Encouraging signs on covid-19 and vaccinations

The Washington Post reports:

In recent weeks, U.S. coronavirus case data — long a closely-watched barometer of the pandemic’s severity — has sent some encouraging signals: The rate of newly recorded infections is plummeting from coast to coast and the worst surge yet is finally relenting.

But scientists are split on why, exactly, it is happening. Some point to the quickening pace of coronavirus vaccine administration, some say it’s because of the natural seasonal ebb of respiratory viruses and others chalk it up to social distancing measures.

And every explanation is appended with two significant caveats: The country is still in a bad place … and recent progress could still be imperiled, either by new fast-spreading virus variants or by relaxed social distancing measures.

The rolling daily average of new infections in the United States hit its all-time high of 248,200 on Jan. 12…. Since then, the number has dropped every day, hitting 91,000 on Sunday, its lowest level since November.…

“Two [factors] are driving down transmission,” [a February 12 briefing by the University of Washington’s Institute for Health Metrics and Evaluation] says. “1) the continued scale-up of vaccination helped by the fraction of adults willing to accept the vaccine reaching 71 percent, and 2) declining seasonality, which will contribute to declining transmission potential from now until August.”

The model predicts 152,000 more covid-19 deaths by June 1, but projects that the vaccine rollout will save 114,000 lives.

In the past week, the country collectively administered 1.62 million vaccine doses per day…. It was the best week yet for the shots, topping even President Biden’s lofty goal of 1.5 million vaccinations per day.

Nearly 40 million people have received at least their first dose of a coronavirus vaccine, about 12 percent of the U.S. population. Experts have said that 70 percent to 90 percent of people need to have immunity, either through vaccination or prior infection, to quash the pandemic.

 

Get vaccinated as soon as possible!

How the coronavirus (covid-19) is "unique"

A physician who's fully recovered from covid-19 talks about his experience:

The mornings are better, but it sort of teases folks — myself included — into thinking that it's going away. And then, boom! It comes right back. For me, that went on for eight days in a row.

The nights are so bad, because as a physician, I know what can happen. And so I would sit awake, counting the minutes until morning almost, wondering if my breathing was going to get worse and I'd end up on a ventilator. That was the horror of it.…

We don't have a proven treatment and I think that's essential to understand. It points out how spoiled we've become in the world of medicine. We have so many treatments for so many disorders that we just assume that when something pops up, we can handle this.

But the reason we can handle it for other diseases is that we've had time to do randomized trials that we haven't had time to do with COVID.…

I'm a little bit ashamed of myself, because I could have put myself into harm's way in terms of sudden death. That can happen when you use those two particular drugs [hydroxychloroquine and azithromycin] together … and I was not being monitored properly.

The take-home point is I totally get why someone who's that sick would want something, because doing nothing is very, very difficult.

On the other hand, we really do need randomized controlled trials to tell us the truth of what the drug regimen does or does not do, and what its safety profile is. Until we have that, we're really trying to fly an airplane in fog without instruments.…

The infection is not like the flu that hits you all at once. These symptoms sort of gradually creep up on folks, and then it crescendos.…

Read the whole interview here.

This animated graph shows you how fast the coronavirus is overtaking other causes of death

Did you notice that everyone who likened the coronavirus to the flu* (or other causes of death) always left out one thing? They always left out the rate at which the coronavirus was increasing. Watch this animated graph to see how fast Covid-19 has grown over time relative to other causes of death in the US. (This goes up to April 3; I hope it keeps getting updated.)

* I use the past tense because not many people are seriously doing this anymore.

Things I'm tired of hearing about the coronavirus

🦠 "More people die in car crashes!”* (But car crashes have been decreasing for years, while Covid-19 is doubling every few days.)

🦠 "Why are people hoarding toilet paper? They must have some irrational bias!" (Right, because it's not like people have a good reason for buying more toilet paper than usual when they and their family members have to be at home all the time, and governments are announcing increasingly strict lockdowns.)

🦠 "Look, it's not that hard, just wash your hands and don't touch your face!” (Actually, it's pretty hard to wash your hands often enough and never touch your face.)

🦠 "Quit whining, other people have had to go to war, while you're just sitting around on the couch!" (That's a little tone-deaf when many people are sitting at home worried about how they're going to pay the rent or feed their families because they lost their jobs as a result of the virus.)

🦠 "China has almost no coronavirus cases anymore, so let's figure out what they're doing right and copy that!" (Yes, let's trust official reports from an authoritarian government known for secrecy and censorship. Also, China has admitted it isn't counting asymptomatic cases, unlike other countries.)

* These aren't exact quotes; I'm summing up what I've been hearing a lot, and linking to relevant sources.

Why the right response to stories of vaccines triggering illness isn't to dismiss them out of hand

This is an important point about vaccines that I had never heard of before seeing this op-ed in the Wall Street Journal (by Michael Segal, a neurologist and neuroscientist):

the Centers for Disease Control and Prevention reported April 26 that there have been 704 cases of measles so far this year. “The suffering we are seeing today is completely avoidable,” Health and Human Services Secretary Alex Azar said Monday. “We know vaccines are safe because they’re among some of the most studied medical products we have.”

So why does skepticism persist? One reason is that scientists, physicians and journalists are overly dismissive of the observations that circulate among the public.… A study led by neurologist Samuel Berkovic applied that approach to vaccine reactions, and the results provide a model for understanding and overcoming skepticism about the safety of vaccines.

Dr. Berkovic and his colleagues studied a genetic form of epilepsy caused by mutations in the SCN1A gene, a DNA sequence that specifies part of a channel in nerve-cell membranes that allows sodium ions to enter the cell. Children born with such SCN1A mutations are destined to develop seizures and regress neurologically.

The researchers found that the onset of these seizures peaked in the days after vaccination but then dipped below baseline in subsequent weeks. The net result was that vaccines had no effect on the likelihood of developing the inevitable deterioration from these mutations.

That is, vaccines did trigger the deterioration—but had the children not been vaccinated, the same deterioration would have occurred anyway the next time they had a cold.

These results are fully consistent with the large-population studies. But by studying the detailed time course in a genetically characterized population, they illustrated how vaccines can appear to be the proximate cause of an injury, yet the ultimate cause is genetic.

When parents ask me about vaccines, I inspire confidence by telling them that my three kids got all the recommended vaccinations on schedule. But when dealing with public policy about mandatory vaccinations, one needs to address the elephant in the room: the stories of deterioration following vaccinations. Many experts prefer to ignore such anecdotes, and when engaged in public debate, find it hard to resist the ethos of an advocate—pushing the conclusion but playing down the complexity. That’s been counterproductive. People hear stories about neurological deteriorations and trust their friends more than the experts.

Unless we act like scientists and explain the science, we won’t be effective in helping laymen put the anecdotes in context.

"Too big for the industry"

This model, Agnes Hedengård, talks about being rejected for being "too big." Her BMI is 17.5, which is considered underweight.

Anti-circumcision activists are anti-science

A Slate article from a couple years ago explains how they're like anti-vaxers:

Like most fringe groups, the anti-circumcision faction is almost comically bizarre, peddling fabricated facts, self-pity, and paranoia. The intactivists also obsess about sex to an alarming degree. Still, some of their tactics are shrewd. The first rule of anti-circumcision activism, for instance, is to never, ever say circumcision: The movement prefers propaganda-style terms like male genital cutting and genital mutilation, the latter meant to invoke the odious practice of female genital mutilation. (Intactivists like to claim the two are equivalent, an utter falsity that is demeaning to victims of FGM.)

Anti-circumcision activists then deploy a two-pronged attack on some of humanity’s most persistent weaknesses: sexual insecurity and resentment of one’s parents. Your parents, you are told by the intactivists, mutilated you when you were a defenseless child, violating your human rights and your bodily integrity. Without your consent, they destroyed the most vital component of your penis, seriously reducing your sexual pleasure and permanently hobbling you with a maimed member. Anti-circumcision activists craft an almost cultic devotion to the mythical powers of the foreskin, claiming it is responsible for the majority of pleasure derived from any sexual encounter. Your foreskin, intactivists suggest, could have provided you with a life of satisfaction and joy. Without it, you are consigned to a pleasureless, colorless, possibly sexless existence.

Intactivists gain validity and a measure of mainstream acceptance through their sheer tenacity. Their most successful strategy is pure ubiquity, causing a casual observer to assume their strange fixations are widely accepted. Just check the comment section of any article pertaining to circumcision. When Slate’s Troy Patterson wrote a piece thoughtfully weighing circumcision’s pros and cons, he was attacked for supporting a “barbaric practice” of “mutilation” that “ought to be illegal.” A lighthearted Dear Prudence column suffered the same fate. Intactivists pummeled the Amazon rankings of a book about the history of AIDS that mentioned circumcision as a proven preventive measure. Check any Internet message board and you’ll find the same ideas peddled as unimpeachable fact: Circumcision is amputation, a brutally cruel and despicable form of abuse. It damages penises and violates human rights. And it irrevocably, undeniably ruins male sexuality for life.

The problem with these arguments is that they’re either entirely made up or thoroughly disproven. None of intactivists’ cornerstone beliefs are based in reality or science; rather, they’re founded in lore, devilishly clever sophistry dressed up as logic. The facts about circumcision may be hard to find on an Internet cluttered with casuistry—but they are there. And they prove that even as intactivists dominate the Internet, the real-world, fact-based consensus on circumcision is tipping in the opposite direction.

Take, for example, the key rallying cry of intactivists: That circumcision seriously reduces penis sensitivity and thus sexual pleasure. Study after study after study has proven this notion untrue. Some men circumcised as adults actually report an increase in sensitivity, while many report no appreciable difference; virtually none noted any notable decrease. Men circumcised as adults also almost universally report no adverse effect in overall sexual satisfaction following the procedure. (That fits with what my colleague Emily Bazelon found when she asked readers for their circumcision stories a few years ago.) And genital sensitivity in response to erotic stimulation is identical in circumcised and uncircumcised men. Don’t trust individual studies? A systematic review of all available data on circumcision came to the same conclusion. Intactivists, then, aren’t disputing a few flimsy studies: They’re contradicting an entire field of research.

So much for circumcision’s supposedly crippling effect on sexual pleasure. But what about its effect on health? Intactivists like to call circumcision “medically unnecessary.” In reality, however, circumcision is an extremely effective preventive measure against global disease. Circumcision lowers the risk of HIV acquisition in heterosexual men by about 60 to 70 percent. And circumcision reduces HIV risk over a man’s lifetime, unlike condoms, which must be used during each sexual encounter. It’s no wonder that the World Health Organization has pushed circumcision as a key tool in the fight against HIV.

But that’s not circumcision’s only benefit. The procedure also protects men against a variety of other STDs, significantly reducing their odds of contracting herpes and syphilis. Moreover, circumcision is highly effective in preventing transmission of HPV in men, which in turn reduces their risk of penile cancer. And circumcised men are far less likely to contract genital warts* or develop urinary tract infections. Fewer circumcisions mean more STDs and infections—and billions more in health care spending.

As both a personal and public health matter, circumcision is clearly in men’s best interest. But intactivists, predictably, aren’t having any of it. Like anti-vaccine conspiracy theorists, anti-circumcision activists reject all science that doesn’t fit their angry, victimized orthodoxy.

* I added this link to replace a dead link in the original article.

Thomas Sowell on vaccines

Sowell, the libertarian/conservative economist who's deeply skeptical of most government regulation, writes:

[T]he “evidence” on which the original claim that vaccines caused autism was based was just twelve children. But the campaign to convince the public was a masterpiece of propaganda.

The storyline was that pharmaceutical companies who produced the vaccine were callously risking and sacrificing helpless children in pursuit of profit. This is the kind of dramatic stuff the media love. It never seemed to occur to the media that lawyers who were suing pharmaceutical companies had a vested interest in this storyline that the media fed on to the public.

Unfortunately, it takes time to run careful scientific studies, involving vast numbers of children in different countries. That allowed the propaganda against vaccines to go on for years. Eventually, however, the results of the studies so completely discredited the claim that the measles vaccine caused autism that the medical journal which had published the article publicly repudiated it. The doctor who wrote the article had his license revoked. By this time, however, there was a whole anti-vaccine movement, and crusading movements are seldom stopped by facts. . . .

Some say the decision to vaccinate or not should be the parents’ choice. That would be fine if their child would live isolated from other children. But that is impossible.

Those who cannot remember our past measles epidemic will make other people's children repeat it.

Margaret Talbot writes in the New Yorker:

Twenty-five years ago, when a doctor named Robert Ross was the deputy health commissioner of Philadelphia, a measles epidemic swept the country. Until this year’s outbreak, which started at Disneyland and has so far sickened more than a hundred people, the 1989-91 epidemic was the most alarming that the United States had seen since 1963, when the measles vaccine was introduced. Nationwide, there were more than fifty-five thousand cases and eleven thousand hospitalizations; a hundred and twenty-three people died. Most of those infected were unimmunized babies and toddlers, predominantly poor and minority kids living in cities. Ross thought that the blame for the outbreak could be placed partly on poverty and partly on crack cocaine, which was “making a lot of families forget how to raise children.”

One cluster of kids was getting sick, though, not because their parents lacked the wherewithal to have them immunized but because the parents, members of the Faith Tabernacle congregation, did not believe in immunization. When children in the congregation started dying—ultimately, five did—Ross and his colleagues began going door to door, telling parents that kids whose lives were in danger could be hospitalized by court order. In one house, Ross found an ashen-faced girl of eight or nine who could barely breathe. He got her to the hospital and, when he saw her the next day in the I.C.U., had no doubt that taking her from her home had saved her life. The memory of those who weren’t saved still troubles Ross: “These were kids who had no business being lowered into the ground. And I’ve never gotten over it.”

The epidemic spurred the creation, in 1993, of a federal program, Vaccines for Children, which subsidized shots for children who were uninsured or on Medicaid. Immunization rates soared. Then a new skepticism about vaccination settled in—this time, more often than not, among affluent parents who were drawn to holistic living and were dubious about medical authority. An infamous 1998 study in The Lancet, which claimed that the rising incidence of autism was linked to vaccinations, was particularly influential with some of those parents—even though the data were found to be falsified and the author’s medical license was revoked. Another theory, tying autism to thimerosal, a preservative added to vaccines, has also been debunked. Since 2001, thimerosal has been used only in the flu vaccine—and there is a thimerosal-free alternative—but the incidence of autism continues to rise.

Nevertheless, the skepticism endured, and one result has been the decisive return of infectious diseases. First, it was whooping cough: in 2012, more than forty-eight thousand cases and twenty deaths were reported to the Centers for Disease Control, the greatest number since 1955. Now it’s measles. Both illnesses pose an especially serious threat to babies (infants under a year old cannot be vaccinated) and to people who cannot be vaccinated for medical reasons—if their immune systems are weakened by cancer drugs, for instance—and the complications are costly to treat. As many as one in every twenty children with measles will develop pneumonia; one in every thousand will develop encephalitis, which can leave a child deaf or brain-damaged. In addition, measles is airborne and extremely contagious; virus transmitted by a sneeze on the Dumbo ride or in the doctor’s-office waiting room can still infect people an hour later. That is why, in the case of measles, a community generally needs more than ninety per cent of its members to be immunized against the virus in order to protect those who can’t be. “Herd immunity” doesn’t work unless most of the herd is vaccinated.

What does work is legislation. The highest vaccination rate in the country is in Mississippi, a state with an otherwise dismal set of health statistics. It allows people to opt out of vaccines only for medical reasons—not for religious or personal ones. States that make it easier not to vaccinate have higher rates of infectious diseases. California, which has seen ninety-nine cases in this epidemic, is one of nineteen states that allow people to opt out not only for religious and medical reasons but also on the basis of a loosely defined “personal belief.” In 2012, though, the state legislature passed a law requiring parents to consult with a health-care professional about vaccination before they reject it, and the opt-out rates declined slightly for the first time in years. (Washington passed a similar law and has experienced a bigger decline.) Last week, legislators in California introduced a bill to eliminate the personal-belief exemption—but that may actually be too abrupt and punitive a solution. According to some epidemiologists who study the anti-vaccine movement, it’s probably more effective to continue to enforce a regime that makes it more difficult but not impossible for parents to opt out.

What does not help at all is to treat vaccines and the diseases they prevent as partisan political matters. In 1993, when the Clinton Administration championed Vaccines for Children, it drew bipartisan support; it would have seemed bizarre to cast a measure aimed at preventing epidemics of childhood disease in ideological terms. In fact, until recently, vaccine refusal wasn’t a partisan issue—some objections came from anti-government types but many were from self-identified progressives. In the current discussion, however, conservatives have been embracing a precious individual right to shun inoculation. On Fox News, Sean Hannity declared that he wasn’t “trusting President Obama to tell me whether to vaccinate my kids.” Asked about immunization on CNN last week, Senator Rand Paul, a potential Republican candidate for President—and a doctor—painted a pointlessly terrifying scenario: “I’ve heard of many tragic cases of walking, talking, normal children who wound up with profound mental disorders after vaccines.” No doubt, he has heard such stories, but the evidence does not support them. . . .

Robert Ross believes that “doubling down on education” about infectious diseases will help the situation, but he wonders if that’s enough to “reacquaint some parents”—not to mention some elected officials—“with the dangers of these diseases.” Ross had to rely on the law and the courts to help him save children’s lives in Philadelphia. By then, the situation was dire. He worries that more children will die unnecessary deaths before reason again takes hold.

Why anti-vaxxers are liberal and conservative

Michael Gerson writes in WaPo:

[A] significant minority of parents — often well-educated parents — are opting out of vaccination. Many states (including California) make it relatively easy to refuse vaccination for “philosophic” reasons. This does not, I suspect, mean that people are reading Immanuel Kant or John Stuart Mill; it means they are consuming dodgy sources on the ­Internet.

Resistance to vaccination on the left often reflects an obsession with purity. Vaccines are placed in the same mental category as genetically modified organisms (GMOs), DDT and gluten. But the problem with organic health care is that the “natural” rate of child mortality is unacceptably high. Organically raised children can get some very nasty ­diseases.

Opposition to vaccination on the right often reflects an obsession with liberty — in this case, freedom from intrusive state mandates. It has always struck me as odd that a parent would defend his or her children with a gun but leave them vulnerable to a microbe. Some conservatives get especially exercised when vaccination has anything to do with sex — as with the human papillomavirus (HPV) vaccine — on the questionable theory that teenagers are more likely to fornicate if they have a medical permission slip (or less likely to without it).

Whether hipsters or home-schoolers, parents who don’t vaccinate are free riders. Their children benefit from herd immunity without assuming the very small risk of adverse reaction to vaccination. It is a game that works — until too many play it.

Herd immunity requires about 90 percent vaccine coverage. Some children with highly vulnerable immune systems — say, those being treated for leukemia — can’t be vaccinated for medical reasons. When the number of non-medical exemptions from vaccination gets large enough, the child with leukemia becomes the most vulnerable to the spread of disease.

The government (in this case, state governments) has the responsibility to keep vaccination rates above 90 percent, which benefits everyone. This requires burdening the freedom of parents in a variety of ways — not putting them in jail if they refuse to vaccinate but instead denying them some public good (such as public education) and subjecting them to stigma (which they generally deserve). As the rate of vaccination goes lower, the level of coercion must increase — making exemptions more difficult and burdensome to secure (as California needs to do).

Best. Blood donor. Ever.

James Harrison has donated blood more than 1,000 times, saving millions of babies' lives.

If people are bad at deciding what's best for themselves, is government the solution?

Ann Althouse (my mom) sums up Cass Sunstein's review of a book called Against Autonomy: Justifying Coercive Paternalism, by Sarah Conly:

Sunstein refers to social science research that shows people actually aren't very good at making decisions for themselves. We have "present bias" (and don't pay enough attention to the future), we're bad at assessing probability, and we're "unrealistically optimistic."

Sunstein writes:

Many Americans abhor paternalism. They think that people should be able to go their own way, even if they end up in a ditch. When they run risks, even foolish ones, it isn’t anybody’s business that they do. In this respect, a significant strand in American culture appears to endorse the central argument of John Stuart Mill’s On Liberty. In his great essay, Mill insisted that as a general rule, government cannot legitimately coerce people if its only goal is to protect people from themselves. ...

Until now, we have lacked a serious philosophical discussion of whether and how recent behavioral findings undermine Mill’s harm principle and thus open the way toward paternalism. Sarah Conly’s illuminating book Against Autonomy provides such a discussion. Her starting point is that in light of the recent findings, we should be able to agree that Mill was quite wrong about the competence of human beings as choosers. “We are too fat, we are too much in debt, and we save too little for the future.” With that claim in mind, Conly insists that coercion should not be ruled out of bounds....

Conly insists that mandates and bans can be much more effective than mere nudges. If the benefits justify the costs, she is willing to eliminate freedom of choice, not to prevent people from obtaining their own goals but to ensure that they do so.

Sunstein has several good objections to this theory:

Conly is right to insist that no democratic government can or should live entirely within Mill’s strictures. But in my view, she underestimates the possibility that once all benefits and all costs are considered, we will generally be drawn to approaches that preserve freedom of choice. One reason involves the bluntness of coercive paternalism and the sheer diversity of people’s tastes and situations. Some of us care a great deal about the future, while others focus intensely on today and tomorrow. This difference may make perfect sense in light not of some bias toward the present, but of people’s different economic situations, ages, and valuations. Some people eat a lot more than others, and the reason may not be an absence of willpower or a neglect of long-term goals, but sheer enjoyment of food. Our ends are hardly limited to longevity and health; our short-term goals are a large part of what makes life worth living.

Conly favors a paternalism of means, but the line between means and ends can be fuzzy, and there is a risk that well-motivated efforts to promote people’s ends will end up mischaracterizing them.... [M]eans-focused paternalists may be badly mistaken about people’s goals. Those who delay dieting may not be failing to promote their ends; they might simply care more about good meals than about losing weight.

Freedom of choice is an important safeguard against the potential mistakes of even the most well-motivated officials.... Officials may well be subject to the same kinds of errors that concern Conly in the first place.

I see at least two major problems with Sarah Conly's line of reasoning — that we're bad at making rational decisions in our personal lives, so government should remedy this problem through coercive regulations.

Of course, people are often irrational — they act against their own best interests. We don't need social science research to know that, though the research is worthwhile for pinpointing exactly how we're irrational.

But it doesn't follow logically that government regulations are the solution.

Problem 1: We're all just a bunch of flawed people. If people are irrational, then laws — written by politicians who are up for reelection, enforced by police officers, and interpreted by judges who are possibly biased and definitely busy — might also be irrational. Cass Sunstein makes a similar point above, but I'd go further and say government is often more irrational than individuals: even if regulators are rational, it often serves their interests to regulate in a way that doesn't serve yours, possibly because they're beholden to lobbyists. Meanwhile, the public has a hard time holding government accountable because it's often not obvious how regulations eventually lead to bad consequences.

Government isn't an all-purpose social-utility machine just waiting to help us make better decisions, if only we'd be willing to give up our stubborn adherence to the principle of individual autonomy. Even if we were to set aside all our cherished notions about how liberty is intrinsically good, it would still make sense to be skeptical of whether regulators know or care about the full consequences of their regulations.

Problem 2: If helping people involves insulating them from the natural consequences of their actions, this could "nudge" them to be less effective at rational thinking. Being free to make mistakes, and suffering the consequences as a direct result, can help you learn to do better in the future.

And what one person considers a mistake, someone else might see as a useful opportunity. The other day I blogged Evgeny Morozov's critique of "smart" kitchens gadgets:

To grasp the intellectual poverty that awaits us in a smart world, look no further than recent blueprints for a "smart kitchen"—an odd but persistent goal of today's computer scientists, most recently in designs from the University of Washington and Kyoto Sangyo University in Japan.

Once we step into this magic space, we are surrounded by video cameras that recognize whatever ingredients we hold in our hands. Tiny countertop robots inform us that, say, arugula doesn't go with boiled carrots or that lemon grass tastes awful with chocolate milk. This kitchen might be smart, but it's also a place where every mistake, every deviation from the master plan, is frowned upon. It's a world that looks more like a Taylorist factory than a place for culinary innovation. Rest assured that lasagna and sushi weren't invented by a committee armed with formulas or with "big data" about recent consumer wants.

Creative experimentation propels our culture forward. That our stories of innovation tend to glorify the breakthroughs and edit out all the experimental mistakes doesn't mean that mistakes play a trivial role. As any artist or scientist knows, without some protected, even sacred space for mistakes, innovation would cease.

Conly might respond that she's talking about irrational behavior with long-term consequences, which we're bad at foreseeing. First of all, I'm not convinced that the article's main example, obesity, is so distant in time from the behavior that causes it. If you go on a diet, you can often notice the results (or lack thereof) pretty soon.

But more fundamentally: why should I expect government to be better at considering my long-term future than I am? Are politicians truly concerned about what happens to me decades from now? I'm not sure about that. What I am sure about is that I care about what happens to me decades from now, and that politicians care about winning the next election. So is government really in a better position to look out for our own interests than we are?

Why did Rick Perry fail?

It might have been sleep apnea.

Carbon monoxide

It's good for you! (via)

Michele Bachmann's comments about HPV vaccination will lead to more cervical cancer.

That's the implication of this New York Times article:

During a debate last week for Republican presidential candidates and in interviews after it, Representative Michele Bachmann called the vaccine to prevent cervical cancer “dangerous.” Medical experts fired back quickly. Her statements were false, they said, emphasizing that the vaccine is safe and can save lives. Mrs. Bachmann was soon on the defensive, acknowledging that she was not a doctor or a scientist.

But the harm to public health may have already been done. When politicians or celebrities raise alarms about vaccines, even false alarms, vaccination rates drop.

“These things always set you back about three years, which is exactly what we can’t afford,” said Dr. Rodney E. Willoughby, a professor of pediatrics at the Medical College of Wisconsin and a member of the committee on infectious diseases of the American Academy of Pediatrics. . . .

The vaccine, recommended by the medical groups for 11- and 12-year-olds, protects against the human papillomavirus, or HPV, a sexually transmitted infection that can cause cancer. Use of the vaccine was disturbingly low even before the Bachmann flap, health officials say. That is partly because of the recent climate of fear about vaccines in general, and partly because some parents feel that giving the vaccine somehow implies that they are accepting or even condoning the idea that their young daughters will soon start having sex.

Allegations that vaccines could cause autism have frightened some parents away from giving them to children. But the question has been studied repeatedly, and there is no evidence for such a link; the research that first promoted the idea was subsequently proved fraudulent.

Indeed, a report published last month by the Institute of Medicine, which advises the government, found that the HPV vaccine was safe.

It did find “strong and generally suggestive” — though not conclusive — evidence that the vaccine could cause severe allergic reactions. But such reactions have been rare.

Historically, Dr. Willoughby said, vaccine scares have caused vaccination rates to drop for three or four years, and have led to outbreaks of diseases that had previously been under control, like measles and whooping cough. Measles cases in the United States reached a 15-year high last spring, with more than 100 cases, most in people who had never been vaccinated.

Once the disease begins to reappear, parents become worried and start vaccinating again. With cervical cancer, Dr. Willoughby said, “unfortunately, the outbreak is silent and will take 20 years to manifest.”

The Times is actually understating Bachmann's scare tactics. She has repeatedly told about a mother who came up to her after the last debate, and tearfully described how her daughter got the vaccination and then became mentally retarded. She describes it in the last 30 seconds of this video:



Notice that she doesn't say there's any empirical evidence suggesting that the vaccine might cause retardation. She just says the daughter got vaccinated and then became mentally retarded — and that people should "draw their own conclusions." Presumably, she doesn't explicitly say there's any causation because she realizes that this would be a classic "post hoc" fallacy. But she knows what conclusion some people are going to draw.

Dr. Jack Kevorkian dies at 83.

Dr. Jack Kevorkian, "the central figure in the tumultuous national drama surrounding assisted suicide," died today.

"My ultimate aim is to make euthanasia a positive experience. . . . I’m trying to knock the medical profession into accepting its responsibilities, and those responsibilities include assisting their patients with death."

I also posted a Metafilter thread, which is getting a lot of comments. "Silentgoldfish" says:

I've worked in a palliative care ward. All he was trying to do was make legal the kind of things that happen already but aren't spoken of. And stop people needlessly suffering.

Another commenter, "sotonohito," says:

I watched my father, already pretty much brain dead, suffer two weeks of agony. The hospital wouldn't give him enough medication because that would cause constipation of all insane things. It went on until a nurse risked his job and told us that we had the right to order my father transferred to a hospice.

We did, and though they allowed him to die (removed ventilation), and administered sufficient painkillers, they still were prevented from simply ending his life [which] we knew he would have wanted.

What Medicare services should be cut?

The New York Times' Room for Debate gives some suggestions.

Nicholas Kristof reports from a hospital in Bahrain

On his Facebook page:

At the main hospital in Bahrain, I interviewed doctors who said they treated about 600 injured. I saw 3 dead in morgue with gunshot wounds. Interviewed ambulance drivers/paramedics who said they were beaten for trying to treat the injured. Hospital says government has barred ambulances from going out on calls. The hospital scene breaks my heart.

UPDATE: Just 2 days later, the New York Times reports:

Thousands of jubilant protesters surged back into the symbolic heart of Bahrain [Pearl Square in Manama] on Saturday after the government withdrew its security forces, calling for calm after days of violent crackdowns. . . .

The shift . . . was at least a temporary victory for the Shiite protesters, who had rejected a call to negotiate from Bahrain’s Sunni monarch until the authorities pulled the military off the streets.

What public-service advertising is and isn't considered acceptable in America?

1. NYC's anti-soda ads are considered acceptable.

As that article suggests, the debate behind the scenes boiled down to "fear" ("'I think what people fear is getting fat'") vs. "science" ("'As we get into this exacting science, the idea of a sugary drink becoming fat is absurd'"). Guess which value won out?

2. But this German ad promoting condom use would probably not be considered acceptable in America.

The German text in the ad uses a double entendre to explain the visual joke: "Prevents short-sightedness."

I almost want to put a "NSFW" disclaimer because some people might consider the ad too graphic. But that's part of the problem.

Does wearing pink for Breast Cancer Awareness Month do any good?

Robin Hanson says:

In case you haven’t noticed, there’s lots of pink on display this month, especially in things that aren’t usually pink. The pink reflects a campaign to “raise awareness about breast cancer”, and I’ve been pondering what about it bugs me the most. . . .

I think I’m . . . bothered by the campaign being less about doing something and more about “awareness”, which translates mostly into social pressure to get other folks to show pink, buying pink products, wearing pink clothes, etc. Much of the money donated goes not to tests or research but to paying celebrities to make more publicity.

Now this social pressure couldn’t really work if it weren’t pretty widely known that showing pink is associated with the breast cancer, which seems at odds with the claim that there is a lack of awareness of breast cancer. Even more at odds is the fact that pink campaigns rarely offer concrete arguments that theirs is an especially worthy cause; it is just assumed that listeners pretty much agree. Really, what fraction of folks don’t know breasts can get cancer, tests might detect it, and academics research it? . . .

[A]nti-breast-cancer is framed as being pro-women. Thus one can insinuate that folks who resist social pressures to support the campaign are anti-women. Since folks fear seeming anti-women much more than seeming anti-health, a breast-cancer campaign can tap into far more social pressure than can an exercise or sleep campaign.

Think pink gets much of its energy by offering a way for folks to be indirectly political; one can seem pro-women, and insinuate that others are anti-women, while only ever explicitly talking about health and medicine. AIDS awareness gets a similar political punch; one can talk only health, yet insinuate that others are anti-gay. Much of medicine is not about health, but about showing that you care, in this case caring about the right political groups.

One good argument for breast cancer awareness would be that breast cancer used to be stigmatized. I'd agree that erasing this stigma is important. But have we not reached the point where the stigma has been successfully erased?

A commenter on Hanson's post notes the irony that the more beneficial an awareness campaign would be, the less likely it is to happen:

There are diseases that are not well known where wider knowledge could significantly improve the lives of those who suffer from it (such as Coeliac). However, because most people are ignorant of them and thus would require a larger time commitment in explaining them, they have little signaling value.

Another commenter says pink culture is actively harmful:

Someone who had breast cancer told me she hates it because it served as a ubiquitous reminder of her illness. Even after she was better, everything from tyres to water bottles made it impossible for her to move on. This seems like a significant cost to sufferers.

This is similar to the critique given by Barbara Ehrenreich, who devotes the whole first chapter of her book Bright-Sided to analyzing pink culture. She argues:

[T]here is a problem when positive thinking "fails" and the cancer spreads or eludes treatment. Then the patient can only blame herself: she is not being positive enough; possibly it was her negative attitude that brought on the disease in the first place. At this point, the exhortation to think positively is "an additional burden to an already devastated patient," as oncology nurse Cynthia Rittenberg has written. (42)

Ehrenreich gives her first-hand experience:

I, at least, was saved from this additional burden by my persistent anger—which would have been even stronger if I had suspected, as I do now, that my cancer was iatrogenic, that is, caused by the medical profession . . . .

Breast cancer, I can now report, did not make me prettier or stronger, more feminine or more spiritual. (43-44)

What I'd like to know is why certain kinds of cancer seem to be privileged over others. How do the people with less glorified kinds of cancer feel? Maybe they'll turn down a hospital blanket, saying, "'No, not for me . . . . That's for the other people.'"