What the hell is wrong with you people??!?: part infinity

Oh, GOP. You make my teeth hurt, what with all the clenching. I half expect Margaret Chase Smith to rise from the grave and slap the ever-living crap out of most of you any minute now. (Though that raises the question of what would be left of you afterward. Hey-oh!!)

Seriously. I can't understand why you cannot tell the difference between principled opposition to your political rivals' goals and hateful, essentially seditious demagoguery.

Let's start with you, Jim Greer. The estimable Mr. Greer is the head of the Republican Party in Florida. How has Mr. Greer contributed to the steady recession of my gums? Over to you, TPM:

I just spoke with Florida Republican Party press secretary Katie Gordon, regarding state party chairman Jim Greer's denunciation of President Obama's upcoming national address to schoolchildren on Tuesday. Gordon stood by the party's press release -- and said that children should not be subjected to what she said is a clear attempt at political indoctrination by the Obama administration. Indeed, she said parents should be able to opt-out their kids from the speech.

[snip]

"Our point is that there are some questions about this address that need to be answered, and parents need to be given the option to choose whether or not their children who are students are going to be expected to watch this propaganda in a public school," Gordon later explained. "Students can't pray in school, but they can discuss new ideas and actions that the President is challenging them to think about. Well, I know that a lot of the President's ideas don't reflect my values and don't reflect the values that I would be teaching my children. And to be quite honest, there are a lot of the President's ideas that I wouldn't want my children discussing in a public school. It's not appropriate, the place for that is in the home."

Sweet merciful crap! This is the President of the United States of America, you cretins! What kind of absurd world do you live in, that you would decry the potential "indoctrination" of our youth by a speech the President of the United States of America would deliver to them? He is not Mullah Omar. His speech will doubtless be full of hearty exhortations to do well, study hard, and strive to achieve greatness for themselves and their country. Have you lost your minds?

Look, I think I have made my overall loathing of the most recent former POTUS pretty plain. By the end of his second term, I could barely stand to see his face on the television. But never, not in my wildest, most partisan fever dreams, would I ever have accused him of "indocrinating" our youth. Because, like most basically sane and civil American citizens, I confer a certain degree of respect for the person who holds that office, which includes a presumption of basic decency. It is patently obvious that partisanship has overwhelmed the Florida GOP's sense of same.

Oh, and they changed the language those mouth-breathers found most objectionable, so hopefully nobody skipped school.

And now, there's you, Sen. Inhofe (R - 14th Century). I see, via the Dish, that you have chosen a less temperate criticism of the President than I would have hoped. What was it you said?

He continued, “I don’t know why President Obama is obsessed with turning terrorists loose in America.”

[snip]

“Those of you who think like I do,” Inhofe said, “hope this country can hang on another 16 months.”

Those of you who think like he does, I hope you don't miss your appointment for ECT.

This man, dear readers, is a sitting member of the US Senate, and is telling his constituents that the President of the United States of America wants to "turn terrorists loose in America." Which he either cannot really believe, or he is too deranged to safely fill the office of municipal dog catcher, much less sit in the most august elected body in the nation.

I know there must be a few honest, intelligent and sane conservatives out there. I just wonder which bunker they've decided to hide in while the lunatics who ostensibly speak for them run rampant.

In which I beg to differ

For those of you who don't spend every free moment picking through the flotsam and jetsam that bobs endlessly on the surface of our political sea, you're probably not aware of the existence of one Bob McDonnell. Mr. McDonnell, a former Virginia attorney general and member of that state's legislature, is in the early stages of a run for the governorship as a Republican. So far, no big whoop.

What is causing him no small headache is a graduate thesis he wrote twenty years ago while attending Pat Robertson's Regent University. In it, he expressed some... colorful views on women, contraception and gays, among others. His opponent, as well as the liberal blogs, have been all over it.

From TPM:

The Washington Post yesterday reported on the masters thesis of Virginia GOP gubernatorial candidate Bob McDonnell. As the paper noted, McDonnell argued, among other things, that working women and feminists are "detrimental" to the family; that government policy should favor married couples over "cohabitators, homosexuals or fornicators;" and that the court decision legalizing the use of contraception by unmarried couples was "illogical," because at the time non-marital sex was itself a crime.

[snip]

Soon after calling the Supreme Court's decision on contraceptives "illogical," McDonnell blasts "the perverted notion of liberty that each individual should be able to live out his sexual life in any way he chooses without interference from the state" (pg. 15). It was essentially that "perverted notion of liberty," of course, that the Supreme Court would uphold in 2003 when it struck down Texas's anti-sodomy law.

There's a lot there, and it's all quite conservative and out of keeping with what one would call moderate social policy. In other words, it's exactly the kind of thing you'd expect to be written in a graduate thesis by a student at a university founded by Pat Robertson.

Over at Ordinary Gents, Will has ruled the thesis as out of bounds for current political consideration. He writes:

There is such a thing as a sincere change of heart. McDonnell hasn’t disavowed everything he wrote, but he’s definitely walked back some of his more controversial views. In light of the fact that this was written 20 years ago, I’m inclined to give McDonnell the benefit of the doubt. Politicians should at least pretend to be open to empirical or ethical persuasion, and unless the pol in question has a history of being an egregious liar, I’m willing to accept the “changed my mind” explanation at face value.

[snip]

...I’m wary of the chilling effect academic witch-hunts have on the interaction between experts and politicians. Presumably, we want our political leaders to get advice from academics, who are disinterested and frequently more knowledgeable on a particular subject. Academic documents are also fundamentally different from political ones – they’re less vetted, more exploratory, and ultimately less subject to artificial political constraints. I think this is a good thing, and I’d like to see more practical interaction between the academy and policy-makers precisely because academics have more freedom to come up with good ideas.

As Will notes, McDonnell has indicated that his personal views have not informed his priorities thus far, and will not impact the kind of policy he will implement if he is to be elected. Fair enough. But I don't think it's particularly surprising or objectionable that people have seized upon the thesis and have expected McDonnell to make an accounting of it.

First of all, it is hopelessly naive for any candidate for any major political office to expect any published material to go un-scrutinized or un-exploited. For crying out loud, look at the brouhaha that erupted over a single reference to a "wise latina" that Justice Sotomayor made in one speech many years ago. This is the world in which we live, and it is pointless to pretend that we're all too high-minded to delve into the murky past of any candidate for dirt.

Further, I think it is entirely legitimate for people to want to know the social views of their prospective governor. And the views in that thesis are extreme. Do I think that they automatically disqualify McDonnell from office? No, I most certainly do not. It is not unreasonable, as Will notes, to take him at his word when he claims that his views have changed with time. (It would be an understatement of epic proportions to say that my own social views have changed in twenty years.) But neither is it unreasonable for people to ask about what he said, what he believes now, and how those beliefs would impact how he governed the state.

Will goes on to compare McDonnell's ordeal to the travails of Cass Sunstein, whose lengthy academic paper trail was used against him during his confirmation to the Office of Information and Regulatory Affairs. To which I say, Cass Sunstein must surely have known that it was coming, unless he has been writing those articles for The New Republic from a cave on Mars for lo these many years. Perhaps, as Will suggests, this kind of academic mining will dissuade academics from entering the political sphere. That might be unfortunate in the abstract, but an aphorism about heat and kitchens springs to mind.

Just so

Over at TNR (still waiting for you to fix my digital subscription, guys), Royce Flippin (who is new to me) writes about the current state of our health care system:

One of the reasons people pay so much for health care is that average people are not told what their fees will be at the time of service. And even if a patient takes it upon himself to ask, getting the full answer is far from easy: He can usually find out the basic charge for an office visit--but what about a scan or a lab test? And how about the cost of those prescription medications being swiftly scribbled down? Most likely, the doctor or his or her staff will tell the inquisitive patient he has to wait for his insurance statement--or worse, the bill--to arrive in the mail.

[snip]

While the national debate over health care reform boils and bubbles, I have a simple proposal that I believe can help contain rising health care costs without requiring any changes in the way health care is delivered and paid for: Require our nation’s medical care providers to publish a complete price list for all their services, procedures, medications, and tests. This price list would be required of all doctors, hospitals and emergency departments, consulting specialists, freestanding radiology labs, visiting nurse services, physical therapists, and any other institution involved in providing health care services.

I think this is perfectly sensible. In fact, legislation to require disclosure of this information was recently introduced in Maine, though I can't find information about it online.

Truth be told, I have no idea what most tests or medications cost. I know how much our office visits cost, but that's about it. I know which medications are available in generic form, but that doesn't always translate into a good guess about price. Giving this information to patients would make them more informed, and thus theoretically better, consumers.

Now, this will inevitably lead to patients choosing to refuse medication and treatment that they need because they know up-front what it will cost them. Is this better, on a grand scale, than treating them and then socking them with a big bill? It depends on what the treatment is, and how badly they need it. But, the fact that we can reasonably foresee that people would defer care they might need because they know in advance how little they can afford is an argument for why we need universal health care, including a public health option.

Dudes, it's soda

Remember oat bran? Back in the 80s (I think), someone somewhere determined that the soluble fiber in the husks of oats had a (somewhat) salubrious effect on serum cholesterol levels. Suddenly, oat bran was the miracle food that would let you live forever, and would correct the ill effects of all the other horrid food choices you'd ever made. The marketing gurus found ways of putting it in just about everything. (While I never saw oat bran toothpaste, I wouldn't have put it past the people at Procter & Gamble.) Never mind that you have to eat the actual oats on a prolonged basis to have any effect, and that the long-term impact on health is hard to determine. Oat bran! Oat bran, oat bran, oat bran!

Well, now it's green tea's day in the sun. Apparently, the "antioxidants" in the tea will make you super fantastic healthy forever. (This is hearsay, so take it with a grain of salt, but I once heard from a tea purveyor that they spray most tea with so many pesticides that any antioxidant effect is probably canceled right out.) Whatever the benefits of actual, brewed green tea may be, I think I may have found the most ridiculous beverage yet. Behold.



Yes, sparkling, fruit-flavored "green tea." Even more ludicrous, there is a "diet" version, which is hilarious considering that actual green tea has no calories. Let's look at the ingredient list, shall we?

Ingredients:
CARBONATED WATER, HIGH FRUCTOSE CORN SYRUP, NATURAL FLAVOR, CITRIC ACID, GREEN TEA, SODIUM HEXAMETAPHOSPHATE (TO PROTECT FLAVOR), PHOSPHORIC ACID, ASCORBIC ACID (TO PROTECT FLAVOR), POTASSIUM SORBATE (PRESERVES FRESHNESS), ACESULFAME POTASSIUM, CALCIUM DISODIUM EDTA (TO PROTECT FLAVOR), CARAMEL COLOR, YELLOW 5, BLUE 1.

Wow. Green tea makes it all the way to ingredient five! I've never heard of sodium hexametaphosphate, but it doesn't sound like an antioxidant to me.

Look, I have no beef with flavored, sparkly beverages. But let's not kid ourselves that there is any particular health benefit to a soda that happens to contain some green tea. As it is, this sounds like the perfect drink to wash down your Double Down "sandwich."

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.