Denialism Blog

Denialism Blog

  • Mitt Romney is the wrong choice for healthcare

    It seems every day brings a new, glaring falsehood about medical care from Romney, who has bizarrely decided to run against his own healthcare plan in order to appease right wing voters. Now he’s claiming Americans don’t die from lack of healthcare coverage. His reasoning? The unfunded mandate and healthcare-of-last resort stopgap that is EMTALA. For those of you who don’t know the function of the Emergency Medical Treatment and Active Labor Act, it’s law passed in the Reagan era to stop hospitals from dumping patients who were acutely ill and needed emergency care. It prevents hospitals from refusing or delaying treatment of an emergency condition if the patient is uninsured or their ability to pay is unknown. It only obligates hospitals to provide enough care to stabilize the patient, and then the patient is discharged or transferred to another center if a higher level of care is needed. Despite the mandate that such patients be cared for, the federal government did not prescribe a method of reimbursement for such patients, making it an unfunded mandate, and as a result, some 55% of emergency room care goes uncompensated. EMTALA also doesn’t protect you from hospitals attempts to recoup their losses, and those that can pay often receive a surprisingly large bill that can easily bankrupt those living on the edge of solvency. But besides being a cruel and stupid thing to say for someone who proposes to lead our country, it’s also wildly false. Not only does the Institute of Medicine estimate these deaths at about 20,000 a year, but we also see it in admissions that aren’t due to prolonged illness or chronic medical conditions, for example we see a 40% higher trauma mortality among uninsured patients even after accounting for age, race, sex, and severity or mechanism of injury. If you are injured in a car accident, you are 40% more likely to die just by virtue of being uninsured, because the fact is, many hospitals will treat you differently if you can’t pay for your care.

    As someone who has done almost all of my medical training at medical centers that are the highest level of care in the region, I’ve seen many of these patients and transfers. Often at such centers you hear griping that a patient’s condition had been exaggerated to suggest that the patient was sicker than they actually were, in order to initiate the transfer of a patient that would be costly to treat, but perfectly within their means to care for. Sometimes you hear complaints the referring hospitals could have done a better job stabilizing a patient before transferring them, it’s impossible to know the motivations of the referrers in any given instance, and I generally believe that the physicians are acting in their patient’s best interests, but we can’t ignore the fact that EMTALA creates a conflict of interest between physician and patient interests by creating a financial incentive for transfer. I suspect such patterns are the reason why you find such a huge disparity in medicare reimbursements and imaging and procedure costs between hospitals. In order to recover the costs of their “mission” expenditures, hospitals that care for more uninsured have to charge medicare and insurers more to reflect their “cost of doing business”, whereas smaller private hospitals that manage to deflect more of these patients can offer elective services cheaper.

    In the end, it’s all one big stupid cost-shifting game that ignores the central problem. No matter what, we end up paying for people’s medical care! There is no avoiding it. You can either pay for it prospectively, thoughtfully, and humanely by giving people care in primary care offices, or you can wait for them to get really sick, not to mention really expensive to care for, and pay for it then. But there’s no avoiding the bill. The type of care advocated by Romney here is also just plain stupid. For example, what is the point of stabilizing a patient with COPD and asthma as they come in the hospital in crisis every month, rather than just paying for their medications as an outpatient? ICU admissions, intubation, medications, doctors fees and nursing are all far more expensive (not to mention hard on the patient) than a couple of inhalers a month. Or how about the uninsured patient with a mental illness that requires constant stabilization with inpatient admissions because no one will pay for their anti-psychotic medications? You see it happen like clockwork, a patient is discharged “plugged in” with a month of medications, plans for follow up etc., and then as they can’t pay for medications after that time is up they start missing appointments, losing their job or their housing arrangement, then they’re back in the ER in crisis. Or think about the risk involved in all those transfers, which the current system encourages referring hospitals to engage in even if the patient might not benefit, because it allows them to unload a patient that will just create uncompensated costs for the hospital?

    This is leadership on healthcare? I don’t think so.

  • The New York Times doesn't know how to write a headline

    I don’t understand how they could write the headline,”On Health Care, Two Visions With Their Own Set of Facts” in regards to the debate between Obama and Romney last week. The appropriate headline should have been “On Health Care, Two Visions With Romney Telling Falsehoods”.

    It’s another example of the NYT’s false-parity reporting. Every single instance described in the article describes Romney lying about Obama’s law, lying about his own proposals, and lying about other facts.

    For instance:

    Mr. Romney made a similar claim in an appearance last month on NBC’s “Meet the Press.” At the time, he said, “I’m not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage.”

    But Mr. Romney’s aides later clarified that he would only explicitly guarantee insurance for people with pre-existing conditions if they have maintained coverage with no significant lapses. That could exclude millions of Americans with conditions like cancer, heart disease and asthma.

    He’s for covering pre-existing conditions, except for the single instance in which it matters! When you are unhealthy and lack coverage! This is such an egregious example of mendacity, and it’s not like he didn’t provide a dozen such instances the night of the debate. The article headline suggests that there were falsehoods told by Obama, or at least that he has another view similarly divorced from reality, but the article doesn’t provide such examples. Obama’s worst crime seems to be from trying fill in the blanks in Romney and Ryan’s proposals, making reasonable assumptions about how such proposals and plans would work and be paid for. Take for example factcheck.org’s summary of claims in the debate, again trying to create parity. Take the first claim:

    Obama accused Romney of proposing a $5 trillion tax cut. Not true. Romney proposes to offset his rate cuts and promises he won’t add to the deficit.

    Yes, but Romney is still proposing a 5 trillion dollar cut if he really intends to drop rates as far as he says. How he’s going to pay for that is hazy and vague. He “proposes” to offset his rate cuts and “promises” he won’t add to the deficit, but there is no loophole you could close to cover that amount of revenue, nor possible way to offer these cuts without adding to the deficit.

    Obama’s other great errors? An incorrect stating of a true fact (healthcare spending has slowed), a rounding error (5 million new jobs rather than 4.6), etc. Then factcheck commits it’s own classic disgusting parity routine with this one:

    Obama again said he’d raise taxes on upper-income persons only to the “rates that we had when Bill Clinton was president.” Actually, many high-income persons would pay more than they did then, because of new taxes in Obama’s health care law.

    Yeah, but his statement is true! He was talking about rates, not overall tax burden. Why does this get counted as counterfactual? Or this:

    Obama again touted his “$4 trillion” deficit reduction plan, which includes $1 trillion from winding down wars that are coming to an end in any event.

    Why doesn’t ending wars count? This is an Obama accomplishment, isn’t it? And it’s the source of a huge component of a the deficit! I’m all for ending stupid wars in the wrong countries. That’s a conservative ideal if you ask me.

    If you look at Romney’s exaggerations (I would call them lies), they are much more severe. They include doubling the amount of jobless, repeating the 50% lie about jobless college grads, exaggerating bankruptcies in an energy investment program (less than 10% went bankrupt like Solyndra, not “half” as Romney claimed), he repeated the “death panels” trope, he repeated the often debunked “716 billion cut” from medicare lie, he claimed Obama doubled the deficit (it barely changed at all from Bush), and he doubled the amount of income loss during Obama’s term.

    I don’t understand how these sets of inaccuracies are comparable. Obama, at worst, seems to have used the wrong word “premiums”, during his most inaccurate statement, committed a rounding error, and is being punished for applying arithmetic to Romney’s vague proposals. Whereas Romney doubles every statistic, fabricates others, and misrepresents fundamental facts about the state of the country and laws that are passed and on the books, all the while never providing details as to how he’s going to do anything he proposes.

    Both the NYT and factcheck are engaging in false parity here. I find it very upsetting when a presidential candidate addresses a national audience with such falsehoods, and they should be addressed appropriately as such by the media. Until then these races will always be between people who will say whatever is necessary to get elected and those who are trying to make an honest effort (if we’re lucky – eventually we won’t even have that). I could never vote for a global-warming denying (or in this case minimizing), pro-choice before he was pro-life, quackery-promoting etch-a-sketch candidate like Romney. I hope for a day when we actually have an alternative vision provided by a candidate, a true conservative, with a small government vision, but one that’s based on details, facts, and personal responsibility. I don’t want tax cuts for the sake of tax cuts, I want a government that will pay it’s bills, and Romney’s tax plan is insane. Most importantly I want a candidate that believes in facts. Don’t tell me pre-existing coverage will exist in your program then have your minions the next day clarify pre-existing conditions won’t be covered. Own up to it! Say, “I’m a conservative, in my vision of America, you’re on your own.” Be honest about it for once, and consistent, and maybe the message would be more appealing. If your vision of limited government also meant no more unnecessary transvaginal ultrasound laws, no more anti-gay bigotry, no more interfering in the doctor-patient relationship, etc., people might be able to get behind it.

  • Monckton goes birther – demonstrates crank magnetism

    Via Ed I see that Christopher Monckton is expanding his crankery from denying global warming, claiming to be and MP despite cease and desist letters from parliament asking him to stop, curing HIV, the flu, MS and the common cold to now engaging in Birtherism. It’s pathetic when you’ve been pre-debunked by snopes, but there’s no stopping a crank like Monckton.

    This reminds me of all the fuss last month over Lewandowsky’s study that basically demonstrated crank magnetism, that is, the tendency of those who believe in one kind of conspiratorial nonsense to believe all sorts of other conspiratorial nonsense if it fits with their ideological worldview. One of the major criticisms of his results was the idea that it was scammed by people trying to make global warming denialists look bad, because there were too many respondents who believed in all the conspiracies. Lewandowsky responded that even removing the “true nutters” did not affect his analysis, but I disagree with the move, and as he notes in the post, Christopher Monckton is an example of why such responses are likely real. This guy is convinced he’s an expert on global warming (and that it doesn’t exist), that he’s cured HIV, that he’s a member of Parliament (despite a cease-and-desist letter from Parliament), and now that Obama is Kenyan. Why anyone should have been surprised by Lewandowsky’s results is beyond me.

  • Conspiracy-targeted Campaigning from Romney

    Slate has an interesting article about Romney campaign mailings that appear to contain buzzwords for chronic Lyme disease advocates in Virginia. Romney’s plan for Lyme disease includes these two points:

    IMPROVE SYNERGY
    Ensure that government agencies have an open line of communication and work with patients, researchers, doctors, and businesses in an objective, comprehensive manner.

    SUPPORT TREATMENT
    Encourage increased options for the treatment of Lyme Disease and provide local physicians with protection from lawsuits to ensure they can treat the disease with the aggressive antibiotics that are required.

    Note the “aggressive antibiotics” line. This refers to a bogus medical practice of prescribing long courses of antibiotics, often in IV form, for “chronic Lyme” syndrome. While people can have chronic complications of actual Lyme disease, another, crankier disease entity has been promoted by irresponsible doctors who treat a syndrome similar to fibromyalgia, or chronic fatigue, or maybe even depression, with long-term IV antibiotics. These treatments are administered at their own clinics, usually without insurance paying for it (insurance companies can smell this BS and won’t cover it), at great expense because IV antibiotics cost a lot more to administer, and often without evidence of Lyme infection by tests or history.

    This has been a season of bizarre political conspiracy mongering with everything from birtherism from Mitt Romney, Sheriff Joe’s craziness, magic Kenyan Telegrams, Aurora conspiracies, job numbers conspiracies, polling conspiracy theories from America’s least-accurate pollster Dick Morris, and my favorite Obama is buying bullets for the Social Security Administration to kill all Americans conspiracy theory. Now, rather than coming up with Obama conspiracies it looks like they’re trying to solicit vocal conspiracy theorists who think the pharma/CDC/infectious disease society illuminati are trying to suppress a bogus diagnosis their doctor has successfully treated by emptying out their wallets.

    It’s very sad, really. People with a legitimate medical disorder, likely along a similar spectrum with fibromyalgia and chronic fatigue that have a disordered sense of pain perception, are being exploited by quack physicians who directly profit from a dangerous course of powerful antibiotics. Antibiotics are not benign drugs, and should not be used carelessly, as they too often are. And the non-evidence based used of megadoses of these drugs, often without any actual evidence of infection should result in a campaign to revoke these physicians’ licenses, not to solicit their votes by hinting at support of quack medical theories and protection of irresponsible physicians from liability. Is this a new all time low for a political campaign?

  • AEI writes an honest article about ObamaCare

    This article from the Sunday Times by AEI fellow J.D. Kleinke is exceptional for two reasons. For one, it’s an excellent explanation for why conservatives should agree with Obamacare. Second, despite coming from the American Enterprise Institute, an organization that regularly contributes global warming and other conspiratorial nonsense to the WSJ editorial page, it appears to contain nothing but factual information. It’s a good reminder of why liberals have been weak in their defense of the law – it’s really just Federal Romney/Bob Dole care, but also provides a very striking critique of the justifications of conservatives opposing it. Including my favorite argument for why the supposedly free-market system we enjoy now is bogus:

    Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.

    This is spot on. The analysis of the possible true motivations for the bile and invective levied at what is essentially a conservative piece of legislation are also stunning coming from a conservative:

    Clear away all the demagogy and scare tactics, and Obamacare is, at its core, Romneycare across state lines. But today’s Republicans dare not own anything built on principles of economic conservatism, if it also protects one of the four horsemen of the social conservatives’ apocalypse: coverage for the full spectrum of women’s reproductive health, from birth control to abortion.

    Social conservatives’ hostility to the health care act is a natural corollary to their broader agenda of controlling women’s bodies. These are not the objections of traditional “conservatives,” but of agitators for prying, invasive government — the very things they project, erroneously, onto the workings of the president’s plan. Decrying the legislation for interfering in the doctor-patient relationship, while seeking to pass grossly intrusive laws involving the OB-GYN-patient relationship, is one of the more bizarre disconnects in American politics.

    This is a rare, clear-eyed, honest, and insightful piece of writing from AEI. Have they turned a corner?

  • Anti-GMO study is appropriately dismissed as biased, poorly-performed

    The anti-GMO study released late last week has raised so many bad science red flags that I’m losing count. Orac and Steve Novella have both discussed fatal flaws in the research, the New Scientist discussed the researchers’ historical behavior of inflating insignificant results to hysterical headlines. And all this new paper seems to be proof of is that these researchers have become more savvy at manipulating press coverage. The result of this clever manipulation of the press embargo and news-release stenography by the press is predictable. The internet food crackpot army has a bogus paper to flog eternally with Mike Adams predicting the end of humanity, and Joe Mercola hailing this as the bestest study of GMO Evar. Lefty publications that are susceptible to this nonsense like Mother Jones have largely uncritical coverage and repeat the researchers’ bogus talking points. It’s a wonder Mark Bittman, organic food booster and anti-GMO half-wit hasn’t used it for his assertion that the evidence against GMO is “damning”. He substantiates this claim, by the way, by linking an article without a single scientific citation, just links to crankier and crankier websites.

    Orac and Steve Novella do a good job dissecting many of the methodological flaws of this paper. Similarly, my read (or reads since this paper is unnecessarily obtuse in its data presentation), is that this paper is so flawed as to be meaningless.

    Critically, these rates of tumor formation are well established from the pre-GMO era. This paper is exceptional for a low rate of tumor formation in the controls compared to historical controls and knowledge of tumor formation in this rat strain.

    Second, the sample groups were small, and the parameters measured were large, almost guaranteeing false-postive events would outnumber true-positive events. Take a data set like they generated, and then perform subgroup analysis, and false-positive yet statistically-significant events are going to jump out at you like mad. The researchers then indeed seem to engage in this behavior, selecting a single time point to present their measurements of various biomarkers, rather than showing them over time. This is particularly notable in figure 5 and table 3. This is a sign of sloppy thinking, sloppy experimental design, and a failure to understand Bayesian probabilities. If you study 100 variables at random, you are likely to find false-positive statistically significant events about 5 percent of the time, even though there is no actual difference between groups. The pre-test probability of an effect being meaningful should determine whether a test should be performed and reported, and this “fishing trip” kind of experiment should only be the beginning of the process. It’s simply not possible to know the relevance of any of these ostensibly significant results found by subgroup analysis until they are subsequently studied as primary endpoints of a study.

    The histology in figure 3 is demonstrative of nothing, and the scary rat tumor pictures notably lack a control rat – and we know the controls make tumors too. So why aren’t any control tumors shown? With the concern for bias throughout this paper I find the entire figure to be of no value, since it’s purely qualitative and highly susceptible to bias. Histology slides should be used to show something meaningful in terms of big qualitative effects, unusual structure, or a specific pathology. If one is to make claims about differences between groups by histology, you still have to subject it to rigorous and blinded analysis. I’ve done it, published on it, etc. It can be done. Worse, we know the controls have tumors, and that in this strain tumors are frequent. Why are the control samples always completely normal if not for biased selection of samples? Don’t show me one kidney, show me all the kidneys. Don’t show me one control slide, show me ten, or ideally the results of a blinded quantitative evaluation for tumors or histopathologic grade.

    Similarly with figure 4, I don’t see a significant difference between the fields examined, and looking back at previous papers from the same group none of their ultrastructural evaluation of glyphosphate exposed or glyphosphate-resistant feed exposed cells and animals appears consistent or convincing. I don’t think many people have exposure to EM anymore as an assay, but having performed it, it’s very hard to say anything quantitative or meaningful with it. You’re going to find something in every grid, and it largely serves as a qualitative evaluation of cellular ultrastructure. I’m very wary of someone saying, upon presentation of a couple EM slides, that two groups of cells are “different”, and I’m confused by the assertion that the areas they describe represent aggregates of glycogen. What is the significance of glycogen being more dispersed in one cell versus another? You found some residual bodies, so what? They’re everywhere. Is this really a consistent effect? Show me numbers – summaries from 10 grids. Is there any clinical significance of such a change? The answer is no. If I were a reviewer I would have told them to junk the figure unless they wanted it to provide evidence of no difference between the cells.

    In general the paper is confusing and poorly-written. Others have pointed out that Figure 1 is unnecessarily complex and better representation of the same data shows no consistent pattern of effect. I would say, given the sample sizes and effect sizes that the likelihood is the researchers are studying noise. There simply is no signal there, if there were there would be a consistent dose-response effect, rather than in many cases the “low dose” group having more tumors than the “high dose” groups. Without error bars it’s hard to be sure but my read of figure 1, in particular the inset panels, is that there really is no difference between any of the groups in terms of tumor formation.

    We also have to consider that in the end, this whole idea is kind of dumb. Is there really a plausible explanation for how eating feed with an enzyme that’s resistant to glyphosate generates more tumors in rats, and so does exposure to glyphosate? Why would this protein be tumorigenic? If indeed the roundup-ready crop may have residual levels of glyphosate on it, and that’s the explanation for the similarity between groups, then aren’t you just admitting you’ve done a completely uncontrolled analysis of exposure to the compound? Couldn’t and shouldn’t this have been assayed? Isn’t this whole study kind of crap?

    This paper should not have passed peer-review and represents a failure by the editors and reviewers to adequately vet this paper.

  • Katie Couric Picking Up Where Oprah Left Off

    Gawker reports that on the first day of Katie Couric’s new show, Sheryl Crow discusses her theory that cell phone use caused her to have a brain tumor.

    Update: The Chronicle reports that the show is just a celebrity infomercial, with softball questions, and no critical discussion:

    You would be forgiven for mistakenly thinking you’d tuned in to an infomercial for Weight Watchers in the first half hour of Katie Couric’s new syndicated talk show, “Katie,” which premiered Monday afternoon…

  • $15 To Turn off "Special Offers" Bravo Amazon.com!

    With the announcement of the Kindle Fire HD, some users were upset to learn that Amazon was going to stuff “special offers” on the device. But the company quickly retreated, and now is offering the option to turn of the ads for a mere $15.

    This is a good development for consumers. We should have the choice to move away from ad-supported business models. As I explain with my co-author Jan Whittington, there is a cost to free business models. “Free,” ad-supported services are packed with hidden costs to privacy and other consumer interests.

    While the ads are gone, there is still no word on whether Amazon will reduce tracking of Kindle users. Without backing off on tracking, this is not a pure privacy play.

    And an interesting data point–how is it that Amazon is willing to give up these special offers for only $15, given that “customers love our special offers“?

  • How Did You Get My Facebook?

    Facebook watchers are reporting that the service is about to launch a new feature for merchants that will allow merchants to target ads to users based upon users’ email and phone numbers. That’s a little confusing. Let me explain with a hypo–

    As I understand it, it might work like this: ABC Corp. has an extensive database of consumer email addresses, but is concerned that no one is reading the company’s spam. So ABC uploads its consumer email database to Facebook, which identifies Facebook members who are customers of ABC. ABC Corp can then send its marketing through Facebook so that it lands in the Facebook Feeds of its existing customers.

    The service has some privacy safeguards, because some hashing will be in place to stop Facebook from just copying the customer databases held by merchants (too bad they don’t do this for address book scanning!), and because the targeting will be based upon phone numbers and email addresses already in possession of the merchant. Thus, the idea is that this is marketing only to people with a business relationship with the advertiser.

    This is a great model for businesses trying to communicate with their existing customers. It lets them reach customers through a new channel (Facebook) that is very popular. It avoids the hassle of telemarketing and possibly the regulatory regime associated with email marketing.

    The Enhancement Problem

    But here’s the catch–two core privacy assumptions are flawed. Merchants have difficulty getting phone numbers and email addresses from customers. Sometimes, instead of asking customers for personal information, they find ways to trick consumers into providing it, or they simply buy emails/phones/home address about a customer based upon whatever data they already possess. This practice is known as data enhancement, it happens where a company links more information about consumers to an existing database.

    A recent case explored this practice at Williams-Sonoma: “After acquiring this information [zip code from Jessica Pineda at the register], the Store used customized computer software to perform reverse searches from databases that contain millions of names, e-mail addresses, residential telephone numbers and residential addresses, and are indexed in a manner that resembles a reverse telephone book. The Store’s software then matched Pineda’s now-known name, zip code or other personal information with her previously unknown address, thereby giving the Store access to her name and address.” That’s how you end up with dead trees in your mailbox.

    The whole point of data enhancement is to get information about the consumer that she is otherwise unwilling to provide. It’s really sneaky and it contravenes transparency and fairness principles. Enhancement obviates many attempts to protect privacy through selective revelation.

    How Did They Get My Facebook?

    There’s a second problem here. Many people do not want to be contacted by the companies that they frequent. In a recent survey, I found with colleagues that 74 percent of Americans thought that a merchant should not be able to call them, even if they gave their phone number to the merchant! Consumers want specific permission controls over direct marketing.

    Finding a new channel to contact people may be great for advertisers, but for users, contact through some new, unexpected channel, can be a bit unwelcome.

    A Fix?

    Perhaps Facebook could correct this problem by requiring merchants using this new service to guarantee that they collected email addresses and phone numbers directly from the consumer, with their consent that the information be used for marketing. Otherwise, this new service will create incentives for companies to engage in more enhancement, and it will further junk up Facebook.

  • The Crackpot Caucus

    Timothy Egan nails it, the Republican caucus is composed of crackpots and cranks.

    Take a look around key committees of the House and you’ll find a governing body stocked with crackpots whose views on major issues are as removed from reality as Missouri’s Representative Todd Akin’s take on the sperm-killing powers of a woman who’s been raped.

    On matters of basic science and peer-reviewed knowledge, from evolution to climate change to elementary fiscal math, many Republicans in power cling to a level of ignorance that would get their ears boxed even in a medieval classroom. Congress incubates and insulates these knuckle-draggers.

    He then goes on to cite multiple examples of what should be career-fatal stupidity that has been routinely ignored and inadequately mocked in the media. My favorite?

    Barton cited the Almighty in questioning energy from wind turbines. Careful, he warned, “wind is God’s way of balancing heat.” Clean energy, he said, “would slow the winds down” and thus could make it hotter. You never know.

    “You can’t regulate God!” Barton barked at the House speaker, Nancy Pelosi, in the midst of discussion on measures to curb global warming.

    I think we need to thank Akin again. He managed to say something so grotesquely stupid, so insanely backwards in terms of its scientific validity and misogyny that we’re actually seeing dialogue about scientific illiteracy in congress again. Perhaps his comments were the straw that broke the camel’s back?