As on the Titanic, as on 9/11, and as in Aurora – this is what men do.
Bioethics
Why Obamacare is worse than understood by most and must be stopped.
The Supreme Court will rule on the constitutionality of Obamacare this year. The arguments and the issue which got the most publicity was the individual mandate. I don’t actually care much about this although it may well violate the Constitution. There are far worse things in the legislation and they should be emphatically rejected by the Supreme Court. The worst of the issues is discussed in detail here. This is a really frightening piece of legislation and I cannot imagine that the Court will let it stand. Of course, given the absence of argument, the Court will have to find this hidden provision itself.
Perhaps nothing in the Obamacare legislation embodies the top-down, command-and-control nature of Progressive healthcare more than the Independent Payment Advisory Board (IPAB), a 15-member panel of “experts” to be appointed by the President. There are three particular features of the IPAB that illustrate this fact: The IPAB will control all healthcare spending, public and private. The IPAB has been awarded near-dictatorial power. And the IPAB is designed to be a nearly immutable entity.
How is this accomplished ?
Specifically, Section 10320 (in the Managers’ Amendments portion of the legislation) grants the IPAB, beginning in 2015, the authority to limit all healthcare expenditures, that is, all healthcare expenditures, and not just expenditures by Medicare or government-run programs.
To emphasize this expanded authority, Section 10320 changes the name of the “Independent Medicare Advisory Board” to the “Independent Payment Advisory Board.” It directs the IPAB, at least every two years, to “submit to Congress and the President recommendations to slow the growth in national health expenditures” for private healthcare programs. Furthermore, it designates that these “recommendations” may be implemented by the Secretary of HHS or other Federal agencies “administratively” (that is, without any action by Congress).
Thus the federal government can control, under penalty of criminal prosecution of doctors, private health care spending ! This goes well beyond Medicare and Medicaid. It will prevent, unless stopped, people from spending their own money on health care.
That is not the worst of it. The IPAB cannot be changed or repealed by Congress. This is unprecedented in US law. Even the ill-advised Prohibition Amendment, promoted as another moral obligation by progressives after World War I, could be repealed by another constitutional amendment.
A quick reading of Section 3403 might leave one with the impression that the IPAB is a sort of Mr. Rogers of healthcare a mild-mannered, friendly, always-helpful, but ultimately undemanding agent for good. This is the impression imparted by the first few paragraphs of the Section, which paint the new entity as an “advisory” board, whose main task is to develop “proposals” and “advisory reports,” which “proposals” and “advisory reports” would solely consist of various “recommendations,” that ought to be “considered” for the purpose of cost reduction.
Nothing could be further from the truth. This language is simply another example of supplying a new law, which is far more radical than the authors would like people to know, with a soothingly misleading introductory paragraph. The IPAB is actually designed to be as all-powerful as it’s possible to be.
Graphic Novels on Health Care and other items….
-from SHOTS, NPR’s Health Care Blog:
Health care reform is no laughing matter, but MIT economist Jonathan Gruber’s new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.
In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.
I draw your attention to another graphic novel: The 9/11 Report: A Graphic Adaptation.
While I was buying a copy of Persepolis from a real-life book store a few years ago, a young woman at the sales counter mentioned that there was a “great” graphic novel about North Korea that I might like. I’m not a graphic novel reader and I think Persepolis is it for me unless I decide to review the health care book, but it interested me that she seemed so enthusiastic about the topic of North Korea and graphic novels. I guess it makes sense given our “information overload” society. I don’t know. Why not look for clarity?
PS: Linking is not endorsement and all that.
PPS: What’s the “all that” about? Eh, I’ve been burning the candle at both ends for the past week or so and my blogging has been pretty terrible because of it. I linked the health care graphic novel because it amused me, not because I am simpatico with the message. I think you all knew that already….
Does this sound familiar ?
The science community is now closing in on an example of scientific fraud at Duke University. The story sounds awfully familiar.
ANIL POTTI, Joseph Nevins and their colleagues at Duke University in Durham, North Carolina, garnered widespread attention in 2006. They reported in the New England Journal of Medicine that they could predict the course of a patient’s lung cancer using devices called expression arrays, which log the activity patterns of thousands of genes in a sample of tissue as a colourful picture. A few months later, they wrote in Nature Medicine that they had developed a similar technique which used gene expression in laboratory cultures of cancer cells, known as cell lines, to predict which chemotherapy would be most effective for an individual patient suffering from lung, breast or ovarian cancer.
At the time, this work looked like a tremendous advance for personalised medicine—the idea that understanding the molecular specifics of an individual’s illness will lead to a tailored treatment.
This would be an incredible step forward in chemotherapy. Sensitivity to anti-tumor drugs is the holy grail of chemotherapy.
Unbeknown to most people in the field, however, within a few weeks of the publication of the Nature Medicine paper a group of biostatisticians at the MD Anderson Cancer Centre in Houston, led by Keith Baggerly and Kevin Coombes, had begun to find serious flaws in the work.
Dr Baggerly and Dr Coombes had been trying to reproduce Dr Potti’s results at the request of clinical researchers at the Anderson centre who wished to use the new technique. When they first encountered problems, they followed normal procedures by asking Dr Potti, who had been in charge of the day-to-day research, and Dr Nevins, who was Dr Potti’s supervisor, for the raw data on which the published analysis was based—and also for further details about the team’s methods, so that they could try to replicate the original findings.
The raw data is always the place that any analysis of another’s work must begin.
Dr Potti and Dr Nevins answered the queries and publicly corrected several errors, but Dr Baggerly and Dr Coombes still found the methods’ predictions were little better than chance. Furthermore, the list of problems they uncovered continued to grow. For example, they saw that in one of their papers Dr Potti and his colleagues had mislabelled the cell lines they used to derive their chemotherapy prediction model, describing those that were sensitive as resistant, and vice versa. This meant that even if the predictive method the team at Duke were describing did work, which Dr Baggerly and Dr Coombes now seriously doubted, patients whose doctors relied on this paper would end up being given a drug they were less likely to benefit from instead of more likely.
In other words, the raw data was a mess. The results had to be random.
David Brooks’ Leash
One of the most prominent examples of experimental genetics is the infamous domesticated silver fox:
The domesticated silver fox …is a domesticated form of the silver morph of the red fox. As a result of selective breeding, the new foxes not only became tamer, but more dog-like as well…
Domesticated foxes exhibit both behavioral and physiological changes from their wild forebears. They are friendlier with humans, put their ears down (like dogs), wag their tails when happy, and vocalize, and bark like domesticated dogs. As a consequence of breeding, they also developed color patterns like domesticated dogs and lost their distinctive musky ‘fox smell’…
The experiment was initiated by scientists hoping to produce easier to handle fur animals and who were interested in the topic of domestication and the process by which wolves became tame domesticated dogs. They saw some retention of juvenile traits by adult dogs, both morphological ones, such as skulls that were unusually broad for their length, and behavioral ones, such as whining, barking, and submission…
[Project founder Dmitry] Belyaev believed that the key factor selected for [in the] domestication of dogs was not size or reproduction, but behavior; specifically, amenability to domestication, or tameability. He selected for low flight distance, that is, the distance one can approach the animal before it runs away. By selecting this behavior it mimics what happened through natural selection in the ancestral past of dogs. More than any other quality, Belyaev believed, tameability must have determined how well an animal would adapt to life among humans. Because behavior is rooted in biology, selecting for tameness and against aggression means selecting for physiological changes in the systems that govern the body’s hormones and neurochemicals. Belyaev decided to test his theory by domesticating foxes; in particular, the silver fox, a dark color form of the red fox. He placed a population of them in the same process of domestication, and he decided to submit this population to a strong selection pressure for inherent tameness.
The result is that Russian scientists now have a number of domesticated foxes that are fundamentally different in temperament and behavior from their wild forebears. Some important changes in physiology and morphology are now visible, such as mottled or spotted colored fur. Many scientists believe that these changes related to selecting for tameness are caused by lower adrenaline production in the new breed, which causes these physiological changes in a very small number of generations, thus allowing for these new genetic offshoots not present in the original species.
Bryant Gumbel once observed of former NFL commissioner Paul Tagliabue and his relationship with late NFL Players Union head Gene Upshaw:
Before he cleans out his office, have Paul Tagliabue show you where he keeps Gene Upshaw’s leash. By making the docile head of the players union his personal pet, your predecessor has kept the peace without giving players the kind of guarantees other pros take for granted. Try to make sure no one competent ever replaces Upshaw on your watch.
While watching this TEDtalk by New York Times columnist David Brooks, I thought of silver foxes, Gene Upshaw, and how David Brooks would be the ideal sire for a selective breeding program to produce a tamer right-winger. Generation after generation, you’d just have to breed for floppy ears, wagging tails, and low flight distance and you’d eventually end up with a more amenable Loyal Opposition. American politics would be a simple matter of showing your successor where you kept David Brooks’ leash.
For the record, Brooks does take some well-aimed potshots at his TEDset/Davos-set masters. But his digs are in that long tradition of peasant humor where the serf was allowed to let off some steam while the lord of the manor reached for his knout to give the recalcitrant peasant a good whipping.
I’m confident the next generation of TED-ready, Davos-approved conservative will offer less lip.
And have floppier ears.
[props Isegoria]