Kevin Drum

Texting Can Save Your Life (Seriously)

| Wed Sep. 23, 2015 12:37 AM EDT

This comes via Dr. Aaron Carroll, who headlines his post, "Texting people actually gets them to improve their modifiable risk factors." I decided on a punchier version. Was I justified? You be the judge.

Here's the background: A team of 15 researchers recruited a group of 710 patients with coronary heart disease. Half of the patients got the usual treatment. The other half got the usual treatment plus one other thing: four text messages each week reminding them to exercise, eat right, quit smoking, etc. That's it. Patients did not respond to the messages. They just received them.

Common sense and all previous research suggests that this would have almost no effect, even with a highly motivated population like this. Here's Carroll:

Let’s take a pause here. If you had asked me to bet, I would have put all the money in my pocket on this being a negative trial. I mean, random text messages? That’s all? One-way communication? No way this would make a difference.

I was wrong. LDL cholesterol was 5 points lower in those in the intervention (79 mg/dL versus 84), and it started higher in the intervention group. Systolic blood pressure was 8 points lower (128 mm Hg versus 136). BMI was 1.3 points lower (28 versus 30.3). Physical activity was way up (936 metabolic equivalent task minutes per week versus 643), and the percentage of people smoking was way down (26% versus 43%).

These results are so spectacular that they cry out for replication. Offhand, I'd note two possible reasons for tentative skepticism:

  • This was a group of people already highly primed to change their lifestyles. How well would this work on people who weren't staring death in the face?
  • The trial lasted only six months. It's one thing for an intervention to get people motivated for a short period. It's quite another to keep them motivated when their enthusiasm flags and the text messages start to become routine and therefore mostly ignored.

Nonetheless, this is pretty interesting. I'm honestly not sure that I want to give the medical establishment yet another medium they can use to bombard me with well-meaning advice, but then, I'm a grouch. If this stuff improves outcomes even modestly when done right, then it's worth doing. And Republican presidential candidates take note: it costs next to nothing. Put it in your next healthcare white paper!

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Scott Baio Got a Great Birthday Present Today

| Tue Sep. 22, 2015 9:47 PM EDT

Good news! A judge has ruled that "Happy Birthday To You" isn't copyrighted after all:

[Warner/Chappell Music] had been enforcing its copyright claim since it paid $15 million to buy Birch Tree Group, the successor to Clayton F. Summy Co., which owned the original copyright. Royalties on the song bring in about $2 million a year for Warner, according to some estimates. Judge George H. King ruled Tuesday afternoon that a copyright filed by the Summy Co. in 1935 granted only the rights to specific arrangements of the music, not the actual song itself.

Why is this such great news? Because it means that chain restaurants can now stop singing all those dreadful birthday songs they've invented as a way of avoiding royalty payments. These "songs" usually go something like this:

Happy Birthday
Thump thump thump
Happy happy happy
Clap clap clap
Another year, another cheer
Clap thump clap thump clap clap clap thump
Yay whistle clap clap hoorah yay

This is just dreadful. Judge King has rendered a service to mankind—unless he gets reversed on appeal, of course.

Alternatively, Warner/Chappell Music could do a service for mankind and just relinquish the copyright voluntarily. Do they really care about the measly $2 million per year? Come on, Warner. Do the right thing.

Health Update

| Tue Sep. 22, 2015 3:05 PM EDT

Do you want a quick summary or all the gory details? The details, of course. Because, really, what's better than listening to an acquaintance ramble on about their health issues?

So: My M-protein marker test—a good proxy for the level of cancerous bone marrow cells—is down from 0.72 last month to 0.63 this month. This is the right direction, but not the right magnitude. So we're going to increase my Revlimid maintenance from 10 mg to 15 mg. This puts at me at a slightly higher risk of blood clots, which means that I will also be starting a daily baby aspirin regimen.

Blood clots aside, the main side effect of the Revlimid is that it weakens your immune system. This is measured primarily by looking at your neutrophil count. Yours is probably around 5000 or so. Mine is now down to 1800. Anything above 1000 is OK, but obviously this is getting close to worrisome. So now we're doing a balancing act: we want to use the highest dose of Revlimid that still keeps me out of the immune system red zone. It will take several months to figure out what that is.

And speaking of this, it turns out that following the stem cell transplant I now have what's effectively a baby immune system. This means that in a month or so I'll start going through all the usual baby immunizations. Not all, actually, but a bunch. Fun.

On a positive note, apparently my bones are in good enough shape that I'll be allowed to do strenuous stuff if my back fully recovers. So that's something to look forward to. Assuming my back ever fully recovers, of course.

And finally, a test to see if my sister reads all the way to the end: I now have permission to clean the cat litter box. So you don't need to come over tonight.

VW Admits to Emissions Fraud in 11 Million Vehicles

| Tue Sep. 22, 2015 2:48 PM EDT

Wow. It's not just half a million cars in the United States. It turns out that Volkswagen installed its emissions cheating software in 11 million cars worldwide, mostly in Europe:

The German automaker said it was setting aside the equivalent of half a year’s profits — 6.5 billion euros, or about $7.3 billion — to cover the cost of fixing the cars to comply with pollution standards and to cover other expenses, which are likely to include fines as well as responses to civil lawsuits from angry customers.

$7.3 billion is just the start of things for VW. This is going to end up costing them a lot more than that. And when you count in lost sales, who knows? This could be a life-threatening event for them.

Housekeeping Note

| Tue Sep. 22, 2015 10:03 AM EDT

I'll be up in LA this morning seeing one of my rotating cast of doctors, so no blogging today. I may put up an item or two later in the day.

Does France Control What American Internet Users Are Allowed to See?

| Tue Sep. 22, 2015 1:21 AM EDT

We all saw this coming eventually, but here's the latest on Europe's ill-considered "right to be forgotten":

French data protection regulators on Monday rejected Google's bid to appeal an order that requires the company to block French results removed under Europe's "right to be forgotten" from all of Google's sites.

....An order from France's Commission Nationale de l’Informatique et des Libertés, or CNIL, earlier this summer required Google to remove requests results from all versions, including, but the company appealed.

A Google spokesman said that the company was trying to cooperate with European authorities, "But as a matter of principle, we respectfully disagree with the idea that a single national Data Protection Authority should determine which Web pages people in other countries can access via search engines."

Well, yeah. There's just no way that a French regulator can force Google to censor results on an American website. The reason should be pretty obvious, even to a French data protection agency: If France can do this, every other country can do it too. It's not hyperbole to say that this would be the end of the internet as we know it. Like it or not, it's just not a tenable position.

So now this gets appealed to EU courts, and hopefully they'll display some common sense. If they don't, I'm not sure what happens. No other country will allow France to unilaterally dictate what their citizens are and aren't allowed to have access to, so in the end the French won't get their way. They just won't. They can block sites in their own country, as the Chinese do, but practically speaking that's all they can do.

If that's how this ends up, the result would be a class-divided internet in France. Smart, well-educated folks would be relatively unaffected. They all know—or would quickly figure out—how to connect with and would routinely get the full story when they ran a search. Conversely, the unwashed masses mostly wouldn't know how to do this and would obliviously continue to use, not knowing that, unlike their elite countrymen, they were seeing an expurgated version of the world. Maybe that would be OK in France. I don't know. But it doesn't sound like a great way to run a country to me.

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Quote of the Day: Carly's Ex Doesn't Think Much of Her Chances

| Tue Sep. 22, 2015 12:46 AM EDT

From Todd Bartlem, Carly Fiorina's first husband, on the GOP presidential race:

In the clown car that is the Republican Party, she's the ultimate clown.

In fairness, if we took the opinions of exes seriously, very few of us would look good. Still, I suspect that Carly may be a pretty reliable generator of quotes of the day for a while. Not from her, mind you, but from people who know her.

This all comes from a piece written a few months ago by Bloomberg's Melinda Henneberger, who also highlights one of the things that bugs me the most about Fiorina: her "secretary to CEO" schtick. She likes to leave the impression that she was some kind of real-life Melanie Griffith, who was stuck taking messages for second-rate men until she eventually proved her savvy and clawed her way to the top against all odds.

Please. Her father was dean of Duke's law school and an appellate judge. She graduated from Stanford. She attended UCLA law school before deciding law wasn't for her. She did work as a receptionist for a few months after that, but it was just a short bit of downtime while she dithered about what to do with her life. When the dithering was over, she spent a couple of years getting an MBA and then started at AT&T as a management trainee.

So don't believe the nonsense about Fiorina bootstrapping herself up from the steno pool. She was a daughter of privilege; well traveled, very smart, and educated at an elite university; and bound for some kind of top-tier job practically from the cradle. It's still a testament to her skills and work ethic that she ended up getting so far, and the real story ought to be more than good enough for her. But I guess she thinks the log cabin version sounds better.

The Fat Lady Finally Sings for Scott Walker

| Mon Sep. 21, 2015 9:47 PM EDT

Scott Walker, low on funds and polling at zero percent, has dropped out of the Republican race for president. Let's see now, what did I say about Walker late last year? Oh yes:

Predictions are hard, especially about the future. But if he runs, I rate Walker a favorite right now.

If I'd been smart, I would have stopped at "future." In my defense, (a) this is a hard race to predict, and (b) who would have guessed that Walker would be quite as incompetent on the campaign trail as he turned out to be? At this point, I guess I'd go with the obvious and put my money on Bush or Rubio. The non-office-holders still don't seem plausible to me; the Cruz/Huckabee/Paul contingent is just too extreme; Kasich seems too moderate; and the rest are mired in nowhereville. But really, who knows?

For what it's worth, I think Walker was a victim of Donald Trump. My sense is that he thought he had the tea party base locked up, and then Trump came along and took it by storm without displaying any kind of normal conservative ideology. So whenever a topic popped up in the news, Walker froze. He knew the "right" response, but Trump was constantly out there stealing the spotlight by saying something different and outrageous. What to do? Spout the usual tea party shibboleths? Or go along with the Trump response that seemed to have everyone so excited? He couldn't make up his mind, so he regularly declined to take any position at all—only to clumsily change his mind a day or two later.

This was the worst possible thing to do, since it made him look completely unprepared for the presidency. If he can't even come up with a simple sound bite about Syrian refugees or how to beat ISIS, what's he going to do if he actually makes it to the Oval Office? In the end, he couldn't figure out what to do about Donald Trump, and he paid dearly for it.

But at least there's one thing we don't have to speculate about: who will pick up all of Walker's supporters. There aren't any left.

Capitalism and Machines Go Together Like Peanut Butter and Jelly

| Mon Sep. 21, 2015 5:29 PM EDT

James Pethokoukis says that economist Deirdre McCloskey has written "the most powerful defense of market capitalism you will ever read." It's based on the chart on the right, which shows the fantastic growth of the world economy since about 1800:

Now, McCloskey does not like the word “capitalism.” She would prefer our economic system be called “technological and institutional betterment at a frenetic pace, tested by unforced exchange among all the parties involved.”

Or perhaps “fantastically successful liberalism, in the old European sense, applied to trade and politics, as it was applied also to science and music and painting and literature.”

Or simply “trade-tested progress.”

I am a considerable fan of capitalism by nearly any standard (aside from the current Republican Party one, which essentially holds that you're a socialist if you believe in any regulation of large corporations at all). So sure: capitalism or free market exchange or whatever you want to call it certainly deserves plenty of credit here.

But was it the main driving force of the post-1800 economy? McCloskey says the Great Expansion wasn't the result of "coal, thrift, transport, high male wages, low female and child wages, surplus value, human capital, geography, railways, institutions, infrastructure, nationalism, the quickening of commerce, the late medieval run-up, Renaissance individualism, the First Divergence, the Black Death, American silver, the original accumulation of capital, piracy, empire, eugenic improvement, the mathematization of celestial mechanics, technical education, or a perfection of property rights." Those had existed for a long time. Rather, it's the fact that European elites "came to accept or even admire the values of trade and betterment."

Does that seem right? I don't know much about China or India—and I might be wrong about Europe too—but I've always thought that trade and commerce were also relatively free during, say, the height of the Roman Empire. The landed elites made a lot of money in trade, and if merchants weren't quite pillars of society, they were hardly social lepers either. The legions were routinely used to protect trade routes. Corruption was endemic, but tariffs and regulations on trade were fairly mild. The pursuit of wealth was respectable, and accounting practices were sophisticated.

Is this all roughly correct? Maybe I'm woefully misinformed. But it seems like the big difference between AD 0 and AD 1800 wasn't so much attitudes toward trade as it was the obvious thing that McCloskey left off her list: machines. As long as humans and animals were the only source of power, there was a limit to how much wealth could be generated. But if the Romans had invented steam engines and electrification, we'd all be speaking Latin today and arguing about what made classical Roman culture so special.

This is something that's been a subject of academic study for a long time, and I hardly expect to break any new ground here. But while a respect for fairly free trade might be a prerequisite for exponential economic growth, the example of Rome suggests that more than that is needed. The truly interesting question, then, is: why did 18th century Europeans invent machine power but 1st century Europeans didn't?

Raw Data: Here's How Black Kids Are Really Doing in School

| Mon Sep. 21, 2015 2:09 PM EDT

Bob Somerby is pretty ticked off at the way our "journalistic elites" cover black kids. In particular, he's ticked off at liberals who seem to care only about black kids getting shot, and conservatives who care only about promoting scare stories that make our public schools look as horrible as possible:

You will never see those people ask how black kids are doing in school. The reason for that seems abundantly clear:

None of those people care!

Just for the record, this is what score gains in math look like over the past twenty years. You’ll see these data nowhere else.

Twenty years?!? How about 40 years? I've got that for you right here, courtesy of the NAEP long-term assessment, which has used a similar test for over four decades precisely so that it's possible to make reasonable long-term comparisons. On the math test, black kids have improved their performance significantly: by 36 points at age nine, 36 points at age thirteen and 18 points at age seventeen. If we use the usual rule of thumb that ten points equals one grade level, that looks pretty good. And the gap between white scores and black scores has shrunk as well.

So maybe our schools are doing pretty well, after all? Maybe so. But at the risk of being a wet blanket, I'll point out one thing that makes all these score gains a little less uplifting: Since 1990, 17-year-old black kids have made no gains in math at all—and the story is the same in reading. Over the past 25 years, younger black kids have improved by one or two grade levels, but those gains are completely washed out by age 17. There may be good explanations for this. School reforms haven't hit high schools yet. A lower dropout rate means there are more mediocre kids still in school at age 17. Maybe, maybe, maybe. But one way or another, nothing matters unless our kids are doing better by the time they finish school. Until we figure out how to keep high school from being the black pit that it apparently is, none of the score gains in lower grades really matter much.