Maryland how I love thee

I’m so proud of my home state for affirming equality for all in the ballot box rather than in the courts. I was born and raised in Maryland, although I’ve spent more of my adult life in Virginia, one of the big things I’ve noticed in the divide between the two states (and I love both of them) is that Marylanders do a better job at taking care of each other, and running an effective state with high quality services. Marylanders believe government can work, and generally (outside of Baltimore) it does. Marylanders also reject bigotry, and with question 4 (the Maryland Dream act) and question 6 affirming the rights of LGBT to marry, I’m so proud of my state for rejecting bigotry and electing to give everyone a chance at the dream.

Another lesson learned from this election is to follow Lincoln’s advice, “it’s better to be quiet and be thought of a fool than to open your mouth and remove all doubt.” Moron fundamentalists’ ideas of how lady parts work and divine rape plans have been extraordinarily costly for the Republicans, and provide hope for the future that voters will reject some of the truly contemptible unscientific beliefs of these bigoted old men running our government. I’m pleased to see there might be an actual limit on the incredibly stupid things one may say, and still expect election to congress. So remember Republicans, you can’t piss off the ladies and expect to keep winning elections. They need to shape up, or at least keep their incredibly stupid ideas to themselves. As women represent more and more of our delegations to congress, hopefully statements like Akin’s and Mourdock’s will just be embarrassing historical footnotes. Although, the continued presence of Michelle Bachmann is reminder that being female is, of course, no protection from believing incredibly stupid things.

Did anyone else snort when Romney mention the “enduring principles on which our society is built” and the first he listed was honesty?

Finally, I’m very curious to see the effect of the decision by Coloradoans and Washingtonians to openly defy Federal law and legalize, not just decriminalize, marijuana use. In this second term of a moderate Democratic president, will this showdown over drug laws finally result in a pull-back in the drug war? The amount of money, time, and jail-space devoted to criminalizing marijuana use is a national disgrace. Maybe these state reversals of marijuana prohibition will result in a more mature national conversation on drug policy?

This election has left me optimistic we will take the right steps to shore up our economy, make the right policy on healthcare, and increase the investment in science and research, which are my priorities. It’s been a good day.

Keep Akin in the race!

Everyone has heard about Akin’s comments about “legitimate rape” and the push now coming from the GOP to get him out of the race. But is this really fair or ideal? The problem with removing Akin from the race over this is that his gaffe was not just one exposing his scientific ignorance, but because it was a Kinsley gaffe. That is, it’s a gaffe because it unintentionally revealed the truth.

I’m not saying that his medieval medical hypothesis has any scientific validity, he is after all just parroting pro-life misinformation spread to attack scientific data about the frequency of pregnancy after rape. The Kinsley gaffe in this case is that he revealed the truth about what he, and other pro-life politicians who support no-exception abortion bans, believe.

Why should we punish this truth-telling with removal of Akin from the race? All that will happen is that the GOP will replace Akin with another pro-life fanatic who is simply better at hiding what he actually believes about women, reproduction, sexual assault, and their autonomy over their own bodies.

I’m thankful for Akin’s honesty, because he has dropped the facade that the radical right cares about women, respects their autonomy, understands sexual assault or has any place in this century. He has pulled back the curtain and shown what they really believe. Other examples of this attitude abound, from the abusive ultrasound bills, to this comment from Idaho Republican Chuck Winder in March wondering if women even know what rape is, to American Vision’s comparison of the blowback against Akin as “like gang-rape”. He has only further exposed the misogyny of the pro-life movement and brought some of their more despicable lies front and center for all to see. We should be thanking him for his honesty.

Transvaginal ultrasound now being legislated in Idaho

In the continual spread of assaults on women’s reproductive freedom in the wake of the 2010 tea party movement, another state, Idaho, is legislating women receive unnecessary and invasive medical procedures prior to obtaining abortion.

This is part of an unprecedented effort at the state level to restrict reproductive rights, and in 2011 a record number of these measures have passed.

And it won’t stop here, as we’ve seen in Georgia, they are trying to pass a law to force women to carry all 20 week gestations to term, even if the fetus is dead. And if you think that’s creepy, Georgia isn’t the first to do it, such laws have succeeded in Nebraska, Idaho, Indiana, Kansas, Oklahoma,Alabama and Utah.

John Scalzi has a guest post from a physician asking “where’s the outrage?”. Well it’s right here. Scalzi’s poster is suggesting that civil disobedience should follow, but I’m worried that that might be the excuse these states are looking for to shut down clinics and effectively ban all abortion within a state. While I agree the situation is untenable, and is requiring physicians to engage in unethical practice I worry that violating the law is just what the zealots are waiting for. But maybe this needs to happen. We need a test case in front of the courts that asks the question, “can legislatures dictate medical practice in conflict with medical ethics, and without medical justification?” I think the answer would be no, and should be no. Physicians shouldn’t be taking orders from the state on what they do in the examining room. Physician autonomy, ethical practice, reproductive freedoms, and the whole doctor-patient relationship are on the line here. Physicians are here to treat patients, not to serve as tools of the state, against our patients’ interests, to score political points for zealots.

Demanding women deliver dead babies is unethical and unsafe

In a debate on the floor of the Georgia State house over a bill to force women to bring all pregnancies after 20 weeks to term, even in cases of dead or non-viable fetus, this Georgia representative reaches a new low. State Rep Terry England seems to be suggesting pigs and cows do it, why can’t humans?

Rep. Terry England compares women to cows, pigs and chickens. from Bryan Long on Vimeo.

Aside from this genius on-the-farm reasoning of Mr England, the failures of reasoning and misrepresentations of scientific knowledge engaged in to pursue this legislation are many.

The legislation is justified ostensibly because of the ability of the fetus to feel pain after 20 weeks, but there is no data or a legitimate scientific basis for this claim. Our knowledge of neurological development would suggest that conscious perception of pain may not be possible for a fetus at any point and the neural framework for transmission of pain is not even mature before 29-34 weeks.

Second is the issue that concern for the pain for a nonviable or dead fetus should not outweigh medical risk to the mother. The American College of Obstetricians and Gynecologists recommend dilation and extraction or induction of labor once the diagnosis of stillbirth has been made. The risks of carrying a non-viable fetus are the higher complication rate of delivery versus dilation and extraction, as well as a very high risk to the mother of complications like disseminated intravascular coagulation (DIC) if the amniotic sac is ruptured and she is exposed to the dying tissue. For stillbirth or nonviable pregnancies, dilation and extraction is far safer and more effective with 24% of patients undergoing labor experiencing complications compared to 3% for D&E.

It has been under-reported that since the 2010 election, the rate of anti-contraception, anti-abortion, and frankly anti-woman legislation has shot through the roof. In 2011 state legislatures have enacted a record number of laws restricting reproductive rights:

In the 50 states combined, legislators introduced more than 1,100 reproductive health and rights-related provisions, a sharp increase from the 950 introduced in 2010. By year’s end, 135 of these provisions had been enacted in 36 states, an increase from the 89 enacted in 2010 and the 77 enacted in 2009.

These include everything from preventing physicians from using telemedicine to prescribe medication to requiring ultrasounds prior to abortion despite the fact no association of OB/Gyns supports universal ultrasound prior to abortion. In an effort to legislate their control of women’s reproductive systems, they are interfering more and more with the physician-patient relationship. It has become so extreme that in 11 states they have legislation requiring physicians to perform unnecessary invasive procedures, basically forcing physicians to engage in unethical medical practices. There is no legitimate medical reason for these measures. These exist to shame women, and increase the expense and difficulty of constitutionally-protected medical procedures and medical decisions like birth control and abortion.

These efforts to ban abortion after 20 weeks, which have succeeded in several states including Nebraska, Idaho, Indiana, Kansas, Oklahoma,Alabama and Utah, are a highly intrusive attack on women’s reproductive freedom. It is once again, an attempt to insert politics in the doctor-patient relationship. Finally it is medically unethical, dangerous, and morally bankrupt to expose women to greater risk by preventing them from having the option of safe termination of pregnancy all for the sake of a dead fetus.

Via Jezebel

What is the cause of excess costs in US healthcare? Take two

We’ve discussed it before, why are costs so much higher in US healthcare compared to other countries? The Washington Post has a pointless article which seems to answer with the tautology costs are high because healthcare in America costs more. How much more? Well, we spend nearly twice as much per capita as the next nearest country while failing to provide universal coverage:

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In the WaPo article they make a big deal of the costs of individual procedures like MRI being over a thousand in the US compared to $280 in France, but this is a simplistic analysis, and I think it misses the point as most authors do when discussing this issue. The reason things costs more is because in order to subsidize the hidden costs of medical care, providers charge more for imaging and procedures. For instance, Atul Gawande, in his New Yorker piece “The Cost Conundrum” wonders why is it costs are higher to treat the same conditions in rural areas and in a major academic centers like UCLA than at a highly specialized private hospitals like the Mayo Clinic? I think the reason is it’s not nearly as expensive to administer and provide care for a select group of insured midwesterners at the Mayo than it is to provide care to the underserved in the poor areas of inner-cities and in poor rural locations.

When you are serving a poorer, under-insured population like you get in LA or Baltimore for that matter, the insured are charged more because EMTALA requires hospitals to treat all comers, regardless of insured status. Medical centers like UCLA or University of Maryland are the final common pathway for the sickest and poorest patients who, even if stabilized at smaller local hospitals, are immediately transferred to such centers. These patients are expensive to treat, often have more co-morbidities like HIV or drug use and mental illness, and there is no reimbursement guarantee for taking care of them even though it is our legal and ethical responsibility to do so.

Further, the cost of defensive medicine, which applies to this patient population as much as any other, ramps the costs of all hospital admissions and medical practice in general. It is also incredibly hard to quantify its contribution to the overall costs of care.

As a result, to pay for excessive care of the uninsured, all procedures, all tests, all imaging, and all hospitalizations cost more. Caring for inpatients and the uninsured is expensive, so the costs are transferred to the prices of outpatient elective care and procedures which are often administered in a fee-for-service model. Hospitals have an incentive to provide as much outpatient elective care as possible in order to offset these other costs and to generate revenue. The providers that perform procedures or expensive testing then become far more expensive to pay as they are the major revenue generators for the hospital (hence surgeon vs pediatrician pay). Especially because in order to generate more revenue they are paid based on how many procedures they perform. All the incentives are towards more utilization, more procedures, more revenue generation. This is the hidden tax of the uninsured.

In a way, we have universal healthcare already, but we pay for it in the most irresponsible and costly way possible. We wait for small problems to become emergent, treat them in the most expensive outpatient provider possible (the ER), and then when we can’t pay the bills for the uninsured, we transfer the balance by increasing the costs of the care of insured patients showing up for their cholecystectomies or back surgery. Tack on the costs of defensive medicine and the fear of being sued unless everything is done to cover your ass, and you have a recipe for extremely costly care.

Other factors figure into higher costs as well, including hugely higher costs of medicare administration since Bush privatized it, higher prescription drug costs since Bush passed medicare part D and prevented bargaining with drug companies, and our incredibly high ICU expenditures at the end of life. the McKinsey report on excess costs demonstrated most of these issues in 2008. This is not news. The US spends far more on medical administration, outpatient/ambulatory care (with hospital-based outpatient care increasing most rapidly in costs), drugs, doctors salaries, and end-of-life care than we should as a percentage of our GDP.

So what should we do about it? At every step we need dismantle the tendency towards increasing costs. Here are my suggestions:
Continue reading “What is the cause of excess costs in US healthcare? Take two”

Are Liberals really more likely to accept science than conservatives Part II?

About a month ago I asked if denialism is truly more frequent on the right or is it that the issues of the day are ones that are more likely to be targets of right wing denialism? After all, one can think of slightly more left wing sources of denialism like GMO paranoia, 9/11 conspiracies, altie-meds, and toxin fear-mongering. The mental heuristics that cause people to believe, and then entrench themselves, in nonsense seem generalizable to humanity rather than just those attracted to conservative politics. Why should those who identify as liberal be any different? Wouldn’t they just believe in nonsense with a liberal bias?

Lately, Chris Mooney has been taking a different tact on explaining the apparent discrepancy between liberal vs conservative rejection of science with the suggestion the conservative brain is fundamentally different.

First of all, it’s not a matter of education. Whenever people complain that disbelief in evolution or climate change or whatever is a matter of education, they’re simply wrong. We can not educate our way out of this mess, and the problem isn’t that the Republicans arguing this nonsense are any less educated. Chris agrees and cites evidence:

Buried in the Pew report was a little chart showing the relationship between one’s political party affiliation, one’s acceptance that humans are causing global warming, and one’s level of education. And here’s the mind-blowing surprise: For Republicans, having a college degree didn’t appear to make one any more open to what scientists have to say. On the contrary, better-educated Republicans were more skeptical of modern climate science than their less educated brethren. Only 19 percent of college-educated Republicans agreed that the planet is warming due to human actions, versus 31 percent of non-college-educated Republicans.

For Democrats and Independents, the opposite was the case. More education correlated with being more accepting of climate science–among Democrats, dramatically so. The difference in acceptance between more and less educated Democrats was 23 percentage points.

And it’s not specifically education on or awareness of the specific topic, as self-reported knowledge of the topic resulted in opinions among conservatives more likely to be aligned against the scientific mainstream. Orac points out this is not an old phenomenon and maybe the Dunning-Kruger effect which we incorporated into our unified theory of the crank. This is the “incompetent but unaware of it” phenomenon, that the more incompetent people are, the more likely they are to be falsely confident of their own abilities and unable to recognize competence in others..

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But the most fascinating part of this article is when Mooney mentions a study to see if liberals were comparatively incompetent in judging the science in an area of high liberal bias – Nuclear power. This would seem to provide an answer to the question from my earlier post, that is, are we missing an equivalent liberal tendency towards denialism because we’re not asking the right questions?

It looks like my hypothesis of possible equivalence might have to be rejected …
Continue reading “Are Liberals really more likely to accept science than conservatives Part II?”

The New Yorker Ranks the Republicans vs. Science

And get’s it wrong

What’s amazing is they rank Newt first at the same time acknowledging he destroyed the Office of Technology Assessment.

Jon Huntsman may have the most rational scientific and technological policies of anyone in the field, but Gingrich, sometimes called Newt Skywalker, has far more passion. As Kelefa Sanneh argues in the current issue, the philosophy of Gingrichism is nothing but a combination of the idiosyncratic views of the man himself–which include his beliefs in the virtues of space exploration and his opposition to regulating the Internet, even when it comes to porn. He was an early adopter of Twitter, and he once made the cover of Wired. He is ranked atop Scientific American’s recent “Geek Guide” to the 2012 candidates. As Sanneh notes, one of Gingrich’s manifestos about information policy includes a preface by the science-fiction writer Jerry Pournelle, declaring, “It’s raining soup, and Newt Gingrich has the blueprints for soup bowls.”

His record is scarcely perfect. As Speaker, Gingrich abolished the Office of Technology Assessment–a move reminiscent of Nixon abolishing the White House’s Office of Science and Technology Policy. But, for the most part, Gingrich has moved policy in the right directions. And he gets extra credit for sitting on the couch with Nancy Pelosi to talk about global warming.

So, he destroyed the office in congress that used science to evaluate legislation, as well as the efficacy of that legislation once enacted. He removed scientific guidance from the legislative branch, but because he’s passionate about the internets that doesn’t make him the worst thing to happen to science in the last 30 years?

I realize we’re looking for the shiny turd in a cowpie here, but Gingrich? No way. Huntsman should be ranked first because he at least acknowledges global warming is real, a brave stand to take amongst a bunch of deniers. Whereas Gingrich dumped that chapter from his book after Rush Limbaugh suggested he might actually be on the side of reality. What’s going to matter more in the next 4 years? A president that took a brave stance on regulating internet porn? Or one that took a stance on global warming?

None of these guys has any scientific chops but that seems too much to ask in politicians on either side these days. But this analysis by the New Yorker is embarrassingly superficial.