Kevin Drum

Health Interlude

| Sun Apr. 5, 2015 12:06 AM EDT

"Flu-like symptoms" my ass.

The last couple of days have been a horror story. On Thursday afternoon, out of the blue, I started having intense lower back pain. Then it got worse. By late evening it was bad enough that I took some morphine, which had very little effect. It got worse through my sleepless night. More morphine at 2 am, then more again at 7 am on Friday morning. At that point, the pain was so excruciating that I wanted to head over to our local ER, but unfortunately Friday was the day we were scheduled to go to LA to have my Hickman port installed for the stem cell transplant. Marian, thank God, insisted on us doing the right thing: driving to LA regardless and getting help there. (On the bright side, Good Friday traffic was light.)

I was practically writhing on the floor for the hour after we got there. Eventually I was taken back to prep, and the doctor tried IV morphine. It had only a minor effect. Then he gave me several IV infusions of Dilaudid, and that did the trick. I was still in pain, but it was tolerable.

Unfortunately, our timing was bad. The Dilaudid was wearing off just as the surgery to install the port began, and they could give me only a limited additional amount until it was over. So the surgery was a horror story too, even though the placement of the port is basically pretty painless.

Long story short, all of this might have been the result of my Neupogen injections, which make my bones work overtime. But my doctors all agreed that although back pain is a common effect of Neupogen, pain of my level was very unusual. Alternatively, all of this could have been due to a pathological fracture in my lower back. A CAT scan ruled that out, thank goodness. So we still don't know for sure what was going on. But after a very bad day and night, apparently the Dilaudid was the right painkiller, and I woke up in the hospital Saturday morning feeling surprisingly good. I would have given long odds against that Friday night.

So....very mysterious. And for me personally, a whole new definition of pain. Hopefully it won't return.

Need a silver lining? As bad as it all was, it was apparently a sign that the Neupogen is working. Routine bloodwork shows that my white cell count is high and getting higher. Hooray! That's what we're hoping for.

On Monday we start putting the Hickman port to use. I will be up at City of Hope for 2-5 days while they extract stem cells and then process them and freeze them. If I'm producing lots of stem cells, they'll finish up in a couple of days. If I'm producing a weak stream of stem cells, it may take as long as five days. Cross your fingers.

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Friday Cat Blogging - 3 April 2015

| Fri Apr. 3, 2015 12:00 PM EDT

They say that no box is complete without a cat on top of it. As you can see, Hilbert agrees.

Catblogging will be a little iffy for the next couple of months, because tomorrow Hilbert and Hopper will be going to my sister's house to stay for a while. This is for hygienic reasons, since obviously Marian could take care of the cats by herself while I'm gone. However, my transplant doctor told us that although indoor cats probably weren't a problem even with a compromised immune system, it would be a good idea to board them somewhere else for a couple of weeks before the stem-cell transplant and extending for a few weeks after I get home. So the two furballs will be with Karen for about two months or so. In the interim, catblogging will depend on (a) whatever pictures she sends along, and (b) my ability to post them.

I'll be off at City of Hope next week starting the stem cell collection, so I thought I'd leave you with more than just catblogging. Spring has sprung, and our garden is full of blooming flowers. So here they are for you to peacefully zen out to. In comments, I expect everyone to figure out exactly which flowers these are.

Against All Odds, We Have a Tentative Nuclear Deal With Iran

| Thu Apr. 2, 2015 3:03 PM EDT

Well, I'll be damned. As President Obama just said, the details of the newly announced nuclear deal with Iran matter, and the deal isn't done until those details are fully worked out. Still, I figured the odds of getting even a framework agreement at about 70-30 against. This time, at least, it looks like John Kerry's tenacity has paid off.

The question of precisely when sanctions on Iran will be lifted seems to have been carefully avoided in the press conferences I've seen so far, but presumably that will get worked out. That aside, the framework seems pretty reasonable. I'll be fascinated to learn what tack Republicans take to justify their inevitable opposition.

Headline of the Day: Our Mideast Allies Suck

| Thu Apr. 2, 2015 10:49 AM EDT

Here's my favorite headline of the day:

Inept Allies in Mideast

Emma Ashford so perfectly channels my view of our putative allies in the Mideast that I won't even pretend to objectivity here. I like her piece for no better reason than the fact that I agree with nearly every word of it.

This doesn't get President Obama off the hook for mistakes he's made, and it doesn't necessarily mean the US has a better strategy available to it. The world is what it is. Still, more people should understand just what we're up against in the region. The answer is: just about everything.

Relax, You're Probably Doing OK As a Parent

| Thu Apr. 2, 2015 10:02 AM EDT

A recent research paper suggests that the amount of time you spend actively parenting your children doesn't really make much difference. Lots of people have cried foul. Justin Wolfers is one of them:

This nonfinding largely reflects the failure of the authors to accurately measure parental input. In particular, the study does not measure how much time parents typically spend with their children. Instead, it measures how much time each parent spends with children on only two particular days — one a weekday and the other a weekend day.

The result is that whether you are categorized as an intensive or a distant parent depends largely on which days of the week you happened to be surveyed. For instance, I began this week by taking a couple of days off to travel with the children to Disneyworld. A survey asking about Sunday or Monday would categorize me as a very intense parent who spent every waking moment engaged with my children. But today, I’m back at work and am unlikely to see them until late. And so a survey asking instead about today would categorize me as an absentee parent. The reality is that neither is accurate.

Trying to get a sense of the time you spend parenting from a single day’s diary is a bit like trying to measure your income from a single day.

This really doesn't hold water. Sure, Justin's Monday this week might be different from his usual Monday. But if your sample size is big enough, this all washes out in the averages. And in this case, the sample size is 1,605, which is plenty big enough to account for individuals here and there whose days are atypical for the particular week of the study. This is basic statistics.

At the risk of igniting a parenting war—and no, I don't have children—middle-class parents tend to resolutely reject the idea that their parenting matters a lot less than they think. It's easy to understand why, but unfortunately, there's a considerable amount of evidence that parenting styles per se have a surprisingly small impact on the personalities and life outcomes of children. Obviously this doesn't hold true at the extremes, but for the broad middle it does.

In a way, this shouldn't come as a big surprise. We all know families whose children are wildly different even though they share parents and share half their genes just to make them even more similar. Is this because the children have been treated extremely differently? That's unlikely. They'll be treated differently to some degree—boys vs. girls, firstborns vs. middle kids, etc.—but the differences generally aren't immense. What's more, the differences that do exist are often reactions to the personalities of the kids themselves. A quiet child will get treated one way, while a loud, demanding child will get treated a different way. But parents shouldn't mix cause and effect: the child's temperament is largely driving the difference in treatment, not the other way around.

There's a second way this shouldn't come as a surprise: when you think about it, parenting is a surprisingly small part of a child's upbringing. There are also peers. And school. And innate personalities. And socioeconomic status. And babysitters. And health differences. Parenting is a part of the mix, but not even the biggest part. Maybe 20 percent or so. The rest is out of your direct control.

Judith Rich Harris made this case at length in The Nurture Assumption, and it's a controversial book. But I think she's right on the basics. As an example, think about this: kids whose parents come from a different country generally grow up speaking English with an American accent. Why? Because they take their cues from peers, not parents. Their peers, and their interactions with peers, are more important than their parents. This means that the single biggest difference you can make is to be rich enough to afford to live in a nice neighborhood that provides nice playmates and good schools.

Now, none of is a license to ignore your kids—I'm not personally as dismissive of parenting as Harris, and it seems clear that parenting styles do have some impact—but parenting probably matters less than you think. Kids are born with personalities, and to the extent they get molded, there are lots of influences. Direct parenting styles play only a moderate role.

But my experience is that middle-class parents pretty flatly reject this idea. They simply can't stand the idea that they're unable to guide their kids in the direction they want. And yet, the number of kids who don't take after their parents is enormous. Neat parents raise slobs. Quiet parents raise extroverts. Honest parents raise crooks. Pacifist parents raise Army recruits. Bohemian parents raise Wall Street analysts.

So this latest study is probably roughly right. You might not like it, but it's probably right. And there's good news here too: Don't beat yourself up too badly if you think you're blowing it as a parent. Unless you're way off the charts, you're probably doing OK.

Once Again, We Are Unlearning the Lesson of the Great Debt Bubble

| Wed Apr. 1, 2015 1:41 PM EDT

Is this good news?

Millions of Americans unable to obtain credit cards, mortgages and auto loans from banks will receive a boost with the launch of a new credit score aimed at consumers regarded as too risky by lenders.

Here's more:

The new score is largely a response to banks’ desire to boost lending volumes by increasing loan originations to borrowers who otherwise wouldn’t qualify, many of whom tend to be charged more for loans....The new score, which isn’t yet named, will be calculated based on consumers’ payment history with their cable, cellphone, electric and gas bills, as well as how often they change addresses and other factors.

....The new score could help applicants who don’t use credit often but are responsible with their monthly payments to get approved for financing....But many borrowers who don’t have a traditional FICO score are very risky.

....Besides increasing their pool of borrowers and loan originations, banks stand to earn more in interest revenue from riskier borrowers. Lenders charge higher interest rates and in some cases extra fees to borrowers who present a higher risk of falling behind on debt payments.

Color me deeply skeptical. Helping people who are denied credit simply because they don't currently use any credit sounds great. And assessing them by their reliability in paying normal monthly bills sounds perfectly reasonable.

But I very much doubt this is really the target of this initiative. After all, people with no previous credit history already have access to credit. They just have to start slowly, with low credit limits and so forth. This new scoring system probably won't change that.

What it will do is give banks an excuse to extend high-cost credit to risky borrowers—exactly the same thing they did during the housing bubble. As you may recall, that didn't turn out well, and there was a simple reason: risky borrowers are risky for a reason. When banks start to get too loose with their lending standards they end up dealing with default rates much higher than they expected.

This won't happen right away, of course. Banks will be relatively cautious at first. They always are. But just wait a few years and it will be a different story. Then the standards will be lowered just a little too far, the rocket scientists will do their thing, and we'll be headed toward yet another debt crisis.

This is almost certainly a bad idea. We'd all like to see everyone get a chance, but there are good reasons to restrict credit to borrowers who are likely to repay. We should remember that.

UPDATE: Megan McArdle has a different take here. I'm skeptical, but it's worth reading.

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More Good News: Obamacare Has Not Overwhelmed the Health Care System

| Wed Apr. 1, 2015 11:20 AM EDT

Obamacare has provided health insurance to millions of people who previously lacked it. And yet, doctors' offices aren't jammed, as some people feared. Sarah Kliff takes a look at why this is, and I think this is the key point:

Federal data released earlier this month shows that the uninsured rate has fallen 35 percent since the coverage expansion began in 2014....In that way, the health law's insurance expansion was big. But put another way, it's also small: 14 million people gaining coverage in a country of more than 300 million residents is kind of a drop in the bucket. We're talking about 4 percent of the country going from uninsured to covered.

And it's not just that. Of that 4 percent, a lot of them were healthy people who simply didn't have much need for medical attention but were forced by the Obamacare mandate to purchase insurance anyway. So they got insurance, but since they were healthy, they still didn't go in to see their new doctors much. In reality, I suspect that the number of new patients with real medical needs probably amounted to 2-3 percent of the population. That's an extra burden on the health system, but not a huge one.

Medicare turned out to be similar when it began in 1965. As Kliff says, "In practice, these programs are relatively small: each only insured a small chunk of the population. Even though they're remaking American health care, they're doing so in a small, slow progression. That helps explain why none of these coverage expansions have overwhelmed doctors, despite our expectations."

IS Expansion Is More Illusion Than Reality

| Wed Apr. 1, 2015 10:58 AM EDT

Islamic State has been getting a lot of attention lately, and not just for its grisly beheading videos coming out of Iraq and Syria. It also seems to be expanding rapidly, with offshoots taking credit for atrocities across northern Africa and the Middle East. But the LA Times wisely suggests today that this should all be taken with more than a pinch of salt:

Like an accelerating drumbeat, the deeds of groups purporting to be linked to Islamic State have mounted, each seemingly designed to exact a toll more cruel than the last....But many intelligence officials and academic experts are skeptical that the parade of gore represents a leap in the degree of command and control being exerted across the region by the group's leadership in Syria and Iraq.

....Some evidence points instead to looser arrangements that nonetheless carry significant benefits for Islamic State and its professed offshoots....Under such informal pacts, opportunistic but relatively obscure militant groups can make themselves appear to be far more powerful players in their chosen arena of conflict, while the media-savvy Islamic State can depict itself as having dramatically widened its geographic spread, an assertion that fits neatly with the group's grandiose claim that its "caliphate" is destined to hold sway across the Muslim world, while also diverting attention from its struggle to hang on to territory seized in Iraq and Syria.

There are homegrown terrorist groups all over the Middle East. Most of them have local grievances, but nonetheless find it useful to be viewed as an ally of a group like IS, which has a useful reputation for extreme brutality. Likewise, IS benefits from a public image of massive, unstoppable growth.

But both are more illusion than reality. Neither the amount nor the target of terrorist activity has changed much over the past year. We're just seeing the publicity results of a very loose "franchise" model combined with a lot of bluster, much as we did with Al Qaeda in the past decade. There's much less here than meets the eye.

That's not to say there aren't some dangers inherent in this model, and the Times does a good job of spelling them out. Generally speaking, though, IS remains in serious trouble in its home territory, and no amount of PR alliances elsewhere really changes that.

Quote of the Day: Republicans Hate Obamacare Except for the Parts They Don't

| Tue Mar. 31, 2015 11:19 PM EDT

From Republican Rep. Cathy McMorris Rodgers, who asked for horror stories about Obamacare and was instead deluged with stories from people who have been helped by it:

The stories are largely around pre-existing conditions and those that are getting health insurance up to age 26.

Well, sure. Everyone likes the idea of making sure that people with pre-existing conditions can get health insurance. Unfortunately, as Greg Sargent points out, Republicans can't just say they support Obamacare's pre-existing conditions provision but oppose the rest of it:

It’s true that Republicans tend to support provisions like the protections for preexisting conditions; after all, they are very popular. But they can’t be tidily untangled from the law. The ACA’s protections for preexisting conditions rely on the individual mandate, because without it, people would simply wait until they got sick to sign up for insurance, driving up premiums; instead, the mandate broadens the risk pool. And the mandate requires the subsidies, so that lower-income people who’d face a penalty for remaining uninsured can afford to buy coverage.

This is something that Republicans steadfastly refuse to admit, even though it's obvious to everyone with even a passing knowledge of how this stuff works. Sargent has more at the link about how this ties into the King v. Burwell lawsuit and Republican claims that they want to replace Obamacare with something better.

If Hillary Clinton Testifies About Her Emails, She Should Do It In Public

| Tue Mar. 31, 2015 4:12 PM EDT

Here's the latest on Hillary Clinton's emails:

The chairman of the House committee investigating the Benghazi attacks asked Hillary Rodham Clinton on Tuesday to appear for a private interview about her exclusive use of a personal email account when she was secretary of state.

....Mr. Gowdy said the committee believed that “a transcribed interview would best protect Secretary Clinton’s privacy, the security of the information queried, and the public’s interest in ensuring this committee has all information needed to accomplish the task set before it.”

Go ahead and call me paranoid, but this sure seems like the perfect setup to allow Gowdy—or someone on his staff—to leak just a few bits and pieces of Clinton's testimony that put her in the worst possible light. Darrell Issa did this so commonly that it was practically part of the rules of the game when he was investigating Benghazi and other Republican obsessions.

Who knows? Maybe Gowdy is a more honest guy. But since Clinton herself has offered to testify publicly, why would anyone not take her up on it? It's not as if any of this risks exposing classified information or anything.