kw: rejected books, policy
It has been too long since my last post. In that time I have read major portions of three books, and in each case, stopped reading and decided not to review the book. In such cases I decline to give the author or title any exposure at all. I have a few reasons for not continuing to read a book, including writing too poor to hold my interest and subject matter that is explained too poorly to be of use (in my estimation); I'll reject a book most quickly when I determine that I don't want to take in what is being offered. It seems all three of these criteria "hit the fan," one after another. There are other reasons, but those three are chief.
So I have begun reading another book, a biography of Dr. Seuss (Ted Geisel). It's long, so at least another week must pass before I finish it and review it here. I can happily report that this book is one I am sure to finish, and with much enjoyment.
Showing posts with label policy. Show all posts
Showing posts with label policy. Show all posts
Monday, July 01, 2019
Saturday, December 15, 2012
Is it time to tear down Lady Liberty?
kw: book reviews, nonfiction, immigration, policy, polemics
Just 32 years ago my wife and I were in a courtroom. I have served on juries, and even stood before a judge to plead guilty on a traffic ticket, so I am no stranger to courtrooms. This occasion was different. The room was nearly full, little children were fidgeting or playing, and the judge was smiling. After a very short ceremony, my wife and about thirty others were sworn in as naturalized citizens of the United States of America. She had been in this country for nine years, and we had been married five years.
There was a time that any person who could demonstrate, via pay stubs and utility bills, five years of residency in this country, could be naturalized with very little paperwork. Prior to 1946, the Alien Registration card (the "green card") didn't even exist. The multitudes who arrived via Ellis Island between 1892 and 1954 mostly didn't have passports or visas. They were issued immigration documents upon arrival, and at least until the 1930s, those documents and a few pay stubs or rental receipts were sufficient proof of residency to be used five years later to be naturalized. Now, you must hold the "green card" for five years (three years if married to a citizen), but it can take ten years or more to get the card in the first place.
The church we attend is multi-ethnic, and the local churches with which we are affiliated, worldwide, are probably the most multi-ethnic that there are. We have hymnals and Bibles for sale in four languages; larger churches nearby have as many as eight. A couple of years ago, our home bible study included people from "here" (me and one other), Japan (my wife), China, Taiwan, Nigeria, South Korea and India. People come and go, particularly in a college town, so at present "only" four ethnicities are represented.
Over the years, we have lived in a lot of places, in seven states. We have sometimes rented rooms to students. At least a few times, a student has turned out to be either "undocumented" or to have overstayed a visa, or to be working even though on a supposedly non-work student visa. Y'know how it is said, "politics is local"? It is strange, I long held rather restrictive, nativist views about "illegal immigration" in general, even as I harbored one "illegal immigrant" or another at times. But the more and deeper I look at the situation, the less sure I am what is right.
Einstein is quoted as saying, "Everything should be as simple as it can be, but not simpler." Politicians violate this statement in both possible ways. The modern debate over "illegal immigration" or "undocumented immigrants" has been at an unusually high pitch for about twenty years, even higher than before President Reagan signed a mis-called "amnesty" bill into law in 1986. The law legalized 3 million immigrants. The country did not fall apart. Anti-immigrant fears died down for 6 or 7 years. Then, as documented by Pilar Marrero in Killing the American Dream: How Anti-Immigration Extremists are Destroying the Nation, nativist rhetoric began heating up again, and has become partly enbodied in policy, such that at least 300,000 "illegals" have been deported yearly during each of the four years of President Obama's first administration. This in spite of Obama's promise during the 2008 campaign to pass a comprehensive immigration law during his first year.
On the campaign trail, candidates oversimplify the "immigration problem". In the chambers of government, legislators and the bureaucracy over-complicate it. Before discussing policy, it is helpful to assess a few facts.
Suppose the dream of certain folks were to come true, and all 12 million "illegals" vanished (including about 2 million kids who are natural-born citizens). Who would do the 7 million jobs they leave behind? What wages would they demand? Face it: the fruit and veggies you buy are cheap because most farm laborers earn less than minimum wage, and if they are "undocumented", even less, much less. Are you ready for produce prices to double or triple? Actually, I would be very willing to pay more for food, under these conditions:
If such conditions were met, much of the "immigrant problem" would vanish. That includes a problem many people never think of. Now that so many restrictive laws can lead to someone being deported after any kind of contact with the police, recent immigrants, even legal ones, won't call 911 even when they are the victim of a crime. From their point of view, they'll just become the victim of a second crime: being jailed until they can prove their "right" to be here, or deportation if they can't. The police find it harder to solve crimes when entire neighborhoods won't talk to them.
Well, I was going to discuss more about policy, but this is getting long. Ms Marrero has quite a good section on policy, well worth the reading. I think another item is well worth reading:
Just 32 years ago my wife and I were in a courtroom. I have served on juries, and even stood before a judge to plead guilty on a traffic ticket, so I am no stranger to courtrooms. This occasion was different. The room was nearly full, little children were fidgeting or playing, and the judge was smiling. After a very short ceremony, my wife and about thirty others were sworn in as naturalized citizens of the United States of America. She had been in this country for nine years, and we had been married five years.
There was a time that any person who could demonstrate, via pay stubs and utility bills, five years of residency in this country, could be naturalized with very little paperwork. Prior to 1946, the Alien Registration card (the "green card") didn't even exist. The multitudes who arrived via Ellis Island between 1892 and 1954 mostly didn't have passports or visas. They were issued immigration documents upon arrival, and at least until the 1930s, those documents and a few pay stubs or rental receipts were sufficient proof of residency to be used five years later to be naturalized. Now, you must hold the "green card" for five years (three years if married to a citizen), but it can take ten years or more to get the card in the first place.
The church we attend is multi-ethnic, and the local churches with which we are affiliated, worldwide, are probably the most multi-ethnic that there are. We have hymnals and Bibles for sale in four languages; larger churches nearby have as many as eight. A couple of years ago, our home bible study included people from "here" (me and one other), Japan (my wife), China, Taiwan, Nigeria, South Korea and India. People come and go, particularly in a college town, so at present "only" four ethnicities are represented.
Over the years, we have lived in a lot of places, in seven states. We have sometimes rented rooms to students. At least a few times, a student has turned out to be either "undocumented" or to have overstayed a visa, or to be working even though on a supposedly non-work student visa. Y'know how it is said, "politics is local"? It is strange, I long held rather restrictive, nativist views about "illegal immigration" in general, even as I harbored one "illegal immigrant" or another at times. But the more and deeper I look at the situation, the less sure I am what is right.
Einstein is quoted as saying, "Everything should be as simple as it can be, but not simpler." Politicians violate this statement in both possible ways. The modern debate over "illegal immigration" or "undocumented immigrants" has been at an unusually high pitch for about twenty years, even higher than before President Reagan signed a mis-called "amnesty" bill into law in 1986. The law legalized 3 million immigrants. The country did not fall apart. Anti-immigrant fears died down for 6 or 7 years. Then, as documented by Pilar Marrero in Killing the American Dream: How Anti-Immigration Extremists are Destroying the Nation, nativist rhetoric began heating up again, and has become partly enbodied in policy, such that at least 300,000 "illegals" have been deported yearly during each of the four years of President Obama's first administration. This in spite of Obama's promise during the 2008 campaign to pass a comprehensive immigration law during his first year.
On the campaign trail, candidates oversimplify the "immigration problem". In the chambers of government, legislators and the bureaucracy over-complicate it. Before discussing policy, it is helpful to assess a few facts.
- Seasonal workers in agriculture, many of them "pickers", number about 5 million.
- 3/4 are Mexican or of Mexican descent. Another 14-15% are of other minorities.
- Only 11% are "white".
Suppose the dream of certain folks were to come true, and all 12 million "illegals" vanished (including about 2 million kids who are natural-born citizens). Who would do the 7 million jobs they leave behind? What wages would they demand? Face it: the fruit and veggies you buy are cheap because most farm laborers earn less than minimum wage, and if they are "undocumented", even less, much less. Are you ready for produce prices to double or triple? Actually, I would be very willing to pay more for food, under these conditions:
- Every farm worker has a documented right to be here.
- A "guest worker" program allowed several million seasonal laborers to freely travel to and from their home, whether in Mexico, Canada, other U.S. states, or wherever.
- All farm workers were paid minimum wage, or more, and also had health insurance provided.
- They were provided with SSN and other identification as needed.
If such conditions were met, much of the "immigrant problem" would vanish. That includes a problem many people never think of. Now that so many restrictive laws can lead to someone being deported after any kind of contact with the police, recent immigrants, even legal ones, won't call 911 even when they are the victim of a crime. From their point of view, they'll just become the victim of a second crime: being jailed until they can prove their "right" to be here, or deportation if they can't. The police find it harder to solve crimes when entire neighborhoods won't talk to them.
Well, I was going to discuss more about policy, but this is getting long. Ms Marrero has quite a good section on policy, well worth the reading. I think another item is well worth reading:
Not like the brazen giant of Greek fameThis is the entirety of the poem inscribed at the base of the Statue of Liberty. The greatness of America was built by those "huddled masses yearning to breathe free", by other lands' "wretched refuse" and "homeless". Something happens to someone who picks up and moves. They usually do better, much better. Do we really wish to cut off the supply of ambitious, creative, usually young, hard-working people who want something better? Let's take those 12 million "illegals" and turn them into fully productive members of society, and if they wish, citizens! If we can't do that, we ought to be honest enough to blow up the "Mother of Exiles" and wall out the world.
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lighting, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame,
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore,
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"
(Emma Lazarus, 1883)
Tuesday, November 27, 2012
Can liberalism save the poor?
kw: book reviews, nonfiction, poverty, policy
Jesus told his disciples, "The poor you will always have with you" (Matt. 26:11 and Mark 14:7), and some think this means God favors some amount of poverty. Instead, we must understand that this phrase expresses God's sad understanding of human nature. It is not to be taken as a prophecy that must be fulfilled. The Old Testament contains frequent admonitions to relieve the poor, and specific provisions for their debts to be forgiven, such as the Sabbatical Year and the Jubilee. In the New Testament we find that, when Judas went out to betray Jesus, the other apostles thought he might be going to give alms, and this tells us that Jesus would send Judas (the group treasurer) to do so from time to time.
Today, what do we find? In the richest nation on Earth (for the present), poverty continues to increase, not just in number, but in proportion. This in spite of the famed "war on poverty" launched by President Johnson nearly 50 years ago. Poverty, as defined by the government, had been decreasing already in the mid 1960s; it had been over 18% (8 million) of families in 1962, and continued to a low of 8.7% (4.8 million) families in 1973. After some gradual swings up and down, the figure currently stands at 11.8% (9.5 million) families. There is a defined threshold for each family size; for a family of 3, it is about $18,000 yearly. Folks, that isn't much!
Curiously, in Washington, DC public schools, spending per student is nearly $19,000, yet the education received is better in "mid-continent" schools (in the Central time zone), where yearly spending is $6,000-9,000. Hang onto this thought.
A few years ago, two prominent liberal activists, Tavis Smiley and Cornel West, launched "The Poverty Tour: A Call to Conscience", a bus tour of 18 cities in 8 states. They write of their experiences and findings in The Rich and the Rest of Us: A Poverty Manifesto. The recession of the past four years has pushed many in the middle class toward the poverty threshold, without necessarily taking them right across it. By grouping the near-poor with those defined as poor, the authors can state that the numbers of struggling Americans is 150 million, "the greatest number in five decades".
After presenting a "Portrait of Poverty", which focuses on poverty as a fact (the lack of sufficient money, and nothing more) the authors present five aspects of poverty: Opportunity, Affirmation, Courage, Compassion, and Imagination (or, in particular, the lacks thereof). Poverty of Affirmation is a particularly insidious difficulty. The (still) well-off have a nearly overwhelming tendency to think that the poor "deserve it". However, one's politics affect this outlook. People with a more liberal attitude expect government to solve problems, and have low rates of charitable donation. People with a more conservative attitude do not expect government to help in a sufficient or useful way, so they give on average four times as much to charity as liberals.
Let's back up to some of the figures above. What would it cost to raise the effective income of those families below the poverty line to, say, $30,000? With no knowledge of the income distribution, I can guess that it doesn't exceed $10,000 on average, for those 9.5 million families. So that is $20,000 times 9.5 million. That comes to $190 billion. Then, for those above the line, but making less than $30,000, we can roughly estimate another 50% added, for a total of about $285 billion. That is substantial, but it is one-third of the money wasted on the TARP programs, just in 2009. However, total charitable giving in 2011 was nearly $300 billion. While most of this went to church programs, some amount was given to organizations such as "missions" that help the poor directly, and many churches pass on funds that come to them to support such efforts.
Government spending on about 50 "war on poverty" programs totaled more than $475 billion last year. Clearly, that hasn't resulted in America's poor living at a $30,000+ level (per family of 3). By far the greatest part of it stays in the pockets of the huge army of civil "servants" who administer and carry out the programs.
The book hardly touches on figures like this. The authors call for more spending. I'd think the focus ought to be on "right spending". I'd prefer a manifesto, a demand, for a simple criterion: that governmental organizations be required to have at least 75% efficiency. Thus, three fourths of every dollar that passes through the hands of every such agency must go directly into the pocket of a poor person, either as direct cash, or as whatever kind of "food stamp" is currently in fashion, or as some other kind of voucher to cover living expenses. But be sure to make welfare frauds such as amassing vouchers for multiple dead persons, punishable by death.
A great effort is also needed to improve education, primarily by doing away with most of the administrators and other non-teachers. In the 1950s, my grade school, with 600 students, had about 20 teachers (class size was about 30), plus a principal, an assistant principal, a secretary, and the janitorial staff. There was no cafeteria staff, as we all brought our lunches. However, in schools that had food programs for poor students, it was handled by the teachers. The grade school our son went to in the 1990s had so many "junk" administrators, that only 40% of the roster was teachers, and their rate of pay was less (adjusted for inflation) than a teacher's salary in 1955. I shudder to think what the situation is now, after another 15 years. I do know this: while a number of my son's teachers, in most years, were very good, there were also a distressing number of "bottom of the barrel", tenured fools in the classroom. We need to get rid of all the vice-assistant-this and that, and apply the money to the salary budget for teachers, and apply realistic accountability for teachers to keep their jobs.
The lowest rate of publication spending is $6,000 per student. Times 20, that is $120,000 per classroom. Suppose we paid 60% of that directly to the teacher? Do you think we could attract some higher-quality teachers? There are other significant problems with public education, but I'll leave them for a different rant.
Here is my greatest area of agreement with Smiley and West: Predatory CEO's make way too much. It seems de rigueur now for a company head to receive at least $1 million per month, and often much more, just in base salary, plus they usually get stock options that can earn them even more than their salary (and how is this not insider trading?). How much is a million a month? Of course, they don't work a 40-hour week. Many are workaholics that stay at their desks 70-80 hours. So, a typical working month might contain 325 hours. That comes to more than $3,000 per hour. Quite frankly, I don't think anybody's time is worth more than about $300-400 per hour, no matter what they do (except maybe a bomb squad guy who saves a few thousand lives—he deserves an extra large bonus). I once walked into a law office to ask about their terms. This was no hotshot agency, just a small practice of four lawyers. There was no free first consultation. The first visit would require a $3,600 retainer, and their rate was $550 per hour. I didn't even smile as I walked out. I found a lawyer who did a fine job at less than half the rate, and the first visit was free.
I used to subscribe to Utne Reader. I don't know if it is still true, but Eric Utne once wrote that they followed a company principle, that the highest paid person could make no more than seven times as much the lowest paid full time worker. I am on the board of a nonprofit organization, that pays its director about $75,000. That's plenty for a good director; it is in the top 20% of national salaries. The receptionist gets something like the mid-$20s, so the place would qualify as a "good" organization by the Utne rule even if the director were paid twice as much.
The book's title is mainly there as a provocation. The only discussion of the rich is similar to the prior two paragraphs, plus a call to prosecute the predatory bankers and congresspersons who actually caused the recent recession. This shows that politics don't matter to a President, only money matters. Both Mr. Bush and Mr. Obama have protected the guilty at every turn.
A lot is made these days about "choice", whether related to abortion ("it's a choice that must be protected") or homosexuality ("it isn't a choice, it is genetic, and must be protected"), or another half dozen areas. More and more of us must realize that poverty is not a choice (except for a few ascetics). The Bible uses the words "oppress", "oppressed" and "oppression" more than 120 times, most frequently in the sense of a rich person taking advantage of a poor person. This is something God particularly hates. This is the core of the problem that Smiley and West are discussing. We have a system that protects the oppressors and oppresses their victims. They suggest 12 points to deal with this. You and I know that none of the 12 points has a breath of a chance of passing Congress or being signed by any President, of whatever party. It will take a renewed civil rights movement to, at the very least, force governments to allow people to escape the direst forms of such oppression, such as by re-occupying foreclosed dwellings that are left vacant by the banks. I just don't know whether such a renewed movement can go forward with as little violence (on the part of the protesters) as was seen 40-50 years ago.
Jesus told his disciples, "The poor you will always have with you" (Matt. 26:11 and Mark 14:7), and some think this means God favors some amount of poverty. Instead, we must understand that this phrase expresses God's sad understanding of human nature. It is not to be taken as a prophecy that must be fulfilled. The Old Testament contains frequent admonitions to relieve the poor, and specific provisions for their debts to be forgiven, such as the Sabbatical Year and the Jubilee. In the New Testament we find that, when Judas went out to betray Jesus, the other apostles thought he might be going to give alms, and this tells us that Jesus would send Judas (the group treasurer) to do so from time to time.
Today, what do we find? In the richest nation on Earth (for the present), poverty continues to increase, not just in number, but in proportion. This in spite of the famed "war on poverty" launched by President Johnson nearly 50 years ago. Poverty, as defined by the government, had been decreasing already in the mid 1960s; it had been over 18% (8 million) of families in 1962, and continued to a low of 8.7% (4.8 million) families in 1973. After some gradual swings up and down, the figure currently stands at 11.8% (9.5 million) families. There is a defined threshold for each family size; for a family of 3, it is about $18,000 yearly. Folks, that isn't much!
Curiously, in Washington, DC public schools, spending per student is nearly $19,000, yet the education received is better in "mid-continent" schools (in the Central time zone), where yearly spending is $6,000-9,000. Hang onto this thought.
A few years ago, two prominent liberal activists, Tavis Smiley and Cornel West, launched "The Poverty Tour: A Call to Conscience", a bus tour of 18 cities in 8 states. They write of their experiences and findings in The Rich and the Rest of Us: A Poverty Manifesto. The recession of the past four years has pushed many in the middle class toward the poverty threshold, without necessarily taking them right across it. By grouping the near-poor with those defined as poor, the authors can state that the numbers of struggling Americans is 150 million, "the greatest number in five decades".
After presenting a "Portrait of Poverty", which focuses on poverty as a fact (the lack of sufficient money, and nothing more) the authors present five aspects of poverty: Opportunity, Affirmation, Courage, Compassion, and Imagination (or, in particular, the lacks thereof). Poverty of Affirmation is a particularly insidious difficulty. The (still) well-off have a nearly overwhelming tendency to think that the poor "deserve it". However, one's politics affect this outlook. People with a more liberal attitude expect government to solve problems, and have low rates of charitable donation. People with a more conservative attitude do not expect government to help in a sufficient or useful way, so they give on average four times as much to charity as liberals.
Let's back up to some of the figures above. What would it cost to raise the effective income of those families below the poverty line to, say, $30,000? With no knowledge of the income distribution, I can guess that it doesn't exceed $10,000 on average, for those 9.5 million families. So that is $20,000 times 9.5 million. That comes to $190 billion. Then, for those above the line, but making less than $30,000, we can roughly estimate another 50% added, for a total of about $285 billion. That is substantial, but it is one-third of the money wasted on the TARP programs, just in 2009. However, total charitable giving in 2011 was nearly $300 billion. While most of this went to church programs, some amount was given to organizations such as "missions" that help the poor directly, and many churches pass on funds that come to them to support such efforts.
Government spending on about 50 "war on poverty" programs totaled more than $475 billion last year. Clearly, that hasn't resulted in America's poor living at a $30,000+ level (per family of 3). By far the greatest part of it stays in the pockets of the huge army of civil "servants" who administer and carry out the programs.
The book hardly touches on figures like this. The authors call for more spending. I'd think the focus ought to be on "right spending". I'd prefer a manifesto, a demand, for a simple criterion: that governmental organizations be required to have at least 75% efficiency. Thus, three fourths of every dollar that passes through the hands of every such agency must go directly into the pocket of a poor person, either as direct cash, or as whatever kind of "food stamp" is currently in fashion, or as some other kind of voucher to cover living expenses. But be sure to make welfare frauds such as amassing vouchers for multiple dead persons, punishable by death.
A great effort is also needed to improve education, primarily by doing away with most of the administrators and other non-teachers. In the 1950s, my grade school, with 600 students, had about 20 teachers (class size was about 30), plus a principal, an assistant principal, a secretary, and the janitorial staff. There was no cafeteria staff, as we all brought our lunches. However, in schools that had food programs for poor students, it was handled by the teachers. The grade school our son went to in the 1990s had so many "junk" administrators, that only 40% of the roster was teachers, and their rate of pay was less (adjusted for inflation) than a teacher's salary in 1955. I shudder to think what the situation is now, after another 15 years. I do know this: while a number of my son's teachers, in most years, were very good, there were also a distressing number of "bottom of the barrel", tenured fools in the classroom. We need to get rid of all the vice-assistant-this and that, and apply the money to the salary budget for teachers, and apply realistic accountability for teachers to keep their jobs.
The lowest rate of publication spending is $6,000 per student. Times 20, that is $120,000 per classroom. Suppose we paid 60% of that directly to the teacher? Do you think we could attract some higher-quality teachers? There are other significant problems with public education, but I'll leave them for a different rant.
Here is my greatest area of agreement with Smiley and West: Predatory CEO's make way too much. It seems de rigueur now for a company head to receive at least $1 million per month, and often much more, just in base salary, plus they usually get stock options that can earn them even more than their salary (and how is this not insider trading?). How much is a million a month? Of course, they don't work a 40-hour week. Many are workaholics that stay at their desks 70-80 hours. So, a typical working month might contain 325 hours. That comes to more than $3,000 per hour. Quite frankly, I don't think anybody's time is worth more than about $300-400 per hour, no matter what they do (except maybe a bomb squad guy who saves a few thousand lives—he deserves an extra large bonus). I once walked into a law office to ask about their terms. This was no hotshot agency, just a small practice of four lawyers. There was no free first consultation. The first visit would require a $3,600 retainer, and their rate was $550 per hour. I didn't even smile as I walked out. I found a lawyer who did a fine job at less than half the rate, and the first visit was free.
I used to subscribe to Utne Reader. I don't know if it is still true, but Eric Utne once wrote that they followed a company principle, that the highest paid person could make no more than seven times as much the lowest paid full time worker. I am on the board of a nonprofit organization, that pays its director about $75,000. That's plenty for a good director; it is in the top 20% of national salaries. The receptionist gets something like the mid-$20s, so the place would qualify as a "good" organization by the Utne rule even if the director were paid twice as much.
The book's title is mainly there as a provocation. The only discussion of the rich is similar to the prior two paragraphs, plus a call to prosecute the predatory bankers and congresspersons who actually caused the recent recession. This shows that politics don't matter to a President, only money matters. Both Mr. Bush and Mr. Obama have protected the guilty at every turn.
A lot is made these days about "choice", whether related to abortion ("it's a choice that must be protected") or homosexuality ("it isn't a choice, it is genetic, and must be protected"), or another half dozen areas. More and more of us must realize that poverty is not a choice (except for a few ascetics). The Bible uses the words "oppress", "oppressed" and "oppression" more than 120 times, most frequently in the sense of a rich person taking advantage of a poor person. This is something God particularly hates. This is the core of the problem that Smiley and West are discussing. We have a system that protects the oppressors and oppresses their victims. They suggest 12 points to deal with this. You and I know that none of the 12 points has a breath of a chance of passing Congress or being signed by any President, of whatever party. It will take a renewed civil rights movement to, at the very least, force governments to allow people to escape the direst forms of such oppression, such as by re-occupying foreclosed dwellings that are left vacant by the banks. I just don't know whether such a renewed movement can go forward with as little violence (on the part of the protesters) as was seen 40-50 years ago.
Thursday, October 25, 2012
Piercing the (medical) gloom
kw: book reviews, nonfiction, medicine, policy
I have read at least a dozen books about the medical profession in the last several years, all warning about various risks or decrying doctors' greed or incompetence. At last, a physician has taken up the cudgels from the other side to argue that medicine in the United States is not nearly so bad as all that. The book is In Excellent Health: Setting the Record Straight on America's Health Care by Scott W. Atlas, MD.
Dr. Atlas is a member of the Hoover Institution's Working Group on Health Care Policy. He aims to overcome certain myths about the quality of medical care in America, and to propose appropriate policy, particularly with a better and less intrusive focus as compared to the Patient Protection and Affordable Care Act (PPACA), popularly known as Obamacare. (My own view: The PPACA should be called Less Patient Protection with Barely Affordable Care, and I am being generous. In contrast to most legislators, I have read major portions of it).
An opening caveat: This is a fact-filled book, meaning it is dense reading, with 44 pages of endnotes. In spite of that, I found it well worth paying attention. Of the book's seven chapters, the first six deal with six myths or misconceptions that the author wishes to correct. The seventh chapter presents his policy suggestions.
The first chapter tackles the World Health Report 2000, by WHO, that ranked nearly 200 nations' medical systems. America's showing was reported to be rather dismal. The report has been discredited time and again ever since, yet it is still treated by many as gospel truth, and is the basis for most of the arguments put forward as the "need" for passing the PPACA. Of a great many weaknesses in the WHO report, the most singular is that the yardsticks used to measure each nation's performance varied from nation to nation. In many cases, there was so little data that a particular "metric" was simply someone's estimate.
In the following five chapters, Dr. Atlas has picked apart the ways that medical metrics are determined, particularly life expectancy, infant mortality, overall quality, ease of access, and specialty care. Consider "overall quality". This is so complex, we need a way to brush aside the clutter. Just ask, when rich and powerful people leave their country to get medical care, which country are they most likely to go to? It's funny, I have never heard of foreign officials traveling to Canada or Norway for a heart transplant or cancer treatment.
In certain ways, America is different from other countries, in ways that underlie the seemingly poor statistics gathered for the WHO report. First and foremost, this country has unequaled diversity. Look beyond the WASP image; The U.S. has large contingents of African Americans and Latinos, of all kinds of Asians (where I work I am outnumbered by Chinese and Indians), and of Native Americans. Secondly, as a very prosperous nation, in spite of a temporarily faltering economy, there are lifestyle issues here that play a great role in our overall health. Just as being too poor can take years off your life, so can being too rich. Although the rich can afford the best of the best medical care, too many are like Diamond Jim Brady, who ate himself to death at the age of 61. What other country needs a TV show like Extreme Makeover: Weight Loss Edition?
Our very prosperity has thus pushed us "over the top" of the health curve as measured from both ends of life. So-called Life Expectancy is impacted by more than just the quality of medical care. It strongly depends on overweight or obesity, on diabetes, and on other risky behavior such as the use of recreational drugs. And the attitude of doing something just because we can has led to American doctors turning millions of miscarriages into "live births", of infants that weigh a pound or less (.45 kilo), even though 70% or more die within a few days. In most nations, they don't even try to "save" infants under two kilos (4.4 lbs). So if you measure infant mortality for each cohort by weight, the American rate of infant death is better than everybody else's for each weight class, and in the lower weights, so few even try that it is little use making the comparison. Then as to life expectancy, if the ranking is done, not starting on day one (even for a 9-oz, or .34 kilo, baby), but from age one month, the U.S. is nearly at the top. A very few nations, such as Japan, would still rank higher, because Japan is so homogeneous; they don't have any enthnicities that tend to have shorter lives, but we have plenty. And on the matter of "access"? Whatever you need, you can get quicker here, hands down, compared to every country with a "centralized" system.
Dr. Atlas contends that the PPACA is misdirected, and in its place, has three recommendations: new tax policies that are really helpful where they are needed most (the opposite is now true); keeping the government out of the health insurance business (in contrast to PPACA which will gradually make the government the only game in town); and something similar to the labeling requirements for food, forcing transparency of price and quality.
I will close by summarizing the book's 5-point critique of the PPACA:
I have read at least a dozen books about the medical profession in the last several years, all warning about various risks or decrying doctors' greed or incompetence. At last, a physician has taken up the cudgels from the other side to argue that medicine in the United States is not nearly so bad as all that. The book is In Excellent Health: Setting the Record Straight on America's Health Care by Scott W. Atlas, MD.
Dr. Atlas is a member of the Hoover Institution's Working Group on Health Care Policy. He aims to overcome certain myths about the quality of medical care in America, and to propose appropriate policy, particularly with a better and less intrusive focus as compared to the Patient Protection and Affordable Care Act (PPACA), popularly known as Obamacare. (My own view: The PPACA should be called Less Patient Protection with Barely Affordable Care, and I am being generous. In contrast to most legislators, I have read major portions of it).
An opening caveat: This is a fact-filled book, meaning it is dense reading, with 44 pages of endnotes. In spite of that, I found it well worth paying attention. Of the book's seven chapters, the first six deal with six myths or misconceptions that the author wishes to correct. The seventh chapter presents his policy suggestions.
The first chapter tackles the World Health Report 2000, by WHO, that ranked nearly 200 nations' medical systems. America's showing was reported to be rather dismal. The report has been discredited time and again ever since, yet it is still treated by many as gospel truth, and is the basis for most of the arguments put forward as the "need" for passing the PPACA. Of a great many weaknesses in the WHO report, the most singular is that the yardsticks used to measure each nation's performance varied from nation to nation. In many cases, there was so little data that a particular "metric" was simply someone's estimate.
In the following five chapters, Dr. Atlas has picked apart the ways that medical metrics are determined, particularly life expectancy, infant mortality, overall quality, ease of access, and specialty care. Consider "overall quality". This is so complex, we need a way to brush aside the clutter. Just ask, when rich and powerful people leave their country to get medical care, which country are they most likely to go to? It's funny, I have never heard of foreign officials traveling to Canada or Norway for a heart transplant or cancer treatment.
In certain ways, America is different from other countries, in ways that underlie the seemingly poor statistics gathered for the WHO report. First and foremost, this country has unequaled diversity. Look beyond the WASP image; The U.S. has large contingents of African Americans and Latinos, of all kinds of Asians (where I work I am outnumbered by Chinese and Indians), and of Native Americans. Secondly, as a very prosperous nation, in spite of a temporarily faltering economy, there are lifestyle issues here that play a great role in our overall health. Just as being too poor can take years off your life, so can being too rich. Although the rich can afford the best of the best medical care, too many are like Diamond Jim Brady, who ate himself to death at the age of 61. What other country needs a TV show like Extreme Makeover: Weight Loss Edition?
Our very prosperity has thus pushed us "over the top" of the health curve as measured from both ends of life. So-called Life Expectancy is impacted by more than just the quality of medical care. It strongly depends on overweight or obesity, on diabetes, and on other risky behavior such as the use of recreational drugs. And the attitude of doing something just because we can has led to American doctors turning millions of miscarriages into "live births", of infants that weigh a pound or less (.45 kilo), even though 70% or more die within a few days. In most nations, they don't even try to "save" infants under two kilos (4.4 lbs). So if you measure infant mortality for each cohort by weight, the American rate of infant death is better than everybody else's for each weight class, and in the lower weights, so few even try that it is little use making the comparison. Then as to life expectancy, if the ranking is done, not starting on day one (even for a 9-oz, or .34 kilo, baby), but from age one month, the U.S. is nearly at the top. A very few nations, such as Japan, would still rank higher, because Japan is so homogeneous; they don't have any enthnicities that tend to have shorter lives, but we have plenty. And on the matter of "access"? Whatever you need, you can get quicker here, hands down, compared to every country with a "centralized" system.
Dr. Atlas contends that the PPACA is misdirected, and in its place, has three recommendations: new tax policies that are really helpful where they are needed most (the opposite is now true); keeping the government out of the health insurance business (in contrast to PPACA which will gradually make the government the only game in town); and something similar to the labeling requirements for food, forcing transparency of price and quality.
I will close by summarizing the book's 5-point critique of the PPACA:
- It imposes centralized controls that resemble those in nations that are, even now, trying to privatize controls so as to increase competition, shorten access times, and reduce costs;
- It would increase the number on Medicaid by about 25%, breaking the back of a system that is already failing;
- It sets up "exchanges" that restrict plans and require coverages that most don't need, adding unneeded expense;
- It increases taxes on technological innovation, just as we are on the verge of breakthroughs in molecular biology converging with medicine;
- It greatly reduces funding for specialist care, expecting your family doctor to be your cardiologist, urologist, etc., unless you want to wait months or years to see the specialist.
Saturday, August 25, 2012
In from the cold - he beat the odds
kw: book reviews, nonfiction, autobiographies, espionage, policy
Sometimes I get a book so far beyond my experience, the author may as well be another species. Such a book is The Art of Intelligence: Lessons From a Life in the CIA's Clandestine Service, by Henry A. Crumpton. You may have read Bob Woodward's book about the first year of the war in Afghanistan, Bush at War. Did you wonder, who was Hank? Wonder no longer. It was Hank Crumpton.
During the first months of the war, the Taliban were routed and many al Qaeda (AQ) fighters killed or driven into hiding. As Woodward wrote and Crumpton confirms, this was largely due to a coordination among the CIA, U.S. Special Forces, and Afghan tribal leaders, well before any American (and Coalition) troops were on the ground. Hank directed this phase of the war. About a third of the book's text covers the war in Afghanistan, but there was a lot that led up to it. I must admit, much was beyond my comprehension. I am a techie, a "geek", and I'm still learning human relations. I do think, however, that I caught a most important fact: The early success (which was not repeated in Iraq) was due to human relations, that led to a vast flow of intelligence that was intelligently used to provide air cover and logistical help and some amount of practical aid for the Afghan ground fighters.
Well, a lot did lead up to this, both in world affairs and in Hank's life. He obtained entry to the CIA and to the Clandestine Service at quite a young age, and did well. He became a productive recruiter of "unilateral resources", foreign nationals who worked with the CIA (this is in concert with Liaison, which is more of a 2-way street). Hank spent years in Africa, and he and his wife raised a family there. When the slow churning of the Federal mind (such as it is) realized that terrorism was becoming a real threat, Hank got the opportunity to work in counterterrorism. This led, in a few years, directly to his being asked to direct the opening phases of the war against AQ and the Taliban in Afghanistan.
After the first year, the war fell into the possession of the professional military. A ground war began, that is still going on, and proceeding slowly if at all. Hank makes the point repeatedly, that the three presidents who best understood the value of intelligence were George Washington (a spymaster supreme), Abraham Lincoln, and George H.W. Bush (former head of the CIA). Presidents Bush, Jr, and Obama both started their terms mostly ignorant of intelligence, but grew to rely on it.
After Afghanistan, Hank worked in National Resources (NR), that arm of the CIA that works on American soil. Few folks realize they are even there. Their task is focused on international policy, not on spying on U.S. nationals, but they use in-country resources, such as business leaders and visiting foreigners, as sources and resources.
One result of the counterterrorism work is friction with the FBI, which treats terror crimes as law enforcement targets, rather than as acts of war (It seems many in civilian government still do not realize that World War III began in 1992, or perhaps earlier. I place it on that date because it is the first bombing of the World Trade Center by AQ). War is different than it was in Roman times, or in 1864, or 1912, or even 1944. The war in Vietnam was our first failure to recognize the value of guerrilla tactics. By the time American forces figured this out and began to get the upper hand, national leaders had lost the political will to win, and pulled out. The later years in Afghanistan, and the entire Iraq adventure, shows most of the Pentagon brass still doesn't get it.
I really have to digress here. A comedian in about 1970 said, "I heard it costs us $150,000 per VC (Viet Cong) fighter we kill. We can buy them off cheaper than that!" The "after-war" in Afghanistan has cost a trillion dollars or so, all consumed by an army that is in the business of blowing things up and killing people. we could have spend 80% of that on infrastructure for the country and jump-started them as a modern nation. The same goes for Iraq. We had won within the first year. Spending the next trillion dollars on rebuilding and modernizing their infrastructure would have gained us a reliable ally. Instead, we have bungled both wars and made a growing roster of enemies as a result.
I hope Hank's successors in Clandestine Services, and in Counterterrorism, and in NR, are doing a good job, as well as he did or better. It is only a matter of time until the next 9/11. Someone will slip through again, because you can't watch everywhere or everybody. The Dept. of Homeland Security needs to recruit us patriotic and loyal citizens as deputies, in a much, much more productive and definite way than having a few signs around that whiningly beg us to report "suspicious activity". We need a National Neighborhood Watch; dare I dub it NNW?
OK, off soap box. Although I didn't understand all he wrote, I really enjoyed Hank's stories. I have two relatives who were spies. One is dead, the other doesn't talk about his service. They were not CIA (not that I know of!). But the essence of such work is human relations. It is like computer hacking; as Kevin Mitnick wrote in Ghost in the Wires, his primary weapon was gaining the confidence of someone who could grant him access to systems he really shouldn't have been getting into. He is a brilliant programmer, no doubt, but it is his human skills that led to his being called the world's most dangerous hacker. So with Hank Crumpton. He didn't need to be a gun-toting gadget-happy James Bond or Matt Helm. He just needed to be a good drinking buddy. He just happens to be a drinking buddy with a razor sharp mind and a prodigious memory. A good writer, too.
Sometimes I get a book so far beyond my experience, the author may as well be another species. Such a book is The Art of Intelligence: Lessons From a Life in the CIA's Clandestine Service, by Henry A. Crumpton. You may have read Bob Woodward's book about the first year of the war in Afghanistan, Bush at War. Did you wonder, who was Hank? Wonder no longer. It was Hank Crumpton.
During the first months of the war, the Taliban were routed and many al Qaeda (AQ) fighters killed or driven into hiding. As Woodward wrote and Crumpton confirms, this was largely due to a coordination among the CIA, U.S. Special Forces, and Afghan tribal leaders, well before any American (and Coalition) troops were on the ground. Hank directed this phase of the war. About a third of the book's text covers the war in Afghanistan, but there was a lot that led up to it. I must admit, much was beyond my comprehension. I am a techie, a "geek", and I'm still learning human relations. I do think, however, that I caught a most important fact: The early success (which was not repeated in Iraq) was due to human relations, that led to a vast flow of intelligence that was intelligently used to provide air cover and logistical help and some amount of practical aid for the Afghan ground fighters.
Well, a lot did lead up to this, both in world affairs and in Hank's life. He obtained entry to the CIA and to the Clandestine Service at quite a young age, and did well. He became a productive recruiter of "unilateral resources", foreign nationals who worked with the CIA (this is in concert with Liaison, which is more of a 2-way street). Hank spent years in Africa, and he and his wife raised a family there. When the slow churning of the Federal mind (such as it is) realized that terrorism was becoming a real threat, Hank got the opportunity to work in counterterrorism. This led, in a few years, directly to his being asked to direct the opening phases of the war against AQ and the Taliban in Afghanistan.
After the first year, the war fell into the possession of the professional military. A ground war began, that is still going on, and proceeding slowly if at all. Hank makes the point repeatedly, that the three presidents who best understood the value of intelligence were George Washington (a spymaster supreme), Abraham Lincoln, and George H.W. Bush (former head of the CIA). Presidents Bush, Jr, and Obama both started their terms mostly ignorant of intelligence, but grew to rely on it.
After Afghanistan, Hank worked in National Resources (NR), that arm of the CIA that works on American soil. Few folks realize they are even there. Their task is focused on international policy, not on spying on U.S. nationals, but they use in-country resources, such as business leaders and visiting foreigners, as sources and resources.
One result of the counterterrorism work is friction with the FBI, which treats terror crimes as law enforcement targets, rather than as acts of war (It seems many in civilian government still do not realize that World War III began in 1992, or perhaps earlier. I place it on that date because it is the first bombing of the World Trade Center by AQ). War is different than it was in Roman times, or in 1864, or 1912, or even 1944. The war in Vietnam was our first failure to recognize the value of guerrilla tactics. By the time American forces figured this out and began to get the upper hand, national leaders had lost the political will to win, and pulled out. The later years in Afghanistan, and the entire Iraq adventure, shows most of the Pentagon brass still doesn't get it.
I really have to digress here. A comedian in about 1970 said, "I heard it costs us $150,000 per VC (Viet Cong) fighter we kill. We can buy them off cheaper than that!" The "after-war" in Afghanistan has cost a trillion dollars or so, all consumed by an army that is in the business of blowing things up and killing people. we could have spend 80% of that on infrastructure for the country and jump-started them as a modern nation. The same goes for Iraq. We had won within the first year. Spending the next trillion dollars on rebuilding and modernizing their infrastructure would have gained us a reliable ally. Instead, we have bungled both wars and made a growing roster of enemies as a result.
I hope Hank's successors in Clandestine Services, and in Counterterrorism, and in NR, are doing a good job, as well as he did or better. It is only a matter of time until the next 9/11. Someone will slip through again, because you can't watch everywhere or everybody. The Dept. of Homeland Security needs to recruit us patriotic and loyal citizens as deputies, in a much, much more productive and definite way than having a few signs around that whiningly beg us to report "suspicious activity". We need a National Neighborhood Watch; dare I dub it NNW?
OK, off soap box. Although I didn't understand all he wrote, I really enjoyed Hank's stories. I have two relatives who were spies. One is dead, the other doesn't talk about his service. They were not CIA (not that I know of!). But the essence of such work is human relations. It is like computer hacking; as Kevin Mitnick wrote in Ghost in the Wires, his primary weapon was gaining the confidence of someone who could grant him access to systems he really shouldn't have been getting into. He is a brilliant programmer, no doubt, but it is his human skills that led to his being called the world's most dangerous hacker. So with Hank Crumpton. He didn't need to be a gun-toting gadget-happy James Bond or Matt Helm. He just needed to be a good drinking buddy. He just happens to be a drinking buddy with a razor sharp mind and a prodigious memory. A good writer, too.
Tuesday, August 14, 2012
Health care - too much and too little
kw: book reviews, nonfiction, medicine, public health, policy
When I finished six months of chemotherapy in mid-2001, I remember saying to my wife, "I am glad for modern medicine. Fifty years ago I simply would have died." As it happened, I lucked out; I hit a sweet spot in the history of colon cancer treatment. Someone today who discovers a large, Dukes' stage C tumor, will probably get care as good as I had, but they will not get identical care.
For one thing, the "gold standard" for chemo has changed. I received 5FU plus Leucovorin. At about the three month point I told the oncologist that it was getting painful to clap my hands (my son was playing basketball in a YMCA league every week). He became very grave, showed me an article about "hand-foot syndrome", and decided to adjust my dosage. He said if the syndrome was not checked, I could suffer from skin sloughing off the palms of my hands and the soles of my feet, and I might also have extensive nerve damage and numbness.
The modern regimen adds oxaliplatin (a platinum-containing cancer suppression substance) to the other two. The code word for this triple play is FOLFOX. It is much more likely to cause nerve damage, but I haven't read whether it makes the hand-foot symptoms worse or better or what. This means a larger number of people do not complete their regimen. Is it better overall? That is not yet known.
Other aspects of my good luck were a totally obsessive and incredibly skilled surgeon, at least one doctor who will talk sense without lying—I still see him every 3 years for a colonoscopy—and the oncologist all local doctors agreed was the one they would use or send family members to.
Many are less fortunate, and Otis Webb Brawley, executive VP of ACS, has encountered a great many of them. Once in a while, a book simply makes me furious. This was the case with Dr. Brawley's book How We Do Harm: A Doctor Breaks Ranks About Being Sick in America. I have reviewed at least a half dozen "anti-medical establishment" books in this blog. This one is the most revealing.
The opening scene is disturbing. A woman comes into an emergency room carrying her breast in a plastic bag. She wants it reattached. It turns out to be a large lump of tumor, so this is clearly not possible. Most doctors have never seen a breast self-amputation, and I had never heard of it before. It happens when breast cancer is untreated for a long enough time: The tumor takes over the blood supply to the point that the rest of the breast dies and just falls off, tumor and all. At the Atlanta hospital called Grady, they see about two such cases per year.
Early on, this woman had health insurance. When she first found a lump in her breast, several years previously, why didn't she see a doctor? Two kinds of fear. Firstly, like many women, she feared being disfigured. But even greater was her fear of losing her job if she took off too many sick days at work. She knew that surgical treatment might cause her to lose almost a week of work, maybe the whole week. She knew that if she had follow-up chemotherapy, she would miss one or two days a week for months. She would get fired. Once the self-amputation happened, keeping her job didn't matter, as she soon died.
Note to medical establishment: Require oncologists to work evenings and weekends. Not all of your patients are conveniently retired. Not all are allowed sufficient sick leave to take off fifty days in six months' time. When I was on chemo, I'd have been delighted to have my 5-hour session start at midnight. I could have slept through it instead of watching inane daytime TV. Ditto for dialysis centers.
This woman's story, and that of a few other patients Otis (he doesn't like to be called "Doc" or "Doctor") saw at Grady, introduce us to his first subject: Under-treatment. When I first got the book, and while I was reading the early chapters, I was expecting a polemic in favor of the PPACA, usually called Obamacare. Actually, this bill is mentioned only once, late in the book, and only in reference to the provision requiring insurers to accept people with "preexisting conditions". A deeper problem he sees is that, whether someone is insured or not, many poorer people are discouraged from getting routine medical care by job restrictions or a bullying culture at work. As a result, they only get "care" by visiting an emergency room, and frequently when it is too late.
The axis of the book is simple. Poor people are under-treated, and the rich and well-insured are over-treated. Both are evils. The middle of the book is about evidence-based medicine. There is precious little of it. Otis writes, "I don't know how you can practice medicine without measuring the effectiveness of the therapies you are administering." (p 166) Yet most doctors operate primarily by feel and supposition. They do what they might have seen in medical school or heard at a conference or read about in a journal, but very few take the time to dig in and find the facts behind it.
I know from my own study, and from a number of things I have read, that articles which report on clinical trials that actually tell us something useful are extremely rare. Many of those few have been gathered and summarized by the Cochrane Collaboration. It seems they have a substantial database, until you learn that there are thousands of clinical trials going on at any time, and tens of thousands that have been published, but a larger number that have not been published because they didn't prove what the company (usually a drug company) paying the bills wanted to prove, and finally that only a few percent are considered reliable enough for CC to recommend!
The over-treatment stories are, if anything, even more horrifying than those of under-treatment. One of the most disturbing is that of a 70-year-old man whom Otis calls Ralph, who was badgered by his wife into getting a PSA test. The ads for PSA testing for "prostate health" are targeted at women, pushing all their worry buttons; confirmed bachelors and unpartnered widowers almost never get screening of any kind, particularly for their prostate. Ralph's PSA measured 4.3, where "normal" is 4 or less. To many doctors, PSA in the range 4-8 means "watch and wait and check, using a finger, periodically." Ralph's doctor sent him for a biopsy, which was actually 12 painful needle sticks. Two showed low-grade cancer. Prostate cancer is typically slow and self-contained. One would think, "OK, let's check it yearly for a few years." Not Ralph's doctor. Ralph was "advised" to get the prostate removed, and eventually he did.
I won't go through the whole story of incontinence and impotence, radiation, eventually a bowel bag and a bladder bag, and death at age 77. Left alone, he had a good change of living into his 80s and dying of something else, never knowing he had cancer. I know only one man who died of prostate cancer, and he was 92. Ralph probably died early, and he sure suffered during those seven years. His death certificate doesn't mention prostate cancer, and because there is no category for iatrogenic over-zealousness, the recorded cause is septicemia.
Otis makes a good case in this chapter that the most likely reason prostate cancer "mortality" has been going down is that more prostate patients are dying of things like hormone treatments and other complications of over-treatment.
The USPSTF is one (so far) entirely honest reporter of well-analyzed clinical and epidemiological data. They do not recommend PSA testing for anyone, any time. The PSA level is very poorly correlated with cancer incidence or severity. It misses half the cancers. The more aggressive tumors get found by finger probing or by symptoms like having a hard time urinating anyway, so PSA is medically useless. It is, however, very useful fattening the wallets of quite a range of medical specialties, not to mention the makers of Depend® undergarments. A single PSA blood test costs between $70 and $240. The annual cost of roughly 20 million of these unnecessary tests is $3 billion, mostly from Medicare. The follow-up treatments, also mostly unneeded, cost billions more. No wonder there is a huge lobby working against setting standards for establishing risk before recommending PSA testing.
That is just one example. Not all screenings are bogus. Colonoscopy, for example, is the one way to prove whether or not you have a polyp or a tumor in the colon. When a polyp is found, a quick snip on the spot will prevent a possible cancer. When a tumor is found, a life may be saved, as mine was. Mammography is also worthwhile for older women. There is a recent flap over whether women 40-49 ought to have a mammograph. I think of it this way. The benefit is very small in this age range, and ten years less radiation exposure means fewer 70-year-old women would develop cancer from the radiation. Mammography is less definitive than colonoscopy, but it is a great deal more useful than a PSA blood test.
The closing chapter is a call to all of us to use our minds, to question our doctors. We all need to ask, "How can we know that (this dangerous condition) exists?"; KNOW, not just suppose. And to ask, "Supposing it exists, what are the effective treatment options?"; EFFECTIVE, not "sounds like a good idea" or "what my grandfather's doctor did". And to ask, "Are you afraid to say 'I don't know' when you don't know?" If the doctor hesitates, you probably have the wrong doctor.
On p 280: "The system is not failing. It's functioning exactly as designed. It's designed to run up health-care costs." In America in 2009, $2.53 trillion changed hands for medical "care". We only spend $1 trillion on food! It really ought to be the other way around: pay a bit more for better food, and a bit for a gym membership, and less for medical intervention. Otis's final call to us: Demand a health care system that can prove it, and when it can't, say "Enough!"
When I finished six months of chemotherapy in mid-2001, I remember saying to my wife, "I am glad for modern medicine. Fifty years ago I simply would have died." As it happened, I lucked out; I hit a sweet spot in the history of colon cancer treatment. Someone today who discovers a large, Dukes' stage C tumor, will probably get care as good as I had, but they will not get identical care.
For one thing, the "gold standard" for chemo has changed. I received 5FU plus Leucovorin. At about the three month point I told the oncologist that it was getting painful to clap my hands (my son was playing basketball in a YMCA league every week). He became very grave, showed me an article about "hand-foot syndrome", and decided to adjust my dosage. He said if the syndrome was not checked, I could suffer from skin sloughing off the palms of my hands and the soles of my feet, and I might also have extensive nerve damage and numbness.
The modern regimen adds oxaliplatin (a platinum-containing cancer suppression substance) to the other two. The code word for this triple play is FOLFOX. It is much more likely to cause nerve damage, but I haven't read whether it makes the hand-foot symptoms worse or better or what. This means a larger number of people do not complete their regimen. Is it better overall? That is not yet known.
Other aspects of my good luck were a totally obsessive and incredibly skilled surgeon, at least one doctor who will talk sense without lying—I still see him every 3 years for a colonoscopy—and the oncologist all local doctors agreed was the one they would use or send family members to.
Many are less fortunate, and Otis Webb Brawley, executive VP of ACS, has encountered a great many of them. Once in a while, a book simply makes me furious. This was the case with Dr. Brawley's book How We Do Harm: A Doctor Breaks Ranks About Being Sick in America. I have reviewed at least a half dozen "anti-medical establishment" books in this blog. This one is the most revealing.
The opening scene is disturbing. A woman comes into an emergency room carrying her breast in a plastic bag. She wants it reattached. It turns out to be a large lump of tumor, so this is clearly not possible. Most doctors have never seen a breast self-amputation, and I had never heard of it before. It happens when breast cancer is untreated for a long enough time: The tumor takes over the blood supply to the point that the rest of the breast dies and just falls off, tumor and all. At the Atlanta hospital called Grady, they see about two such cases per year.
Early on, this woman had health insurance. When she first found a lump in her breast, several years previously, why didn't she see a doctor? Two kinds of fear. Firstly, like many women, she feared being disfigured. But even greater was her fear of losing her job if she took off too many sick days at work. She knew that surgical treatment might cause her to lose almost a week of work, maybe the whole week. She knew that if she had follow-up chemotherapy, she would miss one or two days a week for months. She would get fired. Once the self-amputation happened, keeping her job didn't matter, as she soon died.
Note to medical establishment: Require oncologists to work evenings and weekends. Not all of your patients are conveniently retired. Not all are allowed sufficient sick leave to take off fifty days in six months' time. When I was on chemo, I'd have been delighted to have my 5-hour session start at midnight. I could have slept through it instead of watching inane daytime TV. Ditto for dialysis centers.
This woman's story, and that of a few other patients Otis (he doesn't like to be called "Doc" or "Doctor") saw at Grady, introduce us to his first subject: Under-treatment. When I first got the book, and while I was reading the early chapters, I was expecting a polemic in favor of the PPACA, usually called Obamacare. Actually, this bill is mentioned only once, late in the book, and only in reference to the provision requiring insurers to accept people with "preexisting conditions". A deeper problem he sees is that, whether someone is insured or not, many poorer people are discouraged from getting routine medical care by job restrictions or a bullying culture at work. As a result, they only get "care" by visiting an emergency room, and frequently when it is too late.
The axis of the book is simple. Poor people are under-treated, and the rich and well-insured are over-treated. Both are evils. The middle of the book is about evidence-based medicine. There is precious little of it. Otis writes, "I don't know how you can practice medicine without measuring the effectiveness of the therapies you are administering." (p 166) Yet most doctors operate primarily by feel and supposition. They do what they might have seen in medical school or heard at a conference or read about in a journal, but very few take the time to dig in and find the facts behind it.
I know from my own study, and from a number of things I have read, that articles which report on clinical trials that actually tell us something useful are extremely rare. Many of those few have been gathered and summarized by the Cochrane Collaboration. It seems they have a substantial database, until you learn that there are thousands of clinical trials going on at any time, and tens of thousands that have been published, but a larger number that have not been published because they didn't prove what the company (usually a drug company) paying the bills wanted to prove, and finally that only a few percent are considered reliable enough for CC to recommend!
The over-treatment stories are, if anything, even more horrifying than those of under-treatment. One of the most disturbing is that of a 70-year-old man whom Otis calls Ralph, who was badgered by his wife into getting a PSA test. The ads for PSA testing for "prostate health" are targeted at women, pushing all their worry buttons; confirmed bachelors and unpartnered widowers almost never get screening of any kind, particularly for their prostate. Ralph's PSA measured 4.3, where "normal" is 4 or less. To many doctors, PSA in the range 4-8 means "watch and wait and check, using a finger, periodically." Ralph's doctor sent him for a biopsy, which was actually 12 painful needle sticks. Two showed low-grade cancer. Prostate cancer is typically slow and self-contained. One would think, "OK, let's check it yearly for a few years." Not Ralph's doctor. Ralph was "advised" to get the prostate removed, and eventually he did.
I won't go through the whole story of incontinence and impotence, radiation, eventually a bowel bag and a bladder bag, and death at age 77. Left alone, he had a good change of living into his 80s and dying of something else, never knowing he had cancer. I know only one man who died of prostate cancer, and he was 92. Ralph probably died early, and he sure suffered during those seven years. His death certificate doesn't mention prostate cancer, and because there is no category for iatrogenic over-zealousness, the recorded cause is septicemia.
Otis makes a good case in this chapter that the most likely reason prostate cancer "mortality" has been going down is that more prostate patients are dying of things like hormone treatments and other complications of over-treatment.
The USPSTF is one (so far) entirely honest reporter of well-analyzed clinical and epidemiological data. They do not recommend PSA testing for anyone, any time. The PSA level is very poorly correlated with cancer incidence or severity. It misses half the cancers. The more aggressive tumors get found by finger probing or by symptoms like having a hard time urinating anyway, so PSA is medically useless. It is, however, very useful fattening the wallets of quite a range of medical specialties, not to mention the makers of Depend® undergarments. A single PSA blood test costs between $70 and $240. The annual cost of roughly 20 million of these unnecessary tests is $3 billion, mostly from Medicare. The follow-up treatments, also mostly unneeded, cost billions more. No wonder there is a huge lobby working against setting standards for establishing risk before recommending PSA testing.
That is just one example. Not all screenings are bogus. Colonoscopy, for example, is the one way to prove whether or not you have a polyp or a tumor in the colon. When a polyp is found, a quick snip on the spot will prevent a possible cancer. When a tumor is found, a life may be saved, as mine was. Mammography is also worthwhile for older women. There is a recent flap over whether women 40-49 ought to have a mammograph. I think of it this way. The benefit is very small in this age range, and ten years less radiation exposure means fewer 70-year-old women would develop cancer from the radiation. Mammography is less definitive than colonoscopy, but it is a great deal more useful than a PSA blood test.
The closing chapter is a call to all of us to use our minds, to question our doctors. We all need to ask, "How can we know that (this dangerous condition) exists?"; KNOW, not just suppose. And to ask, "Supposing it exists, what are the effective treatment options?"; EFFECTIVE, not "sounds like a good idea" or "what my grandfather's doctor did". And to ask, "Are you afraid to say 'I don't know' when you don't know?" If the doctor hesitates, you probably have the wrong doctor.
On p 280: "The system is not failing. It's functioning exactly as designed. It's designed to run up health-care costs." In America in 2009, $2.53 trillion changed hands for medical "care". We only spend $1 trillion on food! It really ought to be the other way around: pay a bit more for better food, and a bit for a gym membership, and less for medical intervention. Otis's final call to us: Demand a health care system that can prove it, and when it can't, say "Enough!"
Friday, August 03, 2012
Do high or low taxes work better?
kw: policy, income taxes, analysis
In a recent campaign advertisement, President Obama states that Mitt Romney wants to lower taxes on the rich, expecting this to stimulate the economy and improve employment figures. He says, "That was tried. It didn't work then, and it won't work now."
I beg to differ, Mr. President. First of all, you are lying. Mitt Romney's proposal would indeed keep taxes for the rich from rising, while reducing taxes the most for working Americans with lower incomes. This latter fact is conveniently ignored in the campaign ad.
Look at this chart:
The dollar figures are all adjusted to 1983-4, when the Consumer Price Index was 100; it is 224 today and was about 30 in 1960. Also, these are marginal rates. In 1960 a family earning $50,000 (taxable income; actual gross may have been $60K-$75K) paid 20% on the first $30,000 ($6,000) and 22% on the rest (another $4,400) for a total of $10,400. Average tax rate was actually under 21% on taxable income, and was closer to 15% of the gross. (Actual 1960 dollars: taxable income about $6,600, income tax total $1,380)
I lived through all these years and remember them; I was thirteen in 1960. To pay down the national debt after World War II, Truman and Eisenhower really "soaked the rich". It was during the early 1960s that L. Ron Hubbard, objecting to being taxed nearly 90% (his books were making him rich), started the "church of Scientology" as a tax shield. The so-called "good life" was based on most Americans in the middle class, families earning the modern equivalent of $25K-$50K or so paid less than 20% of their gross income in taxes; also state income taxes were a lot smaller than they are today, and sales taxes seldom exceeded 3%; and corporate tax rates were lower for small business (but that's a subject for some other time).
Jack Kennedy was a conservative by today's standards. He lowered tax rates by about a tenth for most Americans, and by about one-sixth for the richest! Would any modern Democrat dare to reduce Warren Buffet's taxes by one-sixth? America prospered as a result, but not for long, because Lyndon Johnson came in with the "war on poverty", which has clearly made poverty worse instead of better. I don't have much else to say for the Johnson and Nixon presidencies. The Vietnam war drove fiscal policy, which was in a shambles throughout.
Then came Jimmy Carter. He raised taxes on most of the middle class and the near-rich, but lowered them on the richest among us (I never could figure that out). That and his other ham-handed policies led to inflation that approached 20% and the invention of the "misery index".
In two steps, Ronald Reagan, with Tip O'Neill's help, lowered taxes for nearly everybody, but raised the minimum tax from zero to 15% for the lowest tax bracket, claiming this was "fair." America evidently thought so. This led to a huge boom in the American economy, and although those years began with a rise in the national deficit, this was shrinking rapidly by 1992, and continued right through the early Clinton years. The "Clinton surplus" was largely Reagan's doing.
When Bill Clinton raised taxes in 1993, it took a few years to stop the "Reagan revolution", but by 1998 the economy was on another downturn. His legacy to "W" was the 2000 recession.
George W. Bush, in spite of two wars, was able to get taxes reduced a little in 2003. At the same time, banking regulations were loosened up, which added to the prosperity, but eventually were seen to be a mistake, because it became too easy for the greedy to manipulate, and the crash of 2008 was the result. However, 1990's-era regulations have not been reinstated, so it could happen again.
The 2003 tax bill was temporary, and will sunset at the end of this year. Members of congress are bickering over which provisions of the law to convert to permanent law. Of course, modern Democrats want to "soak the rich", but the history I have lived through shows that such policies damage the economy.
In 2011, one-tenth of American taxpayers paid 72% of the income taxes. They are already being soaked. At the same time, between 47% and 49.5% (depends whom you consult) paid no taxes, but not because there is a zero rate at the lowest marginal bracket. Rather, more subtle factors are involved:
Who will pay the most if the "Bush bonus" expires in January 2013? Everybody except the middle class! The lowermost tax rate, currently 10%, will go up to 15%. Your payroll deduction will jump by half, if you are making less than about $20,000. Then those with taxable income between $69,000 and nearly $140,000 will see a rise from 25% to 28% (about one-eighth), those from $140,000 to $212,000 will see a rise from 28% to 31% (about one-ninth), and the richest will see a rise to as high as 39.6% (about one-seventh).
Many say of those in the top brackets, "So what? They can afford it." The people in the top brackets, those paying 25% and up, are already paying three-fourths of all income taxes. Do you want them to pay 100%? Where is your self respect? Can your conscience allow you to accept services for which you have paid nothing? If so, you must be a true liberal.
Think over the points in this post. The President has lied and misled the public with these campaign ads. "Trickle down economics" has worked several times in the past. Mitt Romney is proposing that we let it work again. President Obama has increased the national debt by $4 trillion in three years. The recession is not over, and unemployment remains over 8% officially, but is actually 15% when you count those who no longer qualify for unemployment insurance payments, but still aren't working. Can we afford five more such years?
In a recent campaign advertisement, President Obama states that Mitt Romney wants to lower taxes on the rich, expecting this to stimulate the economy and improve employment figures. He says, "That was tried. It didn't work then, and it won't work now."
I beg to differ, Mr. President. First of all, you are lying. Mitt Romney's proposal would indeed keep taxes for the rich from rising, while reducing taxes the most for working Americans with lower incomes. This latter fact is conveniently ignored in the campaign ad.
Look at this chart:
The dollar figures are all adjusted to 1983-4, when the Consumer Price Index was 100; it is 224 today and was about 30 in 1960. Also, these are marginal rates. In 1960 a family earning $50,000 (taxable income; actual gross may have been $60K-$75K) paid 20% on the first $30,000 ($6,000) and 22% on the rest (another $4,400) for a total of $10,400. Average tax rate was actually under 21% on taxable income, and was closer to 15% of the gross. (Actual 1960 dollars: taxable income about $6,600, income tax total $1,380)
I lived through all these years and remember them; I was thirteen in 1960. To pay down the national debt after World War II, Truman and Eisenhower really "soaked the rich". It was during the early 1960s that L. Ron Hubbard, objecting to being taxed nearly 90% (his books were making him rich), started the "church of Scientology" as a tax shield. The so-called "good life" was based on most Americans in the middle class, families earning the modern equivalent of $25K-$50K or so paid less than 20% of their gross income in taxes; also state income taxes were a lot smaller than they are today, and sales taxes seldom exceeded 3%; and corporate tax rates were lower for small business (but that's a subject for some other time).
Jack Kennedy was a conservative by today's standards. He lowered tax rates by about a tenth for most Americans, and by about one-sixth for the richest! Would any modern Democrat dare to reduce Warren Buffet's taxes by one-sixth? America prospered as a result, but not for long, because Lyndon Johnson came in with the "war on poverty", which has clearly made poverty worse instead of better. I don't have much else to say for the Johnson and Nixon presidencies. The Vietnam war drove fiscal policy, which was in a shambles throughout.
Then came Jimmy Carter. He raised taxes on most of the middle class and the near-rich, but lowered them on the richest among us (I never could figure that out). That and his other ham-handed policies led to inflation that approached 20% and the invention of the "misery index".
In two steps, Ronald Reagan, with Tip O'Neill's help, lowered taxes for nearly everybody, but raised the minimum tax from zero to 15% for the lowest tax bracket, claiming this was "fair." America evidently thought so. This led to a huge boom in the American economy, and although those years began with a rise in the national deficit, this was shrinking rapidly by 1992, and continued right through the early Clinton years. The "Clinton surplus" was largely Reagan's doing.
When Bill Clinton raised taxes in 1993, it took a few years to stop the "Reagan revolution", but by 1998 the economy was on another downturn. His legacy to "W" was the 2000 recession.
George W. Bush, in spite of two wars, was able to get taxes reduced a little in 2003. At the same time, banking regulations were loosened up, which added to the prosperity, but eventually were seen to be a mistake, because it became too easy for the greedy to manipulate, and the crash of 2008 was the result. However, 1990's-era regulations have not been reinstated, so it could happen again.
The 2003 tax bill was temporary, and will sunset at the end of this year. Members of congress are bickering over which provisions of the law to convert to permanent law. Of course, modern Democrats want to "soak the rich", but the history I have lived through shows that such policies damage the economy.
In 2011, one-tenth of American taxpayers paid 72% of the income taxes. They are already being soaked. At the same time, between 47% and 49.5% (depends whom you consult) paid no taxes, but not because there is a zero rate at the lowest marginal bracket. Rather, more subtle factors are involved:
- The EITC (Earned Income Tax Credit), which began in 1975 under Johnson; part of the War on Poverty. For a family of 4 with taxable income of $17,000, this amounts to nearly $5,900, "credited" against a much smaller tax bill (a few hundred), so such families are actually paying a negative tax. The EITC phases out at $45,000, for a 4-person household.
- The Standard Deduction, begun in 1944. It is presently $11,900 for a married couple.
- Personal and Dependent Exemptions. It was $3,800 in 2011, so $15,200 for a family of four. Exemptions are deducted after AGI is calculated.
Who will pay the most if the "Bush bonus" expires in January 2013? Everybody except the middle class! The lowermost tax rate, currently 10%, will go up to 15%. Your payroll deduction will jump by half, if you are making less than about $20,000. Then those with taxable income between $69,000 and nearly $140,000 will see a rise from 25% to 28% (about one-eighth), those from $140,000 to $212,000 will see a rise from 28% to 31% (about one-ninth), and the richest will see a rise to as high as 39.6% (about one-seventh).
Many say of those in the top brackets, "So what? They can afford it." The people in the top brackets, those paying 25% and up, are already paying three-fourths of all income taxes. Do you want them to pay 100%? Where is your self respect? Can your conscience allow you to accept services for which you have paid nothing? If so, you must be a true liberal.
Think over the points in this post. The President has lied and misled the public with these campaign ads. "Trickle down economics" has worked several times in the past. Mitt Romney is proposing that we let it work again. President Obama has increased the national debt by $4 trillion in three years. The recession is not over, and unemployment remains over 8% officially, but is actually 15% when you count those who no longer qualify for unemployment insurance payments, but still aren't working. Can we afford five more such years?
Monday, April 30, 2012
Another step towards Big Brother
kw: politics, policy, internet, privacy, legislation
An act called CISPA (Cyber Intelligence Sharing and Protection Act) passed the U.S. House of Representatives yesterday, and now it goes to the Senate. Proponents say, "Oh, no, it won't impact the privacy of citizens," but we know that's a sham. It is interesting to them precisely because they know it erases most of our privacy protections. See this C|Net article for a good analysis.
I find that Republican congressmen voted in favor 206 to 28. I am ashamed of them. I am a registered Republican, but this sure isn't the party of Abraham Lincoln or Theodore Roosevelt any longer. I may have to become a Libertarian.
I remember the first Terabyte database, which cost about a million dollars to set up in the early 1980s. It was commissioned by the Mormons for genealogical record-keeping. My colleagues and I were joking that if a disk drive with "infinite" capacity were invented—we called it the God file—the government would order two of them. I recall saying, "Sears and GM would be next in line". Today anyone can buy a multi-terabyte disk for about $100. The Google Earth image base is a multi-petabyte (thousands of terabytes) product, and Google is only one of a number of both corporate and government entities to have file bases approaching an exabyte (a million terabytes) in size. The NSA is building a multi-exabyte data store. So just where are they going to get data to fill it? You guessed it: the Internet, and CISPA is an integral part of the process. It gives them the right to "ask" for data dumps without breaking any laws, because CISPA removes or supersedes most current legal protections. The President has stated he will veto it if the Senate passes it. That's one thing he could do that I would like a great deal!
An act called CISPA (Cyber Intelligence Sharing and Protection Act) passed the U.S. House of Representatives yesterday, and now it goes to the Senate. Proponents say, "Oh, no, it won't impact the privacy of citizens," but we know that's a sham. It is interesting to them precisely because they know it erases most of our privacy protections. See this C|Net article for a good analysis.
I find that Republican congressmen voted in favor 206 to 28. I am ashamed of them. I am a registered Republican, but this sure isn't the party of Abraham Lincoln or Theodore Roosevelt any longer. I may have to become a Libertarian.
I remember the first Terabyte database, which cost about a million dollars to set up in the early 1980s. It was commissioned by the Mormons for genealogical record-keeping. My colleagues and I were joking that if a disk drive with "infinite" capacity were invented—we called it the God file—the government would order two of them. I recall saying, "Sears and GM would be next in line". Today anyone can buy a multi-terabyte disk for about $100. The Google Earth image base is a multi-petabyte (thousands of terabytes) product, and Google is only one of a number of both corporate and government entities to have file bases approaching an exabyte (a million terabytes) in size. The NSA is building a multi-exabyte data store. So just where are they going to get data to fill it? You guessed it: the Internet, and CISPA is an integral part of the process. It gives them the right to "ask" for data dumps without breaking any laws, because CISPA removes or supersedes most current legal protections. The President has stated he will veto it if the Senate passes it. That's one thing he could do that I would like a great deal!
Thursday, February 10, 2011
Roving eye at work?
kw: dating, work, policy
I just got an e-mail from Monster.com that refers to this article about office romances. The title in the e-mail was "Office romance: Five reasons not". From a practical point of view, dating or marrying a co-worker, one who is in the same administrative unit, is forbidden by all large and most smaller corporations. Why? To avoid conflict of interest. A romance that a couple tries to keep hidden, when it is found out, will result in this choice: one of you quit, or end the relationship.
There is a second reason office affairs are proscribed. A person with poor self-control is an inferior worker. Over the years, I've known several people who were fired for this reason. Their managers were unhappy with mediocre performance to start with, and the romance simply gave them cause for termination.
I do have colleagues who dated and married, but they were in different organizations, and they both talked to their management before letting the relationship get too far. Since no affair can be kept secret for long, daylight is the best option.
I just got an e-mail from Monster.com that refers to this article about office romances. The title in the e-mail was "Office romance: Five reasons not". From a practical point of view, dating or marrying a co-worker, one who is in the same administrative unit, is forbidden by all large and most smaller corporations. Why? To avoid conflict of interest. A romance that a couple tries to keep hidden, when it is found out, will result in this choice: one of you quit, or end the relationship.
There is a second reason office affairs are proscribed. A person with poor self-control is an inferior worker. Over the years, I've known several people who were fired for this reason. Their managers were unhappy with mediocre performance to start with, and the romance simply gave them cause for termination.
I do have colleagues who dated and married, but they were in different organizations, and they both talked to their management before letting the relationship get too far. Since no affair can be kept secret for long, daylight is the best option.
Saturday, August 02, 2008
On Earth's failure to obey our predictions
kw: book reviews, nonfiction, global warming, policy
It is quite a paradox. After the decade of the 1990s, in which each year was "one of the five hottest of the past century!", the first decade of the 21st Century has been disappointingly cool. A recalculation of some data indicated that 2007 may—just maybe—have been ever-so-slightly hotter than 1998, but 2008 is on track to be the "least warm" year so far since about 1992.
Climate gurus of all stripes are predicting that 2009 will be warmer. Will they have better success with their predictions than Jeanne Dixon, the famously inaccurate 'psychic' of my youth? She made a comfortable living from being right only a quarter of the time.
Climate modelers and other researchers are faced with the fact that climate is in continual flux for many reasons, most of which we are wholly ignorant. Milankovich cycles that span tens of thousands of years, Bond events of unknown cause that span a thousand or two (most recently the Medieval Optimum followed by the Little Ice Age), shorter cycles perhaps mediated by the 22-year Sunspot cycle, and trends both shorter and much longer than any of these that may relate to varying fluxes of cosmic rays: these are things we know a little about, but how many influences are as yet wholly unknown?
To those who'll react, "Isn't the Sunspot cycle 11 years?": one 11-year series has the Sun's magnetic field aligned the same direction as Earth's, while the following series it is in the opposite direction. The effects of solar flares on earth systems during a "same" series differ from flares during an "opposed" series.
My observation of the climate change debate for more than forty years is that as the (emotional) heat increases the light vanishes. I despair of pundits from any "side" of this many-faceted debate showing any reasoned restraint in my lifetime. But perhaps there is a ray of hope. Nigel Lawson (Lord Lawson, former Chancellor of the Exchequer), safely ensconced in retirement, strives to inject a rational note with his little book An Appeal to Reason: A Cool Look at Global Warming.
There is no sense pulling punches. Let's begin with his conclusion:
Looked at carefully, the IPCC predictions for the least warming ("best case") require reducing not just growth, but actually contracting the economic structure of all countries, so as to reduce greenhouse gas emissions by 70%. Think about that. It is, effectively, a rollback of Western lifestyles to the those of the 1920s or earlier, certainly before any kind of air conditioning became widespread and before most people traveled by auto rather than carriage or tram. It requires China and India, home to almost half of humanity, to halt their progress in its tracks. Precisely how likely are these things? My conclusion: ZERO.
Lord Lawson take a look at the very real reports of heat-related deaths during those hotter years in the 1990s. In one year, 2,000 people, mostly elderly, died in France. News reports that year failed to mention that the prior winter, 20,000 people, mostly elderly, died due to the cold...and that was a bit less than usual. Is the point clear? Winter is still a bigger killer than summer. At what point will they become equivalent? Perhaps that is the optimum temperature!
For those who worry that heating will truly get out of hand, the author introduces us to a few folks in the relatively new field of Geoengineering. They are working on methods to cool the planet, whether we reduce CO2 emissions or not. Certain aerosols, for example, result in significant cooling without harming the Ozone layer (a worry that still comes up at times). So, fire a few million tons thereof into the stratosphere! With research, and luck, maybe they'll come up with something more effective and more benign than the sulfates that volcanoes routinely spread, but which come down as acids over a few years' time.
We find buried in the IPCC reports the prediction that warming is bad for some and good for others. They even phase it: a degree or two seems to do more good than harm, while four or five degrees (Celsius, of course) is expected to be mostly bad. Lawson writes, "...is it really plausible that there is an ideal average world temperature, which by some happy chance has recently been visited on us, from which small departures in either direction would spell disaster?" (p. 27). I don't think so either.
The age of Dinosaurs, which ended 65 million years ago, experienced CO2 levels four or five times today's level, and global average temperatures as much as 18°C (32°F) greater than today. That doesn't mean the tropics baked at 50+°C, but that the poles were almost as warm as the tropics, which were only slightly warmer than they are today. All computer climate models predict 5 or more degrees of warming in the Arctic and Antarctic for each degree of equatorial warming. Canada, Siberia, and southern South America will likely be the grain belt of such a future!
Secondary threats such as rising sea level are much touted. Yet they aren't really panning out. Even the IPCC's worst case predicts at most a fifth of a meter (roughly a cubit, or 1.5 feet) of sea level rise by 2100, and then only if a goodly portion of Greenland's ice cap melts. That ice is receding a bit at the edges, but its center is thickening! Perhaps that is why, in thirty years, the sea level at the Maldives has not risen, but fallen slightly! (See N. Morner et al 2004, 'New perspectives for the future of the Maldives', Global and Planetary Change, v40, Jan 2004, pp. 177-182.)
I've been particularly bemused by the idea of carbon trading. What can it accomplish? When Al Gore pays a "carbon offset" to get a few hundred trees planted somewhere so he can feel OK about having a huge mansion and fly about in a private jet, is anything genuine actually happening? Lawson thinks not, saying, "[Buying carbon offsets] resembles nothing so much as the sale of indulgences by the medieval church." (p. 78).
He prefers we do things that might really help. Geoengineering is one possibility. Another is to learn all the climatic influences so we can make our computer models actually meaningful. Today's state of the art is miserable: "The earth's climate is determined by hugely complex systems, many aspects of which are not at all well understood. Reliable prediction is impossible." (p. 91). He favors greatly increasing research spending to bolster our understanding in hopes that this "miserable" situation will be better in the future. Yet we must remember that climate is the quintessential chaotic system. Doing something twice in a row won't always produce the same results. Too much depends on what else happened between time one and time two.
So I am heartened by his effort, but it is bittersweet. His appeal will only resonate with those who really don't need it, and be ignored by those who do.
It is quite a paradox. After the decade of the 1990s, in which each year was "one of the five hottest of the past century!", the first decade of the 21st Century has been disappointingly cool. A recalculation of some data indicated that 2007 may—just maybe—have been ever-so-slightly hotter than 1998, but 2008 is on track to be the "least warm" year so far since about 1992.
Climate gurus of all stripes are predicting that 2009 will be warmer. Will they have better success with their predictions than Jeanne Dixon, the famously inaccurate 'psychic' of my youth? She made a comfortable living from being right only a quarter of the time.
Climate modelers and other researchers are faced with the fact that climate is in continual flux for many reasons, most of which we are wholly ignorant. Milankovich cycles that span tens of thousands of years, Bond events of unknown cause that span a thousand or two (most recently the Medieval Optimum followed by the Little Ice Age), shorter cycles perhaps mediated by the 22-year Sunspot cycle, and trends both shorter and much longer than any of these that may relate to varying fluxes of cosmic rays: these are things we know a little about, but how many influences are as yet wholly unknown?
To those who'll react, "Isn't the Sunspot cycle 11 years?": one 11-year series has the Sun's magnetic field aligned the same direction as Earth's, while the following series it is in the opposite direction. The effects of solar flares on earth systems during a "same" series differ from flares during an "opposed" series.
My observation of the climate change debate for more than forty years is that as the (emotional) heat increases the light vanishes. I despair of pundits from any "side" of this many-faceted debate showing any reasoned restraint in my lifetime. But perhaps there is a ray of hope. Nigel Lawson (Lord Lawson, former Chancellor of the Exchequer), safely ensconced in retirement, strives to inject a rational note with his little book An Appeal to Reason: A Cool Look at Global Warming.
There is no sense pulling punches. Let's begin with his conclusion:
"...a lurch into protectionism, and a rolling back of globalization, would do far more damage to the world economy, and in particular to living standards in developing countries, than could conceivably result from the projected continuation of global warming...[It] is clear that the would-be saviors of the planet are, in practice, the enemies of poverty reduction in the developing world." (p. 106)Though he has more than one central point, I think this is the most telling: The IPCC reports of recent years are based on various projections of the economic progress of developed and developing nations. The "hotter" cases, those that predict greater greenhouse heating of earth, are based on greater economic growth, and the "cooler" cases are based on various amounts of throttling of economic growth. Thus, the IPCC "worst case" scenario predicts that people in the developed nations will be 2.5-3 times better off 100 years from now than their great-grandparents (us) are today; for the developing nations, the figure is between 8 and 10. Their intermediate cases are based on people being perhaps "only" 75% as well off—and require cutting back our own prosperity a similar amount. So our efforts to reduce the greenhouse heating experienced by our unbelievably rich great-grandchildren entail rolling back twenty or more years of economic progress!
Looked at carefully, the IPCC predictions for the least warming ("best case") require reducing not just growth, but actually contracting the economic structure of all countries, so as to reduce greenhouse gas emissions by 70%. Think about that. It is, effectively, a rollback of Western lifestyles to the those of the 1920s or earlier, certainly before any kind of air conditioning became widespread and before most people traveled by auto rather than carriage or tram. It requires China and India, home to almost half of humanity, to halt their progress in its tracks. Precisely how likely are these things? My conclusion: ZERO.
Lord Lawson take a look at the very real reports of heat-related deaths during those hotter years in the 1990s. In one year, 2,000 people, mostly elderly, died in France. News reports that year failed to mention that the prior winter, 20,000 people, mostly elderly, died due to the cold...and that was a bit less than usual. Is the point clear? Winter is still a bigger killer than summer. At what point will they become equivalent? Perhaps that is the optimum temperature!
For those who worry that heating will truly get out of hand, the author introduces us to a few folks in the relatively new field of Geoengineering. They are working on methods to cool the planet, whether we reduce CO2 emissions or not. Certain aerosols, for example, result in significant cooling without harming the Ozone layer (a worry that still comes up at times). So, fire a few million tons thereof into the stratosphere! With research, and luck, maybe they'll come up with something more effective and more benign than the sulfates that volcanoes routinely spread, but which come down as acids over a few years' time.
We find buried in the IPCC reports the prediction that warming is bad for some and good for others. They even phase it: a degree or two seems to do more good than harm, while four or five degrees (Celsius, of course) is expected to be mostly bad. Lawson writes, "...is it really plausible that there is an ideal average world temperature, which by some happy chance has recently been visited on us, from which small departures in either direction would spell disaster?" (p. 27). I don't think so either.
The age of Dinosaurs, which ended 65 million years ago, experienced CO2 levels four or five times today's level, and global average temperatures as much as 18°C (32°F) greater than today. That doesn't mean the tropics baked at 50+°C, but that the poles were almost as warm as the tropics, which were only slightly warmer than they are today. All computer climate models predict 5 or more degrees of warming in the Arctic and Antarctic for each degree of equatorial warming. Canada, Siberia, and southern South America will likely be the grain belt of such a future!
Secondary threats such as rising sea level are much touted. Yet they aren't really panning out. Even the IPCC's worst case predicts at most a fifth of a meter (roughly a cubit, or 1.5 feet) of sea level rise by 2100, and then only if a goodly portion of Greenland's ice cap melts. That ice is receding a bit at the edges, but its center is thickening! Perhaps that is why, in thirty years, the sea level at the Maldives has not risen, but fallen slightly! (See N. Morner et al 2004, 'New perspectives for the future of the Maldives', Global and Planetary Change, v40, Jan 2004, pp. 177-182.)
I've been particularly bemused by the idea of carbon trading. What can it accomplish? When Al Gore pays a "carbon offset" to get a few hundred trees planted somewhere so he can feel OK about having a huge mansion and fly about in a private jet, is anything genuine actually happening? Lawson thinks not, saying, "[Buying carbon offsets] resembles nothing so much as the sale of indulgences by the medieval church." (p. 78).
He prefers we do things that might really help. Geoengineering is one possibility. Another is to learn all the climatic influences so we can make our computer models actually meaningful. Today's state of the art is miserable: "The earth's climate is determined by hugely complex systems, many aspects of which are not at all well understood. Reliable prediction is impossible." (p. 91). He favors greatly increasing research spending to bolster our understanding in hopes that this "miserable" situation will be better in the future. Yet we must remember that climate is the quintessential chaotic system. Doing something twice in a row won't always produce the same results. Too much depends on what else happened between time one and time two.
So I am heartened by his effort, but it is bittersweet. His appeal will only resonate with those who really don't need it, and be ignored by those who do.
Friday, September 22, 2006
Comment Policy
kw: policy, instructions, comments
This blog is not well known. Though the posts are open for moderated comments, few occur. I seldom reject a comment, but on occasion I do. Some guidelines will help:
- Please keep comments short. I'll reject anything over two paragraphs.
- It is OK to point to your own blog or web site in a comment. I'll check it out...and I usually accept the comment. Don't be surprised if I have an editorial statement about the pointed-to site. This is my blog, and I'll point out opinions with which I disagree.
- Please be civil.
When I am on the fence, I check up on the commentor, if possible. I may try to contact the person, inviting a more suitable comment. However, if I can't figure out how to make contact, I will surely reject the comment.
My statement to those who send comments larger than my postings: "Please create your own blog."
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