An odd fight to pick

Recently I took some time to criticize Dr. Andrew Weil, about whom I continue to know very little. My beef was with his recommendation that direct-to-consumer pharmaceutical marketing be banned. However, as far as famous-doctors-who-probably-are-incredibly-rich-and-blog-at-HuffPo are concerned, he seemed relatively benign.

Well, it seems that Dr. Tuteur over at Skeptical OB begs to differ. She's taken after Dr. Weil a couple of times. I will let you check out her post on Dr. Weil's thoughts about preventive medicine yourself. However, I'm a bit perplexed by her more recent gripe.

In his post Fear, Greed and X-rays, Dr. Weil wrote:

Along with over-scanning, over-biopsying, over-blood-working and other diagnostic excesses, fear propels over-treatment. Anytime a physician diverges from standard U.S. treatment protocols, nearly all of which skew toward expensive drugs and surgery, lawsuit-fear looms. "Defensive treatment" strips physicians of clinical judgment, costs billions and leaves patients less healthy, but it's hard to blame physicians who practice it. As one wearily told me, "You never forget your first lawsuit."

Physicians like to discuss the fear side, because it shifts the blame to lawyers. The greed side, however, deserves just as much scrutiny and reform. Consider "The Cost Conundrum: What a Texas town can teach us about health care," a must-read New Yorker article by Atul Gawande, M.D. Gawande visited McAllen, Texas, to discover why per-capita health care expenditures there are the highest in the nation. He found that many physicians in high-medical-cost cities such as McAllen have a diversified "revenue stream," the result of what one hospital administrator termed "entrepreneurial spirit." This "spirit" often manifested in physicians owning their own medical testing equipment, which meant the more tests they ordered, the more money they made. A 2002 University of North Carolina study showed doctors who own imaging equipment sent patients for roughly two to eight times more imaging tests than those who don't own.

[snip]

To quell the fear that drives physicians to over-test and over-treat, we need vigorous legal reform to cap malpractice payouts. Staunching the greed motive requires a more dramatic change. Since a single CT scanner can bring in $400,000 a year in profit, it's vital to sever the link between ordering tests and making money. Restricting ownership of testing equipment to nonprofit, government, or independent private entities is crucial.

As for popularizing less lucrative -- but often better -- low-tech treatments, putting physicians on salary can also help. Whether the paycheck comes from a nonprofit organization such as the Mayo Clinic or some variety of single-payer national health care, stabilized incomes would let physicians more readily focus on the health of their patients rather than on their own finances.

Dr. T responds:

Does greed play a role in healthcare? Unfortunately, in the case of unethical practitioners it does play a role. Should greed play a role? Of course not. So please tell us, Dr. Weil, why we should pay the least bit of attention to your faux outrage? None of the products that you hawk are essential and most do not even provide the health benefits that you claim for them. The only thing they do is line your own pocket.

You're right, Dr. Weil. Patients shouldn't trust doctors who recommend treatments that provide financial benefit for the doctor and little if any health benefit for the patient. In other words, Dr. Weil, by your own logic, patients shouldn't trust you.

Hmmmm. I'm giving this one to Dr. Weil.

First of all, over-testing because you fear a potential lawsuit is a real phenomenon. Ordering tests "just in case" motivates a lot of unnecessary blood tests and CT scans. I fully support capping malpractice claims, and creating a means of tort reform that alleviates the culture of fear that pervades contemporary medical practice.

But I think it is 100% appropriate to call for an end to the unethical, egregious practice of physicians owning the same testing equipment they refer patients to use. It defies any sense to pretend that such double-dipping does not create an incentive to order tests that aren't necessary to bulk up the "revenue stream." Further, I can attest that linking patient care to revenue creates an unhealthy dynamic in which patient care becomes a commodity. I fully support making physician pay salaried, and decoupling it from revenue generation.

Finally, there is a difference between buying some specialty tea or other product because you choose to spend your money that way, and getting a test or procedure because you trust your doctor that it is necessary. People view famous alternative medicine practitioners (who, for the record, I think are in the business of hooey) differently than they view their primary care physicians. If people with the cash to spend want to buy some kind of crack-pot olive oil, who am I to stop them? But it undermines the trust we as physicians rely upon if our colleagues are using that trust to order tests people don't need in order to line their pockets.

My one and only contribution to the Infinite Summer discussion

So, as I've mentioned in occasional previous posts, this is the Infinite Summer, during which numerous writers, readers and bloggers have been reading David Foster Wallace's magnum opus Infinite Jest. As it happens, Infinite Jest is my favorite book, and I've been following along with interest and enthusiasm. Some places of interest are here, here, here and here (though that last one seems to have petered out).

For those of you who are uninterested in Infinite Jest, or my opinion thereof, feel free to tune out now. I will commence ranting about Sarah Palin or health care reform or some such in short order. However, since I'm now sure that the weekly milestones have carried the readers past my favorite moment in the book, I thought I would simply write to mention what it is.

Last chance to jump ship before I reveal myself to be hopelessly sentimental...

So, when Joelle says "And lo" to a seriously-injured Gately on page 619, it makes me cry every time I read it. (In fact, even thinking about it for very long makes my chest go all tight and clenchy.) I realize that this will mean nothing at all to people who have not read the book, but at that moment a character who has cut herself off from other people to such an extent that she has literally veiled herself reveals something personal and private and hidden to someone she has come to trust, and who cares about her. In a nutshell, she lets him know who she is, reversing ever so slightly a long process of walling herself off from the world. Being as it were that the whole novel is about how fraught and fragile and rare true happiness and human connection really is, it's a beautiful and heart-breaking moment (particularly given everything else that's been going on with those two characters) and I just thought I would take a minute and mention it. And, apparently, also out myself as ridiculously sappy deep in the core of my dark, tar heart.

Snark will commence presently.

Confidential to my friends at The New Republic

My, what a busy redesign you've rolled out. How very eye-catching. Inspired by The Atlantic, I would guess?

One small, eensy little request. Please dredge your records for my subscription information, since apparently your fancy new page no longer recognizes the user name I've been using for the better part of the past decade!

Thank you.

Paging Mr. Famine. Please join your party at the stables

Please, in the name of all that is holy, tell me that my eyes deceive me. Or that this is some kind of joke. Or that I am the subject of a secret psychological test, wherein I am faced with brain-melting situations while secret electrodes monitor my brain activity. But, for the love of God, please tell me that this is not reality (via HuffPo):

No. I cannot live in this world. They're replaced the bun with meat?!???!?

Has the world gone mad? Is there a market for this? Has American fast food finally created a product that makes people back away slowly and re-examine their lives? Or will this sell like hotcakes? (Coming soon -- chicken-meat hotcakes.) Will this start a trend? Will Taco Bell start replacing its taco shells with beef?

I need to go lie down and take an Advil.

Update: Ta-Nehisi had the exact same thought I had when I first read about this.

Megan McArdle confounds me

I think Megan McArdle is very smart. Even though I know something only just slightly to the north of "zilch" when it comes to economics, I think much of what she writes on the subject for The Atlantic makes sense. (I don't believe that her fears about health care reform stifling innovation are well-founded, but that's a different topic for a different day.) But I think she is completely around the bend when it comes to the topic of people carrying guns to presidential events.

She's gotten into something of a back-and-forth with Jason Zengerle at The Plank on the topic. Their exchange seems to focus mainly on whether the people carrying the guns pose imminent threats to the POTUS. While I agree more with Zengerle than McArdle on that particular question, I think it is beside the point. In her initial post on the topic, she wrote:

I think carrying guns to protests is entirely counterproductive. Indeed, I'm not sold on the general virtues of protesting, which worked for Gandhi and the civil rights marcher, but has a dismal track record on other concerns. But I think people have a perfect right to do it, including with guns, though I also think the secret service is within its rights to ensure that they don't have a sight line on the president.

But the hysteria about them has been even more ludicrous. Numerous people claim to believe that this makes it likely, even certain, that someone will shoot at the president. This is very silly, because the president is not anywhere most of the gun-toting protesters, who have showed up at all sorts of events. It is, I suppose, more plausible to believe that they might take a shot at someone else. But not very plausible: the rate of crime associated with legal gun possession or carrying seems to be very low. Guns, it turn out, do not turn ordinary people into murderers. They make murderers more effective.

I will leave aside whether the sociopaths carrying the guns have a "perfect right" to do so or not. Let us accept that they do. It is still totally, 100% wrong.

What is the point of carrying the guns? Sure, maybe they don't actually intend to harm the President. But what are they trying to communicate by bringing a deadly assault rifle to a public forum he is attending? It is an inherently menacing thing to do, Second Amendment rights notwithstanding, and communicates an implicit threat of violence, if not now than potentially in the future. It is uncivil in the extreme, and does not comport with the expected behavior of responsible adult members of society.

Let me make two finals points, just to (probably pointlessly) head off a couple of potential criticisms:

1) I am not stridently anti-gun. I know many people who are perfectly honorable, sane, responsible gun owners. I do not begrudge them their right to own their guns, and do no conflate all gun owners with the reactionary thugs in question.

2) I detested George W. Bush, and have never been more pleased to see the departure of an American president from office. It was so bad that, at one point, I could barely stand to look at his face on television. But, had someone taken a shot at him or committed an act of violence on his person, it would have been a wholesale tragedy for the country and the world. I would have felt no less exercised if a bunch of leftist crazies had shown up at his rallies toting guns. This is an issue that transcends ideology.

You don't bring guns to a civic event, period. You especially don't bring them to a presidential event. We may have the right to do all manner of things that are nonetheless wrong. This is one of them.

This clown is the best they can do?

This morning on the way to work, I caught Steve Inskeep's interview with GOP party chairman Michael Steele on Morning Edition. I was... not impressed with the latter's clarity of thought or effectiveness as a spokesman for his viewpoint.

I can't listen to the audio at work, so I can't go back and pick out the choice bits. However, if memory serves, Inskeep actually tried toward the end to come up with a polite way of saying "you're making no sense." Listen to Steele take umbrage at having his viewpoint described as "nuanced."

Suffice it to say, I cannot believe the Republicans couldn't come up with a better person to head their party. He simply sounds incoherent and occasionally confrontational. As far as trying to support his claim that Medicare is somehow sacrosanct and in no need of being made more efficient, I believe the word is "fail."

Update: Well, it seems I'm not the only one who felt this way.

Maine Marriage Equality

As the upcoming election day approaches, when the good people of Maine will go to the ballot box to determine if people like me should have same rights as everybody else, the battle for the hearts of the voters commences. Via the Dish, I see that our side has produced its first ad:

I will, suffice it to say, be as active in the upcoming campaign as can be. Those who support marriage equality in Maine can find out more here.

Why we are not angry

So, there will be a special investigation into the torture of detainees during the past administration. Ducky. Just ducky.

For starters, I share Glenn Greenwald's skepticism about the limited scope of the investigation. If the Justice Department officials and others in the administration who were responsible for the policy of detainee torture are given immunity, then the investigation will fail to achieve a just end. While it passes obvious that those who did the actual torturing in "bad faith" (whatever the hell that is) deserve to be investigated and prosecuted, so do Yoo and Bybee and Cheney. (And yes, that includes any Democrats who were complicit.)

Further, I concur with Will over at Ordinary Gents that the degradation to our national character that resulted from the torture of prisoners was, even by coldest utilitarian calculus, not worth it.

So, why does the anger over all of this seem so limited? Why does there not seem to be much national shame?

Because, at the end of the day, I think Americans are not particularly bothered by the torture of terrorism suspects. First of all, the presumption of innocence goes right out the window when we feel unsafe, and when the people who are being held have distressingly foreign-sounding names, and come from places of which we are only barely aware. I wonder if it occurs to most Americans that often we might simply have captured and tortured the wrong people, people who may have known little or nothing of value.

Once one paints all the detainees with the brush of guilt, it's a short step to accepting their torture. They have it coming, after all. They positively deserve it as an end unto itself, and any data extracted is gravy. The wholesale destruction of American moral authority, and the corrosion of our national identity as a virtuous nation is lost in the brilliant heat of our vengeance, and drowned by the pleasure we feel when we hurt the people we believe have hurt us.

Why are Americans not more exercised by the torture of the detainees? Because, at the end of the day, they were probably glad it happened.

I do not understand this

From the Times:

The Obama administration will continue the Bush administration’s practice of sending terror suspects to third countries for detention and interrogation, but will monitor their treatment to insure they are not tortured, administration officials said on Monday.

The administration officials, who announced the changes on condition that they not be identified, said that unlike the Bush administration, they would give the State Department a larger role in assuring that transferred detainees would not be abused.

I am at a loss to explain this, as it makes no sense to me.

There are a few explanations, I suppose. Perhaps the administration's assertions about the State Department's role in preventing torture is a bunch of hot air, and this is just a continuation of the Bush administration's odious policies. While I hope this is not the case, I am not such a guileless Pollyanna as to presume that it is impossible. If this is the case, then it is a disgraceful moral failure on the part of the President.

The only other idea I have for what this means is that the whole Gitmo-detainee NIMBY phenomenon has left the administration with few choices for what to do with the suspects housed there. Perhaps they really do mean to monitor the prisoners, and they really won't be tortured. While I would find this a sad commentary on the hysteria surrounding Guantanamo, it would be the less horrible explanation.

Anyone else have any ideas? (And yes, John, I already know what you think.)

In which I play devil's advocate

I don't really know a lot about Andrew Weil, MD. While I tend to be somewhat skeptical of celebrity doctor types (because some of them traffic in all manner of hooey), Dr. Weil doesn't seem all that bad. His website offers vaguely medical self-help and "healthy living" advice, and much of the advice he offers seems relatively sensible, if perhaps couched in feel-good terms I find a bit cloying. But he doesn't recommend crack-pot detox plans or eschew vaccines, so all things considered I don't have much of a beef with him.

That being said, I can't endorse the sloppy thinking on display in his recent blog post over at HuffPo. He takes issue with direct-to-consumer ads for medication. I don't actually like DTC medications ads myself, and consider them detrimental to our overall health, as well. But his argument is shoddy.

Sally Field is a talented actor. But what qualifies her to promote Boniva, an osteoporosis drug that is of limited benefit, has worrisome side effects, and for which there are natural alternatives that merit careful consideration?

Well, Ms. Field appears in the ads as a patient who takes Boniva herself. Thus, while she is obviously being paid to do so, her own experience qualifies her to talk about the product at hand as much as any other celebrity endorsement. (All those athletes who hawk Wheaties aren't nutritionists, after all.)

In "What's Wrong with American Medicine?" I point out that many high-technology treatments have a shadow side. In most areas of life, technological development has made services better and cheaper, but (with a few notable exceptions) it has made health care worse and more expensive. The result: an unhealthy populace and an economy that's lurching toward disaster.

I'm not going to quibble with the idea that our health care is too expensive and yields outcomes that are frequently poorer than those in other developed countries. This has been well-documented. But decrying the technological advances in health care as generally making it worse is patently ridiculous. Heart attach victims have much higher survival rates now because of technological advances in opening occluded arteries. We can diagnose appendicitis with much greater ease because of advances in imagining technology. There are myriad examples, and Dr. Weil's medical Ludditism is foolish.

A major component of today's high-tech medical treatment is the reckless overuse of pharmaceutical drugs. An estimated 50 percent of Americans take at least one prescribed medication every day; in 2007, drug sales accounted for an astonishing $315 billion in revenue. When I was growing up, far fewer Americans took prescription drugs.

Um... so? What does that have to do with anything? Many of the medications that are currently available weren't around back then. Perhaps more people would have availed themselves of Claritin (or Lipitor [or Viagra]) had they been available. Perhaps they suffered with ailments (even minor ones) that they would just as soon have done without if they could have. The comparison is meaningless.

On those pesky DTC ads, he writes:

Americans now accept these ads as a matter of course, but in my experience, visitors from other countries find them both amusing and appalling. As well they should: the United States and New Zealand are the only two developed countries that allow DTC advertising.

Again... so? Why does it follow that anyone should be amused or appalled by something just because it only occurs in the United States and New Zealand?

If this anomalous American phenomenon didn't work, it would indeed be merely amusing. Unfortunately, when you "ask your doctor," about a given drug, he or she is likely to hand over a prescription. In 2000, every $1 pharmaceutical companies spent on DTC advertising yielded an additional $4.20 in sales. This bewildering return on investment makes it easy to see why a quarter of drug company revenue is spent on advertising.

I don't dispute those findings, and agree that they are troublesome. However, the libertarian in me (who doesn't get to talk much) puts the responsibility squarely on the patients and their doctors. As much as the pharmaceutical industry functions as an all-purpose boogeyman, I don't see why we should fault them for trying to market their product. It is the responsibility of consumers to make their own decisions with regard to their health, just like they have to decide if they think Pantene will make their hair as shiny as the model's, or that their kids will be suffused with joy just like those kids in the Disneyland commercial.

Further (and I will concede that this can be a big fat pain in the patootie), it's a doctor's job to say if a new medication is worthwhile, or the best option for the patient. Sad to say, but the ease with which patients can stroll home with a new, expensive prescription speaks to lazy medical providers. It's an annoying and frequently stressful part of our jobs to dissuade people when they "ask" us about new medications as per the ads' instructions, but part of our jobs it is, nonetheless.

The free market works well in many ways, but it has failed us here. Whether it is done independently or as part of an omnibus health care reform initiative, we need to make the same decision that the rest of the developed world has made: that is, ban direct-to-consumer advertising of prescription pharmaceutical products.

Well, caveat emptor say I. There are lots of things advertised that aren't good for us. But that's what happens when you value the autonomy and presumed good sense of your populace.

Unholy

I have no truck with Christian fundamentalism. I find its theology offensive, its social conservatism antiquated, and its arrogant presumption to know the mind of God (and further, to speak for it) galling in the extreme. Having been raised in the midst of evangelical fundamentalists, I know them well, and oppose them on essentially all fronts when it comes to a public agenda.

But there is one thing I will say for the church in which I was raised -- the people in it were sincere and good-hearted. They were generous, and truly (if, in my opinion, benightedly) concerned with the souls of their fellow men. While I may work like the dickens to see them checked at every turn when it comes to the public sphere, as individuals I hold many of them in genuine esteem and affection. They are not, in short, bad people.

In stark, high contrast are the despicable, loathsome parasites who purvey what has come to be known as the "prosperity gospel." I lack the words to adequately convey my contempt, my utter and unalloyed scorn, for the likes of them. From the Times, by way of Political Animal:

Onstage before thousands of believers weighed down by debt and economic insecurity, Kenneth and Gloria Copeland and their all-star lineup of “prosperity gospel” preachers delighted the crowd with anecdotes about the luxurious lives they had attained by following the Word of God.

[snip]

Even in an economic downturn, preachers in the “prosperity gospel” movement are drawing sizable, adoring audiences. Their message — that if you have sufficient faith in God and the Bible and donate generously, God will multiply your offerings a hundredfold — is reassuring to many in hard times.

[snip]

The Copelands’ broadcast reaches 134 countries, and the ministry’s income is about $100 million annually.

Read the whole article, but not if you've eaten recently. Poison control centers should keep it on hand to induce vomiting.

I have a lot to say about this. Let us dispense, first of all, with the ignorant notion that the message of Jesus Christ has anything, whatsoever, to do with financial prosperity. Quite the opposite, as it happens. Jesus preached on the value of spiritual poverty. He preached on the spiritual perils of being rich. He preached about storing treasure in heaven, instead of earth. He admonished his followers to trust in God for their material well-being, and to carry as little as possible by way of material things. Early Christians sold all their possessions and gave the proceeds to the poor.

Anyone who says that the Gospel is a treatise for personal wealth is either unfamiliar with it, or misrepresenting it. I know into which category I would put the Copelands and their ilk.

But, more (much more) and worse (much, much worse) than their biblical ignorance when they claim to be spiritual leaders is their blatant avarice, and the nauseating spectacle of parading their wealth as a gift from God in front of the very people they bilked for it. It seems not to occur to the myriad credulous people who show up for these despicable events that the reason the Copelands are rich is that people have sent them their hand-earned money.

I do not really believe in a literal vengeful God, and I do not believe at all in a literal hell of eternal torment for the damned. But I hope something or someone, be they Furies or federal agents, takes these awful people down before they part more simple, desperate fools from their money.

Enough. Let's get on with it

I've said it before. Joe Klein is saying it. Paul Begala is saying it. Even Max Baucus seems to be facing facts. Hell, Minority Whip John Kyl is up-front about it.

The Republicans are not interested in passing health care reform. At all. As their de facto leader made crystal clear today, they don't really care about the health care needs of Americans, anyway.

It would be lovely if a truly bipartisan health care reform bill could emerge from the miasma that surrounds Capitol Hill. It would also be lovely if my infant son would sleep through the night. And change his own diapers. And cook me dinner.

Not going to happen. (And Chuck Grassley, you can take your demand for 80 votes in the Senate and, in the immortal words of Homer Simpson, cram it with walnuts. Because I remember how assiduously your party sought "true" bipartisanship when you were in the majority.) Time to call it like it is, friends. If the Democrats want health care reform, they're going to have to do it themselves, and all that happy-clappy horse dung about bipartisanship can go the way of the dodo.

On that note, it's also time for the rubber to meet the road and for the Democrats to actually craft a bill and pass it. As Gadfly John is all too happy to point out, we have 60 votes in the Senate and a healthy majority in the House. It's now or never, troops.

Update: Also, what these guys said.

Update the Second: Also, this.

The limits of compassion

My political views tend to be a bit scattershot. While it's generally a pretty good bet that I'm going to come down on the liberal side of things, every so often a conservative view will poke its head up and expose itself to scrutiny.

One such area is crime and punishment. While I am not a supporter of capital punishment, I object more on the grounds that it is often unjustly and imperfectly applied than that it is invariably wrong. I am certainly moved by the arguments of opponents like Sister Helen Prejean, sufficient to make me agnostic on the issue. But I didn't shed any tears when Timothy McVeigh was executed, and I lack the conviction to protest the death sentences handed down for heinous crimes.

With that in mind, I am utterly horrified at the release on "compassionate grounds" of Abdelbaset Ali al-Megrahi, who was convicted of the bombing of Pan Am Flight 103, which exploded over Lockerbie, Scotland and cost 270 people their lives. For this mind-bogglingly horrible and inhuman crime, he was sentenced to life in prison. Unless I am gravely mistaken, there is little doubt over his guilt. Rather, he was released because he is dying of cancer, and was sent home to spend his waning days in freedom.

I share the reactions of Clive Crook and Freddie. This was an appallingly, shockingly bad decision. I am hard-pressed to come up with a more reprehensible, vile crime than this one. When he was sentenced to life in prison, that included (by definition) the end thereof. A man who is responsible for the deaths of hundreds of innocent people has no right to spend a single moment of his remaining years in freedom. This is what "punishment" means. He was doomed to die of something sometime, and I have no clue as to why the particular circumstances of his imminent death justify his release.

Compassion is a wonderful virtue, and one I try to cultivate within myself. It is something to be lauded in individual human beings. But in a case such as this, the compassion being meted out is controversial, at best, and causes both real emotional harm to the survivors of those killed in the bombing and tactical harm to the on-going efforts to combat international terrorism, as well as undermining the profundity of the sentence per se. (al-Megrahi's hero's welcome back in Libya turns my stomach.) In the face of such incontrovertible evil, arbitrary displays of compassion by a few public officials on behalf of a stridently dissenting public are misbegotten and wrong.

Update: Beloved frequent commenter Charo has pointed out in the comments that serious questions apparently persist with regard to his guilt. If that is, indeed, the true basis for his release, then it obviously tempers the heat of my objection.

Dept. of Frivolous Entertainments

After much squabbling between Bravo and Lifetime, last night heralded the long-awaited return of Project Runway. (Heterosexual males are free to ignore the remainder of this post, and return to mocking me for never having heard of Plaxico Burress.) It's been gone far too long.

You could tell the last season was recorded a while ago, because [mild spoiler if you haven't seen it yet] guest judge Lindsay Lohan:
1) Still had red hair
2) Looked like she was still eating
3) Elicited excitement from the contestants when she was revealed, having not yet sunk into total cultural irrelevance and self-parody.

That being said, Lilo actually came off as more intelligent and well-spoken than I would have guessed. Her critiques of the clothing were cogent and on-target. (Lilo was not, apparently, a good enough actress to fake enthusiasm when one of the designers suggested that the eyesore she had created was designed with her in mind.) It was a pleasant reminder that, once upon a time, Lindsay Lohan was a promising young actress, and was known for something other than looking like she hasn't showered in weeks.

Update: The sublime Fug Girls offer their take.

Meanwhile, in other environs

I am a sometimes contributor over at League of Ordinary Gentlemen, thanks to the kind indulgence of the various gents. (If you don't read them, you should. Which reminds me that our blogroll is in serious need of updating.) One of them asked for my thoughts on health care reform, and our conversation is available for your perusal.

As always, it was a pleasure to interact with them. Their blog is aptly named.

Oh. Never mind

So, I read the following headline in the Times, and I got weirdly excited.

Burress Pleads Guilty in Weapons Case

"Finally," thought I, "we will be rid of him, and I can move on to finding another member of the Democratic caucus deeply infuriating on principle. And I didn't even know about that weapons case!"

Sleep deprivation, people. (Confidential to The Critter: No matter how cute you are, with your wide-eyed gaze and generalized wonder at the world, 3 AM IS NOT THE TIME!) Turns out, Roland Burris was not involved in a weapons case, and the Senate is still stuck with him. A man I have never heard of who played a sport I do not follow has entered a plea for a crime of which I was not aware.

Oh, well.

He who has ears, let him hear

I like The Plank's take on the whole Chuck Grassley health care reform kabuki. Like Jonathan Chait, I think Sen. Grassley has made it abundantly clear that his feelings about passing health care reform can be adequately summarized using nothing but a serious of rude hand gestures. I also agree that it's time to stop the whole pantomime of bipartisanship, since it's getting us nowhere.

What I find hilarious, though, is Grassley's stated reasons for mucking up the works. From the WaPo:

After being besieged by protesters at meetings across his home state of Iowa, Grassley said he has concluded that the public has rejected the far-reaching proposals Democrats have put on the table, viewing them as overly expensive precursors to "a government takeover of health care."

Grassley said he remains hopeful that he and five other members of the Senate Finance Committee can draft a better, less costly plan capable of winning broad support from Democrats and Republicans. But as the group, known as the Gang of Six, prepared to continue talking via teleconference late Thursday, Grassley said the members may be forced to reassess the breadth of their efforts in light of public concerns.

Then, from later in the article, there's this:

While [Maine Senator Olympia] Snowe said she is hearing a passionate cry for action on health care from her constituents, Grassley, who is up for reelection next year, said Iowans are more interested in making sure that Congress does not mess up what they already have.

First of all, let us not forget that Ol' Chuck has not been making much headway in correcting the public's misinformation about certain aspects of health care reform. You know, what with his actively spreading said misinformation, and all. And, if Grassley's constituents are "more interested in making sure that Congress does not mess up what they already have," then it should be no great effort for him to explain that the President has made it explicitly clear that no health care reform he supports would require anyone to change if they're already happy with what they've got. That is, if he were actually interested in working to pass health care reform.

But no. As the article points out, Grassley is up for re-election next year, and he clearly doesn't want to fight off a primary challenger. So, it's in his political self-interest to oppose just about anything the Democrats put forward in order to appease the hard-right voters who turn out for primaries. It wouldn't matter if the crowds at the rallies all brought instruments and played Handel's "Water Music." He knows which side his bread is buttered on, so after a set period of pretending to play at bipartisanship, he's going to shoot down anything that emerges, because it's in his political self-interest to do so.

In praise of mediocre philosophers

I freely admit to having professional jealousy of dearest friend and co-blogger Dan. He saves and cares for children. One doesn't have a much more palpable way of making the world better. Whereas the good taxpayers of my state part with hard-earned cash so I can write and teach about questions that are often not immediately useful, and may not even be answerable. If the meteor is about to hit Earth, Dan has an easy seat on the escape pod with all the people who are necessary to starting society over again. I don't see anyone (except a philosopher!) arguing that one should bring along a philosopher.

The problem is worsened for all of us philosophers when the sad day arrives that you realize you are not Kant, and you are not going to change the face of ethics and metaphysics and aesthetics (I love the ballsiness of the title "Prolegomena to Any Future Metaphysics," as I cannot imagine being in a position where I thought I produced a work such that ANY future work on the topic MUST take account of it -- I once tried to call a conference I was co-organizing "Prolegomena to Any Future Philosophy Conference" in honor of Kant's chutzpah, but my co-organizers would have none of it). It's sadder for those who ought to have realized it a long time ago and have not as of yet, but that's another issue.

So how do I wake up and face the day doing a less-than-obviously-useful activity, and being unlikely to turn the entire field on its head? Well, there's teaching, of course. So that might keep me in the game. But I am also expected to produce philosophy, even as a non-Kant. And I think Julian Sanchez touches on why that can be useful both in a post he made today, and more directly one a few years ago.

All the quite-bright-but-not-geniuses move the field along. Wittgenstein and Kant made leaps forward, but it's the other, less prominent philosophers, who have chipped away at them who have shown a) exactly why they were so important, and b) also what is worth keeping and what must be gotten rid of. Neither Kant nor Wittgenstain is entirely right, after all. One person, even if a genius, saying an idea is unworkable is not definitive, the crowd saying so is much more so. Another factor is the ability to shine light in a small place. I have something to contribute to my relatively small area of specialization. Scientists generally work on smaller problems rather than the whole big picture -- similarly, we can see philosophy as a collective effort. Without coming up with a whole new way of seeing the world, I can try to answer a small problem, while my colleagues answer other problems, and so the field moves ahead.

This, at least, is how I rationalize what I do to myself.

Watching as reform goes up in flames

I must admit to being relatively pessimistic that health care reform of any real value is going to emerge from the rat's nest on Capitol Hill. With the death of the public option (and I think its prospects are looking pretty damn grim these days) and the lack of a coherent message, I'm feeling a combination of curiosity and dread at what the final bill is actually going to comprise.

I think Howard Fineman's analysis of what went wrong is pretty good. Of particular note, I agree with this:

Focusing on the have-nots
From the beginning, some of Obama’s shrewdest (outside) political advisors have been telling him — almost waving their arms — that the sweet spot on the issue is clamping down on abuses by insurers.

In other words, the White House all along should have been focusing on the fears of the 85 percent who have insurance, not on the 15 percent who do not.

Freddie at Ordinary Gentlemen said something related recently:

Heath insurance is a little different. Very few people go for long without getting some kind of compensation for their contributions to health insurance. But, again, most people pay in more than they take back out; if that wasn’t the case, there would be no health insurance industry. Couldn’t be. We pay in, or should, understanding that we may end up paying far more than we will get back out, because in the event of catastrophic illness or injury we need comprehensive coverage. This, incidentally, is what is so utterly criminal and disgusting about the conduct of health insurance companies that seek to ditch patients because they get sick or wiggle out of covering major expenses. That’s what everyone who pays for health insurance is paying for. (It would be constructive if some of those opposed to reform were more upfront about how incredibly poorly behaved many insurance companies and HMOs in this country have been.)

If Obama had focused on such winning issues as increasing insurance industry transparency, mandating more comprehensive coverage and eliminating so-called "pre-existing condition" obstacles to coverage (which, to be fair, are included in the chop suey currently being debated), he'd have more support and a cleaner bill. By taking care of the under-insured, he could have laid the groundwork for later success in covering more people who currently lack any insurance at all.

I hope that things improve, and that we don't get too distracted by the lunatics with guns who keep showing up at rallies. But I worry that we'll be getting a mediocre bill pushed through by a weakened President that accomplishes less than it needs to in order to make people's lives notably better.

Dept. of Sticky Situations

I wonder about a lot of things. I wonder if the people who write for How I Met Your Mother or According to Jim ever wake in the night, sweating coldly and full of existential despair. I wonder what poor Paula Abdul will do now, since somehow I doubt a return to her singing career is in the cards. I used to wonder if there would be a live-action Thundercats movie, thus completing a childhood toy cum movie hat trick, but have learned (to my sorrow) that there apparently will not be. (It's not too late for you, He-Man!)

But, what I wonder about with perplexing regularity is this -- if you are a moderately famous person and have chosen to make a "private tape" for "personal use," and are sufficiently concerned with its distribution as to retain the services of a lawyer, how on earth does it just happen to find its way onto the internet? (This question obviously does not pertain to shameless fame whores who would covertly distribute tapes of themselves shanking their own grandmothers if it would buy them another week on the cover of Life & Style.) How does this happen?

Did they just loan it out to a few friends? Did they inadvertently leave a copy on a park bench labeled "private sex tape -- not for public viewing"? Was it mistakenly sent back in a Netflix sleeve? How?

Are we plummeting into cinematic decay?

I think Roger Ebert's lament of the dumbing-down of American youthful tastes in film, and Peter Suderman in his criticism of Ebert, are both missing part of the story.

I tend to suspect Suderman is right that dumb has generally done well historically, and that teenagers probably have no more less or more sophisticated taste than they ever did. Ebert says, "They also resist a choice that is not in step with their peer group." Um, well, yes. They are teenagers. They're kinda famous for resisting choices that are not in step with their peer group. The ones who are going to see revivals of L'Atalante either have a peer group where such experimentation is encouraged, or just have a particularly strong interest (and those are probably as rare as kids in the sixties who sought out French New Wave films when their peer groups remained uninterested). But I have no data on this.

But what both sides are ignoring is the concomitant smartening up of television. The smartest, best shows of the past -- Ernie Kovacs, All in the Family, Dick van Dyke, St. Elsewhere, Cheers, Twin Peaks, etc. etc., are all quite good, but most are arguably less complex and rich than The Wire, The Sopranos, Mad Men. While there have always been smart, funny comedies, there usually was only one or two on at any given time. The density of smart comedies (30 Rock, Simpsons, Daily Show, Colbert, and many more) is greater than ever. There's much more TV for people with sophisticated tastes to watch than ever before. And TV is frankly a better medium for those with sophisticated tastes, allowing for a much more richly imagined world to evolve.

I'm a pretty big film nerd. My BA was in film studies, and I got an MA in it too before switching to philosophy. But I watch far more TV than film nowadays.

So it may just be that those with sophisticated tastes are going elsewhere other than to the movies. And the relative box offices of Hurt Locker and Transformers 2 don't actually tell us all that much about American taste. It's funny - my students (ages 18-23, usually) and I see none of the same movies. And yet, most of them have seen and enjoyed my favorite TV shows.

A related aside: one of my bugaboos is the kill-your-television folks, who believe that TV is soul-sucking and disallows imaginative interaction. Not true, and it's not at all clear that TV is far worse for people than movies or even books. This article in the Post today is an interesting suggestion that video games might also be maligned unfairly. I'd love to see more research on this, especially since I have a recently developed fondness for Xbox 360 Tiger Woods PGA Tour 10.

Here's hoping God has a wry sense of humor

Friends, I would like to clue you in for what would surely be the greatest spectacle American politics has offered in... well, forever.

I refer, of course, to Bachmann 2012.

If you're not familiar with Michele Bachmann (R - Pluto), you don't know what you're missing. She's so around-the-bend crazy, she has her own Democratic Party-funded website. She's the one who described Obama's call for national service as a prelude to "re-education camps," though we'll see if her tune changes now that her son has decided to join up with said national service corps.

Anyhow, per TPM, I see that she has thought about what it would take to throw her tinfoil hat into the ring in 2012:

"If I felt that's what the Lord was calling me to do, I would do it," she answered. "When I have sensed that the Lord is calling me to do something, I've said yes to it. But I will not seek a higher office if God is not calling me to do it. That's really my standard.

"If I am called to serve in that realm I would serve," she concluded, "but if I am not called, I wouldn't do it."

To which I reply: please. Please, let God make that call. Not because I think God actually wants Michele Bachmann within a country mile of the Oval Office. (He did all that nice work creating the world and everything, I somehow doubt He wants to bring about its destruction in so ludicrous a fashion.) But because I think we all could use an excuse to pop popcorn, pull up a comfy chair, and watch the GOP debates in anticipation of the wonderful, amazing Grade A crazy that Bachmann would serve up, and I think God appreciates that.

"But they're cousins! Identical cousins all the waaaaay"

I see (via the Dish) that the National Review has seen fit to call out Sarah Palin for her "death panels" comment. So, credit where it's due. I would love to find the space in my heart to simply say "Strong work, National Review!" without having to add a "... but" to the end. But, there's this:

Anyone who thinks rationing by government is something to be feared has reason to worry about the health legislation being discussed in Washington. The president has many times said that cutting costs is the goal of health-care reform and mused aloud about denying services to the elderly as a method of doing so. It is in this context that the controversy erupted over the proposal, now withdrawn, to pay for end-of-life counseling sessions. It was only reasonable to suspect that this proposal was included to encourage people not to get treatments they otherwise would get. (It’s not as though it moved us toward universal coverage.) The proposal to form a board that could recommend against Medicare payments for various procedures, with Congress required to fast-track its advice, raises the same concerns.

Baleful trends among bioethicists should heighten those concerns. The view that medical care should be withheld from people based not merely on the likelihood of success or the cost but on judgments about the quality of their lives is no longer held only by a fringe. Practices that are at best close cousins to euthanasia have become widespread. And as anyone familiar with the work of Wesley Smith knows, inquiries into patients’ intent are not always fastidious.

First of all, true confession here. I don't know Wesley Smith from a hole in the wall. If this somehow makes my opinions uninformed and thusly moot, feel free to ignore everything else I have to say. However, um... I take some pretty gross exception to the above.

Let's start with the first quoted paragraph. I don't know what they would consider "reasonable," but their implication that doctors would discourage people from choosing end-of-life care they would otherwise want in order to cut costs is rank slander to members of my profession. I have never, in years of working with indigent patients at public hospitals in two major cities, ever once seen a medical provider cite cost as a factor for denying any patient end-of-life care. Doctors who discuss end-of-life care with patients are doing so in order to have the patients' wishes known in advance in order to comply with them as fully as possible. To insinuate otherwise is not, in my opinion, "reasonable."

Further, yes, perhaps those consultations will prevent patients from receiving services that they would otherwise "get." (And yes, perhaps money would be saved.) But are they services that they would otherwise want? A common refrain when discussing end-of-life care is "he/she would never have wanted to live hooked up to a machine." Giving people an honest description of what end-of-life care looks like may prevent them from ending up on the grossly-misnamed "life support," with various machines assuming the function of organs that will never recover. Preventing this for people who don't want it is a good, not an ill. And, again, there is no evidence that anyone has ever, or will ever, try to talk people out of the care they would choose because of cost.

Then there's that second paragraph. "Close cousins to euthanasia"? "Widespread"? What the holy hell does that mean? What is a "cousin" to euthanasia? What is this "widespread"? Somehow I think this is their way of describing Terri Schiavo-like circumstances, in which case I would question both what kind of relative that would be to euthanasia, and how "widespread" those cases are.

Still, lamentable crap aside, I do give the chaps at National Review credit for criticizing Sarah Palin. It's a close cousin to sanity.

Let's make this perfectly clear

I suppose the point of having an official blog Gadfly is to goad one into making one's views as clear as possible, so I'm going to have at this one more time.

I have no objection, philosophical or otherwise, to people expressing an opposition to health care reform. While I disagree with them, and believe that a public health option (for example) would be a significant good, I support honest, informed dissent. For a good example of someone who opposes health care reform on philosophical and practical grounds, I refer you to this excellent post by Megan McArdle. (Recent objections notwithstanding, I think she has generally done an admirable job explaining why she is opposed to health care reform.)

Let us then contrast the behavior of one Senator Chuck Grassley. Sen. Grassley told people they had every right to be afraid that the government would "pull the plug on grandma." This despite the fact that he doesn't actually believe that the legislation being debated would give the government that particular power. In other words, he is using inflammatory and dishonest language to shanghai policy he doesn't like. In short, he is lying.

Or, let us consider the aptly-named Dick Armey. When asked about the people carrying "Obama-as-Hitler" signs at rallies, he described these people as "colorful." When they did the same thing with Bush (which, let me just make plain before someone raises the argument, I found disgraceful), he described it as "despicable." So, you know, it's "colorful" to describe the president you oppose as a proto-Nazi, but not the president you supported. Hypocritical and appalling.

So, to wrap up -- you don't like health care reform? Fine. Let's talk about that. I do like health care reform, but am willing to hash out the differences. However, if you want to talk about rank and unalloyed bullshit like "death panels" or euthanasia or comparing the POTUS to a man responsible for the death of six million innocent people, then you can take a flying leap, because you are clearly stupid, insane, mendacious, or some combination of all three.

Who could have seen this coming?

You know, I imagine it doesn't endear the jury to the defendant in a murder case if the defendant in question has chosen "C-Murder" as his stage name.

Dept. of Strange Bedfellows

You know those crazy people who keep showing up at town-hall meetings with pictures of swastikas, Obama-as-Hitler posters, etc? You know, these:



You'd be forgiven for assuming that these were emissaries from some of the crazier corners of the GOP universe. (Because, Lord knows, that universe has gone and spun off on a distinctly crazy axis.) But no!

From The Treatment:

Right-wing protesters aren't the only ones likening Democrats to Nazis for supporting Obamacare. As Josh Marshall notes, a group of LaRouche supporters joined the conservative hecklers who shouted down Representative McGovern last week in Massachusetts, reportedly comparing the congressman to Nazi war criminal Josef Mengele. In fact, the LaRouchies have dubbed their entire campaign, "Stop Obama's Nazi Health Plan," and they have played a central role in disrupting town hall meetings across the country. On the LaRouchePAC website, they cheered their part in shouting down John Dingell in Michigan last week: "When LaRouche PAC organizers held up a large poster, depicting President Obama with a Hitler moustache, and the words ‘I've Changed,' the crowd went wild with approval, taking pictures and videos, and backing down police." The group goes on to brag that their very own "Obama-with-Hitler-moustache" image has been featured on CNN, NBC, and the Wall Street Journal.

Walking around Manhattan, I would occasionally come across a table set up on some sidewalk of the Upper West Side, covered with pamphlets and hand-lettered posters about, say, the Queen of England and Chechen rebels, and some speculative and truly bizarre connection between them. The conspiracies being decried were the kind of over-the-top lunacy that one never actually expects to see decried in real life. "Who are these crazies?" I would wonder to myself as I passed them. They were, it turns out, LaRouche Democrats.

Now, up until then, the only exposure I had had with Lyndon LaRouche's followers was a passing mention in the Bloom County short story "The Great LaRouche Toad-Frog Massacree," in which they were described as "better off dead." As with much of Bloom County (which I read religiously as a middle-schooler in the 80s), I didn't get the joke at the time, but thought it was funny anyway. After I met some in real life, the short story got much, much funnier.

The fact that these people are blending seamlessly into the general rabble attending the health care town-hall meetings is a testament to the overall level of sanity and the quality of discourse said rabble is bringing to the debate about health care reform.

Despair

I want to be able to write about health care reform.

I do.

But, frankly, it's just too damn depressing. A few days ago, Steve Benen marveled at the horrible vitriol that erupted at Sen. Specter's town-hall event in Lebanon, PA and concluded "We're better than this. We have to be."

Me? Not so sure about that. Or at least who this "we" is supposed to be.

There is something monumentally depressing about seeing the absolutely appalling rhetoric, the lies and distortions and obfuscations that have emerged from not only the crowds at those town-hall meetings, but also from prominent members of the GOP and the right-wing noise machine. It makes me incredibly sad for our country that we, apparently, cannot have an actual reasoned debate about health care reform without a bunch of lunatics talking about "death panels" and euthanasia and all the related clap-trap and totally hijacking the conversation. That those same lunatics comprise potential presidential candidates in 2012, members of Congress, and television and radio personalities with millions of listeners/viewers is yet more depressing.

Once upon a time, I considered myself a relatively moderate person, one who would consider voting for candidates of quality from either political party. Those days are long, long, loooooong gone. Seeing Sen. Isakson walk back from his perfectly reasonable response to the whole "death panel" brouhaha because it may have actually helped the Democrats puts paid to that notion.

Wow. The Times can really be a jerk sometimes

Michelle Cottle over at The Plank has described this article from the Style section of today's Times as "the single meanest, snottiest piece I've ever read in a real newspaper." And you know what? I think she may be right. It veritably drips with sneering condescension and preening self-satisfaction.

J.C. PENNEY has broken free of its suburban parking area to invade Herald Square, and the most frequent question on New York’s collective lips seems to be: Why?

Why would this perennially square department store bother to reanimate itself in Manhattan — in the sleekest, scariest fashion city in America — during a hair-raising economic downturn, without taking the opportunity to vigorously rebrand itself? Why would this dowdy Middle American entity waddle into Midtown in its big old shorts and flip-flops without even bothering to update its ancient Helvetica Light logo, which for anyone who grew up with the company is encrusted with decades of boring, even traumatically parental, associations?

Having been raised in a small town in mid-Missouri were Penney's was often the best game in town, I would like to proclaim a hearty "Screw you!" to the jerks who thought that they needed to ruthlessly mock a store where many Americans shop.

I loved living in New York, and still miss it a lot. But one thing I don't miss at all is the pressure to dress in a hopelessly cool way, in stride with all the other painfully cool people around. It was like being in an endless junior high lunch room. (Now that I live in Maine, which is not known for its sartorial flights of fancy, I still look relatively stylish wearing duds I got at H&M years ago.) Why the paper of record felt the need to write something so flagrantly mean is beyond me.

But you know what else is grating about this? Apparently, the Times also felt the need to tell us today (in unrelated articles) that having a pot belly is suddenly fashionable (for men only), and that we should all be leaving the house looking like this:

Dept. of Schadenfreude

There are so many important things I could choose to write about now. Health care reform. The disturbing masses of people showing up to vehemently voice their opposition to same. The signs of economic recovery. You know, important sociopolitical stuff.

But, today I feel like death warmed over. Several weeks of sleep deprivation appear to have been hiding their wrath until today, at which time they have decided to land on me like a pile of bricks. (I know I should consider myself lucky that the Critter sleeps for a few hours at a stretch, but the aching and nausea I'm feeling today are obviating any feelings of luck I would otherwise be experiencing.)

So, instead of expending any energy on getting the brain cells fired up, I am simply going to share with you, my lucky readers, the drek-o-rama that is Mel Gibson's latest directorial effort. It is, apparently, a music video for his paramour and love-child incubator, Oksana Grigorieva. Given my deep feelings for Gibson, the fundamentalist, anti-semitic homophobe responsible for the theological snuff film The Passion, I am just all too happy to see his current career trajectory.

Enjoy!

On difficult fiction

So, this is the summer of Infinite Jest. For those of you unfamiliar with the whole Infinite Summer blog phenomenon, a whole bunch of bloggers (and humble mortals) are reading the monumental novel this summer and writing about it. Some of my favorite bloggers are writing about it at A Supposedly Fun Blog, and I've also been reading along at Infinite Zombies and Infinite Tasks.

As I've mentioned in some past post or another, Infinite Jest happens to be my all-time favorite novel. I know that's the kind of thing that's likely to induce eye-rolling when one hears it, but it happens that I actually love a gigantic and confounding novel with a deep and fervent love. (This seems to be a pretty widespread feeling among people who love the book, perhaps in keeping with all cults and fandoms and such.) And I get strangely defensive in a confusing and almost adolescent way when people don't seem to like it, or (*gasp*) claim that their dislike is because the novel is in some way to blame. When Avery Edison admitted to disliking the book, I was strangely disgruntled (considering that I didn't actually write the thing), and I was genuinely relieved and gratified when she changed her opinion.

I am having a slightly more definable objection to Ezra Klein's criticism of the book at A Supposedly Fun Blog. He writes:

At the end of the day, though, it’s not DFW I’m mad. It’s me. It’s not that I don’t want to finish Infinite Jest. It’s not that I don’t enjoy reading Infinite Jest. It’s that I don’t have time for Infinite Jest. But this is not a book that takes the opportunity cost of the reader seriously. In my other life, I write 15 blog posts a day and a weekly interview column and a twice-monthly food column. I need to read books on the Federal Reserve and papers about obesity and CBO scores. I don’t want to be the sort of person who doesn’t have the time to read a long and serious and difficult novel. But I am that sort of person. And it is not as if Infinite Jest richly rewards every sentence read or page finishing. It is not taut and there is little forward motion. I can’t shake the feeling that DFW is wasting a lot of my time. But at this point, I can’t tell which bits are actually unnecessary, and which just feel that way.

Later, in a follow-up comment, he says:

I think my problem, though, is that I would prefer to be about my 15 posts a day and my stack of papers and my CBO scores. They justify my attention in a way that most of Infinite Jest — the exception being the A.A. storyline and the insights on addiction — simply does not.

I don’t think that’s a particularly popular opinion around these parts, but there’s this implicit claim around IJ that it’s somehow “worth it.” In the intro to my version, Eggers talks about how it makes you a better person. But I’m not seeing it. I have those feelings about Grapes of Wrath, or to be more contemporary about it, The Wire. There is fiction and literature and art that repays your investment a thousand-fold. But IJ isn’t there for me, at least not yet. And the reason I get frustrated with how much of the book seems unnecessary is because time genuinely is precious, and one of the responsibilities of the writer — of any writer — is to take seriously the time demands of the audience. At this point, I want to finish IJ more because I want to have finished IJ than because I want to finish IJ. And that’s even though I’m quite enjoying it! I’m just not enjoying it, or taking enough from it, to justify what it’s asking of me.

Now, as it happens, I decided to tackle Ulysses this summer as part of a (seemingly defunct) Facebook book club. I've made it just past page 300, and I've only just now gotten to the point where I've experienced any kind of genuine enjoyment. Most of the time I've been gritting my teeth and resenting the pointless obscurity and endless allusions. And this is apparently the greatest novel of the 20th century! Joyce seems wholly unconcerned with the time demands of the novel's audience, and must certainly have known when he wrote it that most readers would be too unfamiliar with Irish history, Catholicism and Dublin geography to know what the hell was going on most of the time.

Now, frankly, when it comes to Ulysses I have a sneaking suspicion that there's a naked emperor strolling around. But part of my reaction stems from my preferring to read Absolute Sandman III instead of slogging through Leopold Bloom's stream of consciousness. That latter isn't Joyce's fault. Klein may prefer to write his blog posts and what have you, but his lack of investment in Infinite Jest isn't the novel's fault. He could just as easily lob exactly the same criticism at Gravity's Rainbow (which, full disclosure, I have tried and failed to read three times -- curse you, Pynchon!) or Underworld (which sits on my shelf, haunting me) or Cryptonomicon (which I also loved). Either one accepts that some books are "difficult" and may require more attention and effort than we are inclined to give, or one contents one's self with other pursuits.

Too dumb for me to come up with something witty

I normally like Megan McArdle, and I'm sure she knows far, far more about economics than I do. (This is not saying much. Your average third-grader probably knows more about economics than I do.) I am usually incredibly reluctant to criticize economics writers, because it's a bad policy to expose one's ignorance. But her post about health care "rationing" in the free market set my teeth on edge (partly because I've already written about this elsewhere), and partly because I just think it's so damn dumb.

She writes:

Robert Wright notes that "we already ration health care; we just let the market do the rationing." This is a true point made by the proponents of health care reform. But I'm not sure why it's supposed to be so interesting. You could make this statement about any good:

"We already ration food; we just let the market do the rationing."
"We already ration gasoline; we just let the market do the rationing."
"We already ration cigarettes; we just let the market do the rationing."

And indeed, this was an argument that was made in favor of socialism. (No, okay, I'm not calling you socialists!) And yet, most of us realize that there are huge differences between price rationing and government rationing, and that the latter is usually much worse for everyone. This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they're applied to hip replacements and otitis media.

Dumb. Dumb, dumb, dumb.

There is a fundamental difference between cigarettes and health care. First of all, health care (certainly for any kind of major or chronic illness) is an unaffordably large cost for much of the population, and they can't simply do without to the same degree that they could drive more efficiently or cut down on smoking. (Or, at least not without compromising their health.) Third-party payers are necessary for many people to absorb costs they would otherwise be unable to bear for care they need. The presence of these third parties makes health care a fundamentally different entity than other other commodity.

Nobody agrees to pay a portion of your gas costs or grocery bill for you, based upon their own financial interests. Insurance companies, on the other hand, make calculations about how much of your health care they are willing to pay for in light of their bottom line. They routinely refuse to pay for care for arbitrary reasons, or to cover people who had the misfortune of falling ill before being insured. In this way, health care is "rationed" in a more real, direct manner than anything else in the free market, and in a manner that affects people in a more adverse manner.

I cannot fathom how this very obvious and fundamental difference appears to have escaped a woman as bright and educated as Ms. McArdle.

Mr. Pestilence? Your horse is ready.

Nooooooooooooooooooooooooooooooooo!!!!!!!!!!!!!!

From Us "News" (via HuffPo):

Get ready to see Octuplet mother Nadya Suleman like you've never seen her before.

Octomom: The Incredible Unseen Footage will air as a two-hour special Aug. 19 on FOX.

Why? Why, why, why, why, why? Haven't we, as a nation, suffered enough thanks to the travails of the horrible Gosselins? (Memo to Kate: you may have a "very unique job," but there is no reason that you couldn't get a different job that would involve significantly less trauma to your childrens' collective psyche. Just a thought.)

Seriously. It already offends every sensibility in my soul to see these appalling people leering at me from the cover of In Touch in the grocery check-out line. Why do we reward their loathsome and selfish behavior with more fame?

Confidential to Senator Burris

Apparently, you have decided to walk back a bit on your announcement last month that you would not run to retain your ill-gotten seat in the Senate because you have heard from "people from all over the country and they are saying, 'Don't give up that seat.'" (From ABC News, via Political Animal.) I see.

Very well, then. I live in Maine, and thus I suppose you could reasonably claim to have heard from "all over the country" that you are a disgrace, an embarrassment and a joke. You should most certainly "give up that seat" with all due haste, and I would appreciate it if you took the opportunity to retire from public life for perpetuity throughout the universe.

Thank you. That is all.

For the love of God, just go away already!

Sarah Palin. Sarah, Sarah, Sarah. Just when I thought I couldn't detest you any more, you offer this on your Facebook page (via TPM):

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Let us leave aside the question about whether government health care will refuse to pay for care to a greater degree than for-profit private insurers. (I don't know if Gov. Palin knows this [though considering her astounding level of general ignorance, I would be surprised], but private insurance refuses to pay for care all the bloody time.) Let's just focus on that "death panel" comment.

That, Gov. Palin, is a lie. There is no such thing as a "death panel" in any health care plan put forth by the Democrats, and there never will be. It is a vile, ugly and stomach-turning lie, and serves to remind me exactly why I loathe you so very, very much.

There are legitimate reasons to worry about government-sponsored health care. How much will it cost? Who will make the decisions about what will be covered? How long will people have to wait for specialized care? While I whole-heartedly support government-sponsored health care, I understand why people might oppose it in good faith. But opposing it on the basis of a wholly-fictitious concept such as "death panels" is the very antithesis of good faith.

Lying, in the most inflammatory way possible, about a reform effort to bring health care coverage to those who are suffering without it, is despicable. One might even say it's downright evil.

Update: The answer to Prof. Pollack's rhetorical question is, of course, "no."

In which I disagree with a colleague

As I've mentioned in some post or another in the past, I generally enjoy Skeptical OB, particularly when she is railing against idiotic anti-medical mumbo-jumbo. However, I take exception to something she said in a recent post. In the course of offering sage advice about parents needing to accept their children for who they are, not who parents wish them to be, she says this:

How much more difficult then, to manage this task when your child is disabled in some way. Hence, there is an overwhelming desire to deny the truth of a diagnosis, or, more commonly, to refuse even to have the child evaluated for a diagnosis. Of course, no one expresses their denial in this way. Instead, they claim that they don't want the child to be "labeled." Or, even more fashionably, people assert that learning and psychiatric disabilities are "over diagnosed" among children.

[snip]

What does the diagnosis of a learning or psychiatric disability entail? Those who fear "labeling" imply or assume that the diagnosis of the disability is arbitrary; the psychologist or learning specialist meets the child and on the basis of impressions drawn from that meeting, and impressions drawn from speaking with parents and teachers, arrives at a diagnosis. The reality is that the diagnosis is usually reached by neuro-psychological testing.

Neuro-psych testing is complex and comprehensive. There are a seemingly endless array of tests to diagnose every disability and every possible variation of a disability. A diagnosis is not an "impression," it is a 15-20 page report detailing the tests and results, explaining the child's observed difficulties by reference to the results, and detailing an intervention plan that will be geared toward the way the individual child learns.

The second assumption is that children being "over-diagnosed" with learning and psychiatric disabilities. In other words, children are routinely receiving diagnoses that are not true. Curiously, this assumption is only made in regard to children. No one claims that adults who receive a diagnosis are being "over-diagnosed." This is supposedly a phenomenon that is restricted to children, yet no one offers an explanation as to why "over-diagnosis" is restricted to children.

I'm sorry to say this, but much of what Dr. Tuteur says here is simply wrong, or at least inconsistent with my experience.

Let us assume that the diagnosis we're thinking of when we talk about children being "over-diagnosed" is ADHD. I see a lot of kids because of parent/teacher concern about this diagnosis. (A lot.) And the diagnosis of ADHD is not made through a complicated process of neuro-psychiatric testing. Rather, forms are completed by teachers and parents wherein they record their observations (or, if you prefer, their "impressions") of the child in various settings using a scale. The responses are then tabulated, with certain scores indicating ADHD. It is a very imprecise method of diagnosing the disorder, and one that is incredibly susceptible to bias by frustrated teachers and parents.

Conversely, the people who conduct neuro-psychiatric testing in our area are very clear that they are not in the business of sussing out the source of behavioral problems, and tend to get testy if they think a referral was not indicated. Neuro-psych testing is meant to determine if a specific neurological problem is having psychiatric manifestations. Since ADHD is not related to a known neurological deficit, neuro-pysch testing is not an appropriate means of diagnosis.

Another diagnosis that has enjoyed a recent vogue is bipolar disorder, which is armchair psychiatry's new black. Again, I can't speak with authority about how this disorder is diagnosed by most providers, but I have sat horrified in a seminar at a respected professional conference while colleagues discuss giving the diagnosis to patients in order to justify the use of powerful psychiatric medications that would otherwise not be indicated for treating their more challenging adolescent patients. In other words, by assigning the diagnosis with loose or arbitrary standards, one could use bigger guns when trying to medicate away the troubled behaviors at hand. And I am more than happy to say that many adults are over-diagnosed with psychiatric disorders, not just kids.

I think Dr. T's overall message to parents is sound. Raise the kids you have, rather than pretending they are as perfect or exceptional as you wish. But she evinces too much confidence in how psychiatric diagnoses are made. It is, sadly, far more arbitrary and subjective than she seems to think it is.

Please, tell me this is wrong

You know, a lot was said about the last President. He was stupid. He was incompetent. He was partisan and lazy and unethical. I happen to think he was some combination of most of those qualities, but opinions may vary. However, I really didn't think he was crazy.

Perhaps I was wrong?

I see, via Andrew, that former French President Jacques Chirac has some interesting things to say about W.'s rationale for the invasion of Iraq. From the Council for Secular Humanism:

Incredibly, President George W. Bush told French President Jacques Chirac in early 2003 that Iraq must be invaded to thwart Gog and Magog, the Bible’s satanic agents of the Apocalypse.

Honest. This isn’t a joke. The president of the United States, in a top-secret phone call to a major European ally, asked for French troops to join American soldiers in attacking Iraq as a mission from God.

Now out of office, Chirac recounts that the American leader appealed to their “common faith” (Christianity) and told him: “Gog and Magog are at work in the Middle East…. The biblical prophecies are being fulfilled…. This confrontation is willed by God, who wants to use this conflict to erase his people’s enemies before a New Age begins.”

[snip]

In 2007, Dr. Romer recounted Bush’s strange behavior in Lausanne University’s review, Allez Savoir. A French-language Swiss newspaper, Le Matin Dimanche, printed a sarcastic account titled: “When President George W. Bush Saw the Prophesies of the Bible Coming to Pass.” France’s La Liberte likewise spoofed it under the headline “A Small Scoop on Bush, Chirac, God, Gog and Magog.” But other news media missed the amazing report.

Subsequently, ex-President Chirac confirmed the nutty event in a long interview with French journalist Jean-Claude Maurice, who tells the tale in his new book, Si Vous le Répétez, Je Démentirai (If You Repeat it, I Will Deny), released in March by the publisher Plon.

Oddly, mainstream media are ignoring this alarming revelation that Bush may have been half-cracked when he started his Iraq war. My own paper, The Charleston Gazette in West Virginia, is the only U.S. newspaper to report it so far. Canada’s Toronto Star recounted the story, calling it a “stranger-than-fiction disclosure … which suggests that apocalyptic fervor may have held sway within the walls of the White House.” Fortunately, online commentary sites are spreading the news, filling the press void.

Now, much was made of W.'s beliefs about himself and his role in God's Grand Plan during the last administration. I was inclined to discount a lot of it, perhaps because I just didn't want to believe it. And, frankly, I'm not actually sure how reliable a source Chirac is. (It wouldn't surprise me if he "remembered" things a bit more colorfully out of a sense of personal dislike or disdain for Bush.) However, having known my share of crazy evangelicals in my time, I know that the whole "Gog and Magog" prophecy is a particularly obsession with some, and it seems an odd thing for Chirac to have come up with on his own.

If this is true, then it makes me unbelievably depressed and scared. If (and that's still a big "if" as far as I'm concerned) the President of the United States actually believed that he was helping to bring about end-of-days prophecy and similar folderol, then that's abjectly terrifying, and deeply saddening. (I'm glad to know that the Republic was able to survive, and that apparently "the system" works well enough, no matter who's in charge.)

I'm curious to see if this gets any coverage in the mainstream press, or if a denial is ever issued.