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July 29, 2004

Blogging from Portland, OR

Here I am in the beautiful rose city of Portland, Oregon; home of rhododendrons that grow like weeds, neighborhood taverns with Rogue on tap, no sales taxes, and where it's illegal to even think about pumping your own gas.

I went to college here, and coming back makes me realize how much I love this town. You want to know something of my taste in cities? Two words: Portland. Chicago.

Today I think I'll go trail running in forest park, the largest wilderness park within citiy limits in the United States.

*Yawn* Sorry if I make anyone jealous.

July 27, 2004

Improving ourselves, not others

From self-help books to germline genetic manipulation:

However, if our happiness as individuals is impeded by desires and emotions that we want to disown, there are more everyday ways to try to change ourselves than using genetic modification. Perhaps we are best off if we can make the changes we desire through individual self-examination and insight, associating with people who already seem to have the kind of species-atypical psychological makeup that we aspire to, reading books about the experiences of such people, and so on.

Yet some of the desires and emotions that we want to disown might be too deep for us to reach by these methods. In this case, I see nothing wrong in principle with more direct physical changes to ourselves, such as if we can design safe, effective drugs that help reduce our craving for sugar (or our fear of death, and so on).

The point of this debate, then, should not be that there is a general moral rule against tampering with our inherited nature. Indeed, such tampering might be justified. Rather, we need to acknowledge that it would necessarily be a piecemeal, iterative process. It would begin with efforts by individuals to change those aspects of themselves that they rationally disapprove of. At one end of the spectrum of possibilities, a program of genetic alteration of the personalities of our children would be undesirable. All that said, there is no overriding objection to using technological means to modify our own personalities, and ultimately to reshape human nature. After all, self-help books are a type of technology too [italics mine].

Au contraire, mon frere. You were going great up until the "reshape human nature" bit, at which point you reached too far and fell on your face.

Germline genetic alteration, according to the article, is undesirable because it's "risky" and because it "may never be feasible." In other words, it's undesirable for technical reasons. These are NOT the only, or the most important, reasons why we should not manipulate our germline.

Self-improvement is one thing; if I choose to take Prozac or have my vision corrected surgically, or even tinker with my own genes, I'm engaged in self improvement, which is one of the most admirable and impressive human abilities.

But when I meddle with the germline--even when the technology has been perfected and I am able to do exactly what I wish to do with no risks of making a mistake--I'm no longer engaged in self-improvement. I'm engaged in other improvement, of a profound and largely irreversible kind.

Who among us is arrogant enough to presume to know what makes a "better" human being?

On one hand, this kind of hubris has been deployed in defense of genocide. On the other hand, it doesn't seem that different from a parent's efforts to prevent birth "defects" by seeking quality prenatal care.

The crucial distinction may be between the protection of others, and the improvement of others. Protection may sometimes be justified, as when a mother makes the decision that her unborn child would be better off without cerebral palsy. Even here, the decision has to be made very carefully.

The "improvement" of others through manipulation of the germline is too presumptuous. We cannot know that a higher IQ or an increased lifespan, no matter how much we may want those things for ourselves, will benefit someone who has not yet been born.

Self-improvement and other-protection can be justified. Other-improvement cannot be, so long as we respect each person's privilege and burden to make these decisions for themselves.

(Via political theory daily review.)

July 25, 2004

Yellow Jersey of Jesus

... what? You mean some of you haven't been overwhelmed by Lance Armstrong's sixth Tour de France victory yet, and are still bah-humbugging about bike racing?

Well, I'm... very disappointed. We need to fix this. You just haven't been acculturated to cycling fandom. This will help; it's a prayer that was posted on a message board back in 1991 for for the American cyclist I grew up cheering for, Greg LeMond. I think it nicely bridges the gap between the European cycling culture and the American red-state-voter culture.


Heavenly Father, we, the readers of rec.bicycles, ask you to watch and
guide Greg Lemond as he pits the cardio-vascular intensity of his thighs
against the steepness of Alpe D'Huez,

that he may sense every break and crush it righteously to rise from the
ashes like a Phoenix and breakaway on his own, with or without his team-
mates of Z who may have made a pact with the devil to abandon him,

that he may cross the finish line alone with his hands outstretched to
touch your holy feet in Heaven, while his enemies are littered below on
the mountain vainly speaking in tongues to their team directors,

that he may fulfill your dreams for America by vanquishing the cycling
forces of Satan who ride for the heathen countries where English is not

that he may warp the time-space continuum for a measly 4:42+ and wear the
Yellow Jersey of Jesus, the Son, into the City of Wickedness, the City with
a monument to the Arch-Angel's Triumph, where the armies of Satan drink
powerful dark liquids on the sidewalks and plot the downfall of America with
Moslem expatriates.

Lord, the Father, of this we pray.

Your faithful groveling supplicant,
Dave Harvey

Weekend Rush Lyrics

I know Rush was influenced by Ayn Rand in their naiive and impressionable youth, but I think there's a lot of support in their lyrics for my own agrarian neo-feudalist perspective:

When they turn the pages of history
When these days have passed long ago
Will they read of us with sadness
For the seeds that we let grow
We turned our gaze
From the castles in the distance
Eyes cast down
On the path of least resistance

Cities full of hatred
Fear and lies
Withered hearts
And cruel, tormented eyes
Scheming demons
Dressed in kingly guise
Beating down the multitude
And scoffing at the wise. . . .

--Rush, A Farewell to Kings

July 24, 2004

Armstrong wins Stages 17 and 19!

No doubt this year. No sirree Bob.

As with Merckx, who was booed and on occasion was punched, Armstrong's domination has not earned universal popularity. A small number of spectators have whistled at him at stage starts. He was apparently spat on during the Alpe d'Huez time-trial. While most spectators' placards have been supportive, there was the odd one referring to drugs - 'EPOstal', for example - and the motto 'Lance go home' has been spotted.

Normally he gives away a present or two to the other riders, but since the first stage in the Pyrenees, which he gave to Ivan Basso, there have been no gifts. It is as if he is trying to make the point that he is the strongest and it is up to the others to fight for what they can get.

While fighting cancer left Armstrong weak and frustrated, it also allowed him to rebuild his body into the perfect shape for a cyclist. He had developed a strong upper body through swimming, but lost nine kilograms of muscle during his illness.

As he prepared to walk out to the podium after Thursday's stage to be honored and applauded and kissed on both cheeks - by pretty girls, not by the race officials - Lance Armstrong met fellow five-time champion Bernard Hinault at the top of the stairs. "Perfect," Hinault assured him. "No gifts."

I repeat the negatives over and over every day," he said on the eve of this Tour. "It’s definitely a perception that I need that chip [on my shoulder]. It’s probably also accurate most of the time. But, and this is an important ‘but,’ most athletes perform better when they’re really motivated or angry about something.

"I don't like to lose. I just despise it."

"War" or "Ideological conflict?"

David Brooks discusses the suggestions of the 9-11 commission that "we're not in the middle of a war on terror. . . . We're not facing an axis of evil. Instead, we are in the midst of an ideological conflict."

It seems like a small distinction - emphasizing ideology instead of terror - but it makes all the difference, because if you don't define your problem correctly, you can't contemplate a strategy for victory.

More commentary from Kevin Drum.

July 23, 2004

(The one at the bottom)

Martha: a cute white chicken.

Private benefits, or public welfare

News that United Airlines is suspending pension plan contributions, and may soon terminate these plans altogether, is more evidence that workers shouldn't count on corporate benefactors to provide security for them in their old age.

Stronger unions would help. Ironically though, the unions themselves may have contributed to current worker insecurity with their strategies of the 1950s and 60's. By focusing their energies on winning more generous private pension benefits, instead of on increasing public-sector benefits like Social Security, the unions may have sacrificed long-term stability for short-term gains.

Michael B. Katz explains what happened:

In the 1950s and 1960s, federal officials would have accepted a tradeoff: lower private pensions for higher Social Security. Unions, however, balked at this alternative and cut their own deals with business for higher pensions. In fact, the slow rise in Social Security benefits during these decades reflected the growth in private pensions. After major unions had "carved out a . . . private welfare state for their own members," pointed out historian Nelson Lichtenstein, they "no longer saw an increase in federal welfare expenditures as an urgent task." . . .

"After World War II," argued Charles Noble in his history of welfare, "the best organized industrial workers all but gave up the struggle for universal public provisions to wrestle with employers over private benefits . . . . Organized labor's determined pursuit of the mixed-benefit strategy made it impossible to mount an effort to win universal public benefits or redistributional taxes." [Katz, pp.176-77, footnotes omitted.]

"Private welfare" as Katz calls it, including pensions and employer-provided health insurance, may have seemed safe back in the 1950's when Dad could get a job with Ford for the rest of his life. If the dollar value of the benefits unions could win from private employers was higher than what they could get out of Social Security, it might have made sense in that bygone era to focus on private welfare benefits. Even if , as Katz suggests, this strategy "divided the American working class into a unionized segment, which until recently enjoyed an almost West European level of social welfare protection, and a growing group--predominantly young, minority, and female--who were left out in the cold." [Katz, p.177, internal quotations omitted.]

Today, though, the differences between the solid working class and the poor unemployed riffraff have melted away. Everyone who lives on their wages, and not on their invested capital, is subject to becoming a new member of the riffraff class in the blink of an eye. In this environment, public benefits seem to be the only sure way to provide economic security to wage-earners in their old age.

Another problem with private benefits in America (including employer-sponsored health insurance) is that the "right" to these benefits is always trumped by the right of private business to pursue profits. This, in itself, might not be a bad thing. Why, after all, should private business be expected to provide for the public welfare? That seems to be a role that private business is least well-equipped to play.

The public welfare ought to be provided for by the public, acting through the democratic state. Risks that threaten all of us ought to be insured by the only entity that represents all of us--the government. This includes the risks of old-age poverty, and it also includes the risks of unexpected sickness and injury. So long as we continue to rely on private pension plans and employer-sponsored health insurance, we will ensure that only those citizens fortunate enough to hold a stable job will be protected from risks that confront all of us.

July 21, 2004

Outraged moderates; martyrs die off

Julie Saltman uncovers Thad Anderson's Download for Democracy:

During the last four years, the Bush administration's policies have gone against everything I’ve ever learned about how America is supposed to work: as a political science major, as an Eagle Scout, and as a member of a family that has lived in the American South since before the Declaration of Independence and the Constitution were signed...

With each month of the Bush Presidency, and each new shocking abuse of power, it becomes clearer and clearer that what's really at stake in this election isn't merely about partisan politics. Instead, this a choice between standing up to protect America's democratic institutions, or deciding that we just don't care.

Majikthise links to a description of the "absolute dumbest religious movement in history":

The Circumcellions eventually suffered the same fate that befalls most suicide cults -- it died out due to excessive death.

Armstrong wins stage 16!

This guy is toasting everybody else.

Bio of a Senate candidate

Here's a short bio of Mike Miles, courtesy of the Denver Post. Miles is the Democratic candidate for U.S. Senate from Colorado who received the most delegate votes at his party's convention (and whose name will appear first on the primary ballot). Try to imagine making the same career moves that Miles has made:

Mike Miles

Age: 47

Hometown: Born in Panama Canal Zone; raised in Fountain [a small, lower-middle-class town south of Colorado Springs]

Occupation: Assistant superintendent, Fountain-Fort Carson School District

Family: Wife, Karen; three children

Education: West Point, B.S. in engineering, 1978; University of California at Berkeley, B.A. in Slavic languages and literature, 1986; Columbia University, M.A. in international affairs and Soviet studies, 1989

Career: U.S. Army Ranger, 1979-81; promoted to company commander, 1981-83; custodian, Colorado Springs, 1983; analyst, Congressional Research Service, summers 1987-89; presidential management intern, U.S. State Department, 1989-90; foreign service officer, U.S. Embassy in Warsaw, Poland, 1991-93; general services officer promoted to special assistant to the U.S. ambassador to Russia in Moscow, 1993-94; teacher, Fountain-Fort Carson High School, 1995-99; principal, Fountain Middle School, 1999-2003

Community service: Human Relations Coalition in Colorado Springs, 1996-99; Citizens Project, 1997-99; Black Leadership Forum, 2000-present

What must have motivated Miles to leave the Foreign Service in order to become a high school teacher? He wasn't chasing brass rings -- not like, say, the Democratic Party fat cats who pretend that Mike Miles doesn't exist.

July 20, 2004

Two words:

Industrial food production.

Armstrong wins Stage 15!

Lance Armstrong outsprinted his closest challenger, Ivan Basso, to win the 15th stage of the Tour de France.

Jan Ullrich tried to make up some time on Armstrong today. He failed. Ullrich's unsuccessful attacks may signal that he doesn't have it in him to challenge Armstrong, Basso, or Kloden in tomorrow's time trial up l'Alpe d'Huez.

(Anyone at all interested in the Tour should follow the stages in real time on the official site. I've linked to it in the upper-right corner of my blog. You can see the action in your mind as you read, and the descriptions of the race are...idiosyncratic. An example from today's stage:

At the front of the lead group is Carlos Sastre (CSC). He has been setting the pace for past couple of minutes but now it's time for Azevedo to take over.
With this posse approaching the cat-2 summit, we can expect to see Virenque pounce at any moment... oh, there he goes. What a surprise!

The big time trial tomorrow may determine the winner. Be sure to tune in.

July 19, 2004

Don't hide behind "science"

Many creationists and would-be theocrats in this country don't really understand science.

Sometimes, neither do doctors.

This week's issue of the New England Journal of Medicine carries a letter from one David S. Huckins, M.D., of Newton-Wellesley Hospital in Massachusetts. Huckins expresses his indignation that the President's Council on Bioethics has not done enough to ensure that its deliberations are unbiased. "Medical research conducted with the same bias would be summarily rejected by the scientific community as irrelevant and worthless."

There are plenty of grounds for criticizing the President's Council on Bioethics, and the process used to select its members. Failing to "rigorously exclude preexisting bias" is not one of them. Huckins, apparently, doesn't understand science or the purpose of the Council on Bioethics.

The aim of the President's Council on Bioethics is not the pursuit of scientific truth. Instead, the Council is charged with answering questions that aren't scientific--questions about ethics, values, and morals. These questions, by definition, can never be free from bias.

Perhaps Huckins can be forgiven for confusing the Council's purpose with the subject matter with which it deals. Among the ethical questions facing the Council is whether or not to pursue scientific inquiry using human stem cells derived from embryos. Stem-cell research may be scientific; the questions about whether or not we should do it are ethical.

What Huckins really objects to is not that the Council is biased, but that it is composed of too many individuals that subscribe to the wrong "political and religious ideology." That's a fair charge. But Huckins should stop waving his hands about "science" and own up to the fact that he is simply advocating a different political and religious ideology.

July 18, 2004

Seeking recommendations

Can anyone recommend a trustworthy mechanic in Ann Arbor that can work on my 1985 Subaru?

If you know of any good people, leave a comment or email me. Thanks for your help!

Law school competition

On the eve of my school's law review announcements, and the emotional reactions that will probably follow, let me tell you what I don't want to talk about.

I don't want to talk about whether we should eliminate competition in law school. This just isn't possible. As long as there are more law students than there are desired post-law school positions, there will be competition in law school. Eliminating grades won't get rid of competition; neither will eliminating the competitive law review selection process. Students would find other ways to compete, like kissing up to professors, judges, and firms, or competing to market themselves most effectively: the best resume, the best summer jobs... The best blogs... Please God, no!

I also don't want to talk about the benefits of competition. I'll be the first one to acknowledge that competition often pushes people to do great things that they wouldn't do otherwise. I enthusiastically agree that competition can be exhilarating. Especially if you win. (I feel superbly qualified to speak on this topic, having both won and lost competitions that mattered to me. Of course, virtually every law student is superbly qualified by these criteria.) Competition is usually the best way to select a limited number of students for highly-desired positions. The students who want it the most have a higher chance of getting it, and the position is usually filled with a highly competent, enthusiastic person.

Here's what I do want to talk about: the costs of competition, and the ways competition harms us individually, and harms the law school community. These costs don't make competition any less unavoidable or any less beneficial, but this is no reason to ignore them. Making them explicit helps us to understand what actually happens in law school, and allows us to put competitive successes and failures in the proper context.

1. Competition can interfere with teaching and learning. One phenomenon here at my law school that I've seen with my own eyes (but which still amazes me) is the drop-off in student enthusiasm for class participation after the first semester of 1L year. By class participation, I mean both in-class participation (talking in class, bothering to show up to class) and out-of-class preparation (bothering to do the reading). I've seen it, and faculty routinely acknowledge this to be true. Why does it happen?

There's only one thing that can possibly account for students going from relatively enthusiastic during first semester to relatively apathetic after, and that's grades. Grades, in most cases, are poison. During the first semester, everyone is in the same boat. There haven't been any winners or losers yet. After everyone gets grades following first semester, there are winners and losers; competition has taken its toll. While there are many students who pursue their learning of the law after they've been graded in the same way that they did before they had grades (of whatever sort), there are many others who become more apathetic and more bitter about law school after they've received their first grades.

The reasons for this are many and worthy of a discussion elsewhere, but the bottom line is that grades, which are so necessary for sorting students for the benefit of employers, also interfere with teaching and learning in law school. The apathy and bitterness of second semester made in-class discussions less lively. Out-of-class discussions were less likely to focus on class material than they were first semester. Students were much less likely to respond favorably to a presentation by a professor that they thought was "off-topic" or "irrelevant" to the exam.

I suspect that grades have such a large influence because many students come to law school without a passion for law as such, but more from a lack of any passionate desire to do anything else. I'll compare this with medical school, where (although it has plenty of its own unique problems) the students are almost always passionate about medicine. They really want to be physicians (for various reasons). Few people really want to be lawyers. In this environment, it's not hard to see why law students can get distracted from learning law by every competition that comes along. "Grades are curved? Then grades matter, and if mine aren't great, then what's the point?" What's the point, indeed, if you're not passionate about law. In medical school, bad grades are a disappointment, but for most students, the disappointment isn't so great that it distracts from the desire to learn medicine.

Keep in mind that I'm sympathetic to students who aren't passionate about law school: (a) it's hard to know what to expect before you come to law school; (b) so many run-of-mill jobs out there, even those you can only get with a college degree, are BORING! It makes sense to come to law school, even if law is only slightly less boring; (c) much of law is dull -- admit it; (d) even when you might be passionate about the practice of law, it's absurd to expect that you'll be passionate about law school.

2. Competition breeds bitterness when it's a zero-sum game. There's another way that competition costs us in law school, and that's when it's perceived as a zero-sum game: if you win, then I lose. In law school, and perhaps in the legal profession generally, this perception is enhanced by an obsession with rankings and prestige. Again, a comparison with medical school helps to make the point.

In medical school there is a lot of competition. There are high-prestige and low-prestige doctor jobs; there are more competitive residencies and less competitive residencies. But there's also a sense that the prestigious residencies and jobs don't differ that much from the less prestigious ones. If you're a gastroenterologist, you're going to be doing more or less the same old crap whether you're at Massachusetts General or at some lesser-known hospital. And you'll be doing it for more or less the same amount of money. Therefore, the medical students who don't "win" the competition for MGH residencies haven't really "lost" much either. (Readers may object that the competition for certain specialties like dermatology (dermatology! Yep, strange world...) is zero-sum, and they'd be right, but only a small subset of medical students desperately want to be dermatologists. For most students, the competition is for certain residencies and not for specialties.)

Many law students perceive the competition they face differently from medical students. As far as I can tell, law students believe that there's a huge difference between the plum jobs awarded to the winners, and the leftovers that everybody else gets. Regardless of whether the perception is accurate, law students often feel that their lives will be profoundly different if they "win" instead of "lose." For them, the competition for high grades, law review, clerkships, and legal jobs is zero-sum.

Is this perception true? In my not-fully-informed opinion, yes and no. It's definitely not true in the context of students at "prestigious" law schools competing for jobs with "prestigious" Biglaw firms. Everything that I've learned about those jobs suggests that they're like the gastroenterology case: some are more prestigious, but everyone's doing the same old crap. Ditto for most judicial clerkships (the Supreme Court excepted, of course). Nevertheless, the legal profession, infected as it is with an overweening obsession with prestige, engenders a sense among law students that the competition for jobs in particular Biglaw firms is zero-sum.

But it may be different when you're competing for scarce jobs as a law professor, or if you're at a school that gives you no assurances that Biglaw is in your future. These situations are more like the competition for dermatology slots; whether you win or lose could have a large impact on how you'll actually be spending your time after graduation.

3. Competition can make law students treat one another like shit. This isn't exactly what I want to say. People will treat one another like shit with or without competition; there's always another excuse available when you want one. In the context of a competition that's often perceived as zero-sum, though, the emotions that sometimes follow from "success" or "failure" can make us forget what's important about the people around us. What's important about them isn't that they're on law review, or not on law review. It's whether or not they vote Republican.

Armstrong wins in Pyrenees

In the words of Phil Liggett, "Armstrong, who never actually attacked anyone, watched his team crack an elite field then, as all team leaders should, he finished things off with a win on the top of the viciously hard climb of the Plateau de Beille. His 17th stage win of his career."

Lance Armstrong is a long way from winning a record sixth Tour de France, but with a team as strong as US Postal has proven to be, and with the unexpected weakness of his rivals, it's starting to seem inevitable.

July 17, 2004

Hannah Arendt

My undergraduate thesis was on Hannah Arendt. I don't think it was wholly successful, but in fairness to myself, I can't think of too many people who believe that their thesis was a smashing success. Even when, unlike mine, it really was.

There's one sense in which my thesis did succeed, and that is that it didn't kill my interest in Arendt. When I turned it in, I thought that (a) it was a crappy thesis, but that (b) I'd love to rewrite it. Alas, other priorities: ambulance jobs, medical school... law school. *Sigh* Since I don't like golf on principle, maybe I can come back to it when I retire.

In the meantime, here is one of the pithiest attempts to describe some of what Hannah Arendt was trying to do. The whole article is interesting; here are excerpts.

"Her task was to formulate the morality that kept average people from doing evil in emergency situations. The emergency she had in mind was Nazi Germany. She wished more people had possessed principles that led them to refuse the Nazis. Refusal was exhibited by rare individuals of every social type. Set against them, though, were those "normal" people who couldn't be relied on: Eichmann-types on the one hand, and advanced "intellectuals," her former colleagues, on the other. These two groups loved to judge things by rules-but in the Third Reich all rules had been reversed. "Thou Shalt Kill," she liked to say, became the First Commandment. Therefore, Arendt set herself the difficult task of a morality that would not depend on rules. [Arendt focuses on two faculties that she thought some "banal," average people like Adolf Eichmann had lacked: thinking and judging.]

"Finally, though, it is her idea of judgment that is most alien to us. On Arendt's model, we must judge, and judge, and judge: thoughtfully, implacably, publicly. At both the individual level and the level of the community, people must always be judging the acts and characters of others. If you think of our current world, there may be truth to her charge that we are afraid of judging. We complain about people, we hate them, we love scandals, we opine about what people shouldn't dare say in public. But we would think it arrogant for one person to stand up and coolly say to another-"I, so-and-so, having considered it carefully, judge that what you, Mr. X, did, was morally wrong. I need no more authority to judge you than the fact that I am a fellow human being, and that I have judged by good examples, and asked myself what I, myself, could not live with doing."
Of course, it would be a very curious world in which one constantly dared to judge others, and not so much one's enemies. As Arendt always insisted, the real moral issue was never with one's enemies, who like the Nazis could be so obviously evil) but with one's friends, and those one loved.

More on Arendt here.

July 16, 2004

Fall from truck; ATV vs. tree

The odds and ends of a surgeon on call.

Terrorists or traveling band?

Annie Jacobsen's "Terror in the Skies" has gotten a lot of attention today, helped along by Michelle Malkin.

(Apropos of nothing, Malkin's continuing attempts to refashion herself as a columnist/commentator/journalist/pundit/blogger are each more embarrassing than what came before. I hope someday she'll find her natural talent, but none of these things are it.)

I won't take a position in the debate over how much of Jacobsen's account of Flight 327 is embellished by her own fears, except to say that I think Donald Sensing is (mostly) right. She was already terrified by the sight of a large group of Middle Eastern men waiting in the terminal when she boarded her flight; all of her observations past that point (i.e. the whole damn story) is filtered through this lens of fear.

We can be sure of only one thing. There weren't any other passengers on that flight who avidly read conservative blogs. If there had been, they probably would have posted a comment or two on these blogs corroborating Jacobsen's story. As of now--nada.

(Conservative blogs, for example, here, here, here, and here.)


Somebody was taking pride in their work.

Who blogs more, law students or medical students?

Nick Genes, a medical student blogger of some notoriety (i.e., I know about him) asks, "How come law students blog more than medical students?" (Also posted here.)

That law students are more likely to maintain a blog seems to make intuitive sense. I'm always stumbling across law student blogs; discovering a new med student blog seems like a rarer event. It also fits with my experience of both that law students would blog more than medical students. Law students just seem like bloggier people. At least the ones that I've known.

It's harder to confirm these subjective impressions with real numbers. For instance, how many of each kind of blog are there? Nick cites a blog post that compares the number of Google hits for "law student blog" (276,000) to the number for "med student blog" (16,000). But when I tried "medical student blog," I got 113,000 hits. Many of those were European med student blogs, and many others were websites that just mention blogs and medical students, but aren't themselves med student blogs.

Even if we knew exactly how many of each kind of blog existed, we'd have to compare these with the total number of each kind of student. Even though law school is only three years compared to four for med school, there are more than twice as many law students: 138,000 law students, compared with 66,000 medical students (simple math used to get the totals).* This ratio could be reproduced with some highly selective interpretations of the number of blogs based on Google searches, making it seem like law students and medical students are equally likely to blog.

I don't believe it. I think there really are more law student blogs per capita, but I need a more effective way of determining the number of blogs in each category.

Anyone got any bright ideas?


July 14, 2004

It's a strange world

We all lose things--keys, cell phones, receipts. It's not every day you lose your oil filler cap.

I thought I had lost it at an Indiana gas station on the drive from Denver to Ann Arbor back in May. It was late, I was in a hurry, I had to pop the hood to put oil in my car. When I next popped the hood two weeks ago and found my oil filler cap missing, I couldn't think of anywhere else it could have gone. I couldn't think why anyone would have stolen it. Unless, of course, they were on drugs.

So I got online and ordered a new one. Today, I found my old one. It was in the parking lot at work. One of the small metal teeth that hold it in place had been sheared off, so I guess that's how it fell off. Why it fell off in the parking lot at work is a question I can't answer.

Coincidentally, the UPS guy delivered the new filler cap today. I barely managed to catch him before he drove away, and he gave me the box. It was marked "American Red Cross. Albumin (Human) USP. 5% solution."

Inside was an invoice and the requested oil filler cap for a 1985 Subaru.

That's a human ear all right.

July 13, 2004

Conservative realignment

The inevitable embarrassment of the bankrupt neoconservative ideology has occurred in Iraq. Since virtually no one prior to this debacle had the backbone to stand up to the neocons--the overwhelming vote of confidence the Congress gave Bush is evidence of this--I suppose we should be thankful that we haven't had to wait for two or three more pre-emptive invasions to realize that we don't need what the neoconservatives are selling.

An interesting question now is, which other factions of American conservativism will benefit the most from the neconservative fall? Well, it might just be the paleoconservatives.

The paleos, whose most popular figure nowadays is Pat Buchanan, have several reasons to think that their fortunes might be looking up. The paleos were the faction of the American right most critical of the neocons before the invasion of Iraq. In fact, you'd have to look all the way over to the Greens on the left to find another group that resisted the lure of thinking war would be cheap and easy. This gives the paleos more credibility now. Second, the paleoconservative focus on sealing our borders against third-world immigration might play better now that border security can be recast as a defense against terrorism. We might want to start paying attention to the paleos again.

Let's peek in on a paleoconservative critique of the Iraq war, shall we? Here are excerpts from an article by Andrew J. Bacevich in Pat Buchanan's American Conservative magazine: ten lessons to take away from Iraq.

First, ideology makes a poor substitute for strategy. With the invasion of Iraq, it became impossible to deny that in the heady aftermath of the Cold War American grand strategy became uncoupled from reality. Certain that history had spoken and that Americans were uniquely able to interpret its meaning, policymakers both Democratic and Republican uncorked old vials of Wilsonian illusion and breathed deeply. As a consequence, zealotry supplanted calculations of power and interest as a determinant of U.S. policy. . . .

Second, wars leave loose ends. In a political sense, decisive victory—meaning military success that makes a clean sweep of the complaints giving rise to war in the first place—is a pipe dream. . . .

Third, allies have choices—and will exercise them. Across a decade of hyping the United States as “sole superpower” and “indispensable nation,” too many policymakers persuaded themselves that America’s traditional allies had no alternative but to accede to U.S. “global leadership.” Both the Persian Gulf War of 1990-1991 and the Kosovo conflict of 1999 seemed to show that when Washington called, others clamored to board the bandwagon. To opt out was to be left out and left behind: from Washington’s perspective, this was a risk that few “friends” were likely to take. Iraq demolished such fantasies. Allies are not vassals. . . .

Fourth, Israel’s war is not our war. President Bush’s undifferentiated “global war on terror” has encouraged the government of Ariel Sharon to assert that Israel’s enemies and America’s enemies are one and the same. But they are not. Indeed, Sharon’s misguided effort to crush resistance to Israel’s occupation of the West Bank and Gaza through brute force serves only to complicate and exacerbate our own problems. Sharon’s policy will not work, and as Israel’s chief supporter we get tagged with much of the blame. . . .

Fifth, “shock and awe” gets you only so far. More than a decade ago, the previous U.S. war against Iraq brought to full flower the American romance with high-tech warfare. Operation Iraqi Freedom has offered the fullest illustration to date of what this new American way of war can and cannot do. On the one hand, it affirmed what we already learned in Desert Storm: U.S. forces will make short work of any conventionally organized and equipped adversary foolish enough to put up a fight. . . .

Sixth, the margin of U.S. military supremacy is thinner than advertised. Ours is undoubtedly the mightiest military the world has ever seen, with a more than ample inventory of high-performance fighter jets, aircraft carriers, and top-of-the-line nuclear submarines. But our inventory of soldiers and Marines is grossly inadequate—inadequate at least to implement President Bush’s grandiose plans for sprinkling the blessings of liberty throughout the Greater Middle East. Despite the administration’s obdurate insistence to the contrary, the fact is that the United States today has too few soldiers doing too many things. . . .

Seventh, the myth of American casualty aversion is just that. The conventional wisdom of the 1990s was that a risk-averse military and a casualty-phobic public constituted major obstacles impeding the effective use of force. For the Clinton administration and its defenders, this became a convenient device for offloading onto others responsibility for American military fecklessness. The onus for the pseudo-campaigns of the decade leading up to 9/11—the zenith coming in 1998 when U.S. Navy cruise missiles demolished an empty pharmaceutical factory in Khartoum—lay not with the commander-in-chief but with foot-dragging generals and fainthearted citizens who lacked the stomach for serious military action. . . .

Eighth, so too with the myth of an American genius for spreading democracy. From the very day that U.S. forces entered Baghdad, the officials charged with raising a new Iraq out of the ashes of the old have displayed remarkable ineptitude. However admirable the hard work of those who have risked life and limb to give the Iraqi people a fresh start, the overall effort has misfired. . . .

Ninth, it’s hard to win when you don’t know whom you’re fighting. Much has been made about the blunders in strategic intelligence such as the failure to anticipate 9/11 and the bogus assertions regarding Saddam’s weapons of massive destruction. But the inadequacies of tactical intelligence have been at least as great, if not greater. . . .

Tenth, civil-military relations at the top are broken. The Iraq War has confirmed what had already become evident during the 1990s: the relationship between senior military leaders and the top echelon of civilian officials is dysfunctional. That dysfunction contributes to flawed decisions on crucial issues related to peace and war. . . .

October surprise?

This is just a whisper in the wind right now, but we might see the extended edition (the non-truncated edition) of The Return of the King in theaters later this year.

July 12, 2004


Cottage cheese is a special treat.


I got this bulk email a while back from my law school's career services office. A law firm hoping to recruit new associates was advertising what the social literati among us apparently refer to as a "meet-and-greet." You know, a shmooze session.

The firm's invitation made prominent mention of the fact that there would be a "fromager" present at this little informational soiree. I suppose that's something; it's not every day that one actually gets the chance to talk to a fromager. Maybe the occasional sommelier, but almost never a real fromager.

I meet so few fromagers--dealers in cheese--cheesemongers--that I'm afraid I may not have developed the right mental associations yet. I imagine a short, very plump, red-faced and slightly drunk man in green overalls and a small round hat, talking just a bit too loud and waving his arms around. In each pudgy hand, he grips a wheel of Brie.

That must be wrong. No foofy law firm would invite this guy to a social event designed to seduce young law students with the lure of prestige.

Hot and humid

I went for a run/sweat/dehydration session today in all this heat and humidity. Have you ever tried Bikram's Yoga?

It was like that.

July 10, 2004


Sometimes the spammers make me laugh in spite of myself. I just got a piece of spam with the following at the bottom of the email:

If you have received this message in error, please immediately advise the sender by reply email and then purchase the stellar services being offered for your own benefit.

"Let's roll"

Law professors Michael Froomkin and Brian Leiter link to examples of small-minded harrassment in the name of "homeland security."

Every time I read stories like this, I'm reminded of Todd Beamer's more effective approach to security: "Let's roll." Beamer, Mark Bingham, Tom Burnett, and their fellow passengers and crew who fought the terrorists for control of Flight 93 are heroes. But they're more than just heroes, they're also teachers. It's too bad some of the smallish officials and bureaucrats who see homeland security as an excuse to abuse their authority haven't been paying attention in class.

The heroes of Flight 93 taught us how strong America really is. Within minutes of discovering that the old rules of thumb for dealing with hijackers were not going to be effective any longer, they rewrote the rule book. They demonstrated that the American people are not like a flock of sheep. They're more like bears. Independent, inclined to keep to themselves, sometimes a little frumpy and self-absorbed, but deadly when attacked.

If the analogy seems strained, it might be because the government and the media have saturated us with the sheep analogy for so long. According to the standard line out of Washington, the terrorist threat calls for "strength," not so much from everyday American citizens, as exemplified by the passengers and crew of Flight 93, but from the military and police apparatus assigned to protect the passive public flock from terrorist wolves. When Tom Ridge announces his color alerts, and John Ashcroft warns of "nonspecific intelligence" suggesting the possibility of another attack, the advice from our government is always the same. "We, the Authorities, are on the case. Defer to us when we walk among you. Don't take pictures of those public buildings. Submit to our lordly displays of officiousness, for we are strong, and we are here to protect you." Not enough talk of "strength" these days refers to the kind of strength that was most effective against the terrorists on 9-11, namely, the strength of citizens like Todd Beamer.

Does this mean there is no role for the military, or for the police, or for the courageous people who make it their job to fight terrorists? Certainly not. It would have been better had the terrorists never gotten so far as to provoke the wrath of the passengers of Flight 93. Todd Beamer and Mark Bingham should never have had to demonstrate their strength the way they did. But when the police act as though we were sheep, and harass citizens to demonstrate that they have the power to do it, they reject their strongest and most effective ally in the fight against terrorists.

Legislation like the Patriot Act is based on the idea of two warring powers, the government and the terrorists. The citizens, caught in the middle, are mere sheep amongst whom the terrorists hide, and through whom the government's gaze must penetrate to identify and capture the terrorists. This twisted idea of the "war" against terrorism explains why civil liberties are nothing but obstacles. From this perspective, people who oppose the Patriot Act seem to value their privacy over their lives--since the citizens' only means of protecting life is through greater government power. Similarly, from this perspective, it makes no sense to complain about having your film confiscated by an overzealous security guard, or about being dressed down by some small-fry bureaucrat in an airport. Every sphere of privacy you defend for yourself is a hindrance to the government's ability to protect us against terrorism.

This idea of the passive role of average citizens reveals an ignorance of the lessons that Todd Beamer and his fellow passengers taught us on September 11. One of those lessons is: the government is not the only entity that can neutralize terrorists. The "shoe bomber" Richard Reid got through the government screens at the airport, but not the citizen screens on the airplane. The police and security forces would not be as eager to harass people if they saw the public as their ally and not merely as their flock. For one thing, civil liberties and protection from terrorists would not be cast as mutually exclusive goods. And the petty officials that harass people just because they can, would be much less likely to be tolerated.

July 09, 2004

Time for something different: religion in politics (v.2)

Religion, as used by the right, is a tool for getting the government into your private life. And I'm not talking just about abortion, which would probably be an item of fierce public controversy even without religious arguments. I'm talking about things like marriage, sex, the social roles of men and women--all those things that social conservatives find so necessary to regulate by means of government surveillance and supervision. Lacking the necessary logical or empirical connections between many of the decisions that consenting adults make as they live their private lives, and any consequences for the community that would ordinarily serve as the rationale for the government to regulate behavior, the conservatives reach for another rationale--morality. Faced with the obvious fact that people disagree about which consenting domestic behaviors are immoral, the conservatives reach for their trump card--it's immoral because God says it is. And who are you to disagree with God?

Perhaps because the social conservatives have the greatest desire to regulate private life, they've also had the greatest need for religion in politics. It's the only justification in an otherwise freedom-loving nation for imposing their particular preferences on everybody else.

The left views religion very differently. Religion is itself one of those very personal commitments that people ought to make without the state's interference. This is why the left is perfectly content with a public discourse that never appeals to, or even acknowledges, religion. It isn't that everyone on the left is anti-religious, it's simply that they think legitimate policy questions can be answered without an appeal to God. Instead, the left would prefer to evaluate public policies on some kind of measurable, secular scale, like income inequality. This allows them to reserve questions of religion to each individual's private conscience. All this is perfectly reasonable and persuasive, but...

I think the left needs to get back into the religion business for strategic reasons.

Liberals and others (agrarian traditionalists, for example) who oppose the modern right-wing agenda cannot forget that public religious rhetoric is a powerful weapon. The conservatives have demonstrated this over the past twenty years, to such an extent that religious people will often vote for the religious Republican even when that candidate's policy positions aren't very palatable.. Even though leftists might prefer that this weapon not be used at all, the right wing's zealotry makes this a pipe dream. Since the best option isn't available, the left should choose the second-best--combat with a rough equivalence of arms and ammunition. Metaphorically speaking, of course.

For one thing, supporters of fair, rule-governed markets could benefit from a religious critique of right wing economic rhetoric. One of the reasons this rhetoric seems so shallow is that it seems to ignore important values:

It is curious that in American politics, "values" issues are always social issues but never economic ones. Yet how the disadvantaged among us are treated is clearly a reflection of who we are as a people. Similarly, how workers are treated on the job -- their safety, their working conditions, their remuneration -- also speaks volumes about our values as a nation. This is also true for child poverty.
A young person born in the 1980s, and raised in a non-religious household, might be forgiven for thinking that religion had no way to make this kind of argument. But thankfully, they'd still be wrong. A good example is the tradition within Catholicism that remembers history, and is capable of offering a critique of "modern liberalism" (economic laissez-faire) without succumbing to the fallacy that the alternative is Marxism:
In the same way, John Paul II has recognized some genuine good in a market-based economy and recognizes it as a potential force for human betterment. But . . . he is no different from his precedessors in recalling, at times with language even stronger than theirs, the philosophical errors that undergird liberal capitalism and the worldly excesses to which the “free market” system is not only prone but, today, utterly abandoned. And it is this overarching and radical Catholic critique of the modern liberal ideology that I have never seen even a slight appreciation of in those who loudly proclaim the virtues of the unregulated free market, of government minimalism and so forth.
Other examples abound. The Jewish tradition in the pages of magazines like Tikkun is one that springs to mind. The commenters on my last post remind us of nuns who chain themselves to fences in civil disobedience; the many African-American Baptist churches that have fought injustice for most of America's history, and the old tradition represented in today's public life by civilized people like Bill Moyers. My own favorite, of course, is the agrarian tradition exemplified by people like Wendell Berry.

These people all have something different to say about religion than we're used to hearing. We should listen to them more often. Most importantly, the left should seek them out and give them a big bullhorn, if they'll agree to take it.

There's an article in this week's New Yorker by David Greenberg that I think reveals a lot about the the religious right:

The problem lies, rather, in the specific ways in which Bush uses religion. Abraham Lincoln, in his second Inaugural address, invoked God, but he did so in a spirit of humility, questioning his own certitude and thus inviting further questioning. Bush does the opposite: his use of religion seems designed to remove any doubt -- first in his own mind, then in the public's -- about his course. It doesn't assist Bush with his reasoning; it substitutes for reasoning. Instead of providing a starting point for careful judgments, it assures him that the instincts on which he has based his policy are unerring.
It's time for something different.

July 08, 2004

The rise of the religious left (v.1)

One of the most consequential victories of the American right wing over the past three decades has been their virtually complete capture of the rhetoric of religion.

Their victory has been so complete that the phrase "religious right" seems redundant. Just consider how confusing the phrase "religious left" sounds.

The right wing has made devastatingly effective use of their religious rhetorical dominance. Without the close association that the right wing has managed to cement in the minds of most Americans between "religion" and "conservative," the electoral support for the right would collapse. In virtually every substantive policy arena, the Democrats champion the more centrist, moderate, and mainstream position, when compared with the Republicans' hard-right agenda. If policy was all that mattered, the right wing couldn't have amassed the impressive track record that it has without moderating its approach. Call it a gut feeling, but I don't think America has drifted to the right; I think it's been dragged by extremist right-wing politicians.

But policy, of course, is not all that matters. The politicians may have dragged the country to the right on policy, but the people have willingly followed when it comes to values. As someone who finds doctrinaire religions, churches, and religious writings distasteful, it's a bit difficult for me to get emotionally upset by the absence of the left from the rhetorical field of values. For me, policies embody values; a policy position is a way of expressing a value. I don't want a bunch of pandering politicians to start preaching to me about "family" and "patriotism" and "God." I don't think politicians should be in the preaching business. If I think their policy positions are humane, sensible, fair, and honest, I'll support them. If not, I won't.

But I also have to realize that my opinions aren't shared by everyone. Many people want to hear elected officials talk about values, and affirm religious faith, which undergirds so many of those values. The worst thing that a politician can do in the eyes of many people is not to profess a faith that differs from their own, but to fail to profess any faith at all. That's why I think so many people vote Republican. It isn't that they agree with the Republicans' agenda, it's that they'll vote for the candidate that seems to favor "religion" over the one that doesn't. And the left, since it has no religious vocabulary to speak of, can't win this person's vote.

We need a religious left. I don't think it has to be created. It just needs to speak up.

July 07, 2004

Armstrong in yellow

Lance Armstrong's US Postal team has won the team time trial at the Tour de France, putting Armstrong in the yellow jersey for the first time this year.

Can he stay there? The climb up L'alpe d'Huez will tell. Unfortunately, it looks like Iban Mayo won't be in any position to duel it out with Armstrong or Ullrich in the mountains.

July 06, 2004

Chicago renaissance?

The pride of post-industrial American business is moving into an abandoned cosmetics plant on Chicago's depressed West Side. It will be the first Wal-Mart in the city.

On one level, this is a good thing for Chicago. Wal-Mart will employ people, although it won't pay them very much. It will sell things at low prices, although neighborhood businesses who sell similar items will go out of business. Most importantly, it will ensure that the neighborhood remains populated, if not prosperous, instead of being gradually abandoned altogether as has been the fate of large areas of the city's South Side.

So I suppose we should count our blessings.

One thing's for sure, though. Wal-Mart isn't going to be the savior of Chicago's old industrial neighborhoods. The jobs it creates and the products it sells aren't like those of the old factories that they replace. Those old jobs provided the waves of immigrants who lived in the surrounding neighborhoods with new wealth, which enabled them to save money, raise families and, eventually, climb the rungs of America's economic and social ladder. Those jobs were unionized and well-paid.

The Wal-Mart jobs, to a large extent, simply move the existing money around, subject to a healthy remittance back to Bentonville.

It's a good thing Wal-Mart has low prices, because the people in the neighborhood won't be able to afford to shop anywhere else.

July 05, 2004

Silly economist

One of the things I did this weekend was read this book, What's Your Life Worth? Health Care Rationing... Who Lives? Who Dies? Who Decides? by David Dranove, a healthcare economist. There were good insights here, and some good comic relief, too.

The central point of the book is that we're not spending our health care dollars as efficiently as we could be, because we haven't embraced the techniques of cost-benefit analysis/cost-effectiveness analysis ("CBA/CEA") with enough enthusiasm. Everyone is familiar with these techniques. They're just the old "biggest bang for the buck" approach dressed up with a lot of jargon, and applied to health care spending. Dranove argues that if healthcare payers (the government, employers, and insurers) would explicitly adopt what he constantly (and misleadingly) refers to as the "scientific" approach of CBA/CEA, we could "save many more lives" with the money we choose to spend on health care.

So far, so sleepy. Everyone expects these kinds of arguments from an economist, but Dranove actually says some interesting things in this short book written for the layman. Before I get to the parts that had me laughing out loud in the Starbucks, I'll talk about what I think are the really worthwhile insights of Dranove's book. (You may want to skip ahead to "CEA and QALYs" if you're only reading this for the laughs.)

First, we ration health care--always have, always will. Since we are rationing, it makes more sense to do it explicitly, using techniques that most of us will accept as reasonable, than to do it implicitly by less rational means, all the while denying that we're rationing at all. That's where CBA/CEA comes in. Dranove argues that spending ought to be directed at those treatments that give us the greatest benefit for the least cost, and he thinks the techniques he describes in his book are the best way to do this. All of this is great. Dranove's description of the techniques, though, were good for some really good laughs. Keep reading to find out why...

Second, Dranove argues that we may be spending too little on health care, not too much. It's refreshing to hear this contrarian point of view. I don't know if Dranove is right or not. "Too much" or "too little" are value judgments about which reasonable people will disagree. My own intuition is that health and longevity are so important for most people that if their preferences could be accurately measured, health care spending would, in fact, increase. So I agree with Dranove about this, but I think the argument he uses to get himself there is a little goofy. Ok, a lot goofy. It's the old CBA/CEA thing again, which Dranove fetishizes like an old lady at the slot machine kissing the quarters, or the courtside fans waiting for Kobe to throw them his sweaty jersey. Really; get a grip on yourself, people. Like so many economists, Dranove takes a sensible idea and wields it irrationally, to my great delight in the Starbucks. I just had to laugh.


Ok, here's the funny part: QALYs, which stands for "Quality-Adjusted Life-Years." They're funny because Dranove presents them as a "scientific" alternative to messy and unreliable political appraisals of what medical treatment is worth. His enthusiastic economist's soul loves the numbers so much, he starts to sound like a twelve-year-old boy who's just fallen in love with Cameron Diaz (Cameron Diaz is mentioned in the book on p. 143, but I'm sure it's just a coincidence).

As Dranove explains them, QALYs are a way of measuring the relative desirability of various "health states." I'll let Dranove explain them:

The QALY scale provides a numerical score for different states of health, or what researchers call health states. Examples of health states are "dead," "completely healthy," and "complete visual impairment" (i.e., blind). Health states may include multiple conditions, such as "visual impairment and needs a wheelchair." . . .

A year of full health is worth 1 QALY. Death is worth 0 QALYs. Depending on how individuals respond to survey questions, a year of blindness might score 0.5 QALYs and a year of incontinence might score 0.75 QALYs. . . .

QALYs can be manipulated mathematically. They can be added: if one year of blindness scores 0.5 QALYs, then four years of blindness would score 2 QALYs. Similarly, if two blind individuals each live one year, they have a total of 1 QALY. . . .

Researchers can use QALYs to compute cost-effectiveness scores for treating different health states. . . .

Researchers measure QALY scores by asking carefully worded questions of a large cross-section of respondents. . . . The relative scale approach is by far the easiest. . . . Here is one example you can try yourself. [Gives example of a horizontal line with "0" on one end, marked "Blindness," and "1" on the other, marked "Occasional blurred vision," with ".5" in the middle. Under the line is the instruction: "Use a pencil to indicate where you would place the following health states on this line: (1) frequent blurred vision (2) constant blurred vision."] . . .

The relative scale approach is easy to describe and can even be conducted through the mail. However, the approach has two important weaknesses. First, it easily bogs down when the respondent must rank more than five health states. Second, respondents often get frustrated trying to place health states along the scale [endnote omitted]. . . . This ambiguity makes mathematical manipulations of the scores somewhat tenuous.

To more rigorously quantify the QALY scores, researchers rely on one of two other approaches. Here is the standard gamble approach [endnote omitted]. Once again, you can try this method yourself.

Consider the following alternatives: (1) You will be blind for the rest of your life (2) You will undergo a procedure to restore your vision. The procedure will be successful with probability p, where p is a number between 0 and 1. The procedure will fail with probability 1-p. If the procedure fails, you die instantly.

At what value of p are you indifferent between alternatives 1 and 2?

Many respondents are unfamiliar with the concept of indifference. . . . Many respondents are also unfamiliar with the concept of probabilities. . . .

The third approach is called the time trade-off. To understand the time-tradeoff-approach, we return to the prospect of living with blindness.

Consider the following alternatives: (1) You could live 50 more years with blindness, and then die. (2) You could live y more years in full health, and then die.

How big does y have to be for you to be indifferent between the two choices?

Dranove goes on like this, inviting us to rank blindness, death, "frequent vomiting," and "confined to bed with poor memory." He glowingly describes these procedures as "scientific" and therefore far superior to the more "intuitive" rankings that other methods, such as the political process, tend to provide. Frankly, I don't think I could answer his relatively simple example questions very easily, and if I tried to do it twice, my answers would probably be so different that I'd have to answer them fifty or sixty times before I could even say anything about my ranking of health states, let alone some "objective" society-wide ranking. That ranking would just be a numerical average, and might never actually equal any of my actual rankings at any given point in time.

In fairness to Dranove, he does point out the limitations of QALY surveys for ranking health states, among them unfamiliarity with the condition, ignorance of probability, wide discrepancies in rank between individuals, the enormous influence of the wording of the questions, etc. It's hard to see why he is so enthusiastic about these techniques when he can acknowledge they are plagued with so many apparently unsolvable problems. But wait. There's more.

QALYs are concerned only with the "benefit" side of the cost/benefit analysis, or "CBA." The other side, "costs," aren't explored in depth in Dranove's book. He does occasionally note that reliable cost data is often unavailable. This, at least, seems undoubtedly correct. When you consider the opacity of drug prices and the ubiquity of billing errors, it's not surprising that "good cost data" is often "lacking." Given the extremely complicated nature of our health care system, the costs of treatment may be more difficult to quantify than the benefits.

Even though both sides of the cost/benefit analysis that Dranove holds out as the silver bullet for many of our health care spending problems are deeply problematic, Dranove himself seems oblivious. Nowhere is this more obvious than in his account of Oregon's experiment with the kind of explicit rationing that he argues for in his book.

Oregon, under the leadership of emergency physician John Kitzhaber (who was later elected Governor), adopted a system of explicit rationing for its Medicaid program in the early '90s. Oregon came up with a list of treatments and conditions, and ranked them according to several criteria. It then refused to pay for any treatments that were ranked lower than a certain number. The goal was to use scarce Medicaid dollars for the most important treatments only, enabling the state to expand Medicaid coverage to everyone in Oregon that qualified for the program.

The way Dranove explains the development of the Oregon health plan, it seemed to this reader to demonstrate that the kinds of CBA/CEA techniques that Dranove describes in his book can only be improved by a healthy injection of intuition and political discussion. To Dranove, however, the Oregon health plan is a case study of how "science" lost out to "intuition" and "politics."

Basically, the first few lists that Oregon came up with were unacceptable to real Oregonians. Strict application of CBA/CEA techniques in a vacuum inevitably produced lists that real people weren't happy with--things that people thought should not be excluded were excluded, and vice-versa. Before the Oregon health plan was passed, the lists were subjected to community scrutiny through the political process, and revised. Only then were people comfortable enough with what was covered and what was excluded to support the plan.

Despite the fact that the quantification of "benefits" is supposed to ultimately depend upon what real people think, Dranove treats this after-the-fact revision of the lists as an example of "poorly formed opinions" replacing "scientific inquiry" as the basis for public policy. I'll leave it to you to respond to that one on your own. As for myself--I laughed heartily. Silly economist!

Despite the drawbacks of Dranove's book, there's a lot to recommend it. If you've never had any exposure to QALYs or "costs of illness" (COI), as I hadn't, you'll probably learn something useful from this book. For example, you'll learn that according to virtually every way of measuring that's ever been tried, from questionnaires to studies of salary premiums for high-risk jobs, the cost of an extra year of life is always approximately $150,000. If you believe this number, we're paying too little for health care in this country, since per-capita spending on treatments that offer extra years of life is much less than this.

You'll learn something from Dranove's book. But you'll learn even more if you read it with a healthy degree of skepticism.

July 04, 2004

Happy Fourth!

Have a safe holiday. Remember, fireworks and alcohol do not mix. Unless you'd like to spend your holiday in the Emergency Department.

Michelle Au reminds me why I didn't do pediatrics. I'm glad others rush in where I fear to tread.

Donald at Crescat Sententia asks some smart questions about the "war" effort: "Someone, somewhere, will have to address these questions. And sooner rather than later."

Ming guesses 750 hours to win the how-many-hours-have-I-played-Final Fantasy contest on Heidi Bond's blog. This entry will take guesses on how many ways Heidi will find to rhyme "Ming" with "freak" in the prize poem. :)

Is Blogspot the crappiest blog host ever?

Check out this great ERISA link. I know. Geek.

July 03, 2004

law school laptops

Ann Althouse has a very common-sense post about law school laptops. She describes how many schools, including mine, have chosen to use exam software that won't run on Macs, and she accurately identifies the revulsion that this inspires in people like myself. I've handwritten all my exams so far because I stubbornly refuse to go out of my way to satisfy the demands of my school's favored exam software. Life's too short.

But I'm disappointed, if not exactly revolted, by the need for any exam software at all. The only reason apparent to me that law schools feel they have to use it is that they think their students will cheat on exams if they get the chance. This is insulting, probably false, and counterproductive.

1. Insulting

Insisting that law students use exam software is insulting. It sends the message that the school thinks you might be a dishonest cheat, in spite of all their palaver about how great they think you and your classmates are. If the school really believed that, why do they think it's necessary to depend upon technology to restrain students from lying and cheating? Answer: because they believe that students won't be able to resist the temptation to succumb to their base impulses.

I came to law school from medical school, where we all signed a pledge every year to abide by the school's honor code. When we picked up an in-class exam, we could go anywhere we liked to take it: the back row, the classroom down the hall, the Starbucks. So long as we turned it in on time, we were trusted not to cheat. In some ways, the temptation to cheat was much greater in medical school than in law school. Med school exams were almost always multiple-choice, a format that lends itself well to cheating. Don't remember which antibiotics are effective against TB? It's easy enough to look it up, i.e., to cheat. And the rewards are great. Only a few more right answers could make the difference between a "P" and a coveted "H." But I don't think too many people cheated. It would have been too embarrassing; after all, we were treated like honest professionals.

Now, I don't know how this law school thing works. Maybe exam software is required by the ABA or some other national accrediting organization. Still, though, the disappointment remains. It's just that I'm disappointed in another decision-maker.

2. False assumption that law students cheat absent technological restraint

So whoever it is that requires exam software must think that cheating would be rampant if the software wasn't there to prevent it. I'm open to being proved wrong with historical evidence, but just thinking about it, this doesn't make sense.

If, as has been my experience, doing well on a law school exam does not depend so much on writing down the black-letter law as on applying the law to the facts given on the exam, I don't understand how cutting and pasting notes would really be an effective way to cheat. In fact, it seems to me that if you decided to waste your time doing that kind of thing, you'd be almost guaranteed not to write a high-scoring answer to the exam question. It's not like a medical school multiple-choice test, where cheating can be effective because all you need to do is look up the answer in a textbook.

Take away the exam software, and assume that some students try to cheat, and I'd bet those cheating students wouldn't get the top grades in the class, or even get any better grades than they would have gotten without wasting their time trying to cheat. A few rounds of failed cheating, and the few dishonest law students out there would either stop trying or cheat their way to the bottom of the class.

3. Counterproductive to insist on anti-cheating technology

Even if I'm wrong about (1) and (2), I think the benefits of using anti-cheating software are outweighed by the long-term drawbacks. In my limited experience, people tend to perform to your expectations of them. If you send the message to neophyte lawyers that the solution to dishonesty is technology, there's going to be a lot of practicing lawyers who will learn this lesson too well. Later in their careers, when they find themselves unrestrained and able to cheat, lie, and steal at will, they'll be more likely to do it because they're not accustomed to handling the burdens of trust.

Beyond the fact that exam software that can't be used on a Mac fills me with revulsion and scorn, the whole idea of exam software period is very disappointing.

July 02, 2004

Pinheaded lawyer miasma of doom

I was going to write about ERISA § 502(a) preemption of state "patient protection" laws.

I was planning to argue against the HMOs' assertion that because they merely contract to pay for certain medical treatments, and do not make medical decisions, they should continue to be immune from consequential damages when that medical treatment is inadequate as a result of a negligent interpretation of the plan's coverage requirements. Then I was going to highlight Justice Ginsburg's concurring opinion in Aetna v. Davila, where she writes that--and I quote-- "fresh consideration of the availability of consequential damages under § 502(a)(3) is in order."

But alas. I've changed my mind.

I know you're all terribly disappointed, but please let me explain myself. Although I'm sure some of you will disagree, I think I've found something more interesting to talk about:

Learning the law can turn a vigorous argument into a pinhead lawyer's miasmic dream.

Before I knew anything about the intricacies of ERISA, I thought about issues of HMOs and patients in "big picture" terms. I had no choice. The small details were all in ERISA § 502(a)(1)(B), of which I was blissfully ignorant. I was limited to contemplating big questions, like "what should be the role of private health insurance companies?"

Now, though, I'm not an ERISA virgin. I'm an ERISA neophyte, and like all neophytes, I want to show off my knew knowledge. Now I have options--I can argue like I used to that a complete reliance on the private sector for basic health insurance is a public health failure, because some people will always drag down the profitability of every risk pool. The power of the market bends itself toward excluding these people from coverage entirely, leaving them without any insurance at all. Lyndon Johnson knew this, but today's conservatives seem to forget--willfully, I suspect. It's only one of the many things about the political right that perplexes me...

Ahem, uh, where was I? Oh, yes. ERISA. Now that I know something about the law, I can choose to either make the argument I just made, or I can show off my neophyte's knowledge of ERISA by arguing about whether the Court's reading of § 502(a)(2) in Pegram v. Herdrich should be extended beyond staff-model HMOs to include most instances of prospective coverage decisions that result in inadequate treatment. Indeed, that's what I was originally planning to do in this post.

The problem with this show-offery is that can lead straight into the pinhead lawyer swamp of miasmic doom and despair. In other words, instead of asking fundamental questions about what the healthcare system should look like, I'm reduced to making pinheaded arguments about the minutiae of a system that I believe is fated to utterly collapse. This transformation is profoundly conservative, and I don't mean that in the pejorative, political sense of the word. It's simply that the law-student focus can shift one's attention away from the wide view of everything that's possible, and limit it to the smallest of incremental shifts in current doctrine and practice. That's what I mean by conservative.

I don't believe this narrowing of vision is inevitable, by any means. A knowledge of minute detail can inform and strengthen one's arguments about the bigger picture, and sometimes, small changes can lead to profoundly different results. But even if it isn't inevitable, I'm wary of the possibility that legal training can leave you stranded in the swamp, sinking hip-deep in the slime, with the biting flies buzzing in your ears and the cloying, miasmic odor of rotting putrescence turning your face a revolting shade of puce.