Kevin Drum

Beware the Hype of New Medical Studies

| Mon Mar. 23, 2015 12:58 PM EDT

Julia Belluz thinks the democratization of medical research may have gone too far:

I often wonder whether there is any value in reporting very early research. Journals now publish their findings, and the public seizes on them, but this wasn't always the case: journals were meant for peer-to-peer discussion, not mass consumption.

Working in the current system, we reporters feed on press releases from journals and it's difficult to resist the siren call of flashy findings. We are incentivized to find novel things to write about, just as scientists and research institutions need to attract attention to their work. Patients, of course, want better medicines, better procedures — and hope.

But this cycle is hurting us, and it's obscuring the truths research has to offer.

The truth, Belluz says, is that virtually all initial studies of promising new therapies fail to pan out. Only 6 percent of new journal articles each year are well-designed and relevant enough to inform patient care. Of these, only a fraction end up in a product that successfully makes it to market.

Dr. Oz may be the face of bad medical advice, but the fact is that it's all around us. We're all desperate for cures—I'd certainly like to see one for multiple myeloma—but most of them just don't go anywhere. Belluz has more about the siren call of new miracle cures at the link.

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Three Cheers For the California Miracle!

| Mon Mar. 23, 2015 11:21 AM EDT

Oh dear. Here's some bad news for Ted Cruz on his very first day as an official presidential candidate:

For years, business lobbyists complained about what they derided as "job killer" laws that drive employers out of California. Rival state governors, notably former Texas Gov. Rick Perry, made highly publicized visits to the Golden State in hopes of poaching jobs.

But new numbers from the U.S. Bureau of Labor Statistics tell a different story. Total jobs created in the 12 months ending Jan. 31 show California leading other states. California gained 498,000 new jobs, almost 30% more than the Lone Star State's total of 392,900 for the same period.

Them's the breaks. There's no more "Texas Miracle" for either Cruz or Rick Perry. We're in the middle of a California Miracle right now.

So how is Sodom on the Pacific pulling this off? Actually, that's pretty easy to answer. California was hit hard by the housing bubble, while Texas wasn't. So California's economy took a big hit during the recession and the slow recovery, while Texas did pretty well—aided and abetted by a rise in oil prices.

Now everything has turned around. California is rebounding strongly from the housing crisis while Texas is suffering from the global collapse in oil prices. There is, frankly, nothing very miraculous about either story. It's just the business cycle at work in a fairly normal and predictable way.

In fact, you may recall that there was never much of a Texas Miracle in the first place. It was mostly just PR bluster, as the chart on the right shows. The thick green line shows the unemployment rate in Texas compared to its neighboring states, and Texas is right smack in the middle—and it always has been. It's better than half a dozen nearby states and worse than another half dozen. It is, sad to say, entirely average. That's not something Texans are likely to take kindly to, but numbers don't lie.

Ted Cruz Throws His Hat In General Direction of Presidential Ring

| Mon Mar. 23, 2015 10:37 AM EDT

The big news sweeping my Twitter feed last night was Ted Cruz's rather sudden decision to announce that he's running for president. Usually there's a warmup period of some kind (an "exploratory committee," etc.) but apparently Cruz decided to dispense with all that and simply throw his hat in the ring posthaste. The motivation for his sudden haste is a little mysterious at this point.

The other thing sweeping my Twitter feed was the fact that the URL tedcruz.com leads to the site on the right. Patrick Caldwell explains this and much more in his brisk overview of potential candidates and their unfortunate lack of attention to the basics of internet campaigning:

Unfortunately for the Texas Republican, long before he ran for Senate in 2012, TedCruz.com had been nabbed by an Arizona attorney who shares his name. Based on a search of the Wayback Machine, an internet archive, the Arizona Cruz's website dates back to at least early 2008, when it was a normal, if slightly Geocities-tinged, business website. "Putting All Your Real Estate Needs In 'CRUZ CONTROL,'" the attorney's tagline said at the time. But sometime within the past year he ditched his law site to instead mock the would-be-president. On a simple black background, in large font, the website screamed: "COMING SOON, Presidential Candidate, I Luv CHRISTIE!!!!!" Attorney Cruz wouldn't say anything to Mother Jones over email except to acknowledge that he has owned the domain for several years. But he deleted the section about loving Christie shortly thereafter. Given the initial message, though, it seems unlikely that the Arizona attorney will be easily persuaded to relinquish control of the domain to the senator.

That's bad luck, no? Still, at least Cruz has control of tedcruz.org. It was obviously thrown together pretty quickly, though at least it's got the basics. But why the slapdash approach? According to the New York Times this morning, Cruz was afraid of being upstaged: "By becoming the first candidate to declare himself officially in the race, Republicans briefed on his strategy said, Mr. Cruz hopes to reclaim the affection and attention of those on the party’s right wing who have begun eyeing other contenders, particularly Gov. Scott Walker of Wisconsin."

Cruz's official announcement, inevitably, will be done at Liberty University, Jerry Falwell's shrine to the Christian Right. I think we can expect many, many more speeches and announcements from Republican wannabes there. But Cruz will be the first! Take that, Bobby Jindal!

Why Is Closed Captioning So Bad?

| Sun Mar. 22, 2015 12:24 PM EDT

Over at Marginal Revolution, commenter Jan A. asks:

Why is the (global) state of subtitling and closed captioning so bad?

a/ Subtitling and closed captioning are extremely efficient ways of learning new languages, for example for immigrants wanting to learn the language of their new country.

b/ Furthermore video is now offered on phones, tablets, laptops, desktops, televisions... but very frequently these videos cannot be played with sound on (a phone on public transport, a laptop in public places, televisions in busy places like bars or shops,...).

c/ And most importantly of all, it is crucial for the deaf and hard of hearing.

So why is it so disappointingly bad? Is it just the price (lots of manual work still, despite assistive speech-to-text technologies)? Or don’t producers care?

I use closed captioning all the time even though I'm not really hard of hearing. I just have a hard time picking out dialog when there's a lot of ambient noise in the soundtrack—which is pretty routine these days. So I have a vested interest in higher quality closed captioning. My beef, however, isn't so much with the text itself, which is usually pretty close to the dialog, but with the fact that there are multiple closed captioning standards and sometimes none of them work properly, with the captions either being way out of sync with the dialog or else only partially available. (That is, about one sentence out of three actually gets captioned.)

Given the (a) technical simplicity and low bandwidth required for proper closed captions, and (b) the rather large audience of viewers with hearing difficulties, it surprises me that these problems are so common. I don't suppose that captioning problems cost TV stations a ton of viewers, but they surely cost them a few here and there. Why is it so hard to get right?

POSTSCRIPT: Note that I'm not talking here about real-time captioning, as in live news and sports programming. I understand why it's difficult to do that well.

Friday Cat Blogging - 20 March 2015

| Fri Mar. 20, 2015 2:12 PM EDT

Appearances to the contrary, I might be getting better this morning. Cross your fingers, and we'll see how things go tomorrow.

Our hummingbird babies are fully mobile! I took some pictures of them this morning, and when I carefully edged in for a slightly closer angle they took off like a shot. This was plainly not their maiden voyage. They're all grown up now. Sniff.

In other news, longtime readers will remember that I once blogged about Louis the cathedral cat after a visit to Wells Cathedral in 2008. He was very friendly. However, in one of those inevitable town-gown controversies, Louis is now being accused of attacking dogs in the nearby area. But it might just be a case of mistaken identity: "I’ve heard there is another ginger cat around at the moment," said one witness, "and it’s quite possible that it’s him attacking dogs. We don’t know for sure whether or not Louis was involved. Louis had definitely been in the shop just before the incident happened outside, but it could have been a different cat."

Thursday Hummingbird Blogging - 19 March 2015

| Thu Mar. 19, 2015 2:15 PM EDT

Sorry for the lack of blogging yet again. In the meantime, here's the latest pic of our baby hummingbirds. They look perilously close to flapping their wings and leaving the nest.

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My Stake In the 2016 Election Is Way More Personal Than Usual

| Wed Mar. 18, 2015 1:20 PM EDT

Ed Kilgore:

I'm increasingly convinced that by the end of the Republican presidential nominating process the candidates will have pressured each other into a Pact of Steel to revoke all of Obama's executive orders and regulations. The post-2012 GOP plan to quickly implement the Ryan Budget and an Obamacare repeal in a single reconciliation bill will almost certainly be back in play if Republicans win the White House while holding on to Congress. Republicans (with even Rand Paul more or less going along) are all but calling for a re-invasion of Iraq plus a deliberate lurch into a war footing with Iran. And now more than ever, the direction of the U.S. Supreme Court would seem to vary almost 180 degrees based on which party will control the next couple of appointments.

This is more personal for me than usual. Scary, too. There are no guarantees in life, and there's no guarantee that MoJo will employ me forever. If I lose my job, and Republicans repeal Obamacare, I will be left with a very serious and very expensive medical condition and no insurance to pay for it. And I feel quite certain that Republicans will do nothing to help me out.

Obviously lots of other people are in the same position, and have been for a long time. But there's nothing like being in the crosshairs yourself to bring it all home. If Republicans win in 2016, my life is likely to take a very hard, very personal turn for the worse.

So What's Next For Israel and Palestine?

| Wed Mar. 18, 2015 11:14 AM EDT

I thought all along that Benjamin Netanyahu was going to win this week's election in Israel. I never wrote about it, but Mark Kleiman is my witness. My reasoning was simplistic: the polls were pretty close, and Netanyahu is a survivor. In a close race, he'd somehow figure out a way to pull out a win.

But yikes! I know Israeli politics is tough stuff, but I sure wasn't prepared for the sheer ugliness of Netanyahu's closing run. His speech before Congress turned out to be just a wan little warmup act. When things got down to the wire he flatly promised to keep the West Bank an occupied territory forever, and followed that up with dire warnings of Arabs "coming out in droves" to the polls. Even by Israeli standards this is sordid stuff.

I don't follow Israeli-Palestinian politics closely anymore, having long since given up hope that either side is willing to make the compromises necessary for peace. But even to my unpracticed eye, this election seems to change things. Sure, no one ever believed Netanyahu was truly dedicated to a two-state solution in the first place, but at least it hung out there as a possibility. Now it's gone. This will almost certainly strengthen Hamas and other hardline elements within the Palestinian movement, which in turn will justify ever tighter crackdowns by Israel. Is there any way this doesn't end badly?

I just don't see the endgame here for either side. Can someone enlighten me?

Republicans Take Game Playing to New Heights With Latest Budget

| Wed Mar. 18, 2015 10:27 AM EDT

I would like to nominate this for least surprising headline of the year:

And it gets even better. This is unusually straightforward reporting:

House Republicans called it streamlining, empowering states or “achieving sustainability.” They couched deep spending reductions in any number of gauzy euphemisms.

What they would not do on Tuesday was call their budget plan, which slashes spending by $5.5 trillion over 10 years, a “cut.” The 10-year blueprint for taxes and spending they formally unveiled would balance the federal budget, even promising a surplus by 2024, but only with the sort of sleights of hand that Republicans have so often derided.

I get that budget documents are often as much aspirational as anything else, but surely they should have at least some grounding in reality? Here's the best part:

The plan contains more than $1 trillion in savings from unspecified cuts to programs like food stamps and welfare. To make matters more complicated, the budget demands the full repeal of the Affordable Care Act, including the tax increases that finance the health care law. But the plan assumes the same level of federal revenue over the next 10 years that the Congressional Budget Office foresees with those tax increases in place — essentially counting $1 trillion of taxes that the same budget swears to forgo.

House Republicans sure don't make it easy to take them seriously, do they?

I Have Great Lungs

| Tue Mar. 17, 2015 8:13 PM EDT

In addition to the whole multiple myeloma thing, regular readers may recall that about a year ago I suddenly developed breathing difficulties. Things have improved since then, but I still have regular spells of shortness of breath. In fact, I'm going through one right now, which is likely contributing to all my other woes.

I mention this because today was the last of my pre-stem-cell-transplant workups, which happened to be a lung test. And just as always, I passed with flying colors. It even included a blood draw directly from an artery, which confirmed that my hemoglobin count is outstanding and the oxygen content of the blood in my extremities is normal or even a little above normal. And my lung volume? Better than 100 percent, whatever that means.

So the mystery continues. My lungs are getting plenty of air; they're producing plenty of oxygen; my heart is pumping perfectly; and the oxygen content of my blood is just peachy. Almost by definition, it sounds like there can't be anything wrong. Except that there is. Go figure.

In any case, all my tests are complete, and as far as I know there were no red flags. Next Wednesday I spend the day at City of Hope getting oriented. On Friday I get a nice big bonus round of chemotherapy, after which I spend a week injecting myself with a drug that stimulates white cell production. Then I get a Hickman port installed in my shoulder. Following that, I spend three or four days at City of Hope, where they draw blood through the port, centrifuge it, keep the stem cells, and send the rest back. When they have enough stem cells, they process and freeze them and send me home for a week of rest.

Then comes the stem cell transplant itself. I get a gigantic blast of chemotherapy that kills everything in its path—which includes all the remaining cancerous cells in my bone marrow but also all my non-cancerous plasma stem cells. That would kill me too, so the next day they unfreeze my stem cells and pump them into my body. Then I spend several weeks recuperating.

That's the short version. More later. Despite everything, it appears that all systems are go.