Archive for April 2012

The Council Has Spoken: April 27, 2012

Congratulations to this week’s winners.

Council: JoshuapunditYom Hashoah – Reflections On The Holocaust

Noncouncil:  Raymond Ibrahim- How the Media Whitewashes Muslim Persecution of Christians

Full voting here.

No One Wins in the Zimmerman Trial

My wife is one of the most intelligent people I know, so when she speaks about a topic, I tend to listen. It’s only fair because after two decades of marriage I tend to ignore everything else she says. When George Zimmerman appeared at his bail hearing, she walked past the sofa and said, “You don’t sympathize with that guy, do you?” I said that I’m not sure what happened the night he confronted Trayvon Martin, but that it would be up to the Court to determine that. This didn’t please her in the least, and her normally sharp mind hid behind an emotional statement. “Imagine that was your son he shot,” she said. I said that wasn’t a fair way to judge Zimmerman’s guilt or innocence. “Imagine that Zimmerman was your son accused of killing someone in cold blood when he was protecting himself.” Feeling the moment escalate I dialed back by saying that if he was indeed guilty of gunning down Martin in cold blood, he deserved a lengthy term in prison, but if he was innocent, he deserved freedom.

As I told my wife, I honestly don’t know what happened that night. When the story broke there was bipartisan outrage. I remember watching Fox News anchor Shepherd Smith have a meltdown as he referred to 17 year old Martin as a child and spoke scathingly of Zimmerman. Skittles candy was mentioned so often it sounded as if Martin was a modern-day Hansel and Zimmerman was a pistol packing Old Witch. In the heat of the moment there weren’t conservatives and liberals there were only parents, and losing a child is the stuff of nightmares that wake us up screaming and chill our blood whenever a story breaks of a child killed, especially one near the age of our own. Years ago we lost sleep over the Grossberg-Peterson baby murdered in Delaware, a baby only a few weeks younger than our own. In the years since other children have been killed in accidents or murdered, and their deaths, even to complete strangers like us, were slaps to the face, reminders of our own blessing and luck. The experience of loving a child trumps political ideology. Politics are petty and meaningless when compared to the life of a child.

But past events have taught me to question initial reports, or preferably, to avoid them when possible because they are usually wrong. It takes time for the signal of the truth to be discerned through the noise, and the more high profile the case, the noisier environment the signal hides in. In some cases, such as the Jon Binet Ramsey murder the signal is overwhelmed and the truth is never known.

What happened that night has become a screen for people to project their own biases and fears thanks to the politicization of the murder by the Obama administration, the Justice Department, and race-baiter Al Sharpton. These entities have raised Martin’s death up to the status of icon for their own political gain, and their opponents have begun to do the same. Gun rights supporters initially left Zimmerman alone to take the heat of his shooting Martin, saying that Florida’s “stand your ground” self-defense law didn’t apply because the 9-11 dispatcher suggested Zimmerman avoid confronting Martin. But as gun control advocates began using the shooting as evidence to support the rollback of such laws, they pushed gun rights advocates to take the opposite position, providing at least some support for Zimmerman albeit reluctantly at first.

Coming to gun ownership later in life I am fully aware of the arguments on both sides of the gun issue. “I think he is just a vigilante,” the wife said, and she might be right. Carrying a loaded weapon does provide a measure of power, and that power might cloud judgement and embolden some to cross the line between self-protection to armed aggression. In most cases that line is clear, and in the cases that it’s not, any decent CCW class can provide needed clarity. As one firearms instructor once told me, “Every bullet comes with a lawyer attached,” so gun owners must be more responsible than those who don’t own guns when it comes to the law and know it to the letter. Responsible gun owners also understand that carrying and firing a gun is a last resort. It is the last option when all other options have been tried and none others remain. Guns have life changing consequences, for people at both ends of the barrel, and gun owners must exercise a level of judgement that they know will have to stand the scrutiny of police, prosecutors, judges and juries and ultimately one’s conscience.

None of us was there that night, but the question remains: Did carrying a gun cloud Zimmerman’s judgement? I have been in dangerous situations both in front of the gun and behind it. In the latter case I was with a desperate stranger who claimed to have survived an horrific ordeal, and the guns provided the only protection available in the creeping minutes until the police arrived. Both instances have taught me keeping a clear head in the midst of a traumatic experience where the outcome is unknown is a challenge requiring a tremendous effort of willpower and focus. It’s easy for people to judge when they already know the outcome of an event; it’s much more difficult when you are in the middle of the event, have little or no information to base your decisions on, the police are nowhere around and it’s dark.

Zimmerman needs this trial almost as much as the Martin family does. Perhaps everyone does. We need to learn exactly what happened that night, to put ourselves in Zimmerman’s – and Martin’s – shoes, and determine exactly how and why a 17 year old kid’s life ended. But unfortunately the echoes of that night will not end with a verdict. If Zimmerman is convicted many will think he was railroaded by an administration keen to please its minority base and a special prosecutor doing its bidding. If he is acquitted, many will believe that he got away with murder, adding Martin to the long list of innocents killed by whites over the centuries abetted by a judicial system that is unfair to minorities. Zimmerman has already been judged guilty by many and innocent by others. The verdict will only confirm their beliefs in the fairness/unfairness of the System, it will not change them. As I told my wife as I watched his bail hearing, I am going to try to keep an open mind about his guilt or innocence, but it won’t be easy, I doubt it will be popular, and it may not even be possible.

Cross posted at The Moderate Voice.

Asteroid Mining? About Time

Awhile back I wrote about the logistical challenge and potential profits of mining the moon. It’s nice to learn the idea has fallen on much more fertile ground. Google’s founders have teamed up with James Cameron and a bunch of other liberal billionaires to form a mining company with plans to mine asteroids.

Freakin’ cool.

Space enthusiasts have struggled to get their bearings after the demise of the Apollo program and the disappointment of the shuttle program. They’ve had to content themselves with government funded missions with increasing costs and decreasing utility as taxpayers have demanded Apollo-like bang for pennies of what the program costs.

It’s well past time the exploration of space became the prerogative of private enterprise, and if it takes flaming liberals like Sergey Brin, Larry Page and James Cameron to do it, so be it.

The Council Has Spoken: April 20, 2012

Congratulations to this week’s winners.

Council: Bookworm Room The real threat that the Ann Romneys of the world represent to the statist Left

Noncouncil:   Michael Totten- The Lost City

Full voting here.

Prescription Abuse and the Legalization of Illicit Drugs

I have advocated the legalization of illicit drugs for a very long time. While my politics and party affiliations changed over the years, the belief that most if not all currently illicit drugs should be legalized has never wavered. Whether taking them decades ago or living the Straight Edge path for going on 12 years, I always believed that America would be a better place as a society if it legalized and regulated marijuana, cocaine and heroin.

Walter Russell Mead challenges that belief by comparing the arguments supporting legalization with the reality of prescription drug abuse. Try as I might I’m finding it difficult to argue with the points he makes. Mead writes, “Legally prescribed drugs are now regulated the way many legalization advocates think illegal drugs should be. The flourishing black market in prescription painkillers and the thousands of deaths associated with their use demonstrate that drug use will not be magically fixed by regulating currently illegal drugs. While legalization advocates argue that putting heroin and similar drugs on a prescription basis would reduce fatalities associated with their use, the high toll from overdoses of legal painkillers suggests that this argument is weaker than often believed.

The statistics about prescription drug abuse, to pardon the pun, are sobering. According to the CDC deaths from legal prescription painkillers now surpass those from heroin and cocaine combined. In 2008, 15,000 died from painkiller overdoses. In 2010 12 million Americans used legal painkillers to get high, and that year enough prescriptions were written to keep every single American stoned for a month. That’s 4x more drugs prescribed than in 1999. Today pain is the most common reason for physician visits in the US.

As with any complex issue, there is no simple solution. Until recently doctors had taken more of a “what we cannot cure we must endure” stoic approach with their patients when it came to pain. It wasn’t until the 1970s that doctors began studying pain and specializing in pain treatment and management. Progress has been slow. The foundation of pain management remains addictive narcotics with broad effects instead of the development of drugs that target specific pain. Worse, when used to treat chronic pain these medications may increase pain sensitivity. Even when pain isn’t chronic it may take months, sometimes even years for the underlying injury to resolve. If narcotics are the main treatment for pain, should we be surprised when a patient becomes addicted to pain medications?

There is a big difference between the perception of prescription pain medications and illicit drugs. Generations have been indoctrinated into viewing crack and heroin as “dirty” and socially unacceptable. It takes years for newer drugs such as methamphetamine and ecstasy to be recognized by society as a threat and subject to a mix of propaganda and truth to stigmatize the drug and curtail its usage. In the 1980s and early 1990s meth was underground and commonly used for all night cram sessions by college students and by long haul truck drivers. Now it has been stigmatized as a cheap high for rednecks a step above huffing paint. Prescription drugs have an aura of acceptability that illicit drugs currently lack but would attain if they were legalized. Legalization presents a legitimacy which in turn implies safety. People may naturally view heroin and cocaine as dangerous and consider Oxycontin as innocuous even though one can overdose on Oxycontin as well as heroin. People believe that because a drug is prescribed by a doctor it is somehow completely safe.

While it is possible that after legalization the negative perceptions of the formerly illegal drugs would remain, it is expected legalization would expand usage and abuse. Those favoring the legalization of illicit drugs need to accept this and modify their arguments to reflect this reality. One way to do this is to focus on the core arguments for legalization such as individual freedom and personal responsibility. In the case of prescription drug abuse, doctors need to recognize the danger of supplying patients with narcotics, including the likelihood that the drugs will fall into the hands of others. It is much easier for a physician to prescribe narcotics than it is to advise patients on non-medication pain management therapies such as deep breathing, meditation and exercise. Those that need more should be sent to pain clinics which specialize in pain therapy (and can be monitored closely by authorities).

People need to be educated about pain. Pain is a reality of life and in most cases such as injury it is an important component of the healing process. Dulling it at every opportunity may feel good in the short term but present long term dangers such as prolonged healing, re-injury or addiction. Similarly people need to learn the truth about pain medications. The narcotics on grandma’s shelves are just as dangerous as those being offered for sale on the street a few blocks down.

The solution for drug abuse, whether illegal or legal, is education along with treatment options offered by for-profit and charities. As far as solutions go it’s a lame one, but the alternatives such as the continued prohibition of illicit drugs and the jailing of addicts is far worse. Far better to increase awareness and encourage personal responsibility.

As a recovering alcoholic with 11 years of sobriety under my belt, personal responsibility is the one key component to wellness that gets ignored in the debate. To those sympathetic to the addict and those who take a hard line against illicit drugs, the addict is powerless to resist the drug so the addict must either be protected from his drug or kept away from it through its illegality. Hardly anyone dares tell the addict “You live in a world with your drug. You can have it and ruin your life, or not and live a decent life without it.” There is proof that addiction has a genetic component. For some it may have an epigenetic basis. But regardless of its origin, whether the addict was born that way or acquired it later in life, one is ultimately responsible for one’s own destiny, not Society.

UPDATE:
A documentary on the Oxy Express. The most chilling documentary I’ve seen in years.
An in-depth series on prescription drug abuse by the Delaware News Journal.

The Council Has Spoken: April 13, 2012

Congratulations to this week’s winners.

Council: The RazorWhy There Are No Such Things As Unnecessary Tests

Noncouncil: Sultan Knish-One Hundred Broken Mirrors

Full voting here.

The Council Has Spoken: April 6, 2012

Congratulations to this week’s winners.

Council: JoshuapunditSilent Scream;The Sudan Ethnically Cleanses Its Christians

Noncouncil:  Victor Davis Hanson- The New Anti-Semitism

Full voting here.

Why There Are No Such Things As Unnecessary Tests

My wife is a family doctor working in a small rural practice owned by a regional hospital. While she has not yet been sued for malpractice she knows many doctors who have, and while the vast majority of these suits never reach court they still inflicted many sleepless nights and higher malpractice premiums on the innocent doctors. She recognizes that everything she does may have to be justified someday so that if she is forced to testify she can explain the rationale of her treatment. This is the essence of defensive medicine.

The American Board of Internal Medicine Foundation in partnership with Consumer Reports has announced Choose Wisely, an educational initiative recommending physicians avoid 45 unnecessary tests and procedures the group believes are performed unnecessarily. These include routine EKGs and Stress Tests as well as prescribing antibiotics for minor ailments such as mild sinusitis. Oncologists are also encouraged not to perform cancer screens on breast cancer and prostate cancer patients diagnosed with non-metastatic forms of these cancers.

But as the New York Times article states, these recommendations are controversial and there is fear among some patients and doctors that they will be applied too broadly. The newspaper quotes Dr. Eric Topol, chief academic officer of Scripps Health who says, “These all sound reasonable, but don’t forget that every person you’re looking after is unique…This kind of one-size-fits-all approach can be a real detriment to good care.”

As a resident of the great state that raised John Edwards to the heights of power on the backs of doctors he sued for malpractice, I’m skeptical over this recommendation for a number of reasons. Dr. Topol makes an excellent point. Those who aren’t health care practitioners may fail to understand that patients often do not present with clear cut symptoms. There is a finite number or reasons your car won’t start in the morning such as the battery is dead, the tank is empty or the ECM needs replacement. But the human body is infinitely more complex. What may present as back pain from too much Pilates can turn out to be bone cancer that had metastasized from the esophagus, as happened to my father-in-law. The chronic tickle in the back of the throat that drove my mother-in-law crazy for months, turned out to be an atypical and rare form of breast cancer. Both were dead within months of their initial complaints both were misdiagnosed by their primary care physicians, though it is unlikely in either case the proper diagnosis would have mattered much. But both cases of cancer could have been treated had they been detected early. Obviously doctors cannot perform these tests on everyone because it would take too much time and cost too much, but this decision should be left to the judgment of the doctor and not interfered with by the government, an insurance company or a non-elected body such as the American Board of Internal Medicine Foundation.

These recommendations will no doubt be cheered by insurance companies and the government (since Medicare, Medicaid and Obamacare make the government a de facto insurance company I’ll lump it together with the likes of Kaiser Permanente and Blue Cross for the rest of the article.) Insurance companies can now refuse to pay for these tests or at the least requiring doctors jump through time-consuming and money-losing hoops such as requiring pre-authorization to do them. The article claims that as much as 1/3 of the $2 trillion spent on health care in the USA is unnecessary, so imagine the savings to their bottom lines these companies will enjoy by cutting nearly $700 million from their payments. The problem with this figure is that it’s like the old saying about half of marketing dollars being wasted, but no one knows which half. Because it is impossible to accurately determine which person needs a test and which doesn’t it will be impossible to reap the savings hinted at in these recommendations.

Doctors are taught the cliche, “When you hear hoofbeats, think horses, not zebras.” The problem is in the real world zebras aren’t limited to the Serengeti, they are mixed in with the horses here. And doctors are blind. The practice of medicine remains an art where such non-quantifiable processes as “intuition” still play an important role. A doctor might be presented with a healthy young man in his prime with no signs of heart problems, but something might trigger his intuition to call for an EKG. While rare, young people do make the headlines when they drop dead of cardiac arrest caused by a previously undiagnosed heart condition. The physician suspecting he might have a patient with an undiagnosed heart problem will have to fight to get the insurance company to pay for the EKG, skip the EKG and console himself that the young man is healthy, or do the test for free.

Imagine the doctor finds himself in the dock, facing an attorney hired by the family of his patient. “Why didn’t you do the test, doctor? It’s a simple test you could have performed in your office that would have saved the life of my client’s son. Yet you didn’t. Why?” The American Board of Internal Medicine Foundation will not be on the stand, the doctor will, and parroting off the American Board of Internal Medicine Foundation’s recommendations will not play very well to the jury.

So to avoid that possibility, the doctor will either have to fight the insurance company to pay for the test or will have to perform it gratis. Either way the physician is the one left bearing the responsibility for these recommendations. And 99% of the time the doctor will find that the patient’s heart is fine, in which case outside groups like Consumer Reports will wail about unnecessary tests. But the doctor knows that without tort reform she must do everything to protect herself including ordering tests which may seem considered medically unnecessary but will protect her in court. The tests might be medically unnecessary but until there is tort reform they will be legally necessary and will continue to be performed.

The Insidious Nature of Student Loan Debt

I have a BA degree in Political Science and in the decades since I got the degree it came in useful once: it allowed me to teach English in Japan, a university degree being the sole requirement at the time. Since then I’ve not used it during my career and I likely never will. I have no regrets getting the degree however, because I got it from a state school and graduated with debt I repaid in four years teaching, making $2,000 a month. After returning to the USA with the Kid and the Wife I began a career in IT starting at the bottom by working at a help desk. Over the years I built the career into something that I enjoy and has proven lucrative. The Wife and I also made an investment in her education, graduating medical school 8 years after taking the first steps to do so, albeit saddled with enough education debt to choke an accountant. Together we live comfortably although not extravagantly, and looking back I appreciate that our current circumstances are the outcome of a series of clear-headed decisions and sacrifices we made long ago leavened by a dash of luck.

Now the Kid is approaching college age, and it will soon be time for him to confront some of the same decisions we faced. One of those decisions will be whether to go to college, and for years I have been studying the education landscape with a critical eye in preparation for this day. During that time I have read voraciously and talked to newly minted college graduates and grad students. What follows is based on my experience

If you are a high school student, don’t go to college just because your parents think it’s the next stage in life or its what everyone else is doing. Your parents likely didn’t finish school with sums of debt that they likely couldn’t have supported upon starting their careers, and they are using their experience as a guide. Unfortunately the world has changed tremendously since they got their degrees in the 80’s or 90’s, and their experience can seriously screw up your life. As for going because it’s what everyone else is doing, do yourself a favor and look up “tulip mania” and educate yourself on economic bubbles. These bubbles all burst, eventually hurting those who follow the economic advice of the herd. There are whole industries dedicated to keeping those bubbles going and for encouraging the stampede of young people into education, just as there were Indians who used to stampede herds of buffalo off cliffs.

The simple problem with college today is that it is too expensive. Costs have been rising above inflation for decades, inflated by the cheap money made available for borrowing through student loan programs. Student loans seem innocuous, even beneficial. After all it often makes sense to borrow to buy something that will improve your salary and marketability in the future.

Take it from someone who has to write a large four figure check every month to pay off student loans: Student loans are an insidious form of credit. Most students and their parents wouldn’t dream of piling up tens and hundreds of thousands of dollars in credit card debt yet when they think about student loans they lose their senses. All critical thought evaporates.

What is wrong with student loan debt? Several things, but the most important is that you cannot discharge it through bankruptcy. Go on a bender with your Visa card and you can declare bankruptcy and have the debt erased with only a damaged credit rating to show for it, and even that can be repaired after a few years of sensible living. But student loans are for life. They can never be discharged, and all the so-called forbearance programs like Income-Based Repayment do is spread out the debt over a longer period of by piling on the payments you are missing onto the end of the loan. Add in compound interest and that $1,000 payment you are avoiding today will likely cost you $3,000 by the time you pay it off.

Which brings up the subject of compound interest. Even though I had two mortgages under my belt I was still shocked by this simple accounting concept when it came to handling the Wife’s student loans. It bit me in the butt even though I should have known better. Here’s how.

Imagine that you expect to finish undergrad with $50,000 in debt. $50k sounds manageable, right? Now let’s say that your lender is spreading those payments over 15 years at 6.8% interest. You will end up paying back nearly $80,000. So that $50k you graduated with isn’t really $50k. It’s $80k, 60% more than you thought. During that 15 years of repayment you are going to have numerous debts such as car payments and perhaps a mortgage. You will also have to pay for everything that your parents have paid for. Sewer bills, water bills, personal property taxes, health insurance premiums, dental bills – the costs of living that as a child you’ve never had to consider let alone pay. This is why a general rule of thumb is that your student loan payment should be less than 10% of your income. Add in the other rules of thumb that a mortgage should never take more than 25%, a car payment 10%, and the salary that isn’t allocated to a bill quickly disappears. So to support that $50k debt you are going to have to make $70k a year. See for yourself.

There is just one starting salary out of undergrad that will net you $70k a year: petroleum engineer ($97,900). And that’s today. By the time you graduate that starting salary will likely be much less because other students will have gravitated towards that major, boosting the supply of graduates for a limited supply of jobs, driving down starting salaries. Maybe something else will fill the void, but since you don’t know what it is it is impossible to select that major years in advance.

Maybe you can console yourself that there are plenty of mid-career jobs that pay well over $70k in the Payscale survey. The problem is compound interest. Mid-career is calculated at 15 years, so to get to a point where you can afford the payments, you will need to forbear early in repayment which will tack those payments on to the end of the loan, boosting the total amount you have to repay and saddling you with payments beyond the initial 15 years. That $50k becomes $100k or more.

Everyone says debt is bad but no one really says why. Debt limits your choices. I think this is the most important reason for young people to avoid it completely or at least realistically understand it before taking on substantial chunks of it.

Say that you decide after graduation that you want to take six months off and travel around Europe. Traveling is one of the best things a young person can do. It exposes him or her to new cultures and different ways of living that cannot be learned in the classroom or in a book. The experiences gained from seeing the world are priceless and often life changing. One not only learns about others, traveling teaches one about oneself. For this reason it has been a critical component of liberal arts educations for centuries, but one that has been forgotten except through expensive exchange programs that limit and control new experiences, neutering the benefits of travel while expanding the costs. But you can’t don a backpack and buy a ticket to Istanbul to visit your Turkish friend when you have student loans coming due.

Say you have a great idea and want to start your own business. Starting a business is hard enough when you have little credit history, but go to a bank for a small business loan to get your idea off the ground when you have student loans coming due and you’re just wasting your time. Not only will you not get the loan your business needs, you will have to choose IBR and add to your debt while you work to get your business going, or you’ll have to skip it altogether and choose the first job that provides you with a decent chance of paying the loans back. I have seen first hand student loan debt push medical students into more lucrative specialties just because they pay better instead of those like family medicine and pediatrics that pay much less but require the same debt load.

The statistics I’ve seen suggest that people will change careers several times over their working lives. I’m 15 years into my second, and even within my current career I’ve changed focus and types of jobs many times. I would have been unable to do that if I had been saddled with student loans, forcing me to follow the money instead of my interests. The economy that is evolving requires people to act quickly and nimbly to stay employed and develop new skills, and doing this is much more difficult with student loans holding you back.

Like many liberal arts majors I considered going to law school. If there is one field that I would discourage my son from entering, it is law because it is the worst investment one can make, and the statistics bear that out. As this post by Walter Russel Mead states, unless you get into the top handful of law schools you are wasting your money on a degree that will pay much less than professions that don’t require expensive graduate education. Lawyers have a median salary of $50k, and to get that $50k/year they incur $125k in debt. According to Payscale, one could major in physics, avoid the $125k in graduate debt and start out making $50k a year, with the prospect of doubling that by mid-career.

So what am I telling my own son? I am telling him to not go to college until he has a goal in mind and college makes economic sense to help him to achieve that goal. I am telling him that after he finishes high school he should expect to travel and to work so that he learns about the world and himself. He has shown interest in the military but I have tied that to college, insisting that he only enter the military as an officer. He can attend junior college and get exposure to new fields there for a fraction of the cost of four year schools. As for the social benefits of college, there are alternatives that don’t cost $45/hour. He can pay someone to be his friend and hang out with him for much less, and besides, college friendships are overblown. I have a small stable of friends, and all were met on the job, in high school, or in non-college related activities during my college years.

There are benefits to college, but these benefits have become too costly. There is simply no reason that a 22 year old should saddle him or herself with debt that limits choices until middle age. That’s not what college was supposed to do, but it is what it has become.