Scary is Right

There are so many ways you could go with this one.

The Julia Child of Public Health

My favorite C. Everett Koop story might be a fantasy of my own but that doesn't matter; there's a point to it anyway.

It's about Koop in a movie.  I can't identify it in his Imdb database (yes he has one) so it might have been a lookalike or I might have just made it up.  But still: it's some kind of blaxsploitation thingy from the 90s.  The gent is about to make his moves on the lady when the bearded gent with the bow tie and the gold braid  interrupts to remind him that (I quote from memory) "when you have sex with her, you are having sex with anybody she ever had sex with--and just to drive home the point, I've brought them with me here tonight."  Whereupon we get a parade that would do justice to a Shrine hospital fundraiser.  ("My brother?  You're my brother!--Hey man, you were away for the weekend...)  

And that's all I remember which may mean "that's when I woke up," though rarely are my dreams quite so funny.  Still, even if I did spin this thread out of my own gizzard (very unlikely) or was befuddled by a standin (more possible)--even it wasn't the man himself still, isn't that just the way we think of our late distinguished surgeon general--able make an emotional connection up there with the best of politicians. able to be funny without losing his dignity, able to deliver a health message with with a sense of urgency, yet without making himself a nuisance or a bore? 

Some would say I exaggerate; some will remember the notorious pamphlet he sent to every household in America warning against the risk of AIDS (here's the pamphlet).  Indeed he did ruffle some feathers.   In the pamphlet he talked about condoms and anal sex, and he said that homosexual males were more at risk than the general population.  But can you name any other politician so willing to touch so many third rails on public health--or even more, any who could have gotten away with it?   Koop was one of those rare individuals who could, in effect, say "I'm not a politician but..." and make you believe he really was just trying to speak the truth--and, bye the bye, that he had some warrant, by way of background or knowledge, for speaking as firmly as he did.

The corollary was the emotional connection: we came to see him as a person who really cared about  nothing so much as saving lives, or of removing the impediments against living life well. The attitude imbued his campaigns against AIDS, against tobacco (the other great hot-button issue), against abortion.

Abortion: for anyone who lived through the Reagan years, the story of Koop and abortion scarcely needs retelling.   He came into office as an avowed foe of abortion, yet used almost none of his political capital to pursue that issue.  Called to account, he seemed to try to finesse the issue.  He said he'd concluded that abortion was not essentially unsafe.  Having so concluded (he told the New York Times) "he had declined to speak out on abortion because he thought his job was to deal with factual health issues like the hazards of smoking, not to express opinions on moral issues."

I can believe there is a core of truth in that statement, but I suspect it needs context.  Koop does seem to have had a knack for dialing hot issues down.  And while I don't doubt that he maintained his personal aversion to abortion (he was, after all, a master at saving infant's lives), I wouldn't be at all surprised to find that he came to have compassion for women thrust into the awful choice, and unwilling to intrude himself into a private decision.

I said he was  the Julia Child of public health. Actually, that's too simplistic.  So far as we know, Julia Child had no enemies, none.  Koop had plenty of enemies--on abortion, on tobacco, on homosexual sex and whatnot.  But even the loudest opponents seem oddly blunted, considering the general nature of the debate on issues of this sort.  Maybe it was just political prudence--they felt the heat, even if they didn't see the light.  Whatever: in any event, it cleared the way for Koop to make his connection with America, and to deliver his message.  Maybe Julia Child is not the right comparison: maybe I should have said Oprah.

Jonathan Gruber Explains What's Different About Obamacare

Note the highlighting in the third paragraph:

You were an architect of Mitt Romney’s Massachusetts health programme and an instrumental adviser in the design of the Obama administration’s health reforms. So please settle the question of the year: How similar are they?

They are very, very similar. You can think of the Affordable Care Act as a more ambitious version of the Massachusetts reform. Both reforms have the same core principles: Non-discrimination in insurance markets, health insurance mandates and subsidies so insurance is affordable. In Massachusetts, we stopped there.

The national bill – the Affordable Care Act – has two additional features. One is it’s paid for and two, it takes on cost controls. Romney’s reform was paid for with funding from the federal treasury. The Affordable Care Act is paid for through offsets in the federal budget. And the Affordable Care Act tackles the increase in costs in a serious way, which the Massachusetts bill didn’t do. So you can think of the Affordable Care Act as the Massachusetts bill-plus.

 How to guess your age?  I remember when Republicans paid their debts.   

Let the Dollars Flow!

I think think Aaron Campbell is far too kind to the new study showing the the United States is #1 in world health.  The allegedly-free-market sponsors of the new study reach this unexpected conclusion only by counting the fact that we spend so much money on health care.

  Now, ever since I first began paying attention to this sort of thing, the conservative mantra has always been that you can't solve a problem by throwing money at it.  As a neo-Coolidgeite, I've always thought there was some merit to this insight, although somehow it never seems to apply to, e.g., the military, or CEO compensation.  But can it be that we'd really achieve a new level of beatitude if, for example we simply doubled every doctor's paycheck?  .I certainly hope the question answers itself

In a feeble attempt at even-handedness, I do hereby pick up on a couple areas where, as Aaron observes, we do actually perform pretty well.  TB, for example: second lowest.  Immunizataion: above average.  Sanitation facilities overall, relatively, pretty good.   But that money stuff doesn't pass the giggle test.


Afterthought: If you haven't already done so, go have a look at Aaron's own survey of health quality.   It's the best primer I've seen--much better than anything I know of in conventional (= book) sources.

E. Coli Datapoint of the Morning

The E. Coli virus bacterium,* currently making such a nuisance of itself in Germany and elsewhere, was "discovered" (isolated, identified) by a German physician just 137 years ago.  That would be Theodor Escherich, the "e" in the name.  Escherich was employed at Mainz.  He made his first public presentation on the topic at Munich, based on observations he had made at a cholera epidemic in Naples.

The sequencing of the deadly new variety was carried out in April at the Beijing Genomics Institute, the world's largest.    German scientists had been scrambling to identify the virus.  The Chinese, using samples provided by researchers working in Germany, cracked the code in three days.
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*Thanks to John for the correction. He seems to be correct, although "e coli virus" (in quotes) gets 133,000 Google hits, many from sources you would think ought to know ("e coli bacteria" gets 807,000). A possible source of the confusion may be that it's a virus--a bacteriophage--that turns normally harmless E.coli into a killer.

Lee's Correlation of Everything with Everything

If you haven't found it already, walk-don't-run over to Overcoming Bias for a preview of the best dataporn datamine I've seen in quite a while.  That would be the Ken Lee's  (George Mason) thesis,* inadequately captioned as "How States Vary," not much less inadequately characterized as "the correlation of everything."  As described by his supervisor, Robin Hanson:

Ken collected 81 features of states, 56 cultural rankings and 25 demographic variables ...), and did a factor an analysis on them. 

One--word answer: health, and Robin is doing some followup analysis of the health findings right now (three-word advice: skip cancer screening (link; cf. link)).   The whole project seems almost like a spinoff of  a Hanson blog post of a few months back, where he divided us all into farmers and foragers. The earlier post kicked off a lovely comment thread, including those who think he is totally bollox and and those who just want to tweak the model (maybe three classes?  Farmers, foragers and nomadic herdsmen?) (good comments on the new item too).  One thing you can't easily sidestep: Lee's maps, suggesting that something is going on. 
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*Idle curiosity: why does GMU call it a "thesis" rather than a "dissertation?"

Voodoo Yoga Note

My friend Cindy tells me she's learned a new yoga technique that reduces her blood pressure to a level almost vanishingly low.  That's nice to hear but I wonder--where does all that blood pressure go?  Could it be that we have a technique not merely for reducing one's own blood pressure but for increasing the blood pressure of somebody else?

The city of Louisville is built on a great slab of Bedford limestone--bear with me, there's a sequitur here.  If you want to put down a septic tank, you take a stick of dynamite and blow a hole in the limestone. Sure enough, all the bad stuff will disappear.  The trouble is, it will pop some place else and nobody can say in advance just where.  All we know is that somebody in town is going to wake up one morning to an unpleasant surprise.  I wonder if it works the same way with Cindy's blood pressure.

Or should I be thinking along the lines of "I don't get ulcers, I give 'em"?