Kevin Drum

Health Update

| Thu May 28, 2015 6:53 PM EDT

I spent all morning up at City of Hope for a follow-up appointment with my transplant doctor. My counts all look good. My white blood count is 5500 and my ANC count is at 2800. Both are right in the middle of the normal range, which means my immune system is rebounding as expected. That's very encouraging.

On the actual cancer front, the lab results are frustratingly hazy. The key thing my doctor wants to see is a big drop in my M protein level. Today I got the results from two weeks ago (it takes a while for the lab to do this particular test), and my M protein level had dropped from 1.0 to 0.38. The good news is that this means I responded to the chemotherapy. The hazier news is that it hasn't dropped to zero, as we'd like it to. I won't have the results of today's test until next week, but hopefully it will show a drop that gets me close to zero. Following that, around the end of June, I'll have a biopsy that will provide firm results on how well I responded to the chemo.

So....we wait. I'm not super thrilled with the 0.38 number, but my doctor assures me that this might represent nothing more than old cells lying around that haven't quite died off yet. We'll see.

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Americans Now Approve of Suicide, But Only With a Doctor's Note

| Thu May 28, 2015 10:59 AM EDT

Via Matt Yglesias, here's an interesting Gallup poll measuring American attitudes toward a variety of social behaviors. Unsurprisingly, there's been a general shift leftward. Support is higher than it was 2001 for gay relations, sex between unmarried partners, medical research on human embryos, etc. Here's the full table, with the result I found oddest highlighted in red:

Note that the moral acceptability of suicide has gone up slightly, but it's still very low. Less than one-fifth of the country approves of it. But doctor-assisted suicide is a whole different story. More than half of all Americans approve of it.

I'm not quite sure what this means. Does approval by a guy in a white coat really mean that much to most Americans? Is there an assumption that "doctor-assisted" means that everything possible has been done to talk the patient out of suicide? Or is there an assumption that doctor-assisted suicide is always for people with end-stage diseases that leave them in constant pain?

I'm not sure. In any case, it's also worth noting that public opinion has barely budged on several hot button issues. In particular, support for abortion, cloning, marital affairs, and the death penalty remains virtually unchanged over the past 15 years.

Cubans Really Don't Like Marco Rubio

| Thu May 28, 2015 9:00 AM EDT

Friend of the blog Jay Jaroch recently spent some time in Cuba. Here's the second of three posts about what he observed while he was there.


For obvious reasons, it can be difficult to get a Cuban to open up about their political views. It usually took some time to establish trust, and a certain amount of privacy. Sharing a few rum drinks didn’t seem to hurt either.

But they often did open up, especially when I offered to answer any questions they had for me. And the one question virtually everyone had was this: is Hillary Clinton going to be the next president? When I’d tell them I gave her a 75%-80% chance of winning based on demographic trends alone, they’d exhale. It wasn’t because they had any particular love for Hillary Clinton. It’s that they expected that she would continue Obama’s Cuba policies, whereas a Republican president would reinstate the full embargo. So, viva Hillary.

The more interesting thing, to me, was that they saved a particular brand of venom for Marco Rubio. Cab drivers, bartenders, artists—everyone seem to have something to say about Marco Rubio, and none of it was kind. A few suggested that as a Cuban-American Rubio should display some concern for economic struggles of every day Cubans, or to at least recognize that he was afforded an opportunity that millions of poorer Cubans never had, namely having parents who moved to the United States before Castro took over. (Or as Rubio used to tell it, barely escaping the revolution while Castro personally shot at their raft.) The fact that he was pledging to double down on the embargo was a pledge to make their lives worse, to deny them the new hope they’ve been given these last few years, all to suck up to the aging exile community in Florida.

Yes, I found something Cubans don’t like about America—it’s where Marco Rubio lives.

President Obama, on the other hand, received a fair amount of praise. According to a recent Gallup survey, Obama enjoys a 80% approval rating among Cubans. And it was pretty obvious why. “I loved Obama when he was elected,” one man in Havana told me. “Then I hated him when he turned out to be like every other president. But now, I like him again.”

Not surprisingly, when it came to their view of American politics and politicians, the embargo was a bit of a litmus test. Opinions on our Cuba policy ranged from anger to bewilderment. One man in Cienfuegos asked me, “Why do you bother? You have all the money. We are a poor island. Only 11 million people. Why do you care?”

Another made a smart point. “Our government blames all our problems on you. If you don’t have the embargo, then who can they blame?”

A visit to the Museo de la Revolución in Havana drove the man’s point home. Before you even exit the lobby you come to the Rincon de los Cretinos, or “The Corner of the Pricks.” Four panels featuring cartoon versions of Fulgencio Batista, Ronald Reagan, George H.W. Bush, and George W. Bush, each with a note of thanks translated into three languages.

On George W. Bush’s panel the note read, “Thank you cretin for helping us MAKE SOCIALISM IRREVOCABLE!”

Socialism was misspelled.

Next: How Cubans binge-watch American television.

Health Update

| Wed May 27, 2015 2:39 PM EDT

Last Saturday I wrote a post whining about how tired and nauseous I was and how I crashed every day around 2 pm. I wrote that post a little before noon, and then....nothing. No crash. Sunday: no crash. Monday, Tuesday, Wednesday: no crash. And the nausea has improved dramatically. There are two possible explanations for this:

  • It's just a coincidence.
  • Whining in public is really therapeutic and helped me feel better.

So which is it? Who knows. I suppose it was just a coincidence, but that's not a very satisfying explanation for us pattern-obsessed primates, is it? In any case, I'm still tired and I still make sure to rest frequently throughout the day. But my energy level is distinctly better than last week, and my nausea is clearly getting better too. Genuine progress! Hooray!

Unfortunately, the foul taste in my mouth is still hanging around. In theory, full recovery from the chemo side effects should take 6-7 weeks, and I'm now at week 5. Hopefully this means in another week or two I'll be feeling pretty sprightly and foulness free. We'll see.

Note to Politicians: Stop Being So Self-Centered About Medical Research Funding

| Wed May 27, 2015 1:14 PM EDT

Steve Benen mentions one of my pet peeves today: politicians who want to cut spending on everything except for research on one particular disease that happens to affect them personally. A couple of years ago, for example, Sen. Mark Kirk suddenly became interested in Medicaid's approach to treating strokes after he himself suffered a stroke. The latest example is Jeb Bush, whose mother-in-law has Alzheimer's. I suppose you can guess what's coming next. Here's Jeb in a letter he sent to Maria Shriver:

I have gotten lots of emails based on my comments regarding Alzheimer’s and dementia at a town hall meeting in New Hampshire. It is not the first time I have spoken about this disease. I have done so regularly.

Here is what I believe:

We need to increase funding to find a cure. We need to reform FDA [regulations] to accelerate the approval process for drug and device approval at a much lower cost. We need to find more community based solutions for care.

As Benen points out, Bush vetoed a bunch of bills that would have assisted Alzheimer's patients when he was governor of Florida. I guess that's changed now that he actually knows someone with the disease. However, it doesn't seem to have affected his attitude toward any other kind of medical research spending.

I'm not even sure what to call this syndrome, but it's mighty common. It's also wildly inappropriate. If Jeb wants to personally start a charity that helps fund Alzheimer's research, that's great. But if he's running for president, he should be concerned with medical research for everyone. I mean, where's the billion dollars that I'd like to see invested in multiple myeloma research? Huh?

Presidents and members of Congress represent the country, not their own families. They should get straight on the fact that if their pet disease is being underfunded, then maybe a lot of other diseases are being underfunded too. It shouldn't take a family member getting sick to get them to figure that out.

Republicans Find Yet Another Ingenious Way to Suppress Democratic Votes

| Wed May 27, 2015 11:07 AM EDT

The number of ways that Republicans invent to reduce the voting power of the Democratic Party is truly impressive. Here's the latest:

The court has never resolved whether voting districts should have the same number of people, or the same number of eligible voters. Counting all people amplifies the voting power of places with large numbers of residents who cannot vote legally, including immigrants who are here legally but are not citizens, illegal immigrants, children and prisoners. Those places tend to be urban and to vote Democratic.

A ruling that districts must be based on equal numbers of voters would move political power away from cities, with their many immigrants and children, and toward older and more homogeneous rural areas.

....The Supreme Court over the past nearly 25 years has turned away at least three similar challenges, and many election law experts expressed surprise that the justices agreed to hear this one. But since Chief Justice John G. Roberts has led the court, it has been active in other voting cases.

Over the past few decades we've seen pack-n-crack, photo ID laws, old fashioned gerrymandering, mid-decade gerrymandering, the gutting of the Voting Rights Act, reductions in early voting, the crippling of campaign finance law, illegal purges of voter rolls, and now this: a change in the way people are counted that would favor Republican-leaning districts.

From a purely academic view, you really have to be impressed by the GOP's relentless creativity in finding ever more ways to trim the votes of groups who lean Democratic. They've done a great job. Sure, it's been a violent and cynical assault on our country's notions of fairness in the voting booth, but that's for eggheads to worry about. After all, it worked. Right? Maybe its made a difference of only a point or two in presidential elections and fewer than a dozen districts in congressional elections, but in a closely balanced electorate that counts for a lot.

So: nice work, GOP. You've realized that all the woo-woo talk about democracy and the sacredness of the vote is just a bunch of blah blah blah. We all mouth the words, but no one really cares. There are just too many good shows on TV to pay attention to boring stuff like this.

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Cuba Is Cautiously Hopeful and You Should Be Too

| Wed May 27, 2015 9:00 AM EDT

Friend of the blog Jay Jaroch recently spent some time in Cuba. Here's the first of three posts about what he observed while he was there.


If you’re looking for a country that has solved the problem of income inequality, look no further than Cuba, where everyone has next to nothing. And that’s not snark. It’s an economic reality that quickly presents itself to any Westerner who spends some time there, as I did this month.

Soon after President Obama loosened the travel restrictions, domestic debate about Cuba’s economic future in a post-embargo world split into two predictable camps: those who worried that America would “ruin” Cuba with a heavy dose of fanny-packed tourists and Panera Breads, and those who dismissed this as the “fetishization of poverty” and welcomed the introduction of American-style capitalism as a long overdue tonic. The reality is that these are mostly debates Americans are having about their views of America. Cubans, one quickly learns, are too economically desperate to care.

Havana is unique and dilapidated and strangely beautiful. You almost admire it in the same way you would distressed furniture, or Keith Richard’s face. Havana looks a bit like a hurricane hit the French Quarter of New Orleans in 1965 and no one bothered to clean it up. Zoom in and you’ll find men standing in front of a partially collapsed building holding menus imploring you to come to their paladares next to stray dogs fucking in the street next to a group of Canadian tourists in faux revolutionary berets next to a woman selling fruit from a cart that most Americans wouldn’t eat on a dare. It’s all here.

Without exception, the Cubans I talked to welcomed the thawing of relations with the US, and even more so the coming influx of American tourists. One quickly learns why: because too much of their day-to-day economy is reliant on tourist dollars and euros. America is simply the biggest account they could land, and that’s why they’re hopeful. Also cautious, and not so much because they’re worried about Starbucks; it's because they’re worried their government will mismanage their chance at a better life. The sense was: Raul is finally allowing for some small, common-sense reforms that would have been impossible under Fidel. President Obama is allowing for some small, common sense reforms that will allow Cubans greater access to American dollars. Let’s not screw this up. (More on that tomorrow.)

Outside Havana, the economic stagnation is even more acute. In Cienfuegos, a middle school English teacher named Alex, who had never spoken to an American before, wanted to know what a teacher of his experience would make in Los Angeles. I told him around $75,000 a year. “$75,000 American dollars,” he replied, shaking his head. “I earn 18 dollars a month.” Alex was hardly unique—monthly salaries in Cuba run from about $14 to $20.

In Trinidad, a city about five hours southeast of Havana, an older man sitting in his doorway stopped me on my way down the street. He wanted me to give the Americans a message: “Hay mucha musica, pero nada de trabajo.” We have lots of music, but no work.

This jibed with what I’d seen of Trinidad. Other than the jobs related to tourism, I couldn’t discern any other source of employment. Pablo, my host in Trinidad, was a civil engineer by trade, but a taxi driver by necessity. On one trip through town I asked him what jobs were available to locals beyond the tourist trade. He replied that there weren’t any. I found that hard to believe so I asked the same question of an art gallery employee. I got the same answer—there aren’t any other jobs. The only money coming in to that part of the country came from abroad, either in the form of remittances from family members or from tourism. We were, quite literally, the only game in town.

In some respects, both sides of the American debate can stand down. Cuba is neither ready for Pizza Hut nor gearing up for broad-based market reforms. Yes, Cuba is changing. People who had been there five or even two years before would tell me how much had already changed. But the reality is that they’re starting, slowly, to dig out from a half century deep hole. The infrastructure is in such disarray that they couldn’t take a large scale influx of American tourists if they wanted to. And they want to.

No one really knows what happens next. But this much seems clear: if you want to see what Cuba was like under socialism, you can come next year. You can come in three years. Five. Ten. It will still be there.

Next: What Cubans think of Hillary Clinton and Marco Rubio.

Judges Are Just Extensions of Political Parties These Days

| Tue May 26, 2015 5:33 PM EDT

From a post by Dara Lind about a court ruling on President Obama's immigration plan:

The two Republican-appointed judges hearing the case sided against the administration, while the Democratic-appointed judge on the panel sided with the White House.

How many times have we read sentences exactly like this? It's a wonder that anyone in the country still believes that federal judges are honest brokers these days.

How Many US Troops Will Be In Iraq By the Time Obama Leaves Office?

| Tue May 26, 2015 1:10 PM EDT

Over the past few days I've been trying to catch up with the fall of Ramadi and what it means for the war against ISIS. But it's not easy figuring out what really happened.

According to Defense Secretary Ash Carter, Ramadi was yet another debacle for the Iraqi military: "What apparently happened is the Iraqi forces just showed no will to fight. They were not outnumbered; in fact, they vastly outnumbered the opposing force. That says to me, and I think to most of us, that we have an issue with the will of the Iraqis to fight ISIL and defend themselves."

The inevitable Kenneth Pollack, however, says that just isn't the case:

I think it important to start by putting the fall of Ramadi in its proper perspective. Da’ish [ISIS] forces have been battling for Ramadi since December 2013, so while the denouement may have come somewhat suddenly and unexpectedly, this is not a new front in the war and it ultimately took Da’ish a very long time to take the city. Although Iraqi Security Forces (ISF) did eventually retreat from the town and abandoned at least some heavy weapons doing so, most reports indicate they fell back to defensive positions outside the town. They did not simply drop their guns and run pell-mell, as many did in June 2014.

So what does Iraqi Prime Minister Haider al-Abadi think? He's certain that Carter was fed bad information. Iraqi troops, he says, are just fine: "They have the will to fight, but when they are faced with an onslaught by [the Islamic State] from nowhere . . . with armored trucks packed with explosives — the effect of them is like a small nuclear bomb — it gives a very, very bad effect on our forces,” he said.

Contra Pollack, then, Abadi thinks ISIS did indeed come "from nowhere." Also, he wants us to know that his troops have the will to fight, but not when facing an enemy that uses actual weapons. Or something.

Beyond this, all the usual suspects blame the whole thing on President Obama and his usual weak-kneed reluctance to support our friends overseas. Unfortunately, that matters, regardless of whether or not it's just reflexive partisan nonsense. When it's loud enough and persistent enough, it starts to congeal into conventional wisdom. And if conventional wisdom says that things aren't going well in the war against ISIS, then the pressure to do something ratchets up steadily—and not just from the usual suspects. The pressure also comes in more reasonable form from sympathetic critics. For example here, from Doyle McManus of the LA Times, and here, from Pollack himself.

Zack Beauchamp thinks this friendly criticism matters a lot. Here he is responding to Pollack's piece:

First, Pollack is right on certain points. For example, the US campaign to equip some Sunni fighters hasn't panned out very well....Second, critics like Pollack are going to jack up the pressure on the administration to put American troops in harm's way. Pollack wants Obama to put American forces on the front lines to more accurately call in US airstrikes. He blames the administration's insistence "that not a single American be killed in this fight" for why this hasn't happened.

It's true that the administration has strongly resisted putting American troops in combat positions. That's because they're trying very hard to avoid slouching toward another Iraq war, with a large and growing US combat force that very well might do more harm than good. No combat troops is a red line designed to prevent that escalation.

....The foreign policy consensus in Washington is relatively hawkish, so problems with US interventions tend to be seen as problems resulting from not using enough force or committing enough resources. The more the elite consensus shifts against Obama, the more political pressure to escalate will mount. Obama probably will resist it, but the costs of doing so are going up — as Pollack's piece demonstrates.

So now I feel like I've caught up a bit on this. And it hardly matters. It's the same old stuff. On the surface, everyone agrees that this is an Iraqi fight and Iraqis need to fight it. But of course our training of Iraqi troops is woefully inadequate—something that should come as no surprise to anyone who remembers that a decade wasn't long enough to train Iraqi troops back when George Bush was running things. If Obama could make it happen within a few months, he really would be a miracle worker.

But if our training mission isn't working, the alternative is wearily obvious: more American boots on the ground—which is to say, on the front lines. And again, this comes as no surprise. Anyone who was paying attention knew that Obama's lightweight training-first strategy was likely to take years. We also knew that virtually no one in Washington has that kind of patience. Six months is the usual limit. So even among centrists and moderate hawks, pressure is going to grow to adopt a more aggressive strategy. And that means more Americans fighting on the front lines. And when that isn't enough, even more Americans.

Can Obama resist this pressure? If anyone can, it would be him. But I'm not sure that even he can hold out for too long.

Sen. Lindsey Graham: Iranians in Pool Halls Are All Liars

| Tue May 26, 2015 11:20 AM EDT

Lindsey Graham is the Dr. Jekyll and Mr. Hyde of the US Senate. Here he is, slipping into his Mr. Hyde role:

Senator Lindsey Graham, the first speaker Friday morning, appearing from Washington via video, spoke of losing his parents as a teenager, working in a pool hall and having to help raise his younger sister — and how it relates to his leadership style.

"Everything I learned about Iranians I learned working in the pool room," he said. "I met a lot of liars, and I know the Iranians are lying."

Well, there you have it. It's not entirely clear to me how you'd become so adept at spotting liars in an open game like pool, but I guess ol' Lindsey managed it.

In any case, this is certainly the level of nuance and understanding of world affairs that we're getting accustomed to from the Republican presidential field—and it's only May. By the time, say, September rolls around, they're going to be competing with each other the same way they did four years ago over border security. It won't be long before we start hearing about nukes, giant domes, and Iron Curtain 2.0. Should be lotsa fun.

UPDATE: The BBC has corrected its Lindsey quote. He didn't say "I know the Iranians are liars." He said, "I know the Iranians are lying." I've corrected the text.