2010 - %3, August

Cheap Drugs

| Fri Aug. 27, 2010 9:15 AM EDT

Aaron Carroll writes today that we're addicted to new drugs even though older drugs are often just as good or better than the new ones. The problem is that we don't usually know this for sure since comparative studies are rare. However, a few years ago one was done for blood pressure medications:

There were so many drugs to choose from for this trial (at different costs) that the National Heart, Lung, and Blood Institute (NHLBI) primarily organized and supported a randomized, controlled trial to examine which was best. This study was enormous; it took place in 623 centers in the United States, Canada, Puerto Rico, and the U.S. Virgin Islands between 1994 and 1998, and included over 33,000 participants. Patients received one of four drugs:

  • Amlodipine, a calcium channel blocker
  • Doxazosin, an alpha-adrenergic blocker
  • Lisinopril, an angiotensin-converting enzyme inhibitor
  • Chlorthalidone, a diuretic

The last of these, the diuretic, was the oldest of the drugs, and by far the cheapest. However, at the end of the study, the results were clear. This old, cheap diuretic was significantly better at preventing at least one of the major types of cardiovascular disease when compared to the other, newer drugs. Since the diuretic was also significantly less expensive, it should be the drug of choice in initial treatment of high blood pressure. However, it usually is not.

I'm glad to hear it! My blood pressure has been slowly rising for the past few years, and last year my doctor decided I should start taking something for it. At first she recommended a beta blocker, but as we talked about it she said something that made me a little nervous (I don't remember quite what). "You know," I said, "I actually have a strong preference for the oldest, cheapest, best studied drugs around." She looked slightly surprised, but said that was perfectly reasonable and immediately prescribed a diuretic. I've been taking it ever since. (And, yes, I try to watch my sodium intake too.)

The whole post is worth reading. Sometimes new drugs are great, but I'm willing to bet that we waste upwards of a quarter to a third of the money we spend on pharmaceuticals because both doctors and patients have been brainwashed to always want the latest and greatest. But me? I like drugs that have been really well studied and are known to have infrequent and well understood interaction effects. In fact, new drugs actually make me kind of nervous. I am an insurance company's dream patient.

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Eco-News Roundup: Friday August 27

| Fri Aug. 27, 2010 6:25 AM EDT

What If: Some say health care reform will keep students from being insured.

Head Start: Early childhood education may help future earnings, but not test scores.

Easily Seen: Climate scientists can actually see global vegetation has decreased.

Gay Fears: In Uganda, an official says homosexuality is a European thing.

Ken's Big Day: Ken Mehlman comes out as gay, insiders yawn.

In Living Color: Newsroom diversity stalls out, though AP creates new ethnicity post.

Flooded: As the Pakistani government dithers, Islamic organizations step up flood relief.

You're Welcome: BP said the oil was gone. Our reporter found otherwise.

Katrina's Legacy: Tips from one reporter to another on Katrina's lasting damage.

 

What's Glenn Beck Afraid Of?

| Fri Aug. 27, 2010 6:13 AM EDT

For a guy who loves chalkboards and slogans, Glenn Beck has issued a peculiar edict to potential attendees of his "Restoring Honor" rally at the Lincoln Memorial being held this Saturday. He has repeatedly told people coming to DC not to bring political signs. What? No signs? The hallmark of the last year's worth of tea party rallies that he helped fuel? But it's true. In an info packet on his website about the rally, Beck instructs, "Please refrain from bringing signs (political or otherwise) as they may deter from the peaceful message we are bringing to Washington."

The message is reiterated in a flyer written for the media, which stresses again that Beck doesn't think his rally is a political event: "Not only is the event non-political, we have continuously encouraged those attending to avoid bringing political signs, political flyers, 'I heart the RNC' t-shirts and other similar partisan paraphernalia. There are plenty of opportunities to talk about politics. This isn’t one of them."

The idea that Beck's rally is nonpolitical is sort of laughable, given that he will be sharing the stage with one of the nation's most political celebrities, Sarah Palin. So the sign ban does beg the question: What's Beck worried about? Perhaps the answer is an obvious one. Given that a single nut case with a racist sign will color the media coverage of the entire event, it's in Beck's best interest to try to keep them out. (The nut cases seem pretty drawn to him, too. Recall that Beck follower Byron Williams was arrested last month armed to the gills on his way to kill off the staff of the progressive Tides Foundation, after Beck had bashed the foundation on his show.) Maybe Beck is genuinely concerned about focusing on the troops, who, lest we forget, are the very people the rally is supposed to be honoring.

A more cynical read might suggest that Beck doesn't want anything at the rally to take the spotlight off the star attraction, Beck himself. (Some tea party activists have questioned whether the event is really about anything but Beck, dubbing it "Beckapolooza"). Indeed, Beck has posted a melodramatic video promo for the event (complete with Goldline plug) that basically compares himself to Martin Luther King, Rosa Parks and the Wright Brothers, while likening the rally to the moon landing. But Beck may also have some employment concerns as well. Despite the fact that Palin herself works for Fox News, the conservative news network has been somewhat hesitant about Beck using his show to become an outright political leader. Fox has actually declined to broadcast the event. Headlining a political rally full of angry people waving inflammatory signs might be bad for his long-term TV presence—and scare off even more of his sponsors.

Regardless of the underlying motivations, it's hard to imagine that many of the grassroots activists headed to the rally will adhere to the no-sign rule. But just in case, Tea Party Patriots, a large national umbrella group for grassroots conservatives, will be on hand to coordinate volunteer marshals for security at the event. Presumably one of their main jobs will be crushing errant signage. As another backstop, TPP is also providing an alternate venue for all those patriots gathered for the Beck event dying to wave some signs around the nation's Capitol. The day after the Beck rally, TPP is sponsoring a tea party at the Upper Senate Park at 10 a.m., and encouraging activists to bring signs.  

A Climate Change Thought Experiment

| Fri Aug. 27, 2010 5:00 AM EDT

It's unfair to call Bjørn Lomborg a climate skeptic even if he did write a book called The Skeptical Environmentalist. He believes in global warming, after all. He just thinks it's not our biggest problem right now, and in any case, we can simply adapt to it when it happens. Here he is a couple of days ago on the possibility of a large rise in sea level over the next century:

Here are the facts. A 20-foot rise in sea levels [...] would inundate about 16,000 square miles of coastline, where more than 400 million people currently live. That’s a lot of people, to be sure, but hardly all of mankind. In fact, it amounts to less than 6% of the world’s population — which is to say that 94% of the population would not be inundated. And most of those who do live in the flood areas would never even get their feet wet.

That’s because the vast majority of those 400 million people reside within cities, where they could be protected relatively easily, as in Tokyo. As a result, only about 15 million people would have to be relocated. And that is over the course of a century. In all, according to Nicholls, Tol, and Vafeidis, the total cost of managing this “catastrophe” — if politicians do not dither and pursue smart, coordinated policies — would be about $600 billion a year, or less than 1% of global GDP.

It's a beguiling premise. Only $600 billion a year! And all it depends on is politicians pursuing smart, coordinated policies.

But there's something missing from this equation: namely that the money is largely going to have to be spent in some of the poorest countries on the planet, and it's going to have to come from the richest. But will rich countries be willing to pony up even a fraction of this $600 billion a year? Or will they take a look at each catastrophe separately and take refuge in the mantra that no individual event can be blamed on global warming?

I'd guess the latter. But if Myles Allen of the University of Oxford and some of his colleagues have their way, this excuse is going to get harder and harder to make:

In 2004, Allen and his colleagues showed to a high level of confidence that human greenhouse gas emissions had at least doubled the risk of the European heatwave of 2003 occurring....Kevin Trenberth of the National Center for Atmospheric Research in Boulder, Colorado, thinks similar analyses should be done within weeks of an event. For instance, we know that high sea-surface temperatures and large amounts of moist air over the Indian Ocean helped bring about the Pakistani floods and the heatwave in Russia. It should be possible to determine how great a role human climate change played in these events, Trenberth says.

Allen's team hasn't analyzed the Pakistani floods yet, and climate deniers will point out that Pakistan has had plenty of floods in the past. But what if Allen's models show, say, that climate change doubled the chance of this month's disaster in Pakistan? Does that mean that rich countries ought to bear half the cost of dealing with it? Probably. But just last week the UN reported that "donor fatigue" was hampering aid efforts and that they had raised only a third of the $459 million needed for initial relief. If two or three disasters in a single year makes it hard to raise even a measly half billion dollars for Pakistan's worst flooding in decades, what are the odds of rich countries coming up with anything close to $600 billion each and every year for the next century?

Slim and none. Given the political realities, adaptation is certain to be a necessary part of our strategy for dealing with climate change. But political realities — not to mention physical, chemical, and ecological ones — also make it clear that adaptation alone is a chimera. Citizens of rich countries will never be willing to spend enough on their poorer neighbors to mitigate the damage of climate change even if the necessary amount is "only" one percent of global GDP. The fact remains that the likely damage from climate change is so severe, so varied, and so unpredictable that the only sensible policy is to spend money to try to prevent it in the first place. Short of a massive technical breakthrough in clean energy production, this simply isn't likely to change. The faster we reconcile ourselves to it, the better.

Front page photo: Lui Siu Wai/zumapress.com

We're Still at War: Photo of the Day for August 27, 2010

Fri Aug. 27, 2010 1:59 AM EDT

 

Two Soldiers with Battery C, 2nd Battalion, 12th Field Artillery Regiment, 4th Stryker Brigade Combat Team, 2nd Infantry Division, from Fort Lewis, Wash., patrol a town in the Taji area. Photo via the US Army.

Is the Fed Sadistic?

| Thu Aug. 26, 2010 11:51 PM EDT

Arnold Kling on current Fed policy:

I call it neutron-bomb monetary policy. The banks are still standing, while the people are getting killed. I don't think that is the explicit intent of the Fed, but the structure of the organization makes it much more responsive to the thought process of bankers than to that of ordinary Americans.

Scott Sumner:

Central bankers are a bunch of well-meaning (or at worst amoral) people who act like sadists because they have the wrong model in their heads....What the Fed considers normal, I consider sadistic. Not just this Fed, but earlier Fed’s, and foreign central banks as well. If I knew there was 10% unemployment, I couldn’t sleep at night knowing the markets were predicting only 1% inflation, whereas the target was 2%. I’d keep asking myself; “Why not do more stimulus? We’d improve both the unemployment and inflation situations at the same time.”

Andy Harless:

How does the Recession allow the government to bail out banks? With the recession going on, people are afraid to do anything risky with their assets, so they keep them deposited in banks, earning no interest. Banks can then invest these deposits in Treasury notes and credit the interest on those Treasury notes to their bottom line, thus improving their balance sheets.

...Now this bailout program is not without its risks. The biggest risk is that the economy will recover, which would be a disaster for the program....So the success of this bailout program depends on avoiding recovery, avoiding increases in inflation expectations, and avoiding major declines in Treasury note yields. Now do you understand why the Federal Reserve Bank presidents — representatives of the banking sector — are the most hawkish voices at the FOMC’s policy meetings?

And of course, Paul Krugman:

Why are people who know better sugar-coating economic reality? The answer, I’m sorry to say, is that it’s all about evading responsibility.

In the case of the Fed, admitting that the economy isn’t recovering would put the institution under pressure to do more. And so far, at least, the Fed seems more afraid of the possible loss of face if it tries to help the economy and fails than it is of the costs to the American people if it does nothing, and settles for a recovery that isn’t.

The Fed has very few admirers anywhere on the ideological spectrum these days. And now there's this about tomorrow's economic report from the BEA: "The widening consensus that the U.S. economy has slowed to a crawl will be hammered home Friday with the government's expected announcement that the nation's second-quarter growth was far more anemic than previously estimated. Many economists believe the Commerce Department will revise its estimate of growth in gross domestic product to 1.3% or lower, down from 2.4% — a dismal performance, especially as the country struggles to rebound from recession." Perhaps the Fed should actually consider doing something to help?

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A Sense of Where We Are: Texas On Our Minds

Thu Aug. 26, 2010 11:31 PM EDT


View Westward Expansion in a larger map

Japan's Terrorist-Fighting Dogs

| Thu Aug. 26, 2010 5:24 PM EDT

Japan recently demonstrated one of its fuzziest, toughest terrorist-fighting weapons: dogs. Not just any dogs, dogs specially trained to jump into your car window, grab your gun, and jump back out (see video below). Another dog is trained to disarm terrorists by knocking weapons out of their hands. And as the video shows, these canines take their jobs very seriously. The dogs are part of a demonstration of the Japanese police force's crime-fighting abilities, in advance of the November Asia-Pacific Economic Cooperation summit in Yokohama. Japanese officials are expecting many protests, similar to those at last year's APEC summit in Singapore.


Japan Prepares for Possible APEC Terrorist Attack
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Should Retirement Be Nasty, Brutish, and Shorter?

| Thu Aug. 26, 2010 5:12 PM EDT

Everyone's favorite method for "fixing" Social Security seems to be increasing the retirement age to 70. Can anyone explain why this has become such an article of faith?

On the right, courtesy of the Department of Health and Human Services, is a chart showing the average life expectancy of Americans at age 65. In 1970 it stood at 15.2. Since the Social Security retirement age was also 65, this means the average number of years you could expect to receive benefits after retiring was 15.2 years.

By 2005 life expectancy had gone up to 18.7 years. But full retirement age had already been increased to 67 (that happened in 1983), so in order to keep the expected years of benefits constant at 15.2 years you'd only need to increase retirement age by another year and a half, to 68.5.

Now, I'm not in favor of that. Regardless of life expectancy, I think 67 is plenty old enough to retire. If a reasonable compromise package of reforms came along that included, say, a one-year increase in the retirement age to 68, I might reluctantly go along.

But where does the preoccupation with age 70 come from? That would represent a decrease in the expected number of years of retirement since 1970, during a period in which the United States has become nearly twice as wealthy. That doesn't even begin to make sense. Sure, life expectancy may increase in the future, but if it does then we have the option of increasing the retirement age when it happens. For now, we should make policy based on current reality, and the current reality is that life expectancy at age 65 has increased only 3.5 years since 1970. There's no reason the retirement age should increase five years in response.

Is Being Gay A White, European Thing?

| Thu Aug. 26, 2010 4:05 PM EDT

Ugandan parliament member David Bahati thinks so. The author of the East African country's anti-gay bill told Harper’s contributing editor Jeff Sharlet that "'If you come here [to Uganda], you'll see homosexuals from Europe and America are luring our children into homosexuality by distributing cell phones and iPods and things like this,'" Sharlet recounts in an interview on yesterday's "Fresh Air." How iPods lead to same-sex relationships is beyond me save maybe constant replays of Katy Perry's "I Kissed a Girl." As Sharlet points out, it's actually anti-gay hysteria that's getting exported to Uganda, and the exporters are evangelicals from the US of A. An Advocate cover story penned by Sharlet sheds light on various anti-gay laws gaining traction throughout Africa, and the Americans that are funding them.  

But let's go back to Bahati's suggestion that Europeans and Americans are exporting homosexuality: It's a claim I’ve heard before from some black people, my own family included. The rumor has it that being gay is a white inclination that’s seeped its way into the black experience via colonialization. It's largely based on the misconception that gay people don't exist in African history. And it's comparable to the claims made by some conservatives that gay rights, specifically gay marriage, is a fad not rooted in "traditional values" or espoused by any society in history. Which is just plain false.

After some online sleuthing, I discovered a whole lot of gayness, and gay marriages, in various cultures around the world going back centuries. (I know, I know. Appealing to tradition is a weak way to prove a point, but it is educational and pretty darn fascinating). So from the Bronze Age in China, to the eunuchs of the Roman empire, and even to the cross-dressing mugawe in Kenya, here's a brief (but handy) timeline: