Denialism Blog

Author: MarkH

  • Humane Watch puts lawyers in cages

    In a brilliant parody of the HSUS shelter ads, humane watch has put sad looking lawyers in cages to emphasize that donations to HSUS do not fund shelters.

    HSUS is like PETA but with deodorant and suits. Hah! I love it. HSUS is PETA.

    It’s upsetting that this fake charity has co-opted the reputation of our local humane societies, used ads depicting suffering animals in cages, then taken in millions of dollars from well meaning people to lobby for animal rights causes. Every time I see their ads I get furious. Less than 1% of their take goes to shelters. HSUS is not a humane society at all, it’s an animal rights lobbying group.

  • Higher US expenditures on cancer patients do not result in improved mortality.

    But you’d never know that reading AEI’s highly dubious contribution to the literature in this week’s Health Affairs (lay Reuters article here). Consistent with their free-market solves everything and can do no wrong (cover ears and yell “nananananananana”) attitude towards the broken US healthcare system, they have managed to contaminate the literature with a paper that suggests our higher expenditures on cancer are generating significant returns in patient survival. Except that it doesn’t show this, and to her great credit, Reuter’s Sharon Begley nails it:

    Cancer patients in the United States who were diagnosed from 1995 to 1999 lived an average 11.1 years after that, compared with 9.3 years for those in 10 countries in Europe, researchers led by health economist Tomas Philipson of the University of Chicago reported in an analysis published Monday in the journal Health Affairs.

    Those extra years came at a price. By 1999 (the last year the researchers analyzed), the United States was spending an average of $70,000 per cancer case (up 49 percent since 1983), compared with $44,000 in Europe (up 16 percent). Using standard figures for an extra year of life, the researchers concluded that the value of the U.S. survival gains outweighed the cost by an average $61,000 per case. The greater spending on cancer care in the United States, they conclude, is therefore “worth it.”

    Experts shown an advance copy of the paper by Reuters argued that the tricky statistics of cancer outcomes tripped up the authors.

    “This study is pure folly,” said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. “It’s completely misguided and it’s dangerous. Not only are the authors’ analyses flawed but their conclusions are also wrong.”

    I am amazed, this is real science reporting here, because rather than just doing a press-release rehashing of the AEI-authors’ dubious assertions, she found some real cancer experts and shredded it.

    The mistake they made, or possibly ignored, is lead-time bias. By using survival from diagnosis, rather than the patient’s actual mortality, they create the appearance of improved outcomes. But the reality is, earlier diagnosis is creating a false survival signal. The US isn’t actually extending lives in comparison to treatment in other countries, the overall mortality rates are the same.

    Further the paper only showed the benefit in prostate cancer and breast cancer, and, if anything, worse survival for colon and uterine cancer given the amount of expenditure. The reason is pretty straightforward, and consistent with the lead-time bias issue. In the US, we probably over-screen for breast and prostate cancer, which means more people live with these diagnoses than do in other countries. It’s been a topic of debate among medical professions and discussed extensively by other medical bloggers like Orac because it’s quite possible, especially for breast and prostate cancers, that screening protocols are too inclusive. The result is there are more patients in the US that are given a cancer diagnosis, but they have disease that may never progress to being a life-threatening illness. Excessive screening may even result in unnecessary procedures and treatments when it comes to these two diseases, and we are still trying to work out what protocols will include the most patients with serious disease, while excluding as many false-positive patients as possible. This is acknowledged by Begley’s expert reviewers:

    Even more problematic, said Berry, is a problem cancer experts have only recently recognized: overdiagnosis. Because cancer screening is much more widespread in the United States than in Europe, especially for breast and prostate cancer, “we find many more cancers than are found in Europe,” he said. “These are cancers that tend to be slowly growing and many would never kill anyone.”

    Screening therefore turns thousands of healthy people into cancer patients, even though their tumor would never threaten their health or life. Counting these cases, of which there are more in the United States than Europe, artificially inflates survival time, experts said.

    “As long as your calculation is based on survival gains, it is fundamentally misleading,” said Dr. H. Gilbert Welch, a healthcare expert at the Dartmouth Institute for Health Policy & Clinical Practice.

    In the new analysis, the survival gains in the United States compared with Europe were greatest for prostate cancer, at more than triple the gains for breast cancer, the cancer with the second-greatest U.S. survival edge. “These are the two cancers where screening has raised the most serious issues about lead-time bias and overdiagnosis,” said Welch.

    For melanoma and colorectal and uterine cancer, survival gains over the period analyzed were greater in Europe than the United States.

    If anything the opposite is true based on the correct analysis which is based on mortality statistics, not survival.

    Other calculations cast doubt on the superiority of U.S. cancer care. For instance, breast cancer mortality fell 36 percent in the United Kingdom from 1990 to 2006, calculates MD Anderson’s Berry, and fell 30 percent among whites in the United States. (The U.S. figure would be even lower, he said, if it included African-Americans, who generally have less access to health care.)

    Cancer mortality in the United States is higher than in 11 countries reporting to the Organization for Economic Co-operation and Development, and lower than the rate in 14. Mortality is lower in Switzerland, Sweden, Japan and Finland, among others, but higher in Hungary, Slovenia, France and Britain, in the latest years for which OECD has data.

    The reduction in cancer mortality in the United States since 2000 also puts it toward the middle of OECD countries. It is less than in Israel, Japan, Switzerland and some others, for instance, but better than in Britain, Estonia and Poland.

    To sum up, the authors successfully identified lead-time bias in two cancers which the US is known to screen more for than other nations with universal healthcare systems that have health expenditures of roughly 50% less than ours, per capita. They then falsely attributed this lead time bias to our excessive health expenditures, then generalized this biased finding to suggest our excessive expenditures overall provide benefit to our population. This is despite a large body of literature, using appropriate measures of health outcomes, that suggest many other countries do better than us in cancer and medically-preventible disease mortality in general.

    It is amazing that this paper passed peer-review, and that such a substandard analysis by authors with clear ideological biases was not detected and rejected. And one could have predicted this considering the author’s affiliation with AEI and Manhattan Institutes, think tanks which routinely engage in denial of science like global warming. This is a comparable mistake to accepting a paper from the Discovery Institute, or Peter Duesberg without approaching it with a hefty dose of skepticism. Anti-science ideologues tend to write shoddy, unscientific papers, and some basic peer review should have prevented this analysis from contaminating the literature.

    Shame on Health Affairs for publishing this garbage, but let’s a salute Reuter’s for doing an excellent job in appropriate post hoc review of this flawed paper.

  • Jennifer Lawrence channels Katniss, says "Screw PETA"

    In it’s increasingly bizarre need to inflict it’s animal rights morality on everybody, PETA’s Ingrid Newkirk has criticized Jennifer Lawrence for scenes in Winter’s Bone and the Hunger Games, which show her hunting and eating animals.

    The actress was dubbed “the coolest chick in Hollywood” by Rolling Stone, and in the magazine’s latest issue she recounts her on-screen squirrel-skinning scene in the 2010 movie “Winter’s Bone.”

    “I should say it wasn’t real, for PETA. But screw PETA,” she told the magazine.

    In response to the actress’s comment, PETA president Ingrid Newkirk told Gothamist, “[Lawrence] is young and the plight of animals somehow hasn’t yet touched her heart. As Henry David Thoreau said, ‘The squirrel you kill in jest, dies in earnest.’ We are told that this squirrel was hit by a car, but when people kill animals, it is the animals who are ‘screwed,’ not PETA, and one day I hope she will try to make up for any pain she might have caused any animal who did nothing but try to eke out a humble existence in nature.”

    Gag me with a spoon. Lawrence’s initial instincts were correct. Screw PETA. In these scenes and movies characters are grappling with survival in the face of starvation and poverty. PETA seems to think the appropriate ending for Katniss would have been a moral vegan death from starvation in district 12 rather than being a life-affirming, kickass hunter. And I guess Ree should have morally died from exposure in the Ozarks. The producers bought her a squirrel from a local hunter, and she realistically portrayed the skinning of an animal by hunters for food. I think what really upsets PETA about these portrayals is that they realistically show what humans will do to survive, that hunting and eating animals comes naturally to us, and there’s nothing wrong with hunting for food.

    Let’s hope Lawrence doesn’t back down, for some reason I think she won’t:

    The actress, who spent a month in Missouri with a rural family learning to shoot rifles and chop wood in preparation for “Winter’s Bone,” and was trained by four-time Olympic archer Khatuna Lorig for her role as Katniss in “The Hunger Games,” also told Rolling Stone, that when she is done with her next movie she is “thinking about buying a house. And a big dog. And a shotgun.”

    I’m liking her more and more.

  • Good News, Max snubs PETA, will give to a local shelter

    Maybe my email worked? I got a one sentence reply from Max last night saying he agreed, and today Tucker Max says hellz no to PETA and instead wants to give to a local shelter:

    I do not agree AT ALL with the mission of PETA.

    …

    If we’re talking about what an awful organization PETA is, that’s really just the beginning. They’re so ridiculous, they compared the holocaust to killing chickens. Not only that, but they have a history of shitting on celebrities they’ve worked with in the past. And perhaps worst of all, they are the ones that think violence against women is OK. Their stated ultimate goal is complete animal liberation. They’re serious about that. F*** [sorry to be a prude, ed.] that-I not only disagree, I vehemently oppose that goal.

    …

    To that effect, I am proposing another solution, one that helps dogs but doesn’t force me to give money to an organization that works at odds with most of my personal beliefs:

    In the past, I have supported a cause in Austin called Austin Pets Alive that is trying to open a no kill shelter (another thing I disagree with PETA on, they operate kill shelters). Their new building has numerous naming opportunities. I would love to make a sizable donation to them, and PETA should agree to match whatever I put in. If that happens, I will open it up to any of my fans to contribute as well.

    If PETA doesn’t like Austin Pets Alive for some reason, that’s OK, they are welcome to suggest any other dog-related charity in the Austin (or surrounding Texas) area, and I am down for contributing a lot of money to help them do positive things for dogs. Together, I am sure we can raise several hundred thousand dollars for needy and worthy dogs in the central Texas area.

    Good for him. Whatever flaws he has, he’s no animal liberationist.

    Finally, a note about the HSUS and PETA. They are not for animal welfare. They are for animal liberation. That means they don’t believe in animal agriculture, they don’t believe in animal research, and they don’t believe in pet ownership.

    HSUS runs deceptive and sleazy ads showing suffering puppies and kittens to make you think your money is going to rescue and adoption, yet only 1% of their budget goes to shelters. They are not a rescue organization!

    Their animal experts include ALF morons like JP Goodwin, a high-school dropout who has dedicated his life to animal liberation. People think that since “Humane Society” is in its name, it is affiliated with local humane societies or that it shares the same mission. It does not. If you want to donate money to spaying and neutering of animals, animal rescue, or adoption, give to your local humane society or SPCA, not HSUS. HSUS is a animal liberation advocacy organization, not a shelter! Likewise PETAs shelters euthanize 95% of the animals they receive, they are not interested in promoting pet adoption. They are interested in animal liberation. If you’re for animal liberation fine, but don’t represent yourself as a humane society or animal welfare organization. They’re not the same thing.

  • No Tucker Max, not PETA!

    You may have heard about Planned Parenthood turning down Tucker Max’s 500k charitable donation on the grounds his misogynistic past marred the gift.

    Now PETA is asking for the donation.

    Let’s beg him not to do this. Instead of giving money to the dog-killing animal rightsists, how about a donation to pro-test and put a thumb in the eye of the anti-research pet killers? Send him a message, donate the money to a pro-science group.

    Here’s my email to Tucker:

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  • Readers remember Ayn Rand and cringe

    A great article from the awl asks writers and book critics which books they liked when they were younger, but now make them cringe.

    The results are interesting, the two authors those surveyed reported most cringe-worthy were Kerouac and, you probably guessed it, Ayn Rand. Ha!

  • Bad news for the Affordable Care Act

    The NYTimes reporting suggests a 5-4 split against ACA is likely:

    Justice Kennedy, along with Justices Samuel A. Alito Jr. and Antonin Scalia and Chief Justice John G. Roberts Jr. all asked questions suggesting that they had a problem with the constitutionality of the mandate requiring most Americans to buy insurance. Justice Clarence Thomas, as usual, did not ask any questions, but he is widely expected to vote to overturn the mandate.

    As does CNN’s Toobin’s analysis:

    This is interesting. Part of the issue is how much of the law would fall if they turn against it? Would we still be able to prevent insurers from dumping patients and refusing to cover chronic conditions if the mandate falls? Will both provisions be struck down? All provisions?

    I think a strategic error was made in not describing the penalty as a tax. Because no one doubts congress’ power to tax, and after all, it made sense to tax the uninsured considering as a group they cost the taxpayers $43 billion a year in unpaid medical bills.

    The other interesting outcome may be political. Without Obamacare to rile up the base, what issue will Republicans have left come next fall? This was their touchstone, and if the Supreme Court pulls the rug out from under them, they’re going to have to come up with a new form of librul fascism to rail against for November.

    In the end this may be an opportunity or a catastrophe for medical care depending on how we are led into the future. The failure of this law may result in a tax-supported single payer system. It may result in expansion of health exchanges to cover the uninsured. It may result in a new national flat tax, like Japan’s, that results in income-based subsidization of healthcare costs. All of these things are clearly constitutional based on the congressional ability to tax.

    The worst outcome would be if we saw another 15 year delay in addressing the crisis of rising health care expenditures and coverage for the uninsured. Or, if it became delegated to the states to create individual universal systems as, sadly, most red states have no financial capacity to afford it. Already the southern and para-Mississippi states have higher obesity rates, poorer objective measures of health, worse infant mortality, and higher bankruptcy rates etc., this will likely worsen these disparities. California, New York, Massachusetts (will they lose their mandate?), Maryland and other states which are the major federal revenue generators could probably manage it if they could convince their population to support universal healthcare legislation with additional taxes, but a patchwork approach will create unnecessary complexity. What if a Pennsylvanian gets a surgery in Maryland? What if someone wants to chose an out-of-state hospital, which they very frequently do? What about emergency care for out-of-staters? Will this just further increase disparities between the states until the we see an ever worsening downward slope in quality of life as you approach the Mississippi river? Will states like Texas that can probably afford reform refuse to enact any out of cold-hearted laissez-faire libertarianism?

    It’s sad, but oh well. America gets the government it elects.

  • Mooney now agrees with us – Denialists deserve ridicule, not debate

    He had to realize Nisbett’s framing was worthless and write a whole book on defective Republican reasoning to realize it but it sounds like Chris Mooney has come around to the right way to confront denialism:

    The only solution, then, is to make organized climate denial simply beyond the pale. It has to be the case that taking such a stand is tantamount to asserting that smoking is completely safe, no big deal, go ahead and have two packs a day.

    Sounds a little bit like what I wrote in 2007 when I pointed out denialists should not even be debated:

    The goal instead must be to enforce standards of scientific debate, to delimit sharply what kind of evidence and argument is worthy of being listened to, to educate people about the form of pseudoscientific arguments, and when these arguments are proffered, to refuse to engage on the grounds they aren’t even worthy of consideration.

    Don’t mistake denialism for debate…

    The whole goal of denialists is to create the appearance of a legitimate debate when there is in fact no legitimate scientific debate to be had. What is the point of arguing with someone who denies the moon landing? Or evolution? Or that HIV causes AIDS? Or the holocaust? They get real angry when you mention that one as they feel it creates a moral equivalence between the types of denial. But the operative word is “denial” which is totally unrelated to whatever specific topic one denies. It’s just another helpful distracting strategy, to try to prevent critics from using the legitimate word to describe their pathology – denial – by suggesting it’s a wrongful comparison to one specific type of denial.

    The solution to these problems is not in confrontations or debates or even necessarily careful fisking of their arguments every time they appear in the blogosphere. For one, it’s somewhat futile. They’re cranks. They will just go on and on, immune to any new data, scientific findings, or any evidence the real world can present. Worse, evidence suggests that repetition of false claims reinforces them even if you are debunking the claim. So debating them to supposedly educate those around you is not a legitimate reason because it’s probably making things worse, not to mention legitimizing the denialist. It’s a constant struggle I have to try to write about things in such a way as to reinforce positive true claims rather than repeat false claims with correction. It’s natural, but it doesn’t work.

    Chris is right, the only way to address denialism is to call it what it is and ridicule it. People have to understand the difference between denialism and debate, and when they encounter denialism expose and attack the tactics. Denialism is an established strategy, likely ancient, honed to a science by tobacco companies, and now used by those attacking everything from global warming to evolution. Some of the same fake experts for the tobacco companies are now working for the global warming denialists. The way to win is to remember the way tobacco science was eventually beaten, and that was with exposure of their deceptive techniques, and public ridicule for denial of the obvious reality.

  • Three reasons the Supreme Court should uphold ACA

    With the Supreme Court hearing arguments for the next three days on the Affordable Care Act, many commentators, including Dahlia Lithwick appear to have so much contempt for the Roberts court that they believe the issue will likely be settled on politics rather than law.

    The first proposition is that the health care law is constitutional. The second is that the court could strike it down anyway.
    …
    The law is a completely valid exercise of Congress’ Commerce Clause power, and all the conservative longing for the good old days of the pre-New Deal courts won’t put us back in those days as if by magic. Nor does it amount to much of an argument.

    Despite the fact that reading the entrails of those opinions suggest that they’d contribute to an easy fifth, sixth, and seventh vote to uphold the individual mandate as a legitimate exercise of Congressional power, the real question isn’t whether those Justices will be bound by 70 years of precedent or their own prior writings on federal power. The only question is whether they will ignore it all to deprive the Obama of one of his signature accomplishments.

    Professor Randy Barnett, the intellectual power behind the entire health care challenge, wrote recently that Justice Scalia could break from his previous opinions–freeing him to strike down the Affordable Care Act–“without breaking a sweat.” I suspect that’s right.

    If that’s true, we should stop fussing about old precedents. These old milestones of jurisprudence aren’t what will give Scalia pause. What matters is whether the five conservative justices are so intent in striking down Obama’shealthcare law that they would risk a chilly and divisive 5-4 dip back into the waters of Bush v. Gore and Citizens United.

    It disturbs me when legal commentators as experienced and knowledgeable as Lithwick have essentially given up on the notion that the court is non-partisan or above the political fray. Instead, they seem to think it’s just another political body, making decisions based on partisan point-scoring over legitimate constitutional analysis. With the tea party rallying to keep us uninsured under the false notion that the bill will increase costs (it will actually reduce the deficit according to the CBO) and impinge their freedoms. These are the false arguments that people like Nick Gillespie (or libertarian Fonzie) are using, quite successfully, to convince the American people to oppose their own interest. Gillespie argues in his three point essay that (1) it’s unconstitutionally intrusive legislation (2) it’s price tag is ballooning, and (3) it won’t make us healthier. The first claim is debatable since it’s ultimately up to the courts. However good arguments suggest congress does have the power to pass such regulation.

    For one previous case like Wickard and Raich suggest extensive powers for congress to regulate commerce. Second, if one of every seven dollars is spent on healthcare, it represents a significant portion of the economy. Third, and most importantly, the uninsured inflict an economic penalty on taxpayers and the insured, so rather than claiming they have a right not to buy, I would argue we have a right to address the cost the uninsured inflict on society. The penalty for not carrying insurance I believe makes complete sense in this regard.

    The second claim is blatantly false and his description of the costs as “ballooning” is unsupportable based on the CBO reports. This talking point is an outright lie being spread far and wide by right wingers. The CBO director had to issue a comment to correct this widespread deception.

    The third claim is a bit of a red herring. The health benefits of people being insured may eventually result in a healthier population but probably not by much and it’s besides the point. We’re not arguing the law will make us healthier. We’re arguing that the reform law will reduce healthcare expenditures, and protect people economically from the often devastating costs of illness.

    But rather than just knocking down their arguments I think it’s important to remind people of the positive reasons we should support this bill. So I have my own list of 3 reasons this bill should be upheld and we should all support it.
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  • What is the cause of excess costs in US healthcare? Take three – signs of reform

    We’ve already extensively discussed why it costs twice as much for the US to provide healthcare for it’s citizens all the while failing to cover health care for all. Most recently, we discussed the hidden tax of the uninsured and the perverse incentive structure of US healthcare which encourage costlier care, more utilization, and more procedures.

    i-880005398336c472547ab02e425e6cd0-commonwealthfigureII8.jpg

    To summarize, the US spends more on healthcare compared to other industrialized nations because

    1. We deliver it inefficiently
    2. Without universality problems present when critical and in the ER
    3. Fee-for-service incentives in the form of excessive reimbursement for procedures and hospitals ramp up costs by encouraging doctors to overuse expensive tests and perform more procedures
    4. Direct-to-consumer advertising (we are one of two countries that allow advertisement of prescription drugs) and medicare part D encourage overuse of pharmaceuticals while tying providers hands when it comes to bargaining for lower drug prices
    5. Defensive medicine
    6. Poor management of end-of-life decisions and excessive and futile overuse of resources at the end of life
    7. Absence of a universal electronic medical record (or record format) to prevent redundancy and waste.

    Now, what about the new Affordable Care Act? Are there going to be measures to address these sources of excess cost while creating universal coverage? The WaPo has an article outlining reforms addressing many of these specific problems.

    First off, fee-for-service is going to be discouraged with increased use of “bundling” of costs:
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