Rhinocrisy

This blog serves to some extent as a barometer of my mental health - when it is effulgent and rife with words, it means I’m doing well, my confidence is overabundant, and I’m willing to project my useless blatherings onto the Interspores. When it becomes ghostlike and silent, except for the occasional tumbleweed post, it’s probably the reflection of some dark stormclouds over my head.

Based on this assumption I can construct for myself a chart of my mental health history over the past few years, using the number of posts per quarter. Here it is:

Evidently 2005 was a very happy year for me. I was in the full bloom of my youth, I was in excellent physical shape, I was living with the best set of housemates I’ve ever had, and I had just taken a step back into graduate school, which at the time seemed fresh and exciting.^* The proceeding three years are clearly the result of grim reality setting in, of a succession of defeats wearing down my patience and self-confidence - the usual business of a PhD program. The last few quarters are understandably muddled; I still haven’t learned how to walk in the surreal mooonscape of San Francisco.

^* I was also the much-beloved neighbor of a bevy of beautiful and charming twenty-year old girls, whose company I sorely miss.

One of our most popular posts, google-wise, is hedgehog’s missive about the health effects of bisphenol-A, a common ingredient in many plastics. I happened across a nice letter in PLoS Biology, written by Rebecca Roberts, describing her fears as a new mother on her child’s exposure to BPA. Included is a nice summary and references for some of the research supporting the need for tighter regulation (some say banning) of BPA in plastic products, especially with regards to kids, and a chronicle of the failed legislative efforts at removing it.

While we’re setting fire to myths, I might as well weigh in on this whole autism/vaccination thing, which I’ve been intending to write about for months. Recently Jenny McCarthy (no pictures, sorry) appeared on the Oprah Winfrey (no pictures, sorry) show, along with Holly Robinson Peete (Earthquake, 2004) to discuss autism. Both are mothers of autistic children. Jenny told the following horror story about how she believes her son Evan became autistic:

“Right before his MMR shot, I said to the doctor, “I have a very bad feeling about this shot. This is the autism shot, isn’t it?’ And he said, ‘No, that is ridiculous. It is a mother’s desperate attempt to blame something,’ and he swore at me, and then the nurse gave [Evan] the shot,” she says. “And I remember going, ‘Oh, God, I hope he’s right.’ And soon thereafter-boom-the soul’s gone from his eyes.”

Chilling, indeed. But - do we believe it? Read the rest of this entry »

Hillary Clinton, who has a very strong chance of becoming our next President, recently rolled out her new health care proposal. Clinton, as we all know, proposed a widely-unpopular health care reform package back in 1993, when her husband was President. The gist of that package was “all employers must insure their employees via HMO” - along with restrictions on which HMOs were allowed, based on benefits provided. This was poorly-received in all quarters: businesses hated it because it forced them to spend, and didn’t allow them to spend cheaply. HMOs hated it because it privileged some HMOs over others. And everyone else hated it because it didn’t actually solve the problem of managed care in general; it just forced everyone into its arms.

The modern plan is pretty much identical to the one passed by Mitt Romney in Massachusetts: that is, we will reduce the numbers of the 50 million uninsured by requiring individuals to purchase healthcare if they are not covered, or else face penalties. A key difference between Romney’s scheme and Clinton’s is that the latter deals with affordability via tax cuts, whereas the former has a subsidized state-run health program.

No one seems to be advocating single-payer healthcare, which seems like the obvious solution. First, despite wild fears of “socialism” and “bureaucracy”, it’s well-demonstrated that government-run health care is more efficient than private health care, in terms of cost. An article in the New England Journal of Medicine comparing the systems of the United States and Canada says:

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada.

In addition to efficiency, there is the added issue of keeping down costs. These are related, of course; before 1950, many people didn’t even have private insurance, and medical costs could be paid out of pocket. But health care costs, as a percentage of GNP, have been rising steadily since then. Costs in the US are the highest in the industrial world. There’s considerable debate over why this is, and a number of competing explanations have been advanced. A series of reviews in the Annals of Internal Medicine summarizes seven possibilities:

1. High and rising costs are not such a serious problem.
2. High and rising costs are a problem, but they are created by factors external to the health care system.
3. High and rising costs are caused by the absence of a free market; the remedy is to give patients more responsibility for costs of care and to encourage competition among health insurers and providers.
4. High and rising costs result from medical technologies creating innovation in the diagnosis and treatment of illness.
5. High and rising costs are in part the result of excessive costs of administering the health care system.
6. High and rising costs are explained by the absence of strong cost-containment measures.
7. High and rising costs are the result of the market power of health care providers.

The gist (if I can so blithely summarize a summary of such a complex topic) is that rising costs (and the disparity between the US and the rest of the industrial world) are related mostly to the spread of new medical technology; the relatively greater power of health care providers (e.g. hospitals, pharma companies, etc.) in the market; the fact that doctors are grossly overpaid^* and, in the US, overspecialized, with a lower fraction of general practitioners (and thus, presumably, primary care); and, lastly, a more complicated administrative scheme. This more or less illustrates that cost-containment and coverage are essentially separate problems.

Some attention should be given to the idea of cost containment by removal of third-party payment mechanisms entirely (that is, all medical expenses are paid out-of-pocket, the solution advocated by, e.g., the Cato Institute). A free market in health care seems, at first glance, to be a pretty barbaric solution to any problem, since pricing people out of the market is generally not considered fair for conditions that are often the result of happenstance. Compare:
Ralph: I can’t afford this yacht. I guess I’ll swim at the Y this summer.
with:
Stanley: I can’t afford to have this pituitary adenoma removed. I guess I’ll just live with my gigantism. [ Dunks. ] Swish!

Medical cost is very unevenly distributed; 70% of costs are attributed to only 10% of patients. For the very sick, we must imagine that costs are an unbearable burden, the reverse lottery: I pay you $100,000, and at the end I get to stay exactly the same as I was before (sans hair).

However, other forms of free-market competition can successfully lower costs. Insurance companies were successful in forcing hospitals to lower prices in the 80s and 90s by offering selective contracts on the basis of prices. Private hospitals responded by consolidating into agglomerated networks, effectively forcing insurance companies to play ball and allowing them to raise costs (i.e. make more money). In theory, competition between insurance providers for purchasers could also help lower premiums.

The latter would be unavailable in a single-payer system, meaning that cost containment would have to result from pro-active measures on the part of government. But inter-HMO competition has arguably been rendered ineffective by consolidation amongst hospitals (not to mention consolidation amongst insurance companies). Cost-containment still demands dealing with provider power, and there’s certainly no reason not to remove one layer of enormous complexity, which still leaves the patient as the agent enforcing competition by seeking the best available care.

Keeping down administrative costs is also not to be sneered at. Compare the US and Canada: “After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.” This means a 14% reduction in costs merely by removing the administrative overhead associated with a private insurance system. This doesn’t suffice to close the yawning gap between the US and other industrialized nations in terms of health care costs, but it helps.

Single-payer systems, however, are radically different from the current wild-haired and thoroughly American mess. They inevitably mean that the government must take more of an interest in actively managing cost-containment by controlling things like the proportion of specialists in the population, information infrastructure, hospital administration, and ultimately, prices and renumeration of physicians, etc. They also mean that the government must be proactive about the supply-side of the equation, by encouraging the population to be healthier in the first place (certainly a laudable form of health care cost-containment). Though there is ample evidence that these measures are effective at reducing per-capita health care outlays, I suspect that they’re just too fucking socialist for the American political class.

^* “The ratio of average physician income to average employee compensation is 5.5 in the United States compared to 1.5 in the United Kingdom and Sweden.”

Next time someone asks you what studying evolution has ever done for humankind, you can tell them: “It cures AIDS, Biyotch!”

Whether that’s true is unclear at the moment, but still, this is insanely cool stuff. The Cre/lox system is a well-known tool in the molecular biologist’s napsack. It’s a very simple system that developed in the bacteriophage^* P1. Many phage have the same basic strategy for replication that HIV does - integrate yourself into the host genome. The host then goes through repeated cycles of replication, copying the phage DNA in the process. At the right time, it expresses Cre recombinases, which recognize the two identical “loxP”^† sites flanking the inserted phage genome, neatly excise the intervening viral DNA and stitch together the flanking sequences.
Read the rest of this entry »

Hi, folks. I’m trying to get this wreck of a vessel sea-worthy again, so we’ll start off small:

During my illness I read a little bit about mononucleosis, which involved traversing a field littered with medical jargon. Jargon in general is odious and properly to be despised, but medical jargon seems especially useless, since it seems to add almost no specificity. For example, one of the symptoms of mononucleosis is “splenomegaly”. This is a fancy-pants term that means you have an enlarged spleen. What the Christ? In some instances you might have to have a “splenectomy”, also known as a spleen removal. The utility of creating and employing jargon of this sort is that it produces “macrocephaly” in doctors.

I have mono!

That is all.

Forget black lung. Popcorn worker’s lung.

… a group of California food-flavoring workers recently diagnosed with bronchiolitis obliterans, a rare and life-threatening form of fixed obstructive lung disease. Also known as popcorn workers lung, because it has turned up in workers at microwave-popcorn factories, the disease destroys the lungs. A transplant is the only cure…. Flavoring manufacturers have paid out more than $100 million as a result of lawsuits by people sick with popcorn workers lung over the past five years.

In the “Stuff you can’t make up” department, the head of the WHO’s HIV/AIDS program, which today announced that men should be circumcised in order to reduce their chance of getting HIV by 60%, is named Kevin De Cock.

I’m not sure how I feel about the recommendation myself. Actually, I can tell you that my immediate reaction was anger, before I read the study, which makes it clear that the effect is almost certainly real (that is, attributable directly to the circumcision and not attendant factors). It seems risky in the extreme to pin a lot of emphasis on something with a relatively modest effect if it’s only going to result in more risk-taking behavior. It’s also not cheap at all to circumcise everyone in sub-Saharan Africa (it costs $50-100 a slice), which means it’s arguably a big waste of money as well. But maybe they know what they’re talking about - I’m not a public health specialist.

Judging by our comment history, some of our readership are sadly underdeveloped in the range of skills required to be evil. This might become a problem for them in a hypothetical post-apocalyptic future where they will need to be willing to backstab comrades for those precious six gallons of 93-octane unleaded, or administer some effective eye-gouges in the middle of a knife-fight. We thus present this (possibly) continuing series, hoping to contribute to your greater degeneracy. No need to thank us! That wouldn’t be evil.

So, a coalition of parents is suing Kellogg’s and Nickelodeon because they are apparently running commercial advertisements for “junk food” targeted at children. Both Nickelodeon and Kellogg’s deny this vehemently:

A Nickelodeon spokesman said the network has led young viewers to be more active and eat healthier–and has pushed sponsors for more balance in their offerings. And a Kellogg spokeswoman declared that the breakfast-staple maker is proud of its contributions to healthy diets, and its efforts to educate people about nutrition and exercise.

Let us learn from this example. First of all, you will note the use of official spokespersons. VERY evil. If you have an official spokesperson, you’re probably already well on your way to being a horrible bastard. Ideally, your official spokesperson should brazenly refuse to apologize for your crimes and conclude their sentences with an appropriate maniacal cackle, like the favored “Muahahaha!” or possibly a clangorous “Wahahahaha!”

If that proves impossible, though, it’s nearly AS evil to insist you’re being good when it’s clear to all and sundry that you are, in fact, some sort of cacodaemon. Observe the picture to the right, which combines the Kellogg’s product “Wild Bubbleberry Pop-Tarts” with the popular Nickelodeon character Sponge-Bob Squarepants. Now, let’s establish some facts. Although I haven’t consulted with a botanist, I am fairly certain that there is no such actual berry known as “bubbleberry”, although I have been able to determine that it is the name of a breed of cannabis plant. (I attribute this to coincidence. But those of you at home, note: marketing cannabis-filled Pop-Tarts to children would be AMAZINGLY evil.) For those of you who only consume Müëslïx, I will tell you that a Pop-Tart is a device containing a fruit-facsimile covered with a thin sheen of petroglaze, possibly studded with radioactive nubbins composed of Strontium, Iridium and the especially flavorful Rubidium. They were created as an emergency mechanism to prevent the stomachs of starving college students from collapsing while the damn cafeteria was closed on weekends.

It should be abundantly clear that encouraging kids to consume such a beast is NOT THE RIGHT THING TO DO. Neither Buddha, Jesus, Sgt. Slaughter, or any of the other Good Guys would approve of such a move. Yet not only did Kellogg’s and Nickelodeon team up to do this, they afterwards insisted that they care about the health of children and are proud of what they have done to contribute to it. That, ladies and gentlemen, is evil you can take to the bank and smoke.