday, September 12, 2012

Media Avoids Numbers: Now There's a Surprise

There's a quick little ditty about raising the speed limit in Texas to a whopping 85 mph in the Paper Of Record this week. It quotes some local politicos as they talk with a certain puckish pride of these new autobahn-worthy speed limits. It details that Texan spirit of just-wanna-get-there, and includes a yarn about Governor Rick Perry getting pulled over a few years ago outside Austin when he was Lieutenant Governor. It mentions the almost incomprehensible size of the state and the vast stretches of nothingness between the big cities.

Cute. But what it doesn't mention is any kind of data to indicate how dangerous such new speed limits are.

This isn't difficult in the internet age. With a couple of clicks and the right words entered into Google, one can come up with a range of popular news pieces as well as scholarly articles about the actual, known dangers of such high speed limits. There's a lot of data out there to pluck off the tree. NYT couldn't even give a nod to this? I mean, if you're going put up a postcard about a fantastic speed limit--even if it's mostly intended to be a puff piece--don't you think it might be important to consider an obvious implication of the change? And we haven't even talked about gas consumption.

Not every article has to be a grim humorless slog through public policy. But one sentence about the potential dangers (not speculation, but the objectively known data!) of moving the speed limit well above where it was one generation ago doesn't seem to me to be too much to ask.

Tuesday, September 4, 2012

When A Few Isolated Deaths Should Be Important News

As we have recently discussed here and here, we're not big fans of the "One Person Dead Somewhere From Something Weird, Be Scared Shitless" news stories that frequently populate the health sections of various news organizations. But we think the story of these two deaths associated with the use of Neti Pots bears some careful attention.

Why is that, you ask? Isn't that a complete contradiction from what you've been writing--in recent entries, no less? Plus haven't you already castigated the media for covering deaths associated with this very organism (Nagleria fowleri)?

I don't think it's a contradiction, but a quick explanation of Neti Pots is required. The Neti Pot is used mainly for people with sinus congestion: the goal is to flush the sinuses via the nose with a salt-water solution and clear the mucus away. Having had major sinus problems over the past year for the first time ever, I've become a fan (though reluctantly, for sure--it's no fun cramming 200 ccs of salt water in your nose!).

There is one simple catch to the use of a Neti Pot: you have to use sterile water. Boiling water in your tea kettle and letting it cool down will work perfectly fine. Why? Because your tap water isn't perfectly sterile. Depending on where you live in the US and the type of water treatment facilities your state government runs, there can be a small number of various types of microbes living in your tap water. Note that I say living and not lurking: these guys are perfectly harmless if they travel down the gullet into the highly acidic environment of the stomach where they go no further. Tap water is one of the great advances of civilization--and one at which the libertarian wing of the Republican party appears to be at odds.

Anyway, while drinking tap water is harmless (unless, of course, if you're living in a place where fracking is commonplace), your nose ain't built to defend itself from these microbial badasses in the same way the stomach is, so flushing one's sinuses with a healthy amount of tap water constitutes a game of Russian roulette. As the NYT piece documents, two people have died from the tap water Neti Pot flush. True that in a country of 300 million it ain't much, but this news piece comes with a simple public service announcement. Boil the water, folks. And diphenhydramine or loratidine and their ilk work too.

Monday, September 3, 2012

Labor Day Links

A commentary in the NYT by economist Uwe Reinhardt looks at whether or not there is a physician dearth or glut. Not being highly conversant in the byzantine vocabulary of the dismal science, I cannot evaluate the merits of the article--nor am I totally sure that Reinhardt comes squarely down on one side of the argument (though he seems to imply we have too few physicians as a consequence of bad policies dating back to the mid-90s). The relevance here is that if you are contemplating attending medical school, you shouldn't let a story like this sway you one way or another. Yes, all sorts of things in medicine are changing, and yes, we have no way of knowing how those changes will affect things like salary and lifestyle and what subspecialties will be available; but we'll still need doctors a generation from now, so just apply.

NYT also notes a new strain of swine flu has claimed its first human victim, in addition to the fact that the CDC has stated that the strain can be spread human-to-human instead of the (less scary) pig-to-human manner. As we recently noted with the breathless coverage of the spread of West Nile Virus, fear can quickly warp a realistic sense of the danger this virus poses. Cheeseburgers, beer, and cigarettes continue to be considerably more lethal for the moment. (Though that said, we maintain a healthy respect for influenza here at the Billy Rubin Blog. When available, get your vaccinations!)

Sarah Kliff, a health policy reporter at WaPo, writes about health legislation in California defining the phrase "essential health benefits" to make explicit to insurers what services must be covered for the new customers being delivered to them compliments of the Affordable Care Act, aka Obamacare. (We could just as easily call this "Romneycare", though the Republican Presidential nominee would deny this to the point of an epileptic fit, so desperate is he to prove his bonafides to various Brownshirt constituencies. Whatever. At any rate, while the law is Federal, the States become the arbiters of local coverage to be provided by insurance companies.)

What's beyond mere wonkishness in this post is that the legislation includes acupuncture in the "must cover" list, while leaving out infertility treatment as well as hair restoration. Also off the list (so far) is chiropractic, as well as "massage therapy". This is an early signal of the kinds of battles that may well be looming as we begin to make hard choices about how we will spend money on health care in the years to come. Well-organized special interest groups may come to define what kind of care gets reimbursed, regardless of whether or not there is scientific evidence to support claims for health benefit. For instance, "acupuncture" is covered--but for what indication? Is it just acupuncture in general? Psychologists doing talk therapy are currently hamstrung by much tighter regulations than that, having to provide a specific psychiatric diagnosis for each session, even if several of those sessions could be easily described as "normal people working through normal problems".

I don't hold a strong opinion about this right now--there is a sufficient amount of incredibly expensive procedures in "mainstream medicine" that have little data to support their practice (back surgeries, anyone?). I am, however, concerned about medical reimbursements driven more by advocacy groups than by a rational analysis of studies designed to discover whether a given treatment really does have a benefit. I have no beef with people who want to go to their weekly rolfing session; I do not feel particularly inclined to subsidize it through my annual insurance premium.