Blogging from 39,000 feet

Cool.  On Delta.  Flight is good, and this works.

— uo

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Published in: on November 28, 2009 at 9:18 pm  Leave a Comment  

“That All Depends”

Here’s an excerpt of a conversation between Senator Lindsey Graham and Attorney General Eric Holder at yesterday’s Senate hearing, where even NPR reported that Holder was unprepared:

GRAHAM: If we captured bin Laden tomorrow, would he be entitled to Miranda warnings at the moment of capture?

HOLDER: Again I’m not — that all depends. I mean, the notion that we —

GRAHAM: Well, it does not depend. If you’re going to prosecute anybody in civilian court, our law is clear that the moment custodial interrogation occurs the defendant, the criminal defendant, is entitled to a lawyer and to be informed of their right to remain silent.

That all depends?  Are f-ing kidding me?  Holder’s desire to capture bin Laden and prosecute him in civilian court sure seems to be a big departure from the words his boss said during the campaign.

Read the whole outrageous thing.

Here’s the NPR report on the subject.

More evidence that these guys simply are not nearly as smart as they think they are, as they fail to consider even the most rudimentary unintended consequences.

— uo

Published in: on November 19, 2009 at 10:47 am  Leave a Comment  

AP Poll Results: It’s Nearly Unanimous; The Country is United Against Tax and Spend

The Associated Press sponsored a poll on health care, then wrote a story about it.  Jamie has AP’s original headline: Tax the rich to pay for health bill.  The AP based this headline on the second part of question number 9, which was an eight-part question, where 57% of the respondents said that they favor a tax on people earning more than 250,000 in order to pay for health care.

But Jamie digs deeper than the headline to find some gems that don’t fit the narrative, such as the answer to this question “How much of the time do you think you can trust the government in Washington to do what is right – just about always, most of the time, or only some of the time?”   A total of 24% said all or most of the time.   Holy snikes!  Just 24%!!

Perhaps the article’s headline should have been: Landslide majority doesn’t trust the government to get health care right!

What’s also not told by the AP story, but which is in the actual poll itself, are these results that are even more overwhelming:

  • 88% oppose borrowing the money to pay for health care
  • 74% oppose taxing companies on the money they spend on health care for employees
  • 75% oppose increasing taxes paid by Americans no matter how much they earn
  • 73% favor reducing taxes on small companies if they offer health insurance to their workers

So the AP has these lopsided stats that are focused exclusively on tax and spend issues.  The results are mind-boggling.  You’ve heard about a country divided?  Maybe.  Maybe not.  Because when you look at the actual numbers, the American public is overwhelmingly united against higher taxes and borrowing money.

One other thing I noticed in this poll — President Obama’s ratings on his handling of the 3 most important issues facing this country:

  • On the economy: 49% (less than 50%)
  • On health care: 47% (less than 50%)
  • On terrorism: 49% (less than 50%)

All three less than 50%.  Wow!!

— uo

Published in: on November 17, 2009 at 9:52 pm  Comments (1)  

Science, or Rationing?

So is this the death panel so many healthcare reform opponents have worried about?  Here’s the actual statement from the panel.  Below are excerpts from The New York Times article:

Most women should start regular breast cancer screening at age 50, not 40, according to new guidelines released Monday by an influential group that provides guidance to doctors, insurance companies and policy makers.

The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.


The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services.

While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.

Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69.

The guidelines are not expected to have an immediate effect on insurance coverage but should make health plans less likely to aggressively prompt women in their 40s to have mammograms and older women to have the test annually.

Congress requires Medicare to pay for annual mammograms. Medicare can change its rules to pay for less frequent tests if federal officials direct it to.

Private insurers are required by law in every state except Utah to pay for mammograms for women in their 40s.

But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool.

Researchers worry the new report will be interpreted as a political effort by the Obama administration to save money on health care costs.

Of course, Dr. Berry noted, if the new guidelines are followed, billions of dollars will be saved.

What I find fascinating, especially given the name of this blog, is that the analysis used to make the recommendation appears to be identical in principle to the analysis you would perform if you were counting cards at a blackjack game in Las Vegas, or calculating the value of a financial derivative.  That is, you are trying to balance the risks, the reward and the odds of dying  when doing nothing against the risks, the reward and odds of dying when following the treatment guidelines.  You’re measuring to see if the probability-weighted benefits of treatment outweigh the probability-weighted costs of the treatment when compared to doing nothing.   And I’m not necessarily talking about financial costs.  I’m talking about the cost of radiation exposure, infection from a biopsy, unnecessary surgery, money better spent elsewhere, etc.

Basically, the panel looked at the odds of getting a benefit from the screening for different age groups.  They concluded that the various examinations and diagnostics only prevented one death for every 1904 women screened in the 40-49 age group, which means that 1903 deaths were not prevented by the examinations.  That’s not to say 1903 women died.  It just means that the examinations didn’t help 1903 women because most of them had no cancer in the first place.  For the very few in the 1903 group who did die, the unfortunate truth is that the early mammograms and self-examinations didn’t help.

So you then have to weigh the adverse side effects of those 1903 unhelped women getting radiation exposure from mammograms, which would inevitably lead to a radiologist seeing something on a few of those x-rays, which would lead to biopsies, which sometimes leads to infections or actually finding cancers that would, as the report says, “grow so slowly that they would never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”  Now you’re exposing the patient to chemo, radiation, and surgery.  All have very serious side effects.

So you balance 1 life saved compared to the mortality rate from the side effects of 1903 women who are not getting any benefit from the mammograms and additional unnecessary treatments.  The panel came to the conclusion that the population as a whole is better off not getting the diagnostic tests.

I don’t know what the answer is, but based on what little I know about the subject, the decision doesn’t seem unreasonable.  But here’s the thing.  In healthcare, numbers and logic don’t matter.  Why?

Remember the statistics: mammograms prevent 1 death per 1904 women in age group 40-49.  So if you eliminate mammograms, you will NOT prevent 1 death per 1904 women.  According to the latest Census data, there are about 22-23 million women in the U.S in that age group.  So do the math.  By not screening 40-49 year olds, there will be nearly 12,000 more cancer deaths per year!

It’s a DEATH PANEL!!

What’s not said in that analysis, however, is that there should be more than 12,000 women saved by not suffering from complications due to unnecessary treatment.  But that is not what good headlines are made of!

So here’s my prediction, with a lot of conditional statements:  If the research that prompted the new guidelines is accurate, and if those guidelines go into effect with the recommendations being adopted by insurance companies who stop paying for mammograms for women between 40 and 49, which, according to this research they should not get because it’s actually better for women in that age category to not get examined, then you will see 12,000 additional preventable deaths each and every year.  It’s not my opinion.  That”s just the numbers.

Here’s my opinion: There is going to be outrage!  Nevermind that the same research says that there will be more than 12,000 women saved by not suffering from the complications of misdiagnosis or unnecessary treatment.  The headlines are going to concentrate on those who died, not those who didn’t.

— uo

Published in: on November 17, 2009 at 12:21 pm  Leave a Comment  

“Obama Lied”

Here we go again.  This time, it’s not Joe “You Lie” Wilson or David I want honesty Obey.  Nope, it’s the German magazine Der Speigel.

I’m telling you, the President simply isn’t as smart as people thought.  He and his staff reacted the typical way incompetent leaders react to failure … by bullying his opponents.  The problem is, the opposition has grown from Palin and Fox News to some of his closest allies.

As far as my position on climate change is concerned, I have to say that I agree actually agree with President Obama, and Presidents Clinton and Bush (both of whom never brought the Kyoto Treaty to the Senate for ratification), and the 95 to 0 vote in the Senate twelve years ago: Any climate agreement must include the world’s biggest polluter (note the date of the article!).

— uo

Published in: on November 17, 2009 at 11:18 am  Leave a Comment  

Even Democrats Are Tired Of The Lies … I Mean ‘Stupid Mistakes’

First, it was CBS News, Bloomberg, and Joe Biden’s own admission that the numbers were inaccurate.  Then came news from the Chicago Tribune and the Sacramento Bee that the report on jobs was rife with fraud and mistakes.  Then came revelations from the Boston Globe, followed by the damning news from ABC that money is being spent and jobs are being created in Congressional districts that don’t even exist!

The lies have gotten so bad, that even Democrats in Congress don’t believe the Obama Administration anymore:

A powerful House Democrat used unusually harsh terms to blast the Obama administration’s manipulation of stimulus data Monday night, and demanded an honest accounting of results from the $787 billion government program.

Rep. Dave Obey (D-Wis.), who chairs the House Appropriations Committee, took the administration to task for pervasive errors on the Web site designed to monitor disbursement of the stimulus funds. He called those errors “outrageous.”

“Credibility counts in government and stupid mistakes like this undermine it. We’ve got too many serious problems in this country to let that happen,” Obey said in a statement. “Whether the numbers are good news or bad news, I want the honest numbers and I want them now.”

Oh, one more thing: Don’t panic; these people will be much better when it comes to analyzing data related to health care.

— uo

Published in: on November 17, 2009 at 9:28 am  Comments (1)  

Hey ACLU, Be Careful What You Wish For

My biggest fear with bringing KSM to the U.S. to be tried was centered on three things: security during and after the trial (for the police, the judiciary, the prosecutors, the defense and the jury), the potential that state secrets might be exposed, and the potential that they might actually get acquitted due to evidence being excluded due to the methods used to acquire the evidence.

I hadn’t thought of this:

The greatest danger posed in the trial of Khalid Sheikh Mohammed (KSM) isn’t that he will go free. The greatest danger is that he will be convicted and that during his appeals the courts will ratify all of the extraordinary measures used to capture and convict him.

So to all those so-called civil libertarians, if you think the Bush Administration trampled on your rights before, just imagine what life might be like if these Islamists actually get convicted and the tactics used against them get validated not just overseas, but on U.S. soil as well!

I don’t want to overstate things, or understate them.  But the President’s decision to try KSM in a criminal court could be one of the most consequential decisions a President has made since World War II.

Read the whole thing.

— uo

Published in: on November 17, 2009 at 9:16 am  Comments (1)  

Government Policy Will Lead to 12,000 More Breast Cancer Deaths Per Year

Here’s an interesting nugget from the United States Preventive Services Task Force.  This is the group that said women age 40-49 should NOT get mammograms and should NOT examine their breasts on a regular basis:

Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69.

Let’s do the math:  There are between 22 and 23 million women in that age group.  If there is one death prevented for every 1904 women screened, then when you stop screening, that one death per 1904 will NOT be prevented.  Which means you’ll get an additional 1 death per 1904.  So divide the population group by 1904 and you get somewhere around 11,500 to 12,000 additional breast cancer deaths.

Death Panel Indeed!

Believe me, it’s not the whole story.  There is another side to this, specifically the number of deaths resulting from the side effects of unnecessary treatment.  And I plan on writing more about this later today.  But for now, that statistic stood out and warranted a quick comment.

— uo

Published in: on November 17, 2009 at 8:10 am  Comments (1)  

Even More Stimulus Lies

So how many lies and mistakes does it take to go from a cascade of incompetent errors to fraud?  From ABC News:

Here’s a stimulus success story: In Arizona’s 15th congressional district, 30 jobs have been saved or created with just $761,420 in federal stimulus spending. At least that’s what the Web site set up by the Obama administration to track the $787 billion stimulus says.

There’s one problem, though: There is no 15th congressional district in Arizona; the state has only eight districts.

ABC goes on to note that the government web site that keeps track of the stimulus’ impact lists “hundreds of millions spent and hundreds of jobs created in congressional districts that don’t exist”.

Officials blame it on errors.  By the way, taxpayers spent $18 million to update the error-prone site.  $18 million!!

— uo

See previously:

The Stimulus Exaggerations Keep Piling Up

You Lie!

Published in: on November 16, 2009 at 9:57 pm  Leave a Comment  

Bummer

A Las Vegas strip club has agreed to stop an advertising promotion that involved hauling bikini-clad exotic dancers around in a truck with clear plastic sides.

[HT: Volokh]

— uo

Published in: on November 16, 2009 at 9:38 pm  Leave a Comment